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dentistry

[den-tuh-stree]

dentistry, treatment and care of the teeth and associated oral structures. Dentistry is mainly concerned with tooth decay, disease of the supporting structures, such as the gums, and faulty positioning of the teeth. Like medicine and surgery, it is practiced in specialized fields: oral surgery, orthodontics (corrective dentistry), periodontics (diseases of the gums), prosthodontics (partial or total tooth replacement), endodontics (treatment of dental pulp chamber and canals), and pedodontics (dental problems of children).

Some researchers believe that there is clear evidence of dental drilling in human teeth found in Pakistan that date to 7000 B.C., but unquestioned evidence of dentistry is found only from subsequent millenia. Excellent crowns and bridges were made by the Etruscans in the 7th cent. B.C. At about that time, teeth were being extracted in Asia Minor as a cure for bodily ills and diseases. Skills achieved by the Etruscans, Phoenicians, Egyptians, Greeks, and Romans were largely lost during the Middle Ages, when barbers and roving bands of charlatans practiced unskilled dentistry at marketplaces and fairs. Abulcasis, a Spanish Moor, was one of the few in his time who studied dental surgery, leaving behind instruments and theories quite advanced for the 10th cent. A.D.

French scientist Pierre Fauchard is considered the founder of modern dentistry; by the end of the 17th cent., he was making fillings of lead, tin, and gold and devising artificial dentures. In the 18th cent., German scientist Philip Pfaff was making dentures of plaster of Paris, and shortly thereafter the French discovered how to mold porcelain into dentures. The first American to make use of this process was Charles Willson Peale; he who made the now-famous set of false teeth for George Washington.

As dentistry progressed, the center of accomplishment shifted from Europe to the United States. The first dental school in the world was established in Baltimore in 1840. The development of local and general anesthesia, the invention of the drilling machine, discovery of better substances for filling teeth (amalgam and gold), and, most importantly, the ability to devise replacements closely approximating natural teeth in function and appearance contributed much to the rapid growth of dentistry as a science and an art. Adding fluoride to the local water supply (fluoridation) has made teeth more resistant to cavities; annual applications of fluoride and clear liquid plastic to children's teeth also make them more decay resistant.

New developments include the implantation of artificial teeth or binding posts into the gums or jawbone; antibiotic fiber for periodontal disease; root canal surgery, a procedure that ameliorates pain while permitting teeth to remain in place; and nearly painless lasers to repair dental cavities, usually making local anesthesia unnecessary. In the early 1990s, it was reported that five patients of a Florida dentist with AIDS became infected with HIV; as a result, the Occupational Safety and Health Administration (OSHA) ruled that full protective garb (gloves, mask, glasses or goggles, coat) be worn by dental personnel to protect patients and themselves.

The Columbia Electronic Encyclopedia Copyright © 2004.
Licensed from Columbia University Press

dentistry

Profession concerned with the teeth and mouth. It includes repair or removal of decayed teeth, straightening and adjustment of teeth for proper occlusion, and design, manufacture, and fitting of false teeth and other prosthetic devices. X-rays are used to show conditions not visible on examination. Using local anesthesia, caries in teeth are drilled to remove diseased areas and filled with various materials. Decay that reaches a tooth's root risks infection of the nerve and requires root-canal surgery. Teeth that must be extracted are replaced by crowns for single teeth and full or partial dentures or implants for more. Dentists also educate patients on oral hygiene, examine and clean teeth, and apply fluoride compounds for decay resistance.

Learn more about dentistry with a free trial on Britannica.com.

Encyclopedia Britannica, 2008. Encyclopedia Britannica Online.

Dentistry

''' Dentistry is the "evaluation, diagnosis, prevention and/or treatment (nonsurgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent and associated structures and their impact on the human body". Those in the practice of dentistry are known as dentists. Other people aiding in oral health service include dental assistants, dental hygienists, dental technicians, and dental therapists.

