Eighteenth-Century Advances in Dentistry

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Eighteenth-Century Advances in Dentistry

Overview

The eighteenth century, also known as the Age of Enlightenment or Age of Reason, saw dentistry advance from superstition and the showmanship of tooth-drawers to specialists who studied dentistry as a science. During this century France emerged as the leader in the dental field, a position it retained until about the middle of the nineteenth century when the United States became the leader.

The founder of modern dentistry was Frenchman Pierre Fauchard (1676-1761). He initiated a broad spectrum of advances and was the prime mover in establishing France as the front runner of the art. In Germany Philip Pfaff (1715-1767) described the process of tooth decay as originating from particles caught between the teeth. Meanwhile, English surgeon John Hunter (1728-1793) published several book on dentistry. The rise of American dentistry can be traced to the connection of colonial America to France.

Background

Dental problems have not changed much since the beginning of recorded history. Toothaches, decay, gum problems, periodontal disease, and tooth loss are documented in cave paintings and early recorded history. In about 5,000 b.c.ancient Sumerians recorded on clay tables their belief that toothaches were caused by the gnawing of tiny worms. The idea persisted for thousands of years.

The exact date at which dental art made its first appearance is not known. Some have speculated that dentistry was practiced before medicine. The first known dentist was Hesi-Re, the chief dentist to the Egyptian pharaohs around 3,000 b.c.. In addition to the Egyptians, the Etruscans of central Italy, Assyrians, and Chinese had some awareness of the problems of teeth. After the fall of Rome in a.d. 410 the scientific and technological advances of Western civilization largely vanished, and magic and superstition took over.

During the Middle Ages monks acted as physicians and dentists, with barbers as their assistants. The barbers had to take over completely when in 1163 the pope ruled that shedding of blood was not a priestly function. Guilds of barber-surgeons remained active until about 1745 in France, and later than that in America. The barber-surgeon would wrap the bloody rags after surgery around outside poles; this became the symbol of the barber-surgeon, which evolved into the modern red-and-white stripped barber pole.

Others were also pulling teeth. A band of vagabonds know as tooth-drawers roamed the towns of Europe pulling teeth. These tooth-drawers were entertainers who operated in the town squares and drew huge crowds. One famous showman was "le grand Thomas," who operated in Paris during the reign of Louis XV.

The Renaissance saw a rebirth in many areas of work, especially in the fields of anatomy. In the 1300s books about anatomy began to come out of major universities like Paris, Oxford, and Bologna. The famous French surgeon Guy de Chauliac (1300?-1368) wrote several chapters devoted to teeth and was the first to coin the term "dentator," which the English made into the word "dentist." Another mediaeval surgeon, Giovanni de Areoli (circa 1400), devised the pelican for extracting teeth and advised good cleaning habits. Leonardo da Vinci (1452-1519) presented the earliest accurate drawings of skull, teeth, and associated structures and maxillary sinus. His work inspired the dissector Andreas Vesalius (1514-1564), who accurately described the teeth and their chambers and laid the foundation for scientific investigation.

The first book describing work with teeth, titled Artzney Buchlein, appeared anonymously in Germany in 1530 and was used by the barber-surgeons. In 1563 Eustachio (1520-1574) wrote the Book of the Teeth, the first book on the anatomy of teeth.

French surgeons began to focus on dentistry, and in 1697 regulated the practice. It was in France that the term surgeon dentist was first used. The licensed dentists usually limited their practice to the wealthy. The common people still suffered with barbers, tooth-drawers, and fake doctors.

Impact

The eighteenth century saw the rise of France as the world leader in the field of dentistry. The outstanding dentist of the era was Pierre Fauchard, who was dubbed the father of scientific dentistry. Published in 1728, his two-volume book The Surgeon Dentist described dental anatomy, tooth decay, medicine, dental surgery, gum disease, and other aspects of dentistry. Some of his treatments included the use of lead to fill cavities and oil of cloves and cinnamon for infection. He also made dentures with springs and real teeth.

Fauchard moved dentistry to a higher level of sophistication and advocated education for dentists. His amazing innovations were indeed unique for the time. For example, the earliest devices for removing decay were picks and enamel scissors. Instruments were then designed with two cutting edges that could be rotated between the fingers. Fauchard improved the drill in 1728, using catgut twisted around a cylinder to produce a rotating motion. He downplayed mere extraction to solve tooth problems.

Fauchard created techniques for filling, filing, and transplanting. With his interest in correcting cosmetic problems and straightening teeth, he became known as the originator of modern orthodontics. Another of his innovative ideas was the use of crowns and bridges to replace and cover missing parts of teeth. Fauchard worked and practiced until 1768 when he died at the age of 83.

