"HUMAN PROGRESS MARCHES 
ONLY WHEN CHILDREN EXCEL THEIR PARENTS" 
GEORGIA DEPARTMENT Of. PUBLIC HEALTH 
ATLANTA,GEORGIA DENTISTRY FOR CHILDREN 
"One of the important factors in general health 
is dental health. No public health program is com- 
plete without an effective dental health program. In 
all phases of preventive medicine and dentistry we 
must begin with the child. The dentists of Georgia 
are to be commended for their increasing interest in 
child health." 
T. F. Abercrombie, M. D., Director 
State Department of Public Health 
This bulletin is offered as supplementary material to the 
Refresher Course in Children’s Dentistry given to the dentists 
of Georgia by the Georgia State Department of Public Health, 
April, 1939, Dr. Walter C. McBride, clinician. 
We wish to acknowledge help received from various pamphlets and 
articles published by the Bureau of Public Relations of the 
American Dental Association, Bulletin on Children’s Dentistry 
by the Nebraska State Department of Public Health, Outline of 
Instruction, Postgraduate Course in Children’s Dentistry, pub- 
lished by the Minnesota Department of Public Health. The tech- 
nical procedures in this bulletin were prepared by Doctors 
Frank Lamons and H. H. Burkart, Atlanta. 
April, 1939 INTRODUCTION 
Existing Dental Conditions Present Health Problem 
Evidences of the need for dental health and dental health educa- 
tion for children are indicated in reports of surveys made by the 
United States Public Health Service. Quoting bulletin No. 622, United 
States Public Health Service: 
"For a number of years the United States Public 
Health Service has been engaged in studies and in- 
vestigations of the physical status of school chil- 
dren, and as a result of these investigations it has 
repeatedly drawn attention to the overwhelming pre- 
ponderance of dental defects over those of all other 
classes. 
"The bad effect of decaying teeth, of inflamed 
gums, and of suppurating areas in the oral cavity on 
the health and development of young children is 
obvious, and no effort should be spared to prevent 
the occurrence of such conditions. 
"The provision of dental facilities, both pre- 
ventive and operative, for school children, is a 
measure which promises to yield the most fruitful 
results in conserving their health. 
"This article has been prepared as a result of 
the long-felt need of this form of health supervision, 
and in response to the numerous requests received for 
information pertaining to the establishment of school 
dental clinics. 
"The great need for dental health education can 
best be illustrated by statistics showing the incidence 
of dental defects in various groups. It is generally 
agreed that almost 100$ of the adult population are 
affected by dental defects. Examination of the mouths 
of school children show an appalling percentage of 
defects. According to a survey made by the United 
States Public Health Service in conjunction with the 
American Dental Association, in 1933 and 1934, the 
examination of school children, aged 6 to 14 years, 
revealed dental defects in over 90$ of cases. In 
children aged 9 to 11, over 55$ had dental decay in 
permanent teeth. In the same age groups, only 37$ 
had had dental treatment prior to examination. 
"These statistics show that, of all defects 
observed in school children, the class of dental 
defects is not only larger than any other, but larger 
than all others combined. 
"In view of the lack of attention to the dental 
needs of the children of the land, it is not surprising 
that of 925,873 men who were found unfit for military duty by the first selective draft examinations, by 
reason of physical causes, the second highest of all 
causes of physical rejections was that of dental 
defects.” 
Dental Survey of School Children in Georgia - 1937-58 reveals the following 
conditions: 
Of 171,463 white children examined in 128 counties, 69.8$ had 
cavities. In considering cavities in deciduous teeth, it was found 
that of the number who had cavities there were 2.3 cavities per child; 
and considering permanent teeth, the number of children of elementary 
school age with cavities averaged 2 cavities per child, while high 
school children averaged 3.3 per child. Considering permanent and 
deciduous teeth, there were found to be 4 cavities per child for 119,725 
children who had cavities. 
Progress in Georgia 
The Georgia Department of Public Health expresses appreciation to 
the dentists of Georgia for their assistance in attacking the problem 
of dental health. The 1937-38 report shows that 1018 schools in 128 
counties had a dental inspection. Four years ago only 26 counties 
were participating in the State Dental Program. Of 171,463 children 
inspected in 1937-38 it was learned that 33.3$ had been to a dentist 
within the last year. The report also indicates that 46 counties 
showed an appreciable reduction in percentage of children with decayed 
teeth. Sixteen of these counties reduced the incidence of decay 10$ 
or more. In McDuffie County where an effective program has been in 
operation for several years, the number of children with cavities was 
reduced to 23$ in 1937-38. This is about as low percentage of children 
with decayed teeth as it is possible to attain. 
Refresher Courses in Children’s Dentistry 
Refresher Courses in Children’s Dentistry are planned for the 
purpose of assisting the practicing dentist in the management of chil- 
dren and the technique of children’s dentistry. 
In May, 1938, the Georgia Department of Public Health, with 
the aid of Social Security funds conducted a five-day Refresher Course 
in Georgia. The meetings were held in five conveniently located centers 
of the State, with Dr. Walter McBride of Detroit, Michigan, as clinician. 
There was an attendance of more than 220. Because of the success of the 
Refresher Course last year, and through popular request, the Georgia 
Department of Public Health is again offering to the dentists of the 
State a Refresher Course in Children’s Dentistry. Dr. McBride is return- 
ing to Georgia to conduct the courses. Dr. McBride has been an out- 
standing specialist in dentistry for children for the past fifteen years. 
He has a practical, usable message for dentists. GEORGIA’S DENTAL HEALTH EDUCATION PROGRAM 
For education wo must depend upon the school; for dental health we must 
look to the dental and health professions. The program of the Division of 
Dental Health Education seeks to combine the forces of education and dental 
health. No matter how efficient the dental profession may become, it must 
depend upon the school to educate the public as to the value of mouth health 
and the factors involved in building and preserving sound teeth. Present 
mouth health conditions of children and adults would indicate that common 
practice lags far behind scientific knowledge of the dental profession con- 
cerning the care of the teeth. One of the surest and most effective ways to 
bridge the gap between common practice and scientific knowledge is through 
the health education program in the school and community. 
