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About History of
Dentistry
Shaynes Dental Site

Ancient People & Dental Disorders

Dental disorders have been a significant problem as long as humans have lived on the earth.
In Stone Age cultures the caries rate appears to be closely related to diet. Populations
having higher meat diets had lower caries rates, while populations with diets higher in
vegetables had higher caries rates. Some pre-contact Eskimos have been reported to have
the lowest caries rate, about 1% of all teeth. Pre-contact American Indians with mixed diets
such as the Calapuya of the Willamette Valley show a caries rate of about 10% of all teeth.
Pre-contact Zuni Indians with high vegetable diets had 75%. Lower class, ancient
Egyptians had a very low caries rate whereas the royalty, who had diets richer in
carbohydrates, had around 80% incidence of caries.

People High High Mixed Caries

Meat Vegetable Diet Rate
Diet Diet
Native X 1%
Americans:
Alaskan
Native X 10%
Americans:
Calapuya,
Willamette
Valley
Native X 75%
Americans:
Zuni
Egypt: X low
commoners
Egypt: X 80%
royalty
Modern 90-
industrial 99%
societies

In 1962 Americans who had not already lost their teeth had an average of 18 decayed,
missing or filled teeth or a decay rate of approximately 65% of teeth. Figured on the basis
of incidence or percentage of individuals with caries, most modern societies range from 90
to 99%.

These figures do not present a complete assessment of caries in ancient people. The age at
onset of caries, the number of lesions per tooth and the extent of the lesions would also
need to be considered. The only point being made here is that caries has apparently always
been present in humans. It became much more extensive in many European countries in the
17th century with the introduction of inexpensive sugar from the East Indies and the New
World. Prior to this time sugar had been a luxury. Skulls from 16th century Flanders show
low caries rates similar to Stone Age skulls, but 17th century skulls show an enormous
increase, and the paintings of Rembrandt and other 17th century Dutch painters show many
of the people with most of their teeth missing.

Caries is not the whole story of dental disease. Ancient people also show significant
incidence of periodontal disease, supernumerary teeth, impacted teeth, malocclusion, and
congenitally missing teeth. The incidence of these disorders is generally lower than for
most present-day populations. However, two dental problems were much more common
and serious among the ancients; these were severe destructive attrition and alveolar
abscesses.

Many of the abscesses appear to have resulted from the rapid dental attrition. Some authors
argue that such attrition was beneficial in removing cuspal interferences, thus preventing
malocclusions and bruxism. This may be so, but the attrition was usually so rapid that by
around age 40 most of these people began to experience pulp exposure and abscess
formation.

There is no proof that any Stone Age people were able to extract firmly attached teeth
therapeutically.
This will be discussed further in connection with the Egyptians and some later sections.
Most abscesses went without any effective treatment. Many such abscesses must have
resulted in fatal infections such as cavernous sinus infection and Ludwig's Angina.

Dental infections (and complications of tooth extraction) were among the most common
causes of death listed in the "Bills of Mortality" from the time the recording began in the
1600s until around 1800.
As recently as the late 1700s and early 1800s many infected third molars were not extracted
because there were so few practitioners capable of performing the operation.
Dental infections are responsible for some deaths today, but such cases are not common.

In ancient people it was apparently one of the more common causes of death.

Greco-Roman Dentistry (c.350 BC-750 AD)

Dental Science and the Separation of Medicine from Religion

The city of Alexandria, Egypt was founded by Alexander the Great in 332 B.C.and for
centuries it was an outstanding center of Greek science. One of the earliest institutions in
the city was an excellent medical school. Human dissection was initiated there, but
unfortunately most of the descriptions were lost when the main library and a subsidiary
library were destroyed by fires in the 3rd, 4th and 7th centuries A.D. Subsequent cultures in
Western Civilization forbade human dissection for nearly 2,000 years. Consequently,
anatomic sciences were retarded until the time of Vesalius and da Vinci in the 16th century
A.D.

However, during this early period of Greek science, Aristotle (384-322 B.C.) laid the
foundations of Natural History and Comparative Anatomy (including Dental Anatomy).
One of his books, On Different Parts of Animals, has a chapter devoted to the study of
teeth. In his book, History of Animals, he compares the dental systems of different animals.
In describing the functions of different classes of teeth he was quite accurate.

It seems quite amazing that the brilliant Greek Scientist-Philosophers did not see the need
either for experimentation or comparing and recording a great number of observations
before drawing conclusions. Thus errors such as Aristotle's statement that men have more
teeth than women were accepted and perpetuated for eighteen centuries.

Credit should also be given to Aristotle for some very astute observations and conclusions.
He observed, for instance, that some of the veins in the head terminate with very slender
branches inside the teeth. In a book entitled Problems he queried "Why do figs, when they
are soft and sweet, produce damage to the teeth?" He went on then to speculate that perhaps
small particles of the figs insinuate themselves into the inter-proximal areas and become the
cause of the putrification process. This concept, however, was not prevalent and for
centuries no other medical writers made note of any strong connection between such sweet
fruits and caries.

One of the greatest and most famous physicians in history is Hippocrates of Cos, known
from ancient times as Hippocrates The Great. The exact times of his birth and death are
uncertain, but he lived from approximately 460 B.C. to 377 B.C., contemporary with Plato
and a little before Aristotle. He was apparently the son of a physician (Asclepiad) and
trained as a physician himself. His writing was extensive, including many dental topics.

Among HippocratesÕ contributions, which earned him the title "The Father of MedicineÓ:
 ¥He was the most prominent leader of a medical revolution in Greece which
demanded

the separation of medicine and religion. Physicians left the temples and set up their
practices in shops in the streets.

¥In the same spirit, he insisted that medical knowledge should be based on
observation

and not religious explanations.

¥He is known for a collection of observations and theories (which were more than
likely

not all written by him, but he was a leading figure in such activities)

¥The Hippocratic Oath, his famous statement of medical ethics

Hippocrates was much more fond of the practice of medicine than surgery and preferred to
leave the use of the knife to people more skillful in its use than he was. Beginning about
this time there occurred a separation between medicine and surgery which persisted for
many centuries and still exists in some countries such as England where physicians and
surgeons go to different schools, receive different degrees and have completely separate
licensing and practice privileges.

Hippocrates was also largely responsible for establishing the humoral theory of pathology.
The theory had been formulated previously by Empedocles (490-430 B.C.) and other Greek
philosophers. Basically, the theory held that the body's state of health or illness was
determined by the balance of four fluids or humors. These humors were blood, yellow bile,
black bile and phlegm. If the body or the diseased area was hot and moist, the fluid in
excess was blood and the treatment would be some method of reducing or moving the
blood; if the body was hot and dry, there was an excess of yellow bile; cold and moist
indicated excess phlegm, and cold and dry was a sign of excess black bile. The theory was
by no means universally accepted prior to Hippocrates, but Hippocrates' acceptance of and
support for the theory did much to establish it firmly.

The Romans gradually conquered and annexed all of the Greek states between 197 and 30
B.C. There was so much cultural exchange before, during, and after the conquests that in
medical- dental history these two great cultures can in many ways be considered as one, the
Greco-Roman culture.

Claudius Galen (c. 130-200 A.D.), a Greek physician who practiced in Rome, has for
centuries been considered the greatest physician of antiquity next to Hippocrates. Galen
supported the humoral theory and popularized many treatments based on the theory. The
humoral theory was virtually unquestioned until the mid 1800s. As late as 1910 one dental
textbook explained the variations in tooth form as a consequence of the particular humoral
balance of the individual, and such terms as being in a "good humor" or a "bad humors'' are
part of today's common speech. In the realm of dental science, Galen was the first to
identify the nerves in teeth and postulate that the sensations of teeth arose in the pulp.

Galen proposed that caries was caused by the internal action of acrid and corroding humors.
In the same way he believed cutaneous ulcers were caused by internal acrid humors without
any external cause. The cure must consist of astringent and tonic remedies, either locally
applied or taken internally to strengthen the basic substance of the teeth. Toothache was
thought to be caused by an inflammation in the teeth which caused an excess nutrition and
excess of hot humors. These humors should be reduced by counteracting humors such as
astringents, or more generally by laxatives or blood letting or cupping.

For ulcerated gums (herpes, aphthous ulcers, gingivostomatitis) Galen recommends, among
other things, cauterizing the ulcers with boiling oil carried to the site with a sort of
homemade Roman Q-tip.

When a tooth is extruded above the level of the other teeth, Galen would hold the tooth
firmly with a small piece of cloth while he filed it with an iron file. When the patient began
to feel too much pain, he dismissed the patient to return the next day and continue the
treatment. This went on until the tooth was filed even with the other teeth. During the
course of the treatment he advised the patient to remain silent and nourish himself with
liquid or soft food and take remedies prescribed to strengthen the teeth.

Dental Physicians and Dental Technician

A t approximately the same time as this separation of medicine and surgery, practitioners
began to specialize in Greece and Rome as had been the case in ancient Egypt. As with the
Egyptians, it appears that the specialization was not hard and fast. If a general practitioner
wanted to practice general medicine and surgery and one or more specialties he could do
so.

Some aspects of dentistry were practiced in the Roman world by four different groups of
practitioners:

¥the regular physician, Medicus

¥the physician specializing in dentistry, Medicus artificus dentium

¥the dental technician, artificus dentium.

¥the surgeons, chirurgus.

