Clinical Dentistry 4th Edition Crispian

Scully
Visit to download the full and correct content document:
https://textbookfull.com/product/clinical-dentistry-4th-edition-crispian-scully/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Scully’s Handbook of Medical Problems in Dentistry

Crispian Scully

https://textbookfull.com/product/scullys-handbook-of-medical-
problems-in-dentistry-crispian-scully/

Pediatric dentistry: a clinical approach Third Edition

Espelid

https://textbookfull.com/product/pediatric-dentistry-a-clinical-
approach-third-edition-espelid/

Oxford handbook of clinical dentistry 6 ed. Edition

Laura Mitchell

https://textbookfull.com/product/oxford-handbook-of-clinical-
dentistry-6-ed-edition-laura-mitchell/

Sleep Disorders in Pediatric Dentistry Clinical Guide

on Diagnosis and Management Edmund Liem

https://textbookfull.com/product/sleep-disorders-in-pediatric-
dentistry-clinical-guide-on-diagnosis-and-management-edmund-liem/
Clinical Effectiveness and Clinical Governance Made
Easy 4th Edition Boath

https://textbookfull.com/product/clinical-effectiveness-and-
clinical-governance-made-easy-4th-edition-boath/

Foundations of Clinical Psychiatry 4th ed 4th Edition

Sidney Bloch

https://textbookfull.com/product/foundations-of-clinical-
psychiatry-4th-ed-4th-edition-sidney-bloch/

Clinical Virology 4th Edition Douglas D. Richman

https://textbookfull.com/product/clinical-virology-4th-edition-
douglas-d-richman/

Clinical Reasoning in the Health Professions, 4th ed

4th Edition Joy Higgs

https://textbookfull.com/product/clinical-reasoning-in-the-
health-professions-4th-ed-4th-edition-joy-higgs/

Modern Sports Dentistry Mark Roettger

https://textbookfull.com/product/modern-sports-dentistry-mark-
roettger/
CHURCHILL’S POCKETBOOKS

Clinical Dentistry
4th EDITION

Edited by
Professor Crispian Scully CBE
MD, PhD, MDS, MRCS, BSc, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE,
FRCPath, FMedSci, FHEA, FUCL, FSB, DSc, DChD, DMed (HC), Dr.hc

Co-Director, WHO Collaborating Centre for Oral Health-General Health;

Emeritus Professor, UCL (London) and Visiting Professor, Universities
of Athens, Edinburgh, Helsinki, Hertfordshire, Middlesex and Plymouth

Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2016
© 2016 Elsevier Ltd. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any

means, electronic or mechanical, including photocopying, recording, or any information
storage and retrieval system, without permission in writing from the publisher. Details on
how to seek permission, further information about the Publisher’s permissions policies
and our arrangements with organizations such as the Copyright Clearance Center and the
Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under
copyright by the Publisher (other than as may be noted herein).

First edition 1998

Second edition 2002
Third edition 2007
Fourth edition 2016

ISBN 978-0-7020-5150-0
International ISBN 978-0-7020-5149-4

Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional
practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and
knowledge in evaluating and using any information, methods, compounds, or
experiments described herein. In using such information or methods they should be
mindful of their own safety and the safety of others, including parties for whom they have
a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to
check the most current information provided (i) on procedures featured or (ii) by the
manufacturer of each product to be administered, to verify the recommended dose or
formula, the method and duration of administration, and contraindications. It is the
responsibility of practitioners, relying on their own experience and knowledge of their
patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
editors, assume any liability for any injury and/or damage to persons or property as a
matter of products liability, negligence or otherwise, or from any use or operation of any
methods, products, instructions, or ideas contained in the material herein.

Content Strategist: Alison Taylor The

Content Development Specialist: Lynn Watt publisher’s
Project Manager: Julie Taylor policy is to use
Designer: Miles Hitchen paper manufactured
Illustration Manager: Emily Costantino
from sustainable forests
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
 Preface to the
Fourth Edition

As initiators of Clinical Dentistry, and editors of the first three edi-

tions, we are not only pleased to note the impressive success of the book
internationally but, in our increasingly busy senior academic roles, are also
delighted to pass the reins to our long-time colleague and friend, Professor
Crispian Scully CBE, and wish him and the contributors continued success
with the 4th edition.
Professor Ivor Chestnutt Cardiff
Professor John Gibson Glasgow

The primary objective of this Pocketbook was to provide a readily

accessible source of information when it is most needed, as an aide-
mémoire prior to carrying out clinical tasks or to enable students
(at undergraduate and postgraduate level) to apprise themselves
of important details prior to tutorials and seminars. Those aims
remain.
In a publication of this nature, information must be presented in
a concise and, at times, didactic fashion. The intent is to include
sufficient basic information to permit examinations to be passed.
However, the desire of an educationalist is always to promote deep
learning and the layout and content of the text are intended to moti-
vate and guide the reader to the appropriate parts of more substan-
tive texts, many of which have proven both inspirational and
motivational for the editors and contributors of this book throughout
their careers.
This textbook is widely used by more and more undergraduate
dental students, vocational dental practitioners, general professional
trainees, dental surgeons in primary care and in the hospital service,
as well as dental care professionals in-training and post-qualification.
I was requested to take on the editing of the 4th edition. For this
edition I have expanded the size and type of authorship. Although a
large proportion of current contributors were involved in earlier
editions, some previous authors were unavailable to help, so we have
also recruited a range of other top people in their fields. The current
authors are all experienced clinicians, teachers and/or managers
within their individual specialties and emphasis has been given to
information of practical clinical significance. Descriptions of rarely
encountered conditions and situations have been deliberately
minimized.
vi • Preface to the Fourth Edition

In updating this edition, each author has addressed significant

changes within his or her areas of expertise and I am grateful to them
for their enthusiasm and great industry and particularly for comply-
ing with deadlines.
Thus this new 4th edition has not only been invigorated and
enhanced but also the chapter order has been rearranged. We have
also expanded on practical aspects related to the regulator – the
General Dental Council; and on the dental team roles, and practice
management. The book has been written to be used in conjunction
with Scully’s Handbook of Medical Problems in Dentistry (Elsevier
2016) and now includes issues related to overseas dental staff, access
for disabled, advertising, aetiopathogenesis of dental disease, assaults
on staff, behaviour at work and outside (GDC standards), building
design, chaperoning, clothing, finance management, foundation and
vocational training, governance, health and safety, hiring and firing,
identifying staff, independent practice, infection control, information
technology, management skills, marketing, NHS regulations, over-
seas staff, professionalism, protected characteristics, significant event
analysis, time-keeping and things staff must do before starting work
and leaving a job. The aims and objectives remain the same – to
educate and inspire each member of the whole dental team, whether
in-training or post-qualification.
I am indebted for support from the authors, Professor Ivor Chest-
nutt, Professor John Gibson, Professor Justin Stebbing and at Elsevier,
Mrs Lynn Watt and Mrs Alison Taylor. Our thanks are also due to
former contributors, including Iain. B. Buchanan, Barbara. L. Chad-
wick, Ivor. G. Chestnutt, John Gibson, Jason Leitch, Joe McManners,
Jeremy Rees and Dave Stenhouse.
Crispian Scully
London, 2016
 Contributors

Stephen Barter
BDS MSurgDent RCS
Specialist Oral Surgeon
Perlan Specialist Dental Centre
Hartfield Road
Eastbourne, UK

Stephen Barter is Clinical Director of Perlan Specialist Dental Centre, East-

bourne; Specialist in Oral Surgery and Hon. Lecturer in the Department of
Periodontology, UCL Eastman Dental Institute, London; ITI Fellow and past
Chairman of the UK and Ireland ITI Section and has been involved in the teach-
ing and development of dental implantology for over 20 years.

John A.D. Cameron

BDS DGDP LLB (Hons)
Senior Clinical/Dental Adviser
Practitioner Services
NHS National Services Scotland
Edinburgh;
University of Aberdeen Dental School
Aberdeen, UK

John Cameron is Senior Dental Adviser at NHS National Services Scotland,

Senior Clinical Lecturer at the University of Aberdeen Dental School, Lead for
Law, Ethics and Professionalism. He is also Chairman of the Dentists Health
Support Programme and Trust.
viii • Contributors

Iain Chapple
BDS FDSRCPS PhD FDSRCS CCST (Rest Dent)
Periodontal Research Group and MRC Centre for
Immune Regulation
School of Dentistry
College of Medical and Dental Sciences
University of Birmingham
Birmingham, UK

Professor Iain Chapple is Head of Periodontology at the University Birming-

ham’s School of Dentistry and Clinical Lead for an NHS service base of 6
million. He is Associate Editor of Journal of Clinical Periodontology and Period-
ontology 2000 and former Scientific Editor of the British Dental Journal and
former Associate Editor of Journal of Periodontal Research. President of The
British Society of Periodontology (2014–2015), President of The Periodontal
Research Group of the International Association of Dental Research (2007),
Treasurer and Executive Committee member of the European Federation of
Periodontology (EFP) (2007–2013), EFP Scientific Advisory Committee Chair-
man (2013–2015), Secretary General (2016–), EFP Workshop Co-Chairman
(2009–current). He has written and edited seven books and 16 book chapters
and published over 140 full papers on Medline. He was awarded the Tomes
Medal by the Royal College of Surgeons of England in 2012.

Fiona Cox
B.Ed MInstLM
Ferndale Dental Clinic Ltd
Devizes, UK

Fiona Cox is co-owner at Ferndale Dental Implant and Cosmetic Clinic. She has
a wide experience in management within the private health sector and the NHS
dental and medical health fields.
 Contributors • ix

Martyn Cox
BSc (Hons) BDS MFGDP RCS (Eng) FRSM, PhD
Clinical Director Ferndale Dental Implant Clinic
Implant mentor and tutor Dentale Advanced
Implant course, Honorary Specialist Oral Surgeon,
Solihull Hospital
Lecturer

Martyn Cox is the Clinical Director at Ferndale Dental Implant and Cosmetic
Clinic, Devizes. He is a clinical trainer/lecturer and mentor in Advanced
Implantology in Bristol and Shrewsbury, an Honorary Oral Surgeon at Solihull
Hospital, Birmingham and a lecturer on the FGDP Oral Surgery course. Martyn
has been awarded numerous research prizes in the UK and has published
widely in both UK and international peer-reviewed journals including several
oral cancer textbooks and has lectured on implantology, oral cancer and
human papilloma virus genetics in the UK, Europe and the USA.

