A Millennium of Dentistry: A Look Into the Past, Present and Future of Dentistry

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 B.C.) that describes "tooth worms" as a cause of dental decay. No one can deny that dentistry has made tremendous strides over the years.

"Things have certainly changed from the Middle Ages to the early 1700s, when most dental therapy was provided by so-called ‘barber surgeons‘," said Academy of General Dentistry spokesperson Eric Curtis, DDS, renowned dental historian. "These jacks-of-all-trades would extract teeth and perform minor surgery, in addition to cutting hair, applying leeches and performing embalming."

Dental practitioners migrated to the American colonies in the 1700s and devoted themselves primarily to the removal of diseased teeth and the insertion of artificial dentures. In the 1800s, dental practices included such duties as extracting teeth with a turnkey (a primitive tool like a ratchet wrench, used for extracting teeth), cleaning the teeth with scrapers and removing cavities with hand instruments. The filling materials used then were tin, gold foil, lead and silver. Dentures were carved from ivory or fashioned from the teeth of cattle.

In the past century, human life expectancy has almost doubled and immense changes in quality of life have occurred. Some of the changes that have had a positive impact on dentistry include increased emphasis on personal hygiene; availability of antibiotics, vaccines and fluoridation; improved diets; electricity and heating; the X-ray; and the telephone, computers and the Internet. Present-day dental accomplishments include the use of silver and white fillings, air-abrasion techniques for the filling of cavities and more.

An increase in people over the age of 65 who retain their teeth also has affected dentistry, with more attention being paid to the complex needs of this older population. A more knowledgeable and affluent U.S. population has resulted in an increase in dental visits for an improved smile, in sharp contrast to the reasons for dental visits 100 years ago, i.e., to alleviate pain and restore function. This consumer trend will strengthen in the next century as more people retain their healthy teeth for a lifetime.

"No one can know for certain what the future of dentistry will hold," stated Dr. Curtis. "I think we will see an integration of dentistry into comprehensive health care and an increased focus on the link between oral health and overall health as we enter the 21st century. Computer-assisted technology for diagnosis and treatment, and gene-mediated therapeutics, which alters the genetic structure of teeth to make them impervious to decay, will likely play an important role in the future of dentistry," said Dr. Curtis.

The beginnings of dentistry

2900 B.C.E. Egyptian lower jaw demonstrates two holes drilled through the bone, presumably to drain an abscessed tooth. Egyptians were the first to designate a doctor that specializes in treating teeth.

2700 B.C.E. Evidence that the Chinese used acupuncture to treat pain associated with tooth decay.

1700 B.C.E. Ancient Egyptian papers called the Ebers papyrus, which date back as far as 3700 B.C.E., contain references to diseases of the teeth, as well as prescriptions for substances to be mixed and applied to the mouth to relieve pain.

1300 B.C.E. Aesculapius, a Greek physician, first writes about the concept of extracting diseased teeth.

500 B.C.E. Hippocrates and Aristotle write of ointments and sterilization procedures using a red-hot wire to treat diseases of the teeth and oral tissues. They also speak of tooth extraction and the use of wires to stabilize jaw fractures and bind loose teeth.100 Roman medical writer Celsus writes extensively of oral diseases as well as dental treatments such as narcotic-containing emollients and astringents.

Visions of the future in the 1600 and 1700s

1685 First dental textbook is published in English by Charles Allen titled "The Operator for Teeth."

1728 Pierre Fauchard publishes his master work, "The Surgeon Dentist," which describes for the first time a vision of dentistry as a modern profession.

1785 John Greenwood, who served as George Washington's dentist helps raise public awareness about porcelain teeth.

The enlightening 1800s

1816 Auguste Taveau develops the first dental amalgam, or fillings, made from silver coins mixed with mercury.

1839 Charles Goodyear discovers vulcanized rubber. This discovery made denture bases, previously fashioned out of gold, affordable for the average person.

