Page 399 - My FlipBook

MANAGEMENT OP CHILDEEn's TEETH. 251
way, and, by proper instructions to parents, they may be kept
clean by brushing, and the teeth, although mutilated and out of
shape, will be useful to the time of their shedding. All cases
treated in this way should be carefully watched, and if any sign
of the recurrence of decay is noted, the silver nitrate should
again be applied.
A word of caution should be said about the use of silver
nitrate, and it is an important one. It must not be used if the
decay has approached near the pulp of the tooth. There is
nothing else that will cause so severe a toothache as silver nitrate
used over a pulp that is nearly exposed by decay. Personally,
I have had a few Very memorable experiences with it. The pain
was so severe and so uncontrollable that I felt compelled to
sacrifice important teeth. One may use silver nitrate with per-
fect freedom wherever there is a good coating of sound dentin
over the pulp, but we must not risk affecting the pulp. Of course,
up to a certain age we have the recourse of destroying the pulp
and removing it, but after the beginning of the absorption of
the roots that recourse is lost to us. Treatment with silver
nitrate should be confined strictly to shallow cavities. It is not
well suited to deep cavities in which there will be accumulation.
Its success depends much upon strict cleanliness and free wash-
ings by the fluids of the mouth and by foodstuffs after the
treatment. Other plans of treatment must be employed for
deeper cavities. The application of the silver nitrate seems
to be of much benefit also in beginning caries of enamel. "When
it has been precipitated freely among the loosened ends of the
enamel rods, decay does not rebegin so readily and such vigorous
cleaning is not necessary to hold it in check.
A word as to the handling of children in this class of cases.
A dental school clinic is not a suitable place to handle little
children. We are practically debarred by the conditions from
teaching this clinically in schools. If I am to handle children,
I want to know the parents; I want to know that they are
depending on me to manage the teeth of their children and that
I will have their assistance and sympathy in this management.
I will not undertake, further than for present relief, the handling
of children of strangers, and I would not advise anyone to try to
do it. Remember that in undertaking to treat decay of these
teeth, it is a thing that one must begin to-day and follow it up
from week to week and from year to year, until the shedding
time of these teeth, and one should have that particularly in view
and have the parents particularly impressed with this necessity.