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AUTHORS:
C. D. Lynch: Registrar in Restorative Dentistry, Department of Restorative Dentistry, National University of Ireland, Cork, Ireland;
C. T. MacGillycuddy: Postgraduate Student, Department of French, National University of Ireland, Cork, Ireland;
V. R. O’Sullivan: Professor of Anatomy, RSCI Medical University of Bahrain, Bahrain
The design and fabrication of oral appliances to replace parts of the palate missing due to congenital defects or lost through tumours, infection or trauma has been a considerable challenge for clinicians throughout the history of dentistry. Significant advances were made during the eighteenth century towards resolving the problem of constructing satisfactory obturators by the first ‘surgeon-dentist’, Pierre Fauchard. This paper reviews his innovative designs.
Introduction
The presence of a palatal defect can cause functional, aesthetic, and social distress for patients.1 The provision of a suitable prosthesis that obturates the defect presents clinical and technical challenges to the clinician,2 but in recent times useful progress in the provision of satisfactory obturator appliances has been made. The reasons for this include the development of techniques for making impressions of defects; the introduction of new materials from which appliances can be constructed; the use of reliable dental implants; and the establishment of closer cooperation between the surgeon and the maxillofacial prosthodontist.3 It is important to appreciate that palates affected by defects provide limited tissue support for any prosthesis that rests on them. Local invasion by tumours or infections limits the potential to use features such as the depth of sulci, muscle function or neuromuscular control, which can improve retention.2
Nowadays, palatal defects occur as a result of surgical resection of tumours, trauma or congenital defects.3 In the eighteenth century such defects were mainly the result of syphilis or trauma. Children born with congenital clefts did not usually survive, owing to a failure to nurse.4 At that time, the practice of providing obturators was novel and the available devices were quite primitive. There were no detailed descriptions available of how they were to be constructed. The appliances were made from metals, ceramics or leather. The concept of impression making (using wax) was not described until later in the eighteenth century.4 However, considerable advances were being made in the practice of dentistry by Pierre Fauchard (1678-1761). He styled himself a chirurgien-dentiste (surgeon dentist), the first practitioner to use this title, and was responsible for developing some new and ingenious designs for obturators which greatly improved the outlook for those patients unfortunate enough to require them.
Refereed Paper Accepted 10 August 2005
doi: 10.1038/sj.bdj.4812926
© British Dental Journal 2005; 199: 603–605
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Pierre Fauchard (Fig. 1)
Pierre Fauchard
Pierre Fauchard was born in Brittany, France, in 1678.5 He was originally apprenticed as a surgeon in the French Navy, following which he began working as a dentist in Western France. He read widely and studied crafts such as watchmaking and jewellery, from which he adapted techniques and instruments that he felt useful to his practice.6 Fauchard’s unprecedented competency and conscientiousness earned him an outstanding reputation, attracting discerning patients who journeyed great distances to see him.7 In 1719 he established a practice at the University Circle in Paris.5 Eighteenth century Paris was regarded as the centre of learning and enlightenment in Europe.
Quickly recognised as a dentist of unparalleled skill and acumen, Fauchard’s advice and talents were regularly in demand by some of the city’s most accomplished surgeons.
The practitioners of dentistry at that time could broadly be described in two categories. 8 The first was the untrained ‘toothpuller’ who attended village fairs, and on whom the poor relied. These frequently employed the use of magic potions and spells to treat dental diseases and toothaches. Members of the middle and upper classes could afford the skills of more reputable practitioners who had some form of training, albeit in surgery rather than in dentistry. The practice of dentistry in these circles had been stifled by jealousy.5 Knowledge and techniques were regarded as valuable property by the more competent and skilled practitioners, and were rarely shared with colleagues. In a significant break with tradition, Fauchard published a textbook in 1728 entitled Le Chriurgien Dentiste ou Traité des Dent (The Surgeon Dentist or Treatise on the Teeth).5 This comprised two volumes of over 800 pages and included many illustrations. In this way Fauchard shared his considerable knowledge and wealth of observations with colleagues and students, describing his techniques with exceptional clarity and detail. Many of his suggestions were radical for practice in those days. For example, he advised the seating of patients for dental procedures when the conventional approach was to lay the patient on the floor. He demonstrated the presence of roots on deciduous teeth, something that was not readily accepted at the time.5
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