In the 11th century, long before the first comprehensive scientific textbook on dentistry, Fauchard’s Le Chirurgien Dentiste, was published in 1728, dentistry was practiced by a variety of craftsmen, primarily barbers, but also wig makers, bloodletters, goldsmiths, and blacksmiths, among others. Yet despite their lack of formal, academic training, these medieval practitioners possessed a distinctive skillset and used specialized instruments to remove, repair, and replace the hardest tissue in the body.
The prominence of the early dental practitioner dates back to 1092 when Pope Cyril II of Alexandria decreed that priests and monks would have a new grooming style, a shaven face and a unique hairstyle. The Pope invited razor et minutor (barbers and blood removers) to take up the task. As a result, barbers and the instruments they used — razor, lance, and scissors — became part of a budding surgical profession and barber-surgeons were created. The use of a scalpel was not far behind.
Priests could read medical texts and became physicians but they were not allowed to have blood on their hands and so performed no invasive interventions. The prohibition against bloodletting and surgery by physician-priests began in 1163 when Pope Alexander III, as part of the Council of Tour, declared: “ecclesia abhorret a sanguine.” Loosely translated it meant, “shedding of blood is incompatible with the cleric’s holy duty to God.” This was the beginning of the separation of physicians from surgeons, a division that lasted for approximately 800 years. The separation is still visible in the names of venerable institutions that include the words “College of Physicians and Surgeons,” as, for example, in Columbia University College of Physicians and Surgeons and the Royal College of Physicians and Surgeons of Canada.
In the early medieval pecking order, barber-surgeons were ranked not only as inferior to formally educated physicians, but, in medieval France, they were ranked further. The term “Surgeons of the Long Robe” referred to those with some academic training to distinguish them from barber-surgeons, or “Surgeons of the Short Robe.” The academically-trained surgeons were situated socially between physician-priests at the top and the lowly barber-surgeons. Yet the low status of the barber-surgeons did not prevent kings and queens from using them in military ground battles and on long naval voyages, where they gained experience treating wounded soldiers and sailors. Necessity is the mother of invention and barber-surgeons, who were practical and innovative, responded by making technical advances that went on to have a major impact on society.
The first and arguably most prominent of these was Ambroise Paré (1510-1590), a barber-surgeon to four French kings, who replaced hot oil cauterization of bleeding wounds with ligature. Prior to Paré’s innovation, hot boiling oil poured in a wound, without anesthesia, was thought to “purge” gunshot wounds of the presumed poisonous nature of the gunpowder. Many of the soldiers died of shock and sepsis following such excruciating treatment. Paré, known as “the gentle surgeon,” invented the use of a soothing wound dressing, thereby reducing pain caused by the hot oil and greatly enhancing wound healing and survival. Paré, a Huguenot, was so valuable that his Catholic king, Charles IX, hid him in his bedchamber’s closet during the night of August 24, 1572, the date of the “St. Bartholomew massacre,” to save him from the murderous rampage. Paré lived to be 80, leading a productive life, adopting new surgical techniques, and developing extraction instruments that we still use today. His ligature of blood vessels and wound dressing technique changed surgery forever.
Pierre Fauchard (1678-1761), considered the “father of modern dentistry,” began as a naval surgeon apprentice to Alexandre Poteleret, surgeon-in-chief to his Majesty’s ship in Louis XIV’s court. Fauchard witnessed the ravaging effect of scurvy on sailors and in particular on their gums. From this experience and the fact that a lack of funds prevented him from completing formal training in surgery, Fauchard decided to pursue dentistry, which did not require a costly apprenticeship. His experience with Poteleret was more extensive than many practicing dentists had at the time. He became a dental surgeon, one of 21 dentists in Paris at the time. His seminal book, “Le Chirurgien Dentiste,” is a compilation of scientific knowledge of dentistry at the turn of the 18th century. The manuscript has many original elements, such as the use of carved ivory obturators with attached teeth for cleft palate, a description of tooth dysplasia, new prosthodontic devices for replacement of missing teeth, and innovation in the type and use of dental instruments.
Dr. Horace Wells, a dentist from Connecticut, who was responsible for the use of anesthesia in dentistry, had an impact on both medicine and dentistry. He was the first patient to have a tooth extracted under nitrous oxide (NO) anesthesia.
Following a demonstration the day before during which Wells observed the use of NO for public entertainment, one of the performers, who was under the influence of the anesthetic, seemed unaware of an open flesh wound on his leg and of pain from a self-inflicted wound he had incurred while prancing around on stage. Wells instantly realized the implications for painless surgery and arranged for a demonstration in his practice. The next day, Dec 11, 1844, Dr. John Rigg, a local periodontist, performed an extraction on Wells. Gardner Quincy Colton, the itinerant entertainer who brought NO to town, was at hand to administer the anesthetic. The extraction was painless even though the subsequent public demonstration at Massachusetts General Hospital was a dismal failure. That doomed the use of NO in general surgery. However, present at that failed demonstration was a former student and partner of Wells,’ a part-time medical student and adventurer, William Morton, who subsequently went on to use ether as a surgical anesthetic. On October 16, 1846, the first public demonstration at Massachusetts General Hospital, dubbed “ether day,” with Morton present, was a rousing success. It set the stage for painless surgery in the US and around the world.
Subsequent technological advances were more incremental and less impactful on other branches of medicine. Nevertheless, these advances helped to make dentistry a highly respected and sought-after profession.
These are but a few examples in the long and distinguished history of discoveries, technological innovations, and transformations in the stature of the profession that have made dentistry a progressive force for improved public health. Today, dental treatment for caries and periodontal disease is moving into a period of fewer invasive and more preventive interventions. The availability of ever more information, smart technology, know-how, and non-invasive treatments will continue to advance the profession’s momentum by making it easier, faster, better, and more enjoyable for patients.