TEE TIL 



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There liave been pcrlons who liave had load in their 

 teeth feveiity years, and upwards, without any annoyance 

 from it. 



Of drawing or extrading a Tooth. — We fhall conclude this 

 article with a few obfervations upon the furgical operation of 

 extrafting a tooth from its focket. 



The following cafes make the performance of it necef- 

 fary. 



1. A carious tooth, producing a fe\ere degree of pain, 

 which can be abated by no remedies. 



2. A (liarp tooth, which irritates and hurts the tongue, 

 and does not admit of being amended with the file. 



3. An ulcer, or abfcefs of the maxillary finus. 



4. A tooth which renders the focket carious, or caufes 

 abfcefles, or excrefcences of the gums, fiftulx of the jaw, or 

 fome other troublefome complaints. 



5. A milk-tooth not being fhed at the ufiial period, and 

 its prefence forcing one of the permanent ftft to grow in a 

 wrong direftion. 



6. A tooth growing out of the palate, or in any otlier 

 unnatural place. 



On the other hand, the operation is contraindicatcd, when 

 the gums are highly inflamed ; or when a tooth-ache, excited 

 by mercury, or the fcurvy, is prcfent. Drawing a tooth, 

 in thefe circumftances, might give rife to exteniive inflam- 

 mation and angina in a dangerous degree. 



The common inftruments are, 



1. The odontagra. 



2. The pelicanus. 



3. The clavis, or key. 



Thefe three inftruments are objeftionable in one refpeft : 

 namely, they pull the tooth out of its focket obliquely ; 

 and hence they often break the alveolary procefs, or the tooth 

 itfelf. 



4. But the tooth-inftrument which Aitken has defcribed, 

 draws the tooth out of the focket perpenaicularly ; and, on 

 this account, has an advantage. See Eftays on feveral im- 

 portant Subjefts in Surgery, London, 1771, p. 196. 



5. The tooth forceps. 



fi. The pes caprinus, or punch. 



The molares, when they can be firmly taken hold of, may 

 be extrafted with either of the firft four inftruments. 



The incifores, canini, and firft molares, may be drawn 

 out with the forceps. 



Stumps and fangs cannot be taken hold of with thefe in- 

 ftruments ; they muft, therefore, be puftied out of the al- 

 veolary procefs with the pes caprinus, or punch, and then 

 be removed with a pair of forceps. 



The patient and furgeon are to place themfelves as 

 follows. 



I . If the tooth be in the up.per jaw, and it is to be taken 

 out with the odontagra, pelicanus, or punch ; or if the 

 tooth, which is to be drawn, is in the lower jaw, the patient 

 muft be feated in a low chair, or on the ground, the furgeon 

 ftanding behind him. 



;. But if the tooth is to be taken out with the key, or 

 from the upper jaw with the forceps, the patient is to fit 

 in a common chair, and the furgeon is to ftand in front of 

 him. 



The following are the different methods of performing the 

 operation. 



I. Of extrafting a tooth with the odontagra. 



The inner gum of the tooth about to be drawn, is to be 

 deprefted with the claw of the inftrument nearly down to the 

 alveolary procefs. The other part of the inftrument is to 

 lie apphed to the crown of the tooth. 



While the thumb is employed in making iirm preffurc 



upon the claw, the liandle is to be held with the fingers, 

 and, under the diredion of tlie palm, the tooth is to be 

 raifed perpendicularly from its focket. 



By means of the fcrew, which admits of- being turned, 

 the inftrument may readily be adapted to the larger 

 teeth. 



2. Of drawing a tooth with the key. 



The key is applied to the tooth nearly in the fame way as 

 the odontagra, except that the thumb of the other hand is 

 placed upon the claw. At the commencement, the key is to 

 be turned verj* gradually ; and the tooth, when it yields, is 

 to be cautioully and (lowly raifed, left it flip away, and re- 

 main adherent to the gum. 



3. Of drawing a tooth with the pfclicanus. 



'J'he claw of this inltrumcnt is to be applied to the infide 

 of the neck of the tooth, while the rotula is to be put upon 

 the two neighbouring teeth. The thumb of tlie liand not 

 holding the inftrument is to be applied to the infide of thein, 

 fo as to counteraft the refiftance of tlie rotula. 



4. Of the cxtradtion of a tooth with the forceps. 



The neck of the tooth being firmly grafped with the 

 forceps, is to be gradually moved, until it is fufficicntly 

 loofened to admit of being taken out perpendicularly. 



5. Of taking out a tooth with the pes caprinus, or 

 punch. 



The two points of the inftrument are to be firmly applied, 

 under the gum, to the lower part of the neck of the re- 

 maining portion of the tooth. The tliumb of the hand not 

 thus employed is to be covered with fome linen, and ap- 

 plied internally. The fang is then to be puflicd out of the 

 focket, and removed with a pair of forceps. 



With regard to the fymptoms arifing after the operation : 

 a flight hn?morrhage, and a fwelling of the gums and check, 

 are the ufual confequences. Thefe, however, are free from 

 danger, and, when the mouth is waflicd with a gargle of 

 tepid vinegar, they are foon relieved. 



The more ferious confequences, which fometiines occur 

 after the extraftion of a tooth, are, 



1. A violent and dangerous degree of hxmorrhage. 



2. Alarming inflammation of the gums and cheek. 



3. Abfcefles of the gums ; vei-y apt to take place, when 

 the gums have been confiderably bruifed by the inftrument, 

 or when fphntcrs of bone are left b.^hind. 



4. A frafture of the alveolary procefs, or of the pailate. 

 This accident is moft hable to happen, when the fangs of 

 the teeth diverge, or when the fang and focket have grown 

 together by the procefs of olTification. The cxiftence of the 

 laft cafe may be known by the neck of the tooth being 

 curved. Here the tooth fhould always be drawn out to- 

 wards its concave fide. 



5. Diflocation of the jaw. This may occur, if thCmouth 

 be too much open, or the lower jaw be brought too much 

 forward, in the operation. The luxation ought to be im- 

 mediately reduced. See Lvxation. 



6. Frafture of the jaw. See Frac ruuE. 



7. Caries of the focket. 



8. Laftly, frafture and luxation of the tooth may be the 

 confequences of an unfuccefsful attempt to perform the 

 operation. 



In the preceding remarks, we have been chiefly aflifted 

 by Plenck's excellent compendium, entitled " Doftrina de 

 Morbis Dentium," &c. Lovanii, 1796. 



Some interefting obfervations on the difeafes of the teeth, 

 particularly with a view to the qucftion whether thefe parts 

 are vafcular, will be found in the article CitANiui.f. 



For a defcription of the difeafes of the gums, we refer to 

 Gums, Difeafes of. 



A Daniflt 