Daljit Gill
BDS BSc MSc FDS RCS MOrth FDS (Orth) RCS (Eng)
UCLH Eastman Dental Hospital
London, UK

Dr Daljit Gill is a Consultant Orthodontist at Great Ormond Street NHS Founda-

tion Trust and UCLH Eastman Dental Hospital. He has written a number of
textbooks and is involved in training orthodontists, therapists and nurses.
x • Contributors

Nikos Donos
DDS MS FHEA FDSRCSEngl PhD
Head Centre for Oral Clinical Research
Professor and Chair Periodontology and Implant Dentistry
Honorary Professor, UCL Eastman Dental Institute, UK
Honorary Professor, University of Hong Kong
Honorary Professor, Griffith University, Australia
Centre for Clinical Oral Research
Institute of DentistryBarts and The London School of
Medicine and DentistryQueen Mary University of
London (QMUL)

Awarded the title of Honorary Professor at the Faculty of Dentistry in Hong

Kong (2009) and the title of Adjunct Professor at the Dental School, Griffith
University, Australia (2012), Professor Donos is involved as editorial board
member in a number of international and national peer-reviewed journals in
the field of Periodontology and Implant Dentistry and has published exten-
sively. In 2011, he was awarded the prestigious annual IADR-Periodontology
Group Award in Periodontal Regenerative Medicine. His clinical expertise is in
the field of Periodontics and Implant Dentistry and he has significant experi-
ence in periodontal/bone regeneration and implant related surgical procedures
as well as treatment of peri-implantitis, topics which he regularly lectures on
at a national and international level.

David H. Felix
BDS MB ChB FDS RCS (Eng) FDS RCPS (Glasg) FDS
RCS(Ed) FRCP(Ed)
Dean of Postgraduate Dental Education
NHS Education for Scotland
Edinburgh, UK

Dr David H. Felix is Postgraduate Dental Dean, NHS Education for Scotland and
Chair of the Joint Committee for Postgraduate Training in Dentistry. Previously
Consultant in Oral Medicine Glasgow Dental Hospital and School. He is a
former Dean of the Faculty of Dental Surgery of The Royal College of Surgeons
of Edinburgh and a former President of the British Society for Oral Medicine.

Mark Griffiths
MBBS FDS RCS BDS
Visiting Professor, UCL (Eastman Dental Institute);
Honorary Research Fellow, School of Physiology,
Pharmacology and Neuroscience
University of Bristol
Bristol, UK

Mark Griffiths is Visiting Professor, UCL (Eastman Dental Institute), London,

UK and Honorary Research Fellow, School of Physiology, Pharmacology and
Neuroscience at the University of Bristol. He is a retired NHS Consultant in
Special Care Dentistry at the Bristol Dental Hospital. Holder of Patent: Monitor-
ing electrical activity (Electroencephalograph) and Member of University of
Bristol Neuroscience Community.
 Contributors • xi

Athanasios Kalantzis
DipDS MFDSRCS MBChB MRCS FRCS (OMF)
Oral and Maxillofacial Surgery Consultant
Central Manchester Foundation Trust
Manchester, UK

After qualifying in Dentistry in Athens, Greece and in Medicine in Sheffield,

UK, Mr Kalantzis trained in Oral and Maxillofacial Surgery at the Oxford Uni-
versity Hospitals and served as Members Representative and Fellows in Train-
ing Representative of the British Association of Oral & Maxillofacial Surgeons
as well as Officer of the Junior Trainees Group. He is a member of the Royal
College of Surgeons of England and has taught oral and maxillofacial trainees
for several years. He has presented papers nationally and internationally and
has experience in organizing as well as chairing national and international
conferences.
Mr Kalantzis is co-author of the books Oxford Handbook of Dental Patient Care
2e and the Oxford Specialist Handbook of Medicine and Surgery for Dentists and is
on the Editorial Board of Medical Problems in Dentistry 6e, and is a regular
reviewer for journals such as Oral Oncology and British Journal of Oral & Maxil-
lofacial Surgery.

Tatiana Macfarlane
BSc PhD MICR FHEA
Senior Research Fellow
University of Aberdeen, Dental School
Aberdeen, UK

Dr Tatiana Macfarlane is a Senior Research Fellow at the University of Aber-

deen Dental School, UK. She previously worked at the University of Manchester
in England, European Institute of Oncology in Italy and International Agency
for Research of Cancer in France. Her main research interests are in epidemiol-
ogy of head and neck cancer and oral health epidemiology. She has been
involved in major international collaborations such as Alcohol-related Cancers
and Genetic Susceptibility in Europe (ARCAGE) and International Head and
Neck Cancer Epidemiology Consortium (INHANCE). She is a Fellow of the
Royal Statistical Society (RSS), Fellow of the Institute of Learning and Teaching
in Higher Education (ILTHE), member of the International Epidemiological
Association (IEA), member of the American Association for Cancer Research
(AACR) and professional member of the Institute of Clinical Research (ICR).
She has authored over 120 peer-reviewed papers.
xii • Contributors

Avril Macpherson
BDS (Edin) FDS RCSEd MFDS RCSEd MSND RCSEd
DipConSed (N’castle) PGCTLCP (Edgehill) FHEA
Clinical Director
Liverpool University, Dental Hospital
Liverpool, UK

Avril Macpherson was appointed Consultant/Honorary Senior Clinical Lec-

turer in Special Care Dentistry, Liverpool University Dental Hospital and School
of Dentistry, in 2010. She is a member of the British Society of Disability and
Oral Health Executive Committee, the Specialty Advisory Committee in Special
Care Dentistry (RCSEng), the Specialty Advisory Board in Oral Medicine and
Special Care Dentistry (RCSEd) and is a Regional Specialty Advisor in Special
Care Dentistry (RCSEng). Avril teaches widely in conscious sedation and special
care dentistry and is a member of teaching faculty of the Society for the
Advancement of Anaesthesia in Dentistry and a Resuscitation Council
Advanced Life Support instructor. She is a RCSEd examiner for MFDS and
MSCD examinations.

Jasmine Murphy
BDS (Hons) MSt (Camb) MFGDP UK MFDS RCS (Edin)
MFDS RCS (Eng) MRes (Manc) FDS RCS (Eng) FFPH
Consultant in Public Health (Children and Young
People, Sexual Health, Dental Public Health)
Leicester City Council
Leicester, UK

Jasmine Murphy is a Consultant in Public Health at Leicester City Council and

registered as a Specialist in Dental Public Health with the General Dental
Council. Children in Leicester have been reported to have the worst level of
dental health in England and therefore Jasmine established the Oral Health
Promotion Partnership Board and is driving forward the implementation and
mobilization of Leicester’s first Oral Health Promotion Strategy for pre-school
children. Leicester’s dental public health programme ‘Healthy Teeth, Happy
Smiles!’ is an early intervention programme that is modelled on Scotland’s
ChildSmile. Jasmine also contributed to Public Health England’s ‘Commission-
ing Better Oral Health’ guidance, is a core member of the National Institute
of Health and Care Excellence (NICE) Public Health Advisory Committee
and is also currently contributing to NHS England’s Commissioning Guide on
Paediatric Dentistry. Jasmine has also recently been invited to join the Editorial
Board of Oral Diseases journal.
 Contributors • xiii

Farhad B. Naini
BDS (Guy’s) MSc (Lond) PhD (KCL) FDSRCS (Eng)
MOrthRCS (Eng) FDSOrth.RCS (Eng) GCAP(KCL) FHEA
Consultant Orthodontist
Maxillofacial Unit
Kingston Hospital and St George’s Hospital
London, UK

Dr Naini is the Consultant Orthodontist in the Maxillofacial Units at Kingston

Hospital and St George’s Hospital, Chair of the multidisciplinary Cranio-Orbito-
Facial Surgery Group and Research Lead for Dentistry and Orthognathic
Surgery. He has over 80 peer-reviewed publications and is editor of major
textbooks on orthodontics and orthognathic surgery. He is also author of the
reference textbook Facial aesthetics: concepts and clinical diagnosis.

Tim Newton
BA PhD CPsychol AFBPsS CSci
Unit of Social and Behavioural Sciences
King’s College London, Dental Institute
Guy’s Hospital
London, UK

Professor of Psychology as Applied to Dentistry and Honorary Consultant

Health Psychologist at King’s College London Dental Institute, Tim has worked
in the behavioural sciences in relation to dentistry for over 20 years, and his
particular interests include the management of dental anxiety, interventions
to enhance oral health related behaviour and the working life of the dental
team. He has published over 250 peer-reviewed articles in scientific journals.

Paul P. Nixon
BDS FDSRCS (Eng) DDRRCR
Consultant in Maxillofacial Radiology
School of Dentistry
Liverpool University, Dental Hospital
Liverpool, UK

Paul Nixon is Consultant in Maxillofacial Radiology in Royal Liverpool Univer-

sity Hospital, clinical lead in the Dental Radiology Department and is also a
specialist in Oral Surgery. He is an honorary clinical lecturer of the University
of Liverpool and has an honorary contract at Alder Hey Children’s Hospital.
He has authored or coauthored 26 publications. He is on the council of the
British Society of Dental and Maxillofacial Radiology where he is audit lead and
is responsible for their website. He recently served as external examiner for the
MSc in Maxillofacial radiology at King’s College London for 6 years, is an
examiner for the MJDF examination of the Royal College of Surgeons of
England and is a member of the Royal College of Radiologists.
xiv • Contributors

Will Palin
BMedSc MPhil PhD FADM
Biomaterials Unit, The School of Dentistry
College of Medical and Dental Sciences
University of Birmingham
Birmingham, UK

Will Palin is a Reader in Biomaterials at the School of Dentistry, University of

Birmingham. With a background in materials science, his developmental
research for both dental and wider medical applications has attracted grant
funding from the EPSRC, BBSRC, NIHR, Ministry of Defence and various indus-
trial partners. He has authored over 70 publications and six book chapters. He
is Editor of the European Journal of Prosthodontics and Restorative Dentistry,
Subject Editor for Biomaterials Adhesion, International Journal of Adhesion and
Adhesives and Board Member for Journal of Biomaterials Applications, Dental
Materials and Journal of Dentistry.

