Page 314 - My FlipBook

286 THE MICRO-ORGANISMS OF THE HUMAN MOUTH.

processes may occur which Avill be discussed here only in as far
as is essential to an understanding of the subject under treat-
ment.
In regard to the faculty which the pulp possesses in taking
up germs of infection and transmitting them to the tissues sur-
rounding the apex of the root or even to the entire organism,
I distinguish the following possibilities :
1. The infection of the pulp begins either on the surface or
in the superficial layers; a progressive suppurative destruction
of the tissue takes place, gradually spreading towards the apex
of the root.
2. An infection of the entire pulp occurs, causing a total puru-
lent inflammation; or, a local septic infection becomes general:
for example, a case of pulpitis acuta partialis purulenta develops
into a case of pulpitis acuta totalis ulcerosa (Rothmann.)
In both 1 and 2 micro-organisms of a more or less pronounced
pathogenic character make their way to the apex of the root, or
may even encroach upon the periapical tissue.
3. Necrosis of the pulp occurs without any preceding infection
(in cases of total acute inflammation, destruction of the pulp by
arsenious acid, etc.). After the death of the pulp has occurred,
whether in the manner described in number 1, 2, or 3, an inva-
sion of various bacteria, strictly saprogenic as well as pathogenic,
usually takes place : the pulp, or its remains, becomes a stinking,
cheesy, or semi-fluid mass (gangrene).
4. We should take into consideration the possibility that
micro-organisms may be taken into the circulatory system from
a small focus of suppuration in the pulp, such as pulpitis acuta
partialis purulenta, etc, thereby leading to diseases of a more
serious nature. It is universally known that such a general in-
fection may proceed from alveolar abscesses, as shown by the
cases cited below. But, as far as I know, no communications
have been made as to the possibility of septicaemia or pyaemia,
etc., arising directly from the pulp without the intervening stage
of an alveolar abscess, which acts as an accumulator of the poison.
A case which may belong under this head is that reported by
Schmid (page 291).
5. By way of the circulatory system microbes which acci-