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THE USE OP WATEB. 51

of water at the proper temperature, for the purpose of removing
all debris from the cavity and from the mouth of the patient.
Before placing the rubber dam, water should be used to
free the necks of the teeth from microorganisms, even in the
most cleanly mouths. A thin scaler should be passed around
all of the surfaces, loosening up any gummy substance adhering
to them, and this should be washed away with a strong jet of
warm water. If the case is not especially cleanly, there is
greater necessity for this proceeding, provided, of course, that
this has not been done preparatory to some previous operation
at the same sitting.
The object of this care is especially to prevent pushing a
mass of microorganisms and debris under the free margin of
the gum by the rubber and the ligature. Often the gums are more
or less bruised by this procedure, and if at the same time a mass
of debris containing many active microorganisms is crowded
into the soft tissue and held there for a considerable time, the
microorganisms will take hold of this injured tissue, and cause
very inconvenient soreness, or actual suppuration. Many incur-
able cases of phagedenic pericementitis are started in this way.
After removing the rubber dam, the gums should be treated
with a thorough douching with warm water while kneading
them thoroughly with the fingers of the other hand. This is
especially important to the comfort of the patient. The rubber
dam has been in place for a considerable time, perhaps for an
hour or more, and during this time the free margins of the gums
have been tightly compressd by the rubber and the ligatures
or other appliances for securing it in place. The circulation
of the blood through this part has been impeded. The douching,
together with the kneading, causes the blood to return to these
tissues, starts it into active circulation again, and removes any
poisonous material that may have been forced into the gingival
space by the rubber. It imparts a feeling of comfort to the parts
and causes at once the most complete feeling of rest from the
operation that it is possible for the operator to give.
The washing away of powdered stone and debris during and
after polishing fillings, should be thorough and complete, and
the patient dismissed with a clean mouth.