Page 366 - My FlipBook

228 PATHOLOGY OF THE HABD TISSUES OF THE TEETH.

by the sufficient use of the brush. This can be done, however,
and recurrence of decay prevented if the patient is sufficiently
careful in the cleaning.
When these cavities occur in numbers in the teeth of young
girls or young married women complicated with many proximal
decays that interfere with chewing food, and are neglected, the
conditions become the worst that are met with in dental practice.
These seem not so frequent now as they were thirty or forty
years ago for the reason, apparently, that there is not the same
neglect of them, but occasionally such cases will be presented.
On account of several exposed pulps in occlusal and proximal
cavities, the patient becomes unable to chew food, and practically
ceases to use the teeth. What food she takes is of the softest
variety, often mostly starchy foods, cleaning by mastication fails,
artificial cleaning is entirely neglected, cavities of decay are filled
with fermentable material, hyperesthesia is greatly increased,
and gingival third decays become general. In this condition
the patient is harassed day and night with pain, becomes anemic
and some intercurrent affection is liable to end life, when under
normal oral conditions, recovery would have been easy and sure.
Early in my practice a number of these cases occurring together
with this result, aroused me more than any other thing that
has ever engaged my attention. For some years afterward I
extracted all the teeth and made artificial teeth, sometimes in
persons not more than sixteen to eighteen years old. As years
went on, I found these persons again in very bad condition on
account of the great shrinkage of the alveolar processes. They
were again placed in a condition in which they could not chew
food with any degree of satisfaction or comfort. The result has
been a very close clinical study of these conditions and of the
treatment possible in these neglected cases in young people.
The first thing to do is to relieve pain, and on account of
the extreme sensitiveness of the persons, the most difficult thing
is to gain that control of them that will give opportunity for the
necessary manipulation. Confidence must be obtained slowly.
Artificial cleaning must be instituted, and gradually each sensi-
tive point that interferes with it, eliminated. Exposed pulps
must be removed and the cavities filled temporarily. No perma-
nent fillings whatever should be attempted. All buccal or labial
cavities in which decay is burrowing in the dentin, should be
fully opened by clipping away all overhanging enamel, and left
as wide open as possible in order to admit free washing, both in
artificial cleaning and by fresh clean saliva. The softened mate-