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THE FORCE USED IjST MASTICATION. 169
of the teeth, which is necessary to the health and strength of
the peridental membranes.
Disease of the peridental membranes is now becoming a
far more serious menace to the teeth than dental caries. Not by
greater' frequency of occurrence, but by its greater destructive-
ness when it does occur. This is to be guarded against as well
as dental caries. In both, cleanliness is the principal factor.
This is an additional reason for inquiry as to cause of tender-
ness of the peridental membranes. The cause will generally be
found (1) in tenderness of carious cavities which has prevented
proper use of the teeth for a time, (2) actual beginning of dis-
ease of the peridental membranes about the gingival margins,
(3) tenderness in the apical space from diseased tooth pulps or
following the death of the pulps of one or several teeth, (4) from
the habit of bolting food without the proper and normal masti-
cation, or the adoption of articles of diet not requiring force
in mastication. Any one of these causes may be found by such
examination as will exclude the others. Frequently the diag-
nosis is so difficult as to require that this plan of rigorous exclu-
sion be followed. Causes 1, 2 and 3 may usually be found by
physical examination, and in any case of difficulty this examina-
tion should be rigorously made. Cavities of decay sufficient
to cause pain in chewing food, are generally sufficiently appar-
ent or are well known to the patient. The same is true of teeth,
the peridental membranes of which have become sensitive
because of disease or death of the tooth's pulp. In disease of
the peridental membranes, the patient is generally not conscious
of any cause for the pain to pressure, for they have already
ceased to use the teeth with vigor.
When the cause of the difficulty has been established, the
treatment becomes simple, if the condition is causd by tender-
ness resulting from dental caries. Diseases of the peridental
membranes beginning at the gingival margins will not be dis-
cussed. If the cause is found to be teeth that have become sensi-
tive to the pressure of food in mastication due to caries, the first
thing to be done is to remove this by temporary expedients and
put the patient in condition to rebegin the vigorous mastication
of food. No attempt should be made to make gold fillings for
persons whose peridental membranes are abnormally sensitive,
(1) because unnecessary pain will be inflicted, (2) because the
operation can not be so well done. If there are exposed and
inflamed pulps the first thing to do is to remove these pulps
and place the patient in a comfortable condition by the use of