Advances in Dental Treatment

Hippocrates made one simple recommendation often overlooked by both physicians and
dentists. He advised that when a patient "has an ulcer of long duration on the margin of the
tongue, one should examine the teeth on that side to see if some one of them does not, by
chance, present a sharp point.Ó Such a point would then be filed with an iron file.
Regarding fracture of the lower jaw, Hippocrates discusses separately complete fractures,
incomplete, and fractures of the symphysis. He recommended "if the teeth in the proximity
of the lesion (fracture) be shaken, one ought, after having reduced the fracture, to bind them
one to the other, until the consolidation of bone, using preferably gold wire for the purpose;
but if this be wanting, linen thread can be used instead, and not only ought the two teeth
next to the site of the fracture to be bound, but several of the others besidesÓ.

He also mentions that if the procedure is done properly, healing is rapid and the teeth
occlude and function properly. If it is not done right "the cure is retarded, the fragments
unite in bad position, and the teeth are injured and become useless".

Artificial fixed and removable bridges were fairly common among the wealthy classes of
Rome. Several writers refer to such appliances. Martial in one place refers to Aegle who
"counterfeits reality with teeth of bone and Indian Ivory". In another place he makes
reference to a Roman dentist, apparently a physician specializing in dentistry, named
Cascellius "who has grown rich like a senator among the great men and fine women, and
who cures the dental diseases and can

pull teeth".

Romans apparently suffered from a high incidence of dental disease. For treatment of
toothache Scribonius Largus (c. 47 A.D.) says "Nearly everybody says that the forceps is
the cure for aching teeth, and yet I know that there are many beneficial procedures less
violent than this last resort. So when a tooth is decayed in part, my advice is to not have the
tooth out forthwith, but to have the decayed part removed with a surgical knife, which is a
painless (?) process, for then the remaining portion will have the appearance and serve all
the functions of a tooth. But if the pain becomes too bad, it is to be soothed in various
ways, by the mastication of various things, or by the fumigation of the mouth, or by
Òlaying of certain things on the tooth."

Aulus Celsus, one of the greatest Roman physicians, stated regarding toothache: "It may be
numbered amongst the worst tortures, the patient must abstain entirely from wine, and at
first even from food; afterwards, he may partake of soft food but very sparingly, so as not
to irritate the teeth by mastication. Meanwhile by means of a sponge he must let the stream
of hot water reach the affected part and apply externally, on the side corresponding with the
pain, a cerate of cypress or of iris on which he must then place some wool and keep the
head well covered up."

Celsus advised (as others did) that extraction only be submitted to when all other methods
of cure (of which there were hundreds) had been tried. If extraction did become necessary,
he introduced the idea for decayed teeth of first filling the cavity with unraveled linen or
with lead to prevent breaking the tooth during extraction. The idea of therapeutic filling to
permanently restore the lost structure did not occur until many centuries later.
Archigenes (c. 54 BC to 17 A.D.), a talented Roman general physician (including surgery
and dentistry) stated that many cases of toothache (odontalgia) are caused from a disease in
the interior of the tooth (pulpitis). In such cases he introduced a technique which has
continued

to the present day, perforating the pulp with a drill, known as trephining. He invented a
special

drill for this purpose.

Some of the other treatments he recommended for toothache were:

1. Cleaning the caries from the cavity and then placing a mixture of turpentine and iron
sulfate into the cavity, then dropping some of the same mixture into the ear on the side
where the pain was felt.

2. The slough of a serpent, burnt and then reduced, by the addition of oil, to
the consistency of solidified honey to be introduced into the prepared
carious hollow and plastered over all the tooth and surrounding parts.

3. Roasted earthworms and spikenard (a medicinal plant) ointment mixed

with crushed eggs of spiders to be introduced into the cleaned carious
hollow.

4. If the pain is in a broken tooth, Archigenes recommended cauterization with a red-hot

iron.

5. For bleeding gums, Archigenes recommended rubbing them with a mixture of very
finely pulverized myrtle and then applying astringent and tonic liquids.

An endless number of local remedies evolved. In the second century A.D., one text
recommended fumigation of the toothworms with smoke from burning henbane. This
treatment was popular until modern times. There were two theories of tooth decay:
toothworms and inflammation (excess hot moist humors).

Paul of Aegina (c. 625-690 A.D.) wrote a medical compendium of seven volumes in which
he describes excision of oral tumors, e.g. fibroma (referred to as epulis), and incision and
drainage of abscesses (referred to as parulis). When incision and drainage results in a putrid
ulcer rather than a cure, the next step is cauterization of the area with an oval-shaped
cautery. During this period we also see warnings such as "If an eye tooth hurts, do not have
it extracted, because of the eye". Canines are difficult to extract because of their long wide
roots. Certainly during an extraction without anesthesia it might feel like the root tip is next
to the eye. It may also be that cases had actually been encountered where an infection
subsequent to the extraction of a maxillary canine extended into the cavernous sinus
causing great swelling in the region of the eye and serious consequences. In any case, it was
firmly believed from ancient times until the time of a French surgeon-dentist Robert Bunon,
c. 1750 A.D., that there was a direct connection between the maxillary canine and the eye
and such an extraction could cause ocular diseases and perhaps blindness.

Misconception Concerning Anesthesia

A common misconception regarding dental and surgical treatment in this period is that the
ancients had devised some clever method of surgical anesthesia by the use of drugs or
compression of the carotid arteries or hypnosis. Such is not the case. Surgical procedures
were extremely conservative and performed only in the face of absolute necessity. The
writings and drawings of the period show surgery being done on wakeful patients generally
being restrained by assistants or friends. This fallacy has been promulgated largely because
the Greeks did write that compressing the carotid arteries caused a person to fall to the
ground unconscious, but this is all they said about it and there is no evidence of any
medical use of this simple procedure.

Advances in Oral Hygiene

The chewstick for cleaning teeth was apparently borrowed from the Chinese and
Babylonians. It is first mentioned as a common method of cleaning the teeth by the
Romans. It consists of a stick a little smaller in diameter.than a pencil and about 6 inches
long. It is made from any one of a number of fibrous woods. One end is chewed to separate
the fibers and then the teeth are scrubbed one at a time. This method is still used in many
parts of Africa and many Islamic countries. It can be a very effective toothbrush.

Some Romans preferred a variation on this method, the chew sponge. Some present-day
peoples still use the method also. Long branches and vines about a meter in length are
collected, the bark removed by scorching, beaten with rocks to separate the fibers, washed,
and then wound into a ball (referred to as a sponge). As a convenient bite-size of the sponge
is chewed it releases a foaming substance. Much rinsing with astringents and expectoration
accompanies the chewing which lasts about 20 minutes.

Paul of Aegina (Greek, 625-690 A.D.) mentioned that the incrustations (calculus) on the
teeth must be removed either by means of scrapers or a small file.

Finally, one oral hygiene method can hardly be classified as an "advance", but it did persist
long enough to earn a place in the history of dentistry. There is evidence that this custom
also was borrowed from the Chinese. It consists of the use of urine as a mouthwash. It is
first noted by Strabo who says it was customary among the inhabitants of Spain. Eighteen
hundred years later we find the great surgeon-dentist Pierre Fauchard advising people to
use their own urine and only when they are feeling well. He admits it is difficult to get
accustomed to, but then he adds "what would one not do for the sake of one's health.

Islamic-Medieval Europe
(750 AD-1200 AD)

The Roman Empire began to decline after the death of Marcus Aurelius in 180 A.D. and
had completely fallen by 476 when Rome was sacked by the Vandals. Following the
disorganization of the Roman Empire, most of the works of Aristotle, Hippocrates, Galen
and other medical writers were lost for several centuries.

Beginning at the time of the death of Mohammed in 632 AD, the Muslims began
conquering almost all the known world. By 750 AD they were the dominant culture and
ruling power of the world. Their empire included India, Persia, Arabia, North Africa
(including Egypt), Spain, Sicily (in 827) and eventually small portions of southern Italy,
Asia Minor, and Greece.

A. Universities and preservation of Greco-Roman learning: Medical-Dental

Education
In the capital city of Baghdad, the Muslim Caliph Ma«mun established the "House of
Wisdom" in 830 AD, a center of learning with a library, a translation bureau, and a school.
A story of the beginning of this center relates that Ma«mun was worried about applying
reason to God's universe. One night, according to the story, Aristotle appeared to the Caliph
in a dream and assured him that there was no conflict between reason and religion. With
this he ordered the building of the center. "All true knowledge is of God."

The Caliph rewarded scholars handsomely and the center was like a magnet to some of the
best minds in the world. Within 75 years after the House of Wisdom was established, the
greatest works of the Greeks and other early peoples had been discovered and translated
into Arabic. Among them were the books of Aristotle, Hippocrates, and Galen as well as
some important Persian and Indian scientific works.

An example of this intellectual activity can be seen in the work of a Persian, Hunayn (c
830 AD). He studied medicine under a physician in Baghdad who had been trained in a
famous medical school in Jundishajsur, Persia. Hunayn ran into a conflict with his teacher
and was expelled. He found other medical teachers and also learned Greek. His ability and
talents were recognized by some of the Arabic scholars who employed him to seek out
Greek manuscripts -- especially the works of Galen. He pursued the Galen manuscripts into
Mesopotamia, Palestine, Egypt and Syria. He finally found half the manuscripts in
Damascus. He was then appointed to supervise 92 other translators. In order to obtain the
most accurate results possible, some works were first translated from Greek into Syriac, in
which Hunayn was most proficient, and then rendered into Arabic by one of his assistants
who was especially gifted in that language.

By this kind of painstaking scholarship, the scientific writings of the ancient Greeks and
Romans were retrieved, eventually translated into Latin and made their way west through
Sicily and Spain. Centers of learning, like the House of Wisdom, were established
throughout the Empire. One of the most prominent was in Cordova, Spain.

