(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 treatment. Acute Pulpitis 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 canal(s). SYMPTOMS—The 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. SIGNS—You  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 267.52 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. TREATMENT—Gently  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. Periapical  Abscess 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. SYMPTOMS—The  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. SIGNS—You  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 temperature. TREATMENT—Drain  the  abscess  to  relieve the  pressure,  which  will  cause  the  pain  to  dis- appear.  If  a  carious  lesion  is  present  in  the 2-46