Teeth: Shining behind an uncanny smile !!

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Teeth bite. They also make our smiles more beautiful. We often use shining teeth to portray happiness and joy. Thirty-two in an adult, we tend them with utmost care. Indeed, this is one part of body, that always gives us a second chance. All of us shed our milk-teeth, to give space for something more durable. However, as we grow older, we tend to loose them again. Over the years, we have improvised on how to take care of these losses. Ancient texts have extensively described artificial teeth, and these were our first artificial implants. We have used various materials such as gold, shells, and even stone as successful replacements. Today, teeth and their care is a growing 40 billion USD industry.

Pulling em out

Pulling out of bad teeth is a necessity. Alas, all of us have had bad teeth at some point in our lives. Their removal invokes pain. In ancient times, barbers were responsible for care of teeth, hair, nails, wounds, fistulas, haemorrhoids and abscesses. They used crude instruments such as pelicans to pull out teeth. By 14th century, we had more specialised barber-surgeons. Somehow, these early surgeons, did not recognise tooth-care as part of their speciality, and tooth-pulling remained with the barbers. This changed only in 18th century.

Pierre Fauchard (1678-1761) a French surgeon, compiled all available oral health resources of his time. He wrote a textbook “Le Chirurgien Dentiste” or “The surgeon dentist”. This exhaustive book, has 38 chapters, and spans two volumes. Later, Fauchard also improvised on available dental instruments. Fauchard’s book, recognised dentistry (this word has its origin in French) as a distinct branch. Today, dentists regard him as “father of modern dentistry”.

Painless extractions

In absence of any anaesthetics, extraction technique had to be quick and effective. Dentists perfected these techniques, well before availability of anaesthesia. First inadvertent use of anaesthesia in 1842 was for a dental extraction. Two years later, in 1844 Horace Wells and Gardner Colton used nitrous oxide for many dental extractions. William Morton, who popularised use of ether-based general anaesthesia was also a dentist. Wells, Colton and Morton share credit for beginnings of anaesthesia and also painless dental extractions. Four decades later, in 1884 we discovered cocaine as first local anaesthetic, and by 1904 we improved it to synthetic procaine and epinephrine mix. Today most dental procedures are done in local anaesthesia. This was pathbreaking for growth of dentistry.

Contribution of photography to Growth of Dentistry

Before 1840s, royals, rich and famous would commission artists to draw their portraits. With invention of photography, it was possible to click pictures, however exposure times were still about 15-20 minutes. Stern faces from portraits, were translated to photographs and no-one would smile. Most likely reason for “stern-portraits” was actually a necessity – for any good photograph, you had to be still for minutes. Kodak snapshot camera came in 1888, and it was possible to capture instant smiles in photography. Kodak advertisements in 1908, popularised grin. This American phenomenon of showing teeth in a photo spread like a wildfire. It is no wonder, that it fuelled desire for sparkling photogenic teeth.

Toothpaste in a tube

Desire for “perfect teeth” led to growth of various products. Till 1800s, we used various plant powders to clean teeth. These included tobacco, lime-stone and even coal. By 1850s we had pastes in a jar, and had added soap and chalk to these powders. In 1892, an American dentist Sheffield invented tooth-paste in a tube. This idea was commercialised by Colgate, and company grew from soap to paste. We also began using toothpastes multiple times a day. Thus, social desirability, and photogenic smiles all led to the need for perfect teeth.

Dental education

Before 1840s, there was no formal training in Dentistry. The art and science passed on from one generation to another, through informal training. First dental college started in Baltimore, US in 1840. First British qualifications were offered in 1858, and registration requirements were introduced only by early 1900s.

In India, Dr Rafiuddin Ahmed established first Dental college in Calcutta in 1920. He had returned back to India in 1919, after studying dentistry in the United States. The first dental college was a privately funded institute. Dr Ahmed also established first Dental journal, and founded Dental Council of India. In 1949, he donated his college to the government of West Bengal. In 2020, India-post released a “my-stamp” postage in his honour.

Growth and explosion of Dental education in India is quite recent. Till independence there were only a handful of dental training centres. Indian Dental act of 1948 paved way for most Dental colleges in India. Today India has more than 300 dental colleges.

Dentistry instruments in postage stamps

Dentistry is a skill, and depends a lot on instrumentation and their growth. Today the instruments have progressed far beyond pelican, forceps and extractors.

Specialisations in Dentistry

Today dentistry uses modern technology for better prosthesis, alignment, and jaw-lines. We have more than a dozen specialisations in dentistry. These range from maxillofacial surgery, periodontology, orthodontics, prosthodontics, oral pathology, and public health dentistry. Further, today we also have a number of dedicated allied dental health providers, from technicians to hygienists and educators. Second only to United States, India has second highest number of registered dentists in the world.

Recognition and need for oral health has grown, and so has the number of dental providers. History of dentistry as a profession is quite recent, and its growth is indeed an achievement.

Smiles are often mysterious. While it is an expression of joy, we often use it to hide pain. Smile can be treacherous. There is a saying we attribute to Confucius “behind every smile, there are teeth”.