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THE CHILDHOOD PESIOD OF THE PERMANENT TEETH. 273
teeth are still as much as one-third covered with gum tissue,
making the adjustment of the rubber dam especially difficult and
painful. No kind of filling, temporary or permanent, can be
properly done without it. When the rubber dam can be held on
the teeth by the contact points aided by bits of cotton, gutta-
percha or cement, the difficulty of forcing the rubber dam down
by ligatures will be averted. In these cases it is especially desir-
able to use a quick-setting cement, and, while holding the rubber
well down on the lingual and labial, stick a globule on the tooth
and hold it until it stiffens enough to hold the dam in place.
The requirement is that cavities be cut very wide toward the
labio-gingival and linguo-gingival angles of the proximal surface
so as to include the whole area of liability, or that extension for
prevention be carried to its full limit and the prepared cavity
solidly filled with gold. By this it is not meant that the cavity
shall be cut over onto the labial surface so as to show much gold,
but only so far toward the angle of the tooth as to relieve the
margin of the filling from near contact with the proximating
tooth. Extension for prevention does not call for the cutting of
proximal cavities of incisors over onto the labial surface in any
case, and this should never be done except when demanded by
the extension of actual decay of the dentin and backward decay
of the enamel. Whenever the condition of the patient as to cour-
age and endurance will warrant this procedure, it should be done
without hesitation or delay. Clinical results mark this course as
being at once safe and reliable and so markedly the best as to
speak most positively against the opinion so often expressed
against using metallic fillings in the teeth of young children. The
reason that these so commonly fail is that they are so comm only
not well done; the extension for prevention is not carried out,
nor is the filling well placed, the reasons being mainly that the
difficulties are not overcome. Such operating is useless under
these conditions and had better not be attempted. In any case
of this nature, in which the operator can not see his way to carry
out extension for prevention to the full limit and make a perfect
filling, he will do better to fill temporarily with gutta-percha, or
Hill's stopping, after making the best excavation the conditions
will allow at the time and await better conditions. The tem-
porary fillings must be carefully watched, and redone frequently,
the patient encouraged in every way, and, at the first oppor-
tunity for successful work, the permanent fillings should be made.
In excavating, it should be especially remembered that at
this time the pulp of the tooth is much larger than in the adult,