History of Dentistry

The oldest known dental text, a Sumerian document of c. 1900 BCE, attributed toothache to worms entering the teeth. The “tooth-worm” theory proved remarkably durable: it appears in Greek medical writing, in Aristotle and in texts of the Hippocratic corpus, and was still being discussed by European practitioners in the eighteenth century. It was a theory of cause, not of treatment — and treatment was limited.

In Egypt, the Ebers Papyrus (c. 1550 BCE) contains remedies for toothache — topical applications and mixtures to be applied to the aching tooth — alongside instructions for extraction. In Rome, Aulus Cornelius Celsus, in De re medicina (c. 30 CE), described extraction with a ligature and forceps and advised that teeth be extracted only when necessary. The ancient Egyptian medicine topic covers the wider medical context of these remedies.

In the medieval Islamic world, Al-Zahrawi (Abulcasis, 936–1013), working in Al-Andalus, included dental instruments and procedures in his Kitab al-Tasrif (c. 1000), one of the earliest systematic descriptions of dental practice in the medieval world. In medieval Europe, tooth work fell to barber-surgeons, whose guilds were formalised by charter — including the Paris surgeons' guild in the fourteenth century. In London, the Barbers' Company and the surgeons were united by royal charter as the Company of Barber-Surgeons in 1540. Extraction remained the default treatment; pain was managed with speed, restraint, alcohol, and opiates.

Non-European traditions treated toothache too, though the documentary record is thinner. Nineteenth-century Western accounts of Chinese practice, for example, record the cauterisation of carious teeth with silver nitrate — a practice that Western dentistry would later adopt and refine.

Pierre Fauchard (1678–1738) published Le chirurgien-dentiste (The Surgeon-Dentist) in Paris in 1728. It was the first comprehensive treatise to treat dentistry as a distinct discipline: it described extraction forceps, the dental chair, methods of filling and preserving teeth, and the construction of dentures. Later generations called Fauchard the “father of modern dentistry” — a retrospective reputation rather than a contemporary title — but his book did fix the craft’s vocabulary and instruments for the next century.

Dentures were the visible product of the eighteenth-century trade. They were made from human teeth (sometimes obtained from the poor or the dead, in what was known as “grave teeth”), horse teeth, and ivory; porcelain dentures appeared later in the century. A good set of teeth was a marker of status, and the trade in replacement teeth was a real, if uncomfortable, economy.

Before 1840 there was no dedicated dental college. Practitioners learned by apprenticeship, by reading Fauchard, or by itinerant work as “tooth-drawers.” The craft’s instruments — forceps, probes, mirrors — were already specialised, but the knowledge behind them was still craft knowledge, not medical knowledge.

In 1840 the Baltimore College of Dental Surgery opened, the first dental school in the world. By the end of the century, dental schools existed in the United States, Britain, and continental Europe, and the profession had its own journals, societies, and examinations. In the United States, the Alabama enacted the first state dental-practice law in 1841, and the American Dental Association was founded in 1859; in Britain, the Dentists Act of 1878 was the first law to regulate the profession. Licensing separated qualified dentists from itinerant operators — a pattern traced in the history of medical licensing.

Anaesthesia changed what the profession could promise. In December 1844 the American dentist Horace Wells extracted a tooth under nitrous oxide in Hartford, Connecticut, after watching a public gas exhibition; his failed public demonstration in Boston in January 1845 is one of the most consequential near-misses in medical history. In October 1846, William T. G. Morton’s ether demonstration at Massachusetts General Hospital carried painless surgery into the wider world. The dental anaesthesia timeline entry and the history of anaesthesia topic cover the full sequence and the priority disputes that followed.

New materials changed what could be built in the mouth. Goodyear’s vulcanisation of rubber (patented in 1844) was adapted to denture bases in the 1850s, making them cheaper and more durable than ivory. Dental amalgam, introduced in the 1840s, was at first controversial (early formulations could cause severe pain as their zinc component reacted) but became a workhorse filling material. Gold-foil restorations, refined by Green Vardiman Black in the 1890s, became the standard for restorative work and remained so for a century.

Technology followed. George F. Green patented an electric dental engine in the United States in 1875. In 1884 Carl Koller demonstrated cocaine as a local anaesthetic in ophthalmology in Vienna; dentists adopted it quickly, and local anaesthesia became routine in dental practice within a few years. In January 1896, weeks after Röntgen’s announcement, the German dentist Otto Walkhoff made the first dental radiograph. C. Edmund Kells soon demonstrated dental X-rays in the United States, while William H. Rollins of Boston became an early advocate of radiation protection. Imaging connected dentistry to the wider history of radiology and to the first medical X-ray.

The dental hygienist was the first of the new professions. Alfred Fones opened the Fones School of Dental Hygiene in Bridgeport, Connecticut, in 1913; Columbia University established an early university-based programme in 1916. Advocates argued that trained non-dentists could deliver preventive care to schoolchildren at a scale the profession alone could not. School dental programmes, dental education, and the wider team — hygienists, technicians, therapists — moved much routine oral care beyond the dentist’s chair.

By the 1940s, controlled animal experiments had established sugar as a key factor in caries, and antibiotics from the same decade reduced the risk of the fatal dental sepsis that had made serious tooth infection a life threat. Composite resins, introduced in the 1960s, gradually replaced gold and amalgam in many fillings.

The fluoride story is the centrepiece. In 1901 the young dentist Frederick McKay opened a practice in Colorado Springs and found scores of local residents with brown-stained teeth — “Colorado Brown Stain.” In 1909 the researcher G. V. Black joined him; together they found that the stained teeth were developmentally mottled but surprisingly resistant to decay. The water-borne cause was confirmed in the 1920s and 1930s — Oakley, Idaho, and Bauxite, Arkansas — and in 1931 an ALCOA chemist detected fluoride in the affected water. H. Trendley Dean’s epidemiological studies from 1931 established that fluoride levels up to 1.0 ppm did not cause fluorosis in most people. (NIDCR, The Story of Fluoridation)

In 1945 Grand Rapids, Michigan became the first city in the world to fluoridate its drinking water. A 15-year study of almost 30,000 schoolchildren, sponsored by the U.S. Surgeon General and later taken over by the National Institute of Dental Research, found that caries rates among children born after fluoridation began had fallen by more than 60 percent. (NIDCR, The Story of Fluoridation) The current recommended level is 0.7 mg per litre, and fluoridation is credited with reducing cavities by about 25 percent in children and adults; the CDC named it one of the ten great public health achievements of the twentieth century. (CDC, About Community Water Fluoridation)

Prevention did not remove inequality. Caries is often described as the most common chronic disease of childhood, and regular examinations, safe treatment, and access to fluoride remain shaped by income, geography, disability, fear, and insurance — and by whether oral health is integrated into public services at all.