Historcial records indicate that in 1789 a French apothecary named du Chateau had a ceramist make a set of teeth for him. Around this time a dentist named Dubois de Chemant made teeth from mineral paste. He took this specialized knowledge with him when he emigrated to England, and the English began to imitate the method. In 1791 de Chement was in America establishing the first dental clinic in New York City.

Inspired by French dentists, people in other parts of Europe began to investigate dentistry as a science. Philip Pfaff was the personal dentist to Frederick the Great of Prussia. Pfaff was the first to use gold foil to cap the pulp. He wrote a book called Treatise on the Teeth and proposed that dental decay was caused by the rotting or decay of food particles lodged in the teeth. Most people still believed that tooth decay was caused by tiny worms eating away at the teeth. Pfaff was the first to introduce plaster for pouring models of the teeth.

In 1766 Thomas Berdmore of London published the first English dental textbook in which he proposed that sugar was harmful to the teeth. As dentist to King George III, Berdmore trained many pupils who then emigrated to America.

John Hunter in Britain became the leading surgeon and dental physiologist in the late 1700s. He was a marvelous experimenter and worked to improve surgery in his country. His outstanding books The Natural History of the Teeth and Practical Treatise on the Disease of the Teeth (1771) described how teeth grow and develop. Dental development had not previously been explored. He also transplanted teeth and found he must remove the pulp before filling the teeth.

Writings about teeth began to grow in leaps and bounds. Joseph Fox, a pupil of Hunter, wrote The Natural History and Diseases of the Human Teeth (1797), in which he advocated that treatment of teeth be based on scientific knowledge and surgical experience. Also, the turn key, or English key, was developed in Europe. This surgical tool enabled surgeons to remove even the most difficult and deeply rooted teeth.

The American colonies were out of touch with major scientific dental developments during this time. According to records dated 1733-35, James Reading and James Mills were the first tooth-drawers in New York—and perhaps in America. In 1763 James Baker, M.D. and surgeon-dentist, became the earliest known qualified dentist to practice in Boston and America.

France was closely related to the American colonies and many dentists who emigrated to the colonies arrived with their trade. Two French dentists, Joseph Le Mayeur and James Gardette, were asked to teach their techniques to men in the revolutionary army. One person who came under the influence of the French was John Greenwood, who became the personal dentist to General George Washington. In 1790 Greenwood took his mother's foot-treadle spinning wheel, attached it to a drill, and used the modified device to remove decay. However, the idea did not catch on at time.

Greenwood began to use gold bases for dentures and made dentures for George Washington. It was known that Washington suffered terribly from tooth loss and complained about ill-fitting dentures.

At that time dental work was done without any pain killers or anesthesia. In 1772 Joseph Priestley (1733-1804) identified nitrous oxide, and a few years later Humphry Davy (1778-1829) noted that this gas not only made people laugh hilariously, but appeared to be capable of controlling pain. In his 1800 writings he suggested that this gas could possibly be used for surgery one day.

America, in its early years, was still the domain of tooth-drawers, barbers, and charlatans. However, by the middle of the nineteenth century it surpassed France as the world leader in dental treatment. With many of the basic concepts and approaches established during the eighteenth century, the field of dentistry witnessed tremendous advances during the nineteenth century.

EVELYN B. KELLY

LAUGHING GAS IN 1799

Nitrous oxide gas was first used for pain relief in dentistry in the 1840s and continues in wide use today for dental and other short surgical procedures. Isolated by Joseph Priestley in the 1770s, the first inhalation of the gas by humans took place in the Medical Pneumatic Institute near Bristol, England, in March 1799. A physician named Thomas Beddoes had founded the Institute six months earlier to continue the research he had begun years earlier on possible therapeutic uses of gas inhalation. By the spring of 1799 Beddoes's young research director, Humphry Davy, decided to try breathing nitrous oxide. At the time, medical experts considered nitrous oxide to be dangerous, but Davy and others at the Institute proved that humans could safely breath the gas. These researchers also discovered the impressive behavioral effects that breathing low doses of nitrous oxide can produce in man. Poet Robert Southey wrote after breathing the gas that it "made me laugh and tingle in every toe and finger tip. Davy has actually invented a new pleasure, for which language has no name." Others reported vivid hallucinations and other effects. In the 1790s Bristol was a center of literary activity in England, and many notables in addition to Southey visited the Institute to breath the gas or watch its effects in those who did. Southey's friend and fellow poet Samuel Taylor Coleridge participated, as did poets Anna Letietia Barbauld and George Burnett. Other participants included a young Peter Mark Roget, who decades later wrote his famous thesaurus; and inventor James Watt, his wife, and two of their sons. Among the observers of the experiments was novelist Maria Edgeworth. Nitrous oxide quickly became known as "laughing gas" because of its effects on these and other individuals breathing it at the Institute.

A. J. WRIGHT

Science and Its Times: Understanding the Social Significance of Scientific Discovery