Through the cooperation of the Georgia Dental Association, the State 
Department of Education, the Georgia Congress of Parents and Teachers, and the 
Agricultural Extension Service, the State Department of Public Health promotes 
the Dental Health Education program as outlined. 
The Purpose of the Program 
To promote dental health and dental health education as a contri- 
bution to the maintenance and improvement of general health. 
To organize in every school and community a dental health education 
program, including inspections by the local dentists, correction of 
defects, and education of children and parents as to the value of mouth 
health and the preventive measures: early dental care, toothbuilding and 
protective foods, and mouth cleanliness. 
Dental Inspections: 
Local dentists give free dental inspection to pre-school and school 
children and 4-H Club members when properly approached by the county 
health officials and school superintendent. All Record Forms for dental 
inspections are furnished by the State Department of Public Health. 
Correction of Defects 
No plan of health service is complete without dental service. 
Correction cf defects is an important part of this program. Each 
locality promotes the type of corrective program best suited to its 
problems and facilities. Dental Certificates furnished by the State 
Department of Public Health should be given to the children by the 
dentist when he has completed all necessary dental work. 
Education: 
Education of the parent and child as to the value of dental health 
is important. This training is carried on by the local health depart- 
ment, school, parent-teacher association, and 4-H Clubs. Authentic 
information on dental health can be obtained from local dentists and the 
State Department of Public Health and interpreted to the child in terms 
of child learning. DENTAL HEALTH KNOWLEDGE FOR PARENTS AND TEACHERS 
1. Good Dental Practice for a Child Consists of the following: 
a. An early visit to the dentist (at pre-school age, since many two- 
year-olds have cavities). 
b. Periodic visits to the dentist thereafter. (Twice a year may be 
often enough for the average, but in mouths where there is a tendency 
to decay, the visits should be more often.) 
c. All cavities filled when small. NO CAVITY IS TOO SMALL TO FILL. 
(Bite-wing radiographs will help to find them early.) 
d. All infected (abscessed) teeth removed from the mouth unless they can 
be successfully treated and filled, 
e. Adequate and complete care of the first teeth, including the permanent 
teeth as they erupt. (The six-year molar does not replace any of the 
first teeth, but is added on in the back. It should be carefully 
watched and filled when necessary.) 
2. Children Should Eat an Adequate Diet to Aid Tooth-Building. 
Daily diet should include those foods which help to build strong teeth 
and surrounding structures. Coarse foods should be eaten for exercise 
of the teeth and gums. 
A Suggested Adequate Diet 
Milk - 8 ounce glass of milk at mealtime. 
1 egg a day (minimum of 4 a week). 
1 serving of meat, fish, chicken, liver, or cheese daily. 
2 vegetables a day, one green or yellow, one raw. 
1 serving of citrus fruit, tomato juice, raw cabbage or carrot daily. 
1 fruit in addition to the above. 
God liver oil - 1 teaspoon daily (especially important for the first two 
years; advisable in winter months for ages 2 to 5). 
Butter - 1 tablespoon daily. 
Bread - whole or cracked grain. 
Cereal - (Avoid highly refined cereals because vitamins and minerals 
are decreased and starch content increased.) 
It is advisable to avoid excessive amounts of sugars and starches as 
candy, syrups, pies, and pastries. 
3. Tootkbrushing, Properly Done: - 
a. Will keep the teeth cleaner. 
b. Will keep the mouth cleaner (as a receiving station for the foods we 
eat, it should be clean). 
c. Will tend to prevent certain forms of decay of the teeth. 
d. May prevent pyorrhea in later life. 
4. Mouth habits, such as finger and thumb sucking, lip biting, etc., may cause 
irregular teeth. Irregular tooth arrangement may be corrected by the 
orthodontist. 
5. Drugs should be used only on the advice of a qualified person. 
a. Proprietary products are often useless, expensive and injurious, 
b. Any dentifrice that is used should have the American Dental asso- 
ciation’s ’’accepted” seal. 
c. A mixture of salt and soda (3 to 1) makes an excellent dentifrice. 
d. Stain removers may destroy the enamel. 
e. Patent pain relievers may be fatally injurious. 
6. Since fear of the dentist prevents much of the needed repair of the teeth, 
EDUCATE THE CHILD TO LOOK UPON THE DENTIST AS A FRIENDLY HEALTH COUNSELLOR. WHY FILL CHILDREN’S TEETH? 
1. To maintain function of the teeth and jaws of these young patients during 
the early growing period of their lives. To have adequate function, the 
teeth must be in good condition with correct restorations where cavities 
have appeared. Proper fillings will prevent the loss of teeth and preserve 
the integrity of the arch, thereby maintaining the greatest efficiency of 
the teeth for mastication. Children should learn to chew and thoroughly 
masticate their food, and they must have good teeth with which to do it. 
2. To prevent disease in the mouth, through which all food must pass, and to 
prevent systemic infection which is so often the sequelae of abscessed 
deciduous teeth. A cavity in a deciduous tooth will soon lead to a dis- 
turbance in the pulp, followed by a gumboil, which is an abscessed tooth. 
A correct filling before the cavity has become large is an excellent means 
of prevention. 
3. To prevent pain. To prevent suffering, days lost from school or healthy 
play and recreation. To prevent upset nervous systems which are often 
caused by severe and prolonged toothache. 
4. To prevent some types of malocclusion which follow when cavities lead to 
abscess formation and cause the premature loss of these teeth. 
5. To prevent the loss of the first permanent molars. Statistics from Georgia 
surveys show that the first permanent molars are lost more frequently than 
are any of the other teeth. These teeth are the strongest and most useful 
from the standpoint of proper mastication. They are called the "Keystones” 
of the dental arch because of their importance. Early and proper attention 
to the defects in the occlusal surface (pits and fissures) will save the 
vast majority of these teeth. 
