Dental extraction

A dental extraction, sometimes referred to as exodontia, is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons, including tooth decay that has destroyed enough tooth structure to prevent restoration. Extractions of impacted or problematic wisdom teeth are also routinely performed, as are extractions of some permanent teeth to make space for orthodontic treatment
History
Historically, dental extractions have been used to treat a variety of illnesses, as well as a method of torture to obtain forced confessions. Before the discovery of antibiotics, chronic tooth infections were often linked to a variety of health problems, and therefore removal of a diseased tooth was a common treatment for various medical conditions. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac invented the dental pelican, which was used through the late 18th century. The pelican was replaced by the dental key which, in turn, was replaced by modern forceps in the 20th century. As dental extractions can vary tremendously in difficulty, depending on the patient and the tooth, a wide variety of instruments exist to address specific situations.
Reasons for tooth extraction
The most common reason for extracting a tooth is tooth damage due to breakage or decay. Some other possible reasons for tooth extraction are as follows:
Severe tooth decay or infection. Despite the reduction in world-wide prevalence of dental caries, still it is the most common reason for extraction of (non-third molar) teeth with up to two thirds of extractions.[1]
Extra teeth which are blocking other teeth from coming in.
Severe gum disease which may affect the supporting tissues and bone structures of teeth.
In preparation for orthodontic treatment (braces)
Insufficient space for wisdom teeth (impacted third molars). Although many dentists remove asymptomatic impacted third molars,[2][3] American as well as British Health Authorities recommended against this routine procedure, unless there are evidences for disease in the impacted tooth or the near environment.[4]
Receiving radiation to the head and neck may require extraction of teeth in the field of radiation
Types of extraction
Extractions are often categorized as "simple" or "surgical".
Simple extractions are performed on teeth that are visible in the mouth, usually under local anaesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically the tooth is lifted using an elevator, and subsequently using dental forceps, rocked back and forth until the periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove.
Surgical extractions involve the removal of teeth that cannot be easily accessed, either because they have broken under the gum line or because they have not erupted fully. Surgical extractions almost always require an incision. In a surgical extraction the doctor may elevate the soft tissues covering the tooth and bone and may also remove some of the overlying and/or surrounding bone tissue with a drill or osteotome. Frequently, the tooth may be split into multiple pieces to facilitate its removal
Complications

1.Infection: although rare, it does occur on occasion. The dentist may opt to prescribe antibiotics pre- and/or post-operatively if he/she determines the patient to be at risk.
2.Prolonged bleeding: The dentist has a variety of means at his/her disposal to address bleeding, however, it is important to note that small amounts of blood mixed in the saliva after extractions are normal--even up to 72 hours after extraction.
3.Swelling: Often dictated by the amount of surgery performed to extract a tooth (e.g. surgical insult to the tissues both hard and soft surrounding a tooth). Generally, when a surgical flap must be elevated (i.e. and the periosteum covering the bone is thus injured), minor to moderate swelling will occur. A poorly-cut soft tissue flap, for instance, where the periosteum is torn off rather than cleanly elevated off the underlying bone will often increase such swelling. Similarly, when bone must be removed using a drill, more swelling is likely to occur.
4.Sinus exposure and oral-antral communication: This can occur when extracting upper molars (and in some patients, upper premolars). The maxillary sinus sits right above the roots of maxillary molars and premolars. There is a bony floor of the sinus dividing the tooth socket from the sinus itself. This bone can range from thick to thin from tooth to tooth from patient to patient. In some cases it is absent and the root is in fact in the sinus. At other times, this bone may be removed with the tooth, or may be perforated during surgical extractions. The doctor typically mentions this risk to patients, based on evaluation of radiographs showing the relationship of the tooth to the sinus. It is important to note that the sinus cavity is lined with a membrane called the Sniderian membrane, which may or may not be perforated. If this membrane is exposed after an extraction, but remains intact, a "sinus exposed" has occurred. If the membrane is perforated, however, it is a "sinus communication". These two conditions are treated differently. In the event of a sinus communication, the dentist may decide to let it heal on its own or may need to surgically obtain primary closure--depending on the size of the exposure as well as the likelihood of the patient to heal. In both cases, a resorbable material called "gelfoam" is typically placed in the extraction site to promote clotting and serve as a framework for granulation tissue to accumulate. Patients are typically provided with prescriptions for antibiotics that cover sinus bacterial flora, decongestants, as well as careful instructions to follow during the healing period.
5.Nerve injury: This is primarily an issue with extraction of third molars, however, can technically occur with the extraction of any tooth should the nerve be in close proximity to the surgical site. Two nerves are typically of concern, and are found in duplicate (one left and one right side): 1. the inferior alveolar nerve, which enters the mandible at the mandibular foramen and exits the mandible at the sides of the chin from the mental foramen. This nerve supplies sensation to the lower teeth on the right or left half of the dental arch, as well as sense of touch to the right or left half of the chin and lower lip. 2. The lingual nerve (one right and one left side), which branches off the mandibular branches of the trigeminal nerve and courses just inside the jaw bone, entering the tongue and supplying sense of touch and taste to the right and left half of the anterior 2/3 of the tongue as well as the lingual gingiva (i.e. the gums on the inside surface of the dental arch). Such injuries can occur while lifting teeth (typically the inferior alveolar), but are most commonly caused by inadvertent damage with a surgical drill. Such injuries are rare and are usually temporary, but depending on the type of injury (i.e. Seddon classification: neuropraxia, axonotmesis, & neurotmesis), can be prolonged or even permanent.
6.Displacement of tooth or part of tooth into the maxillary sinus (upper teeth only). In such cases, almost always the tooth or tooth fragment must be retrieved. In some cases, the sinus cavity can be irrigated with saline (antral lavage) and the tooth fragment may be brought back to the site of the opening through which it entered the sinus, and may be retrievable. At other times, a window must be made into the sinus in the canine fossa--a procedure referred to as "Caldwell luc".
