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TWENTY-EIGHTH LECTURE.

The time of the occurrence of proximate cavities, as we
see them in practice, would seem to present no definite order
or rule, except that they have their beginning almost entirely
in youth. In persons but slightly susceptible most of the
proximate surfaces do not decay, and many of them that do,
linger, making slow progress hidden away between the teeth,
and are not discovered until adult life. These are so easy of
management when discovered before the pulp is too closely
approached as to give no great concern. The number of
proximate decays that begin in the enamel and stop before
the dentine is reached, because of the coming of immunity to
the locality, is very large. These show themselves later by a
brown or black spot in the enamel, just to the gingival of the
contact point. The dark color often spreads away, thinning
out, toward the buccal and lingual, marking out the area of
liability to caries very perfectly. They are of no conse-
quence, and when it is determined that there has been no
penetration of the enamel they should be let alone.
In highly susceptible persons proximate cavities are very
destructive to the teeth and destroy them quickly. In this case
they are more liable to attack the teeth in the order of their
eruption, and are often discovered within two to four years
after the teeth have taken their places. In this case they are
the most diflicult of cavities to treat successfully. We have
the child to deal with, the teeth become abnormally sensitive,
and every movement in the treatment is painful, the self-con-
trol and endurance of the patient is low, and yet this is just
the case in which the technical procedures need to be carried
out with the greatest degree of minuteness to be successful.
For a number of years the filling must resist the sharpest
susceptibility to recurrence of decay. The operator may
know well his duty and be skillful in manipulation, and yet, if
he has not the moral courage back of his convictions, great
patience and persistence, he will do well to transfer the little
patient to someone better qualified in these particulars.
Even with the most intense susceptibility some of the proxi-

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