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252 PATHOLOGY OF THE HARD TISSUES OF THE TEETH.
Of course, we can not expect much assistance from the child,
as the rule. Yet, many of them become enthusiastic and do
their part most bravely. Furthermore, the prophylactic work
with the tooth brush must be done by the parent or the nurse,
and this should be insisted upon, and when we have made a
silver nitrate treatment we must expect to have the child brought
to us and examine these teeth from time to time and see that
decay has not again started and is making inroads. We may,
if decay is again starting up in some part of a surface that has
been treated in this way, treat it again and stop it again, and
again, if necessary.
There are some objections to this method of treatment.
The first objection is that it makes the cut surfaces of the teeth
very black, and often this will show through the enamel and
give it a very bad appearance. This adds to the disfigurement
caused by the necessary cutting. For this reason, it is a very
objectionable practice from the esthetic standpoint, and yet,
with all of its objections, it is often the best we can do. Parents
will object to the discoloration of the teeth in many cases ; yet,
if the child is very sensitive, we can scarcely do better than to
use this method. The teeth can be made to look very much better
by other methods of treatment, however, methods that will be
more painful to the child.
We MAY EXCAVATE THE CAVITIES AND FILL WITH CEMENT,
hill's stopping, or base plate gutta-percha. Where we can
succeed in making the necessary excavation, this should be pre-
ferred, but to fill with these materials at all successfully, we
must excavate the cavities quite thoroughly. In filling these
little teeth with cement, I should not insist upon extensions
of the cavity — extensions for prevention — but should simply
remove the decay, cutting away the overhanging margins of
enamel and making the filling without any considerable effort
at extension. Unfortunately, the cements are not reliable and
in many cases they will wash out from these little teeth very
quickly; in some other cases again, they seem to stand quite
well. Sometimes cement fillings, put in early, stand until the
teeth are shed. But whenever fillings of this class are used,
the child should be seen frequently and the fillings renewed if
they waste away, or are found to be very leaky fronTskrinkage.
Extensions of decay beside the filling will also require treat-
ment. We need to watch these teeth much closer than we
watch the teeth of older persons, for changes occur rapidly;
the predisposition to decay is often very severe, so that the