General practices

Surgery

Dentistry encompasses a number of practices related to the oral cavity. The most common treatments involve the dental surgery on the teeth as a treatment for dental caries. Decayed teeth are filled with dental amalgam, dental composite, or dental porcelain. Oral and maxillofacial surgery is a more specialized form of dental surgery. Dentists can prescribe medication, x-rays, and devices for home or in-office use. Many oral diseases (such as bilateral odontogenic keratocysts) and abnormalities (such as several unerupted teeth) can indicate systemic, neural, or other diseases. Most general practitioners of dentistry perform restorative, prosthetic, routine endodontic therapy, routine periodontal therapy, and simple exodontia, as well as performing examinations. Many general practitioners are comfortable treating complex cases, as well as placing implants and surgically extracting third molars (wisdom teeth). All dentists must achieve a certain degree of skill in various disciplines in order to graduate from dental school and earn licensure.

Prevention

Dentists also encourage prevention of dental caries through proper oral hygiene (tooth brushing and flossing), fluoride, and tooth polishing. Recognized but less conventional preventive agents include xylitol, which is bacteriostatic, casein derivatives, and proprietary products such as Cavistat BasicMints.

Education and licensing

The Baltimore College of Dental Surgery, the first dental school in the world, opened in Baltimore, Maryland in 1840, and in 1867, Harvard Dental School became the first dental school affiliated with a university.
Studies showed that dentists graduated from different countries, or even from different dental schools in one country, may have different clinical decisions for the same clinical condition. For example, dentists graduated from Israeli dental schools may recommend more often for the removal of asymptomatic impacted third molar (wisdom teeth) than dentists graduated from Latin-American or Eastern European dental schools.

In England, the 1878 British Dentists Act and 1879 Dentists Register limited the title of "dentist" and "dental surgeon" to qualified and registered practitioners. The practice of dentistry in the United Kingdom became fully regulated with the 1921 Dentists Act, which required the registration of anyone practicing dentistry. The British Dental Association, formed in 1880 with Sir John Tomes as president, played a major role in prosecuting dentists practicing illegally. A dentist is a healthcare professional qualified to practice dentistry after graduating with a degree of either Doctor of Dental Surgery (DDS), Doctor of Dental Medicine (DMD), Bachelor of Dentistry (BDent), Bachelor of Dental Science (BDSc), or Bachelor of Dental Surgery/Chirurgiae (BDS) or (BChD) or equivalent. In most western countries, to become a qualified dentist one must usually complete at least 4 years of postgraduate study. Most dentists attend at least 8 years of post secondary education obtaining both undergraduate and professional degrees before practicing. Though not mandatory, many dentists choose to complete residencies focusing on specific aspects of dental care after they have received their doctorate.

Specialities

In addition to general dentistry, there are about 9 or 8 recognized dental specialties in the US, Canada, and Australia. To become a specialist requires one to train in a residency or advanced graduate training program. Once residency is completed, the doctor is granted a certificate of specialty training. Many specialty programs have optional or required advanced degrees such as (MD/MBBS specific to Maxillofacial Surgery), MS, or PhD.

Dental public health (study of dental epidemiology and social health policies),
Endodontics (root canal therapy and study of diseases of the dental pulp),
Oral and Maxillofacial Pathology (study, diagnosis, and sometimes the treatment of oral and maxillofacial related diseases),
Oral and Maxillofacial Radiology (study and radiologic interpretation of oral and maxillofacial diseases),
Oral and Maxillofacial Surgery (extractions, implants, and facial surgery),
Orthodontics and Dentofacial Orthopaedics (straightening of teeth and modification of midface and mandibular growth),
Periodontics (study and treatment of diseases of the periodontium (non-surgical and surgical), and placement and maintenance of dental implants),
Pediatric Dentistry (i.e. dentistry for children, formerly known as "pedodontics"),
Prosthodontics (dentures, bridges and the restoration of implants. Some prosthodontists further their training in "oral and maxillofacial prosthodontics"--a discipline concerned with the replacement of missing facial structures--such as ears, eyes, nose, etc.)

Specialists in these fields are designated registrable (U.S. "Board Eligible") and warrant exclusive titles such as orthodontist, oral and maxillofacial surgeon, endodontist, pediatric dentist, periodontist, or prosthodontist upon satisfying certain local (U.S. "Board Certified"), (Australia/NZ: "FRACDS"), or (Canada: "FRCD(C)") registry requirements.

