History of dentistry
The history of dentistry is in short, one disturbing story after another. If you are a bit squeamish please stop reading now.
If you are one of the many who dislike the thought of having to come to the dentist spare a thought for all the people who have preceded you, they would all say that we don’t know how lucky we have it. For example up until the mid 1840s all work including extractions was done without anaesthetic!
Even dentistry has its patron saint.
Saint Apollonia was a nun who lived in Alexandria (Egypt). In 249 AD anti-Christian rioting broke out in the city. Apollonia was set upon by a crowd and was tortured in an attempt to get her to mutter impious words against Christ . She refused and all her teeth were violently pulled out or broken, then she was burnt alive.
People suffering toothache are asked to think of her plight during their time of need.
In many cultures an important age-determining factor has been how long your teeth last. Traditional diets were often a lot more fibrous but less sugary than our present diet, and as a result teeth would wear down a lot faster but would not be at risk of as much decay.
Life expectancy would often be round 40 years of age; it would be likely that by this time major dental problems would be developing. Often these would be avoided as illness or disease would kill a person.
However, in larger more civilised societies where some could be expected to live a long time and the access to sugar was greater, dental problems were common. In these communities basic dental treatments and theories began to be recorded and develop.
The first evidence of dentistry
The first evidence of a cavity being drilled into a tooth goes back to Neolithic culture of 7000 BC in the mountain regions of what is now Pakistan. There, teeth have been found in skulls which have had circular holes drilled into them. Due to the location, usually on the back molar teeth, on areas unlikely to have had decay it has been speculated that these holes were actually drilled for religious reasons, for example to release evil spirits.
Ancient peoples seemed to universally conclude that tooth decay was in fact caused by the “tooth worm”. A Sumerians (Modern Iran) text from 5000 BC is the first to claim this. Similar claims are also made in ancient Indian, Egyptian, Chinese, Japanese and Greek texts.
In the ancient Mesopotamian text Code of Hammurabi 1800 BC there is a reference to the effectiveness of using tooth extraction as a form of punishment.
There is evidence that knowledge was being collected and written down.
Hippocrates (460 – 370 BC) and Aristotle (384 to 322 BC) wrote in detail about dental problems and treatments. This included tooth eruption patterns, and ways to stabilise loose teeth and broken jaws.
From as early as 700 BC false teeth or dentures were being made.
We credit the Etruscans (Romans) round the year 200 AD with being the dentist of the ancients. There is evidence from their culture that they were using gold to crown /cap teeth and were making gold-based partial dentures.
As mentioned earlier ancient Chinese and Japanese texts referred to the “tooth worm” as the cause of dental decay. Acupuncture was used from at least 2600 BC for the relief of tooth pain. In 700 AD reference has been made to the use of a “silver paste” to fill teeth.
The first Dentist
This title belongs to the Egyptian Hesy- Re who died in 2600 BC. On his tomb is inscribed “the greatest of those who deal with teeth and physicians” . Very little is known about what treatments he performed or how he worked as a dentist.
Early and Middle Ages in Europe
With the fall of the Roman Empire, Europe descended into what many people call the dark ages. The fall of the empire ultimately resulted in the loss of a vast amount of knowledge. The practise and knowledge of medicine and dentistry were only kept alive by the Monks.
Living in their monasteries they led a relatively isolated existence. However, they were always in regular contact with the local barber who would shave their faces and cut their hair. As the barbers carried and used sharp knives and razors they would help assist the monks with surgical procedures.
Papal edicts of the twelfth century then prohibited Monks from doing any type of surgery. The result of this was that the monk’s knowledge was passed on to the barbers who then became responsible for performing basic surgical procedures such as tooth extraction, abscess incising, and blood letting.
Around this period refined sugar was bought en masse from the new world to Europe. Being expensive the wealthy could not get enough of it.
Extensive use of sugar was known to blacken the teeth and black teeth became an Elizabethan status symbol. This fashion fad was so popular amongst Upper Class Elizabethans that cosmetics were used to create an illusion of black teeth!
