These seems to be little doubt that dentistry in some form has been practiced from the most ancient times, there seems to be but little doubt, since considerable fragmentary evidence still exists as to the general methods used by the ancients. If we stop to enquire who first extracted teeth, made plates or filled carious cavities we shall find that all such information is shrouded in the mists of antiquity along with the history of the pyramids and other relics of early civilization.
Oral disease has been a problem for humans since the beginning of time. Skulls of the Cro-Magnon people, who inhabited the earth 25,000 years ago, show evidence of tooth decay. The earliest recorded reference to oral disease is from a Sumerian text (circa 5,000 BC) that describes “tooth worms” as a cause of dental decay.
Dentistry, as a part of the medical art, was first practiced by the priests as a sort of religious rite, but later material remedies were added to aid in effecting cures and help to maintain the prestige of the priesthood. Later the laity became interested, and surgery, including dentistry, was for a long period practiced by barbers and travelling charlatans, who resorted to music and various other forms of entertainment to attract the people. Finally, a few of the more far-seeing medical and dental practitioners became convinced of the necessity for better educated men to practice this important speciality, and thus dentistry gradually rose from about the beginning of the sixteenth century from a desultory trade or calling to the dignity of a learned profession.
However, not until the latter half of the nineteenth century and the first part of the twentieth century did it really make rapid progress. It is a notable fact that many worthy dentists of modern times began their career in the laboratory or office of older practitioners. Later, however, they added to this training such scientific knowledge as was obtainable at the time and reached an honorable position among professional men. Not until 1840 was a dental college organized to teach systematically the theory and practice of dental surgery. This, the Baltimore College of Dental Surgery, was chartered February 1, 1840, opened in that year, and is still in existence.
Perhaps it is within the last thirty-two years that the greatest progress has been made by this young profession, during which time Dr Black (Fig. 1.1) introduced scientific cavity preparation and a balanced alloy, Drs. Callahan, Rhein, Best et al gave us scientific root-canal work, and Dr Taggart perfected and introduced the gold inlay, while silicate fillings have come to occupy an important place in operative work, and the Roentgen ray has become an indispensable aid in diagnosing pathological conditions. In 1910 Dr. William Hunter, of London, contributed his celebrated paper on the “Relation between Oral Infection and Systemic Disease,” and woke the dental profession to its responsibilities. Oral prophylaxis has progressed to a point where unclean mouths are no longer tolerated, and the prosthesis has come to our aid with removable bridge-work and more scientific methods of denture-making.
In the words of a distinguished writer, “To know the history of a profession is to know the profession itself.”
It has also been said, “There is nothing new under the sun;” but be that as it may, it is a fact that much that is considered new in medicine, dentistry and surgery was known to Hippocrates, Fauchard, Galen and Pare. Sacerdotal Medicine, which was practiced in remote times by the priesthood, was mostly derived from the false notion prevalent among primitive peoples that the afflicted person had been stricken by the wrath of some divinity. The priests were always ready to treat such cases, as they were well paid, and if the person recovered, their prestige was considerably increased, while if the patient did not improve it was because the supposed offender was not worthy of receiving the desired pardon.
The first physician of record was I-Em-Hetep (“He who cometh in peace”), who lived in the region of King Tosher of the Third Dynasty of Egypt, about 4000 BC. He was evidently a man of great prominence, since the Egyptians constructed a pyramid at Sakkra in his honor, and as many statuary likenesses of him have been found, it is evident that after his death he was worshipped as the Egyptian God of Medicine. That the early Egyptian surgeons had to use great skill in the treatment of disease is proven by the oldest book in existence, called The Instruction of Path- Hetep.
Ancient Egypt was the seat of culture and learning; many students were drawn there from other lands in search of knowledge, and we are told that during the time of Herod- Otus, about 500 BC, dentistry was practiced as a specialty, so that “Egypt is quite full of doctors: those for the eyes, those for the head, and some for the teeth, others for the belly or for occult maladies.”
The Saracens invaded Egypt in the seventh century, and in 642 A.D., shamefully destroyed the great library at Alexandria. It is probable that much valuable literature pertaining to early medicine and dentistry was thus lost, among others the writings of Herophilus and Erasistratus, who, about 300 B.C., were pioneers in dissection not only of cadavers but of living men condemned to death by the kings of Egypt.
Dental art among the ancient Egyptians is described at some length in the papyrus of Ebers a name derived from the material on which it is written (papyrus, a form of ancient parchment, or paper), and the discoverer, Prof George Ebers who found it at Thebes in 1872. This work, which dates from 3500 to 1500 BC, gives many remedies for toothache and the so-called “Benut blisters in the teeth.” These remedies consisted of dough, honey, oil, fennel seeds, incense, onions and similar ingredients used in various combinations, to be made into a plaster and applied to the aching tooth. One prescription consists of the following:
It is evident that dentistry in some of its cruder forms must have come into being as soon as man began to experience trouble with his teeth. The teeth are likewise largely relied upon to furnish diagnostic evidence in determining whether prehistoric skulls found in excavating are of human or animal origin. Prehistoric teeth do not, as a rule, show evidence of caries, and if it be present it is said to be an evidence of considerable age, though it is difficult to understand the reason for this assumption, since caries is usually most prevalent among children. Signs of abrasion are quite common, owing to the food habits and long life of the subject.
