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212 PATHOLOGY OF THE HAED TISSUES OF THE TEETH. ;
which no enamel rods have yet fallen out, serve the best purpose
for in these the whole condition remains unchanged. After actual
cavities have been formed, it is often difficult to be certain
whether the case is one of extension of decay on the enamel, or
a case of leakage from poor adaptation of the filling material,
or the faulty preparation of an enamel margin. If these early
beginnings of recurrence of caries are noted carefully with a
study of the nearness of the approach of the surface of the proxi-
mating tooth to them, the opportunity for cleaning of the cavity
margin by excursions of food, the shapes of the occluding sur-
faces as controlling food pressure through them, the actual con-
ditions of cleanliness of the part, together with the habits of the
patient in artificial cleaning, much will be learned of the condi-
tions of recurrence of decay that will give valuable information
for guidance in the management of this class of cases. These are
conditions which, I am persuaded, very few dentists have learned
to study in a really practical way that will make the information
gained available in practice. While these studies, coupled with
a proper and available development of technical skill, ought to
place the dentist in such rapport with his cases that few recur-
rences of decay will be found in after years, it is too much to
expect that these will be actually banished. This occurred to me
some time ago. In 1875 I undertook the care of the teeth of a
young man, then nineteen years old, who had many proximal
cavities, and gingival third cavities in the central and lateral
incisors, with some whitened areas on the gingival thirds of the
buccal surfaces of the bicuspids. Altogether it seemed an ugly
case. After a study of it, he was placed under pretty close
instructions for prophylactic use of the brush and made com-
fortable by the removal of two exposed pulps, so that he could
make full use of his teeth again and recover from sensitiveness
of the peridental membranes so as to endure the mallet well.
The fillings were made without hurry, occupying about six
months' time. The extensions were full and free as I could now
recommend. Within the next four years several other decays
were found beginning, after which there was complete immunity.
In 1903 he came to me for advice. No fillings had been lost. In
several cases recent recurrence had formed cavities at the bucco-
gingival angles of fillings. Whitened areas of begimfig decay
were demonstrable in a similar relation to every proximal filling
and every gingival third filling that had been made. Many new
decays were starting in areas not decayed before. Films of very
firm gelatinous material (plaques) were present upon all of the