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618 EXTRACTION OF TEKTIL

a patient insists upon liaving removed in order to avoid the diseom-
fort attendant upon their treatment and Idling-. Xo one (piestions
or denies the enormous beiietit of general anesthetics in dentistry,
i)artienlarlv Avhen painlul operations are to be ])erformed upon ner-
vous women and children, but if the patient be billing- to suffer a little
pain it is g;enerally better to extract M'ithout a j^eneral anesthetic, as in
that case the patient can assist the operator by keeping the liead in
a desired position Mith the mouth and lip.; ^vell open, and in various
other ways, while under the influence of an anesthctie the muscles
supporting the head, jaws, and cheeks are so relaxed that it io difiicult
to keep the mouth and lips well open.
If the operation is to extract a difficult tooth, the operator is limited
to the time when the patient is under the influence of an anesthetic, and
in the case of nitrous oxid the time is very short ; but without an anes-
thetic there is not this limitation as to time, and the extraction may be
done with that care and deliberation essential to a proper operation. It
is an important rule in any Ijranch of surgery that the time required to
do an operation must l)e sutficient to do it properly and without un-
necessary injury to the adjoining tissues.
Examination of a Patient before the Administration of a Gen-
eral Anesthetic.—The physical examination should be made in such a
way that it will not cause alarm to the patient. The result of this ex-
amination governs the selection of the anesthetic, and to some extent
shows how far the patient should be carried under its influence. It has
been said that a greater amount of care should be used if the patient
has or is suspected of having organic or functional disease of either the
heart or the lungs. This is quite true, but at the same time the greatest
amount of care should be observed in all cases. For the physiological
action of various anesthetics the student is referred to special works on
this subject.
The question often arises whether anesthetics should be used at all
if the patient has either organic or functional disorder of the heart.
That depends to a large degree on other conditions of the patient. If
the shock of extraction will be less under ether or nitrous oxid, then by
all means give the anesthetic and carry the patient fairly well under its
influence, so that there will be neither pain nor knowledge of the ope-
ration. Occasionally patients suffering from heart disorders can bear
a certain amount of pain without shock ; in such cases it is better, if
the operation be a simple one, to extract while in the normal condition.
The use of ether for extracting has certain advantages. If for any
reason the operation requires longer time for its performance than the
influence of the nitrous oxid will last— say from one to two minutes
—it is better to use ether. Ether can be given after the patient has