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CLINICAL HISTORY OF CARIES. 789

cavities. There is much reason, however, to believe that the environ-
ment of the causative agent becomes with advancing age less favorable
to progress. The first of the permanent teeth to take their places in
the arch are those most frequently affected by caries (see charts). Caries
already begun advances less rapidly in older persons, and in some cases
cavities cease to progress. The cases of general spontaneous cessation
of progress in carious cavities are few, no matter what the age, yet a
number of such cases have occurred under my observation. The dis-
position to caries is not steady, however, but presents fluctuations more
or less marked. These are sometimes seen following an illness. In
women it is often noted in pregnancy, especially in first and second preg-
nancies. Other conditions have from time to time been noted which
seemed temporarily to dispose the individual to an exacerbation of the
tendency to caries. Yet in the great majority of cases this disposition
is gradually diminished with increasing age to such an extent that if
the cavities are well treated but few decays will begin after the patient
is thirty or thirty-five years old, and the beginning of these will gener-
ally be found to depend upon some change in the conditions giving
opportunity.
This leads to the consideration of the infectious nature of caries,
which is best shown by the results of treatment in cases which mani-
fest a strong predisposition to the disease. Many times I have
undertaken cases in which there seemed to be but little hope of
success yet I have found that if caries could be eradicated from the
;
mouth, and its exclusion maintained for a time, the tendency to the
disease rapidly diminished, and to such an extent as to make its con-
trol a matter of but little difficulty. Infection is always a strong
element in the beginning of caries. I have had, in numbers of cases,
opportunity to study this feature in the children of the same family,
where some would be careless and others fairly careful in attendance for
operations. Those who were careless, and in this way allowed the con-
tinuance of the conditions favoring infection—namel}", a number of
cavities continuing in progress and adding to the amount of the fungus
growing in the mouth—have almost uniformly had much the larger
number of cavities at the age of twenty or twenty-five. It is doubtful
if this fungus grows well in the mouth where it is fully exposed to the
saliva. Partial seclusion seems more favorable to it. Certainly it does
not produce results unless it is fairly well secluded and sheltered from
the fluids of the mouth. Possibly, as already explained, this may be
due to the washing away of its products.
In a considerable number of cases there is a spontaneous cessation
of caries in cavities that have made considerable progress. This is, in
most instances, connected with some change in the form of the cavity,
usually the breakage of one or more of its walls in such a manner as
to give to all of its parts free access of the fluids of the mouth. This,
if the individual is approaching middle life and the predisposition to
caries has not been very considerable, will be sufficient to stop the prog-
ress of the decay. In case the predisposition to caries is strong, it is
necessary that the whole surface decayed be exposed to the friction of
mastication to bring about a cessation of the decay. In this case the