Milestones in Dental Public Health NOTES

INTRODUCTION

The history of man's fight for health begins with his earliest existence when he was completely at the mercy of nature with no effective means of combating its hazards.

Ancient Egyptians used a variety of ways to treats the diseases of the mouth whereas efforts related to prevention of oral diseases dates back to Hippocrates

Then came to the process of learning and research in medical and dental field has resulted in a dramatic acceleration in health knowledge but dental diseases continue to be most common diseases and are still progressing

This is because conventional dentistry has traditionally been curative rather than preventive. The need of the hour is the application of evidence based Dentistry at the community level

In public health dentistry, the individual patient is not the sole object of study. The entire community is in focus










DEFINITION


1.DENTISTRY

Dentistry is defined as the evaluation, diagnosis, prevention and/or treatment [non surgical, surgical or related procedures] of diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent associated structures and their impact on the human body; provided by a dentist within his/her scope of education, training and experience, in accordance with the ethics of the profession and applicable law.


2. DENTAL PUBLIC HEALTH

“The science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It's that form of dental practice which serves the community as a patient rather than the individual. It's concerned with dental health education of the public, with applied dental research and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis.” 


3. ORAL HEALTH

The World Health Organization (1982) defined oral health as “ The retention throughout the life of a functional, aesthetic and natural dentition of not less than 20 teeth and not requiring a prosthesis.”

An alternative definition of oral health given by U.K Department of Health (1994) is “Oral health is a standard of health of the oral and related tissues which enables an individual to eat, speak and socialize without active disease, discomfort or embarrassment and which contributes to general well being.”



HISTORY OF DENTISTRY
STAGES OF EVOLUTION OF DENTISTRY


Stage-1 Undifferentiated occupation

-Folk medicine was used in the treatment of toothache n infections

-A few individuals denote some time to perform simple dental procedures

-None depended solely on dentistry for their livelihood


Stage-2 Differentiated occupation

-Indigenous practitioners emerged without any formal training


-Devotion of entire time to dentistry profession

-Fabrication of dental prosthesis was done

-No restriction of govt for the practice of dentistry


Stage-3 Initial professionalization

-Dentists form a guild/association

-Formal training of 6months-2years was organized

-Restrictive legislation is enacted

-Profession comes into being


Stage-4 Intermediate professionalization

-Independent dental schools were established with increased course n duration

-Minimum requirement for admission was secondary education

-Dental education stresses on technical aspects of profession

-Professional associations became stronger due to increase in dental professionals

-Unqualified professionals strived due to deficiencies in laws n their enforcements


Stage-5 Advanced professionalization

-Dentistry becomes recognized as health profession

-It becomes strongly organized n institutionalized

-Post graduation studies develop

-Dental practice by unqualified personnel disappears




MILESTONES IN DENTAL PUBLIC HEALTH

Efforts towards the prevention of dental disease date back to 2600 years before Christ where an inscription on the tomb of Hesy-Re, an Egyptian scribe reads that he was “the greatest of those who deal with teeth and of physicians.” This is the earliest known reference to a person identified as a dental practitioner and is often called “the first dentist.”

2500 BC – H Wang Ti from China devotes a chapter in his book to dental and gingival diseases

1500 BC – Ebers papyrus from Egypt describes oral diseases and offers a number of prescriptions for strengthening of teeth and gums

480 BC – Hippocrates of Cos, the father of modern medicine, discussed the functions and eruptions of teeth and also the etiology of periodontal diseases

15 BC – Aulus Cornelius Celsus (Roman) refers to the disease that affects the soft parts of the mouth and their treatment. Paul of Aegina (Roman) differentiated between Epulis and Parulis

9th century AD – The Arabs were interested in the care of the teeth rather than in their extraction and replacement and mouth hygiene was a well-established technique. They used a small wooden stick, the end of which was often chewed, the wooden fibers being used as a brush called “Siwak”

Late 10th century AD – The first recognition for removal of calcareous deposits as important in control of periodontal diseases was mentioned by Abulcasis


14th century AD – Guy de Chauliac records a fairly definite set of rules for oral hygiene based on Arab writings involving a number of dietary prohibitions including viscous food such as figs and confectionery made with honey and also directions for cleansing the teeth with a dentrifice

