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Review Article

Milestones of Dental History

Abstract Rajesh Mahant,

Since ages, human beings suffer from the dental problems. With the journey as time elapsed the S. Vineet Agrawal,
person treating the teeth changed (i.e., from barbers and monks to present dentists), equipment Sonali Kapoor,
changed (i.e., from bow drills to airotor and laser handpieces), materials changed (i.e., from ground
mastic alum/honey to tooth colored composite and ceramics). There has been drastic change in Isha Agrawal
treatment planning from extraction to the conservation of teeth and from manual restoration to Department of Conservative
computerized restorations computer‑aided design/computer‑aided manufacturing. Thus, this review is Dentistry and Endodontics,
Manubhai Patel Dental College
an attempt to have an insight into major milestones of the dental timeline. and Hospital, Vadodara,
Gujarat, India
Keywords: Amalgam, dental handpiece and burs, dental history

Introduction Hesi‑Re was the earliest Egyptian dentist

A profession that is ignorant of its past
experiences has lost a valuable asset
because “it has missed its best guide to the
future.”
Dentistry has a long and fascinating history.
From the earliest of times, humans have
been plagued by dental disease. Many
of the remarkable techniques in modern
dentistry can be traced to the very earliest
of times in every culture. Dental disease
can include cavities or caries and gum
disease or periodontal disease. It can lead
to systemic, somatic disease.
Dental history timeline
• 7000 BC‑evidence of ancient dentistry
has recently been found in a Neolithic
graveyard in ancient Pakistan. Teeth
dating from around 7000 to 5500 BC
show evidence of holes from dental
drills were found in people of the Indus
Valley Civilization
• 5000 BC‑A Sumerian text of this date
describes “tooth worms” as the cause
of dental decay. The legend of the
worm is also found in the writings of
Homer, and as late as the 1300’s AD the
surgeon Guy de Chauliac still promoted
the belief that worms cause tooth decay
[Figure 1]
• 1700‑1550 BC‑An Egyptian text, the
Ebers Papyrus, refers to diseases of the
teeth and various toothache remedies.
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who practiced in 3000 BC, was called
“Chief of the Toothers” and often called the
first “dentist.” An inscription on his tomb
includes the title “the greatest of those who
deal with teeth, and of physicians.”[1]
Egyptian pharaohs suffered from
periodontal (gum) disease but teeth were not
bad as wear from a rougher, nonprocessed
diet removed small cavities before they had
a chance to get established.
Hippocrat, the father of medicine, wrote
a book “on affection” in 0BC–370BC. He
observed that if tooth is decayed and loose
it must be extracted. If neither decayed nor
loose and still painful it is necessary to
desiccate it by cauterizing.
Historical perspectives on erroneous
theories
In early 1900s, focal infection theory,
i.e., teeth with infected necrotic pulps
and endodontically treated teeth might
leak bacteria or their toxins into the
Address for correspondence:
body, causing arthritis and diseases of the
Dr. Rajesh Mahant,
kidney, heart, nervous, gastrointestinal, 3/233, Guj. H. Board (Old),
endocrine and other systems, resulted in Gorwa, Vadodara ‑ 390 003,
a frightening era of tooth extraction both Gujarat, India.
E‑mail: rhmahant@gmail.com
for the treatment of systemic diseases
and as a prophylactic measure against
future illness. Fortunately, subsequent Access this article online
microbiological and epidemiological
Website: www.cjhr.org
studies disproved the claims that
extraction of teeth could restore the DOI: 10.4103/cjhr.cjhr_37_17
Quick Response Code:
systemically ill person to good health. The
extraction tide was stemmed.[2]
How to cite this article: Mahant R, Agrawal SV,
Kapoor S, Agrawal I. Milestones of dental history.
CHRISMED J Health Res 2017;4:229-34.

© 2017 CHRISMED Journal of Health and Research | Published by Wolters Kluwer - Medknow 229
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Mahant, et al.: Dental history
Middle ages and the renaissance: Beginnings of the
dental profession
In 500–1000, medicine, surgery, and dentistry, are
generally practiced by monks. In 1130–1163 barbers
assume the monks’ surgical duties: Bloodletting, lancing
abscesses, extracting teeth, etc. In 1210, a guild of barbers
is established in France.