7.Alveolar osteitis is a painful phenomenon that most commonly occurs a few days following the removal of mandibular (lower) wisdom teeth. It is commonly believed that it occurs because the blood clot within the healing tooth extraction site is disrupted. More likely, alveolar osteitis is a phenomenon of painful inflammation within the empty tooth socket because of the relatively poor blood supply to this area of the mandible (which explains why dry socket is usually not experienced in other parts of the jaws). Inflamed alveolar bone, unprotected and exposed to the oral environment after tooth extraction, can become packed with food and debris. A dry socket typically presents as a sharp and sudden increase in pain commencing 2–5 days following the extraction of a mandibular molar, most commonly the third molar. This is often extremely unpleasant for the patient; the only symptom of dry socket is pain, which often radiates up and down the head and neck. A dry socket is not an infection, and is not directly associated with swelling because it occurs entirely within bone — it is a phenomenon of inflammation within the bony lining of an empty tooth socket. Because dry socket is not an infection, the use of antibiotics has no effect on its rate of occurrence. The risk factor for alveolar osteitis can dramatically increase with smoking after an extraction.

Dental care

Dental care is the taking care of teeth. It includes, and may refer to:
Oral hygiene, the practice of keeping the mouth and teeth clean in order to prevent cavities (dental caries), gum disease, and other dental disorders.
Dentistry, the professional care of teeth, including professional oral hygiene and dental surgery
Oral hygiene is the practice of keeping the mouth and teeth clean in order to prevent dental problems and bad breath.the professional care of teeth, including professional oral hygiene and dental surgery.
Teeth cleaning:
Teeth cleaning is the removal of dental plaque and tartar from teeth in order to prevent cavities, gingivitis, and gum disease. Severe gum disease causes at least one-third of adult tooth loss.
Generally, dentists recommend that teeth be cleaned professionally at least twice per year. Professional cleaning includes tooth scaling, tooth polishing, and, if too much tartar has built up, debridement. This is usually followed by a fluoride treatment for children and adults.
Between cleanings by a dental hygienist, good oral hygiene is essential for preventing tartar build-up which causes the problems mentioned above. This is done by carefully and frequently brushing with a toothbrush and the use of dental floss to prevent accumulation of plaque on the teeth.[1]
Interdental brushing
Periodontologists nowadays prefer the use of interdental brushes to dental floss. Apart from being more gentle to the gums, it also carries less risk for hard dental tissue damage. There are different sizes of brushes that are recommended according to the size of the interdental space.[citation needed]
Tongue cleaning
Dental specialists recommend daily use of a tongue cleaner as an essential way to remove the debris coating the tongue, composed of a large variety of bacteria, oral fungi, decaying food particles, and dead cells, that all together generate bad breath (also named halitosis) and may affect the health of teeth and gums (tooth decay, gingivitis and periodontitis). The protein rich surface of the tongue harbours the highest amount of bacteria thriving in the oral cavity. That explains the utmost importance of thoroughly cleaning the tongue with a properly designed tongue cleaner
Flossing
The use of dental floss is an important element of the oral hygiene, since it removes the plaque and the decaying food remains stuck between the teeth. This food decay and plaque cause irritation to the gums, allowing the gum tissue to bleed more easily. Flossing for a proper inter-dental cleaning is recommended at least once per day, preferably before bedtime, to help prevent receding gums, gum disease, and cavities between the teeth
Gum care
Massaging gums is generally recommended for good oral health. Flossing is recommended at least once per day, preferably before bedtime, to help prevent receding gums, gum disease, and cavities between the teeth
Oral irrigation
Dental professionals recommend oral irrigation as a great way to really clean teeth and gums. Oral irrigators get what tooth brushes and floss can't reach, - 3-4 mm under the gum line - so plaque and tartar and the resulting advanced gum disease don't come back.
Food and drink
Foods that help muscles and bones also help teeth and gums. Breads and cereals are rich in vitamin B while fruits and vegetables contain vitamin C, both of which contribute to healthy gum tissue.(8) Lean meat, fish, and poultry provide magnesium and zinc for teeth. Some people recommend that teeth be brushed after every meal and at bedtime, and flossed at least once per day, preferably at night before sleep. For some people, flossing might be recommended after every meal.
Beneficial foods
Some foods may protect against cavities. Fluoride is a primary protector against dental cavities. Fluoride makes the surface of teeth more resistant to acids during the process of remineralisation. Drinking fluoridated water is recommended by some dental professionals while others say that using toothpaste alone is enough. Milk and cheese are also rich in calcium and phosphate, and may also encourage remineralisation. All foods increase saliva production, and since saliva contains buffer chemicals this helps to stabilize the pH to near 7 (neutral) in the mouth. Foods high in fiber may also help to increase the flow of saliva. Sugar-free chewing gum stimulates saliva production, and helps to clean the surface of the teeth.(8)
Detrimental foods
Sugars are commonly associated with dental cavities. Other carbohydrates, especially cooked starches, e.g. crisps/potato chips, may also damage teeth, although to a lesser degree since starch has to be converted by enzymes in saliva first.
Sucrose (table sugar) is most commonly associated with cavities. The amount of sugar consumed at any one time is less important than how often food and drinks that contain sugar are consumed. The more frequently sugars are consumed, the greater the time during which the tooth is exposed to low pH levels, at which point demineralisation occurs (below 5.5 for most people). It is important therefore to try to encourage infrequent consumption of food and drinks containing sugar so that teeth have a chance to be repaired by remineralisation and fluoride. Limiting sugar-containing foods and drinks to meal times is one way to reduce the incidence of cavities. Sugars from fruit and fruit juices, e.g., glucose, fructose, and maltose seem equally likely to cause cavities.[citation needed]
Acids contained in fruit juice and soft drinks lower the pH level of the oral cavity which causes the enamel to demineralize. Drinking drinks such as orange juice or cola throughout the day raises the risk of dental cavities tremendously.[citation needed]
Another factor which affects the risk of developing cavities is the stickiness of foods. Some foods or sweets may stick to the teeth and so reduce the pH in the mouth for an extended time, particularly if they are sugary. It is important that teeth be cleaned at least twice a day, preferably with a toothbrush and fluoride toothpaste, to remove any food sticking to the teeth. Regular brushing and the use of dental floss also removes the dental plaque coating the tooth surface.
Chewing gum assists oral irrigation between and around the teeth, cleaning and removing particles, but for teeth in poor condition it may damage or remove loose fillings as well.
Other
Smoking and chewing tobacco are both strongly linked with multiple dental diseases.[2] Regular vomiting, as seen in bulimics, also causes significant damage.
Mouthwash or mouth rinse improve oral hygiene. Dental chewing gums claim to improve dental health.
