,,extraction ,,( ,,! ,,tee?4 ,,extraction ,,( ,,! ,,tee? ,,by ,j4 ,f4 ,,coly]1 ,l4,r4,c4,p41 ,m4,r4,c4,s4 ,l4,d4,s4 ,d5tal ,surgeon & ,lectur] on ,d5tal ,surg]y to ,*>+ ,cross ,hospital3 ,assi/ant ,d5tal ,surgeon to ! ,d5tal ,hospital ( ,london ,london3 ,,claudius ,,a% ,,sons1 ,,limit$1 #e1 #f1 #g1 #h ,,& #i1 ,,broad ,,/reet1 ,,gold5 ,,squ>e1 ,w4 #ahif ,,cont5ts4 ,,*apt] ,i4 ,,page ,,! ,,g5]al ,,pr9ciples ,,( ,,extraction ,,( ,,! ,,tee? #a ,,*apt] ,,ii4 ,,! ,,extraction ,,( ,,individual ,,tee? #ai ,,*apt] ,,iii4 ,,! ,,extraction ,,( ,,misplac$ ,,tee? #df ,,*apt] ,,iv4 ,,! ,,use ,,( ,,an,,/hetics ,,dur+ ,,extraction ,,( ,,! ,,tee? #ef ,,*apt] ,v4 ,,difficulties1 ,,complications1 ,,& ,,sequel ,,( ,,extraction ,,( ,,! ,,tee? #fc ,,index #if ,,extraction ,,( ,,! ,,tee?4 ,,*apt] ,i4 ,! ,g5]al ,pr9ciples ( ,extraction ( ! ,tee?4 ,z an op]ation1 extraction ( tee? is =tunately becom+ m r>e1 b ev5 n[ l>ge numb]s are ne$lessly sacrific$1 9 _m cases ow+ to ignorance on ! "p ( ! pati5t ( ! value ( ! tee?1 at times to lack ( k on ! "p ( bo? op]ator & pati5t ( ! mod]n me?ods ( cons]vative d5ti/ry4 ,) ! assi/ance ( antiseptics 9 ! treatm5t ( root-canals1 & ! increase 9 k ( ! me?ods ( fill+ & cr[n+ tee?1 x is n[ possible to reta9 _m :i* w\ld 9 =m] days h be5 extract$--inde$ x may be said ) tru? t all tee? & _m roots are capable ( be+ sav$ & r5d]$ useful1 ) ! exception (-- 7#a7 ,^? tee? ^: roots are mu* %ort5$ by absorption4 7#b7 ,^? tee? f :i* ! alveol> process has disappe>$ to su* an ext5t z to leave !m q loose2 & 7#c7 ,^? tee? attack$ ) *ronic p]iodontitis1 :i*1 9 spite ( treatm5t1 t5ds to become worse4 ,special circum/ances naturally alt] cases2 = in/ance1 ) pati5ts ! subjects ( n]v\s pro/ration1 or feeble 9 heal?1 a l5g?y op]ation is (t5 contra-indicat$1 & "u su* conditions extraction may be pref]able to ! l5g?y & t$i\s processes ( cons]vative treatm5t4 ,ano!r indication = extraction is 9 cases ( tee? sett+ up or aggravat+ ulc]ation ( ! tongue1 lips1 or o!r s(t p>ts ( ! m\?4 ,tee? fractur$ 9 a longitud9al direction %\ld g5]ally be remov$1 & ! same rule applies to ^? :i* are s misplac$ z to be incapable ( be+ br\ght into ! normal ar*4 ,9 cr[d$ conditions ( ! tee? extraction is (t5 call$ =1 & "u su* circum/ances is really cons]vative treatm5t4 ,if extraction be det]m9$ ^u1 a c>eful exam9ation ( ! too? to be remov$ %\ld be made4 ,?is w all[ "s idea to be =m$ ( ! am\nt ( s\nd tissue pres5t1 & also ( ! =ce :i* w be necess>y = ! dislodgm5t ( ! too?4 ,9 ! case ( roots1 ! edges mu/ be def9$1 & = ?is purpose a blunt probe1 simil> 9 patt]n to t %[n 9 fig4 #a w be f\nd useful4 ,illu/ration3 ,,fig4 #a4 ,in/rum5ts4--,! in/rum5ts 9 g5]al use = ! removal ( tee? are =ceps & elevators4 ,! ,=ceps is an amplifi$ pair ( p9c]s or pli]s4 ,x is made up ( ?ree p>ts1 namely1 ! blades or portions beyond ! jo9t :i* are appli$ to ! too?1 ! jo9t itself1 & ! h&les4 ,=ceps %\ld be made ( f9e /eel1 %\ld be light & yet /rong en\gh to )/& )\t b5d+ any /ra9 t may be put ^u !m4#a ,! blades %\ld be %ap$ to fit ! too? !y are int5d$ to remove1 & !y %\ld be cle> ( ! cr[n :5 appli$4 ,on longitud9al section a blade %\ld pres5t a ?9 w$ge-%ap$ appe>ance4 ,two k9ds ( jo9ts are met )4 ,9 ! fir/ v>iety "o half ( ! =ceps passes ?r\gh a slot 9 ! o!r1 ! two be+ held toge!r by a rivet pass+ ?r\gh ! c5tre 7fig4 #b74 ,9 ! second v>iety 7fig4 #c7 ! two halves are held toge!r side by side by a screw or p9 :i* takes ! entire /ra94 ,mo/ =ceps ( ,engli% manufacture are made on ! latt] plan1 :i* has ! advantage ( p]mitt+ ! in/rum5t to be easily clean$2 x also all[s a slight lat]al movem5t ( ! two halves--a po9t ( "s practical importance4 ,x is urg$ aga9/ ?is /yle ( jo9t t x is weak2 9 practice1 h[ev]1 ?is is n f\nd to be ! case4 ,illu/ration3 ,,fig4 #b4 ,illu/ration3 ,,fig4 #c4 ,! h&les %\ld be ( a size & %ape to lie com=tably 9 ! palm ( ! h&1 & %\ld be 9 su* relation to ! blades t :5 ! latt] are appli$ 9 ! direction ( ! long axis ( ! too?1 ! h&les cle> ! lips4 ,z a g5]al rule1 9 =ceps design$ = ! removal ( ! ant]ior tee? 9 ! maxilla1 ! blades & h&les are 9 ! same l9e 7fig4 #d71 ,illu/ration3 ,,fig4 #d4 ,illu/ration3 ,,fig4 #e4 :ile = ! upp] back tee? ! h&les =m a curve ( great] or less ext5t ) ! blades 7fig4 #e74 ,9 =ceps = ! l[] tee? ! blades are b5t d[n f ! h&les to an angle ( ne>ly n9ety degrees4 ,9 "o class1 namely1 ! hawk's-bill1 :5 ! blades are appli$ to ! too? ! h&les are at "r angles to ! l9e ( ! ar* 7fig4 #f71 :ile 9 o!r classes ! h&les are 9 l9e ) ! ar* 7fig4 #g74 ,illu/ration3 ,,fig4 #f4 ,illu/ration3 ,,fig4 #g4 ,! mann] ( hold+ =ceps is %[n 9 figs4 #h1 #i1 #aj4 ,! h&les %\ld re/ com=tably 9 ! palm> surface ( ! h&1 & 9 su* a mann] t ! end ( "o h&le re/s betwe5 ! !n> & hypo!n> em95ces--a portion ( ! h& :]e =ce c be appli$ ) advantage4 ,! ?umb plac$ betwe5 ! h&les acts z a regulator to control ! am\nt ( pressure ( ! blades ^u ! too?4 ,z a precaution x is well to h ! ball ( ! ?umb well betwe5 ! h&les1 s t ! pressure is c\nt]act$ n only by ! s(t tissues1 b also by ! t]m9al bony phalanx ( ! ?umb4 ,if ?is precaution be n obs]v$1 any sudd5 cru%+ ( ! too? may be accompani$ by a sev]e & v pa9ful contusion ( ! op]ator's ?umb4 ,illu/ration3 ,,fig4 #h4 ,mode ( hold+ =ceps = ! removal ( upp] tee?4 ,! ,elevator consi/s ( two p>ts--! h&le & ! blade4 ,! =m]1 usually made ( wood or ivory1 is ab\t f\r in*es 9 l5g? & ( a %ape suitable to all[ a firm grip be+ obta9$ ( x by ! h&4 ,! blade is made ( f9e /eel1 & is ab\t two in*es long4 ,elevators are ( two v>ieties1 /raight & curv$4 ,9 ! fir/ =m ! blade is ?91 ab\t "o-fif? ( an in* 9 bread?1 "o surface be+ made convex & ! o!r flat4 ,! po9t ( ! blade may be r\nd$ z %[n 9 fig4 #aa1 or spe>-%ap$1 z %[n 9 fig4 #ab4 ,illu/ration3 ,,fig4 #i4 ,mode ( hold+ l[] 8hawk's bill0 patt]n =ceps4 ,illu/ration3 ,,fig4 #aj4 ,mode ( hold+ =ceps ( patt]n %[n 9 fig4 #cj4 ,9 ! curv$ v>iety1 ! t]m9al half in* ( ! /eel portion ( ! in/rum5t is b5t at an angle ) ! %aft ( ! in/rum5t 7fig4 #di74 ,! edge ( ! blade ( an elevator %\ld always be kept %>p4 ,! me?od ( hold+ an elevator is %[n 9 fig4 #ac4 ,! h&le %\ld re/ com=tably 9 ! palm ( ! h&1 ! fir/ f+] ly+ along ! blade & be+ br\ght ne> ! po9t s z to prev5t ! in/rum5t slipp+4 ,:5 us+ ! elevator = ! removal ( tee? on ! "r side ( ! m&ible1 ! f+] %\ld lie along ! curv$ side ( ! blade1 & on ! flat side :5 extract+ tee? on ! left side4 ,illu/ration3 ,,fig4 #aa4 ,! ,screw 7fig4 #ad7 is an in/rum5t :i* on r>e occasions is useful = ! removal ( deep seat$ roots4 ,illu/ration3 ,,fig4 #ab4 ,aft] be+ us$1 in/rum5ts ( e k9d %\ld be fre$ f all =eign matt] & !n c>efully /]ilis$4 ,! next po9t :i* dem&s att5tion is ! position ( ! op]ator & pati5t4 ,! *air %\ld be plac$ be=e a good light1 & if a prop] d5tal *air is n to h& an ord9>y arm *air may be utilis$2 fail+ ?is1 two ord9>y *airs may be plac$ back to back1 on "o ( :i* ! left leg ( ! op]ator %\ld be rais$ to =m a re/ = ! pati5t's head4 ,! pati5t %\ld be plac$ 9 su* an uncon/ra9$ position z w all[ ! op]ator to ex]t all necess>y movem5ts ) fre$om4 ,illu/ration3 ,,fig4 #ac4 ,illu/ration3 ,,fig4 #ad4 ,! op]ator %\ld place himself s z to use 8 =ce to ! greate/ advantage4 ,8 left arm may be utilis$1 if necess>y1 = /eady+ ! movem5ts ( ! pati5t's head1 :ile ! f+]s ( ! left h& c be employ$-- 7#a7 ,to keep ! *eek & o!r s(t p>ts away s z to obta9 a cle> view ( ! too? to be extract$ & its imm$iate neighb\rs2 7#b7 ,to support ! m&ible2 7#c7 ,to grasp ! alveolus & s all[ "s idea to be ga9$ ( ! effect ( ! =ce employ$4 ,! special positions = ! removal ( diff]5t tee? w be describ$ 9 *apt] ii4 ,x may be advantage\s1 be=e describ+ ! /eps ( ! op]ation ( extraction1 to ref] briefly to a few po9ts 9 ! anatomy ( ! tee? & jaws :i* h a direct be>+ ^u ! mann] ( c>ry+ x out4 ,if ! tee? be exam9$ x w be notic$ t !y are capable ( division into-- 7#a7 ,tee? ) s+le1 r\nd$ tap]+ roots2 7#b7 ,tee? ) s+le roots m or less irregul>ly flatt5$ or curv$2 7#c7 ,tee? ) multiple roots4 ,"u 7#a7 are includ$ ! upp] incisors 7tempor>y & p]man5t7 & ! l[] bicuspids2 7#b7 ! l[] incisors & can9es 7tempor>y & p]man5t71 & also ! upp] can9es & bicuspids2 7#c7 ! upp] & l[] mol>s 7tempor>y & p]man5t7 & frequ5tly ! fir/ upp] bicuspids4#b ,! %ape ( ! roots1 z we %all subsequ5tly f9d1 has an important be>+ ^u ! mann] 9 :i* =ce is to be appli$ :5 sev]+ !m f _! atta*m5ts4 ,a correct acqua9tance ) ! disposition ( ! alveoli ( ! tee? is ( importance = skilful & successful op]at+4 ,fig4 #ae gives a g5]al idea ( ! appe>ance ( ! alveoli1 b x is ne$less to say t a full k c only be really obta9$ by a c>eful /udy ( ! bones !mselves2 by ?is means1 too1 "s idea ( ! /r5g? ( diff]5t portions ( ! alveol> bord]s c be obta9$--a matt] ( "s mom5t :5 apply+ =ce 9 ! process ( remov+ a too? f its socket4 ,! po9ts to be specially not$ 9 ! maxilla are ! ?9ness ( ! out] alveol> wall z comp>$ ) ! inn]1 ! prom95ce ( ! can9e socket1 & ! cancell\s "* ( ! bone 9 ! region ( ! ?ird mol>4 ,9 ! m&ible ! out] alveol> bord] w be se5 to be ?9n] ?an ! inn]1 ) ! exception ( t portion 9 ! region ( ! ,illu/ration3 ,,fig4 #ae4 ,f ! 8,am]ican ,sy/em ( ,d5ti/ry40 ?ird1 & (t5 ( ! second mol>2 ano!r fact wor?y ( att5tion is t at ! po/]ior portion ( ! socket ( ! ?ird mol> ! bone is mod]ately d5se4 ,:5 p]=m$ ) =ceps ! op]ation ( too? extraction may be divid$ into ?ree /ages3-- 7#a7 ,adaptation ( ! =ceps to ! too?4 7#b7 ,de/ruction ( its membran\s connections )1 & dilatation (1 ! socket4 7#c7 ,removal ( ! too? f ! socket4 ,9 ! initial /age ! fir/ /ep is ! application ( ! blades1 &1 9 ?is connection1 c>e mu/ be tak5 to see t ! po9ts pass betwe5 ! gum & ! too?1 & also t !y are appli$ p>allel ) ! long axis ( ! root4 ,x is1 z a rule1 be/ fir/ to apply ! blade on ! side ( ! too? mo/ obscur$ f view1 & !n lightly to close ! o!r ^u ! opposite side4 ,! blades %\ld !n be =cibly press$ upw>ds or d[nw>ds1 z ! case may be1 9 ! direction ( ! apex ( ! root2 a slight rot>y or wriggl+ motion w (t5 be f\nd ( assi/ance 9 ! process4 ,?is 8press+0 movem5t %\ld be cont9u$ until a firm hold ( ! root has be5 obta9$--a po9t ( great importance1 z ^u x ! successful removal ( ! too? 9 a l>ge measure dep5ds4 ,! h&les %\ld next be firmly clos$1 s z to give ! blades a good grip1 & ! am\nt ( pressure appli$ %\ld be su*1 t :5 movem5t has comm5c$ ! blades d n ride ^u ! surface ( ! root4 ,! am\nt ( pressure to be appli$ mu/ naturally v>y accord+ to ! "* ( ! too? to be remov$1 & ! resi/ance (f]$ by ! alveol> process4 ,! ?umb plac$ betwe5 ! h&les ( ! =ceps1 z previ\sly po9t$ out1 %\ld c\nt]act ! pressure appli$ to ! root & prev5t cru%+1 :i*1 %\ld x occur1 may make ! subsequ5t removal v difficult4 ,! second /age--! de/ruction ( ! membran\s atta*m5ts & dilatation ( ! socket--is accompli%$ by employ+ =ce 9 ei!r a rot>y or a lat]al direction4 ,! movem5t to be employ$ dep5ds ^u ! =m ( ! root or roots to be remov$ & ! resi/+ /r5g? ( ! surr\nd+ h>d /ructures1 & at ?is po9t x ne$ only be rem>k$ t rot>y motion is alone admissible 9 ! case ( tee? possess+ a s+le conical root4 ,! f9al /age is c>ri$ out by ex]t+ extractive =ce 9 ! direction ( ! long axis ( ! too?1 & also 9 t ( lea/ resi/ance2 ! latt] is det]m9$ by a k ( ! anatomy ( ! alveol> bord]1 & by ! s5sation convey$ to ! h& ?r\gh ! =ceps4 ,! removal ( a too? ) a /raight elevator is accompli%$ 9 ! foll[+ mann]4 ,! blade1 ) ! flatt5$ surface t[>ds ! too? to be remov$1 is ins]t$ betwe5 ! root & ! alveolus1 ! in/rum5t be+ kept z f> z possible p>allel ) ! ant]ior surface ( ! cr[n4 ,! blade is !n =c$ d[nw>ds s z to rea* ! root at z l[ a po9t z possible2 ! h&le ( ! elevator is !n rotat$ away f ! direction 9 :i* ! too? is to be remov$4 ,?is has ! effect ( bo? rais+ ! too? 9 its socket & displac+ x 9 ! requir$ direction4 ,"o su* movem5t ( ! in/rum5t r>ely suffices = ! removal ( a too?1 a second1 & sometimes a ?ird grip1 ea* "t ne>] to ! apex ( ! root1 hav+ to be obta9$4 ,! me?od ( us+ a curv$ elevator w be describ$ 9 deal+ ) ! removal ( ! roots ( l[] mol> tee?4 ,! w\nd result+ f ! removal ( a too? is a lac]at$ "o1 & heals by 8granulation40 ,! socket imm$iately aft] ! op]ation becomes fill$ ) coagulat$ blood1 :i* is ev5tually replac$ by granulation tissue1 foll[$ at a lat] p]iod by ! =mation ( loose cancell\s bone4 ,a v>y+ am\nt ( absorption ( ! alveol> bord] always foll[s ! removal ( a too?1 ! cont9uity 9 ! surface ( ! gum be+ re/or$ by ord9>y cicatricial fibr\s tissue4 ,! w\nd is be/ treat$ by keep+ ! p>ts c>efully cleans$ z f> z possible f all =eign matt]1 & = ?is purpose an antiseptic m\?