(ZOE) temporary filling, following the instruc-
tions on the kit. Use a Woodson No. 2 or 3 plastic
instrument to place the filling in the cavity as
illustrated in figure 2-9. Do not pack the cavity.
Do not exert pressure on the filling; however, be
sure the cavity is sealed off from the saliva.
Smooth the filling with a cotton pellet dipped in
water, so the filling does not keep the patient from
closing the teeth together. Tell the patient not to
chew solids for 2 hours, then to chew on the
opposite side of the mouth until seen by a
dentist. Stress the temporary nature of the
Acute pulpitis is a severe inflammation of the
tooth pulp. Usually, it is the result of dental caries.
It is the most frequent cause of severe dental pain.
The pain is caused by the pressure of fluids
building up inside the pulp chamber or the root
SYMPTOMSThe patient may present with
a continuous, piercing, and pulsating pain in the
affected area; an increase of pain upon lying
down; an increase or decrease of pain when the
tooth is exposed to heat or cold; or an increase
of pain when pressure is applied to the tooth.
SIGNSYou may see a large cavity with or
without a pulpal opening, with blood or pus
oozing from an opening, or with swollen gingival
tissue near the affected tooth. A painful reaction
Figure 2-9.Placing the temporary filling.
may occur when pressure is applied to the tooth
by pressing the exterior of the tooth lightly with
a finger or an instrument.
TREATMENTGently remove loose debris
from the cavity with a spoon excavator, being
careful not to touch the pulpal opening. Dry the
cavity very gently with a cotton pellet. Remove
enough cotton fibers from a cotton pellet to make
a smaller pellet. Slightly moisten the smaller pellet
with a small amount of eugenol, and then blot
the pellet on a gauze pad. NOTE: Excess eugenol
can harm the tooth pulp. Place the pellet
moistened with eugenol in the cavity, and cover
the pellet with a dry cotton pellet.
Tell the patient that the treatment is temporary
and may have to be repeated during the night.
Give analgesics for pain, and refer the patient to
a dentist as soon as possible.
A periapical absscess usually results from an
infection of the tooth pulp. Therefore, the abscess
often develops as a result of unchecked pulpitis.
Infection of the tooth pulp causes fluids to build
up within the walls of the pulp chamber and root
canal(s). A periapical abscess is formed when these
fluids escape from the interior of the tooth
through the apex of a root canal. The escaping
fluids create a fistula in the soft tissue. When the
fluids reach a soft tissue drainage site, they form
a large swelling called a parulis, or gumboil, as
shown in figures 2-10 and 2-11.
SYMPTOMSThe patient may complain of
a constant, throbbing pain in the affected area
and an increase of pain when chewing or lying
down. The complaint may also include a bad
taste, a tooth that feels longer than the others,
or a gumboil.
SIGNSYou may cause severe pain when
applying finger pressure to the affected tooth or
when you tap the tooth lightly with the end of an
instrument. You may see swelling or a gumboil
on the soft tissues and facial swelling near
the affected area. You may also discover the tooth
is loose, and the patient may have an elevated
TREATMENTDrain the abscess to relieve
the pressure, which will cause the pain to dis-
appear. If a carious lesion is present in the