DOI: 10.1051/odfen/2011103 J Dentofacial Anom Orthod 2011;14:104 Ó RODF / EDP Sciences

Pierre Fauchard the ‘‘inventor’’ of

Julien PHILIPPE

ABSTRACT No one before Pierre Fauchard had claimed to be able to move teeth except Celsus who suggested applying finger pressure to a tooth that was erupting in the wrong direction. Fauchard advised to examine a patient’s mouth and occlusion first and then, if necessary, to use one of a number of methods he proposed to ‘‘straighten’’ irregular teeth. The principal device was a ‘‘plate,’’ a small segment of thin metal attached to anchor teeth from which force could be exerted on mal-positioned teeth. He uprighted teeth leaning inward by luxation with a ‘‘pelican.’’ The two chapters of his book that were devoted to ‘‘straightening’’ teeth constitute the origin of modern orthodontics.

KEYWORDS

Pierre Fauchard History of orthodontics Conflicts of interest: none Received: 08-2010. Straightening teeth. Accepted: 10-2010.

1 – INTRODUCTION

Did orthodontics exist before the 1728 temporary tooth should be extracted and publication of Pierre Fauchard’s book, The that corrective finger pressure should be Surgeon or a Treatise on the Teeth? applied to the erupting tooth every day. This It is true that Celsus a Roman contem- is the only known pre-Fauchard reference to porary of Jesus Christ wrote that when a tooth straightening. Certainly, Chauliac and tooth was erupting in a faulty direction the Dionis advised dentists to file down teeth

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that were too long and certainly ‘‘straightening’’ teeth. To use the term Dupont and Allen thought that teeth orthodontics would be an anachron- could be moved, but no one, except ism. Chapter XXVIII of the first tome of Celsus, had indicated how that could Fauchard’s work is entitled ‘‘Twelve be done. Fauchard wrote that ‘‘many observations on deformed and poorly people have told me that they have arranged teeth’’ (fig. 1). Chapter VIII of often seen teeth straightened and the second volume is entitled ‘‘Tortu- arranged by the late Mr. Carmeline ous (sic) teeth, badly arranged and and by many others.’’ But Carmeline luxated, instruments and remedies never published. that are useful in operating on them In other words there was virtually when dentists straighten and stabilize no available documentation on the them’’ (fig. 2). These two chapters, subject when Fauchard wrote the fewer than fifty pages, established the two chapters of his book that served specialty that would later become 1 as the basis for a dental practice of orthodontics .

2 – THE CLINICAL EXAMINATION

Fauchard did not begin his appoint- check to see if they are longer or ment with a patient by leaping im- larger than the straight teeth that are mediately at the tooth that needed alongside them. If the tooth to be straightening, as his contemporaries corrected is longer or larger than it would have. Instead he introduced the ought to be, it should be filed down to practice of an initial clinical examina- the size of the teeth in good position tion, writing, ‘‘After having seated the before any movement is attempted. person in an appropriately designed The dentist should also file down the chair, before straightening the teeth teeth in the opposing jaw if they have that need correction the dentist achieved an eruptive height greater should first make an examination to than they should have so that in determine what situation to place movements of the jaws these teeth them in; to accomplish this, will not be thrust against their antago- the dentist must open and close the nists that are being straightened.’’ mouth of the subject upon whom In these few words Pierre Fauchard the operation will be performed. First introduced the idea of occlusal equili- the dentist should examine the teeth bration to the dental profession. that are curved or overly inclined,

3 – FINDING ROOM IN THE ARCH

Fauchard did not know about, nor Lefoulon. In order to resolve even imagine, the possibility of problems arising from crowding, expanding the arch. This procedure Fauchard had only two methods at was not discovered until 1841, by his disposal, extraction or filing,

2 Philippe J. Pierre Fauchard the ‘‘inventor’’ of orthodontics PIERRE FAUCHARD THE ‘‘INVENTOR’’ OF ORTHODONTICS

Figure 1 Figure 2 The first page of chapter XXVII of volume 1, which The beginning of chapter VIII of volume II, which contains a series of clinical observations. describes the procedures to be used for ‘‘straighten- ing’’ teeth.

