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218 PATHOLOGY OF THE HARD TISSUES OP THE TEETH.

with a number of slowly progressive proximal cavities in the
bicuspids and molars, or cavities in which fillings have failed.
If these cases are not so bad as to have materially limited
mastication, or if the patient has not contracted mincing habits
at table, they are generally easy to manage. They require little
else than the careful performance of the required technical pro-
cedures after a study of the requirements of extension for pre-
vention in the individual cavities.
If, however, the case presents many open cavities that have
long rendered chewing painful and ineffective, and the habit of
avoiding foods requiring effort in mastication has been long con-
firmed, they may prove exceedingly difficult to treat. The whole
mouth is often in a condition of hyperesthesia; everything we
do for them hurts. In operating we must treat them as we
would treat children, but otherwise as adults. Often we must
gain their confidence by selecting the least painful operations
in the beginning, and then, as rapidly as possible, remove the
hindrances to mastication and train them into the vigorous use
of their teeth. It is often well to use temporary fillings in those
cases requiring long, tedious packing of gold until chewing has
become effective and the membranes strong and firm. Then the
necessary malleting to make a good filling can be borne without
difficulty.
If, in any such cases, there are pulp exposures that are
preventing the patient from chewing food, these must be elimi-
nated by the appropriate treatment as a first procedure whenever
practicable. Operators most often overlook bad contacts or
open cavities, which allow food to so impinge upon the gums as
to continually cause pain. Whenever such places are present,
they should be treated with temporary fillings in such a way as
to substantially remove the difficulty without waiting for the
more tedious permanent operations. The recovery of the health
of the gums, and particularly of the gum septums, and recovery
of the peridental membranes from sensitiveness caused by iri'i-
tation and lack of use, should always be especially looked to in
the making of temporary fillings, and these must be so made as
to promote this. Often gutta-percha is forced upon the gum
septum in such a way as to cause its absorption and do per-
manent injury. This should, by all means, be guarded against
with jealous care; for, when it occurs, the interproximal space
will be continuously unclean, except as it is cleaned artificially.
This becomes a continuous menace to the health of the parts.
When this has occurred, every effort should be made by artificial