History of Tooth Extraction: 5th Century to Modern Day
This paper traces the history of tooth extraction from the 5th century through the present day. Beginning with barber-surgeons and crude instruments such as the dental pelican and dental key, the paper examines how primitive extraction methods gave way to more refined practices over centuries. It covers the contributions of key figures such as Pierre Fauchard, the introduction of anesthesia in the 19th century, and the shift toward preventive dentistry and tooth-preserving treatments in the 20th century. The paper illustrates how advances in tools, materials, and professional training gradually transformed tooth extraction from a feared and often barbaric procedure into a last resort within a broader system of modern oral healthcare.
- Introduction to Tooth Extraction: Definition, reasons, and types of extraction
- Tooth Extraction in the Past: Early Methods and Practitioners: Barber-surgeons, monks, and tooth-drawers
- Instruments of Extraction: From the Pelican to the Forceps: Dental pelican, dental key, and forceps evolution
- Dentistry in the 18th Century: Fauchard and Transplantation: Fauchard's contributions, transplants, and early dentures
- 19th Century: Anesthesia and Professionalisation: Anesthesia, vulcanite dentures, and x-rays
- 20th Century and Beyond: Preservation Over Extraction: Fillings, laser treatment, and preventive dentistry
- Conclusion: Reflection on progress from barbaric to modern dentistry
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What makes this paper effective
- The paper uses a clear chronological structure, moving from the 5th century through to the present day, making the historical progression easy to follow.
- It grounds abstract historical claims in concrete examples — such as the barber-surgeon's red-and-white striped pole and the mechanics of the dental key — helping readers visualize practices that are far removed from modern experience.
- The paper balances social history (who performed extractions and for whom) with technological history (instrument development), giving the argument both human and material dimensions.
Key academic technique demonstrated
The paper demonstrates effective use of periodization as an organizational and analytical tool. Rather than simply listing facts, the author groups developments by century to show how changes in social structure, professional training, and technology were interconnected — for example, linking the rise of anesthesia in the 19th century to increased patient acceptance of extraction and, in turn, growing demand for affordable dentures.
Structure breakdown
The paper opens with a definition of tooth extraction and its current context, then moves backward and forward chronologically: early practitioners (5th–14th century), instrument evolution (14th–20th century), 18th-century professional developments, 19th-century anesthesia and mass dentistry, and 20th-century preventive care. A brief conclusion synthesizes the arc from barbaric necessity to modern last resort. Each section builds on the last, creating a coherent narrative of professional and technological progress.
Introduction to Tooth Extraction
The process of removing teeth from their dental sockets is referred to as tooth extraction (Vignoletti et al.). There are many reasons for extractions, but the most common is removal when teeth become unrestorable because of tooth decay, dental trauma, or periodontal disease. People resort to tooth extraction when these conditions are accompanied by toothache. Tooth extraction may also occur when teeth are crowded, creating space for the remaining teeth to grow or be straightened. Extraction was not only performed when a person's tooth was painful; it was also used as a pain reliever for other diseases.
Currently, tooth extraction is straightforward and is mostly performed while the patient is awake using only local anesthetic, which eliminates pain sensations. Tooth extractions are either surgical or simple. Simple extractions involve teeth that are visible in the mouth and are performed using local anesthetic. Teeth that cannot be accessed easily are extracted surgically. Lack of access most commonly means that the tooth has broken below the gum line.
Tooth Extraction in the Past: Early Methods and Practitioners
Dentistry as we know it today was not a recognized profession in the 5th century. Back then, dentistry was not a formal discipline, and unskilled people handled all dental problems. During that period, toothaches were painful and plentiful, and the only available remedy was extraction. Barbers used to double as dentists. They were designated as dental practitioners because they were experienced with handling knives and razors. Barbers handled any activity that involved bloodletting, and since tooth extraction involved bloodletting, they were the preferred people to perform it.
In Europe, monks performed tooth extractions as they were the most educated members of society. Monks were charged with performing surgery, dentistry, and the practice of medicine. However, the Church Council eventually prohibited monks from any activity involving bloodletting (Klein and Lorber). Barbers then became commonly known as barber-surgeons, and they displayed a red-and-white striped pole outside their shops to indicate that they performed bloodletting activities. Barber-surgeons eventually became distinguished from surgeons, who learned and specialized in complex surgical operations. Barber-surgeons remained popular until the 1700s because they were affordable and offered a range of services.