which we would call today, inter- proximal stripping. can be placed in line with the others thanks to an existing gap, the dentist can straighten that tooth as much as 3 – 1 – EXTRACTION space allows.’’ ‘‘Sometimes crooked teeth cannot be brought into place because there is 3 – 2 – ‘‘FILING’’ TEETH insufficient available space to accom- modate them. In such cases the Filing teeth was an operation that dentist is obliged to remove one of Fauchard employed frequently and the the crooked teeth in order to distribute long chapter he devoted to it sug- space to those that need it.... If, on gested three indications for this pro- the other hand, a poorly located tooth cedure:

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- teeth that were crowded could be be immersed in hot water before use made slimmer so that they could be to protect the patient from feeling a properly aligned; cold shock and the filing should be - teeth that were broken and that cut limited to the enamel layer, which was into the cheeks could be smoothed thinner in children. That is why ‘‘there out; is less danger in filing the teeth of - teeth that were too long could be older people’’. In addition, teeth of shortened for esthetic reasons or to older patients are ‘‘not as sensitive as equilibrate the occlusion. the teeth of younger people’’. ‘‘It Fauchard described in minute detail doesn’t often occur that older people what position operators should take in find it hard to endure the pain of filing regard to their patients and how to teeth; while sometimes younger peo- place the fingers of the left hand for ple have teeth that are not too each group of teeth to be filed. The sensitive and are able to sit through labial commisures were protected this operation without feeling pain.’’ with a ‘‘fine cloth’’. The file should

4 – FAUCHARD’S STRAIGHTENING TECHNIQUES2,4,5

4 – 1 – The finger diastemas between incisors and to straighten teeth inclined laterally. ‘‘The teeth of young subjects are much easier to straighten than those of adults. That is why it is best first to 4 – 3 – The or silver blade try to reposition teeth with finger or plate pressure, which should be done many times over the course of the day.’’ ‘‘If the teeth are so severely inclined that the wire cannot gain purchase, the dentist should use a thin plate of 4 – 2 – The wire gold or silver whose length should not exceed that of the two straight teeth ‘‘When the teeth are leaning out- between which the crooked teeth are side or inside the arch finger pressure located...this plate should be neither alone doesn’t suffice to straighten too solid nor too flexible’’. ‘‘The them, the dentist should utilize a wire dentist makes two holes on both ends or waxed silk folded over many of the plate, and passes a wire times.’’ Fauchard wrote, explaining in through both of them and does the minute detail how to derive support same thing at the other end with a from well-aligned teeth, wrapping the similar wire.’’ In principle, the wire is wire around several times so that it placed on the side of the mal-posi- ‘‘embraces’’ the tooth inclined lin- tioned tooth, buccally for a tooth gually or buccally. ‘‘The dentist acti- leaning buccally and lingually for a vates these wires several times a tooth leaning lingually. The wires are week and more often if necessary.’’ tied around the anchor teeth situated The wire is also used to close on each side of the mal-positioned

4 Philippe J. Pierre Fauchard the ‘‘inventor’’ of orthodontics PIERRE FAUCHARD THE ‘‘INVENTOR’’ OF ORTHODONTICS

Figure 3 The gold or silver ‘‘plate’’. Its extremities were ligated to well-placed teeth and, in accordance with the needs of each case, exerted pressure or traction, with the aid Figure 4 of a ligature, on crooked teeth. Laforgue used the same plate, only slightly modified, in 1802.

teeth and, by their pressure, ‘‘the sheet will over time straighten the other more expeditious and less in- crooked teeth’’. The dentist might convenient methods, I found what I want to replace the holes with inden- wanted with the pelican and straight tations. Dentists may also decide to tweezers (and forceps for maxillary place the sheet buccally to correct a incisors). With the help of these two lingually inclined tooth if they fear that instruments dentists, when they have with lingual placement ‘‘patients mastered their use, can, in a moment, would have difficulty in talking or have accomplish what they are able to do their tongues made uncomfortable’’. with wire and plate only after a Fauchard used this metal sheet for a variety of purposes that he thought- fully described for his readers. He employed it, in fact, in much the same way that today’s orthodontists utilize arch wires. And Fauchard’s successors would continue to employ his thin metal plate for more that a century (fig. 4).

