The Study of Dental History: Raison D’être

David A. Chernin, DMD, MLS Executive Director, American Academy of the History of Dentistry

The following is adapted from Dr. Chernin’s presentation of the Frank & Phyllis Orland Memorial Lecture, delivered at the 62nd Annual Meeting of the American Academy of the History of Dentistry, October 19,th 2013, in Boston, Massachusetts.

Our Academy was conceived in the late 1940’s and organized in 1951 by a small group of dentists concerned that the rapid growth and technological advancements occurring in American dentistry would adversely affect the basic tenets of the profession. It was their belief, and our Academy’s present position, that using the lens of historical perspective and analysis enables our profession’s evolution by building on our predecessors’ successes and failures.

Tonight I will speak on the importance of dental history from our past “dental sages” and my own personal belief.

In 1889, Dr. John R. Patrick, when asked why it was important to include history in dental education, responded that: [1]

"…every age should profit by the experience of the preceding ones; but without a record [and study] of what has been accomplished each investigator commences a new series of trials, and wanders over the same ground in search of truths which have long been discovered; or adopt theories that have been long ago discarded."

We know that his perspectives were neither unique nor original when delivered 125 years ago. During the development and growth of the art of writing, we have documentation that individuals throughout the ages held similar beliefs. We should view Dr. Patrick as a member of that important contingent of “beacons of light” that remind those of us who know what we do not know, and assist those of us who do not know, to know.

Dr. Charles McManus’ introduction to Dr. Vincenzo Guerini’s classic text on the history of dentistry discussed the need to study dental history to appreciate “the importance and value of the dental art and science as a humane service reaching far back in an unbroken line to the mist of antiquity.” [2] McManus’ reference to “humane service” acknowledges that we deal with mankind’s physical pain and suffering, and that our professional intellect has evolved through the ages. We provide relief from oral afflictions by reducing the length of their morbidity, and offer a sophisticated degree of reconstructive and restorative therapies. The understanding and awareness of our predecessors’ achievements, discoveries, inventions and failures is the umbilical cord of dental professional life.

It is this noble contribution—the relief from pain and suffering—that has been our profession’s universal and undeniable achievement. I refer not only to the improvement in 18th- and 19th-century extraction instruments and techniques, nor Horace Well’s monumental gift of anesthesia, but our continuing commitment to scientific advancements in the treatment and prevention of the most common disease, dental caries, which unfortunately is still a health concern. Bernard Wolf Weinberger believed that: [3]

"The entire structure of dentistry, theories, methods and results obtained by the most painstaking experimentations, even the fundamentals, are subject to constant scrutiny, revision and amendment. On the other hand, the study of the development of an art from the historical standpoint has a definite value, and is indeed indispensable to one who does serious work. No one can understand and appreciate the tendencies and movements in scientific research today until he has acquired a thorough knowledge of the origin and growth of these same tendencies and movements through a careful reading of the literature of his and other professions."

The study of dental History provides the substance whereby we are able to develop a rational philosophy of dentistry.

Now, I would not say that “those who do not read history are doomed to repeat it” [4] —we all know that mankind continues to repeat its Faustian errors. But it is by experiencing history as a story related to our professional endeavors that we will understand the profession best.

While there is still the perennial selling of “new and improved devices,” abetted by industry’s successful use of cutting-edge technology, we are confronted by a new concern with grave consequences. It appears today that dental information is only perceived as current and up-to-date if available online. Additionally, as a mechanism to establish reliability, the trend du jour of “dental knowledge” is often “evidence–based medicine/dentistry.” These statistical approaches, developed from epidemiology, are an attempt to aid practitioners in their decision of how best to provide treatment to their patients. Now, I do not have an issue with the employment of meta-analyses and systematic reviews. Both provide valuable in-sight and usable information. The issue that I have is the near complete support (financial, educational and political) of this particular resource alone, concurrent with the neglect of preserving and analyzing nearly 500 years of clinical practice and scientific thought.

The study of history is essential in developing that valuable skill of critical thinking, so important in personal and professional growth.

How do we convey that subtle ingredient— that academic pursuit, that self-knowledge which borders on autobiography—to clinical care?

