Hello, and in this video we’re going to be exploring some of the elements of the history of dentistry, and I’ve arranged some stuff from the dental school archive in front of me, and I’m pleased to be joined by Sandra Zijlstra-Straw, who is a dentist, to offer some modern day insight around the objects that we’ve gathered. So, hello Sandra, and here we’ve got some stuff for both restoring and repairing, and doing dental checkups. So, if I pull out one of the first items that we’ve got, which is a probe and mirror from about the 1700s or so, I think is. It should hopefully be quite recognisable to people at home as well a modern day dentist would use, yeah? Yeah.
This isn’t that different. I mean, the handles are not sterilizable the way we would want them to be sterilazable these days. They’re beautifully made, a bit like people’s beauty equipment in those days, and a nice mirror so you can actually around corners. And this is slightly different, because these days, we tend not to try and poke holes in things because we now know - we have the knowledge - that things can heal if you put fluoride on them, they will often get better. So, but whereas in these days, they were just poking around to see which bit gave because that was the bit where the decay was.
OK, so just to compare those, these are ones I pinched, literally, off the clinic this morning. So, we’ve got the equivalent there for modern day, and they’re quite recognisable as being related, aren’t they? Well, that’s right. If you look at the mirrors, they’re virtually identical. There’s a slight further bend on that, and they’ve both got replaceable heads. You can see the screw there. But the screw on this one is actually within the handle, because often we would just replace the mirror, because the mirror is the part that’s vulnerable. You can actually see that this one is slightly damaged.
And when you’ve got the probe here - once upon a time we used to dig it into things - now we just use it to remove food debris, plaque debris. We won’t be poking into things in the way we used to do. That’s good to hear. OK. So, if I put this back, let’s talk about something a little bit more grizzly, shall we say, and a little more obvious. This is about removing teeth, these instruments here. This one’s called a dental key, and this came from the same era as these probes here, sort of late 1700s into 1800s. How would you have used this thing? It looks horrible.
Well, the thing was that they used to take teeth out a bit like you take the can off a bottle of beer. So, you’d bob that into somebody’s mouth, click that underneath the tooth, and then twist. Now, the problem with that is, unless you really do know what you’re doing, you stand a good chance of breaking somebody’s jaw. There’s a massive handle on here, and well, they weren’t the nicest things in the world to use, and I think the problem with dentistry is you’ve got a lot of historical - That’s quite a grab on it, as well. - yeah. You’ve got a lot of historical nastiness to get over. So, this is about speed, isn’t it, really, I think?
It is about speed because we have to remember the patients weren’t anaesthetised then. Right, lovely. OK, so, what followed this dental key, or tooth key, was these instruments, and this one is from 1790, and you grabbed some from - I borrowed some yesterday, and what you see is that actually they’ve not changed a lot. You’ve still got a handle with all these markings on so that you’ve got something you can grip really well. The blades are designed to actually fit around the roots of the teeth, which is why you’ve got blades designed this way. These are for premolars that are single rooted, you can fit around that way.
And the other ones I’ve picked up are for molars, and you can actually see that they’ve got a different dent there for two roots, and the idea is you hold the tooth with those and then you gently manoeuvre it to allow the socket to get slightly bigger and slightly bigger, because bone is elastic and actually gives, and then you can just simply lift the tooth out. So, there was a case of brute force and ignorance, and here is much more about technique. And when I qualified, people use to ask, well, you’re a woman, can you take teeth out? And the answer is, well, yes, I can. It’s not about brute force and ignorance.
It is about technique and about using our knowledge of the biology in order to just remove the tooth that’s a problem for the patient. Yeah. And in hundreds of years, very little difference at all. Very little difference in design, but then the anatomy’s not changed either. No, no. I suppose not. OK. So, going from extracting teeth to restoring teeth. We’ve got a selection here, if I just move this out the way, of dentures from around the same era again. So, from sort of 1700s. This one I believe is carved ivory through to vulcanite, and then this is a modern denture that somebody would be given today. So, can we just talk through the differences here that we’ve got?
So, this is a carved denture, then? That’s a carved denture, and as you can see, they carved it out of ivory. They’ve also used all sorts of - they used bone. It depended on how much money you had, how much you could afford, because obviously there’s a lot of work in those. And the other problem with these, because they’re natural substances, you can see this one’s become grubby. Well, they would become grubby in the mouth, and then they would rot away. So this was a problem. You needed money, and they were very expensive, and a lot of time, and trouble, and skill. Then they moved on.
I mean, at some point they actually used extracted teeth from dead bodies to actually make dentures out of. But then they moved on and they developed porcelain teeth, and these teeth are quite nice. They look like teeth. They’ve been beautifully made out of a ceramic, and they embedded them in this material called vulcanite, which is a sort of rubber. And I actually met a patient once - I mean, they weren’t made to measure the way we make the dentures now - I met a patient once, and he’d had his teeth for ages.
