ALVEOLAR PERIOSTITIS. 293 



maxillary bone, which lies at the division between the third and 

 fourth molars. Alterations in the diseased tooth or its gum may 

 usually be detected by introducing the hand into the mouth. Should 

 the tooth be displaced and loose, there need be no doubt as to its 

 condition. A round punch about one half to three quarters of an 

 inch thick and with a flattened end or, in certain cases, a bent punch 

 like an angular doorbolt, is now placed on the root of the diseased 

 tooth, care being taken that the punch points in the general direction 

 of the tooth itself. Light blows on the punch with a rather heavy 

 hammer drive the tooth from its socket into the mouth. During 

 operation a hand should be passed into the mouth and applied to the 

 diseased tooth to ascertain the effect of the blows. The pain of 

 repulsion makes the use of an anaesthetic necessary, and even in deep 

 narcosis some animals react to the blows of the hammer. 



Only the pre-molars and the first two molars of the upper jaw 

 can be removed by punching. The last molar having its root in the 

 hindmost portion of the superior maxillary sinus cannot be con- 

 veniently reached, nor can the back molars of the lower jaw, lying 

 as they do too far from the lower border of the bone. Care should 

 be taken in using the punch to strike only the affected tooth, other- 

 wise neighbouring teeth may be loosened, or the maxillary bone 

 fractured. 



During punching a mouth gag must be used to allow of the hand 

 being introduced to catch the tooth and prevent its being swallowed. 

 A preferable method consists in only driving the tooth so far down- 

 wards as to enable it to be reached from the mouth with forceps, 

 with which extraction is completed. Bouley and Stockfleth, by 

 performing an oesophageal operation, succeeded in removing teeth 

 which had been swallowed ; but in another case the tooth produced 

 perforation of the caecum and death. In operating on the upper 

 jaw it is necessary to avoid injuring the fifth and seventh nerves ; 

 in the lower jaw the inferior maxillary division of the fifth. After 

 removing the tooth the socket is plugged with a piece of antiseptic 

 tow, or gauze, which, if possible, should be renewed daily. In some 

 cases this is indispensable to enable the animal to drink. The opening 

 usually closes in three to six weeks, but sometimes not till later ; 

 occasionally a fistula remains. The trephine opening should not be 

 allowed to close until the alveolus has been filled up. Bad results 

 seldom follow skilful removal, but where the tooth or jaw bone are 

 splintered serious bleeding or pus formation may ensue. 



Extraction with forceps, when possible, is preferable to the above 

 described method. It is simpler and less painful, although requiring 



