Page 405 - My FlipBook

PATHOLOGICAL TENDENCIES OF THE PULP. 403

power of resistance to the pathogenic character of these forms of life.
It is axiomatic that the activity of inflammatory processes is usually iu
proportion to the degree and the kind of infection. Therefore it must be
held here as elsewhere in surgical procedures that the existence of infec-
tive influences and their control have to be kept clearly in view.
This consideration enables us to understand the causes which render
conservative treatment inoperative, in cases in which there has existed
' for a considerable period the opportunity for active invasion of the pulp
by micro-organisms. When these deleterious influences have long con-
tinued, the deeper tissues of the pulp, as before stated, become involved
;
the chief factors producing the disturbed state eventuate in a suppura-
tive condition. This state of the organ clearly indicates invasion by pyo-
genic germs, the inflammatory processes attending this condition being
superinduced by the peculiar irritation caused by the infection. This
results in some instances in stasis followed by gangrene ; in other cases,
Avhere the arterial tension has not been great, in suppuration. The cha-
racter of the suppurative process, rarely, is a circumscribed abscess of
the pulp, the more common form being by
Fig. 390.
progressive and destructive ulceration of
the organ.
Fig. 390 (after Arkovy) shows the
phenomenon of invasion of the pulp by
micrococci.^
In the treatment of an orphan which
cannot be brought under ocular inspec-
tion, the chief guides to determine its state
are the apparent conditions—viewed in con-
nection with the symptomatology of the
case under treatment.
Invasion of pulp by micrococci.
The above-stated anatomical relations,
physiological qualities, and pathological tendencies have an interesting
bearing upon conservative treatment of the pulp.
Exposure of the Pulp.—As an indication of the tolerance of the
pidp to the approach of caries it is a common experience that after
solution of the enamel has taken place, caries of the dentin proceeds
until the pulp is nearly reached by the destructive process with little or
no signs of irritation, as evinced by pain, appearing. It is the excep-
tion that even persons of high nervous sensibility are cognizant of the
influence of the carious process upon the pulp previous to actual
encroachment.
In the earlier stages of exposure the elements of the organ involved
^ In this connection see Micro-organisms of the Human Mouth, by W. D. Miller, pp..
293-295.