6. To start early preventive periodic visits to the dentist, and establish 
proper habits of dental health. 
Many other reasons might be given. Write your own. 
DENTAL CERTIFICATE 
The Georgia Department of Public Health furnishes Dental Certificates 
free to dentists. These certificates indicate to the school that all 
necessary dental work has been completed, attention is called to the 
following message on the back of the Dental Certificate: 
"The STATE DEPARTMENT OF PUBLIC HEALTH is interested in 
the general welfare of the child. A dental certificate should 
be issued only when all necessary dental treatment has been 
completed and the child is dismissed. 
A dental certificate should mean that: 
The mouth should be as clean as possible. 
All cavities should be adequately treated. 
A.11 abscessed deciduous teeth should be extracted. 
Final judgment concerning any mouth condition rests with 
the family dentist.” CALCIFICATION, ERUPTION, EXFOLIATION 
(R. Kronfeld, The Bur, Mar., 1935) 
Deciduous Dentition 
Tooth 
*First 
Calcific 
Crown 
Completed 
Eruption 
Root 
Completed 
Resorpt. 
Begins 
Shedding 
Cent. 
5 mo. 
4 mo. 
6-8 mo. 
l|-2 yr. 
5-6 yr. 
6-7 yr. 
Lat. 
5 mo. 
5 mo. 
8-10 mo. 
Iff-2 yr. 
5-6 yr 
7-8 yr. 
Cusp. 
6 mo. 
9 mo. 
16-20 mo. 
2f-3 yr. 
6-7 yr. 
10-12 yr. 
1st M. 
5 mo. 
6 mo. 
12-16 mo. 
2-2-g- yr. 
4-5 yr. 
9-11 yr. 
2nd M. 6 mo. 
*Intrauterine 
10-12 mo. v 
20-30 mo. 
3 yr. 
4-5 yr. 
10-12 yr. 
Permanent Dentition 
Tooth First Evidence Crown Eruption Root 
Calcification Completed Completed 
Maxillary 
Central 
3-4 mo. 
4-5 yr. 
7-8 yr. 
10 yr. 
Lateral 
1 yr. 
4-5 yr. 
8-9 yr. 
11 yr. 
Cuspid 
4-5 mo. 
6-7 yr. 
11-12 yr. 
13-15 yr. 
1st Eicuspid 
1-J-l 3/4 yr. 
5-6 yr. 
10-11 yr. 
12-13 yr. 
2nd Bicuspid 
2-2-J yr. 
6-7 yr. 
10-12 yr. 
12-14 yr. 
1st Molar 
Birth 
aJ-3 yr. 
6-7 yr. 
9-10 yr. 
2nd Molar 
2J-3 yr. 
7-8 yr. 
12-14 yr. 
14-16 yr. 
3rd Molar 
7-9 yr. 
12-16 yr. 
17-30 yr. 
18-25 yr. 
Mandibular 
Central 
3-4 mo. 
4-5 yr. 
6-7 yr. 
9 yr. 
Lateral 
3-4 mo. 
4-5 yr. 
7-8 yr. 
10 yr. 
Cuspid 
4-5 mo. 
6-7 yr. 
10-11 yr. 
12-14 yr. 
1st Bicuspid 
1 3/4-2 yr. 
5-6 yr. 
10-12 yr. 
12-13 yr. 
2nd Bicuspid 
2f-2-g- yr. 
6-7 yr. 
11-12 yr. 
13-14 yr. 
1st Molar 
Birth 
2-J-3 yr. 
6-7 yr. 
9-10 yr. 
2nd Molar 
2-g—3 yr. 
7-8 yr. 
12-13 yr. 
14-15 yr. 
3rd Molar 
8-10 yr. 
12-16 yr. 
17-30 yr. 
18-25 yr. THE FIRST APPOINTMENT 
1. Introductory 
The child, zoologically, is a small edition of the adult patient and, as 
such, he deserves adult consideration. We must appreciate the fact that a 
child's first visit to the dentist is important to his future behavior and 
well-being, and accordingly we must see that it is pleasant and, insofar as 
possible, painless. Let us see further that it is educational, so that we 
not only render a health service, but also prepare him for economical oper- 
ating at the succeeding appointments. 
2. Chart 
Develop or secure a chart which is comprehensive enough to secure the 
information that is needed for a good record of services to be, and that 
have been rendered and for recording previous health information. Keep 
progress and developmental records as well as financial records. 
3. Paradontia For The Child 
A. Oral Hygiene Examination: Has he retained food, stain, or calculus? 
How often does he brush his teeth? 
B. Technique for Prophylaxis at the Chair 
1. Prophylaxis for children is simple procedure. Seldom are accretions 
found prior to age cf twelve or fourteen. 
2. Polishing: Establish a rule of continuity, .always start on same 
tooth and proceed in same manner. 
Use a good-tasting paste and polish one quarter of the mouth at a 
time. Try the following: 
Flour of Pumice 170.00 gm. 
Borax 30.00 gm. 
Carmine (coloring) .25 gm. 
Glycerine 75.00 cc. 
Oil of Spearmint 1.00 drop 
A routine procedure for prophylaxis might be outlined as follows: 
Cleanse all smooth surfaces of crowns with paste in rubber 
cups. 
(1) This removes all soft gingival accumulations. 
(2) Exposes accretions, if any, and uncovers decalcified 
areas. 
(3) Removes stains. 
3. Disclosing Solution; Check the entire mouth with a disclosing 
solution. The following will be found satisfactory: 
Mereurochrome 5% solution 1.5 gm. 
Water to make 30.0 cc. 
If stain persists, use sandpaper disks, sulci disks, and 
smooth stones before final polishing. ALL STAIN REMOVERS 
ARE INJURIOUS TO THE ENAMEL. 8. 
4. Smooth Surfaces of Fillings: Use plug finishing burs for pits and 
fissures; and for the larger occlusal surfaces, one may use a large 
round bur, run backwards, or a tapered carborundum stone. The 
proximal margins should be smoothed with sandpaper disks, followed 
with Burlew Disks. 
