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408 CONSERVATIVE TREATMENT OF THE PULP.
The normal averages of table
9 cases from + 152° to + 140°
average + 143.3° — 43.2° = 100° range of tolerance
;
7 cases from + 140° to ^ 130°
average + 132.3° — 62.7° = 69.6° range of tolerance
7 cases from + 130° to + 118°
average + 123° — 07° = 56° range of tolerance.
Occult Cases of Reflected Pain.
Cases difficult of diagnosis sometimes appear in which the question
arises whether tlie pain is caused by a hyperesthetic pulp, by tlie influ-
ence of malarial poisoning, or by a gouty condition. When the origin
depends upon the two causes last named the teeth are not subject to
thermal irritation ; also from these causes the occurrences of pain are
not confined to the evening, as usually is the case with teeth in the
early stages of disturbance.
The stages of pulp exposure are divisible into three periods — (1) of
(2) of subjective symptoms, and (3) of ohjecfive manifestations.
quiescence ;
(1) Quiescence may continue in many instances for a considerable
period after caries has reached the pulp where the situation is such
that the force of mastication cannot cause compression of the contents
of the cavity. Notwithstanding constant saturation of the gelatinous
covering, and the presence of the micrococci concei'ued in producing
the caries of the dentin, excitement of the pulp may not occur. The
fact should not be overlooked that some persons escape odontalgic
symptoms notwithstanding such progressive alteration of the pulp tissue
takes place as to result in gangrene of the organ.
(2) Usually, however, after a period of quiescence ofa longer or shorter
duration there arises a train of subjective disturbances brought on by
the continuance of chemical irritation and by the presence of fluids in
the cavity, these influences becoming accelerated as the area of exposure
becomes increased. The pain which occurs in this stage is reflected to
one or more branches of the fifth pair of nerves. Flashes of pain
occur to the teeth of the other maxilla, to the eye, or the supraorbital
region, the most common region affected being the nerves of the ear,
pain in this organ being probably the most general form of reflection
which occurs. The exacerbations take place usually in the evening and
at first entirely remit in the daytime. The pain in this stage will fre-
quently pass away as the pulp is relieved from pressure and chemical
irritation.
In this stage the surface of the pulp does not present indications of
being inflamed. From the lack of continuity of the symptoms it is
a reasonable inference that the hyperesthesia observed in this condition
is due to impressions made upon the point of encroachment and is con-
;
408 CONSERVATIVE TREATMENT OF THE PULP.
The normal averages of table
9 cases from + 152° to + 140°
average + 143.3° — 43.2° = 100° range of tolerance
;
7 cases from + 140° to ^ 130°
average + 132.3° — 62.7° = 69.6° range of tolerance
7 cases from + 130° to + 118°
average + 123° — 07° = 56° range of tolerance.
Occult Cases of Reflected Pain.
Cases difficult of diagnosis sometimes appear in which the question
arises whether tlie pain is caused by a hyperesthetic pulp, by tlie influ-
ence of malarial poisoning, or by a gouty condition. When the origin
depends upon the two causes last named the teeth are not subject to
thermal irritation ; also from these causes the occurrences of pain are
not confined to the evening, as usually is the case with teeth in the
early stages of disturbance.
The stages of pulp exposure are divisible into three periods — (1) of
(2) of subjective symptoms, and (3) of ohjecfive manifestations.
quiescence ;
(1) Quiescence may continue in many instances for a considerable
period after caries has reached the pulp where the situation is such
that the force of mastication cannot cause compression of the contents
of the cavity. Notwithstanding constant saturation of the gelatinous
covering, and the presence of the micrococci concei'ued in producing
the caries of the dentin, excitement of the pulp may not occur. The
fact should not be overlooked that some persons escape odontalgic
symptoms notwithstanding such progressive alteration of the pulp tissue
takes place as to result in gangrene of the organ.
(2) Usually, however, after a period of quiescence ofa longer or shorter
duration there arises a train of subjective disturbances brought on by
the continuance of chemical irritation and by the presence of fluids in
the cavity, these influences becoming accelerated as the area of exposure
becomes increased. The pain which occurs in this stage is reflected to
one or more branches of the fifth pair of nerves. Flashes of pain
occur to the teeth of the other maxilla, to the eye, or the supraorbital
region, the most common region affected being the nerves of the ear,
pain in this organ being probably the most general form of reflection
which occurs. The exacerbations take place usually in the evening and
at first entirely remit in the daytime. The pain in this stage will fre-
quently pass away as the pulp is relieved from pressure and chemical
irritation.
In this stage the surface of the pulp does not present indications of
being inflamed. From the lack of continuity of the symptoms it is
a reasonable inference that the hyperesthesia observed in this condition
is due to impressions made upon the point of encroachment and is con-
