The 19th century saw a crisis of cavities driven by increased consumption of sugar and refined flours. Poor hygiene practices, coupled with a lack of understanding of bacterial decay, meant that most people suffered from chronic tooth pain and infection. This widespread suffering created a constant demand for dental intervention, often as a desperate measure for pain relief. Dentistry began as an unregulated trade, where the most common intervention for a decayed tooth was simply to remove it.
The Primary Treatment: Tooth Extraction
When a tooth was irreparably damaged or intensely painful, the most common solution was complete removal. Extraction was a brutal, non-sterile procedure performed without reliable anesthesia during the first half of the century. Tools were designed for leverage and brute strength rather than surgical precision.
The dental key was a favored instrument. It functioned by placing a claw over the tooth’s crown and a fixed support, called a bolster, against the root and gum. The practitioner rotated the handle, wrenching the tooth from its socket. This crude mechanical action often resulted in shattered teeth, extensive gum damage, or a fractured jawbone.
An earlier instrument was the dental pelican, a lever-style tool with a hinged claw that pulled the tooth outward. Later in the century, specialized forceps began to replace both the pelican and the dental key, offering a slightly more controlled grip. All these procedures were fast-paced and traumatic, designed to end the patient’s suffering as quickly as possible.
Early Efforts at Preservation: Filling Materials
A more progressive, though less common, approach was to preserve the tooth by filling the cavity after removing the decayed tissue. Before the 1870s, cavity preparation was a tedious process involving hand-cutting instruments like chisels, hatchets, and spoon excavators. These sharp tools were used to scrape out decay and shape the cavity walls to securely hold the filling material. Forcing these instruments against the tooth structure made preparation a lengthy and painful ordeal.
The standard material for restoration was gold foil, which was packed meticulously into the prepared cavity in small, hammered layers. This process was labor-intensive, required significant skill and time, and was consequently expensive. Gold was considered the superior material because of its durability, limiting its use primarily to the wealthy.
The introduction of dental amalgam around the 1830s changed the landscape. Amalgam was an alloy containing silver, tin, copper, zinc, and mercury. It was much cheaper and easier to work with than gold foil, requiring less time and skill to place. The use of mercury sparked the “Amalgam War” in the 1840s, as the first national dental association warned against its toxicity. Despite this controversy, amalgam’s ease of use and affordability cemented its place as a common filling, especially for less affluent patients.
The Practitioners and Pain Relief
In the early 1800s, dental care was provided by traveling operators, blacksmiths, and barber-surgeons whose skill levels varied widely. Dentistry was not formalized, and training was typically an apprenticeship. This began to change with the establishment of institutions like the Baltimore College of Dental Surgery in 1840, marking the transition toward a recognized and regulated profession.
The most profound change to the patient experience was the advent of chemical anesthesia in the 1840s. Before this, patients endured extractions and cavity preparations without any effective pain mitigation. Dentists were instrumental in pioneering this change; Horace Wells, a dentist, first demonstrated the use of nitrous oxide, or “laughing gas,” for a painless extraction in 1844.
Shortly thereafter, in 1846, William T.G. Morton, another dentist, publicly demonstrated the effectiveness of ether as a surgical anesthetic. The successful use of these chemical agents revolutionized all forms of surgery, but particularly dentistry, where tooth extraction was the most common surgical procedure. This development fundamentally shifted the nature of dental treatment, moving it from a traumatic ordeal to a manageable medical procedure.