5. For Occlusal Surfaces: Use crescent brushes in contra angle. The 
midget size is desirable and more practical due to the fact that the 
shanks are shorter. 
C. Vincents Infection appears in children about as regularly as in adults 
but is seldom as severe. Frequently it is more of a severe gingivitis 
and seldom advanced ulcerative stages are seen. 
Treatment is not different from that used for adults. Young patients 
should be seen daily during the acute stages, and they respond very 
readily to treatment. 
Local application of any good spirocheticide with proper home care is 
usually sufficient. 
5io Salvarsan in glucose (obtained in ampules) is an effective drug; 
should be worked in around the gingivae and other infected areas. A 
good method of application is with the use of a rubber polishing cup 
held in a porte polisher. 
The home treatment advised is as follows: 
1. Mouthwash of sodium perborate - level teaspoonful to large glass of 
water. (Should not be used over a prolonged period of time.) 
2. Discard old toothbrush. 
3. Liberal ingestion of milk and orange juice. 
4. Segregation of utensils. 
5. Abstinence from kissing. 
6. Saline cathartic. 
7. Rest. 
After Vincents Infection has cleared up, a thorough prophylaxis should 
be given and all cavities filled. All abscessed teeth and remaining 
roots (if present) should be removed at this stage and never during 
the acute infection. REQUISITES OF FI LUNG MATERIALS AND TECHNIQUE FOR 
MANAGING 3MaLL~CHILD’S CARIOUS TEETH SHOULD BE 
1. Practical. Simplify operative technique so as to shorten operating time. 
2. Rational. Select filling materials on the basis of physical properties 
rather than on wonderful claims on package label and irrational 
claims of manufacturers. 
3, adequate. We must insert fillings that will last until the tooth is ex- 
foliated if we are to justify our teachings as to the necessity 
of childrenrs seeing their dentist at pre-school age. 
Filling Materials 
1. Gutta Percha. Temporary Stopping is readily penetrated by moisture. 
Base-plate gutta percha is more satisfactory as a temporary filling. 
It expands on heating and contracts on cooling. 
2. Cements. The use of cements alone as a filling material on the basis of 
physical properties cannot be justified. 
a. Zinc Cements. Crushing resistance is low. It shrinks on setting. 
It is soluble in saliva. 
b. Black Copper Cement. Has a low crushing resistance, is quite 
soluble, and is a gum irritant. Germicidal value questionable. 
c. Red Copper Cement. The same. 
d. Silicate Cements. Show a negligible solubility. The average 
hardness is about l/l2 to 1/4 that of softest surface enamel. 
3. Cold Foil. Because of the possibility of pulpal death, gold foil should 
be used with discretion in young permanent teeth. 
4. Cold Inlay. Excessive cutting, cost, faulty hygiene of many children, 
possibility of recurrent decay common to newly erupted teeth, all contra- 
indicate the use of the gold inlay in the young child patient. When the 
child reaches the teen age, the inlay should be considered seriously. 
5. Tin Foil. Has a Iovj temperature conductivity. It is probably inadequate 
as far as Brinnell test and specific gravity is concerned. 
6. Copper Amalgam. Chief virtue is its comparatively little change in form 
after setting, and its adaptability and adherence to margins of the 
cavity. See comparison with silver amalgam on the following page. 
Copper Amalgam is indicated where there is poorly formed enamel or 
denuded areas. It is useful in hypopastic molars where cavity prepara- 
tion is difficult and recurrent caries is highly probable. 
7. Silver Amalgam. This is without doubt the most satisfactory filling 
material, all things considered, for use in deciduous and young permanent 
posterior teeth. It has greater strength than any other filling material 
except the gold inlay, and because of its rapid setting it is especially 
adapted for use with children. Comparison of Amalgams; 
Copper Amalgam 
It will cup out 
Impossible to maintain contact 
Edges are brittle 
Cannot be condensed 
Has decided shrinkage during 
setting period 
It may kill the pulp 
It is soluble 
Will stain tooth 
Is a tissue irritant 
Silver Amalgam 
Retains occlusion 
Can be carved 
Maintains contact 
Can be condensed 
Gives desirable expansion 
Not soluble 
Will not stain tooth 
The thermal conductivity is about the same. 
TWO OE THE BEST CONTROLS FOR ELIMINATION OF DECIDUOUS PULP 
DEATHS UNDER AMALGAM OR ANY FILLING MATERIAL ARE: 
1. The ability of the operator to differentiate 
between a normal vital tooth and one with 
questionable prognosis. 
2. The use of a cavity lining or base under all 
fillings of appreciable depth. SUGGESTED FILLING MATERIALS INDICaTIONS FOR SAME 
(In Order Of Preference) 
A. Deciduous anterior Teeth 
1. Proximal and Labial Restorations 
a. Silicate 
b. Silver amalgam 
B. Deciduous Posterior Teeth 
1. Occlusal Restorations 
a. Silver Amalgam 
b. Inlay 
c. Copper .amalgam (in selected cases) 
2. Proximo-occlusal Restorations 
a. Silver amalgam 
b. Inlay 
c. Over-lay 
C. Permanent Anterior Teeth 
1. Proximal Restorations 
a. Silicate 
b. Gold Inlay 
c. Gold Foil 
d. Porcelain Inlay 
2. Proximo-incisal Restorations 
a. Gold Inlay 
b. Porcelain Inlay 
c. Gold Inlay with Porcelain Window 
3. Labial Restorations 
a. Silicate 
b. Porcelain Inlay 
c. Gold Foil 
4. Lingual Restorations 
a. Gold Foil 
b. Silver Amalgam 
c. Silicate 
D. Permanent Posterior Teeth 
1. Occlusal Restorations 
a. Silver Amalgam 
b. Gold Foil 
c. Gold Inlay 
d. Copper Amalgam (in selected cases) 
2. Proximo-occlusal Restorations 
a. Silver Amalgam 
b. Gold Inlay 
c. Over-lay 
3. Buccal Pit Restorations 
a. Silver Amalgam 
b. Gold Foil 
c. Copper Amalgam (in selected cases) 
4. Lingual Pit Restorations 
a. Silver Amalgam 
b. Gold Foil FRACTURED AND LOST ANTERIORS 
With so much emphasis being placed on physical education and competitive 
games in our school curriculum and the many social activities of our boys and 
girls, accidents resulting in fractured and lost teeth are becoming more 
frequent. 
