Dentistry, also known asdental medicine andoral medicine, is the branch ofmedicine focused on theteeth,gums, andmouth. It consists of the study,diagnosis, prevention, management, and treatment ofdiseases, disorders, and conditions of the mouth, most commonly focused ondentition (the development and arrangement of teeth) as well as theoral mucosa.[2] Dentistry may also encompass other aspects of thecraniofacial complex including thetemporomandibular joint. The practitioner is called adentist.
The history of dentistry is almost as ancient as the history of humanity and civilization, with the earliest evidence dating from 7000 BC to 5500 BC.[3] Dentistry is thought to have been the first specialization inmedicine which has gone on to develop its own accredited degree with its own specializations.[4] Dentistry is often also understood to subsume the now largely defunctmedical specialty ofstomatology (the study of the mouth and its disorders and diseases) for which reason the two terms are used interchangeably in certain regions. However, some specialties such asoral and maxillofacial surgery (facial reconstruction) may require both medical and dental degrees to accomplish. In European history, dentistry is considered to have stemmed from the trade ofbarber surgeons.[5]
The modern movement ofevidence-based dentistry calls for the use of high-quality scientific research and evidence to guide decision-making such as in manual tooth conservation, use of fluoride water treatment and fluoride toothpaste, dealing with oral diseases such astooth decay andperiodontitis, as well as systematic diseases such asosteoporosis,diabetes,celiac disease,cancer, andHIV/AIDS which could also affect the oral cavity. Other practices relevant toevidence-based dentistry includeradiology of the mouth to inspect teeth deformity or oral malaises,haematology (study of blood) to avoid bleeding complications during dental surgery,cardiology (due to various severe complications arising from dental surgery with patients with heart disease), etc.
The term dentistry comes fromdentist, which comes from Frenchdentiste, which comes from the French and Latin words for tooth.[6] The term for the associated scientific study of teeth isodontology (fromAncient Greek:ὀδούς,romanized: odoús,lit. 'tooth') – the study of the structure, development, and abnormalities of the teeth.
Dentistry usually encompasses practices related to the oral cavity.[7] According to theWorld Health Organization, oral diseases are major public health problems due to their high incidence and prevalence across the globe, with the disadvantaged affected more than other socio-economic groups.[8]
By nature of their general training, dentists, without specialization can carry out the majority of dental treatments such as restorative (fillings,crowns,bridges), prosthetic (dentures), endodontic (root canal) therapy, periodontal (gum) therapy, and extraction of teeth, as well as performing examinations, radiographs (x-rays), and diagnosis. Dentists can also prescribemedications used in the field such asantibiotics,sedatives, and any other drugs used in patient management. Depending on their licensing boards, general dentists may be required to complete additional training to perform sedation, dental implants, etc.
Irreversible enamel defects caused by an untreated celiac disease. They may be the only clue to its diagnosis, even in absence of gastrointestinal symptoms, but are often confused with fluorosis,tetracycline discoloration, acid reflux or other causes.[10][11][12] The National Institutes of Health include a dental exam in the diagnostic protocol ofceliac disease.[10]
Dentists also encourage the prevention of oral diseases through properhygiene and regular, twice or more yearly, checkups for professional cleaning and evaluation. Oral infections and inflammations may affect overall health and conditions in the oral cavity may be indicative of systemic diseases, such asosteoporosis,diabetes,celiac disease orcancer.[7][10][13][14] Many studies have also shown thatgum disease is associated with an increased risk of diabetes,heart disease, andpreterm birth. The concept that oral health can affect systemic health and disease is referred to as "oral-systemic health".
A sagittal cross-section of a molar tooth; 1: crown, 2: root, 3: enamel, 4: dentin and dentin tubules, 5: pulp chamber, 6: blood vessels and nerve, 7: periodontal ligament, 8: apex and periapical region, 9: alveolar boneEarly dental chair in Pioneer West Museum inShamrock, Texas
Studies show that dentists that graduated from different countries,[18] or even from different dental schools in one country,[19] may make different clinical decisions for the same clinical condition. For example, dentists that graduated fromIsraeli dental schools may recommend the removal of asymptomaticimpactedthird molar (wisdom teeth) more often than dentists that graduated from Latin American or Eastern European dental schools.[20]
In the United Kingdom, the first dental schools, theLondon School of Dental Surgery and the Metropolitan School of Dental Science, both in London, opened in 1859.[21] The British Dentists Act of 1878 and the 1879 Dentists Register limited the title of "dentist" and "dental surgeon" to qualified and registered practitioners.[22][23] However, others could legally describe themselves as "dental experts" or "dental consultants".[24] The practice of dentistry in the United Kingdom became fully regulated with the 1921 Dentists Act, which required the registration of anyone practising dentistry.[25] TheBritish Dental Association, formed in 1880 with SirJohn Tomes as president, played a major role in prosecuting dentists practising illegally.[22] Dentists in the United Kingdom are now regulated by theGeneral Dental Council.
