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TREATMENT OF HYPERSENSITIVE DENTINE 197
ulatc the dentist to his best efforts and work to the advancement of
the really progressive operator.
The Irresponsible Individuals who have no mental or physical
stamina require a strong hand to control them in any emergency in
life. They go to the dentist only when forced there by pain or are
children brought by their parents. While a dentist should never be
harsh with any patient, yet this class will necessitate, many times,
stern commands, and a "why, of course" method. In cases of this
character where the operator has chosen to assume the role of a dis-
ciplinarian, the stern proceeding should universally be tempered with
the kindest of tones before the patient leaves the chair, that he may
depart with the impression that the dentist is kind of heart and has
been severe only for the patient's good.
The Naturally Cowardly Patient Avho is strong, healthy and ro-
bust, yet lives in mortal dread of any phj^sieal discomfort, is the hard-
est class to manage. This class of patients have generally been raised
in luxury and taught by example made possible by their environ-
ment, that they should not even be inconvenienced. They seldom
work and mistake that tired feeling for sickness. To be hungry, cold
or warm, is described by them as "simply terrible." With such,
often the best an operator can do is simply to temporize to keep the
teeth comfortable. To attempt thorough work merely drives them
away to seek gas for painless extraction.
The Patient Who Simulates Pain should be early detected and
severely dealt with. An operator should remember that a large
amount of the gesticulation, grabbing the working hand, cringing
and outcry, is simply voluntary on the part of many patients to in-
form the dentist that he is hurting them. Most of this can be done
away with by the following procedure:
First tell the patient that "this will not hurt you," and then pro-
ceed to make the statement true by working on enamel margins,
even to gently scratching on the external surface. Then state to
the patient that "this may hurt a little" and the operator can pro-
ceed to test the dentine for its sensitive portions. He may then pro-
ceed to do the less painful parts of cavity preparation. Lastly when
it comes to cutting the angles and cutting sensitive portions the pa-
tient should be warned that this particular place may be sensitive
but that a certain amount of cutting is necessary. Advise the pa-
tient to hold still for just a second or two and then he will be allowed
to rest. Caution him against moving during this brief period as
it will undo what has been accomplished, necessitating his withstand-
ing the pain again. Praise the patient for his bravery when he has