Tooth extraction

“ Fainting is best treated by bending the head down towards the knees, at the same time loosening anything tight about the neck and applying ordinary salts of{94} ammonia to the nose. In severe cases the patient should be removed from the chair and laid on the floor, and the chest should be exposed and flipped with a towel dipped in cold water. In more severe cases it may be necessary to inject ether or some other stimulant, such as brandy. Fatal syncope following tooth extraction has occurred, and a case which took place at Marseilles in 1881 is mentioned by Tomes. ”

“ After the extraction we may consume the flesh that is left by sprinkling it with finely levigated salts, and afterwards gargles of wine or oxycrate may be used until the completion of the cure. And since sometimes supernumerary teeth are formed, those that are fixed in the socket we must scrape down with a graving-tool, but those that are not so fixed we must extract with a tooth-extractor. If any tooth grow to an unnatural size, or is broken, we may scrape away the projecting or redundant part of it with a file. ”

“ Whenever a general anæsthetic is given for the removal of teeth, two people should always be present, one to confine his attention solely to the administration of the anæsthetic, the other to the removal of the tooth, as it is impossible for one person to operate and at the same time to observe the condition of the patient during the anæsthetic period. ”

“ It is advisable to inform the patient of the possibility of pain following the extraction of a tooth, especially after periodontitis, and in all cases where a large number of teeth have been extracted a mouth-wash [20] should be prescribed; for, even if there is no pain, it will prevent the discharge from the sockets of the teeth undergoing putrefactive changes.
In pain due to necrosis of the socket deodorant antiseptic injections must be used, while in extensive laceration of the soft and hard parts an anodyne mouth-wash [21] may be tried. ”

“ With regard to this subject, the following passage is worthy of note, for in it we find sketched out the theory of preventive extraction as a means of facilitating the eruption of the wisdom tooth: “It is better to have the teeth incomplete as to number than to have the ordinary number badly arranged; for the mouth will appear none the less well furnished because of having one or two teeth the less; the other teeth will be commodiously distributed, and the last molars will find sufficient room when they come forth ”

“ As useful an instrument as any for their removal is a curved elevator (fig. 49) , the blade of which can often be inserted under the crown, and assuming that good leverage is thus obtained, the tooth can be prised up. Sometimes the tooth is firmly embedded in the bone. In such cases a clear view of the tooth may be obtained by gradually packing the soft tissues apart, the periosteum covering the alveolus should then be raised, and the bone surrounding the tooth cut away with suitable instruments. The tooth, when freely exposed, should be removed with an elevator or forceps. ”

“ In cases where the caries penetrates to some depth, without, however, the destruction of the crown of the tooth being so extensive as to render it useless, Hunter believed the best mode of treatment to be extraction and replanting of the tooth after having subjected it to boiling in order to cleanse it perfectly and to destroy its vitality entirely, this being, according to him, the mode of preventing the further destruction of the tooth, which once dead can no longer be the seat of any disease. ”

“ Teeth isolated are always firmer than those in series; this is accounted for by a consolidation of the bone around them. Experience will act as a guide, and it is to a certain extent possible, after a little observation, to gather from the general appearance of a tooth if it will give more than normal trouble in removal. Should undue resistance be met with, steady attempts to move the tooth slightly in different directions should be made and persevered with; if this precaution is not taken and too much force is used in any one direction, fracture of the tooth or alveolus is sure to result. ”

“ To sever these teeth from their attachments force must be applied first slightly inwards and then outwards, the movements being repeated if necessary, the removal of the tooth from the socket being carried out by exerting force in a downward and outward direction. Too much outward movement leads to undue bending or fracture of the external alveolar plate. ”

“ The milk teeth should never be allowed to remain in the mouth after the corresponding permanent teeth are fairly up. If removal prior to this period does no good, now the operation is suggested by its accordance with the natural process, and the sooner it is undertaken the better: any delay will only create difficulty, and render the restoration of the displaced tooth, more problematical. The unabsorbing fang, will, in time, become united to the bone; and if its extraction is then attempted, fracture of the jaw may be the consequence. ”

“ Extraction. This operation, says Dionis, ought not to be performed too lightly, but only in those cases in which it is really necessary; that is, when a tooth is the cause of insupportable pain and its crown is almost entirely worn away; when nothing remains of a tooth but its root; when a tooth is so loosened in its socket as to leave no hope of its again becoming firm; when supernumerary teeth or irregularly planted teeth give rise to inconvenience or deformity; and lastly, to remove deciduous teeth that have become loosened. ”

“ Then they fall to with their spades, cutting the flesh away from the lower part of the tooth and loosening it, and completing the extraction by main strength, very much after the fashion of a dentist, but by means of the falls instead of forceps. Often the loop slips off of the tooth suddenly, letting down the men who are swaying away on the falls, and starting shouts of laughter. Or the whole strip of teeth may come together, held together by the gums. When the teeth have all been drawn the jaw is sawed into slabs for convenient use, for the jawbone is very hard and close-grained. ”

“ In other words, if you sit down to a meal after chewing gum for two or three hours, the saliva that you mix with your food will not have the normal digestive elements. One might say that the "strength" of the saliva has been lost while chewing gum.
If your teeth are decayed the offending members should be removed or the cavities filled. It is always wise to retain every tooth you can until extraction is practically compulsory. Decayed teeth should be filled promptly. As long as a tooth can be filled it should not be extracted. A good dentist should be consulted at frequent intervals. ”

