The first European dentures we would recognise as such, with a base plate resting on gum, were carved from solid blocks of ivory or bone in the fifteenth century. The mouth would have been measured with a type of calliper with the fitting surface hand carved to produce the best 'fit'. Needless to say neither stability nor function was achieved and with an ivory denture easily weighing 0.045 kg, retention was non-existent!
To help with stability, dentures in the early eighteenth century had flat whalebone springs connected between the upper and lower ivory bases to keep then 'sprung' apart and against the gums. Within 50 years whalebone had been superseded by the more efficient coiled gold or silver springs.
The first tangible improvement to denture comfort came in 1756 when Philipp Pfaff of Berlin used wax for a jaw impression and then cast a plaster model from the imprint. This meant the ivory block could be carved to fit the model without the patient being present for numerous adjustments. To improve their aesthetics the blocks often had human incisors and canines attached to the labial surfaces. The teeth used were either extracted from the mouths of the destitute for money or 'resurrected' from the dead for free. The supply of teeth became much more plentiful in times of war and so became known as 'Waterloo Teeth'.
Ivory and bone are porous and if worn for any length of time became foul, producing an unpleasant taste for the wearer and an even worse halitosis to be endured by neighbours. Fans were not only a fashion accessory in the eighteenth century but an essential element in wafting away the odours of mankind.
The 1780s brought relief from denture smells with the production of one piece porcelain dentures. They were first made by Alexis Duchateau, an apothecary in Paris, but developed further by Nicholas Dubois de Chemant. He moved his practice to London in 1792 to avoid the excesses of the French revolution and the loss of his aristocratic clientele. The porcelain paste for his 'mineral paste dentures' was supplied by Wedgwood, but severe shrinkage on firing meant the fit was never satisfactory.
With the failure of ivory, bone and porcelain as satisfactory base materials, dentists turned to metal, especially gold, for the answer. By the 1820s the plaster models were being duplicated in lead or zinc which made them strong enough for gold sheets to be tamped down onto them without breaking. This was superseded in the 1840s by swaging, whereby a gold sheet was compressed between opposing cast moulds, thereby producing the most accurate fitting base plate to date. This remained true until the early twentieth century when it was superseded by the 'lost wax technique' which is still in use today.
Until the 1850s all dentures were very expensive and beyond the reach of all but the wealthy. This was all to change with the invention of 'vulcanite' by the Goodyear Rubber Company whereby natural rubber was infused with sulphur making it pliable, odour free and no longer sticky. Thin strips of vulcanite were cut to fit a dental model and the strips fused together when subjected to pressure and heat in a vulcaniser which by the end of the process produced a hard, accurately fitting denture base to which porcelain teeth were then attached with metal pins. To further improve retention rubber suction pads were often incorporated into the palatal fitting surface and by the 1880s had superseded the necessity of springs which had been used 'successfully' for over 100 years.
Unfortunately the brownish colour of vulcanite was aesthetically unacceptable. To improve the appearance, thin slithers of porcelain were attached to the labial surface of the denture to mimic the colour and texture of healthy gum. However, vulcanite, though a great improvement over ivory, was brittle and, unlike ivory, prone to fracture. A broken denture could mean a soldier was unfit for active service. To be combat-ready a recruit had to have at least six pairs of functioning teeth, whether natural or artificial. To stop the breakages and the loss of troops from the front line aluminium dentures were introduced. They were first exhibited at the Baltimore Dental Meeting of 1866 by the American dentist Dr James Baxter Bean. The technique was revived and improved in 1917 by two American dentists while at the Presbyterian Base Hospital Unit, British Expeditionary Forces in France. They perfected the technique of making a complete full aluminium denture, including the teeth, from one casting. The design became known as 'Amex' dentures after the AMerican EXpeditionary force. The dentures were cheap to manufacture, lightweight, easily cleaned and almost indestructible - but very ugly. No one wanted a metal smile! Relatively few were made and at the end of the war production stopped.
All materials used in the mouth had proved inadequate in one way or another; even vulcanite became foul from bacterial growth over time and gold was the wrong colour. With the development of 'plastics' in the early twentieth century new materials became available for denture construction, but many like Bakelite, Celluloid and ICI Kellodent proved unsatisfactory. Following World War 2 acrylic resins came to the fore and have remained the material of choice for full dentures to this day.
So are dentures a necessity or just vanity? Well with the enormous amount of time and ingenuity spent by mankind to produce the perfect denture the answer must be...
The fascinating collection pictured here has been kindly donated to the BDA Museum by Dr Maurice Faigenblum in memory of Professor Arthur Chick, Head of Prosthetics at the Royal Dental Hospital.
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Williams, B. BDA Museum: Dentures: necessity or vanity?. Br Dent J 218, 94–95 (2015). https://doi.org/10.1038/sj.bdj.2015.62