According to Rhazes (Arabian author) (841–926 AD),
carious teeth were filled with ground mastic, alum and
honey. In 1460–1525 AD, removal of carious matter from
teeth before filling with gold leaf was given by Giovanni
Da Vigo in his article “Practica copiosa in arte chirurgica.”
Remove them with trephines, files or any other convenient
instruments and fill the cavity with gold. During 1517–1590
AD, Ambroise Pare prepared artificial tooth from bone and
ivory. In 1589 AD, RIVIERE mentioned the use of oil of
clove in dental operations.
1746
Claude Mouton describes a gold crown and post to
be retained in the root canal. He also recommends
white enameling for gold crowns for a more esthetic
appearance.
1844
Samuel S. White, a Philadelphia Jeweler, used porcelain
to fill large cavities and established his S.S. White dental
manufacturing company.
1723
Pierre Fauchard, a French Surgeon Publishes The Surgeon
Dentist, A Treatise on Teeth (Le Chirurgien Dentiste).
Fauchard is credited as being the Father of Modern
Dentistry because his book was the first to describe a
comprehensive system for the practice of dentistry.
1801
R.C Skinner published his book “a treatise on human
tooth.” It is a 16‑page pamphlet and deals with dental
disease and their prevention.
Figure 1: Tooth worms
230 CHRISMED Journal of Health and Research | Volume 4 | Issue 4 | October-December 2017
1890
Greene Vardiman Black wrote the book “A description
anatomy of human tooth.” He standardized the rules
for cavity preparation, hand instrument formula, and
manufacturing process of silver amalgam.[3] He developed
the principle of “extension for prevention” and remembered
as “Father of Operative Dentistry.”[4‑8]
Etiology
Romans thought the worm just appeared or drilled its way
into a tooth. If the tooth pain was severe, it meant that
the worm was moving around. If the aching stopped, then
the worm was resting. People smeared their aching teeth
with honey and waited all night with tweezers in hand,
ready to pull out the tooth worm. In 1683, Antony Van
Leeuwenhoek identified oral bacteria using a microscope.
In 1890, Willoughby Miller an American dentist in
Germany, notes the microbial basis of dental decay.[9]
Device
Handpiece and bur
There is evidence that the Maya and other ancient cultures
used primitive “bow drills” and other devices to prepare
round ornamental cavities in teeth.
In 1728, Pierre Fauchard, “Le Chirurgien Dentiste”‑first
detailed description of dental practice represented the use
of bow drill to prepare teeth with cutters [Figure 2].
By the nineteenth century, hand drills with steel bur heads
were used by twirling the long handles with the fingers.
Later, a “bur thimble,” was used. S.S. White, however,
shows an 1867 manually twisted drill in its catalog of the
same era.
In 1871, Morrison introduced his foot treadle dental
engine [Figure 3] which was followed by handpieces
with hand‑made steel drills.[10] This represented the
Figure 2: Pierre Fauchard’s bow drill
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Mahant, et al.: Dental history
first significant increase in rotational speed over the
hand‑operated long‑handled drills. In 1874, most significant
development was the introduction of electric motor with
1000 rpm.
In 1891, the S.S. White company introduced the first
machine‑made steel burs, known as revelation burs.[11]
In 1942, diamond cutting instruments with 5000 rpm
were introduced. In 1947 Carbide Burs with 12,000 rpm
replaced the steel burs. Recently, smart burs are introduced
which are harder than infected dentin but softer than
affected and healthier dentin. Hence, they tend to remove
a just infected portion of tooth preventing the inadvertent
removal.
Many of the handpieces are noteworthy, such as norlen’s
“dentalair,” conceived in 1948, walsh’s air turbine handpiece
(1952). In 1950, speed of 60,000 rpm and above had been
attained by new equipment employing speed‑multiplying
internal belt drives. In 1955, Page‑Chayes handpiece was
the first belt‑driven angle handpiece to operate successfully
at speed over 100,000 rpm. It was in 1957, John borden
introduced his sensational airotor handpiece, operated by air
and allowing for rotational speeds up to 20,000 rpm.[12] 42.
