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History of Dentistry

History of Oral Surgery

by Iiley R. Thompson, D.M.D.

Probably the earliest man to be designated as an oral surgeon was Simon P. Hullihen (1810-1857). He has been called ÒThe Father of Oral Surgery" by some. He finished his formal education at the age of sixteen and obtained honorary medical and dental degrees after many years of practice as a Òdental, oral and general surgeon". His talents in surgery were recognized in the form of an honorary D.D.S. from Baltimore College of Dental Surgery. He achieved a truly remarkable record of operations which covered the entire field of oral surgery, including plastic operations.

James E. Garretson (1828-1895) was another pioneer and is generally recognized as "The Father of Oral Surgery". Modern development began in 1869 with the publication of his great book A System of Oral Surgery. The book went through six editions between 1869 and 1896. This was the first American text dealing with this subject. Dr. Garretson's influence as a teacher and educator were largely responsible for the establishment of oral surgery as a branch of medicine and dentistry, though distinct from both. Thus, it was the custom for several early generations of oral surgeons to hold dual degrees. Neither dental nor medical training alone was considered adequate for oral surgery.

All of the following men had medical as well as dental degrees, and the contributions of these pioneers in oral surgery are a joint heritage of dentistry and of surgery. They are bridges between the two professions, but as both dental and medical courses were lengthened it became impractical to require the dual degrees.

Truman W. Brophy (1848-1928), about whom it has been said that he made the dumb speak and the sad smile. He was known everywhere for the special operation on cleft palate and harelip. He was also the organizer of the Chicago Dental College, and served that institution as professor of oral surgery and as dean for about forty years.

Matthew H. Cryer (1840-1921) was a recognized authority on cranial and facial anatomy, and his book on the subject became a classic. He collaborated with other dentists and oral surgeons in establishing the first complete hospital dental service in the United States in 1901 at the Philadelphia General Hospital.

Thomas L. Gilmer (1849-1931) of Chicago, whose major affiliations were with dental schools also had staff positions on hospitals, which gave him standing as a medical man as well. He was accepted as a Fellow of the American College of Surgeons when it was founded in 1912.

George V. I. Brown of Milwaukee was another oral surgeon who specialized in cleft palate surgery, and differed so radically from Dr. Brophy on the subject that they were not on speaking terms.

Dr. John Sayre Marshall (1846-1922), a Civil War veteran, was one of the early teachers and practitioners of oral surgery. He wrote a book which was a standard textbook for teaching oral surgery in dental schools. Dr. Marshall is perhaps best known as the founder of the U. S. Army Dental Corps in 1901.

Although instruction in basic surgery was a keystone to the dental curriculum from the first formal dental college in 1839, the concentrated postgraduate education and hospital training for oral surgery did not emerge until some fifty years ago.

With the beginning of a complete hospital dental service and internship at the Philadelphia General Hospital in 1901, other hospitals in various parts of the country gradually followed suit as the needs of hospital patients for dental and oral surgical service became more generally recognized. Today there are few important hospitals in the country that do not have a well-organized dental service, and many of them offer residency training for specialization in oral surgery.

In 1918 the American Society of Oral Surgeons and Exodontists was organized. In 1929 the Society was incorporated under the laws of the State of Illinois as a component part of the American Dental Association. The purposes of the Society were Òto promote and advance the science of Oral Surgery and Exodontia; to encourage research; to promote unity and harmony among its members and to elevate the standard of practice; to cooperate with other dental societies; and to enlighten the dental and medical professions and the general public in matters relating to Oral Surgery and Exodontia.Ó In 1944 the name of the Society was changed to the American Society or Oral Surgeons. The Society continued its growth, and today it represents a unified group endeavoring to promote and further the goals of oral surgery throughout the continent.

The American Board of Oral Surgery was established in 1946. The purpose of the Board is to evaluate tile competency of specialists in this field and to encourage a continued elevation of standards. Board certification serves to assist hospitals in questions of relative responsibility and surgical privileges for staff oral surgeons in patient care.

The forceps used by the oral surgeons were instruments of torture until the introduction of inhalation anesthesia by Horace Wells in 1844. At least Horace Wells received credit for the discovery of general anesthesia. After using the gas very timidly at first, several individuals established themselves as "specialist extractors under gas". In order to secure patients, the specialists appeared at every gathering of dentists giving clinics, which could more properly be classed as exhibitions of their skill and speed. The specialist extractor with the blood bespattered face, gory forceps in hand, and roots and teeth flying in all directions, was a common sight at dental meetings.

The use of pure nitrous oxide anesthesia was of short duration. It worked well when but one or two teeth were to be extracted. The speed that was required to remove several teeth at one sitting before the patient had regained consciousness often resulted in mutilation of the alveolar tissue, and many broken roots were left in the jaws. Still, nitrous oxide anesthesia was a great improvement on the methods of the old days when whiskey stupor was the usual method for easing the tortures of extraction.

In 1860, Dr. Edmund Andrews of Chicago introduced a mixture of oxygen and nitrous oxide. The mixture, the improvements in apparatus, and the ready availability of the gas which was now supplied by the manufacturers, helped to popularize the use of general anesthesia.

The next advance was the introduction of novocaine. The widespread use of local anesthesia by practically every dentist did not put the specialist out of business, however. The recognition of the seriousness of focal infection burst upon the profession just about the time that novocaine was introduced. Extraction and surgical removal of teeth had spread like an epidemic and specialists were busier than ever before.

With local and general anesthesia at their command, the specialists who now have become known as "exodontists" filled a very useful place in the profession. Some of the young graduates, many of whom were also physicians, performed all types of oral surgery, including plastic corrections of the face.

As dentistry and surgery became increasingly specialized, each made its separate approach to the field of oral surgery. It was inveitable that ultimately dentists and surgeons would confront one another as rivals rather than as collaborators in this field. This situation was unfortunate, particularly for the patient, because each profession had its own contributions to make.

Today communication between specialties is improving, appreciation of preparation and abilities continues, and the goal of better patient care has brought increased realization of oral surgery skill. There are many favorable signs of continued improvement in the understanding of this specialty in health care. The prospects suggest an optimism for a specialty that has evolved gradually in response to a definite need.

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