In many countries, dentists usually complete between five and eight years of post-secondary education before practising. Though not mandatory, many dentists choose to complete an internship or residency focusing on specific aspects of dental care after they have received their dental degree. In a few countries, to become a qualified dentist one must usually complete at least four years of postgraduate study;[26]Dental degrees awarded around the world include the Doctor of Dental Surgery (DDS) and Doctor of Dental Medicine (DMD) in North America (US and Canada), and the Bachelor of Dental Surgery/Baccalaureus Dentalis Chirurgiae (BDS, BDent, BChD, BDSc) in the UK and current and former British Commonwealth countries.
All dentists in the United States undergo at least three years of undergraduate studies, but nearly all complete a bachelor's degree. This schooling is followed by four years of dental school to qualify as a "Doctor of Dental Surgery" (DDS) or "Doctor of Dental Medicine" (DMD). Specialization in dentistry is available in the fields of Anesthesiology, Dental Public Health, Endodontics, Oral Radiology, Oral and Maxillofacial Surgery, Oral Medicine, Orofacial Pain, Pathology, Orthodontics, Pediatric Dentistry (Pedodontics), Periodontics, and Prosthodontics.[27]
Some dentists undertake further training after their initial degree in order to specialize. Exactly which subjects are recognized by dental registration bodies varies according to location. Examples include:
Anesthesiology[28] – The specialty of dentistry that deals with the advanced use of general anesthesia, sedation and pain management to facilitate dental procedures.
Cosmetic dentistry – Focuses on improving the appearance of the mouth, teeth and smile.
Forensic odontology – The gathering and use of dental evidence in law. This may be performed by anydentist with experience or training in this field. The function of the forensic dentist is primarily documentation and verification of identity.
Geriatric dentistry orgeriodontics – The delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal aging and age-related diseases as part of an interdisciplinary team with other health care professionals.
Oral and maxillofacial pathology – The study, diagnosis, and sometimes the treatment of oral and maxillofacial related diseases.
Periodontology (also calledperiodontics) – The study and treatment of diseases of theperiodontium (non-surgical and surgical) as well as placement and maintenance of dental implants
Some prosthodontists super-specialize inmaxillofacial prosthetics, which is the discipline originally concerned with the rehabilitation of patients with congenital facial and oral defects such ascleft lip and palate or patients born with an underdeveloped ear (microtia). Today, most maxillofacial prosthodontists return function and esthetics to patients with acquired defects secondary to surgical removal of head and neck tumors, or secondary to trauma from war or motor vehicle accidents.
Sports dentistry – the branch ofsports medicine dealing with prevention and treatment of dental injuries and oral diseases associated with sports and exercise.[29] The sports dentist works as an individual consultant or as a member of theSports Medicine Team.
Tooth decay was low inpre-agricultural societies, but the advent offarming society about 10,000 years ago correlated with an increase intooth decay (cavities).[32] An infected tooth from Italy partially cleaned with flint tools, between 13,820 and 14,160 years old, represents the oldest known dentistry,[33] although a 2017 study suggests that 130,000 years ago theNeanderthals already used rudimentary dentistry tools.[34] In Italy evidence dated to the Paleolithic, around 13,000 years ago, points to bitumen used to fill a tooth[35] and in Neolithic Slovenia, 6500 years ago, beeswax was used to close a fracture in a tooth.[36] TheIndus valley has yielded evidence of dentistry being practised as far back as 7000 BC, during theStone Age.[37] TheNeolithic site ofMehrgarh (now in Pakistan's south western province ofBalochistan) indicates that this form of dentistry involved curing tooth related disorders withbow drills operated, perhaps, by skilled bead-crafters.[3] The reconstruction of this ancient form of dentistry showed that the methods used were reliable and effective.[38] The earliestdental filling, made ofbeeswax, was discovered inSlovenia and dates from 6500 years ago.[39] Dentistry was practised in prehistoricMalta, as evidenced by a skull which had adental abscess lanced from the root of a tooth dating back to around 2500 BC.[40] The practice of dentistry dates back thousands of years, with evidence of dental procedures such as tooth extraction and fillings found in ancient civilizations like the Egyptians and the Greeks. One notable historical figure isPierre Fauchard, often referred to as the 'father of modern dentistry,' who wrote the first comprehensive book on the subject in 1728.
