Dental pulp

“ Evidently desiring to describe the mode practised by the specialists of those days for fixing artificial teeth, he erroneously imagines that the metal thread was passed through the holes drilled in the natural teeth; this would have been impossible, first, because of the atrocious pain due to the sensibility of the dentine and of the dental pulp, and then because of the pathological consequences to which the perforation of the teeth would have given rise. ”

“ Inflammation of exposed dentine cannot surely be entirely arrested in any case by filling the pulp cavity with any known extraneous material, and especially is handicraft wanting to even imperfectly protect the minute and often tortuous canals leading down to the apical foramina of the majority of the teeth. ”

“ It is used with the most gratifying results in the treatment of pyorrhea alveolaris, and is an invaluable agent in treating pulpless teeth, as by its action all decomposed matter from the pulp chamber and dentinal tubuli is readily ejected, thereby removing the most frequent cause of discoloring of this class of teeth, of inflammation of the peridontal membrane, as well as alveolar abscesses.
The efficacy of peroxide of hydrogen depends on the case with which it is decomposed into oxygen and water. Pus is one of the many substances which causes this decomposition. ”

“ The dictum that, “a tooth that can be so treated as to be satisfactorily filled with anything, is worth filling,” is one, I think, that all who value conservative surgery must readily agree with.
That “unskilful and unscrupulous Dentists fill with tin covered with gold, thereby causing galvanic action, pulpitis, death of the pulp, abscess, and loss of the tooth,” has certainly not been an accepted creed in this country, for I was early taught the use of this material both alone, and in combination with gold, when I first commenced the study of my profession with Mr. ”

“ When it has reached that stage, the only thing to be done, in my opinion, is to apply arsenious acid and destroy it.
Dr. Werner:—I look upon the treatment of a pulp principally from the standpoint of whether such pulp is absolutely necessary for the welfare of the tooth. The pulp is a formative organ. Its function decreases as the tooth develops. In young persons it is largest; grows smaller and smaller, and in old age it is nearly ossified or obliterated; that is, its retrogressive stage begins materially after the crown of the tooth erupts through the gum. ”

“ It seems to me that in all the cases of actual exposure, the question of capping the pulp is merely one of expediency for the purpose of keeping the tooth along. You do not wish to destroy the pulp at that time, perhaps, because it is a young tooth; or perhaps you dread the trouble and inflammation which is likely to ensue from the use of arsenious acid at that time, or possibly the patient is going away. In those cases I have had no trouble in putting a dressing in, which has kept the tooth quiet for a long time, but I always expect that sooner or later I will have a dead pulp to attend to. ”

“ I do not hesitate to destroy pulps to-day, because we have such an excellent knowledge of the structure of the tooth, and we now know that simply because the pulp is lost we must not suppose the tooth to be entirely dead, but there is still life from the membranes of the root. So I am now inclined to cap only those pulps which present the best conditions for capping. If a pulp presents any symptoms of congestion or inflammation, I believe you had better dispatch it at once, in order to give the best results to the patient, but I am not a believer in the wholesale destroying of pulps. ”

“ The most of the patients who come to us with exposed pulps have a debilitated state of the system. It is not the best vitalized class of people, but those who are sickly and delicate, and who have not much reserve force for the body, to say nothing about the teeth. The question of conservative treatment, in a large majority of cases, with the hope of any lasting results, I shrink from. If I can painlessly treat my patient and take him past the trouble by destroying the pulp and filling the cavity and canal, I feel that I have done the best that can be done for him. ”

“ From a surgical standpoint the amputation of part of the pulp may at times be successful, for we know how resistive they often are to any kind of arsenious acid treatment, yet I should never do it unless it were in a partially developed tooth, where the life of the pulp is essential. What the surgeon does after trepanning the skull, we should do in capping or bridging over the pulp cavity. He does not flow escharotics like oxychloride or oxyphosphate of zinc over the brain. He mechanically covers and takes good care not to press on the contents of the cavity. ”

“ The tooth pulp must be treated in the same way; a simple mechanical covering over it being all that is necessary. Whether you put a metallic cap, or whether you put court plaster, or one of gutta-percha (though I should hesitate about using the latter) , makes little difference, only be sure that you do not press upon the pulp. With the knowledge we have to-day in treating devitalized teeth, there seems little reason for a young man to risk trying to save bad cases of exposed pulps. It is in extreme practice successful only for the time being—sooner or later ending in failure. ”

“ The treatment of the exposed pulp has given rise to great difference of sentiment among well educated dentists, but mainly about the means which should be employed for that purpose, agreeing pretty generally that it is bad practice to destroy it entirely. ”

“ 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. ”

“ Phosphates or chlorides mixed to the consistency of cream make an unstable, strongly acid compound, that when hard very soon dissolves in water, or to a large extent will become deteriorated in water or moisture. In my opinion, the best treatment to save a pulp, provided the patient is strong and robust enough to help out any treatment, is to relieve it from all irritation, disinfect it, and let nature take [Pg 547] care of it. Any non-irritating mechanical means you can use to that end will be more beneficial than stimulating, bleeding, etc. ”

“ Niles:—If it was irritating you would have inflammation.
Dr. Gillett:—A pulp will sometimes stand much irritation without showing evidence of inflammation. An inflamed pulp is not always painful. My experience with decalcified dentine under fillings has been gained chiefly from removing fillings which other dentists have inserted over such decalcified dentine, and I have seen many cases where the results were anything but satisfactory. ”

