Historical Overview

Oral disease has been a problem for humans from the beginning of history. Skulls of Cro-Magnon peoples, who inhabited the earth 25,000 years ago, show evidence of tooth decay. The earliest recorded reference to oral disease is from an ancient (5000 BC) Sumerian text that describes "tooth worms" as a cause of dental decay. There is historical evidence that the Chinese used acupuncture around 2700 BC to treat pain associated with tooth decay.

Among the papyri of ancient Egypt is the Ebers papyrus, which throws light on medical practices. It was written between 1700 and 1500 BC and contains material dating back as far as 3700 BC. The Papyrus Ebers contains references to diseases of the teeth, as well as prescriptions for substances such as olive oil, dates, onions, beans, and green lead, to be mixed and applied "against the throbbing of the bennut blisters in the teeth." An Egyptian lower jaw, dated by experts from 2900 to 2750 BC, demonstrates two holes drilled through the bone, presumably to drain an abscessed tooth. Much of early dentistry was practiced as part of the general practice of medicine. By the 5th century BC, Herodotus, a Greek historian, wrote "in Egypt, medicine is practiced on a plan of separation--each physician treats a single disorder, and no more...some undertaking to cure diseases of the eye, others the head, others again of the teeth."

Aesculapius--later regarded as a god but probably an actual person, a Greek physician, who lived between 1300 and 1200 BC-- is credited by many with the concept of extracting diseased teeth. Later (500-300 BC), Hippocrates and Aristotle wrote of ointments and cautery with a red hot wire to treat diseases of the teeth and oral tissues. They also spoke of tooth extraction and the use of wires to stabilize jaw fractures or bind loose teeth.

A renowned Roman medical writer, Celsus (100 BC), wrote extensively of oral diseases, including bleeding gums and ulcers of the oral cavity, as well as dental treatment such as narcotic-containing emollients and astringents. Arabian physicians attached great importance to clean teeth. They described various procedures to "scrape" the teeth and designed sets of specialized instruments to accomplish that task. Mouthwashes and dentifrice powders were applied by the Arabians using a "toothbrush," a small polishing stick that was beaten and softened at one end.

Throughout the Middle Ages in Europe, dentistry was made available to wealthier individuals by physicians or surgeons who would go to the patient's home. Decay would sometimes be removed from teeth with a "dental drill," a metal rod that was rotated between the palms. Soft filling materials provided short-term alleviation of discomfort by keeping air from the open cavity. Dentistry for poorer people took place in the marketplace, where self-taught vagabonds would extract teeth for a small fee. From the Middle Ages to the early 1700s much dental therapy was provided by so called "barber surgeons." These jacks-of-all-trades would not only extract teeth and perform minor surgery, but they also cut hair, applied leeches to let blood, and performed embalming.

Italian sources from the 1400s mention the use of gold leaf as dental filling material. Later, the French described the use of soft lead fillings to repair teeth after decay was removed. Pierre Fauchard (1678-1761 ), a French surgeon, is credited with being the "father of modem dentistry." His book, The Surgeon Dentist, A Treatise on Teeth. describes the basic oral anatomy and function, signs and symptoms of oral pathology, operative methods for removing decay and restoring teeth, periodontal disease (pyorrhea), orthodontics, replacement of missing teeth, and tooth transplantation. Fauchard`s text was followed by others that continued to expand the knowledge of the profession throughout Europe. Two popular books, Natural History of Human Teeth (1771 ) and Practical Treatise on the Diseases of the Teeth (1778), were written by English physiologist John Hunter, surgeon general to the British army.

Dental practitioners migrated to the American colonies in the 1700s and devoted themselves primarily to the removal of diseased teeth and insertion of artificial dentures. Paul Revere, historically noted for his "midnight ride," was by trade a metalworker who constructed dentures from ivory and gold. George Washington had dentures made of metal and carved ivory, or metal and carved cow teeth, but none made of wood. Until the mid-1800s, dentures continued to be individually constructed by skilled artisans. Gold, silver, and ivory were common components, causing them to be very expensive and available only to the very wealthy. In 1851 a process to harden the juices of certain tropical plants into vulcanized rubber was discovered. The ability to mold this new material against a model of the patient's mouth and attach artificial porcelain teeth allowed the manufacture of less expensive dentures. Later, acrylic plastics replaced the use of rubber and porcelain in denture construction.

A major contribution from the dental profession to the future of health care occurred in 1844 when Dr. Horace Wells, a Connecticut dentist, observed an exhibition of people reacting to inhalation of nitrous oxide (laughing gas). He initiated the use of nitrous oxide inhalation during dental therapy and founded the concept of inhalation analgesia and anesthesia. The medical community later modified and adopted inhalation anesthesia as a standard surgical management procedure.

Greene Vardiman Black 1831-1915) was the leading reformer of American dentistry. Black devised a foot engine that allowed the dentist to keep both hands free while powering the dental drill. He developed modem techniques for filling teeth based upon biological principles and microscopic evaluation. Black also noted a densely matted bacterial coating on the teeth, and he proposed that dental caries and periodontal diseases were infections initiated by Bacteria. It was not until the early 1960s, however, that scientific evidence confirmed this theory.