Dentistry - Past and Present
Dental ailments have remained remarkably similar throughout history. Decay, toothaches, periodontal disease and premature tooth loss were documented in ancient chronicles. The exact time that dental art made its appearance isn't known; however, there is ample proof of its existence among the civilizations of Egypt, Etruscans of Central Italy, Assyrians, China, etc. Since Dental History is such a broad field, a few of the highlights of dentistry will be mentioned in order of importance and chronology.
I. Pre-historic era.
At the beginning, life consisted of simple creatures of the sea, which consisted of masses of protoplasmic cells.
By engulfing themselves around a desired morsel, they were able to absorb food. Later a slit developed, the forerunner of the oral cavity and great gut.
Much later tentacles and feelers developed around this slit. The tentacles helped to carry the food to the slit, oral cavity and great gut.
Then nature took the outer layer of skin and carried it inward to the oral cavity. This skin contained tentacles which were the forerunners of our teeth. These tentacles, also called
shagreen, were calcified.
Some of these sea creatures developed lungs and became amphibians. Some began to spend time on land. At first they crawled on their bellies, later they developed limbs and feet and arose from the ground. Faced with a new environment including a mixed diet, the creatures evolved into stronger animals made up of hard bone and tough muscle fiber. Originally three single tentacles fused and became tri-conodonts. These later changed into teeth very similar to the teeth of the Catarrine Apes (who inhabited the earth about 40,000,000 years ago in the middle of the Tertiary Period). The descendants of these apes have the same dental formula as man. Somehow fire and its benefits were discovered. Cooking made sea food more palatable. Fish and shell fish became the staple diet as well as nuts, fruits, and the flesh of animals. Due to this food supply many of the tribes of Egypt and China thrived in the river valleys. Later cultivated grains such as rice, wheat and barley were added to the diet. If we set the beginning of history at 4000 B.C., toothaches can be traced to the earliest records. In the Egyptian manuscripts known as Eber's Papyri, which dates back to 3700 B.C., dental maladies such as toothaches and sore gums are mentioned. Also about 3000 years ago, the Chinese were concerned about the condition of their teeth and gums. In manuscripts of that period, at least nine dental ailments were listed and also prescriptions for their treatment. Ancient petrified skulls showed the presence of decay. In the Giza Pyramids skulls were found with evidence of tooth decay. Be it Asia, Africa or America among the Co-magnon (direct ancestor of man) who painted walls of caves 20,000 B.C., we find all men suffered their share of dental ills. Magic played an important part in the treatment of dental ills, and people of early ages had odd beliefs concerning teeth. The Egyptians believed that the mouse was under the direct protection of the sun, therefore if one had a toothache the split body of a warm mouse was applied to the affected side. In India the cuspid of Buddha was enshrined in a famous temple (at Kandi) and prayed to in fertility rites. Prayers were offered up to saints for the relief of pain. St. Apollonia of Alexandria, 249 A.D., was one such saint. She is now the Patron Saint of Dentistry.
II. Egyptians and Chinese
The first known dentist was an Egyptian named Hesi-Re (3000 B.C.). He was the chief toothist to the Pharaohs. He was also a physician, indicating an association between medicine and dentistry. In the 5th century B.C. Herodatus, a historian, described the medical art in Egypt: "The art of medicine is distributed thus: Each physician is a physician of one disease and no more; and the whole country is full of physicians, for some profess themselves to be physicians of the eyes, others of the head, others of the teeth, others of affections of the stomach, and others of more obscure ailments".
Dentistry today is somewhat specialized. The eight specialties are as follows:
1. 1901 Orthodontics
2. 1918 Oral Surgery
3. 1918 Periodontics
4. 1918 Prosthodontics
5. 1927 Pedodontics
6. 1937 Public Health
7. 1946 Oral Pathology
8. 1963 Endodontics
The first evidence of a surgical operation was found in Egypt. A mandible with two perforations just below the root of the first molar indicated the establishment of drainage of an abscessed tooth. The approximate date is 2750 B.C. The splinting of teeth also was practiced by Egyptians; evidence by a specimen from Cizeh, 2500 B.C. It shows two molars fastened with heavy gold wire.
The Chinese were known to have treated dental ills with knife, cautery, and acupuncture, a technique whereby they punctured different areas of the body with a needle. There is no evidence of mechanical dentistry at that time, 2700 B.C., however. Marco Polo stated that the Chinese did cover teeth with thin gold leafs only as decorations, 1280 A.D. The earliest practice of the prosthetic arts was among the ancient Phoenicians circa 500 B.C. Hammarabi, ruler of all lower Meso-potamia (1760 B.C.), established a state controlled economy in which fees charged by physicians were set. His low code contained two paragraphs dealing with teeth "If a person knocks out the teeth of an equal, his teeth shall be knocked out." "If he knocks out the tooth of a freed slave, he shall pay one third of a mine." Teeth were knocked out as a form of punishment among these early people.
II. The Greeks, Etruscans and Romans
A. The Greeks
The contribution of the Greeks was mostly on the medical side. The ancient Greek physician,
Aesculapius - 1250 B.C. - gained great frame for medical knowledge and skill. In time he was deified. Apollo was listed as his father. Aesculapius originated the art of bandaging and use of purgatives. He also advocated cleaning of teeth and extractions.