1840 Horace Wells first demonstrates the use of nitrous oxide for sedation.

1840 Thomas Morton first demonstrates the use of ether anesthesia for surgery.

1840 Horace Hayden and Chapin Harris invent modern dentistry. They:

• Founded the first dental school, the Baltimore College of Dental Surgery.
• Invented the modern doctorate of dental surgery (DDS) degree.
• Started the world's first dental society, the American Society of Dental Surgeons, which eventually formed into the American Dental Association.

1870s Baked porcelain inlays come into use for filling large cavities.

1866 Lucy Hobbs, the first woman to obtain a DDS degree, graduates from Ohio College of Dental Surgery.

1871 James Beall Morrison patents the first mechanized dental drill. This drill twirled very slowly and a filling could take several hours to complete.

1890s Willoughby Miller first describes the microbial basis of dental cavities, which initially raised cavity-prevention awareness and led the way for oral care companies to market at-home oral health care products.

1895 G.V. Black standardizes both cavity preparation and the manufacturing process of silver fillings.

1896 Edmund Kells adapts Wilhelm Roentgen's new X-ray for dentistry.

1896 The toothpaste tube is introduced by Washington Wentworth Sheffield.

Scientific advances in the 1900s

1900s With Thomas Edison's invention of electricity, dental offices begin to use electric drills.

1907 Novocain is introduced into U.S. dental offices by Heinrich Braun.

1907 William McTaggart invents his "lost wax" casting machine, which allows dentists to make precision cast fillings to fill a cavity.

1926 The Gies Report, urging dental schools to become university-based, is issued by the Carnegie Foundation.

1929 Penicillin is invented, having a major impact on treatment protocols for dental infections.

1945 Grand Rapids, Michigan, is the first city in the world to fluoridate drinking water.

1955 Michael Buonocore invents white (composite) fillings. He also described a method of bonding resin to tooth enamel, enabling dentists to repair cracked enamel on front teeth.

1957 John Borden invented a high-speed, air-driven hand piece, increasing drill power from the traditional 5,000 rpm (rotations per minute) to 300,000 rpm, which shortens the time to prepare a tooth for a filling to a matter of minutes.

1958 The first fully reclining dental chair is introduced, allowing more patient and dentist comfort and enabling the dentist to have an assistant help with procedures.

1970 The electric toothbrush is introduced in the U.S.

1970s Sit-down, "four-handed" dentistry becomes common. Most dentists have dental assistants helping with procedures, drastically improving efficiency and shortening the treatment time.

1980s Per Ingvar Branemark describes techniques for dental implants.

1989 The first at-home tooth bleaching system is introduced.

1990s "Invisible" braces, or aligners, are introduced in the United States, offering an alternative to traditional braces.

Into the 21st century

• Integrating dentistry into comprehensive health care.
• Increased focus on the link between oral health and overall health.
• Gene-mediated therapeutics, which means altering the genetic structure of teeth to make them impervious to decay.
  
• Some researchers are now investigating the possibility of growing new tooth structure around weakened enamel.
• Increased knowledge base and computer-assisted technology approach for diagnosis and treatment.
  
• Community-based health promotion for oral health care.

The History of Dental Advances

Many of the most common dental tools were used as early as the Stone Age. Thankfully, technology and continuing education have made going to the dentist a much more pleasant – and painless – experience. Here is a look at the history of dentistry's most common tools, and how they came to be vital components of our oral health care needs.

Where did toothbrushes and toothpaste come from?

The first toothbrushes were small sticks or twigs mashed at one end to create a broader cleaning surface. The Chinese lay claim to the first bristle toothbrush. Europe adopted the bristle brush in the 17th century, and many dentists practicing in colonial America advised their patients to use the brush. The first electric toothbrush was marketed in 1880, though the Swiss developed the first effective electric toothbrush just after World War II. It was introduced in the United States around 1960. A year later, the first cordless model was developed and proved to be popular with both consumers and dentists.

Toothpaste also saw its earliest form in ancient civilizations. Early toothpaste ingredients included powdered fruit, burnt or ground shells, talc, honey and dried flowers. Less agreeable ingredients included mice, rabbit heads, lizard livers and urine. Despite the decidedly non-minty flavor of early toothpaste, various recipes continued to appear throughout ancient history and well into the Middle Ages. Unfortunately, many of these toothpastes contained corrosive elements that dissolved tooth enamel.

