8 Kinds of Dental Specialties

On completion of dental school, graduates are awarded a degree in general dentistry, which, depending on the school, designates them as either a DDS (doctor of dental surgery) or DMD (doctor of dental medicine). Both degrees represent the same amount of training, with no differentiation made between the two. General dentists who wish to specialize in a specific dental field must undergo postgraduate training. The American Dental Association lists eight different dental specialties.

1. Orthodontics and Dentofacial Orthopedics

Specialists in this field are primarily concerned with the prevention and correction of irregularities in the arrangement of the teeth. To prevent these problems, the orthodontist may show the patient how to correct a faulty use of the tongue and lips in swallowing or ask the patient to eliminate certain habits, such as lip or tongue biting or lip or finger sucking, all of which can cause malocclusion. Once an irregularity has developed, it may be corrected through exercises and the use of orthodontic appliances.

2. Oral Surgery and Maxillofacial Surgery

Oral surgeons, many of whom are also physicians, perform extractions, correct protruding jaws, remove oral cysts, and correct cleft lips and palates. Extractions and other minor procedures are generally performed in the dentist's office, but the more complicated operations are usually carried out in a hospital.

3. Pediatric Dentistry

Dentists in this specialty are concerned with the oral health of children, from infancy through adolescence. Procedures carried out by pediatric dentists include filling cavities, treating gum infections, preventing malocclusions, and performing endodontic, or pulp, therapy. The specialist may also construct space-maintaining appliances when a child's baby teeth are lost before the permanent teeth are ready to erupt.

4. Periodontics

Specialists who deal with the prevention and treatment of gum diseases are called periodontists. Gum diseases are often the result of improper mouth hygiene, but they may also be caused by nutritional deficiencies, allergies, and endocrine gland disturbances.

5. Other Specialties

Prosthodontics deals with tooth restoration and the replacement of lost teeth, while endodontics is concerned with root canal work. Oral and maxillofacial pathology addresses the diagnosis, study, and treatment of mouth infections and other disorders. Specialists in oral and maxillofacial radiology employ X-rays, computed tomography (CT) scans, and other radiological imaging tools in their work. Public health dentists, employed by governmental and private agencies, are concerned with the dental health and education of the public.

6. Dental Hygienist

The position of dental hygienist was originated by Alfred D. Fones, a Connecticut dentist who, in 1905, trained his assistant to perform prophylactic procedures. Two years later, at the suggestion of Fones, the Connecticut legislature passed a law allowing dentists to employ trained, licensed assistants for prophylactic work. Today, dental hygienists are employed by private dentists, dental clinics, and public health programs conducted by federal, state, and local governments. As with dentists, dental hygienists must pass a state examination in order to receive a license to practice. In addition, they are generally required to be graduates of an accredited dental hygiene school, and sometimes they are required to hold a bachelor's degree.

7. Dental Laboratory Technician

The dental laboratory technician is generally a highly skilled person who constructs artificial dentures, bridges, and other dental appliances. Technicians are employed by private dentists and commercial dental laboratories, and they are prohibited by law from working directly on patients. Some technicians perform all types of laboratory work, but others specialize in one aspect of constructing dentures or other appliances.

Many dental technicians learn their work through three or four years of on-the-job training after graduation from high school. Others may take special courses in high schools or junior colleges, or enroll in a two-year training program at a school accredited by the American Dental Association.

8. Dental Assistant

Dental assistants perform a wide variety of duties in the dentist's office. They prepare patients for treatment, hand instruments and materials to the dentist as he or she works on the patient, and also often perform secretarial duties. Dental assistants are generally high school graduates who have taken special training programs.

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History and Technical Advances of Dentistry in the 20th Century

With the advent of the 20th century, dentistry continued to progress on many fronts, including dental technology, oral hygiene, preventive dentistry and dental education. There was also an increasing awareness of the need for dental research, and today there are many major research projects concerned with the cause and prevention of dental decay, gum diseases, and other dental problems.

Technical Advances

In 1907, William Taggert first cast gold inlays, and since then the casting process has been perfected to allow for the shrinkage of the gold as it sets. In 1924 synthetic resins began to replace vulcanite as a material for denture bases. These new materials appear more lifelike than vulcanite and more closely resemble natural gum tissue. In 1925 the use of flexible materials for making impressions of the teeth started to replace the use of plaster, which was difficult to manipulate in the mouth.

After the introduction of ether and other general anesthetics in the mid-1800s, scientists began searching for drugs that would act as local anesthetic agents. Cocaine was used as a local anesthetic in the 1880s, but it was not very satisfactory because of the toxicity and narcotic nature of the drug. In 1905 the American physician Albert Einhorn synthesized procaine (Novocain), and it soon became the most widely used dental anesthetic. Injected directly into the gum tissue, it temporarily numbs the area so that a tooth can be painlessly drilled or extracted.

