A History of Dentistry from the most Ancient Times until the end of the Eighteenth Century

by Vincenzo Guerini

France is therefore the first country where modern dentistry reached a high degree of development and also the first country where, earlier than elsewhere, that is, about 1700, the dentists began to form a well-defined class, to belong to which it was necessary to pass a special examination. This examination, as we learn from Fauchard, was held before a commission of which no dentist formed a part, and exactly for this reason gave but negative results and responded but little to its intended aim. The greater number of those who were authorized to practise dentistry after undergoing this examination showed a professional ability below mediocrity. Nevertheless, although few in number, good and able dentists were in no way wanting, as clearly appears from the preface to Fauchard’s work, and better still from the following paragraph,[411] wherein the author speaks of the great perfection reached by dental surgery in Paris:

“The teeth and the other parts of the mouth being subject, as we have seen in the course of this work, to so many important diseases, requiring the aid of the most able dentists, it is strange that the sovereigns of foreign countries, the heads of republics, and also the administrators of our own provinces do not provide for the expense of sending young surgeons to Paris, to be instructed in a part of surgery so essential, and, notwithstanding, so ignored and neglected everywhere excepting in this great city, where it has reached its highest perfection, both as regards the embellishment of the mouth and the cure of diseases, often of a most serious nature. These scholars would, thereafter, form others and would render great services to their nation and to their fellow citizens.”

In the first chapter of his work, Fauchard speaks “of the structure, position, and connection of the teeth; of their origin and of their growth.” He distinguishes in each tooth a body, a root, and a neck, making the remark, however, that this last is to be considered as forming part of the body. According to the author, the name of “crown” can only be applied suitably to the body of the molar teeth, but not to that of the incisors or of the canines, which has no resemblance with a crown. Although in the adult the number of the teeth is normally thirty-two, it may be that some persons have, nevertheless, thirty-one, thirty, twenty-nine, or even only twenty-eight teeth, and this independently of any eventual loss, but for the simple reason that the wisdom teeth are often cut very late in life (even after fifty years of age), or do not all come forth, or sometimes are never cut at all. The author refers to some cases of a supernumerary tooth situated in general between the two superior central incisors and similar in form to the lateral incisors. He also observed two individuals who had each thirty-four teeth, sixteen in the lower and eighteen in the upper jaw, and in these cases the two supernumeraries were situated behind the incisors. Fauchard declares the popular opinion expressed also by some ancient authors, of the milk teeth having no roots, to be false. The roots of these teeth, he says, are gradually worn away before the latter are shed, when the permanent teeth are just on the point of coming through; however, if it so happens that one or more of the milk teeth be extracted some time before the period in which they are usually shed, their roots are found to be as long and as strong in proportion to the body as those of the permanent teeth. In children one finds, besides the twenty deciduous teeth, the germs of the thirty-two permanent ones, for which reason it may be said that children have in all thirty-two teeth without counting the germs that may sometimes be found at the extremities of the roots of the large molars. As, however, the existence of such germs is an exceptional fact, the twelve large molars, if extracted, are not ordinarily regenerated. This may be possible, however, if the germs in question exist, and, indeed, the author observed two persons in both of whom a large molar had been regenerated in the place of the one which had to be extracted.

Fauchard gives an excellent description of the alveoli and of the roots of the teeth; he alludes to the varieties which these latter may present, and to the importance of the same from the point of view of extraction. Thus, speaking of the molars, he says: “Their roots sometimes touch one another at the points, whilst at the base, close to the body of the tooth, they are far apart. These are the so-called dents barrées (barred teeth), which it is so difficult to extract, it being unavoidable to bring away together with the tooth the spongy osseous part occupying the interval between the roots.”

In this same chapter the author calls our attention to some anomalies worthy of note. He says that he has observed teeth that seemed to him to be derived from the union of two or three germs. He also relates that a colleague of his showed him a tooth that appeared to be formed by the union of two, between the roots of which was a third tooth whose crown was united to the vault formed by the roots of the first two.

Fauchard describes exactly the pulp cavity and the root canals, and speaks of their gradual restriction, ending in an almost entire disappearance in old age.[412] He treats of the nerves, of the arteries, and of the veins of the teeth in a most detailed manner; then, after alluding to their general structure, he goes on to speak of the microscopic constitution of the enamel, following in this the description given of it in 1699 by the academician La Hire.

In regard to the development of the teeth, Fauchard repeats what Urbain Hémard had previously written. He apparently ignores the researches of the Italian anatomists, from whom, and especially from Eustachius, Urbain Hémard had literally reproduced all that concerns odontogeny.

In the second chapter Fauchard speaks “of the maladies of children at the period of teething and of the remedies best adapted thereto.” Among other means of treatment, he advises the incision of the gum when this is red, swollen, and distended and the tooth below it can be felt. For the incisors and canines a simple incision ought to be made in the same curve as the dental arch; for the molars a crosswise incision should be made directly down to the tooth below, taking care not to leave any strips of uncut gingival tissue, lest these, being distended by the emerging tooth, should continue to be the cause of pain and other morbid phenomena.

Although Fauchard does not tell us anything substantially new about teething maladies and their treatment, he nevertheless treats this subject with much practical good sense, and does not merely make servile repetition of what preceding authors have written about it.

In the three following chapters the author speaks of the utility of the teeth, of the rules to be observed for their preservation, of the modes of keeping them white, and of strengthening the gums.