The Evolution of America’s Scientific Advancements in Dentistry in the Past 150 Years
James L. Gutmann, DDS
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ABSTRACT
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Background. During the last 150 years, dentistry in the United States faced many challenges as it developed its scientific foundation. In the latter part of the 19th century, clinical practice was driven by empirical evidence, and the first few decades of the 20th century set the stage for America’s scientific evolution of dentistry.
Conclusions. Seminal developments in America’s contribution to science in dentistry and oral health included the 1926 Carnegie Foundation for the Advancement of Teaching report and the vision of William J. Gies; the development of scientific dental journals; the role of immigrant dental scientists from Europe and oral biology as a discipline; and the establishment of the National Institute of Dental Research in 1948.
Clinical Implications. Due in large part to America’s contribution to dental science and practice, we are at the brink of a transformation that may expand the role of the dental profession dramatically and improve the oral health of people throughout the world.
Key Words: Dental science; dental practice; history of dental scienceAbbreviations: FDI: Fédération Dentaire Internationale • IADR: International Association for Dental Research • JADA: The Journal of the American Dental Association • JDR: Journal of Dental Research • NDA: National Dental Association • NIDCR: National Institute of Dental and Craniofacial Research • NIDR: National Institute of Dental Research • NIH: National Institutes of Health • NIST: National Institute of Standards and Technology • PRC: Paffenbarger Research Center
Major advances in dentistry during the past 150 years include the use of safe and effective local anesthetic, radiographs, high-speed instrumentation, new dental materials and dental implants. It was not until the last 50 years, however, that science became a prominent component of dental education and an integral part of dental practice. The scientific evolution of America’s contribution to dental practice and science occurred because of many factors, but four major events had a significant effect on bringing science to dentistry. These included the 1926 Carnegie Foundation for the Advancement of Teaching report1 and the vision of William J. Gies; the formation of scientific journals; the role of immigrant dental scientists from Europe and oral biology as a discipline; and the establishment of the National Institute of Dental Research in 1948.
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THE EARLY YEARS
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In the mid-19th century, the United States was viewed globally as the geographical center of innovation in dentistry, but the innovations were based on applied research as opposed to more basic science, which flourished in Europe.2 Early examples of innovations in dentistry in America include the development of the use of general anesthetic by Horace Wells, who administered nitrous oxide to patients so that they would experience little or no pain during tooth extractions, and the subsequent introduction of ether as another way to induce anesthesia, a development that often has been attributed to William T.G. Morton.3 Other notable examples of applied research were the discovery of the welding property of annealed gold foil by Robert Arthur, the development of innovative oral surgical methods by Simon Hullihen, the characterization of oral deformities and procedures for their correction by Norman Kingsley, the classification of malocclusion and treatment by Edward Angle, surgical procedures for closure of clefts by Truman Brophy, the use of radiographs to reveal anatomical and pathological conditions of the teeth and jaws by C. Edmund Kells, and the major contributions of Greene Vardiman (G.V.) Black in operative dentistry and oral pathology.4,5 Even in light of these developments, however, skeptics such as Alton Howard Thompson from Topeka, Kan., challenged the empirical basis of dentistry as it was practiced in the 19th century.6
Willoughby D. Miller, who received his Doctor of Dental Surgery degree from the University of Pennsylvania, Philadelphia, in 1879, was one of the first true American dental scientists. His seminal 1890 publication, "The Micro-Organisms of the Human Mouth: The Local and General Diseases Which Are Caused by Them,"7 reported that when carbohydrates are mixed with saliva and incubated at 37°C, they generated lactic acid that could decalcify an entire tooth crown. He also identified several bacteria that created acids during their metabolism, presented various proposals regarding the role of bacteria in oral disease and proposed that saliva could be used for research. Perhaps most importantly, he attempted to reorient the dental profession from focusing on treatment to focusing on disease prevention.