Retainers can be cleaned in mouthwash or denture cleaning fluid.[3] Dental braces may be recommended by a dentist for best oral hygiene and health. Dentures, retainers, and other appliances must be kept extremely clean. This includes regular brushing and may include soaking them in a cleansing solution.
Oral hygiene and systemic diseases
Several recent clinical studies show a direct link between poor oral hygiene (oral bacteria & oral infections) and serious systemic diseases, such as: [4] [5]
Cardiovascular Disease (Heart attack and Stroke),
Bacterial Pneumonia,
Low Birth Weight,
Diabetes complications,
Osteoporosis

Significant Events in the History of Operative Dentistry

By Thomas M. Schulein, DDS, MS. Associate Professor Department of Operative Dentistry, College of Dentistry, The University of Iowa.
Numerous events have transformed the practice of operative dentistry into one that is more efficient and more comfortable for the patient as well as for the operating team, and, often, one that is more productive for the dental office than it was previously.A number of significant occurrences in the history of operative dentistry can be studied by grouping them into the categories of analgesia and anesthesia; etiology, diagnosis and treatment regimes; equipment and devices; direct restorative materials; indirect restorative materials and illumination and magnification.This article presents a narrative that traces these significant events along categorical lines and a chronology of events in the development of the art and science of operative dentistry.
Introduction
During the mid-1800s, the field of operative dentistry encompassed all of chairside dentistry. In an 1889 textbook, ""Operative Dentistry," 1 oral surgery and fixed prosthodontics were still included in the area of operative dentistry. It was only later that the branch of operative dentistry as we know it today, came into being, after prosthetics, oral surgery and other disciplines broke off on their own.This paper presents the key events in the history of operative dentistry in topical fashion. Within each topic, the events are presented chronologically. At the end of the paper, a table summarizes the chronology of events.
Analgesia and Anesthesia
Prior to the introduction of ether in 1842 by Morton and nitrous oxide in 1844 by Wells, there was little that could be done to obtund the discomfort associated with the performance of operative dentistry. And, since these agents were used principally for analgesia or anesthesia during extractions and other surgical procedures, most patients did not experience anesthesia until after the introduction of conduction anesthesia in the late 1800s.In 1884, Carl Koller discovered the analgesic properties of cocaine. 2 Shortly after, in that same year of 1884, William S. Halsted introduced conduction anesthesia byusing cocaine to block the inferior alveolar nerve. 3 Although cocaine was effective for achieving profound anesthesia, it proved to be highly addicting.In 1904 or 1905, procaine was synthesized by Einhorn and Uhfelder in Germany. 4,5 When mixed with a very small proportion of epinephrine, this agent was found to be highly effective and safe as a local anesthetic agent for most patients.Procaine (Novocaine ®) was widely used by physicians and dentists into the 1950s and Novocaine ® is still the name that patients commonly associate with local anesthetics.By the 1950s, lidocaine (Xylocaine®) became widelyaccepted by the dental profession. This agent, developed in 1943,6,7 was found to have extreme safety, surpassing that of Novocaine, and lidocaine became a widely used anesthetic agent. 8 Although many other local anesthetic agents are currently in use and nitrous oxide is often used for its analgesic effect, lidocaine remains the principal anesthetic in routine use.
Etiology, Diagnosis and Treatment Regimes
Little was known of the causation of dental caries and no scientific basis existed for infection control prior to the second half of the nineteenth centuryAntiseptic agents were known to surgeons during the American Civil War but they were misused. 9By 1865, Louis Pasteur came to the conclusion that microorganisms caused putrefaction and could be transferred from one place to another by solids or liquids as well as by airborne means10 He also discovered that some microorganisms could be destroyed by heat or other methods. His work provided the basis for the "germ theory," of infection. Joseph Lister is considered to be the discoverer of antisepsis. In 1867, he published a ers counterin the acce ted idea of "'laudable pus,"' building on and complementing the work of Pasteur."' 11 Then, it was Robert Koch who cultured microorganisms, separating and classifying them. 12 Among other things, Koch discovered the bacilli that caused tuberculosis and cholera. After considerable research, Willoughby D. Miller published his chemicobactcrial theory of dental caries in 1890.5 Thus, the foundations of microbiology and infection control were firmly established in the medical and dental professions in the latter half of the nineteenth century. The value of and methods for sterilization of dental instruments were recognized by the late 1800s, but it wasn't until 1966 that the American Dental Association went on record stating that the best method for the sterilization of dental instruments was by means of saturated steam under pressure. 13The venerable G.V. Black was almost single-handedly responsible for the development of the scientific cavity preparation, his work being published in 1891.14-18Although preceded in his work on dental nomenclature by others, Black was the major author of the modern system of nomenclature, presented in 1893.19 Two yearslater, in 1895, x-rays were discovered by Wilhelm Conrad -Rontgen. 20 During the next year, Dr. C. Edmund Kells adapted the new discovery to dentistry. 21,22 However, even by 1930, fewer than half of dental school graduates purchased x-ray machines when first equipping their offices. The advancements in dental radiology have been traced in an historical article by Frommer. 23Another significant advancement for operative dentistry was the introduction of dental hygienists. This occurred in 1906 by Dr. Alfred Fones, who established his own school of dental hygiene - 24-26,27,28 With the addition of a dental hygienist, the dentist was free to perform more operative procedures and had a valuable auxiliary to aid in the treatment and education of patients. Not to be left out is the significance of the earlier adoption of dental assistants into dental practices. This occurred in the late 1800s. Among those who utilized dental assistants early on was Dr. C. Edmund Kells.By 1874, it was recognized that fluorine had a preventive effect on dental caries. This recognition was to have far-reaching effects. During the first three decades of the 1900s, Dr. Frederick McKay of Colorado Springs observed that mottling of enamel was confined to specific geographical locations. McKay and Dr. H. Trendley Dean showed that fluoride that was naturallyoccurring in water caused the mottling. Later, Dean demonstrated that by adjusting the level of fluoride in community water supplies to one part per million, mottling could be reduced or eliminated and yet the caries rate was much reduced. This classic work led to the widespread fluoridation Of community water supplies throughout the United States. 29
Equipment and Devices
There is evidence that the Maya and other ancient cultures used primitive "'bow drills"" and other devices to prepare round ornamental cavities in teeth. Some early attempts at filling teeth are also in evidence.By the nineteenth century, hand drills with steel bur heads were used by twirling the long handles with the fingers. Later, a ""bur thimble," was used. Some drills were made bendable by attaching flexible shanks between the bur heads and the handles, allowing the more posterior portions of the mouth to be accessed. In addition, many mechanical devices were introduced, notably the Lewis drill from 1838, Chevalier's *"'drill stock"' from the 1850s or earlier, and Merry's drill of about 1858.