B. Advances in dental treatment

1. Specialization
The Islamic physicians did not develop a system of formal specialization with the exception
of ophthalmology. Eye diseases were common among the Arabs. The first textbook on
ophthalmology was written. Surgery was seen as a minor part of medicine. One of the
greatest surgeon-physisians, Abulcasis, wrote extensively on dentistry and surgery, and in
his practice was essentially a specialist in dentistry and surgery.

2. First Therapeutic Filling

One of the most famous Muslim clinicians was Rhazes (860 - 932). He wrote more than
200 books on subjects from alchemy and theology to astronomy and medicine. He is best
known as the first person to differentiate smallpox from the many other eruptive febrile
diseases. It is not as well known that he was the first, also, to recommend a therapeutic
dental filling. It was not a very permanent filling, and perhaps this is why it is not more
often mentioned. Rhazes recommended cleaning out all the carious material and then filling
the cavity with a cement made of mastic and alum.

3. Other Treatments
For the treatment of periodontitis Rhazes recommended opium, oil of roses, scarification
(making numerous small punctures or incisions) of the gums, application of a leech, or
blood-letting from a vein.

In the history of surgery and dentistry, the greatest name in the Islamic period is Abulcasis
of Cordova (1013 - 1106 A.D.). He was the first to write on the practical methods of
treatment of deformities of the mouth and dental arches. His books contain numerous
illustrations of dental and surgical instruments, some of which are still copied and only
modified for modern surgery. He was the first to thoroughly discuss dental calculus from a
theoretical and practical point of view in a chapter titled On the Scraping of the Teeth. He
described its harmful effect on the gingiva and recommended its regular removal. His set of
14 scaling instruments is illustrated in one of his books. He also recommended, along with
regular scaling, the polishing of teeth with fine abrasives until they were white.

Like all Arabian physicians, he considered it wrong to extract a tooth unless there was no
other choice. Then he recommended a most careful and thorough procedure to avoid
fracture. If the tooth fractured he insisted that the root fragment must be removed and he
described an appropriate operation.

He described methods of splinting teeth and making bridges to restore function as well as
appearance. His books are the first to show illustrations of dental instruments. He was the
first to mention that some barbers had taken up the extraction of teeth and he condemned
the practice because of their lack of training in either the theory or practice of surgery. They
had also started practicing bloodletting and other surgical procedures.

Abulcasis improved on many prior techniques. He improved the method for resecting an
unsightly, supererupted tooth. He devised a tube to protect the surrounding tissues when
cauterizing teeth. In addition to being an excellent scholar, he was a superb clinician. He
stated that there were in existence at that time many more dental instruments than he could
illustrate in his book and his illustrations were numerous including files for caries removal,
saws and axes for crown resection, forceps for crown resection, forceps for extracting bone
fragments and root tips, forceps for loosening teeth, varieties of forceps for extracting teeth,
scrapers for calculus removal, cautery instruments, elevators and lancets. Unfortunately the
Islamic religion forbade human dissection and no real progress was made by the Muslims
in the science of anatomy.

C. Hygiene
The Muslims were the first to license physicians and require standards of cleanliness in
their hospitals. They were the first to establish permanent general hospitals with
dispensaries and libraries. The Romans had introduced the idea of military hospitals.

The chewstick used to clean teeth was known to the Muslims as the Miswak or Siwak.
Mouth cleanliness was (and still is) part of their religion. Muslims who lived between 630
and 1200 A.D. probably had better teeth than most other peoples because of the daily
religious use of the Siwak stick. If they had used dental floss, they would have been up with
the 20th century in oral hygiene.

D. Alchemy
Alchemy combined the chemical craft with much religious mysticism. This form of
mystical chemistry included elements of astrology, search for elixirs of youth and
transmutation of substances into other substances (hopefully gold), but in the process many
valuable chemical reactions and compounds were discovered and recorded. In particular the
Muslims discovered the mineral acids and many volatile substances ("spirits"). One Muslim
sect believed very strongly that all men were equal and extended educational opportunities
to artisans and craftsmen such as alchemists. They also encouraged Islamic guilds including
a guild of alchemists.

Muslim physicians added to the drugs used by Galen making medicine more complex.
Many prescriptions had sixty to seventy ingredients -- mostly plant and animal
preparations, but with some of the new mineral compounds developed by alchemists.

E. Avicenna's Cannon
Avicenna (980 - 1037 A.D.), called the "Prince of Physicians,Ó was one of the most
prolific scientific writers. His ÒCanon of Medicine" was a collection of the findings of all
the great physicians since Hippocrates. Although he was one of the most widely studied
authorities for centuries, Avicenna's influence on medieval medicine and dentistry was in
some ways detrimental. He reinforced the idea that reasoning from tradition and logic was
better than first-hand investigation. He set back the progress of surgery by his attitude that
the surgical art was an inferior and separate branch of medicine, and by his
recommendation that cautery be substituted for the knife.

Avicenna listed many causes of toothache including the little worms that gnawed away the
tooth substance. Part of the table of contents from his books dealing with dental maladies is
included below.

Avicenna's Canon
(Contents of One Book Covering Dental Subjects)

Mouth & Tongue:

 • Anatomy of the mouth & tongue
• Diseases of the tongue
• Loss of taste of the tongue
• Paresis of the tongue, and
• Paralysis of the tongue
• Macroglossia
• Tongue-tie
• Swellings of the tongue
• Defects of speech
• Ranula
• Glossitis
• Treatment of the fissures
• Protrusion of the tongue
• Mouth eruptions/difficulty of articulation
• Malignant ulcers
• Salivation
• Deodorants
• Hemorrhage
• Halitosis
• Mouth breathing

The Teeth:

• General discussion
• Dental hygiene
• Exhaustive discussion of the treatment of teeth
• Diseases of the teeth
• Substances used in the treatment of the diseases of the teeth
• Substances for pain
• The loose tooth
• Decay of the teeth
• Crumbling of the teeth
• Discoloration of the teeth
• Easing the eruption of teeth
• Extraction of teeth
• Painless extraction
• Toothworms
• Causes of gnashing of teeth
• Elongation of teeth
• Teeth on edge
• Sensitive teeth
• Weakness of the teeth

The Gums & Lips:

• Diseases of the gums

• Bleeding gums
 • Gum fissures
• Ulcers of the gums
• Suppuration of the gums
• Recession of the gums
• Looseness of the gums
• Epulis
• The lips and their diseases
• Lip fissures
• Swellings and ulcers of the lips
• Varicose lips
• Lip tremor

F. Common misconceptions regarding barbers, surgury, and dentistry.

There is a common misconception that barbers were the first surgeons and dentists. They
did practice some surgery and extract teeth from about 1100 until the late 1700s, but they
were not the first to do so; and most of the dentistry even during this period was practiced
either by physicians, surgeons, or beginning about 1700, by specialists known as dentists.

Western Dentistry
(1750-1868)

A. Organization and Regulation of Dental Practice

1. France
The French Revolution had a very detrimental effect on dentistry around the turn of the
19th century. In 1792, by vote, the 18 medical faculties, 15 medical colleges, the Royal
Society of Medicine, and the Academy of Surgery were all abolished. An edict was issued
abolishing all restrictions on professions and trades. The practices of medicine, surgery,
midwifery and dentistry were thrown open to anyone who could pay for a license. By about
1820, the French had realized what a disastrous situation had been created and began trying
to reestablish restrictions. It took until 1846 to begin again regulating dental practice, and it
was not really successful until 1892.

2. Germany
The first serious attempt to regulate dental practice in Germany occurred in August, 1825
when a law was passed requiring that aspirants for the title of dentist must first already be
practicing physicians or surgeons and then pass the examination in dentistry. Shortly after
this, the law was modified to allow candidates to take the examination if they had
completed a satisfactory course in anatomy, surgery, materia medica, and therapeutics
(even though they may not have received a diploma in medicine or surgery). In 1852 this
was changed again to restrict the practice of dentistry to practitioners holding the M.D.
degree. This kind of vacillation about who could practice dentistry has resulted in a two-
level system in many countries in Europe and Russia. One type of dentist in these countries
is the M.D.-Stomatologist; the other level is a more technically educated dentist without the
doctor's degree. There has always been a problem in producing enough M.D.-
Stomatologists to meet the demand for care, but the current trend in Russia and some
European countries is to increase the number.

3. United States
In the United States there were French surgeon-dentists who had emigrated during the
French Revolution; there were British dentists with and without the M.D. Degree, but
before long the majority of American dentists were Americans who had served
preceptorships under other established dentists. Beginning in the late 1700's they began to
refer to themselves as dental surgeons.

The first regularly established course of lectures on dentistry was given at the medical
school at the University of Maryland in 1821. In 1837, these lectures were being presented
by a prominent American dentist named Horace Hayden. Hayden had served a
preceptorship under John Greenwood, Washington's dentist. He studied medicine after he
began practicing dentistry and was later awarded an honorary M.D. Degree.

Another prominent dentist in Baltimore at this time was Chapin Harris who had received
his license to practice medicine first and then served a preceptorship in dentistry. Both
Hayden and Harris recognized the need for some kind of organized, comprehensive
instruction for dentists. They discussed the subject at length and then submitted a request to
the University of Maryland for the establishment of a dental department. Had this request
been approved, it is possible that dentistry may have been established as a specialty of
medicine in the United States. The application was not approved. Hayden and Harris both
felt there was more than one way to achieve their goal, and organizing a separate
independent school seemed a very good alternative. They applied to the state legislature for
a charter to establish an independent school of dentistry and to award a new degree
"Chirurgiae Dentium DoctorÓ (Doctor of Dental Surgery) and to use the English
initials D.D.S. The legislature at Annapolis approved the request. In 1839 the first dental
school in the world was organized, the Baltimore College of Dental Surgery.

