Page 272 - My FlipBook

courage to sacrifice two or three good teeth for a possible
gain in occlusion and expression in the somewhat remote
future.
The time at zvJiich first molars are lost is important.
They are the first of the permanent teeth. They are placed to
the distal of the deciduous set. When they have taken their
places and the uppers and lowers have occluded with each
other, the shedding of the diciduous teeth begins, and the
first molars hold the jaws in position and preserve the sym-
metry of the face while the deciduous teeth are being shed
and replaced by the permanent ones. The second molars are
not erupted until the twelfth year, and by this time the shed-
ding and replacement of the teeth have been nearly com-
pleted ; therefore the face is apt to be shortened because of
the lack of support for the lower jaw, the normal movement
of the front of the mouth forward is diminished and de-
rangements in the occlusion occur. All of these consid-
erations demand that these teeth be saved yet children
;
are brought to us continually with their teeth decayed beyond
all hope of repair, and they must be removed as the lesser
of two evils. In many cases in which permanent repair is
impossible, the teeth may receive such treatment as to render
them comfortable and useful temporarily. Under these cir-
cumstances the operator is able to choose the time for their
removal. On this point there is much difference of opinion,
but most dentists agree that the best arrangement of the
remaining teeth will be obtained when they are removed some
time before the eruption of the second molars, or about the
'tenth to the eleventh year. My own observation corroborates
this opinion, for at this time enough of the anterior teeth will
be in position to give the occlusion considerable support, the
second molars will come forward nearly into the position of
the lost first, in erupting, 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
interproximate contacts will be much better than when these
teeth are removed later. M^ own observations, however, do
not lead me to the opinion that there is a material gain in
waiting to the tenth year that compensates for the difficulties
and dangers in the treatment of these teeth, in cases that
promise much difficulty and pain, when there is no longer
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