Page 351 - My FlipBook

MANAGEMENT OF CAVITIES BY CLASSES. 213
fillings on buccal surfaces or other positions of easy access for
examination. These had spread beyond the margins of the fill-
ings. The enamel was decaying under these extensions. Indeed,
the whole denture was going to pieces with so-called "chalky
decay." The man seemed to be in ordinary health, but he had
had a reverse in fortune a few years before, which had left him
despondent and he had become entirely careless in his habits of
cleanliness. His teeth, gums and peridental membranes had
become sensitive (there was no calculus) and he had almost
ceased to chew food. The only chance for this man lay in a com-
plete change to cleanly habits, with radical training in the masti-
cation of food. Otherwise fillings would be of little value. No
amount of extension for prevention would have been available
for the prevention of extension of decay in such a case and the
effort to meet such conditions in that way should never be made.
Cases of lesser gravity will occasionally occur in practice which
can not be covered with any reasonable extensions of cavity walls.
A judicious operator will make no effort to provide for such
cases in his general plans of management of his cases. He
should, however, so manage in his treatment of proximal and
gingival third cavities that such recurrent decay will not be
found so long as persons are making reasonably vigorous use of
their teeth in chewing food. During the past year I was con-
sulted by a person who had unusually broad whitened areas on
all of the buccal and labial gingival thirds of his teeth, and much
of the same conditions showing in the proximal surfaces. From
the history of his case, it appeared that he had recently had
typhoid fever, during which his mouth and lips were much
gummed over with gelatinous material (sordes). Except for
this, he had been immune to decay. To all appearances, he was
again immune. No enamel rods had fallen out; no penetration
of enamel had yet occurred; the teeth were disfigured by the
change in color, but the probability is that further decay will
not occur. The whitened areas will probably become dark very
slowly if the strict cleanliness and the habit of vigorous use
of the teeth, as rebegun after his recovery, is maintained. Such
beginnings of decay following typhoid fever, in which there
has been much sordes, are not very uncommon, but such a case
as above related is very rare. It serves well to point out the
usefulness of vigorous mastication of food, and reasonable and
intelligent use of the brush as matters of treatment.
These processes, taken as a whole, are carried out for their
curative and prophylactic value. Many persons seem to think