That same year the first dental periodical was published, the American Journal of Dental
Science and the first national dental society was formed, the American Society of Dental
Surgeons. 1839 was the year of the birth of organized dentistry in the United States, and
for the next 100 years American dentists led the world both in the development of clinical
procedures and in dental research.

A common misconception about this event is that dentistry was rejected by the medical
profession. A few medical educators in Baltimore in 1839 were opposed to the
establishment of dentistry as a new specialty, but this was not very important. Most
specialties, such as obstetrics, surgery and psychiatry had to struggle for recognition.

The problem with establishing a full dental department was that internal dissensions and a
lack of facilities made it impractical to "graft" another department of any kind upon the
medical school at that time, but the general attitude toward dentistry was favorable. In
1839, one of the medical school faculty wrote of the new American Journal of Dental
Science "the above is the title of a new periodical devoted particularly to the interest of the
file and the forceps . . . We commend it to (the) favorable of the medical community. We
do this most cheerfully because of the intimate connection which exists in reality between
this branch of our profession and thus to the interest of which we are more immediately
devoted.Ó

In 1840, the charter for Baltimore College was actually granted. The same year, the medical
school awarded Horace Hayden the honorary degree Doctor of Medicine. Hayden had
taken some medical courses to enhance his dental practice (medical schools were very
flexible in those days) but had not completed the entire curriculum.

The dental historian, M. D. K. Bremner, refers to the three events of 1839 -- dental
organization, education and journalism -- as the three essential foundation blocks of a
profession. In my opinion, as the disorganization following the French Revolution
illustrates, a fourth must be added -- regulation. In the history of dentistry (and medicine
and surgery) whenever there has been a lack of regulation, quackery has flourished.

The dentists of New York State had organized in 1934 and stated one of their main goals to
be the regulation of dental practice in that state. The first state, though, to pass a law to
regulate the practice of dentistry was Alabama in 1841. By 1876 a large number of states
had passed similar laws.

The D.M.D. Degree

Between 1840 and 1867, nine more dental schools were organized after the pattern of
Baltimore College -- completely separate autonomous schools. In 1867, the first dental
school associated with a larger parent university was organized, Harvard University
Dental School. The organizers were not happy with the D.D.S. Degree. If they used the
Latin initials, as was the classical tradition, it came out C.D.D. In addition it was felt that
dentistry was not a branch of surgery and not a separate science, but a branch of medicine.
It was finally decided to prefix the Latin word "Dentariae" to the old degree "Medicinae
Doctoris" thus meeting the classical requirements and making a distinctive title, D.M.D. for
the profession which was actually a branch of medicine.

For many years there were only four schools in the United States that awarded the D.M.D.
Degree -- Harvard, Tufts, North Pacific (University of Oregon), and Alabama. Since 1970
approximately fifteen additional U.S. schools have discontinued the D.D.S. and adopted the
D.M.D. Degree. The different degrees in no way reflect any differences in curricula. Many
educators simply see the D.M.D. as a more correct designation of dentistry as a branch of
the large field of medicine and not limited to surgery.

4. Britain
In 1857 two dental organizations were formed in England. One was the Odontological
Society of London, dedicated to establishing dentistry as a specialty of medicine or
surgery. The other was the College of Dentists of England, with three times as many
members, favoring the establishment of an independent profession. Neither organization
included a very large percentage of the practicing dentists. Most of them remained aloof
and indifferent to the battle.
The unwillingness of either group to compromise and unite prevented the early
establishment of either system. Eventually they did unite and the outcome was that the
original licensing was under the control of the Royal College of Surgeons, and the diploma
awarded was Licentiate in Dental Surgery (L.D.S.); but the profession has evolved as an
independent profession.

Early dental practice acts in England were so faulty and full of loopholes that effective
regulation of the profession was not achieved until 1921. The basic science component of
dental education under all three of these systems is very similar to the medical curriculum.
This has been so since the inception of all three systems. In the 1930's, the dental historian
Arthur Lufkin assessed them this way: the American system (in his opinion) stressed the
technical aspects at the expense of medical sciences; the Stomatologic system (e.g. in Italy)
stressed medical science at the expense of technical dental education, and the British
system he felt represented a more healthy balance. In recent years, much activity occurred
in reassessing dental curricula to find the best balance of basic science, clinical science,
behavioral science, and clinical practice.

B. Giuseppangelo Fonzi and Prosthetics

At the turn of the 19th century, artificial dentures did little more than fill in the sunken
appearance of the face of an edentulous patient. Carved ivory had a uniform color, tended
to stain, decay, and smell bad. Human and animal teeth had similar problems. Dentures did
not fit well and had to be held in by opposing action of springs. Masticatory function was
virtually impossible. Duch‰teau and deChamant had worked with porcelain but had given
the profession nothing of any practical value.

The first big breakthrough in solving the problems of removable dentures came in 1808
with a report on individual porcelain teeth with platinum pins to be soldered to a metal
denture base. This technique was invented and reported by an Italian dentist living in Paris,
Giuseppangelo Fonzi.

Fonzi was born near Terano in central Italy in 1768. From an early age he gave evidence of
extraordinary intelligence. He had just turned 16 when he finished school and began
studying law -- the profession of his father. Fonzi grew impatient to travel and expand his
horizons; so he approached his father asking to be allowed to attend the university at
Naples. The family had one other son in the university at Naples and two in seminary.
Because of the added cost, his father told him he would have to wait until the oldest son
had finished his studies. Fonzi couldn't wait, so he took a silver knife, fork and spoon from
his home (to sell) and went to Rome. He spent some time with some poets there (Fonzi had
considerable literary talent), then traveled to Naples and after a brief stay, joined the
Spanish Navy.

His first commander became a personal friend and enjoyed Fonzi's company and his poetry,
and Fonzi enjoyed traveling with the Navy for several years. When he was assigned a
different ship, the picture changed and he found his life drudgerous; so he abandoned ship
in a Spanish port and never went back. He saw a "tooth drawer" one day working in a
public square. The work intrigued him and he needed to make a living, so he served a short
apprenticeship as a tooth drawer. Not satisfied with this narrow scope of practice, he
studied on his own to make himself a dentist. Spain at this time was very backward in
dentistry and there were very few books, so he learned French and read the works of the
great French dentists, Fauchard, Bunon, Bourdette and others. He built a successful practice
in Spain but needed a more stimulating environment. About 1795 he went to Paris and soon
had an established practice there. It is not known if he served any kind of preceptorship
there since the restrictions had been abolished by the revolutionary government. In 1801,
Fonzi returned to Italy and for a while was dentist to the King and Queen of Naples. He
was a brilliant conversationalist with vast experience and ability in languages so the queen
approached him with the proposal that, for considerable pay, he become an informant to the
king and queen concerning the noble families of the kingdom of Naples. Not wanting to
accept the offer, he chose to return to Paris.

Fonzi loved physics and chemistry and for the next six years he worked continuously on the
idea of making individual porcelain teeth that would look natural and could be attached to
the denture base. In 1808 he presented his invention which he called terro-metallic teeth
to the Athenium of Arts and the Academy of Medicine of Paris (which had been
reinstated after their dissolution by the revolutionary government).

What this invention meant was that dentures would require less time to make because there
was no carving. Bulky denture bases would no longer be needed. A thin metal base could
be swaged to a model getting closer adaptation to the mouth. Since the bases were not so
bulky the entire palate could be covered obtaining some suction (a principle already
discovered but little used). The teeth looked more natural than carved ivory because they
were actually separate and could be made slightly different shades of color. The teeth
would not stain, decay or smell bad. Dentures for the first time looked a little bit natural,
didn't stink, and could actually sometimes provide a little function.

Fonzi became famous and people from all over Europe crowded his office in Paris. He
traveled to Bavaria, Russia and Spain at the request of those countries to serve the dental
needs of the royal families and was given a lifetime pension by the Spanish government. He
also made other less spectacular inventions, wrote five plays, three epic poems and books
on The Religions of India, The Origin of the Gods, and A History of Persian Customs.

At the age of 72, Fonzi wished to return to his home and family in Italy. Upon arriving in
Barcelona to board a ship to Naples, he fell seriously ill and died on September 2, 1840.

C. Levi Spear Parmly and Preventive Dentistry

In 1800, the accepted theory of decay was that it was initiated by an internal inflammation
caused by an excess of acrid humors. This theory had first been posited by Galen and had
not changed substantially. Some people still believed in the toothworms, but most dentists
from Fauchard's time on were either skeptical or flatly stated that there were no such
parasites.
One American dentist published, in 1819, a book, A Practical Guide to the Management of
Teeth, comprising the discovery of the origin of caries or decay of the teeth. He was far
ahead of his time.

The dentist was Levi Spear Parmly (1790-1859). The following is an excerpt from his
book:

"The great and leading cause, of the diseases of the teeth and gums, is to be
sought for in the exercise of their functions. Being the agents of introducing
the supplies to the system, they must act on these supplies mechanically, and
fit them for passing into the stomach; and, in doing so, part of that matter, of
which the supplies consist, must adhere, and receive, if allowed to remain,
that change which enables it to act upon, and erode their enamel and bone;
and to contribute to that peculiar secretion on the teeth, known by the name
of tartar, which is another cause of inflammation and disease of the gums.

This is the true source of caries, or decay of the teeth.