Andrew Paterson
LLM BDS (Hons) FDSRCPS DRDRCS (Edin) MRDRCS (Edin)
Consultant in Restorative Dentistry, NHS Ayrshire and
Arran;
Honorary Clinical Senior Lecturer, University of
Glasgow;
Maxillofacial Unit
The University Hospital Crosshouse
Kilmarnock, UK

Andrew Paterson is a Consultant in Restorative Dentistry mainly involved in

the prosthodontic management of head and neck cancer, trauma and hypo-
dontia patients in a District General Hospital. Formerly an NHS Consultant at
Glasgow Dental Hospital with 20 years’ experience in a private specialist restor-
ative and prosthodontics referral practice dealing with all aspects of restorative
dentistry. Part-time associate dento-legal adviser with an indemnity insurer.
Contributor to all previous editions of this textbook.

Crispian Scully
CBE PhD MD MDS MRCS FDSRCPS FFDRCSI FDSRCS
FDSRCSE FRCPath FmedSci FHEA FUCL FSB DSc DChD
DMed (HC) Dr HC
Emeritus Professor
University College London
London, UK

Professor Crispian Scully is a Director of the WHO Collaborating Centre in

Oral Health-General Health; journal Founder and Editor of Oral Oncology and
Oral Diseases; and author or editor of 50 books, 200 book chapters and over
1000 papers on MEDLINE. He is UCL Professor Emeritus, has been Dean at UCL
and Bristol, and president of several international and UK societies and has
medals from Universities of Helsinki, Santiago de Compostela and Granada;
Fellowship of UCL; and Doctorates from Universities of Athens, Granada, Hel-
sinki and Pretoria.
 Contributors • xv

John C. Steele
MB ChB BDS MFDS RCSEd FDS (OM) RCSEd Dip Oral
Med PGCTLCP FHEA
Consultant and Specialist in Oral Medicine
The Leeds Teaching Hospitals NHS Trust;
Honorary Senior Lecturer in Oral Medicine
Faculty of Medicine & Health
University of Leeds
Leeds, UK

Dr John C. Steele is dual qualified in both medicine and dentistry and is cur-
rently Consultant, Honorary Senior Lecturer and Specialist in Oral Medicine
based in Leeds. He has previously worked in a number of medical and surgical
posts including emergency medicine. He has co-authored 14 articles published
in peer-reviewed journals and has reviewed manuscripts for five national and
international dental and medical journals. He is a current member of Council
of the British Society for Oral Medicine.

Damien Walmsley
PhD MSc BDS FDSRCPS
The School of Dentistry
College of Medical and Dental Sciences
University of Birmingham
Birmingham, UK

Professor Walmsley is a recognised both for his research and teaching. His
research is on the the use of ultrasonics in dentistry including its use in period-
ontology, endodontics and its healing effects in repairing teeth. His present
research funding includes imaging biofilm and observing its real time removal
via ultrasonic instruments. He is very active in Interdisciplinary doctoral train-
ing centres at the University of Birmingham and is Graduate Director for
Dentistry. He publishes his work in high impact scientific journals which has
resulted in research and advisory roles for all the major dental companies. He
is a well respected educator in Prosthodontics and also contributes to courses
on Information Technology and Law/ethics courses. Clinically his work evolves
around Prosthodontics and he is the leader of a busy NHS department. He is
Scientific Advisor to the British Dental Association and enjoys a high profile in
the media. He is a past President of the British Prosthodontic Society. Interna-
tional roles include Past President of the Association for Dental Education in
Europe and deputy chair of U21 Health Sciences. Editorial duties include past
Editor of the Journal of Dentistry and he is on the Editorial boards of the BDJ,
European Journal of Dental Education, Journal of Dental Education, Journal
of Endodontics. European Journal of Restorative Dentistry and Dental Update.
xvi • Contributors

Richard Welbury
Professor of Paediatric Dentistry
School of Dentistry
University of Central Lancashire
Preston, UK

Richard Welbury is Professor of Paediatric Dentistry at the University of

Glasgow Dental School and currently Dean of the Dental Faculty and Vice-
President of the Royal College of Physicians and Surgeons of Glasgow.

Paul H.R. Wilson

BSc BDS MSc FDSRCPS FDS(RestDent) DipDSed
Consultant in Restorative Dentistry
Oxford University Hospitals NHS
Foundation Trust, Headington, Oxford UK
The Circus Dental Practice
Bath, UK

Paul H.R. Wilson is Consultant in Restorative Dentistry at Oxford University

Hospitals NHS Foundation Trust and he works in private specialist dental prac-
tice in Bath. He is visiting Senior Clinical Lecturer at the Universities of Aber-
deen and Bristol. He completed postgraduate training at Guy’s & St Thomas’
Hospitals, London and King’s College London.

Graeme Wright
BDS FDS(Paed Dent) RCPSG MPaed Dent RCSEd
PGCLTHE FHEA
Consultant in Paediatric Dentistry
Royal Hospital for Sick Children
Edinburgh, UK

Graeme Wright is Consultant in Paediatric Dentistry at Edinburgh Royal

Hospital for Sick Children. He is an Executive Board member of BSPD, organizer
of the IAPD 2015 International Congress and editorial board member of
‘Dental Traumatology’. His sub-specialty interests are Dental Traumatology
and Oncology/Haematology related to dentistry.
 Contents

Preface to the Fourth Edition v

Contributors vii

1. Dental public health, epidemiology and prevention 1

Tatiana Macfarlane, Jasmine Murphy

2. Social and psychological aspects of dental care 27

Tim Newton

3. Dental disease 39
Crispian Scully

4. The dental team 71

Crispian Scully, John Cameron

5. Law, ethics and quality dental care 93

John Cameron

6. Practice management 121

Fiona Cox, Martyn Cox

7. History and examination 167

Mark Griffiths

8. Dental and maxillofacial radiology 175

Paul Nixon

9. Pain and anxiety management 201

Avril Macpherson

10. Drug prescribing and therapeutics 223

Mark Griffiths

11. Dental materials 237

William Palin, Damien Walmsley
xviii • Contents

12. Implantology 269

Stephen Barter, Nikos Donos

13. Oral medicine 289

David H. Felix

14. Oral and maxillofacial surgery 337

Athanasios Kalantzis

15. Orthodontics 391

Daljit Gill, Farhad Naini

16. Paediatric dentistry 429

Graeme Wright, Richard Welbury

17. Periodontology 461

Iain Chapple

18. Removable prosthodontics 475

Andrew Paterson

19. Operative dentistry 513

Paul H.R. Wilson

20. Special care dentistry 577

Avril Macpherson

21. Emergencies 621

John Steele

Appendices 637
Appendix A: Average dates of mineralization and eruption
of the primary dentition 638
Appendix B: Tooth notation 640
Appendix C: Tooth eruption 640

Index 643

Dental public health,
epidemiology
and prevention
Dental public health 1
Oral health epidemiology 3
The prevention of oral diseases 4
The wider determinants of
health 5
Oral health promotion 6
Common risk factors 6
Barriers to healthy behaviours 7
Changing disease levels 8
Caries risk 9
Diet and dental caries 10
Fluoride 12
Modes of action 12
Smoking and oral health 16
Smokeless tobacco and oral
health 17
Electronic cigarettes and oral
health 18
1
Hookah (shisha) and oral health 19
Alcohol consumption and oral
health 19
Other substance abuse and oral
health 21
HIV infection and oral health 21
Prevention of dental neglect 22
Sport trauma 23
Temporomandibular disorders 23
Frequency of dental attendance 23
Routine scale and polish 23
Prevention in older patients 24
Pregnancy and oral health 25
Oral health in special population
groups 25
Conclusion 26

Dental public health

Definition
This is a non-clinical specialty involving the science and art of preventing oral
diseases, promoting oral health to the population rather than the individual.
It involves the assessment of dental health needs, developing policy and
strategy and ensuring appropriate dental health services to meet the needs
of the population.

Dental Public Health (DPH) is concerned with the oral health of a

population rather than individuals and has been defined as the
science and art of preventing oral diseases, promoting oral health
and improving the quality of life through the organized efforts of
society. Dental public health practice requires an understanding of
the challenges in the delivery, planning and management of health
services in order to ensure that the provision of health services meets
the needs of the population. This dental specialty requires specific
skills in undertaking oral health needs assessments and developing
specific oral health policies and strategies that protect and promote
2 • C L I N I C A L D E N T I S T RY

population level oral health. It also involves a comprehensive under-

standing and appreciation of the principles and methods that under-
pin oral health promotion, oral health inequalities, the wider
determinants of health and health behaviour.
Oral health has improved in the UK over the last 30 years, but there
is evidence that inequalities have widened. With limited funding and
the ever-growing evidence base for interventions, dental public
health specialists must make decisions, develop policies and imple-
ment strategies that are based on the best available scientific evidence
in order to meet oral health goals, reduce oral health inequalities and
sustain necessary resources. Such activities also involve the system-
atic use of data and information systems, application of programme
planning frameworks, engagement with the communities in the
decision-making process, conducting sound evaluation and dissemi-
nating lessons that have been learnt.
The evidence-based decision-making process which is applied
in dental public health integrates best available research evidence,
practitioner expertise and other available resources including the
characteristics, needs, values and preferences of those who will
be affected by the intervention. Once health needs are identified
through a community assessment, the scientific literature can iden-
tify programmes and policies that have been effective in addressing
those needs. However, the amount of available evidence can be
overwhelming.
There are many types of evidence (e.g. randomized controlled
trials, cohort studies, qualitative research) and the best type of evi-
dence depends on the question being asked. Not all types of evidence
(e.g. qualitative research) are equally represented in reviews and
guidelines. The concept of a ‘hierarchy of evidence’ can be problem-
atic when appraising the evidence for public health interventions
as not all populations, settings and health issues are necessarily
represented in evidence-based guidelines and/or systematic reviews.
An important objective for those engaged in evidence-based dental
public health is to improve the quality, availability and use of evi-
dence in public health decision-making. The wide-scale implementa-
tion of evidence-based dental public health requires not only a
workforce that understands and can implement the evidence base for
dental public health efficiently but also sustained support from health
department leaders, practitioners and policy makers.
Evidence-based practice guidelines are based on systematic reviews
and/or meta-analyses of research-tested interventions and can help
practitioners select interventions for implementation.

