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vice versa, the lining membrane and nerve lose their vitality,
the crown of the tooth changes its colour from a yellowish
white to a peculiar dark bluish, while all the internal cavity
of the tooth usually becomes entirely decayed.
The enamel resists the process longest, and is often seen
a mere shell and fotm of a tooth, having an opening when
the caries first commenced until, at last, by some slight accident
in mastication, the remaining shell of the tooth is broken,
and the fang or fangs of it are left in their sockets. As the
fangs of the teeth are nourished by the blood-vessels of the
gums externally, and the blood-vessels of the lining mem-
brane internally, if support from the last is lost, still if the
gums arc in a healthy state, the fangs will often live many
years ; but if the gums are in a diseased state, the stumps of
the teeth soon die, and become a source of great injury to
the other teeth, if any remain. In the progress of this dis-
ease, from the first commencement of caries until the tooth is
destroyed, we notice, for the sake of clearly understanding the
surgical treatment, four stages of the disease, which require
distinct treatment and a separate notice.
First, The simple abrasion and decay of some part of the
enamel, and often a destruction of a small portion of the
substance of the tooth beneath the decayed portion of the
enamel.
A perfect cure of the tooth in this stage of the disease,
may be made by skilfully filing away all the diseased portion
of the tooth, so that not the least vestige of decay shall be
left. This operation is one of no small importance, and
should be skilfully and effectually performed to be of service
to the diseased tooth, for if any part of the decay is left, it
usually proceeds until the tooth is destroyed, or farther ope-
rations for its cure are rendered necessary. I could, in this
case, mention many cases, both from the works of others and
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