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Dr. William J. Gies
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Although many people were at the forefront of dentistry as an evolving science in the United States, the following deserve special mention: G.V. Black, Truman Brophy, Edmund Noyes, Charles N. Johnson, Thomas Gilmer, W.G. Skillen, Edgar D. Coolidge, Balint Orban, Frederick B. Moorehead, Edward H. Hatton and S.D. Tylman. Many of these people were associated with schools in the Chicago area, including the Chicago College of Dental Surgery at Loyola University; Northwestern University Dental School; and the University of Illinois, College of Dentistry. The development of science that would define the essence of dentistry as a whole, beyond that of a technical or empirical profession, had its roots in the late 1800s and early 1900s, and major benchmarks that affected contemporary dentistry in the third to the fifth decades of the 20th century were set. Before the late 1800s and early 1900s, dentistry in the United States was recognized throughout the Western world for its technical excellence, but it was not recognized generally as having a scientific basis.
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THE CARNEGIE FOUNDATION FOR THE ADVANCEMENT OF TEACHING REPORT AND THE VISION OF WILLIAM J. GIES
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In 1926, the Carnegie Foundation for the Advancement of Teaching published a report by William J. Gies, a professor of biological chemistry at Columbia University, New York City, that encouraged faculty to conduct research in dental schools and include a scientific basis for dentistry in the curriculum.1 The report urged U.S. and Canadian dental schools to improve their curricula by employing well-trained and full-time teachers, by encouraging and conducting research and by providing adequate libraries.1 In 1928, the American Dental Association (ADA) created the National Board of Dental Examiners, and dental school graduates began taking examinations in the basic sciences and the mechanical aspects of dentistry.3 Gies proposed that predental and dental educational requirements should include a minimum of two years of college before entry into dental school; however, it was not until 1937 that prospective dental students were required to have two years of college.3 Furthermore, Gies called for dentists to receive graduate-level instruction after graduating from dental school, for more complete dental libraries, for better cooperation between dentistry and medicine, for the elimination of independent or proprietary dental schools, and for the affiliation of dental schools with private or state-supported universities.8 He also called for increased financial support for dental education and for dental educators to have a greater appreciation for the biological and medical aspects of dentistry.
Gies envisioned an organization in which all research-oriented people could promote interest in dental research. On Dec. 20, 1920—two years after the formation of the Journal of Dental Research (JDR)—Gies and 24 colleagues organized the International Association for Dental Research (IADR) to bring together dentists and scientists to enhance dental research.4,8 The North American Division of IADR first met in 1952. In 1970, the North American Division had 2,102 members from the United States, Canada and Mexico.4 This division consisted of 37 sections with councilors to IADR. The division existed only on paper until it was formally activated in 1972.4 Helmut Zander, an immigrant dental scientist from Germany who was one of the leaders in the transformation of American dentistry into a science, was the first president of the North American Division. Since its inception, IADR has played a critical role in the scientific evolution of dentistry in the United States and has been a staunch advocate for U.S. governmental funding of oral and craniofacial research through the National Institute of Dental and Craniofacial Research (NIDCR).
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THE DEVELOPMENT OF SCIENTIFIC DENTAL JOURNALS
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Dental journals had a significant influence on the advancement of dental science. The first dental periodical, the American Journal of Dental Science, was introduced in 1839; it was renamed the American Journal and Library of Dental Science in its second volume. Other early dental publications were Stockton’s Dental Intelligencer, The New York Dental Recorder, The Dental Register of the West, Southern Dental Journal, The Dental Review, Dental Items of Interest and the Dental News Letter, which was renamed Dental Cosmos in 1859.3 Dental Cosmos, under the auspices of the S.S. White Manufacturing Company, Philadelphia, published a wide range of subject matter, including historical accounts, practitioners’ techniques and opinions. Much of its content was empirical.
In 1913, the Official Bulletin of the National Dental Association (NDA) was introduced, and it was renamed The Journal of the National Dental Association in 1915. When the name of the NDA was changed to the American Dental Association in 1922, the journal’s name was changed to The Journal of the American Dental Association (JADA). In 1932, African American dentists formed a national association called the National Dental Association. In 1936, JADA merged with Dental Cosmos, and the first joint edition was published in 1937.