And apparently, when I asked him how he got his teeth, it turns out he was going on board the ship to be posted to the Far East in World War II, and somebody said, hey, you can’t go without your teeth, have my spare set. And he wore them for the following 22 years without any problem whatsoever. So, they were very adaptable. I mean, my parents tell tales of going to SS White in Liverpool. And you’d go in, and you know like you can go to the supermarket today and try on glasses? You went in there and you tried on different dentures till you found the pair that you thought was comfortable.
And you thought it was important to have a pair that matched. No, no. Any pair would do. So, you can see that we moved on. This one, obviously somebody has liked it, because somebody has had to try and repair it. But the problem is that as the technology changed, our knowledge of the technology and how you do these things also changed. So, what you’ve got here is the modern acrylic trying to repair the old vulcanite and keep the porcelain teeth. So, what they’ve had to do here is actually cut a key, so you’ve got a mechanical lock. So, the whole thing is held together by mechanical locks. So, that was carved out of a piece.
These are held together by a mechanical lock, and now, with the development of the plastics, we use these. They’re made of acrylic, and the teeth are also made and moulded of acrylic, so the whole thing binds chemically together. What’s interesting is that when I was an undergrad, they had to make these. These are made individually. We would make individual impressions. They would only fit one patient. We used to make them and they used to pop them together, and now they can injection mould them. And we’re waiting for the day when the new developments in things like 3D printing will enable us to simply 3D print our patient’s new dentures.
So, coming from these dentures and the idea of - we’ve gone from extraction and the rather grizzly side of it, into restoration and repair. It’s a good time to bring in this book, which is Pierre Fauchard’s 1720s manual on dentistry, which we’ve got from the archive here. And I can show you his picture because he’s in the frontispiece, in a rather spectacular wig. Cross infection control was pretty bad in those days. So, this is his handbook on dentistry. Now, this is the first English translation by Lilian Lindsay, who was also a rather famous - A very interesting lady, yes. But it wasn’t done until 1946. So, this is the first English translation.
Now, in this book, Pierre Fauchard sets up the idea of modern dentistry. He tells his patients not to eat too much sugar, to brush their teeth. He has the idea of a chair that you stand behind and you treat your patients with good light, and so on and so forth. So, this is kind of the starting of the modern era, isn’t it? Yeah. I think this a case of having a medical biological base for dentistry, rather than just you get a toothache, you get your tooth pulled out, maybe then you move on to dentures.
This is more of a case of the foundations of prevention that we are able to advise patients to prevent dental problems arising in the first place. And also that dental problems, even if they do arise, don’t have to be treated by extractions. We can actually repair the tooth. We can actually look after them. People can retain their teeth for a lot longer than they used to. I think it’s also one of the startings of dental science in the sense of testing and improving, because he throws out quite abruptly in this book the idea that tooth decay is formed by worms.
There was a theory at the time that the holes in your teeth were burrowed in there by a worm, and tooth decay was when the worm was wiggling around. And he’s quite rude about that and saying that it has nothing to do with it, and we should approach this with science, yeah. I’ve got another book which is related more to the materials if we’re talking about restoration, and this is from 1910. And this is a dental metallurgy sort of cookbook, if you like, for a dentist on how to make their fillings that they have to make. They have to make them themselves in the surgery.
I’ve been reading through, and I found a lovely page here which talks about how to make amalgams with gold in, and it tells you how much to shave off a gold sovereign and mix with your amalgam in order to make it useful. It also tells you to be very wary of fake gold coins, as well, because as it says, there are a very large number of splendid imitations about. But of course, you don’t mix your own amalgams anymore, do you? No. How do you do it? This is all gone. Nowadays, we actually get the amalgam in a powder.
What he’s talking about there is making the metals and grinding up the powders, which they then mixed with mercury, and often they did in the pestle and mortar. Nowadays, we’re not allowed to touch it. Mercury hygiene is really important. So you actually get the mercury in one end of this capsule, you get the powder in the other, and you have to squash it, put it in a mixer, and then it all comes out ready mixed for you.
We’re actually moving away from using that because the problem with the mercury is not once it’s mixed, once it’s mixed into the amalgam, it’s reasonably stable. But it’s how the mercury gets in there, and how you dispose of everything that’s left that’s the problem. Yeah, and this sort of wraps up this section, but I’m going to say that we’re going to be exploring in more detail in this course how a dental checkup happens, and how these instruments are used. We’ll be meeting oral surgery specialists and they’ll be talking about their particular discipline and how they take teeth out.
But also we’ll be exploring both the materials and how modern dentures are made in the course, so this wraps up this sequence quite nicely, and sets up, I think, what we’re going to be learning over the next few weeks.