History of Dentistry in the 18th Century

Teeth #4 Josiah Flagg Chair
Teeth #4 Josiah Flagg Chair

Throughout the eighteenth century, upper and lower classes both shared the same woes when it came to decaying teeth and the somewhat primitive, even barbaric means of dental care.  Diseases like smallpox, malaria, scurvy, and syphilis (to name a few) were rampant.  So too were the diets heavy on sugar, sweetened teas, fortified wines, and sugary alcohol, and light on fresh fruits and vegetables.  Both disease and sugar diets contributed directly to gum and tooth decay ultimately leading to the  loss of teeth.  For many, there was no avoiding this slow and painful process.   Dentistry came into its own during the seventeen hundreds.  Treatises were published, scientific lectures were given, the first surgeons were trained specifically in dentistry, exposed nerves leading to pain were considered, nonsense remedies were rejected, and many inventions   were patented.  Though dentistry was still in its infancy, more could be done to ease pain, help patients chew their food, and improve general appearance.  As always, the quality of care and materials determined on the class of an individual.

Popular opinion believes that during colonial times, false teeth were carved from wood.  George Washington is referred to as a perfect example.  That is why he never smiled during any of his painted portraits. Wrong.  George Washington was a very wealthy man.  He could sport some of the highest quality false teeth of his time.

While the wealthy could afford trained dentists, rural folks depended on the village blacksmith, hairdresser, silversmith, etc. to help eleviate toothaches and extract teeth.  Market fairs sold tinctures, toothpowders and abrasive dentifrices.  Among the rural farmers, barbers, and tooth drawers, there were many painful practices adopted to extract teeth;  forceps, pliers, hot coals, string, etc.

False teeth became more common using various materials.  Even live teeth from humans was sought after.  Children were lured to allow their teeth to be extracted for the benefit of the wealthy in exchange for a few shillings.  In 1782, an ad in New York City’s Riverton’s Royal Gazette offered four guineas for each sound front tooth.  Another ad stated, “Most money given for live teeth.”

Renowned Dentists and Dental Practice

Prior to the 18th century, teeth extractions were the main means to alleviate tooth decay.  Lorenz Heister (1683-1758), of Frankfurt-am-Main, published a treatise on dentistry entitled De Dentium Delore in 1711.  As opposed to abstracting the entire tooth when it became decayed, he advised removing just the decayed part using a file or toothpick (metalic) and filling the cavity with white wax, mastic or gold, or lead-foil.  If large portions of the tooth were removed, he described prosthetic pieces made of ivory or hippopotamus tusks that could be inserted and held in position by their form alone.  Rene Jacques Croissant de Garengeot (1688-1759) believed that filings ruined the enamel and refrained from encouraging the practice.

Teeth #1 English Key
Teeth #1 English Key

Right up to the eighteenth century, the pelican or forceps were used to extract teeth by exerting lateral force on the tooth.  By the early 1700’s, the forceps were modified into what became known as the ‘key of Garengeot.  It was at first supposed that Garengeot had invented the key named for him (bent shaft type of iron toothkey with molded stem and turned bone handle). However, the key was used prior to Garengeot’s use and attributed to German origin.  The instrument was far more efficent for extracting teeth and was in general use throughout the 18th century and beyond.   John Aitkin pefected the English key in 1771, which rendered the extraction of teeth easier and less liable to fracture the jaw, teeth, or gums.

Another early dentist,  Johann Adolph Goritz of Regensburg, wrote a treatise in 1725 that opposed too many extractions.  He also frowned upon the insertions of prosthetic pieces such as ivory porcelain.  He believed that by wiring them to the natural tooth, it caused great strain on the tooth and loosened the abutments resulting in tooth loss.

Heinrich Bass (1690 – 1754), fumed over the abuse of extracting teeth inconsiderately and without absolute necessity.  He believed the extradition of upper molars could produce the opening of Highmore’s antrum (pyramid-shaped maxillary sinus, largest nasal sinus) and give rise to “regrettable accidents.”

Pierre Fauchard was born in Brittany around 1690 and died at Paris in 1761.  He is considered the founder of modern dentistry.  He offered valuable opinions and pioneered practical procedures.   His highly detailed and comprehensive work on dentistry was published in 1728.  Entitled Le Chirurgien Dentiste, it marked a new epoch in the history of dental care.   It was compiled in two volumes with forty full page plates, 863 pages in all.  It covered all aspects of dentistry as understood and practiced in the mid-eighteenth century.   Fauchard did not create the art of dentistry, but elevated it to a more piratical science through his inventions and by collecting and publishing all available knowledge on the subject.

Very little was written about dentistry prior to Fauchard.  The knowledge of dentistry was passed down from master to apprentice.  Earlier dentists guarded their knowledge with secrecy so someone else might not profit at their knowledge.  Fauchard firmly believed that there should be a school of surgery in which the theory and the practice of dental surgery could be made available to all who were qualified and properly taught.