It is from this design that all current air operated high‑speed
handpieces have evolved.
Air abrasion
Air abrasion dentistry has evolved over a period as a new
concept of drill‑less technique to excavate caries for the
preservation of a maximal sound tooth structure. The use of
air abrasion technology initiated by Dr. Robert Black in the
1940s was successfully introduced in 1951 with the Airdent
air abrasion unit (S.S. White). During air abrasion, a fine
stream of particles is aimed at the decayed portion of the
tooth by compressed air or gas that runs through the dental
handpiece. These particles are made of silica, aluminum
oxide, or a baking soda mixture.[13]
Figure 3: Morrison’s foot drill
CHRISMED Journal of Health and Research | Volume 4 | Issue 4 | October-December 2017
Lasers
Proposed in 1990 by Hibst and Keller, who introduced
the possibility of using an Er:YAG laser as an alternative
to conventional instruments such as the turbine and
micro‑motor. FDA approves the erbium YAG laser
to treat tooth decay. Thanks to the affinity of the Er:
YAG laser wavelength (2940 nm) to water (absorption
peak = 3000 nm) and hydroxyapatite (absorption
peak = 2800 nm), laser technology allows for efficient
ablation of hard dental tissues without the risk of
micro‑ and macro‑fractures. The dentin surface treated by
laser appears clean, without a smear layer and with the
tubules open and clear.[14]
X‑ray
On Friday, November 8, 1895, Professor Wilhelm Conrad
Roentgen, a professor of physics at the University of
Wurzburg in Germany, serendipitously discovered a
“new kind of ray – X‑ray.” The first X‑rays were called
“roentgenograms.”[15] Friedrich Otto Walkhoff (1860–1934).
Within 14 days of the announcement of Roentgen’s rays, the
first dental images were made by Friedrich Otto Walkhoff
and Wilhelm Konig using an ordinary photographic glass
plate wrapped in a rubber dam as an image receptor.
After about nine decades, radiovisiography marked the
starting point of intraoral digital radiographic techniques
in dentistry invented by Dr. Frances Mouyens and
manufactured by Trophy Radiologie (Vincennes, France) in
1984.
The 1st generation computed tomography (CT) was
invented in 1967 by Sir Godfrey N. Hounsfield, who won
Nobel Prize in 1979. It gave the three‑dimensional image
of the tooth. The first cone beam CT (CBCT) scanner was
built by Robles RA in 1982 for angiography purpose[3]
CBCT is more advanced for its resolutions.
Direct Restorative Materials
In the history of operative dentistry, direct restorative
materials have principally included: lead, mastic, gold,
tin, amalgam, fuisble metal of darcet, gutta‑percha, silicate
cement, direct filling methyl methacrylate resin, composite
resin, and glass ionomer cement (GIC).
Medieval and Early Modern Period
The use of gold leaf to fill cavity was the most significant
development during this period. Early Greeks produced
gold leaf of approximately 1/100,000 inch thickness.
Gold is one of oldest materials used for at least 2500 years.
Guerini provides indirect evidence of the possibility that the
Arabs used gold foil for filling teeth in a later 8th century.
In 1746–1755, Claude Mouton makes a gold crown and
post and recommends enameling the gold crown white to
promote more pleasing esthetic dentistry. In 1855, Robert
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Mahant, et al.: Dental history
Arthur originates the cohesive gold foil method allowing
dentists to insert gold into a cavity with minimal pressure.
A powdered gold encapsulated in fibrous gold foil was
introduced in 1962.
In the succeeding years, direct gold changed very little,
except for the introduction of mat gold and gold pellets,
both of which enhanced the speed of compaction.
History of Amalgam
A medical text in China mentions the use of “silver paste,”
a type of amalgam in 700. August taveau, of Paris, mixed
shavings from French five‑franc pieces with Mercury
in 1826.[16] The Crawcour brothers introduced amalgam
into the United States in 1833. Unfortunately, they used
the material unscrupulously and gave it a bad name, so
major rift known as amalgam war occurred. The American
Society of Dental Surgeons was established and a couple of
years later they banned the use of silver amalgam (1840).
