Dentistry traces back almost as far as human civilization itself, with the earliest traces dating back to around 7000 BC to 5500 BC. It's believed to be among the earliest medical specializations, eventually evolving into a distinct field with its own accredited degree programs and specialized branches.
The term "dentistry" originates from "dentist," which is derived from the French word "dentiste," stemming from French (dent) and Latin (dens) words referring to "tooth." The scientific study related to teeth is known as odontology, derived from the Ancient Greek word "odoús," meaning "tooth."
The advent of agricultural societies and a more diverse diet, including increased consumption of carbohydrates like refined sugar and white flour, led to a rise in tooth decay in humans. Archaeological findings from sites worldwide reveal evidence of prehistoric dental care practices, such as teeth scraping, cleaning, and even drilling and filling to remove decayed tissue.
Additionally, discoveries of jawbones from the Paleolithic era show signs of tooth extraction likely achieved using a sharp wooden stake and a rock mallet. One of the earliest instances of attempted tooth disease treatment is evidenced by grooves carved for scraping away caries with flint tools into an infected tooth discovered in Italy approximately 14,000 years ago.
The development of the dental drill marked a significant advancement in the treatment of dental conditions, believed to have originated around 9,000 years ago, before the emergence of civilization, writing, and even the wheel by millennia. The earliest known dental filling, made from beeswax (antibacterial and anti-inflammatory), dates back approximately 6,500 years.
The Babylonians developed a theory attributing toothaches to the tooth worm (worm theory), a belief echoed by civilizations worldwide until the 18th century. Various methods, from fumigation to magical charms, were employed to rid teeth of these supposed worms, highlighting the superstitious origins of dentistry and medicine.
The earliest recorded dentist known to us was Hesy-Re, an ancient Egyptian. Ancient Egyptian society segmented medicine into specialized practitioners, with specific individuals dedicated to oral health treatment, known as "Toothers" or "treaters of teeth." These practitioners focused on surgical procedures, differentiating dentistry from the broader field of medicine, which dealt with medicinal remedies. They developed scaling instruments similar to modern scalers and developed the first toothpaste using ingredients like rock salt, black pepper, flowers, and mint. Evidence also suggests they performed early dental surgical procedures, such as drilling holes in mandibles to relieve abscesses.
In addition to surgical interventions, ancient civilizations like the Egyptians and Phoenicians demonstrated advanced dental techniques, including bridgework using materials like gold and silver wire. Hippocrates and Aristotle in classical Greece contributed to dental knowledge, with Hippocrates proposing treatments for dental decay and gum disease, while Aristotle correctly attributed dental caries to sweet foods like figs.
The Romans continued to advance dental practices, with figures like Claudius Galen making significant discoveries about tooth composition and dental diseases. Meanwhile, ancient Chinese civilization practiced dentistry as early as 7000 BCE and the historical evidence of early dental amalgam first appeared in the Ming Dynasty. The Chinese created 18 decoctions in pill and mouthwash forms to alleviate toothaches. Additionally, they employed acupuncture, employing up to 26 puncture points for toothaches and six for gum issues, some located far from the mouth.
Similarly, ancient India saw discussions on dental techniques, in Susruta Samhita, a work compiled by ancient surgeon Susruta. Esculapius, a Greek physician, was credited with inventing tooth extractions and is often considered the earliest documented figure associated with dental surgery. 'Plumbeumodontagogoon' was mentioned as the leaden instrument used for tooth extraction.
During the Middle Ages, dentistry was often performed by physicians and barbers under the umbrella of general medicine. Dentistry fell within the purview of barbers, leveraging their manual dexterity and access to tools. Barbers could be categorized into two distinct groups: the first comprised educated surgeons proficient in conducting intricate surgical procedures, while the second consisted of lay barbers (barber surgeons). The latter primarily undertook routine hygienic tasks such as shaving, and tooth extraction. Guy de Chauliac in France made notable contributions to dental surgery, detailing techniques, and inventing instruments like the dental pelican a predecessor of forceps for tooth extractions.
The Arabians were the first society to actually recognize dentistry as a profession. They drilled teeth and filled them with medicaments to cure any form of constant tooth pain. Their approaches ranged from conservative treatments like filling cavities with mastic and alum cement to more invasive methods such as applying hot needles to teeth with periapical lesions, using chemicals like asafetida to devitalize teeth, and even tooth extraction as a last resort. Additionally, they made advancements in dental instrumentation and surgical techniques, including cauterization (periapical abscess) and tooth ligation (cases of fall or blow).
In 1530, the first book exclusively devoted to dentistry emerged in Germany under the title "Artzney Buchlein" or "The Little Medicinal Book for All Types of Dental Diseases and Ailments." This publication proved invaluable for untrained barber surgeons in administering oral care. It encompassed a wide array of subjects such as oral hygiene, tooth extraction, dental drilling, and the application of gold fillings.
The modern profession of dentistry owes much to Pierre Fauchard, known as the 'Father of Modern Dentistry', who transformed dentistry from a craft into a scientific profession. Fauchard's seminal work, "The Surgeon Dentist" (1723), provided a comprehensive scientific description of dentistry and debunked the tooth worm theory by identifying that acids from sugar led to tooth decay.
The first national dental society, the American Society of Dental Surgeons, was established in 1840, pioneering the publication of the first dental journal, The American Journal of Dental Science. During this time, practicing dentists had received their qualifications from medical schools, where dentistry was part of the curriculum, but gained their skills through apprenticeship.
Horace H. Hayden and Chapin Harris established the world's first independent dental college, the Baltimore College of Dental Surgery, in 1840, introducing the dental degree and basing their curriculum on Fauchard's teachings. The regulation of dentistry began with the enactment of the first Dental Practice Act in Alabama in 1841. The American Dental Association was founded in 1859 by 26 dentists from various dental societies in the United States.
