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THE CHILDHOOD PEEIOD OF THE PERMANENT TEETH. 267
ful temporarily. Under these circumstances, the operator is
able to choose the time for their removal. On this point there
is much difference of opinion, but most careful observers agree
that the best arrangement of the features and the remaining
teeth will be obtained when they are removed some time before
the eruption of the second molars, or about the ninth to the
tenth year. My own observation corroborates this opinion.
At this time enough of the teeth in the front of the mouth will
be in position to give the occlusion considerable support; the
second molars, in erupting, will come forward nearly into the
position of the lost first molars; somewhat less flattening of
the face will occur than when they are removed earlier; the
surfaces of the second molars will usually be in better occlusion
and the interproximal contacts will be much better than when
these teeth are removed later. My own observations, however,
do not lead me to the opinion that, when there is no longer a hope
for their permanent retention, there is a material gain in wait-
ing to the ninth year that compensates for the dangers of suf-
fering and discouragement to the patient in the treatment of
these teeth in cases that promise much difficulty and pain. There-
fore, in many of the cases presented, I should remove them at
once as the lesser of two evils. It is especially desirable at this
time that the little patients be not troubled with teeth that are
frequently sore and interfering with the free use of the teeth
in the mastication of food. To have a child in a condition of
inability to masticate food in comfort for a considerable time
because teeth are sore, establishes a habit of bolting food that
is very damaging to the physical development of the person.
In the consideration of the question of permanent retention
of these teeth, the superficial area of the decay is of secondary
importance. The depth of the decay, its relation to the pulp of
the tooth, and the condition of the pulp, are the important ques-
tions. In adults, if the pulp of the tooth becomes involved, we
may remove it and retain the tooth in serviceable condition. With
the first molars in patients eight or nine years old we are
debarred, and under twelve years old we are likely to be debarred
from root-filling because the apical foramina have not been'Wr-
rowed by the completion of the growth of the roots. Really root-
filling is decidedly unsafe before the fourteenth or fifteenth year.
Even when done at from fourteen to sixteen my observation leads
me to the conclusion that most of these teeth with root fillings
are lost before the person is thirty years old. Therefore, if the
pulp has become hopelessly involved, the tooth will be lost and