spoil the results, besides making the gum sore about the neck of that particular tooth.

Wires will break, no matter how much care you may give the case, and these must be replaced by new ones. Experience has taught that when one wire breaks, both ligatures must be renewed, for when twisting the unbroken one for the second time it will surely break.

The technic of replacing broken ligatures is as follows: With the pliers straighten and untwist the bent ends and separate them. Cut the doubled wire about the neck of the tooth, place the middle of a 10-inch piece of dental tape between the short ends of the wire and then twist the ends together forming an eye. (Fig. 5.) Seize the other end of the wire with the pliers and, using counter pressure, pull the wire from around the tooth, making the tape take its place. This in turn becomes the means by which the new ligature is carried to place; that is, by reversing the process. (Fig. 6.)

Throughout the period of treatment keep a snug Barton bandage on the head. A word of caution about fastening the safety pins at the side of the jaw is in order. After putting the pin in position seize the pin part with a hemostat and hold it rigid until the pin is fastened. When the lower jaw is in two or three pieces, a portion may be easily displaced by accidental pressure while pinning with safety pins.

Infection frequently appears after the fracture is in splints. When pus is present, simply incise the gum from below upward from the junction of the cheek or lip with the gum. With periosteal elevators rip away the soft tissue from the bone for a distance of about three-eighths of an inch on either side of the line of fracture and retract. Where pus has been present for 15 or 20 hours, the outer plate of the bone covering that area will be very thin and can easily be broken down with the chisel and mallet, but the bone must be supported by an assistant while using these instruments. Of course a fissure bur may be used. It pays well to make a good exposure of the infected area and thoroughly curette, making sure that there are no small particles of detached bone left. Place one or two sutures, as the case may demand, leaving enough opening to dress from above. With a pipette flood the area with dichloramine T solution and insert a small sterile gauze wick, carrying it to the bottom of the wound. From this time on the healing will proceed slowly, and the case must be dressed each day until the wound is filled in from the bottom. Of course, the dichloramine T solution is a matter of choice.

Diet must of necessity be liquid or thin enough to be drawn through the teeth. Never extract a tooth for the purpose of feeding.

46457-23- 4

Such items as the following are useful: Soups-turtle, tomato, pea, chicken, oyster, and vegetable. The semiliquid substance of creamed celery, potatoes, cauliflower, and onion can readily be drawn through or around the teeth. Coddled eggs; eggnog; soft custards; gelatin; chicken jelly; milk; tea; cocoa and coffee with plenty of cream; and fruit juices of all kinds.

There is one point that must be considered regarding fractures posterior to the last molar tooth, and this is to be considered whether the wiring method is used or not. It is the question of whether the two opposing ends of bone should be wired together, opening from the outside for the purpose. Just now I have under observation a case which was fractured and wired about six months ago, and recent X-ray examinations show unmistakable disintegration of bone tissue where the wire passes through, and I believe that it is only a question of time before this wire will have to be removed. The only time such a wire is indicated is when there are two lines of fracture, one at the angle and the other at the neck of the condyle. In the case of a single line of fracture the joint action of the two pterygoides on the inside and the joint action of the two parts of the masseter muscle on the outside of the ramus supported by the heavy or thick gum tissue are quite sufficient to keep the bones lined up.

Just a word about the number of teeth to be wired. It is noticed that Marshall and Blair seem to be content with wiring only four sets of opposing teeth-that is, two upper to two lower on each side— and many dental officers with whom I have discussed the subject think that sufficient. Experience has taught me that the greater the number of teeth wired the more certain is success.

The writer has been questioned several times lately as to whether he did not think a Barton bandage sufficient. Most emphatically no. Of course the bone may unite, but faulty occlusion is sure to result. For obvious reasons, it is best to restrict the liberty of fracture cases until all splints have been removed.

THE USE OF THE MODIFIED BAKER ANCHORAGE IN THE NAVAL DENTAL

SERVICE.

By W. L. Darnall, Lieutenant Commander, Dental Corps, United States Navy. The principles involved in the treatment of mandibular fractures are the same as those applied to fractures of all bones, namely, that there be a proper reduction of the fragments, their retention in apposition, and proper care of the tissues of the mouth. Maintenance of mouth hygiene is a very important factor and becomes more of a necessity because of the possibility of infection from the oral cavity.