First amalgam war
In 1843, American Society of Dental Surgeons condemned
the use of all filling materials other than gold as toxic,
thereby igniting “First Amalgam War.”[17,18] Dr. Towsend
of Philadelphia (1855) proposed the combination of 4
parts of Ag and 5 parts of Sn. However, it was unbalanced
having poor edge strength and was used until about 1863.
This “battle” pitted many highly‑respected dentists against
each other.[19] G.V. Black introduced a balanced amalgam
formula to the profession in 1895.[20,21] This formulation
and its derivatives remained essentially unchanged until
at least the 1960s and were responsible for the salvation
of countless millions of teeth. In late 1870, an organized
movement supporting the use of amalgam to become
known as “new departure” begins.
Second amalgam war
In mid‑1920s German dentist Professor A. Stock started the
so‑called “Second Amalgam War.” Absorption of mercury
from dental Amalgam, led to various health problems,
stating that nearly all dentists had excess mercury in their
urine. Mercury released from amalgam responsible for
human diseases affecting cardiovascular and nervous system
recovery from multiple sclerosis, Alzheimer’s diseases
when removing amalgam fillings. However, research in
the United States and other countries demonstrated clearly
that there is no cause‑effect relationship between dental
amalgam restoration and other health problems.
Third amalgam war
The current controversy, sometimes termed as “Third
Amalgam War” began in 1980 primarily through the
seminars and writings of Dr. Huggins, a practicing dentist
in Colorado.
Gutta‑percha was discovered in India in 1842. In 1847,
Hill Developed “Hill’s‑stopping” a restorative temporary
232 CHRISMED Journal of Health and Research | Volume 4 | Issue 4 | October-December 2017
material, a mixture of bleached gutta‑percha and carbonate
of lime and quartz.[22]
Various cements have been used under the restorative
material:
• 1858 ‑ zinc oxide eugenol cement
• 1860 ‑ zinc oxychloride cement
• 1879 ‑ zinc phosphate cement
• 1920 ‑ calcium hydroxide cement (Hermann).
History of Tooth Colored Restorative Materials
In 1908, silicate cement was introduced in the United
States, although earlier, cruder forms were used in Europe
in the late 1800s.[23] Silicate cement had the advantage of
high fluoride release but was highly soluble in oral fluids.
To replace silicate, methacrylate resins were introduced
in 1947.[24] These resins have tooth color like appearance,
insolubility in oral fluids, ease of manipulation and low
cost. In 1955, Dr. Michael Baunocore opened the way
of bonding of resins by applying phosphoric acid to
enamel.[25,26] As a result, Dr. Ray L. Bowen of American
Dental Association research unit in 1962 developed
a new type of composite material. He innovated
Bis‑GMA, a dimethacrylate resin and organic silane
coupling agent to form a bond between filler particle
and resin matrix.
In the late 1960s and early 1970s, pit and fissure sealants
advocated for prevention of caries in children accompanied
by early skepticism and later with better material gain
acceptance.[27,28] Such practice has become widespread and
has been responsible for the adoption of very conservative
restorative procedure.
Microfilled resin introduced in 1977 was highly polishable
and stain resistant.[29] First composite was cured by
chemical activation polymerizing process by mixing two
pastes. Its drawbacks were; trapping of oxygen in pores,
inhibit polymerization, and weaken the structure. To
overcome these problems resins were developed which
use photosensitive initiator system and light source for
activation. In 1973, ultraviolet lights were used.[29] Soon it
replaced by more cooler visible light in 1978.
Microfilled, hybrid, and microhybrid resins are used
extensively in cosmetic procedures, ranging from small
Class III restorations to diastema closures, large Class IV
restorations, and direct anterior veneers. In addition,
composite resins have come into widespread use for the
restoration of all classes of cavities in posterior teeth.