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In 1871, Morrison introduced his foot treadle dental engine. 30 This was the first practical foot operated dental engine to be used in dentistry, although John Greenwood made the first dental foot engine in 1790. Shortly after this, dental handpieces were developed to accept hand-made steel drills. This represented the first significant increase in rotational speed over the hand-operated long-handled drills.A major innovation was the rubber dam, introduced by a New York dentist, Sanford Barnum, in 1864. 31,32 This allowed for the dryness so crucial to the proper placement of cohesive gold foil restorations, developed a short time before. Barnum received accolades, including the bestowal of a medal, from the dental profession, for his gift of the rubber dam without the motive of financial remuneration.In 1891, the S. S. Mite Company introduced the first machine-made steel burs, known as Revelation Burs.® 33 Also, at about this time, corundum and crude diamond instruments were introduced to assist in the preparation efforts. In 1891, Acheson discovered a method for making an industrial abrasive composed of silicon carbide, which he patented in 1893 and named Carborundum.®34 When the material was adapted to dentistry, it became a very important abrasive substance for reducing tooth structure and for dental laboratory work. At first, however, it was in short supply and did not become widely available in dentistry until later. 35In 1867, Morrison introduced his first dental chair. 36 This was a noteworthy device, incorporating a wide range of adjustments. In 1877, the first pump type hydraulic dental chair, the Wilkerson chair, was introduced. 37 Dental chairs continued to evolve, designed mostly for stand-up dentistry, until some models were introduced that were geared toward sitdown dentistry. In 1954, a group of dentists, including Dr. Sanford S. Golden, met to develop a reclining chair for patients that would allow the dentist to sit while operating. The result of their efforts led to the introduction of the Ritter Euphorian Chair. Although this chair received an award for being the first dental chair exhibiting a major change in 50 years, it would not permit the patient to be fully reclined without his/her feet going up in the air. 38 The introduction of the DenTal-Ez® chair,, by John Naughton in 1958,, was the event that ushered in the era of modern sit-down, four-handed dentistry. 38,39 This chair had an articulated seat and back and became "accepted as the standard by the profession."Electricity was discovered in the late 1800s. The first electric drill, which was battery powered, was introduced the same year as the first foot pedal drill, in 1871. With the introduction of electrification to communities, electric dental drills began to be introduced, although slowly. Well after their introduction, however, foot-operated drills were still in widespread use. As an example, the University of Iowa's new College of Dentistry building, opened in 1918, featured footoperated drills. Nevertheless, by 1915, the electric dental engine was seriously competing with the foot treadle drill. Even so, these early electric dental drills were limited to rotational speeds of about 4,000 rpm. Modern diamond instruments were introduced in Europe in the 1930s and in the United States shortly thereafter. 40 Their full potential was not to be realized until sometime later, however, when high-speed handpieces came into use.The first commercially produced amalgamator was introduced in 1937. 30 Prior to that time, amalgam was mixed in a mortar and pestle, a time consuming and unhygienic process.A series of developments led to the use of highspeed instrumentation. Many of the handpieces are noteworthy, such as Norlen's "Dentalair," conceived in 1948, Walsh's air turbine handpiece of 1949, Nelsen"s water turbine handpiece (1952) and Page's belt-driven high-speed handpiece of 1955.41 It was in 1957, however, that a handpiece was introduced that revolutionized the practice of dentistry almost overnight. John Borden introduced his sensational Airotor handpiece, operated by air and allowing for rotational speeds of up to 200,000 rpm. 42 The development of miniature ball bearings, in part, facilitated its development. 43,44 It is from this design that all current airoperated high-speed handpieces have evolved. The carbide dental bur,, introduced in 1947,33 now had a vehicle with which its full potential could be realized. And, the diamond rotary instruments could also be used with high efficiency.Today, electric high-speed handpieces, under development for the past 40 years and in common use in Europe, rival and in some ways surpass the merits of air-driven high-speed handpieces. 41 Their use in the United States has continued to increase. Some of their principal advantages are quietness of operation, great concentricity and very high torque, but these things are countered by their relatively high cost.Many other devices have made dentistry more efficient and safe. Among these are sterile, disposable needles (1959)13 and precapsulated dental amalgam (1970).
Direct Restorative Materials
In the history of operative dentistry, direct restorative materials have principally included: lead, mastic, gold, tin, amalgam, fusible metal of Darcet, gutta percha, silicate cement, directfilling methyl methacrylate resin, composite resin and glass ionomer cement.In the first century AD, Celsus may have recommended lint, lead and other materials to fill cavities. Other early substances used to fill teeth included alum, honey and ground mastic (a yellowish resin that comes from a small Mediterranean evergreen tree). 45 It appears that gold leaf, in a non-cohesive form, has been used to fill teeth for over 500 years. Pierre Fauchard, wrote in the 1700s of the use of lead, tin and gold as filling materials, but he preferred tin.
