In medieval Europe, barber-surgeons might cut your hair, shave your face, do a bit of blood-letting and tend to a broken limb.
They might also pull a tooth out with a “pelican” – a crude beak-like shank – or lever it out with an iron “tooth key”. By the 17th century they might just knock it out with a steel punch elevator.
It’s a winding, gruesome road from these early practitioners of dentistry to today’s world of 3D printing, artificial intelligence and robots that can create dental implants.
Wayne Sampson, a dental historian and emeritus professor at the University of Adelaide, says the history of dental work goes back much further than the barber-surgeons.
“If you look archaeologically you’ll find evidence of something dental – the Etruscans were using gold wire to fasten a tooth, usually an animal tooth, but it could have been human,” he says.
Guardian Australia is meeting Sampson in the PR Begg Museum in central Adelaide, where he is surrounded by examples of tooth moulds and braces, and equipment including a pedal-operated drill. There are elegantly shaped wires, an ashtray and a box full of teeth wrapped in various metals.
After discarding its connection to barbers, dentistry stayed under medicine in many parts of the world before becoming its own speciality in the early 19th century. But it was still a fairly crude practice for the next 100 years.
Enter Dr Percy Raymond Begg, better known as Tick Begg, who modernised orthodontic techniques and transformed braces.
“The industry has changed dramatically,” Sampson says. “And I think Dr Begg fits fairly neatly at the turning point. Because before him, orthodontics was very crude, with limited machinery to try to move teeth … mainly with crowbars,” he jokes.
“It was characterised by not particularly well-directed heavy forces, which largely just tipped the tooth over … and Dr Begg changed all of that.”
Begg studied in Melbourne before training under the acclaimed US orthodontist Dr Edward Hartley Angle. He treated his first patient in Adelaide in 1926.
“He was not the first orthodontist in Australia … [but he was] one of the first proper orthodontists trained or recognised in Australia, if not the world,” Sampson says.
The SA History Hub describes Begg as faithfully following Angle’s methods until 1928, when he “broke with established tradition and became the first orthodontist to extract selected teeth to correct dental crowding”.
The Begg technique “used new styles of brackets, stainless steel wire, light forces and three well-organised stages of treatment” to correct teeth more gently, efficiently and cheaply.
“What he quickly realised was that Angle was not right … about being a non-extractionist, never taking out any permanent teeth,” Sampson says.
“Begg tried to practise non-extraction for a few years and he very quickly realised it was not working. So then he came upon the revolutionary idea of extracting some teeth to make room.”
He studied overcrowding, wear and tear, and movement. His findings and technique were picked up globally.
“Adelaide became the orthodontic centre of the world,” Sampson says. “We had people coming here from all sorts of places. Big names. As students you think, wow, they visited here. Americans actually know where Adelaide is.
“There’s not many people in any field, any walk of life that can actually change the way things were done on a global scale.”
Sampson says the museum is a homage to Begg. “He deserves the recognition.
“Modern orthodontics and the patients who receive it at whatever end of the scale of technology, Begg has in some way influenced all of it. He revolutionised the way it was all done.
“He truly was a pioneer orthodontist.”
AI advances
Now practices are changing faster than Begg could ever have envisaged.
Khaled Ahmed, associate professor of restorative dentistry and general practice at the Royal Melbourne dental hospital, says digital dentistry has brought “astounding” advances.
“We can … quickly get a very accurate scan of the patient’s mouth, digitally design the filling or dental crown they need, and 3D-print or mill that customised restoration and fit it through a very streamlined workflow that can be as short as an hour instead of days or weeks,” he says.
Missing a tooth and need a dental implant and crown? Soon a robot will assist your dental surgeon in placing that implant accurately and efficiently.
The first of these, Yomi, has been approved in the US.
Ahmed says robotics will eventually expand to help with fillings and root canals. “These robots will also be guided by artificial intelligence trained on massive patient datasets,” he says.
AI will be able to generate bespoke treatment plans, help dentists detect tooth decay and gum disease, help patients book appointments and even give them advice. But there will still be challenges surrounding privacy, affordable access and upskilling, Ahmed says.
A promotional video for Yomi shows a dentist placing six implants in 90 seconds. Another shows its robotic arm guiding the surgeon, and the drill into the right position, where Yomi drills to a precise depth.
If that sounds only a touch less terrifying than facing a pelican, a tooth key or a punch elevator, rest assured that the dentists who use it say patients are “more comfortable and satisfied” and that it can “alleviate anxiety”.
