EXTRACTION OF TEpTH. 3 



pressing the jaws down as deeply as possible against the 

 alveolus. In many cases the diseased tooth can be clearly 

 seen, especially with the aid of the reflecting lamp, and the 

 forceps may be readily applied by visual aid and this is 

 frequently preferable to the sense of touch. Withdraw the 

 free hand from the mouth, grasp the handles firmly and 

 loosen the tooth in its alveolus by establishing and maintain- 

 ing as long as necessary a gentle to and fro lateral move- 

 ment. The tooth is thus loosened in its alveolus by caus- 

 ing it to revolve very slightly back and forth on its long 

 axis, thereby spreading the cavity. When the tooth has 

 become well loosened, as indicated by its revolving with 

 the forceps and by the audible crepitant sound caused by 

 the passage of air bubbles to and fro through the blood 

 and lymph in the alveolus, maintain the forceps in position 

 with one hand and with the other introduce the fulcrum to 

 a point where the depression on its superior surface will 

 receive the projecting rivet-head of the instrument or in an 

 otherwise secure position and give it a safe support, while 

 the inferior surface rests evenly upon the crown of a tooth 

 anterior to that which it is desired to extract, as is shown 

 in Plate I. The fulcrum needs be held firmly in place in 

 order to prevent it from gliding forward under pressure. 

 In extracting the first premolars there is no opportunity 

 for resting a fulcrum on teeth anterior thereto and con- 

 sequently forceps have been made with fulcra beyond the 

 forceps jaws resting upon teeth more posteriorly situated- 

 This is not essential. If the tooth is thoroughly loosened, 

 as it should be, one hand placed in the interdental space 

 with the dorsal surface against the jaw and the volar grasp- 

 ing the instrument, will serve as an effective fulcrum. In 

 other cases an iron or steel fulcrum is not essential, but a 

 stick of hard wood of proper size a4d form acts quite as 

 efficiently and may even keep its position better because 

 the teeth upon which it rests sink into it somewhat. On 



