Dentistry

Dentistry. Throughout the Colonial Era, Americans suffered from extremely poor dental health. Dental decay and soft‐tissue disease were rampant, and people typically relied on their own resources for dental care. Toothbrushes were rare, but many owned a “tooth forcep” to pull rotting teeth. Domestic dental care prevailed until the later eighteenth century, when European‐trained “operators for the teeth” arrived to seek their fortune. These operators (later called surgeon‐dentists) not only introduced the formal practice of dentistry but served as preceptors to local folk, usually skilled mechanics, who wished to learn the trade.

Early nineteenth‐century dental practice consisted largely of tooth restoration and extraction and the construction of artificial dentures. In 1846 the Hartford, Connecticut, dentist Horace Wells launched a revolution in dental (and general) surgery with his successful demonstration of the use of nitrous oxide as a general anesthetic. At about the same time, William T.G. Morton of Boston began using sulfuric ether for the same purpose.

The Gilded Age saw the emergence of dentistry as a distinctive profession, with its own schools, societies, and journals. Dentists organized the American Dental Association in 1866, the American Academy of Dental Science in 1876, and the National Association of Dental Examiners in 1883. By 1900, some one hundred dental schools were scattered throughout the country, most of them of inferior quality. In 1926, William J. Gies completed a survey of the state of American dental education, analogous to the more famous Flexner Report of 1910 on medical education. As Gies saw it, dentists had two choices for upgrading their profession: making dentistry a medical specialty and requiring an M.D. degree, or bringing dental schools up to the quality of medical schools. American dentists chose the latter course.

In the early twentieth century, dental practice became increasingly specialized. Orthodontics (preventing and correcting irregularities of the teeth) became a recognized specialty in 1901, thanks to the efforts of Edward H. Angle, the first American dentist to limit his practice to a particular area of expertise. Periodontics (which focused on the gums) followed in 1918, oral surgery in 1918. Oral pathology (1936), dental public health (1937), and endodontics (which focused on the roots of teeth, 1959) eventually emerged as dental specialties as well. Twentieth‐century dentists continued to devote much of their practice to prosthetics, replacing missing parts of the mouth and jaw with artificial devices such as dentures and bridges.

In 1919 the U.S. Department of Public Health established a dental division to call attention to the needs of the indigent, the disabled, and minorities; in 1948 the National Institutes of Health created the National Institute for Dental Research. Among these agencies' most successful programs were fluoridating public drinking water to prevent cavities, screening for oral cancer, and encouraging the use of mouth protectors by athletes.

Twentieth‐century dental practice was greatly influenced by the increasing presence of dental hygienists and assistants. In 1908, Alfred C. Fones established the first school for dental hygienists; by midcentury, every state recognized and regulated hygienists. During the second half of the century, dental technicians, often working independently in laboratories, fabricated various forms of tooth replacements. The economics of dental practice changed as well, with fewer and fewer patients needing cavities to be filled and more and more of them covered by dental insurance.
See also Medicine; Professionalization.

Bibliography

Robert Koch , A History of Dental Surgery, 1909.
Bernhard W. Weinberger , An Introduction to the History of Dentistry, 1948.
Malvin E. Ring , Dentistry: An Illustrated History, 1985.
Milton B. Asbell , Dentistry: A Historical Perspective, 1988.

Milton B. Asbell