Page 276 - My FlipBook

Success in capping pulps depends, first, upon the selec-
tion of suitable cases, and, second, upon the accuracy of every
detail in carrying out the procedures. The best cases are
those in which the exposure has been made in cutting hard
dentin. If the pulp is found exposed, and by this is not
meant fully open to the saliva, but contact of carious material
with the pulp, the case is of the gravest character. The pulp
will certainly be inflamed, whether there has or has not been
paroxysms of pain, and with any treatment, over fifty per cent
of the cases will be lost. There are, however, a sufficient
minority of cases recover to demand that- the effort be made
in the more favorable cases. Much tinkering in the treatment
should be avoided. If the case does not do well after one or
two straightforward efforts, abandon it without further worry
to the child. In this class of cases every failure, or rather
every period of hyperemiic excitement, diminishes the chances
of recovery and adds materially to the difficulty of controlling
the child. The treatment giving me the greatest percentage
of success has been to flood the cavity, after complete exca-
vation, with 1-2-3, or oil of cloves (another stimulating and
practically non-poisonous antispetic may do as well), and re-
tain this in contact with the pulp (under the rubber dam) as
long as the patience of the child will permit, or for an hour.
Then remove this and cap with oxyphosphate of zinc and fill
temporarily with gutta-percha. If this does well, reinforce
the capping with a considerable thickness of oxyphosphate
of zinc and make a permanent filling over it. Sometimes a
second effort will succeed when the first has failed, but a
third is not advisable.
When these eamties are presented to ns in patients fifteen
years old, or over, they present no more of difficulty than

other pit cavities. Other teeth are not so often deeply de-
cayed so early after presenting through the gums, and do not
demand attention when the child is so young. They are, there-
fore, not so frequently neglected, and when they do occur
the increased self-control of the patient makes the treatment
easier and more certain. Decay involving the loss of the
pulp in any tooth before the completion of the roots involves
the loss of the tooth for the reason that root fillings cannot
be successfully made. This fact should be ever present in the
mind of the practitioner, and the time of the completion of

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