Pierre Fauchard

Fauchard was born in a very modest home in Saint-Denis-de-Gastines in 1679. In 1693 he joined the French Royal Navy at the age of 15, much to his family's distress, and came under the influence of Alexander Poteleret, a surgeon major, who had spent considerable time studying diseases of the teeth and mouth.

During that time, Fauchard learned that sailors who were on long voyages suffered severely from dental ailments, scurvy in particular. Eventually Major Poteleret inspired and encouraged him to read and carefully investigate the findings of his predecessors in the healing arts. He said he wanted to disseminate the knowledge he learned at sea based on actual practice. This idea led Fauchard to become a combat medic as Poteleret's protégé.

Dental needle-nose pliers designed by Fauchard in the late 17th century to use in prosthodontics.

Once Fauchard left the navy, he shortly settled down in Angers, where he practiced medicine at the University of Angers Hospital. In Angers, he started much of the revolutionary medical work we know today, and he was the pioneer of scientific oral and maxillofacial surgery. Fauchard often described himself as a "Chirurgien Dentiste" (surgical dentist), a term very rare at the time as dentists in the 17th century generally extracted decayed teeth rather than treating them.

Despite the limitations of the primitive surgical instruments during the late 17th and early 18th century, Fauchard was considered a highly skilled surgeon by many of his colleagues at Angers University Hospital. Fauchard made remarkable improvisations of dental instruments, often adapting tools from watch makers, jewelers and even barbers, that he thought could be used in dentistry.

Fauchard introduced dental fillings as treatment for dental cavities. He asserted that sugar derivate acids like tartaric acid were responsible for dental decay, and also suggested that tumors surrounding the teeth, in the gums, could appear in the later stages of tooth decay.

Fauchard was the pioneer of dental prosthesis, and he discovered many methods to replace lost teeth. He suggested that substitutes could be made from carved blocks of ivory or bone and those artificially-made dental pieces would be useful as the natural ones. One of this methods stated that the artificial teeth would be held in place by tying them to the remaining solid teeth by pivots, using waxed thread or gold wire. He also introduced dental 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. Waxed linen or silk threads were usually employed to fasten the braces.

Early 18th century diagram made by doctor Fauchard on his book where he shows the procedure involved in denture construction.

During 1716 to 1718, Fauchard gained great prestige. During that time he spent long periods away from home studying and sharing his medical practice with other surgeons across France.

In 1718, Fauchard moved to Paris. During his stay in that city, Pierre realized that many medical libraries lacked good textbooks on dentistry and that an encyclopedic teaching book of oral surgery was needed, so he made the decision to write a professional dentist's treatise based on his medical experience.

For many months Fauchard gathered as many medical research books as he could, interviewed the many dentists he had met, and reviewed his personal diaries during his years at Angers to write his manual. Finally in 1723, at the age of 45, he completed the first 600-page manuscript for "Le Chirurgien Dentiste" (roughly translated as "The Surgical Dentist"). Fauchard sought further feedback from his peers over the next five years, and the manuscript had grown to 783 pages by the time it was published in 1728 in two volumes.[2] The book was well received in the European medical community.[2] A German translation was already available in 1733, an enlarged edition in French was published in 1746, yet an English translation had to await 200 more years to 1946.

People would often go to barbers or tooth-pullers to have work done on their teeth instead of doctors. Tooth pullers would often use tools called pelicans to draw teeth. These pelicans were not very precise, and would often pull healthy teeth along with the problematic ones. Sometimes, these pelicans would take out part of the jaw too. Surgeons were trying to gain status during this time and wanted to distance themselves from the tooth-pullers. Hence, Fauchard was rather unusual to be a surgeon who studied teeth at the time.[3]

Literature on teeth was generally found in treatises on surgery, as there were no books written explicitly on teeth at the time.[4]

There was no regulation on who could do work on teeth until the Paris Medical Faculty issued the Edict of 1699, which created the title of expert pours les dents, or "tooth expert," for people certified to do dental work.[5]

Fauchard bemoaned how the medical community had largely ignored teeth. He said that "The most famous surgeons having abandoned this part of the art, or at least having paid little attention to it, have caused by this negligence, the rise of people who without theory or experience, have degraded it, and practiced haphazard, without principles or method."[6] He believed that too many tooth-pullers were spending too much time learning how to pull teeth through trial and error, and he believed that people who worked with teeth ought to spend more time learning how to preserve teeth instead.[3]

Fauchard believed that the main way people should keep their teeth clean is by washing their mouth every morning with water and rubbing the teeth with a wet sponge. He also stated that some ethanol mixed with the water would be a sufficient cleaning solution. He stated that toothbrushes ought to use sponge instead of cloth or linen because cloth was too rough and would often wear down the teeth.[7]

Fauchard noted that common dentrifice ingredients such as brick, porcelain, pumic stone, calcined talc, calcined aluminum do more harm than good. The juice of sorrel, lemon juice, spirits of vitriol, and salt were also observed to destroy the enamel. The dentrifice Fauchard recommends is a mixture of coral, dragon's blood, burnt honey, seed pearls, cuttle fish bone, crayfish eyes, bol d'armerie, terre sigillee, terre hematite, canelle, calcined alum, completely reduced to a fine powder and mixed together. However, he recommended only using such a dentrifice if brushing and rinsing with water were not enough.[7]

• Fauchard described the symptoms of 103 mouth diseases, along how to treat them.[4]
• He suggested that the German tooth worm theory was mistaken in its explanation of dental decay. His observations through the microscope showed there was no evidence of worms.[8]
• He also said the cause of dental caries was sugar, and people should limit it from their diet.[8]
• He disproved theories of spontaneous tooth generation, arguing that the first teeth, which are called milk teeth, separate themselves from their roots. Some dentists at Fauchard's time believed they didn't have roots.[8]
• He introduced dental fillings as treatment for dental cavities, and he suggested amalgams like lead, tin and sometimes gold. He also said that teeth should be cleaned periodically by a dentist.[8]
• He said that braces should be used to correct the position of teeth, and that children's teeth could be moved more easily and quickly than adults', a result of the size of the teeth roots, according to Fauchard.[8]
• He was ahead of his time in medical practice and he described the way the patient should be greeted by the doctor and the position in which the patient should sit.[8]
• He recommended that the dentist should stand behind the patient to help them relax, and he introduced the concept of dentist's chair light.[8]
• Yet, he recommended that one gargle twice a day with freshly collected urine ("..se rinser la bouche tous les matins, & même le soir, avant que de se coucher, avec quelques cuillerées de son urine tout nouvellement renduë..." />[9]

Late 17th-century surgical instruments made by Pierre Fauchard during his research in oral surgery, (from left to right) a saw, two kinds of forceps, (bottom from left to right) two kinds of files and a gimlet.