Sir, we would like to thank Fitzgerald and Sawbridge for their correspondence1 in relation to our article on the history of commonly used dental elevators,2 however, we would like to clarify a few points.

We did not set out to give the entire history of dental elevators, but merely started the introduction to the topic at a point in time and stage of development/evolution when these instruments became noticeably similar to the modern day equivalents, and when associated dates and names became definite. The main thrust of the article is on the history of the modern day elevators ie Warwick James, Cryers and Couplands that are in current use.

As stated at the end of our article,2 'The list of elevators currently available to purchase is extensive (at least 33 different named instruments!). These could potentially be the focus of a future research project.' Therefore, any of these could have originated from any number of sources, such as instruments in Roman times or at the time of Celsus, but we focused on three named modern day types. We would welcome any information on the origin of any of the other named elevators.

Celsus may have described an operation which would (or could) require the use of an elevator; however, it is supposition to say that an elevator may have been required when no details of the instrument(s) available are described.

Firstly, from the text quoted, the description of the procedure fits more closely with the use of a curette type instrument ('scraped all round, that the gum may be loosened from it'). The concept that the gum may be scraped away from a tooth by an instrument that is not an elevator is described by Fauchard (1678–1761), who advised separating the tooth from the gum with a very sharp lancet3 and also by Benjamin Bell who described a scarificator to freely separate the gums from the stump (in 1786).4

Secondly, the next part of the procedure seems even closer to a description of an extraction with a forceps type device ('then it is to be shook; which must be continued till it move easily'). This is supported by the finding that forceps are the first described oral surgical instruments, with the oldest dental forceps in existence dating back to 50 AD5 and by the description of shaking a tooth with forceps before extraction with a Pelican in 1575.6

Regarding the dental and surgical instruments from the Roman period, there is only very vague resemblance to modern day elevators, they could quite easily be curettes, retractors or probing/exploratory instruments and we do not think it is possible to identify exactly what these instruments were used for, as Fitzgerald and Sawbridge say '..which may be elevators..', there is no actual detail provided on what these instruments were used for, or the techniques employed with them.