An ancientSumerian text describes a "tooth worm" as the cause ofdental caries.[41] Evidence of this belief has also been found in ancient India,Egypt, Japan, and China. The legend of the worm is also found in theHomeric Hymns,[42] and as late as the 14th century AD the surgeonGuy de Chauliac still promoted the belief that worms cause tooth decay.[43]
Recipes for the treatment of toothache, infections and loose teeth are spread throughout theEbers Papyrus,Kahun Papyri,Brugsch Papyrus, andHearst papyrus ofAncient Egypt.[44] TheEdwin Smith Papyrus, written in the 17th century BC but which may reflect previous manuscripts from as early as 3000 BC, discusses the treatment of dislocated or fractured jaws.[44][45] In the 18th century BC, theCode of Hammurabi referenced dental extraction twice as it related to punishment.[46] Examination of the remains of someancient Egyptians andGreco-Romans reveals early attempts at dentalprosthetics.[47] However, it is possible the prosthetics were prepared after death for aesthetic reasons.[44]
Ancient Greek scholarsHippocrates andAristotle wrote about dentistry, including the eruption pattern of teeth, treating decayed teeth and gum disease, extracting teeth withforceps, and using wires to stabilize loose teeth and fractured jaws.[48] Use of dental appliances,bridges and dentures was applied by theEtruscans in northern Italy, from as early as 700 BC, of human or other animal teeth fastened together with gold bands.[49][50][51] TheRomans had likely borrowed this technique by the 5th century BC.[50][52] ThePhoenicians crafted dentures during the 6th–4th century BC, fashioning them from gold wire and incorporating two ivory teeth.[53] In ancient Egypt,Hesy-Ra is the first named "dentist" (greatest of the teeth). The Egyptians bound replacement teeth together with gold wire.Roman medical writerCornelius Celsus wrote extensively of oral diseases as well as dental treatments such as narcotic-containingemollients andastringents.[54] The earliestdental amalgams were first documented in aTang dynasty medical text written by the Chinese physician Su Kung in 659, and appeared in Germany in 1528.[55][56]
During theIslamic Golden Age Dentistry was discussed in several famous books of medicine such asThe Canon in medicine written byAvicenna and Al-Tasreef byAl-Zahrawi who is considered the greatestsurgeon of theMiddle Ages,[57] Avicenna said that jaw fracture should be reduced according to the occlusal guidance of the teeth; this principle is still valid in modern times. Al-Zahrawi invented over 200 surgical tools that resemble the modern kind.[58]
Historically, dental extractions have been used to treat a variety of illnesses. During theMiddle Ages and throughout the 19th century, dentistry was not a profession in itself, and often dental procedures were performed by barbers or generalphysicians.Barbers usually limited their practice to extracting teeth which alleviatedpain and associated chronic toothinfection. Instruments used for dental extractions date back several centuries. In the 14th century,Guy de Chauliac most probably invented the dental pelican[59] (resembling apelican's beak) which was used to performdental extractions up until the late 18th century. The pelican was replaced by thedental key[60] which, in turn, was replaced by modern forceps in the 19th century.[61]
The first book focused solely on dentistry was the "Artzney Buchlein" in 1530,[48] and the first dental textbook written in English was called "Operator for the Teeth" by Charles Allen in 1685.[23]
In the United Kingdom, there was no formal qualification for the providers of dental treatment until 1859 and it was only in 1921 that the practice of dentistry was limited to those who were professionally qualified. TheRoyal Commission on the National Health Service in 1979 reported that there were then more than twice as many registered dentists per 10,000 population in the UK than there were in 1921.[62]
The Egyptian Mummies that I have seen, have had their Mouths open, and somewhat gaping, which affordeth a good opportunity to view and observe their Teeth, wherein 'tis not easie to find any wanting or decayed: and therefore in Egypt, where one Man practised but one Operation, or the Diseases but of single Parts, it must needs be a barren Profession to confine unto that of drawing of Teeth, and little better than to have been Tooth-drawer unto King Pyrrhus, who had but two in his Head.
