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every child is referred for treatment whose permanent teeth show
defects, however slight, as indicated by the "catch" of a sharp probe
during inspection. So far as the temporary dentition is concerned,
the standard of inspection is necessarily not so high. Of the permanent
teeth those that most frequently require attention in the
order of their liability to dental caries, are: (1) the first lower
molars; (2) the first upper molars; (3) the second lower molars;
(4) the second upper molars. It has been estimated that more than
90 per cent. of the permanent molar teeth are eventually attacked
by caries, and that in the case of children more than 70 per cent.
permanent molar teeth have structural defects on their occlusal
surfaces that will permit the entry of a sharp find probe. Recognition
of these facts has led to the operative technique termed Prophylactic
Odontotomy, i.e., " The removal by cutting of a defective
part of a tooth in order that the area so treated may be protected
from a threatened onset of caries, the operation being confined to
pre-carious pits and fissures." Time would not permit the adoption
by the School Dentist of all the measures advocated by the Prophylactic
Odontotomists, but there are obvious advantages in
treating dental defects at the earliest possible moment. Among
these may be mentioned:—
(a) The painlessness of the operation—an important
point, especially in the case of nervous children.
(b) The avoidance of pulp infection from deep seated
caries.
(c) The smallness of the fillings—being small, they are
rapidly inserted, permanent, and unlikely to
cause pulp irritation.
One frequently notes with satisfaction that the insertion of
small fillings in the pits and fissures of molar teeth confers immunity
for several years. A child who has had all the four first permanent
molar teeth treated in this way at the age of seven, frequently
requires no further treatment so far as the permanent teeth are
concerned for a period of five years until the eruption of the second
permanent molars. It is found that the latter teeth quickly become
carious in those cases where the first permanent molars required
fillings at an early age. In such cases, indeed, the second permanent
molars not infrequently require conservative treatment
before their complete eruption. A further point noticed is that
caries is markedly bilateral. If a molar on one side of the mouth
becomes carious, not only is it almost invariably found that the
corresponding tooth on the other side of the mouth is also attacked,
but the situation of the caries in each case is frequently identical.