Page 207 - My FlipBook

CARIES AS A WHOLE. ITS CLINICAL FEATURES. 103
by local stimulants and the case kept under observation in the
effort to have it refill the interproximal space.
Any condition which allows food to leak into the interproxi-
mal space, be held and forced onto the gum tissue, will cause the
absorption of the gum tissue and result in the formation of a
pocket. In time, one of two things is certain to happen : (1) acid
fermentation will become established in the pocket and decay
will occur farther toward the gingival line, or (2) putrefactive
decomposition will become established, and finally disease of
the peridental membrane will result. Careful clinical study has
shown conclusively that much the greater number of the decays
met with in practice that extend far toward the gingival line, or
past it into the cementum, have occurred in this way. It is true,
however, that a considerable proportion of these have occurred
in what may be called the more normal way by the spread of
decay along the dento-enamel junction and backward decay of
the enamel. This later can occur only in the badly neglected
cases.
The crowding of food between the teeth after the placing
of so-called contour fillings in the earlier days of cohesive gold
work was the cause of widespread loss of fillings by under-
mining by decay at the gingival margin. The former employ-
ment of the separating file as it had been developed in the use
of non-cohesive gold was continued for the finishing of cohesive
gold fillings. Flat contacts were made and the forms of proxi-
mal surfaces were left otherwise in imperfect form. There had
not been that close study of tooth forms which enabled men to
copy them with accuracy, or to appreciate the correctness of
forms of interproximal contacts ; neither did they have suitable
instruments. It is only by the complete relegation of the sepa-
rating file to past history, the study of the best natural forms
of interproximal contacts and their function in the protection
of the interproximal spaces, the copying of these in the shaping
of proximal surfaces of fillings, which are made to restore the
full mesio-distal breadth of the teeth, that this difficulty in the
treatment of caries of proximal surfaces is being overcome.
Decays recurring from these causes are especially difficult of
treatment, often requiring the removal of a filling previously
made, in order to reach them from the occlusal snrface. They
are also complicated with great difficulties in getting the rubber
dam far enough to the gingival to protect them from moisture.
Therefore, in practice, a complaint of pain being produced
by food lodgments, or of food being held between the teeth in