• Systematic reviews use explicit methods that focus on a particular

research question which locates and critically appraises all high
quality research evidence relevant to that question. They result
 Dental public health, epidemiology and prevention • 3

in reports and recommendations that summarize the effectiveness

of particular interventions, treatments or services and often
include information about their applicability, costs and implemen-
tation barriers.
• Meta-analysis is a statistical technique to combine pertinent data
from several studies to develop a single conclusion that has
greater statistical power. The benefits of meta-analysis include a
consolidated and quantitative review of the large, complex and
sometimes conflicting body of literature.

The Cochrane Library (http://www.cochranelibrary.com) is an

online collection of databases that contain different types of high-
quality, independent evidence to inform healthcare decision-making.
The Centre for Evidence-based Dentistry (CEBD; http://www.cebd.org)
sets out an approach to systematizing the evidence for different
research questions, with the highest level of evidence being system-
atic reviews and randomized clinical trials, with case series and
expert opinion as the lowest level of evidence.
To find evidence tailored to their own context, practitioners may
need to search resources that contain original data and analysis.
Peer-reviewed research articles, conference proceedings and techni-
cal reports can be found for example in PubMed (http://www.ncbi
.nlm.nih.gov/pubmed). Maintained by the US National Library of
Medicine, PubMed is the largest and most widely available biblio-
graphic database of biomedical literature.

Oral health epidemiology

Epidemiology, which is defined as the study of disease distribution
and its determinants in specified populations, is the basic science of
public health because it studies the patterns, causes and effects of
health and disease conditions in human populations. It is the corner-
stone of public health and informs policy decisions and evidence-
based practice by identifying risk factors for disease and targets for
preventive health care. Furthermore, epidemiology has been used to
generate much of the information required by public health profes-
sionals to develop, implement and evaluate effective intervention
programmes for the prevention of disease and promotion of health,
such as the eradication of smallpox, the anticipated eradication of
poliomyelitis, and prevention of diphtheria, tetanus, measles, menin-
gitis and mumps, heart disease and cancer. The ‘art’ of epidemiology
is knowing when and how to apply the various epidemiological strat-
egies to answer specific health questions. Such designs include
descriptive epidemiological studies (such as cross-sectional or
surveys) and analytical (such as cohort studies, case-control studies
and randomized clinical trials).
4 • C L I N I C A L D E N T I S T RY

Dental caries is a public health concern and collecting data on its

prevalence, incidence and trends is an important field in oral health
epidemiology. Definitions used include:
• Prevalence: the proportion of individuals with disease (cases) in
a population at a specific point in time.
• Incidence: the number or proportion of individuals in a popula-
tion who experience new disease during a specific time period.
• Trend: the changes or differences in the prevalence or incidence
of disease with respect to time.

The prevention of oral diseases

The major oral diseases – dental caries, periodontal disease and
mouth cancer (see Chapter 3) – are not inevitable, but are to a large
extent influenced by the wider determinants of health, i.e. psychoso-
cial, economic, political, environmental, social and lifestyle factors.
The aetiology of these conditions is increasingly well understood and
prevention is largely possible if appropriate policies and strategies are
in place which influence or assist people in adopting appropriate
changes in behaviour.
Prevention is defined in three stages:

• Primary prevention – steps taken to ensure disease does not occur

• Secondary prevention – promoting early intervention in those already
affected to halt progression at incipient stage of disease
• Tertiary prevention – treatment of well-established disease to restore
function and avoid further episodes

The prevention of oral diseases can also be regarded as measures

applied either on a population basis, or at an individual level. Examples
of measures applied on a population basis include water fluoridation
and health promotion campaigns. Preventive measures on an indi-
vidual basis can be applied either by a dental professional (e.g. fluo-
ride varnish, fissure sealants, diet counselling, smoking cessation) or
by the individual, e.g. tooth-brushing.
In the developed world, dentistry has traditionally taken a
‘treatment-oriented’ approach, with the view that individuals were
reliant on dental professionals for maintenance of oral health, but
recent decades have seen a change to a more ‘preventive-oriented’
approach. Factors influencing this transition include:
• increased understanding of the nature of dental caries, periodon-
tal disease and other oral diseases
• increased appreciation of the shortcomings of traditional restora-
tive dentistry
 Dental public health, epidemiology and prevention • 5

• increased evidence based on preventative approaches

• changing aspirations of patients (perhaps of greatest
importance).

The wider determinants of health

Oral health and general health are determined by a complex interac-
tion between individual characteristics, lifestyle and the physical,
social and economic environment. People living in poorer areas tend
to have worse oral and general health when compared to those living
in more affluent areas. Given the close links between oral health and
other indicators such as family income, there is increasing pressure
to tackle the wider social determinants of health through the imple-
mentation of appropriate interventions. The wider social determi-
nants of health (Figure 1.1) are the circumstances in which people
are born, grow up, live, work, and age. These circumstances are in
turn shaped by a wider set of forces: economics, social policies and
politics.
Oral health inequalities are the ‘differences in oral health status
between different population groups’. Inequalities in oral health exist
between social classes, countries within the United Kingdom and
among certain minority ethnic and population groups. Oral health
inequalities can only be reduced through the implementation of
effective and appropriate oral health promotion policies and strate-
gies which tackle the wider social determinants of health. The

General socioeconomic,
cultural and environmental conditions
Living and working
conditions
Social and
community networks
Individual
lifestyle factors

• Work environment Individuals • Housing

• Unemployment (age, gender and • Water and sanitation
• Education genetic factors) • Agriculture and food
• Healthcare services production

Figure 1.1 Determinants of health (based on Dahlgren G & Whitehead M 1991

Policies and strategies to promote social equity in health. Institute for Future
Studies, Stockholm (Mimeo).
6 • C L I N I C A L D E N T I S T RY

improvements in oral health over the last 30 years have been largely
a result of fluoride toothpaste and social, economic and environmen-
tal factors.

Oral health promotion

Health promotion is the process of enabling people to increase control
over, and to improve their health (World Health Organization
[WHO]). It moves beyond a focus on individual behaviour towards a
wide range of social and environmental interventions. Health pro-
motion describes activities and actions designed to enhance positive
health and prevent ill-health by a combination of prevention, health
education and health protection. There are a number of approaches
that can be chosen when planning an oral health promotion initia-
tive including: settings (e.g. nurseries, schools, care homes), popula-
tion group (e.g. children, pregnant women, adults, vulnerable
groups) and topic based (e.g. dental caries, periodontal disease, oral
cancer).
Prevention. Described above.
Health education. Any combination of learning experiences
designed to help individuals and communities improve their health
by increasing their knowledge or influencing their attitudes (WHO).
It involves the provision of information aimed at influencing beliefs,
attitudes and behaviour relating to oral and dental health. In its
widest sense, it also includes provision of information about access
to and appropriate use of health services.
The key messages for oral health (see Chapter 3) are: reduce the
intake of sugar-containing food and drink, particularly the frequency
of sugar consumption and avoid between-meal sugar snacks; brush
teeth twice daily with a toothpaste containing fluoride; attend the
dentist regularly; do not use tobacco; reduce alcohol consumption.
Health protection. The practice of a nation to protect, improve and
restore health of individuals in a community or entire populations.
It functions through collective societal activities, programmes, serv-
ices and institutions aimed at improving health of people. It com-
prises laws, regulations, policies and voluntary codes of practice
aimed at preventing disease and enhancing health, e.g. legislation
making use of car seat-belts compulsory, thereby reducing the preva-
lence of maxillofacial injuries due to road traffic accidents.

Common risk factors

Traditionally, there has been an emphasis on dental health educa-
tion, either with individuals or groups, which has focused on impart-
ing knowledge. It has been shown that conventional oral health
 Dental public health, epidemiology and prevention • 7

Risk conditions

Risk factors Diseases Risk factors

Diet Obesity Tobacco
Cancers
Stress Heart disease Alcohol
School Workplace
Respiratory disease
Control Dental caries Exercise
Periodontal disease
Policy Hygiene Trauma Injuries Housing

Political Physical Social

environment environment environment
Figure 1.2 Common risk approach. Reproduced from Watt RG, Sheiham S 2000
The common risk factor approach: a rational basis for promoting oral health.
Community Dentistry and Oral Epidemiology 28(6):399–406 with permission
from John Wiley.

education is neither effective nor efficient (Kay and Locker, 1996),

especially if these oral health programmes only concentrate on indi-
vidual behaviour change and do not take into account the influence
of socio-political factors as the key determinants of health.
The common risk factor approach (Figure 1.2) takes a broader
perspective and targets risk factors common to many chronic condi-
tions and their underlying social determinants. The key concept of this
approach is that concerted action against common health risks and
their underlying social determinants will achieve improvements in a
range of chronic health conditions more effectively and efficiently
than isolated, disease-specific approaches. This approach acknowl-
edges that many diseases have common predisposing risk factors to
oral health. A poor diet that is high in sugars, and smoking are
examples of behaviours which impact adversely upon oral as well as
general health. As these causes are common to a number of other
chronic diseases, adopting a collaborative approach is more rational
than one that is disease specific. It also recognizes that engendering
lasting changes in individual ‘lifestyle’ behaviours requires support-
ive social, economic and political environments.

