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MANAGEMENT OF CAVITIES BY CLASSES. 215

and Hnguo-gingival angles. This is distinctly pointed out and
illustrated in the volume devoted to technical procedures in
filling teeth. The same rules apply to bicuspids and molars,
with this difference: Incisor cavities must be filled from the
labial or lingual, because they are not cut out to the incisal.
Proximal cavities in bicuspids and molars are cut out to the
occlusal and are filled from the occlusal direction. For con-
venience in operating, and in order that the filling can with
certainty be well made, it is necessary that the cavity be as
broad bucco-lingually at the occlusal as at the gingival portion.
Therefore, any extension made at the gingival portion toward
the buccal or lingual must be carried out to the occlusal. This
makes cavities somewhat larger in these surfaces. But in no
case is it necessary in satisfying the demands of extension for
prevention, to extend fully to the angle of the tooth, much less
beyond the angle. Extension for prevention has no relation
whatever to the depth of cavities. Every cavity prepared for
filling should be as shallow as the removal of all carious material
will allow wherever this will give safe anchorage in dentin. This
should be taken as the expression of a principle in all treatment
of caries by filling. Large fillings extending far out onto buccal
or labial surfaces should be made only when demanded by actual
extension of decay.
In highly susceptible persons, proximal cavities are very
destructive to the teeth and destroy them quickly. In such cases,
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 the arch. These are the
most difficult of cavities to treat successfully. "We have the
child to deal with, the teeth become abnormally sensitive, every
movement in the treatment is painful, the self-control and endur-
ance of the patient are low, and, yet, this is just the case in
which prophylactic cleaning and the technical procedures in
treatment need to be carried out with the greatest degree of
minuteness to be successful.
For a number of years the fillings 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
some one better qualified in these particulars. Even with the
most intense susceptibility some of the proximal surfaces usually
escape decay, the local conditions as to form and cleanliness