You can come in now.
A visit to the dentist is many people's idea of a nightmare
and, for much of our history, that's exactly what it was.
Agonising toothaches, horrifying extractions and ill-fitting
false teeth have cast this dark shadow over our dental past.
I'm Professor Joanna Bourke and whilst writing
and researching a recent book about the history of pain,
I discovered that, down the centuries, our teeth have been
a constant source of agony, suffering and woe.
In a world of perfect smiles and pain-free procedures,
we've overcome many of the things that made dentistry,
and our teeth, something to be feared.
So, why does sitting in the dentist's chair still evoke
images of torture and horror?
I think history has a lot to answer for.
The past has left an indelible mark on our collective memory.
In this film, I'll chart how dentistry has been transformed
from a medieval back-street horror show into a gleaming modern science.
Along the way, I'll discover the horrifying lengths some would
go to achieve the perfect smile.
So, basically, if you're rich enough,
you can actually get dead men's teeth?
I'll get hands on with the barbaric tools of the trade...
I stick it in someone's mouth? Carefully, yes!
..and I uncover the unlikely story of how a convicted criminal
revolutionised our dental health.
Oh, no! I broke it.
This is the story of our teeth and of those who've tried to fix them.
Rotten and neglected teeth have been a part of daily life
since the dawn of time.
But, for thousands of years, the only real treatment for a toothache
was extraction, and there have always been those willing to oblige.
If you had a painful tooth in medieval England, you might
take your chances with the brute strength of the local blacksmith
or try your luck with another equally-unlikely candidate...
..the barber.
Because, in the medieval age, barbers didn't just cut hair.
At this modern barber shop, I'm meeting Professor Damien Walmsley,
who has researched the brutal beginnings of modern dentistry.
Damien, tell me, if we were living in medieval England
and let's say I had a really, really bad toothache, what would I do?
Well, it would depend how much money you had.
If you didn't have much money, you'd go to the blacksmith
and you wouldn't know what they would be doing to your teeth to take them out.
But if you did have money, you'd come to the barber surgeon.
So these are barbers, people who do your hair?
That's right, yes, they do blood letting in the medieval ages,
but they would also take teeth out.
So what kind of training would these dental surgeons get?
They would have been relying on watching the master do the work
and then an apprenticeship, they'd have taken over.
Do you want to see what they used? Yes, what.
Here we are, simple pliers. So there we are, Joanna, have a look at those.
Oh, they are really crude. They're very crude.
How would you actually use them?
I've got a beer bottle
and I'm going to ask you to take the cap off with those pliers.
You've got to use one hand. Try and use one hand.
And this is the tooth and you just... Try to pull, it's not easy.
You've got no leverage. No, I can't.
No lever, so you can't get at that.
If you're using such instruments, you would have had to try
and get a good application and you'd probably ended up grabbing
most of the bone, the skin, so as you're taking out with this,
you probably took out a lot more than just the tooth,
and that's if you got the right tooth, in the first place.
In medieval England, extractions weren't just performed
for toothache. They were also used as form of torture and punishment.
Those who ate meat during Lent were handed over to the tooth-drawer,
who would then pull out their front teeth as a warning to other sinners.
Those are the pliers and I've got, underneath here,
something called the pelican.
The pelican, because it resembled the beaks of a bird.
So how would you actually use this?
This part was placed against the skin,
and so you'd hook onto the teeth, press against the bone
and then, actually, lever the tooth out.
That motion was picked up with something called a key.
This is, to me, more barbaric, because it actually...
It looks like a bottle opener.
Yes, very much so. If you got the lower..
I'm onto the lower teeth there. You would put that on here...
Then you just go... Very quickly, speed was the essence. Oh!
You can see, that could have been really catastrophic for the patient.
Yes. There's every chance, as you were ripping that out,
it ripped out bone, skin, other teeth.
So I think the message is, you don't want to have a toothache
in this period of history. No, you don't.
I think it would have been a very uncomfortable experience
and would not have been pleasant, at all,
with a high chance of infection and a high chance of having to go
back again, to have the whole procedure done, yet again.
For centuries, if you had a throbbing or broken tooth,
the savage methods of the barber-surgeon
were the only treatment available.
But having a toothache in the medieval era, could be more
than painful. It could be fatal.
In 1665, the year of the Great Plague,
if we exclude the thousands of plague victims,
around 10% of all fatalities in London were due to teeth.
Is it any wonder that dentistry was associated with horror
and with death?
For much of the past 500 years, that's essentially what it was.
For dentistry to move beyond the blunt arts of tooth pulling,
aspiring dentists would need to understand the causes
of toothache and, more importantly, the anatomy of our teeth.
In the 17th and 18th centuries, the worlds of art,
philosophy, politics and science would undergo profound changes.
Driving this was the embrace of reason
and logic, as the way to understand the world.
This new movement would become known as The Enlightenment
and dentistry would also be swept up in this intellectual revolution.
