Like poverty, toothache and periodontal disease have always been with us. Extraction was the earliest and most basic dental procedure to treat these problems. For many people living in Britain before the 20th century, having a tooth extracted would have been their main experience of dentistry. Early suppliers of this invaluable service were non-specialists who offered it as a sideline: wig-makers, barbers, jewellers, apothecaries and even blacksmiths.

There were also specialist toothdrawers, who travelled the country to tend to people needing extractions, often setting up stall in markets and fairs, and acting like showmen to bring in the customers. Such characters were not always the better option for the hapless patient, however. There are many stories of toothdrawers planting stooges amongst the crowds that visited their stalls. These actors would be the first to have their ‘extraction’ done, and then exclaim how quick and painless it had been. Subsequent patients would not be so lucky. A seemingly straightforward procedure, extraction could be fraught with danger. Gum and bone were often removed along with the tooth, and an untrained person could even break the patient’s jaw. The British Dental Association estimates that dental procedures accounted for 10% of deaths during the medieval period.

The term ‘dentist’ first appeared in the 18th century. By this time, things had developed beyond simply extracting – for those who could afford it, at least. By the 1750s, practitioners calling themselves dentists were advertising their services in the press, including scaling and even tooth whitening. By 1780, the first commercially available toothbrush was being produced, with bone handles and bristles made from horse or pig hair. They cost 6d, the equivalent of just a couple of pounds in today’s money, but still much too expensive for the ordinary person to buy, so most people did not clean their teeth.

With a lot of people therefore losing teeth to extractions or gum disease, there was a demand for dentures to replace what had been lost. This demand only grew with increasing post-medieval sugar consumption: an excavation in Spitalfields, London, which contained burials from 1729-1852, found that 87 per cent of people interred had cavities.

Most early dentures were made from hippopotamus ivory as a base, with the teeth themselves made from materials such as cow’s teeth, elephant ivory or walrus tusks. Such materials rarely fitted well, and darkened and discoloured within months due to the actions of saliva, although advertisements from the time were ever optimistic. One placed by John Watts of Fleet Street, London, in 1711 offered artificial teeth that were “not to be distinguish’d from natural, not to be taken out at night, as is by some falsely suggested, but may be worn for years together… they are an ornament for the mouth and greatly help the speech”. The result for the unfortunate wearer was something that didn’t look very good, caused foul breath and gave a rotten taste in the mouth; it was no wonder that fans were so fashionable at the time.

While comfort and fit improved somewhat with the introduction of Vulcanite denture bases in 1851, dentures still made the wearer look a little odd. For those with money, more natural-looking dentures made from human teeth could be bought – these subsequently became known as ‘Waterloo teeth’. Battlefield scavengers routinely stripped corpses of dead soldiers for teeth, as the unwitting donors were mostly young and otherwise healthy; the estimated 50,000 dead at the battle of Waterloo provided a bumper harvest for the industry. ‘Waterloo teeth’ continued to be offered via dental supply catalogues as late as the 1860s, the source by then being the American Civil War.

While this might seem unpleasant for the wearer, this was not the most unpalatable source of teeth for recycling into dentures. Some came courtesy of ‘resurrectionists’, professional grave robbers who dug up freshly interred bodies to supply to anatomists and medical schools; the sale of the deceased’s teeth would have been a nice side line for such men.

The pain caused by dental treatment had always been a problem, with people having to weigh the pain of treatment against the pain of what needed to be treated. Experiments to find suitable ways of treating dental pain had therefore long been carried out. In the medieval world, a variety of natural substances were tried, such as hemlock, opium and henbane. Nothing much changed for a long time. In the 1840s, however, the long-suffering dental patient was offered hope with the discovery of general anaesthesia: 1844, Horace Wells first demonstrated the use of nitrous oxide (laughing gas) as an anaesthetic, and this was swiftly followed by the introduction of ether in 1846 and chloroform in 1847.

While the discovery of anaesthesia was undoubtedly one of the great medical advancements of the age, things were still far from ideal. Chloroform and ether could only knock patients out for short periods, so dentists could perform a limited range of procedures while the patient was under. More worrying issues were the unpleasant side-effects caused by these vapours (such as nausea), and the ease with which a fatal overdose could be accidently administered.

Ether and chloroform soon began to fall out of favour with dentists, but a new drug that could provide a local anaesthetic was first demonstrated in 1884 and seemed to offer hope: cocaine. This was not automatically included in the treatment, however. An advertisement from a Mr Bradlaw in 1901 showed that you needed to pay an extra 2 shillings and 6d for your pain relief, although reduced fees were available “to servants and persons of limited means”. The introduction of improved anaesthesia encouraged more people to undergo lengthier dental treatments – fillings became a more realistic alternative to extracting a bad tooth.

This is not to say that filling bad teeth was a new idea. The principle had been around since at least the 16th century, but with the only means of excavating the tooth being a jeweller’s bow drill, and later a slow clockwork drill, the idea never really caught on. The invention of the treadle drill by James Morrison in 1871 revolutionised things, however. Operated by a foot treadle like a sewing machine, this device offered greater speed and control for the dentist, although how quickly he could drill your tooth depended on how quickly (and smoothly) he could ply the treadle. Morrison boasted that his machine “is completely painless and relatively more pleasant than other methods of resection”. While claims for it being painless are questionable, it certainly started the process of faster and more accurate drills being developed for dentistry, and things gradually improved for people with rotten teeth.

Dentistry began to come more professional from the late 19th century. The first British dental licence was awarded in 1860 to Sir John Tomes, a pioneer who designed one of the first dental chairs. The number of dentists in Britain rose from 1,584 at this time to 5,309 (including 140 women) in 1901. However, it took until the Dentists Act of 1921 for the practice of dentistry to be restricted to qualified professionals. The new era of properly professional dentistry had begun and with the advent of the NHS in 1948, it finally became fully available to all.