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A large proportion of the population have pulpless teeth, hence the importance of this subject. The main principles concerned in the treatment of pulpless teeth are: the removal of the pulp in its entirety, the drainage of the stump of the severed pulp, the cleansing and drying of the root canals and the filling of the tooth cavity.
Local anæsthesia is preferable to caustics for desensitizing the tooth pulp prior to its removal. Antiseptics used in a dry condition are preferable to those used in a moist condition for root canal treatment.
Nothing is gained by filling the root canals, if the peri-apical tissues have scarred there is no further discharge into these canals; and if they have not scarred the filling of the root canals will only obstruct drainage. If the discharge from the canals is copious, the tooth cavity should be left open to the mouth except for the insertion of a loosely placed dressing.
Untreated pulpless teeth are more liable to give rise to “open” sepsis; treated pulpless teeth to “closed” sepsis.
The crux of the question as to whether pulpless teeth should be retained or extracted is one of evaluating their advantages and disadvantages.
A tooth deprived of its pulp owing to infective changes gives rise to subjective and objective symptoms and signs.
A tooth deprived of its pulp owing to physiological changes gives rise to no apparent ill effects.