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250 PATHOLOGY OF THE HABD TISSUES OF THE TEETH.
decays with silver nitrate without this exposure to light. But
when the full black color is obtained, decay is generally effec-
tually stopped. To do tbis requires such control of the child
as will enable one to use the file a little at a time and succeed in
shaping the surfaces and in polishing them. This may be done
with a thin stone in the engine and finished with disks. In this
work the child need not be troubled with the rubber dam or any
close confinement. But in applying silver nitrate, the rubber dam
should be used. Applications made without it will generally be
useless. One should make no attempt to tie on the rubber dam.
Indeed, nothing should be done that is likely to cause pain.
When this has been beld in position for ten minutes, or longer,
if the child is not too restless, throw a stream of water on it
to wash away superfluous silver nitrate and end the sitting for
the day. When it is apparent that the first application is
ineffective, make another after one or two days. Bepeat this
as often as may be necessary. All exposed dentin and the decay
should assume a full black color. Sound enamel will not be
stained. Any silver nitrate precipitated on the surface of the
enamel will disappear witbin a few days.
Generally decay is effectually stopped by this treatment
if the teeth and cut surfaces are kept fairly well cleaned. The
cleaning may be done by the mother or the nurse after proper
instruction. The dentist, bowever, should see tbese cases fre-
quently to know that the cleaning is well done. He may find it
necessary to repeat the treatment with silver nitrate occasion-
ally. Sometimes we find caries of the enamel beginning in the
gingival thirds of the labial surfaces. If these can be discov-
ered before the enamel rods have fallen out, they may be cleaned,
using caution not to break away tlie frail enamel, and treated
with silver nitrate without further preparation. Then tbe clean-
ing with the brush should be effective.
Eitber this incipient decay of the enamel or the deeper
decays of the proximal surfaces will be stopped, provided the
surface is such that it can be kept fairly clean. In this treat-
ment one will escape most of the painful part of the operation
in the treatment of these cases, for the little filing that is to be
done will generally not be very painful. This is applicable to
the proximal surfaces of incisors and cuspids and to labial
cavities. The labial cavities, from which enamel rods have
fallen, can not be cut away very completely, but we can break
away the enamel and trim it carefully so as to make these depres-
sions as smooth as possible and then treat them in the same