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184 PATHOLOGY OF THE HAED TISSUES OF THE TEETH.
to exposure of the pulp of a tooth by decay in some secluded
locality. The character of the pain will indicate, to one who has
had some experience, something as to the nature of the cause.
Pains that are due to inflammation of the peridental membrane,
such as incipient alveolar abscess and the like, are usually accom-
panied by soreness of the teeth, which usually separates them
quite sharply from inflammation or hyperemia of the pulp of
the tooth ; for the sense of touch for the tooth is in the peridental
membrane. In this case the patient is able to locate the cause of
pain definitely. In hyperemia of the pulp, the pain is fitful, com-
ing and going, and is readily aroused by thermal changes. The
patient, if he has been observant, finds that hot or cold drinks,
or hot and cold foods, taken into the mouth arouse the pain,
which passes away in a short time when these are removed. This
character of pain is almost always from hyperemia of the pulp
of a tooth, or it may be from inflammation and suppuration of
the pulp of a tooth that has occurred from some exposure by a
proximal cavity that is hidden between the teeth, or a cavity
that has become covered by some fold of the gum about the gin-
gival margins. This latter will usually be indicated by a redness
of the gum at that point, which will appear to the eye, or a flab-
biness that will be told by the touch when the finger is passed over
it, either of which will lead to an instrumental examination
revealing the facts.
In examinations of this character, it must be remembered
that hyperemia of the pulp may occur in a tooth that is perfectly
sound and normal in every other respect. It may have been
aroused by ice water, by a blow, by catching something between
the teeth, or in many ways that will be very difficult to find from
anything that will appear in the examination or that the patient
can tell, but the fact that warm or cold water will arouse pain in
the particular tooth is usually sufficient to determine a condition
of hyperemia of the pulp. In a few cases an inflammation of the
peridental membrane of low degree has been found to show con-
siderable thermal sensitiveness that serves to confuse one in this
examination, but such a condition is rare and has usually
occurred in teeth from which the pulp has recently been removed.
It is also well to remember that some forms of neuralgia
occurring about the jaws simulate a condition arising from
exposure, or hyperemia of the pulp, very closely, and it requires
a very particular examination of the teeth to exclude diseases of
the pulp in determining a condition of neuralgia. Often the pains
in facial neuralgia shift from place to place, as much as the pains