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    • 08 MAR 17
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    Dentistry Through History – Tooth Worms, Swine Bristles and Carved Ivory

    The Roots of Dentistry Grow from Ancient Times

    It seems people have been interested in oral health since man first walked the earth. The very first recordings of dentistry date back as early as 5000 BC with a Sumerian text of this date that describes “tooth worms” as the cause of dental decay. In 2600 BC Hesy-Re, an Egyptian scribe is often called the first “dentist.” An inscription on his tomb includes the title “the greatest of those who deal with teeth, and of physicians.” This is the earliest known reference to a person identified as a dental practitioner.

    Around 500-300 BC Hippocrates and Aristotle write about dentistry, including the eruption pattern of teeth, treating decayed teeth and gum disease, extracting teeth with forceps, and using wires to stabilize loose teeth and fractured jaws. In 100 BC Celsus, a Roman medical scribe, writes extensively in his important compendium of medicine on oral hygiene, stabilization of loose teeth, and treatments for toothache, teething pain, and jaw fractures. Between 166-201 AD the Etruscans practice dental prosthetics using gold crowns and fixed bridgework.

    Pierre Fauchard (1678-1761), considered the “father of modern dentistry,” published the first comprehensive scientific textbook on dentistry, “Le Chirurgien Dentiste,” in 1728. The manuscript has many original elements, such as the use of carved ivory obturators with attached teeth for cleft palate, a description of tooth dysplasia, new prosthodontic devices for replacement of missing teeth, and innovation in the type and use of dental instruments.

    In 1844 Dr. Horace Wells, a dentist from Connecticut, who was responsible for the use of anesthesia in dentistry, had an impact on both medicine and dentistry. He was the first patient to have a tooth extracted under nitrous oxide (NO) anesthesia.

    Subsequent technological advances were more incremental and less impactful on other branches of medicine.

    They include the invention of amalgam as a material for tooth restoration. Two Englishmen, the Crawcour brothers, introduced it in the United States in 1833, amid considerable animosity and professional jealousy from colleagues. Amalgam contained shavings of silver coins, tin, and mercury mixed into a paste. It has been the dental restoration material of choice for the past 180 years, and only recently has it become displaced by advances in highly fracture-resistant aesthetic bonding materials.

    In the mid-19th century, dentures to replace missing teeth were made of ivory, hippopotamus or human bone, or metal (brass or lead). Starting in 1851 they were replaced by a new technology, vulcanized rubber, invented by Charles Goodyear, an American, who succeeded in hardening the resin of the rubber tree. An American dentist émigré to Paris, Thomas Evans, first used it as a denture base in 1848.

    Caries investigation was significantly advanced when a German-educated, American scientist, Dr. Willoughby D. Miller, described the Acid Dissolution Theory in 1890. Until that time, caries, the most common infectious disease affecting humans, was thought to be caused by worms.

    The dental drill was a major breakthrough in speeding up removal of decayed tissue. The use of a drill on teeth dates back 6,500 years. The use of modern dental drills started with George F. Green, an American dentist who in 1868 invented the foot pedal-operated pneumatic drill and seven years later patented the electric drill.

    The pneumatic high-speed air rotor drill developed by Dr. John Patrick Walsh in 1949 in New Zealand followed the invention of the electric slow-speed drill. Dr. John Borden commercialized the high-speed drill in the 1950s in the US.

    The toothbrush has ancient roots. But the invention of the commercial mass-produced toothbrush is attributed to the Englishman William Addis, who in 1770 came up with the idea while in prison. Using swine bristles thread through holes at the ends of a carved cattle bone, he created the first toothbrush prototype. Once released from prison, he started to mass-produce it. The first three-row bristle toothbrush was invented in 1844 and the first nylon toothbrush was commercialized by DuPont in 1938. The first electric toothbrush was created in 1939.

    Toothpaste was invented in 1850. The first toothpaste was based on a formulation of powder or pumice. The invention of modern toothpaste is attributed to the American dentist Dr. Washington Wentworth Sheffield, who came up with the patent in 1878. He is also credited with placing it into collapsible tubes. The idea came to him while in France observing the tubes used by Parisian painters.

    One of the most significant advances in modern dentistry derives from the use of dental sealants to prevent dental decay. In the mid-1960s, Drs. Michael Buonocore and E. I. Cueto introduced the first commercial sealant. The product was based on Dr. Buonocore’s work on the development of materials to prevent occlusal caries in posterior teeth. In 1974, Drs. J.W. McLean and A. D. Wilson introduced the glass ionomer cement currently used for fissure sealants.

    The discovery of the role that fluoride plays in caries prevention is an achievement that the CDC ranks among the 10 greatest public health advances of the 20th century. Fluoride research had its beginning in 1901, when a young dental school graduate, Frederick McKay, left the East Coast to open a dental practice in Colorado Springs, Colorado. When he arrived, McKay was astounded to find scores of residents with grotesque brown stains on their teeth and began research, in collaboration with renowned dental researcher Dr. G.V. Black, that led to recognition of fluoride’s preventive capabilities, and, 30 years later, to the knowledge that water-borne fluoride can prevent cavities.

    Dental implants made of shells (alloplasts) were used by the Mayan civilization in 600 AD. The origin of modern titanium dental implants goes back to the late 1940s and early 1950s but their success was uneven. Dr. Per-Ingvar Brånemark developed the first scientifically documented, successful implant system in 1965.

    Digital dentistry refers to a wide scope of technologies and devices — introduced in the past several decades — that incorporate digital or computer-controlled components in contrast to mechanical or electrical devices alone. The digital technologies that might be used in the dental office include CAD/CAM (computer-assisted design, computer-assisted manufacture), cone beam CT, digital X-rays, intra-oral camera, dental lasers, and optical scanners, among them.

    One of the most recent technological advances is Invisalign®, a system that creates a series of computer-generated clear plastic orthodontic realigners to correct slight malocclusions. Invisalign® “democratized” orthodontics by making the system available to general practitioners. The 1997 invention is attributed to Zia Chishti and Kelsey Wirth.

    Today, dental treatment for caries and periodontal disease is moving into a period of fewer invasive and more preventive interventions. The availability of ever more information, smart technology, know-how, and non-invasive treatments will continue to advance the profession’s momentum by making it easier, faster, better, and more enjoyable for patients.

    Source: NYU College of Dentistry, American Dental Association

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