What are the roots of modern dentistry?

“We tend to think dentistry has been around since, well, forever, but it hasn’t,” explains Dr Paul Craddock, cultural historian of medicine on an upcoming episode of the HistoryExtra podcast. “Dental care was traditionally limited to pulling teeth.” That is not to say there isn’t evidence of forms of tooth care going back to the civilisations of antiquity, and earlier into prehistory, from the Indus Valley c7000 BC to the Sumerians, Chinese, Etruscans and Egyptians. Indeed, the name most often claimed to be the earliest-known dentist was an Egyptian high official from the Third Dynasty called Hesy-Re.

• Read more | A bite-sized history of teeth

But, like in other areas of medicine, dentistry was still a long way from becoming a specialist profession with detailed understanding of anatomy. “Back then, people all over the world thought that toothache was caused by a little worm,” explains Craddock. “There are references to tooth worms in ancient Egypt, Madagascar, Borneo, Babylonia, medieval Germany, and there were lockets with depictions of these worms from early modern France.

“The Cherokee in North America have a tooth worm and all kinds of folk remedies promised to get rid of them. My favourites were that you would have to kiss a donkey, or spit salt on a fresh grave.” The tooth worm theory persisted until well into the 18th century.

At that time, people still relied on barber-surgeons to treat any complaint of the mouth, if not visiting a tooth-puller. Significant advances in science and medicine had been made from the Renaissance and Enlightenment, but Craddock points out that in the 18th century it became more “desirable” to look after one’s teeth and “achieve a good smile.”

“People had worse teeth than ever because of a combination of sugar consumption and malnutrition. But they also wanted to look good as beauty and fashion industries, and not to mention high street shopping, were blossoming. Beauty manuals were out. Poets wrote warnings to young girls to look after their hair and to brush their teeth. Dentistry was a response to these societal changes.”

The person who fundamentally put the scientific approach into dental care was a French surgeon named Pierre Fauchard (1678-1761). Although he was not the first – a book concerned with dentistry, The Little Medicinal Book for All Kinds of Diseases and Infirmities of the Teeth, was published in 1530 – Fauchard’s work was hugely important. Earlier dentistry was a mixture of folk medicine, very basic surgery, and common sense.

A highly skilled surgeon in Paris who had developed his own dentist’s tools and methods, he collected all information he could to build a comprehensive encyclopedia on teeth and teeth care. He was frustrated that no such resource existed, so wrote one himself. In 1723, he published his two-volume masterpiece, Le Chirurgien Dentiste, ou Traité des Dents (The Surgeon Dentist, a Treatise on the Teeth).

“His entire approach was based on observation, and it led him to offer a new kind of tooth care business, aimed at prevention and the promotion of cleaning teeth and not eating sugar” says Craddock. “If that failed, he had a menu of techniques, like creating fillings that he invented and washing the mouth out with soap.”

In his book, Fauchard introduced revolutionary ideas, such as the suggestion that acids and sugar could cause teeth decay, and discussed all areas of dental care from diagnosis to expert treatments, including the tenets of orthodontics, prosthetics and surgery. For that, he has become known as the father of modern dentistry.

He also disproved the tooth worm theory once and for all, as Craddock explains. “For Fauchard, he saw this worm as a major problem and he set out to find it. But no matter how hard he tried, even with a microscope and the most advanced tools of his age, he couldn’t. He concluded that they didn’t exist. Even if they did, they probably had nothing to do with toothache, he thought.”

Dr Paul Craddock is a cultural historian and Honorary Senior Research Associate in UCL’s Division of Surgery and the author of Spare Parts: An Unexpected History of Transplants (Penguin, 2022)