Quality Dentistry in England 150 Years Ago

How has the quality of dentistry changed over the past 150 years? Many years ago I found a little booklet in an antique shop titled:

Howard on the Teeth

‘On the LOSS OF TEETH and the best means of restoring them’ by Thomas Howard , Surgeon Dentist to his Grace THE ARCHBISHOP OF CANTERBURY, 17 George Street, Hanover Square , London …. Published in 1857!

Howard on the Teeth

Below is a synopsis of some of the main points he makes:

Toothache is one of the most excruciating and incapacitating ills a person can experience, caused by an exposed dental nerve!
In those days, unfortunately, few people had not experienced it. He refers to what we know as referred pain from a tooth. That is where a diseased tooth can result in pain being felt elsewhere in the jaw and face. We know that this relates to areas that have a common sensory nerve supply with that particular tooth.

Quality dentistryHe maintains that the only true remedy is early plugging (filling) of the decayed tooth. Most people neglect their teeth until they become painful. Early treatment prolongs the retention of teeth, even for the rest of one’s life. (Albeit, life span was somewhat shorter in those days than it is today). He advises that the dental profession needs to find a filling material that is ‘white’ and ‘free of metallic or mineral substance’. Today, 150 years later, there are dentists still placing metallic (silver mercury) fillings.

He emphasises that regular healthy teeth contribute immensely to facial beauty and a ‘happy countenance when speaking and more evidently when smiling. The retention of teeth ensures a more youthful appearance. He points out those regular healthy teeth not only contribute to beauty, but to function (‘articulation’ or speech). He explains how speech is greatly affected by loss of teeth, particularly front ones. Missing teeth should be replaced with artificial ones to aid sufficient mastication of food before entering the stomach, and so avoiding problems of poor digestion.

Accumulation of tartar will result in loosening of teeth and their loss. So, observing strict cleanliness, using proper tooth brushes, morning and evening with tooth paste will avoid that. He emphasises early attention and prevention. It is pointed out what a great error it is that people may not mind the loss of back teeth, and are more concerned about just keeping (the more visible) front ones.

Loss of back teeth results in excess pressure on the front ones, wearing them down or loosening them. Front teeth are meant to cut, not grind. He points out that losing one tooth actually means losing two teeth as the opposing tooth is rendered useless, may over-erupt and subsequently become loose and be lost itself. He advocated the use of partial dentures (‘artificial teeth’) to protect and preserve the remaining natural teeth … they aren’t ‘just for show’ they need to be functional. Retaining as many teeth (or even just their roots) as possible preserves the jaw bone.

There is a lot more in this booklet, much of it of remarkably ‘scientific’ in nature.

The bottom line is that this book is amazing! The degree of knowledge and the professional approach demonstrated a century and a half ago is truly impressive. Really it shows how basic principles have changed little and all the advice Dr Howard was giving is such common sense and as pertinent today as it was then.

It is an indictment of our profession, in this country at least, as well as government, health care system, education etc. that to this day one in eight three year olds already has dental decay and the biggest cause of hospital admissions in 3 to ten year olds is for dental disease treatments such as tooth extractions.

Finally, how is this for a quote from the book: ‘It is the duty of all, and the wish of the benevolent, to preserve their health and personal appearance for the satisfaction of those who love them.’ We couldn’t agree more!

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