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470 THE TREATMENT AND FILLING OF BOOT CANALS.
cocci and streptococci, which find a suitabk' liabitat in tlic live ])nlp.
Advancino- first ah)n(i:; the lines of the veins, their toxic waste jn'od-
nets cansinii" intlainniation, the organisms invade, peptonize, and li(jnefy
the iiitlanuuatory effusions. As these cocci advance toward the apex
of the root, the necrotic and altered tissues which arc left behind
become the breeding-ground of other organisms, ])artienlarly the bacteria
of putrefaction. The altered portions of pulp tissue are decomposed
into products of progressively simpler chemical comj)osition, until all
of the albuminous substances have been transformed : first peptones are
formed, further decomposition produces ptomains, next such bases as
leucin, tyrosin, and the amines, together with fatty acids ; ' finally the
end ])roduets are hydrogen sulfid, ammonia, carbon dioxid, and water
(see Fig. 31) fungi concerned lire, and the extent of decomposition is conditioned by the
iiuniher of fungi" (Ziegler).
As there are several distinct types of decomposition, so is there a cor-
responding numl)er of varieties of organisms. The septic cases may be
divided into two classes : First : Those in which septic invasion has not
passed beyond the apical foramen and given evidence of pericemental
irritation or inflammation, these tissues being threatened though not
invaded. Second : Those in which the pericementum has become the
seat of septic invasion. This latter class is subdivided according to the
nature and extent of the septic processes : the first subdivision comprises
cases of acute pericementitis non-purulent ; the second, of chronic peri-
cementitis without evident pus formation ; the third, of purulent peri-
cementitis, which may be either acute or chronic,
1. In the first of the first class of these cases—those in which the
suppurative process has invaded the pulp to near its end—the necrotic
portions of the pulp are undergoing putrefactive decom]>osition. To-
ward the end of the process, when the apical portion of the pulp is
invaded, it is not uncommon to find evidences of ])ericeniental irritation
this frequently ceases spontaneously, as though the irritation had caused
the formation of a barrier between the tissues of the apical region
and the suppurating pulp. An increasing discoloration of the dentin
shows the contents of the dentinal tubules to be also undergoing de-
composition. It is necessary to remove this mass, destroying the
products, the causes, and the soil of decomposition : this without carry-
ing infection to the vital tissues beyond the apex. When the odor of
hydrogen sulfid may be detected, it is evidence that the ultimate de-
composition of albuminous matter is in progress. As it is quite ])rol)-
able and an imminent danger that organisms might, n])on a l)roach
injudiciously employed, be carried from the body of the putrescent
1 Ziegler, Oeneral Paiholucjij, 1895, p. 437.
470 THE TREATMENT AND FILLING OF BOOT CANALS.
cocci and streptococci, which find a suitabk' liabitat in tlic live ])nlp.
Advancino- first ah)n(i:; the lines of the veins, their toxic waste jn'od-
nets cansinii" intlainniation, the organisms invade, peptonize, and li(jnefy
the iiitlanuuatory effusions. As these cocci advance toward the apex
of the root, the necrotic and altered tissues which arc left behind
become the breeding-ground of other organisms, ])artienlarly the bacteria
of putrefaction. The altered portions of pulp tissue are decomposed
into products of progressively simpler chemical comj)osition, until all
of the albuminous substances have been transformed : first peptones are
formed, further decomposition produces ptomains, next such bases as
leucin, tyrosin, and the amines, together with fatty acids ; ' finally the
end ])roduets are hydrogen sulfid, ammonia, carbon dioxid, and water
(see Fig. 31)
iiuniher of fungi" (Ziegler).
As there are several distinct types of decomposition, so is there a cor-
responding numl)er of varieties of organisms. The septic cases may be
divided into two classes : First : Those in which septic invasion has not
passed beyond the apical foramen and given evidence of pericemental
irritation or inflammation, these tissues being threatened though not
invaded. Second : Those in which the pericementum has become the
seat of septic invasion. This latter class is subdivided according to the
nature and extent of the septic processes : the first subdivision comprises
cases of acute pericementitis non-purulent ; the second, of chronic peri-
cementitis without evident pus formation ; the third, of purulent peri-
cementitis, which may be either acute or chronic,
1. In the first of the first class of these cases—those in which the
suppurative process has invaded the pulp to near its end—the necrotic
portions of the pulp are undergoing putrefactive decom]>osition. To-
ward the end of the process, when the apical portion of the pulp is
invaded, it is not uncommon to find evidences of ])ericeniental irritation
this frequently ceases spontaneously, as though the irritation had caused
the formation of a barrier between the tissues of the apical region
and the suppurating pulp. An increasing discoloration of the dentin
shows the contents of the dentinal tubules to be also undergoing de-
composition. It is necessary to remove this mass, destroying the
products, the causes, and the soil of decomposition : this without carry-
ing infection to the vital tissues beyond the apex. When the odor of
hydrogen sulfid may be detected, it is evidence that the ultimate de-
composition of albuminous matter is in progress. As it is quite ])rol)-
able and an imminent danger that organisms might, n])on a l)roach
injudiciously employed, be carried from the body of the putrescent
1 Ziegler, Oeneral Paiholucjij, 1895, p. 437.
