Open Wide

by

Lauren Roberts

One can live without teeth, but it’s not pleasant. I can still remember, even after decades, coming across my grandmother’s bridge in a water cup one night while I was staying with her. Honestly, it was gross. I hadn’t realized until that night that some of her teeth were false, and the sight of those four or five teeth with a small silver bar connecting them—I didn’t look too closely so that’s as best a description as I can come up with—convinced me to brush two and, if I manage it, three times a day. Like most people I’m not that crazy about dental visits but I willingly visit my dentist twice a year. There’s nothing like the consequences of someone not taking care of her teeth to inspire me to care.

Unfortunately, not everyone has had that kind of life-changing experience, and dentists and dental associations will embark on advertising and other promotional campaigns to remind people that healthy teeth require routine care. These bookmarks from the 1940s are part of that. The Georgia Department of Public Health located in Atlanta issued them to encourage young adults to visit their dentist regularly.

But what exactly is dentistry? It is “the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the oral cavity, maxillofacial area, and the adjacent and associated structures and their impact on the human body.” Though degrees are needed to become a dentist in modern society, it wasn’t always that way.

Evidence going back as far back as 7000 BC yields up the fact that dentistry was practiced in the Indus Valley Civilization. A recent article in the journal Nature reported that researchers carbon-dated at least nine skulls that had been found in a Neolithic Pakistan graveyard with eleven drill holes going in as deep as one-seventh of a inch. And these teeth were the hard-to-reach molars which, in one poor patient’s case, had been drilled from the inside back end of the tooth toward the front of the mouth. But no sign of fillings was found. Was it done to release “evil spirits”? No one knows.

All this had been done with a bow drill (a bearing block or handhold, a drill, a hearth or fireboard, and a simple bow) using flint heads. It’s painful to even contemplate how that must have worked, yet apparently it was effective—in more ways than one because the Code of Hammurabi references dental extractions twice as it is related to punishment.

A Sumerian text from 5000 BC describes “tooth worms” as the cause of tooth decay, and the belief in this worm was evidently widespread. It is found in Homer’s writings and even crossed over into India, Egypt, Japan, and China. There is a reference, on a tomb inscription, that in ancient Egypt (ca. 2600 BC) that Hesy-Re may have actually been an early dental practitioner. That inscription refers to him as “the greatest of those who deal with teeth, and of physicians.” Later, around 1700-1550 BC, a text known as the Ebers Papyrus refers to diseases of the teeth and to various toothache remedies.

In ancient Greece, Hippocrates and Aristotle wrote about dentistry, including the eruption pattern of teeth, the treatment of decayed teeth, extracting teeth with forceps, using wire to stabilize loose teeth and fractured jaws, and gum disease. By 700 BC dental appliances or bridges—what I had seen in Grandma’s water glass—had been developed and were in use by the Etruscans. And in ancient Egypt, replacement teeth were held together with gold wire.

Dental practices in Rome are described in the treatise De Medicina by Aulus Cornelius Celsus (14 BC-37 AD). Whether Celsus was a medical practitioner or a writer is unknown, but what we do know is that he described the practices painfully well:

In the mouth too some conditions are treated by surgery. In the first place, teeth sometimes become loose, either from weakness of the roots, or from disease drying up the gums. In either case the cautery should be applied so as to touch the gums lightly without pressure. The gums so cauterized are smeared with honey, and swilled with honey wine. When the ulcerations have begun to clean, dry medicaments, acting as repressants, are dusted on. But if a tooth gives pain and it is decided to extract it because medicaments afford no relief, the tooth should be scraped round in order that the gum may become separated from it; then the tooth is to be shaken. And this is to be done until it is quite moveable: for it is very dangerous to extract a tooth that is tight, and sometimes the jaw is dislocated. With the upper teeth there is even greater danger, for the temples or eyes may be concussed. Then the tooth is to be extracted, by hand, if possible, failing that with the forceps. But if the tooth is decayed, the cavity should be neatly filled first, whether with lint or with lead, so that the tooth does not break in pieces under the forceps. The forceps is to be pulled straight upwards, lest if the roots are bent, the thin bone to which the tooth is attached should break at some part. And this procedure is not altogether free from danger, especially in the case of the short teeth, which generally have shorter roots, for often when the forceps cannot grip the tooth, or does not do so properly, it grips and breaks the bone under the gum. But as soon as there is a large flow of blood it is clear that something has been broken off the bone. It is necessary therefore to search with a probe for the scale of bone which has been separated, and to extract it with a small forceps. If this does not succeed the gum must be cut into until the loose scale is found. And if this has been done at once, the jaw outside the tooth hardens, so that the patient cannot open his mouth. But a hot poultice made of flour and a fig is then to be put on until pus is formed there: then the gum should be cut into. A free flow of pus also indicates a fragment of bone; so then too it is proper to extract the fragment; sometimes also when the bone is injured a fistula is formed which has to be scraped out. . . . But if teeth become loosened by a blow, or any other accident, they are to be tied by gold wire to firmly fixed teeth, and repressants must be held in the mouth, such as wine in which some pomegranate rind has been cooked, or into which burning oak galls have been thrown. In children too if a second tooth is growing up before the first one has fallen out, the tooth which ought to come out must be freed all round and extracted; the tooth which has grown up in place of the former one is to be pressed upwards with a finger every day until it has reached its proper height. And whenever, after extraction, a root has been left behind, this too must be at once removed by the forceps made for the purpose which the Greeks call rhizagra.

During the early Middle Ages (ca. 500-1000 AD), medicine and surgery were generally the realm of the monks, the most educated people of the period. But then a series of Papal edicts was issued between 1130 and 1163 prohibiting monks from performing any type of surgery, bloodletting, or tooth extractions. Barbers may have fallen into performing the latter because they may have assisted the monks in their surgical ministry when they visited the monasteries to shave the monks’ heads, and because they would have had the sharp knives and razors used in both types of procedures. From this early practice grew the Guild of Barbers in France, established around 1210. The single group eventually split into two: surgeons who were trained to perform complex surgical operations and lay barbers or barber-surgeons who performed more routine hygienic services including tooth extraction. Dentistry as a profession was still a ways off.

The pre-runners today’s dental forceps or extracting device came about at this time. The instrument was called the dental pelican (because it resembled a pelican’s beak). It was invented in the fourteenth century by Guy de Chauliac, who also still believed in “tooth worms.” The pelican was often made by the village blacksmith and required little skill to use. Needless to say, it cause terrible pain and permanent damage. (It wasn’t until the 1700s that it was replaced by the dental key, and that remained in use until the forceps were invented in the twentieth century.)

But there were indications that dentistry would at some point become a separate profession. In 1530, the first book solely devoted to dentistry was published in Germany—Artzney Buchlein. Written for barbers and surgeons who treated the mouth, it covered such practical topics as oral hygiene, tooth extraction, drilling, and placement of gold fillings. It wasn’t until nearly 150 years later that the first dental textbook in English—Operator for the Teeth—by Charles Allen was published in 1685, by which time the science of modern dentistry was in development. In fact it was the seventeenth-century French physician Pierre Fachard who started up the science and for that he is called “the father of modern dentistry.” Among his many developments were dental prostheses and dental fillings. His belief that sugar derivative acids were responsible for tooth decay was not just startling but as we know today accurate.

In the early eighteenth century, dentistry was seen as a lesser part of medicine but by the end of the it the profession had begun to emerge as a discipline in its own right. This was due at least partially to genuine textbooks including Pierre Fauchard’s comprehensive 1723 work, Le Chirurgien Dentiste (The Surgeon Dentist; or Treatise on Teeth), which brought together all the knowledge that was known in the western world. He was also the first to practice dentistry in a scientific manner, practice management techniques for the enhancement of patient comfort, and advocate what today we call dental health. Probably because of him, the word “dentist,” borrowed from the French, began to be used to describe specialists or tooth operators in Britain at this time.

As always, care varied depending on one’s financial status. The wealthy could use the skilled dentist, while everyone else was dependent on the village blacksmith. But quackery and charlatans abounded, and tinctures, toothpowders, and abrasive dentifrices could often be purchases at market fairs through which these wanderers passed. Of course the upper classes because they had the wealth ate a lot of sugar and so utilized the wider range of dental treatments available to them including artificial teeth. Dentures were popular, and at this time were made from natural materials including walrus, elephant, or hippopotamus teeth. Human teeth including what were termed “Waterloo teeth” (sourced from battlefields or graveyards) were attached to the base. No matter. They were ill-fitting and decidedly uncomfortable. Their replacements, porcelain dentures, introduced in the 1790s were better, but only barely because of their bright colors and tendency to crack.