-wa%#c %\ld be us$ sev]al times a day4 ,f ! w\nd result+ f ! extraction ( an upp] too? ! dis*>ge dra9s away 9 a natural mann] ow+ to ! orifice be+ ! mo/ dep5d5t "p4 ,f ! w\nd caus$ by ! removal ( a l[] too? su* is n ! case1 & %\ld suppuration take place ! socket mu/ be frequ5tly syr+$ ) "s antiseptic solution1 & if necess>y1 pack$4 ,! ,extraction ( ! ,tempor>y ,tee?4--,al?\gh ! actual details ( ! extraction ( ! tempor>y tee? d n diff] f ^? ( ! p]man5t tee?1 !re are1 nev]!less1 "o or two po9ts to :i* att5tion may ) advantage be direct$4 ,fir/ & =emo/1 a *ild %\ld n be deceiv$1 & if x is necess>y to extract a too?1 ! *ild %\ld be told & n tak5 unaw>es4 ,:51 too1 a *ild resi/s hav+ a too? remov$1 ! op]ation mu/ n be =cibly c>ri$ out1 = by a little pati5ce & moral suasion on ! "p ( ! op]ator1 ! bett] side ( a *ild's nature c g5]ally be ga9$4 ,x %\ld also be rememb]$ t an/hetics are q z ne$ful = ! extraction ( ! tempor>y z ! p]man5t tee?1 ! pa9 to be borne by a *ild be+ q z great z t to be endur$ by an adult4 ,,*apt] ,,ii4 ,! ,extraction ( ,individual ,tee?4 7#a7,,upp] ,,tee?4--,= ! removal ( tee? 9 ! maxilla ! pati5t %\ld be plac$ at su* a level t ! arm ( ! op]ator c1 if necess>y1 embrace ! head ( ! pati5t ) com=t4 ,! op]ator %\ld /& at ! "r side ( ! pati5t1 & slightly 9 front1 ! fir/ f+] & ?umb be+ plac$ on ei!r side ( ! alveolus 7fig4 #af74 ,9 ! ev5t ( ! pati5t becom+ re/less1 ! arm %\ld be %ift$ s z to encircle ! head & hold x firmly4 7a7 ,upp] ,incisors4--,! roots ( bo? ! upp] c5tral & lat]al incisors are usually cone %ap$1 ! ant]ior surface be+ ! arc ( a great] circle ?an t ( ! po/]ior4 ,=ceps = ! removal ( ^! tee? ought !re=e to h ! blades made 9 a correspond+ mann] 7see fig4 #ag74 ,! lat]al incisor is small] ?an ! c5tral1 & has at times a root some:at flatt5$4 ,9 remov+ upp] incisors ! po/]ior blade is appli$ fir/1 c>e be+ tak5 to ,illu/ration3 ,,fig4 #af4 see t ! edge ( ! in/rum5t passes betwe5 ! gum & ! too?4 ,to dislodge ^! tee? a firm inw>d movem5t %\ld be made 9 a direction t[>ds ! palate1 ?is movem5t be+ foll[$ by "o 9 an outw>d direction4 ,if ?is fails to dislodge ! too? f its atta*m5ts1 a firm rot>y motion1 fir/ to ! "r & !n to ! left1 may be tri$ 7! am\nt ( rotation necess>y be+ only ab\t an eigh? ( ! circle repres5t$ by ! circumf]5ce ( ! root74 ,rotation is g5]ally recomm5d$ 9 ! fir/ in/ance = ! extraction ( ^! tee?1 b ! inw>d movem5t is1 ,i ?9k1 be/1 ! tee? yield+ m readily & ) less lac]ation ( ! s(t tissues4 ,! extraction ( ! roots ( ^! tee? does n z a rule pres5t mu* difficulty4 ,:5 mod]ately s\nd ! in/rum5t %[n 9 fig4 #ag may be us$1 b 9 ^? in/ances :]e ! root is mu* decay$1 & lies well bel[ ! gum m>g91 a r f9] pair w be f\nd m s]viceable4 ,! mann] ( removal is simil> to t us$ :5 ! cr[n is /&+4 ,illu/ration3 ,,fig4 #ag4 7b7 ,upp] ,can9es4--,^! tee?1 l ! incisors1 are s+le root$1 b ! diff]5ce betwe5 ! curve ( ! ant]ior & po/]ior surfaces is great]4 ,! roots too are mu* long]1 m firmly implant$1 & h5ce require m =ce 9 _! removal4 ,=ceps simil> 9 patt]n to ^? us$ = incisors may be us$1 ! sev]ance ( ! too? f its atta*m5ts be+ br\ght ab\t by =ce appli$ 9 an inw>d1 foll[$ by an outw>d1 direction4 ,! root be+ m or less ?ree sid$1 rotation _c well be adopt$4 ,! roots ( can9e tee? are to be remov$ 9 ! same mann] z t adopt$ = ! :ole too?4 7c7 ,upp] ,bicuspids4--,! fir/ bicuspid has usually "o root flatt5$ & m or less longitud9ally groov$ on its mesial & di/al surfaces4 ,if ?is groov+ is mu* m>k$1 x results 9 a great] or less division ( ! root into two sl5d] t]m9ations4 ,:e!r su* bifurcation exi/s or n c seldom be det]m9$ be=e op]ation & w\ld n modify ! me?od adopt$1 b ! t5d5cy to ?is v>iation %\ld be borne 9 m9d & ! lat]al movem5t be v g5tly appli$4 ,! int]nal & ext]nal surfaces ( ! root are = all practical purposes ( equal curvature4 ,! second bicuspid has usually only "o root1 :i* is n s flatt5$ 9 ! ant]o-po/]ior diamet] z ! fir/4 ,!re is also n ! same t5d5cy to groov+ or bifurcation ( ! root z !re is 9 ! fir/ bicuspid4 ,! blades ( =ceps = ! bicuspids %\ld be equal segm5ts ( ! same circle2 !y %\ld also be b5t at an angle ) ! h&les1 s t ! latt] may cle> ! l[] lip4 ,! =ceps %[n 9 fig4 #ah is a useful patt]n4 ,9 remov+ an upp] bicuspid1 ! inn] blade ( ! =ceps %\ld be appli$ fir/4 ,= sev]+ ! too? f its atta*m5ts a slight inw>d movem5t %\ld fir/ be made1 foll[$ by an outw>d "o4 ,if ?is fails to cause ! socket to yield1 ! inw>d movem5t may aga9 be made1 foll[$ by an outw>d "o1 & repeat$ if necess>y4 ,! removal ( ! too? f its socket is to be c>ri$ out by =ce appli$ 9 a d[nw>d & outw>d direction4 ,x is well to rememb] t ! =ce appli$ to ! inw>d %\ld always be slight comp>$ to t us$ 9 ! outw>d direction4 ,! removal ( bicuspid roots is c>ri$ out 9 a mann] simil> to t = ! :ole too?4 ,illu/ration3 ,,fig4 #ah4 7d7 ,upp] ,mol>s4--,! fir/ upp] mol> has ?ree roots1 "o int]nal t[>ds ! palate 7palat9e71 & two ext]nal 7buccal72 ( ! ?ree ! palat9e is ! l>ge/1 sub-cyl9drical 9 =m1 & (t5 curv$4 ,! two buccal roots are plac$ 9 an ant]ior & po/]ior position1 ! latt] be+ 9 a plane int]nal to ! ant]ior "o2 bo? ^! roots are some:at flatt5$1 & ( ! two ! ant]ior is ! l>g]4 ,! roots ( ! second mol> are simil> 9 %ape to ! fir/1 b are usually small]4 ,! ?ird mol>1 :5 normal1 has ?ree roots1 b v frequ5tly ^! are all fus$ toge!r s z to =m an abrupt tap]+ cone1 ! po9t ( :i* is (t5 curv$4 ,illu/ration3 ,,fig4 #ai4 ,ow+ to ! disposition ( ! roots diff]5t =ceps w be requir$ = ! removal ( upp] mol>s on ! "r & left side4 ,( ! blades1 ! out] or buccal %\ld possess two grooves1 ! ant]ior be+ ! broad] & plac$ 9 a m ext]nal plane4 ,?is blade %\ld also h a slight projection betwe5 ! groov$ surfaces to adapt itself to ! space betwe5 ! buccal roots4 ,! inn] or palatal blade %\ld possess only "o groove4 ,a well-made pair ( upp] mol> =ceps %\ld fit ! neck ( a fir/ upp] p]man5t mol> accurately4 ,! blades %\ld be b5t at an angle ) ! h&les1 s t :5 9 use ! latt] may cle> ! l[] lip 7fig4 #ai74 ,! palat9e blade %\ld be appli$ fir/1 & 9 br++ ! out] blade into place ! po9t %\ld be kept ov] ! groove on ! buccal side ( ! too?1 z ?is groove is a guide to ! space betwe5 ! out] roots4 ,to sev] ^! tee? f _! atta*m5ts =ce mu/ be appli$ fir/ slightly inw>ds & !n outw>ds1 ! movem5ts be+ repeat$ if necess>y1 ! removal ( ! too? f ! socket be+ c>ri$ out by ex]t+ =ce 9 a d[nw>d & outw>d direction4 ,too mu* outw>d movem5t leads to undue b5d+ or fracture ( ! ext]nal alveol> plate4 ,illu/ration3 ,,fig4 #bj4 ,9 remov+ ! ?ird mol>s x is advisable n to h ! pati5t's m\? op5$ to ! fulle/ ext5t1 z ! t5sion ( ! tissues ( ! *eek w !reby be less5$ & a cle>] view ( ! out] side ( ! too? ?us ga9$4 ,! application ( ! =ceps is ( ! utmo/ importance1 z "o is liable1 unless c>e is tak51 to include "s ( ! s(t tissue betwe5 ! blades & ! too? & s cause a pa9ful lac]ation4 ,=ce appli$ inw>ds & !n outw>ds is g5]ally suffici5t to loos5 ^! tee?1 _! removal be+ c>ri$ out by a d[nw>d & outw>d movem5t4 ,=ceps simil> to ^? %[n 9 fig4 #ai may be us$ = ! removal ( ! ?ird mol>s1 b mo/ op]ators use patt]ns ! blades ( :i* are simil> segm5ts ( ! same circle 7fig4 #bj74 ,illu/ration3 ,,fig4 #ba4 7a7 ,normal upp] fir/ p]man5t mol>4 7b7 ,oblique root$ upp] fir/ p]man5t mol>4 7c7 ,normal upp] second p]man5t mol>4 7d7 ,oblique root$ second p]man5t mol>4 ,!re is an abnormality ( ! upp] mol>s :i* may ) advantage be m5tion$ "h4 ,9 ?is de=mity ! po/]ior buccal root is situat$ 9 a plane mu* int]nal to ! ant]ior--9 o!r words1 x is an exagg]ation ( ! normal arrangem5t4 ,su* tee? h be5 t]m$ by ,mr4 ,boo? ,pe>sall 8oblique root$0 7fig4 #ba74 ,! abnormality is met ) mo/ frequ5tly 9 ! ?ird mol>1 sometimes 9 ! second1 r>ely 9 ! fir/4 ,! difficulty enc\nt]$ 9 extract+ ^! tee? is t ! out] blade ( ! =ceps t5ds to slip r\nd4 ,oblique-root$ tee? c at times be diagnos$ by not+ an undue prom95ce ( ! alveolus ov] ! ant]ior buccal root1 & are be/ remov$ ) =ceps simil> to t %[n 9 fig4 #bj4 ,9 cases :]e a portion ( ! cr[n rema9s & ! decay ext5ds well bel[ ! gum on ei!r ! palatal or buccal side1 ord9>y mol> =ceps %\ld be disc>d$ & root =ceps employ$2 useful patt]ns are %[n 9 figs4 #ah1 #bb & #bc4 ,! removal ( tee? 9 ?is condition is c>ri$ out z foll[s1 & = ! sake ( description x w be suppos$ t ! decay ext5ds deeply on ! palat9e side4 ,"o blade ( ! =ceps %\ld be fir/ appli$ to ! buccal side ( ! too? & to ! root :i* is consid]$ ! /rong]2 ! inn] blade %\ld !n be appli$ to ! palat9e root c>e be+ tak5 to ins9uate x betwe5 ! alveolus & ! root4 ,! =ceps %\ld !n be pu%$ well upw>ds until a firm hold ( ! root is obta9$4 ,a firm inw>d movem5t %\ld !n be made1 z ?is w all[ ! inn] blade to pass /ill high] up ! palat9e fang & insure /ead9ess %\ld ! blades t5d to ride ^u ! surface ( ! root4 ,an outw>d movem5t %\ld next be made1 b to no?