those operations which were almost wholly mechanical, had developed a considerable body of dental artisans who, though without medical education in many cases, possessed a high degree of manipulative skill. Thus there came to be two classes of practitioners, the first regarding dentistry as a specialty of medicine, the latter as a distinct and separate calling.
In America representatives of both classes of dentists began to arrive from England and France about the time of the Revolution. Among these were John Wooffendale (1766), a student of Robert Berdmore of Liverpool, surgeon-dentist to George III.; James Gardette (1778), a French physician and surgeon; and Joseph Lemaire (1781), a French dentist who went out with the army of Count Rochambeau. During the winter of 1781-1782, while the Continental army was in winter quarters at Providence, Rhode Island, Lemaire found time and opportunity to practise his calling, and also to instruct one or two persons, notably Josiah Flagg, probably the first American dentist. Dental practice was thus established upon American soil, where it has produced such fertile results.
Until well into the 19th century apprenticeship afforded the only means of acquiring a knowledge of dentistry. The profits derived from the apprenticeship system fostered secrecy and quackery among many of the early practitioners; but the more liberal minded and better educated of the craft developed an increasing opposition to these narrow methods. In 1837 a local Course of training. association of dentists was formed in New York, and in 1840 a national association, The American Society of Dental Surgeons, the object of which was “to advance the science by free communication and interchange of sentiments.” The first dental periodical in the world, The American Journal of Dental Science, was issued in June 1839, and in November 1840 was established the Baltimore College of Dental Surgery, the first college in the world for the systematic education of dentists. Thus the year 1839-1840 marks the birth of the three factors essential to professional growth in dentistry. All this, combined with the refusal of the medical schools to furnish the desired facilities for dental instruction, placed dentistry for the time being upon a footing entirely separate from general medicine. Since then the curriculum of study preparatory to dental practice has been systematically increased both as to its content and length, until in all fundamental principles it is practically equal to that required for the training of medical specialists, and in addition includes the technical subjects peculiar to dentistry. In England, and to some extent upon the continent, the old apprenticeship system is retained as an adjunct to the college course, but it is rapidly dying out, as it has already done in America. Owing to the regulation by law of the educational requirements, the increase of institutions devoted to the professional training of dentists has been rapid in all civilized countries, and during the past twenty years especially so in the United States. Great Britain possesses upwards of twelve institutions for dental instruction, France two, Germany and Switzerland six, all being based upon the conception that dentistry is a department of general medicine. In the United States there were in 1878 twelve dental schools, with about 700 students; in 1907 there were fifty-seven schools, with 6919 students. Of these fifty-seven schools, thirty-seven are departments of universities or of medical institutions, and there is a growing tendency to regard dentistry from its educational aspect as a special department of the general medical and surgical practice.
Recent studies have shown that besides being an important part of the digestive system, the mouth sustains intimate relationship with the general nervous system, and is important as the portal of entrance for the majority of the bacteria that cause specific diseases. This fact has rendered more intimate the relations between dentistry and the general practice of medicine, and has given a powerful impetus to scientific studies in dentistry. Research. Through the researches of Sir J. Tomes, Mummery, Hopewell Smith, Williams and others in England, O. Hertwig, Weil and Röse in Germany, Andrews, Sudduth and Black in America, the minute anatomy and embryology of the dental tissues have been worked out with great fulness and precision. In particular, it has been demonstrated that certain general systemic diseases have a distinct oral expression. Through their extensive nervous connexions with the largest of the cranial nerves and with the sympathetic nervous system, the teeth frequently cause irritation resulting in profound reflex nervous phenomena, which are curable only by removal of the local tooth disorder. Gout, lithaemia, scurvy, rickets, lead and mercurial poisoning, and certain forms of chronic nephritis, produce dental and oral lesions which are either pathognomonic or strongly indicative of their several constitutional causes, and are thus of great importance in diagnosis. The most important dental research of modern times is that which was carried out by Professor W. D. Miller of Berlin (1884) upon the cause of caries of the teeth, a disease said to affect the human race more extensively than any other. Miller demonstrated that, as previous observers had suspected, caries is of bacterial origin, and that acids play an important rôle in the process. The disease is brought about by a group of bacteria which develop in the mouth, growing naturally upon the débris of starchy or carbohydrate food, producing fermentation of the mass, with lactic acid as the end product. The lactic acid dissolves the mineral constituent of the tooth structure, calcium phosphate, leaving the organic matrix of the tooth exposed. Another class of germs, the peptonising and putrefactive bacteria, then convert the organic matter into liquid or gaseous end products. The accuracy of the conclusions obtained from his analytic research was synthetically proved, after the manner of Koch, by producing the disease artificially. Caries of the teeth has been shown to bear highly important relation to more remote or systemic diseases. Exposure and death of the dental pulp furnishes an avenue of entrance for disease-producing bacteria, by which invasion of the deeper tissues may readily take place, causing necrosis, tuberculosis, actinomycosis, phlegmon and other destructive inflammations, certain of which, affecting the various sinuses of the head, have been found to cause meningitis, chronic empyema, metastatic abscesses in remote parts of the body, paralysis, epilepsy and insanity.
Operative Dentistry.—The art of dentistry is usually divided arbitrarily into operative dentistry, the purpose of which is to preserve as far as possible the teeth and associated tissues, and prosthetic dentistry, the purpose of which is to supply the loss of Filling or stopping. teeth by artificial substitutes. The filling of carious cavities was probably first performed with lead, suggested apparently by an operation recorded by Celsus (100 B.C.), who recommended that frail or decayed teeth be stuffed with lead previous to extraction, in order that they might not break under the forceps. The use of lead as a filling was sufficiently prevalent in France during the 17th century to bring into use the word plombage, which is still occasionally applied in that country to the operation of filling. Gold as a filling material came into general use about the beginning of the 19th century. The earlier preparations of gold were so impure as to be virtually without cohesion, so that they were of use only in cavities which had sound walls for its retention. In the form of rolls or tape it was forced into the previously cleaned and prepared cavity, condensed with instruments under heavy hand pressure, smoothed with files, and finally burnished. Tin foil was also used to a limited extent and by the same method. Improvements in the refining of gold for dental use brought the product to a fair degree of purity, and, about 1855, led to the invention by Dr Robert Arthur of Baltimore of a method by which it could be welded firmly within the cavity. The cohesive properties of the foil were developed by passing it through an alcohol flame, which dispelled its surface contaminations. The gold was then welded piece by piece into a homogeneous mass by plugging instruments with serrated points. In this process of cold-welding, the mallet, hitherto in only limited use, was found more efficient than hand pressure, and was rapidly developed. The primitive mallet of wood, ivory, lead or steel, was supplanted by a mallet in which
- The filling of teeth with gold foil is recorded in the oldest known book on dentistry, Artzney Buchlein, published anonymously in 1530, in which the operation is quoted from Mesue (A.D. 857), physician to the caliph Haroun al-Raschid.