Previously, the world of dentistry was riddled with absurd theories
and populated by charlatans and fraudsters.
Even in the 17th century, a myth still persisted that
toothache was caused by worms living in the teeth.
Its reputation for quackery,
and the fact that most dentists were lowly barbers or blacksmiths,
meant the profession was held in very low regard.
Here at the Royal Society in London, is a rare first edition
of a remarkable book that, for the first time,
applied scientific rigour to our teeth.
Its author was a man named John Hunter, who's often
remembered as an anatomist and pioneering surgeon,
but Hunter was also a key figure in turning dentistry
into a modern science.
As a young man, Hunter had failed to forge a career in medicine,
so, instead, he turned his attention to dentistry.
I'm meeting medical historian, Wendy Moore,
who is an authority on Hunter's life.
This is John Hunter's first book.
It was published in 1771 and the second part in 1778.
It's one of the most important books in the history of dentistry
and that's because it's really the first, in English,
comprehensive look at the anatomy of the teeth and the jaws
and it really places dentistry on a scientific basis for the first time.
So it's called The Natural History of the Human Teeth, explaining
their structure, use, formation, growth and diseases.
That's pretty comprehensive.
Exactly. And you can see from the contents, he looks
at every aspect of the jaw and the teeth, the muscles of the jaw,
the structure of the teeth, the substance of the teeth, the number
of teeth. And also, he describes the classes, or the names, of the teeth.
Before, they were known as the incisors, the canines
and the grinders, but he came up with four classes of teeth and
he gives them the names of incisors, cuspid, bi-cuspids and molars.
Hunter's naming and classifications of the teeth
is still in use around the world today.
He discusses the importance of cleaning the teeth,
he actually mentions eating fruit
and salad to keep the teeth clean, he talks about decay.
But perhaps what's most remarkable about the book,
is these exquisite drawings.
They're amazing. They're so detailed.
They're absolutely beautiful and beautifully accurate,
with different angles.
And here's a lovely cross-section of the jaw,
showing the roots of the teeth, which they called fangs, at the time.
So, these really-detailed illustrations,
these would have been used for teaching purposes, primarily?
Partly, yes. Certainly for teaching students
and also qualified surgeons and physicians,
but also general interest.
People would buy the book as a work of art and as an instructive manual.
At the time, dentistry was really looked down upon by most
physicians and surgeons, and, effectively,
what he did was to make dentistry a respectable profession.
As well as setting dentistry on the road to becoming a modern science,
Hunter's book also popularised a rather
controversial dental procedure - the transplanting of human teeth.
In this satirical cartoon, a dentist is pulling
the teeth from a chimney sweep, ready to be
implanted into the waiting mouth of an aristocratic lady.
Lurking in the background, is a grotesque character, inspecting
his new set of gnashers, which have been pulled from two poor children.
Few of these transplanted teeth took permanent root,
and there was a real risk of contracting
diseases like syphilis, but that didn't deter the vain rich.
John Hunter had fuelled a craze, which meant
the teeth of the poor, became a prized asset to be bought and sold.
But within a few years, it was the teeth of the dead that would
grab the public's imagination.
In the early 19th century, human teeth became an increasingly
valuable commodity.
In fact, they were so in demand,
that grave robbers could earn the equivalent of 10,000 a night
stealing the teeth from corpses.
These grisly trophies of the dead were used to make life-like
dentures for the rich.
But in 1815, these grave robbers almost went out of business.
In June that year, 50,000 men were slaughtered
at the Battle of Waterloo.
As night fell, ghoulish scavengers arrived on the Battlefield
and began to pull the teeth from the dead and dying.
And their teeth, they flooded the British market.
As a consequence, even the toothless middle classes
could afford to buy their own grin.
The era of fashionable false teeth had arrived.
One of the largest collections of false teeth in the world,
is managed by the British Dental Association.
False teeth have a long history.
The ancient Etruscans, who lived in what's now Tuscany,
were making serviceable gold dentures from around 700BC.
Curator Rachel Bairstow has catalogued hundreds of sets
of false teeth, including those made from the dead soldiers
of Waterloo.
Rachel, I've heard so much about Waterloo teeth.
What to they actually look like?
Here we go. We've got a treat for you.
This is a set of Waterloo teeth.
You can see it's a carved ivory denture a full set, top and bottom.
This is hippopotamus, or walrus ivory, was commonly used
and here we have the human teeth.
They were riveted into place with these metal pins, to make this
rather wonderful set.
And how would you fix them inside your mouth?
Well they'd have gold piano wire springs attached on the sides here,
which would attempt to keep it in the mouth through
the pressure that would force it up and force it down.
And very difficult to eat with, I should think? Absolutely.
I should think that they probably took it out
and chopped up their food another way,
rather than attempting to eat with this.
I find it amazing. These are actually human teeth.
These are actually human teeth taken from the soldiers from
the battlefields of Waterloo.
So, those healthy teeth that they could find from those dead bodies.
