Dentistry: The History of Mankind's Oldest Medical Discipline

Treating dental disease is not a modern invention - archaeologists date the origins of dentistry as far back as the third millennium BC. But over time, the methods and the image of the experts changed: from the respected dentist of the rulers to the traveling barber, the surgical "craftsman" for the common people. Nowadays, dentistry encompasses numerous disciplines, which in turn work with innovations from nanotechnology and digital technology. But a sometimes brutal and bloody path led to this point.

First references to dentistry in the pre- and early Christian era

For a long time, scientists were of the opinion that Stone Age people shouldn't have any dental problems. After all, our ancestors ate neither sugar nor concentrated carbohydrates from domesticated grain, so that caries bacteria actually lacked the basic food source. However, archaeological finds from North Africa proved the experts wrong: the 14,000-year-old dentition of hunters and gatherers showed such a dilapidated state of the teeth as is known in modern times only from industrialized countries.

Around 90 percent of adults in the Late Stone Age suffered from tooth decay, and around half of the people lived with at least one large cavity in their teeth. Did Neolithic dental patients have any choice but to simply endure the pain? In fact: traces of pointed stone tools on the teeth indicate that even then attempts were made to "drill out" the holes. This practice can also be proven later; eg in 8,000 year old molars from Pakistan.

Stone Age seals

Archaeologists discovered a very early variant of tooth fillings in Slovenia. There, around 6500 years ago, an attempt was made to restore a canine tooth with beeswax. The researchers speculate that the wax filling was intended to alleviate the pain when chewing, which the broken tooth must have caused its owner.

Early importance of tooth cleaning and prophylaxis

In ancient times, teeth were not only treated and reconstructed, they were also cared for in order to preserve them as best as possible. The inhabitants of North Africa, the Arabian Peninsula and India used the branches of the arrack tree for dental hygiene. This tree, which is also known as the "toothbrush tree", contains natural bassanite crystals in the wood, which clean the tooth enamel like the cleaning particles in toothpaste. The plant parts also have a significant fluoride content.

In practice, you cut off a branch of the tree about 20 centimeters long and chewed on the wood until one end frayed into fibers and took the shape of a brush. It can then be used to care for teeth, gums and tongue. In the Islamic world, this "primordial toothbrush" is known under the names Miswak or Siwak. Historians document the earliest use of natural toothbrushes by the Babylonians around 3500 BC. Christ.

Mouthwash for the brave

Mouthwash has a similarly long tradition in China. Here, however, no menthol-containing mixture was used as we know it today, but children's urine was used as a gargle solution. The reason: urine contains carbamide peroxide and urea, which can relieve pain and promote healing processes in the mouth. Self-urine therapy remained popular for centuries right up to modern times: In France, it was still practiced by the upper class at the time of "Sun King" Louis XIV. The noble Marquise de Sévigné instructed her daughter in a letter that she should have her teeth prophylactically in the morning and Should rinse with fresh urine in the evening to prevent tooth decay.

Early interpretations of dental disease - the toothworm

Thousands of years ago, people valued dental hygiene and treated caries and tooth loss reconstructively. But how did you explain tooth decay back then? Hardly any ancient culture made a connection between eating habits and dental status - instead, a medical legend spread globally: the toothworm.

Archaeologists found its earliest mention on a Sumerian stone tablet near modern-day Baghdad. It says that a worm is the cause of a toothache. A Babylonian text describes the nature of the creature: During the creation of the world, the worm would have rejected the divine gifts of the sweet fruit and wanted to drink the blood of the teeth instead. At the same time, the text offers an incantation against toothworm for toothache sufferers to recite before treating their ailment with folk remedies.

An urban legend travels the world

As amusing as the idea of ​​small worms eating the characteristic cavities in the teeth sounds, it was widespread in earlier centuries: personal physicians to the Roman emperors recommended driving the worm out of its hiding place with an incense treatment made from henbane, while the Aztecs and Maya filled the tooth cavities with tobacco to fight toothworm. In Japan and China, diseased teeth were also referred to as "worm teeth" and even Homer, the greatest poet in the Greek world, described the legendary toothworm in his Odyssey.

After all, the toothworm legend offered many quacks material to sell their products to the public. They embedded earthworms in pastes that toothache patients were supposed to suck during a therapy demonstration. When the worm appeared on the tongue, the hawker removed it from the eyes of onlookers to suggest the effectiveness of the antidote.