Fauchard wrote clearly and concisely.  The following is an example taken from Taylor’s text on the History of Dentistry, page 52:    “They may be cleaned… straightened, and shortened.  Caries [decay] be removed… may be cauterized [burned or seared], filled with lead, separated, placed in proper position, fastened, removed from the jaw, replaced in the jaw, or they may be taken out to be placed in another person’s mouth… All of these operations demand a skillful, steady, and trained hand and a complete theory.”

WormsFauchard also did away with the foolish idea that worms burrowed in teeth causing toothaches and tooth decay.  This was accepted as fact for over a thousand years.  Some continued to give credence to an ancient Chinese remedy to rid oneself of worms, “Roast a bit of garlic and crush it between the teeth; mix with chopped horseradish seeds or saltpeter; make into a paste with human milk; form pills and introduce one into the nostril on the opposite side to where the pain is felt.”   Arsenic pills were also used.

Teeth #2 Extraction using Key
Teeth #2 Extraction using Key

Nicolas Andry (1658 – 1742), appointed dean of the medical faculty of Paris in 1724, wrote extensively on worms and claimed he had seen them through his microscope.  He even described them as having small round heads, a black spot, and long, fine body.   Andry also states that bad breath is caused by worms.  He supported the use of smoke from henbane seeds as a way to cause the worms to drop out.  Fauchard did all he could to try and support Andry’s claims.  He used the finest microscopes of Manteville and diligently followed Andry’s procedures.  He never found worms.  He finally had to write that there is no conclusive evidence of their presence and therefore denied their existence.

Toothache Cures:  L. B. Lentin, a German surgeon, acknowledged his use of electricity as a cure for toothache in a pamphlet he wrote in 1756.  Steel magnets were claimed to be effective in curing toothaches by many learned men of the times.  In the later half of the seventeenth century, Talbot, J. J. Weckes, P. Borelli, and the Swiss dentist Paracelsus related several cures of headache & toothache by the use of magnets.   In the early eighteenth century, F. W. Klaerich, a doctor in Gottengin, wrote that he had successfully used magnets in over a hundred and thirty cases in the cure of toothaches. Brunner and J. G. Taske championed magnets.  The later wrote a treatise in 1765 entitled New Experiments for the curing of Toothache by Means of Magnet Steel.  Claude Mouton’s remedy against toothache used subluxation of the teeth (basically to loosen the tooth manually) for the purpose of severing the dental nerve and reducing pain.   

Elixers:  Fauchard strongly condemned the use of elixirs and crank cures by magical means.  The practice was so common that Fauchard is known to have exclaimed “There will shortly be more dentists than persons affected with dental diseases.”   Fauchard was the first to champion the need of comfortable seating during operations.  Common practice of the day included sitting the patient on the ground, the floor, or holding him or her between the operator’s knees.  It was both unskillful and unsanitary and in the case of pregnant women, could have been  harmful.   Acids:  Far-sighted, Fauchard wrote in his monumental treatise that it was sugar derivate acids such as tartaric acids that were responsible for decaying teeth.

Teeth #5 18th Century Pelican Forceps
Teeth #5 18th Century Pelican Forceps

Crowns:  In 1746, Mouton wrote a monograph on mechanical dentistry in 1746.  He describes the application of gold crowns to teeth which were badly decayed.   Caps:  Philip Pfaff, dentist to Frederick the Great practiced capping an exposed nerve before placing a filling in the cavity.  Fauchard filled the cavity directly over the exposed nerve.

Frenchman Louis Bourdet, dentist to the King of France, proceeded Fauchard’s book with his own The Dentist’s Art.  He included a section on extracting carious teeth (having caries or decay) then filling them with gold or lead and replanting them.   He dedicated a chapter to tooth alignment and application.  He perfected the ‘Blandeau’ (a horseshoe-shaped piece of iron that helped expand the arch).  He was also the first dentist to recommend extraction of the premolar teeth to alleviate crowding and to improve jaw growth.  He lamented the act of putting hard objects in childrens’ mouths to help them ‘cut their teeth.’  He held the practice useless and condemned it as harmful.  As to decay, he thought that frequent changes of temperatures was a factor; unlike bones that were protected by flesh and organic material.

False teeth and Dentures

As mentioned, wooden teeth never existed.  The eighteenth century saw the first treatises on proper extraction of teeth and the development of special instruments like the ‘English key.’   False teeth were made from bone, various animals (esp. sheep), ivory from walrus, elephant or hippopotamus, and human teeth.  (After the battle of Waterloo in 1815, a herd of entrepaneaurs swarmed over the battle field extracting teeth from the fallen soldiers.  For decades dentists advertised dentures made of ‘Waterloo’ teeth).

