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TWENTY-NINTH LECTURE.

Proximate caijities in the incisor teeth may occur as early
as the eighth year in very susceptible families, but it is seldom
that we detect them so early. When they do occur they are
^(difficult of management, mainly on account of the tender age
of the patient and the comparatively long period of sharp sus-
ceptibility which must follow. Often the crowns of the teeth
are still as much as one-third covered with gum tissue, mak-
ing the adjustment of the rubber dam especially difficult and
painful, and no kind of filling, temporary or permanent, can
be properly done without" it.
The requirement is that cavities be cut very wide toward
the labio-gingival and linguo-gingival, so as to include the
whole area of liability of the proximate surfaces, or that
extension for prevention be carried to its full limit and the
prepared cavity solidly filled with gold. Whenever the con-
ditions of the patient as to courage and endurance will war-
rant this procedure, this should be done without hesitation
or delay. Clinical results mark this course as being at once
safe and reliable, so markedly so that I must speak most posi-
tively against the opinion so often expressed against using
metallic fillings in the teeth of young children. The reason
that these so commonly fail is that they are so commonly not
well done. The extension for prevention is not carried out,
nor is the filling well placed, the reasons being mainly that
the difficulties are not overcome. Such operating is useless
under these conditions, and had better not be attempted. In
any case of this nature in which the operator cannot see his
way to carry out extension for prevention to the full limit and
make a perfect filling, he will do better to fill temporarily with
gutta-percha, after making the best excavation the conditions
will allow at the time, and await better conditions. The tem-
porary fillings must be carefully watched, and redone fre-
quently, the patient encouraged in every way, and, at the
first opportunity for successful work, the permanent fillings
should be made.
In excavating it should be especially remembered that the

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