to prevent their proper use in mastication, causing great inconvenience and embarrassment; but that is not the most serious consequence to be feared. The influence of such conditions upon the germs of the permanent teeth almost certainly results in imperfectly formed or developed teeth. Parents and guardians should fully realize that they ought to be cared for, kept thoroughly clean, be well used in mastication, and upon such food as will keep them properly exercised. When they become decayed it is important that they should be promptly looked after, so that incipient decay may be removed, or cavities already formed be filled before such. operations would be too late. In the filling of these teeth a temporary material may be used. Hill's stopping, gutta-percha, or oxyphosphate of zinc, etc., etc., will serve the purpose. Every one knows that it is a very serious matter to attempt a prolonged and difficult operation upon the temporary teeth of young children, and so the necessity of the case seems to require that something that can be readily applied in a very brief time shall be employed. Happily for the patient these things are at hand.

Dr. HORTON: In the treatment of the temporary teeth much trouble arises from the fact that the people are not properly instructed regarding the necessity of their care and preservation. They are of the opinion that these teeth are of short duration, and that they can be removed without detriment if they cause annoyance or irritation, as they will be replaced by the permanent set in a very short time.

Within the last two or three years a physician in whose family I have practiced for a long time sent to me his little boy, about six years old, with the pulps of the first inferior temporary molars exposed, with the order to have them extracted. The first inferior permanent molars were decayed at the time they were erupted, and before the boy was six years old the crowns had almost entirely disappeared and abscesses had formed at the root of each. This created such an irritation that it was necessary to extract them; so when the boy came to me with the pulps of the temporary teeth exposed, I sent for his father and demonstrated to him that the boy would have nothing to masticate his food with for five or six years, if those two teeth were extracted as he desired. He told me to do as I thought best. I put the rubber dam upon those two teeth and very carefully cleaned them as well as I could without puncturing the exposed pulps. I then prepared some oxyphosphate of zinc about as thick as cream and dropped on each of the live pulps. Letting that harden

I mixed some more a little thicker and let that harden also, and then with great care completed the fillings with amalgam. That was done three years ago last summer. A few weeks ago I saw the case, and I am certain that those pulps were alive and well, and the circulation as complete as before they were exposed.

That is the treatment I give,-in a modified form,-to temporary teeth in such cases. These teeth should never be extracted as long as there is vitality, because the absorption of the roots of the temporary teeth is a vital process. Whenever a tooth becomes devital

ized from any cause this vital action ceases.

A few months since I extracted six roots of temporary teeth that were in a very good state of preservation from around the upper bicuspids of a young lady twenty-six years old. You all know those roots should have been removed at ten or twelve years of age, by nature's operations. They remained at least fourteen years beyond the time they were of any use, simply because there was no attention paid to the condition of the mouth by the patient, or the dentist, if she had one.

There are but few cases in which I would remove temporary teeth. One is where there is trouble that is causing the death of the pulp, and great irritation or inflammation follows. Another is where the permanent teeth are erupted and there is no possibility of the absorption of the roots.

Dr. WATKINS: I have a case of a young lady, nineteen years of age, who has not lost the second temporary molars, which seem to be firm in the jaw. They are not decayed, and there seems to be no sign of the bicuspids coming. I would like to ask Dr. Horton what he would do in that case?

Dr. HORTON: If there is no evidence of the permanent tooth coming, leave the temporary tooth there. Perhaps the germ of the permanent tooth is wanting. I recollect one family that have no upper bicuspids at all, and their temporary teeth are to-day in the mouth, and some of the family have reached mature age.

Dr. WATKINS: Do you not think that nature has already supplied the germs of the permanent teeth, and that the irritation caused by the removal of the temporary ones would stimulate nature to do its duty, and that the appearance of the missing teeth would soon follow.

Dr. HORTON: If there is no evidence of it I would let the temporary tooth remain.

Dr. RHEIN: I differ somewhat from the doctor in regard to this

matter. I had a case very much like the one to which Dr. Watkins has referred. A gentleman, aged about twenty-three, came to me a few months ago complaining very much of a swelling in the neighborhood of what would be the first permanent molar on the right side. The parts around the tooth were very much swollen. He told me he had had trouble of the same nature about this time every year for the three years last past, and he had gone to different dentists on each occasion and they had given him relief. It was impossible to make a thorough examination because of the inflammation. I treated the mouth to reduce the inflammation and told him to return the following day, and when he appeared, with a burnisher introduced around the tooth, I found it was his temporary second molar which was causing the trouble. I extracted the tooth at once, and found the roots entirely absorbed and the second bicuspid immediately underneath the gum. I have not seen the patient since, but I feel almost positive that the bicuspid will not come into proper position, from the view I obtained of it. I have seen a number of cases in which the second bicuspid has been erupted in a very irregular position-that is to say, the buccal surface of the tooth has been turned around to the approximal side, in one way or another. This is generally due to the fact that the second temporary molar has been allowed to remain too long in the mouth. The second temporary molar seems, in some manner, even after the roots have been thoroughly absorbed, to be held in place in the jaw very firmly. In the case I have described nature had for the last four years attempted to throw off this tooth but did not succeed, because the crown, the roots being absorbed, was wedged in between the first bicuspid and first molar. The same patient has a very irregular condition of his teeth generally. He has always been under dental treatment, and his four temporary canines,-merely because the dentist did not believe in extracting the temporary teeth,-were allowed to remain, and the consequence is that with the possession of eight canines and the lack of a number of posterior teeth, a worse condition of affairs could hardly exist than is to be found in his mouth.

