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Compendium

March 2010, Volume 31, Issue 2
Published by AEGIS Communications


Innovation in Dental Practice in the Decade 2000 to 2010 - A Confluence of Science, Politics, and Social Change

Edward F. Rossomando, DDS, PhD, MS

Part 1 of 4

First in a four-part series, this article begins with a consideration of dental technology in the first decade of a given century, placing advances and discoveries in the context of other developments of the day. Throughout the series, these historic comparisons will be used to illuminate 21st century technology and shed light on what the future may hold.

The first 10 years of the 21st century will soon be history, and pundits in many areas and disciplines will compare actual events with expectations and predications made in 2000. The dental profession will no doubt reflect and assess its progress, too. Since 2000 the dental profession’s acquisition of new equipment, such as lasers, computer-aided design/computer-aided manufacturing, and digital x-rays, has been remarkable. Also, new products for restoration and replacement of lost and damaged teeth, such as adhesives and implants, have changed the way dentists think about treatment.

Although most of the new equipment and products entered the profession in the past 10 years, their technology was based on discoveries made in the latter half of the 20th century. A similar phenomenon occurred from 1900 to 1910. In that decade, the dental profession embraced x-ray machines and electric motor-driven dental engines. Again, the discoveries of this equipment were based on those in the preceding century—starting in the 1850s.

Given the rapid evolution of technology in the decade from 2000 to 2010, it is reasonable to inquire if something in American society created an environment that encouraged change. It is also logical to consider if, in the decade from 1900 to 1910, a similar environment existed.

This four-part series will compare these two eras. The discoveries and cultural attitudes in the preceding century will be explored to uncover how the new equipment and products had developed and what might have promoted an environment that encouraged change. The first article will examine the science and culture of 19th century America; the second, the equipment and products introduced in the decade 1900 to 1910; the third, science and culture of 20th century America; and the fourth, the equipment and products introduced from 2000 to 2010. Whether this analysis helps promote the development of new products and equipment and accelerate their rate of acquisition will be discussed in the fourth article.

The 19th Century: America Becomes Independent—Finally

After the conclusion of the War of 1812, Americans were in the throes of a new wave of egalitarian nationalism. In 1832 they elected Andrew Jackson, a Democrat, who was perhaps remembered best for his military win in New Orleans and for ushering in the “spoils system.” His election was viewed by most Americans as a victory for the “people.” His success also stimulated an atmosphere of change—Americans had beaten the British twice and finally felt independent.

Jackson’s election and the America first attitude would have encouraged dentists Horace Hayden and Chapin Harris as they thought about establishing dentistry as a learned profession. Until the mid 19th century, there was no dental profession or dental schools. Typically, dentists trained in medicine and chose to specialize in dentistry, usually through apprenticeship. In Europe, especially England, dentistry was a branch of medicine. There has been much speculation about why Hayden and Harris chose a very independent path; however, a plausible explanation might have more to do with American society in the 1830s.

Hayden and Harris: American Originals

In 1839, the first issue of the American Journal of Dental Science was published. In August 1840, just 7 months after the opening of the first dental college, Harris organized the first national dental organization—the American Society of Dental Surgeons. By 1841, the dental leadership had established all three elements needed to define a profession: a journal, professional society, and formal process of education. It may not be coincidence that two out of the three dental entities had the word American in their title. Americans intended to make it clear, particularly to the British and other Europeans, that they were ready to declare cultural and academic independence.

But American political independence did not mean intellectual and educational accomplishments were free from European influence. In designing the Baltimore College of Dental Surgery, Hayden and Harris were no doubt cognizant of the emergence of science in Europe, especially Germany, Great Britain, and France, and the contribution that science had made to progress in all three countries. Although the telegraph and transatlantic cable would not be available until 1844 and 1865, respectively, transatlantic steamship travel became commercially available in 1838, two years before the dental school opened. While there is no evidence that Hayden or Harris had traveled to Europe, the U.S. had trade legations in Germany, Great Britain, and France, suggesting a lively transatlantic correspondence.

In Europe, science generated what it often generates—new knowledge and a greater understanding of natural phenomena. While new information was of interest, perhaps what most appealed to Hayden and Harris was the success of the scientific method as a way of thinking. Often called the Cartesian method after its founder French philosopher René Descartes, the approach provided an alternative perspective on exploring and understanding natural phenomena to the one proffered by organized religion. In his 1637 seminal paper “Discourse on the Method of Rightly Conducting the Reason and Seeking Truth in the Sciences,” Descartes challenged the Aristotelian approach to understanding natural phenomena. It was Descartes who said, “I think, therefore I am.”

