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248 PATHOLOGY OF THE HARD TISSUES OF THE TEETH.

and our sympathy for the child will prevent us from doing that
which seems necessary to be done. We must temporize in our
treatment. How can we temporize to advantage, becomes the
question. Can we make successful use of prophylaxis by arti-
ficial cleaning of the areas of liability to caries and in this way
prevent caries? In highly susceptible families, this would have
to be begun very early to be successful. While the teeth should
be kept generally clean, the more especial attention should be
confined to the areas of liability. These are occasionally found
with beginning decay of the enamel within a few months after
they come through the gums. Is it possible to handle these bad
cases in this cleaning process ? Those who are especially inter-
ested in the development of this method of combating caries
will do well to try handling the little ones in very susceptible
families.
TREATMENT OF DECAYS OF THE DECIDUOUS INCISORS AND CUSPIDS.
In consideration of other methods, there are certain con-
ditions peculiar to the child that are important for us to consider.
We may say that by the end of the third year (speaking of the
deciduous incisors and cuspids particularly), fhe growth of the
jaws and the development of the permanent teeth in the region
of the roots of the deciduous incisors have begun to carry these
little teeth slightly apart; at least, the effect of the growth will
prevent these teeth from dropping together if the contacts are
cut away at this age. And, as the child grows older, the ten-
dency is for these teeth to stand apart. This we can take advan-
tage of in the treatment and do that which we can not do with
the permanent teeth. We can cut them apart freely, make spaces
between them, and these spaces will be self-cleaning and remain
permanent; that is, after the child is about three years old.
The teeth will then be in contact as shown somewhat enlarged
in Figures 177, 178. One of the best methods of treatment for
decays of slight depth that have started in the proximal sur-
faces of the incisors or the mesial surfaces of the cuspids — such
as are shown in Figures 179, 180, is to file them out, or file them
partly out. With a small chisel or an 8-3-6 hoe excavator, chip
away the undermined enamel. Make the cavity as broad as
possible in that way so as to reduce the amount of filing. Then
with a thin jeweler's file, cut them flat from labial to lingual.
Do not cut the full depth of the decay in the dentin, but only
the depth of the enamel. That can be filed away without arous-
ing sensitiveness, and, when necessary, may be done a little at