The journals of the New York Institute of Stomatology, American Academy of Dental Science, Harvard Odontological Society and Metropolitan District (Massachusetts State Dental Society) combined in 1906, and in 1912 their quarterly journal became known as The Journal of the Allied Societies. By late 1918, William J. Gies made plans for publishing JDR as a journal for dental investigators, and The Journal of the Allied Dental Societies was discontinued and replaced in March 1919 by JDR. JDR was a quarterly publication and "a journal of stomatology; devoted to the advancement and dissemination of knowledge pertaining to the mouth and teeth, and to their relation to the body as a whole."4 Gies was listed as the executive officer of JDR and was its editor from 1919 through 1935. His initiative and vision spearheaded a significant increase in dental research, which resulted in JDR’s becoming a bimonthly publication in 1928. In 1934, the journal became an IADR publication, and, along with many other journals with a focus on oral health research, JDR and JADA have served as vehicles for disseminating research findings and explaining the scientific basis of dentistry to the profession. In the latter part of the 20th century, major biological and medical journals began to publish articles that described the results of dental and craniofacial research, providing evidence that the science of dentistry had matured into a discipline that was accepted widely by the broader scientific community.
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THE ROLE OF IMMIGRANT EUROPEAN DENTAL SCIENTISTS AND ORAL BIOLOGY
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American dentistry was recognized widely for its technical excellence in the first few decades of the 20th century, but it was not known for having a scientific basis. In the early to middle 1920s, a group of scientists from the University of Vienna were linked to dentistry in the United States through their participation in Fédération Dentaire Internationale (FDI) World Dental Federation. They were welcomed into academia in the United States despite the Great Depression and the resistance of the National Association of Dental Examiners and most state dental boards. During this time, dentistry in the United States was attempting to rise to the challenges and dictates set forth by the Gies report of 1926. The scientists in the Vienna group had biological expertise that complemented the U.S. dentists’ technical expertise in restorative dentistry, which helped give the struggling, yet emerging, dental research effort in the United States a sound and credible foundation that enabled the profession to take advantage of the development of IADR and federal funding of research that would take place after World War II. Among these immigrants were Bernhard Gottlieb, Balint Orban, Rudolf Kronfeld, Harry D. Sicher and Joseph Peter Weinmann.
A turning point occurred in the mid-1920s when the dean of dentistry at Chicago College of Dental Surgery at Loyola University, William H.G. Logan, sought the advice of Bernhard Gottlieb2,9 on how to establish a research endeavor in an academic environment.9 Gottlieb moved to the United States in 1940. He was associated briefly with Columbia University and the University of Michigan, Ann Arbor, before moving to Baylor University, Dallas, where he was a professor and the chair of the Department of Pathology and Research in the School of Dentistry until his death in 1950.10,11 During his career, Gottlieb wrote numerous scientific articles and four textbooks and is responsible for founding the study of oral histology. He has been acknowledged as being the first dentist to integrate basic science information with clinical treatment.12
Balint Orban, a protégé of Bernhard Gottlieb, came to the United States from Vienna in 1927 to establish a research program at the Chicago College of Dental Surgery at Loyola University. He later joined the faculty at the University of Illinois College of Dentistry, Chicago. Rudolf Kronfeld was another protégé of Bernhard Gottlieb. His short career at Loyola University was marked by many research advancements that helped place science into the practice of dentistry. His message to clinical dentists was expressed in an article in which he delineated the crucial connection between the techniques of restorative dentistry and the biological foundation on which those techniques rested.13 In 1939, one month before he was to become president of IADR, Kronfeld died, as his colleague Edgar D. Coolidge put it, "surrounded by his library, his histological material and his work in progress for the coming season."14
Harry D. Sicher began his career in the United States at the Chicago Medical College, and then he moved to the Chicago College of Dental Surgery at Loyola University. Joseph Peter Weinmann began his U.S. career in 1938 at the University of Illinois College of Dentistry, followed by one year at Columbia University. He then joined the faculty at the Chicago College of Dental Surgery at Loyola University. In 1946, he returned to the University of Illinois. Both scientists undertook significant research endeavors in oral anatomy, histology, bone physiology and oral pathology; Weinmann received significant grant funding from the National Institutes of Health (NIH).9
