Page 90 - My FlipBook

METHODS OF FILLING TEETH.
76
has been too little considered. It is a general practice in many cases
a stratum of between tooth and The
to interpose oxyphosphate gold.
ordinary custom is to allow the plastic to set, before proceeding with
the insertion of gold. I touched slightly upon this subject when dis-
cussing oxyphosphate, but I have reserved until this time a fuller de-
of the method and the conditions in which it is indicated.
scription
There are many cases where dentine is excruciatingly sensitive while
the tooth is being prepared for filling. I allude to teeth in which there
of and em-
is not a suspicion pulp-exposure. I state dogmatically
that these teeth should never be with
phatically, hypersensitive filled gold,
allowing the metal to come in contact with the dentine. To emphasize
the point which I wish to make, let us briefly consider the cause of
sensitiveness in dentine. Dentine is made up of succeeding stratifica-
tions of hollow tubes, the dentinal tubuli. These tubes contain living
matter; whether fluid, semi-fluid, or true nerve- tissue, is undetermined
and for my purpose immaterial. The contents of these tubes lead
directly to, and come into actual contact with the pulp itself. This
pulp is highly organized, and traversed with nerve-filaments to such
an extent that no part of it may be touched without responding by a
painful form of sensation. Consequently, the contents of the tubuli
rest against a tissue which reports painfully upon the slightest provo-
cation. These in their turn, whatever their formation, have the power
of transmitting impressions. Thus, when an excavator cuts across
them, pressure is produced, and transmitted to the pulp, which re-
sponds at once. Now, the dentine is sensitive, or responsive in this
way, in exact proportion to the relative size of the tubuli and their
contents. That which has a large number of tubuli, with small diame-
ters, will be less sensitive than that which has fewer tubuli of larger
size, for here we find more living tissue, more power to transmit
and more The
pressure, consequently pain. patient says, "Doctor,
the nerve is exposed, because you hurt me very much." The learned
gentleman remarks, "No, madam; there is no exposure. The den-
tine is sensitive, that is all." That is all ! But microscopically speak-
ing the patient is correct. The pulp is exposed in hundreds of places.
Every gaping tubule is an open passage to the pulp. Hypersensitive
teeth, those which I say should not receive gold directly against the
dentine, are those where the tubuli are abnormally large. To place
against the open ends of these tubes a mass of metal of such conduc-
as is to invite, and to induce, the death the
tivity gold, often of pulp.
"
These are the teeth where the returns and Doctor, that
patient says,
"
tooth hurts whenever I drink cold or hot drinks. The dentist re-
"
That will off." This is true, and it occurs in one of two
plies, pass
ways. Sometimes the pulp dies, after which of course hot drinks do
not cause sensation. Then, again, Nature may succeed in repairing