Alternative therapies sound therapy

Patients who do not respond to the tricyclic anti-depressants have two alternative therapies available, both of which increase the availability of neurotransmitter amines in the brain. The monoamine oxidase inhibitors (Section 9.4, p. 359) are highly effective but impose dietary restraints and have often caused dangerous surges in blood-pressure. Electroconvulsive therapy, which may sound brutal, but is actually painless to the patient, can achieve lasting improvement (Green, Heale and Grahame-Smith, 1977). 

Alternatively the pulp may be saved by the process of pulp capping. This involves placing some sort of material over the pulp to protect it and maintain its viability so that more extreme treatment (extraction or endodontic therapy) can be avoided [1]. Two possible approaches are available, namely direct pulp capping, in which a bioactive material is placed directly over the exposed pulp, and indirect pulp capping, in which a cavity liner or sealant material is placed over a residual thin layer of dentine, which may be sound or carious. In the latter approach, the pulp has not been exposed, but it is at risk of becoming so either by the progress of the residual caries or by the process of tooth preparation. 

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