“ The roots too are much longer, more firmly implanted, and hence require more force in their removal. Forceps similar in pattern to those used for incisors may be used, the severance of the{22} tooth from its attachments being brought about by force applied in an inward, followed by an outward, direction. The root being more or less three sided, rotation cannot well be adopted. ”

“ At the present time methods of curing pus pockets at the base of the teeth are not very adequate, so that the extraction of the tooth has to be resorted to, but there is every reason to believe that the dental profession will shortly find methods by which pus pockets can be controlled without having to sacrifice the teeth. ”

“ Guerini, many of the medicaments used as topical applications to facilitate the extraction of teeth were wholly without any possible effect of that character, it cannot be doubted that the application of arsenical preparations, such as those referred to by Mesue, could not fail to set up an arsenical necrosis about the roots of the tooth, rendering it loose and easy of removal, but necessarily with the disadvantage of producing a dangerously extensive necrosis of the tissues. ”

“ As an operation, extraction of teeth is fortunately becoming more rare, but even now large numbers are needlessly sacrificed, in many cases owing to ignorance on the part of the patient of the value of the teeth, at times to lack of knowledge on the part of both operator and patient of the modern methods of conservative dentistry. ”

“ When one or more teeth have appeared in an irregular position and offend the walls of the oral cavity or else the tongue, the excision (resection) of the tooth or teeth must be performed with a pair of strong pincers, whose shape must vary according to whether the teeth are situated externally or internally with regard to the dental arches. But as after the resection there will almost always remain some points or sharp irregularities, which by their presence would continue to irritate the soft parts, it will be necessary to remove these irritating prominences by means of the file. ”

“ This was so much of a success that I threw aside chloroform and ether in removing the living nerve of a tooth with instruments instead of using arsenic; and for excavating sensitive caries in teeth, preparatory to filling, as well as many teeth extracted by it. But this was short-lived, for it led to another step. Sometimes I would inflict severe pain in cases of congested pulps or from its hasty application, or pushing it to do too much, when my patient invariably would draw or inhale the breath very forcibly and rapidly. ”

“ As to decayed teeth and the pain that they produce, when the evil cannot be remedied with oil of cinnamon or oil of cloves, with the actual cautery, or by stopping, one must have recourse to extraction, and this to satisfy four different indications, that is, before all, to procure the cessation of violent pain ”

“ It is written in popular style, and the author certainly intended it for the instruction of the public, and not for professional men; so true is this, that in it he does not speak of the technical part of the extraction of teeth, or of gold filling—a method already known for a long time—or of dental prosthesis.
The first part, relative to diseases of the eyes and the manner of curing them, has no importance for us. ”

“ A tooth must not be sacrificed excepting when it is loose and attacked by incipient necrosis, so as to leave no hope of arresting the putrefactive process. It is then our duty, says Heurn, to remove the tooth without causing much pain. For this purpose, after the tooth has been separated all around from the gums, it must be raised somewhat from the alveolus; then it must be sprinkled with powder of euphorbia, or a paste made with flour and the juice of the tithymalus must be applied around it, taking care, however, to cover the neighboring teeth with wax. ”

“ It always does more harm than good to file or to scrape the decayed part of a tooth, without stopping it afterward, as by thus doing, says the author, one only renders it still more liable to the access and the action of harmful external influences. In preparing the cavity for stopping, the bottom of it should be more ample than its external aperture, that the filling may remain firm.
For extracting molars, he makes use either of the pelican or of the key; for the incisors and the canines, of the forceps ”

“ If, as often happens, that the seat of the erosion lies in such a manner between two teeth as to make it impossible to apply caustics or other medicaments, one must file just sufficiently between the healthy and the corroded tooth to render the part accessible, taking care, however, to file more on the side of the affected tooth than on that of the healthy one. ”

“ The pain resulting from advanced caries of the deciduous teeth, owing to the difficulties encountered in controlling the patient, is not easily treated; moreover, the injurious impressions thus made on the system of the child abide through life. There is no doubt hundreds of thousands of teeth are unnecessarily extracted each year, and then drugs are given with a view of curing the patient of the disorders of digestion and other abnormal conditions which follow, and which in turn arise from imperfect mastication of food, verily for the want of teeth. ”

“ The first difficulty is more easily gotten over, for it is not necessary that the tooth transplanted should correspond exactly in shape and size to the one extracted; if it is too large, it may be carefully reduced; or if too small, new osseous deposit will supply the deficiency. Neither is it necessary, as we have seen, that the transplanted tooth should be a freshly extracted one. ”

“ In all obscure cases an application should be made to the socket of some local anodyne such as tincture of opium{88} or cocaine, and a mouth wash having similar properties should at the same time be prescribed.
(4) DIFFICULTIES, COMPLICATIONS AND SEQUELÆ ARISING DURING EXTRACTION UNDER ANÆSTHETICS.
(a) Tongue slipping back.—During extraction under anæsthetics the tongue not being under control may slip over the larynx, or may be forcibly pushed back by the fingers of the operator. Symptoms of difficult breathing or even arrest of respiration will follow this accident. ”

“ When a tooth has gone so far to decay, that it cannot be cured by stopping, it should not be suffered to remain in the mouth, lest it infect the rest. Front teeth, however, when the roots remain sound, and firmly based in the sockets, ought not to be extracted, as upon the latter artificial teeth can be placed with great advantage. In such cases, the removal of the crown only is necessary. ”