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ATROPHY OF THE TEETH. 25

in atrophied teeth. Dentists generally have not realized that
the pulps were so close to the surface. When it is realized that
these sheets of interglobular spaces, of which the line of atrophy
in the dentin showing in Figure 31 and in Figure 33 is a section,
spread through the entire area of the crown of the tooth, form-
ing openings through which microorganisms may readily grow,
it will be understood why it is so difficult to prevent the destruc-
tion of these teeth by caries. It will also be understood how
decay may quickly undermine the entire enamel cap, allowing
it to fall away, exposing a blackened stump of dentin in all of
the central portion with jagged enamel upon its margins, with
decay persisting around the circumference where the line, or
sheet, of interglobular spaces dips to the gingival near the dento-
enamel junction. In the child, one is prohibited from forming
a cavity of such depth as required to hold such a broad filling
because of the nearness of the pulp of the tooth.
The grave significance of this lies in the fact that caries
beginning in the imperfections of the occlusal surface quickly
reaches this zone of interglobular spaces and spreads rapidly
through it, undermining and destroying the whole occlusal por-
tion of the tooth. It often happens that the whole of this has
been swept away so quickly that the area is uncovered before
decay has proceeded further toward the pulp. The decaying
area is then fully exposed to the fluids of the mouth, and the
progress of the caries is arrested. In this case, the tooth remains
as a blackened stump that soon rises in its alveolus and occludes
with its fellow, which is generally in a similar condition, and
both do good service. More often, however, decay continues
in that portion of the zone of injury referred to, that dips under
the strong enamel around the margins of the crown. Being thus
protected, it continues to burrow, finally reaching the pulp and
completing the destruction. This is the general fate of atrophied
first permanent molars. Case after case comes before me in the
great clinic of Northwestern University Dental School, showing
atrophy of the anterior teeth in young people. The rule is that
the first molars have already been lost. Children from eight to
twelve years old are coming often to have these teeth extracted.
Treatment of Atrophied Teeth.
First molars. Such treatment of atrophied first molars as
will prevent the results detailed above, is exceedingly desirable.
The treatment is required as early as the eighth year, often in
the seventh. A few cases may be successfully filled. Cases
4b