Page 422 - My FlipBook

420 CONSERVATIVE TREATMENT OF THE PULP.

conclusive as to the ability of the pulp at all stages of its existence to
take on this action when the conditions are as stated. On the contrary,
when the disturbances are active the formation of calcific deposits on
the walls of the pulp chamber do not take })lacc, or if in the earlier
progress of decay they have commenced, as the j)rogress of the destruc-
tive action ap})roaches the pulp this (change is suspended, and in some
instances resorption of the secondary deposit takes j)lace.
It is apparently in this manner that the pulp becomes denuded under
the influence of thermal or traumatic irritation in cases in which there
was no evidence of exposure at the time of the preparation and filling
of the cavity. This result would appear to be related to the principle
that secondary structures and tissue of repair are liable to resorption as
the result of irritation or disturbances of nutrition.
The frequent occurrence of secondary dentin following the conserva-
tive treatment of the pulp and in some instances occurring spontaneously
over exposed pulps, raises imjmrtant considerations connected with the
subject. The writer has had many instances come under his observation
in which secondary dentin has obliterated exposures, both in his own
cases and in those of others.
The influence of the tendency to nodular deposits upon the results
of conservative treatment does not appear to be detrimental unless the
pulp chamber becomes largely filled with them. The pulp at the period
of life when calcific deposits usually take place is not so sensitive as it
is at an earlier age, and therefore, unless senile conditions appear to be
present or imminent, the existence of such deposits should not be inim-
ical to the preservation of the pulp. The writer, who has had frequent
cases of pulp devitalization after conservative treatment, has rarely ob-
served " pulp stones " in these cases.
It is an important consideration that when calcific deposits take
place beneath fillings where the pul]) has been nearly exposed, or where
they have followed conservative treatment of the pulp, they arc liable
to resorption on the occurrence of irritation of the pulp from any cause
which brings on an increased blood supply. This is more remarkable
since there are no lymphatic vessels in the pulp. This change can occur
only by the development of osteoclasts on the surface of the pulp.
Of this development there have been several recorded instances
where the dentin has suffered resorption until the enamel has been
encroached upon by the process of denudation, and when favorable
conditions were established a deposition or formation of secondary
dentin has occurred.