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890 DISEASES OF THE DENTAL PULP, AND TREATMENT —
final devitalization. In moderately or very dense teeth this may produce
but slight irritati(jn, and, following the general law, may result in extra
development of secondary dentine, an ett'ectual barrier being thus inter-
posed against further irritation. The operation of this law is beautifully
illustrated in the formation of secondary dentine by occlusion in teeth
worn down on the cutting edges and in the development of extra-cemen-
tal tissue in exostosis, and also in the calcification of the tubuli in caries
in dense teeth. This is, however, only possible under favorable condi-
tions—conditions rarely or never present in young teeth. Hence the
filling of all such teeth with good conductors, without some intervening
media to prevent the irritating influence, -must be regarded as an ob-
jectionable practice. In exact ratio to the sensitiveness of the tissue
will be the danger of thermal action, and this hypersesthetic state will
be in proportion to the conditions already described.
It is important to bear in mind the possible pathological contingencies
in the treatment of so-called sensitive dentine. Over-stimulation from
an irritant will have a very deleterious effect if too long continued or if
applied over a too thin layer of dentine. The peculiar and quite diifer-
ent action of various obtundents must be carefully studied in their pos-
sible relations to the pulp, those being the best to use—if used at all
that confine their action to the superficial layer ; and those of great
penetrating power, of violent action, or that continue their devitalizing
power through absorption should be used sparingly or be abandoned
altogether. Among those of great penetrating power may be classed
chloride of zinc, and of devitalizing power, arsenic.
The possible changes that may arise through thermal action necessi-
tate care in the treatment of all teeth, no matter what may be the struc-
ture. While it does not come within the province of this paper to dis-
cuss the question, it will not be out of place to suggest that as a general
rule no very sensitive teeth should be filled with as good a conductor as
gold without a preparatory layer of gutta-percha, tin, or some equally
reliable non-conducting material. Especially is this applicable to im-
mature teeth or the teeth of children between the ages of twelve and
fifteen. Indeed, so liable is the pulp to be affected during this period
that it is very questionable whether gold should ever be used in that
class of tecitli.
The destructive action through conditions heretofore alluded to result
eventually, if not checked by remedial agents, in direct irritation of the
central organ. This opens up a long chain of tissue-disturbance that
may end in the total destruction of tiie tooth, and possibly to more
remote and serious lesions. These changes from the normal to abnor-
mal may be classified as follows
1st. Simple exposure.
2d. Superficial pulpitis.
3d. D('e])-seated pulpitis.
4th. Devitalization.
5th. Gangrene.
6th. (So-called) Dry gangrene.
Simple Expomrc.—The jirogress of the destructive forces eventually
removes all intervening layers of dentine, and the pulp lies directly
890 DISEASES OF THE DENTAL PULP, AND TREATMENT —
final devitalization. In moderately or very dense teeth this may produce
but slight irritati(jn, and, following the general law, may result in extra
development of secondary dentine, an ett'ectual barrier being thus inter-
posed against further irritation. The operation of this law is beautifully
illustrated in the formation of secondary dentine by occlusion in teeth
worn down on the cutting edges and in the development of extra-cemen-
tal tissue in exostosis, and also in the calcification of the tubuli in caries
in dense teeth. This is, however, only possible under favorable condi-
tions—conditions rarely or never present in young teeth. Hence the
filling of all such teeth with good conductors, without some intervening
media to prevent the irritating influence, -must be regarded as an ob-
jectionable practice. In exact ratio to the sensitiveness of the tissue
will be the danger of thermal action, and this hypersesthetic state will
be in proportion to the conditions already described.
It is important to bear in mind the possible pathological contingencies
in the treatment of so-called sensitive dentine. Over-stimulation from
an irritant will have a very deleterious effect if too long continued or if
applied over a too thin layer of dentine. The peculiar and quite diifer-
ent action of various obtundents must be carefully studied in their pos-
sible relations to the pulp, those being the best to use—if used at all
that confine their action to the superficial layer ; and those of great
penetrating power, of violent action, or that continue their devitalizing
power through absorption should be used sparingly or be abandoned
altogether. Among those of great penetrating power may be classed
chloride of zinc, and of devitalizing power, arsenic.
The possible changes that may arise through thermal action necessi-
tate care in the treatment of all teeth, no matter what may be the struc-
ture. While it does not come within the province of this paper to dis-
cuss the question, it will not be out of place to suggest that as a general
rule no very sensitive teeth should be filled with as good a conductor as
gold without a preparatory layer of gutta-percha, tin, or some equally
reliable non-conducting material. Especially is this applicable to im-
mature teeth or the teeth of children between the ages of twelve and
fifteen. Indeed, so liable is the pulp to be affected during this period
that it is very questionable whether gold should ever be used in that
class of tecitli.
The destructive action through conditions heretofore alluded to result
eventually, if not checked by remedial agents, in direct irritation of the
central organ. This opens up a long chain of tissue-disturbance that
may end in the total destruction of tiie tooth, and possibly to more
remote and serious lesions. These changes from the normal to abnor-
mal may be classified as follows
1st. Simple exposure.
2d. Superficial pulpitis.
3d. D('e])-seated pulpitis.
4th. Devitalization.
5th. Gangrene.
6th. (So-called) Dry gangrene.
Simple Expomrc.—The jirogress of the destructive forces eventually
removes all intervening layers of dentine, and the pulp lies directly