Queen Elizabeth (1533 -1603) is always portrayed in pictures as being a beautiful lady with a good set of teeth. While this may have been true in her early days it may not have been so as she grew older.
It was noted by Foreign Ambassadors that Queen Elizabeth had black teeth. She also had some teeth missing which made understanding her words at times difficult.
As there was no form of anaesthesia available a person, even a queen, either had to endure the toothache or have the tooth extracted.
Queen Elizabeth had suffered for a long while from severe toothache, but was too afraid to have her tooth out.After seeing that the Archbishop could tolerate the pain of the extraction, and that the procedure was rather simple, she agreed to have her troublesome tooth out. However, the loyal Archbishop had to go through the painful procedure of having another tooth extracted before the Queen was satisfied that it was safe!
1530 had seen the publishing of the first dental text book. Some of the remedies were debatable and included blood letting by the use of leeches!
1700 and on
Pierre Fauchard (1678 -1761) the father of modern dentistry published his first text book in 1723. He made the link between sugar consumption and dental decay.
During the 1700s dental fashion went full circle with regard to appearance. No longer was a blackened set of teeth seen as a status symbol. Basic brushing and cleaning of teeth was common. However, a wealthy person in their later years undoubtedly suffered from substantial dental problems.
False teeth were the obvious solution. These had been around since the Etruscans of 700 BC. The major problem was to find a material from which to make them.
The Japanese had made wooden dentures from the mid 1500s. However, enzymes in saliva break down the cellulose in the wood, also moisture would cause them to swell up in size (Please note that US President George Washington did not wear wooden dentures as is commonly claimed).
Ivory (from hippopotamus or walrus) was also commonly used, the teeth were a white colour, however, they were expensive, time consuming to make and the teeth were extremely brittle.
In London in 1820, Claudius Ash, a goldsmith by trade, began manufacturing high-quality porcelain dentures mounted on 18-carat gold plates.
A solution to ivory teeth was found by using old human teeth set into various bases. This became the most popular method. Unfortunately demand greatly outstripped the supply. Teeth were sourced from executed criminals, battlefields, grave robbing and even paying people to have their teeth extracted. Dead soldiers were an ideal source as their teeth were usually in good condition. After the Battle of Waterloo, where 50,000 men were killed, 52 barrels of teeth were sent to London giving the term Waterloo Teeth.
The Crimean War in the mid 1850s and then the US Civil war all helped to stock the dentures of Europe and, as late as 1865 dentists on Pall Mall (London) proudly used these Waterloo Teeth.
You will be glad to know that advances in porcelain ended this market shortly after.
The early 1800s saw the introduction of the first dental drill, then dental chair. The 1830s saw the first use of dental amalgam, (please refer to History of Fillings for a more detailed account) however, as yet no form of anaesthesia was offered.
Nitrous oxide (laughing gas) and chloroform were initially used and then in 1846 the first local anaesthetic was used. With the addition of cocaine into the solution its effectiveness were increased. In 1901 Novocaine the first modern mass-produced local anaesthetic was produced.
X-rays were discovered by William Rontgen in 1895.
1900 and on
The twentieth century saw an exponential growth in dental knowledge, awareness and care to the standard of what we expect today.
The First World War, highlighted the need for good dental health in a population as a large number of potential soldiers were deemed unfit due to their poor dental status. Service men were issued with tooth-brushes in their rations and on their return they introduced the idea of tooth brushing to their families. After WW1 many countries set up national schemes to help address the dental issues with children (their future soldiers). This idea was expanded after WW2 as one of the components of the welfare state in many countries.
Marketing and the media has also helped to spread the message of good dental care and now a nice smile is the expectation of most.
Technology has advanced at a high rate. Currently titanium implants are the cutting edge, however, these, like everything else, will be superseded. Although most people would rather be at another place than the dentist at this moment in time the dental profession is at least able to offer effective care and treatment for our teeth.
If there is one thing to learn from the history of dentistry it is that is we are very lucky to live now!