Here they are, strung up for sale.
So these could be purchased from the markets, from some dental catalogues
So, basically, if you're rich enough,
you can actually get dead men's teeth.
Yes, absolutely and they were very popular to London's wealthy,
because they just look so more real.
How long would they actually last in someone's mouth?
Not very long.
You've got to imagine that this probably a putrid mouth already.
There's a lot going on in there.
It's not very nice and ivory is going to decay
and it's going to rot in the mouth.
So, no, for such an expensive set, they're really not going
to last very long.
As ivory dentures would rot in the mouth, social gatherings
would have been unbelievably smelly, due to all the reeking breath.
In the 19th century, the trend for ladies to carry fans wasn't
anything to do with flirting, but to keep bad breath from delicate noses.
So, it's one size fits all?
There must have been unhappy customers, to put it mildly.
There were unhappy customers,
and this is a letter from a vicar in Wales, who's actually
complaining about his set of porcelain teeth here.
This is Thomas Bateman, 1810.
Yes, and he's writing to a dentist in London and he's complaining
that his set of mail order teeth don't fit and what can be done!
There's no way of measuring the mouth
and it, literally, is mail order - one size fits all.
So this is not a good solution. When does this start improving?
It starts improving in the 1840s.
Long after Bateman? Long after Bateman, I'm afraid.
He doesn't get the benefit of vulcanite.
So this is vulcanite?
This is a rubber coming from America.
It's a lot lighter. It's a lot lighter.
It's much cheaper, it's much more cost effective,
it's much easier for the dentist to make this.
And it looks better. It looks better. It's pink! It's pink.
It looks better, it would fit better,
it's more easy to eat with these ones?
It's much easier to eat with these. They were cheaper to mend and fix.
And a set of these would probably last you your lifetime,
so combine that with an anaesthetic, you'd have a complete clearance
of the mouth and a set of these fitted
and that's cost effective dentistry for the rest of your life, isn't it?
That's what was thought.
False teeth were a potent symbol of the dentist's stock-in-trade,
bloody and painful extractions.
To protect our teeth from the ravages of decay,
new inventions would be needed to help keep them clean.
In 1780, a rag trader named William Addis,
was arrested near Spitalfields in London for his part
in organising an anti-government riot.
He was found guilty and thrown into Newgate Gaol.
While sitting in his squalid new home, he had a remarkable brainwave.
In his cell, William Addis was attempting to clean his teeth
using a piece of old rag, when he saw a broom in the corner.
Realising that a brush would be much more effective,
he set about making a prototype.
Addis had used a piece of bone left over from his supper to
make a handle and persuaded a guard to buy him some bristles.
The modern toothbrush was born.
Here at the Kent Brush factory in Hemel Hempstead,
they still make brushes by hand, using methods
and materials that William Addis would recognise.
When he started experimenting with his new invention,
William Addis realised that, for an effective, but gentle brush,
he'd need to add a rather special ingredient - pig bristles.
Today, Kent imports their fine pig hair from Siberia, where the
cold climate produces a sturdy bristle perfect for toothbrushes.
How long would it take to make just one toothbrush?
It takes me about 15 minutes.
That's a long time.
Of course, when they were first made, they were all done by
piece work, so you only got paid for the ones you made,
so, obviously, speed was the really most important thing.
Dawn, I've been watching you now, for a while.
I don't think I can do this, but can I have a go?
You're welcome to. So, what do I do? Talk me through this.
You've got to make a loop, poke it through the hole.
Poke it through the hole.
Is that the hole?
No, it's not going through. Nice and straight. Oh, dear.
I'm going to mess up this one for you, aren't I? That's all right!
I've done it. I've got it through the hole.
OK, then I make them - I watched this bit that you were doing
really carefully - then you put it in, divide in half, like that?
Bend in half. Bend it in half?
Oh, that's hard to do, they're really tough.
OK. Then I just pull it, do I? Yeah, the long bit.
Bit more of a grip. Oh, no I've broken it.
This is when you have to start again, isn't it? Yeah.
You take a few bunches out. Really sorry, Dawn. Don't worry.
I've really messed up badly here.
If this was piece work, you'd have just lost, actually,
a sizeable part of your daily income. Yeah.
OK, that's as good as I can do.
By inventing the toothbrush, William Addis would be transformed
from a jailbird into successful businessman.
Within a decade, he'd amassed a vast fortune
and his toothbrush would become a fashionable item for the wealthy.
William Addis's eureka moment was to prove a milestone in dental hygiene.
But it was only the first step in a long road to healthy teeth.
After all, each of his toothbrushes cost six pennies,
far too expensive for most of the population.
For a long time, even those who could afford a brush
would often share it with other family members.
But the toothbrush isn't the only thing people have used to try
and clean their teeth.
It's tingling fresh. It's fresh as ice, it's Gibbs SR toothpaste.
In September 1955, this was first-ever advert seen on British
television screens - a milestone for both TV and our teeth.