It was in the century, specifically in 1760, that English dental practices came to America. John Baker, a medically-trained dentist, emigrated to the United States and set up his practice. It may have been Baker from whom Paul Revere gained his knowledge of dentistry because between 1768 and 1770 he placed advertisements in a Boston newspaper offering his services as a dentist. Interestingly, it was Revere who testified in the first known case of post-mortem dental forensics when he identified his friend, Dr. Joseph Warren, who died in the Battle of Breed’s Hill, through a bridge he had constructed for him.

Improvements continued. The first modern toothbrush was manufactured in 1780, and exactly ten years later Josiah Flagg, a prominent American dentist, constructed the first chair made especially for dental patients. He had taken a common Windsor chair, attached an adjustable headrest and then added an art extension to hold the instruments. And in 1801, Richard C. Skinner wrote the first dental book to be published in America, Treatise on Human Teeth.

But things were moving at a slow pace as can be seen from a letter Jane Austen wrote to Cassandra on September 16, 1813 detailing a visit she made while accompanying three of her nieces to a London dentist (she later used the experience in her novel, Emma):

The poor girls and their teeth! I have not mentioned them yet, but we were a whole hour at Spence’s, and Lizzy’s were filed and lamented over again, and poor Marianne had two taken out after all, the two just beyond the eye teeth, to make room for those in front. When her doom was fixed, Fanny, Lizzy, and I walked into the next room, where we heard each of the two sharp and hasty screams.

The little girls’ teeth I can suppose in a critical state, but I think he must be a lover of teeth and money and mischief, to parade about Fanny’s. I would not have had him look at mine for a shilling a tooth and double it. It was a disagreeable hour.

At the time of the Regency, oral hygiene was not a well-advocated practice; visits to dentists were for taking care of problems, not preventing them. Toothpicks were common and even fashionable, but toothbrushes, most often frayed sticks for chewing on or hogs hair toothbrushes, were in limited use. Toothaches and cavities were common.

As a result, extraction was the only quick means of alleviating dental pain at the time. Once a tooth had been extracted, the only solution for filling the gap was donor teeth (usually pulled fresh from a willing accomplice who would rather have cash than teeth) set into the hole where the tooth had been pulled from, or dentures.

Nevertheless, the era did give rise to innovations in dental care, including fillings for cavities, which were first developed in the early 1800s. Later variations of filling material, from tin to gold, had quantities of mercury, a dangerous substance. Levi Spear Parmly promoted teeth flossing with a piece of silk thread in 1815.

In America, the number of practicing dentists had increased markedly by the middle of the nineteenth century. Samuel Stockton began commercially manufacturing porcelain teeth under the name of the S.S. White Dental Manufacturing Company in 1825; he was so successful that he dominated the dental supply market throughout the nineteenth century. Then beginning in the 1830s (and running through the 1890s) two brothers from France, the Crawcours, introduced amalgam filling material in the U.S. Unfortunately, they were charlatans whose unscrupulous methods sparked the “amalgam wars” within the dental profession.

It was this kind of thing that led to pressure for reform of the profession, and in 1840 the call was answered with the first dental school, Baltimore College of Dental Surgery, which opened in Maryland. It was shortly followed by the Philadelphia Dental College, founded in 1863. Around the same time, in 1839, the American Journal of Dental Science, the world’s first dental journal began publication joined in 1843 by the British Dental Journal. Professionalism was on the rise—and none too soon.

Then the first true dental miracle. Horace Wells, a Connecticut dentist, discovered that nitrious oxide could be used as an anesthesetic and in 1844 he conducted several extractions in his private practice. But when in the following year he offered a public demonstration, the patient cried out during the operation, and it was deemed a failure. In 1846, another dentist (and a student of Wells) did conduct a successful public demonstration with ether. It was in 1859 that the American Dental Association was formed when twenty-six dentists met for a convention in New York, than ten years later, the first African-American, Dr. Robert Tanner Freeman, earned a dental degree (from Harvard University Dental School).