New drilling instruments were also introduced in the 20th century. The use of diamond bits and carbide burs began around 1925, and the modern high-speed and ultra high-speed dental drills came into use around 1957. These new drills revolve at speeds ranging from 300 to 400 thousand revolutions per minute and do not produce an annoying whirring sound.

Oral Hygiene

The value of proper oral hygiene was also a subject of much research in the early 1900s. Sir William Hunter, in 1910, published an article entitled "The Role of Sepsis and Antisepsis in Medicine," in which he pointed out that general health may be affected by infections around the teeth. Hunter's work, together with that of Edward C. Rosenow and others, added further impetus to the teaching of medical subjects to dental students. It also affected members of the medical profession, who began to consider more seriously the claims of dentists that oral infections may be an important cause of systemic disease, including cardiac ailments. Between the years 1909 and 1912, W. G. Ebersole, then the chairman of the Oral Hygiene Committee of the National Dental Association, actively campaigned to impress upon his fellow dentists the value of proper oral hygiene. He also introduced the teaching of oral hygiene to school children.

Preventive Dentistry

The field of preventive dentistry advanced greatly with the discovery of the decay-preventing action of fluorides. In 1908, Frederick Sumter McKay, a dentist in Colorado, noticed that many of his patients, while having few cavities, had mottled tooth enamel. It was soon found that the mottling of the teeth, as well as the apparent resistance to tooth decay, were related to substances in the drinking water, and in 1931 it was found that the particular substance was a fluoride. In 1938 the U.S. Public Health Service conducted detailed studies in two communities in Illinois, Galesburg and Quincy. In Galesburg the water supply was known to have a relatively high fluoride content while that of the Quincy water supply was free of fluorides. The results of these studies showed that the chil dren of Galesburg had many fewer cavities than did the children of Quincy. Through studies in other communities it was found that a fluoride content of 1 part per million (ppm) was high enough to help prevent dental cavities in children but was still low enough to keep the teeth from becoming mottled.

In 1942 David B. Ast, then the director of the New York State Bureau of Dental Health, suggested the artificial fluoridation of water in communities with fluoride-deficient water. In 1944 the water supply of Newburgh, N.Y., was artificially fluoridated to bring its fluoride content up to 1 ppm while the neighboring city of Kingston, which had no fluorides in its water supply, was used as a control. As a result of this and similar experiments, it was found that fluoridation of water supplies can reduce dental decay in children by as much as 60%. About 145 million people in the United States are currently supplied with fluoridated water. Fluoridation has also become widespread in other parts of the world, including in the United Kingdom, Canada, and Australia.

Dental Education

One of the most important contributions to modern dental education was the report of a survey conducted by the Carnegie Foundation in 1921. The survey, headed by William J. Gies, one of the founders of the Columbia University School of Dental and Oral Surgery, obtained information concerning dental education from state dental board examiners, practitioners, teachers, dental schools, and professional educators. The results of the survey brought about great advances in the quality of dental education and led to improvements in the facilities of dental schools. It also created a public awareness of the value of dental education and research.

Until 1869 a dental course in the United States consisted of one academic year (16 weeks) of training with no pre-dental requirements. In 1870 the program was increased to two academic years (16 to 20 weeks each), and in 1891 it was lengthened to three (28 to 32 weeks each). In 1917 the dental course was increased to four years of 32 weeks each. Between 1899 and 1902 the academic requirement for entrance to dental school was one year of high school. From 1902 to 1907 it was two years of high school, and from 1907 to 1910 it was increased to three years of high school. In 1910 high school graduation was required, and in 1921 a minimum of two years of college training was set as the requirement. Today, entry preference is given to college graduates, although acceptance to dental school is possible following a minimum of three years of undergraduate course work. Pre-dental college requirements include courses in physics, chemistry, and biology.

Current Research

Present-day dental research is primarily aimed at finding the causes, cures, and prevention of oral diseases, especially dental caries, gum diseases, and tooth irregularities. Current studies include research into the use of a vaccine to guard against the development of colonies of Streptococcus mutans that normally exist in the mouth. A bacterium, S. mutans encourages tooth decay by converting sugar to lactic acid, which destroys tooth enamel. Other research may lead to the development of a harmless, genetically modified strain of S. mutans to colonize the mouth in place of the naturally occurring microbe.

The molecular biology of dental disease also is under investigation. For example, researchers have decoded the genetic sequence of both S. mutans and the bacterium Porphyromonas gingivalis, which is thought to play an important part in the development of periodontitis (gum disease). Research is also under way to develop new, more durable compounds that can be used in place of current composite materials (resin-based compounds that, because they resemble natural tooth material, have become popular as fillings).