See your dentist regularly and brush with SR,
the tingling fresh toothpaste for teeth and gums.
Gibbs SR.
Using weird and wonderful concoctions to clean our teeth
isn't a modern invention. It stretches back thousands of years.
In ancient Rome, it was common to rinse your mouth with urine,
in order to give them a pearly-white appearance.
I'm meeting Dr Martin Ashley of Manchester University Hospital,
who has researched the often-bizarre methods people have used
to try keep their teeth clean.
So, Martin, what really interests me
is how did people actually brushed their teeth in the past?
Well, Joanna, way before we got toothbrushes,
some people liked the idea of having clean teeth.
Not everybody, but some people did and they would use pretty much,
whatever they could get their hands on and they recognised the need
for something a little bit abrasive to clean the dirt off their teeth.
This is oyster shells, that are ground up. Can I touch?
By all means, yes. It's pretty abrasive. It is, isn't it?
Rather than show that on my own teeth,
I will show you on a Perspex block.
We use this when toothbrushes are being tested and toothpaste.
It's not quite as hard as enamel, but if we see an effect
on the plastic here, we know, eventually,
it'll effect the enamel, as well.
You just use you finger.
We believe so, and forgive me, I won't do it.
Apply that to the surface of a block there.
And, presumably, that's about the pressure we'd use,
finger pressure, and do this I can feel the roughness there.
This is one day, one day's worth of brushing.
Feel the difference, it doesn't look a lot,
but the next day and the next day, and do this year after year,
and there'll be nothing left of the teeth.
This would be better. What's this one?
This is soot, chimney soot. So, again, readily available.
Rather than just use their finger they'd use a bit of lint
or some sort of cloth.
What period are we talking about for this?
Probably Tudor times.
And then rubbing some soot on your teeth.
That's a bit smoother.
Nothing like as gritty as this and it tends to break up,
gradually, in the water.
The idea, I suppose, is that it came from fire,
so it was thought to be clean.
And then a mouthful of this looked very dirty and, as you spat out
and rinsed out, your white teeth emerged and LOOKED clean -
as much a contrast to the darkness, as anything else.
My least favourite. The idea of... Can I?
This is brick dust.
Oh, I can hear it, that's awful. Goes right through you, doesn't it?
That's awful. I can't imagine this in my mouth.
So, this would really wreck your teeth.
If I just wipe this clean, you feel the difference.
That's very abrasive. That's the worst.
What would happen if you brushed your teeth with this every day?
Immediately, you're getting through onto the enamel of the teeth
and it would scratch it through.
The protective coating goes,
the natural bright surface of the tooth goes.
Without the enamel there, the tooth is even less resistant
to the abrasions.
It wasn't just cleaning our teeth that caused problems.
Throughout history, teeth have been at the mercy of everything
we've put in our mouths.
Jerry knows that there are certain foods we should eat to help
keep our bodies healthy and develop healthy teeth.
Why, this very morning, Jerry and his sister, Suzy,
started with a good nourishing breakfast,
because eating the right foods can help you keep healthy and your teeth
will have a better chance to grow and develop.
Unfortunately, we've not always been as well informed as Jerry.
For huge swathes of the past, what we ate had a pretty disastrous
impact on our teeth.
In the Museum of London's archives, is a unique record
of the changing state of British mouths.
In these boxes are the remains of hundreds of long-dead Londoners.
Each and every one can tell us something about the diet
and bad habits of the past.
I'm meeting archaeologist, Mike Henderson, who has spent
years charting the changing fortunes of our dental health.
Teeth are one of the hardest,
densest substances in the human body, so we can get lots of
information about a person's diet, their health, their oral hygiene.
One of the things we see commonly in the medieval and earlier
populations, is dental attrition - wear on the surfaces of the teeth.
You can see here, the teeth have worn down to the dentine,
this orange surface there.
That is because the diet was a lot coarser.
If you imagine grinding flour in a mortar to make bread
and parts of grit are going to get incorporated in that.
As you eat, that bit wears the teeth down over time.
Once the stone and grit in bread wore your teeth to the pulp,
the nerves would be exposed,
and it's likely you'd be in constant agony and suffering.
And this one here, this looks like also the person
who's got a bad toothache.
Yes, if you have a lot of cavities,
a side effect could be bacteria enters the tooth
and if it reaches the pulp chamber and starts to cause inflammation,
pus starts to build up and causes a lot of pressure, and it needs
to escape and this is where you see these sinuses, abscesses forming.
So this is where pus has tried to escape?
Yes, to relieve the pressure.
But the pain and decay of the past would be nothing compared to what
would happen when our teeth were exposed to a new luxury commodity.
Towards the 18th, 19th centuries,
sugar becomes more commonplace in the diet, more affordable,
all rates of dental disease, decay starts to shoot up.
This one here looks a very serious case.
As far as I can see, he or she doesn't seem to have any teeth.