+ l s great a degree z t us$ 9 extract+ mol>s ) ! :ole ( ! cr[n /&+4 ,?is inw>d & outw>d movem5t is to be repeat$ until ! too? is fre$1 ! =ce be+ pr9cipally appli$ 9 ! inw>d direction4 ,illu/ration3 ,,fig4 #bb4 ,illu/ration3 ,,fig4 #bc4 ,= ! removal ( roots t[>ds ! back ( ! m\?4 ,:5 ! m ext5sive decay has tak5 place on ! buccal side ! ord] ( proce$+ is slightly diff]5t4 ,! fir/ blade to be appli$ %\ld be ! palat9e1 ! out] blade be+ clos$ ^u :i*ev] ( ! buccal roots is consid]$ ! /rong]4 ,! extractive =ce %\ld be appli$ fir/ outw>ds & !n inw>ds1 ^! movem5ts be+ repeat$ if necess>y1 ! pr9cipal =ce be+ outw>ds1 z ! object 9 view is to prev5t ! in/rum5t slipp+ (f ! m decay$ side4 ,:5 a mol> is s decay$ t b little ( ! cr[n rema9s1 b all ! roots are /ill unit$1 root =ceps are indicat$4 ,9 su* a case ! inn] blade is to be appli$ to ! palat9e root fir/1 ! out] blade be+ clos$ ^u ! /rong] ( ! buccal fangs4 ,inw>d foll[$ by outw>d movem5t %\ld be employ$1 ! po9t to be> 9 m9d be+ to use =ce t[>ds ! side ( ! too? :i* is consid]$ ! weak]4 ,9 ! majority ( su* cases ! ?ree roots come away toge!r1 b ev5 if ?is does n happ51 "o or p]haps two w be remov$1 ! rema9d] be+ subsequ5tly remov$ ) b little difficulty4 ,9 cases :]e ! resi/ance pres5t$ by ! roots is v great & an unsuccessful attempt has be5 made ) ord9>y root =ceps1 an in/rum5t ) a buccal blade simil> to t %[n 9 fig4 #bd may be us$4 ,! inn] blade is fir/ appli$1 ! out] "o be+ br\ght s z to come1 if possible1 into ! space betwe5 ! buccal roots4 ,a firm hold ( ! roots hav+ be5 ga9$1 an attempt to extract %\ld be made by =ce appli$ 9 an inw>d & outw>d direction2 ?is fail+1 suffici5t pressure %\ld be put ^u ! h&les to split ! roots asund]4 ,! %>p out] blade ( ! =ceps w !n pass betwe5 ! divid$ buccal roots on to ! palat9e root1 :i* c ?us readily be br\ght away4 ,a pair ( ord9>y upp] root =ceps %\ld be employ$ = remov+ ! buccal roots4 ,if all ! ?ree roots ( a mol> are sep>ate1 _! extraction pres5ts b little difficulty1 a slight rot>y movem5t g5]ally suffic+4 ,9 all cases :]e !re is a fe> ( a mol> fractur+1 root 9 pref]5ce to ord9>y =ceps %\ld be us$4 ,illu/ration3 ,,fig4 #bd4 7#b7 ,,l[] ,,tee?4--,= ! removal ( l[] tee? ! pati5t %\ld be plac$ on a l[ level1 ! head be+ kept a little =w>d & ! *9 depress$4 ,! position ( ! op]ator w naturally diff] ) ! too? to be remov$ ,illu/ration3 ,,fig4 #be4 & also ) ! in/rum5t to be us$4 ,) tee? on ! "r side1 :5 hawk's-bill patt]n =ceps or elevators are us$1 ! op]ator %\ld /& beh9d & to ! "r ( ! pati5t1 ! left arm be+ br\ght r\nd ! pati5t's head4 ,! ?umb ( ! left h& %\ld be plac$ on ! inn] side & ! fir/ f+] on ! out] side ( ! alveolus ( ! too? to be remov$1 & ! ?ree rema9+ f+]s "u & support+ ! *94 ,9 plac+ ! f+]s 9 ! m\?1 c>e %\ld be tak5 to keep ! wri/ well d[n s z n to imp$e ! entrance ( light 7fig4 #be74 ,illu/ration3 ,,fig4 #bf4 ,:5 remov+ ! ant]ior tee? or ^? on ! left side ( ! m\?1 ! op]ator %\ld /& on ! "r side & slightly 9 front ( ! pati5t4 ,! left h& %\ld be plac$ z foll[s3 ! second f+] on ! l+ual side1 & ! fir/ on ! labial side ( ! alveolus ( ! too? to be extract$1 ! ?umb be+ plac$ "u ! *9 7fig4 #bf74 ,:5 employ+ =ceps ( ! /raight patt]n %[n 9 fig4 #cj1 ! op]ator %\ld /& z %[n 9 fig4 #bf1 b x w be f\nd difficult to place ! f+]s ( ! left h& on ei!r side ( ! alveolus1 inde$ !y c only well be us$ = retract+ ! *eek & support+ ! jaw4 ,9 remov+ tee? f ! l[] jaw1 ! op]ator %\ld be c>eful1 9 rais+ ! too? f ! socket1 to gu>d aga9/ a sudd5 sep>ation ( ! too? f its atta*m5ts :i* might result 9 damage to ! upp] tee?4 ,illu/ration3 ,,fig4 #bg4 7a7 ,l[] ,incisors4--,^! tee? ea* h a s+le root :i* is mu* flatt5$ lat]ally4 ,= _! removal1 =ceps simil> to ^? %[n 9 fig4 #bg %\ld be us$1 ! blades be+ equal segm5ts ( ! same circle4 ,! l+ual blade %\ld be appli$ fir/1 ! loos5+ movem5t be+ made by tak+ ! too? slightly inw>ds & !n outw>ds1 ! f9al extractive =ce be+ upw>ds & outw>ds4 ,! removal ( l[] incisor roots is c>ri$ out 9 a simil> mann]4 7b7 ,l[] ,can9es4--,! l[] can9es h normally "o root1 :i* is flatt5$ lat]ally4 ,9 comp>ison ) ! incisors1 ! root is /rong] & long]4 ,! removal ( a l[] can9e is c>ri$ out 9 a mann] simil> to t employ$ = a l[] incisor1 b z ! too? pres5ts m resi/ance1 a great] am\nt ( =ce is usually requir$4 7c7 ,l[] ,bicuspids4--,! l[] bicuspids h normally "o root :i* is conical 9 %ape4 ,9 ! fir/ bicuspid ! conical %ape ( ! root is n s m>k$ z 9 ! second1 ! out] aspect be+ ! arc ( r a l>g] circle ?an ! po/]ior4 ,=ceps simil> to ^? %[n 9 fig4 #bg may be us$1 ! blades = all practical purposes be+ equal 9 size & %ape4 ,! l+ual blade ( ! in/rum5t %\ld be appli$ fir/1 ! sev]+ ( ! too? f its atta*m5ts be+ c>ri$ out by a slight rot>y movem5t ar\nd ! long axis ( ! too? fir/ 9 "o direction & !n 9 ! o!r2 %\ld ?is n succe$1 a slight inw>d foll[$ by an outw>d movem5t may be tri$1 ! too? be+ rais$ f its socket by =ce appli$ 9 an upw>d & slightly outw>d direction4 ,! roots ( l[] bicuspids are to be remov$ 9 a mann] simil> to t requir$ = ! extraction ( a :ole too?4 ,:5 ! root lies mu* bel[ ! level ( ! gum ! extraction is (t5 tr\blesome ow+ to ! difficulty 9 ga9+ a hold ) ! blades ( ! =ceps2 9 su* cases1 if an attempt ) =ceps has fail$1 ! /raight elevator may be employ$4 ,illu/ration3 ,,fig4 #bh4 7d7 ,l[] ,mol>s4--,l[] mol>s h two roots1 plac$ ant]iorly & po/]iorly4 ,! roots are mu* flatt5$ & h a t5d5cy to curve backw>ds1 ?is be+ well m>k$ 9 ! second & especially s 9 ! ?ird mol>2 a fusion ( ! two roots is at times met ) 9 ! second & frequ5tly 9 ! ?ird mol>4 ,a section ( a l[] mol> at ! neck %[s bo? ! buccal & l+ual aspects to be compos$ ( two segm5ts ( a circle t\*+ ea* o!r at "o extremity2 ! ant]ior segm5t be+ slightly ! l>g] 7fig4 #bh74 ,ea* blade ( ! =ceps us$ = ^! tee? %\ld possess two grooves1 ,illu/ration3 ,,fig4 #bi4 ,illu/ration3 ,,fig4 #cj4 sep>at$ by a projection :i* fits into ! division betwe5 ! ant]ior & po/]ior roots2 = all practical purposes ! blades may be made ( ! same size1 s t "o in/rum5t w suffice = bo? sides ( ! jaw4 ,! in/rum5t be/ adapt$ = ! removal ( ^! tee? is %[n 9 fig4 #bi1 ?\gh "s op]ators pref] ! %ape illu/rat$ 9 fig4 #cj4 ,! advantages ( ! =m] ov] ! latt] may be briefly summ$ up z foll[s3 7#a7 ,a cle> view ( ! too? & its surr\nd+s c be obta9$ dur+ ! :ole p]iod ( removal4 7#b7 ,=ce c be appli$ ) great] advantage4 7#c7 ,! alveolus c be easily embrac$ by ! f+]s1 or by ! f+] & ?umb ( ! left h&4 7#d7 ,9 remov+ ! too? f ! socket a slight backw>d movem5t c be employ$4 ,"o disadvantage ( %ape fig4 #bi is t x is difficult to employ mu* inw>d movem5t1 & !re=e1 = tee? ly+ inw>ds1 namely1 ) ! cr[n direct$ t[>ds ! tongue1 hawk's-bill-%ap$ =ceps _c easily be us$4 ,ano!r disadvantage is t ! ext5t ( inw>d movem5t is limit$ by ! proximity ( ! upp] tee?1 & 9 case ( trismus x is (t5 bett] to use /raight =ceps 7fig4 #cj74 ,9 cases :]e !re are also mu* swell+ & rigidity ( ! *eek ! /raight =ceps cause less inconv5i5ce to ! pati5t4 ,9 remov+ l[] mol>s ) =ceps1 ! inn] blade %\ld be fir/ appli$ & !n ! out]1 c>e be+ tak5 to get ! po9ts ( ! blades betwe5 ! int]space ( ! roots4 ,= sev]+ ^! tee? f _! atta*m5ts1 a slight inw>d movem5t %\ld be fir/ made1 foll[$ by "o well outw>ds1 ?is inw>d & outw>d movem5t be+ repeat$ if necess>y4 ,! removal ( ! too? f its socket is c>ri$ out by =ce us$ 9 an upw>d & outw>d direction4 ,! upw>d =ce ex]t$ ^u l[] tee? %\ld always be well "u control1 z n infrequ5tly ! resi/ance is v sudd5ly ov]come1 &1 if su* precaution is n tak51 !re is dang] ( /rik+ ! upp] tee? ) consid]able =ce4 ,illu/ration3 ,,fig4 #ca4 ,z previ\sly po9t$ out1 ! roots ( ^! tee? are at times curv$ a little backw>ds s t x is (t5 ne$ful 9 remov+ ! tee? f _! sockets to twi/ ! =ceps 9 a curv$ direction backw>ds4 ,9 ! removal ( ! second mol> too mu* outw>d movem5t is n p]missible1 z ! out] alveolus is (t5 v d5se4 ,! ?ird mol> is be/ remov$ ) a /raight elevator4 ,a glance at ! illu/ration ( ?is too? 7fig4 #ca7 w %[ t ! roots h a well-m>k$ curve backw>ds1 9 addition to :i* ! bone =m+ ! socket ( ?is too? is /rong] ?an is ! case ) ! ant]ior mol>s4 ,! removal ( ! ?ird mol> has !re=e to be accompli%$ by us+ =ce 9 a direction upw>ds & backw>ds1 9 o!r words1 9 a curve simil> to ! arc ( ! circle =m$ by ! roots4 ,?is movem5t _c well be c>ri$ out ) =ceps1 b is easily accompli%$ ) ! elevator z foll[s 7x be+ assum$ t ! second mol> is 9 place73--,hold ! elevator z %[n 9 fig4 #ac1 & ins]t ! blade betwe5 ! ant]ior surface ( ! root & ! alveolus1 keep+ ! flatt5$ side ( ! in/rum5t z f> z possible p>allel ) ! root surface4 ,!n =ce ! blade d[nw>ds 9 a direction t[>ds ! apex ( ! root2 foll[+ ?is1 rotate ! h&le away f ! direction 9 :i* ! too? is to be mov$4 ,?is has ! effect ( bo? rais+ ! too? 9 its socket & displac+ x backw>d4 ,! edge ( ! elevator :i* is to be br\ght into contact ) ! surface ( ! root %\ld be %>p s z to cut some:at into ! cem5tum4 ,%\ld ?is prove insuffici5t ! h&le %\ld aga9 be rais$ & ! flatt5$ surface ( ! in/rum5t br\ght p>allel ) ! ant]ior surface ( ! root & ! extractive movem5t repeat$ until ! too? is completely rais$ f its socket4 ,9 us+ ! elevator1 especial c>e mu/ be tak5 to protect ! tongue ) ! f+]s or ?umb ( ! left h&1 s z to prev5t a slip1 :i* might result 9 puncture ( ! tongue1 or ( ! op]ator's f+]4 ,) ! ?ird l[] mol> !re is a t5d5cy = ! gum to adh]e t5aci\sly to ! po/]ior "p ( ! neck ( ! too?4 ,:5 ?is happ5s x is bett] to simply raise ! too? f its socket ) ! elevator or =ceps1 z ! case may be1 & !n cut ! gum away ) a curv$ pair ( scissors4 ,by ?is me?od a sev]e lac]ation ( ! gum may at times be avoid$4 ,:5 ! ?ird mol> is isolat$ ow+ to ! abs5ce ( ! second mol>1 ! elevator may /ill be employ$ = its removal1 on ! "r side ! fir/ f+]1 & on ! left side ! ?umb ( ! left h& be+ us$ z ! fulcrum4 ,9 su* cases1 h[ev]1 _m op]ators pref] to use ord9>y l[] mol> =ceps4 ,! removal ( l[] mol>s :5 a portion ( ! cr[n is /&+1 b ! decay has progress$ bel[ ! gum on ei!r ! buccal or ! l+ual aspect1 is c>ri$ out ) root =ceps ( %ape %[n 9 fig4 #bg4 ,a condition simil> to ?is 9 upp] mol>s & ! me?od indicat$ = _! removal 7 ref]r$ to on page #bg4 ,! pr9ciples enum]at$ !re apply equally to ! removal ( l[] mol>s1 s t x w n be necess>y to repeat !m4 ,! ma9 po9ts to be> 9 m9d are1 to apply ! blades ( ! =ceps to ! /rong] root1 & to use ! pr9cipal =ce 9 ! direction ( ! weak] wall4 ,:]e ! roots ( mol>s are /ill unit$1 root =ceps %\ld be us$1 ! blade be+ fir/ appli$ to ! l+ual surface ( ! /rong] root4 ,a firm hold hav+ be5 obta9$1 ! root may be remov$ by employ+ =ce 9 a mann] simil> to t employ$ ) ord9>y mol> =ceps4 ,9 ?is way bo? roots w usually come away toge!r4 ,if1 h[ev]1 only "o root is extract$1 ! rema9+ "o c easily be remov$1 ei!r ) ! same =ceps or a curv$ elevator4 ,! curv$ elevator 7fig4 #di7 may be employ$ ei!r by plac+ x aga9/ ! root1 & s =c+ x into ! socket ( ! root already remov$1 or by plac+ ! blade 9 ! socket ( ! extract$ root1 =c+ ! po9t ( ! in/rum5t ?r\gh ! int]v5+ bone & !n elevat+ ! rema9+ root4 ,) roots ( l[] mol>s :i* pres5t great resi/ance1 =ceps ) cutt+ blades may be us$ 7fig4 #cb74 ,! blades are ins]t$ on ! l+ual & buccal aspects ( ! ar* 9 su* a mann] t ! po9ts pass into ! space betwe5 ! roots4 ,! h&les are !n clos$ & an attempt is made to remove ! roots 9 ! ord9>y way1 b %\ld ?is prove unsuccessful ! h&les mu/ be =cibly clos$1 s z to divide ! roots :i* c !n1 z a rule1 be remov$ ) ord9>y root =ceps4 ,! value ( splitt+ roots 9 a case simil> to t %[n 9 fig4 #cc is app>5t1 =1 z w be se51 x all[s ea* root to be remov$ 9 ! l9e ( its incl9ation4 ,illu/ration3 ,,fig4 #cb4 ,9 ^? cases :]e ! roots are sep>at$ _! removal is c>ri$ out ) root =ceps1 an inw>d & outw>d movem5t be+ usually suffici5t4 ,! roots ( ?ird mol>s are be/ remov$ ) a /raight elevator4 ,! modus op]&i is simil> to t us$ 9 extract+ ! :ole too?4 ,illu/ration3 ,,fig4 #cc4 7a7 ,l[] mol> ) div]g5t roots4 7b7 ,! dott$ l9es %[ ! direction 9 :i* ! root c be remov$ if ! too? is divid$ z sugge/$ 9 ! text4 ,at times ! l[] mol> tee? are mu* tilt$ 9 su* a way t ! cr[n surface /&s t[>ds ! tongue4--,"u su* conditions _! removal is be/ c>ri$ out ) in/rum5ts ( ! patt]n %[n 9 fig4 #cj1 s9ce ! h&les ( =ceps ( ! hawk's-bill patt]n :5 appli$ w\ld come 9 contact ) ! upp] tee?1 & ?us imp$e ! inw>d movem5t :i* is s necess>y = ! removal ( tee? 9 ?is position4 ,! ,tempor>y ,tee?4--,= ! removal ( upp] incisors & can9es1 a small pair ( /raight =ceps ( ! patt]n %[n 9 fig4 #cd %\ld be us$4 ,! fir/ upp] tempor>y mol>s are be/ remov$ ) a pair ( =ceps l fig4 #ce4 ,! l[] incisors & can9es require a small pair ( hawk's-bill =ceps simil> to ! %ape %[n 9 fig4 #bg4 ,= ! l[] tempor>y mol>s1 a small pair ( =ceps simil> to t illu/rat$ 9 fig4 #bi %\ld be us$4 ,illu/ration3 ,,fig4 #cd4 ,illu/ration3 ,,fig4 #ce4 ,9 remov+ ! tempor>y tee?1 c>e mu/ be tak5 n to drive ! =ceps up too high1 = fe> ( injur+ ! p]man5t tee?2 ?is is m especially to be not$ 9 connection ) ! tempor>y mol>s1 z ! roots ( ^! tee? practically embrace ! cr[ns ( ! bicuspids4 ,g5]ally speak+1 if a tempor>y mol> fractures 9 ! attempt to remove x1 ! portion ( too? rema9+ 9 ! jaw %\ld be left alone unless x c be br\ght away q easily4 ,illu/ration3 ,,fig4 #cf4 ,roots 9 ! condition %[n 9 fig4 #cf are be/ remov$ ) an elevator z foll[s3 ! ?umb ( ! "r h& be+ plac$ on an adjac5t too? s z to ga9 a hold1 ! po9t ( ! elevator %\ld be plac$ bel[ ! end ( ! root & =ce appli$4 ,9 a few cases x may be necess>y to cut ! gum ) a lancet be=e us+ ! elevator4 ,small pieces ( ! tempor>y tee? :i* p]si/ & become w$g$ 9 betwe5 ! p]man5t tee? c be be/ remov$ ) an excavator or a simil> suitable in/rum5t4 ,,*apt] ,,iii4 ,! ,extraction ( ,misplac$ ,tee?4 ,no?