Hippocrates (500 B.C.) was supposed to be a descendant of Aesculapius. Hippocrates became famous both as practioner and writer on medical subjects. He did not believe in magic. He stressed nature's role in healing. Hippocrates raised the art of medicine to a high level. Also in one of his texts (Peri-Arthron) he devoted 32 paragraphs to the dentition. He appreciated the importance of teeth. He accurately described the the technique for reducing a fracture of the jaw and also for replacing a dislocated mandible. He was familiar with extraction forceps for this is mentioned in one of his writings. Aristotle - 384 B.C. - who follows Hippocrates, accurately described extraction forceps and in his book De Partibus Animal Culum devoted a complete chapter to the teeth. He also stated figs and soft sweets produce decay. He called it a putrefactive process instead of fermentative.
B. The Etruscans
Etruscans (100 - 400 B.C.) in the hills of Central Italy made the greatest contribution in restorative dentistry. In Italian museums there are numerous specimens of crowns and bridges which were the equal of many made in Europe and America up until 1870 when the dental engine was invented. A very unusual specimen is a bridge constructed about 2500 years ago. This consists of several gold bands fastened to natural teeth and supporting three artificial teeth, two of which are made from a calf's tooth grooved in the center to appear like two central incisors. Etruscan art, seen at its best in Florence, reflects some oriental influence but essentially it is their own. Conquered in 309 B.C., they were absorbed by the Roman Empire.
C. The Romans
Famous Roman physicians are named below:
1. Celsus (25 B.C. - 50 A.D.) like Hippocrates did not believe in magic. He believed that General Physical deterioration caused dental diseases. For toothaches he prescribed:
a. Hot water fomentations
b. Narcotics
c. Mustard seed
d. Counter irritants
e. Use of the cautery
f. Alum for soft tissue disease
g. Extraction of badly broken down teeth. He recommended filling the cavity with lead prior to extraction as a means of lessening the chance of fracturing the crown.
h. Gave the technique for reducing fractures
I. Gave first technique for tooth straightening or positioning.
2.Archigenus (100 A.D.)
a.Recognized pulpitis
b.Invented the dental drill to open into pulp chamber
3. Galen (200 A.D.) considered the greatest physician since Hippocrates, was the first to recognize that a toothache could be:
a. Pulpitis (inflammation of the pulp)
b. Pericementitis (inflammation of radicular portion of the tooth)
He classified teeth into centrals, cuspids and molars. The Romans were not especially gifted in their dental art. They borrowed their medicine from the Greeks and restorative dentistry from the Etruscans.
IV. The Hebrews
As for the Hebrews, first evidence of dentistry among the Jews, relief of toothache and
artificial restorations may be found in a collection of books known as the Talmud (352 A.D. -
407). In this collection, mention is made that women were more particular about facial
appearance than were men. It stated that teeth were made of gold, silver and wood. The worm
was blamed for decay. Also stated that gum disease started in the mouth but ended in the gut. One
treatment for abscess was as follows:
Rx: Take earth near the outhouse, mix with honey then eat it.
As for extractions - all cultures expressed anxiety about removing a cuspid for fear of eye injury.
This superstition continues today. The Hebrews are known for ethics, morals and religion.Despite numerous Hebrew writings that have survived, there is little written about dentistry.
V. The Middle Ages
After the fall of Rome (410 A.D.) the clever and rational approaches of Hippocrates and Celsus had disappeared; magic and superstitious nostrums became accepted cures. Then came Albucasis, a Spanish moor of Cordova (1013 A.D.). He is considered the great Exponent of Dental Surgery in the middle ages. In his book we find what is perhaps the first illustration of dental instruments. They are as follows:
1. 14 scalers
2. Elevators for surgery
3. Cautery
4. Forceps for surgery
5. Dental saws and files for removal of caries Besides being a famous surgeon and competent writer, he was also a greater teacher. He insisted on arriving at an accurate diagnosis. He believed in the referred pain theory. He accurately described technique for extractions, with special emphasis on careful manipulation of soft tissue. He also described treatment for partially luxated teeth.
VI. The Barber-Surgeons
At the onset of the Middle Ages, whatever knowledge had remained found its way into the
monasteries. The monks became physicians and dentists. Barbers had acted as assistants to
the monks. When the pope in 1163 ruled that any operation involving the shedding of blood
was incompatible with the priestly office, the barber took over the practice of Surgery. The
barber surgeons were not the only ones doing extractions, another group made up of
Vagabonds were known as tooth drawers. They plied their trade in public squares. For awhile
then, dentistry was carried on by barber-surgeons both in France and England. However, in
France in 1700 anyone desiring to practice oral surgery and restorative dentistry had to take a
regular prescribed examination.