Among the common varieties of fractures are the following: 
1. Diagonal 
a. Incisal Angles, involving the mesio-incisal angles of the 
central incisors. 
b. Angles and Third, involving the mesio-incisal angle of one 
tooth and the mesio-incisal Third of another, with pulpal 
involvement of the latter. 
2. Lateral 
a. Usually involves half of the crown and the pulp chamber. 
b. Occasionally the tooth is severed at gingiva. 
c. Sometimes just the incisal portion. 
d. Multiple Lateral - involving a portion of two or more teeth. 
e. Central Lobe, just the central lobe of incisal. 
f. Incisal Third, generally a lateral fracture of this third of 
the two central incisors, and consequently the pulps of each. 
3. Longitudinal 
a. Terminating in pulp chamber. 
b. Often well below the gingiva. 
TREATMENT AND RESTORATION OF FRACTURED ANTERIORS 
1. Immediate Treatment 
a. Make radiogram to determine 
(1) the proximity of fracture (no pulp involvement) to horn 
of pulp. 
(2) the apical development. 
(3) possibility of alveolar or root fracture. 
b. If fracture is slight as in l.a., 2.c., or 2.e., disking of 
roughened surface will suffice. 
c. If pulpal area shows pink through dentine or if pulp is 
slightly exposed: 
(1) make radiogram. 
(2) isolate tooth and wipe with oil of cloves. 
(3) place a celluloid crown filled with a paste of zinc-oxide 
and oil of cloves and leave for ten days to two weeks. 
d. If exposure is larger or pulp protruding: 
(1) make radiogram. 
(2) if patient is seen immediately do a pulpotomy, using 
novocain. 
(3) if after 24 hours, do a pulpectomy. 
2. Temporary Restoration (Ton days or two weeks later) 
a. Gold Crown. 
b. Orthodontic Band with silicate, 
c. Clasp-onlay with silicate window (sometimes called a slipper 
overlay). 3. Permanent Restoration (at sixteen to eighteen years) 
a. Porcelain Jacket Crown. 
b. Three-quarter Crown with porcelain windows. 
RESTORATION OF LOST PERMANENT TEETH 
1. If adjacent teeth are fully erupted, the so-called orthodontic 
bridge, constructed by banding two adjacent teeth with orthodontic 
band material and on an .030 wire connecting the two, solder a 
pontic backing. This will suffice until teeth will support a 
permanent bridge. 
2. Dentures with clasps supplying the teeth. 
3. space maintainer if family finances will not permit one of the 
above. 
Space Maintainance 
The early or premature loss of deciduous teeth, particularly the deciduous 
molars, is a very frequent cause of malocclusion. Many such cases can be pre- 
vented by the judicious use of a space maintainer. 
All spaces caused by the premature loss of deciduous teeth do not show a 
tendency to drift. Close observation of these cases will determine the need or 
lack of need of a space maintainor, which should be placed if drifting of the 
adjacent teeth or closure of the space is observed. 
The band and loop maintainor will serve in the majority of cases. 
Where orthodontic materials are not available, the following technique may 
be found useful: 
a. Secure an impression of the abutment tooth (usually a posterior) in 
the same fashion as for making a cast overlay. 
b. The impression is poured in inlay investment material. 
c. When thoroughly hard, separate and trim down the gingivae, giving the 
tooth, an elongated appearance. This allows the band to fit underneath 
the gingivae giving more retention. 
d. Using thin, 28 or 30 gauge Korr wax, adapt a band to the tooth. Do not 
allow wax to rest on occlusal so that when completed it will strike the 
opposing tooth in occlusion. 
e. Make a circular loop of 18 gauge sprue wax with a diameter equal to 
the space to be maintained, and adapt this to the tissue with a saddle 
effect. 
f. Lute this to the wax band, .udd the necessary sprues. 
g. Invest and cast, using hard gold. 
For other types of space maintainors, the operator is referred to the 
journals or any of the text books on Juvenile Dentistry. CAVITY PREPARATION 
With the exception that less depth can be procured in deciduous teeth, 
Black’s prescribed cavity preparation will, generally speaking, answer all re- 
quirements in the cavity preparation of deciduous teeth. 
Pain-reducing factors: 
a. Use a slow motor and a large bur when removing caries. 
b. Speed of engine s ould be uniform. 
c. Use sharp burs and instruments. 
d. The indiscriminate use of air to dry cavity is painful. Use cotton 
pellets instead. 
e. Less pain is caused if decay is removed with large round burs. The 
size of the bur is determined by the size of the cavity. 
Summary of Instruments, Burs, etc., Used in Cavity Preparation of 
Deciduous Teeth 
(Adapted from Juvenile Dentistry, Dr. Walter C. McBride) 
Incipient Class I Cavities: 
Fissure opening - #34 bur. 
Fissure extension - #557 bur. 
Caries removal - #2 bur. 
Open Class I Cavities: 
Caries removal - #8 bur; #3 or #4 for periphery. 
Wall extension - #558 bur. 
Fissure extension - #34 bur; #557 bur. 
Smooth margins - Tapering carborundum stone 
Incipient Proximal Cavities: 
Cavity opening - #701 bur or #73 Chayos Stone; #558 bur. 
Caries Removal - Selected round burs; smaller round burs for periphery. 
Step preparation - #34 bur; #558 bur; #559 bur. 
Proximal wall and floor - #559 bur. 
Smooth margins - Tapering carborundum stone. 
