Pierre Fauchard

Pierre Fauchard (1678–1761) is often called the founder of modern dentistry. A highly respected Paris practitioner, Fauchard authored Le chirurgien dentiste (The Surgeon Dentist) in 1728, the first scientific book devoted exclusively to the subject. Until this point in the history of human medicine, the care of teeth and gums was a generally barbaric practice, driven by lingering medieval superstitions. "Fauchard revolutionized dentistry in part simply by promulgating all he knew," wrote James Wynbrandt in The Excruciating History of Dentistry: Toothsome Tales and Oral Oddities from Babylon to Braces. "Previous practitioners had done their best to conceal whatever wisdom they thought they possessed."

Fauchard came from Brittany, the peninsula of northwest France with historic ties to the British Isles. He was born in 1678, during the reign of Louis XIV, France's Sun King. At the age of 15, Fauchard enlisted in the French navy against the wishes of his parents, and served for three years at sea. It was here that he was informally trained in dentistry, as the assistant to a talented ship's surgeon, Alexander Poteleret. He returned to the Brittany area in 1696, and opened his own practice in the university town of Angers.

Worms and Dead Mice

At the time, dentistry was just emerging as a recognized medical specialty, and France was at the forefront of this development. For centuries, superstition and quack science dominated human knowledge about the care of the teeth and gums. Tooth decay was common due to poor hygiene in an era when dental care was nonexistent, and the subsequent rotting of the tooth structure eventually led to painful toothaches, which Fauchard noted in his book was an affliction "we all have." Since ancient times, most people believed that tiny worms invaded the mouth and caused teeth to rot. Toothache remedies ranged from the bizarre—early Egyptians thought that the half-body of a still-warm dead mouse was an effective treatment for pain—to the useless, and most diseased teeth eventually had to be pulled. In an era before anesthesia, this was a painful experience that, if done improperly, could lead to infection and death.

In the cities of late Renaissance Europe, local barbers extracted diseased teeth for a fee, among the other minor surgical procedures and medical treatments they provided. In the countryside towns, itinerant tooth-pullers occasionally set up shop, and gathered a crowd of potential customers through deceptive practices. But France had been making notable advances in dentistry for many years prior to the time of Fauchard's career. The surgeon Guy de Chauliac, a professor at the University of Montpelier, left an impressive text on surgical procedures behind when he died in 1368, and it discussed several diseases of the mouth. De Chauliac's work was also the first written mention of the term "dentista," as well as "dentator" and "dentateur," all of which referred to those who specialize in surgeries of the mouth. Later, a renowned French barber-surgeon of the sixteenth century, Ambrose Paré, made several advances in the treatment of gums and teeth. Other pioneers elsewhere in Europe, such as the Flemish anatomist Andreas Vesalius (1514–1564) and his Italian cohort, Bartolomeo Eustachi, left behind detailed scientific examinations of the human tooth and surrounding anatomy.

Obsessed with Cosmetic Dentistry

Louis XIV ruled France for 72 years, the longest-serving European monarch in history. The Sun King was known as an autocratic ruler, and at the immense palace complex he built at Versailles, he commanded his entire court to spend most of the year with him there, where extravagant spending was obligatory. A premium was placed on one's appearance, and the care of teeth became important. Thanks to this development, France became the leader in dentistry during the latter half of the 1600s. There were a growing number of well-trained professionals to serve the aristocratic class, and many became particularly adept at fashioning and fitting dentures for those who had lost most of their original teeth to decay. In Paris, an examining board was established in 1697 to test new entrants to the profession, and three years later the French College of Surgeons established a department for dental surgery. Only the wealthy, however, could afford such services. The rest of the citizenry relied on quack dentists, and in Paris they gathered at the Pont-Neuf bridge over the Seine every morning.

Fauchard called himself a "Chirurgien Dentiste," or surgeon dentist, in Angers. He was a talented practitioner, and was said to have been ambidextrous, or able to use both the right and left hands with the same ease. His reputation grew, and he decided to move to Paris around 1718. Within a short time he was known as one of the best dentists in the city. He used his position to rail against the Pont-Neuf charlatans who, he claimed, often hoodwinked the crowd with the help of a paid "audience member" who came forward complaining of a toothache. The quack dentists would then surreptitiously insert a tooth wrapped in a membrane containing chicken blood on the pretext of examining the sufferer, and then would wave a hand or ring a bell, and the paid performer would spit the bloody tooth out, to the awe of the crowd.

Fauchard decided that education was the best way to combat the quackery and superstition that dominated dentistry. He set out to write the definitive book on the subject, and finished Le chirurgien dentiste (The Surgeon Dentist) in 1725. He then asked several respected professionals to review it for accuracy, and it was published in 1728. The Surgeon Dentist is an immense, two-volume work that is 863 pages in length. It was the first scientific text exclusively on the subject of teeth, and was soon translated into other languages and became the standard text for the profession. "The teeth in the natural condition are the most polished and hardest of all the bones of the human body; but at the same time they are the most subject to diseases which cause acute pain, and sometimes become very dangerous," Fauchard wrote in his introduction.

