Blade to Brace

Nobody likes going to the dentist. Nobody likes having multiple needle-sharp tools in their mouth for hours straight while the dentist makes awkward small talk. Half the time, you can’t even hear what they say as it gets muffled behind their mask and the noise of their equipment. The other time, even when you do hear them, you cannot respond as you are expected to keep your mouth open wide. I never understood dentists. And no, I’m not referring to their questionable timing in asking questions. I’m referring to their difference from other doctors. To specialise in any other field, a medical student must first complete medical school, where the curriculum is more general, and only afterwards can they train in their speciality. However, dentists have separate schools for dental studies. They aren’t required to attend medical school, but every other physician does. They are “outcasts” in the medical world despite practising medicine themselves. Does medical practise in the mouth not count? It clearly does, but then, why the exclusion?

Doctors, engineers, and lawyers are every parent’s dream aspiration for their kids, but back in medieval Europe, a barber was the dream job to pursue. Barbers were given high prestige for their skilled use of tools, such as blades. Now, cracking hard entrance exams and years of medical school are the qualifications for being a surgeon, but before, you just had to know how to cut hair to be able to cut someone. And since these barber-surgeons had no formal medical education, no matter what the problem was, there was often one prescription: surgery. Many of the patients (or victims) of these operations died due to infections or from bleeding out. Due to the many deaths from the poorly conducted and mostly unnecessary surgeries, several European countries came out with health codes and qualifications about who could conduct surgery and when. Barber-surgeons had to choose between being barbers or surgeons. Those who chose to be barbers had to let go of all medical practises but were still allowed to do dental work. Dentistry back then mostly meant the extraction of the tooth, no matter how minor the ache. Interestingly, a barber’s pole, that twisting sign outside a barbershop, was meant to show the barber conducted surgeries and tooth extractions rather than to advertise a haircutter on the block. The brass basin on top of the pole stood for the vessel where leeches were kept, while the bottom basin stood for the vessel kept to store blood. The red stripe spiralling on the white pole symbolised the patient’s blood on bandages. Allegedly, the addition of a blue stripe was a nod to patriotism when American barbers started installing barber poles. Barbers being restricted from other medical practises but still being able to conduct tooth extractions is what set off the early distinction of dentists from the rest of the medical world.

The forerunner of modern dentistry is Pierre Fauchard. In his early teens, he had joined the French Royal Navy, where he met Alexandre Poteleret. Poteleret was a surgeon-dentist who had spent the majority of his life learning about the diseases in the mouth and teeth. Under Poteleret’s teachings, Fauchard noticed that many sailors suffered from dental diseases, especially scurvy. This compelled him to study dentistry. After leaving the navy, he started practising dentistry in Angers. Now, Fauchard is rightly credited as the father of modern dentistry, having changed people’s perception of oral care with his book, Le Chirurgien Dentiste, ou Traité des Dents (The Surgeon Dentist or Treatise on the Teeth). The book listed 103 diseases, an extensive list for any textbook of that era. It addressed oral anatomy and its functions, explained the signs of oral pathology, and provided instructions for performing operations in cases of tooth transplants, restoring teeth, treating gum inflammations, and making dental corrections, among other procedures. He also advocated for oral hygiene, emphasising that one should prioritise daily maintenance and cleanliness oneself. His contributions weren’t limited to his writings. He brought many innovations to the table. He promoted the idea of using lead, tin and gold as fillings. He also introduced several orthodontic practices, such as the Bandeau, the earliest versions of modern retainers and braces. Many of the tools he revolutionised were inspired by the tools jewellery makers, watchmakers, and barbers used.

Fauchard’s contributions kick-started dental research. John Hunter wrote two important books: Natural History of Human Teeth and Practical Treatise on the Diseases of the Teeth. The books theorised the possibility of tooth transplantation from one person to another. He stated that it was best when the tooth was as “fresh” as possible. This concept led to a greater understanding of other organ transplantations. Dr Horace Wells was the early pioneer of using anaesthesia during tooth extractions and later surgeries across fields. He was inspired by a public entertainment performer under anaesthesia who seemed unaware of the open wounds they had. The Crawcour brothers introduced amalgam as a material for tooth restoration, which led to the invention of other dental prosthetics. The dental drill revolutionised the removal of dental decay. The earliest version of a dental drill was the foot pedal-operated pneumatic drill invented by George F. Green, who later patented the electric drill. There weren’t just advancements within dentistry; there were also advancements in the field of dentistry as a whole in the medical world. The Dentist Act was passed in 1878 in the UK, and the British Dental Association was formed in 1879. Several countries were introducing health codes, taking oral and dental medicine seriously, thus putting dentistry on par with other medical fields.

From being performed in dull barbershops to being exclusive to fluorescent-lighted clinics, dentistry has surely evolved. Understanding the enamel around the teeth must have been harder than the enamel itself, but Pierre Fauchard and other early dentists not only understood but also created inventions that paved the way for oral and dental care today. Recent inventions like the painless Invisalign definitely couldn’t have been done without the introduction of the horseshoe-shaped Bandeau. I definitely wouldn’t be able to survive any tooth extraction without undergoing anaesthesia. Though dental school is still separate from medical school, this distinction showcases its unique history on the way to where it is today. Dentistry’s transformation marked not just the advancement of oral health care but the recognition of it as an essential pillar of modern medicine.