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CHAPTER XXXIX.
EXTRACTION OF PERMANENT TEETH

General Consideration. Under normal conditions tooth extrac-
tion is not a difficult operation. However, there is no oral surgeon
even of experience who meets with universal success. There are
abnormal conditions which render unsuccessful any attempts at
removal by ordinary means; but if the patient is placed under an
anesthetic there are instruments manufactured and competent and
able surgeons to handle them, that can remove the tooth entirel>',
and if need be the entire maxillae with it. Yet there is a limit to
all operations.
There is a time to stop. All oral surgeons have had the same ex-
perience, finding cases where the unavoidable injury to the tissues
in removing the tooth would do more harm than alloM ing a small
part of the tooth to remain. To the laity, however, the skillful ex-
traction of a tooth seems "quite a trick." For instance, the black-
smith or a man of great strength, who has not made a careful study
of the teeth and their environment, may attempt to extract the
tooth and fail. One who has made the subject a study, although
possessed of far less strength, removes the same tooth skillfully
and seemingly without the exertion of much muscular effort. Un-
less the force is properly and scientifically applied, it accomplishes
nothing but injury. If the force is applied in a proper direction,
with proper movements, the dislocation of a tooth is quite an easy
matter. The old saying that there is no rule without an exception,
and that the exception proves the rule, will apply to the rules for
extraction; for there is probably as much difference in the forma-
tion of teeth and adjacent structure as in the facial expression of
different persons. Therefore it is difficult to formulate any rules
which we can follow literally in all cases. Still the extraction of
teeth is best accomplished by the application of scientific principles.
These principles properly applied will give better results than
extracting the teeth merely to get them out. For this reason avc
must study that which we wish to accomplish and how best to ac-
complish it, by considering the various shapes of that part of the
teeth which cause their retention in the jaw; also the structures,
strength and position of those tissues which hold the teeth in place.
Principal Retention. The constricted portion of a tooth at its
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