Future improvements also are expected in dental implantation, in which lost teeth are replaced by a metal post that has been secured to the jawbone and topped with a crown, bridge, or denture. Advanced imaging technology and greater knowledge regarding post-implant healing should ultimately permit greater success in providing stable attachments between the post and jaw.

Genetic engineering may one day provide a means of natural tooth restoration. Researchers have discovered stem cells (unspecialized cells that have not yet differentiated into specific types of tissue cells) in children's primary dentition (commonly called baby teeth). The investigators have found that these stem cells, harvested after falling naturally from a child's mouth, can be induced to form dentin, the tissue that makes up the bulk of a tooth, and so may eventually prove useful in tooth repair.

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History and Technical Advances of Dentistry in the 19th Century

The 19th century was probably the most active period in the history of dentistry. Many technical advances were made and discoveries in related scientific fields were successfully applied to the practice of dentistry. In addition, the 19th century saw the rise in the professional status of dentists.

Technical Advances

Among the most outstanding technical achievements was that of Giuseppe Angelo Fonzi, who, in 1806, constructed individual artificial teeth with metal pins in each tooth for attachment to the denture base. He also introduced the practice of shading or coloring artificial teeth to resemble natural teeth. In 1847, Edwin Truman introduced gutta percha as a temporary filling material, and in 1886, C. H. Land developed a method of making dental crowns of porcelain. A special chair for dental operations was introduced in 1865, and the electric dental drill was devised in 1883.

In 1854, Thomas Evans, an American dentist practicing in Paris, made a vulcanite rubber denture base for Charles Goodyear, who had procured a patent for vulcanizing rubber in 1851. Vulcanite was relatively inexpensive and easy to mold and soon became widely used as a denture base. Norman Kingsley devised vulcanite plates with attachments for correcting overcrowded teeth, and in 1879 published A Treatise on Oral Deformities as a Branch of Mechanical Dentistry. In 1895 another American dentist, Greene Vardiman Black, perfected silver amalgam as a material for filling cavities. Silver amalgam is an alloy consisting mainly of silver, mercury, and tin, and unlike other metals that had been used, amalgam does not expand or shrink after it is placed in the cavity. Black also recommended that a dental cavity should be enlarged before it is filled in order to prevent the recurrence of decay.

In 1888 the first book exclusively devoted to orthodontics was published by John N. Farrar, and in that same year, Edward H. Angle devised a system for classifying malocclusions. Angle, who in 1890 became the first dentist to limit his practice entirely to orthodontics, founded the Angle School of Orthodontia and the American Society of Orthodontists.

Anesthesia

Probably the most important dental and medical achievement in the 19th century was the development of anesthesia. Since earliest times, humans have been constantly seeking means to alleviate pain, and with the progress of surgery the need for anesthetic agents became acute. Nowhere was this lack felt more than in the extraction of teeth. Although alcoholic drinks, hypnotism, and narcotics, such as opium, were sometimes used to relieve pain during operations, most tooth extractions were performed without the use of anesthetics. Then, in the 1840s, two American dentists, Horace Wells and William Thomas Green Morton, introduced the use of two anesthetics -nitrous oxide (laughing gas) and ether.

In 1844, Wells, while under the influence of nitrous oxide gas, had a tooth extracted from his mouth and reported feeling no pain during the operation. Wells subsequently used nitrous oxide gas on a number of patients undergoing extractions. However, when he administered it to a patient in front of an audience composed largely of dentists, physicians, and students, the patient was heard to groan after the tooth was removed, and the experiment was considered a failure even though the patient later admitted that he had felt no pain.

Morton, who had been a student of Wells', was present at the demonstration and was determined to continue experimenting with the gas but was unable to obtain any nitrous oxide. At the suggestion of Charles T. Jackson, a physician and chemist, he began working with ether and in 1846 he successfully demonstrated the value of this gas as an anesthetic agent. Wells' contribution to the development of anesthesia was nearly forgotten for a number of years, but in 1864 the National (later American) Dental Association declared him to be the real discoverer of anesthesia.

Professional Status

The development of dentistry as a recognized profession was evidenced by the establishment of national dental organizations, dental schools, and licensing practices in many countries. In the United States, two physicians who also practiced dentistry, Horace H. Hayden and Chapin A. Harris, tried to establish a department of dentistry at the University of Maryland. When their efforts failed, they established the Baltimore College of Dental Surgery, the world's first dental school. The school was founded in 1839 and in 1841 it granted its first degrees, the Chirurgiae Dentium Doctor (Doctor of Dental Surgery, or D.D.S.). This first dental school met with much opposition. For many years the students considered those studies not directly concerned with the mechanical phase of dentistry to be a waste of time, and such subjects had to be made compulsory to ensure the attendance of students.