Barriers to healthy behaviours

The principle of health education is that by provision of appropriate
information and circumstances, beliefs and attitudes of individuals
8 • C L I N I C A L D E N T I S T RY

Upstream
Stop! Do not
‘Causes of the
jump in
causes’

General
politics Midstream
Help Help
Social policy

Public health policy + strategy

Health promotion Health care and services

Downstream

Lifestyle
Economy Life chances Health Quality of life
and environment

Figure 1.3 Upstream and downstream approaches.

will be affected sufficiently to result in the adoption of behaviour

likely to enhance health and diminish the chance of disease. However,
dental disease is heavily influenced by socioeconomic and other con-
straints that may restrict the choices available. Whilst parents may
realize that fresh fruit is preferable to chocolate bars, non-availability
or price may preclude its provision. Similarly, sugar-containing food-
stuffs are often given to children not only when they are hungry but
also as a reward or a pacifier.
The dominant preventive approach in dentistry, i.e. narrowly
focusing on changing the behaviours of high-risk individuals, has
failed to effectively reduce oral health inequalities, and indeed may
have increased the oral health equity gap. A conceptual shift is
needed away from this biomedical/behavioural ‘downstream’
approach, to one addressing the ‘upstream’ underlying social deter-
minants of population oral health (Figure 1.3).
Failure to change our preventive approach is a dereliction of
ethical and scientific integrity (Public Health England, 2014).

Changing disease levels

Dental disease levels in the UK population have reduced significantly
in the last three decades.
 Dental public health, epidemiology and prevention • 9

The 2009 Adult Dental Health Survey demonstrated that the pro-
portion of edentulous adults fell dramatically from 30% in 1978 to
6% in 2009. However, the survey also showed that stark inequalities
exist. For example, people from managerial and professional occupa-
tion households had better oral health (91%) compared with people
from routine and manual occupation households (79%) (The Health
and Social Care Information Centre, 2011).
The 2013 National Children’s Dental Health Survey (Office for
National Statistics, 2015) showed that there were reductions in the
extent and severity of tooth decay present in the permanent teeth of
12 and 15 year olds overall in England, Wales and Northern Ireland
between 2003 and 2013.
Large proportions of children, however, continue to be affected by
disease, and the burden of disease is substantial in those children that
have it. In 2013, nearly a half (46 per cent) of 15 year olds and a
third (34 per cent) of 12 year olds had “obvious decay experience” in
their permanent teeth. This was a reduction from 2003, when the
comparable figures were 56 per cent and 43 per cent respectively.
Furthermore, nearly a third (31 per cent) of 5 year olds and nearly
a half (46 per cent) of 8 year olds had obvious decay experience in
their primary teeth. Untreated decay into dentine in primary teeth
was found in 28 per cent of 5 year olds and 39 per cent of 8 year
olds. Overall, 58 per cent of 12 year olds and 45 per cent of 15 year
olds reported that their daily life had been affected by problems with
their teeth and mouth in the past three months.
Caries still affects a large number of children in lower socioeco-
nomic groups and within some ethnic minorities, as do its sequelae
(odontogenic infections; Chapter 3). There is a threefold difference in
levels of caries between the least and most deprived communities.
Upstream action addressing risks, beliefs, behaviours and the living
environment by ensuring appropriate policies and strategies are in
place are probably as important as affordable access to professional
treatment. This follows the sentiment of the Marmot Review ‘Fair
Society, Healthy Lives’, which dominates the wider public health
agenda of tackling avoidable differences in health using an ‘upstream’
approach. An upstream approach is when trying to change people’s
individual behaviours (such as encouraging the use of fluoride tooth-
paste with tooth brushing or adding fluoride to the water supply),
leads to beneficial effects flowing ‘downstream’ in the reduction in
dental treatment required due to a reduction in caries prevalence in
the population.

Caries risk
The ability to determine susceptibility to dental caries on either a
population or individual patient basis would offer a number of
advantages.
10 • C L I N I C A L D E N T I S T RY

Population basis. Permits developing appropriate policies and strat-

egies which seek to target resources, the location of clinics and the
implementation of preventive programmes.
Individual basis. Determines the need for caries control measures
such as socioeconomic factors, existing caries status, clinical judge-
ment of dental professional, the timing of dental recall appointments,
decisions as to suitability for advanced restorations, suitability for
orthodontic treatment.
Various tests have been devised for determining caries risk such as:
• counts of salivary lactobacilli (Dentocult LB), mutans streptococci
(Dentocult SM)
• tests of salivary buffering capacity (Dentobuff).
These tests have met with limited success as, due to the multifactorial
aetiology of dental caries, variation precludes accuracy and consist-
ent estimation of the caries susceptibility of an individual patient at
the chairside. The clinical judgement of the dental clinician, current
caries experience and socioeconomic factors of the patients have
proven the most reliable indicators of caries risk assessment. Deter-
mination of disease risk is an important factor in determining how
frequently patients should attend for preventive dental care such as
fluoride varnish applications, fissure sealants, etc.

Diet and dental caries (see also Chapter 3)

Evidence that sugar causes caries
There is clear and extensive evidence of the relationship between the
frequency and amount of sugar consumption and the prevalence and
severity of dental caries:
• epidemiological data show a correlation between sugar consump-
tion and caries on a national basis
• caries prevalence is higher in communities with high sugar
intake, e.g. sugar cane and confectionery industry workers
• caries prevalence increases following introduction of a sugar-
containing diet in isolated communities, e.g. the Inuit, island
communities such as Tristan da Cunha
• experimental clinical studies (such as Vipeholm Study) investigat-
ing the relationship between sugar intake and dental caries show
positive correlation between consumption of sugar (between
meals and at meals) and caries increment
• caries decreases following restriction of sugar, e.g. wartime diets.
Recently a number of research papers have argued that the increased
availability of fluoride has lessened the impact of sugar in the aetiol-
ogy of dental caries. However, there can be little doubt that a diet rich
 Dental public health, epidemiology and prevention • 11

pH
Plaque pH
Critical pH 5.5
Safe Net loss of calcium and phosphate ions below critical pH
zone

Danger
zone

6 7 8 9 10 11 12
Bottle Breakfast Snack Sippy cup Sippy cup Lunch
Figure 1.4 The effect of repeated sugar consumption.

in sugar, particularly if consumed at frequent intervals, will result in

caries development.

Factors influencing cariogenicity of foods

Cariogenic potential is related to consistency: sticky retentive foods
are more cariogenic than liquid non-retentive forms, e.g. toffee is
more cariogenic than chocolate.
The frequency of consumption is crucial. Snacking or ‘grazing’ results
in plaque pH being below the point where net outflow of calcium and
phosphate ions from the tooth surface occurs for prolonged periods
(Figure 1.4).

Dietary advice
The factors related to changing behaviour are particularly important
in encouraging patients to adopt a less cariogenic diet. Effective
dietary counselling requires knowledge of a patient’s habits relating
to non-milk extrinsic sugar consumption.

Diet diary
• Useful for those with high caries experience
• Must encourage patient to complete accurately
• Should cover a 3-day period including either Saturday or Sunday
• When completed, analyse with patient; highlight cariogenic food-
stuffs, particularly hidden sugars
• Allows formulation of personal advice for each individual
• Where possible, advise patient (and parent) in both written and
verbal form.

The ultimate message is ‘eat less sugar and eat sugar

less often’.
12 • C L I N I C A L D E N T I S T RY

Non-sugar sweeteners. Non-cariogenic and useful sugar

substitutes.
Bulk sweeteners, e.g. sorbitol and xylitol, provide calories and bulk;
useful as sugar substitutes in confectionery, chewing gum and
medicines.
Intense sweeteners, e.g. saccharin and aspartame are calorie free;
popular in ‘slimmers’ foods’.
From a dental point of view, whilst bulk and intense sweeteners
are non-cariogenic and therefore useful sugar substitutes, use of arti-
ficial sweeteners also perpetuates the craving for sweet foods.
‘Tooth-friendly’ sweets. Identified by the ‘tooth-friendly’ logo, these
sweets contain non-sugar sweeteners. Their use should be restricted
in small children due to possible adverse effects on the gastrointesti-
nal system (e.g. diarrhoea).
Chewing-gum. Sugar-free chewing-gum stimulates saliva and thus
increases salivary buffers and enhances washout of sugar. May be of
benefit in some patients, but should not be viewed as a prime caries-
preventive measure.
Carbonated beverages. Carbonated drinks have a pH of 2–3 and
can cause marked loss of tooth structure via erosion – an increasing
problem in teenagers. Even ‘diet’ varieties can lead to erosion.
Detersive foodstuffs. Contrary to previous beliefs, detersive foods
are of little or no benefit in removal of plaque. Effective plaque
removal is dependent on tooth-brushing. However, carrots, apples,
etc. are preferable to high-sugar snacks.

Fluoride
Evidence for the efficacy of fluoride in the prevention of dental caries
is incontrovertible. A series of systematic reviews published by the
Cochrane Library have concluded that children who brush their
teeth at least once a day with toothpaste that contains fluoride will
have less tooth decay. These reviews have also shown that fluoride
has a caries preventive action when delivered in vehicles other than
toothpaste. Public Health England (PHE) has published a report
‘Water fluoridation health monitoring report for England 2014’. The
report provides further reassurance that water fluoridation is a safe
and effective public health measure. PHE continues to keep the evi-
dence base under review.