Prior to the 1880s, dentifrice had only been available in liquid or powder form. It was usually made by individual dentists and sold in bottles, porcelain pots, or paper boxes, and there was no standard of quality. Once the collapsible metal tube was invented, it revolutionized toothpaste manufacturing and marketing. National brands of tube toothpaste became the norm within twenty years. Shortly after that, a man named Willoughby Miller, an American dentist practicing in Germany, published Micro-Organisms of the Human Mouth, which detailed the microbial basis of dental decay. It generated massive interest in oral hygiene for the first time and started a worldwide movement to promote regular brushing and flossing. At around the same time x-rays were discovered by a German physicist. The technology entered the dental market when a prominent New Orleans dentist, C. Edmond Kells, took the first dental x-ray of a living person in the U.S.

Just after the turn of the twentieth century, in 1901, a German chemist named Alfred Einhorn introduced a local anesthetic called procain which was marketed beginning in 1905 as Novocain. It was another tremendous step forward in helping to change the public’s attitude towards dentistry. Moreover, it was only the first step of the twentieth century’s progress in dentistry practices which would henceforth proceed at a pace far beyond anyone’s imagination. Among those steps”

The world’s first oral hygiene school, the Fones Clinic for Dental Hygienists, was opened in Bridgeport, Connecticut. The first class graduated twenty-seven women, most of whom were employed by the Bridgeport Board of Education to clean the teeth of schoolchildren. This practice, the first of its kind, greatly reduced the incidence of cavities among the children. (Female dental assistants had been seen in the nineteenth century when “Lady in Attendance” signs were posted in some dental offices. However, these were not specialized professionals. They tended to do everything from reception to chair-side assistance.) Then in 1924, the American Dental Assistants Association was formed.

Another breakthrough occurred in the 1930s when a Colorado dentist named Frederick S. McKay, became convinced that the mottling on his patients’ teeth were related to the water supply. Further research verified that the drinking water had high levels of naturally-occurring fluoride, which while helping patients avoid cavities also created the brown stains he was finding. By the early 1940s, when these bookmarks were produced, the ideal level of fluoride in drinking water was established to substantially reduce decay without mottling. (Fluoride toothpastes did not appear until the 1950s.) And at the same time, the nylon toothbrush, the first one made with synthetic bristles, had appeared on the market.

With the introduction of the fully reclining dental chair, in 1958, the practice of dentistry was so far advanced from bow drills and flint heads that it isn’t even funny. I have previously written about the history of and advances in toothpaste, which of course goes along with the development of the dentistry profession. Since 1958, when this narrative stops, many more advances have occurred. Today, trips to dentists are nearly pain-free and certainly much more pleasant than in the past. And I can honestly say that no granddaughter of mine will ever have to look at a set of dentures in a glass of water.

Note: For those whose appetite for dental history has been awakened, may I suggest planning a visit to the fascinating National Museum of Dentistry in Baltimore Maryland. If you think such a thing couldn’t possibly be interesting be prepared to be wrong, very wrong. I can also recommend a book I came across while doing research into this topic. I plan to buy it, but I think I may have to force myself to read it: The Excruciating History of Dentistry: Toothsome Tales & Oral Oddities from Babylon to Braces by James Wynbrandt. Published in 1998, it is certain to make you glad to live today when dentistry is truly a caring and careful profession and a mostly pain-free one.

Bookmark specifications:
Dimensions: 8" x 1 1/2"
Material: Paper
Manufacturer: Georgia Dept. of Public Health
Date: 1940s
Acquired: eBay

Almost since her childhood days of Mother Goose, Lauren has been giving her opinion on books to anyone who will listen. That “talent” eventually took her out of magazine writing and into book reviewing in 2000 for an online review site where she cut her teeth (as well as a few authors). Stints as book editor for her local newspaper and contributing editor to Booklist and Bookmarks magazines has reinforced her belief that she has interesting things to say about books. Lauren shares her home with several significant others including three cats, nearly 1,300 bookmarks and approximately the same number of books that, whether previously read or not, constitute her to-be-read stack. She is a member of the National Books Critics Circle (NBCC) as well as a longtime book design judge for Publishers Marketing Association’s Benjamin Franklin Awards. Contact Lauren.