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MANAGEMENT OF CHILDREN'S TEETH. 245

this process is varied somewhat, as I have stated. In the case
where a permanent tooth fails to develop, which occurs occa-
sionally with the lateral incisors, the absorptive process will
generally go on and the little tooth drop away, notwithstanding
the fact that there is no permanent tooth to take its place. The
cuspid tooth, on the other hand, generally remains if there is
no permanent tooth coming forward to take its place. If the
cuspid happens to be deflected from its position from some other
cause, or becomes impacted within the bone by taking a wrong
direction, the deciduous cuspid often remains in its place, the
absorption only partially removing the root, and may be found
in its place on up to middle life, and in a few cases it may be
seen continuing in its position and doing service until old age.
These retained deciduous cuspid teeth require somewhat
careful handling. It is often difficult for us to know whether
the permanent tooth is likely to come forward later or not.
The author has seen them come forward as late as twenty, and
in one case in which the person was twenty-five years old, but
generally, if they do not come forward somewhere near their
normal time, we need not expect them. Often much light may
be thrown on this by an X-ray picture, which will show the posi-
tion of the permanent cuspid. If it is not present that fact
may be determined. It is often important that we retain these
deciduous cuspids, not only for the appearance, but for the real
service that they will do, and as they are liable to decay the
same as other teeth, they require filling.
In handling these teeth, any considerable disturbance is
likely to hasten the absorptive process and cause the tooth to
loosen and fall away, or at least it has been observed in a
number of cases where these deciduous cuspids, that seemed
quite firm in their position, have fallen away soon after a filling
was made. This observation has occurred so often as to sug-
gest strongly that a considerable disturbance of the peridental
membrane by much malleting is very liable to start up this
absorptive process afresh and cause the loss of the tooth. There-
fore, when it is necessary to make fillings, these teeth should be
handled very cautiously.
Occasionally we find temporary molars remaining in posi-
tion, and, in a few instances, a bicuspid is seen deflected mesially
or distally and takes its place beside the temporary molar ; but,
generally, if they are deflected at all, they will be deflected to
the buccal in the upper jaw or to either the buccal or lingual in
the lower. These teeth do not often remain so late in life as