In 1790, Josiah Flagg, a prominent American dentist, designed the first chair specifically for dental patients. The field of dentistry saw the entry of women with the hiring of the first full-time female dental assistant, Malvina Cueria, by C. Edmond Kells in 1885. This development enhanced dental care accessibility for women and marked an important milestone in the profession's history.
Further advancements in dentistry included the contributions of Greene Vardiman Black, who revolutionized operative dentistry with his work on amalgam alloy and cavity standardization. George F. Green went on to patent the electric dental engine, a self-contained motor, and a dental handpiece. At the same time, James Morrison patented the first commercially manufactured foot-treadle dental engine. These mechanized tools supply dental burs with enough speed to cut enamel and dentin smoothly and quickly, revolutionizing the practice of dentistry.
Horace Wells, a dentist, was among the first to recognize the potential of using anesthesia in dental surgery and advocated for its adoption, marking a transformative moment in dentistry. Subsequently, William Morton, an associate of Wells, successfully demonstrated the use of ether as an inhaled anesthetic in 1846. Later, William Halstead, MD, discovered the effectiveness of cocaine solutions as local anesthetics in medical surgery, laying the groundwork for the development of non-psychoactive derivatives such as novocaine in 1904 and lidocaine in 1943, which are still in use today. This marked a significant shift from the excruciating and dreaded dental experiences of the past.
Another noteworthy innovation originating in dentistry was the use of suction devices, which revolutionized surgical procedures by making blood removal easier for surgeons and safer for patients. Additionally, the discovery of X-rays by Wilhelm Roentgen in 1895 and the subsequent development of radiographs were embraced by dentists as invaluable tools for detection, diagnosis, and treatment. Otto Walkhoff was the first dentist to take a radiograph of his tooth just 14 days after Roentgen's discovery. Edmond Kells pioneered the use of X-rays to visualize tooth roots in his practice in 1896.
The introduction of fluoride marked a significant milestone in the fight against cavities and elevated dentistry's role in public health. Frederick McKay's observation of a common brown stain on patients' teeth in Colorado Springs in 1907 led to collaborative research with GV Black, revealing that high fluoride levels in the water supply were causing the staining while also rendering teeth resistant to cavities. Further research by H. Trendly Dean in the 1930s confirmed the benefits of fluoride in preventing cavities.
In 1957, John Borden unveiled the high-speed air-driven handpiece, capable of reaching speeds of 300,000 rpm, heralding the dawn of a new era in high-speed dentistry. Specialization in dentistry began with orthodontics, a pioneering effort led by Edward H. Angle. This marked a significant milestone in the profession's advancement and specialization. Currently, there are 12 dental specialties in addition to general dentistry.
The first documented case of postmortem dental forensics occurred when Paul Revere confirmed the death of his friend, Joseph Warren, by identifying the bridge he had constructed for him. During the early 1990s, advancements in tooth-colored composite restorations, porcelain veneers, teeth bleaching, and dental implants, marked the onset of a new era in meeting the public's demand for cosmetic dentistry.
Evidence-based dentistry serves as a cornerstone of modern dental practice, promoting the delivery of high-quality, patient-centered care based on the best available evidence and clinical expertise.
Additionally, the digital age has brought about a complete revolution in dentistry with advancements such as digital radiography, CAD/CAM systems, and 3D printing. With digital dentistry, tasks such as diagnostics, treatment planning, and restoration fabrication are conducted using computerized systems and software. Overall, digital dentistry is revolutionizing the way dental care is delivered and experienced.
People think dentistry is just a small field of medicine but it's definitely not. It's a blend of art and science, requiring extensive practice and skill to excel. I would say dentistry itself is a specialty course. We learn basic medicine and anatomy etc., along with studying oral structures and oral health. Given that many diseases manifest symptoms in the oral cavity, the importance of dentistry in diagnosing these cases early and treating them accordingly is undeniable. But, people think of a dentist as not equal to a doctor, especially in India. Even though it has a great scope and is an excellent profession, we're being underestimated.
Dr. Vasumathy B.D.S, Chief Dental Surgeon, Smiley Dental Care, Kanchipuram, Tamil Nadu, India
The journey of dentistry from its ancient origins to the modern era of digital dentistry is a testament to the resilience, innovation, and dedication of dental professionals throughout history. From the skilled "Toothers" of ancient Egypt to the pioneering work of Pierre Fauchard in the 18th century, dentistry has evolved from a primitive craft to a sophisticated profession. What began as an ancient practice rooted in tradition has evolved into a modern profession guided by science and technology. Dentistry continues to evolve, shaping the future of oral health care for generations to come.
References
Kezian SA. The History of the Dental Profession - From Ancient Origins to Modern Day. Pacific Journal of Health [Internet]. 2020 [cited 2024 Apr 18]; 3(1). Available from: https://scholarlycommons.pacific.edu/pjh/vol3/iss1/2.
Hussain A, Khan FA. History of dentistry. Archives of Medicine and Health Sciences [Internet]. 2014 [cited 2024 Apr 23]; 2(1):106. Available from: https://journals.lww.com/armh/Fulltext/2014/02010/History_of_dentistry.22.aspx.
https://www.ada.org/resources/ada-library/dental-history
https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.0886
Rasmussen CM, McMillan KB, McMillan DC, Assael LA, Arce K. Education Solutions to the Medical-Dental Divide. AMA Journal of Ethics [Internet]. 2022 [cited 2024 Apr 18]; 24(1):27–32. Available from: https://journalofethics.ama-assn.org/article/education-solutions-medical-dental-divide/2022-01.
(By Dr. Nirainila Joseph)