I can, with confidence, assert, that if the teeth and gums are regularly
cleaned, no caries can possibly take place. This, then, is a simple and clear
view of the subject, and the grand desideratum for retaining these important
organs in a sound and healthy state, to the latest period of existence . . .Ó

"The first part to be used is the brush. It is made hollow in the middle, to
embrace every part of the teeth, except the interstices; and thus, at one
operation, the top (a part hitherto entirely neglected) the outer and inner
surfaces are completely freed from all extraneous matter. The second part is
the dentifrice polisher, for removing roughness, stains, etc., from the
enamel, and restoring to the teeth their natural smoothness and colour. The
third part is the waxed silken thread, which, though simple, is the most
important. It is to be passed through the interstices of the teeth, between
their necks and the arches of the gum, to dislodge that irritating matter
which no brush can remove, and which is the real source of disease. With
this apparatus, thus regularly and daily used, the teeth and gums will be
preserved free from disease...

"The best dentifrice that can be used is common table salt: itis perfectly
innocent, as it completely dissolves in the saliva, and produces all the
friction that is necessary for cleansing the teeth."

D. Fusible Metal -- Silver Paste and the Amalgam War

Joseph Fox, a prominent English dentist and former student of John Hunter, invented, in
1803, a metallic filling material to be put into a cavity in liquid form which when it cooled
would solidify to the exact shape of the cavity. He referred to it as "Fusible Metal". It
consisted of 8 parts bismuth, 5 parts lead, and 3 parts tin. The first problem with the
material was that the melting temperature was 212¡ F, the boiling temperature for water.
This is a low fusing temperature for a metal but not low enough for the patient to accept
cheerfully. A second problem with Fox's material was the awkwardness and danger
involved in trying to fill cavities in maxillary teeth! The technique gained the attention of
dentists and the public and was employed in France, England and the United States, but
was not a raving success.

By adding mercury to the alloy the fusing temperature was brought down to 140¡ F. Pieces
of the metal could then be put into cavities and melted with a red-hot iron -- a distinct
improvement. Somewhere around 1826, August Taveau of Paris and Thomas Bell of
England both conceived the idea of mixing coin silver filings with mercury to make an
amalgam filling material that would be soft during insertion and harden very quickly.
Taveau is best known for this and he called his material "silver paste". Coin silver at that
time was 90% or more silver with the rest mainly copper. When mixed with mercury it
made a good filling material except for one thing. After setting there was a considerable
delayed expansion, and it was not rare for a patient to return in a few days with a fractured
tooth or the filling protruding above the cavity and interfering with the bite.

In spite of this drawback many dentists used it and experimented with the material. Some
tried altering the formula but without sufficient scientific control and then went the other
way -- the material shrunk upon setting and began to leak or fell out of the cavity.

The material was introduced into the United States by two French dentists, the Crawcour
brothers in 1833. They did so with extravagant claims for this new material which they
called "Royal Mineral Succedaneum" because it was supposed to take the place of the
"royal mineral", gold.

The most competent dentists in the country very quickly recognized the problems of this
early amalgam and were violently opposed to the use of innocent paying patients for
experimentation. In addition to the expansion -- contraction problems, many dentists were
worried about the casual use of mercury (a concern which has been raised again recently).

E. The Amalgam War

The American Society of Dental Surgeons was organized in 1840 and in 1843 took up the
amalgam controversy. The controversy developed into what dental historians call the
"Amalgam War" and is a prime example of the damage that can be done when a
controversy becomes an emotional fight resolved by force rather than objective arbitration.

The first thing done was to appoint a select committee to report back on all mercury
compounds used for dental fillings. Without adequate scientific proof, the committee
reported "that all such articles were harmful to the teeth and every part of the patients'
mouths". The Society then, on July 20, 1843, went on record declaring "the use of amalgam
to be malpractice". The statement had little effect though, and those who wished to,
continued to use the material -- perhaps even more so. A faction had formed in the Society,
determined to push this issue to the limit, undoubtedly convinced that what they were doing
was for the best good of both the profession and the public. They pushed through a
resolution establishing a committee to investigate the membership "regarding their use of
and attitude toward amalgam". This resulted in their designing the following pledge to be
signed by every member or they would face expulsion from the organization:
"I hereby certify it to be my opinion and firm conviction that any amalgam whatever...is
unfit for the plugging of teeth or fangs and I pledge myself never under any circumstances
to make use of it in my practice, as a dental surgeon, and furthermore, as a member of the
American Association of Dental surgeons, I do subscribe and unite with them in this protest
against the use of the same. Given under my hand and seal the _________ day of
______________, 184_ .

Signed ______________________Ó

Many of those who were strongly opposed to amalgam as a filling material were even more
strongly opposed to this infringement on their individual freedom to exercise their own
professional judgement. This resulted in a tremendous loss of membership. A few members
were expelled but many more withdrew voluntarily. By 1850 the pledge was rescinded but
it was too late. At the annual meeting scheduled for August 1, 1856, the American Society
of Dental Surgeons was disbanded for lack of a quorum.

In 1859, representatives of several state dental societies met in Niagara Falls, New York,
and formed a new national organization, The American Dental Association.

F. The Discovery of Anesthesia

In the history of science, there has been in the past much controversy over who should be
called the "discoverer" of one principle or another and who should be credited with
"priority" or the first statement or use of a principle. One answer to this dilemma, and the
one used by many current historians, is to designate as a discoverer, the person whose work
actually altered the course of history in the area being considered. By this standard, some
historians consider Horace Wells (1815-1848), a Hartford, Connecticut dentist, the
discoverer of anesthesia and others consider a Boston dentist, William T.G. Morton, the
discoverer. Some considered them co-discoverers.

In the 1840's ether and nitrous oxide were being sniffed by science students at parties, and
their effects demonstrated publically at more respectable quasi-scientific exhibitions. One
such exhibition was given in Hartford, Connecticut on December 11, 1844. In the audience
was Dr. Horace Wells with his wife. One of the volunteers to experience nitrous oxide was
Sam Cooley, a man with whom Horace Wells was acquainted. At one point, Cooley, under
the influence of nitrous oxide, leaped from the stage to chase one of the men in the
audience who had been laughing at him. The man fled and Cooley stumbled into the seats.
After the exertion and rapid ventilation, Cooley sat down next to Dr. Wells. It took several
minutes for Cooley to realize he had hurt himself. Finally he pulled up his trouser leg and
saw a bruised and bloody leg with a deep ugly cut across the shinbone. Dr. Wells asked him
if he had not experienced any pain and Sam replied that he had not. This may have been
brushed aside by many people but to Wells it was most significant. He was deeply
concerned about pain and wished for some means of controlling it. He remembered once
doing an extraction of a multiple-rooted tooth; when the roots fractured, a two-hour ordeal
left the patient, a young healthy medical student, semi-conscious and exhausted from the
agony. He had several times, after very painful operations, abandoned his practice for
weeks at a time and had seriously considered giving up the practice of dentistry because of
the unbearable stress of having to inflict such pain.
He seized on the possibility of finding an answer to the problem of surgical pain and
approached the demonstrator, a self-proclaimed professor of science, Gardner Q. Colton,
with a suggestion to try nitrous oxide for an extraction the next day. Colton was afraid to
administer as much of the gas as he thought would be necessary to achieve the result but
Wells was insistent, agreeing to have one of his own teeth extracted by a colleague. Colton
agreed. Then Wells spent half the night persuading his associate, Dr. John Riggs, to
perform the operation. Riggs also felt they were taking too great a risk to push the effect of
nitrous oxide to such a degree, but he finally agreed to do the extraction. The next day they
carried out their plan. Af ter the procedure was done and the nitrous oxide wore off, Wells
exclaimed "I didn't feel so much as the prick of a pin". Riggs went on in 1881 to introduce
techniques for treatment of periodontal disease known as Riggs' disease.

Over the next few weeks Wells administered nitrous oxide to 15 patients. He obtained
complete pain control on about half of them and only partial pain control on the rest. He
was in a hurry to give his discovery to the world, so he went to Boston to ask his former
partner Dr. William T. G. Morton (1819-1868) to arrange a demonstration at
Massachusetts General Hospital. Morton, who was a former student of Wells, was well
known in Boston and acquainted with the medical officials at the hospital. The story is
quite well known that when Wells gave his demonstration, the patient screamed and the
audience booed and walked out.

Wells was devastated by this experience. He returned to Hartford and continued to use
nitrous oxide and later to experiment with other agents, but apparently never quite
recovered from the humiliation. Perhaps that same sensitivity that caused him to have the
insight and perseverance to discover the anesthetic effects of nitrous oxide also contributed
to his downfall.

During the next year and a half Morton may have heard that Wells was still using nitrous
oxide. In any case, on September 30, 1846, he visited a physician/chemist Charles T.
Jackson to find out how to get some nitrous oxide. Jackson was not impressed with the idea
of anesthesia, but suggested that ether would be easier to obtain than nitrous oxide and
would produce essentially the same effect.

That same evening, a man came to Dr. Morton's office suffering great pain from a
toothache. He wanted the tooth extracted but was terrified of the operation. He had been
reading about mesmerism. Apparently he thought Morton might be familiar with the
technique because he asked him if he could mesmerize him before the extraction. Morton
told him he had something better; he saturated his handkerchief with ether and gave it to the
man to breathe through. The patient became unconscious and the tooth was extracted
painlessly.

About two weeks later, Morton contacted the same man who had previously arranged
Well's unsuccessful demonstration, the Chief Surgeon, Dr. John Collins Warren. One has
to admire Dr. Morton's perseverance. Warren, surprisingly, agreed to another
demonstration. For the demonstration, Morton had a glass bulb made with an opening for
the patient to breathe through. A sponge was placed inside the bulb and saturated with
ether.
The demonstration occurred on October 16, 1846, in what is now called the Ether Dome of
Massachusetts General Hospital. It is considered by historians to be one of the most
significant events in the history of mankind. Dr. Morton administered the anesthetic. Dr.
Warren removed a tumor from the patient's lower jaw -- with no pain.