The oldest written account of a dental operation, other than extraction, is found in a statement by Archigenes, of Rome, who advocated the repining of a tooth which ached without there being evidence of caries, his idea being that the pain was caused by morbid material in the interior of the tooth, which by this means could be evacuated.
Among the ancient Hebrews neither the Bible nor the Talmud makes any mention of dental operations, though the teeth and their beauties are often extolled. “An eye for an eye and a tooth for a tooth” was a part of the law of the land, as, also, “If a man smite out one of his servant's teeth he shall let him go free.”
The Chinese boast a very ancient civilization, and it is not unlikely that dentistry in some of its cruder forms was known to them at a very early period in the world's history. The Chinese “Father of Medicine,” was Hwang-ti, who lived about 2700 BC.
The celebrated medical works of China refer to toothache, which is called “Ya-tong,” and describe nine varieties of this malady, and in addition there to seven distinct diseases of the gums. Puncturing the gums as well as distant parts of the body for the relief of toothache and abscesses was practiced, this being, perhaps, one of the oldest forms of dental or oral surgery. The same method of treatment, known as acupuncture, was applied to many other diseases as well and the Chinese doctors chose their points of election in a very scientific and learned manner, having altogether three hundred and eighty-eight sites for puncturing, twenty-six of which were for the relief of toothache. For this purpose they used gold, silver or steel needles and cauterized the site afterward with a cone of moxa, a sort of slow-burning vegetable wool applied through a hole in a coin. The moxa is compact and burns slowly, drawing up the epidermis into a blister without violence or excessive heat.
According to Dabry, the Chinese believed there were worms in the teeth, and among the remedies used therefore arsenic is said to have been made into pills, and one placed near the aching tooth or into the ear on the opposite side from the aching organ, whereupon the pain would positively cease. Another favorite prescription used by the Chinese read as follows: “Roast a bit of garlic and crush it between the teeth; mix with chopped horseradish seeds or saltpeter; make into a paste with human milk; form pills and introduce one into the nostril on the opposite side to where the pain is felt.”
According to the Greeks, Aesculapius, the God of Medicine, is supposed to have been the son of Apollo. Cicero mentions three deities of this name, the third of which was said to be the son of Arsippus, who was the first to teach tooth-drawing and blood-letting. The instrument used for tooth-drawing is supposed to have been the “odontagogon” of lead mentioned by Celius Aurelianus and exhibited in the temple of Apollo at Delphi, sculapius, who was worshipped by the Greeks as one of their many Gods, was said to have healed the sick and to have raised the dead as well. As time elapsed there were reputed to be not only one, or, as related by Cicero, three sculapii, but tradition gave rise to many Gods of this name to whom numerous temples known as “Asklepeia” were erected, among which was the famous temple of Cos, where Hippocrates gained most of his knowledge of medicine. The priests or followers of Esculapius were known as “Asklepiadi.”
To Hippocrates is accorded the honorable title of Father of Medicine, and even in those early days the “oath of Hippocrates” was a solemn obligation to be taken by all who undertook the study or practice of medicine. Hippocrates was born on the island of Cos about 460 BC and first studied medicine under his father, but later devoted his attention to the medical books in the temple of Cos. Hippocrates wrote much in regard to dental maladies and their remedial measures, among which were considered extraction and cauterization. He was the inventor of certain crude dental forceps and other dental instruments. He practiced the extraction of loose teeth and cauterization of those that ached but were not loose. He also recognized that the first teeth are formed before birth by the nourishment of the fetus in the womb.
In speaking of fracture of the lower jaw, Hippocrates recommended binding the teeth next to the lesion together. He distinguished between the complete and the incomplete fractures and treated separately of fractures of the symphysis. If the teeth were loosened he advised binding several together on either side of the fracture until consolidation of the bone had taken place, using for this purpose either gold wire or linen thread.
At this time lay medicine had begun to supplant sacerdotal medicine, and healing by the priests as a religious rite was slowly giving place to more scientific and rational methods.
Galen, who lived about six hundred years after Hippocrates, was an able writer and commented on Hippocrates's work. Galen was a noted anatomist, and although he classified the teeth as bones, he said they were unlike other bones. He was the first to recognize nerves (pulps) in the teeth, and also erroneously believed that the teeth have something to do with the sense of taste. In his anatomical researches he recognized seven pairs of cranial nerves and classified the trigeminal as the third pair. He was also of the opinion that the teeth grow and thus repair the wear on them, basing his opinion on the fact, no doubt, that a tooth having no opponent became longer. In painful Dentition Galen advised rubbing the gums with the milk of a bitch or the brains of hare.” He was, in his day, one of the most famous medical men of Rome and the author of many works on medicine.
By this time the doctors' shops were well supplied with medicines, bandages and a great variety of instruments, showing that the medical art had made considerable advancement. Dentistry had not yet become a separate profession, but was practiced by the doctors along with medicine and surgery.
The Etruscans, or early Italians inhabiting that part of Italy known as Etruria, between the Tiber and Arno, about 1000 to 200 BC, used bridges made of gold rings holding ox teeth, for the purpose of replacing lost dental organs.
Just who these Etruscans or Toshi were, from whence they came or what became of them is not definitely known, and their language is equally extinct, no code having been discovered by which their writings can be deciphered.