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August Taveau, of Paris, mixed shavings from French five-franc pieces with mercury in 1826.46 The resulting amalgam restorations, although inferior by today's standards, permitted a means by which teeth could be saved in a relatively easy and inexpensive manner. The Crawcour brothers introduced amalgam into the United States in 1833. 46 Unfortunately, they used the material unscrupulously and gave it a bad name. Eventually, a major rift known as the "amalgam war"' resulted, pitting amalgam advocates against opponents of amalgam. 47,48 The controversy over the use of amalgam raged for most of the rest of the 1800s and many early operative dentistry textbook authors denigrated its use.49-52 in the late 1870s, an organized movement supporting the use of amalgam, to become known as the ""new departure,"' began. 53 Ring states that amalgam was the predominant restorative material in the late 1880s. 25 Nonetheless, during the 1890s, a great controversy still raged over the propriety of using amalgam. This "'battle" pitted many highly-respected dentists against each other. 54 Fortunately, the advocates finally prevailed and, after many years of experimentation, G. V. Black introduced a balanced amalgam formula to the profession in 1895. 55,56 This formulation and its derivatives remained essentially unchanged until at least the 1960s and were responsible for the salvation of countless millions of teeth.In 1963, Dr. William Youdelis, a Canadian metallurgist,, developed high copper amalgam. 57 This form of amalgam yielded enhanced long-term marginal integrity and is the major material in use today.In the 1830s, a fusible alloy of lead, bismuth and tin, known as "Darcet's metal"' was used to fill teeth. This material was heated and then poured into the tooth in the molten state, after which it quickly hardened. Later, improvements were made to lower the melting point of the material. According to one source, 58 it was used in France more than any other material between the years of about 1835 to 1845.Until the latter part of the nineteenth century or the early part of the twentieth century, the use of tin for filling teeth was promoted by many. As a foil, its virtues were espoused through many publications. 59,60,61 In fact, tin was considered by many to be second to gold as the most desirable direct filling material. 49-51,62 The use of tin in combination with gold and other metals was also promoted as a means of more rapidly building up a restoration and enhancing the properties of tin.Gutta percha was discovered in India in 1842. It was used as a filling material, although mostly as a temporary one, and in its early history was also used for the filling of root canals, sometimes mixed with chloroform.Zinc oxychloride cement was introduced in 1860.63 It was used as a filling material, although it was not a very good one, and was also used as a cement. In 1879, zinc phosphate cement was introduced in dentistry.64 Zinc phosphate represented an improvement over zinc oxychloride and was also used as a filling material and as a cement. Today, zinc phosphate remains a highly respected cement, well over 100 years after its introduction.There is good evidence that gold foil has been used to fill teeth for over 500 years. Until 1855, all such gold was non-cohesive and required substantial undercuts near the cavosurface areas of cavities in order to retain the restorations. The frustration frequently encountered with such use of direct gold led practitioners to try other restorative materials, such as crude amalgams and gutta percha in the early 1800s. A crystalline form of gold, known as "'sponge gold"" was tried in the 1840s or 1850s. This gold was in a form somewhat like today's mat gold. It was hard to handle and not much better than the plain sheets of gold foil in use previously.However, in 1855, Robert Arthur discovered that by heating the gold foil, impurities could be driven off and the gold could be made to adhere to itself, a property known as cohesion. 65 This was a major advance for dentistry.In the succeeding years, direct gold changed very little, except for the introduction of mat gold and gold pellets, both of which enhanced the speed of compaction. The use of direct gold is no longer commonplace. Its high technique sensitivity, demanding regime and high placement time, along with the development of high quality composite resin materials has led to its disfavor. A small cadre of users still exists, however, and the material, when well placed is an extremely good one.In 1908, silicate cement was introduced in the United States, although earlier,, cruder forms were used in Europe in the late 1800s. 64 This was the first direct semi-esthetic filling material. Silicate cement had the advantage of high fluoride release but also was highly soluble in oral fluids. As a result, the longevity of restorations made from silicate cement was relatively poor. Silicate cement remained in widespread use into the 1960s and early 1970s, when composite resin replaced it as the primary direct esthetic filling material. In 1967, Gilmore stated that silicate cement "'is the most commonly used anterior restorative material and for the most part has not been altered for three-quarters of a century. "66 In 1947, direct-filling methyl methacrylate resins were introduced into the United States 67 and came into general use by 1949. They were heralded by some as a significant improvement over silicate cements. These resins had low solubility, but their shrinkage and subsequent marginal leakage was high, often leading to significant interfacial staining.
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In 1955, Dr. Michael Buonocore made a significant discovery that opened the way to a vast world of bonding of resins and cosmetic dentistry to unfold over the next fifty years. 68 He found that by applying a solution of phosphoric acid to enamel, significant mechanical bonding of resins could be achieved. 69After the introduction of composite rcsins, developed by Bowen in 1962, the use of silicate cements and acrylic resins decreased dramatically. In fact, within about two years after composite resins were introduced, the use of silicate cements and acrylic resins essentially came to an end. 70A notable event in the evolution of composite resins was the introduction of ultraviolet lightcuring around 1973,70 resulting in command-setting resins. With the UV system, fractured anterior teeth could be rebuilt quite esthetically and conveniently, unlike with the previous chemically-setting resins. These UV resins remained popular for a number of years, until the introduction of visible light-curing composite resins in about 1978.70 The visible lightcuring resins offered the advantages of no UV hazards, faster setting times and better color stability.The development of dentin bonding agents was another significant advancement. 71 Many generations of such agents have existed, since their introduction in the late 1950s. The restoration of root surfaces with little or no enamel present is reliable with the currentlyavailable agents.Microfilled resins came into use around 1977,70 providing practitioners with highlypolishable and stainresistant restorations when used in conjunction with the acid- etch technique. Hybrid and microhybrid resins, now in widespread usage, offer both high strength and relatively good polishability. Microfilled, hybrid and microhybrid resins are used extensively in cosmetic procedures, ranging from small Class III restorations to diastema closures, large class IV restorations, and direct anterior veneers. In addition, composite resins have come into widespread use for the restoration of all classes of cavities in posterior teeth.In the late 1960s and early 1970s, resin pit and fissure sealants were introduced and advocated for the prevention of caries in susceptible pits and fissures in children. 72 These agents were accompanied by early skepticism within the profession. With time, and with the introduction of better materials, sealants gained acceptance and were found to be highly effective. 73 The termpreventive resin restoration is applied to the treatment of early carious lesions in pits and fissures, involving the removal of carious tooth structure and its restoration with composite resin, followed by the application of a sealant to cover all remaining pits and fissures. Such practice has become widespread and has been responsible for the adoption of very conservative restorative procedures that generally weaken teeth less than when amalgam is used.Glass ionomer cements were invented in 1968 and first described by Wilson and Kent in 1971.74,75 Like silicates, these restorative materials exhibited the property of high fluoride release. However, unlike the silicates, the glass ionomer cements showed low solubility. Glass ionomer cements have been widely adopted by the profession and currently have extensive applications.