Sought to End Quackery

In his book, Fauchard attempted to dispel many of the commonly held beliefs about teeth. He railed against the practitioners on the Pont-Neuf, and those who claimed that a tooth was proving to be difficult to pull because it was an "eye" tooth. People actually believed that some teeth were connected by nerves or muscles to the eye, and that pulling such a tooth would result in a loss of vision. Fauchard wrote about less ethical practitioners who were known to put acids on a tooth, which caused them to decay; when the patient returned with a complaint of a toothache, the dentist could then extract the tooth for a fee. He also warned that some practitioners charged for gold fillings that were actually tin with a layer of gold on top. Others, he noted, had no knowledge of dentistry at all. Cutlers, or knife-makers, sometimes came up with new tools, and "apparently the instruments which they make gives them an itch to try them," wrote Fauchard, and mentioned one such trades-person he knew of in Paris. "This particular man who had seen several charlatans operate, thinking that it would be as easy to draw teeth as to make knives, has joined the ranks … if he does not always take out the tooth whole he does manage to take a piece of it."

Fauchard's book described five kinds of instruments that dentists should use. The gum lancet was used to separate the tooth or root from the gum; a punch pushed the tooth inward; pincers "pinched" it out for easier removal; a lever could lift it, but Fauchard noted that this was more likely to break the tooth than extract it. The last standard tool he cited was known as the pelican, named for its hooks that pointed inward like pelican's beak, and he noted that this should be the primary method of extraction. Fauchard also suggested that instead of pulling a tooth, it would be better to scrape the diseased cavity clean and then fill it with lead or gold leaf. His text contained detailed procedures for filling and treating cavities. Removing the diseased part could be done with a primitive type of drill that he invented. His was made from catgut (actually treated cord made from the intestines of sheep or goat) which was used for violin strings; he twisted his around a cylinder, which produced a rotating motion that could dig out the diseased parts of a tooth.

Fauchard disdained the still-prevalent idea that worms caused decay, suggesting instead that sugary foods were to be avoided. He provided recipes for mixtures to treat infections of the mouth, which used items commonly available from apothecaries, such as oil of cloves and cinnamon. One of his more unusual recommendations to patients, however, was "rinsing out the mouth every morning and also evening … with some spoonfuls of their own urine, just after it has been passed … it is true that it is not very agreeable, except inasmuch as it brings distinct relief." The use of urine was not entirely unusual at the time, and had persisted in many previous cultures and eras throughout history as a medical remedy.

Professional Heirs Continued Progress

Some of the innovations that Fauchard devised were chronicled in The Surgeon Dentist, while others came later in his lengthy career. He devised sets of dentures that used real teeth, with springs to connect them, and wrote about crowns and bridges, which could either replace or cover parts of teeth that were missing. In his book are some of his more innovative ideas about how to fasten these to the root of the tooth with threads of silk, linen, or metal; some of these techniques were still used in modern times. He also suggested ideas for straightening crooked teeth, which would make him the founder of modern orthodontics. His book also offered guidelines for the best treatment position for patients and dentists. Oftentimes the dentist sat on the floor, with a patient's head on his lap. Fauchard recommended using a chair instead, in which a patient could recline. The dentist should be behind the patient, not in front; this helped reduce fear in the patient, he believed, and did not block the light the dentist needed to see inside the mouth.

Fauchard died on March 22, 1761, in Paris. A successor of his, Nicholas Dubois de Chemant, created a set of teeth made out of mineral paste that were then glazed in a kiln in 1788. These were the first dentures created entirely from artificial materials, and de Chemant settled in England to work on creating dentures with the famous Wedgwood porcelain factory by the early 1790s. Some reports note that he later became the first to set up a dentistry practice in New York City. France remained a leader in the profession for a century after Fauchard's death, until it was overtaken by the United States, which became home to the first professional school for dentistry in the world, the Baltimore College of Dentistry, in 1847. There are professional awards named in Fauchard's honor, as well as an international society, the Pierre Fauchard Academy, which provides scholarships, mentoring, and research fellowships.

Books

Lerner, K. Lee, and Brenda Wilmoth Lerner, Eds., Gale Encyclopedia of Science, 3rd ed., Gale, 2004.

Lauer, Josh, and Neil Schlager, Eds., Science and Its Times: Understanding the Social Significance of Scientific Discovery, Gale, 2000.

Wynbrandt, James, The Excruciating History of Dentistry: Toothsome Tales and Oral Oddities from Babylon to Braces, St. Martin's Press, 1998.

Periodicals

Skeptical Inquirer, May-June 1999.

Online

"Who is Pierre Fauchard? A Remembrance/ by Monsieur Jean Claude de Vaux," Pierre Fauchard Academy, http://fauchard.org/publications/remembrance.htm (January 2, 2006).