The Romans have also left us some specimens of bridge-work and other prosthetic appliances, which for the most part are found in tombs or in the urns containing the ashes of those cremated. It was said to be a custom to remove such pieces from the mouth before cremation and afterward place them in the urn with the ashes. According to the Law of the Twelve Tables, written in Rome about 450 BC, it was not unlawful to bury or burn corpses with the gold that was used to bind the teeth together.
At this early period in the world's history, Rome must have had dentists, though she had as yet no doctors. According to Dr. Guerini and others a gold crown is now in the museum of Pope Julius, in Rome, which was discovered in excavating at Satricum, near that city.
This would tend to prove that the Etruscans not only did bridge-work, but were versed in the art of making crowns also. The appliance found at Satricum was made of two plates of gold stamped to represent the labial and lingual surfaces of the lower central incisor, and were then soldered together to form the crown of the tooth. It is soldered to a narrow strip of gold which is contoured in such manner as to encircle the neighboring teeth, which act as a support for the appliance.
Saint Apollonia in the year 300 AD, was canonized by the Church of Rome, and since then has been the patron saint of dentistry. The ninth day of February has been observed by the Church of Rome in her commemoration. A photograph of the painting of this saint was, in 1900, presented to the Academy of Stomatology of Philadelphia, on behalf of Dr Mary H Stillwell, of Pittsburgh, by Dr C N Pierce, together with this historical sketch:
“Longing to obtain the grace of baptism, she made her way to Saint Leonine, a disciple of St. Anthony of Egypt, and, as he baptized her, he bade her go to Alexandria and preach the faith. So she went forth, and though she was only a woman, young and frail, yet so eloquent were her words, so fervent her zeal, that she made many converts. About this time a tumult had been stirred up in the city against the Christians and the mass of the people were enraged at her teaching and came with bitter complaints to her father, who gave her up to be judged by the governor.
They brought her before the idol temple and bade her worship the graven image. It is reported that she made a sign of the cross, and there came forth from the statue an evil spirit shrieking, ‘Apollonia has driven me hence!’ This was more than could be borne; the people thirsted for vengeance, so they tried by torture to overcome her constancy. She was bound and one by one her teeth were drawn out, but still she did not flinch or fear, and on her refusal to accede to the demands of her persecutors and renounce her faith, she was brutally clubbed about the head and face, and subsequently suffered death by fire.
“For a period of nearly fifteen hundred years her intercession has been sought for relief from all pain incident to dental diseases, and her relics have been and are regarded as possessing great efficacy in the cure of the same.”
Scribonius Largus, writing during the first century of the Christian era, was perhaps the first author to give rise to the belief that worms were the cause of pain and decay in the teeth. As we shall find later this superstition existed throughout the Middle Ages, and it was not until the early part of the eighteenth century that Fauchard first cast doubt on their existence. As a remedy for these worms, Scribonius Largus suggested that if the seeds of hyoscyamus (henbane) be burned on charcoal and the fumes inhaled they would cause the worms to fall from the teeth. It is a noteworthy fact that the seed buds of henbane, when burned, form an ash that much resembles worms, and as the drug has a narcotic effect that probably soothed and relieved the pain, it is no wonder that the ignorant populace of that time readily gave ear to such seemingly plausible humbug.
Celius Aurelianus gave an account of the odontagogon of lead found in the temple of Apollo at Delphi, by which it was assumed that teeth should not be extracted unless loose enough to be removed with a leaden instrument, though some have contended that this was only a model placed there, probably by Esculapius, to be reproduced with an iron instrument by those wishing to copy it, lead being less affected by corrosion, and therefore more lasting. He also wrote on fractures and dislocation of the jaw, and described the methods to be used in their reduction.
Celsus gave a prescription for producing sleep in persons afflicted with toothache. It contained acorns, castoreum, cinnamon, poppy, mandrake and pepper. When there was a large carious hollow in the tooth to be extracted, Celsus recommended that it should first be filled either with lint or lead, in order to prevent the tooth from breaking under the pressure of the instrument. It is not definitely known that he used fillings as a means of preserving the teeth or relieving toothache.
Marshall H Saville, according to an article in the Bulletin of the Pan- American Union, reported the finding of teeth inlaid with gold, turquoise, rock crystal, red cement and other foreign substances in skulls of the aborigines who lived in various parts of North and South America. These teeth had been bored out with some tool and the filling skillfully placed in the cavity.
This custom was quite common in Mexico, Central America and the province of Esmeraldas, Ecuador. In this latter province he also secured an upper jaw from one of the natives which contained not only teeth inlaid with gold, but also a right lateral incisor which had been transplanted to replace a lost central incisor, showing that dentistry had reached a high stage of development as a means of ornamentation at least. He also discovered in an excavation at Copan a lower jaw with a left lateral incisor that had been carved from some dark stone and implanted to take the place of one that had been lost. In one case several teeth were found bound together with gold bands.
There are in the Peabody Museum of Harvard University teeth in which had been placed inlays of jade, iron pyrites and gold, some of them arranged symmetrically in triangles, also banded inlays, all of which apparently were used for ornamentation (Dental Cosmos, 1916, Iviii, 281).
Among Primitive People, even at the present time, some very peculiar customs prevail which have, no doubt, been a heritage from ancient times. Most of these people have beautiful strong teeth which they ornament and embellish in various ways for cosmetic or religious purposes, much to the detriment of these valuable organs. The substitution of gold teeth for missing ones has been practiced in Java from remote times, and among the natives in many parts of Asia and the Pacific Islands there is prevalent the custom of dyeing the teeth black. In Sumatra the women file their teeth down to the gums or into points, or partially remove the enamel, so as to be able to apply the dye.
