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MANAGEMENT OF PATIENTS. 155

person is generally good, there is immunity from decay and they
go along, possibly through life, without any need for artificial
cleaning. There are no deposits from the saliva of these persons,
their saliva is thin and watery and seems to dissolve and remove
the last trace of debris. But such perfect conditions are the
exception to the rule.
The tooth brush. Most persons need to use the tooth
brush, and it becomes the duty of the dentist to prescribe the
manner of its use; not only to prescribe the manner of use,
but to teach his patients the correct use of the brush. Nearly
every person who uses the brush will fall into certain fixed
habits. Some will take the brush and make a few strokes in this
direction or that, and are done. They have brushed their teeth,
and they will tell you very conscientiously that they have brushed
them carefully. Others will use the brush vigorously. They
form the habil of going through certain motions. An examina-
tion will show the cleaning to be very imperfect in that certain
parts are missed and not cleaned at all. Make it a rule to say to
little patients, "The next time you come, bring your brush with
you ; I want to see how you brush your teeth. ' ' They will gen-
erally do it very carefully, better than they do it at home; or
some will and some will not. Impress in some way the lesson
that it is necessary for them to do this thing carefully, and then
prescribe the method of doing it. One may brush the buccal
surfaces of the teeth with a back-and-forward motion, but this
will not brush the embrasures well; the bristles of the brush
will not get in toward the proximal surfaces of the teeth. Teach
patients to use the up-and-down motion along the length of the
teeth ; the bristles of the brush will go into the embrasures and
clean the surfaces close to the contact points when used in this
way. This may be done all over the mouth. It is just as easy a
motion as the other when once learned. The manner of brushing
will depend a good deal upon the tendencies in the case. Children
and young people particularly, should brush their teeth with this
up-and-down motion, for the tendency in them is usually for the
formation of proximal cavities. As they come to adult age,
there is more necessity for brushing the buccal surfaces; they
are more liable to be developing gingival third cavities. If
patients are found with a tendency to the development of gingi-
val third cavities, the back-and-forth motion becomes the impor-
tant method of brushing, because it cleans the portions of the sur-
faces of the teeth that are then most liable to decay. Wherever
patients show a tendency to buccal decays, say to them, "By