A short time after this, a report came out of India of successful operations using hypnosis,
but was completely overshadowed by the magnitude of the news about ether.

The following year, chloroform anesthesia was discovered in Scotland. Horace Wells began
to experiment with it and became addicted. He had moved to New York and opened an
office. One day as he was just recovering from the effects of some self-administered
chloroform, he saw two prostitutes on the street, grabbed a vial of acid and ran out and
threw it on them. He was arrested and put in Tombs Prison. This was on a Friday. He was
to be released the following Monday. After attending church services in the prison, he spent
the rest of the day composing a letter to his family and praying. That night, he apparently
administered himself a vial of chloroform and then slashed his left femoral artery.

His letter read in part: "... May God forgive me! Oh! my dear wife and child, whom I leave
destitute of the means of support -- I would still live and work for you, but I cannot -- for
were I to live on, I should become a maniac. I feel that I am but little better than one
already ..."

Had he lived just a week or two longer, Horace Wells would have received a letter which
had already been mailed from Paris informing him that the French Academy of Medicine
had, after considerable investigation and debate, decided to recognize Horace Wells of
Hartford, Connecticut as the Discoverer of Anesthesia.

Today many historians argue that since Morton used a more effective agent, and conducted
the first successful demonstration of anesthesia, his work changed the course of history and
should be designated the discoverer. I believe they should be considered codiscoverers
since it was really the work of both men that produced the result.

Perhaps more important than the question of who did the most is a consideration of the
personality traits in these two men that caused them to achieve what they did.

Horace Wells had the original insight because he was a warm empathetic man with an
overriding dedication to finding a way to control pain. William T. G. Morton was also
committed to finding a way to control pain. He may not have been as sensitive as Wells but
displayed an admirable degree of courage and perseverance necessary to achieve the
breakthrough of surgical anesthesia.

Western Dentistry
(1850-)
A. Greene Vardiman Black
The most commanding personality in dentistry in the 19th century was Greene Vardiman
Black. He provided the first comprehensive systematization, classification and
nomenclature in operative dentistry. Through years of meticulous research, he produced the
first balanced silver amalgam restorative material. He did exhaustive research and wrote
standard textbooks on Dental Anatomy, Operative Dentistry and Pathology. He developed
teaching aids and methods. He instigated curricular changes in dental education -- and the
list goes on.

This versatile genius was born on a farm near Winchester, Illinois in 1836. He loved nature
and knowledge but did not like school very much. His later life would suggest that he
learned much too fast to tolerate the inhibiting effects of the structured classroom -- an odd
paradox since he became a world-renowned teacher.

At the age of nineteen he went to Clayton, Illinois to serve a preceptorship under his
brother, Tom, a practicing physician. He spent a couple of years with Tom and then was
attracted to dentistry. After a few weeks with a rather mediocre dentist, Dr. J. C. Speers, in
Mt. Sterling, Illinois, Black decided he was ready to open his own office. He married and
started a dental practice in Winchester, near his home. He was the first and only dentist in
the county. Shortly after that, he volunteered for service in the Civil War. He injured his
knees soon after joining the army and spent several months in the hospital. He apparently
never saw combat.

After the war, Black decided to go into partnership with an older dentist, J. C. Cox, in the
larger city of jacksonville, Illinois. Jacksonville had several educational institutions
including the first college in the state, a public library, literary union, philharmonic society,
and a number of well-educated physicians and dentists. Black had the opportunity to
perform dissections and increase his knowledge of human anatomy. He was asked. to
discuss the ether spray for lbcal anesthesia to the local medical society. Then he was asked
to return and he presented papers on "Diagnosis of Kidney Disease", "Inflammation",
"Theory of Sight", "Typhoid and Scarlet Fever" and others. In 1869 he presented his first
paper to the Illinois State Dental Society on "Gold Foil".

Black organized a Chemistry Club which promptly elected him to be the teacher and
seminar leader. This gave him the opportunity to learn in the most effective way for him,
through teaching. He was so unusually intelligent that having his class filled with other
educated physicians and dentists only supplied sufficient challenge and direction for his
studies.

Later he formed a Microscope Club for the same reason. He obtained one of the first
microscopes in Illinois and became the de facto consulting pathologist for the region. The
story is told that an ophthalmologist once brought Black a small foreign body he had
removed from a patient's eye. Black at the time was treating a patient and told the
ophthalmologist to leave the specimen on the table. A few days later the ophthalmologist
returned while Black was inserting a gold foil restoration, but the specimen had been
analyzed and identified by him as a specific gland from the leg of a potato bug which had
much the same irritant effect as Spanish Fly. He was quite surprised that the
ophthalmologist had not recognized it.

Black had taught himself Latin and French but much of the scientific literature at that time,
especially in cellular pathology, was coming from Germany. He went to a local merchant
who was German and arranged to buy him supper and cigars every Thursday night for
some instruction in German. Before long he was able to get the German scientific journals
directly and read them without having to wait for translations.

Black was married and had several children. He was an excellent musician and member of
the Philharmonic Society, the Dramatic Club, Grand Master of a Mason's Lodge, Public
Library Committee, Literary Society, and Chairman of the Third Ward Republican Club for
three years.

In 1870, he was offered a professorship in Oral Pathology at Missouri Dental College.

During the next ten years he spent two days a week in St. Louis Missouri at the dental
school and the rest of his time in Chicago. During this time, in addition to his private
practice, teaching and studying, he published approximately a hundred scientific articles.

During this period, the state of Illinois announced that they would begin licensing
physicians in 1878. Since Black had actually engaged in medical practice prior to that time
he could have registered to continue without taking the examination, but he chose to be one
of the first to take the examination. Thirty- four candidates took the first examination. Only
half of them passed with the required score of over 80% specified by the board, but G. V.
Black had no problem passing it the first time and was licensed to practice medicine. He
never listed himself as a physician or attempted to build a practice in general medicine, but
apparently he wanted whatever opportunities and freedoms such a credential might carry to
enhance his dental career. He was such an enthusiastic scholar that perhaps he just couldn't
pass up the opportunity to show himself how well he could do.

That same year (1878), after he had been a professor at Missouri Dental College for eight
years, the school decided to award this man, who had never attended a medical or dental
school, a D.D.S. Degree. His degrees were all honorary. In 1884 he was given an M.D.
Degree by the Chicago Medical College; in 1892, an Sc.D. from Illinois College; in 1898,
an L.L.D. from Northwestern and in 1915 another Sc.D. from the University of
Pennsylvania.

In 1880 he quit teaching at Missouri. In 1883 he was teaching again, this time at the
Chicago College of Dental Surgery. In 1884, he published his first full length book, The
Formation of Poisons by Micro-organisms.

At about this time, Dr. Black began his research on silver amalgam. He had to invent and
either build or have built much of the equipment because of the newness of the field. He
also served during this time on the Illinois State Board of Dental Examiners. In 1891, he
left Chicago College and began teaching at Northwestern University Dental School.
Dr. Black was a meticulous researcher, repeating every experiment at least three times. The
problems with amalgams were tremendous. He investigated the effects of moisture and
drying, different methods of mixing, mixing times, and many alloy formulas. He calculated
the force of mastication on the teeth with every conceivable hardness of food. He analyzed
expansion and contraction of the metals, shear strength, compressive strength, corrosion
and a host of other factors and related them all to each other. In 1895 he had succeeded in
analyzing every requirement of an adequate filling material and developed a balance of
ingredients for a silver alloy with a specific percentage of mercury to produce the first
satisfactory amalgam fillings.

He prepared a series of articles to publish his results. At this point he was approached by
friends who asked him if he realized that by patenting his process, keeping it a secret and
going into the manufacturing business he could become a millionaire. Of course he realized
this but said it offered no temptation. He was financially secure and had an exciting career
that really couldn't be measured in monitary value. He offered to present a series of lectures
on the metallurgical parts of his research to any manufacturers who wanted to pay $100.00
tuition, after which he said the full report of his research would be published to the world.

In 1895, his series of articles began in Dental Cosmos under the general title of ÒAn
Investigation of the Physical Characters of the Human Teeth in Relation to Their Diseases
and to the Practical Dental Operations, together with the Physical Characters of Filling
Materials.Ó The series was concurrently published in dental journals in virtually every
civilized country of the world.

From the beginning of dental history there had never been a good long-lasting treatment to
repair the damage of dental caries and prevent further caries that was available at a cost that
was reasonable to the general public. Silver amalgam was not only a relatively inexpensive
material (lead had been used for over 100 years) but it required a fraction of the operating
time, cutting the cost to the patient dramatically. This was the most significant event up to
that time to bring a high quality of conservative dental treatment to the general population.

In 1897, C. V. Black became Dean of Northwestern University Dental School. He died in

1915. Over his life he made many, many contributions in all aspects of dental science,
dental practice, and dental education; and there is certainly not room to list them here.

Carl E. Black and Bessie M. Black wrote biographies of G. V. Black and his son Arthur D.
Black (also a famous dental educator) in a book titled From Pioneer to Scientist, Bruce
Publishing Co., St. Paul, Minn., 1940. A statue of G. V. Black stands in Lincoln Park in
Chicago as an inspiration to those interested in the life and work of this great man.

B. Operative Dentistry
During the second half of the 19th century tremendous progress in operative dentistry
occurred, much of it in the United States of America.