In Japan the married women dye their teeth black in order to distinguish them from the single women, using a dye that is made of urine, iron and a substance called “saki.” It is claimed that this dye is very durable and does not wear off for many years. Dr L Ottofy, in an article on “Dentistry in Japan,” says, “The practice of blackening teeth, as a symbol of the marital state, on the part of women is becoming obsolete, yet a number still continue the practice.” Formerly large quantities of black artificial porcelain teeth were exported from America to Japan, where artificial plates for men and single women were made with white teeth and those for married women with black teeth. There are on exhibition in the Army Medical Museum at Washington, D C, several sets of teeth of Japanese origin, carved from wood, that bear out the foregoing statement.
In Eastern India some of the people plane their teeth down to an even level and dye them red by masticating areca nuts. It is also said to be a custom in New South Wales for a young man to have his front teeth knocked out with a stone on reaching the age of virility, this being supposed to enhance his personal appearance. The natives of the Hawaiian Islands knock out their front teeth as a sacrifice to their god Eatoa.
DENTISTRY DURING THE MIDDLE AGES
Abulcasis (1050–1122), an Arabian author, who lived at Cordova, was one of the most able writers and surgeons of the Middle Ages. He wrote a treatise on medicine, entitled De Chirurgia, consisting of three volumes, the first of which was devoted entirely to the subject of cauterization, a form of treatment much practiced at that time. His method of performing this operation was to insert a red-hot cautery through a tube to protect the surrounding parts.
He was especially interested at that early date in prophylaxis and devoted special attention to the tartar on the teeth, illustrating and describing fourteen forms of scrapers or sealers for its removal. He was a very religious and devout man, cautious in the treatment of his patients and firmly opposed to the needless extraction of teeth. When it became necessary to extract, he used one form of forceps to loosen the tooth and another for its removal. Elevators were used if the forceps failed or the tooth was broken. According to this author, replantation was extensively practiced and artificial substitutes were made of ox bone to replace teeth that had been lost. He advocated replanting teeth that had been removed by mistake or accident, holding them in place with ligatures of gold or silver wire until they had again become firm.
Garriopontus, an Arabian writer, in 1045 AD, said: “On the island of Delphi a painful molar tooth, which was extracted by an inexperienced physician, occasioned the death of a philosopher, for the marrow of the tooth, which originates from the brain, ran down into the lungs and killed that philosopher.” For all we know this is the first record of a death resulting from the extraction of a tooth.
John Gaddesden (1400–1450), an English doctor at Oxford, stated that dried cows’ dung or the fat of a green frog would positively cause teeth to fall out when applied to them, and said, “If an ox, peradventure, chewed a little frog with the grass, its teeth would fall out on the spot”. He is also authority for the statement that “The brains of a hare rubbed on the gums not only facilitate dentition but will make teeth grow again where they have been lost”. All of these remedies were recommended and employed by many later writers, who claimed to have performed marvellous cures by such absurd treatment.
Such statements as the foregoing seem ridiculous to us, as anyone could have easily satisfied himself of their falsity. The application of the cautery or arsenical compounds must have met with some success, as the latter is known to produce extensive necrosis.
Guy de Chauliac (1300–1368) was the most noted surgeon of the Middle Ages. He and others of that period wrote extensively of dental ailments and operations for their relief by both physicians and barbers. Guy followed in the foot-steps of the Arabians, who had made considerable progress before him, and referred explicitly to dentators and their instruments, thus beginning the recognition of dentistry as a specialty of medicine. He advised that dental operations be performed for greater security under the supervision of doctors, but had no criticism to make of dentators. This learned doctor used camphor, sulphur, myrrh and asafcetida as a filling material for carious cavities, and, like his predecessors, lent belief to the superstitious idea of worms in the teeth. It is uncertain whether the worms referred to by him were particles of decaying food, nerves, larvae of insects or the burning henbane seed, as previously referred to, but the accepted belief was that they were responsible for the pain in odontalgia. Fumigations with seeds of leek, onion and henbane mixed with goats’ tallow were resorted to in order to drive out the worms, after the manner first described by Scribonius Largus.
Guy de Chauliac also refers to medicines which send the patient to sleep, among which are decoctions of opium, hyoscyamus and lettuce. A new sponge was soaked in these medicines and then dried, and when sleep was to be produced it was wet and applied to the patient's nostrils. This form of anesthesia must have been very effective, for it is related that it was used for surgical operations, amputations actually being performed in this manner. To awaken the patient from this deep slumber, another sponge was wet with vinegar and applied, or the juice of the rue fennel was placed in the patient's nostrils. This fact is of great importance, as it marks the first step in general anesthesia and antedates Horace Wells's discovery by five hundred years, though it is doubtful if this old method was ever used extensively. This author is the first to cast doubt on the efficacy of the fat of green frogs for the purpose of causing the teeth to fall out. Superstition being uppermost in the lives of the people in those days, it took considerable courage to contradict the old authorities on such a well-established belief.
In 1308, the barbers and surgeons of London were incorporated into one guild and the name of barber-surgeon was used to denote practitioners in all branches of surgery. This arrangement lasted until 1745 before it was finally dissolved, after which the barbers were only allowed to extract teeth. This should give one a fair conception of the low repute into which surgery had fallen during that period.