This is an older female, potentially, as a result of decay, she's lost
all of her teeth. You're more likely to lose teeth as you get older.
You're more exposed to sugar in the diet.
People also had their teeth taken out, to prevent further
suffering in life.
I am a modern historian, so I'm actually more used
to dealing with paper in a archive,
rather than dismembered human skulls.
It's really is fascinating to see the evidence
of what diet and sugar did to our teeth.
The arrival of sugar on British shores was a dark day for our teeth.
And our insatiable appetite for all things sweet would have huge social,
political and economic consequences.
From its very beginnings, the British Empire
was built on the back of the sugar trade.
From the 16th century, vast sugar plantations in the West Indies
churned out massive quantities of raw cane sugar for export to Europe.
In turn, the sugar industry would drive
the expansion of the brutal slave trade,
which provided the labour needed to harvest and process all that sugar.
It isn't actually sugar that causes decay.
Sugar sticks to our teeth providing fuel for harmful bacteria,
which in turn produce an acid.
It's this acid that corrodes tooth enamel,
eventually leading to cavities.
From sugar's first arrival on these shores,
the British public couldn't get enough of the sweet stuff,
and over the next few centuries, our teeth would suffer the consequences.
But for many years, sugar was the preserve of the rich -
initially the nobility and by the Georgian Age, the middle classes.
But all that would change in the reign of Queen Victoria.
In 1874, the Prime Minister William Gladstone would finally
repeal a punitive tax on sugar.
For the first time, millions of people could afford
to indulge their sweet tooth.
In the next few decades, sugar would wreak havoc in the mouths
of working-class Britons.
The age of mass tooth decay had arrived.
The impact of sugar on British mouths was highlighted during
the Boer War. It was discovered that many British soldiers had
teeth so bad that mincing machines were needed to allow them to eat.
As our teeth began to decay en masse,
dentists would have to find new ways to try and stop the rot.
In the past, a cavity would usually spell the end for a tooth.
What was needed was a way repair the damage and prevent further decay.
One Victorian solution was to hammer small lumps
of gold into the cavity - a long and painful procedure.
But all that would change with the discovery of amalgam, a blend
of mercury and silver, which allowed dentists to fill cavities fast.
But fillings would only really become successful when dentists
also had the means to quickly and effectively remove the decay.
Professor Tim Watson of King's College London has collected
together some historic dentist's tools to demonstrate just how
difficult drilling was in the past.
What would they do to me if I went to a dentist in the 19th century?
Well, if you had a cavity that needed working on or filling
then they would have used hand instruments.
This is an example of a hand drill.
So this is Victorian period. This is Victorian period.
Put that into the end of it
and then that twists... you twist it between your fingers
and that way you can then remove the decay.
Do you want to have a go? I want to have a go, yes. Thank you.
Put that over that finger...
That's right, very good. We'll make a dentist of you yet.
Oh, OK.
Then it just sort of rests in there. That's right.
And then I stick it someone's mouth. Carefully, yes. Carefully, yes...
And hope you don't... Oh, I just stabbed them. Absolutely.
It would be really quite tricky to use
and it would only work actually in the very soft decay.
It wouldn't cut the sound surface of the tooth at all.
It's no wonder that Victorian dentists had such trouble
drilling teeth by hand.
On a mineral hardness-scale, tooth enamel ranks as tougher than steel.
So this is very, very slow. What came after this?
There were various inventions of mechanical ways to drive
the burr round quicker,
but the thing that revolutionised dentistry was
the development of the treadle dental engine.
This looks more elaborate. You can see it here.
What we have here is a hand piece and mechanical drive
and that was powered by a treadle which was foot operated.
So how fast would this go? Quite a lot faster.
You're in the hundreds of RPM rather than single RPM.
It's quite difficult to do, isn't it?
It requires coordination. Can I have a go at this as well?
OK, there we go. OK. Grr!
OK, cavity, here I come! OK, so, this is my poor patient. Yeah.
Oh.
It's kind of like a sewing machine. Absolutely, yes.
You put it inside the person's mouth and... And drill away.
..and drill away like that.
This inside your mouth must be quite horrible. Yes, indeed, yes.
You can hear the grinding noise going, so... Well, yes.
I don't think I'll be coming to you in a hurry!
The arrival of the treadle drill really did change dentistry forever.
For the first time, dentists could fight back
against cavities and save our teeth from extraction.
But to make full use of these new tools, dentists would have to
overcome the problem of their screaming, struggling patients.
In the distant past, pain relief left a lot to be desired.
If you were lucky, while having a tooth extracted, you might be
given a slug of whisky...
or you might need to seek
comfort in prayers to Saint Apollonia,
the patron saint of dentistry.
Pain would only be overcome in the late 19th century
through the discovery of an almost magical set of chemicals and gasses.
The first substance to be used as a general anaesthetic was
nitrous oxide, or laughing gas.
This is one way to keep a child quiet.
Perhaps you'd like to do this for your child some time?
