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CLINICAL HISTORY OF CARIES. 779 ;
to all forms of disease that interfere ^vitli the usual motions of the
mouth or with the usual care of the teeth. There is no sufficient evi-
dence that diseased conditions give rise to changes in the teeth them-
selves that render them more susceptible to caries.
There is, however, sufficient proof that a predisposition to caries is
often acquii'ed in cases Avhere it did not exist in early life or is not
transmitted as a hereditary predisposition. As explained in connection
with the subject of heredity, the supposition that some change in the
constitution of the saliva renders it a more favorable soil for the prop-
agation of fermentation is the only hypothesis which, with our present
knowledge, seems tenable. This explanation applies to variations in the
constitution of the fluids brought about by temporary deviations from
health, as well as more lasting changes.
Clinical History of Caries.
Under this caption it is intended to study caries of the teeth as jt
appears clinically, laying aside the consideration of its etiology and
microscopic features except as incidental references.
Caries has pretty definitely fixed habits as to its points of beginning,
and one of its most notable characteristics is that it never attacks a
tooth on a surface that is smooth and is constantly kept worn and
clean by the attrition of mastication or the friction of the tongue,
lips, or cheeks. All such points are absolutely exempt from attack.
The points on the surface of the teeth at which caries has its begin-
nings may conveniently be divided into four classes, according to the
character of the surface
Class 1st. Pits and grooves in the enamel
Glass 2d. Proximal surfaces
;
Class 3d. Smooth surfaces which from any cause are habitually
unclean
Class J/ih. Necks of the teeth, at or near the junction of the cemen-
tuni and enamel.
These classes of caries have different characters peculiar to these posi-
tions, and which are of considerable importance in a clinical sense.
The first class is, in a large majority of patients presenting themselves
for dental operations, the earliest to make its appearance. It occurs in
the pits and grooves in the enamel wherever found—in the molars, in
the corrugations of the grinding surface, and in the groove or pit which
is often present in the buccal surface ; in the bicuspids, in the groove in
the grinding surface or pits that often occur at either end of this groove
in the upper incisors, in a pit or groove often present in the lingual sur-
face ; in any pits, grooves, or imperfections resulting from faulty forma-
tions or arrest of development in any position in the surface oif any of
the teeth.
The occurrence of this class of decays is dependent principally on the
opportunity ^iven for fermentation at these points by the depth of the
pits and grooves in the several teeth. This is modified by the individ-
ual predisposition to caries. In the child this latter may be inferred
after having learned the condition of the teeth of the parents. If caries
;
;
CLINICAL HISTORY OF CARIES. 779 ;
to all forms of disease that interfere ^vitli the usual motions of the
mouth or with the usual care of the teeth. There is no sufficient evi-
dence that diseased conditions give rise to changes in the teeth them-
selves that render them more susceptible to caries.
There is, however, sufficient proof that a predisposition to caries is
often acquii'ed in cases Avhere it did not exist in early life or is not
transmitted as a hereditary predisposition. As explained in connection
with the subject of heredity, the supposition that some change in the
constitution of the saliva renders it a more favorable soil for the prop-
agation of fermentation is the only hypothesis which, with our present
knowledge, seems tenable. This explanation applies to variations in the
constitution of the fluids brought about by temporary deviations from
health, as well as more lasting changes.
Clinical History of Caries.
Under this caption it is intended to study caries of the teeth as jt
appears clinically, laying aside the consideration of its etiology and
microscopic features except as incidental references.
Caries has pretty definitely fixed habits as to its points of beginning,
and one of its most notable characteristics is that it never attacks a
tooth on a surface that is smooth and is constantly kept worn and
clean by the attrition of mastication or the friction of the tongue,
lips, or cheeks. All such points are absolutely exempt from attack.
The points on the surface of the teeth at which caries has its begin-
nings may conveniently be divided into four classes, according to the
character of the surface
Class 1st. Pits and grooves in the enamel
Glass 2d. Proximal surfaces
;
Class 3d. Smooth surfaces which from any cause are habitually
unclean
Class J/ih. Necks of the teeth, at or near the junction of the cemen-
tuni and enamel.
These classes of caries have different characters peculiar to these posi-
tions, and which are of considerable importance in a clinical sense.
The first class is, in a large majority of patients presenting themselves
for dental operations, the earliest to make its appearance. It occurs in
the pits and grooves in the enamel wherever found—in the molars, in
the corrugations of the grinding surface, and in the groove or pit which
is often present in the buccal surface ; in the bicuspids, in the groove in
the grinding surface or pits that often occur at either end of this groove
in the upper incisors, in a pit or groove often present in the lingual sur-
face ; in any pits, grooves, or imperfections resulting from faulty forma-
tions or arrest of development in any position in the surface oif any of
the teeth.
The occurrence of this class of decays is dependent principally on the
opportunity ^iven for fermentation at these points by the depth of the
pits and grooves in the several teeth. This is modified by the individ-
ual predisposition to caries. In the child this latter may be inferred
after having learned the condition of the teeth of the parents. If caries
