History of Pain-free Dentistry

Horace Wells Discovers Pain-free Dentistry

National Museum of American History

By Emily E. Gifford

In the early 19th century Hartford dentists Horace Wells and William Morton played instrumental roles in the development of anesthesia for dental and other medical applications. Horace Wells, born in Hartford, Vermont, and educated in Boston, began his practice in Hartford, Connecticut, in 1836 and quickly rose to prominence. He married Elizabeth Wales in 1838 and continued to write about dentistry and invent various devices, such as a foot-powered shower.

Horace Wells

Wells Sees Potential in Laughing Gas

In 1842, Wells took Morton, first, as his student and then as his partner. Morton, who was born in Massachusetts and trained for dentistry in Baltimore, Maryland, married Elizabeth Whitman, daughter of Lemuel Whitman, on her father’s condition that he quit dentistry and study to practice medicine instead. In 1844, Morton began (but never completed) his studies at Harvard Medical College.

Although Wells tried to form a dentistry practice with Morton in Massachusetts, the new partnership lasted less than two weeks, and Wells returned to Connecticut. In December of 1844, Wells and his wife attended a demonstration at Union Hall in Hartford of “laughing gas” (nitrous oxide) put on by showman Gardner Colton, who had briefly studied medicine. Wells noticed that one of the volunteers, while ingesting the gas to the amusement of the audience, had injured his leg during the demonstration. Wells later talked to the man and found he was unaware he had suffered an injury.

Since Wells had long been concerned about the amount of pain suffered by his patients during dental procedures, he immediately enlisted Colton’s help. The day after the demonstration, Colton came to Wells’s practice and administered nitrous oxide while Wells’s associate, John Riggs, extracted one of Wells’s own troublesome wisdom teeth. Feeling not “so much as the prick of a pin” in the course of this usually painful procedure, Wells believed that he, with the help of Colton and Riggs, had invented painless dentistry.

Experiments with Anesthesia

After Colton taught Wells how to administer the gas, Wells performed a dozen painless procedures over the next few weeks. Always intense, Wells became more excited with each successful procedure. He decided to demonstrate painless dentistry in Boston and did so in January of 1845 at Massachusetts General Hospital for the benefit of Harvard Medical School students and faculty members. The demonstration did not go well. The patient moaned as if in pain, and the audience drove Wells from the lecture hall with cries of “Humbug” and “Swindler,” even though the patient tried to explain that he was not, in fact, in pain.

Despite his setback in Boston, Wells continued to use nitrous oxide in his practice in Hartford and freely shared his discovery area dentists. While dental patients elsewhere continued to suffer, many throughout Hartford were enjoying painless dentistry by the middle of 1845. Wells’s apparent failure in Boston, however, temporarily deterred him from any further attempts to publicize his innovation nationally.

Meanwhile, in Boston, Wells’s former partner Morton was experimenting with the use of ether as an anesthetic. In 1846, Morton demonstrated the use of ether to perform a painless tooth extraction. He did not, however, identify his anesthetic as being ether. Instead, Morton called it “letheon” and applied for a patent for his “substance.” He established a monopoly on painless dentistry in the Boston area and soon got positive publicity for his discovery of ether’s medical applications. Morton also tried to make a profit from his discovery, but his attempts to claim sole discovery of anesthesia in general and ether in particular were denied.

Both Horace Wells and Charles Jackson, who had been Morton’s chemistry professor at Harvard and originally introduced him to ether, stepped forward to challenge Morton’s claim that he had discovered anesthesia. Wells, for his part, sought to strengthen his claims by publishing History of the Discovery of the Application of Nitrous Oxide, Ether, and Other Vapors, to Surgical Operations (1847). Morton and Jackson entered into protracted legal battles in their attempts to prove their claims.

Wells Seeks Fortune in NYC

Wells was also trying to find a way to gain fame and fortune as an anesthetist. By the end of 1847, he had participated in dental and other surgical procedures in Hartford, but decided that he should relocate to New York City to achieve greater recognition and success.