A tenth specialty, dental anesthesiology, the study of how to relieve pain through advanced use of local and general anesthesia techniques is not yet considered to be one of the recognized dental specialties. However, CODA is in the process of accrediting all dental anesthesiology programs.

Two other post-graduate formal advanced education programs: General Practice Residency (advanced clinical and didactic training with intense hospital experience) and Advanced Education in General Dentistry (advanced training in clinical dentistry) recognized by the ADA do not lead to specialization.

The American Board of Dental Sleep Medicine (ABDSM) provides board-certification examinations annually for qualified dentists. These dentists collaborate with sleep physicians at accredited sleep centers and can provide oral appliance therapy and upper airway surgery to treat sleep-related breathing disorders. While Diplomate status granted by the ABDSM is not one of the recognized dental specialties, it is recognized by the American Academy of Sleep Medicine (AASM).

Special category: Oral Biology - Research in Dental and Craniofacial Biology

Other dental education exists where no post-graduate formal university training is required: cosmetic dentistry, dental implant, temporo-mandibular joint therapy. These usually require the attendance of one or more continuing education courses that typically last for one to several days. There are restrictions on allowing these dentists to call themselves specialists in these fields. The specialist titles are registrable titles and controlled by the local dental licensing bodies.

Forensic odontology consists of the gathering and use of dental evidence in law. This may be performed by any dentist with experience or training in this field. The function of the forensic dentist is primarily documentation and verification of identity.

Geriatric dentistry or geriodontics is the delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal ageing and age-related diseases as part of an interdisciplinary team with other health care professionals.

Veterinary dentistry, a speciality of veterinary medicine, is the field of dentistry applied to the care of animals.

Aviation dentistry, a subcategory of (military) aviation medicine deals with dental topics related to aircrews, e.g., dental barotrauma and barodontalgia. In addition, the aircrew population is a unique high-risk group to several diseases and harmful conditions due to irregular work shifts with irregular self-oral care habits and irregular meals (usually carbonated drinks and high energy snacks) and work-related stress.

History

Evidence of ancient dentistry has recently been found in a Neolithic graveyard in ancient Pakistan. Teeth dating from around 7000 to 5500 BC show evidence of holes from dental drills. The teeth were found in people of the Indus Valley Civilization. A Sumerian text from 5000 BC describes a "tooth worm" as the cause of dental caries. Evidence of this belief has also been found in ancient India, Egypt, Japan, and China. The legend of the worm is also found in the writings of Homer, and as late as the 1300s AD the surgeon Guy de Chauliac still promoted the belief that worms cause tooth decay.

The Edwin Smith Papyrus, written in the 17th century BC but which may reflect previous manuscripts from as early as 3000 BC, includes the treatment of several dental ailments. In the 18th century BC, the Code of Hammurabi referenced dental extraction twice as it related to punishment. Examination of the remains of some ancient Egyptians and Greco-Romans reveals early attempts at dental prosthetics and surgery.

Historically, dental extractions have been used to treat a variety of illnesses. During the Middle Ages and throughout the 19th century, dentistry was not a profession in itself, and often dental procedures were performed by barbers or general physicians. Barbers usually limited their practice to extracting teeth, which not only resulted in the alleviation of pain, but often cured a variety of ailments linked to chronic tooth infection. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac invented the dental pelican (resembling a pelican's beak) which was used up until the late 18th century. The pelican was replaced by the dental key which, in turn, was replaced by modern forceps in the 20th century.

The first book focused solely on dentistry was the "Artzney Buchlein" in 1530, and the first dental textbook written in English was called "Operator for the Teeth" by Charles Allen in 1685. It is said that the 17th century French physician Pierre Fauchard started dentistry science as we know it today, and he has been named "the father of modern dentistry". Among many of his developments were the extensive use of dental prosthesis, the introduction of dental fillings as a treatment for dental caries and the statement that sugar derivate acids such as tartaric acid are responsible for dental decay.