Pierre Fauchard and Dental Science
Although mankind has practised some form of dentistry for thousands of years, it is through the last three hundred years that modern dentistry has emerged as a truly effective medical specialty. This rapid emergence can be attributed to the new spirit of scientific inquiry evident in these centuries, coupled with practical advances in dental materials and techniques, in dental anesthetics, and in radiography.
Much of dentistry’s early credibility has its basis in the writings of a French doctor, Pierre Fauchard. In 1728, he published a two-volume, illustrated treatise whose translation in English is called The Surgeon Dentist. The treatise represents the first scientific survey of the theory and practice of modern dentistry, and, for this reason, Fauchard is often cited as the “father of modern dentistry.”
Fauchard’s two-volume work was a compendium of dental knowledge as derived from, or confirmed by, the writer’s own medical experience. In it, Fauchard described dental anatomy and methods of diagnosis and treatment of dental pathology and abnormality. He also discussed most modern branches of dentistry in a list ranging from periodontics to oral maxillofacial surgery. Fauchard refuted the ancient notion that “tooth worms” caused tooth decay, suggesting instead that sugar consumption was more likely responsible for decay. Moreover, where dentists of his day often focussed on tooth extractions, Fauchard advocated the dentistry of reconstruction. He is generally credited with introducing the technique of dental fillings, and his treatise discussed the use of lead, tin, and even gold in amalgams to be used in filling cavities. He was an advocate of dental cleanings, prostheses for lost teeth, and dental braces. He suggested that children’s teeth were more amenable to orthodontic treatments because of their smaller root systems. Fauchard also outlined a dental etiquette useful for reassuring patients and supplied ideas for positioning patients for optimal comfort and treatment. He introduced use of the dental light, used a dental drill, and invented many other dental tools. Additionally, Fauchard denounced the dental charlatans of his day and advocated the establishment of professional standards for dentistry. In combination with his invaluable codification of dental knowledge, Fauchard’s certainty as to the necessity of standardizing dental care served to create an expectation of dentistry as a skilled and ethical branch of medical practice, an expectation which has continued in force to the present day. In terms of fostering the spirit of science within dentistry as a reconstructive discipline, there is probably no greater figure than Pierre Fauchard.
The centuries which followed were to produce two great improvements in dental materials. With tooth decay being by far the most widespread dental disease, lack of a suitable filling compound was a serious barrier to improved general dental health. Fauchard had suggested lead, mixed with tin, both soft metals that were easy to fit into the drilled-out cavities. Although lead would be later rejected because of its toxicity, neither of these metals was really hard enough to withstand the pressure of chewing, especially in the back teeth. Gold was sometimes used as a filling material, as it is even today, but gold was too expensive a material for most dental clients. Nor was gold easy to work at room temperature.
In 1812, a British chemist by the name of Joseph Bell produced his “silver paste,” a mixture of powdered silver coins and mercury for use as a dental filling material. In contrast to other filling materials which required heating or combination with harmful acids, Bell’s “paste” required only mixing to make it suitable for placement in cavities. The amalgam self-hardened to produce an early version of the longest lasting filling material we have had to date. Although American dentists at first objected to the inclusion of mercury in dental amalgams on the basis that mercury was a toxin, the American Dental Association endorsed the use of such amalgams in 1856 and remains in support of them even today. Recently controversy has again surfaced about the safety of using mercury in dental amalgam, and several Scandinavian countries no longer allow such fillings. Nevertheless, two facts about silver-mercury amalgam fillings remain. First, whatever their purported risks, they have meant centuries of affordable dental care to millions of people. Secondly, even with our modern array of tooth-coloured fillings, amalgam fillings still represent the best affordable choice for strength and duration, especially in the back teeth. Whatever the future, the development of silver-mercury amalgam fillings marked an important milestone in society’s progress towards greater dental health.
A second important advance in the development of dental materials came in the area of tooth replacement. Fauchard believed firmly in tooth replacement. He built spring-fitting dentures of ivory or bone and fastened them in the mouth with wires or thread. Compared to modern dentures, however, these dentures were neither comfortable nor strong. In 1839, one of the Goodyear brothers, Charles Goodyear, began to produce porcelain dentures with a base of vulcanized rubber. Not only were these strong and comfortable, they were manufactured at a price and on a scale of production that made them affordable to a majority of patients. In fact, vulcanized rubber proved to be so satisfactory as a base for dentures that it was outdistanced by acrylic only in the mid-twentieth century and primarily because acrylic could be produced in colours more closely approximating those of the human gums. The advent of vulcanized rubber-based dentures, then, really marked the beginning of satisfactory denture manufacture. It also established vulcanized rubber as the second truly socially revolutionary dental material.
Of course, drilling techniques were also greatly improved from the days of Fauchard. Fauchard, himself, used a manual drill powered much like a spring-wound clock. In 1790, a foot-pedal drill was patented by an American named John Greenwood. By 1875, an electric drill was in use. Since then the drill has seen many modifications making it more accurate and easier for dentists to use and for patients to tolerate. However, it is notable that satisfactory drilling does not begin with the modern drill. Surprisingly accurate drilling precedes Fauchard by millennia. It is notable also that, while development of faster and even more accurate drilling did not produce miraculous permanent change within modern human life, reliable tooth amalgams and well-anchored comfortable false teeth did.
Since Fauchard’s time, there have also been revolutionary changes for the patient in the dental chair. Though patient comfort was of importance to Fauchard, he had little to offer in the way of pain relief during dental procedures. Only alcohol and opiates would have been available, and he is not noted for his endorsement of their use. Real pain management began in the 1840’s when ether was introduced by William Morton and nitrous oxide by Horace Wells. These drugs were inhaled by patients and were widely used for dental surgery or dental extraction. The invention of the hypodermic syringe in 1853 opened the possibility of injecting drugs into the gums to block pain to specific areas of the mouth. By 1884, the injection method was being used to provide cocaine to relieve patient discomfort during reconstructive dental work. Though cocaine proved too addictive for general use, non-addictive procaine (Novocaine) was developed in 1905. In the 1950’s, lidocaine (Xylocaine) was introduced. Both lidocaine and nitrous oxide are widely used today.
Another important change that Fauchard did not foresee was the advent of dental x-rays. Dental x-rays began as an adaptation of x-rays from medical practice and were not much used before 1916. Dental x-rays did become important, however, because they offered a clear view of hidden dental structures, impacted wisdom teeth, virtually all tooth cavities, and a range of periodontal problems including tumours existing under gum surfaces. By 1933, an x-ray housing specific to dental needs was produced for the dental market, and x-ray machines were increasingly seen in dental offices.
However, despite these few omissions, Pierre Fauchard did comprehensively define much of the scope of dental practice for centuries after his death. It was a commanding achievement. It is also true that, although there have been countless other refinements in materials and techniques, the introduction of silver-mercury amalgam and vulcanized rubber, were single and early expansions of Fauchard’s work that made incalculable differences in general dental health. Fauchard lived a long and dedicated life as scientist, doctor, and dentist. He would have been glad to see the advent of dental anesthesia and x-rays and delighted with the transformation of the dental experience to one of relative comfort and certainty for both dentist and patient. This was the comfort and confidence that he strove to give centuries ago. As modern patients look forward to keeping their teeth through new techniques of tooth replacement and improved hygiene, they can also look back and appreciate how much a discipline can owe to a truly great scientist and thinker. Pierre Fauchard was a man who firmly established dentistry within the legacy of science and shed light into centuries of dental advance for the men and women who followed his ideas.