Indirect Restorative Materials
Indirect restorations have generally been fabricated from impressions taken of prepared teeth. The earliest impression material was probably beeswax. A reference to the use of wax for dental impressions was made in 1684 by a German surgeon. 76 Wax was a poor impression material by today's standards, but it functioned adequately in its day by being capable of removal over undercuts.Gutta percha, obtained from certain trees in Malaysia, may have been introduced as an impression material in 1848, but it was not very satisfactory for that purpose.The first use of plaster of Paris, so named because one of the most extensive deposits was found in the "'Paris Basin,," near Paris, France, 77 is uncertain. One source traces its introduction to the dental profession to about 1844,77 whereas another traces its roots to the very early 1800s. 76 John Greenwood attested to his first use of plaster of Paris in 1826.78 Plaster was apparently used for developing ("pouring up,") dental impressions before it was used as an impression material. Plaster was an accurate impression material, but had the significant disadvantage of being inflexible. It typically fractured upon its removal but, when reassembled, could produce an excellent impression. Plaster of Paris was the most commonly used impression material in 1904.79Charles Stent developed modeling compound in England in 1857.80,81 This modeling compound was an attempt to improve gutta percha by adding stearine, a substance made from animal fat, to improve plasticity and stability, and talc, used as an inert filler to strengthen and "add to the texture," of the material, and a red coloration. 82,83 This became a common material to use for making impressions. Copper bands or other devices were used in the late 1800s, along with impression compound, to make impressions for full crowns. Then, tin was onto a die and solder was melted to form the occlusal surfaces. In a similar manner, inlays and onlays of gold could be fabricated. A major textbook of 1932 described the construction of gold inlays by the indirect method, utilizing impression compound extensively for impression making. 84 Over the years, the formulation of impression compound has been enhanced and it is still in common use in clinical dentistry.
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Reversible hydrocolloid was introduced to the dental profession in 1925 85 by Alphons Poller, an Austrian. The product was patented as "Nogacoll." In 1931, the material was also sold under the name of "'Denticole." The material was first used for making impressions of human faces to fabricate plaster reproductions, but was soon after adapted to dentistry. By 1935, almost a dozen competing brands were in use. The fundamental ingredient of hydrocolloid is agar-agar, a colloid obtained from seaweed. Prior to the development of hydrocolloid, only wax, gutta percha, modeling compound and plaster of Paris were available to the dental profession for purposes of obtaining impressions of any kind. Now, a flexible material was offered that could spring over undercuts and recover and be used to produce an accurate model. These agar-type reversible hydrocolloids were probably used only for removable partial denture impression work prior to about 1935, when A. W. Sears promoted the material for use in fixed partial denture impression making. 86During the World War II era, or just before, irreversible hydrocolloids were developed and they were introduced to the dental profession in 1943.87 Agaragar had become scarce, since most of it came from Japan. Like their reversible counterparts irreversible hydrocolloids, known as alginates, were developed from seaweed and were salts of alginic acid, such as sodium alginate.Until the introduction of polysulfide impression materials in 1953,67 the hydrocolloids were the only elastomeric impression materials available to the practices of operative dentistry and prosthodontics. The new elastomeric polysulfides, although messy and relatively sensitive to distortion, offered much more strength than the hydrocolloid material and soon became very popular.As elastomeric impression materials evolved, the polysulfides gave way to more stable, less messy materials such as the polyethers (late 1960s), the condensation silicone materials and the polyvinyl silicone (addition silicone) materials (1970s) that are now in widespread use.Porcelain inlays were described at least as early as1857. 63 Enamel was also ground to form rather crude inlays for cementation into cavities in teeth. Porcelain inlays played a significant role in the restoration of teeth in the last part of the nineteenth and early part of the twentieth centuries judging by the large number of publications devoted to techniques for their fabrication and placement.88-95 This is only a sampling of the hundreds of references to the porcelain inlay to be found in this era. In the period from 1900 to 1910, there was a particularly large number of articles published on porcelain inlays, whereas after 1915 the number was vastly reduced. It is probable that the recent introduction of the cast gold inlay and silicate cements were responsible for the diminished interest in the porcelain inlay. The first cement, oxychloride of zinc, was introduced in 1860.63 However, a better material, zinc phosphate cement, was introduced in 1879. Over the years, a wide variety of other cements have been introduced. Even so, zinc phosphate cement remains one of the tried and tested cements still in widespread use.There is good evidence that metal casting, utilizing the lost wax or "'cire perdue"" method, has been utilized since ancient times. 96 In 1844, a French dentist, Agiulhon de Saran, reportedly formed an investment mold from an impression of a cavity and melted gold into it to produce an inlay. 45 In the latter half of the nineteenth century, many techniques were described for the fabrication of gold inlays, most of them involving the procedure of flowing solder into molds made of tooth cavities. 79,97,98 Although the art of casting as we now know it had not been yet described, a wide variety of sophisticated crowns and bridges had already been described by the late 1880s.2 One of the greatest achievements in restorative dentistry occurred with the introduction, by William Taggart, in 1907, of his method of making gold castings. 99 Although systems somewhat paralleling his were advocated and used in the 1890s or before, 100 Taggart's was revolutionary. Dentists were able to cast complete gold crowns with precision. Further refinements were soon made to his technique, including the introduction of the centrifugal casting machine by Jamieson in that same year of 1907. Soon thereafter, accurate methods for controlling expansion and contraction were developed, leading to the ability to fabricate very precise castings. The work of Taggart has been widely heralded as one of the greatest achievements in the history of restorative dentistry.In recent years, inlays and onlays made of high strength plastic materials and porcelain have been introduced. In 1985, the first ceramic inlay made by a chairside CAD/CAM device was cemented into a patient's tooth. 101 In 2000, the Cerec 3® was introduced. This latest system provides a means by which a sophisticated ceramic inlay or onlay can be fabricated, with a handheld scanner reading the details of the preparation and software subsequently being used to drive the mechanism to precision mill (grind) a restoration without the use of an impression and without the need for a second dental appointment.
