and bridges, still attached to the teeth, were discovered in pre‐Roman era Etruscan graves (Weinberger, 1926). All these findings bear witness to the awareness of our ancestors to oral health issues.
Recognition of malocclusions and individual variability in facial morphology and function were first noted in Ancient Greece. Hippocrates of Cos (460–377 BCE), who is the founder of Greek medicine, instituted for the first time a careful, systematic, and thorough examination of the patient. His writings are the first known literature pertaining to the teeth. He discussed the timing of shedding of primary teeth and stated that “teeth that come forth after these grow old with the person, unless disease destroys them.” He also commented that the teeth are important in processing nutrition, and the production of sound. Hippocrates, like other well‐educated people of his time, was keenly aware of the variability in the shapes of the human craniofacial complex. He stated that “among those individuals whose heads are long‐shaped, some have thick necks, strong limbs and bones; others have highly arched palates, their teeth are disposed irregularly, crowding one on the other, and they are afflicted by headaches and otorrhea” (Weinberger, 1926). This statement is apparently the first written description of a human malocclusion. Interestingly, Hippocrates saw here a direct connection between the malocclusion and other craniofacial pathologies.
A prominent Roman physician, Celsus (25 BCE–50 CE; Figure 1.3), was apparently the first to recommend the use of mechanical force to evoke tooth movement. In his Book VII, Chapter XII entitled “Operations requisite in the mouth,” he wrote: “If a permanent tooth happens to grow in children before the deciduous one has fallen out, that which should have dropped must be scrapped round and pulled out; that which is growing in place of former must be pushed into its proper place with the finger every day, till it comes to its own size.” Celsus was also the first to recommend the use of a file in the mouth, mainly for the treatment of carious teeth (Weinberger, 1926). Another Roman dentist, Plinius Secundus (23–79), expressed opposition to the extraction of teeth for the correction of malocclusions, and advocated filing elongated teeth “to bring them into proper alignment.” Plinius was evidently the first to recommend using files to address the vertical dimension of malocclusion, and this method had been widely used until the nineteenth century (Weinberger, 1926).
Figure 1.3 Aulus Cornelius Celsus (25 BCE–50 CE).
(Picture courtesy: http://www.general‐anaesthesia.com/.)
There were few, if any, known advances in the fields of medicine, dentistry, and orthodontics from the first to the eighteenth centuries, with the exception of Galen (131–201), who established experimental medicine, and defined anatomy as the basis of medicine. He devoted chapters to teeth, and, like Celsus, a century earlier, advocated the use of finger pressure to align malposed teeth. Galen advocated the same method to that of Celsus through his writings in 180 CE, which stated that a tooth that projects beyond its neighbors should be filed off to reduce the irregularity (Caster, 1934). Another exception was Vesalius (1514–1564), whose dissections produced the first illustrated and precise book on human anatomy.
For reasons connected with the church, Galen and his writings monopolized medicine for more than a thousand years. However, there were minor advancements in European medicine during that protracted era and advancements evidenced by writings of Muslim physicians from Arabia, Spain, Egypt, and Persia.
Orthodontic treatment during the Industrial Revolution: Emergence of identification of biological factors
The writings of authors in the Middle Ages were mainly repetitions of what already existed, and there were no new references to mechanical principles for correcting dental irregularities. It was Pierre Fauchard (1678–1761), the father of dentistry and orthodontics (Figure 1.4), who organized previous knowledge and opinions, and provided an extensive discussion on the rationale for numerous clinical procedures (Wahl, 2005a). His book titled Le chirurgien dentiste (The Surgeon‐Dentist) was published in two editions, the first in 1728 and the second in 1746. The second edition described a few orthodontic cases (Volume II, Chapter VIII) along with an extensive description of appliances and mechanical principles. This book is considered to be dentistry’s first scientific publication. Fauchard also advocated keeping young patients under observation and removing long‐retained deciduous teeth to prevent irregularity in the permanent dentition. He also stated that blows and violent efforts may increase the chances of developing an irregular tooth arrangement and reported that the greatest incidence of these mishaps occur in the incisor and canine regions. Most of the appliances he fabricated were made of gold or silver and were designed according to the patient’s needs, marking the beginning of “customized orthodontic appliances” (Figure 1.5). The orthodontic appliance described by Fauchard used silk or silver ligatures to move malposed teeth to new positions, and “pelican” pliers for instant alignment of incisors, facilitated by bending of the alveolar bone. After placing teeth in position with pelican forceps, he retained them with silver ligatures or lead plates adjusted on either side, over which linen was placed and sewed into position with needle and thread, between interproximal spaces and over the occlusal surfaces of the teeth. This device, named bandeau, marked the beginning of the era of modern orthodontic appliances and their utilization in treating malocclusions (Asbell, 1990).
Figure 1.4 (a) Pierre Fauchard (1678–1761), the father of dentistry and orthodontics.
(Source: Vasconcellos Vilella, 2007.)
(b) His book titled Le chirurgien dentiste(The Surgeon‐Dentist).
(Source: Picture courtesy: Andrew I. Spielman.)
Figure 1.5 (a) Dental pelican forceps (resembling a pelican’s beak).
(Source: Courtesy of Alex Peck Medical Antiques.)
(b) Bandeau–the appliance devised by Pierre Fauchard.
(Source: Vasconcellos Vilella, 2007.)
John Hunter (1728–1793), in 1778, in his book titled A Practical Treatise on the Diseases of the Teeth, stated that teeth might be moved by applied force, because “bone moves out of the way of pressure.” This book, along with his previously published book, titled The Natural History of Human Teeth, marked the beginning of a new era in the practice of dentistry in England (Wahl, 2005a). Hunter recognized the best time to carry out orthodontic treatment to be the youthful period, in which the jaws have an adaptive disposition. In 1815, Delabarre reported that orthodontic forces cause pain and swelling of paradental tissues, two cardinal signs of inflammation.
Up to 1841, about a century after Fauchard had written a chapter about orthodontics, there was no single book devoted entirely to orthodontics alone, but in 1841, Schange published a book solely confined to orthodontics (Wahl, 2005a),
