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TREATMENT OF DESTINAL HYPERSENSITIVITY. 193

when caries occurs bears some relation to the relative tolerance of the
teeth to reduction of temperature.
On these premises it is not difficult to account for the manifestation
of acute sensitivity, and to build thereon an hypothesis governing the
various conditions presented by dentin when it is subjected to the irri-
tation of the carious process. These views have steadily gained sup-
port with the advance of microscopic study of the tissues, and have
supplanted the older view tliat the sensitivity of dentin is a result of
mechanical vibrations extending to the dental pulp.

Treatment of Hypersensitivity of the Dentin.
Having considered the general principles governing h}^ersensitivity
of dentin, we are prepared to enter upon a study of the treatment.
This is to be considered under the following general lines : namely,
the therapeutic, the chemical, the anesthetic, and the mechanical.
Treatment of Slight Hypersensitivity.—The first requisites to be
observed here are a calm manner and earnest sympathy, accompanied
with the assurance that if severity of pain occurs, mitigating means will
be resorted to. It is an important and laudable object to remove dread
and secure confidence, which is attained among other means by select-
ing at first the simpler and less painful operations. When confidence
is secured, slight pain arouses the courage of the patient. The effect of
the opposite course of indifference and harsh cutting alarms the patient,
arouses apprehension, and greatly increases the nervous exaltation.
In the simpler eases sharp instruments used with quick, light, and
rapid movements are called for. It should in this connection be noted
that cutting in this manner stimulates somewhat the nervous force of
the patient, and if the movements are in very quick succession they
appear to paralyze the part ; the pain is thus lessened in comparison
with deliberate and slow instrumentation. The movements of the ex-
cavators should be in a direction away from the pulp rather than toward
it, and the cuts should be by drawing the points instead of pushing
them : this is for the reason that the pressure in the latter case is greater
than in the former.
AVhon the sensitiveness is so great as to interdict immediate excava-
tion and formation of the cavity, some method of treatment of the sur-
face is required to overcome or to confine it witliin a tolerable degree.
The Therapeutic Treatment.— lender this head the available reme-
dies are morphin, veratrin, and cocain,—each of them being applied
with glycerin as a menstruum. It should be stated that neither have
much immediate effect, and therefore they should be sealed in the cavity
after the opening in the enamel has been prepared, and the softer caries
has been lifted and peeled off. The closure should be effected by
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