4 – 4 – The pelican (fig. 5) ‘‘When people are somewhat ad- vanced in age, it takes a fairly con- Figure 5 siderable amount of time before one This sketch shows a pelican being used to extract a can carry out the technique that I just molar tooth. It is easy to see how the operator could described. This period, which is some- also employ it to upright ‘‘teeth inclined inward’’ by times quite long, induced me to seek gaining purchase on the buccal gingiva.

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considerable amount of time.’’ But 4 – 5 – Retention Fauchard added an important caveat: ‘‘the pelican should be used only for Once they were luxated, teeth were teeth that are leaning inward’’. held in place by ligatures or, some- times, by the application on each side In using the pelican orthodontically of a plate, furnished with a bit of the operator gained purchase on gingiva cloth or linen to prevent it from and applied pressure from the buccal slipping*. These plates were affixed side of the tooth tilted lingually. This is a by gold wires that went from one to risky maneuver and Fauchard warned the other between the teeth. It was repeatedly of its dangers. This didn’t imported for patients to use prevent his ‘‘boy’’ (apprentice) from mouthwashes: ‘‘four ounces of wine fracturing the tooth of a ‘‘young and with one ounce of rosat honey’’. beautiful lady’’ that he was trying to straighten. Fauchard was proud of this *Described by B. Martin, in 16793. procedure that he had invented.

5 – CLINICAL OBSERVATIONS

Fauchard promised his readers by application of retention wires for ‘‘Twelve observations on deformed one or two weeks. These patients and badly arranged teeth’’ but, in fact, were 9 to 30 years old, with an included fourteen in his text. For each average age of 18. The first of these observation Fauchard gave the names treatments took place in in and ages of the patients, described the 1696. It was the only one that required state of their dentitions, and explained extractions, of four canines ‘‘which how he had operated. These observa- were placed so far out of the mouth tions are extremely expressive, giving that the incisors were leaning toward an animated idea of how Fauchard the tongue’’. performed as a practitioner. Most of these procedures took Seven of the cases he treated with place between 1719 and 1723. His the plate and ligature, after having latest case report, from 1727, de- filed or stripped the teeth. The treat- scribed the closing of space after ments of patients 11 to 14 years old, extraction of the root of a broken with an average age of 12 years and 9 incisor, following by the equilibration months, were completed, on the of the uneven and chipped incisal average, in five weeks. edges of the remaining anterior teeth. He treated seven other cases by manipulation of the pelican followed

6 – CONCLUSION

Pierre Fauchard was the first to moved with an appliance designed demonstrate that the teeth could be for that purpose. The one that he

6 Philippe J. Pierre Fauchard the ‘‘inventor’’ of orthodontics PIERRE FAUCHARD THE ‘‘INVENTOR’’ OF ORTHODONTICS

proposed the ‘‘plate’’ was lengthened French pioneers became a biological little by little by Fauchard’s successors science thanks to the work of the until it became the arch wire used Scottish surgeon and anatomist John today3. Hunter who published two books on Fauchard founded orthodontics. So the teeth, gingival tissues, and their its birthplace was . The infant diseases in 1771 and 1778. science would be fleshed out by From then on orthodontics gradually Bunon in 1743 and further improved spread throughout the world, improv- by Bourdet in 1757. The practical ing ceaselessly. application of orthodontics by these

REFERENCES

1. Fauchard P. Le Chirurgien dentiste ou Traite´ des dents. : Mariette, 1728;vol.I : 309–330, et vol.II : 85–111. 2. Gysel C. Histoire de l’orthodontie. Bruxelles : SBO, 1997. 3. Martin B. Dissertation sur les dents. Paris, 1679. 4. Philippe J. L’orthodontie de Pierre Fauchard. L’Information dentaire du 8 fev. 1996:341– 345. 5. Weinberger, BW. The History of Orthodontia. Intern Dental J 1916:103–110.

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