Although the demand for dental services increased steadily in the United States as the population grew, there was only a very small change in the type of men practicing dentistry for many years after the Baltimore College of Dental Surgery was founded. The public demand for dentists who had graduated from dental school was practically nonexistent until after the Civil War. Even by 1870 there were only about 1,000 graduates of dental schools in the United States, while the total number of practicing dentists was close to 10,000. Slowly, the need for qualified dentists led to the founding of numerous dental schools, and by 1960 there were 87 dental colleges in the United States. These included the Harvard Dental School, which was founded in 1867, and the University of Pennsylvania School of Dentistry, established in 1878. With the rise of dental schools came the establishment of several dental clinics, including one in New York City (1849), one in Philadelphia (1861), and another in Boston (1867).

The world's first national dental association and first dental journal were also established in the United States during the 19th century. The first dental journal, the American Journal of Dental Science, was founded in 1839, and the following year the American Society of Dental Surgeons was established. Other associations and publications soon followed, furthering the communication of ideas among practicing dentists. The first American textbook on dentistry, A Treatise on the Human Teeth, was published in 1801 by R. C. Skinner, and dental journals published by dental supply manufacturers and dealers appeared in 1847, when the S. S. White Company published the Dental Newsletter. In 1859 the name of this publication was changed to Dental Cosmos, and in 1937 it merged with the Journal of the American Dental Association.

The first state to enact legislation relating to the practice of dentistry was Alabama, which, in 1841, passed restrictions regulating the licensing of dentists. Forty years later, 12 states had similar laws, and by 1900 this figure had risen to 37. In 1880 the dentists of the District of Columbia tried to obtain federal legislation to govern the practice of dentistry but their attempt failed. It was not until 1891 that a bill was passed changing the United States census classification of dentists from technicians to professional men.

The founding of dental schools, societies, and professional journals in the United States was followed by similar developments in other countries. In England, the College of Dentists was founded in 1857, and the following year the London School of Dentistry was organized. In 1880 the British Dental Association was founded, along with the British Dental Journal. In France two dental associations were founded in 1879, and the first French dental school was established in 1880. In Germany the first dental journal was founded in 1849, and 10 years later the first national dental organization was formed. The first German dental school was founded in 1884, and many others were soon established.

Advances in Related Fields

Toward the close of the 19th century there was an increasing appreciation of the many advances made in the field of biology and other related sciences, and many of these advances were successfully applied to the field of dentistry. The announcement in 1860 by Louis Pasteur of the germ theory and Robert Koch's development of a technique for growing cultures of bacteria in the laboratory initiated the study of bacteria as a cause of dental decay. One of Koch's students, Willoughby Miller, was among the first to investigate this area of research, and in 1890 he published his findings in the book Microorganisms of the Human Mouth. In this book Miller stated that fermented food particles lodged between and on the teeth produce an acid that penetrates the enamel of the teeth and permits the microorganisms in the mouth to attack the protein matrix, or ground substance, of the enamel, thus producing dental cavities.

In 1896 J. Leon Williams stated that dental decay is a result of acid acting on a particular spot of a tooth under a gelatinous plaque that prevents the spot from coming in contact with the saliva in the mouth. Williams advocated the frequent and thorough cleaning of the teeth and introduced the slogan, "A clean tooth never decays." Although the validity of this statement is questionable, Williams' theory led to an increase in the practice of proper mouth hygiene.

Another major scientific advance in the late 19th century was the discovery of X-rays in 1895 by Wilhelm Roentgen. The following year, C. Edmund Kells of New Orleans, La., and Otto Walkhoff of Munich, Germany, made the first X-rays of the teeth. At first, dental X-rays were used primarily to detect impacted teeth and other teeth that fail to erupt normally but soon dentists began using them to diagnose dental caries, deformities of the jaw bone, and other disorders of the mouth.

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History of Dentistry in the 18th Century

During the 18th century, France became the world leader in the field of dentistry and retained its position until about the middle of the 19th century, when it was surpassed by the United States. The man reputed to be the outstanding dentist of the day was Pierre Fauchard, who is often considered to be the founder of modern dentistry. In his book Le chirurgien dentiste (The Surgeon Dentist), which was published in 1728, he covered dental anatomy, tooth decay, medicines for treating diseases of the teeth, dental surgery, gum diseases, and other aspects of dentistry. He also devised the bandelette, an appliance for expanding crowded teeth.