+1 p]haps1 te/s ! skill ( a good op]ator m ?an ! extraction ( a misplac$ or impact$ too?1 & al?\gh x is impossible to give any?+ l a complete li/ ( ! v>i\s malpositions met )1 ^? mo/ commonly se5 w be m5tion$1 & ! usual me?od = remov+ su* tee? indicat$4 ,illu/ration3 ,,fig4 #cg4 7a7 ,upp] ,c5tral ,incisors4--,an irregul>ity ( ?is too? call+ = removal is %[n 9 fig4 #cg4 ,! extraction is be/ c>ri$ out ) an in/rum5t simil> to t %[n 9 fig4 #ch1 ! f9e inn] blade be+ appli$ on ! palatal side & ! broad blade on ! labial4 ,extractive =ce %\ld be appli$ pr9cipally 9 ! outw>d direction1 & if ?is is n suffici5t1 slight rot>y movem5t %\ld be tri$4 ,9 cases :]e !re is less room betwe5 ! approximal tee?1 ! project+ too? may be remov$ ) a pair ( /raight =ceps 7fig4 #ag71 ! blades be+ appli$ to ! mesial & di/al aspects ( ! root4 ,! blades %\ld n be driv5 v f> up1 & ! loos5+ ( ! too? %\ld be accompli%$ by slight rot>y motion1 9 us+ :i* c>e %\ld be tak5 to avoid loos5+ ! approximal tee?4 ,illu/ration3 ,,fig4 #ch4 7b7 ,upp] ,lat]al ,incisors ly+ int]nal to ! ar*1 z %[n 9 fig4 #ci1 c be remov$ ) ! =ceps %[n 9 fig4 #ch1 by plac+ ! f9e blade on ! labial & ! broad blade on ! palatal side ( ! too?4 ,extractive movem5t %\ld be made inw>ds1 foll[$ by v slight outw>d movem5t2 ?is fail+1 rotation %\ld be tri$1 b z po9t$ out on a previ\s page1 ?is =m ( movem5t is n s suitable = lat]al incisors z = c5trals4 ,illu/ration3 ,,fig4 #ci4 7c7 ,upp] ,can9es plac$ high 9 ! ar*1 z %[n 9 fig4 #dj1 may be extract$ ) a /raight pair ( =ceps 7fig4 #ag71 ! blades be+ plac$ on ! mesial & labial aspects ( ! root4 ,extraction ( su* tee? is v difficult4 ,slight b firm rotation may fir/ be tri$2 if ?is fails to loos5 ! too?1 slight lat]al movem5t may be attempt$1 ! =ce be+ appli$ t[>ds & !n away f ! m$ian l9e ( ! m\?4 ,illu/ration3 ,,fig4 #dj4 ,illu/ration3 ,,fig4 #da4 7d7 ,upp] ,bicuspids misplac$1 z %[n 9 fig4 #da1 c be remov$ ) =ceps1 z %[n 9 figs4 #ah & #bb1 ! blades be+ appli$ on ! ant]ior & po/]ior aspects ( ! too?4 ,=ce %\ld be appli$ 9 a backw>d & =w>d direction1 ! movem5ts be+ repeat$ & p]sev]$ ) until ! too? is loos5$ 9 its socket4 ,illu/ration3 ,,fig4 #db4 ,illu/ration3 ,,fig4 #dc4 ,a bicuspid plac$ z %[n 9 fig4 #db c be remov$ ) =ceps simil> 9 =m to ^? depict$ 9 figs4 #ah & #bb1 ) ! out] blade /rong b n>r[4 ,! extractive movem5t %\ld be made ma9ly 9 an inw>d direction4 ,illu/ration3 ,,fig4 #dd4 7e7 ,l[] ,c5tral ,incisors plac$ simil>ly to t %[n 9 fig4 #dc may be remov$ ) ord9>y l[] root =ceps 7hawk's-bill patt]n71 ! blades be+ plac$ on ! mesial & di/al surfaces ( ! root1 & movem5t appli$ 9 a direction to & away f ! m$ian l9e ( ! m\?4 ,:5 ! cr[d+ is n s extreme z %[n 9 fig4 #dd1 =ceps ( ! hawk's-bill patt]n ) a /rong b n>r[ inn] blade %\ld be us$ 7fig4 #de71 & ! pr9cipal extractive movem5t made 9 an outw>d direction4 ,= an incisor plac$ z %[n 9 fig4 #dg1 ! n>r[ blade %\ld be ! out] "o 7fig4 #df71 & ! pr9cipal =ce %\ld be appli$ 9 an inw>d direction4 7f7 ,l[] ,bicuspids plac$ z 9 fig4 #dh are ,illu/ration3 ,,fig4 #de4 ,illu/ration3 ,,fig4 #df4 mo/ difficult tee? to remove4 ,"o ( ! mo/ useful in/rum5ts = _! extraction is a pair ( upp] root =ceps 7,read's patt]n1 fig4 #bb71 :i* %\ld be held s t ! curve ( ! blades is d[nw>ds4 ,! blades %\ld grasp ! root on its ant]ior & po/]ior surfaces4 ,slight rot>y movem5t may fir/ be attempt$1 foll[$ by lat]al motion4 ,^! movem5ts may be p]sev]$ ) until ! too? is f\nd to yield4 ,too mu* ha/e may lead to a fracture1 :i* w\ld be extremely difficult to deal )4 ,illu/ration3 ,,fig4 #dg4 ,illu/ration3 ,,fig4 #dh4 ,9 cases :]e ! cr[d+ is n s great1 & ! too? is m 9 ! normal l9e ( ! ar*1 a =ceps ) a n>r[ out] blade w suffice 7fig4 #df74 ,extractive =ce %\ld be us$ pr9cipally t[>ds ! m$ian l9e ( ! m\?1 & ?is may be comb9$ ) slight rot>y movem5t4 ,illu/ration3 ,,fig4 #di4 7g7 ,impact$ ,l[] ,?ird ,mol>s are among/ ! mo/ difficult tee? to extract4 ,:]e ! too? is deep-seat$1 ! gum %\ld be pu%$ aside by c>eful pack+1 & z cle> a view ( ! too? z is possible obta9$4 ,= remov+ ^! tee? x is difficult to give any rules1 z ea* case mu/ be treat$ on its own m]its4 ,z useful an in/rum5t z any = _! removal is a curv$ elevator 7fig4 #di71 ! blade ( :i* c (t5 be ins]t$ "u ! cr[n1 & assum+ t good lev]age is ?us obta9$1 ! too? c be pris$ up4 ,sometimes ! too? is firmly emb$d$ 9 ! bone4 ,9 su* cases a cle> view ( ! too? may be obta9$ by gradually pack+ ! s(t tissues ap>t1 ! p]io/eum cov]+ ! alveolus %\ld !n be rais$1 & ! bone surr\nd+ ! too? cut away ) suitable in/rum5ts4 ,! too?1 :5 freely expos$1 %\ld be remov$ ) an elevator or =ceps4 ,! w\nd result+ mu/ be c>efully pack$ & treat$ z describ$ on page #he4 ,,*apt] ,,iv4 ,! ,use ( ,an/hetics dur+ ,extraction ( ! ,tee?4 ,! an/hetics us$ dur+ ! extraction ( tee? may be divid$ into two classes1 viz43--g5]al & local4 ,x is n propos$ to make any allusion to ! me?ods ( adm9i/]+ g5]al an/hetics1 z !y h>dly fall )9 ! scope ( ?is volume4 ,!re are1 h[ev]1 a few po9ts :i* ! op]ator %\ld be> 9 m9d :5 employ+ !m & :i* may ) advantage be briefly dwelt ^u1 b be=e consid]+ ^!1 a ^w or two may n be out ( place ) reg>d to ! *oice ( ! an/hetic4 ,9 d5tal practice ?ree ag5ts are g5]ally us$1 nitr\s oxide alone or 9 comb9ation ) air or oxyg51 e!r & *lor(orm4 ,9 ! v l>ge majority ( d5tal op]ations nitr\s oxide is to be pref]r$ to e!r & *lor(orm1 & possesses ! great advantage ov] !m ( be+ practically safe4 ,9 addition1 ! adm9i/ration ( nitr\s oxide occupies a %ort] p]iod1 & ! recov]y is rapid & complete4 ,)9 ! la/ few ye>s1 comb9ations ( nitr\s oxide ) oxyg5 & ) air h be5 introduc$ by ,dr4 ,hewitt & ,mr4 ,r[ell respectively1 & bo? comb9ations possess advantages ov] nitr\s oxide us$ alone4 ,! advantages ( nitr\s oxide & oxyg5 ov] nitr\s oxide alone are3-- 7#a7 ,! an/hesia is quiet]4 7#b7 ,! muc\s membranes ( ! m\? d n swell to ! same ext5t1 & ! op]ator !re=e ga9s a cle>] view ( ! too?4 7#c7 ,! p]iod ( an/hesia is l5g!n$1 p]haps by only a few seconds1 b ! quiet] condition ( ! pati5t assi/s indirectly 9 prolong+ ! p]iod = op]at+4 ,! advantages ( nitr\s oxide ) air ov] nitr\s oxide alone are some:at simil> to ^? ( nitr\s oxide & oxyg51 ?\gh less m>k$4 ,= op]ations requir+ a long an/hesia1 su* z ! extraction ( a difficult ?ird mol>1 e!r %\ld be us$1 ! adm9i/ration be+ comm5c$ ) nitr\s oxide4 ,9 su* cases _m op]ators pref] to use *lor(orm1 b ! regul> employm5t ( ?is ag5t 9 d5tal surg]y is to be sev]ely condemn$1 & ! cases are r>e inde$ 9 :i* its use is call$ =4 ,a mo/ c>eful inquiry into ?is important subject has be5 made by ,dr4 ,hewitt1 & ! results ( 8 "w 7 communicat$ 9 an exhau/ive pap] publi%$ 9 ! ,j\rnal ( ! ,briti% ,d5tal ,association = ,novemb]1 #ahie1 :i* is well wor?y ! p]usal ( all ^? :o are 9 ! habit ( adm9i/]+ *lor(orm4 ,:5ev] a g5]al an/hetic is giv5 = ! removal ( tee?1 two p %\ld always be pres5t1 "o to conf9e 8 att5tion solely to ! adm9i/ration ( ! an/hetic1 ! o!r to ! removal ( ! too?1 z x is impossible = "o p]son to op]ate & at ! same "t to obs]ve ! condition ( ! pati5t dur+ ! an/hetic p]iod4 ,?is rule %\ld be /rictly adh]$ to4 ,= extraction "u nitr\s oxide1 & also to a great ext5t "u e!r1 ! positions ( ! pati5ts %\ld diff] b little if at all f ^? already advocat$1 ) ?is exception1 x is advisable n to h ! head too f> back4 ,be=e ! adm9i/ration ( ! an/hetic is comm5c$1 any removable artificial tee? t may be 9 ! m\? %\ld be tak5 out2 ! op]ator %\ld decide exactly :at he int5ds to d2 at ! same "t x is well n to attempt too mu* & to avoid prick+ ! gum dur+ ! exam9ation ( any roots t x may be necess>y to extract4 ,! prop %\ld be plac$ on s\nd firm tee? 9 su* a position t ! op]ator c "w )\t be+ h9d]$ by x1 & a f9al view ( ! m\? %\ld be tak54 ,:]e sev]al tee? h to be extract$ at "o sitt+1 _! ord] ( removal %\ld be decid$ ^u be=e ! op]ation is comm5c$1 & if any p>ticul> too? is caus+ pa91 x %\ld be extract$ fir/4 ,! ord] ( removal %\ld also z f> z possible be arrang$ s t *anges ( in/rum5ts are r$uc$ to a m9imum4 ,z a rule1 l[] tee? %\ld be extract$ be=e upp] tee?1 because if ! latt] are remov$ fir/1 ! blood may pass d[n & s obscure ! l[] ones4 ,roots %\ld be remov$ be=e :ole tee? = ! same reason4 ,ea* too? or root mu/ be cle>$ f ! m\? be=e any attempt is made to remove ano!r except 9 cases :]e ! gum is ?or\ghly adh]5t2 "u ?is condition ! too? or root may be left & fre$ f ! gum :5 ! pati5t has recov]$4 ,) tee? :i* h a liability to slip out f betwe5 ! blades ( ! =ceps1 x is well z a precaution to keep a f+] ( ! left h& beh9d ! blades to prev5t ! too? pass+ backw>ds %\ld x slip out4 ,,local ,,an,,/hetics4 7a7 ,coca9e4--,! mo/ efficaci\s ( ! local an/hetics 9 use is coca9e4 ,x is an alkaloid obta9$ f ! dry leaves ( ,ery?roxylon ,coca1 & 9 practice ! hydro*lorate =m is g5]ally us$4 ,= ! removal ( tee? x is necess>y to inject a solution ( ! drug into ! tissues1 a simple application to ! gum be+ ( little use4 ,coca9e has ! reputation ( n be+ ?or\ghly reliable 9 its action1 b ?is 9 a great measure (t5 arises f want ( c>e 9 inject+ x4 ,n m ?an half a gra9 %\ld be inject$ = ! removal ( a too?1 & ev5 !n ) p ( feeble heal?1 unt[>d symptoms may sup]v5e4 ,mode ( ,employm5t4--,a fre% solution ( ! drug %\ld be made ea* "t its use is call$ =1 by dissolv+ a tabloid weigh+ half a gra9 9 #e m9ims ( di/ill$ wat]4 ,half ( ! solution %\ld be inject$ into ! gum on ea* side ( ! alveolus4 ,! gum be+ su* a d5se tissue1 ! solution %\ld be inject$ sl[ly1 o!rwise ! bulk ( x w escape by ! side ( ! ne$le into ! m\?4 ,z !re is always a t5d5cy = ?is to happ5 ev5 :5 ! solution is sl[ly inject$1 x is well to keep a f+] ( ! left h& press$ on ! gum :]e ! ne$le is ins]t$4 ,speak+ p]sonally1 ,i usually occupy ab\t eight m9utes ov] ! injection1 & wait = f\r or five m9utes aft] its completion be=e op]at+4 ,z a local an/hetic ,i h g5]ally f\nd coca9e satisfactory1 s f> z its an/hetic prop]ties are conc]n$1 b ! occasional appe>ance ( toxic symptoms1 especially 9 ^? ( feeble heal?1 %\ld n be lo/ sight (4 ,tropacoca9e has be5 recomm5d$ z possess+ ! an/hetic prop]ties ( coca9e )\t giv+ rise to toxic effects1 b 9 practice ,i h n f\nd ^! /atem5ts fully borne out4 ,toxic ,effects4--,! adm9i/ration ( coca9e1 especially if giv5 9 l>ge doses1 may be foll[$ by well-m>k$ toxic effects ( :i* ! foll[+ are cit$ by ,dr4 ,hewitt4#d 8,heada*e2 v]tigo2 pallor2 a cold1 moi/ sk92 a feeble1 sl[1 or rapid pulse1 becom+ imp]ceptible 9 grave cases2 incoh]5ce ( spee*2 nausea2 vomit+2 unconsci\sness2 trismus & o!r muscul> spasms2 epilepti=m attacks2 dilat$ or unequal pupils2 & di/urbances ( respiration1 culm9at+ 9 dyspna & asphyxia40 ,! treatm5t ( coca9e poison+ %\ld be direct$ fir/ to re/or+ ! circulation by ! adm9i/ration ( a rapidly act+ /imulant1 su* z sal-volatile1 br&y1 or ! hypod]mic injection ( e!r4 ,! pati5t %\ld be plac$ 9 ! horizontal position1 & ! respiration wat*$ =2 %\ld ?is t5d to fail1 artificial respiration mu/ be imm$iately resort$ to4 7b7 ,freez+ ,ag5ts4--,?is gr\p includes su* prep>ations z *loride ( e?yl1 coryl 7a mixture ( *loride ( e?yl & *loride ( me?yl 9 su* proportions t ! mixture boils at #j ,c47 & ane/ile4 ,g5]ally speak+1 ! an/hesia produc$ is by no means satisfactory1 & to use !m to ! greate/ advantage1 att5tion mu/ be giv5 to ! foll[+ po9ts3-- 7#a7 ,! gums mu/ be well dri$1 & z f> z possible all neighb\r+ regions1 su* z ! *eeks or tongue1 protect$ by napk9s or o!r suitable mat]ial4 7#b7 ,! gums mu/ be ?or\ghly froz5 be=e comm5c+ to op]ate4 7#c7 ,! extraction mu/ be c>ri$ out z quickly z is consi/5t ) ?or\ghness4 7#d7 ,if possible ! spray %\ld be cont9u$ dur+ ! op]ation4 7#e7 ,too great a jet %\ld n be us$4 ,freez+ ag5ts c be employ$ mu* bett] = front ?an = back tee?1 9 fact x is f\nd at times difficult to freeze ! gums at all satisfactorily at ! back ( ! m\?4 ,,*apt] ,v4 ,difficulties1 ,complications & ,sequel ( ,extraction ( ! ,tee?4 ,l all o!r surgical op]ations1 ! extraction ( tee? is at times att5d$ ) c]ta9 difficulties1 complications & sequel :i* = ! sake ( description w be consid]$ "u ! foll[+ head+s3 7#a7 ,difficulties1 complications & sequel connect$ ) ! tee? !mselves4 7#b7 ,difficulties1 complications & sequel connect$ ) ! jaws4 7#c7 ,difficulties1 complications & sequel connect$ ) ! s(t p>ts4 7#d7 ,difficulties1 complications & sequel aris+ dur+ extraction "u an/hetics4 7#e7 ,miscellane\s complications1 difficulties & sequel4 7#a7 ,,difficulties1 ,,complications ,,& ,,sequel ,,connect$ ,,) ,,! ,,tee? ,,!mselves4 7a7 ,undue ,resi/ance ( ! too? & alveolus4--,consid]able resi/ance to our ef=ts to remove a too? at times occurs4 ,?is is naturally mo/ (t51 ?\gh by no means always1 met ) 9 ^? ( /rong physique4 ,tee? isolat$ are always firm] ?an ^? 9 s]ies2 ?is is acc\nt$ = by a consolidation ( ! bone ar\nd !m4 ,exp]i5ce w act z a guide1 & x is to a c]ta9 ext5t possible1 aft] a little obs]vation1 to ga!r f ! g5]al appe>ance ( a too? if x w give m ?an normal tr\ble 9 removal4 ,%\ld undue resi/ance be met )1 /eady attempts to move ! too? slightly 9 diff]5t directions %\ld be made & p]sev]$ )2 if ?is precaution is n tak5 & too mu* =ce is us$ 9 any "o direction1 fracture ( ! too? or alveolus is sure to result4 ,x may1 p]haps1 be f\nd impossible to remove ! too?2 :5 ?is is ! case x is be/ to dismiss ! pati5t & to make a fre% attempt two or ?ree days lat]2 ! too? w !n probably be loose1 z a result ( ! inflammation :i* has be5 set up by ! previ\s attempt at extraction1 & c be easily remov$4 ,! causes ( undue resi/ance are3-- 7i47 ,abnormal d5sity ( ! alveol> process4 7ii47 ,div]g5t & twi/$ roots4 7iii47 ,alt]ation 9 ! %apes ( ! roots br\ght ab\t by p]iodontal inflammation 7exo/osis74 7b7 ,fracture ( ! too?4--,! pr9cipal causes ( ?is accid5t are3-- 7i47 ,! use ( badly fitt+ =ceps4 7ii47 ,! use ( unnecess>y or wrongly appli$ =ce 9 attempt+ to loos5 ! too? 9 its socket4 ,a too? hav+ be5 fractur$1 ! pati5t %\ld be made to r9se ! m\? until ! ble$+ has ceas$1 ! socket %\ld be dri$ ) cotton-wool1 & ! position & edge ( ! root def9$ ) a probe be=e attempt+ to remove ! fractur$ portion4 ,x is neglect ( ^! /eps t s (t5 leads to failure to remove ! rema9+ portion ( a fractur$ root4 ,too _m attempts to remove a fractur$ root %\ld n be made2 if a second endeav\r proves fruitless1 ! pati5t %\ld be dismiss$ & a fre% attempt1 if necess>y1 made aft] a p]iod ( "o or two days1 z ! too? w probably !n be loos] f inflammatory tr\ble1 moreov]1 ! hmorrhage hav+ ceas$1 x w be possible to obta9 a cle>] view ( ! root4 ,be=e1 h[ev]1 dismiss+ ! pati5t1 an anodyne m\? wa% %\ld be prescrib$1 & ! pulp if expos$ t\*$ ) c>bolic or nitric acid4 ,! l[] ?ird ( a root may g5]ally be left )\t fe> ( unpleasant consequ5ces2 b x is always well to in=m ! pati5t :5 any portion ( a too? is all[$ to rema9 9 ! jaw1 z su* k may be ( assi/ance %\ld any tr\ble arise at a subsequ5t date4 7c7 ,cr[d$ & irregul> tee?4--,! removal ( ^! has already be5 ref]r$ to 9 ,*apt] ,,iii4 7d7 ,! ,removal ( ! wrong too?4--,! removal ( ! wrong too? may occur & is naturally due to c>elessness on ! "p ( ! op]ator4 ,%\ld ?is accid5t arise1 ! too? mu/ be imm$iately replac$ & if necess>y secur$ ) a ligature4 ,if ! pulp subsequ5tly %[s signs ( deg5]ation or inflammation x %\ld be remov$ & ! canal treat$ & fill$4 7e7 ,removal ( a neighb\r+ too?4--,?is may occur & is g5]ally due to a cr[d$ arrangem5t ( ! tee?4 ,! accid5t seems to occur mo/ frequ5tly ) ! removal ( ! fir/ p]man5t l[] mol>1 ! neighb\r+ too? usually involv$ be+ ! second bicuspid :i* is simultane\sly dislocat$ f its socket4 ,?is accid5t c be avoid$ by plac+ ! ?umb on ! too? :i* %[s a t5d5cy to move1 & ex]t+ only z mu* =ce 9 ! removal ( ! too? :i* is be+ extract$ z c be controll$ by ! ?umb4 ,if a neighb\r+ too? is remov$ x mu/ be replac$ & treat$ 9 ! same mann] z describ$ above4 7f7 ,removal ( an un]upt$ bicuspid4--,?is may be an avoidable or an unavoidable accid5t4 ,at times ! develop+ bicuspid is s firmly embrac$ by ! roots ( ! decidu\s mol> t dur+ ! extraction ( ! latt] too? ! bicuspid is remov$--su* an accid5t _c be avoid$4 ,x is an avoidable accid5t :5 x occurs dur+ ! extraction ( ! roots ( a tempor>y mol> & arises f us+ too mu* =ce4 ,z previ\sly po9t$ out x is be/ to leave ! fractur$ roots ( tempor>y mol>s alone unless !y c be easily remov$4 7g7 ,break+ "o too? 9 extract+ ano!r4--,9 ! extraction ( l[] tee? ) hawk's-bill =ceps ! upp] tee? may be fractur$4 ,?is accid5t is mo/ likely to occur to ! inexp]i5c$1 & arises f ! too? leav+ its socket sudd5ly1 due frequ5tly to ! extract+ =ce be+ us$ 9 an upw>d r ?an an outw>d direction4 ,x may1 h[ev]1 occur :5 a l[] too? has be5 m ?an normally resi/ant4 ,9 all su* cases x is well = ! op]ator to be on gu>d by keep+ ! ?umb or a f+] ( ! left h& ov] ! jo9t ( ! =ceps4 ,also 9 us+ ! elevator an adjac5t too? may be fractur$4 7#b7 ,,difficulties1 ,,complications ,,& ,,sequel ,,connect$ ,,) ,,! ,,jaws4 7a7 ,fracture4--,! fracture & removal ( a small piece ( ! alveolus is n an unfrequ5t accid5t :i* is =tunately by no means s]i\s4 ,x is sometimes unavoidable b at o!r times is due to gett+ ! blades ( ! =ceps on ! out] sides ( ! alveolus in/ead ( betwe5 ! bone & ! root ( ! too?4 ,ext5sive fracture is sometimes se51 = in/ance 9 a case t came "u my notice at ! ,d5tal ,hospital ( ,london an unqualifi$ p]son 9 remov+ ! fir/ l[] "r p]man5t mol> fractur$ ! bone 9 a horizontal direction s t ! second & fir/ bicuspids ) ! can9e 7 completely sep>at$ f ! body ( ! bone4 ,mr4 ,salt]#e gives an acc\nt ( an ext5sive fracture ( ! jaw :i* occurr$ 9 a lady t4 #ce4 ,! fracture occurr$ 9 connection ) ! removal ( ! sup]ior c5tral incisors4 ,! "r c5tral incisor requir$ "s =ce = its removal1 & :5 x came away ! :ole ( ! front ( ! alveolus 0 firmly atta*$ to ! root4 ,9 remov+ ! left c5tral incisor consid]able =ce 0 requir$ dur+ ! ex]tion ( :i* ! bone 0 fractur$4 ,on exam9ation ( ! p>ts ! mass ( bone correspond+ to ! int]maxill>y bone 0 f\nd to be m]ely held 9 place by ! s(t tissues4 8,a v]tical fracture ext5d$ f ! side ( ! can9e up to ! root ( ! nose1 !n ne>ly horizontally across to ! opposite side1 be+ connect$ !re ) ano!r v]tical fracture4 ,! lesion pass$ completely ?r\gh ! jaw f be=e backw>ds1 & !re 0 a w\nd 9 ! palate ?ree qu>t]s ( an in* f ! alveol> bord]1 ?r\gh :i* 0 consid]able hmorrhage40 ,a /ill m sev]e example ( fracture dur+ extraction ( tee? is record$ by ,mr4 ,cattl91#f :]e 9 an attempt to remove a ?ird upp] mol> ) an elevator ! tub]osity ( ! maxilla1 a portion ( ! floor ( ! antrum & "p ( ! sph5oid 7 fractur$4 ,fracture ( ! maxilla tub]osity may occur dur+ ! removal ( ! ?ird upp] mol>1 & ,mr4 ,nicol#g records su* an accid5t dur+ ! removal ( ! second upp] p]man5t mol>4 ,9 a case record$ by ,mr4 ,l4 ,ma!son#h a transv]se fracture ( ! maxilla occurr$ 9 a l9e betwe5 ! fir/ & second p]man5t mol>s dur+ ! removal ( ! fir/-nam$ too?4 ,direct transv]se fracture ( ! horizontal ramus ( ! m&ible due to extraction ( ! tee? has also be5 record$4 ,treatm5t4--,9 fracture ( small portions ( ! alveol> process1 no special treatm5t is call$ = except t all loose fragm5ts %\ld be remov$4 ,:5 ! fracture is ( a m ext5sive "*1 ! fragm5ts mu/ be reta9$ 9 position by a suitable =m ( spl9t1 a description ( :i* w be f\nd 9 mo/ works on d5tal surg]y4 7b7 ,necrosis ( ! alveolus may result f extraction & is g5]ally ! result ( undue viol5ce or ( "s septic process occurr+ 9 ! w\nd4 ,! treatm5t to be foll[$ consi/s ( ! use ( antiseptic & deodorant m\? wa%es2 ! necros$ bone :5 q sep>at$ f ! liv+ tissue %\ld be remov$ ) a pair ( suitable =ceps4 7c7 ,dislocation ( ! m&ible4--,! use ( too mu* =ce 9 extract+ a l[] too? & n at ! same "t c\nt]act+ ! =ce by support+ ! *91 may lead to unilat]al or bilat]al dislocation ( ! m&ible4 ,?is accid5t may also be br\ght ab\t by =c+ ! m\? op5 too mu* ) a ,mason's gag dur+ ! adm9i/ration ( an an/hetic4 ,x may likewise occur )\t ! employm5t ( undue =ce 9 ^? :o h previ\sly met ) or are liable to dislocation4 ,r$uction may be br\ght ab\t by plac+ ! ?umbs1 c>efully wrapp$ 9 a napk91 on ! mol> tee? & ! palm> surfaces ( ! f+]s bel[ ! *94 ,if d[nw>d pressure is !n made ) ! ?umbs1 & upw>d pressure ) ! f+]s1 ! condyles ( ! m&ible w g5]ally pass back easily into ! gl5oid cavity4 ,9 cases :]e m difficulty ?an ?is is exp]i5c$1 ! pati5t %\ld be plac$ 9 a recumb5t position1 & corks %\ld be ins]t$ betwe5 ! back tee?4 ,upw>d pressure %\ld !n be appli$ on ! "u surface ( ! *94 ,x is advisable1 aft] r$uction1 = ! pati5t to we> a f\r-tail$ b&age = ab\t a week4 7d7 ,=c+ a root into ! antrum4--,?is accid5t occurs mo/ly 9 connection ) ! extraction ( ! second upp] bicuspid root & buccal roots ( ! fir/ upp] p]man5t mol>4 ,if a root has be5 s dislocat$ into ! antral cavity z to /ill p>tly rema9 9 its socket1 ! be/ c\rse to pursue is to leave x alone & n to attempt removal z ! attempt might only result 9 complete dislocation ( ! root into ! antrum4 ,! socket %\ld be kept q clean by ! cont9ual use ( antiseptic wa%es4 ,z a rule ! root gives rise to no subsequ5t tr\ble4 ,:5 a root has be5 =c$ completely into ! antrum1 ! latt] %\ld be enl>g$ & ! antral cavity ?or\ghly syr+$4 ,= ?is purpose x is well to use an aural syr+e ( five or six ounce capacity4 ,! rationale ( ?is =m ( treatm5t is t ! root may pass out ) ! return curr5t f ! antrum4 ,if ?is treatm5t fails1 an attempt may be made to remove ! root ) a little scoop ( gutta-p]*a fix$ on to a flexible wire4 ,:5 x _c be remov$ 9 ?is mann]1 ! cavity %\ld be ?or\ghly irrigat$ ) an antiseptic solution & ! root left alone1 z x w 9 all probability become ency/$ & n give rise to any subsequ5t tr\ble4 ,if1 h[ev]1 ! pati5t has a hi/ory ( epi!liomat\s disease ( ! jaws fur!r attempts %\ld be made to remove x4 ,a case :]e a too? 0 =c$ into ! antrum 9 a pati5t ) a family hi/ory ( epi!lioma ( ! jaw is record$ 9 ! ,transactions ( ! ,odontological ,society1 vol4 ii41 page #ae1 old s]ies4 7e7 ,=c+ a too? into an abscess cavity4--,?is accid5t may occur2 if x does1 x requires simil> treatm5t to ! accid5t j describ$ 9 connection ) ! antrum4 7f7 ,trismus4--,inability to op5 ! m\? naturally r5d]s extraction ( ! tee? m difficult ?an usual4 ,:51 h[ev]1 ! closure is ! result ( inflammatory tr\ble 9 connection ) ! l[] mol>s1 an an/hetic %\ld be giv5 & ! m\? op5$ =cibly ) a ,mason's gag4 ,if ! trismus is ! result ( tonic contraction ( ! muscles clos+ ! jaw1 e!r %\ld be us$ 9 ord] to ov]come ! resi/ance ( ! muscles1 z nitr\s oxide w\ld n h ! desir$ effect4 7#c7 ,,difficulties1 ,,complications ,,& ,,sequel ,,9 ,,connection ,,) ,,! ,,s(t ,,tissues4 7a7 ,ext5sive lac]ation ( ! gum4--,9 cases :]e a too? has giv5 rise to mu* tr\ble 9 removal1 ! s(t tissues naturally suff]1 b ap>t f ?is !y may be sev]ely lac]at$ :5 ! gum is m ?an usually adh]5t to a too?4 ,?is is mo/ frequ5tly se5 9 ! removal ( ! l[] ?ird mol>1 b x is also sometimes met ) 9 ! removal ( loose tee?4 ,:5 ! gum is f\nd m ?an usually adh]5t ! too? %\ld be left 9 ! socket until ! gum atta*m5t has be5 divid$ ) a pair ( scissors or a lancet4 ,cont9u$ attempts to remove ! too? ) ! =ceps be=e ! gum has be5 divid$ w only lead to undue lac]ation4 ,9 all cases :]e ! gums h be5 badly lac]at$1 an anodyne m\? wa% %\ld be prescrib$4 7b7 ,w\nd+ ! tongue4--,?is is mo/ likely to occur "u nitr\s oxide1 z ! tongue dur+ an/hesia is g5]ally swoll51 & is1 moreov]1 n "u ! control ( ! pati5t4 ,w\nd+ ! tongue is ne>ly always due to c>elessness1 & arises g5]ally 9 us+ ! elevator4 ,:5 ! tongue is mu* lac]at$1 ! ov]hang+ portions %\ld be trimm$ (f ) scissors & ! surface kept clean ) antiseptic m\? wa%es4 ,if ! tongue is punctur$ & ! w\nd does n involve a l>ge bran* ( ! l+ual art]y1 b yet ble$s freely1 ! tongue %\ld be drawn =w>d2 if ?is does n prove successful ! ins]tion ( a /it* w g5]ally cause ! hmorrhage to cease4 ,if ! tongue is punctur$ & a l>ge bran* ( ! l+ual art]y is involv$1 ! f+] %\ld be plac$ on ! back ( ! tongue & ! organ drawn =w>d2 ?is compresses ! l+ual art]y aga9/ ! hyoid bone4 ,! ble$+ po9t mu/ !n be s\ght = &1 if f\nd1 an attempt made to twi/ ! w\nd$ vessel4 ,if ?is fails caut]isation may be tri$1 & z a la/ res\rce1 if caut]isation does n /op ! ble$+1 ! l+ual art]y mu/ be ti$4 7c7 ,bruis+ ! l[] lips4--,?is may occur 9 ! removal ( upp] bicuspids & mol>s1 & is due to hav+ ! m\? insuffici5tly op5$1 & us+ =ceps ( too /raight a patt]n4 7d7 ,injury ( ! m&ibul> n]ve4--,! m&ibul> n]ve may be injur$ dur+ ! removal ( ! l[] mol>s & bicuspids4 ,loss ( s5sation ov] ! p>ts suppli$ by ! n]ve1 ) dribbl+ ( saliva1 g5]ally foll[s ! accid5t4 ,s5sation is1 h[ev]1 usually re/or$1 & 9 cases ( lac]ation ! n]ve g5]ally unites4 ,mr4 ,sewill records a case 9 :i* 8! roots ( a l[] wisdom too? conta9$ a groove & a =am51 ?r\gh :i* ! inf]ior d5tal n]ve _h evid5tly pass$40 7e7 ,hmorrhage foll[+ too? extraction is a mo/ important complication1 & "o :i* ne$s prompt treatm5t4 ,hmorrhage is pr$ispos$ to by a dia!sis kn[n z hmophylia4 ,( its pa?ology b little seems to be def9itely kn[n4 ,! blood 9 ?is condition is said by ,wal%am to be defici5t 9 fibr94 ,hmorrhage may occur 9 p n pr$ispos$ to ! above-nam$ dia!sis2 9 "s in/ances x is probably due to pa?ological *anges 9 ! art]y supply+ ! too?1 ^! *anges be+ frequ5tly induc$ by inflammation ar\nd ! apex ( ! root1 & ! vessel becom+ adh]5t to its bony surr\nd+1 & ?us prev5t$ f contract+4 ,ano!r condition1 :i* may or may n h any practical be>+1 is ! occurr5ce ( hmorrhage dur+ ! m5/rual p]iod4 ,i h1 on two occasions1 _h "u notice pati5ts = :om tee? h be5 extract$ dur+ ?is p]iod1 & 9 :om hmorrhage foll[$1 b ceas$ at ! t]m9ation ( ! p]iod4 ,tee? _h be5 extract$ = bo? ^! pati5ts on previ\s occasions1 )\t undue hmorrhage foll[+4 ,hmorrhage is g5]ally divid$ into ?ree /ages1 viz43--prim>y1 int]m$iate & second>y4 ,9 ! m\? we (t5 f9d ! prim>y runn+ into ! int]m$iate4 ,! treatm5t ( prim>y hmorrhage1 or t occurr+ at ! "t ( ! op]ation1 is n ( s]i\s import4 ,if x is at all %>p a useful plan is to give ! pati5t "s t9cture ( hamamelis 9 ! wat] us$ = r9s+ ! m\?4 ,at ! same "t ab\t fifte5 gra9s ( gallic acid#i %\ld be giv51 & ! pati5t %\ld be ord]$ to take a simil> quantity e two or ?ree h\rs until ! hmorrhage ceases4 ,! socket %\ld also be loosely plugg$ ) cotton-wool dipp$ 9 "s /yptic1 su* z gallic acid4 ,int]m$iate & second>y hmorrhage is ( a m s]i\s nature1 & g5]ally sets 9 at night4 ,:5 a case ( int]m$iate hmorrhage is fir/ se51 ^! two important po9ts %\ld be asc]ta9$ be=e treat+ x3--fir/1 :e!r ! ble$+ is com+ f ! gums or ! socket ( ! too?2 secondly1 :e!r ! blood %[s a t5d5cy to coagulation4 ,! latt] po9t w act z a guide 9 ! *oice ( drugs = int]nal adm9i/ration4 ,9 hmorrhage f ! gum se>* %\ld be made = any small vessels t may be ! cause ( x1 & if f\nd !y %\ld be twi/$ or compress$4 ,if ! vessel is only p>tially divid$ x %\ld be completely sev]$1 z ?is w probably all[ contraction to take place4 ,if ! ble$+ is capill>y 9 "*1 a pad ( gutta-p]*a l9$ ) l9t dipp$ 9 "s /yptic & appli$ ) firm pressure is usually suffici5t to /op x4#aj ,:5 ! ble$+ proce$s f ! socket ! foll[+ mode ( proc$ure is adopt$3 "s small cone-%ap$ pieces ( non-absorb5t cotton-wool are prep>$ 7ea* ab\t to in* long & in* broad at ! base71 also a pad ( l9t & a f\r-tail$ b&age2 a syr+e1 a pair ( convey+ =ceps1 "s cold wat] & ! *os5 /yptic are likewise plac$ ready = use4 ,! socket is fir/ fre$ f clot1 !n syr+$1 !n dri$ out ) a pl$get ( cotton-wool1 & directly aft]w>ds "o ( ! cone-%ap$ pieces ( cotton-wool dipp$ 9 ! /yptic 7! mo/ useful be+ tann97 is plac$ 9 ! socket & =c$ to ! apex1 ) a fair am\nt ( pressure2 ! hmorrhage is arre/$ f> m by pressure ?an by ! /yptic4 ,m pl$gets ( wool are ins]t$ until ! socket is q full2 a plug ( l9t is !n plac$ ov] all & kept 9 position by antagonism ) ! upp] tee?1 a f\r-tail$ b&age be+ us$ = ?is purpose4 ,an excell5t me?od ( keep+ ! plug 9 ! socket if ! approximal tee? are /&+ is to w$ge a piece ( wood betwe5 !m4 ,excell5t z ?is plan is1 h[ev]1 if ! hmorrhage is at all %>p x is bett] to use ! f\r-tail$ b&age to make m c]ta9 ( reta9+ ! plug 9 position4 ,! numb] ( pl$gets ( wool ins]t$ 9 ! socket %\ld be c\nt$4 ,! g5]al directions to be giv5 to ! pati5t1 ?\gh app>5tly trivial1 are mo/ important & %\ld nev] be =gott54 ,he or %e %\ld be advis$ to g home v quietly1 to avoid all =ms ( excitem5t1 to assume ! sitt+ position usual dur+ ! day1 & to use a high pill[ at night4 ,! pati5t %\ld be f$ ?r\gh a b5t tube1 & all fluids %\ld be giv5 cold4 ,9 addition to plugg+ ! socket1 hmo/atics %\ld be adm9i/]$ int]nally4 ,9 cases :]e !re is a ?9 wat]y blood & no t5d5cy to coagulation x may be fairly assum$ t ! cause ( ! hmorrhage lies 9 ! blood1 & su* drugs z gallic acid#aa & p]*loride ( iron#ab are indicat$1 b :5 ! blood %[s a m>k$ t5d5cy to coagulate 9 ! m\?1 z (t5 happ5s1 & ! ble$+ /ill cont9ues1 su* drugs z ergot#ac are indicat$2 9 ?is latt] condition x may be assum$ t ! cause ( ! hmorrhage lies 9 "s want ( contractility ( ! vessel wall1 & ergot causes contraction ( un/rip$ muscul> tissue4 ,at ! "t ( plugg+ ! socket a dose ( gallic acid1 p]*loride ( iron or ergot %\ld be giv51 & its adm9i/ration cont9u$ at int]vals until ! ble$+ ceases4 ,mr4 ,morton ,smale pref]s a hypod]mic injection ( ergot9e4#ad ,! pati5t %\ld be se5 )9 tw5ty-f\r h\rs aft] treatm5t1 & if ! ble$+ has ceas$ ! plugs may be remov$ & an antiseptic m\? wa% prescrib$4 ,?is c\rse is n recomm5d$ :5 ! hmorrhage has be5 sev]e2 "u su* circum/ances ! plugs %\ld be all[$ to "w !mselves out4 ,if ! hmorrhage has n !n ceas$1 ! socket %\ld be replugg$ tight] ?an be=e ) a plug ( wood wrapp$ 9 non-absorb5t cotton-wool4 ,%\ld ?is prove ( no avail ! actual caut]y may be tri$2 if ?is fails1 & ! ble$+ is f ! m&ible1 ! canal %\ld be treph9$ & a plug ( ivory ins]t$1 s z to compress ! art]y aga9/ ! inn] plate ( ! bone4 ,9 uncontrollable hmorrhage f ! maxilla digital pressure on ! common c>otid opposite ! transv]se process ( ! six? c]vical v]tebra may be tri$2 %\ld ?is fail to /op ! hmorrhage1 ligature ( t vessel mu/ be resort$ to4 ,9 "o case ( hmorrhage f ! region ( ! ?ird "r l[] mol> ,mr4 ,boyd#ae divid$ ! lip 9 ! m$ian l9e & reflect$ ! *eek f ! jaw4 ,! m&ibul> canal 0 !n laid op5 by excis+ ! out] plate ( ! bone1 & ! ble$+ 0 arre/$ by plugg+ ! mesial & di/al ends ( ! canal4 ,9 extreme cases1 ) sign ( collapse1 normal sal9e solution#af mu/ be infus$ into ! m$ian basilic ve94 ,9 pati5ts pr$ispos$ to hmorrhage extraction %\ld be if possible avoid$2 b1 if ! removal ( ! too? be absolutely necess>y1 prophylactic treatm5t %\ld be pursu$ = ?ree or f\r days previ\s to ! op]ation by ! adm9i/ration ( "o or o!r ( ! rem$ies previ\sly m5tion$4 ,a new /yptic1 consi/+ ( fibr9 f]m5t #a to #aj to :i* #a p] c5t4 ( calcium *loride has be5 add$1 is said by ,wal%am to act only on ! blood1 n on ! tissues1 & to be p]fectly aseptic4 ,x 0 f\nd to be effectual 9 arre/+ hmorrhage aft] ! division ( all ! ve9s except ! common jugul> 9 a dog's neck4 ,! too? %\ld be extract$ 9 ! e>ly morn+1 z we !n h ! day be=e u %\ld hmorrhage occur4 ,"s hmo/atic %\ld be adm9i/]$ at ! "t ( ! op]ation & ! socket plugg$ at once2 = x is mo/ important to rememb] t 9 ^! cases x is f> easi] to prev5t ! hmorrhage occurr+ ?an to arre/ x :5 once x has comm5c$4 ,! subsequ5t treatm5t w consi/ 9 ! cont9u$ adm9i/ration ( hmo/atic drugs4 7f7 ,injury ( ! art]ies 9 ! neighb\rhood ( ! tee?4--,w\nd ( ! l+ual art]y has be5 ref]r$ to "u ! head+ ( injuries to ! tongue4 ,lac]ation ( ! ran9e1 ant]ior & po/]ior palat9e art]ies may also occur4 ,su* accid5ts are usually ! result ( ! =ceps slipp+ & are !re=e avoidable4 ,treatm5t consi/s 9 pressure or 9 twi/+ or ty+ ! divid$ vessel4 ,9 ! case ( ! ant]ior or po/]ior palat9e art]y x may be f\nd necess>y to plug ! =am9a :i* give passage to ^! vessels4 7g7 ,pa9 foll[+ too? extraction4--,! causes giv+ rise to pa9 foll[+ ! extraction ( a too? are3-- 7#a7 ,incomplete extraction ( ! too?1 m especially :5 ! rema9+ portion conta9s an expos$ pulp4 7#b7 ,too rapid heal+ ( ! orifice ( ! socket4--,x sometimes happ5s t ! m>g9s ( ! w\nd left aft] extraction unite v e>ly1 & :5 ?is occurs ! dis*>ges :i* naturally come away f ! granulat+ surface at ! base ( ! socket1 h no exit2 ! consequ5ce is t !y are reta9$ & set up a local traumatic inflammation1 lead+ to swell+ ( ! surr\nd+ tissue4 7#c7 ,suppuration 9 ! too? socket4--,?is may be due 9 ! fir/ in/ance to ! use ( dirty =ceps1 & "u su* circum/ances x may be class$ z a poison$ w\nd4 ,an exam9ation w reveal ! pres5ce ( gre5i% putrid pus1 :ile ! tissue ar\nd w be mu* inflam$1 & ! portion imm$iately bord]+ ! w\nd w h a t5d5cy to sl\gh4 ,a condition ( ?is k9d is (t5 se5 9 hospital nurses & m$ical /ud5ts & is no d\bt due to infection met ) 9 _! daily duties4 ,suppuration 9 ! socket may be due to a l[]$ vitality ( ! tissue1 produc$ by "s su* local causes z acute or *ronic inflammation1 & is especially well se5 9 cases ( extraction = ! relief ( p]iodontitis1 or :]e ! op]ation has be5 p]=m$ 9 pati5ts suff]+ f g5]al debility1 syphilis1 /ruma or 9 fact any ( ^? sy/emic diseases :i* t5d to l[] ! vitality ( ! organism4 7#d7 ,ext5sive lac]ation ( ! h>d & s(t tissues 9 ! neighb\rhood ( ! socket2 & 7#e7 ,necrosis ( ! socket ( ! too? are also fruitful s\rces ( pa9 foll[+ too? extraction4 7#f7 ,! pres5ce 9 ! w\nd ( a =eign body4--,a curi\s example ( ?is came "u notice a few ye>s ago4 ,a pati5t appli$ = ! extraction ( ! left fir/ p]man5t mol>4 ,dur+ ! op]ation a portion ( "o ( ! cusps disappe>$2 a se>* 0 made = x b1 z x 0 n f\nd1 ! natural supposition 0 t x _h be5 remov$ 9 r9s+ ! m\?4 ,! pati5t = ! next ?ree weeks compla9$ ( slight pa9 9 ! socket = :i* rem$ies 7 tri$ b prov$ ( little use4 ,ev5tually ! pati5t discov]$ ! cusp on ! top ( ! granulation tissue :i* _h fill$ up ! socket4 ,9 ano!r case ( ! same "* :i* came "u notice1 ! (f5d+ mat]ial 0 a piece ( an amalgam fill+4 ,a fractur$ blade ( =ceps may likewise act z ! (f5d+ body4 7#g7 ,injury to ! n]ve4--,direct injury to ! trunk ( ! n]ve is m likely to occur dur+ extraction ( ! l[] ?ird mol> ?an ) any o!r too?4 ,x is m ?an probable t _m obscure cases ( pa9 foll[+ too? extraction are due to exposure & irritation ( ! n]ve at ! apex ( ! socket4 ,an int]e/+ case ( ?is "* 0 lately report$ by ,mr4 ,/or] ,b5nett4#ag ,! pati5t1 a lady t4 #bc1 _h _h ! ?ird upp] mol> dislocat$ ?r\gh ! use ( a ,wood's gag1 &1 z x 0 consid]$ hopeless to re/ore ! dislocat$ too?1 x 0 extract$ )\t difficulty4 ,! socket 9 spite ( treatm5t rema9$ pa9ful = ! next twelve days1 b 9 ! mean:ile granulat$ heal?ily1 except at its apex1 :]e by ! aid ( a mirror & probe a spot ab\t ! size ( a p9's head 0 notic$ :i* caus$ ! greate/ agony on be+ t\*$4 ,incision ( ! n]ve produc$ p]man5t relief4 ,treatm5t4--,! treatm5t naturally dep5ds v mu* ^u ! cause4 ,a ?or\gh exam9ation ( ! socket %\ld be made ) probe & mirror4 ,:5 due to incomplete extraction1 ano!r attempt1 if consid]$ advisable1 may be made to remove ! too?4 ,?is prov+ unsuccessful1 ! socket %\ld be swabb$ ) an anodyne drug &1 if !re is an expos$ pulp 9 ! rema9+ portion ( ! too?1 ! pulp %\ld be t\*$ ) fum+ nitric acid or /rong c>bolic acid4 ,! pati5t %\ld also be advis$ to use "s poppy head fom5tation4#ah ,9 too rapid heal+ ( ! orifice ( ! socket1 ! fre%ly heal$ surface mu/ be sep>at$1 ! socket syr+$ out1 & a small t5t ( l9t all[$ to rema9 9 ! orifice = ab\t twelve h\rs4 ,an antiseptic m\? wa% %\ld also be prescrib$4 ,9 ^? cases :]e ! pus is putrid & !re is reason to suspect infection1 ! socket %\ld be ?or\ghly syr+$ ) "s antiseptic su* z hyd4 p]*lor4 #a 9 #a1jjj1 c>bolic acid #a 9 #dj2 foll[+ ?is ! p>ts %\ld be c>efully dri$ ) cotton-wool4 ,a small piece ( *loride ( z9c %\ld !n be introduc$ & all[$ to dissolve 9 ! socket1 :i* mu/ be subsequ5tly kept aseptic by con/ant irrigation ) "s antiseptic solution4 ,suppuration is mo/ frequ5tly se5 aft] extraction ( ! l[] tee? ow+ to ! fact t dra9age is less easily effect$ ?an 9 ! upp]1 ow+ to ! dep5d5t position ( ! socket4 ,9 _m cases x w be f\nd necess>y to plug ! socket tightly ) non-absorb5t cotton-wool dipp$ 9 an antiseptic solution2 ?is prev5ts ! accumulation ( dbris :i* w\ld act z an irritant4 ,9 cases ( suppuration occurr+ 9 pati5ts ( dim9i%$ vitality a tonic =m ( treatm5t %\ld be prescrib$2#ai ! dress+ 9 ! socket %\ld be remov$ two or ?ree times a day & ! socket syr+$4 ,c>e mu/ be ex]cis$ 9 apply+ es*>otics to sockets to :i* ! n]ve may be 9 close proximity2 ?is is especially necess>y 9 deal+ ) impact$ l[] ?ird mol>s4 ,two cases illu/rat+ ?is po9t h come "u my notice4 ,9 ! fir/ a second l[] bicuspid ) a long /&+ *ronic abscess _h be5 remov$4 ,! pati5t compla9$ ( pa91 ! socket 0 syr+$ out & a small piece ( *loride ( z9c ins]t$4 ,int5se agoniz+ pa9 foll[$ :i* all local anodynes fail$ to relieve4 ,9 ! second case an impact$ "r l[] ?ird mol> _h be5 remov$4 ,! socket suppurat$1 & ! pa9 al?\gh sev]e 0 n int5se4 ,treatm5t simil> to t us$ 9 ! fir/ case 0 adopt$ ) simil> results4 ,s9ce !n 9 all cases :]e x is possible t ! trunk ( ! n]ve may be 9 close proximity to ! socket1 ,i h us$ non-irritat+ antiseptic injections & plugg$ ! socket ) cotton-wool dipp$ 9 t9cture ( opium ) mu* m satisfactory results4 ,x is advisable to in=m ! pati5t ( ! possibility ( pa9 foll[+ ! extraction ( a too?1 especially aft] p]iodontitis1 & 9 all cases :]e a l>ge numb] ( tee? h be5 extract$ a m\?-wa%#bj %\ld be prescrib$2 =1 ev5 if !re is no pa91 x w prev5t ! dis*>ge f ! sockets ( ! tee? und]go+ putrefactive *anges4 ,9 pa9 due to necrosis ( ! socket deodorant antiseptic injections mu/ be us$1 :ile 9 ext5sive lac]ation ( ! s(t & h>d p>ts an anodyne m\?-wa%#ba may be tri$4 ,9 all obscure cases an application %\ld be made to ! socket ( "s local anodyne su* z t9cture ( opium or coca9e1 & a m\? wa% hav+ simil> prop]ties %\ld at ! same "t be prescrib$4 7#d7 ,,difficulties1 ,,complications ,,& ,,sequel ,,aris+ ,,dur+ ,,extraction ,,"u ,,an,,/hetics4 7a7 ,tongue slipp+ back4--,dur+ extraction "u an/hetics ! tongue n be+ "u control may slip ov] ! l>ynx1 or may be =cibly pu%$ back by ! f+]s ( ! op]ator4 ,symptoms ( difficult brea?+ or ev5 arre/ ( respiration w foll[ ?is accid5t4 ,x is n en\gh to wat* ! *e/ walls1 z respiratory movem5t may cont9ue )\t air ent]+ ! lungs4 ,treatm5t consi/s 9 pull+ ! tongue =cibly =w>d ) a suitable in/rum5t & =cibly ext5d+ ! head on ! sp9al column4 7b7 ,=c+ out a too? ) a prop or a ,mason's gag4--,) a prop ?is accid5t may arise f re/+ x ^u tee? :i* are loose or f plac+ x 9 su* a way t undue lev]age is br\ght to be> on ! tee?4 ,x is an accid5t mo/ likely to occur :5 ! prop is fix$ on ! front tee? & ! m\? op5$ to its wide/ ext5t4 ,"u su* conditions undue lev]age at "r angles to ! long axis ( ! too? is br\ght to be> ^u ! palatal surfaces ( ! upp] tee? & !y are consequ5tly =c$ outw>ds4 ,) a ,mason's gag ! accid5t is due at times to clums9ess2 great c>e %\ld !re=e be ex]cis$ :5 us+ ?is v p[]ful in/rum5t4 ,if a too? is =c$ out x %\ld if possible be imm$iately replac$4 7c7 ,passage ( a =eign body ?r\gh ! i/hmus ( ! fauces4--,a =eign body1 su* z a too?1 a brok5 piece ( =ceps or a prop1 pass+ ?r\gh ! i/hmus ( ! fauces may become impact$ 9 ei!r ! air or food passages4 ,9 ! air passages x may lodge 7#a7 ov] ! entrance ( ! l>ynx1 7#b7 9 ! l>ynx1 7#c7 9 ! tra*ea or bron*us4 ,9 ! food passages x may lodge 7#a7 9 ! ph>ynx1 7#b7 9 ! sophagus1 7#c7 at ! pyloric op5+ ( ! /oma*4 ,9 ! air passages4--,%\ld ! =eign body lodge ov] ! entrance ( or 9 ! l>ynx ! pati5t w be seiz$ ) a viol5t fit ( c\gh+ :i* may expel x2 b1 %\ld ?is n happ51 symptoms ( asphyxia w sup]v5e4 ,) reg>d to treatm5t2 ! head %\ld imm$iately be br\ght =w>d & ! f+] ins]t$ along ! side ( ! m\? into ! ph>ynx1 & !n giv5 a =w>d sweep+ movem5t2 by ?is means ! =eign body1 if lodg$ at ! back ( ! tongue1 w probably be remov$4 ,?is fail+1 ! pati5t mu/ if possible be inv]t$ & a =cible slap giv5 on ! back4 ,if ! =eign body is n dislodg$ by ?is me?od1 l>yngotomy %\ld be imm$iately p]=m$4 ,!re mu/ be no hesitation ab\t ! p]=mance ( ?is op]ation & x mu/ be c>ri$ out promptly1 = ! long] x is delay$ ! less becomes ! *ance ( sav+ ! life ( ! pati5t4 ,a =eign body 9 ! tra*ea or bron*us may give rise to no imm$iate symptoms1 b g5]ally a viol5t fit ( c\gh+1 ) signs ( imp5d+ asphyxia1 takes place at ! "t ( ! accid5t4 ,^! signs pass away1 to be foll[$ at int]vals by fre% attacks ( c\gh+ & ev5tually by symptoms ( collapse ( ! lung or lungs4 ,9 a case record$ by ,sir ,william ,mac,cormac1#bb dur+ ! removal ( an upp] bicuspid ! palat9e blade ( ! =ceps snapp$ (f close to ! jo9t & disappe>$4 ,! pati5t imm$iately suff]$ f great dyspna & appe>$ to be dy+4 ,! symptoms pass$ away1 & = ! foll[+ six weeks ! pati5t's condition gave no great cause = anxiety1 al?\gh %e suff]$ f a con/ant hack+ c\gh accompani$ by bloody expectoration4 ,sev5 weeks aft] ! accid5t %e 0 admitt$ into ,/4 ,?omas's ,hospital1 ! =eign body 0 ) difficulty remov$ f ! "r bron*us1 & ! pati5t made an excell5t recov]y4 ,! diagnosis ( a =eign body 9 "o bron*us is made by an abs5ce ( signs ( respiration ov] ! :ole or "p ( ! lung on t side1 ) exagg]at$ s\nds 7pu]ile brea?+7 ov] ! opposite side4 ,treatm5t consi/s 9 p]=m+ tra*eotomy & remov+ ! =eign body4 ,9 ! food passages4--,a =eign body impact$ 9 ! ph>ynx w give rise to pa91 symptoms ( dysphagia & dyspna4 ,a hack+ c\gh is g5]ally pres5t4 ,%\ld a =eign body be suspect$ 9 ! ph>ynx1 its pres5ce c usually be asc]ta9$ by digital exploration2 ?is fail+1 ! cavity %\ld be exam9$ by ! aid ( a l>yngoscope4 ,an attempt %\ld fir/ be made to remove ! body ) ! f+]s1 & if ?is is unsuccessful ph>yngeal =ceps mu/ be call$ into use4 ,9 "s cases :]e ! impaction is v firm x may be necess>y to p]=m ph>yngotomy4 ,a =eign body 9 ! sophagus w cause dysphagia1 & w probably give rise to con/ant pa92 if x is situat$ 9 ! upp] "p x w 9 all probability give rise to dyspna4 ,on apply+ ! /e?oscope ov] ! region ( ! sophagus1 a gurgl+ s\nd w be he>d :5 ! pati5t swall[s fluids4 ,! pres5ce ( a =eign body may be def9itely asc]ta9$ by pass+ a b\gie2 ?is /ep w also enable ! surgeon to det]m9e ! position 9 :i* ! =eign body is lodg$4 ,if impact$ 9 ! upp] "p ( ! sophagus1 an attempt may be made to remove ! impact$ body ) =ceps2 ?is fail+1 sophagotomy mu/ be p]=m$4 ,if lodg$ ne> ! c>diac end ( ! sophagus an attempt may be made ) a b\gie to pu% ! =eign body into ! /oma*2 ?is fail+1 ga/rotomy %\ld be p]=m$4 ,if a =eign body becomes impact$ at ! pyloric op5+ ( ! /oma*1 x w give rise to ga/ric dilatation4 ,"u su* circum/ances ! /oma* mu/ be empti$ ( its cont5ts1 & ga/rotomy !n p]=m$4 ,a =eign body go+ ?r\gh ! i/hmus ( ! fauces w z a rule pass into ! sophagus1 !n into ! /oma*1 & w give rise to no tr\ble4 ,! details ( su* op]ations z ga/rotomy1 sophagotomy1 c41 d n lie )9 ! scope ( ?is book1 & %\ld be s\ght = 9 works deal+ ) g5]al surg]y4 ,! necessity ( be+ ready = su* em]g5cies z ! above _c be too fully emphasis$1 & all :o adm9i/] an/hetics %\ld be provid$ ) ! in/rum5ts necess>y to p]=m l>yngotomy4 ,^! %\ld be kept 9 a little case1 & no an/hetic %\ld be adm9i/]$ )\t ! case be+ ne> at h&4 ,adh]5ce to ?is rule is important4 7#e7 ,,miscellane\s ,,difficulties1 ,,complications ,,& ,,sequel4 7a7 ,ut]9e pa94--,a case is quot$ by ,mr4 ,s]combe :]e extraction ( a too? 0 foll[$ by p>oxysmal ut]9e pa91 foll[$ by ! cure ( an ob/9ate leucorrha4#bc 7b7 ,%ock4--,! fact t too? extraction is a surgical op]ation1 & may be foll[$ by %ock1 is (t5 ov]look$4 ,! am\nt ( %ock :i* foll[s z a rule is practically nil1 b at times1 especially 9 ! weak1 x may be well m>k$4 ,?is is n tak5 suffici5tly into acc\nt :5 a "q arises z to ! numb] ( tee? to be extract$ at "o sitt+1 & x %\ld be cle>ly borne 9 m9d t :at a /rong1 able-bodi$ p]son1 c /&1 "o ( weak] physique _c be>4 ,! :olesale extraction ( tee? at "o sitt+ :i* is c>ri$ out by "s op]ators is n advisable1 & ! am\nt ( pro/ration t foll[s is sometimes v sev]e4 ,syncope at ! "t ( ! op]ation sometimes occurs4 ,%\ld x sup]v5e dur+ ! extraction ( ! too? ! op]ator %\ld imm$iately desi/ until recov]y ensues4 ,fa9t+ is be/ treat$ by b5d+ ! head d[n t[>ds ! knees1 at ! same "t loos5+ any?+ tight ab\t ! neck & apply+ ord9>y salts ( ammonia to ! nose4 ,9 sev]e cases ! pati5t %\ld be remov$ f ! *air & laid on ! floor1 & ! *e/ %\ld be expos$ & flipp$ ) a t[el dipp$ 9 cold wat]4 ,9 m sev]e cases x may be necess>y to inject e!r or "s o!r /imulant1 su* z br&y4 ,fatal syncope foll[+ too? extraction has occurr$1 & a case :i* took place at ,m>seilles 9 #ahha is m5tion$ by ,tomes4#bd ,! pati5t 0 a female1 & an attempt 0 made to remove a too?1 b 0 desi/$ 9 ow+ to al>m+ syncope4 ,a second attempt 0 made1 or r ab\t to be made1 :5 fatal syncope ensu$4 ,po/-mortem exam9ation %[$ no?