Pierre Fauchard

Lore & Background

Fauchard was born in a modest home in Saint-Denis-de-Gastines on 2 January 1679. In 1693 he joined the French Royal Navy at age 14, much to his family's distress, and came under the influence of Alexander Poteleret, a surgeon major who had spent considerable time studying diseases of the teeth and mouth. During that time, Fauchard learned that sailors on long voyages suffered severely from dental ailments, scurvy in particular. Poteleret inspired him to read and investigate the findings of his predecessors, and Fauchard became a combat medic as Poteleret's protégé. After leaving the navy, he settled in Angers and practiced at the University of Angers Hospital, pioneering scientific oral and maxillofacial surgery. He often described himself as a "Chirurgien Dentiste," a rare term at the time. Despite primitive instruments, he was considered a highly skilled surgeon and made remarkable improvisations of dental instruments, adapting tools from watch makers, jewelers, and barbers. He introduced dental fillings for cavities, asserted that sugar-derived acids like tartaric acid caused decay, and suggested that tumors surrounding teeth could appear in later stages of decay. He pioneered dental prosthesis, carving substitutes from ivory or bone and holding them in place with pivots, waxed thread, or gold wire. He also introduced dental braces, initially made of gold, using waxed linen or silk threads to fasten them.

Reader's Guide

Pierre Fauchard transformed dentistry from a craft into a science. Before his work, people went to barbers or tooth-pullers who used imprecise tools called pelicans that often pulled healthy teeth or parts of the jaw. Literature on teeth was only found in general surgical treatises, and no regulation existed until the Edict of 1699 created the title "expert pour les dents." Fauchard bemoaned that the medical community had largely ignored teeth, allowing untrained people to practice without theory or method. He believed practitioners should learn to preserve teeth instead of just pulling them. His book *Le Chirurgien Dentiste* consisted of 38 chapters in volume 1 and 26 in volume 2, covering dental education, anatomy, caries, pathology, orthodontics, surgery, replanting and transplanting, and prosthetic dentistry, with 42 plates depicting instruments. He described symptoms of 103 mouth diseases, argued against the German tooth worm theory, identified sugar as a cause of caries, and recommended limiting sugar in the diet. He disproved theories of spontaneous tooth generation, explaining that milk teeth separate from their roots. He introduced dental fillings using lead, tin, or gold, and said teeth should be cleaned periodically by a dentist. He recommended braces to correct tooth position and noted that children's teeth could be moved more easily than adults'. He advised that the dentist should stand behind the patient to help them relax and introduced the concept of a dentist's chair light. The book was well received: a German translation appeared in 1733, an enlarged French edition in 1746, but an English translation had to wait until 1946.

Did You Know?

• Fauchard joined the French Royal Navy at age 14 in 1693, much to his family's distress.
• He adapted dental instruments from tools used by watch makers, jewelers, and barbers.
• Fauchard's book *Le Chirurgien Dentiste* grew from a 600-page manuscript in 1723 to 783 pages by its 1728 publication.
• He recommended that human urine be used in the treatment of early stages of caries, noting that ammonia was the active compound.
• An English translation of his book did not appear until 1946, over 200 years after the original French publication.

Naval Origins and the Seed of a Vocation

Pierre Fauchard was born in a modest home in Saint-Denis-de-Gastines on 2 January 1679. In 1693 he joined the French Royal Navy at the age of 14, much to his family's distress, and came under the influence of Alexander Poteleret, a surgeon major who had spent considerable time studying diseases of the teeth and mouth. During that time, Fauchard learned that sailors who were on long voyages suffered severely from dental ailments, scurvy in particular. Eventually Major Poteleret inspired and encouraged him to read and carefully investigate the findings of his predecessors in the healing arts. He said he wanted to disseminate the knowledge he learned at sea based on actual practice. This idea led Fauchard to become a combat medic as Poteleret's protégé.

Pioneering Techniques in Angers

Once Fauchard left the navy, he shortly settled down in Angers, where he practiced medicine at the University of Angers Hospital. In Angers, he started much of the revolutionary medical work we know today, and he was the pioneer of scientific oral and maxillofacial surgery. Fauchard often described himself as a "Chirurgien Dentiste" (surgical dentist), a term very rare at the time as dentists in the 17th century generally extracted decayed teeth rather than treating them. Despite the limitations of the primitive surgical instruments during the late 17th and early 18th century, Fauchard was considered a highly skilled surgeon by many of his colleagues at Angers University Hospital. Fauchard made remarkable improvisations of dental instruments, often adapting tools from watch makers, jewelers and even barbers, that he thought could be used in dentistry. Fauchard introduced dental fillings as treatment for dental cavities. He asserted that sugar derivate acids like tartaric acid were responsible for dental decay, and also suggested that tumors surrounding the teeth, in the gums, could appear in the later stages of tooth decay. Fauchard was the pioneer of dental prosthesis, and he discovered many methods to replace lost teeth. He suggested that substitutes could be made from carved blocks of ivory or bone and those artificially-made dental pieces would be useful as the natural ones. One of his methods stated that the artificial teeth would be held in place by tying them to the remaining solid teeth by pivots, using waxed thread or gold wire. He also introduced dental braces, although they were initially made of gold, he discovered that the teeth position could be corrected as the teeth would follow the pattern of the wires. Waxed linen or silk threads were usually employed to fasten the braces.

The Book That Defined a Discipline

During 1716 to 1718, Fauchard gained great prestige. During that time he spent long periods away from home studying and sharing his medical practice with other surgeons across France. In 1718, Fauchard moved to Paris. During his stay in that city, Pierre realized that many medical libraries lacked good textbooks on dentistry and that an encyclopedic teaching book of oral surgery was needed, so he made the decision to write a professional dentist's treatise based on his medical experience. For many months Fauchard gathered as many medical research books as he could, interviewed the many dentists he had met, and reviewed his personal diaries during his years at Angers to write his manual. Finally in 1723, at the age of 45, he completed the first 600-page manuscript for "Le Chirurgien Dentiste" (roughly translated as "The Surgical Dentist"). Fauchard sought further feedback from his peers over the next five years, and the manuscript had grown to 783 pages by the time it was published in 1728 in two volumes. The book was well received in the European medical community. A German translation was already available in 1733, an enlarged edition in French was published in 1746, yet an English translation had to await 200 more years to 1946.

Challenging a Century of Neglect

Fauchard bemoaned how the medical community had largely ignored teeth. He said that "The most famous surgeons having abandoned this part of the art, or at least having paid little attention to it, have caused by this negligence, the rise of people who without theory or experience, have degraded it, and practiced haphazard, without principles or method." He believed that too many tooth-pullers were spending too much time learning how to pull teeth through trial and error, and he believed that people who worked with teeth ought to spend more time learning how to preserve teeth instead. People would often go to barbers or tooth-pullers to have work done on their teeth instead of doctors. Tooth pullers would often use tools called pelicans to draw teeth. These pelicans were not very precise, and would often pull healthy teeth along with the problematic ones. Sometimes, these pelicans would take out part of the jaw too. Surgeons were trying to gain status during this time and wanted to distance themselves from the tooth-pullers. Hence, Fauchard was rather unusual to be a surgeon who studied teeth at the time. Literature on teeth was generally found in treatises on surgery, as there were no books written explicitly on teeth at the time. There was no regulation on who could do work on teeth until the Paris Medical Faculty issued the Edict of 1699, which created the title of expert pour les dents, or "tooth expert," for people certified to do dental work.