Largely as a result of Fauchard's work, dentistry became a field of active study in France. Books were published on dental surgery, the anatomy of the teeth, dental instruments, and measures for preventing mouth diseases. In addition, two types of artificial teeth were developed. In 1774 an apothecary named du Château had a ceramist make a set of porcelain teeth for him, and in 1789, Dubois de Chémant, a dentist, received a patent for a new type of artificial tooth made of mineral paste.

Influenced by the work of French dentists, men in other parts of Europe began publishing books on various aspects of dentistry. In Germany, Philipp Pfaff wrote a book in which he attributed dental decay to the putrefaction of food particles caught between the teeth. In England several scientists, including the physician John Hunter, published outstanding books on dentistry. In Hunter's book, The Natural History of the Teeth and Practical Treatise on the Disease of the Teeth (1771), he included a description of the formation and growth of the teeth -topics that had previously been largely ignored. Joseph Fox, in The Natural History and Diseases of the Human Teeth (1797), advocated that the treatment of teeth be based on scientific knowledge and surgical experience. Other well-known works of the 18th century included Joseph Hurlock's Treatise upon Dentition, or the Breeding of Teeth in Children, which was published in 1742; Benjamin Bell's System of Surgery, published in 1787; and Robert Blake's Essays upon the Structure of the Teeth in Man and Various Animals, published in 1799.

Another major development in Europe during the 18th century was the introduction of the English key, or turnkey, a new instrument for extracting teeth. Unlike the pelican or other instruments, it removed teeth with a turning motion and could extract even the most firmly rooted teeth. The turnkey was first introduced around 1740 and this instrument soon became widely used, replacing both the pelican and the straight lever.

The development of dentistry in colonial America can be traced directly to France. During the American Revolution two French dentists, Joseph Le Mayeur and James Gardette, went to America and taught their techniques to men in the colonial army. Among these men was John Greenwood, who invented a foot-powered dental drill in 1785. In 1791 the first dental clinic to treat the poor was established in New York City, but throughout most of the colonial period dentistry was practiced by barbers, blacksmiths, jewelers, and itinerant quacks.

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History of Dentistry in the Renaissance

During the Renaissance advances in the study of anatomy and physiology shed new light on the structure and functioning of the teeth as well as on other organs and tissues of the body. The first book devoted to dentistry, Artzney Buchlein, was published anonymously in Germany in 1530. Many new editions of the book were published during the next few decades and they were widely used by barber surgeons. Another outstanding book of the day was Bartolomeo Eustachio's Libellus de dentibus (Book of the Teeth), which was published in 1563 and was the first book devoted entirely to the anatomy of the teeth.

Also during the 1500s, Benvenuto Cellini invented gold casting, which later became the basis of casting gold inlays, and Jacques Guillermeau advocated the use of wax, coral, and mastic for artificial teeth rather than ivory, which is porous and becomes discolored in the mouth. Ambrose Paré, the French surgeon, devised methods of extraction, recommended gum incisions for difficult cases of tooth eruption, and suggested the use of artificial teeth made of bone. However, he and others still believed dental decay to be caused by worms.

In France, the term chirurgien dentiste came into use around 1620, and by 1697 the practice of dentistry was regulated by the government of that century. Anyone who wished to practice dentistry in France after that date had to enroll in the College of Surgeons, work for two years with a licensed dentist, pass an examination on the theory and practice of dentistry, and take an oath before the chief surgeon. Licensed dentists, however, generally limited their practice to the wealthy, and most of the common people were treated by barber surgeons, tooth-drawers, and itinerant charlatans.

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History of Dentistry in the Middle Ages

After the fall of Rome in 476 A.D., and for much of the Middle Ages, little progress was made in the field of dentistry. During the first few centuries of this period, most of the advances that were made were the result of work done by Arab physicians. Rhazes (865-925) advocated the use of dentifrices and described a metallic filling material for the teeth. Abul Kasim (Abulcasis), in the 11th century, considered dental tartar to be harmful, and he described a method of transplanting teeth. He also operated on cleft lips. The Arabian physicians refused to extract teeth and relegated this operation to barbers.

Throughout much of Europe in the Middle Ages the practice of dentistry was largely limited to monks, but in 1131 the Council of Reims forbade the clergy from performing any surgical procedures. Thereafter, until the 19th century, dentistry was largely practiced by barber surgeons and other men outside the medical profession. In 1308 the Guild of Barber Surgeons was founded in England, and it remained in existence for more than 400 years. Although Guy de Chauliac, a 14th century surgeon at the University of Montpellier in France, considered dentistry a specialized branch of medicine and recommended that dental operations be performed by medical specialists, most physicians did not agree with him and dentistry continued to be practiced by barbers, barber surgeons, and the so-called tooth-drawers.

