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DYSTROPHIES OF THE TEETH. 23
protected, it continues to burrow, finally reaching the pulp and
completing the destruction. This is the general fate of these mal-
formed first permanent molars. Many cases come before me in
the great clinic of Northwestern University Dental School, show-
ing involvement of the anterior teeth in young people. The rule
is that the first molars have already been lost. Children from
eight to twelve years old are coming often to have these teeth
extracted.
Treatment.
First molars. Treatment of these malformed first molars
to prevent the results detailed above, is exceedingly desirable.
The treatment is required as early as the eighth year, often in
the seventh. A few cases may be successfully filled. Cases
which promise good results and in which the child can be con-
trolled to do this work, the fissures should be properly prepared
and filled with gold at once when discovered. Generally, how-
ever, it will be found impracticable to make the proper prepara-
tion and the fillings at so early an age because of failure to con-
trol the child. As the rule, it would be necessary to do this dur-
ing the seventh or eighth year. A large proportion of these
cases are too badly decayed before the ninth year for filling, and
many of them are decayed to exposure of the pulp, or the occlusal
surface is lost during the seventh or eighth year. Ordinarily
they will be seen first by the dentist when the child is brought for
consultation regarding the deformity of the incisor teeth, the
parents not having noticed the deformity of the first molars.
Even at that time, in many cases, the first molars will be found
badly decayed. This very early appearance of caries in these
cases, and the fact that the pulp of the tooth is so often exposed
by a decay that seems not to be very deep, greatly increases the
difficulty of treatment.
When the teeth can be seen very early, or as soon as they
have come through the gums, and the occlusal surfaces are found
badly deformed, showing many wrinkles and deep fissures,
it
is generally best to grind away any small, sharp spiculse of
cusps that are liable to be broken in chewing food.
Then, if
decay has not actually begun in the fissures, these may be dried
out and filled at once with oxyphosphate of copper cement with-
out further preparation. Often such a course will be necessary
In
in order to do anything that will be of service to the child.
the deeper fissures in which decay starts earliest, it will do excel-
lent temporary service. When decay has made some progress
the softened material should be removed, after breaking away