(Exception is taken to this procedure when the adjacent tooth is the first 
permanent molar or if the marginal ridge of the second deciduous molar is intact 
and not undermined; then the cavities in the mesial surfaces of those teeth may 
be prepared us pit cavities. In these cases the "step" preparation is done first.' 
Open Proximal Cavities: 
Caries removal - Break down walls with chisels; #8 round bur; #3 bur for 
periphery. 
Step preparation - #34 bur; #558 bur; #559 bur. 
Proximal wall and floor - /r559 bur. 
Smooth margins - Tapering carborundum stone. 
Mesial Pit Cavities: 
Pit opening - #34 bur. 
Pit extension - #557 bur. 
Caries removal - #2 bur. 
Class III Cavities: 
Incipient Class III Cavities Open Class III Cavities 
Access - #700 bur. Caries removal - Selected round bur 
Caries removal - 7#2 bur. Extension - #557 bur. 
Extension - #557 bur. Retention - #§■ bur or #33g- bur. 
Class IV Cavities: Disk away the proximal contact to depth of carious tissue. 
Because of the exfoliation age of the deciduous cuspids, this should not 
be done, but the cavities should be prepared for filling. 
Class V Cavities: May bo treated as Class I Cavities. OUTLINE OF FILLING PROCEDURE 
keep the chain intact: 
1. Cavity Preparation 
2. Sterilization 
3. Dry Area 
4. Insertion of lining or base 
5. Use of matrix 
6. Packing and condensing of alloy 
7. Carving 
8. Disking of opposing cusp 
9. Polishing 
1. Follow outline of cavity preparation. 
2. Notwithstanding the fact that it cannot be confined and does discolor, 
silver nitrate (ammoniacal), reduced by oil of cloves, is perhaps the best 
sterilizing agent for posterior teeth. Phenol or oil of cloves may be used 
for anterior teeth. Ammoniacal silver nitrate may be obtained in ampules 
or prepared as follows: 
Preparation of ammoniacal silver nitrate 
"Put three grams of silver nitrate crystals in test 
tube and add one cubic centimeter of water. Heat ever 
flame to dissolve, being careful not to let it boil. Let 
it cool until you can hold it in the palm of your hand. 
Now add 28aJo ammonia water slowly. At first a black pre- 
cipitate will be formed. Keep adding the ammonia and 
shaking the mixture until the black is almost dissolved. 
DO NOT LET IT ALL DISSOLVE or you will have too much 
ammonia, which is undesirable. Filter through filtering 
paper. Keep solution in brown well-stoppered bottle." 
From Forsyth Interne’s Manual. 
After application of this solution to tooth, let stand for 1 to 2 minutes 
and reduce with oil of cloves for same length of time. 
3. Dry area with warm air before inserting cement lining or base. 
4. Any of the cements will make a satisfactory lining. 
5. Use a matrix for two reasons: 
a. To give a fourth wall so filling may be properly condensed. 
b. To prevent bulk of material overhanging at cervical margin. 
6. Filling must be thoroughly packed and condensed. Small pluggers are 
suggested for condensing and packing alloy. 
7. Excess amalgam clinging to matrix should be removed before the band is 
removed. Margins should be trimmed with suitable carvers. The occlusal 
surface of fillings in deciduous teeth should not be carved as deeply as those in permanent teeth, because of the possibility of weakening them 
at the "step”, which is already a weak point. The marginal ridge should 
be so defined that food will not be impacted at contact point. Wipe all 
margins with cotton pellet. It saves time in final finish. 
8. Many good fillings are lost because of the pointed cusps of some opposing 
deciduous teeth. This is particularly true of lingual cusp of upper first 
deciduous molar. In occlusion this cusp seats deeply in proximal areas and 
where the cavity has been of long standing it seats deeper, due to con- 
current exfoliation. Have the patient close his teeth and observe the 
occlusion prior to inserting filling. If the bite appears close, take the 
opposing cusp out of occlusion by disking with a stone. 
9, All restorations should be polished. Use disks for mesial and distal 
surfaces. Plug finishing burs or tapered carborundum stones for occlusal 
surfaces. Burlaw Disks and pumice followed with tin oxide complete the 
polish. 
Reasons for do-over work 
1. Fillings loft too high. 
2. Occlusal carved, too deeply. 
3. Failure to disk opposing cusp out of occlusion. 
4. Failure to use matrix and properly condense filling. Fig. 1* 
Fig. 2 
Occlusal View of Class Two 
Cavity Preparation Showing 
Wide Neck. 
Proximal View of Class Two 
Cavity Preparation. 
Fig. 3 
Fig. 4 
The distal preparation for 
the cuspid. 
The prophylactic fissure filling. 
Fig. 5 
Fig. 6 
Occlusal View of Band and Loop 
Space Maintainer. Use .030 wire 
for loop or may be cast. 
Orthodontic Bridge. This 
Appliance Restores Lost Perma* 
nent Incisor for Child. Made 
by Means of Orthodontia Bands 
and Facing and Backing Soldered 
to the Bands. 
on this page are arranged from those in the Nebraska and Minnesota 
bulletins. PULP MAUAGFMEUT FOR DECIDUOUS AND YOUNG PERMANENT TEETH 
"The best pulp management in all children’s dentistry 
is preventive operative dentistry, begun early and continued 
regularly." Dr. K. A. Easlick. 
Deep Deciduous Cavities - Routinely seal a sedative treatment in all teeth 
presenting with a history of an ache and in all deep seated cavities, even 
though the tooth has not been troublesome. A paste made by incorporating 
zinc-oxide powder in one or two drops of oil of cloves, to which paste is 
added a little powdered silver nitrate just before insertion, is very 
effective. Upon the patient’s return, the remaining caries is removed, 
silver nitrate reduced by oil of cloves, cement base placed, and filling 
inserted. 
Exposed Vital Deciduous Pulps - When exposures occur from instrumentation or 
caries, one has a choice of: 
1. Pulp Capping. 
2. Pulpotomy (partial pulp removal). 
3. Pulpectomy (complete pulp removal). 
4. Extraction. 
1. Pulp capping may bo successful in selected cases. However, it is not 
advocated after the pulp has begun its resorptive period. 
