Page 271 - My FlipBook

in these teeth is so grave, that in this consideration these
should constitute a sub-class to themselves. The teeth are
the first of the permanent teeth erupted, and are usually
through the gums by the middle of the sixth year of the
child's life. They are more often neglected than other teeth,
for the reason that many parents, ordinarily careful, do not
recognize them as permanent teeth and expect that they will
soon be shed as deciduous teeth. They are often deeply de-
cayed by the eighth year, and are pretty certain to require
fillings by that time in families in whom there is considerable
susceptibility to caries. There are no other teeth that are so
often lost from inattention at the proper time as these. There
are no other teeth easier to save by proper attention cor-
rectly timed. They are also the most important of the molar
teeth. They are the largest, strongest and most effective in
mastication. For several reasons their loss causes more de-
rangement of the masticatory apparatus and of facial expres-
sion than any other, not even excepting the incisors. If these
latter are lost early or late, the loss is replaced artificially and
the form of the face and the expression retained and mas-
tication not seriously deranged. When the first molars are
lost, the damage is practically irreparable. The occlusion of
the remaining teeth is necessarily deranged by the falling
backward of the bicuspids, and the movement forward of the
remaining molars. When they are removed as early as the
ninth or tenth year, the space of the first molars will be closed
by these movements of the teeth and the occlusion will be
better than if lost later, but the normal prominence of the
front teeth and lips will be wanting, which is a permanent in-
jury to the expression of the face. The occlusion will be im-
perfect at best, in many cases will be very defective, for often
the molar teeth assume such an inclination to the mesial that
the occlusal surfaces do not meet fairly together, but strike
only upon the distal cusps, rendering mastication imperfect.
If one only is lost, the incisor teeth are generally crowded to
that side in the filling of the lost space, moving away from the
median line and seriously deranging the expression of the
mouth. When two are lost on the same side, the whole front
of the mouth will be generally thrown to one side. Both
theoretically and practically it seems best when one must be
lost to extract all four; but few operators have the moral

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