The French surgeonPierre Fauchard became known as the "father of modern dentistry". Despite the limitations of the primitive surgical instruments during the late 17th and early 18th century, Fauchard was a highly skilledsurgeon who made remarkable improvisations of dental instruments, often adapting tools fromwatchmakers,jewelers and evenbarbers, that he thought could be used in dentistry. He introduceddental fillings as treatment fordental cavities. He asserted thatsugar-derived acids liketartaric acid were responsible fordental decay, and also suggested that tumors surrounding the teeth and in thegums could appear in the later stages of tooth decay.[63][64]
Panoramic radiograph of historic dental implants, made 1978
Fauchard was the pioneer ofdental prosthesis, and he invented many methods to replace lost teeth. He suggested that substitutes could be made from carved blocks ofivory orbone. He also introduceddental braces, although they were initially made of gold, he discovered that the teeth position could be corrected as the teeth would follow the pattern of the wires. Waxedlinen orsilk threads were usually employed to fasten the braces. His contributions to the world of dental science consist primarily of his 1728 publication Le chirurgien dentiste or The Surgeon Dentist. The French text included "basic oral anatomy and function, dental construction, and various operative and restorative techniques, and effectively separated dentistry from the wider category of surgery".[63][64]
A modern dentist's chair
After Fauchard, the study of dentistry rapidly expanded. Two important books,Natural History of Human Teeth (1771) andPractical Treatise on the Diseases of the Teeth (1778), were published by British surgeonJohn Hunter. In 1763, he entered into a period of collaboration with the London-based dentist James Spence. He began to theorise about the possibility oftooth transplants from one person to another. He realised that the chances of a successful tooth transplant (initially, at least) would be improved if the donor tooth was as fresh as possible and was matched for size with the recipient. These principles are still used in the transplantation ofinternal organs. Hunter conducted a series of pioneering operations, in which he attempted a tooth transplant. Although the donated teeth never properly bonded with the recipients' gums, one of Hunter's patients stated that he had three which lasted for six years, a remarkable achievement for the period.[65]
Major advances in science were made in the 19th century, and dentistry evolved from a trade to a profession. The profession came under government regulation by the end of the 19th century. In the UK, the Dentist Act was passed in 1878 and the British Dental Association formed in 1879. In the same year,Francis Brodie Imlach was the first ever dentist to be elected President of the Royal College of Surgeons (Edinburgh), raising dentistry onto a par with clinical surgery for the first time.[66]
Long term occupational noise exposure can contribute to permanent hearing loss, which is referred to asnoise-induced hearing loss (NIHL) andtinnitus. Noise exposure can cause excessive stimulation of the hearing mechanism, which damages the delicate structures of the inner ear.[67] NIHL can occur when an individual is exposed to sound levels above 90 dBA according to theOccupational Safety and Health Administration (OSHA). Regulations state that the permissible noise exposure levels for individuals is 90 dBA.[68] For the National Institute for Occupational Safety and Health (NIOSH), exposure limits are set to 85 dBA. Exposures below 85 dBA are not considered to be hazardous. Time limits are placed on how long an individual can stay in an environment above 85 dBA before it causes hearing loss. OSHA places that limitation at 8 hours for 85 dBA. The exposure time becomes shorter as the dBA level increases.
Within the field of dentistry, a variety of cleaning tools are used including piezoelectric and sonic scalers, and ultrasonic scalers and cleaners.[69] While a majority of the tools do not exceed 75 dBA,[70] prolonged exposure over many years can lead to hearing loss or complaints of tinnitus.[71] Few dentists have reported using personal hearing protective devices,[72][73] which could offset any potential hearing loss or tinnitus.
There is a movement in modern dentistry to place a greater emphasis on high-quality scientific evidence in decision-making.Evidence-based dentistry (EBD) uses current scientific evidence to guide decisions. It is an approach to oral health that requires the application and examination of relevant scientific data related to the patient's oral and medical health. Along with the dentist's professional skill and expertise, EBD allows dentists to stay up to date on the latest procedures and patients to receive improved treatment. A new paradigm for medical education designed to incorporate current research into education and practice was developed to help practitioners provide the best care for their patients.[74] It was first introduced byGordon Guyatt and the Evidence-Based Medicine Working Group atMcMaster University inOntario, Canada in the 1990s. It is part of the larger movement towardevidence-based medicine and otherevidence-based practices, especially since a major part of dentistry involves dealing with oral and systemic diseases. Other issues relevant to the dental field in terms of evidence-based research and evidence-based practice include population oral health, dental clinical practice, tooth morphology etc.
