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EXTRACTION OF TEMPORARY TEETH 273

The central incisors in the inferior maxilla stand on either side
of the symphysis, or where the two segments of the jawbone unite.
In the superior maxilla the central incisors stand on either side of
the median line in the intermaxillary bones. If the temporary
laterals are extracted before the centrals are fully erupted, should
the jaw continue proper development, the central incisors will stand
apart as they do not have the lateral incisors to hold them toward
the median line. Thus when the laterals attempt to come into place,
their space has been encroached upon and they may fail to crowd
the centrals over to place.
However in most cases the bones do not continue proper develop-
ment and the space between the two temporary cuspids occupied
by the four temporary incisors, is not sufficiently increased to ac-
commodate the permanent incisors; hence the crowded condition
frequently met with.
Therefore no lateral incisors should be extracted until the cen-
tral incisors are quite in position. If the central incisors do not
seem to have sufficient room, instruct the patient to put pressure
with the tongue or fingers in the labial direction which will put
them into proper position; but for no reason whatever should the
laterals be extracted before the centrals have attained their proper
height in the line of occlusion.
Next we lose the lateral incisors. As this tooth erupts after the
temporary lateral has been extracted, it very frequently loosens the
temporary cuspid, which by this time has had its root quite freely
resorbed. Patients then request that the cuspid be extracted as
the lateral has not sufficient room. Very frequently it will look
as though this was necessary. However if we extract the cuspid
at this point rest assured that there will not be room enough for
the permanent cuspid, when it wishes admittance to the arch. "We
should insist upon the retention of the cuspids and as the lateral
crowds for room, development all through the jaw and especially at
the median line will take place.
In the superior jaw the intermaxillary bones materially develop
at this age, and as the temporary cuspid is not lost until between
the eleventh and thirteenth year the development is ample. So
the incisor teeth (the two centrals and two laterals), have allotted
to them the space between the temporary cuspids, as well as that
which is made bj^ the growth of the jaw between the time of their
eruption and the loss of the cuspid teeth.
Therefore the lateral, which did not seem to have space enough
when it erupted will have ample space in five years as it is that