He moved there in January of 1848, intending to establish himself before sending for his wife and their young son, Charles Wells. Loneliness and homesickness overcame him, however, and Wells began using ether and chloroform in an attempt to ease his depression. Wells spent several days intoxicated on the combination of drugs, eventually becoming so confused that he could not distinguish sleep, dreams, and reality.

On the night of his 33rd birthday, Wells went out and threw acid on a pair of women in the street. Fortunately, the acid only burned their clothing and did not permanently injure the women. The police responded to their cries for help and arrested Wells, who they incarcerated in the Tombs Prison. He continued to ingest chloroform and ether while in jail, but in moments of clarity realized the depths to which he had sunk.

Believing that he had disgraced himself and his family beyond repair, Wells took a large dose of chloroform and used a razor to slash a major artery on his thigh. He quickly bled to death, and his body was released to his family for burial at Old North Burying Ground in Hartford. In 1908, Charles Wells re-buried his father and mother (who had died in 1889 and been buried alongside her husband) at Cedar Hill Cemetery. Wells’s tombstone identifies him as the “discoverer of anesthesia.” (In like fashion, Morton’s stone acclaims him as the “Inventor and Revealer of Inhalation Anesthesia.”)

The Nature of Discovery

In 1864, the American Dental Association, followed by the American Medical Association in 1870, recognized Horace Wells as the discoverer of anesthesia. Morton was never able to gain the fortune he sought for his own contributions to the field, including a $100,000 prize which was contested by Jackson and Wells’s survivors.

Although claims to singular discovery reinforce society’s fascination with individual genius, historians of science note that it is not unusual for innovations to occur at a moment when several individuals—sometimes with knowledge of each others’ efforts and sometimes not—are working along similar lines. Discovery, they emphasize, is not typically an event but a process. Wells, then, is rightly recognized for his pioneering role in pain-free dentistry and the field of medical anesthesia.

Emily E. Gifford is an independent historian specializing in the history of religion and social movements in the United States.

HISTORY AND BENEFITS OF DENTAL IMPLANTS

History and Benefits of Dental Implants

by Dr. Howard Kopel

The first evidence of dental implants is attributed to the Mayan population roughly around 600 AD where they excelled in utilizing pieces of shells as implants as a replacement for mandibular teeth. The first post-type endosseous implant is attributed to Formiggini (“Father of Modern Implantology”) in the 1940’s. In the ensuing decades many different materials and techniques were employed to find a predictable implant system for replacing missing teeth. In 1978, Dr. P. Brånemark presented a two-stage threaded titanium root-form implant that modern implants are based on. Finally, today our implants have special coatings that promote osseointegration with the bone they are placed in and have become a very predictable modality.

Today it is no longer necessary to have removable partial dentures and full dentures as our parents and grandparents needed after having extractions. Gone are the days that embarrassing and uncomfortable loose dentures must be endured. Drilling down perfectly good teeth to place fixed bridgework is an outdated procedure now that implants are readily available.

Here are many reasons dental implants are often the first choice and a standard of care compared to other options to restore missing or damaged teeth.