A tremendous debt is owed to the dentists and dental scientists who emigrated from Europe to the United States in the 1930s and 1940s; they were instrumental in nourishing dental research and incorporating it into the dental school curriculum. During this period, Europe was experiencing political upheaval, anti-Semitism and war. Under these conditions, many dentists and medical scientists—primarily from the University of Vienna—sought refuge in the United States. This created a struggle between the members of the dental profession in the United States who viewed the emigration of foreign-trained scientists as an opportunity for the dental profession and as a moral responsibility, and those who viewed it as an economic threat. Some practicing dentists in Austria and Germany were able to emigrate to the United States, and some who had lost their academic positions in Europe received help from their U.S. colleagues.9 Russell W. Bunting, then dean of the University of Michigan School of Dentistry stated that the dental schools making up the American Association of Dental Schools "are faced with a decision as to what they will do to orient the stranger dentists within our gates to become useful citizens and respected practitioners."15
The development of oral biology as a discipline has been an integral factor in America’s contribution to dental science and practice. Its origins can be traced back to 1928, when the University of Rochester Medical Center, Rochester, N.Y., established the first oral biology research and training program in the United States. The program eventually became the Department of Dental Research in the School of Medicine and Dentistry. In 1998, the Department of Dental Research (renamed the Center for Oral Biology) joined five other research centers to form the Aab Institute of Biomedical Sciences.16
The American Institute of Oral Biology was founded in 1943 to encourage basic and clinical research for the prevention and treatment of oral disease. It offered practitioners the opportunity to acquire knowledge in allied clinical fields, as well as in fields traditionally associated with dentistry. It also served as a meeting ground for academically oriented researchers and clinicians. In 1959, IADR and the ADA sponsored the First International Conference on Oral Biology (with a grant from the Colgate-Palmolive Company, New York City) and the proceedings were published in JDR.17 The journal Archives of Oral Biology began publication the same year. In 1988, the first step was taken to form a society of oral biologists as part of a section of the American Association for Dental Research. This organization became the American Association of Oral Biologists, and its first annual meeting was in 1989.
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President Harry S. Truman signs the bill establishing the National Institute of Dental Research, June 24, 1948. Also present (from left): Dr. C. Willard Camalier, director, Washington office of the American Dental Association; Congressman Walter E. Brehm (Ohio), author of the bill; Dr. H.B. Washburn, ADA president; Dr. Bruce D. Forsyth, chief dental officer, Public Health Service; Dr. Carl O. Flagstad, chairman, ADA Committee on Legislation; Dr. Daniel F. Lynch, past president, District of Columbia Dental Society; and Dr. H. Trendley Dean, dental director, National Institutes of Health.
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THE NATIONAL INSTITUTES OF HEALTH, THE NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH AND U.S. FUNDING OF ORAL HEALTH RESEARCH
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Overall, the major driver of America’s contribution to the science of dental practice and oral health has been the National Institute of Dental and Craniofacial Research (NIDCR)—known as the National Institute of Dental Research (NIDR) until Oct. 21, 1998. The institute was founded in 1948 and has stimulated and funded many of the scientific advances in dentistry and dental practice. Directed by visionary dental scientists, NIDCR has been instrumental in transforming dentistry from a technical profession to one that is based firmly in prevention and technological innovation.18 NIDCR-supported research has had a major impact on public health, dental practice and our understanding of dental and craniofacial function and disorders. It has played a critical role in many areas of public health and dental practice, such as caries and water fluoridation, dental sealants, composite restorations, acid-etch bonding, periodontal disease and therapy, oral cancer, pain control, and salivary function.18 The table19 highlights the directors and history of NIDCR.