Laughing gas had been used as a recreational drug for decades when
in 1844 an American dentist named Horace Wells spotted its potential.
One day, Horace Wells was sitting in the audience
of a laughing gas road show,
where members of the audience would be invited on stage
to try some gas. Once intoxicated, these guinea pigs
provided entertainment for the rest of the audience.
Then, Wells noticed a very interesting thing.
One man came off the stage with a very serious gash in his leg,
but he felt no pain.
To discover just how effective nitrous oxide is, I'm going to be
administered a carefully controlled dose of "gas and air", the same
mixture of oxygen and laughing gas used in maternity wards.
In 1844, when Horace Wells experimented on himself,
he had a friend pull out a tooth.
Well, I'm not going to have a tooth extracted,
but I do want to test its pain-relieving properties.
I have a needle here. Let me just prick myself. Ouch!
That really, really hurt. Let's see if this works.
Let's see now what happens.
It doesn't feel like anything.
Erm, I feel really quite light-headed.
Am I slurring my words? I'm not sure.
But anyway, clearly it didn't hurt
because I pricked myself a few times that time.
And, erm, yeah...
I don't really know what to say now.
Just...cut!
SHE GIGGLES
OK.
Nitrous oxide undoubtedly worked, but during a public demonstration,
Wells failed to give his patient enough gas.
He was humiliated
and his discovery discredited in the eyes of the medical profession.
But that wasn't the end of the story for pain relief
and to find out what happened next, I've come to
the School of Pharmacy at University College London.
I'm meeting Dr Stephanie Snow,
an authority on the history of anaesthesia.
So, laughing gas is not working, so what comes next?
Well, soon after, dentists and surgeons began to use chemicals.
First they start with ether and then they use chloroform.
Ether is discovered first by American dentists.
It was a safer anaesthetic that chloroform
but it was harder to establish unconsciousness.
So how do they administer these drugs
and are they both administered in practically the same ways?
Yes, the chloroform would be dropped or poured onto a sponge.
So this is just an ordinary sponge. Yeah, just an ordinary sponge.
The sponge would then be wrapped up in a cloth, a handkerchief,
whatever they had to hand,
and then it would be pushed over the patient's nose and mouth
and they would have to be held.
That's really suffocating. That's right, yes.
This is a really imprecise method of administering anaesthetic.
Completely.
I mean, if we look at this, a fatal dose would be something around 30ml,
which would around that.
So if you are using a spoon or a dropper, even, it's very easy
to go over without realising it.
There were quite a few fatalities?
Yes, chloroform particularly had a high level of fatalities,
and it was really because of that that by the 1860s,
dentists started to go back to using nitrous oxide
because it was much safer.
Despite the risks, ether
and chloroform continued to be widely used alongside laughing gas.
But another discovery would soon change pain relief forever.
Ether and chloroform were general anaesthetics.
What dentists really needed was a way of targeting pain relief,
of being able to numb and deaden pain
just in one small place in the mouth or jaw.
So it's here that we turn to coca in the story of pain relief.
So this is cocaine?
This is cocaine. It's produced from coca leaves.
It was used for many years as a stimulant.
It was used in tonics, in Coca Cola, of course.
But in 1884 an eye surgeon in Vienna, Karl Koller,
discovered that it had anaesthetic properties. And what he did,
he made a solution of cocaine, administered it to his eye
and then stuck needles in his eye and found he experienced no pain.
So this obviously is an advance over chloroform or ether.
How did they administer this kind of anaesthetic?
In parallel with discovery of local anaesthetics like cocaine,
the hypodermic syringe was invented and this enabled them
to deliver cocaine to a specific part of the jaw or mouth.
The needle is just there.
But as you'll see, it's not very fine at the end.
That's not fine at all. No.
Actually, that would be quite painful going into you. Yes.
And then they would administer it like that. Yes.
But, I mean, if you think about the precision of that,
being able to target a particular spot, that was a much safer way
of giving dental patients anaesthesia than ether or chloroform.
Yes, obviously.
By injecting cocaine directly into the gums, dentists could now
numb individual teeth providing a much safer
and easier way to carry out fillings.
The arrival of pain relief was a major turning point
in the history of dentistry - from that moment,
dentists could perform more and more complex procedures on our teeth.
But painless dentistry did not mean that it
lost its reputation as a terrifying and agonising ordeal.
Nothing better demonstrates the public perception of dentistry than
the release in July 1914 of Charlie Chaplin's film Laughing Gas.
Chaplin helped cement the idea that a visit to the dentist
was still as barbaric and painful as ever,
despite all the new technologies and use of anaesthetics.
Just a month after the release of Chaplin's film, dentistry would
take another huge leap forward
during the calamity of the First World War.
In August 1914, the British Army went to war
without a single dentist.
But that would change
when one of the most senior British generals got a toothache.
When General Douglas Haig was struck down with a sore tooth,
he was shocked to discover that there wasn't anyone
in British uniform who could help.