The title of Doctor was first bestowed by the universities during the twelfth century and was used to denote a learned man in any profession. The title of Doctor of Medicine was first bestowed on William Gordenia by the College at Asti, in Italy, in 1329. Whether this title was earned or honorary is not known. The title of Surgeon Dentist was first given to Gillies and several other men in France in 1622, though the title was not fully established for many years afterward.
Giovanni Plateario (1450–1525), a professor at Pisa, was the first dentist to use the sitting posture for performing operations on the teeth, others before him having used the horizontal position. The prevailing custom was to let the patient lie prone on ground and to hold his head between operator's knees with a vise-like grip.
DENTISTRY IN THE SIXTEENTH AND SEVENTEENTH CENTURIES
Dentistry, with the other arts and sciences, made its most notable advancement as a learned profession during the sixteenth century, for it was about this time that the world as we know it, made its first rapid strides forward. The invention of the printing press in 1436, the taking of Constantinople by the Turks in 1453 and the discovery of America in 1492 all led to much migration of peoples and the dissemination of knowledge, which constituted the beginning of a new era in which dentistry had its part.
In Germany, dentistry had been practiced for many centuries, as shown by artificial teeth in the urns of those who had been cremated, and at this time the Germans had made considerable progress. Here, as elsewhere, medicine was first practiced as a religious rite combined with witchcraft and empirical remedies. As early as 1460 Heinrich von Pfolsprundt wrote a book on medicine and surgery in which he described wounds and fractures and the mode of their treatment. Pains of the teeth and gums were treated by him by the use of beverages, showing his lack of skill in that direction.
Walter Herman Ryff (died 1570) wrote the first book which treated of dentistry independently of medicine in 1548. He is conspicuous for the fact that his book was written in German, a living tongue, instead of the customary Latin, so that he may be looked upon as the first who attempted to diffuse useful medical knowledge among the common people. One of the most interesting things about his writings is that he is the first author to recognize the relation between diseases of the eyes and teeth, declaring that because of their intimate relation, neither can be healthy without the other being so too. While this reasoning is clearly wrong in the light of our present knowledge, it nevertheless marks a step in the right direction. According to Ryff the principal causes of dental diseases are heat, cold, traumatism and the gathering of humors, and he says “The most atrocious pain is when an apostema ripens in the root”.
Andreas Vesalius (1514–1564), who at the early age of twenty-five years became famous as an anatomist, was the first who dared to correct the errors in Galen's work, and gave a much more accurate description of the anatomy of the teeth than that given by Galen. His researches in regard to the teeth are incomplete, since he states that the permanent teeth grow from the roots of the temporary teeth. This erroneous conclusion was due to the fact, no doubt, that the deciduous teeth have no roots when shed.
Gabrielus Fallopius (1523–1562), a pupil of Vesalius, carried out more fully his investigations of the development of the teeth and corrected Vesalius’ error by showing that the permanent teeth do not grow from the roots of the temporary teeth, but that they are generated twice over, the first time in the uterus. He gave the first account of the dental follicle, and likened the teeth in their formation to the feathers of a bird (De Dentibus Libellus, Venice, 1563).
Bartholomeus Eustachius (died in 1574) was another great anatomist of the sixteenth century. After long and patient research he brought much light to bear on the macroscopic (gross) anatomy of the teeth, the number and variations of the roots, the alveoli, etc,. and gave a very clear description of the ligaments of the teeth and the means by which they are held in the alveolus. He also gave an account of the central cavity of the tooth, and stated that it contains blood- vessels and nerves, and not marrow, as was claimed by some anatomists. He also investigated the embryology of the teeth and confirmed the claim of Hippocrates that the first teeth are formed in the uterus. Eustachius is the first to deny that the teeth grow during a whole lifetime, as was first claimed by Aristotle. Speaking of dental diseases, this author remarked that dental surgery was in his days a most abject calling, notwithstanding its having had as its initiator no less a person than Aesculapius, the God of Medicine.
Ambro'ise Pare, born in France (1517–1592), is justly entitled to the credit of being known as the “Father of Modern Surgery.” As an anatomist he is less accurate than either Vesalius or Eustachius, but as a surgeon he gained great renown, having been successively a barber, surgeon- barber, and finally, in 1562, chief surgeon to the court. In his works this surgeon treated of dental maladies very thoroughly, which fact may be attributed to his having first been a barber and consequently a tooth-puller. He described fractures of the jaw and the methods of their reduction with considerable thoroughness, and related some interesting cases which he had treated. In one instance a friend of his had his jaw broken and three teeth knocked out by a blow from a dagger, whereupon Pare so skillfully treated the injury that all the teeth were successfully replaced and made of use.
The Golden Tooth, in 1593 much was said in Germany of a Silesian child, aged seven years, in whose mouth a golden tooth had erupted. Great credence was given to this story and the learned doctors and philosophers speculated upon the phenomenon without the slightest doubt as to its genuineness. Many books and papers were written to explain the strange occurrence, and one writer, Jacob Horst, claimed that on the date of the child's birth, that is, December 22, 1585, the Sun was in conjunction with Saturn in the sign of Aries, and in consequence the nutritive force had developed so much that instead of osseous substance, golden matter had been secreted. It appears that the golden tooth was nothing more than a crown or lamina of gold let down deep into the gum, and made by a dentist or jeweler for the purpose of deception, since a fee was charged for seeing the child. Balthasar Camindus, a doctor of Frankfort, had noted that the boy had not lent himself to being examined by the learned, who were likely to expose the fraud, and further relates that a certain nobleman, being denied the privilege of seeing the tooth, struck a dagger into the boy's mouth and wounded him so badly that a surgeon was called and the fraud exposed.