+ beyond a slight am\nt ( c]ebral conge/ion4 7c7 ,epilepsy4--,9 ^? pre-dispos$ to epilepsy an attack (t5 comm5ces imm$iately aft] ! extraction ( a too?4 ,9 ! ev5t ( a fit occurr+ ! pati5t %\ld be remov$ f ! *air & plac$ on ! floor1 ! clo!s be+ at ! same "t loos5$1 & a w$ge ( wood or "s suitable mat]ial plac$ betwe5 ! tee? to prev5t injury to ! tongue4 7d7 ,hy/]ia4--,manife/ations ( ?is disord] at times foll[ too? extraction1 b d n call = any special treatm5t beyond t usually adopt$ = ?is disord]4 7e7 ,septic & infective sequel4--,scatt]$ ?r\gh d5tal lit]ature w be f\nd a l>ge numb] ( records ( septic & infective diseases :i* h foll[$ ! extraction ( tee?4 ,9 _m ( ^! cases x w\ld be difficult to say t ! infection 0 always ! result ( ! op]ation2 9 a numb] ( !m ! actual cause 0 due to ! neglect$ condition ( ! too? :i* call$ = extraction4 ,infection c1 h[ev]1 at times und\bt$ly be trac$ to ! op]ation1 & once aga9 att5tion _c be too /rongly drawn to ! fact t antiseptic precautions %\ld be c>ri$ out z f> z possible4 ,suppuration ( ! socket & its appropriate treatm5t has already be5 dwelt ^u 7page #hb74 ,cases ( syphilis hav+ be5 acquir$ ?r\gh ! use ( infect$ =ceps are record$1 :ile septicmia1 saprmia1 cellulitis1 o/eitis1 o/eomyelitis1 p]io/itis1 pymia1 tetanus1 h all be5 kn[n to foll[ ! removal ( a too?1 b ! treatm5t ( ^! conditions h>dly lies )9 ! scope ( ?is book4 ,,index4 ,a ,,page ,abnormality ( upp] mol>s1 #bf ,,accid5ts ,,"u ,,an,,/hetics3-- ,=c+ out a too? ) a prop or a ,mason's gag1 #hh ,passage ( a =eign body ?r\gh ! i/hmus ( ! fauces1 #hi ,tongue slipp+ back1 #hh ,alveoli ( ! tee?1 disposition ( !1 #ab ,alveolus1 fracture ( !1 dur+ extraction1 #fg 8 8 8 8 treatm5t (1 #fi 8 necrosis ( !1 foll[+ extraction1 #gj ,an/hetics1 ! use (1 dur+ ! extraction ( tee?1 #ef ,art]ies1 injury to !1 9 ! neighb\rhood ( ! too? dur+ extraction1 #ha ,b ,bicuspids1 ! extraction ( l[]1 #cd 8 8 8 8 misplac$ l[]1 #ea 8 8 8 8 8 upp]1 #di 8 8 8 8 upp]1 #bb ,break+ "o too? 9 extract+ ano!r1 #fg ,bruis+ ! l[] lips dur+ extraction1 #gd ,c ,can9es1 ! extraction ( l[]1 #cd 8 8 8 8 upp]1 #ba ,c5tral incisors1 ! extraction ( l[]1 #cc1 #ea 8 8 8 8 8 upp]1 #ai ,*loride ( e?yl1 #fa ,*lor(orm1 ! use (1 dur+ ! extraction ( ! tee?1 #ef1 #eg ,coca9e1 mode ( employm5t1 #fj 8 toxic effects1 #fa ,,complications1 ,,difficulties ,,& ,,sequel ,,( ,,extraction ,,( ,,! ,,tee?3-- ,complications1 difficulties1 & sequel aris+ dur+ extraction1 miscellane\s1 #id ,complications1 difficulties & sequel aris+ dur+ extraction "u an/hetics1 #hh ,complications1 difficulties & sequel ( extraction ( ! tee? connect$ ) ! jaws1 #fg ,complications1 difficulties & sequel ( extraction ( ! tee? connect$ ) ! s(t tissues1 #gb ,complications1 difficulties & sequel ( extraction ( ! tee? connect$ ) ! tee? !mselves1 #fc ,coryl1 #fa ,d ,,difficulties1 ,,complications ,,& ,,sequel ,,aris+ ,,dur+ ,,extraction1 ,,miscellane\s3-- ,epilepsy1 #id ,hy/]ia1 #id ,septic & infective sequel1 #ie ,%ock1 #ic ,ut]9e pa91 #ic ,,difficulties1 ,,complications ,,& ,,sequel ,,aris+ ,,dur+ ,,extraction ,,"u ,,an,,/hetics3-- ,tongue slipp+ back1 #hh ,=c+ a too? out ) a prop or ,mason's gag1 #hh ,passage ( a =eign body ?r\gh ! i/hmus ( ! fauces1 #hi ,,difficulties1 ,,complications ,,& ,,sequel ,,connect$ ,,) ,,! ,,jaws3-- ,dislocation ( ! m&ible1 #gj ,=c+ a root into ! antrum1 #ga ,=c+ a too? into an abscess cavity1 #gb ,fracture1 #fg 8 treatm5t (1 #fi ,necrosis1 #gj ,trismus1 #gb ,,difficulties1 ,,complications ,,& ,,sequel ,,connect$ ,,) ,,! ,,tee? ,,!mselves3-- ,break+ "o too? 9 extract+ ano!r1 #fg ,cr[d$ & irregul> tee?1 #fe ,fracture ( ! too?1 #fd ,! removal ( a neighb\r+ too?1 #ff 8 8 an un]upt$ bicuspid1 #ff 8 8 ! wrong too?1 #ff ,undue resi/ance ( ! too? & alveolus1 #fc ,,difficulties1 ,,complications ,,& ,,sequel ,,9 ,,connection ,,) ,,! ,,s(t ,,tissues3-- ,bruis+ ! l[] lips1 #gd ,ext5sive lac]ation ( ! gum1 #gb ,hmorrhage foll[+ too?-extraction1 #gd 8 8 8 treatm5t (1 #gf ,injury ( ! art]ies 9 ! neighb\rhood ( ! tee?1 #ha ,injury ( ! m&ibul> n]ve1 #gd ,pa9 foll[+ too? extraction1 #ha ,w\nd+ ! tongue1 #gc ,disposition ( ! alveoli ( ! tee?1 #ab ,e ,elevator1 #g ,epilepsy1 attack (1 foll[+ too? extraction1 #id ,e?yl1 *loride (1 #fa ,extraction ( impact$ l[] ?ird mol>s1 #ed 8 8 individual tee?1 #ai 8 8 l[] bicuspids1 #cd 8 8 8 can9es1 #cd 8 8 8 incisors1 #cc 8 8 8 mol>s1 #ce 8 8 8 tee?1 #cj 8 8 misplac$ l[] bicuspids1 #ea 8 8 8 8 incisors1 #ea 8 8 8 tee?1 #df 8 8 8 upp] bicuspids1 #di 8 8 8 8 can9es1 #dh 8 8 8 8 c5tral incisors1 #dg 8 8 8 8 lat]al 81 #dg 8 8 tempor>y tee?1 #ag1 #dc ,extraction ( upp] bicuspids1 #bb 8 8 8 can9es1 #ba 8 8 8 incisors1 #ai 8 8 8 mol>s1 #bc 8 8 8 tee?1 #ai 8 8 ! tee?1 g5]al pr9ciples (1 #a 8 ) =ceps1 #ad ,f ,=ceps1 hold+ (1 #f ,=ceps1 !1 #c ,=c+ a root into ! antrum dur+ too? extraction1 #ga 8 8 too? into an abscess cavity dur+ too? extraction1 #gb 8 out a too? ) a prop or a ,mason's gag1 accid5ts "u an/hetics1 #hh ,fracture ( ! alveolus dur+ too? extraction1 #fg 8 8 8 8 treatm5t (1 #fi 8 8 8 too? dur+ too? extraction1 #fd ,freez+ ag5ts1 local an/hetics1 #fa ,g ,g5]al pr9ciples ( extraction ( ! tee?1 #a ,gum1 ext5sive lac]ation ( !1 dur+ too? extraction1 #gb ,h ,hmorrhage foll[+ too? extraction1 #gd 8 8 8 8 treatm5t (1 #gf ,hewitt1 ,dr41 on ! toxic effects ( coca9e1 #fa 8 8 8 8 use ( *lor(orm 9 op]ations1 #eg ,hold+ ( elevator1 #i 8 8 ! =ceps1 #f ,hy/]ia1 attack (1 foll[+ too? extraction1 #id ,i ,impact$ l[] ?ird mol>s1 ! extraction (1 #ed ,incisors1 ! extraction ( l[]1 #cc 8 8 8 8 misplac$ l[]1 #ea 8 8 8 8 8 upp] c5tral1 #dg 8 8 8 8 8 8 lat]al1 #dg ,incisors1 ! extraction ( upp]1 #ai ,individual tee?1 ! extraction (1 #ai ,injury ( ! art]ies 9 ! neighb\rhood ( ! too? dur+ extraction1 #ha 8 to ! m&ibul> n]ve dur+ too? extraction1 #gd ,in/rum5ts1 #c ,irregul> & cr[d$ tee?1 difficulties dur+ extraction ?r\gh1 #fe ,l ,lac]ation ( ! gum ?r\gh too? extraction1 ext5sive1 #gb ,lat]al incisors1 ! extraction ( misplac$ upp]1 #dg ,lips1 bruis+ ! l[]1 dur+ too? extraction1 #gd ,local an/hetics1 #ei ,l[] bicuspids1 misplac$1 ! extraction (1 #ea 8 incisors1 misplac$1 ! extraction (1 #ea 8 8 ! extraction (1 #cc 8 tee?1 ! extraction (1 #cj 8 ?ird mol>s1 impact$1 ! extraction (1 #ed ,m ,m&ible1 ,dislocation ( !1 dur+ too? extraction1 #gj ,m&ibul> n]ve1 injury to !1 dur+ too? extraction1 #gd ,miscellane\s complications1 difficulties & sequel1 #ic ,misplac$ l[] bicuspids1 ! extraction (1 #ea 8 8 incisors1 ! extraction (1 #ea 8 tee?1 ! extraction (1 #di 8 upp] bicuspids1 ! extraction (1 #di 8 8 can9es 8 81 #dh 8 8 c5tral incisors1 ! extraction (1 #dg 8 8 lat]al 8 81 #dg ,mol>s1 impact$ l[] ?ird1 #ed 8 ! extraction ( l[]1 #ce 8 8 8 upp]1 #bc ,n ,necrosis ( ! alveolus foll[+ too? extraction1 #gj ,nitr\s oxide1 ! use (1 dur+ ! extraction ( ! tee?1 #ef1 #eg1 #eh ,nitr\s oxide ) air1 ! use (1 dur+ ! extraction ( ! tee?1 #ef1 #eg1 #eh ,o 8,oblique root$0 mol>s1 #bf ,op]ations requir+ a long an/hesia1 #eg ,ord] ( removal ( tee?1 #ei ,p ,pa9 foll[+ too? extraction1 #hc ,passage ( a =eign body ?r\gh ! i/hmus ( ! fauces1 accid5ts "u an/hetics1 #hi ,po9ts 9 ! anatomy ( ! tee? & jaws1 #aa ,position ( ! op]ator & pati5t1 #aj ,r ,removal ( a neighb\r+ too? dur+ extraction1 #ff 8 8 an un]upt$ bicuspid 8 81 #ff 8 8 tee?1 ! ord] (1 "u an/hetics1 #ei 8 8 8 ) /raight elevator1 #ae 8 8 ! wrong too? dur+ too? extraction1 #ff ,s ,screw1 !1 #i ,septic & infective sequel foll[+ extraction1 #ie ,sequel1 difficulties & complications aris+ dur+ extraction1 miscellane\s1 #ic ,sequel1 difficulties1 complications &1 aris+ dur+ extraction "u an/hetics1 #hh ,sequel1 difficulties1 complications &1 ( extraction ( ! tee? connect$ ) ! jaws1 #fg ,sequel1 difficulties1 complications &1 ( extraction ( ! tee? connect$ ) ! s(t p>ts1 #gb ,sequel1 difficulties1 complications &1 ( extraction ( ! tee? connect$ ) ! tee? !mselves1 #fc ,%ock foll[+ extraction1 #ic ,t ,tee?1 g5]al pr9ciples ( extraction ( ! tee?1 #a 8 :i* require extraction1 #a ,tempor>y tee?1 ! extraction (1 #ag1 #dc ,tongue slipp+ back1 accid5ts "u an/hetics1 #hh ,treatm5t ( fracture ( ! alveolus dur+ too? extraction1 #fi ,treatm5t ( hmorrhage foll[+ too? extraction1 #gf ,trismus1 treatm5t (1 #gb ,u ,undue resi/ance ( ! too? & alveolus1 #fc ,upp] bicuspids1 misplac$1 ! extraction (1 #di 8 can9es1 misplac$1 ! extraction (1 #dh 8 c5tral incisor1 misplac$1 ! extraction (1 #dg 8 lat]al 8 8 8 8 81 #dg 8 tee?1 ! extraction (1 #ai ,use ( an/hetics dur+ ! extraction ( ! tee?1 #ef ,ut]9e pa9 foll[+ too? extraction1 #ic ,w ,w\nd+ ! tongue dur+ too? extraction1 #gc ,w\nd result+ f removal ( a too?1 #af 99 99 99 99 99 ,,diseases ,,& ,,injuries ,,( ,,! ,,tee?1 ,includ+ ,pa?ology & ,treatm5t1 ,a ,manual ( ,practical ,d5ti/ry = ,/ud5ts & ,practition]s4 ,,by ,,morton ,,smale1 ,m4,r4,c4,s41 ,l4,s4,a41 ,l4,d4,s41 ,d5tal ,surgeon to ,/4 ,m>y's ,hospital2 ,dean ( ! ,s*ool1 ,d5tal ,hospital ( ,london2 ,memb] ( ,bo>d ( ,exam9]s 9 ,d5tal ,surg]y1 ,royal ,college ( ,surgeons ( ,engl&4 ,,& ,j4 ,f4 ,,coly]1 ,l4,r4,c4,p41 ,m4,r4,c4,s41 ,l4,d4,s41 ,d5tal ,surgeon & ,lectur] on ,d5tal ,surg]y to ,*>+ ,cross ,hospital & to ! ,d5tal ,hospital ( ,london4 #ccd illu/rations4 #djg pp4 & ,index4 #hvo1 clo?4 ,price #aes4 ,,suppli$ ,,by ,,claudius ,,a% ,,sons1 ,limit$1 #e1 #f1 #g1 #h1 #i1 ,,broad ,,/reet1 ,,gold5 ,,squ>e1 ,,london1 ,w4 ,,engl&4 ,,footnotes3 #a ,a description ( ! diff]5t in/rum5ts 9 g5]al use = ! removal ( ! v>i\s tee? w be f\nd 9 *apt] ii4 #b ,a description ( ! =m ( ea* too?1 ) respect to its be>+ ^u ! con/ruction ( =ceps & its removal1 w be f\nd 9 *apt] ii4 #c ,! foll[+ is a useful =mula3-- ,liquoris potass vi4 ,acidi c>bolici glacialis ij4 ,aquam ad4 viii4 ,m4 ,"o teaspoonful to be us$ ) half a tumbl]-full ( w>m wat] z a m\? wa%4 #d 8,a ,sy/em ( ,surg]y0 7edit$ by ,fr$]ick ,treves71 vol4 i41 page #bib4 #e 8,d5tal ,pa?ology & ,surg]y10 page #cdj4 #f ,transactions ,odontological ,society1 vol4 iii41 page #ach4 #g ,transactions ,odontological ,society1 vol4 xxviii41 page #c4 #h ,j\rnal ,briti% ,d5tal ,association1 vol4 xiv41 page #gbg4 #i ,acidi gallici ij4 ,ft4 pulv4 viij4 ,"o p[d] e two h\rs until ! hmorrhage ceases4 #aj ,p]*loride ( iron %\ld be avoid$ z a /yptic1 x ne>ly always conta9s "s free acid1 & is !re=e detrim5tal to ! tee?2 9 addition to ?is x leads to ext5sive clott+ 9 ! ve9s1 z well z to a c]ta9 am\nt ( sl\gh+ ( ! gums4 #aa ,acidi gallici ij4 ,ft4 pulv4 viij4 ,"o p[d] e two h\rs until ! hmorrhage ceases4 #ab ,liq4 f]ri p]*loridi xxv4 ,aqu *lor(ormi ij4 ,aquam ad j4 ,mitte viij4 ,m4 ,two tablespoonfuls e ?ree h\rs until ! hmorrhage ceases4 #ac ,ext4 ergot liquidi xx4 ,acidi sulphurici diluti x4 ,aquam ros ad4 j4 ,mitte viij4 ,m4 ,two tablespoonfuls e ?ree h\rs until ! hmorrhage ceases4 #ad ,injectio ergot9i hypod]mica ,b4,p43 #a ( ergot9e to #b ( camphor wat]4 ,dose #c to #aj m9ims1 made z requir$4 #ae ,d5tal ,record1 vol4 xi41 p4 #dbe4 #af ,common salt1 j41 wat] #j;j4 at #ii ,f4 #ag ,transactions ( ! ,odontological ,society1 vol4 xxvii41 page #abc4 #ah ,two ounces ( poppy heads %\ld be plac$ 9 "o p9t ( boil+ wat]1 ! wat] be+ boil$ d[n to half a p9t4 #ai ,f]ri et qu9i citratis gr4 vi4 ,aqu *lor(ormi ij4 ,infusum quassi ad4 i4 ,mitte viij4 ,m4 ,two tablespoonfuls ?ree times a day aft] meals4 #bj ,! foll[+ w be f\nd useful3-- ,boro-glyc]ide 7,b>ff7 ,eau de ,cologne aa4 iv4 ,t9ct4 kram]i ,_s v9i4 rect4 ad4 iv4 ,fiat lotio4 ,to be us$ ) wat] z a m\? wa%4 ,%ake be=e us+4 #ba ,z9ci sulphatis gr4 viij4 ,z9ci *loridi gr4 vi4 ,morph9 acetatis gr4 ij4 ,aquam ad4 viij4 ,fiat lotio4 ,to be us$ ) an equal quantity ( wat] z a m\?-wa%4 #bb ,! ,j\rnal ( ! ,briti% ,d5tal ,association1 vol4 vii41 page #cb4 #bc ,briti% ,j\rnal ,d5tal ,sci5ce1 vol4 iii41 page #bba4 #bd 8,a ,sy/em ( ,d5tal ,surg]y10 #crd edition1 page #fbf4