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170 PATHOLOGY OF THE HARD TISSUES OF THE TEETH.
temporary fillings of gutta-percha. If the difficulty is from
alveolar abscess in any of its forms, the treatment of these must
be done and completed temporarily with gutta-percha fillings.
These should be good enough for temporary use, made smooth
and neat and of such form that the patient may use the
teeth without difficulty. If decays are in proximal cavities, the
greatest care must be had that there is ample space for the
interproximal gum tissue to resume its normal form, and with
such interproximal contact as will prevent food from leaking
into this space. The whole treatment must be planned with
the view of freeing the gums and peridental membranes from
irritation, restoring them to the normal and giving the patient
the full use of the teeth in the mastication of food. The excava-
tion and formation of cavities should be ample for this purpose.
When the tenderness is very considerable, extensions of cavities
and the final finishing to form may be left until another time,
or, in cases less acute, this may be practically completed.
When this has been done, the patient should at once go into
training in chewing food. For this purpose many persons
should make a more or less complete change in diet. Nowadays
people often adopt a diet that does not require the use of the
teeth ; when such is the case, the diet should be changed to foods
that will give exercise to the teeth. This should not be too severe
at first, but the work should be increased as rapidly as prac-
ticable until full vigorous mastication has been established.
With the continuance of this for a few weeks, the sensitiveness
of the peridental membranes will have mostly disappeared.
Most cases of extreme sensitiveness to the mallet should be
watched to see that the patient is using all parts of the mouth.
Any hindrances to this should be corrected and the treatment
continued.
Patients who could exert only thirty pounds on the molars
without extreme pain have often exerted 100 pounds within
one month, and 150 pounds within three or four months. Any
person who can give a gnathodynamometer record of 125 pounds
will not suffer much inconvenience from such malleting as may
be required for the building of any ordinary gold filling. The
operator can then make fillings as he pleases and do himself
and his patient full justice.
If in the diagnosis it is found that the patient has fallen
into the habit of using a diet in which mastication is not needed,
or has formed the habit of simply patting food into a bolus with