“ Occasionally I find one that comes back after a time, showing signs that the tooth is dead, and of course the tooth is then opened and treated; but the proportion of them is so very small that I believe in a conservative treatment of them, and think the first thing to be done is to get rid of whatever congestion there may be, if any, and I do not see why a pulp should not then live as well under a careful and skillful capping as it should against the hard, bony wall of the pulp cavity. ”

“ If we were not able to judge something of the depth of decayed dentine, we would be in constant danger of exposing the pulp. If you cannot tell by the feeling of your excavator when you are near the pulp, I would like to know what you are going to do in those cases where you cannot see the bottom of the cavity? ”

“ The hard parts of a tooth commonly enclose a central pulp-cavity into which projects the pulp, a papilla of the dermis including blood-vessels and nerves. As long as growth continues the outer layers of this pulp become successively calcified and added to the substance of the dentine. In young growing teeth the pulp-cavity remains widely open, but in mammals the general rule is that as a tooth gets older and the crown becomes fully formed, the remainder of the pulp becomes converted into one or more tapering roots which are imbedded in the alveolar cavities of the jaws. ”

“ Again I wish to assert my opinion, that after the foramen was closed and the tooth well developed, it would not be a great calamity for a tooth if the pulp were devitalized and the pulp cavity well filled. I am much of the opinion that a tooth in a devitalized condition resists better than a live tooth the attacks of caries. This is perhaps an extraordinary statement to make, and I know is contrary to the teachings of good authority, yet the many pulpless filled teeth I see free from decay, while their living neighbors do decay, leads me to this opinion. ”

“ In proximal cavities attacked by this kind of caries, separate freely on the lingual side, and fill with tin. When such fillings have been removed the dentin has been found somewhat discolored and greatly solidified as compared to its former condition; this solidification or calcification is more frequent under tin than gold, which is partly due to the tin as a poor conductor of heat. Nature will not restore the lost part, but will do the next best thing—solidify the dentin. In some cases, under tin, the pulp gradually recedes, and the pulp-cavity is obliterated by secondary dentin. ”

“ Never pick the teeth with a pin or needle. The biting off of thread, finger nails, and other hard material may crack the enamel. It may also be softened and eaten away by acid formed where food remains about a tooth. For this reason a quill or wooden pick or piece of tough thread, called dental floss, should be used to clear the teeth of food after each meal. Slimy matter collects over the whole surface of the teeth, and is likely to cause decay in spots unless it is cleaned off night and morning with brush and water. ”

“ The teeth are thus nourished like other parts of the body. The exposure of the delicate pulp to the air, due to the decay of the dentine, gives rise to the pain of toothache.
Surrounding the cavity on all sides is the hard substance known as the dentine, or tooth ivory. Outside the dentine of the root is a substance closely resembling bone, called cement. In fact, it is true bone, but lacks the Haversian canals. The root is held in its socket by a dense fibrous membrane which surrounds the cement as the periosteum does bone. ”

“ Numberless methods have been invented for the operation. Pulpless teeth are thus preserved through long periods of usefulness, and even those remains of teeth in which the crowns have been lost are rendered comfortable and useful as supports for artificial crowns, and as abutments for assemblages of crowns, known as bridge-work.
The discoloration of the pulpless tooth through putrefactive changes in its organic matter were first overcome by bleaching it with chlorine. Small quantities of calcium hypochlorite are packed into the pulp-chamber and moistened with dilute acetic acid ”

“ Let the nerve alone; nature has provided a covering, why should it be torn away? If there is any irritation, it is very easily removed. In my opinion, a pulp is never inflamed to an extent that needs treatment when it is free from soreness by percussion. If there is inflammation at all in the pulp there will be periosteal disturbance to give warning; but if the periodental membrane is not inflamed, it may be concluded that the pulp is free from irritation ”

“ When we reflect on the mode of nutrition of the tooth, it seems almost self-evident that any depressing agency which could lead to disease of the pulp must, by an augmented action, cause greater disease in the structures which depend on the pulp for their nutrition to start with. At most, disease and pain in the pulp alone must be nothing less than a pathological curiosity. Such, however, is not the case in the vast multitude of cases dependent on caries, in which the pulp has lost in part or in whole its protection from external morbid influences. ”

“ 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 ”

“ Heavy black lines indicate enamel, enclosing areas of dentine, cement covering the whole tooth.
In the true elephants the dental formula is: i 1/0, c 0/0, p 0/0, m 3/3, × 2 = 14, though this formula is misleading, to the extent that the milk premolars, three in number in each jaw, take the place and perform the functions of the premolars, thus adding 12 to the effective number of teeth. The single upper incisor on each side grows into an immense tusk, which has enamel only on the tip, where it is speedily worn away; the lower jaw is without incisors and there are no canines above or below. ”

“ The tooth, which previously seemed to be on the eve of piercing the gum, after the extraction of the milk incisor never came up,—nor will any person who has thought for an instant, wonder if the violence, necessarily used, does occasionally injure or rupture the delicate vessels and gelatinous tissues of the pulp. More often the breeder’s impatient interference breaks the tooth off at the neck and leaves the fang in the jaw. ”