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198 PATHOLOGY OF THE HARD TISSUES OF THE TEETH.
cases, and yet it is important that he do his work well, because
there may be a return of susceptibility that will try even these
fillings severely. When persons have come to the adult age and
the expression of immunity is apparent in the mouth, any tyro
can make fillings that will be apparently successful. That which
tries the skill of the dentist is the making of fillings which will
stand the test of time for the very susceptible child, with a hered-
itary condition continuing this susceptibility on to maturity.
Selection of Filling Material.
Jn the management of cases, the selection of filling material
should have careful consideration, and this is especially true in
the management of families of children. The plan of manage-
ment should always include this selection, and it should be deter-
mined early in the consideration of each individual case.
Gold should always hold the first place and be regarded as
the material for use, unless displaced, for some specific reasons.
Gold holds this place because of its intrinsic merits as a filling
material for the cure of caries, aside from any consideration of
its expense or of the popular consideration of its purity, inde-
structibility, or that glamour that comes from its universal use
as money and consequent high consideration of its value. These
points that make so much for the use of gold in the public mind,
should have little consideration by the dentist intrinsically, and
yet these popular fads can not be ignored entirely in our dealings
with the people. They have their place in the minds of those
with whom we deal and must be considered as fixed facts that
can not easily be brushed aside. For these reasons, the dentist
will often be induced to use gold in positions of extreme difficulty
for both himself and his patient, when his own better judgment
would lead him to use another material. Again, esthetic con-
siderations will call for the use of gold in restorations in posi-
tions where the filling can not be hidden, and will call for long
and tedious malleting upon a sensitive peridental membrane that
will be in danger of permanent injury. In a general practice it
wilL often occur that such circumstances limit the power of choice.
This difficulty, that has been felt to be very real and trying in
the past, is being much relieved by the use of the porcelain inlay
in difficult cases that come in prominent view, and the gold inlay
in large cavities in the molars.
The general rule should be that gold should be used for
young people and for children, for the reason that with it the
placement can be more accurate than with any other material,