346 



OPERATIONS ON THE DIGESTIVE APPARATUS. 



insertion and implantation less tenacious than in the lower. The 

 extraction of the front is less difficult than that of the posterior 

 molars. At times, as when the teeth are partly destroyed by 



caries, a single effort wiU be suffi- 

 cient to extract them ; but ia other 

 cases, as when the periosteum is dis- 

 eased, and the roots adhere more 

 intimately to the alveola, the extrac- 

 tion becomes very difficult. And 

 again, if the tooth having a hyper- 

 trophied root, resists the action of 

 the instruments through the op- 

 position of those immediately sur- 

 rounding it, which, though healthy, 

 are less firmly fixed in. their alveola, 

 which are mechanically dilated by 

 the outward pressure made upon 

 the plates of the maxillary bone, is 

 easy to loosen and dislocate them; 

 and this is a circumstance which 

 must not be overlooked during the 

 manipulation required for the ex- 

 traction, in order to avoid serious 

 disturbances of the dental appa- 

 ratus. 



In the extraction of a molar, the 

 patient must be thrown, and the 

 head well elevated, the mouth being 

 kept well open by means of a per- 

 fectly safe speculum, such as that of 

 LeceUier (Fig. 350), but we think 

 it rather clumsy to handle. Bouley 

 recommends the etherization of the 

 patient. The mouth is to be thor- 

 oughly cleansed. There are circum- 

 stances, however, in which the op- 

 eration of casting is unnecessary, 

 and, in fact, our own personal ex- 

 perience has raised doubts in our 

 mind as to the necessity at any 



Big. 350.— Speculum of Leoellier. 



