Page 255 - My FlipBook

we should cut off the tooth Hke this, or rounding the cut to
the surface of the enaniel at the ging-ival, so that food going
into it will slide toward the hn^-ual and pass out in that
direction, and in this way keep it continually clean.
If we cut tliese boldly apart, cutting away the entire proxi-
mate surface, the teeth will usually not come together en-
tirely, because oif the wide spreading of the roots, but I
have found that where I have done this a difficulty is ex-
perienced from the fact that there is a broad gum septum
exposed, and in the act of mastication food is forced upon
that, and it becomes so painful that the child will almost
refuse to chew meats or any food that requires considerable
mastication, and the teeth become almost useless if cut sufff-
ciently to keep them apart, i. e., where the whole S'urface is
cut away so there will be no contact. We must always be
on our guard about cutting too far, and you will notice that
this kind of treatment requires that it be instituted before
the cavities are large. Of course, we may use nitrate of
silver in these cases and not cut out the entire decayed area,
just the same as in the incisor teeth.
Fining these proximate cavities is a difficult proceed-
ing on account of the sensitiveness and on account of the
difffculties of position. The teeth are strongly bell crowned,
generally; the gums come up into the interproximate spaces
very near to the contact, usually, even though we find some

decay; it is only after it has been decaying for a consider-
able time and food has lodged that the, gum^s are out of the
way. One of the difficulties of the treatment by cutting is
thiat we will come upon the gums.
Another difficulty is the proximity of the pulp Otf the
tOiOth. The pulps in these teeth are /pretty large and we are
liable to eneroach upon the pulp too closely if the cavities
are much too' large to cut out in the way I have mentioned.
Of course, where we cam control the child tO' cut out these
cavities and make fillings, even though we cannot make
much extension, it is still the better method to make fillings
rather than cut away the surfaces, and for this purpose I
should say that there is nothing better than a good amalgam,
if well put in and poiished properly afterward. This matter
of care in putting in these fillings, however, is just as im-
portant as it is in the teeth of adults. We should not neg-

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