Instead, a French civilian had to ease his suffering.
Haig's toothache would have an immediate impact -
by the end of 1914, there were 20 dentists at the front
and over 850 by the war's end.
But dentists weren't just needed for toothaches, fillings and dentures.
The nature of trench warfare meant soldier's heads
were often exposed to fire.
And high-velocity bullets
and shrapnel smashed faces beyond recognition.
Huge numbers of men flooded back to Britain with faces
seemingly damaged beyond repair.
Many of their injuries were so severe it seemed a miracle
they had survived at all.
Working in conjunction with plastic surgeons, dentists would be
at the forefront of rebuilding these men's faces, and their lives.
I've come to the Royal College of Surgeons where there is a unique
record of how dentists treated these shattered faces of World War I.
I'm meeting historian Kristin Hussey who has researched these
pioneering dental surgeons and their patients.
Kristin, what do we have in front of us?
We have got a file - Yarnold. Yes. Tell us about this particular man.
What we are looking at here is this man's case file.
You can see he was wounded in October 1918.
So very unfortunate, very close to the end of the war.
Age 24.
Yes, a very young man. You can see here that he has received
a gunshot wound of the chin and a fracture of the mandible.
'Gunshot wounds and shrapnel blasts caused some of the most disfiguring
'of all injuries, often removing entire sections
'of the face and jaw.'
One of the first things they would have done for him
was extract teeth.
Teeth would often become septic on the trip from the continent
back to Britain, so they were the one of first things to go and
indeed dental surgeons would be one of the first people he encountered.
What would the dental surgeons actually do?
What were they able to do in this period?
One of the number one things dentists would have done was provided
splints to support the jaw in order to aid its healing,
but also they crafted incredible dentures
and external supports to really recreate the structure
of the face, that hard tissue structure,
that the plastic surgeons could then graft over.
If you look here at the images, you can see he's lost
the majority of his jaw on that side. Yes, all gone.
'Private Yarnold's injured chin was being repaired with a tubular
'skin graft, grown from his neck.'
So not only are the plastic surgeons rebuilding that area with
skin grafts, it was also suggested by the consulting dental surgeon
they use a bone graft to fill in that gap.
What bone would be used from his body?
They would have used graft from the tibia, so the shin bone,
to recreate that part of the jaw,
which was a very pioneering technique at the time.
Unfortunately with this soldier, it was decided it wasn't advisable,
he wasn't strong enough to undergo that treatment.
In the course of the war, over 60,000 British soldiers
received facial injuries.
These wounds were often so severe that dentists
had little idea what they were dealing with, so specialised
techniques were needed to diagnose and plan treatment.
One method was to make dental casts of the injured soldiers' mouths.
This is quite a striking image.
You can see that the gunshot has entered the jaw just there,
carrying away a significant proportion of the bone.
What would happen to a man with a wound like this?
This dental cast would have the first step towards his healing
because it would have helped them visualise his injury, but also
plan the procedures, the surgical operations to be carried out.
Another important tool for diagnosis was the X-ray which had been
discovered in 1895, but its use was still in its infancy.
Dentists and plastic surgeons adapted
and improved existing techniques for use on the face.
I thought you would be interested in seeing this one.
What does this show?
You can see the extent of the gunshot injury of the lower jaw.
Obviously it's been splinted, probably by someone
in a clearing station to send them back to Britain.
All of these dark spots you can see are dirt and probably cloth that
have become caught in the wound when the blast was received to the face.
So we have a real problem here with infection.
Exactly, and that was why the dental surgeons were
so important in removing teeth.
They were trying to make the mouth and the oral cavity no longer
infected so they could proceed with treatment.
It was a challenge for dental surgeons to try and tackle the extent
of these injuries that they had never experienced in peacetime.
But for the soldiers who had facial injuries in the war,
there really was no final end point.
It was always going to be a struggle for them.
There's one major debate. Is war good for medicine?
Unfortunately, in the case of facial surgery, it was.
In the crucible of the First World War, it took pioneers
to radically transform surgical practices.
In doing so, they literally changed forever the lives of so many men
who otherwise would have lived out quite miserable existences.
By harnessing new technologies, dentistry was on the road
to becoming the modern science we know today.
But at the same time, our teeth were gradually getting worse.
Years of sugar consumption meant a whole generation had rotten mouths.
In the early 20th century, dental care was so expensive
that some people would choose to have all their teeth extracted
in order to avoid a lifetime of dental costs.
Believe it or not, having all your teeth removed was considered
the perfect gift for a 21st birthday or a newly-married bride.
Oh, well, I had very bad teeth then, they were terrible.
I'd keep having toothache so I thought,
"Oh, right, get them all out together."
So I've had them all out.
They just decayed and I had to get them out.
I was suffering in agony and pain.
The universally terrible state of British teeth would take on a whole
new importance during the Second World War. Bad teeth wouldn't just
be a national embarrassment, they'd become a matter of life and death.
BELL RINGS
Attacking measures met. Tally-ho.
