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^1*4 OPEttATIVfe DfiNTlSTtiV

long before any teeth in its immediate vicinity are disturbed. Na-
ture then skips this cuspid tooth which is to hold the incisors in
place, and the first temporary molar is replaced by the bicuspid
which has ample room and needs little attention beyond the re-
moval of its predecessor at the proper time. Just at this point the
second temporary molar may become decayed or lost and patients
will insist upon its extraction ; but if by any means the patient can
be made comparatively comfortable it should not be extracted as
its removal allows the first permanent molar to move forward
caused by the growing and developing second permanent molar at
this age. When the first bicuspid is fully erupted to the line of
mastication, we are justified in removing the second temporary
molar to give place to its successor. During the eruption of the
first bicuspid, the cuspid will very frequently become loose and pos-
sibly hard to retain, and the patient will again insist upon its re-
moval ; but it should not be extracted at this time.
Leave the temporary cuspid in position until all of the other
teeth have been replaced. If the order which nature has mapped
out has been preserved, an even set of teeth will result in almost
every instance. If the order has been interfered with in the least,
the patient's mouth is placed in a condition where gross irregu-
larities, faulty occlusion, and great disfigurement is almost sure to
result. Therefore the great necessity for the preservation of na-
ture 's order in the extraction of the temporary teeth. It is the one
thing to be looked after and adhered to and should be disregarded
only in extreme cases, which does not mean merely the satisfaction
of the ideas of parents. The operation of extracting temporary
teeth is simple. If Ave have carefully looked the mouth over and
decided that it is necessary to extract any tooth, it can be accom-
plished with almost any pair of forceps. Great care should h?
taken not to take too deep a grasp upon the tooth, that the develop-
ing permanent tooth, which is supposed to be close to its tem-
porary predecessor, may not be injured in the removal of the tem-
porary tooth. It is also advantageous to use a lance separating the
gum from the tooth as the gum at or near the neck of the tooth
frequently adheres quite strongly to the cementum. By using the
lance, laceration of the parts is avoided.
When there is nothing left but the separated or decayed points
or unabsorbed portions of roots, it is best to remove them with a
root elevator or chisel.