1 6 REPULSION OF TEETH. 



ally loosened and can then be readily removed with the aid 

 of the gouge or forceps. Remove carefully all fragments of 

 tooth or of loosened bone, cleanse and disinfect the wound, 

 pack with iodoform gauze and dress daily. 



In cases where a fistulous opening remains after repulsion 

 of molars in the usual manner without the removal of the 

 alveolar wall, or if a tooth has been drawn by means of the 

 forceps and the alveolus fails to heal, the bony plate should 

 be removed in the same manner as indicated for the removal 

 of the teeth. 



Dangers. Wounding of neighboring teeth, fracture of 

 the inferior maxilla, fracture of the bony palate. 



Wounding of the adjoining tooth is to be avoided chiefly 

 by carefully locating the fang of the affected one and 

 placing the center of the trephine as exactly as possible over 

 the center of the tooth, by using a trephine not exceeding 

 2 to 2.5 cm. in diameter and cautiously trephining through 

 the compact layer of the external plate only, removing the 

 cancellated tissue with the gouge and extending the opening 

 in the desired direction after the outlines of the tooth fang 

 have been clearly determined. If an adjoining fang is 

 wounded the tooth should be removed as it will not heal but 

 will result in a permanent tooth fistula. 



The fracture of the alveolar walls of the inferior maxilla is 

 to be constantly guarded against by being cautious to see after 

 each stroke on the punch that it has not slipped inward along 

 the median side of the tooth, pressing the internal plate away 

 from the tooth row and tending to produce a longitudinal 

 fracture nearly or quite as long as the dental arcade. Careful 

 digital exploration in the mouth may discover this fracture 

 while still " simple " but a stroke or two more will convert it 

 into the very much more serious " compound " fracture open- 

 ing into the oral cavity. Keeping one hand constantly in the 

 mouth at the point of impact is always desirable as a precau- 

 tionary measure. Transverse fracture of the tooth while 



