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CABIES AS A WHOLE. ITS CLINICAL FEATUREa 91

CARIES AS A WHOLE. ITS CLINICAL FEATURES.

In the further consideration of the injuries inflicted by
caries of the teeth, we may include caries of both the enamel
and dentin. In this we may consider the processes as a whole,
noticing the various characters presented in the beginning and
progress, controlled purely by local or clinical conditions. These
conditions have no special signification as to immediate or remote
cause of caries further than location or condition of tissue which
may influence the action of these causes. Yet these causes which
are brought into action, seemingly because favorable conditions
for their active development have been presented, can not be
lost sight of in any consideration whatever. It may truly be said
that, without the presence of the principal causes no decay could
occur, and also that, without reasonably favorable conditions for
their action, these causes would not produce decay.
This may be said to constitute the clinical features of dental
caries, and in its consideration frequent reference will be made
to the clinical management of cases. One of the surprising
features of the study of dental caries that comes sharply in view
when the history of the development of our knowledge of it is
closely scanned, has been its complete divorcement from all
clinical consideration. It seems to be correct to say that a large
number of even the most earnest workers in dentistry are doing
their work of treatment by rote, without any proper thought
of the relations which their plan of treatment may bear to the
conditions that have localized the decay being treated at that
particular spot, and making inadequate provision, or too often
no provision at all, for the prevention of a recurrence of the
trouble. It is only recently that there has been any special study
given to the conditions of the beginning of caries of the enamel,
which really is the all-important question in the study of dental
caries considered from the clinical standpoint. One of the
noblest pieces of scientific work in pathology was Dr. W. D.
Miller's investigation of dental caries. It not only developed
the questions at issue, but completed the investigation so that
the rest of us, in repeating his experimental work, could only
say, well and correctly done. But this investigation was con-
fined exclusively to the immediate active cause of caries as it
occurs in dentin. Decay of enamel, or the conditions localizing