Page 538 - My FlipBook

536 DISCOLORED TEETH AND THETR TREATMENT.
The violence of the pulpitis preceding the death and disintegration
of the pulp, in a considerable degree determines the rapidity of the
])rocess of subsequent tooth discoloration. AVhere congestion of the
pulp has been relatively slight and the necrotic process has proceeded
slowly, the sudden infiltration of the dentin with hemoglobin does not
occur, consequently the initial change in color following complete death
of the pulp may be so slight as to escape detection except ujion most
searching examination with special means of illumination, and even
then may be manifested only by a slight diminution in the normal
translucency of the tooth as compared with adjoining teeth. Such teeth,
however, if permitted to remain untreated, eventually grow darker,
and while they may not acquire a degree of discoloration equal to those
which have suffered sudden and violent death of the pulp, still they
become so unsightly as to demand treatment for the restoration of
their normal color.
The Rationale of the Process of Discoloration.—In teeth dis-
colored as a consequence of the death of the pulp without its exposure —
viz. those of the first class—it is evident that the sources of pigmenta-
tion are internal to the tooth and are to l)e sought for solely in the
products of decomposition of the elements of the pulp tissue and of its
vascular supply.
The proteid elements of the pulp tissue are complex cond>inations
of carbon, oxygen, hydrogen, nitrogen, sulfur, and phosphorus, which
in their gradual breaking down by the process of putrefactive decom-
position are split up finally into carbon dioxid, water, ammonia, and
hydrogen sulfid, with possibly the formation of traces of phos])hatic
salts. The group of substances entering into the composition of the
histological elements of pulp tissue contains no constituents which in
the progressive changes resulting from putrefactive decomposition
should form compounds likely to cause permanent discoloration of
the tooth structures.
When, however, the vascular supply is considered as a factor, the
explanation of the cause of discoloration in the cases in question
becomes reasonably clear. The red blood corpuscles contain as their
characteristic component hemoglobin or oxyhemoglobin according as the
blood is venous or arterial, and this substance is its essential coloring
ingredient. When undergoing gradual decomposition, hemoglobin
passes through a variety of alterations in its chemical constitution,
accompanied by a corresponding series of color changes.
A familiar illustration of these color changes is furnished by the
cycle of color alterations witnessed in a bruise. Immediately following
on injury to the flesh, of the character alluded to, an extravasation of
blood in the bruised territory occurs, causing undue reddening of the