Toothache—A History of Agony
In the marketplace of a medieval town square, a magnificently dressed charlatan boasts that he can extract teeth painlessly. His accomplice, pretending reluctance, steps forward, and the tooth puller fakes an extraction, holding up a bloodstained molar for all to see. Toothache sufferers are soon encouraged to part with their money and their teeth. Drums and trumpets drown out their screams so as not to dissuade others. Within days, dangerous cases of sepsis sometimes appear, but by then the charlatan is long gone.
FEW victims of toothache have to resort to the services of such rogues today. Modern dentists can cure toothache, and they can often prevent tooth loss. Even so, many people feel anxious about visiting a dentist. A look at how dentists first learned to relieve their patients of pain may help us to appreciate modern dentistry.
Tooth decay is said to be mankind’s second most common disease, after the common cold. It is not merely a modern disease. The poetry of King Solomon reveals that in ancient Israel the discomfort of having few teeth was the expected lot of older people.—Ecclesiastes 12:3.
Even Royalty Suffered
Although Elizabeth I was queen of England, she could not escape toothache. A German visitor who observed her black teeth reported that it was “a defect that the English seem subject to, from their great use of sugar.” In December 1578, a toothache tormented the queen day and night. Her physicians recommended that the diseased tooth be pulled out, but she refused, possibly in fear of the pain it would cause. To encourage her, John Aylmer, bishop of London, had one of his own teeth, perhaps one that had decayed, extracted before her—a gallant act, since the old man had few teeth to spare!
At that time, commoners who needed a tooth pulled went to a barber or even a blacksmith. But when more people became able to afford sugar, toothache increased—as did the demand for skilled pullers. Thus, some physicians and surgeons began taking an interest in the treatment of diseased teeth. They had to teach themselves, however, since experts jealously guarded their trade secrets. There were also few books on the subject.
A century after the time of Elizabeth I, Louis XIV ruled as king of France. He was tormented by toothache for much of his life, and in 1685 he had all his upper left teeth extracted. Some claim that the king’s dental infections explain his disastrous decision that year to sign away freedom of worship in France, an act that unleashed a wave of brutal persecution against religious minorities.
The Birth of Modern Dentistry
The influence of Louis XIV’s lavish lifestyle on Parisian society led to the birth of the dental profession. Success in court and society depended on a fashionable appearance. The demand for false teeth, worn more for appearance than for eating, produced a new group of surgeons—dentists working for an elite clientele. The leading dentist in Paris was Pierre Fauchard, who learned to practice surgery in the French navy. He criticized surgeons who left tooth-pulling to incompetent barbers and charlatans and was the first to call himself a dental surgeon.
Breaking the custom of guarding trade secrets, in 1728, Fauchard wrote a book in which he passed on all the procedures he knew. As a result, he came to be called “the Father of Dentistry.” He was the first to seat patients in a dentist’s chair rather than on the floor. Fauchard also developed five tools for extracting teeth, but he was much more than a tooth puller. He developed a dentist’s drill and methods of filling cavities. He learned to fill a root canal and to attach an artificial tooth to the root. His dentures, carved from ivory, had a spring to keep the upper set in position. Fauchard established dentistry as a profession. His influence even extended across the Atlantic.
The First U.S. President’s Torment
A century after Louis XIV, George Washington suffered toothache in America. He had a tooth pulled almost yearly starting when he was 22 years of age. Imagine the misery he must have endured while leading his Continental Army! By the time he became the first president of the United States, in 1789, he was practically toothless.
Washington also suffered mental anguish because of the disfiguring effect of his tooth loss and his ill-fitting dentures. He was acutely conscious of his appearance as he struggled to establish a public image for the presidency of a new nation. In those days, dentures were not cast from impressions but were crafted from ivory, so they were difficult to keep in place. English gentlemen experienced the same difficulties as Washington. It has been said that their dry form of wit originated from the need to avoid laughing out loud and revealing their false teeth.
A legend that Washington wore wooden dentures is apparently untrue. He had dentures made of human teeth, ivory, and lead, but not wood. His dentists probably obtained teeth from grave robbers. Traders in teeth would also follow armies and pull the teeth from the dead and dying after a battle. Dentures were thus a rich man’s luxury. Not until the 1850’s, with the discovery of vulcanized rubber, which came to be used in making denture bases, did dentures become available to the common people. Although Washington’s dentists were at the cutting edge of the profession, they still did not fully understand the cause of toothache.
The Truth About Toothache
Since ancient times, people had thought that worms caused toothache—a theory that persisted until the 1700’s. In 1890, Willoughby Miller, an American dentist working in Germany at the University of Berlin, identified the cause of tooth decay, which is a major cause of toothache. A certain type of bacteria that thrive especially on sugar produce acid that attacks the teeth. But how can tooth decay be prevented? An answer came to light quite by accident.
For decades dentists in Colorado, U.S.A., had wondered why so many people there had mottled teeth. Finally, an excess of fluoride in the water supply was found to be the cause. But while studying that local problem, researchers stumbled across a fact of worldwide importance for the prevention of toothache: People raised where drinking water contains inadequate fluoride have more tooth decay. Fluoride, which many water supplies contain naturally, is an ingredient of tooth enamel. When people who lack fluoride in their water supply are provided with the ideal amount, the incidence of tooth decay drops by as much as 65 percent.
Thus the mystery was solved. Most toothache is produced by tooth decay. Sugar helps cause it. Fluoride helps prevent it. Of course, it has been well established that fluoride is no substitute for adequate brushing and flossing.
Searching for Painless Dentistry
Before anesthetics were discovered, dental procedures caused agony to patients. Dentists gouged out sensitive, decayed teeth with sharp instruments and then pounded hot metal into the cavity as a filling. Since they did not have any other treatment, they would cauterize a tooth that had infected pulp by pushing a red-hot iron rod into the root canal. Before special tools and anesthetics were developed, an extraction was also a grim experience. People submitted to such torture only because living with toothache was even worse. Although herbal preparations such as opium, Indian hemp, and mandrakes had been used for centuries, these merely dulled pain. Would dentists ever be able to perform painless surgery?
The anesthetic properties of nitrous oxide, or laughing gas, were observed soon after the English chemist Joseph Priestley first prepared it in 1772. But no one used it as an anesthetic until 1844. On December 10 of that year, Horace Wells, a dentist in Hartford, Connecticut, U.S.A., attended a lecture at which people were entertained with laughing gas. Wells noticed that a person under its influence scraped his shin on a heavy bench and yet showed no signs of pain. Wells was a sympathetic man and felt deeply disturbed by the pain he inflicted on his patients. He immediately thought of using the gas as an anesthetic. But before giving it to others, he decided to try it on himself. The very next day, he sat down in his own operating chair and inhaled the gas until he lost consciousness. Then a colleague extracted his aching wisdom tooth. This was a historic event. At last, painless dentistry had arrived!*
Since then, the practice of dentistry has undergone many technological improvements. Hence, you will find that a visit to the dentist today will prove to be a much more pleasant experience.
Today local anesthetics are used more extensively than nitrous oxide.
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An ivory denture belonging to George Washington, the first U.S. president
Courtesy of The National Museum of Dentistry, Baltimore, MD
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An artist’s depiction of the first dental operation using nitrous oxide as an anesthetic, 1844
Courtesy of the National Library of Medicine
[Picture Credit Line on page 27]
Courtesy of the National Library of Medicine