We think nothing of it when our teeth do their job—and we can think of little else when they subject us to agony. Perhaps that’s why humorists depict the history of dentistry as a chronicle of pain. If that is true, then it turned out to be just the incentive needed. Dentists pioneered anesthesia, one of the pillars of modern surgery. And dentists scored again by producing some of the first materials and techniques for repairing and replacing body parts—body parts assaulted daily by a phalanx of mechanical and chemical stresses.
Dentistry continues to lead the charge in key areas. Dentists are migrating to digital x-ray technology. Dentists have started to employ computer aided design/computer aided manufacturing (CAD/CAM) to aid restoration. By focusing on the body’s portal for nourishment, dentists are also doing their share to prevent disease.
The French surgeon Pierre Fauchard is considered the father of modern dentistry. Working in Paris, he published a systematic study of the subject in 1728 (The Surgeon Dentist, A Treatise on Teeth). Until that time, the few skilled dentists kept their knowledge secret. Fauchard described a number of dental instruments and recommended the use of human urine to treat early-stage tooth decay—an idea that originated in ancient times. (The ammonia often found in urine is truly beneficial.) Fauchard debunked the “worm theory” of tooth decay, identified sugar derivates such as tartaric acid as the true cause, and prescribed the use of lead fillings.
In 1790, John Greenwood—famous for producing President George Washington’s dentures—used an old spinning wheel to build what may have been the first foot operated drill. Mercifully, he didn’t use it to drill patients’ teeth; he used it to fashion dental prostheses. However, it wasn’t long before dentists began using hand drills running about 15 revolutions per minute (RPM) on patients.
In 1864, British dentist George Fellows Harrington invented a clockwork dental drill—a drill that was wound up like a clock and ran for two minutes. However, that invention was preempted by James Beall Morrison’s 2,000 RPM pedal powered drill in 1871. It reduced drilling time by about 50% but had an unintended downside: In the 19th century, dentistry was completely unregulated, and once the pedal powered drill became affordable, the field was flooded with uneducated, unskilled, and unethical practitioners.
The S.S. White Company introduced the first battery-powered electric drill in 1883. To modern readers, this might suggest the company was seeking to create wireless drills. In truth, they employed batteries because there was no power distribution grid at the time.
High speed (60,000 RPM) turbine drills were developed after World War II by John Walsh, a dentist with the Royal Australian Air Force, and Dr. Robert J. Nelsen, research associate with the American Dental Association at the National Bureau of Standards (NBS) in Washington, D.C. Then Dr. John V. Borden used compressed air to power his 250,000 RPM Airotor. Air turbine units are still used for 95% of dental drilling—though high-speed, microprocessor-controlled electric hand pieces threaten to replace them.
New technologies have been developed for early detection of cavities and even oral cancer. KaVo Dental’s Diagnodent uses a 655 nanometer wavelength laser to detect small cavities. LED Dental’s VELscope employs a blue light to detect fluorescence associated with potentially malignant tissue.
Dentists played a leading role in the development of anesthesia. In 1844, Horace Wells in Connecticut discovered nitrous oxide’s anesthetic properties and used it to perform tooth extractions. He conducted the first public demonstration of anesthesia in 1845, but the demonstration was a failure because the patient cried out. In 1846, Wells’s student William Thomas Green Morton conducted the first successful public demonstration of anesthesia using ether. Many people have pointed out that Morton did not invent ether. However, that argument misses the point. It was Morton who recognized the importance of administering the right amount of anesthetic at the right rate using the right equipment. He invented a way to make anesthesia reliable and safe. (Ironically, today most dental procedures use local anesthetic.)
Roentgen’s discovery of x-rays in 1895 was a boon to dentistry. Dental x-rays reveal problems such as cavities, hidden teeth, and bone loss. Fortunately, most dentists didn’t embrace x-ray technology until after 1930; by that time more was known about the health risks associated with x-rays and exposure times had been greatly reduced. (Even so, many dentists and their assistants developed cancers on their fingers from the habit of holding films in place in their patient’s mouths.)
Traditional film-based dental radiography is being replaced by digital x-ray technology. X-ray film must be shielded from light before use, developed in a darkroom using harsh chemicals, and then physically stored for future reference. Digital x-ray technology is safer, saves time, and ultimately saves money. Digital x-rays can be viewed immediately. It’s easy for dentists to share digital x-ray images with specialists; instead of sending the original film or a copy in an envelope, the images can be sent via email. Another advantage of digital x-ray technology is that it requires less than half as much radiation exposure. There are even special CT scanners for planning dental implants.
Dentistry is rapidly changing thanks to new technology. Or perhaps it would be more accurate to say that consumers’ expectations from dentistry are rapidly changing thanks to new technology. As one dentist told me, dentists who do not use the latest technology, or at least offer referrals to dentists using the latest technology, risk being accused of malpractice.
Next time: Bodies in Cyberspace
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