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Illumination and Magnification
In the early days of dentistry, only natural light was available. The first artificial dental light was probably a candle. 30 In the latter part of the nineteenth century, dentists used kerosene lamps with focusing devices to direct light into patients' mouths. After the introduction of electricity, large ball-like ceiling fixtures were used in operatories. In the first decade of the twentieth century, the first patient lights were introduced. 102 These were lights that could be focused directly into the mouth. With the introduction of lights such as the Castle Pano Vision® in the 1950s, high illumination was finally realized, permitting the dentist to visualize the oral cavity to a more significant degree. Mouth mirrors were introduced in the 1800s, but it wasn't until 1950 that front surface mirrors103 into widespread were advocated, 103 and later came into widespread use. Now, clear images without the double image of the glass-covered mirrors formerly in use, were possible.Miner-type headlamps were used by dentists,often oral surgeons, in the 1950s, but by the 1990s, vastly improved,. small headlamps were available to dentists so that any operative dentist could utilize enhanced intraoral illumination.The use of magnification in dentistry is not new,, with references to it found at least as long ago as the nineteenth century. In 1866, Atkinson published on the merits of intraoral magnification. 104 In 1873, Parsons recommended the use of a large two to three inch diameter magnifying lens, with a handle, to examine teeth intraorally for gold margins, fissures and cracks. 105The magnification in use by the 1930s consisted of rather crude devices, and later plastic "loupes," were clipped onto eyeglass frames or attached to headbands. By the 1980s, highquality ground glass optical telescopes were available to the dental profession. 106,107 Today, a significant number of practitioners, including ever-increasing numbers of dental students, avail themselves of these significant improvements to vision. As a secondary benefit the use of telescopes allows dentists to maintain improved posture.
Summary
Many notable events in the development of the art and science of operative dentistry have been presented. Not only has ""necessity been the mother of invention," but many individuals have shown independent brilliance in their innovations and fabrications. Operative dentistry continues to grow and become enriched as the most recent developments become refined. It is especially the current age of cosmetic dentistry that has been a real boon for the public and the profession. It has spurred the development of many new techniques and materials and made a wide variety of cosmetic procedures available to vast numbers of patients. No doubt, the field of operative dentistry will continue to evolve and change just as it has for so long in the past.
Chronology of Events
1826 Use of filings of French five-franc pieces mixed with mercury by August Taveau, of Paris 1833 Introduction of amalgam into the United States by the unscrupulous Crawcour brothers from France 1844 Plaster of Paris introduced, by this date, for impressions of teeth 1855 Cohesive gold foil is discovered by Robert Arthur 1857 Charles Stent develops impression (modeling) compound 1857 Description of the porcelain inlay 1864 Rubber dam introduced by Sanford Barnum 1865 Pasteur described putrefaction and transmission of microorganisms, leading to the "'germ theory"1867 Antiseptic Era inaugurated by Joseph Lister 1867 Introduction of the Morrison dental chair 1871 Morrison foot-treadle dental engine introduced 1879 Koch identified the microorganisms causing wound infection 1879 Zinc phosphate cements introduced 1884 Conduction anesthesia demonstrated by William S. Halsted using cocaine 1890 Publication of the chemicobacterial cause of dental caries by Willoughby D. Miller, an American dentist 1891 Introduction of the first machine-made steel bur, the S.S.White Revelation Bur 1891 Scientific cavity preparation described by G. V. Black 1893 Modern system of dental nomenclature presented by G. V. BlackJournal of the History of Dentistry/Vol. 53, No. 2/July 200569Chronology of Events (continued)1893 Process for making Carborundum® (silicon carbide) patented 1895 "'Balanced" formulation for dental amalgam proposed by G.V. Black1950 Widespread acceptance of Xylocaine® (Lidocaine), discovered in 1943, by the dental profession1950 Introduction of the front surface mirror 1895 Discovery of X-rays by Wilhelm Conrad Rontgen 1953 Introduction of polysulfide elastomeric impression materials 1896 C. Edmund Kells adapted X-rays to dentistry 1955 Acid etching of enamel described by Michael J. Buonocore 1800s Introduction of dental assistants late in the century 1957 Borden Airator introduced 1905 Discovery of Procaine (Novocaine@) by Einhorn and Uhfelder1958 Modern reclining dental chair developed by Naughton 1906 Introduction of dental hygienists into the dental office1950s Dentin bonding agents introduced late in this decade 1907 Cast gold process described by William Taggart 1962 Composite resins described by Rafael Bowen 1963 High copper amalgam alloys developed 1908 Silicate dental cement introduced 1960s Introduction of pit and fissure sealants 1915 Electric dental engine becoming wide-spread in use 1968 Glass ionomer cement invented 1970 Ultraviolet light-curing composite resins developed 1925 Reversible hydrocolloid impression materials introduced 1977 Introduction of microfilled COMF 1934 Introduction of modern diamond instruments1978 Visible light-curing composite resins introduced 1937 Introduction of the Wig-L-Bug® the first commercially produced amalgamator1982 Introduction of high quality high magnification loupes (telescopes) in dentistry 1941 Irreversible hydrocolloid impression materials (alginates) developed 1985 Cerec® ceramic inlay system introduced 1990 Use of modern high-speed electric dental handpieces1942 Recognition of the caries preventive property of fluoride in concentrations I part per million in drinking water1990 Operator headlamp lighting widely of available 1947 Carbide dental burs introduced 1990S Adoption of advanced dentin bonding 1947 Direct methylmethacrylate filling materials agents introduced in the United States
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The Future of Dentistry

The following are several hot articles on the future of dentistry. The full "Future of Dentistry Report" is a long read written for professionals. However, the interview with ADA president Timothy Rose is good summary for the layperson.
The Future of Dentistry ReportThe Future of Dentistry report was developed by a large group of experts in the dental profession. The report is intended to be a practical guide for the profession's next generation.
The Future of Dentistry - Chat With the ADA PresidentIn an ABC NEWS interview Dr. Timothy Rose discussed: replacements for dental drills in development at the present time that use a very accurate spray of silica "sand" to actually cut and prepare teeth for filling and stimulating the jaw's bone structure to spur new tooth growth.
Nanotechnology: The future of dentistryThe recent thing that we will be talking about is nanotechnology! The speed at which advances are being made in science has catapulted nanotechnology from its theoretical foundations straight into the real world. Dentistry also is facing a major revolution in the wake of this technology having already been targeted with novel 'nano-materials.'

Orthodontics Including Invisalign Braces

OrthodonticsAlthough teeth straightening and extraction to improve alignment of remaining teeth has been practiced since early times, orthodontics as a science of its own did not really exits until the 1880s. The history of dental braces or the science of orthodontics is very complex. Many different inventors helped to create braces, as we know them today.
In 1728, Pierre Fauchard published a book called the "The Surgeon Dentist" with an entire chapter on ways to straighten teeth. In 1957, the French dentist Bourdet wrote a book called "The Dentist's Art". It also had a chapter on tooth alignment and using appliances in the mouth. These books were the first important references to the new dental science of orthodontics.
