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METALLIC PIVOTS. 323

case, too great care can not be recommended ; and
prior treatment will sometimes be advantageous.
After periostitis has supervened, either constitutional
or local treatment, or both, may be employed ; con-
stitutional, by emetics and saline cathartics, and,
indeed, any agent that will equalize the circulation
and counteract the inflammation ; and local, by the

same means as already prescribed for periostitis else-
where—in addition to which, it may sometimes be
necessary to remove the crown and pivot from the
root. It is always important to commence the treat-
ment of such cases at the first indications of the
disease.
Sometimes, even with considerable care, a crown
will be split by the introduction or the expansion of
in which case, of course, another tooth
the pivot ;
must be selected. When a pivot breaks off, and a
portion adheres in the root, this may be drawn out

with pliers or a pivot-extractor, or, if it does not pro-
trude enough for this, it may be drilled out. A root
is sometimes split by the expansion of a tightly-fitting
pivot, or by a blow on the crown of the tooth ; and
when this happens, it must be removed, since it can
not be made any longer to retain a tooth. Pivot

teeth should seldom, if ever, be worn in a mouth in
which teeth on plate are worn. They are now far
less frequently worn than formerly, because, perhaps,