Late 1440’s – The first modern idea of a toothbrush was invented in China by the Chinese


1640 – Toothbrush is introduced into the western world

1723 – Pierre Fauchard , a French surgeon publishes “The  Surgeon Dentist”, a treatise on teeth. Fauchard is credited as being the Father of the Modern Dentistry because his book was the first to describe a comprehensive system for the practice of dentistry including basic oral anatomy and function, operative and restorative techniques and denture reconstruction


1776 – The first modern known case of post-mortem dental forensics. Paul Revere, a dentist, verifies the death of his friend, Dr. Joseph Warren in the Battle of Breed’s Hill, when he identifies the bridge that he constructed for Warren

1789 – Frenchman Nicolas Dubois de Chemant receives the first patent for porcelain teeth

1790 – John Greenwood, son of Issac Greenwood and one of George Washington’s dentists, constructs the first known dental foot engine. He adopts his mother’s foot treadle spinning wheel to rotate a drill

1790 – Josaiah Flagg, a prominent American Dentist, constructs the first dental chair made specially for dental patients. To a wooden Windson chair, Flagg attached an adjustable headrest plus an arm extension to hold the instruments

1791 – The first dispensary for the treatment of poor was established by Skinner in NYC. Dental services were also offered there.

1801 – Richard C Skinner writes the Treatise on the human teeth, the first dental book published in America

1825 – Samuel Stockton begins commercial manufacture of porcelain teeth. His SS White Dental Manufacturing Company establishes and dominates the dental supply market throughout the 19th century

1832 – James Snell invents the first reclining dental chair

1833 – The Crawcour brothers introduce amalgam in the US and advertise it as a substitute for gold restorations

1839 – The American Journal of Dental Science, the world’s first dental journal begins its publication


1839 – Charles Goodyear invents the vulcanization process for hardening rubber. The resulting Vulcanite, an inexpensive material easily moulded, makes an excellent base for false teeth.

1840 – The American  Society of Dental Surgeons, the world’s first national dental organization is founded


1844 – Horace Wells, a Connecticut dentist discovers that nitrous oxide can be used as an anesthesia and successfully uses it to conduct several extractions in his clinic. In 1845 the public demonstration of the same failed after the patient cried out during the operation. In 1846, another dentist, William Mortan (student of Wells) takes the credit for the discovery when he conducts the first successful public demonstration of the use of ether as an anesthesia for surgery

1849 – The Society of Dental Surgeons of the state of New York founded its own dental infirmary

1854 – The earliest known lab in the US., Sutton & Raynor, opens in NYC

1857 – The first patent for toothbrush by HN Wadsworth in the US

1859 – 26 dentists meet in Niagara Falls and forms American Dental Association

1861 – Dental service became a part of charity hospital of Philadelphia

1864 – Sanford C Barnum develops the rubber dam which solves the problem of isolating a tooth

1865 – The first children’s dental clinic was established in Strasbourg, Germany

1866 – Lucy Hobbs graduated from Ohio College of Dental Surgery, becoming the first woman to earn a dental degree

1867 – The Harvard University Dental School, the first university-affiliated dental institution is founded. The school calls its degree Dentariae Medicinae Doctorae (DMD)

1867 – Small dental clinic for low income people was opened in Boston

1871 – James B Morrison patents the first commercially manufactured foot-treadle dental engine. This inexpensive mechanized tool supplies dental burs with enough speed to cut enamel n dentin smoothly and quickly, revolutionizing the practice of dentistry


1871 – George F Green receives the patent for the first electric dental engine, a self contained motor and handpiece

1877 – The Wilkerson chair, the first pump type hydraulic dental chair is introduced

1884 – ML Rhein of NYC urges dentists to teach their patients proper tooth brushing method. He coins the term “Oral Hygiene”

1885 – Dr. C Edmung Kells of New Orleans hires his first lady dental assistant in assisting his lady patients

1890 – In England through the stimulation of W Mac Pherson Fisher of Dundee, a committee was appointed to carry on oral hygiene work in schools which led to the appointment of dentists in many elementary schools

1892 – Dr. Washington Sheffield of New London, Connecticut manufactures toothpaste in a collapsible tube and names it Dr. Sheffield’s Crème Dentifrice