In the 1800s, Americans were very much thinking about thinking. From religion to politics, Americans were asking why they did things the way they did, and why they believed what they believed. Almost daily, new religions were formed, new social movements emerged, and new political systems were born. Thinking can lead to questions and doubt. Throughout the 1800s, doubt was an integral part of American thought, seeping into both political and religious discussions.

Technology Advances in the 19th Century—Putting Science to Work

The second half of the 19th century, technology and science surged, directly impacting society and eventually dental practice. In the 1830s Michael Faraday showed how an electromagnetic field could be generated and produced a rudimentary electric motor. By 1864 George F. Harrington developed the first dental drill powered by a motor that he had modified. In the 1870s, Green Vardiman Black’s introduction of the “extension for prevention” principle made it easier for dentists to implement because the electric motor had been added as a power source.

Progress in the application of scientific discoveries to dentistry would continue through the 1890s. In 1895 W. Roentgen discovered x-rays, and almost 2 weeks after Roentgen’s announcement, F. Otto Walkhoff in Germany produced the first dental x-ray exposure. Eight months later, Edmund Kells became the first American dentist to use an x-ray to capture the internal image of a tooth.

There was to be another scientific discovery with a major impact on dentistry. In the early 1800s dental decay was thought to be caused by everything from worms to substances in food. Lacking a definitive causal agent made it difficult for the dental profession to become proactive. In a series of papers published in the 1890s, W.D. Miller, building on Louis Pasteur’s findings, showed that tooth decay resulted from microbial action. Miller’s findings provided dentists with a scientific rationale for diagnosis of dental decay and, equally as important, a justification for therapeutic measures, such as Extension for Prevention.

It is impossible to discuss the advances in the 19th century without mentioning the serendipitous discovery of the use of nitrous oxide by Horace Wells and ether by William T. G. Morton. The story of nitrous oxide and Wells is well known. What may not be so well known is the role played by Humphrey Davy. Working at the Pneumatic Institute in Bristol, England, around 1800, Davy discovered breathing pure nitrous oxide had an unusually euphoric effect. It was given the trivial name of laughing gas. However, while Davy recognized the analgesic effect of the gas, he argued against its use in pain control because he was concerned about its effect on blood flow. It is doubtful Wells knew of the research or writings of Davy; when he witnessed the effect of nitrous oxide on pain perception, Wells realized its potential immediately.

Conclusion

By 1900 dentistry had made rapid strides. Between 1840 and 1900, the following had occurred: its foundation as a profession had been established by Hayden and Harris; a scientific basis for caries and periodontal disease had been demonstrated by Miller and Black; and many diagnostic and therapeutic innovations had been introduced, such as x-rays for diagnosis by Kells and the electric motorized drill for excavation by Harrington. Finally, dental professionals won the “amalgam wars”—by 1900, the use of amalgam as a restorative material had become the standard of care.

However, with the start of the century, a storm was about to break. A paper published by William Hunter in 1900 and a presentation 13 years later would profoundly affect dental practice and, in particular, the development of endodontics. Hunter’s publications and their impact on dentistry will be covered in the next article in this series. The 20th century would begin literally with a bang: William McKinley would be killed by an assassin’s bullet and Theodore Roosevelt would become president. In the first decade, many more surprises were about to appear in science and transportation. All this and their effects on the dental profession will be covered in the next article.

Acknowledgment

The author wishes to express his gratitude to Dr. Scott Swank, Curator, The Dr. Samuel D. Harris National Museum of Dentistry, for his review of the manuscript and assistance providing the historical images.

Many readers may feel I omitted some seminal event or discovery of the 19th century that impacted our profession. I would ask that you write me at erossomando@uchc.edu, and I will include as many as possible in subsequent articles.

About the Author

Edward F. Rossomando, DDS, PhD, MS
Professor
University of Connecticut School of Dental Medicine
Farmington, Connecticut

Director
Center for Research and Education in Technology Evaluation


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Figure 1  <strong>Horace Hayden.</strong> Image courtesy of The Dr. Samuel D. Harris National Museum of Dentistry. Used with permission.

Figure 1