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DEVITALIZATION AND EXTIRPATION OF THE PULP. 421
Devitalization and Extirpation of the Dental Pulp.
When the existing conditions are snch as to require the devitalization
of the pulp there are several requirements essential to secure a satis-
factory result
(i) That little pain be inflicted.
(2) That the destruction be quickly effected.
(3) That precaution be taken to prevent discoloration of the dentin.
The first requirement is the most important, since, if the means used
to effect the devitalization are painless or nearly so, the pulp promptly
yields to the devitalizing agent and there is little danger of discoloration
of the dentin.
At present there are three general methods of procedure : by chemi-
cal means, by extirpation with suitable instruments, and by narcotization
of the tissue.
Reliance has usually been placed upon chemical agents, these being
— 1. Zinc chlorid 2. Caustic potassa ; 3. Chromic acid; 4. Arsenous
;
acid ; 5. Arsenical ore (cobalt).
The agents 1, 2, 3 are usually painful, of slow progress, difficult of
application, and uncertain. Hence arsenous acid has usually been
depended on. This substance, notwithstanding certain objections, is the
most available and most reliable of the substances above named. It
has generally been combined with acetate of morphin in variable pro-
portions, to which has been added in the formation of this paste a suf-
ficient quantity of creosote, carbolic acid, or one of the essential oils, to
give the combination the consistence of cream.'
In making this formula it is important that the ingredients be
thoroughly ground together to effect the comminution of the arsenic
and the morphin as well as to intimately mix the components. The
morphin is used as a sedative to counteract the excessive irritation fre-
quently caused by the action of the arsenous acid, which is also modified
by the anesthetic influence of the creosote. Carbolic acid has been fre-
quently substituted for creosote as being of less disagreeable odor, and
as, from its coagulatlve action upon the surface of the pulp, it prepares
the tissue to absorb the arsenic and markedly lessens the time of absorp-
tion. It is a well-known fact that with great frequency the application
of arsenous acid to the pulp is so greatly irritating to it that much pain
* Of late cocain has largely superseded the morphin salt as an ingredient of these pre-
scriptions. As
B Acid, arsenosi,
Cocainre hydrochl., da. pars aeq.
Ol. caryopliylli, q. s.
M. et ft. pasta.
DEVITALIZATION AND EXTIRPATION OF THE PULP. 421
Devitalization and Extirpation of the Dental Pulp.
When the existing conditions are snch as to require the devitalization
of the pulp there are several requirements essential to secure a satis-
factory result
(i) That little pain be inflicted.
(2) That the destruction be quickly effected.
(3) That precaution be taken to prevent discoloration of the dentin.
The first requirement is the most important, since, if the means used
to effect the devitalization are painless or nearly so, the pulp promptly
yields to the devitalizing agent and there is little danger of discoloration
of the dentin.
At present there are three general methods of procedure : by chemi-
cal means, by extirpation with suitable instruments, and by narcotization
of the tissue.
Reliance has usually been placed upon chemical agents, these being
— 1. Zinc chlorid 2. Caustic potassa ; 3. Chromic acid; 4. Arsenous
;
acid ; 5. Arsenical ore (cobalt).
The agents 1, 2, 3 are usually painful, of slow progress, difficult of
application, and uncertain. Hence arsenous acid has usually been
depended on. This substance, notwithstanding certain objections, is the
most available and most reliable of the substances above named. It
has generally been combined with acetate of morphin in variable pro-
portions, to which has been added in the formation of this paste a suf-
ficient quantity of creosote, carbolic acid, or one of the essential oils, to
give the combination the consistence of cream.'
In making this formula it is important that the ingredients be
thoroughly ground together to effect the comminution of the arsenic
and the morphin as well as to intimately mix the components. The
morphin is used as a sedative to counteract the excessive irritation fre-
quently caused by the action of the arsenous acid, which is also modified
by the anesthetic influence of the creosote. Carbolic acid has been fre-
quently substituted for creosote as being of less disagreeable odor, and
as, from its coagulatlve action upon the surface of the pulp, it prepares
the tissue to absorb the arsenic and markedly lessens the time of absorp-
tion. It is a well-known fact that with great frequency the application
of arsenous acid to the pulp is so greatly irritating to it that much pain
* Of late cocain has largely superseded the morphin salt as an ingredient of these pre-
scriptions. As
B Acid, arsenosi,
Cocainre hydrochl., da. pars aeq.
Ol. caryopliylli, q. s.
M. et ft. pasta.