2. Pulpotomy is the partial removal of the pulp. In preference to using 
pressure or novocain anaesthesia, Easlick has revamped the formula of 
one of the former desensitizing pastes and his technique follows. (See 
Page 21.) 
3. Pulpectomy is the complete removal of pulp and is indicated where the 
pulpal tissue is vital yet in all probability has had a bacterial in- 
vasion. This may be done by the use of: 
a. Pressure anaesthesia. 
b. Conduction anaesthesia. 
c. Desensitizing paste. 
d. Devitalizing paste. 
After desensitization or devitalization, in an isolated field the 
pulp chamber is completely opened and the pulpal tissue removed 
from the canals with a fine barbed broach. The operator must bear 
in mind that the canal terminates about one to two mm. from the apex 
of the root. After extirpation of pulp, seal in a sedative such as 
oil of cloves for a few days prior to filling. The Kerr Sealer 
powder and glycerine-iodine solution as used in pulpotomies or any 
paste amenable to tissue and which becomes sufficiently hard upon 
setting will be effective as a root canal filling. 
4. Extraction of teeth with exposures should be the last resort. Spaces 
should bo maintained for harmonious growth. Retain the teeth unless 
they cannot be successfully treated and filled. 
AcuteAbscesses and Putrescent Deciduous Teeth - If an acute abscess will drain 
promptly upon opening, it can be treated in a few days as in any other 
putrescent tooth condition which has subsided after its initial acute stage. 
For those teeth with acute abscesses which do not drain, promptly after they 
are opened, extraction is indicated. Putrescent teeth may be classified into two types on basis of their 
response to treatment: 
1. Those that drain through cavity in crown of tooth and respond to 
drug therapy. 
First Appointment: Radiograph. Open pulp chamber, remove debris, 
and seal in drug. Those most frequently used are beechwood 
creosote, azochloramide, merthiolate, and Lugols Iodine Solution. 
Second Appointment: Remove root canal contents and repeat drug 
treatment. (Putrescent teeth should be treated until we have at 
least one negative culture.) 
Third Appointment; Place root canal filling and restoration. 
2. Those in which drainage has been established through a fistula - 
group which may be treated with difficulty. 
These cases seldom respond to drug treatment, particularly if the 
radiogram shows a large area of bone destruction at the bifurcation 
between the roots. Extraction is generally indicated. 
Young Permanent Teeth 
Young permanent teeth present three problems in pulp management: 
1. Near exposures 
a. Remove all leathery dentine until comparatively firm dentine appears. 
b. Reduce ammoniacal silver nitrate with oil of cloves. 
c. Place a thin plastic mix of zinc cement and then a heavier mix to 
complete the base. 
d. Place restoration. 
2. Vital exposures 
a. Remove leathery dentine and seal in oil of cloves or some similar 
sedative under cement. 
b. At next appointment anesthetize the tooth by conduction and peri- 
dental infiltration. 
c. Isolate field with rubber dam, sterilize tooth and instruments to 
be used. 
d. Amputate occlusal portion of pulp to the entrance of each canal. 
e. Cauterize each canal stump with hot instrument. 
f. Flood the chamber with hydrogen peroxide, followed with saline 
solution and then dried. 
g. Use the same paste and technique as outlined for deciduous tooth 
pulpotomy. (See Page 21.) 
3. Putrescent Teeth 
The anterior teeth can always be managed by a root canal filling and 
root resection. However, once a young permanent tooth becomes infected, 
the procedure of choice is extraction. PARTIAL PULPECTOMY TECHNIQUE FOR MANAGING VITAL EXPOSURES IN DECIDUOUS TEETH 
(Dr. K, A. Easlick) 
1. First Appointment 
a. On finding a vital exposure, wipe out the cavity with some sedative - 
eugenol, oil of cloves, or chloretone-eugenol. 
b. Place a little paste on the tip of a plastic instrument and wipe off 
over the exposure. 
c. Seal with a plastic mix of zinc cement for one week to two weeks. 
(If the cavity is wiped out with a sedative and the formaldehyde paste 
not forced into the pulp chamber with a stiff mix of cement, there will 
be no pain caused by the paste. A half aspirin tablet has quieted any 
toothache we have caused in a small child.) 
2. Second Appointment (10 days to 2 weeks later) 
a. Isolate the tooth well with cotton rolls; sterilize the cemented tooth 
with tincture of iodine; dip all spoons and burs in an antiseptic; for 
example, phenol or metaphen. 
b. Cut the occlusal wide open over the pulp chamber with a cross cut 
fissure bur and amputate the pulp, level with the floor of the pulp 
chamber with a suitable size round bur. It is not necessary to go into 
the root canals. (If the paste has devitalized properly, the pulp 
tissue will show no sensation when pricked and will not bleed when 
amputated. If not completely devitalized, seal paraform paste for 
another week.) 
c. Clean and dry pulp chamber, 
d. Make a "whipped-cream" mix of one capsule of Kerr Sealer powder and one 
drop of glycerine-iodine and smear in pulp chamber with a plastic 
instrument. 
Glycerine-Iodine 
Iodine Crystals 8-12 grains 
Glycerine 1 ounce 
Heat on hot water bath until crystals go into solution. 
e. Cut a piece of base-plate gutta poreha about the size of the pulp 
chamber; pick it up on a hot amalgam plugger; soften slightly in a 
flame; use this as a plunger to push the paste tight against the pulp 
chamber floor over the ends of the pulp tissue in the canals. Burnish 
the gutta porcha to place with a hot ball burnisher. 
f. Cement base md amalgam filling at once. 
Paraform Paste "H" 
Paraformaldehyde 1.00 gram 
Procaine Base 0.30 gram 
Powdered Asbestos 0.50 gram 
Vaseline 1.25 gram 
Carmine to color HOME CARE OF TIIE TEETH 
1. Instruct patients in technique of brushing. 
See American Dental Association Brushing Charts. (May be secured from 
Bureau of Public Relations, American Dental Association.) 