Toward the end of the Middle Ages two important new instruments were devised for the rapid extraction of firmly rooted teeth. These instruments, called the straight lever and the pelican, were hinged, two-piece levers that remained important dental aids until the middle of the 18th century.

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History of Dentistry: Early Dentistry

The first recorded reference to toothache is found in the Sumerian clay tablets excavated near Ur in the Euphrates valley in Mesopotamia. These tablets, which date back to about 2500 B.C., contain advice on curing toothache by means of medicines, mechanical procedures, and incantations. The tablets also contain the so-called legend of the worm, which states that worms cause tooth decay. This belief still exists in some parts of the world.

Early descriptions of mouth diseases are contained in the Hindu Veda Agurveda, which also describes the use of frayed aromatic wooden sticks for cleaning the teeth. The ancient Hindus are also known to have inserted gold and jewels into holes drilled in the teeth and they used extraction tools and other dental instruments. They also treated gum diseases.

In ancient China, dating as far back at 2700 B.C., toothaches, like other ailments, were treated by acupuncture, the insertion of thin metal needles into various parts of the body. After the needle was withdrawn, the painful spot was cauterized in the belief that it would draw out the humor that caused the pain. Acupuncture was also practiced by the Japanese, and it is still used to treat disease in some parts of Asia.

In Biblical times, the Hebrews treated toothaches by applying vinegar to the teeth, and they replaced lost teeth with artificial ones of gold, silver, and wood. The value of healthy teeth is implied in the Old Testament admonition of "a tooth for a tooth," and during the existence of the temple at Jerusalem, a priest with defective teeth was not permitted to conduct services.

In ancient Egypt, from as early as 3700 B.C., dentistry arose as a branch of medicine, and many physicians specialized in treating diseases of the teeth. The Ebers Papyrus, which was written about 1500 B.C. and named for Georg Ebers who discovered it in 1875, describes many remedies for treating dental ailments, including fractured jaws and mouth wounds.

The use of artificial dental appliances was known in ancient Phoenicia during the 4th and 5th centuries B.C. Lost teeth were replaced with teeth extracted from slaves, and they were held in place with gold wire. At about the same time the Etruscans in Italy made dental bridges using ox teeth that were held in place by gold bands.

The Greek physician Hippocrates (5th–4th century B.C.) wrote about diseases of the teeth and described their treatment. He also devised simple dental instruments, practiced extractions, and performed other operations on the teeth and jaws. Galen (2d century A.D.), a noted Greek contributor to medical knowledge, was the founder of the theory that inflammation is the cause of tooth decay. According to this theory decay is caused by disturbances in the blood that inflame the teeth. Although many dental procedures were performed by the Greek physicians, extractions were generally performed by barbers, and artificial ivory teeth were constructed by artisans.

Dentistry during the Roman Empire incorporated many of the techniques and procedures used by the Greeks. As early as 450 B.C., Roman law (Laws of the Twelve Tables) forbade burying any gold in the grave with the dead except for the gold used to fasten the teeth. Celsus, who lived during the 1st century A.D., wrote about diseases of the mouth and their treatment. He also wrote about tooth extraction and described the first method of treating crowded teeth and other irregularities of the teeth. Pliny the Elder (1st century A.D.) wrote about mouth hygiene and bad breath and described mechanical means for correcting irregularities in the positioning of the teeth.

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7 Modern Procedures and Techniques of Dentistry

Among the many services performed by the dentist are prophylaxis (the thorough cleaning of the teeth), the detection of dental decay and other disorders, the filling of dental cavities, the treatment of diseases affecting the gums and periodontal tissue, the extraction of teeth that are so badly diseased or decayed that they cannot be saved, and the replacement of lost teeth with artificial bridges, dentures, or implants. Dentists are also concerned with occlusal reconstruction, the restoring of the vertical and horizontal dimensions of the teeth after their chewing surfaces are worn down. Sometimes, dentists also remove cysts and other types of growths, correct cleft lips and cleft palates, and correct jaws that protrude or recede too far or jaws that are fractured by injuries.

1. Prophylaxis and Examination

In prophylaxis, the dentist or dental hygienist uses special abrasives and scraping tools to remove dental tartar and other substances from the teeth. The dentist or an assistant may then X-ray the teeth to determine if there is any decay or other type of abnormality, such as an impacted tooth. Sometimes, all the teeth may be X-rayed with a single film, called a pentographic film. Most often, however, smaller individual films are used, with each film covering only a few teeth. In some cases, such as when dentures are to be fitted, when the teeth are to be straightened, or when some disease is suspected in the jaw bones, additional X-rays may be taken, including side and full-face views of the entire head. Similar X-ray films may be taken if the dentist decides upon a program of oral rehabilitation that includes relocating the teeth to correct a structural abnormality such as a malocclusion, or improper bite.