Historical Development of Glass Ionomer
Cement
GIC was invented in 1968 and first described by Wilson
and Kent in 1971 which has high fluoride and low
solubility.[30,31] Glass ionomers used the aluminosilicate
powder from silicates and the polyacrylic acid liquid of
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Mahant, et al.: Dental history
polycarboxylates. Its earliest commercial product was also
known as aluminosilicate polyacrylic acid.
In 1980s, to increase physical properties of GIC, it was
modified by adding metal filler particles and termed as
metal modified GIC which are of two types: miracle mix
(Simmons 1983) and cermet (Lean and Gasser 1985)
particle reinforced.
In early 1990s, GIC was further modified by replacing filler
particle and making the setting reaction more composite
like and termed as resin‑modified glass ionomer.
Polyacid‑modified resin composite or compomers is
most recent evolution of GIC. It has 2 components:
polymer‑based composite and glass ionomer except water.
It is excluded to prevent premature setting of material
and to ensure that setting occurs through polymerization
reaction.
Indirect Restorative Materials
Indirect restorations have generally been fabricated from
impressions taken of prepared teeth.
The earliest impression was probably beeswax. A reference
to the use of wax for dental impressions was made in
1684 by a German surgeon.[32] Wax was a poor impression
material by todays’ standards, but it functioned adequately
in its day by being capable of removal over undercuts.
Still, for the present time Von Horn (1910) recommended
wax pattern investment at a temperature equal to mouth
temperature using high silica content investment.
Gutta‑percha, obtained from certain trees in Malaysia, may
have been introduced as impression material in 1848, but it
was not very satisfactory for the purpose.
Reversible hydrocolloid was introduced to the
dental profession in 1925, 85 by Alphonse Poller, an
Austrian.[33] The product was patented as “Nogacoll.”
In 1931, the material was also sold under the name of
“denticole.” The fundamental ingredient of hydrocolloid is
agar‑agar, a colloid obtained from seaweed.
During the World War II era, or just before, irreversible
hydrocollois was developed and they were introduced to
the dental profession in 1943.[34] Agar‑agar had become
scarce since most of it came from Japan. Like their
reversible counterparts irreversible hydrocolloids, known as
alginates, were developed from seaweed and were salts of
alginic acid, such as sodium alginate.
One of the greatest achievements in restorative dentistry
occurred with the introduction of “Lost Wax Technique,”
by William Taggart, in 1907, method of making gold
castings.[35,36] Dentists were able to cast complete gold
crowns with precision. Further refinements were soon
made to his technique, including the introduction of the
centrifugal casting machine by Jamieson in that same year
of 1907.
CHRISMED Journal of Health and Research | Volume 4 | Issue 4 | October-December 2017
French dentist Agiulhon da Saran (1844) reported to form
investment mold from the impression of the cavity and
pour gold to make inlay.
Ceramic
In 16 century, Jacques Guillemeau (1550–1613 AD)
prepared a paste by fusing waxes gums, ground mastic,
and powdered pearl and white corelle. It was used as filling
material. It is a forerunner of esthetic fused porcelain.
Gueseppangelo Fonzi (1806) prepared 1st baked porcelain
single tooth with attached platinum hooks. He also made
26 shades of porcelain by using metal oxides. Porcelain
inlays were described at least as early as 1857. In the
period from 1900 to 1910, there was a particularly large
number of articles published on porcelain inlays, whereas
after 1915 the number was vastly reduced.
1902
Dr. C. H. Land develop fused porcelain jacket crown design
to replace all or major part of the enamel of the tooth.
1908‑Basic principle of porcelain inlay given by John Q
Byram.
In recent years, inlays and onlays nade of high strength
plastic materials and porcelain have been introduced.
In 1985, the first ceramic inlay made by a chairside
computer‑aided design/computer‑aided manufacturing
device was cemented into a patient’s tooth.[37] In 2000, the
CEREC 3® was introduced. This latest system provides a
means by which a sophisticated ceramic inlay or onlay can
be fabricated, with a hand‑held scanner reading the details
of the preparation and software subsequently being used to
drive the mechanism to precision mill (grind) a restoration
without the use of an impression and without the need for a
second dental appointment.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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