Teeth #3 Washington's Dentures
Teeth #3 Washington’s Dentures

By the end of the eighteenth century, teeth were made of other products, esp. porcelain.  The porcelain teeth were mounted on gold or platinum bases.  The process of constructing these teeth was the same as used in making fine porcelain; a fine texture, slightly translucent, and like enamel, having enormous strength.

John Hunter, celebrated English surgeon who was made Surgeon-Dentist to the British Army in 1776, practiced extracting teeth and then replanting them.  He did extensive research and what would be considered lab experiments as he refined his art.  He described these operations much more fully than ever before.  In 1771, he published a book entitled Natural History of the Human Teeth, and in 1776, another work entitled Practical Treatise on the Diseases of the Teeth.  He was a sought after lecturer and kept an excellent anatomical collection and extensive library.  He experimented by transplanting a sound tooth drawn from a living person into a cock’s comb by making an incision with a lancet.  Months later the cock was killed. The head was injected and examined.  The tooth was found to be attaced and circulation established as is found in the natural gums.  Transplanting and replanting was common at the time.  It was also profitable.  Paul Eurialius Jullion’s fee was five pounds, five shillings for transplanting a live tooth and two pounds two shillings for a dead tooth.

The first problem in making both bridges and dentures was how to keep them in the mouth and remain in the right position.  Also how to make the baseplate material; that which held the false teeth which were mounted on a gold or ivory base.  Denture plates were made of carved hippopotamus ivory into which human teeth (along with parts of both horse and donkey teeth) were fitted.  Sometimes the entire bridge was carved from the same material, therefore all became one piece that fitted into the mouth.  Philip Pfaff (pioneer of caping teeth) made what is considered the most important contribution to dental science.  It was the invention of the plaster model that was poured in a beeswax impression.  Isaac Greenwood brought this technique when he imigrated to Boston.

Mouton, who did research on nerve endings, invented a method of applying partial dentures by fixing them to the natural teeth with springs or clasps.  It became very popular throughout the century.  In 1737, Fauchard made a full upper set of teeth for a lady of high rank, holding it in place with springs.  He writes that the lady ate with it easily and could not get along without it.  He also writes of constructing a full upper and lower set for a man who had worn them for more than twenty-four years.  In making a full upper set of teeth, Fauchard used flat springs to hold the piece in place.  Atmospheric suction was not used until the next century.

Early on, Dentists were seeking other materials to construct false teeth.  In 1710, Jacques Guillemeau combined materials of his own invention for making artificial teeth.  He suggested making a paste composed of white wax, softened with a little gum elemi.  A powder of white mastic of coral and pearl was added.  He and later others claimed that teeth made of this composition never yellowed.  Fauchard described how he constructed artificial teeth using silver, mother of pearl, and even enamelled copper.

Around 1774, Alexis Duchateau developed the first porcelain dentures.  These early teeth were prone to chip and tended to appear too white to be convincing.   He became disgusted with a the odor of a denture he was wearing of hippopotamus ivory.  He told a porcelain manufacturer in Paris, Guerhard, to have a porcelain set made.  Due to the contraction of porcelain, many attempts were  unsuccessful.  A set was eventually made, but not to Duchateau’s satisfaction.  Further experiments were conducted without positive result.  He sought help by turning to Nicholas Dubois de Chamant.  Finally, a set was built that Duchateau could wear.  Duchateau tried to make money by provinding porcelain teeth to persons of high rank, but his knowledge of dentistry was limited.  Duchateau gave up, however Chemant continued the work.  He perfected it by using Fontainebleau sand, alicant soda, marl, and oxide of iron to give proper coloring and control shrinkage.  To his advantage, he had access to the French government’s porcelain laboratory in which he developed his recipes and made experiments.  After many successful attempts, he published the results in 1788.  In 1789, he informed the Academy of Sciences of his invention and applied for a patent.

Toothbrush

Fauchard made reference to toothbrushes that were already in use.  These were made of horsehair or hog bristles.  First conceived in China, they became popular in Europe by the seventeenth century.  The first mention of the word toothbrush was found in a 1690 autobiography by Anthony Wood   Fauchard believed they were too rough and destructive to teeth.  He advised using small sponges to rub up and down on the teeth, both inside and out.  The sponges were to be dipped in tepid water.  He recommended dipping the sponges in aqua vitae (concentrated solution of ethanol typically prepared by distilling wine) as he wrote: “… the better to fortify the gums and render the teeth firm.”  In 1780 William Addis massproduced the first toothbrush as we know it.  In 1770, while jailed for causing a riot, he witnessed jailees rubbing their teeth with a rag coated with soot and salt.  Upon release, he set about manufacturing large numbers of toothbrushes of bone and wooden handles implanted with bristles.  He became very wealthy.  His company exists to this day as Wisdom Toothbrushes.