After X-raying the teeth, the dentist begins a physical examination of the teeth and other mouth tissues. He looks for areas where the enamel of a tooth may be deficient or entirely missing and he notices whether the soft tissues are being injured when the person chews. He also looks for teeth that have not developed properly and may test the vitality of the teeth with an electrical pulp tester. The dentist also examines any fillings, inlays, or bridges previously placed in the mouth to see if they still protect the teeth and to determine if decay has occurred under them. If new bridges or crowns are to be constructed, the dentist makes impressions of the teeth and later makes casts that he or a technician can use as a guide in preparing the bridge or crown.

As part of the examination, the dentist also records the patient's past dental and related medical history. If the patient has a gum disease, the dentist may inquire about his general health to determine if the gum disorder is a manifestation of an underlying systemic disease, such as an allergy, anemia, or a nutritional deficiency. In addition, the patient's medical history enables the dentist to know whether certain drugs and anesthetics should be avoided. For example, procaine (Novocain) is generally not given to older people or to people with known heart ailments.

After the dentist diagnoses any mouth disease or dental disorder, he plans his treatment and consults with the patient. He may advise the patient on home care of the mouth and prescribe fillings, bridges, or other restoration appliances that suit the patient's needs. He may also instruct the patient on how to brush his teeth, massage his gums, or use other techniques necessary for proper mouth hygiene.

2. Filling Cavities

Dental cavities are caused by decay and they can be detected either through X-rays of the teeth or by probing the teeth with a sharp pointed instrument known as an explorer. Once a cavity is detected, the dentist uses a high-speed drill to remove the decay and shape the hollow so that the filling material will be retained. Usually, the tooth nerve (pulp) and surrounding tissue are anesthetized so that the patient feels no pain while the tooth is drilled.

The major types of filling material are silver amalgam, gold, porcelain, synthetic porcelain, and plastic. Generally, the same kind of filling material is used in opposing teeth or teeth that are next to each other to avoid a mild electric shock caused by the difference in electric potential of the different metals. The most widely used filling material is silver amalgam, which is commonly used for small cavities. More extensive cavities are often filled with gold, which is less brittle than the silver amalgam and is stronger at the edges. Gold is generally used in making inlays or crowns. An inlay is a solid piece of gold that is cast to fit the cavity exactly. A crown, or cap, covers the entire tooth after the tooth's enamel has been removed. Crowns may be made of gold, plastic, or porcelain. Gold is often used for crowns on the teeth in the back of the mouth, while porcelain and plastic are used for front teeth because they are available in shades to match the patient's own teeth.

Sometimes the decay reaches the pulp of the tooth, causing the nerve to become inflamed and allowing infection to spread to the bone around the tooth. In such cases, the tooth can be preserved by endodontic therapy, which is popularly known as root canal work. The dentist removes the pulp of the tooth and replaces it with metal, gutta percha, cement, or some other material. The decayed portion of the tooth is then replaced with filling material, a gold inlay, or a gold or porcelain crown.

3. Treating Gum Diseases

Gum diseases are a major cause of tooth loss in adults. About 40% of all teeth that are lost result from the wasting away of the bone surrounding the teeth when diseases of the gums and periodontal tissue are neglected.

Injuries and diseases of the gums and periodontal tissue are often caused by accidents, irritation from improperly fitting crowns or dentures, impacted food particles, or the accumulation of dental tartar on the teeth. Dental tartar is a dense, chalklike material that collects on the teeth, and if it is not removed, it irritates the gums and may bring about infection. Usually, diseases of the gums and periodontal tissue are treated by chemical or surgical means. Surgical treatment entails the removal of diseased or superfluous tissues surrounding the teeth. Treatment with chemicals is usually done after the teeth are mechanically scraped to shrink the gums and to relieve any infection.

4. Occlusal Reconstruction

Occlusal reconstruction, also known as stomatognathics, is the restoration of the vertical and horizontal dimensions of the teeth after the chewing surfaces have been worn down. This practice takes into consideration the interdependence of the form and function of the teeth, the relation of the jaws to each other and to the skull, the occlusion of the teeth, and the appearance of the face. This type of treatment eliminates interferences in chewing and avoids injuries caused by improper bite.

Usually, the patient is first fitted with temporary splints or other structures to determine the amount of opening of the bite that can be tolerated. The final restorations are made of gold, stainless steel, porcelain, or plastic, and they may include crowns, inlays, fittings, and removable or fixed bridges.

