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Dental surgery has been practiced at least from the time of the pharaohs and certainly much earlier. Prior to the 17th century, dentistry was passed from one practitioner to another much like any other trade. "Tooth pullers", or barber-surgeons, spent most of their time out-of-doors and traveled from one town to another in a carnival atmosphere, not only extracting teeth, but lancing boils, bloodletting, cutting hair, and occasionally extracting kidney stones (1-3).

Pull a Tooth, Cure a Patient

In the absence of ways to treat infection in the preantibiotic era, dental extraction was frequently the treatment of choice and extraction instruments date back many centuries. Some of the earliest instruments were simple pliers-like tools made by armorers and blacksmiths (4). In the early 14th century, Guy de Chauliac invented an instrument that remained popular into the late 18th century called a dental pelican because of its resemblance to the beak of that bird (4a). Door keys became the models for the next generation of extraction instruments, called tooth keys, which were popular into the 20th century (5-6).

A Patron Saint

For centuries many questions were unanswered regarding the pathophysiology of disease so that mysticism and superstition helped explain the unexplainable. People looked to religion as St. Apollonia became the patron saint of dentistry after she was martyred in 249 AD (7-8). At her death, all her teeth were pulled, some of which are now claimed to be in churches throughout the world.

A First Step

Dentistry became a respectable profession with the publication of "Le Chirurgien Dentiste" in 1728, by Pierre Fouchard (9). Fouchard was interested in dental pathophysiology and surgical techniques, and helped to distinguish dentists from the earlier barber-surgeons. He was interested in dental anatomy though many earlier examples of dental art are found in the drawings of Leonardo da Vinci among others (10-13).

Manufacturers and Craftsmen Enter

As the population grew in the 19th century, so did the need for dentists and dental equipment. Blacksmiths had provided a great deal of early dental equipment until John D. Chevalier opened the first dental supply house in 1833 in New York City. Beginning in 1844, Samuel S. White became the preeminent maker of dental instruments and supplies into the 20th century. Dental technique, and thus the need for a better variety in instrumentation dramatically advanced with the discovery of anesthesia in the mid 19th century (14). Some of the finest instruments ever made then became available incorporating such exotic materials as ebony, ivory, tortoise shell, and mother of pearl (15-19), sometimes produced as either presentation or exhibition sets (20-23). Unfortunately, however, these instruments could not be adequately sterilized so ironically they may have actually contributed to the morbidity of those operated upon. Manufacturers were interested in sales and dentists were interested in impressing their patients despite the well-known beneficial effect of asepsis.

1-3) Early Barber-Surgeons

Traveling barber-surgeons had many trades, including tooth-pulling as seen in this 1523 print by Lucas van Leyden and in "The Country Dentist" (1654) by Jan Victors, both at the Rijksmuseum in Amsterdam. These early practitioners of many trades were looked down upon by the established medical profession and were characterized as monkeys in this 16th century engraving, now at the Bibliotheque Nationale de Paris.

4,4a) Extraction Forceps and Dental Pelican

The iron extraction forceps are from the 16th century and probably made by a blacksmith, while the screw type ebony handled dental pelican from the 18th century. It was used for prying out the diseased tooth and probably was associated with a great deal of discomfort and local damage.

5-6) The Key to Dental Extraction

The toothkey was a very common tool for dental extraction in the 19th century. The proper method is demonstrated here by Bourgery in "Traite Complet de L'Anatomie de L'Homme" (1866-1871). The similarity of the dental toothkey to an early housekey can be seen in the first two of the five toothkeys shown. Also note the various handles of wood, ebony, ivory and finally the last one of metal manufactured in the aseptic era.

7-8) St. Apollonia, The Patron Saint of Dentistry

St. Apollonia was martyred as her teeth were pulled out in this 15th century representation "Hours of Etienne Chevalier" by Jean Fouquet. St. Apollonia has a Mona Lisa like smile in the pictured 19th century (?) oil. She is holding the characteristic palm leaf in one hand and a large extraction instrument in the other. The original painter was Sassoferrato (1609-1685), though it is unclear whether this is an original or a reproduction.

9) Pierre Fouchard

This is a portrait of Pierre Fouchard, painted in the early 18th century by J. Le Bel. Fouchard was a major figure in the history of dentistry and his text helped establish dentistry as a specialty.

10-13) Dental Anatomy

Most of the early artists spent time studying dental anatomy, beginning with the great Leonardo da Vinci's sketches in the early 16th century. The greatest anatomy of the 17th century was "Anatomia Humani Corporis" (1685), by Govert Bidloo, while dental anatomy was beautifully illustrated by Bourgery in "Traite Complet de "L'Anatomie de L'Homme" (1866-1871). One of the finest American dental anatomies was "The Anatomy, Physiology and Pathology of the Human Teeth" (1844), by Paul Goddard.

14) The Wilcox-Jewett Obtunder

This early 20th century anesthetic device was useful in the local injection of cocaine under pressure.

15-19) Miscellaneous Instruments

Prior to electricity, mechanical drills were powered in a number of ways, including those using the principle of Archimedes.  This ivory handled instrument (ca 1840) has 4 drill bits, which fit nicely into the handle. A fine illustration of mid 19th century extraction instruments is seen here in Bourgery. An ebony handled jaw brace was often necessary to "remind" patients to keep their mouths open during dental procedures. Delmond invented the pictured broach in 1824; it is an ivory instrument with a wound gold tip shaft that was used to remove the nerve from teeth broken off at extraction. Benjamin Bell invented the split shaft elevator in 1795 and the dental screw seen here was used to remove those broken off teeth that could not be removed with extraction forceps.

20-23) Chevalier Dental Set

This is a very fine dental set from the mid 19th century. JD Chevalier was one of the major manufacturers of dental equipment in the United States during that period and this set contains the highest quality ivory and carved mother of pearl instruments available at the time. The dental key and cocaine syringe are rarely found in similar large sets. The extraction forceps are not original to the set, but were all made by Chevalier.

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2) 17th Century Barber-Surgeon

4a) Dental Pelican

6) Dental Toothkeys

8) Portrait of St. Apollonia

9) Pierre Fouchard

11) Bidloo Anatomy

14) Pain Obturator

15) Archimedes Drill, ca 1880

23) Chevalier Dental Set