The late 20th and early 21st Centuries saw many breathtaking technological advances. The internet, self-driving vehicles, helicopters on Mars and the introduction of the global battlefield/pit of despair known as social media. All without questions hugely significant milestones for the human race – but what about dentistry?
Now, bear with me, I know dentistry might not strike you as one of the more thrilling and progressive advancements of the modern age, but with dental fear – dentophobia – affecting between 40% and 75% of the population, and with 10% to 20% experiencing it so badly they actively avoid ever going, this has long been a sizeable problem.
But what is interesting is that dentophobia is much more common today in adults than in children, which is thought to be down to the excellent advancements in technology and pain relief in modern dentistry.
Even up until the final decades of the 20th Century, a visit to the dentist still filled many with the same stomach-churning dread that I imagine those going over the top must have felt during World War I. Yes of course I am being very facetious here, but for those who lived before this sparkling era of modern dentistry, an appointment with your local dental hacker to have a filling done was about as enticing as a colonoscopy – or say walking across coal.
Those watching this video will likely fall into three categories; the very young who have only ever experienced the very best of modern dentistry, those lucky enough to grow up with excellent teeth who managed to escape the worst of the savagery, and the final group who still experience PTSD style flashbacks every time they hear an electric drill as they shudder at the harrowing memories of their youth.
Today we’re going to delve into the wild and wonderful history of dentistry going back almost 17,000 years and examine some of the creative methods that have appeared throughout its evolution – some of which worked and some certainly did not.
A Modern (ish) Problem
In the modern age, dental issues are some of the most common medical ailments that we experience. You need only check the sheer number of dentists in your local area to show you just how frequent teeth, gum and mouth problems, in general, are in the 21st Century.
We have of course dramatically exacerbated the problem in recent decades with the introduction of food and drink with mountainous amounts of sugar that slowly decays our teeth, but there was an even more significant change that occurred thousands of years ago that set us on our course for dental ruin.
During the palaeolithic era, when humans were still hunter-gatherers, instances of tooth decay were relatively low. It was only after we decided to pack in all that hunting and gathering and grow easily chewable crops instead, did we see the first signs of notable and widespread tooth decay.
The earliest recorded evidence of any kind of dentistry comes from a tooth found in Italy thought to be between 13,820 and 14,160 years old which archaeologists believed had been partially cleaned using flint tools. Sadly, this find stands completely alone in terms of its age, so we don’t really have a clear idea as to whether this was common practice or simply a single palaeolithic human lightyears ahead of their time.
Much clearer evidence comes from the Indus Valley, located between modern India and Pakistan, where findings suggested the use of bow drills to address tooth disorders dating back nearly 9,000 years. These drills were often used to create jewellery, but a finding of nine skeletons with tiny holes just 1 to 3 mm (0.03 – 0.1 inches) in diameter in their teeth showed that this may have been the world’s first dentist drill. If you think fillings are a modern invention then think again, a single tooth found in Slovenia had beeswax used to fill a cavity dating from 6,500 BC.
The Legend of the Worm
So, as we’ve seen, the practice of trying to relieve toothaches goes back at least 11,000 years, and probably much further, but it wasn’t until the discovery of a Babylonian cuneiform tablet titled “The Legend of the Worm” dating from between 2,000 and 3,000 BC, do we see the first concise theory regarding what exactly a toothache was.
According to the short verse found on the tablet, tooth pain was caused by tiny worms that had somehow found their way into the mouth where they feasted in style on both blood and teeth.
Sounds outlandish I know but this was a theory that persisted to some degree or another until the 18th Century when microscopic studies finally proved it to be factually inaccurate. However, it wasn’t quite as outrageous as you might think. Modern research on dissected teeth has shown that necrotic pulp, which appears during the final stage of a disease called pulpitis in which the tooth dies, does look a little like worms.
And it wasn’t just the Babylonians who held this squirmish idea. Similar evidence has been found pointing to the theory of tooth worms in China, Japan, India and Egypt. The term also appears in the Homeric Hymns, a collection of anonymous Greek poems, the oldest of which dates back to 7,000 BC.
In terms of actual treatment, one of the earliest from this period, which didn’t involve praying to a god for divine help, was to heat a combination of beeswax and henbane seeds, which created a smoky effect. The concoction would then either be put directly into the mouth or perhaps the patient would hold their mouth open above the smoke, allowing the henbane’s natural pain-relieving qualities to take effect – and hopefully drive out those damn worms in the process.
