Page 236 - My FlipBook

232 OPERATIVE DENTISTRY

tions when used on posterior teeth, but it is nevertheless good prac-
tice in many eases as it materially retards the process of decay.
The Management of Permanent Teeth in Childhood constitutes
one of the greatest trials of dental practice and is at the same time
of the utmost importance. These teeth are erupted at a time of
life when the oral conditions are the most favorable to decay.
Again these teeth are expected to give their user the longest period
of service of any of the entire set of permanent teeth.
It Requires Extra Vigilance on the part of the dentist to prevent
irreparable injury to the first permanent molars, as the parents are
not usually aware that permanent teeth are present at this age
and do not assist the dentist in detecting incipient decays. More
is expected and required of the first permanent molar than any
other tooth. It must stand the onslaught of the most unhygienic
conditions.
It must give its possessor longer years of service and that in a
position in the mouth most often subjected to the stress of masti-
cation. Slight faults in enamel should be sought out early and
filled with amalgam to be changed for gold in more mature years.
When badly broken down they should be restored to full contour
v/ith amalgam and crowned only when the second permanent mo-
lar is fully in position. If gold is used, it should be in the form of
the inlay under about fourteen years of age as the tooth should
not receive severe and prolonged condensing force till certain of
full development, which is from ten to fourteen years with the
first permanent molar.
Treating First Permanent Molars. In treating and filling the
root canals of these teeth before fully developed, the apical
foramen will many times be found quite large. In some cases the
circulation is so great that devitalization is most difficult. In un-
certain cases it is well to use a medicated root canal filling that is
easy of removal and instruct patient to return in a few months or
perhaps a year for final filling.
A Good Root Filling for Such Cases is phenolized iodoform for
the canals, topped with gutta-percha base plate for the pulp cham-
ber and covered with amalgam. When the case returns it will
generally be possible to determine the length of the root and size
of the foramen when a correct root filling of chlora-percha will be
possible. In applying arsenic for devitalization in teeth that have
not fully developed as may be expected from their age, great care
should he exercised, as there is great danger of apical arsenical
poisoning which nearly always causes the speedy loss of the tooth.