Page 338 - My FlipBook

200 PATHOLOGY OF THE HAED TISSUES OF THE TEETH.
used exclusively in those portions from the beginning. This may
be the molar teeth or tbe molars and bicuspids. A question that
I have found myself asking many times in this connection has
been: "Will amalgam fillings in the mesial surfaces of the
bicuspids in this mouth show a dark color that can be noticed
in ordinary social intercourse?" The answer to this question
should have decided weight in the choice of material for these
teeth, and in young girls, particularly those with thin lips, light
complexion and active facial muscles that will, upon occasion,
show these teeth prominently, esthetic considerations should
debar amalgam. It will not do to say, "This is only a little girl
and the appearance is not important. " In a very few years the
girl of twelve or fourteen is the young lady of eighteen, with all
of the pride of personal appearance belonging to that age, and
esthetic considerations in case of the younger girl should have
the young lady in society in view, and the choice of filling mate-
rial should be made accordingly. On the other hand, if the lips
are thicker, the facial muscles less active, the teeth better covered
and the complexion darker, there will be less objection to the use
of amalgam in the bicuspids.
These matters should be considered and determined for each
person, and afterward there should be no commingling hap-
hazard of amalgam and gold fillings in the back teeth. It should
be all one or the other in the limits determined upon.
In older people, these considerations become less important,
but are never obliterated. As a rule, they are stronger in women
than in men, but they never disappear at any age, or in either
sex.
The use of gold fillings becomes limited in many cases by
reason of disease of the peridental membrane. Often a very
little appearance of disease limits materially the endurance of
the peridental membrane under the stress of mallet pressure to
such an extent as to properly prohibit the building of large gold
fillings. Further, when a very large filling is to be built in a
molar tooth and the membranes are not particularly strong, the
long-continued malleting necessary to the proper condensation
of the gold is likely to do permanent injury. In all such cases,
amalgam or inlays become the more appropriate material. These
conditions usually occur at a more advanced age, when the inten-
sity of the tendency to caries has become so much modified that
the danger of recurrence of decay is much less.
In the front teeth, amalgam is debarred. In case the mem-
brane has become so weakened that gold can not be used, it is