Modes of action
Systemic (pre-eruptive) effect. Fluoride ions are incorporated into
enamel structure in the form of fluor-apatite during tooth formation.
This decreases the mineral solubility.
Another random document with
no related content on Scribd:
 “That’s no good here and you know it’s no good,” said the officer.
“Wainboro! And a year old too. Why didn’t you come and get your
permit when you got to town? You’ve been in this game long enough
to know you’ve got to do that. All these concessions have permits,
except those under carnival management.”
“Some towns—” began McDennison.
“Never mind about some towns. You know you’ve got to get a
permit in this town. Why didn’t you do it?”
The harassed performer began again, “You guys⸺”
“Never mind about that now,” said the officer. “I was sent here to
see your permit and to bring you down to the office if you didn’t have
it. You know all about it; you were at the Elks’ Fair three years ago.
You better come along and get your permit, Charlie. You’ll have to
take care of a fine, too.”
“You don’t mean now?” the diving wonder asked. “Ain’t you going
to leave me do my trick? I go on in about five minutes. You fellers
sure got the knife in us. If I belonged in this here town⸺”
“Come on, McDennison,” said the officer in a way of quiet finality.
“You know the game as well as I do. We’re not interested in your
trick, only your permit. Come on, get your duds on. I guess you’ve
been through all this before. Come on, speed up.”
Diving Denniver cast his cigarette from him, bestowing a look of
unutterable contempt on the officer. In that sneering scorn he
seemed to include the whole of Farrelton and all constituted
authorities the world over. And Hervey joined him in his contempt
and loathing. Diving Denniver had been through all that before. He
knew the permit towns and the non-permit towns and the towns
where a “tip” would save him the expense of a permit. Hervey had
not dreamed that this enchanted creature ever had to do anything
but dive, he did not know that the wonder of two continents had hit
Farrelton penniless.
I will not recount the language used by Diving Denniver as he
pulled on a shabby suit of clothes and threw a funny little derby hat
on the back of his head. How prosaic and odd he looked! But his
language was not prosaic; it was quite as spectacular as his famous
exploit—his trick, as he called it. Poor McDennison, it was all he had
to sell—his trick. And sometimes he had so much trouble about it.
A funny little figure he made trotting excitedly along with the
officer, his derby hat on the back of his head bespeaking haste and
anger. He smoked a cigarette and talked volubly and swore as he
hurried away, leaving Hervey staring aghast.
Such a troublesome and distracting thing it is to be a wonder of
two continents.
 CHAPTER XXIX
THE WHITE LIGHT
Well at all events, Hervey might now inspect freely the sanctum of
the diving wonder. His enthusiasm for the hero was not dimmed.
Even the derby hat had not entirely covered up Diving Denniver.
Here was just another exhibition authority. That a cop should make
so free with Diving Denniver, even calling him Charlie!
Hervey went into the tent, and stood looking about. Muffled by the
distance he could hear the frightful monotonous music of the merry-
go-round playing Little Annie Rooney for the millionth time. On the
red board were strewn the leavings of Diving Denniver’s supper. The
smutty little oil-stove reeked of kerosene. A long, up-ended box did
duty as a washstand and on this, beside a tin basin, was the
photograph of a girl. A couple of candles burned and sputtered. On
the tent pole hung a broken mirror.
Diving Denniver’s bathrobe and his white bathing suit trimmed
with gold braid lay on the converted couch just as he had thrown
them in his hurry and anger. The very bathrobe, half off and half on
the couch, seemed eloquent of his high disgust at the tyrannical
interruption of his work. Hervey surmised that he would speak with
the management of the carnival on his way out; he wondered why
the two had not gone in that direction. But in truth the diving wonder
did not love his public enough to consider it in his sudden dilemma.
He never went up when the wind was strong. And he was not
thinking of the expectant throng now.
Hervey longed to don that gorgeous exhibition suit. Could he slip it
on in a hurry? With him it was but one step from impulse to action
and in a few seconds he had thrown off his suit and was gazing at
himself in the dirty old mirror, clad in the white and gold habiliments
of the international wonder. How tightly it fitted! How thrillingly
professional it made him feel! What a moment in his young life!
Suddenly, something very extraordinary happened. The trodden
grass at his feet shimmered with a pale brightness. Clearly he saw a
couple of cigarette butts in the grass. It was as if some one had
spilled this brightness on the ground. Then it was gone. And there
was only a dim light where the candles sputtered on the makeshift
table. That was a strange occurrence.
He stepped out of the tent and there was the patch of brightness
near the Ford sedan. How plainly he could read the flaunting words
on the spare tire, THREE HUNDRED FOOT DIVE. Then suddenly,
the square tank and the foot of the dizzy ladder were bathed in light.
A long, dusty column was poking around as if it had lost something.
The sedan was again illuminated. The bright patch moved under the
tent and painted an area of the canvas golden. Was it looking for
Diving Denniver, the wonder of two continents, to come forth and
make his three hundred foot dive?
It found the tank and the ladder again and made them glowing
and resplendent. Then there was wafted on the air the robust sound
of the band playing real music. It drowned the tin-pan whining of the
merry-go-round and sent its rousing strains over the fence which
bore the forbidding sign. What a martial tumult! It made the cane
ringers pause, sent the carriers of kewpie dolls to a point of vantage,
and left the five-legged calf forlorn and alone. Louder and louder it
sent forth its rousing melody.
Come take a ride o’er the clouds with me
Up in the air mid the stars.
Hervey Willetts stood petrified. He was in the hands of the gods—
or the devils. I have sometimes wondered if he ever, ever thought.
Behind every act, good or bad, there is some kind of intention. And I
have told you about boys whose intentions were not of the best. But
what of this boy? There was just never anything behind his acts. No
boy could catch him. Yet the band and the waiting light caught him.
And what did they do to him? The light seemed to be waiting for him,
there at the foot of the ladder. All else was darkness. Only the area
of brightness bathing the ladder and the big tank with its metal
corners. It seemed to say, “Come, I am going up with you.” And, God
help him, he went to it as a moth flies to a flame.
When he had ascended a few feet, he remembered that Diving
Denniver went up very slowly seeming to test each rung. He knew
now that this had been for effect and to make the climb seem long.
For the rungs were sound and strong. Also the performer had
occasionally extended his arm. The substitute realized that there had
been good reason for that, for the breeze was more brisk as he
ascended and he knew that the diver had thus held out his hand by
way of keeping tabs on the breeze.
The small tank permitted no divergence from the straight descent.
To land outside it⸺
He went up slowly, but did not pause at each rung. He could be
reckless, but not theatrical. But he did hold out his hand every few
feet and the gay breeze cooled his sweaty palm. Was the wind too
strong? What would Diving Denniver do? Go back? But in any case
Hervey could not do that. He never turned back.
He continued ascending, up, up, up. He could feel the ladder
sway a little. When he was about half-way up, the breeze made a
little murmur where it was cut by one of the wires extending off
slantingways, far off down to the earth somewhere. It was funny how
he could see these wires in the circle of light that had accompanied
him in his long climb, but could not follow them with his eyes to their
distant anchorages. Each wire disappeared in the darkness, and he
had an odd fear that they did not go anywhere. He saw the lights of
the carnival, but no human beings. Were they gazing at him—
hundreds of upturned faces?
Up, up, up he went. Was there no end to it? Now he did really feel
the force of the breeze. Was it too strong? How could he decide
that? He could hear the band, but he knew it would cease playing
when he reached the top. In that one brief moment of suspense it
would cease playing. His companion light moved with him like a
good pal. And beyond and below all was darkness except for the
lights of the carnival.
Up, up, up he climbed. And he came at last to the little platform at
the top, as big as the top of a stepladder. It was just a little shelf fixed
to the fifth or sixth rung from the top. But the part of the ladder above
that would serve as a back and he could lean against it. By fancying
the ground was right below him, by eliminating the distance from his
mind, he was able to squirm around and get onto this tiny shelf. He
did not know how Diving Denniver did this, but he managed it.
Standing on the little shelf and leaning back, he could feel the
ladder shake under him. Of course, there were several ladders
clamped together and the extending wires could not hold the
towering structure absolutely taut. But it was steady at the top.
Far below him was a square frame of lights marking the sides of
the tank which had been illuminated during his ascent. Within it the
water shimmered. His senses swam and he closed his eyes, then
opened them and got control of himself. A straight down dive would
do it. Would it? Yes, he was sure. He let go the ladder and laid his
two hands palm to palm above his head.
There was no music now.
HERVEY MADE THE GREAT DIVE.
 CHAPTER XXX
STUNT OR SERVICE
The next thing he knew he was lying propped up against a tree
and people were crowding about him. He knew this was not in tribute
to him for he heard a voice say, “Some crazy little fool, all right.”
“Did you ’phone?” he heard some one ask.
“Yes, he’ll be here soon.”
“He isn’t the regular one, is he?” another asked.
“Don’t ask me,” another answered; “I just followed the crowd.”
All the while a boy in a scout suit was moving his hand around
near Hervey’s foot. Emerging from his stunned condition, Hervey
had an odd impression that this boy was stirring something in a bowl.
Far off was the monotonous, incessant music of the merry-go-round.
Then, as Hervey blinked his eyes and brushed his soaking hair back
with a wet hand it seemed as if this boy were playing the music, for
his hand moved in time with that muffled clamor. Hervey lapsed off
into unconcern again and closed his eyes. It was only giddiness.
When he opened them again, he watched the boy with a kind of
detached curiosity. He felt a tightening sensation in his leg. Then he
realized that the boy had been drawing a bandage tighter and tighter
around his calf by revolving a stick. Still Hervey was only vaguely
interested.
“Stopped?” some one asked.
