Page 273 - My FlipBook

a hope for their permanent retention. Therefore, in many
of the cases presented I should remove them at once as
the lesser of two evils. It is especially desirable at this time
that the little patients be not troubled with teeth that are
(frequently sore and interfering with the free use of the teeth
in the mastication of food.
In the consideration of the question of permanent reten-
tion of these teeth, the superficial area of the decay is of sec-
ondary importance. The depth of the decay, its relation to
Ithe pulp of the tooth and the condition of the pulp are the im-
portant questions. In adults, if the pulp of the tooth becomes
involved, we may remove it and retain the tooth in good
condition, but with the first molars in patients under twelve
years old we are debarred from root-filling because the apical
foramen has not been narrowed by the completion of the
growth of the roots, and it is decidedly unsafe before the
fourteenth year. Therefore, if the pulp has become hopelessly
involved, the tooth will be lost, and may as well be extracted
at once. To retain the tooth for a few years, or even eight
or ten, is bad management. These considerations should
lead to the utmost care in the management of these teeth.
Whenever possible, cavities occurring in pits or fissures
should be filled early—before considerable progress has been
made—and should, if the self-control and physical condition
of the child will permit, be filled permanently with gold, as
has been explained.* It is only necessary to uncover the
decayed area and follow out sharp grooves to a good finish-
ing point, no other extension for prevention being needed.
The enamel in the neighborhood of these carious areas is
not subject to decay, because of the friction of mastication;
therefore, a good filling once made is permanent. Of course,
amalgam can be substituted for gold, but at this age of the
patient the greatest degree of susceptibility is present, and
this demands the best of material and the most careful
operating, and gold is the safer material.
In deep cavities, involving considerable dentin, espe-
cially if unusually sensitive, no attempt should be made to
both excavate and fill at the same sitting. In the first place,
this is likely to be too much for the endurance and self-con-
trol of the child, and, second, thermal sensitiveness being
* Technical Procedures in Fillinf? Teeth, page 60.
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