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Cases that come to us before there is considerable im-
pairment of masticating power are more easily dealt with,
and generally permanent fillings may be made at once, or
after resting a week or so with a gutta-percha filling. Cases
of extreme hyperesthesia of the dentine will be met with in
many cavities in persons who have no impairment of masti-
cation, f
Hyperesthesia of the dentine does not limit the use of the
teeth except when food is forced into the cavity in such a way
as to affect the dentine directly. Therefore, in these cases a
s.olid filling, one that does not move or shift, cures the diffi-
culty in mastication as soon as the patient gains confidence
that the use of the tooth will not hurt. This, of course, re-
lates to cases in which the sensitiveness has occurred so re-
cently that there has been no impairment of the tone of the
peridental membranes, a thing which often occurs when the
occlusal wall of a proximate cavity has suddenly broken
away, exposing the cavity to direct food pressure. There is,
in such cases, no reason for deferring the final filling because
of pain in malleting, for that will be borne without difficulty.
The difficulty is only in the preparation of the cavity. But
the question of thermal sensitiveness and the danger of
hyperemia of the pulp will require consideration. This
question generally relates to individual teeth and does not
materially affect the treatment of other cavities. These may
be proceeded with to completion without delay, or in the
meantime the sensitive teeth with temporary stoppings will
have so improved that the extension of the cavitv may be
completed, and these also may be permanently filled.
Older patients, of twenty to thirty-Hire years, often come
to us with a number of slowly progressive proximate cavities
in the molars and bicuspids, or cavities in which fillings have
failed. If these cases are not so bad as to have materially lim-
ited mastication, or if the patient has not contracted mincing
habits at table, they are generally easy to manage. They
require little else than the careful performance of the required
technical procedures after a study of the requirements of ex-
tension for prevention in the individual cavities. If, however,
the case presents many open cavities that have long rendered
chewing painful and ineffective, and the habit of avoiding
foods requiring effort in mastication has been long confirmed,
280
Cases that come to us before there is considerable im-
pairment of masticating power are more easily dealt with,
and generally permanent fillings may be made at once, or
after resting a week or so with a gutta-percha filling. Cases
of extreme hyperesthesia of the dentine will be met with in
many cavities in persons who have no impairment of masti-
cation, f
Hyperesthesia of the dentine does not limit the use of the
teeth except when food is forced into the cavity in such a way
as to affect the dentine directly. Therefore, in these cases a
s.olid filling, one that does not move or shift, cures the diffi-
culty in mastication as soon as the patient gains confidence
that the use of the tooth will not hurt. This, of course, re-
lates to cases in which the sensitiveness has occurred so re-
cently that there has been no impairment of the tone of the
peridental membranes, a thing which often occurs when the
occlusal wall of a proximate cavity has suddenly broken
away, exposing the cavity to direct food pressure. There is,
in such cases, no reason for deferring the final filling because
of pain in malleting, for that will be borne without difficulty.
The difficulty is only in the preparation of the cavity. But
the question of thermal sensitiveness and the danger of
hyperemia of the pulp will require consideration. This
question generally relates to individual teeth and does not
materially affect the treatment of other cavities. These may
be proceeded with to completion without delay, or in the
meantime the sensitive teeth with temporary stoppings will
have so improved that the extension of the cavitv may be
completed, and these also may be permanently filled.
Older patients, of twenty to thirty-Hire years, often come
to us with a number of slowly progressive proximate cavities
in the molars and bicuspids, or cavities in which fillings have
failed. If these cases are not so bad as to have materially lim-
ited mastication, or if the patient has not contracted mincing
habits at table, they are generally easy to manage. They
require little else than the careful performance of the required
technical procedures after a study of the requirements of ex-
tension for prevention in the individual cavities. If, however,
the case presents many open cavities that have long rendered
chewing painful and ineffective, and the habit of avoiding
foods requiring effort in mastication has been long confirmed,
280