  • Next best thing to healthy, natural teeth.  Strong and stable, a dental implant restores a lost tooth so that it looks, feels, fits and functions like a natural tooth. Other options can lead to bone deterioration, and may interfere with eating, smiling, speaking and other activities of everyday life.
  • Built to last. Dental implants are a long-term solution. Traditional, tooth-supported dental bridges only last five to seven years, and with proper care often more than 10 years, but at some point they may need to be replaced. While dental implants may need periodic adjustments, they can last a lifetime when properly placed and cared for over time.
  • Enjoy life without worrying about your teeth!  No need to stay home or feel uncomfortable in public, embarrassed because your smile looks different, or worrying that missing teeth will limit your ability to join in the fun or that removable dentures or tooth-supported replacement teeth will loosen or fall out when you talk, eat or laugh. Teeth restored with dental implants are teeth that let you, not your teeth, lead your life.
  • Retain your natural face shape, and smile.  A face without teeth can sag and appear sunken and sad. Dental implants allow you to maintain the natural shape of your face and smile.
  • Protect healthy bone. Leaving empty spaces in your mouth after losing one or more teeth can lead to additional health issues, such as the loss and deterioration of some of your jawbone. When it is not being used to support a natural tooth, the jawbone deteriorates, losing its strength and firmness. Dental implants are the only dental restoration option that preserves and stimulates natural bone, actually helping to stimulate bone growth and prevent bone loss.
  • Keep your teeth in your mouth – not in a cup. Dental implants allow you to keep your teeth where they belong – in your mouth. And no more worrying that your dentures might slip or fall out. Brush, floss and care for teeth that have been replaced using dental implants exactly the way you would natural teeth – in your mouth.
  • Speak easy.  Adjusting to removable dentures can mean struggling to pronounce everyday words. Not so with dental implants, which function like natural teeth.
  • Eat your favorite foods! Taste and enjoy the foods you love without hesitation. You can bite naturally, eat virtually anything you want and, unlike removable dentures that can feel uncomfortable, you can experience the full taste of the food you eat with dental implants, too.
  • Look Mom, no cavities! Cavities cannot occur in an implant-restored crown, or replacement tooth; however, you will need to visit your dentist as scheduled and clean and care for it and your gums and mouth every day, the same as you would if it were a natural tooth.
  • Keep teeth in place – silently. Dentures may slip when you eat, talk, smile, laugh, kiss, yawn or cough, so that you have to “reposition” them back into place in the mouth. Dental implants are fixed in place and fuse naturally with your jawbone, meaning your replacement teeth won’t move, click or shift.
  • Protect your healthy teeth. Placing a tooth-supported bridge requires grinding away the teeth on one or both sides of the missing tooth or teeth – thereby damaging healthy teeth to restore those that are missing. The modified healthy teeth are attached to, and support, the bridge. Dental implants go in the jawbone, in the spot where your missing tooth root was, without impacting healthy teeth. They also help prevent healthy, adjacent teeth from shifting as they would if an empty space were left for an extended period of time.
  • More predictable than other repair and restoration methods. Dental implant treatment has a track record of reliable, long-term successful outcomes and is often considered “more predictable” than other treatments to repair or replace missing teeth, including bridgework, removable appliances and retreatment of failing root canal (endodontic) therapy.

TOOTH DECAY PREVENTION

By ADA Dental Association

Tooth decay is the destruction of your tooth enamel, the hard, outer layer of your teeth. It can be a problem for children, teens and adults. Plaque, a sticky film of bacteria, constantly forms on your teeth. When you eat or drink foods containing sugars, the bacteria in plaque produce acids that attack tooth enamel. The stickiness of the plaque keeps these acids in contact with your teeth and over time the enamel can break down. This is when cavities can form.

Cavities are more common among children, but changes that occur with aging make cavities an adult problem, too. Recession of the gums away from the teeth, combined with an increased incidence of gum disease, can expose tooth roots to plaque. Tooth roots are covered with cementum, a softer tissue than enamel. They are susceptible to decay and are more sensitive to touch and to hot and cold. It’s common for people over age 50 to have tooth-root decay.

Decay around the edges, or a margin, of fillings is also common for older adults. Because many older adults lacked benefits of fluoride and modern preventive dental care when they were growing up, they often have a number of dental fillings. Over the years, these fillings may weaken and tend to fracture and leak around the edges. Bacteria accumulate in these tiny crevices causing acid to build up which leads to decay.
You can help prevent tooth decay by following these tips:

Brush twice a day with a fluoride toothpaste.
Clean between your teeth daily with floss or interdental cleaner.
Eat nutritious and balanced meals and limit snacking.
Check with your dentist about the use of supplemental fluoride, which strengthens your teeth, and about use of dental sealants (a plastic protective coating) applied to the chewing surfaces of the back teeth (where decay often starts) to protect them from decay.
Visit your dentist regularly for professional cleanings and oral examination.