tooth. If the pulp cannot resist the irritation
caused by the caries, it will die.
SYMPTOMSThe patient may complain
that the affected tooth is sensitive to heat and cold
(usually cold), to sweets, or to pressure from food
particles impacted in the cavity.
Sometimes a patient will point to a healthy
tooth and complain that it aches. There may be
trouble in such a tooth, but it is always advisable
to examine the other teeth on the same side (both
upper and lower arches) for a cavity. This may
be referred pain; that is, a patient feels pain in
a healthy tooth while the true cause of the pain
is located elsewhere.
SIGNSExamine the patient for caries by
using a mouth mirror, an explorer, a cotton
forceps, and a spoon excavator. Locate the af-
fected tooth by asking the patient to point to it.
You may observe some of the following signs.
Chalky white spot on tooth surface
Surface roughness when explorer point
passes lightly over tooth
Dark, stained cavity
Cavity filled with spongy mass of
Find out the depth of the caries. To do this,
you may have to remove loose debris from the
cavity. Use the spoon excavator and very gently
lift out the debris as illustrated in figure 2-7.
NOTE: Never try to scrape or dig the debris from
the interior of the tooth.
Stop the examination if there is bleeding in the
pulp area, if the pulp is exposed, or if the patients
pain is greatly increased.
If there is no pulpal bleeding or exposure or
increased pain, continue removing the debris.
When all of it is removed, lightly dry the interior
of the tooth with a cotton pellet as shown in figure
2-8. Do not use air or extreme pressure in drying
TREATMENTThe following is a treatment
plan for a tooth with no pulpal opening. For a
tooth with a pulpal opening, see the treatment
plan for acute pulpitis.
Figure 2-7.Removing debris from the cavity.
Figure 2-8.Preparing to dry the cavity.
If you have not done so before, remove all
debris from the cavity with an excavator, and
flush the cavity with warm water. Isolate the tooth
with cotton rolls to free the cavity of saliva. If
the tooth is in the mandibular arch, cotton roll
holders will be helpful in isolating it. You can
easily isolate a tooth in the maxillary arch by
placing cotton rolls between the arch and the
cheek or lip, depending upon the location of the
cavity. Carefully dry the interior of the cavity with
clean cotton pellets. Mix a zinc oxide-eugenol