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Tooth Worms to Craniofacial Research: A Brief History of Dentistry

“Every tooth in a man’s head is more valuable than a diamond,” said Miquel de Cervantes. Because of the great value of teeth, man has labored from the earliest times to discover better ways to care for teeth and extend their useful “lifetime.” The following brief history of dentistry details how far man has advanced in caring for his precious “ivories.”

Ancient Man and Dentistry

Dental issues were a pressing problem for ancient man as he often survived on a diet of coarse food that wore down molars and damaged enamel. Yet, the ancient ideas on the causes of tooth decay were often wrong as the tooth worm theory indicates. Seven thousand years ago, the Sumerians believed that cavities were caused by tooth worms. This idea persisted up to the 1300s.

Despite mistaken theories, recent discoveries indicate that ancient man practiced basic forms of dentistry for therapeutic reasons. In 2006, French researchers published evidence of teeth that were drilled as early as 9000 B.C. The team unearthed human remains in an ancient burial ground in Pakistan. After examining the teeth of those ancient people, they identified nine individuals who had eleven teeth drilled with an instrument made from flint heads. “While some teeth had been drilled more than once, four showed signs of decay … suggesting a possible therapeutic intervention,” said paleoanthropologist Roberto Macchiarelli, one of the lead researchers. The scientists believe the ancient dental skills developed from the practice of drilling beads to make jewelry with an instrument similar to fire-making tools of Native Americans. A wooden shaft with a sharp piece of flint at the tip was looped to the drawstring of a bow. As the bow was moved back and forth, the shaft would be rotated quickly, which powered the sharp tip to drill into teeth.

By 1700 B.C., ancient dentistry grew much more sophisticated. Egyptian papyrus from that period records treatments for a variety of dental problems, ranging from stabilizing loose teeth to the filling of cavities. The earliest dental bridges were also created by Egyptians, as they used metal wires to re-attach teeth by anchoring them to neighboring healthy teeth. The first person identified as a dentist was an Egyptian physician named Hesi-Re. “He was an official, physician and scribe who lived during the Third dynasty of Egypt, around 1600 BC, and served under the pharaoh Djoser. He bore titles such as ‘Chief of Dentists and Physicians,’ ‘Doctor of the Tooth’ and ‘Chief of the King's Scribes,’ ” writes April Holloway.

 

Dentistry in the Middle Ages

Though often practiced by early physicians in the ancient world, the later practice of dentistry was conducted on many different levels. Often barbers performed basic dental treatments during the Middle Ages, along with their hair-care and blood-letting practices. Yet, several important advances occur in Medieval period that advanced dentistry.

First, Chinese physicians developed the first dental amalgams, metal alloys used to fill cavities. Su Kung, a Chinese doctor wrote of using fillings made of a mixture of tin and silver in 659 A.D. It would take almost 600 years for the practice of using amalgams to be discovered and employed in Europe when they began to be used in Germany in 1528.

Another important advance happened in Germany in 1530 with the publication of “Little Medicinal Book for All Kinds of Diseases and Infirmities of the Teeth,” the first textbook devoted to dental practices and treatments.

 

Modern Dentistry is Born

The foundation of modern dentistry was laid in 1728 with the publication of “The Surgeon Dentist” by French surgeon Pierre Fauchard. This was the first scientific work focused on all aspects of dentistry, from descriptions of basic oral structures to orthodontics. Because of this important text, Fauchard is known as “the father of modern dentistry.”

Fauchard’s book marked the beginning of many important developments in the 1700s that brought dentistry into the modern world. Here are some of the most significant:

1746-The First Gold Crown—Claude Mouton, a French dentist, was the first to suggest crowning a damaged tooth with gold that was attached to a metal post anchored in the root canal. If attached to a front tooth, he recommended covering the gold with white enamel.

1766-The First Trained Dentist in AmericaJohn Baker, an English doctor with training in dentistry, immigrated to Boston in 1766 to establish a dental practice. In his advertisement in the Boston Post-Boy newspaper on June 30, 1766, Baker identified himself as “An Operator for the Teeth.” In 1772, George Washington became Baker’s patient after he relocated to Williamsburg. Baker removed several of Washington’s decayed teeth and introduced him to the basics of dental hygiene.