As the Battle of Britain raged and bombing missions began over Germany,
the Royal Air Force realised that it had a serious problem -
many pilots were suffering agonising toothaches whilst in the air.
At high altitudes, cavities and defects in the teeth
could become acutely painful and in consequence,
some 5% of missions were being aborted due to toothache.
With aircrew in desperately short supply,
something needed to be done urgently.
To get pilots' teeth in shape, the RAF drafted in a band of young women
who would teach them how to clean their teeth and correct
years of neglect. These women would become Britain's first hygienists.
Freda Rimini qualified soon after the war's end,
but completed the same course as the first wave of RAF hygienists.
The training they underwent was often quite bizarre.
I remember we started off by carving wax blocks.
We were given a tooth and we had to reproduce the tooth.
This was to increase our manual dexterity, which I think it did.
After we had done that, we moved onto door handles.
These were mounted onto the headrest of the dental chair
and the door handle was painted
and we then, with a variety of instruments, had to remove the paint.
And having removed the paint, it was then replaced
and we removed it again.
Having trained for nine months scraping paint
and learning about anatomy, hygienists went to work
immediately improving the teeth of pilots and aircrew.
In those days, the mouths were pretty awful, really.
We'd remove all this...the debris
and then we'd suggest they use a toothbrush - might be a good idea -
and then we sent them away and they came back six months later
and we did it all again.
Within just a few years, a trip to the dentist's wouldn't be
complete without a hygienist giving you a scale and polish,
and perhaps a bit of friendly brushing advice.
It takes at least 200 brushstrokes to get around a complete
set of teeth properly, and Sally is told that this should take her
approximately three minutes every time she cleans her teeth.
During the Second World War, millions of ordinary Britons had
been given free medical and dental treatment by the armed forces.
When peace finally arrived, many believed this duty of care
should be taken on by the state.
To make this happen, the government commissioned an economist
named William Beveridge to investigate what ordinary
Britons' lives were like.
His findings would lead to the creation of the Welfare State
and a new National Health Service.
This leaflet is coming through your letterbox one day soon,
or maybe you have already had your copy.
Read it carefully.
It tells you what the new National Health Service is
and how you can use what it offers.
Study the leaflet then keep it by you.
You'll need it for reference.
From the 5th July 1948, all aspects of medical care would be
provided free of charge.
When the first wave of patients arrived, dentists set to work
rectifying years of neglect.
We had a hell of a lot of work to do when the NHS came into being.
Mainly extractions to begin with and dentures
and then the fact that you could save teeth pretty painlessly
and that seeped through the population, and they came
and had their dental treatment, had their fillings done.
In just nine months, NHS dental technicians made over 33 million
replacement teeth, and dentists filled over four million cavities.
There were long queues outside some dental surgeries
and overworked dentists were seeing hundreds of patients a day.
In the first few years, the NHS dental budget was more than
double what had been planned.
So in the early 1950s, charges for dental treatment
had to be introduced.
The arrival of the NHS was probably the most important change
in British dentistry. For the first time,
ordinary people could afford to go to the dentist.
But the democratisation of dental care did not lead to significant
changes in our attitudes - most people would still
only go to a dentist if forced to by pain.
NHS dentists would work wonders fixing Britain's rotten mouths,
but that was only half the battle. The war for Britain's teeth
would be won not in the dentist's chair but in the bathroom.
Of the thousands of new innovations
and dental products that found their way into British homes,
there was one that really would transform the state of our teeth.
I've heard a great deal about a chemical that can be
used on the teeth to help prevent decay.
Is that a good thing to use?
It certainly is.
We use a fluoride solution and we have evidence that for some people,
this fluoride treatment helps prevent decay.
The addition of fluoride to toothpastes
and some water supplies coupled with increasing numbers
of people cleaning their teeth had a dramatic impact on British mouths.
In the 1960s, over 40% of all adults had no teeth at all,
but by the year 2000, that figure had fallen to just 6%.
British mouths had been transformed beyond recognition in just
a few decades and today a set of healthy, straight,
white teeth is considered a mark of wealth and success.
If you can afford it, you too can be the proud owner of a perfect smile.
A visit to the dentist today is unrecognisable from just
100 years ago, let alone from the days of the brutal barber surgeon.
But despite all the advances of the past 500 years,
one in ten of us are still terrified at the prospect of a dentist
poking and prodding at our teeth.
In some ways, it's not surprising -
our mouths are among the most personal and sensitive parts
of our body - so strong reactions are understandable.
But that doesn't explain it all.
It seems to me that the past still exerts a powerful influence
on our current attitudes and fears, but also on our collective memory.
Millennia of pain and terror are deeply embedded within
the fabric of our society - phrases like "pulling teeth"
litter our language, recalling those darker days.
So despite all the great scientific advancements,
pain-free trips to the dentist and those gleaming Hollywood smiles,
we still can't seem to forget dentistry's long and bloody history.
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