Historians claim that two different men deserve the title of being called "The Father of Orthodontics." One man was Norman W. Kingsley, a dentist, writer, artist, and sculptor, who wrote his "Treatise on Oral Deformities" in 1880. What Kingsley wrote influenced the new dental science greatly. The second man who deserves credit was a dentist named J. N. Farrar who wrote two volumes entitled "A Treatise on the Irregularities of the Teeth and Their Corrections". Farrar was very good at designing brace appliances, and he was the first to suggest the use of mild force at timed intervals to move teeth.
Edward H. Angle (1855-1930) devised the first simple classification system for malocclusions, which is still in use today. His classification system was a way for dentists to describe how crooked teeth are, what way teeth are pointing, and how teeth fit together. In 1901, Angle started the first school of orthodontics.
In 1864, Dr. S.C. Barnum of New York invented the rubber dam.
Eugene Solomon Talbot's (1847-1924) was the first person to use X-rays for orthodontic diagnosis.
Calvin S. Case was the first person to use rubber elastics with braces.
Invisalign BracesInvisalign braces invented by Zia Chishti, are transparent, removable, and moldable braces. Instead of one pair of braces that are constantly adjusted, a series of braces are worn in succession each created by a computer. Unlike regular braces, Invisaligns can be removed for teeth cleaning. Zia Chishti, along with his business partner Kelsey Wirth, founded Align Technology in 1997 to develop and manufacture the braces. Invisalign braces were first made available to the public in May of 2000.

Fillings, Dentist Chair, Drills, False Teeth & Novocain

Dental Fillings - Dental AmalgamCavities are holes in our teeth created by the wear, tear, and decay of tooth enamel. Dental cavities have been repaired or filled with a variety of materials including: stone chips, turpentine resin, gum, and metals. Arculanus (Giovanni d' Arcoli) was the first person to recommend gold-leaf fillings in 1848.
History of the Debate about Mercury"French dentists were the first to mix mercury with various other metals and plug the mixture into cavities in teeth. The first mixtures, developed in the early 1800s, had relatively little mercury in them and had to be heated to get the metals to bind. In 1819, a man named Bell in England developed an amalgam mix with much more mercury in it that bound the metals at room temperature. Taveau in France developed a similar mixture in 1826."
Dentist's ChairIn 1848, Waldo Hanchett patented the dental chair.
Dentist's DrillOn January 26, 1875, George Green patented the first electric dental drill.
False TeethFalse teeth date back as far as 700 BC. The Etruscans designed false teeth out of ivory and bone that were secured into the mouth by gold bridgework.
Novocain - Alfred EinhornThere is historical evidence that the ancient Chinese used acupuncture around 2700 BC to treat the pain associated with tooth decay. The first local anesthetic used in dentistry was Cocaine, introduced as an anesthetic by Carl Koller (1857-1944) in 1884. Researchers soon began working on a non-addictive substitute for Cocaine, and as a result German Chemist, Alfred Einkorn introduced Novocain in 1905. Alfred Einkorn was researching an easy-to-use and safe local anesthesia to use on soldiers during wartime. He refined the chemical procaine until it was more effective, and named the new product Novocain. Novocain never became popular for military use; however, it did become popular as an anesthetic among dentists. In 1846, Dr. William Morton, a Massachusetts dentist, was the first dentist to use anesthesia for tooth extraction.

history of dentistry and dental care

ToothbrushNatural bristle brushes were invented by the ancient Chinese who made toothbrushes with bristles from the necks of cold climate pigs.
French dentists were the first Europeans to promote the use of toothbrushes in the seventeenth and early eighteenth centuries. William Addis of Clerkenwald, England, created the first mass-produced toothbrush. The first American to patent a toothbrush was H. N. Wadsworth and many American Companies began to mass-produce toothbrushes after 1885. The Pro-phy-lac-tic brush made by the Florence Manufacturing Company of Massachusetts is one example of an early American made toothbrush. The Florence Manufacturing Company was also the first to sell toothbrushes packaged in boxes. In 1938, DuPont manufactured the first nylon bristle toothbrushes.
Hard to believe, but most Americans did not brush their teeth until Army soldiers brought their enforced habits of tooth brushing back home after World War II.
The first real electric toothbrush was produced in 1939, and developed in Switzerland. In 1960, Squibb marketed the first American electrical toothbrush in the United States called the Broxodent. General Electric introduced a rechargeable cordless toothbrush in 1961. Introduced in 1987, Interplak was the first rotary action electrical toothbrush for home use.
ToothpasteToothpaste was used as long ago as 500 BC in both China and India; however, modern toothpastes were developed in the 1800s. In 1824, a dentist named Peabody was the first person to add soap to toothpaste. John Harris first added chalk as an ingredient to toothpaste in the 1850s. In 1873, Colgate mass-produced the first toothpaste in a jar. In 1892, Dr. Washington Sheffield of Connecticut manufactured toothpaste into a collapsible tube. Sheffield's toothpaste was called Dr. Sheffield's Creme Dentifrice. In 1896, Colgate Dental Cream was packaged in collapsible tubes imitating Sheffield. Advancements in synthetic detergents made after WW II allowed for the replacement of the soap used in toothpaste with emulsifying agents such as Sodium Lauryl Sulphate and Sodium Ricinoleate. A few years later, Colgate started to add fluoride to toothpaste.
Dental FlossDental floss is an ancient invention. Researchers have found dental floss and toothpick grooves in the teeth of prehistoric humans. Levi Spear Parmly (1790-1859), a New Orleans dentist is credited as being the inventor of modern dental floss (or maybe the term re-inventor would be more accurate). Parmly promoted teeth flossing with a piece of silk thread in 1815.
In 1882, the Codman and Shurtleft Company of Randolph, Massachusetts started to mass-produce unwaxed silk floss for commercial home use. The Johnson and Johnson Company of New Brunswick, New Jersey were the first to patent dental floss in 1898. Dr. Charles C. Bass developed nylon floss as a replacement for silk floss during WW II. Dr. Bass was also responsible for making teeth flossing an important part of dental hygiene.
ToothpickIn 1872, Silas Noble and J. P. Cooley patented the first toothpick-manufacturing machine