Ancient treatment methods

Even the ancient Egyptians, Greeks and Romans went to great lengths to keep their teeth functional and aesthetic. Gold was used, as it is today:

Tooth preservation in Egyptian mummies

A stone relief from the famous tomb of Saqqara shows a respected man of the Egyptian upper class: Hesi-Re lived on the banks of the Nile 2,700 years ago and was honored with the title "Head of Dentists" at the Pharaoh's court. How much practical experience the dignitary actually had in the field of dentistry is uncertain, since he also had a number of other honorary degrees.

In the kingdom of the pharaohs, dentures were not only intended for the living, but were a special privilege of the dead, as mummies have found. The belief that one would continue to exist in the afterlife after death, together with the body and grave goods, shaped how the deceased were treated: they were carefully mummified, and in addition to lost limbs, damaged teeth were also replaced in order to give them the best possible “equipment” for their afterlife to give.

Dental implants by the Celts

Dental implants are now considered the most elegant form of tooth replacement - perhaps the Etruscans already wanted to benefit from them. At least that is what the find in a 2,300-year-old Celtic grave suggests: The teeth of the approximately 30-year-old deceased were complete during her lifetime, apart from a single incisor, in the place of which an iron pin was inserted. In this case, it was not possible to clarify whether the tooth gap was closed post mortem for the afterlife or during one's lifetime.

A younger grave, in which a young man was buried 1900 years ago, offered clear indications. An iron pin had grown into his jawbone as a dental implant – so he had received and used the dentures during his lifetime. It remains unclear whether the metal pins remained uncovered at the time or whether they were made of bone, ivory or wood.

Etruscan prostheses

The Etruscans, who lived around 1000 to 800 BC. BC before the Romans settled in Italy are considered the inventors of the dental bridge. Here, artificial teeth made of bone or ivory were connected with gold wire and - similar to what is still common today - attached to the patient's own teeth with metal brackets. This custom was then adopted by the Roman upper class, who even adapted their burial rites to dentures. It was actually forbidden in the Roman Basic Law to bury the deceased with golden valuables - only for the dentures made of precious metal there was an exception clause.

Early stunning methods

After the fall of the Roman Empire and the beginning of the "Dark Ages", dark times also began for dentistry. Artistic dentures went out of fashion - rotten teeth were more likely to be extracted than to try to laboriously restore them. Medieval dentists therefore did not operate with filigree instruments, but primarily needed ropes to tie their patients down, as well as brandy and wooden hammers for sedation.

In these rough times, opium poppy was considered the most advanced anesthetic, but it brought with it strong side effects. At that time, how well the therapy worked depended on which therapist the patient went to. After all, no license was required to pull teeth: every pharmacist, every traveling alchemist and every barber could offer the medical service.

Barber as “dentist”

"Bader" was what the medieval vernacular called the operator of a bathhouse. The public baths were well frequented at that time, since hardly anyone had running water in the house, and they functioned as a popular social meeting place. However, since the establishments were also hubs for prostitution and shady business, in some places barbers were counted among the dishonest professions that were not allowed to organize themselves into guilds. In the 11th century, however, the barbers achieved a leading position in dentistry: at that time they assisted priests in pulling teeth.

After the church forbade the clergy from this sideline, the right passed entirely to the barbers. They took over the dental treatment of large parts of the medieval population. At the same time, they practiced bloodletting and cupping and developed sub-areas of surgery, such as opening and cauterizing plague boils or straightening broken bones.

Development of medical dentistry

Where are the links between modern dentistry and its ancient traditions? After all, the Celts already knew metal dental implants and the Etruscans used fixed bridges. Modern tooth fillings are also based on centuries-old predecessors. As early as the 7th century AD, Chinese dentists filled drilled teeth with an alloy of silver, tin and mercury – this mixture is now known as amalgam. The term seal is derived from the Latin word "plumbum" for "lead". The cheap metal was used by dentists in the Middle Ages as an alternative to gold fillings. The latter can look back on a particularly long history: as early as 1,000 BC. the Chinese filled caries holes by pressing in fine gold leaf.

Modern anesthetics allow for calm treatment

In 1844, the dentist H. Wells used nitrous oxide as an anesthetic for the first time, and the first anesthesia with ether took place in Boston two years later. These milestones in anesthesia finally made it possible for dentists in the 19th century to work in peace and significantly encouraged patients to accept treatment. There were also advances in prosthetics, where removable dentures were made of porcelain, the rubber base of which was relatively comfortable to wear. Porcelain as a tooth material made it possible to produce dentures that could be individually adapted to the wearer; an advance on earlier times when the teeth of animals or the dead were made into dentures.