Smaller editions may be obtained for distribution to parents. They are 
useful to hang on the back of the door in the medicine cabinet for daily 
instruction. 
2. Teach parents to brush the teeth of the child. 
The parent should brush the child’s teeth carefully once a day until the 
child is old enough to follow the technique properly. Parents should not 
expect the small child to properly brush the teeth any more than a small 
boy would be expected to wash his ears clean. 
3. Teach brushing the teeth for cleanliness as a daily habit. 
4. ’’DEBUNK” the toothpaste racket. 
Suggest a dentifrice which carries the ’’Seal of .approval of the American 
Dental association.” 
WHAT KIND OF TOOTHBRUSH FOR THE CHILD? 
For the Baby 
A tiny brush with a single row of bristles may be used. The bristles should 
be soft so as not to injure the tissues. Cotton or gauze with or without 
impregnation of boric acid should suffice to keep tho teeth clean. 
For tho throe-year-old and up to twelve 
A child-size brush. The brush head should be about one inch long, tho tufts 
of bristles should bo set apart and tho bristles should be of medium stiff- 
ness. 
After twelve years 
A regular adult brush may be used. 
The daily use of antiseptic mouthwashes is not necessary. 
Medicated mouthwashes should be prescribed by the dentist for specific treat- 
ment of specific conditions. 
Where tho parents desire to use a mouth wash, suggest a mild solution of salt 
water (tabic salt). HINTS ON CHILD MANAGEMENT 
i. Treat the child with understanding. 
2. Try to conquer by persuasion. 
3. Be kind but firm, and smile. 
4. Go about the operation in a methodical manner and an attitude of assurance. 
A child will soon sense indecision. Be master of the situation at all times. 
5. Never lie to a child. If you think the operation will be painful, tell the 
child so and assure him that with his cooperation you will do the necessary 
work as easily as possible. In this way you will gain the confidence of the 
child much quicker and more completely. 
6. Call the child by his or her first name. Don’t use pet names. 
7. Treat the child with simple and respectful dignity. Do not use ’’baby talk” 
or attempt to be patronizing. 
8. Make the first visit as pleasant as possible. Greet the child with a 
smile and approach him slowly. Do not attempt to rush him into the operating 
room. Give him a chance to look you over and gain an impression of your 
kindness and sincerity. 
9. When a child is brought in with toothache at first visit, do nothing but 
relieve the toothache and make him as comfortable as possible; other work 
should wait until subsequent visits when he will be more receptive to your 
ability to be of service in preventing a recurrence of the toothache. 
10. Answer questions intelligently and fully. Short answers tend to destroy 
confidence. The asking of questions indicates an interest and your answers 
can easily lead to discussions of health and the value of the service you 
are rendering. 
11. As a rule, better work can be done and the child more easily handled if the 
parent does not come into the operating room. The parent should not answer 
questions you expect the child to answer. The parent should not attempt to 
help you control the child. This is your work. 
12. Finish what you start; otherwise, future work will be difficult. 
13. Show an interest in the child’s activities and hobbies. The child lives in 
a world which is just as important to him as your world is to you. 
14. Do not keep the child for long appointments. He tires easily. Do not keep 
him waiting in the reception room too long. Meet appointments as promptly 
as possible. 
15. Show genuine admiration when the child acts bravely. Do not belittle honest 
fear in the child. Dentistry may be a neiv and totally different experience; 
and all people, big or little, are afraid of new experiences. 
16. Give honest service and do not leave the impression with the parent that 
because the patient is a child the work is not important or may be done for 
half price. They will think you are doing only half price work and will 
treat dental health for the child accordingly. DENTAL HEALTH PROMOTION IN YOUR COMMUNITY 
1. Promotion of the annual dental inspections of every school child by 
(a) inspections in schools by dentists. 
(b) examination of classrooms of children of individual 
children in the dental office. 
No dental inspections should be made, however, without the card system 
which notifies the parents of the condition of the child’s teeth (the 
number of cavities should not be mentioned, however) and a system in the 
schoolroom which urges dental care and records which indicate when it is 
completed. 
2. Promotion of demonstrations on dental health with such groups as the 4-H 
Clubs; parent-teacher associations; civic clubs; and other groups which 
are generally interested in the betterment of the community. 
3. Organization and use of a Speakers’ Bureau of dentists who will agree to 
talk to various lay groups in their own or other counties and cities. 
4. The purchase and use of slides and movies for lecture work. May be obtained 
from the Public Relations Bureau of the American Dental Association. 
5. Tho purchase and use of exhibit material, models, charts, etc., for county 
fairs, health weeks, and every suitable occasion. May also be obtained 
from the American Dental Association at very reasonable cost, or from the 
State Department of Public Health. 
6. The purchase and use of the now American Dental Association newspaper dental 
health stories released in September 1938 for use in local newspaper. 
7. Participation in and promotion of all health work in the county, not in 
dentistry alone. 
8. Support public health nursing programs and promote the appreciation of 
the necessity of having public health nurses in every county and in every 
school system. 
9. Work with parent-teacher groups to stimulate dental care of the pre-school 
groups in your community. This is one of the most effective phases of 
dental health education. 
10. Promote Children’s Dentistry - the doing of it by the dentists in your 
county and the importance of it among your laity. Join the American Society 
for the Promotion of Dentistry for Children and keep actively abreast with 
the latest trends in this field. 
11. Promote the use of visual education devices for daily use in the dental 
office and the occasional use for lay meetings. 
12. Cooperate with local physicians in advice for pre-natal dental care. 
13. Encourage the selection of protective foods by all people as a safety 
measure for general and dental health. 
14. NEVER SIGN A SCHOOL CHILD’S CARE "DENTAL WORK ALL COMPLETED" UNLESS THE 
WORK HAS ACTUALLY BEEN COMPLETED. It is unfair to the child and destroys 
faith in the profession as well as faith in the importance of DENTAL HEALTH. 
AP - 10,901