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MANAGEMENT OF PATIENTS. 159
back and forth, bringing it out at the occlusal ; then against the
mesial surface of the next tooth, and so on around the arch.
Generally, it is a pretty difficult thing to get patients to clean
all of the proximal surfaces. If it is a full denture, there are
sixty-four surfaces to clean; it requires sixty-four distinct
motions to go around the arch and clean all of these surfaces.
It is a simple matter to clean one or two or three, but to get
the patient to clean all of them and do it regularly is quite
another matter. It takes a little time, not very much; but to
form the habit in such a way as to clean every proximal surface
is difficult, and very few persons accomplish it completely for
any considerable length of time.
Perhaps the use of toothpicks is the most common method
of cleaning proximal surfaces, but the toothpick, as it is habit-
ually used, removes only lodgments of food. With the tooth-
pick, however, the proximal surfaces may be pretty thoroughly
cleaned; microbic plaques that have been formed upon these
surfaces can be removed, but generally it is very imperfectly
done. For this purpose the quill toothpick is much better than
the ordinary wooden toothpick. Nowadays machinery has been
made for making the wooden toothpicks and large factories are
established for the purpose, and they have become so very cheap
that every one may use them. But the wooden toothpicks that
come to us are not always perfectly smooth. There is more or
less slivering of the wood in many of them, and we are liable, in
using these toothpicks, to leave little slivers of wood in the gum
tissue that do injury. A good many cases of injury are caused
by forcing spiculse of wood into the peridental membrane
between the tooth and its alveolar wall, causing soreness and
suppuration. However, some wooden toothpicks are made very
smooth and very nice ; but, upon the whole, the quill toothpicks
are very much the better to use ; they will get into places where
the wooden toothpicks will not reach and will clean the surfaces
better.
The difference in persons as to the need of toothpicks is
very great indeed. Most young people have very little use for
the toothpick, if their teeth are well formed, if the proximal
contacts are good. The rubber band is much better. Where-
ever lodgments occur, the person should be instructed to use
the toothpick and to use it regularly after each meal. Persons
who habitually have lodgments between their teeth are very
liable to neglect them; the lodgment from one meal remains
until the next meal, and that original lodgment is forced farther