VII. Founding of Universities and Introduction of Dental Texts
Around 1300 universities like those at Paris, Oxford and Bologna were founded and important books made their appearance. One such text, Chirurgia Magna, was written by the famous French surgeon Guy de Chauliac in 1386. In this test he devoted some space to pathology and therapeutics of the teeth. Chauliac was first to coin the term dentator and dentists. The English term dentist came from his original terms. Following Chauliac cam Giovanni de Arcoli in 1400. His opinions and instruments were somewhat modern. His pelican for extraction of teeth was used for years and his root forceps could be used today. He advised good oral cleaning habits and to avoid hot and cold substances and sweet stuffs. He was first to mention filling teeth with gold.
I. Famous Scientists and Their Research
Most of the great surgeons had no knowledge of Anatomy but their teachings were not refuted until Vesalius, 1500 of Belgium, rebelled and became an anatomist at the University of Padua, Italy. He freed the mind of the medical profession and laid the foundation for true scientific research which is the basis of our present day medical practice. He accurately described the teeth and pulp chambers. Fallopius was another anatomist, a pupil of Vesalius. He is credited with the descriptions of the dental follicle, tri-geminal nerve, auditory nerve, LX nerve, the glosso pharyngeal, and hard and soft palate. He stated that teeth were not true bone.
II. Other Famous Scientists
A. Eustachius (1500) - complete anatomical description of teeth and their development, the
periodontal membrane and alveoli. He was credited with the first complete dental book, ninety five pages of anatomy, embryology, physiology, blood and nerve supply of the teeth. In this text, he completely describes the anatomy of the teeth, their development, the alveolus and the periodontal membrane.
B. Leonardo da Vinci (end of 15th Century) - he described the anatomy of the jaws, teeth and maxillary sinus. These drawings are the first to accurately describe the maxillary sinus. However, credit has been given to Dr. Nathaniel Highmore of England (1650).
C. Ambrose Pare (16th Century) - he was born in Paris. He was a Barber -Surgeon at 16 years of age and became a member of the College of Surgeons at age 37. He was the first to describe Palatal Obturators, and transplant techniques, etc. His instruments though crude could be used today. He was not interested in restorative dentistry. He believed toothache was due to worms attacking the teeth.
D. Leeuwenhoek (17th Century) - invented the microscope. He described the dental tubuli and was the first to see organisms of the mouth
E. Malpighi (17th Century) - great Italian anatomist.He was founder of histology and made great
use of the microscope for tissue studies. F. M. Bourdet (mid 18th Century) - described use of gold for baseplates
G. Purman of Breslau (middle 17th Century) - known for wax impressions.
H. Charles Goodyear (1840) - discovered vulcanite rubber. It was used for denture bases. This
discovery led to false teeth for the millions. Dentures were called vulcanite dentures.
I. Philip Pfaff (18th Century) - German. He introduced plaster for pouring up models.
J. E.J. Dunning (1844) - plaster of Paris impressions, first shown in America.
K. John Greenwood (1789) - dentures for George Washington were made by him.
L. Pierre Fauchard (18th Century - 1728) - Father of Scientific Dentistry. Wrote a great text "Surgeon Dentist". He also wrote a complete work on Odontology in two volumes, 843 pages. He recognized the intimate relationship between oral conditions and general health. He advocated the use of lead (plombagel) to fill cavities. He removed all decay and if the pulp was exposed, he used the cautery. He prescribed oil of cloves and cinnamon for pulpitis. He described partial dentures and full dentures in his text. He constructed dentures with springs and used human teeth. Gold dowels were used in root canals filled with lead. He was also known as Father of Orthodontics.He was married 3 times. Only three children grew to maturity, one Jean Baptiste became a famous comedian. Fauchard died in 1768 at the age of 83.
III. Authors Who Followed Fauchard
A. Robert Bunon (1743) - printed the first dental therapeutics text, dentistry's first pharmacopeia.
B. John Hunter - "Natural History of the Human Teeth" in 1771.
C. Thomas Berdmore - "Disorders and Deformities of Teeth and Gums" in 1768.
D. Joseph Fox - Pupil of Hunter; wrote text, same title "Natural History of the Human Teeth".
He amplified the work of his teacher and influenced dentistry in England and U.S.
These men on the continent and in England were not physicians or surgeons writing on the
teeth but dentists recording their observations. Their objective: to build this emerging branch
of the healing art into a scientific profession.
IV. Women in Dentistry
The first woman dentist in England was a widow of Dr. Povey - 1719. When he died she took over his practice. The first woman dentist in the United States was Emeline Rupert Jones of Connecticut. She too, took over her husband's practice after he died. In 1854, soon after they were married, she offered to assist him. He refused, stating that dentistry was no occupation for frail and clumsy fingers. Secretly she filled several hundred extracted teeth and demonstrated her skill to her husband. He then let her operate on a few of his patients. After his death, she took over and practiced for a least 50 years. She was accepted in both the Connecticut State Dental Society in 1893 and National Dental Association in 1914. The honor of being the first woman graduate dentist goes to Dr. Lucy Hobbs, 1865. She graduated from the Ohio Dental College. Creighton University Boyne School of Dental Science:
1. Dr. Ellen Kelley - first woman graduate - 1908.
2. Dr. Marilyn Bradshaw - 1949 Last female graduate until:
3. Dr. Cheri Lewis - 1976 - first woman since Dr. Bradshaw.
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