In the early part of the seventeenth century the dental art was still in a pitiful state of development, as shown by the literature on the subject, only about twenty publications having appeared in Europe during the preceding century.
Johann Stephan Strobelberger, physician to the Imperial Baths at Carlsbad, published a book in 1630 in which he referred to “Gout in the teeth”, which included all of the diseased humors of the teeth that were supposed to fall by drops into the articular cavities and surrounding parts. In his writings we find that many crude and worthless remedies were still used for toothache, and the instruments for extraction consisted for the most part of the pelican, named from its likeness to the beak of that bird, and also some very rude forceps. He was one of the first to cast doubt on the value of fumigations with hyoscyamus seeds to cause worms to fall from the teeth, though he did not in the least doubt the existence of the worms themselves, suggesting oil of vitriol or a decoction made of a frog cooked in vinegar to kill them instead. Among the remedies he suggested for odontalgia is the American tobacco plant (Nicotiana tabacum).
Nathaniel Highmore (1613–1684) (published a treatise on anatomy in 1651, in which for the first time the maxillary sinus named for him is accurately described), though its existence had long been known. He pointed out for the first time the anatomical relation between the teeth and antrum, and related a most amusing incident in connection with perforation of this sinus. A lady, having much pain in her teeth finally had the upper canine tooth extracted, after which there was an incessant flow of humors (pus) from the antrum. The patient herself wishing to learn the cause thereof passed a silver probe into the cavity its entire length, which produced the effect of its having reached the eye. Much amazed she stripped a long feather and passed it into it so great a distance that she concluded that it had reached her brain, not knowing that the feather simply curled up in the cavity. He was able to allay her fears by informing her of the cavity in the bone and the opening produced by the extraction of the canine tooth.
William Cowper (1666–1709) was the first to practise opening the antrum by the extraction of the first molar. This was toward the end of the seventeenth century, and he seems to be the first to recognize antral diseases. This was something like 50 years after Highmore had described the antrum.
James Drake, a contemporary of Cowper, operated in the same manner, and it was this author who made known in a book entitled Anthropologia nova, published in 1707, the method of Cowper, for which reason the above-mentioned proceeding is sometimes called the “Cowper-Drake operation.”
Wilhelm Fabry, better known under the Latin name of Fabricius Hildanus (1560–1634), chief doctor to the city of Berne, gave some very interesting clinical reports on the relation between dental affections and tic douloureux, and cited an instance where a lady who had suffered atrociously for four years with pain in the head was completely cured by the extraction of four decayed teeth. He also gave an account of an interesting case of rhinoplasty performed by Dr J Griffon, an eminent surgeon of that day, upon a young girl of Geneva, whose nose had been cut off by the Duke of Savoy's soldiers in a fit of rage. Fabry testifies to the natural appearance of the nose even for twenty years afterward. He stated that Gaspare Tagliacozzi, of the University of Bologna, was the inventor of this operation.
Antoni Van Leeuwenhoek (1632–1723), a Dutchman, was the first to make high-powered microscopes with which, in 1678, he made discovery of the tubular structure of dentine, and in 1683 he discovered microorganisms in tartar scraped from between the teeth. From a perusal of his writings and drawings it appears that these bodies were bacteria rather than animalcules, as he supposed. Both Carpenter and Beal state that his work was done with single lenses, as the compound microscope did not reach a useful stage until about 1820 to 1830. It is astonishing how much was accomplished by such primitive means. This in all probability represents the first step in bacteriology, which was only made possible by the aid of high-powered lenses.
Matthias Gottfried Purmann (1648–1721) has the honor of being the first writer to make mention of wax models in connection with prosthetic work. Whether these models were made from molds or not is a disputed question, but the supposition is that they were carved to the desired shape and then passed on to a craftsman who reproduced them in bone or ivory.
Many other incidents of considerable interest during the seventeenth century have to be omitted in a history of this character, and consideration will now be given to the development of the eighteenth century.
DENTISTRY IN THE EIGHTEENTH CENTURY
In 1700, France took the lead in the dental art and had recognized the importance of dentistry by requiring prospective practitioners to take an examination under the edict of 1699 to show their qualifications before entering the profession. There is abundant evidence that the Germans had also made considerable progress during the two preceding Centuries and they have likewise left us considerable literature upon dental surgery. Dentistry had already begun to flourish as a distinct specialty of medicine, but it remained, as we shall see later, for Pierre Fauchard to effect the final separation.
Lorenz Heister (1683–1758), of Frankfurt-am-Main, published a treatise on dentistry entitled De Dentium Dolore in 1711, in which he advised removing the decayed part of a tooth with a file or toothpick and filling the cavity with white wax, mastic or gold or lead-foil. In this work he gave a very concise description of removable prosthetic pieces made of ivory or hippopotamus tusks and maintained in position simply by their form. Heister also refers to nasal prosthesis, which was then carried out by applying noses of wood or silver, properly painted. There was at this time much contention among dentists as to the advisability of removing caries by the use of the file, as practised by Heister and others, because of the destruction of the enamel of the tooth. We find, however, that this was practised for a long period, and was advocated in a modified form by such eminent dentists as Drs. Chapin A. Harris and Robert Arthur more than a century later.