The wealthy could hire trained surgeons to perform tooth extractions, but the middle class sought the services of barber-surgeons. The poor who could not afford barber-surgeons turned to tooth-drawers — individuals who pulled teeth for entertainment purposes and were mainly found in marketplaces. Teeth were also extracted by tying a string to the tooth and having another person pull the string to remove it. Drummers in the background would increase the tempo of their playing to relax the person before the tooth was pulled. This was quite barbaric, but it represented a phase that people had to pass through in the past.
Instruments of Extraction: From the Pelican to the Forceps
Guy de Chauliac invented the dental pelican in the 14th century. The tool was shaped by the local blacksmith, and it made tooth extractions brutal and painful (Wilson, Bairsto, and Gelbier). Using the dental pelican frequently resulted in the accidental removal or loosening of surrounding teeth. The pelican remained in use until the 18th century, when it was replaced by the dental key.
The dental key was modelled after a door key and came with a claw that would be placed on the tooth, while a long metal rod was positioned at the root. The key would then be turned, and the tooth would be dislodged if all went well. However, this process often resulted in the shattering of the tooth, which then had to be removed piece by piece from the gum tissue. The dental key could also remove the bone attached to the tooth, which was entirely undesirable. In the hands of untrained practitioners, the dental key proved disastrous — there were cases in which jaws were broken during attempted extractions.
The modern forceps came into use in the 20th century (Clement). Dental forceps can be defined as two levers connected with a hinge, with the hinge serving as the fulcrum. In order for the forceps to grasp the tooth, pressure must be applied to the handles and increased gradually. Too much pressure could result in the crushing of the tooth. The force applied is intended only for grasping, and no extraction takes place at this stage. Extraction occurs when the dentist pulls the tooth to dislodge it from its socket.
Tooth extraction left patients aesthetically challenged. The absence of a tooth was frowned upon by the wealthy, who preferred implants. Unfortunately, dentures had not yet been developed at this time, leaving patients with two options: live teeth or dead teeth. Live teeth were removed from a donor who was still alive — a person would have their rotten teeth removed, and teeth from various donors would be extracted until a suitable match was found. This was a costly method affordable only to the wealthy, which left the middle class with the option of obtaining donor teeth from deceased individuals. These were cheaper and more accessible. The significant downside to both methods was the risk of spreading tuberculosis and syphilis.
Conclusion
Tooth extraction was a necessity in the middle ages because it was the only way a person could eliminate a toothache. During those days, extraction involved barbaric methods that are difficult to imagine in the 21st century. The history of tooth extraction is not a comfortable one, yet it allows us to appreciate the many advances made in the field of dentistry. Currently, tooth extraction is performed only when no alternative treatment exists. Dentists are encouraging their patients to adopt preventive measures to ensure their teeth do not suffer from decay. With continued knowledge and public education, cases of tooth decay and the need for extraction will eventually become rare occurrences.
References
Clement, Milton A. "Dental Forceps." Google Patents, 2011. Print.
DiVito, E., O. A. Peters, and G. Olivi. "Effectiveness of the Erbium: YAG Laser and New Design Radial and Stripped Tips in Removing the Smear Layer after Root Canal Instrumentation." Lasers in Medical Science 27.2 (2012): 273–80. Print.
Klein, C., and C. G. Lorber. "[Historical Development of Surgical Wisdom Tooth Extraction]." Fortschritte der Kiefer- und Gesichts-Chirurgie 40 (1994): 113–16. Print.
Philippe, Julien. "Pierre Fauchard the 'Inventor' of Orthodontics." Journal of Dentofacial Anomalies and Orthodontics 14.01 (2011): 104. Print.
Vignoletti, Fabio, et al. "Surgical Protocols for Ridge Preservation after Tooth Extraction: A Systematic Review." Clinical Oral Implants Research 23.s5 (2012): 22–38. Print.
Wilson, N., R. Bairsto, and S. Gelbier. "Creating the John McLean Archive: A Living History of Dentistry." Dental Historian: Lindsay Club Newsletter 56 (2012): 70. Print.
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