Pierre Fauchard: father of dentistry

The dentist Pierre Fauchard (1678-1761) set new standards in dentistry with his books. He cleared up the fairy tale of toothworm and made it clear that sugar damages teeth and that its daily consumption must be limited. His standard work contains the basics of anatomy as well as descriptions of surgical and prosthetic methods. Fauchard was the first to describe the symptoms of periodontitis and recommended professional tooth cleaning by a dentist. He also recommended lead, tin and gold as filling materials, gave tips on suitable toothbrush materials and described how a knocked out tooth could be re-implanted.

In Germany, Philipp Pfaff, the court dentist of Frederick the Great, wrote a basic textbook based on Fauchard's findings. One of his own groundbreaking ideas was the process of taking an impression of the jaw using sealing wax to create dentures.

The age of sugar - changes for dentistry

Scientists now know that bacteria that cause tooth decay, such as Streptococcus mutans, multiply particularly well in the mouth if they are fed carbohydrates. The bacteria excrete acids that attack the enamel and promote tooth decay. The bacteria's favorite food, carbohydrates, is found in its most concentrated form in sugar - which is why the warning to children that they get tooth decay from sweets and gummy bears is anchored in popular consciousness.

The white gold makes black teeth

Pure refined sugar as we know it today and use it in many foods is a relatively new invention. It was not until the early 12th century that the first sugar arrived in Europe in the luggage of the Crusaders – and at that time only the rich could afford it. Like salt, sugar and honey, its natural counterpart, were used sparingly and in small pinches as spices. The "white gold" was immensely valuable in the Middle Ages: 1 kilogram of sugar was as expensive as 100 kilograms of wheat. Even honey as a sweetener was no bargain, because there was no commercial beekeeping. In the Middle Ages, the beekeepers had to laboriously search for the golden juice in the forest and steal it from the wild bee colonies - no harmless task.

Sugar could only be produced relatively cheaply in Europe when a German chemist discovered the sugar content of the local sugar beet in 1747 - before that, cane sugar was a luxury import product from the West Indies. From the 18th century, desserts, cakes and patisserie were booming thanks to cheap beet sugar at the courts and among the wealthy bourgeoisie. The result: Tooth decay became an epidemic for the wealthy classes and – the cheaper beet sugar became – also a problem for the common people.

Dentistry today – numerous disciplines

Function, health and aesthetics – modern dentistry follows these principles. The broad field is split into numerous specialist areas:

tooth preservation

Conservative dentistry today deals with both caries-related and non-caries-related tooth damage. This area also includes prophylaxis, which is intended to prevent damage with oral hygiene products and professional tooth cleaning. Defects are filled within caries therapy; crowning damaged teeth is also a task of conservative dental treatment. Another modern measure for tooth preservation is root treatment with electronic measurement of the tooth root canal, in which inflamed or dead tooth nerves are removed more quickly and safely in order to save the diseased tooth.

periodontology

This discipline revolves around the health of the periodontium. It is understood as the entirety of the alveolus (the tooth socket in the jawbone), gums, periodontium and cementum. Periodontists deal with preventive and curative measures against diseases of the gums and jawbone. The best known is periodontitis, in which inflammation causes the gums to recede and ultimately leads to bone loss in the periodontium.

oral surgery

Oral surgery includes many sub-areas; from the removal of wisdom teeth to the correction of frenulum of the lips and tongue to modern implantology. Modern dental implants are based on biocompatible titanium and high-performance ceramics. Rough surfaces of the artificial tooth roots today promote their ingrowth into the jawbone and lead to resilient and long-lasting results.

orthodontics

This discipline deals with the therapy and prevention of misaligned teeth and jaws. Depending on the age of the patient, there are many methods from braces to surgery. Today, experts recommend early treatment of potential misalignments at the time when the deciduous teeth are complete (3 years of age) or of the complete mixed dentition (6 to 8 years of age).

prosthetics

Replacing missing teeth as functionally and elegantly as possible – this is what dental prosthetics is all about. There are various options for removable prostheses and fixed bridges. In modern times, digital milling techniques and 3D printing help to customize dentures with millimeter precision.

Dentistry has a long history

Stunning with a wooden hammer method and dental treatment with your own urine - with a look at the history of dentistry, patients of the 21st century can count themselves lucky. However, as innovative as today's materials and methods may appear, they are still based on man's millennia-old striving to keep his teeth complete and functional.

06.09.2021

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