A dental chair at the University of Michigan School of Dentistry
Dentistry is unique in that it requires dental students to have competence-based clinical skills that can only be acquired through supervised specialized laboratory training and direct patient care.[75] This necessitates the need for a scientific and professional basis of care with a foundation of extensive research-based education.[76] According to some experts, the accreditation of dental schools can enhance the quality and professionalism of dental education.[77][78]
^Whether Dentists are referred to as "Doctor" is subject to geographic variation. For example, they are called "Doctor" in the US. In the UK, dentists have traditionally been referred to as "Mister" as they identified themselves withbarber surgeons more thanphysicians (as do surgeons in the UK, seeSurgeon#Titles). However more UK dentists now refer to themselves as "Doctor", although this was considered to be potentially misleading by the British public in a single report (see Costley and Fawcett 2010).
^The scope of oral and maxillofacial surgery is variable. In some countries, both a medical and dental degree is required for training, and the scope includes head and neck oncology and craniofacial deformity.
^abc"Diagnosis of Celiac Disease". National Institute of Health (NIH). Archived from the original on 15 May 2017. Retrieved6 June 2017.{{cite web}}: CS1 maint: bot: original URL status unknown (link)
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^Owen, Lorrie K., ed. (1999).Dictionary of Ohio Historic Places. Vol. 2. St. Clair Shores: Somerset. pp. 1217–1218.
^Mary, Otto (2017).Teeth: the story of beauty, inequality, and the struggle for oral health in America. New York: The New Press. p. 70.ISBN978-1-62097-144-4.OCLC958458166.
^"History".Pennsylvania School of Dental Medicine. Retrieved13 January 2016.
^Zadik Yehuda; Levin Liran (April 2006). "Decision making of Hebrew University and Tel Aviv University Dental Schools graduates in every day dentistry—is there a difference?".J Isr Dent Assoc.23 (2):19–23.PMID16886872.
^Zadik Yehuda; Levin Liran (April 2007). "Decision making of Israeli, East European, and South American dental school graduates in third molar surgery: is there a difference?".J Oral Maxillofac Surg.65 (4):658–62.doi:10.1016/j.joms.2006.09.002.PMID17368360.
^Coppa, A.; et al. (2006). "Early Neolithic tradition of dentistry".Nature.440 (7085). Springer Science and Business Media LLC:755–756.doi:10.1038/440755a.ISSN0028-0836.PMID16598247.
^Bjørklund G (1989). "The history of dental amalgam (in Norwegian)".Tidsskr Nor Laegeforen.109 (34–36):3582–85.PMID2694433.
^Czarnetzki, A.; Ehrhardt S. (1990). "Re-dating the Chinese amalgam-filling of teeth in Europe".International Journal of Anthropology.5 (4):325–32.
^Meri, Josef (2005).Medieval Islamic Civilization: An Encyclopedia (Routledge Encyclopedias of the Middle Ages). Psychology Press.ISBN978-0-415-96690-0.
^Friedman, Saul S. (2006).A history of the Middle East. Jefferson, N.C.: Mcfarland. p. 152.ISBN0786451343.
^Gregory Ribitzky."Pelican". Archived fromthe original on 25 January 2020. Retrieved23 June 2018.
^Gregory Ribitzky."Toothkey". Archived fromthe original on 23 June 2018. Retrieved23 June 2018.
^Gregory Ribitzky."Forceps". Archived fromthe original on 23 June 2018. Retrieved23 June 2018.
^Stevens, M (1999). "Is someone listening to the din of occupational noise exposure in dentistry".RDH (19):34–85.
^Merrel, HB (1992). "Noise pollution and hearing loss in the dental office".Dental Assisting Journal.61 (3):6–9.
^Wilson, J.D. (2002). "Effects of occupational ultrasonic noise exposure on hearing of dental hygienists: A pilot study".Journal of Dental Hygiene.76 (4):262–69.PMID12592917.
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^Formicola, Allan J.; Bailit, Howard L.; Beazoglou, Tryfon J.; Tedesco, Lisa A. (February 2008). "The interrelationship of accreditation and dental education: history and current environment".Journal of Dental Education.72 (2 Suppl):53–60.doi:10.1002/j.0022-0337.2008.72.2_suppl.tb04480.x.ISSN0022-0337.PMID18250379.
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