Page 413 - My FlipBook

THE CHILDHOOD PERIOD OF THE PERMANENT TEETH. 261
sixteen, coming through at twelve. I have never seen a cuspid
that was not complete at sixteen, yet I know of several cases
where they were decidedly incomplete at fifteen, and they are
generally incomplete at fourteen. We occasionally have condi-
tions calling for the destruction of the pulp in the second molar
before the roots have been completed. I have had a number
of cases in which I destroyed the pulp of this tooth too early,
removed the pulp and found broad, open apical foramina that
defeated root filling. We can not calculate certainly that this
tooth will be completed before the person is fifteen to eighteen
years old.
In cases of delayed eruption, we should always be on our
guard as to the removal of pulps. A patient may present with
a tooth in position, and without gaining a history of the tooth,
we may not know that it has been delayed in eruption and be
unable to make a root filling because of the lack of development
of the root. One case came to me a number of years ago, where
a friend of mine got into difficulty, and got me into difficulty,
too, with a patient of mine who happened to be visiting him.
He found an exposed pulp in a bicuspid, or one that was so
nearly exposed that he destroyed it. He returned the patient
to me, stating in a note that he had gotten into trouble with the
tooth — an abscess had formed that would not heal. I found
he had lost a pledget of cotton through a broad, open root canal.
I cut through the tissues and removed the cotton. I cut off
considerable of the root and filled it with gutta-percha, but the
tooth was lost some six months afterward. Possibly, if the
circumstances had been known, that tooth might have been
tided along for a year or so without destroying the pulp, giving
opportunity for the apical foramen to be narrowed down. We
should be as careful as possible not to destroy pulps before the
roots are completed.
It is deplorable to have a patient present with an exposed
pulp in an important tooth, the root of which we know to be
only partially developed, making it impossible to remove the
pulp and make a serviceable root filling. My advice is not to
undertake to do impossible things. In cases in which there is
a possibility of the root being sufficiently developed, the effort
should be made to treat it, but the patient or the parents should
know what may be expected, that it will probably be necessary
to extract the tooth.