The U.S. government’s funding of oral health research can be traced back many years. In 1916, President Woodrow Wilson created the National Research Council of the National Academy of Sciences to coordinate the nation’s scientific research facilities for defense work. It was one of the first federal governmental bodies to promote dental biological research.3 In 1918, a division of medical sciences was created, and, in 1919, a committee chaired by Thomas B. Hartzell from the University of Minnesota was formed to encourage scientific research in dentistry; however, it faced many roadblocks including lack of financial support. A breakthrough occurred in 1924, however, when the Carnegie Corporation, New York City, a member of the National Research Council of the National Academy of Sciences, awarded $85,000 to the University of California College of Dentistry in San Francisco "to undertake, through cooperation of a number of men in different fields of science, a joint study of pyorrhea and its possible relation to other human maladies."20 The ADA Scientific Foundation and Research Commission helped plan the project, and the award marked the first large dental research grant in the United States from a foundation outside the dental community.21
The NIH originated in 1887 in Staten Island, N.Y., as a small laboratory called the Laboratory of Hygiene in the Marine Hospital Service, a precursor to the U.S. Public Health Service. In 1891, the Hygienic Laboratory, as the small laboratory became known as, moved to Washington, and, in 1930, the Ransdell Act changed the name of the Hygienic Laboratory to the National Institute of Health and established research fellowships to investigate basic biological and medical problems. In July 1930, the ADA passed a resolution that requested the U.S. surgeon general to conduct dental research.22
In 1948, largely through the efforts of the ADA with support from IADR, President Harry S. Truman signed legislation that established NIDR, now NIDCR.20 NIDR was one of the first of the 27 NIH institutes and centers to be established. Much of the impetus for this legislation was that during World War II many young American men could not serve in the military because they did not have the minimum number of six opposing teeth required to qualify for combat.20 Fluoridation was the first challenge faced by the leaders of the fledgling institute, and the need to train dental researchers was critical. By 1972, NIDR had supported more than 1,600 trainees and fellows, most of whom were involved in teaching and research and more than one-half of whom were involved in providing patient care.20
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RECENT TRENDS IN DENTAL SCIENCE AND PRACTICE
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In the late 20th century, and continuing now, evidence-based practice, bioinformatics and biomimetics emerged and promise to have a major impact on the future of dental practice. Evidence-based practice is the process of integrating clinically relevant scientific evidence with the patient’s oral and medical conditions and histories, the dentist’s clinical expertise, and the patient’s treatment needs and preferences.23 Dental bioinformatics has been defined as the "application of computer and informational sciences to improve dental practice, research, education and professional management,"24 and it will play an increasingly important role in the way dentistry is practiced in the future. For example, bioinformatics will facilitate the discovery of more sensitive and specific drugs for the treatment and management of diseases and disorders, and it will enable dental and medical records to be accessed readily anywhere in the world. Biomimetics is the study of the structure and function of biological systems as models for the design and engineering of materials and machines. While biomimetics has had a place in dentistry for many years in developing dental materials, it promises to take on new importance in terms of tissue engineering and the development of true biological biomaterials to replace body parts such as teeth, salivary glands, muscle, cartilage, bones and joints.25 Taken together, these relatively new disciplines hold great promise for the future of dental education and clinical practice and, ultimately, for the improvement of oral and craniofacial health.
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CONCLUSIONS
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In the last 150 years, dentistry has faced many challenges as it has moved from a purely technical profession to one that is increasingly science-based. The future must be driven by a global vision for the provision of science-driven oral health care and the commitment of dental educators and practitioners to embrace science as an integral part of our profession.
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TABLE A brief history of the National Institute of Dental Research/National Institute of Dental and Craniofacial Research and its directors.
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FOOTNOTES
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Dr. Gutmann is a professor emeritus, Department of Restorative Sciences, Baylor College of Dentistry, Texas A&M University Health Science Center, Dallas, and maintains a private practice limited to endodontics, Dallas. Address reprint requests to Dr. Gutmann at 1416 Spenwick Terrace, Dallas, Texas 75204-5529, e-mail "jlgutmann{at}earthlink.net".
Disclosure. Dr. Gutmann did not report any relevant disclosures.
