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26 PATHOLOGY OF THE HARD TISSUES OF THE TEETH.

which promise good results and iu which the child can be con-
trolled to do this work, the fissures should be properly prepared
and filled with gold at once when discovered. Generally, how-
ever, it will be found impracticable to make the proper prepara-
tion and the fillings at so early an age because of failure to con-
trol the child. As the rule, it would be necessary to do this dur-
ing the seventh or eighth year. A large proportion of these
cases are too badly decayed before the ninth year for filling, and
many of them are decayed to exposure of the pulp, or the occlusal
surface is lost during the seventh or eighth year. Ordinarily
they will be seen first by the dentist when the child is brought for
consultation I'egarding the deformity of the incisor teeth, the
parents not having noticed the deformity of the first molars.
Even at that time, in many cases, the first molars will be found
badly decayed. This very early appearance of caries in these
cases, and the fact that the pulp of the tooth is so often exposed
by a decay that seems not to be very deep, greatly increases the
difficulty of treatment.
When the teeth can be seen very early, or as soon as they
have come through the gums, and the occlusal surfaces are found
badly deformed, showing many wrinkles and deep fissures, it
is generally best to grind away any small, sharp spiculae of
cusps that are liable to be broken in chewing food. Then, if
decay has not actually begun in the fissures, these may be dried
out and filled at once with oxyphosphate of copper cement with-
out further preparation. Often such a course will be necessary
in order to do anything that will be of service to the child. A
good article of this cement is often very adhesive and will remain
for a considerable time in a very slight crevice and seems to
prevent the beginning of decay. In the deeper fissures in which
decay starts earliest, it will do excellent temporary service.
When decay has made some progress the softened material
should, if possible, be removed after breaking away any
undermined enamel, and the cavity thus formed filled with oxy-
phosphate of copper. In many of these cases even this slight
preparation will appear impracticable. The child will need
encouragement and a gradual building up of confidence, and often
much may be done by making the filling without any excavation
that will cause pain and defer the excavation to another time.
Such fillings should be examined after a month to note the result
and, when necessarj% something further may be done. Many
children will become proud of what they can do in the dental
chair and after a few visits will bear a considerable operation.