Page 204 - My FlipBook

202 DENTAL MEDICINE.

from the action of the arsenic; or, extraordinary vital power in
the pulp, which may be due to the peculiar constitution of the pa-
tient, who probably would not be as susceptible to the action of
arsenic as the majority of persons are, even if it were adminis-
tered by the mouth.
Such resistance to the action of the devitalizing agent may be
overcome either by the removal of the granulated surface where
it exists, or, in cases of non-susceptibility, by puncturing the
pulp with a pointed instrument, charged with the arsenical prep-
aration ; first taking the precaution to obtund the sensibility of
the organ by the application of a benumbing agent. The action
of arsenic depends upon both local and systemic conditions.
When the capillaries of the pulp are congested as a result of the
inflammation, the absorption of the agent is prevented or re-
tarded, and it acts chemically upon the superficial tissue of the
exposed portion of the pulp and causes pain, rendering it neces-
sary to relieve the congestion before the nerve tissue can be
primarily affected. In case of a lymphatic temperament, charac-
terized by low vital power and excess of fluids in the tissues, the
arsenic is readily absorbed and devitalization speedily results;
whereas in cases where there is great nerve-power or excessive
nervous irritability, the susceptibility of the tissues to its influence
is very feeble, and the devitalization of the pulp is difficult and
sometimes impossible, unless repeated applications are made.
It is not considered advisable to apply arsenious acid to a
dental pulp in an acute stage of inflammation, and the method
generally pursued in such cases is to remove the loose matter in
the cavity, first applying the rubber dam, and relieve the conges-
tion by slightly puncturing the pulp so as to cause a slight hem-
orrhage. Then apply an anodyne, such as oil of cassia, oil of
cloves, eugenol, terpinol, or other agent of like properties. This
should be carefully sealed in the cavity, without pressure being
made upon the pulp, for from one to three days, according to the
degree of inflammation existing in the parts. At the expiration
of such time, the dressing is removed, and if the inflammation
has subsided, as is shown by the symptoms presented during the
period the dressing has remained in the tooth, an application of