Page 479 - My FlipBook

ABRASION OF THK TEETH. 219

tages of this or that plan. Although I have had wide observation
of these cases and the results of efforts at treatment, I have not
followed it with suitable models and that completeness of rec-
ords which now seem so necessary to accuracy of statement. But
a few things seem to be well established. The greatest difficulty
is to make a prognosis that will serve as a sufficient basis of treat-
ment, early enough to render the best form of treatment effec-
tive. If from the conditions present one could foresee what the
condition would be ten or twenty years later without treatment,
it would place the whole matter in a different light. We have
been too much inclined to allow these cases of abrasion to go
on until the teeth are excessively shortened and otherwise in bad
shape, and then undertake wholesale operations of building up
with large fillings, crowns and bridges. My observation has
led me to prefer more conservative treatment begun at an earlier
period. In many cases, if taken early, much aid can be rendered
those whose teeth are wearing away abnormally by making fill-
ings in certain teeth that will take the weight of the occlusion
for a considerable time and save much of the wear of other teeth,
or, in building up certain worn cusps, that will prevent certain
sliding movements. Careful selections should be made of the
particular teeth to receive fillings so that the two sides of the
mouth will remain fairly and equally balanced to the pressure
of the occlusion. Other certain worn cusps should be built up
to prevent excessive sliding of the teeth laterally. Observation
of the results of efforts that have been made at the wholesale
building uji of worn teeth has not given sufficient confidence in
this practice to recommend it very favorably. It is a long and
severe undertaking for both operator and patient, and within
a few years some part of this operation is pretty certain to fail
and make the case worse than if it had not been done. A few
well chosen fillings which will serve to limit the abrasion and
excessive sliding movements seem to have given better service.
In cases of excessive wear, the general rule is that there has
been a fault in the intercusping of the teeth in such a way as to
permit excessive lateral motion. This is first brought to notice
by the excessive wear for the time of life of certain cusps which
have worn first at their points instead of upon their slopes, as
should be the case if the intercusping were normal. Then the
question of judiciously limiting this excessive lateral motion
should be studied. It will often be found that the building up
of the worn cusps will do most good. If there are several of
them in opposite jaws that have slid over each other and have