Dentists in America

James Mills ran an ad on January 6, 1735, in the New York Weekly Journal. “Teeth drawn and old stumps taken out safely… instructed in the art by the late James Reading, deceased… [Mills] is to be spoke with at his shop in the house of the deceased near the Old Slip Market.”

Isaac Greenwood practiced dentistry in Boston about 1750.  It is recorded that he carved false teeth from hippopotamus tusks and used beeswax molds in his pattern.  His skills in dentistry was as an ‘ivory turner’ only.  He had other interests as a mathematical instrument maker and umbrella manufacturer.  He also made the first electric machine for Benjamin Franklin.

Josiah Flagg was a Bostonian and the first native born American dentist who exclusively prepared for the profession.  In 1790, he constructed the first chair made specifically for dental patients.  He used a windsor chair and attached an adjustable headrest and extended arm to hold instruments.

James Daniel was a Boston hairdresser by trade.  He also added dentistry claiming “The business so absolutely necessary in this city.”  His placed an ad in 1766 offering to operate on teeth.  It was not uncommon for early dentists to have one trade and do dentistry on the side.  A Mr. Hamilton, no relation to the famed treasurer, advertised in 1767 in the New York Chronicle that he could cure violent toothaches stating, “no cure, no pay.”

Robert Wooffendale (17601819) was instructed by Thomas Berdmore, dentist to King George III.  He arrived in America in 1766.  He practiced in NY briefly before moving to Philadelphia.  He advertised in the Pennsylvania Chronicle claiming that he had been instructed by the “present operator of the King’s teeth” and that he “performs all operations upon the teeth, gums, sockets, and palate; also fixes artificial teeth.”  He later moved back to NY.  When Berdmore died in 1768, he assumed the role as King’s Dentist and moved back to England.  He returned to NY in 1795 and eventually retired to Long Island.

John Baker put an ad in the Boston News Letter in 1767 stating that he had administered dental services to the royal elite of Europe.  He is noted to have taught the art of dentistry to the Boston silversmith, Paul Revere.  As a silversmith, it was not too farfetched that Paul Revere would also apply his metal skills to dentistry; silver was one of the materials used in construction, fillings, and caps.  He constructed a dental bridge for Dr. Joseph Warren.  Dr. Warren was at the Battle of Bunker Hill and killed by a British musket ball to the head.  The high caliber of shot would have disfigured Warren’s facial features dramatically.  Revere identified Warren after claiming the dental bridge was the doctor’s.  This the first known case of postmortem dental forensics.

Washington

As mentioned, false teeth were not constructed of wood.  George Washington ordered a pair of dentures from the New York ivory turner, Dr. Greenwood in 1798.  It was constructed of gold wire springs and teeth carved of hippopotamus ivory.  Though the dentures would seem uncomfortable to the modern eye, they were a great improvement over what Washington had been wearing.

Washington began losing his teeth at twenty-two.  He was a wealthy man and could afford to order dentures made from among the finest dentists of Europe.  It is believed that prior to the pair of false teeth he purchased from Greenwood, was a set made by the famous Parisian dentist Nicholas De Chemant; pioneer of porcelain teeth.

Washington was gracious to Greenwood and appreciated his workmanship.  However, when he sent some dentures to Greenwood for cleaning, he received a cordial reply in dental care not unlike that given today.  “The set [of false teeth] that you sent me from Philadelphia… were very black, occasioned either by your soaking them in port wine (common practice), or by your drinking it.  Port wine being sour, takes all the polish… Acid [from the wine] has a tendency to soften every kind of teeth and bone… I advise you to either take them out after dinner and put them in clean water and put in another set or clean them with a brush and some chalk scraped fine, it will absorb the acids which collects from the mouth and preserve them longer.”

RESOURCES

Guerini, Dr. Vincenzo.  A History of Dentistry From the Most Ancient Times Until the End of the   Eighteenth Century. 1909:  Lea & Febiger, Philadelphia, PA.

Hillam, Christine.  Dental Practice in Europe at the end of the Eighteenth Century. 2003:   Editions Rodopi B.V., Amsterdam-New York, NY.

Lennmalm, Herman, D.D.S.  World’s History and Review of Dentistry. 1894: C. B. Conkey Co.,    Chicago, IL.

Taylor, J. A., D.D.S.  History of Dentistry, A Practical Treatise.  1922:  Lea & Febiger,      Philadelphia, PA.

White, Samuel S., History of Dental and Oral Science in America.  1876:  The American   Academy of Dental Science, Boston, MA.

Wynbrandt, James.  The Excruciating History of Dentistry:  Toothsome Tales & Oral Oddities       from Babylon to Braces.  2000:  Macmillan Publishing Company, New York, NY.

Read the first installment of A Black Man’s Destiny (Shades of Liberty) here.

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