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Early Orthodontics

Early Orthodontics

“Among those individuals whose head are long shaped, some have thick necks, strong members and bones; others have strongly arched palates; thus teeth are disposed to irregularity, crowding one on the other and they are molested by headaches and otorrhea.”

These words, written by the ancient Greek physician Hippocrates in the 5th century BC, are the first written reference to an irregularity of the teeth. They can be found in his work Epidemics and are related to a section on how the shape of the face can cause other diseases. Hippocrates mentioned teeth several times in his books, covering the formation of teeth, the eruption of children’s teeth and their replacement with permanent teeth.

The first reference to the actual treatment of irregular teeth is recorded by the Roman encyclopedist Aulus Cornelius Celsus (25BC – 50AD) in his work De Medicina.

“In children too if a second tooth is growing up before the first one has fallen out, the tooth which ought to come out must be freed all round and extracted; the tooth which has grown up in place of the former one is to be pressed upwards with a finger every day until it has reached its proper height.”

Finger pressure to move teeth continued to be used until the 18th century. Another Roman Pliny the Elder (23 – 79AD) suggested filing teeth which were too long to bring them all into line. Galen, a Greek physician from the 2nd century AD, also advocated this treatment with the use of a metal file. He did state that if the patient found it too painful the treatment could be carried out over several sessions. This treatment remained popular until the 1800s.

It was not until the 16th century that orthodontics was written about again. The French surgeon Pierre Dionis (1658-1718) was the first to refer to dentistry as a separate practice. He called dentists ‘operators for the teeth’ and stated that they could “open or widen the teeth when they are set too close together”. In 1729 the French physician Pierre Fauchard, who is known as the ‘father of dentistry’ published his work Le Chiurgien Dentiste. It was the first work to put dentistry on a scientific basis and included several chapters on the correction of irregular teeth. Fauchard was the first to describe the examination process of a patient. He recommended several treatments for treating irregular teeth, including filing teeth to make them narrower or shorter and extraction to provide space for teeth to move into. Fauchard

recommended using finger pressure to straighten teeth. If that was not sufficient an appliance he called the bandolet was used; a gold or silver band was placed against the teeth to be straightened and tied to the adjacent teeth with a silk thread to pull the teeth into line.

The famous anatomist and surgeon John Hunter was the first to try and arrange the teeth into different types as well as the first to describe the normal positions of the teeth in his book The Natural History of the Human Teeth (1771). One of Hunter’s students Joseph Fox dedicated four chapters of his book Natural History and Diseases of the Human Teeth (1814) to orthodontics. He described several orthodontic treatments including extraction, the use of bite blocks, an expansion arch and a chin cup.

In 1841 Joachim Lefoulon, a French dentist named the practice of treating teeth irregularities orthodontosie. The 19th century was a time of growth and development for dentistry with the first qualification, the LDS, introduced in 1860 and the passing of the Dentists Act in 1879. This Act limited dental practice to those registered in the Dentists Register. Orthodontics was mainly practised by individual dentists using ivory or gold appliances. The BOS Museum collection includes an ivory appliance dating from about 1860. It is carved out of a piece of ivory and is designed to fit behind the upper teeth. Hickory wood sticks were placed into small holes drilled into the appliance behind the teeth which need straightening. These sticks swelled due to the saliva in the mouth and pushed the teeth into place. Ivory appliances are referenced in Sir John Tomes’ book A System of Dental Surgery (1859). Tomes himself preferred metal plates tied into place with silk threads but he refers to the work of his friend William Anthony Harrison who advocated the use of ivory plates with wooden wedges.

Another early appliance is this metal removable appliance, which was kept in place with very simple clasps around the molars. The appliance was designed to expand the arch as it has an early example of an expansion screw in the centre.

At the end of the 19th century, the American Edward Hartley Angle established orthodontics as its own specialty. He opened the first orthodontic school in St. Louis in 1899 and many British dentists travelled to America to attend Angle’s lessons. In 1907 the British Society for the Study of Orthodontics was established as a place for interested dentists to discuss cases and treatment, and since then orthodontics has continued to progress as a profession.