Critical thinking, the ability to recognize a problem and strive to achieve a satisfactory solution, sharpens the diagnostician’s skill by advancing the understanding of the progression of the patient’s signs and symptoms, leading to a coherent, valid and reliable interpretation. This interpretation may then require additional diagnostic tests, which will support an educated diagnosis; enabling the presentation of an etiology, prognosis and treatment options.

How many of our recent graduates or students are familiar with Celsus, credited with recording the cardinal signs of inflammation: calor (warmth), dolor (pain), tumor (swelling) and rubor (redness and hyperemia)? I would venture very few; but moreover, I think we could poll our entire professional ranks and discover similar numbers.

We are a healthcare profession that fundamentally deals with inflammation and infections, so eloquently stated by McManus. Are we reduced to the establishment of “best practices” based on “X”-amount of recent reviews or protocols, which always includes the caveat, “in conjunction with clinical experience”?

Is there not value in knowing about the 2,000 years of observations, findings, reports and treatment outcomes from our professional forbearers, as noted by Patrick? What is one of the fundamental bases of scientific inquiry? Is it
not observation? Is it not observing changes over time? Has Weinberger missed the point, or is his perspective just dated? My embrace of such opinions and suggestions has rewarded me with a successful and meaningful professional experience.

So, what do we mean by “dental history”? On its surface, dental generally is found to mean pertaining to tooth or teeth; [5] history, a systematic record of past events relating to a particular people, country, period, person, etc, a continuous
systematic record of past events usually written in chronological order. [6]

But on a deeper level: from our earliest days as dental students migrating into professional practice, the cornerstone of clinical practice is our patient’s “dental history.” This “history” refers to a document containing as complete and detailed information of all aspects of the patient’s current and past oral health, general health, diagnostic test results, radiographic images/reports and previous treatments.

Are we so narrow in our outlook that our professional focus limits the connotation of these two terms to just the above interpretation?

As we embark on our professional journey the time we allot for the reading and study of dental history will provide the mental and intellectual skills to examine and re-assess the growth and direction of American dentistry, and our role in this saga. It is self-evident that our leadership and colleagues continue to labor over issues, events and ideas as if they are new dilemmas for our profession (e.g. amalgam controversy, focal theory of infection, and affordable oral care); we, on the other hand, are empowered with the knowledge and wisdom from failed endeavors and successes in our professional past.

While our profession and colleagues may perceive the continuing pressure of new and re-occurring dilemmas as just: [7]

“The Slings and Arrows of outrageous Fortune, they take Arms against a Sea of troubles, And by opposing, hope to end them… But that the dread of something unknown, The undiscovered Country, from whose bourn they have yet to travel, Puzzles their will, And makes them rather bear those ills they have, Than fly to others that they know not of. Thus Conscience can make them Cowards, And thus the Native hue of Resolution Is sicklied o’er, with the pale cast of Thought, And enterprises of great pitch and moment, With this regard their Currents turn awry, And lose the name of Action.”

The growth and development of dentistry is part of the record of human progress, containing the stories of our accomplishments and failures. The integration of dental history as an educational component confers deeper understanding of the progress and the controversies in our profession’s development and ethical evolution.

The study of dental history enables the exploring, assessing and critiquing the path by which American dentistry endeavors to obtain, maintain and sustain the necessary credentials as a health profession. Historical research provides insight into dentistry’s adaptation to the changes in scientific, technical and educational advancements and the evolving social contract of a healthcare profession—offering guidance as we deliberate present dilemmas.

In closing, let me leave you with a thought to consider:

Knowing where to find knowledge is the most important part of scholarship.


[1] Patrick JR. Dental history: why? Dental Review.
1889; 3(July):426.
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[2] McManus C. In: A History of Dentistry. Guerini
V, ed. New York: Lea & Febiger. 1909, p. x.
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[3] Weinberger BW. An Introduction to the History of
Dentistry, Vol. 1. St. Louis: C.V. Mosby Co. 1948, p. x.
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[4] George Santayana, paraphrasing, The Life of
Reason or the Phases of Human Progress, vol. I, ch. 12.
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[5] Jablonski S. Illustrated Dictionary of Dentistry. Philadelphia: Saunders Co. 1982. p. 235.
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[6] Ibid. p. 390.
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[7] Shakespeare, paraphrase, “To be or not to be”
Hamlet, Act III, Sc. 1.
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