Page 266 - My FlipBook

and this is called thermal sensitiveness. It is entirely sepa-
rate and distinct from sensitiveness of dentin. We may
have sensitive dentin existing and continuing for a long time
without any particular thermal sensitiveness, or we may have
thermal sensitiveness without abnormal sensitiveness of the
dentin, or we may have the two existing together. They are
distinct conditions.
Thermal sensitiveness is liable to be aroused in many
different ways. I have suffered from it myself occasionally
in my incisor teeth from its being aroused from the heat
of a cigar in smoking, so much so that I had to either cease
smoking or protect the teeth. It may be caused suddenly
by an extraordinary exposure to cold, as ice water. It may
be caused suddenly by exposure to hot drinks, and the den-
tist may develop it suddenly by the heat of a disk in finishing
a filling or the heat of a burr in excavating, in any tooth that
has a living pulp. Often thermal sensitiveness is aroused
during the progress of decay, especially when the decay has
reached the neighborhood of the pulp of the tooth, some-
times when the decay has not nearly reache/1 the pulp of
the tooth, and the patient will have paroxysms of pain from
every exposure to thermal changes, passing away quickly,
perhaps. As it becomes worse the paroxysms of pain will
continue longer. This continuation of the paroxysms of
pain marks the severity of the case, and finally, if it continues
to grow worse, the patient will have pain when lying down,
will have pain at night, the difference in blood pressure be-
tween the horizontal position and the upright position will
be sufficient to determine a condition of pain. They will
become so sensitive as that. I have seen cases in which
throwing of a stream of water on the tooth three degrees off
either way from the normal temperature of the body would
induce excruciating pain.
In the management of cases it is of the utmost impor-
tance that we recognize what may occur, and use due cau-
tion in regard to running disks dry, or even in running them
wet we may sometimes produce too much heat, or running
burrs too long in excavating, or any of these things that
are calculated to produce heat which may suddenly precipi-
tate a condition of hyperemia of the pulp, or thermal sensi-
tiveness.

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