Page 423 - My FlipBook

THE CHILDHOOD PERIOD OF THE PERMANENT TEETH. 271
avoided. If tile case does not do well after one or two straight-
forward efforts, abandon it without further worry to the child.
In this class of cases every failure, or rather every period of
hyperemic excitement, diminishes the chances of recovery and
adds materially to the difficulty of controlling the child. The
treatment giving me the greatest percentage of success has been
given above. Sometimes, a second effort will succeed when the
first has failed, but a third is not advisable.
When these cavities are presented to us in patients fifteen
years old, or over, they present no more of difficulty than other
pit cavities. Other teeth are not so often deeply decayed so early
after presenting through the gums and do not demand attention
when the child is so young. They are, therefore, not so fre-
quently neglected, and when they do occur, the increased self-
control of the patient makes the treatment easier and more cer-
tain. Decay involving the loss of the pulp in any tooth before
the completion of the roots, involves the loss of the tooth for the
reason that root fillings can not be successfully made. This fact
should be ever present in the mind of the practitioner, and the
time of the completion of the roots of the individual teeth as per-
fectly known as their variations will allow.
It not infrequently happens that the mesial surface of the
first molar begins to decay while still in contact with the second
deciduous molar, and this will be the first proximal cavity. In
children of good self-control and endurance, these should be pre-
pared and filled with gold when discovered, even as early as the
eighth year. In the reverse conditions in which the teeth are
excessively sensitive and the child very difficult to control, it is
better to use gutta-percha, zinc phosphate or copper phosphate
temporarily, await the shedding of the deciduous molar and seize
the opportunity when the whole proximal surface is exposed to
view to make the permanent filling. The operator must not be
tempted by these favorable conditions into making this a simple
cavity without due extension for prevention or without cutting
the full retention seat in the occlusal surface. He must form the
proximal surface and contact point to meet with the second bicus-
pid, which will be quickly in position. A principal point in the
treatment will be to determine what will be the area of liability
when the bicuspid is in position and include it in the area of the
filling. Failure in either of these directions will be fatal to the
future of the filling. If existing conditions will not allow these
things to be very well done, it is better to use temporary expedi-
ents and await better opportunity for making permanent fillings.