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REFERENCES
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- Lesky E. The Vienna Medical School of the 19th Century. Baltimore: Johns Hopkins University Press; 1976.
- Lufkin AW. A History of Dentistry. Philadelphia: Lea & Febiger; 1938.
- International Association for Dental Research. The First Fifty-Year History of the International Association for Dental Research. Chicago: University of Chicago Printing Department; 1973.
- Prinz H. Dental Chronology: A Record of the More Important Historic Events in the Evolution of Dentistry. Philadelphia: Lea & Febiger; 1945.
- Thompson AH. Scientific methods in practice. Dent Cosmos 1884;26(8): 455–464.
- Miller WD. The Micro-Organisms of the Human Mouth: The Local and General Diseases Which Are Caused by Them. Basel, Switzerland: S. Karger; 1973.
- Orland FJ. William John Gies: His Contributions to the Advancement of Dentistry. New York City: The William J. Gies Foundation for the Advancement of Dentistry; 1992.
- Kremenak NW, Squier CA. Pioneers in oral biology: the migrations of Gottlieb, Kronfeld, Orban, Weinmann, and Sicher from Vienna to America. Crit Rev Oral Biol Med 1997;8(2):108–128.[Abstract/Free Full Text]
- Ornish N. Pioneer Jewish Texans: Their Impact on Texas and American History for Four Hundred Years, 1590–1990. Dallas: Texas Heritage Press; 1989.
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- Davis WL, Jones RG. A new look at the Gottlieb collection: the continuing evaluation of the Gottleib collection reveals new and significant scientific information. Baylor Dent J 1985;29:22–29.
- Kronfeld R. Research and the future of dentistry. Bull Chicago Dent Soc 1939;19:17.
- Coolidge ED. Rudolf Kronfeld, BS, MD, DDS. J Dent Res 1943;19: 266–276.
- Bunting RW. The educational problem presented by the refugee dentist from Europe. In: Proceedings of the Sixteenth Annual Meeting of the American Association of Dental Schools Held at Cleveland, Ohio, March Twenty-First, Twenty-Second and Twenty-Third, Nineteen-Hundred and Thirty-Nine. Indianapolis: American Association of Dental Schools; 1939: 40–46.
- Goldsmith LA, Tabak LA, Stein JH. Aab Institute of Biomedical Sciences. Mol Med 1999;5(10):645–653.[Medline]
- Williams NB, Robinson HGB. First International Conference on Oral Biology: abstracts of papers presented. J Dent Res 1960;39:1083–1097.[Free Full Text]
- Pihlstrom BL, Tabak L. The National Institute of Dental and Craniofacial Research: research for the practicing dentist. JADA 2005;136(6): 728–737.[Abstract/Free Full Text]
- U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, Md.: U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research; 2000. NIH publication 00-4713.
- Harris RR. Dental Science in a New Age: A History of the National Institute of Dental Research. Rockville, Md.: Montrose Press; 1989.
- Annual report of the secretary-treasurer of the Scientific Foundation and Research Commission of the American Dental Association from July 1, 1923, to June 30, 1924. Transactions 1924:182–183.
- Report of the American Dental Association Commission on Dental Legislation to the National Institutes of Health. Transactions 1930:160.
- Ismail AI, Bader JD; ADA Council on Scientific Affairs and Division of Science; Journal of the American Dental Association. Evidence-based dentistry in clinical practice. JADA 2004;135(1):78–83.[Abstract/Free Full Text]
- Schleyer T, Spallek H. Dental informatics: a cornerstone of dental practice. JADA 2001;132(5):605–613.[Abstract/Free Full Text]
- Slavkin HC. Building sound and regular teeth: the National Institute of Dental Research celebrates its golden anniversary. JADA 1998;129(6): 694–701.[Free Full Text]
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B. L. Pihlstrom
Highlights of America's Scientific Contributions to Dentistry: 150 Years and Still Counting
J Am Dent Assoc,
September 1, 2009;
140(suppl_1):
4S - 6S.
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ABSTRACT
THE EARLY YEARS