5. Fitting Artificial Dentures

Artificial dentures may be either partial or complete. Partial dentures are used when some of the patient's natural teeth remain in the jaw, and complete dentures are used when all the teeth from either jaw are lost. Partial dentures are generally removable and are held in place by metal clasps that attach them to the neighboring natural teeth. A fixed bridge is a type of partial denture that is permanently attached to the natural teeth. Properly fitting complete dentures are held in place naturally. Adhesive powders and pastes if used for a long time are harmful to the gums and collect debris, stale saliva, and other mouth fluids that become offensive.

Modern techniques and materials have made it possible to construct highly efficient dentures with plastic gums that appear lifelike. However, dentists are experimenting with the implantation of artificial teeth directly into the gums to replace lost teeth or to serve as abutments for bridges perhaps eventually eliminating the need for artificial removable dentures.

6. Extracting Teeth

The extraction of teeth is always considered a last resort. Today, even badly decayed teeth that formerly would have been extracted can be saved with new techniques and drugs, especially antibiotics.

Extraction is usually painless under local anesthetics, such as Novocain, or general anesthetics, such as phenothal. In extracting a tooth, the dentist first anesthetizes the tooth and uses a scalpel or other sharp cutting instrument to loosen the gum from around the tooth. He then lifts out the teeth with a forceps or a sharp pointed instrument called an elevator. If the tooth has not yet erupted from below the gum, the dentist first makes an incision into the gum and then removes the tooth. Extraction is no longer a hazardous procedure but is performed with a surgical technique that minimizes the destruction of mouth tissues. Also, the aftereffects of an extraction are controlled so that healing occurs in a relatively short time.

7. Orthodontic Treatment

Abnormalities in the positioning of the teeth may be due to many causes, including heredity, improper use of the teeth in chewing, finger sucking, and generalized body diseases. The special appliances used to correct orthodontic problems include removable plates and fixed metal bands and wires. In cases where the jawbones are not large enough to accommodate all the teeth, some of them may be extracted in an attempt to overcome crowding or to correct protruding teeth.

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History of Chiropractic

Early Egyptian, Greek, Hindu, and Chinese manuscripts reveal that chiropractic types of treatment have been employed since antiquity. Such practices also existed during the Middle Ages, with techniques for bone manipulation passed from parent to child, while early Native Americans had children walk barefoot on an injured back to ease pain. Modern chiropractic, however, is said to have been founded by Daniel David Palmer, a Canadian-born Iowa grocer and so-called "magnetic healer."

Palmer claimed to have discovered the potential for chiropractic therapy in 1895, when he was consulted by a patient who had become deaf 17 years earlier while stooping in a mine. Palmer asserted that he saw a prominent, painful vertebra in the patient's upper spine and, in adjusting it, restored the man's hearing.

Three years later Palmer established the Palmer College of Chiropractic, in Davenport, Iowa, and in 1910 his textbook, The Science, Art and Philosophy of Chiropractic, was published. In this book Palmer described chiropractic as "the science of adjusting by hand any and all luxations of the articular joints of the human body; more especially, the articulations of the spinal column, for the purpose of freeing any and all impinged nerves which cause deranged functions."

Before Palmer's death, in 1913, his son, Bartlett Joshua, joined him in developing methods of modern chiropractic. Bartlett's son, David Daniel, also became a leader in the field, emphasizing manual manipulation of the spine as the principal chiropractic procedure.

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Definition of Chiropractic

Chiropractic is a form of medicine in which spinal manipulation is employed as the primary means of treating disease. The term chiropractic is derived from the Greek words cheir, meaning "hand," and praktikos, meaning "effective." Practitioners of this drugless therapy hold that the nervous system integrates all of the body's functions, including its defenses against disease, and that when the nervous system is impaired in any way -as by pressure on a nerve- it cannot perform properly, resulting in aches, pains, reduced disease resistance, and other disorders.

The core of the nervous system is the spinal cord, which runs inside the 24 movable vertebrae of the backbone. Between these vertebrae are small openings through which nerves branch out to every part of the body. Chiropractors contend that even a slight subluxation, or displacement, of the vertebrae can cause mechanical interference with the spinal cord and nerves. Chiropractic treatment, therefore, is frequently aimed at eliminating such interference by adjusting the misplaced vertebrae, after which, practitioners maintain, the body itself can remedy the ailment. Although most adjustments are made in or near the spine, where misalignments and dislocations are more likely to occur, treatment may extend to the pelvis or any area where manipulation of bones, muscles, and other tissues will remove the perceived nerve interference.

Chiropractors claim notable success in treating many disorders, including lumbago, slipped disk, arthritis, hay fever, and high blood pressure. Leading practitioners contend that, contrary to popular belief, reliable chiropractors do not claim to cure diseases such as cancer, heart disease, or blood disorders, nor do they perform surgery or intrude into areas outside their province of training, such as drug prescription.

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