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surgeon and the minimum inconvenience of the patient. This is nowhere
better exemplified than in the running of a Dental Gas Extraction Clinic,
where the dentist requires his patient to be sufficiently asleep to enable
him to complete an extraction without undue haste and the patient
expects to recover and leave within a very short space of time. When
dealing with the teeth of an expectant mother one also has to bear in
mind the well-being of a yet unborn child. The latter may be harmed
by the injudicious choice or faulty administration of an anaesthetic
agent to its mother.
Bearing these points in mind I recommended the acquisition of a
"Walton" gas-oxygen machine with which gas can be delivered through
a mask which covers the nose only and leaves the mouth entirely free.
Oxygen can be added in a sufficient quantity to prevent any suffocation
either to a prospective mother or the child she carries. Owing to the use
of a nasal mask gas can be delivered throughout the entire operation,
thus preventing any likelihood of a patient awakening during its progress
and also ensuring both ample time for the extraction and free access to the
mouth. This apparatus has two simple controls, the first a handle
regulating the percentage of oxygen which is added to the gas and a
second (a foot lever) which increases the presence of the gaseous mixture
so that in cases which "mouth breathe" gas may be forced down the
nose. This latter function sounds more brutal than it really is, as any
excess pressure readily finds its way out of the mouth. During the
extraction of the last tooth the anaesthetic is stopped so that recovery
takes place almost immediately the surgeon is finished.
Owing to the use of oxygen any number of teeth can be extracted
without harming the patient from an anaesthetic point of view. In
practice, however, this is the upper limit for reasons that are beyond
my province, discomfort being the chief. Occasionally a total clearance
is done, but only on nervous patients who might not pluck up enough
courage to attend again.
Nitrous-Oxide ("dental-gas") and Oxygen is unfortunately not
very suitable for young children. If given by the old method of putting
the child to sleep and operating during the recovery period, the surgeon
is limited to about fifteen seconds in which to work. As milk teeth are
very brittle and apt to splinter when extracted rapidly this time is too
short. If the continuous nasal method is employed and enough oxygen
added to prevent suffocation the young patient is seldom sufficiently