The Extraction of the Temporary Teeth.—Although the actual details of the extraction of the temporary teeth do not differ from those of the permanent teeth, there are, nevertheless, one or two points to which attention may with advantage be directed. First and foremost, a child should not be deceived, and if it is necessary to extract a tooth, the child should be told and not taken unawares. When, too, a child resists having a tooth removed, the operation must not be forcibly carried out, for by a little patience and moral suasion on the part of the operator, the better side of a child’s nature can generally be gained. It should also be remembered that anæsthetics are quite as needful for the extraction of the temporary as the permanent teeth, the pain to be borne by a child being quite as great as that to be endured by an adult.
CHAPTER II.
———
The Extraction of Individual Teeth.
(1)UPPER TEETH.—For the removal of teeth in the maxilla the patient should be placed at such a level that the arm of the operator can, if necessary, embrace the head of the patient with comfort. The operator should stand at the right side of the patient, and slightly in front, the first finger and thumb being placed on either side of the alveolus ([fig. 16]). In the event of the patient becoming restless, the arm should be shifted so as to encircle the head and hold it firmly.
(a) Upper Incisors.—The roots of both the upper central and lateral incisors are usually cone shaped, the anterior surface being the arc of a greater circle than that of the posterior. Forceps for the removal of these teeth ought therefore to have the blades made in a corresponding manner (see [fig. 17]). The lateral incisor is smaller than the central, and has at times a root somewhat flattened. In removing upper incisors the posterior blade is applied first, care being taken to
Fig. 16.
see that the edge of the instrument passes between the gum and the tooth. To dislodge these teeth a firm inward movement should be made in a direction towards the palate, this movement being followed by one in an outward direction. If this fails to dislodge the tooth from its attachments, a firm rotary motion, first to the right and then to the left, may be tried (the amount of rotation necessary being only about an eighth of the circle represented by the circumference of the root). Rotation is generally recommended in the first instance for the extraction of these teeth, but the inward movement is, I think, best, the teeth yielding more readily and with less laceration of the soft tissues.
The extraction of the roots of these teeth does not as a rule present much difficulty. When moderately sound the instrument shown in [fig. 17] may be used, but in those instances where the root is much decayed, and lies well below the gum margin, a rather finer pair will be found more serviceable. The manner of removal is similar to that used when the crown is standing.