“Yep,” said the boy. He sat at Hervey’s feet with hands clasped
around his drawn-up knees. Soon he arose and stood looking as if to
ascertain on his own account if some one were coming.
“Who are you looking for?” Hervey asked weakly.
“The doctor,” answered the boy. He was a tall boy. As he stood
looking, he kicked something with his foot.
“What’s that?” Hervey asked.
 The boy picked it up and dangled it in front of him, laughing. It was
just about recognizable as the body of a kewpie doll, and it was a
ghastly sight, for the head hung loose and the body was mangled
and out of shape. “Glad you’re not as bad off as that, hey?” said the
scout. “I won that blamed thing ringing canes and I got—I bet I got
three yards of cloth off it; there goes.” And twirling it cruelly by one
leg, he hurled it gayly over the heads of the throng.
“You people get away from here, go on,” said the robust voice of a
policeman. “Go on, all of yer, get away from here; he ain’t hurt much.
Go on, chase yourselves, you kids.”
“He can’t chase me anyway,” said Hervey.
“That’s a good one,” laughed the boy. “Nor me either; I’m the
surgeon general or whatever you call it.”
“You can’t chase me,” said Hervey to the policeman. “That’s
where I’ve got the laugh on you.”
“If I was your father, I’d chase you to the padded cell,” the
policeman commented, then busied himself clearing away the
loiterers.
The scout examined his twisted bandage and gave it one more
twist. Then he sat down on the ground beside Hervey. Two or three
men and the policeman lingered about, but did not bother these two.
“That was some crazy stunt all right,” said the scout.
“Did I—where did I fall?” Hervey asked.
“You went in the tank, but only just, I guess. Your foot must have
knocked the edge; four of the electric bulbs were broken. I don’t think
there’s any glass in your foot; anyway, I stopped it bleeding. Gee,
boy, I did murder that kewpie doll! How the dickens did you happen
to do that, anyway?” Hervey told him briefly.
“Good night, some daredevil! I dived to-day, but I had the whole
river to dive in. Me for that tank stuff—not.”
“Are you a scout in this town?” Hervey asked. “Yep, South
Farrelton. I was here last night and I had my fortune told and the old
woman told me I’d be lucky. I was all right. And believe me, so were
you.”
“How were you lucky?” Hervey asked.
 “Oh, things came my way. I’m here with my patrol to-night; I guess
the cop chased them—good thing. They’d have trampled all over
you.”
“They’re always chasing people,” Hervey said. “They came and
got that diving wonder even, they’re so blamed fresh. And he’s a
wonder of two continents. Anyway, I’m always lucky.”
“I’ll say you are!”
“I’m going out to Montana, maybe to South America. I bet you can
do what you want down there. They weave Panama hats under the
water; gee, I bet I could do that. I always land right side up, that’s
one thing about me.”
“It’s a darned good thing,” said the scout.
Hervey did not bother to ask him his name, but the boy told him; it
was Wyne Corson. “That’s a good first name, hey?” he said. “Wyne?
It’s better than lose. There’s a scout in our troop named Luze—they
call us Win and Lose. He’s a Hungarian on his great granddaughter’s
side, I guess. Here comes the crowd back; I guess the doctor’s
coming.”
The doctor came and kneeled down, brisk, smiling and efficient.
He seemed not to take any interest in the spectacular exploit, only in
the injured foot. “Well, I guess you’re all right,” he said after treating
and bandaging the foot. “You won’t be able to run any marathon
races to-morrow.”
“Can I the next day?” Hervey asked.
“No, you can’t the next day,” the doctor laughed. “Who’s going to
take you home?”
Then he offered to do it himself and Wyne Corson got the hero’s
brown shirt and knickerbockers from the tent and maneuvered him
into them. He even placed the treasured hat on his head at an
unconventional angle. He seemed to have an inspired appreciation
of Hervey’s bizarre character. Then they helped him to the waiting
car. Gaping stragglers watched the self-appointed understudy of the
diving wonder as he limped between the doctor and the scout, past
the enclosure of the five-legged calf, and around the festooned
platform where the merry dance was on. Whirling couples paused to
stare at him and one girl ran out and boldly inspected the celebrity
from head to foot. “Oh, he has the brightest eyes,” she confided to
her waiting partner, “and the funniest little hat with all sorts of buttons
on it. Do you know who he reminds me of? Peter Pan.”
At the doctor’s car half a dozen scouts stood about gazing at
Hervey. They hardly knew what to make of him, but they had a kind
of instinctive respect for him and showed it. I am not sure that this
was just on account of his daredevil exploit. There was something
about him and that’s all there is to it. Good or bad, he was different.
“Did I do the right thing?” Wyne Corson ventured to ask the
doctor. He had hoped he might be asked to accompany Hervey, but
apparently this was not to be.
“Oh yes indeed—the only thing,” said the doctor. “You were on the
job and efficient and clever. That’s the kind of thing I like to see.”
“You ought to have seen what he did,” Wyne ventured. Was he
falling for this cracked-brained youngster too?
“I don’t believe I’d care to see that,” said the doctor with brisk
good-humor.
And there stood Wyne Corson with his scout comrades about him.
They did not comment upon his efficiency nor the doctor’s ready
compliment.
“Did he talk to you? What did he say?” asked one.
“Where does he live?” asked another.
“Is he friendly, sort of?” asked a third.
“For the love of Christopher, why didn’t you talk to him
yourselves?” laughed Wyne. “He wouldn’t eat you up. Come on, I’m
going to treat to ice cream again, then let’s go home.”
 CHAPTER XXXI
HOPELESS
He sat in a big old-fashioned chair in the living room with his
injured foot upon a stool, in deference to the powers that be. There
was a knock on the front door and presently young Mr. Ebin Talbot,
scoutmaster, poked his head around the casing of the living room in
a way of mock temerity.
“May I come in and have a look at the wonder of wonders?” he
asked. “How are we; getting better?”
“It hurts a little when I stand on it.”
“Then the best thing is not to stand on it, hey? Like the advice to a
young man about to stand on his head on a steeple—Don’t. Good
advice, huh? Well Herve, old boy, I’ve got you where I want you at
last; your foot’s hurt and you can’t get away from me. Did you ever
hear the story about the donkey that kicked the lion? Only the lion
was dead. Well, I’m the donkey and you’re the lion; I’ve got you
where you can’t jump down my neck. Do you know that was a crazy
thing you did, Herve? You just put yourself in my power. Maybe you
did it so you wouldn’t have to go to school, huh? Where’s your dad?”
“He’s at the store.”
“Have you heard about this conspiracy to send you to military
school?” Poor man, he was trying to reach Hervey by the good pal
method. He drew his chair close and spoke most confidentially. “I
think we can beat it,” he said.
“Leave it to me,” said Hervey.
“You’re not worrying?”
“I’d be there about three days,” said Hervey.
“I think you’d be there about three years, my boy.”
“What do you bet? Everybody’s calling me a crazy daredevil. Do
you think I wouldn’t be enough of a daredevil to get away from a
military school? Bimbo, that’s a cinch.”
It seemed to be something that Hervey was quite looking forward
to; a lure to new adventure. Mr. Talbot went on another tack.
“Well, I thought if we could slip you into the Scouts in time, we
could beat your dad to it.”
“I’ll beat them all to it, all right,” said Hervey vaguely. “They
arrested that wonder—even of two continents he’s a wonder—but I
gave them a good run. I nearly bit that feller’s hand off when he
grabbed me. Do you dare me that I won’t get away from military
school?”
“Oh goodness no, but listen, Herve.” He became soft and serious.
“You can listen, can’t you? You haven’t got anything else to do—now.
You know that boy who put the jigamerig around your leg?”
“Carter—something like that?”
“You don’t remember his name, Herve? Wyne Corson. That fellow
is in the troop they’ve got down in the south end; they’ve got quite an
outfit. One of them—he’s just a kid—wants to have a hat like yours.
When you jumped, you jumped right into the hearts of the Raccoon
Patrol; you didn’t hit the tank at all. Well, that fellow was—now listen,
here’s a knockout for you. Do you know how those fellows happened
to be at the carnival last night?”
“Do you think I bother ringing canes?” said Hervey.
“Well, it’s good he won a kewpie doll, now isn’t it? But that’s not
the knockout. He won a prize yesterday and he was giving his patrol
a kind of a blowout last night at the carnival. I think there’s going to
be a shortage of pop-corn for the next forty-’leven years.”
“Well, yesterday morning he was up the river with that scout—that
little stocky fellow; did you notice him?”
“No.”
“Well, he noticed you. They were up on Blackberry Cliff; as near
as I can make out they’re always out for eats. There was a girl in a
canoe down below; she belongs in that white house right across
from the cliff. What I’m telling you is in this afternoon’s paper—you
can see it. Well sir, the canoe upset, and this Wyne, he dived from
the Cliff—that’s pretty high, you know, Herve, and he got her and
swam to shore with her—now wait. Here’s the punch. He gets the
Ellen C. Bentley reward for this year. You remember nobody got it
last year. He goes on a trip to California next summer—six weeks.
Naturally he was feeling pretty good last night. And he never told you
a word about it! Think of those two things that scout did yesterday!
Dived from a cliff and saved a life, won a trip across the continent,
then put a what-d’ye-call-it around your leg when you might have
bled to death after making a crazy dive that didn’t get you anything—
not one blessed thing.”
“Do you think I didn’t have any fun?”
“Hervey, boy, why did you do it? Why—why did you do it? A crazy
fool thing like that!” Hervey was silent, a trifle abashed by the
seriousness and vehemence of his visitor.
“Why did you do it?”
“I—I couldn’t help it.”
Young Ebin Talbot just looked at him as a wrestler might look,
trying to decide where to take his adversary. “I guess so,” he said
low and resignedly.
But he was not to be beaten so easily. “Hervey, there are only two
boys in this town who could do what Wyne Corson did, and he is one
of them and you’re the other one. Why are you never in the right
place at the right time?”
Hervey flared up, “Do you mean to tell me I don’t know any one
who could do that—what Wyne Corson did? Do you bet me I don’t?”
“Oh, for goodness’ sakes, Hervey! You did a hair-brained thing, a
big stunt if you will; and Corson did a heroic act. And here you are
making bets with me about something of no importance. What’s the
matter with you? Why I was paying you a compliment!”
“You said I don’t know anybody who could swim out like that. Do
you say I can’t—do you dare me⸺”
Young Mr. Talbot held up his hand impatiently. Hervey not only
never did the right thing, but he even couldn’t talk about the right