The First Dentist
Things kicked on with the glittering age of the Ancient Egyptians and treatments for toothache, infections and loose teeth have been found on several papyri dating from the period. This is also when we see the first mention of what we would today call a dentist.
Hesy-Ra was an Egyptian high official during the early Third Dynasty of Egypt, which started around 2,686 BC. He came with a catalogue of titles, as the upper echelon of Egyptian society tended to have back then, including Wer-ibeḥsenjw – meaning either “Great one of the ivory cutters” or “Great one of the dentists”. While there are some question marks over the exact translation, Hesy-Ra is often regarded as the first recorded occupational dentist.
Early Teeth Replacements
Today, if you happen to knock a tooth out a replacement can be quite easily inserted in its place. But those who lost a tooth in ancient times could either go without or undergo the kind of early dentistry that shares many parallels with torture. Evidence from China dating from 4,000 years ago suggests that carved bamboo pegs were tapped directly into the bone to act as replacement teeth. In Ancient Egypt, they had the same idea but instead of bamboo, it was precious metals or ivory that were used, while mummies have been found that appear to have somebody else’s teeth jammed into their empty cavities.
Jumping forward 2,000 years or so, a discovery in Honduras showed a skeleton that had specially carved seashells inserted into the mouth. Bone growth around the shells, as well as the formation of calculus, seemed to suggest that the shells had not simply been for aesthetic purposes and that the female had been able to use them in exactly the same way as normal teeth.
As any good dentist will tell you, preventive care goes a long way. While there had been plenty of ideas about addressing tooth problems after they arose, it took some time before real preventative practices came along.
Some of the earliest such examples were the Babylonian chew sticks dating from around 3500 BC, while the Hindu texts known as the Vedas also included passages that recommend using a twig with a frayed end to chew and brush against the teeth.
The first bristle toothbrush was invented by the Chinese sometime between 619-907 AD with the bristles made from – wait for it – coarse hairs of the cold-climate hog that lived in Siberia and Northern China.
While it would be a stretch to say dentistry leapt forward during the glory days of Ancient Rome, there were certainly some of the most important steps forward. It was here that we see the first early crowns and bridgework done while there were also some significant improvements with dental prosthetics.
Medical writer Cornelius Celsus was way ahead of his time in many ways and it’s believed that he administered some of the earliest fillings using molten lead – though it’s not immediately clear whether this was to create a long-lasting tooth substitute or to simply enlarge the tooth to aid with extraction.
The Romans also used frayed sticks to clean their teeth but also a powder to accompany it made from ground-up hooves, pumice, eggshells, seashells, and ash. And lastly, we come to perhaps the earliest known mouthwash used to whiten teeth – human urine. Yes, that’s right, Celsus recommended swishing the first morning drops – and he was particular that it needed to be the first – around the mouth before spitting it out.
And if you thought that was questionable, how about the urine collectors who were stationed on street corners where they would collect the morning nectar of passer-bys before selling it on to other customers. Sounds stomach curdling I know, but again, there is some scientific basis for this, in that urine does contain high levels of ammonia, which is a cleaning agent.
With the collapse of the Roman Empire, Europe lurched backwards into what we now call the Dark Ages and it’s safe to say that much of the progress done with dentistry came underdone. In Europe at least, much of the preventative care was abandoned and if you had a toothache you would often head to your local blacksmith who would yank the tooth out before you typically fainted from the pain.
It would take some time until recognised dentists appeared and until then your options were fairly limited. Barber surgeons would be your first choice – men who could cut your hair, shave you, amputate your arm and pull a tooth out all in the same visit. Sometimes monks would agree to give it go, but this was eventually banned by the church, probably because the actions of these men of God were causing so many deaths.
Techniques used during this period would be the source of modern nightmares. Dental keys could be used to lever out a tooth, or even break it apart to make extraction easier. Hammers, chisels, forceps and many other grim apparatus that you might find in a SAW film were used in the most appalling of ways. Needless to say, without any form of anaesthesia or detailed knowledge about infections, this was not only hellishly painful but carried a high risk of death also.
As time progressed, we saw the appearance of specialised tooth-drawers who would either travel throughout the country or have their own establishment where they would pull teeth for a small fee. Now, no doubt some were genuine, but many were not, and in fact, it was during this period that the word ‘charlatan’, meaning a person who falsely claims to have special knowledge or skills, first appeared.
Travelling tooth drawers would sometimes be accompanied by musicians and entertainers who would effectively put on a show for the village with the main event of the tooth extractions. The problem was that many of these teeth probably didn’t actually need pulling and the tooth-drawers would often use the occasion to sell various highly dubious medicines, ointments and charms.
