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VITAL PHENOMENA IN CAKIES. 151
the pulp, and the patient will have paroxysms of pain from every
exposure to thermal changes. Usually these pass away quickly.
As it becomes worse, the paroxysms of pain will continue longer.
This continuation of the paroxysms of pain marks the severity
of the case, and, finally, if it continues to grow worse, the patient
will have pain when lying down, will have pain at night; the
difference in blood pressure between the horizontal position and
the upright position will be sufficient to determine a condition of
pain. Cases occur occasionally in which a stream of water three
degrees off either way from the normal temperature of the body
will induce excruciating pain.
In the management of cases, it is of the utmost importance
that we recognize what may occur, and exercise due caution in
the use of disks, whether dry or lubricated, stones even when
wet, or in running burs too long or too rapidly in excavating, or
any of these things that are calculated to produce heat which
may suddenly precipitate a condition of hyperemia of the pulp
or thermal sensitiveness.
There is only one thing to do in the treatment, and that
is to protect the case as absolutely as possible from thermal
changes until it recovers. This may be done in various ways.
In some of the worst cases, caps of gutta-percha may be put over
the teeth involved, covering them in completely, particularly for
persons who must be out in the cold air. Patients may protect
the teeth from thermal changes; they may avoid cold or hot
drinks; they may avoid cold or hot foods; they may avoid
breathing through the mouth when out of doors in cold weather,
and, in this way, protect the teeth. This is very much the best
way to protect them from thermal changes. Gutta-percha caps
over the teeth will be very annoying, and it is often difficult to
induce patients to wear them. A thing that seems so simple to
do often becomes very annoying because of failure. But the
fact is that, in moments of freedom from pain, patients forget
and in an unguarded moment precipitate another paroxysm of
pain.
Cases of very severe thermal sensitiveness will generally
get well promptly, or within a week or ten days, if properly pro-
tected. Sometimes, however, it may require more time, and
whenever we find thermal sensitiveness developed to any extraor-
dinary degree so as to be very annoying, we should desist
from all operations upon the tooth involved, except those cal-
culated to mitigate this condition. If it has occurred from a
cavity of decay, it is best to remove all decayed dentin com-