Page 404 - My FlipBook

402 CONSERVATIVE TREATMENT OF THE PULP. —
(4) The absence of lynn)luitics, which deprives the pulp of the power
to remove infiammatory ett'usions or to convey insoluble medicaments.
It should be noted that the pulp in a normal state is not a highly
sensitive organ, but is rendered exquisitely so by the irritation from
external chemical and infectious influences incident to its ex})osure.
And it is under all conditions so extremely impatient of compression
that a severe sliock of that kind renders recuperation nearly impossible.
This is pr()l)ably due to the liability of disconnection of the pulp with
its walls at some point on account of its feeble attachment to them.
The pathological tendencies of the pulp under irritation are
(1) To hyperesthesia,
(2) To circumscribed hyperemia under slight irritation.
(3) To congestion or mechanical hyperemia under increased irrita-
tion which terminates at length in stasis by the restriction of the
circulation.
(4) To proliferation of the deeper tissues as the result of latent con-
gestion attended by fatty degeneration of cells and the development of
dentinal nodules — pulj) stones.
An important consideration connected with the treatment of the
pulp is the indication presented by a state of the teeth designated as
the "temperature sense." This is a variable condition with different
individuals, some being able to apply the coldest water in the mouth
and to crunch ice without pain, whilst others whose teeth are sound are
disturbed if cool water is brought into direct contact with these organs.
When irritation of the pulp occurs the temperature sense is exaggerated
in the individual tooth. This variation from the normal, as determined
by a comparative test of the sound teeth, becomes an important diag-
nostic indication, as will appear later.
A further pertinent consideration bearing upon the various condi-
tions of the exposed ])ulp, as shown by the symptomatology, is here in
place. It has already been indicated that when the exposure of the pulp
to irritation has been slight—that is, M'here this organ has been measur-
ably protected from exterior influences by the covering layer of incom-
pletely decalcified dentin—the pulp is ordinarily but slightly affected.
When the denudation has become complete and the amount of pulp
surface in contact with the carious matter has become considerable,
and further, when by the solution and displacement of the carious
matter the influence of the contents of the mouth is direct, the disturb-
ances of the pulp become progressively increased. In the light of pres-
ent knowledge of these injurious influences the causes of their operation
must be attributed to infection of the pulp by the various minute organ-
isms which have their habitat in the mouth. The pulp tissue becomes
infected in the degree to which it is exposed and in proportion to its