Toothpaste as we know it emerged in the 1800s, with ingredients that included soap and chalk. In 1892, the first collapsible tube was marketed and reigned supreme until 1984, when the pump dispenser was introduced. In 1956, Proctor & Gamble introduced Crest brand toothpaste with fluoride.

When was drinking water fluoridated?

In 1945, Grand Rapids, Michigan introduced fluoride into their public water systems to help fight tooth decay among residents. At the same time, a group of Wisconsin-based dentists succeeded in getting the state's water system fluoridated. After substantial testing showed that fluoride reduced the incidence of cavities by as much as two-thirds, in 1951 the U.S. Public Health Service urged the entire country to fluoridate public drinking water.

The idea for water fluoridation resulted from an observation made by a dentist from Colorado Springs, Colorado, in the early 1900s. Frederick McKay noticed that locals had brown stains on their teeth. He called the staining "enamel mottling" and attributed it to drinking water with high fluoride content. He reported that the locals had a reduced incidence of tooth decay. In 1940, another dentist revealed that one part fluoride per one million parts water was the ideal ratio for reducing decay while preventing staining. Soon after, fluoride gained acceptance, and today more than 60 percent of Americans have fluoridated water.

What's the history behind false teeth?

Thanks to modern technology, today's false teeth are largely indistinguishable from real teeth. This wasn't always the case. Perhaps the most famous false-toothed American was the first president, George Washington. Popular history gave Washington wooden teeth, though this was not the case. In fact, wooden teeth are impossible; the corrosive effects of saliva would have turned them into mushy pulp before long. As a matter of fact, the first president's false teeth came from a variety of sources, including teeth extracted from human and animal corpses.

Despite this seemingly gruesome practice, dental practitioners preceding Washington's time attempted aesthetic restorations. Ancient civilizations used ivory and bone to create new teeth. Unfortunately, this craft was lost until the mid-1800s. Rotten or damaged teeth were simply extracted, and gaps became a way of life. When false teeth were warranted, threads of silk or tightly coiled springs were used to hold the new teeth in place; it wasn't much of an anchor, and teeth had to be removed before eating, lest they literally spring from the wearer's mouth. Additionally, genuine teeth extracted from the living and the dead and set in another's mouth soon rotted. Those who could afford it opted to have new teeth fashioned from ivory, gold or silver.

It wasn't until 1774 that two Frenchmen, a pharmacist and a dentist, designed a set of porcelain teeth. Steady improvements were made on the teeth, most notably in 1808 when an Italian dentist invented a single porcelain tooth imbedded with a platinum pin. These teeth came to America in 1822, and for the rest of the century dentists and technicians tinkered with the design, fit and feel of the teeth. A breakthrough occurred in 1839 with the discovery of vulcanized rubber, which was used to hold false teeth. Today's dentures are made of either plastic or ceramic.

How long have we had anesthesia?

Though dentistry has been around in one form or another since the days of primitive humans, painless extraction wasn't available until the 1830s. In the beginning, teeth were removed with a well-placed chisel and a hard swing of a mallet. Thousands of years later, during peaks of the great Greek and Roman civilizations, the chisel-and-mallet method was abandoned in favor of forceps.

In the 1790s, a British chemist began to experiment with the use of nitrous oxide as a pain-inhibitor and noted its most famous side effect, laughing. He coined the anesthetic's popular nickname, "laughing gas." During the next 50 years, the gas became very popular. In 1863 the gas was combined with oxygen, becoming a staple of surgical procedures.

Soon after the adoption of nitrous oxide, local anesthetics were developed. Just prior to the 1900s, cocaine was used, but once its addictive qualities were identified, the search began for a suitable alternative. Many of the alternatives were forms of synthetic cocaine, but none were successful until 1905 when a German chemist discovered procaine, which he named Novocain. The anesthetic proved extremely popular with dental professionals, as well as a public relieved at the sound of "painless dentistry."