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MANAGEMENT OF CAVITIES BY CLASSES. 221
trations, Figures 121-123 and 124-128, inclusive. Good manage-
ment of cases requires especial watchfulness for such conditions.
No case in which lodgment is suspected, or in which complaint
is made by a patient, should be allowed to pass without the
closest scrutiny and a determination of the facts. Often there
will be no complaint by the patient on which to base a special
examination, and sometimes the symptoms remain very obscure
until much injury has been done. This insidiousness of the con-
ditions is one of its greatest dangers. In many of the cases,
however, in the absence of complaint by the patient, the symp-
toms are plainly marked. The most prominent symptoms are
the swelling and redness of the interproximal gum tissue, and an
enlargement of its festoons on the buccal or lingual, or both, in
some one or more of the interproximal spaces, without apparent
reason to be seen in the general conditions of the mouth. This
may be so prominent that it will catch the eye of a skilled
observer at once, or it may be so slight as to easily escape notice.
In many of the cases in which increased redness is not apparent,
the gum tissue will have become festooned, i. e., the tissue,
instead of rounding smoothly into the interproximal space as is
normal in healthy mouths, becomes enlarged and pointed in
the embrasure. This may occur as a general condition of the
gums in cases of a slight gingivitus from uncleanness, or occa-
sionally, from constitutional causes. The condition passes away
readily when the causes which induced it have been removed.
This general condition must not be confused with the local con-
dition occurring at isolated points. "When patients complain
of pain from forcing food into any interproximal space, a care-
ful examination will generally show that the central portion
bucco-lingually of the gum septum has been absorbed by the
pressure of the retained food, forming a pocket of more or less
depth. When the patient has not complained but still the symp-
toms noted above are found, careful examination will, usually,
reveal similar conditions. This will confirm the diagnosis in
either case. Then it becomes necessary to determine the cause
In many cases it will be found
of the condition and to remedy it.
to be caused by the roughening of the proximal surfaces by
beginning decay and the remedy is in making the appropriate
filling, or fillings, in proper form. This should not be delayed
because the decay is as yet very slight. Figures 121-123 show
conclusively that wide extensions of decay toward the gingival
occur from this cause, making a grave complication of the case
even before the enamel rods have fallen away in the original