1895 – Wilhelm  Conrad Rontgen a German physicist discovers the X-ray

1896 – A prominent New Orleans dentist C Edmond Kells takes the first dental radiograph of a living person in US

1898 – J Leon Williams, a dental histologist gave a slogan “A clean tooth never decays” which led to higher standards of mouth hygiene

1899 – Edward Hartley Angle classifies the various forms of malocclusion

1900 – FDI is formed

1901 – Dr Federick Mckay discovers Colorado stains in Colorado springs, US

1905 – Alfred C Fones of Bridgeport trains Mrs. Irene Newman to undertake oral prophylaxis

1908 – Epidemiologic studies related to mottled enamel was done

1913 - Alfred C Fones opens the Fones Clinic For Dental Hygienists in Bridgeport, Connecticut, the world’s first oral hygiene school. Dr. Fones uses the term dental hygienist to become known as the Father of Dental Hygiene

1921 – The first training school for dental nurses come into existence in New Zealand in Willington at the urging of T A Hunter

1926 – The Carnegie Foundation-sponsored Gies report, the first comprehensive report on the state of dental education, is published and has an immediate impact on dental profession

1931 – Fluoride is identified by H V Churchill in New Kensington, Pennsylvania , Smith MC, Lantz EM, Smith HV in Arizona and Velu H, Balozet L in France

1938 – The nylon toothbrush made with synthetic bristles is introduced by DuPoint

1945 – The water fluoridation era begins when the city of Grand Rapids, Michigan, add sodium fluoride to their public water systems

1948 – WHO was formed

1955 – Michael Buonocore describes the acid etch technique, a simple method of increasing the adhesion of acrylic filings to enamel

1956 – The Oral Health Unit was established in WHO

1957 – John Borden introduces a high speed air driven contra-angle handpiece. The airotor obtains speed upto 300,000 rotations per minute

1958 – A fully reclining dental chair is introduced

1959 – The first electric toothbrush, the Broxodent is introduced by Bristol-Myers company at the centennial of ADA

1960s – Lasers are developed and approved for soft tissue procedures

1969 – WHO establishes the WHO epidemilogical data bank which collects data on dental health and dental needs in many countries around the globe

1982 – International conference on the declining prevalence of dental carried is organized by Forsyth Dental Centre, Boston in June

1996 – WHO establishes an internet online oral health database, supported by the WHO Collaborating Centre in oral health at Malmo University, Sweden and the University of Niigata, Japan. The WHO Oral health Country/Area Profile Program (CAPP) aims at presenting information on oral diseases in individual countries, including data on oral health services, programs, dental education and human resources



MILESTONES IN THE INDIAN CONTEXT

1000 BC – Sushrutha Samhita-numerous descriptions of severe periodontal disease with loose teeth and purulent discharge

Charaka Samhita – Stressed on tooth brushing-the stick for tooth brushing, should be bitter, pungent or astringent. One of its ends should be cleaned in the form of a brush and should be used twice a day taking care that gums are not injured. Neem twigs are used even today


The father of Dentistry in India is considered to be Dr. Rafiuddin Ahmed, who was born on December 24, 1890, and later became the first president of Indian Dental Association (then known as All India Dental Association)

1920 – Dr. Ahmed founded the first dental college in India which was financed by starting the New York Soda Foundation in Calcutta

1925 – Dr. Ahmed establishes the Bengal Dental Association and establishes the Indian Dental Journal

1939 – Dr. Ahmed helps to form the Bengal Dentists Act, which was the first governmental regulation in India

1948 – Dentists act is passed by the Indian Parliament in close association with All India Dental Association on the 29th of March. This Act was introduced to regulate the profession of dentistry in India. The Act was amended on 1st July 1955 to make the law applicable to the state of Jammu and Kashmir

1971 – Mr. Orango started the department of Community Dentistry at Government Dental College, Bangalore under Dr. Mohandas Bhat

1988 – National Oral Health Care Program, (NOHCP)  project of DGHS and Ministry of Health and Family Welfare is initiated to improve the oral health of the masses and to prevent or reduce the burden of oral disease in the country

1995 – The re-drafted Oral Health Policy is accepted in principle as a part of the National Health Policy during the Fourth Conference of Central Council of Health and Family Welfare


2002-2003 – National oral health survey was carried out by the Dental Council of India



REFERENCES
• Soben Peter
• Hiremath