Page 249 - My FlipBook

lated and out of shape, will be useful to the time of their
shedding.
Now, I want to utter a word of caution about the use of
silver nitrate, and it is an important one. You must not use
silver nitrate if the decay has approached near the pulp of the
tooth. There is nothing I know of that will get up so severe
a too'tihache as silver nitrate used over a pulp that is nearly
exposed by decay. I have had some cases where I have been
compelled to extract important teeth, because I had gotten
up a toothache that I could not control, in order to prevent
the wearing out of the child with pain. You may use nitrate
of silver wath perfect freedom, wherever there is a good
coating of sound dentin over the pulp, but we must not risk
affecting the pulp. Of course, up to a certain age we have
the recourse of destroying the pulp and removing it, but after
the beginning of the aibsorption of the roots that recourse is
lost to us.
Now a word as to the handling of children in this class
of cases. I do not feel like trying to handle little children
here in the clinic ; it seems to me it is impossible, the condi-
ftions are too unfavorable. If I am to handle children I want
to know the parents, I want to know that they are depend-
ing on me to manage the teeth of their children and that I
will have their assistance and sympathy in this management.
I will not undertake, farther than for present reHef, the hand-
ling of children of strangers, and I wouldn't advise anyone to
try to do it. Remember that in undertaking to treat decay
of these little teeth, it is a thing that we must begin to-day and
follow it up from week to week and from year to year, until
the shedding time of these little teeth, and w^e should have
that particularly in view and have the parents particularly
impressed with this necessity, and have the assistance of the
parents. Of course, we cannot expect much assistance from
the child. Furthermore, the prophylactic work wath the tooth
brush mnst be done by the parent or the nurse, and this
should be insisted upon, and when we have made a silver
nitrate treatment we must expect to have the child brought
to us and examine these teeth from time to time and see
that decay has not again started and is making inroads. We

may, if decay is again starting up in somie part of a surface
that has been treated in this way, treat it again and stop it
again, and again, if necessary.
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