thing. Like many men who are genial in hope, he was impatient in
failure. He had not Mr. Walton’s tolerant squint.
“Please don’t dare me, Hervey. Dares and stunts never get a boy
anywhere.”
 “How do you know how many fellers can do a thing?” Hervey
demanded.
“Well, all right then, Hervey, I don’t,” said Mr. Talbot rising. “But let
me just say this to you. I know you could do what Corson did
yesterday and it was a glorious thing, and brings him high reward.
Also, if it’s any satisfaction for you to know it, I believe you could find
a way of escaping from a military school. You see, I give you full
credit. I think there is hardly a single thing that you could not do—
except to do something with a fine purpose. Just to stand on your
head isn’t enough; do you see? The first time you do a brave,
reckless thing for service you’ll be the finest scout that ever lived.
None of them can touch you on action, but action means nothing
without motive. It’s just like a car jacked up and the wheels going
round; it never gets anywhere.”
“Didn’t I do a service to Diving Denniver?” Hervey demanded.
“Well, did you? Honor bright; did you? Did you want to help him?
Was that the idea? Come on now, Hervey. Fair and square, was it?”
“No, it wasn’t.”
“You did it because⸺”
“Didn’t I tell you it was because I couldn’t help it?” said Hervey
angrily.
 CHAPTER XXXII
UPS AND DOWNS
Young Mr. Talbot gave Hervey up. I think he lost patience too
readily. As for Mr. Walton, he was past the stage of quiet argument
with his stepson. He was as firm in resolve as he was patient in
discussion. And never was Hervey more bent on action that was his
harassed guardian from the moment he was apprised of the carnival
escapade. Even gentle Mrs. Walton, who had pled after the satchel
episode, thought now that it was better for Hervey to go to military
school than to break his neck.
“Well, he won’t even break rules there,” said Mrs. Walton.
As for Hervey, he was not worrying about military school. He
never thought or worried about anything. He would meet every
situation as it came. He was not staggered by Wyne Corson’s
opportunity to go west. To give him credit, he was not selfish or
envious. He forgot all about Wyne Corson.
One matter he did bear in mind and it was the very essence of
absurdity. With his own narrow escape to ponder on, and Wyne
Corson’s splendid deed to thrill him (if he was capable of a thrill) he
must set off as soon as he was able to prove his all-important claim
that there was another individual capable of doing what Mr. Talbot
had said that only he and Corson could do. He accepted the young
scoutmaster’s declaration not as a compliment, but as a kind of dare.
That is how his mind worked and I am giving you just the plain facts.
I told you in the beginning that no one understood him.
But now he was to receive something as near to a shock as he
had ever received. He sought out Diving Denniver in his sanctum
and approached him rather sheepishly (for him) for he knew not how
his feat had impressed the wonder of two continents. It was the last
day of the carnival, the matter of the permit had been adjusted, and
Diving Denniver was that evening to dive for the last time in
Farrelton. On this occasion he wore his regular clothes and his little
derby hat was on the back of his head as he packed his trunk in
anticipation of departure.
“Hello,” said Hervey.
“Hello, yer gol blamed little fool.”
“Well, I did it, didn’t I?” said Hervey defensively.
“Sure you did it, but you were just lucky. You’re just a crazy kid,
that’s all. That there kid that’s got his name in the papers fer savin’ a
girl’s life, now he’s a regular guy, he is. If you want to jump why don’t
you get in the big parade, kid?” He folded some clothing and did not
pay much attention to Hervey as he talked. “If yer want ter pull the
big stuff why don’t yer get in with them guys. This here ain’t narthin’.”
“Do you know what a scoutmaster told me?” demanded Hervey,
somewhat aroused. “He said that only two fellers—me and that other
feller—could dive off that cliff and swim to shore with a girl. So as
long as you’re a friend of mine will you come and show him that you
can do it? Just to show him he’s not so smart. Then he’ll see you’re
a friend of mine, and he’ll see you can do it. Hey? So I can put it all
over him. Hey?”
“Naah, cut that stuff, kid. Why wuz yer thinkin’ I can swim and
save lives? I ain’t much on swimmin’, kid.” He reached over to where
Hervey sat dangling his legs from the makeshift table and good-
naturedly ruffled his hair. “Yer got me wrong, kid. What’s bitin’ yer
anyways? This here is a trick, that’s all it is. I know me little trick.
Why wouldn’ I? I been doin’ it fer seven years. There ain’t narthin’ to
it when yer once get it right. Did yer think this here wuz a kind of an
adventure like? Hand me them two saucers, will yer. Listen here, kid.
Here’s how it is. When yer know how ter do it there’ ain’t narthin’ to
it; see? An’ if yer try it when yer don’t know how, yer a blame fool. I
bet yer kin swim better’n what I can, at that. I jus’ do me turn, kid.
See?”
Hervey was staggered. “Ain’t you the wonder of two continents?”
he asked. “Don’t you say it yourself?”
“Sure thing, and I’m sorry I didn’t make it five continents when I
wuz printin’ it. What’s a couple of continents more or less? Pull that
there broken glass down and let’s have it, will yer? Yer don’t think yer
done narthin’ big do yer?” He paused and faced Hervey for just a
moment. “Dis here is just a trick, kid. Go on and join them kids
what’s doin’ the divin’. Come out o’ yer trance, little brother. You’ze
got the makin’s of a regular hop, skip and jumper, yer has. Wuz yer
old man sore at yer?”
Hervey felt as if the bottom had fallen out of the earth. Not that he
wanted praise and recognition; he never craved those. But what he
had done was just nothing at all. He was no more a hero than a man
who tried to commit suicide is a hero. And the wonder of two
continents was just a good-humored, tough little young man who
knew a trick! How brave and splendid seemed the exploit of Wyne
Corson now! That was not a trick.
“You beat it home now,” said McDennison, “and don’t go inter no
business what yer ain’t got the dope on. A kid like you oughter had
that trip ter the coast. Look at me, I ain’t got the carfare ter open up
in Bridgeburgh Fair.”
Hervey went away, not exactly heavy-hearted, for he was never
that. And not exactly thoughtful, for he certainly was never that. But
disgruntled. And even that was unusual with him. He might have had
that trip to the coast. Or at least on a dozen different occasions, he
might have won such a reward. But for all his fine bizarre deeds he
got just nothing; not even honor. And the pity of it was he could not
figure this out. He never remembered what anybody told him; he
never pondered. Yet I think that poor Diving Denniver did some
good; I think he almost reached him.
On the way home, he was saved from any of the perils of thought
by the allurements of action. Near the entrance to the carnival was a
basket full of booklets about Farrelton the Home Town. There was a
sign above this basket which read. Free—Take One. Hervey did not
take a booklet, but he took the sign. It was an oblong wooden sign
and had a hole in it to hang it up by. By inserting a stick in this hole,
he could twirl the sign around as he ambled homeward. He became
greatly preoccupied with this pastime and his concentration
continued till he reached the Aunt Maria Sweet Shoppe. Here were
bottles of honey and tempting jars of preserves standing on a display
shelf outside, and he coyly set the Free—Take One sign on these,
proceeding homeward with that air of innocence that he knew how to
affect.
Crossing the deserted Madden farm, he discovered a garter
snake. It was a harmless little snake, but it filled its destiny in
Hervey’s life. It was necessary for him to lift it on the end of his stick
and, before it wriggled off, send it flying through the broken window
of the Madden barn. This was not easy to do, because the snake
would not hold still. With each cast, however, it seemed to become
more drowsy, until finally it hung over the stick long enough for
Hervey to get a good aim and send the elongated missile flying
through the broken, cobweb-filled window.
The shot was so successful that Hervey could not refrain from
giving an encore. One good sling deserved another. So up he
vaulted to the sill of the old window, brushing ancient cobwebs out of
his eyes and hair, and down he went inside. But he went down
further than he had expected to, for the flooring was quite gone from
the old barn and he alighted all in a heap on a pile of dank straw in
the cellar.
Four unbroken walls of heavy masonry arose to a height of ten or
twelve feet. Far above him, through the shrunken, rotted shingles,
little glints of sunlight penetrated. A few punky boards strewn in this
stenchy dungeon gave evidence that the flooring above had rotted
away before being entirely removed. Perhaps there had been an
intention to lay a new flooring. But it was many years since the
Maddens had gone away and now there were rumors that the
extensive farm land was to become a bungalow colony.
As Hervey lifted one of the punky boards it broke in the middle
and fell almost in shreds at his feet. A number of little flat bugs,
uncovered in their damp abode, went scooting this way and that after
similar shelter. The snake too, recovered from the shock of being a
missile, wriggled off to some agreeable refuge amid the rotting litter
of that dank prison.
 CHAPTER XXXIII
STORM AND CALM
Hervey’s fortunes were never at a lower ebb than when he stood
in that damp cellar as the night came on and tried to reconcile
himself to sleeping on the straw. Even the morrow held only the hope
that by chance some one would discover him in his dreadful
dungeon. It was not until a rotten board, laid diagonally against the
foundation, had collapsed with him that he gave up and threw
himself down with a feeling as near to despair as his buoyant nature
had ever experienced.
Through the cracks and crevices of the shingles high overhead,
he watched the light die away. A ray from the declining sun streamed
through the window from which he had fallen, lingered for a few
moments, then withdrew leaving the place almost in darkness. Such
a price to pay for a merry little game with a snake!
Meanwhile, events occurred which were destined to have a
bearing on Hervey’s life. At about half past nine that night, young Mr.
Talbot emerged from the Walton house and encountered Wyne
Corson coming in through the gateway. They both laughed at the
encounter.
“Missionary work?” Mr. Talbot inquired.
“You beat me to it?” laughed Wyne.
“No, I’m through,” Mr. Talbot said. “He isn’t even home; nobody
knows where he is. No, I’m through working on that prospect, and I
wouldn’t waste my time if I were you, Corson. He’s going to military
school and I guess that’s the best place for him.”
“The fellows in my troop are crazy about him,” said Wyne.
“They might better be crazy about you,” Mr. Talbot answered. “If
they’re as crazy as all that, they’re better off without another crazy
fellow in their troop. Come on, walk along with me; there’s no one