1776-The First Case of Dental Forensics—While he practiced dentistry in Boston, Dr. Baker taught Paul Revere the art of making and fitting patients with false teeth. Revere’s skill as a silversmith served him well in this new skill, and he began to make dental bridges to supplement his income. In 1776, Revere was called upon to identify the remains of Major General Joseph Warren, who had been killed in the Battle of Bunker’s Hill. Warren had been killed by a British musket shot to the head which had disfigured his facial features. He then was stripped of identifying clothing and articles and buried in a mass grave. Revere was able to identify Warren because he had made a silver dental bridge for him several years before. Thus, Revere became the first to practice dental forensics.

1780-The First Mass-Produced Tooth Brush—The Chinese were the first to invent the tooth brush. By the 1700s, the tooth brush had made it to Europe, but controversy surrounded its use. In 1780 American William Addis began the first mass-production of tooth brushes. They were made of handles of wood or bone with attached bristles. Addis became wealthy from the sale of his tooth brushes. The company continues today under the name Wisdom Toothbrushes.

1790-The First Dentist Chair—A Boston dentist named Joseph Flagg invented the first dentist chair in 1790. Before that time, a dentist might have a patient sit on the floor as he worked on their teeth. Flagg’s chair was a Windsor-style chair with an attached adjustable headrest for the patient and an oversized arm for the dentist to place his instruments.

 

Dentistry Grows Up

Even with the great strides in dentistry through the 1700s it still took more than another century for modern dentistry to come of age. For example, until 1859 there were no formal qualifications required to practice dentistry in the United Kingdom. It was not until 1921 in the United Kingdom that dentistry was restricted to only those professionally qualified.

There were several improvements in dentistry that developed in the twentieth century. First, the local anesthetic Novocain was invented by German chemist Alfred Einhorn. This was the first non-addictive narcotic developed and Einhorn envisioned it as an ideal drug for amputations. Much to his dismay, surgeons refused to embrace the use of Novocain as they preferred a general anesthetic for surgery. Yet, modern dentistry saw the potential for pain-free dental work through the use of Novocain and began to use it widely. Unfortunately, Einhorn never reconciled himself to this trend. “Its inventor spent the remaining years of his life traveling from dental school to dental school making speeches that forbade dentists from ‘misusing’ his noble invention in applications for which he had not intended it,” writes business guru Peter Drucker.

Second, the modern dental hygienist profession was established by Alfred C. Fones. He opened the first dental hygienist school in 1913 in Bridgeport, Connecticut. Though dentists had resisted earlier programs like this, Fones approach won broad approval after many of his graduates were employed by the local school district to clean the teeth of school children. The dramatic reduction in cavities in the children proved the value of such training.

Third, fluoride’s beneficial dental effects were discovered by Colorado dentist Frederick S. McKay in the 1930s. His research into the effects of drinking water with high levels of fluoride proved that it helped lower the incidence of cavities. By 1945, fluoridation of municipal water supplies began in Newburgh, New York and Grand Rapids, Michigan.

Fourth, the use of dental implants developed through the pioneering work of Per-Ingvar Branemark, a Swedish physician and researcher. In 1982, Branemark revealed his discoveries over the previous 15 years concerning “osseointegration,” the process of bone fusing naturally with implanted titanium hardware. This ground-breaking work opened the door for dental implants using titanium posts that can become permanent replacements for missing teeth.

Finally, modern dentistry was recognized for its importance to the overall health and well-being of individuals when President Harry S Truman created the National Institute of Dental Research in 1948. This government institute was tasked with improving the dental and oral health of individuals through research, training, and dissemination of public health information. In 1998, its name was changed to the National Institute of Dental and Craniofacial Research with its expanded focus to include all topics related to craniofacial health such as oral cancer, orofacial pain, and the connection between oral health and overall health.

 

Dentistry has come a long way from its humble beginnings of flint drills and bowstrings. Yet, the one constant all through its long journey has been the relief of suffering and the improvement of the lives of people.

 

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