1. Gold Foil
Pure gold had been used as a filling material since at least 1484, but the process was very
awkward. Several techniques had developed but all of them amounted to attempting to just
stuff the cavity with gold and hope there were no voids within the filling or at the margins
that would leak. Very often they did leak. In 1855 Robert Arthur, one of the two
graduates of the first class at Baltimore College of Dental Surgery, discovered the principle
of cohesive gold. By thoroughly annealing the foil over an alcohol lamp he found that it
developed an adhesive or cohesive property. As so often happens in the history of science,
several dentists sprang up insisting that they had discovered the principle several years
previously and the answer was then as it is now -- who cares! If you discover something
and don't tell anyone about it and it does no one any good but you and perhaps a few
patients, don't expect to get credit for a discovery.

Dr. Arthur's discovery, and several other recommendations in the gold foil operation, were
published for the whole profession to benefit from. This seems like a simple discovery, as
many do, but it meant a tremendous improvement in the success of gold foil restorations.

2. Dry Operative Field

The discovery of cohesive gold foil emphasized another problem in operative dentistry: the
need to maintain a dry field. A number of methods to obtain a dry field had been tried.
They ranged from filling the mouth with blotting paper, punk or rolls of cotton to clamping
the salivary ducts with gold wire tongs. Dr. Arthur recommended a section of rubber tubing
fit over the tooth and also invented a saliva suction pump. It was a crude manual device. In
short nothing worked and it was frustrating to have such a good technique as the cohesive
gold foil technic and only be able to employ it in a few situations where a dry field was
easy to maintain over a fairly long time.

3. Rubber Dam
In 1864, Dr. S.C. Barnum of New York invented the rubber dam. Many patients and third
year dental students curse the device, but it was so valuable to the dentists at that time to
finally be able to operate in a dry field that at a meeting of the American Dental
Association in 1870, a resolution was adopted thanking Dr. Barnum for his invention and
presenting him with a gift of $1,800.00 and a gold watch from the A.D.A. members. In
addition, a gold medal was given to him from the California Dental Association, a gold
watch and chain and some money from the New York Odontological Society and the
Massachusetts Dental Society and similar gifts from others.

In the 1870's some improvements were made replacing the saliva pump with a saliva
ejector that worked off the principle of suction produced by having the ejector connected to
the water supply.

4. Matrices
Many of the most routine dental operations today were either very difficult or impossible a
hundred years ago. Proximal cavities were a very difficult problem. Generally they were
treated by filing away the decay and cauterizing the cavity. Around 1870, some dentists
were using separators on anterior teeth to gain enough space to insert a gold foil filling and
then allow the teeth to return to their normal positions. Proximal cavities in posterior teeth
were virtually impossible to restore.
In the Dental Cosmos for April, 1871, Dr. Louis Jack described the first matrices designed
to provide a form for proximal fillings. They were double wedge-shaped pieces of steel
with the thick edges to be located cervically and buccally. In addition to the basic shape,
they were hollowed dut in a variety of shapes and sizes to approximate the shapes of
proximal contours. A tremendous number of them were required to fit the range of sizes
and shapes of teeth. Immediately other dentists began introducing several types of thin
metal matrix bands to be attached to the teeth in a number of clever ways with strings,
clamps, and screws.

5. Rotary Cutting Instruments

Rotary cutting instruments or dental drills have gone through four basic stages of
development:

1. Simple hand drills requiring two hands to both hold and rotate the drill at the same
time
2. Automatically rotating drills driven by hand-power but with a mechanical advantage
such as springs or gears or both
3. Automatically rotating drills driven by foot-power
4. Automatically rotating drills with an automatic source of power.

Improvements in the first type of drill may have been made prior to 1850, but none appear
in writing. Between 1850 and 1905 several inventions by dentists provided mechanical
advantages and some automatic rotation. The best known of these is the one invented by
Charles Merry in 1858. It had a flexible joint coupling to provide an angle for the working
end. The rotary end was connected by a flexible wound wire to a fairly large driving wheel
with a handle to turn it.

The first improvement of the third type (with automatic rotation by foot-power) was G. F.
Green's pneumatic engine in 1868. It was an air-driven hand piece! The air power was
provided by foot bellows. The air went through a rubber tube to the hand piece. This
exciting idea was reinvented in the late 1950's using compressed air and is the standard
instrument today.

Green's instrument was nowhere near as efficient as the famous Morrison foot pedal engine
introduced in 1871. S. S. White improved on the Morrison Engine in 1875. A number of
these instruments are in modern museums, and one is in the Dean's office at the Oregon
Health Sciences University School of Dentistry.

The fourth type of dental engine, with an automatic source of power was actually invented
by G. F. Green between 1856 and 1858 -- at least 10 years before his pneumatic drill -- but
he was too far ahead of his time. He called his instrument the Òelectrical burning engineÓ.
His design for a handpiece driven by electricity was excellent. The problems were that
electric motors were in their infancy, there was no available source of electric current and
electric batteries were difficult to obtain and maintain.

Around the turn of the century when electric power became available, several
manufacturers simply picked up on the concept Green had described decades before and
electric dental engines became standard. While all this was occurring some dentists tried
water pressure -- an idea again tried in the 1950's, apparently without any better results than
the first time it was tried. Edmond Noyes in his History of Operative Dentistry (1909) says
he knew one dentist who "made for himself a little steam engine which drove his dental
engine and laboratory lathe, the exhaust being made noiseless and inoffensive by being
carried through a pipe into a pail of water". Clever -- if it worked.

While all these technical improvements were being made, G. V. Black was outlining the
principles of scientific cavity preparation and conservative restorative principles.

There is no room here to cover all the many additional improvements in filling materials,
instruments and techniques but, hopefully, this brief discussion illustrates the general trend
in the development of operative dentistry in the latter half of the 19th century.

C. Removable Prosthodontics
Fonzi's terro-metalic teeth had made possible a great improvement in full denture technique
but many dentists considered his porcelain teeth (which they referred to as French beans) to
be far short of perfection in esthetic form. The American laboratory technician and dentist,
Dr. S. S. White improved the color and form of porcelain teeth to a point where most
people felt they could not be detected from natural teeth.

S. S. White began manufacturing porcelain teeth in 1844. That same year, Dr. John Allen of
Cincinnati, Ohio, began working on an all-porcelain denture with a platinum base that
would restore not only the lost teeth but also the lost alveolar ridge, form and appearance of
the gums. It took him seven years. He mastered the problems of shrinkage and color and
produced one of the most admirably esthetic and functional dentures ever made -- known as
the "continuous gum" denture. The problem was that these dentures cost between $2,000
and $5,000 a set -- in the year 1855! All dentures were costly. The standard techniques
using gold or silver bases cost several hundred dollars a set -- still too expensive for most
people. Of the people who could afford dentures, some could afford the continuous gum
denture, but something was needed for the rest of the people.

Several materials like Celluloid were being tried as denture bases, but they all had
problems. Celluloid, for instance, tended to turn green and smell bad. In 1854 Dr. Thomas
W. Evans of Paris made a denture for Charles Goodyear, Sr., using a hard rubber base
(vulcanite) invented by the Goodyear family. In 1855, Charles Goodyear, Jr. was granted a
patent on the use of vulcanite rubber as a denture base.

Vulcanite turned out to provide a very good denture base at very low cost. Sometimes
vulcanite was used in conjunction with metal bases but this really was not necessary.
Porcelain teeth with holes or pins forretention could be set into the rubber before
processing. Various shades of veneer rubber could be used to give the appearance of gum
tissue. The material was well-tolerated by the oral tissues and sets were sometimes made
for as little as $5.00.

D. Local Anesthesia
Concurrent with this technology, was the development of anesthesia-- first the gases and
later local anesthetic -- so people who previously would have endured agonizing toothaches
for years, rather than submit to the greater agony of extraction, now had those teeth
removed. In addition, the dental and medical professions were becoming increasingly
concerned about infection and felt that infected teeth may be the cause of some systemic
diseases. The dental historian Bremner refers to this period (c. 1850 - 1925) as the "Era of
Blood, Vulcanite and False Teeth for the Millions". This period of history is still fairly
recent and probably explains why many people still think that the natural course of events
is for everyone to end up with false teeth in their middle or later years. It is unfortunate that
many teeth were lost that today probably would have been saved, but some positive things
had occurred. By 1900, the cost of both conservative and radical dental treatment had been
brought within reach of the average person, and effective methods had been developed to
control pain.

The discovery of surgical anesthesia stimulated some practitioners to think about some
method of local anesthesia. In 1848, James Arnott suggested a small pig's bladder half-
filled with water to be placed over the teeth and gums. Then some crushed ice was to be
added along with salt to lower the freezing point; it was then to be held in position for
fifteen to twenty minutes. It wasn't a very useful technique.

In 1856, J. B. Francis invented a technique for extracting teeth using forceps attached to an
electric battery. The patient held the positive pole in his or her hand. When the forceps
touched the tooth, the circuit was completed and the tooth was quickly extracted. This was
not a huge success either.

In 1884, Sigmund Freud invited an ophthalmologist friend to do some work with him
investigating the effects of cocaine. Freud was primarily interested in the neurological and
psychological effects of cocaine. He left for a short vacation and while he was gone, his
friend, Carl Koller, with his assistant, tried dropping cocaine into the eyes of animals and
found that it produced local anesthesia. Koller presented his discovery in a paper on
September 15, 1884. Freud had a burning desire to become famous, which had not yet
occurred by that time. He wrote that it really bothered him that he missed out on either
being a discoverer or co-discoverer of local anesthesia, but he never tried to take any of the
credit from his friend, whom he referred to in later years as Dr. Coca Koller.