Modern Dentistry Emerges
Until the 18th and 19th Centuries, dentistry was still typically barbaric, often carried out by those who didn’t really have any idea about the complexities of the human mouth. It wasn’t uncommon for pieces of the jaw bone or other teeth to come out during an extraction – which obviously didn’t cure your toothache as one might have hoped.
The French surgeon Pierre Fauchard is widely regarded as the father of modern dentistry and his work was wide-ranging, to say the least. He created or adapted a large selection of tools to be used, pioneered modern dental prosthesis using pieces of carved bone or ivory to mould replacement teeth and was also the first to use braces to straighten teeth out, typically made of gold with waxed linen or silk threads to tighten the braces. We also have Fauchard to thank for his early observation that sugar-derived acids often led to some of the worst teeth decay – though considering how much is still consumed today Fauchard is probably rolling over in his grave with exasperation.
While dentistry was surging forward in terms of treatments, it remained an excruciating experience for many. For thousands of years a huge variety of pain relief had been used, including opium, coca leaves, alcohol and hashish, but at their best, they simply dulled the agony slightly. A trip to the dentist to have a tooth pulled continued to be an absolute horror until the discovery of successful anaesthesia.
Today, forms of anaesthesia are typically divided into three; local, which normally gives a numbing effect for a few hours, sedation, which itself is divided into three, mild, moderate, or deep and general, which means you are completely asleep. What kind of anaesthesia you are given generally depends on how complex the surgery is but also your level of anxiety.
The effects of nitrous oxide – or laughing gas as it’s now commonly known – first came to the fore in 1779 but it took some time for it to really catch on. In the meantime, two other forms of anaesthesia arrived on the scene, namely, ether which was first successfully used in a surgery to remove a tumour from a jaw bone in 1846, and cocaine which began to be commonly used after 1884.
Initially, the drug that would go on to power many a frantic late-night conversation, was seen as a semi-miracle drug championed by none other than Sigmund Freud. However, once the number of people dying from accidental overdoses while in surgery began to soar – accompanied by a growing number who mysteriously just couldn’t get enough of it – cocaine soon fell out of favour.
In 1904, Procaine, otherwise known as Novocaine was discovered and began to be widely used within dentistry right up until the 1940s, and beyond in some places. Today, the go-to local anaesthetic for dentists is Lidocaine, Articaine, Bupivacaine and Mepivacaine. For sedation, dentists might use diazepam (Valium), midazolam, propofol (Diprivan) and nitrous oxide, while general anaesthetic might be given using any one of propofol, ketamine, etomidate, midazolam, diazepam, methohexital and nitrous oxide.
Into the 21st Century
Dentistry, like every other medical procedure, has changed dramatically over the last 200 years or so, but even over the last 50, or even 20 years there have been enormous improvements in terms of equipment and pain relief.
The air-abrasion system, where a fine stream of particles is aimed at the teeth, has largely replaced the traditional, and frankly mentally scarring dental drill, while the use of lasers and robot-assisted dental surgery, though still in their relative infancy, could well completely transform the experience.
Microscopes, CT scans, X-rays and computer-assisted design (CAD) technology now allow dentists to get ahead of teeth and gum issues before they erupt, placing the focus much more on preventative care rather than reactive. In short, going to the dentist in the 21st Century need no longer be the heart-stopping experience it was for hundreds and even thousands of years. Instances of death while at the dentist are now astonishingly rare, but you don’t need to go back too far to find a very different situation. When London began listing its ‘Bills of Mortality in the early 1600s, “teeth” was continually listed as the fifth or sixth leading cause of death – usually because of infection or complications after surgery. And by surgery I mean a brute with a pair of iron forceps and by complications I mean the unexpected and unnecessary removal of vital parts of your mouth, jaw and sometimes head.
So next time you sit back in the dentist chair, spare a thought for the marvellous array of modern technology surrounding you that means that you will almost certainly not die and will most likely feel immensely better after your visit. Compared to what used to happen to us for thousands of years, this is well and truly the golden of dentistry.
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History of dental treatments – Wikipedia
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A Brief History of Dental Anesthesia – Spear Education
A Visual History of the Toothbrush | Museum of EveryDay Life
Barber-surgeons and the history of the dentist | Art UK
The Ancient Romans Had Healthier Smiles Than We Do Today | DOCS Education
All Things Georgian – Writing about anything and everything to do with the Georgian Era (wordpress.com)