Upto the eighteenth century the clumsy pelican or rude forceps, used to exert lateral force on the tooth, was still in general use, but this was modified about this time into what was known as the key of Garengeot, named after the man who perfected, though he did not invent, the instrument. According to some writers this instrument had its origin in Germany, not in England. It was a most efficient instrument for extracting teeth and was in general use for more than a century, having been extensively used in America, and is much used in France and other European countries at the present time.
Johann Adolph Goritz, of Regensburg, writing in 1725, opposed too many extractions and also the insertion of prosthetic pieces, because they caused the loss of the teeth to which they were attached. This was due to their being wired to the natural teeth, causing great strain on and consequent loosening of the abutments.
Pierre Fauchard (born in Brittany about 1690 and died in Paris in 1761) was the founder of modern dentistry. He published a work in 1728 entitled Le Chirurgien Dentiste, which marked a new epoch in the history of the dental art. This book was highly commended by the leading medical authorities of the day. It was translated into German in 1733, and a second revised French edition was issued in 1746, and a third in 1786. It consisted of two volumes in duodecimo, with 40 full-page plates, 863 pages in all, and treated of all branches of dentistry as understood and practiced at that time. According to Fauchard dentistry was then an important calling, as he refers to the examination which prospective practitioners were compelled to undergo even as early as 1700, and advises that a dentist be included in the board of examiners. He expressed himself in no uncertain terms as to the need of a school of surgery in which the theory and practice of dental surgery could be properly taught.
Fauchard lamented that so little was written by able dentists who had preceded him, because these men guarded their knowledge with secrecy lest someone might profit at the author's expense.
It is a mistake to think that he created the art of dentistry, but that he placed it on a higher plane by many valuable inventions and by collecting and publishing all of the available knowledge on the subject, there is no doubt. To show how concisely he wrote, it may suffice to quote the following account of work that may be done on teeth:
“They may be cleaned; they may be straightened; they may be made shorter; caries may be removed from them; they may be cauterized; they may be filled with lead; they may be separated; they may be placed in proper position; they may be fastened; they may be removed from the jaw; they may be replaced in the jaw; or they may be taken out to be placed in another person's mouth; and at last teeth are artificially constructed, and may be placed instead of those that have been lost. All of these operations demand a skillful, steady and trained hand and a complete theory.”
In this work he refers to the popular idea of worms in the teeth, which idea had existed for more than one thousand years. He admits the possibility of them, but states that he has never seen them, and that if they do exist they are not the cause of caries, but the eggs of insects may have entered carious cavities and there hatched and produced worms.
Although Andry relates seeing very small worms with a powerful glass, Fauchard states that he employed the same means but could not see them. Thus he sets forever at rest this foolish superstition in regard to worms in the teeth as a cause of dental ailments so long indulged by the people of those times. Perhaps it is only as a matter of courtesy toward the many authors who preceded him that he admits their presence at all.
Fauchard gave a very accurate description of the anatomy of the teeth, their structure, position, origin, growth and anatomical parts as, body, root and neck. He described accurately the pulp cavity and root canals, and after a most thorough macroscopic description, goes into the histology of the teeth, following the writings of La Hire in 1699. Fauchard agrees with the popular idea of his day in regard to caries, and states that it may have its origin within the tooth as well as without.
From a passage in the fifth chapter of Fauchard's work one learns that tooth-brushes were then already in use, but he says that those made of horsehair are too rough and frequently have a destructive action upon the teeth. He advised using small sponges, with which the teeth should be rubbed up and down, inside and outside, every morning. Before using the sponges they were to be dipped in tepid water or preferably aqua vitae, “the better to fortify the gums and render the teeth firm.”
He was strong in his condemnation of elixirs and cures by magical means so much practised in his day, and a reference is made to the large and increasing number of Charlatans of the day, wherein he exclaimed, “There will shortly be more dentists than persons affected with dental diseases.” He laments over the poor quality of work done by them, relating a case where a deciduous tooth was extracted without roots, whereupon the dentist in an effort to extract the roots removed the permanent tooth just erupting.
Fauchard advised seating the patient in an easy arm-chair for the purpose of performing dental operations, and condemned the practice of seating him on the ground or floor and holding his head between the operator's knees, as was commonly done, as unskillful and unsanitary, and in the case of pregnant women, as capable of doing great harm. He practiced opening the tooth for relieving abscesses by evacuating the pus. After three months he stopped these teeth to prevent their getting worse, but no mention of root-canal work is made, though he placed a little cotton-wool in the cavity with oil of cinnamon and allowed it to remain several weeks before filling them.
Fauchard practiced orthodontia, and relates a case in which he used the file and pelican and put a crooked tooth in place, which operation required about ten minutes. The most difficult cases he states required from three to ten days, and sometimes several months, to complete. He used gold and silver plates, which were perforated with holes through which he passed a silk thread for correcting irregularities, and when this was not sufficient he forced them in place with the pelican or forceps.
