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MANAGEMENT OF CHILDREN'S TEETH. 253
teeth decay very quickly indeed, and, unless we keep a very
close watch of them, we will find that they have decayed badly
in the interim. In this connection, it is especially unfortunate
that our cements are so unreliable. A cement that we may use
this week and find afterward that it is doing good service, may
not be good next month. These changes that occur in the
cements are very vexatious. No means has yet been devised by
which they can be prevented, but very earnest search is being
made. Of course, wherever we can, a gold filling is the right
thing to make, but the cases where we can make gold fillings
successfully in the teeth of little children are very few. It
should be undertaken only when we have the most positive assur-
ance that a really good filling can be made. Also, we must be
especially careful to preserve the courage of the children.
THE TREATMENT OF DECAYS IN THE OCCLUSAL SURFACES OF
DECIDUOUS MOLAR TEETH.
In these we should not care particularly for the color, and
we may use any of the filling materials without the color objec-
tion that pertains in the incisors. If we obtain control of the
child before the decays are large, we may break away the enamel
from about the cavity, open it as widely as possible, and then
use silver nitrate, not, in this case, entirely for the purpose of
stopping decay, but for the purpose of relieving the sensitive-
ness. For this purpose it should be used in almost precisely
the same manner that we would for the stopping of the carious
process in shallow cavities. After the action of the silver nitrate
for a week or ten days, having applied it two or three times,
we will generally find that the sensitiveness has been relieved,
and then we may cut out the decay and make a filling. In the
meantime, especial care should be taken in washing the cavities
clean after eating and keeping them so that they will be washed
freely with the fluids of the mouth. The difficulty with these
decays in the occlusal surfaces is that, unless we can open
them very wide, they will fill up with food which will ferment
and the decay will again progress, notwithstanding the treat-
ment with silver nitrate. Therefore, this treatment should be
mainly for the purpose of obtunding the sensitiveness in order
that we may excavate and make a filling. In this, we are running
the risk of considerable discoloration of the dentin that will
show through the enamel. We will not always succeed well with
this process ; sometimes the sensitiveness will remain and hinder
us from making a sufficient excavation, but the case will be the