THE HISTORY OF DENTISTRY
Diseases of the teeth and gums have troubled humans for thousands
of years. Ancient Egyptian medical texts, dating back to 3500 BC, refer to toothaches.
The earliest record of dental treatment also comes from Egypt, where gum swelling
was treated with a concoction of cumin, incense, and onion. The earliest known
dentist was Hesi-Re, an Egyptian "doctor of the tooth" who lived around
3000 BC. There is evidence that toothaches were treated with acupuncture in China
as early as 2700 BC. By AD 659 the Chinese were filling cavities with a mixture
of mercury, silver, and tin, nearly 1000 years before amalgam was first used in
Western countries. Some cultures, such as the Maya, did not treat disease but
decorated their teeth with stone and metal inlays for ornamental purposes.
Romans were known to be conscientious about their oral hygiene-it
was common for dinner guests to be given gold picks to clean their teeth. As early
as 450 BC Romans treated toothaches, filled cavities and fashioned bridges to
replace extracted teeth. In the 3rd century BC the Greek physician Diocles advised
fellow citizens to rub teeth and gums with pulverized mint to remove particles
of food. The Greek physician Galen, who settled in Rome during the 2nd century
AD, advocated the use of a file to remove decayed portions of a tooth.
During the Middle Ages, from the 5th to the 15th century AD, dentistry
in Europe was practiced by barber-surgeons. These professionals served the townspeople
by performing a wide variety of services including cutting hair, extracting teeth,
and applying leeches to let blood, a practice once believed to cure a variety
of ailments. In the late 14th and early 15th centuries a number of rapid-fire
developments dramatically improved the quality of dental care. For example, during
this time surgeons and anatomists in France, Belgium, Italy, and Germany developed
an improved understanding of tooth anatomy, introduced the use of gold for fillings,
and commonly used materials, such as wood, to replace extracted teeth.
It was not until French dentist Pierre Fauchard published his
influential work The Surgeon Dentist in 1728 that dentistry began to take its
modern form. Fauchard, now recognized as the father of modern dentistry, was the
first person to provide a comprehensive and organized treatise on dental science
for fellow practitioners to use. His work played a key role in enabling the specialty
to break away from medicine and establish itself as a distinct, scientifically
The 19th century witnessed several developments that revolutionized
the field. Organized dentistry began in 1840 when the world's first dental school,
the Baltimore College of Dental Surgery, opened in Baltimore, Maryland. The use
of general anesthesia in dentistry began in 1844 when Connecticut dentist Horace
Wells first used the chemical compound nitrous oxide, commonly known as laughing
gas, to relieve pain during a dental procedure. Two years later, his former partner,
William Thomas Morton, introduced the use of ether as a general anesthetic at
a public demonstration. In 1858 American dentist Greene Vardiman Black invented
the foot-powered dental drill, a novelty that enabled dentists to use both hands
during drilling procedures.
In 1890 American biochemist Willoughby Dayton Miller showed that
sugars in food residue on the teeth are broken down by bacteria, creating acids
that damage tooth enamel, leading to tooth decay. Miller's work played a significant
role in developing the rationale for what is known today as professional tooth
cleaning. The invention of the X ray in 1895 by German physicist Wilhelm Conrad
Roentgen enabled dentists to examine teeth for hidden cavities and decay.
Perhaps the greatest advance of the 20th century for dentistry
began in the early 1900s when the small population of Colorado Springs, Colorado,
was found to have low rates of tooth decay. It was discovered that the town's
water supply contained fluoride, a naturally occurring element found in rocks
and minerals. Public health researchers suggested that adding fluoride to the
water supplies in cities all over the United States could dramatically reduce
the incidence of tooth decay. In 1945 a water fluoridation program was begun in
Michigan to test this hypothesis. Ten years later the test results showed that
tooth decay in participating children was reduced by 50 to 70 percent.
Despite the objections of opponents who fear fluoridation may
have long-term adverse health effects, most of the U.S. water supply is now fluoridated.
Although a controversial issue, numerous public and privately funded studies have
confirmed the benefits and low health risks of water fluoridation, and fluoridation
programs are endorsed by several national and international health organizations,
including the ADA, the American Medical Association (AMA), and the World Health
The field of dentistry continues to evolve. When a woman in Florida
announced in 1990 that she had contracted the virus that causes acquired immunodeficiency
syndrome (AIDS) from her dentist, dentists were forced to reexamine their infection
control methods. While recommendations had been in place to prevent the spread
of viruses that could be passed through blood-to-blood contact, a majority of
dentists did not routinely follow them. Dentists now equip themselves with gloves,
gowns, and masks during dental exams and routinely sterilize their instruments
to provide appropriate protection for their patients.
New and emerging technology may change the way patients receive
dental treatment. Today dentists make an impression of a tooth to make a bridge
or partial denture, but computer aided design-computer assisted manufacturing
(CAD-CAM) technology will enable dentists to scan the damaged tooth and transfer
a three-dimensional image to the computer. The computer can precisely blueprint
the image and physically construct the portion of the tooth necessary to restore
it to its original shape. Lasers, which are used currently to treat diseased gums
and other oral tissues, have recently been approved for use on teeth and may someday
become an alternative to the dental drill.
Genetics and advanced biomaterials research will also significantly
change dentistry in the future. One day saliva and tissue tests will use genetic
techniques to detect the presence of oral disease-causing pathogens. Better materials
with which to restore and replace teeth are already a reality-researchers have
developed better methods to repair the bone that supports teeth, and, eventually,
tooth implants may completely replace dentures.
In the United States, the aging population will have a profound
effect on dental care. Population projections suggest that people age 65 and over
will number 40 million by the year 2010, and with modern dental care, more of
these people are likely to keep their teeth. Instead of the traditional practice
of providing dentures for patients who lose their teeth, dentists of the future
will be able to shift their focus to treatment of age-related oral diseases, such
as advanced gum disease.