Page 367 - My FlipBook

MANAGEMENT OF CAVITIES BY CLASSES. 229
rial in these should be removed by piecemeal, as it can be done
without much pain, and the washing continued with an abundance
of tepid water used with the brush after each meal and before
retiring at night. With the buccal and labial cavities the whole
effort for some time should be directed to the relief of acidity
by washings, and the strictest uncovering of all decayed areas, so
that the acid being formed in the tissues may be dissolved and
removed. But no alkalies should be used ; these have continually
done harm.
In this way the sensitiveness in the teeth will be rapidly
diminished. By careful removal of all hindrances to masti-
cation and encouragement in the use of the teeth, the chewing
of food may again become established. When this has been
accomplished the operator may leisurely make the permanent
fillings required.
This is an illustration of the principles of management that
should be followed in many cases of much less gravity than those
related above. When this has been carefully done, and good con-
ditions have been obtained for making the permanent fillings,
and habits of artificial cleaning have become well established, it
is often surprising how quickly complete immunity to caries will
occur. But the dentist must not hurry the permanent fillings.
For this he must wait until the weakened peridental membranes
have regained their strength and tone. No man is able to do
his best work in filling teeth over tender peridental membranes.
In following these cases with the gnathodynamometer, patients
have increased the crushing power with their teeth from twenty-
five or thirty pounds to one hundred and sixty or one hundred
and seventy pounds, within a few months. With this recovery
of normal conditions, any foods may be masticated with pleasure,
and the very best of operating may be done.
When these cavities occur as late as eighteen, or later, and
are treated promptly, they are not difficult to treat successfully.
When good judgment is used and the technical procedures well
carried out, good results are very certain and satisfactory. The
same may be said of similar cavities occurring in middle life.
Those beginning in the cementum in old age (senile decays) are
often very annoying, and present much difficulty. The softening
often includes a wide area that is so situated as to be very diffi-
cult to keep dry. Safe cavity walls are difficult to obtain, and
pulp exposure in the canals of the roots, particularly of the
molars, is very liable to complicate the cases. Fortunately, these
cases are not frequent, but when they do occur, they require a