Traduction par Malcolm Bishop (Grande Bretagne)


Humans and tool-using animals use their intelligence to devise instruments as an extension of the hand and brain to make actions possible, or easier.

It has been known for a long time that tooth extraction could be performed with finger and thumb. The ‘Kul Oba’ vase (Hermitage Museum St Petersburg), found In 1830 in a fourth century BC Scythian burial mound, seems to show an early example of this sort of operation. The warrior ‘patient’ in a defensive gesture familiar to dentists holds the operator’s arm.

Writing 2,000 years ago, Aulus Cornelius Celsus (c.25 BC – 50 AD) recommended extraction by hand following loosening of the tooth with forceps. His extraction technique is surprisingly modern (pericision, subluxation and extraction) (Medicina VII. 12). Celsus elsewhere compares the action of removing a projectile stuck within a joint to that required to extract a tooth. (De Medicina VII. 5.4).

Ancient instruments, although not definitely attributable to specialised dental use, were clearly capable of adaptation, whether to remove bone splinters, broken arrow heads, or teeth. It did not take much to modify these instruments to suit dental extractions. At Athens, Naples, and Pompei, examples of instruments were found which were more or less suitable for dental use, either for whole teeth or root extractions.

By the mid 3rd century BC such a specialised instrument was known as an ‘odontogagum’ [-on] in Greek, Thanks to Caelius Aurelianus of Sicca (fl. 6th C. AD in Numidia), who translated some sections of the Greek medical texts of Erasistratus of Chios (304-250 BC), it is known that forceps (denti-ducum - tooth-drawers - in Latin) made of lead were on show in the Temple of Apollo at Delphi.

Possibly originally a votive offering, both Aurelianus and Eristratus, writing some 800 years apart, used these leaden forceps to stress the point made also by Celsus that extreme care is needed when extracting teeth. (Aurelianus: De Morb.Chron. Lib. II. Ch.4)

The Hippocratic corpus (disorders 4) advised forceps to extract a mobile or broken down tooth, or cauterisation. Many remedies in the form of medications, fumigations, fomentations, or topical applications were recommended by the ancients to effect relief in the absence of a cure. It would seem that before resorting to cold steel, practitioners used hot iron to cauterise, with classes of cautery instrument for the gums and teeth, with others for filing and scaling and extractions. Gags and mouth props also feature.

Celsus in his encyclopedic De medicina, demonstrates the existence of such instruments with the specific therapeutic indication of each, together with materia medica. (VII, 12, 1). " (VII, 12, 1). Some simple orthodontics is described in the same passage.

Thanks to the printing press, the works of the ancients, and of mediaeval writers, were reproduced in Latin, and were often translated into French (and English), and their wide distribution gave a significant impetus to the medico-surgical literature. As a result, from the sixteenth to the seventeenth centuries, these numerous books make it possible to provide evidence for, and to study, the instruments with which in many cases the surgeons illustrated their works. These pictures of instruments, accompanied by short descriptions, are presented chronologically (from the date of appearance in the texts on the shelves) together with the most representative instruments that have been identified in the museums or in private collections. After the presentation of each instrument, a set of similar ones is shown

Forceps, pelicans, punches, elevators (simple, goats-foot, and ‘pieds de biche’), mouth-props, cauteries and scalers evolved very slowly from the sixteenth to the twentieth century, often appearing under different names depending on author and periods. In the eighteenth century, the Golden Age of French dentistry, the first significant improvements were made which were to come to full development in the nineteenth century.