I have in my mind a patient in whose mouth the second temporary molar was allowed to remain until she was about eighteen, and in consequence the second bicuspid made its appearance with the buccal surface turned toward the posterior approximal side of the first. I think a great deal of harm is done by allowing the temporary teeth to remain in the mouth too long.

Dr. WATKINS: There has been nothing said with regard to the

treatment of children's teeth where the pulps are dead or the teeth abscessed. In the treatment of such teeth I find a preparation of iodoform an excellent thing. I use a prescription which Dr. Bö decker copied from the German and gave to the New York Odontological Society about a year ago. I apply this preparation in the pulp-chamber after removing all decay, and then fill the tooth with some one of the soft fillings, and I have yet to see the first case where any inflammation has followed after the tooth has been filled. I have been using this preparation about a year, and while, previous to that time, by pursuing the methods recommended by many dentists, in many cases I failed, since I have been using this preparation I have not had a single failure. I have also used the same preparation in covering the pulps of temporary teeth where they have been exposed, filling directly over the remedy at the same sitting, and in such cases I have not had a single failure. I find there are a great many dentists who have not used it and I would recommend it to them.

Speaking of children's teeth, I have under my care a child (?) about forty-five years of age, weighing about two hundred pounds, and she has not got her wisdom-teeth. She has a perfect set of teeth otherwise, in number twenty-eight, and there is no sign of the wisdom-teeth and never has been. She has never had any of her permanent teeth extracted. She is troubled with a great deal of neuralgia, and I would like to ask if it is possible that the wisdom-teeth are giving her this trouble, and if removing the second permanent molars would give the wisdom-teeth a chance to erupt and cure that trouble, or if it is too late in life for that.

Dr. STOCKTON: Not long since a lady of about sixty years of age presented herself at my office for consultation, and gave me the following history of her case: A short time before she discovered in the roof of her mouth something that did not belong there. She called the attention of her physician to it, who examined it very carefully and said: "You have a case of necrosis; your jaw is very much diseased, and you will have to have an operation performed." An eminent physician from the City of New York was also consulted, and he pronounced it as the local medical man had done a case of necrosis, and they decided to perform an operation. The patient was very nervous and would not consent at that time, and another appointment was made; but the old lady could not make up her mind to submit to the operation and sent the doctors home.

She asked me to look at her mouth. I did so, and told her that

the necrosis could be cured in half a minute. I extracted a cuspid tooth that had been lying dormant for years, but had recently erupted in consequence of the pressure, I presume, from a rubber plate that she had been wearing. Her necrosis was cured, and she naturally was greatly delighted and went home rejoicing.

Another case I would like to report. A very prominent gentleman in our city had a pulpless wisdom-tooth, which had remained in his mouth in that condition twelve or fifteen years. It finally gave him trouble, and I removed it. The inflammation did not subside, ulceration ensued, and during my treatment the family became very nervous and sent for the family physician, who insisted upon the patient applying warm poultices. The patient was a very large, fleshy gentleman, and his throat was almost closed by the inflammation. In order to quiet the nerves of the family I sent for my friend, Dr. Atkinson. I did not tell him what I had done, knowing that he knew what was right always.

Very much to my rejoicing and to the great satisfaction of the patient and the family he confirmed my treatment, and said, "Don't you apply anything warm, but use ice," as I had advised. If the treatment which the physician advised had been continued, I have no doubt from the temperament and organization of the patient that he would not be alive to-day. The case resulted all right, and the gentleman is well and has gone to Europe.

Dr. BUCKINGHAM: I do not see that we are getting very much information in regard to the treatment of children's teeth. We should consider not so much the extraordinary cases that present themselves and sometimes require extraordinary treatment, but those that generally and constantly require our care. If the temporary teeth are badly decayed, what shall we do?

Shall we destroy the pulps and fill the teeth, or shall we extract them? If we extract, what harm will be done? Will extraction cause the permanent teeth to be irregular? That is a question that has not yet been decided, and one of very considerable importance. Again, if we conclude to treat the teeth and fill them, what is the best treatment we can give? Shall we destroy the pulp with arsenious acid, or shall we use some other medicine that will effect the same result? We must bear in mind that the whole structure of the temporary teeth is much less dense than the structure of the permanent teeth, and for that reason we have to use a more gentle means to produce the effect.

I have no doubt that iodoform will answer in very many cases.