The Evolution of the Filling

It’s hard to imagine any era of human life where cavities didn’t exist. Tooth decay, or dental caries, is a disease caused by bacteria. In extreme cases, cavities can cause death. So when did the use of fillings begin? Was Mercury the first filling material used? Let’s take a look at the evolution of the filling.

Hypotheses of what may have caused teeth to decay have been found in texts of ancient Sumeria, Japan, China, Egypt and India. “Tooth worms” were to blame according to these cultures. Nearly perfect holes in the teeth of skulls found in Pakistan dating back over 9,000 years are believed to be the work of primitive dentistry. But evidence of using fillings is not found.

Teeth were likely pulled in many cases where pain was an issue. Ancient writings document cases of tooth extraction. It is not entirely certain precisely when the use of fillings began. Doctors used many filling materials including cork, stone chips, lead and gold more than 500 years ago. A silver paste is reported to have been found in a tooth dating-back over 2,600 years in China; but evidence of this as a regular practice cannot be found.

The best evidence for the start – and continuation – of the practice of filling teeth with some sort of material, leads us to French physician Ambroise Pare who used cork and lead to fill patients’ teeth in the 1500s. In 1603, German Tobias Kreilius boiled a concoction of copper, acids and mercury which was poured as a hot liquid onto diseased teeth! I wonder which pain was the greatest!

There is an actual “Father of Amalgam”. This name was given to a Frenchman, Louis Regnart. He improved on a boiled mineral cement by adding mercury, which greatly reduced the high temperature originally needed to pour the cement onto a tooth. Amalgam was originally used in France around 1826.

Amalgams became unpopular over the next several years. Respected dental research included in some of the first textbooks of American dentistry discouraged the use of amalgam. The use of mercury was specifically mentioned as “mischievous.” Although it offered certain benefits since 1833, when the French Crawcour brothers brought amalgam across the sea to America, gold, platinum, silver, tin and lead were preferred in the 1840s.

So what might Doc – John Henry – Holliday have used during his short life as a dentist? Literature including the use of dental fillings in the United States during the 1860s makes it very clear what was accepted as professional practice when fixing rotting teeth with filling material. Two texts used by American dentists of this time were, “A Practical Treatise on Operative Dentistry” written by J Taft, and “The Principles and Practice of Dental Surgery”, written by Chapin A Harris.

Taft’s text was published in 1859, Harris’ in 1863. They stated that beginning in the early 19th century, eleven types of metallic fillings were used in teeth damaged by dental caries. The simple process of rolling metal into pellets to be placed into cavities was common. These pellets were made of some of the aforementioned materials like gold, lead, platinum, silver and amalgam as well as aluminum. The texts also cited early uses of materials by various doctors as far back as the 18th century when Pierre Fauchard recommended the use of lead.

The respected Taft and Harris texts make it clear what was used as filling material. We now know much of what was practiced on a regular basis from the 18th century through to the Civil War. One other material that hasn’t been mentioned yet appears in the Harris text. Asbestos was used in the 1850s for its non-conductive properties to be placed under the filling of a sensitive tooth.

At the time, doctors were aware of the dangers of some of these materials. Lead and Mercury were known to be unhealthy, yet they were still used. Graves from the American Civil War were found to contain various soldiers with conventional and odd filling material.

What was recommended by Taft and Harris and what was actually used as fillings were sometimes quite different. Gold was preferred – but very expensive. What was likely a shotgun pellet was found as a filling in one specimen. Thorium, a radioactive element – not known to be radioactive back then – was found in another. Amalgams, tin and iron were found in others.

Today’s dentists may offer alternatives to fillings, depending on the level of tooth damage. Gold and amalgam are still used. Porcelain and composite resin – which can offer the same color as a patient’s healthy teeth – are also used. The Evolution of the Filling has been rather slow and varied, and today we still find materials used that were materials used in the early days of recorded dental practices.