The Archives of Dentistry, Vol. VII, No. 12, December 1890Various
Science
The Archives of Dentistry, Vol. VII, No. 12, December 1890
Various
Dentistry -- Periodicals
The most important thing to avoid in the treatment of exposed pulps,
as held by the authorities, is pressure, and I endorse that opinion
most thoroughly. I believe a large proportion of failures in the
capping of exposed pulps is due to the lack of skill on the part of the
manipulator. We speak of accidental exposures in excavating; I believe
that that exposure is almost inexcusable. I don't believe any graduate
of the dental school of Harvard College has any right to punch an
excavator into a pulp unless he intends to do it when he starts. It may
be a little personal to say that my experience in accidental exposures
is very small, but such is the fact. I have had cases where perhaps
the exposure was excusable. In cases of a malformation of the pulp
or tooth, but under ordinary circumstances, in cases that we usually
meet, such exposure of the pulp I believe to be wholly inexcusable. The
practitioner of to-day in opening into a cavity knows, or should know,
that he is liable to come into contact with the pulp, and he therefore
ought to excavate with the greatest possible care, and with the careful
instructions given in the schools to-day there is no excuse for his
exposing that pulp.
The method cited of using gutta-percha, I do not believe in, and the
placing of gutta-percha directly on the pulp, I condemn, not from my
own experience, but from my observations of cases treated by other
practitioners, the patients have come into my hands afterwards. Trouble
has resulted in every case that I have seen, but they may have been
cases which should not have been capped, and perhaps it is hardly just
to deny that some were successes.
The pulp, while it is an organ of great sensitiveness and extreme
delicacy of structure, I believe to be most persistent in its vitality.
The capillary circulation of the pulp, as you all know, arising from
the vertical vessels forming loops, prevents a combination near the
surface, and the absence of lymphatics in the pulp prevents medicaments
from doing much good, as would be the case upon serous membrane. Where
the trouble is diffused through the entire membrane, in many cases the
application of arsenious acid will only destroy a part of the pulp, and
has to be re-applied again and again.
If a tooth has been aching, and there is congestion about the pulp,
or an exuding of pus, I invariably destroy it. I don't believe a
pulp can be brought to a healthy condition to stand capping after it
has reached that stage. But there are many cases where patients have
neglected their teeth and had a little pain, or after taking sweets,
they have a severe toothache that soon passes off, so that at the time
of examination there is no soreness nor inflammation; or if we have a
strong, robust, healthy patient, and in excavating carefully around the
pulp we remove a layer of decalcified dentine and find just a point
of the pulp exposed; in such cases I do not hesitate to cap, and my
mixture is as follows:
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