A COMPARISON OF CLINICAL, ROENTGEN, AND MICROSCOPICAL FINDINGS IN FIFTEEN CASES OF INFECTED VITAL PULPS

¹ Department of Histology and Pathology, Harvard University Dental School, Boston, Massachusetts

It is interesting to note that, in the fourteen cases of adult patients, the pulp infection was of the chronic type of inflammation. The symptoms were generally indefinite and only occasionally experienced, and the microscopic picture showed that the inflammation was characterized by the infiltration of mononuclear cells. In both diffuse and localized infiltration, the plasma cells predominated. In the case of the deciduous molar, there was acute inflammation, with polymorphonuclear leucocytes called in to fight the infection. The largest number of cases were caused by secondary caries under fillings. This etiological factor is often recognizable in the roentgen picture, especially when the cavity starts from the margin of the filling. In other cases, no defect could be seen under the filling, but still the microscope revealed infected dentinal canals.

These findings emphasize the importance of certain operative measures known to all dentists but, I fear, not always carefully observed. The sense of asepsis needs to be still further developed, and principles of sterilization must be carefully followed. The feeling that a tooth which has been cut into by a burr or other instrument, represents an open wound, must be acquired. A wound in a tooth should have the care and consideration that is given a wound on any other part of the body, perhaps more, because the injured dentinal canals represent a wound-surface more easily infected than a cut in the skin. A tooth does not have the facilities for protection that the soft tissues possess. The cleansing of a wound by hemorrhage from it, and the healing process which, in the soft tissues, includes the formation of a protective crust over the injured surface, are not present in dentine. It is no wonder, therefore, that a pulp becomes infected if a cavity, although properly prepared, is left unprotected for days until a jacket crown is set or an inlay is cemented into place.

No doubt some carious teeth have infected pulps when a patient presents for filling. But this condition should be discovered promptly, and not allowed to take its course until an acute abscess forms, or until the patient becomes a sufferer from neuralgic pains. The danger of general ill health through infectious absorption from a pulp abscess is very great. It is our duty to prevent it by making a careful diagnosis. I hope this contribution will be an aid in the recognition and elimination of pulp infections, and also, in their prevention.