Page 778 - My FlipBook

788 DENTAL CARIES.
is doubtful, however, if any formation or structure of the_ teeth, be they
ever so perfect, could withstand the conditions present in such cases.
The activity of the processes calculated to decompose them is so ener-
getic that the strongest teeth would be destroyed in a short time. The
Avorst cases I have seen were those of two Swedish girls, twin-sisters, •
eighteen years old, who came to me for advice a few years ago. In
these most of the teeth, including the lower incisors, which are so
generally exempt from caries, were already decayed to the gums, and
those that still retained a portion of the crown were attacked at from
one to four points. Fortunately, such cases are rare. With this as the
worst representative of the beginnings and the destructiveness of caries,
we might give cases illustrating all forms of gradation, doM-n to a case
in which an individual tooth shows a dark spot indicating that at some
time in the past the i)roducts of fermentation had injured the enamel.'
Cay'ien of the tedh u easentialhi a dhease of i/ovtJi (compare charts).
This is especially the case with the first and second classes of caries,
which comprise the great mass of cases. It is a notable fact that the
predisposition to caries diminishes as age advances. It is usually
strongest in childhood or youth, and the greater number of cavities
have begun at the age t)f eighteen. Very nearly all of the first and
.second classes have begun before the age of twenty-five. Perhaps
there is more than one reason for this. If we suppose that the dis-
position to caries remains the same, it is presumable that at the age of
twenty-five years all points favorable to the beginnings of decay have
been attacked. All except the wisdom teeth have for a dozen years or
more been exposed to the agents productive of caries; and if beginnings
have not been made within this time, it is presumable that they Avill not
be made unless there is some change in the conditions. This is prob-
ably the ])rincipal condition of tlie cessation of the beginning of new
^ Some years ago I proposed the terms vIk inita (beginning ))ower), from ris, power,
force, and ineo, to begin; and vi-t delela (destroying power), from delco, to blot out, to
destroy, to represent these cliaracteristics. These terms may readily be used for the
purpose of expressing the conditions in any given case, and for this purpose I asso-
ciate with them numbers to show the degree of the special characteristic. The follow-
ing gives the extremes of the possible combinations :
Vis inita 1, combined with vis deleta 1 to 100.
Vis deleta 1, combined with vis inita 1 to 100.
These may be used in the description of cases for the purpose of the more ready and
accurate representation of the facts that may exist or of the conditions observed, without
reference to the causes which may be supposed to underlie these effects. For instance,
in describing the conditions found in case of the two Swedi.sh girls spoken of in the text,
I should say there was present vis inita 100 and vis deleta 100. Tliis exjjresses my
conception of caries of the worst characteristics or tlie most violent i'orm in which it
is manifested. In a case in which a medium number of decays made their appear-
ance, and each of these was running a very rapid course to the destruction of the teeth
attacked, I would represent it as vis inita 50, vis deleta 100. In another case, in which
a medium numljcr of Iteginnings of decay was apparent, and these presented rather a
dark color and showed other characteristics indicating that the progress was rather
slow and yet decided, I would state it as vis inita 50, vis deleta 25. In this way all
gradations of tlie duiracterislics of caries as manifested in the individual case may
l)e readily presented without imnecessary circumlocution. The use of tliis plan is
also of great advantage in teaching.
In this use the term v/.s inita represents the actual exercise of the opportunities pre-
sented for the beginnings of caries in the individual case, and vis deleta the activity
of the progress after the beginnings are made. The terms themselves are purely
arbitrary.