In 1737, Fauchard made a full upper set of teeth for a lady of high rank, holding the same in place with springs, and relates that the lady ate with it easily and could not get along without it. He also relates having made a full upper and lower set for a gentleman, who had worn them for more than twenty-four years. When a full upper set of teeth was made, Fauchard used flat springs to hold the piece in place, atmospheric suction not being recognized and used until the year 1800. He states, however, that he has been successful in three cases in placing full upper sets without the aid of springs. He also brought palatine prosthesis to a high degree of perfection and described five kinds of obturators, which were, however, somewhat-complicated. The materials most in use in dental prosthesis were human teeth, hippopotamus tusks, ivory of the best quality and ox bone. Crowns were placed on natural roots (if healthy) and held in place with screws or bound to neighboring teeth.
The second edition of Fauchard's work, which appeared in 1746, contains (pp. 275-277) the first account of pyorrhea alveolaris, familiarly called “Riggs's disease,” after the American dentist, Dr John M Riggs, who, in 1876, introduced the method of scraping the tartar from the crowns and roots for its cure.
In the first edition of Fauchard's work (vol. ii, p. 30) mention is made of a machine for preparing and drilling into teeth. This machine is illustrated in Siemens d'Odontologie (Jourdain, 1756, p. 207). This was no doubt the beginning of the dental engine, and antedates the dental engine that the Greenwoods made from an old spinning wheel.
Summing up his writings, we may say that, notwithstanding the falsity of some of his ideas, he was far in advance of his profession and was truly the founder of modern dentistry, and has given inestimable service to suffering humanity.
During the first part of the nineteenth century, almost all plates were fitted for the attachment of springs in case they were needed look natural. Mouton also invented a method of applying partial dentures by fixing them to the natural teeth with springs or clasps. He also practiced transplantation of teeth as well as the correction of dental irregularities, and gained great renown thereby. He used subluxation of the teeth for the purpose of severing the dental nerve as a remedy against toothache.
Philip Pfaff, dentist to Frederick the Great, deserves passing mention, since he was the first German to write a real treatise on dentistry. He is the first author who practised capping an exposed nerve before placing a filling in the cavity, Fauchard usually filling the cavity directly over the exposure. He also described the construction of artificial teeth in which he made use of not only ivory, bone and tusks of the hippopotamus and the sea cow, but also of silver, mother of pearl and even enameled copper. His most important contribution to science was the invention of the plaster model, poured in a beeswax impression.
Bourdet, dentist to the King of France, wrote a book on dentistry in 1757, in which the novel idea was advanced of extracting carious teeth, filling them with gold or lead and then replanting them. If the alveolus was injured he replanted the teeth immediately and performed the operation of filling afterward. He also used prosthetic pieces made entirely of gold and covered them with flesh-colored enamel on the outside, showing that some dentists of olden times were even more artistic than a large proportion of the practitioners of the present day who make no pretence of hiding their glaring gold crowns. He also made use of prosthetic pieces of hippopotamus tusk, to which human teeth were fastened with rivets.
Thomas Berdmore, who was dentist to George III of England and the first dentist to the English Royal Family, is mentioned as having instructed Robert Wooffendale, by many reputed to have been the first dentist in America. Wooffen dale emigrated to America in 1766, and though he was preceded by several men who practised the art, he was probably far more efficient than any who preceded him. In 1768 Berdmore published an excellent work on dentistry which went through many editions three English, two German and the last an American edition, appearing in Baltimore, the cradle of American dentistry, in 1844, 76 years after the first edition, affording splendid proof of its value.
John Hunter (the celebrated English surgeon (born February 13, 1728), studied under his brother William, who conducted a school of anatomy in London. In 1771 he published a book entitled Natural History of the Human Teeth, and in 1776 another work entitled Practical Treatise on the Diseases of the Teeth. He was a great lecturer and writer and kept a superb anatomical collection and extensive library. So great did his fame become that he was made Surgeon-General to the English Army. Hunter was a strenuous partisan of replanting and transplanting teeth, and described these operations much more fully than had been done before. He experimented by transplanting a sound tooth drawn from a living person into a cock's comb by making an incision with a lancet. When, some months later, the cock was killed the head was injected and examined and the tooth was found to be attached and circulation established as is found in the natural gums. If we may judge from early writings, transplanting and replanting were far more common at that time than at present, and also profitable, as may be judged by the charges of Paul Eurialius Jullion, whose fee was five pounds five shillings for transplanting a live tooth and two pounds two shillings for a dead tooth.
Robert Bunon (died 1749), a French dentist born at the beginning of the eighteenth century, was one of the first to deny that the eye tooth has anything to do with the organ of sight, showing that it is supplied by the infraorbital nerve. He was an ardent champion of conservative dentistry and prophylaxis and succeeded in converting many medical men, surgeons and priests to his views. When Fauchard's book, Le Chirugien Dentiste, appeared he was disappointed to find but little therein that interested him, and set about to write a book of his own. Before publishing his work he entered the College of Surgery to undertake two years’ practice with a regularly licensed surgeon, to undergo theoretical and practical examinations and to take oath before the Chief Surgeon of the Realm in accordance with the edict of May, 1699, in order to obtain the diploma of surgeon- dentist. He was highly eulogized by the principal journals of the time, and by this means won much fame and many wealthy clients.
One of the chief merits of his book is that of having ascribed to the deciduous teeth all of the importance that they really have. In cases of stomatitis, Bunon advised the complete removal of tartar before administering other treatment. He used the same measures against mercurial stomatitis in the specific treatment of syphilis.