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142 PATHOLOGY OF THE HAED TISSUES OF THE TEETH.

UTILITY OF STUDIES OF DENTAL CARIES.
When Dr. Miller made out the life history of the micro-
organisms which cause caries of the teeth and fully determined
their action in carious dentin, it was hoped by many that this
would be a guide to treatment that would become of great advan-
tage in the practice of dentistry. The profession did not appre-
ciate the wide difference between caries of dentin and caries of
enamel, and did not realize the greater importance of an under-
standing of caries of enamel — which is necessarily the first tis-
sue involved in dental caries — in the practical application of
filling operations for the control of caries. The importance of
this factor in the practical use of Dr. Miller's findings in the
treatment of dental caries has come very slowly to the minds of
men ; but it must now be seen that these findings have been the
basis of advancement in the study of caries of enamel, which
has directed the formulation of our principles of treatment. The
interpretation which held that the teeth decayed because of inher-
ent weakness in the teeth themselves, or from variations in their
calcium salts, seems to have been responsible for much of this
delay. The profession has been very slow to understand that
caries of the enamel is the principal factor to be considered in
any treatment that may be instituted for the control of dental
caries. We can not prevent the growth of microorganisms in the
saliva, as has been determined by Dr. Miller and confirmed by
numbers of men; therefore our attention must, for the present,
be turned to the question of preventing or limiting the injuries
they do to the teeth.
Caries of enamel is the initial lesion and always occurs as
the beginning process of dental caries. When the enamel has
been penetrated and the carious process becomes established in
the dentin, the only possible method of treatment is by its eradi-
cation by excavation and filling. In caries of dentin, the micro-
organisms have become established within the tissue itself and
can not be reached by any antiseptic or prophylactic measures.
Caries of enamel, however, always begins upon the outside of
the tooth, or in pits and fissures in the surface, most of which are
readily reached by careful cleaning and are amenable to prophy-
lactic measures, when these can be applied with sufficient fre-
quency. This, however, as to frequency, seems very nearly