Two months after Koller's discovery, an American surgeon, William Halsted, tried
injecting the drug close to a nerve trunk to see if it would "block" the nerve conduction.
Koller and other Europeans had only used cocaine anesthesia by topical application on
mucous membranes. The first nerve blocked was the inferior alveolar (dental) nerve.
Halsted experimented almost entirely on himself, blocking one nerve after another. Just as
Horace Wells had developed an addiction to chloroform by self-experimentation, Halsted
became addicted to cocaine. He was made aware of the problem and made a valiant fight to
break the addiction -- apparently with success.

Cocaine was a dangerous anesthetic and dentists had a difficult time getting profound
anesthesia over a sufficiently long time without producing serious side effects. One
approach to solving this problem was the invention of high pressure syringes using snug-
fitting needles inserted into either bone or dentin. A high degree of mechanical or chemical
pressure was used to force the solution into a confined area of hard tissue.

In 1901 Heinrich Braun discovered the vasoconstricting property of epinephrine and

suggested its use with cocaine to prolong the anesthesia and slow the rate of absorption.

In 1904, Einhorn and his associates discovered exactly what they had been trying to find, a
synthetic local anesthetic without the side effects of cocaine: procaine (Novocaine).

E. Women in Dentistry
Shortly after her marriage to a Connecticut dentist in 1854, Emiline Roberts Jones became
interested in dentistry and offered to assist her husband, Dr. Daniel Jones. He answered that
dentistry was no occupation for frail and clumsy fingers. She observed her husband's work,
read his books, then saved several hundred extracted teeth and secretly placed restorations
in them. Her husband finally allowed her to begin treating some of his patients while she
received instruction from him and from Dr. R. B. Curtiss of Winsted, Connecticut. When
her husband died in 1864 Emiline took over his practice. She had probably completed a
better preceptorship than most dentists in the 1860's. Years later Emiline trained her son
David in a preceptorship in dentistry. Then she sent him to Yale University and then to
Harvard's School of Dental Medicine.

While Dr. Emiline Jones (as she was known in her community) was beginning to break the
"all-male" barrier in Connecticut, a school teacher named Lucy Hobbs was searching the
State of Ohio for a dentist who would allow a woman to serve a preceptorship in dentistry.
One courageous dentist, Dr. Samuel Wardle, finally accepted her on the same basis as his
other students. Shortly after completing her preceptorship she applied for admission to
Ohio College of Dental Surgery, one of only three existing dental schools at that time. With
a college preparation for teaching and the completion of a preceptorship from a well-
respected dentist, she was obviously better qualified than most of the students applying in
1861, but she was promptly rejected.

At Dr. Wardle's advice she started practice without the advantage of a dental degree (not
yet a common or necessary credential). After trying three different cities, she finally built a
very successful practice in McCrego, Iowa.

In 1865, by means of special resolutions, she was elected to membership in the Iowa State
Dental Society. One of the resolutions passed stated that dentistry ". . . has nothing in its
pursuits foreign to the instincts of women". Now, four years after her first application, Lucy
Hobbs applied again for admission to the Ohio Dental College. Finally she gained
admission. This prompted Dr. George T. Barker to write in the Dental Times an editorial
entitled "Dental Surgery -- should women practice it?" He concluded that "the very form
and structure of a woman unfits her for its duties" and that the creator ". . . in His wisdom,
did not see fit to endow the female of the species with the necessary strength which the
practice of dentistry requires.Ó
Dr. Barker went on to propose an amendment to the National Dental Association "to allow
none but males to be eligible from local societies to the convention". (Dr. Hobbs had been
elected as a delegate from Iowa that year.) The proposed amendment was not adopted.

Dr. Lucy Hobbs next opened an office in Chicago where she met and married James M.
Taylor. She proceeded to train her bridegroom in a dentalpreceptorship. The couple then
moved to Lawrence, Kansas where they lived and practiced dentistry for many years.

In 1867 another woman, Henrietta Hirschfield, applied for admission to Pennsylvania

College of Dental Surgery. She was rejected, but like Lucy Hobbs, she persevered and
finally gained admission; but the anatomy professor steadfastly refused to admit a female to
his course, and she was required to attend the Women's Medical College for her instruction
in anatomy.

In 1868, Dr. James Truman, a faculty member who had supported Miss Hirschfield's
request for admission proposed a resolution to the Board of Trustees favoring the
acceptance of women students. It was tabled, but after years of debate finally passed. It
stated in part "That the advancing spirit of the age and the just right of women require that
they shall be admitted to medical and dental education . . ." In 1872 three female students
were admitted. A petition was sent from the male students to the faculty demanding that the
females be ejected. The faculty agreed to comply with the request! Dr. James Truman
objected and took the matter to the Board of Trustees who referred the question to a
committee. News of the controversy reached the press who championed the women's cause.
It took until spring (March 31, 1873) for the committee to conclude that since the schoolÕs
charter did not prohibit the enterance of women, and the faculty had allowed them to
matriculate and accepted their fees, they were obligated to readmit the women and allow
them to complete their studies.

These examples reflect the opposition of many male dentists toward women entering the
profession in the mid-1800Õs. Obviously, any woman attempting to enter the profession
then had to be willing to oppose enormous odds, but it should be recognized also that a few
courageous men in the profession were willing to face the ridicule and the opposition of
their colleagues to fight for women's rights. It is fortunate that throughout history there
have always been a few individuals willing to fight for a cause simply because they
believed in it.

For many years, the percentage of women in dentistry stayed around 2% in the United
States. For some reason it was seen as a male occupation although in many other countries
of the world it was common to find percentages of women dentists between 25% and 50%
and some were much higher. Since 1970, the number of female dental students has been
climbing in the U.S. but now seems to have leveled off at about 20-30%.

F. W. D. Miller and the Etiology of Dental Caries

We have discussed the theories that dental caries was caused by worms and internal
inflammation from acrid humors. Hippocrates had suggested that the stagnation of
depraved juices caused toothache but the idea fell on deaf ears. As recently as the time of
John Hunter and Joseph Fox (c. 1800) the accepted theory was that caries was caused by
inflammation from within the tooth. During the 1800's several other theories were
promulgated. One was the electro-chemical theory of a group of dentists in New York lead
by Josiah Flagg. They believed that decay was an electro-chemical process and that certain
materials encouraged the process and others inhibited it. Basically they were opposed to the
use of gold in teeth, believing it encouraged decay, and favored the use of gutta-percha,
zinc cement, and amalgam. They claimed that whether or not fillings leaked was not as
important as using a material that inhibited the electro-chemical process. They attempted to
support the theory scientifically but the support was really anecdotal.

Other dentists, as we have seen, came to the conclusion that food remaining in the mouth
putrified and somehow caused the teeth to decay. Parmly (1819) suggested that caries was
externally caused by some as yet unidentified chemical agent. Some even went so far as to
suggest that it was acids that caused decay. Ficinus, a German physician, observed
microorganisms taken from carious cavities and implied that somehow they caused decay
but did not suggest how. Prior to 1889 no one had supplied an adequate theory with
experimental proof. The person who finally did that, producing one of history's outstanding
pieces of scientific research, was W. D. Miller.

Willoughby Dayton Miller was born in Alexandria, Ohio on August 1, 1853. He received
an A.B. Degree from the University of Michigan in 1875 and then went to Scotland to do
graduate work in physics, mathematics and natural philosophy. Then he went to Germany
to study physics at the University of Berlin. There he met some American dentists who
were studying in Europe. He became interested in dentistry and at their suggestion decided
to pursue a dental career. He began studying in the office of one of these dentists, Dr. Frank
Abbott. Then he returned to the United States and in 1879 received his D.D.S. Degree from
the University of Pennsylvania Dental School. He then returned to Germany, married Dr.
Abbott's daughter and accepted an appointment in 1884 to teach operative dentistry at the
University of Berlin. He continued to study and upon taking the German ÒRigorosumÓ
examination was awarded the M.D. Degree. During the 1880's he studied bacteriology
under the famous Dr. Robert Koch. During that decade he did his exhaustive research on
the etiology of dental caries and wrote one of the classics of dental literature,
Microorganisms of the Human Mouth, published in Germany in 1889 and the United States
in 1890. Miller's research was exhaustive. It had to be to answer all the wide range of
theories and arguments at that time regarding caries. He began by producing caries in
sterile teeth outside the mouth using pure strains of specific microorganisms to disprove the
inflammation theory. The facts proven by his long series of careful experiments can be
summarized as follows:

1) Various kinds of foods (bread, sugar, but not meat) mixed with saliva and incubated at
37¡ C could decalcify the entire crown of a tooth.

2) Several types of oral microorganisms (at least 30 were isolated) could produce enough
acid to cause dental caries.

3) Lactic acid was an identifiable product in carbohydrate-saliva incubation mixtures.

4) Different microorganisms (filamentous, long and short bacilli and cocci) invade carious
dentin.

He concluded that no one single organism caused caries. He felt that the process consisted
of one stage in enamel -- simply the dissolution of enamel by acid from acidogenic
microorganisms. Caries in dentin he believed consisted of two stages:

o first the dissolution of the mineral content by acid and

o secondly the dissolution of the protein content by proteolytic organisms.

He summarized his findings in a much more thorough list of eighteen propositions which
are all considered valid today.

W. D. Miller and G. V. Black had been friends for many years. Black had also done
significant research in oral microbiology and coined the term dental plaque. Around the
turn of the century the two men visited in New York. They both had the vision at that time
to recognize that they had lived to see the beginning of a new age of scientific preventive
dentistry.