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Fig. 2 Plate 38 from Le Chriurgien Dentiste. The first two designs for dentate patients are shown in the lower half of this image. The oral component of these was made from metal. The wings visible in their vertical, and subsequently lowered horizontal position, are evident in the prostheses shown in the lower half of this image.
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Fig. 3 Plate 39 from Le Chriurgien Dentiste showing the third design, for edentulous patients. The oral component was made from both metal and ivory and included prosthetic teeth, which can be clearly seen. The retentive wings are shown in their horizontal position in the middle of this image.
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Fauchard’s openness was unprecedented. Subsequent editions of his textbook appeared in both French and German over the following years, but the first English translation was not published until 1946.
Fauchard adopted a rigorously scientific approach to his practice. For example, the presence of worms as the causative agent in dental decay had been an accepted fallacy for centuries. Fauchard demonstrated that this was erroneous, as he studied decayed teeth with a magnifying glass and was unable to detect the presence of worms within the carious lesion.6 His dedication to precise and logical thinking, his conscientiousness in treating patients and his clinical skills led to his name becoming a byword for excellence in the practice of dentistry. The ‘Pierre Fauchard Academy’ was founded in his honour in the 1930's as an international dental honour society to recognise and acknowledge the more dedicated and conscientious dentists throughout the world.9
Fauchard’s designs for palatal obturators
Earlier workers in the sixteenth century, such as Franz Renner (c.1510-1577), Amatus Lusitanus (1511-1568), and Ambroise Paré (1510-1590) had described the use of obturators.4 Renner, who was one of the first to describe the use of obturators in modern times, used sheets of leather, ivory, gold and silver in making prostheses to obturate defects arising as a result of syphilis. These prostheses were quite heavy, and by Renner’s own admission, very painful to insert.4 Lusitanus and Paré expanded on these designs to involve a metal plate and a sponge in the nasal cavity to provide retention — the sponge, once forced into the nasal cavity, expanded.4 Paré was the first to use the term obturatuer (in 1575-1585), having first referred to this prosthesis type as a couvercle (or ‘coverlid’). Very little information was given about their construction. Fauchard, commenting on these obturators, observes ‘they fall out and be displaced so easily as to be useless, embarrassing and uncomfortable’.10 It is also worth noting that both the obturators designed by Lusitanus and Paré could not be easily removed, and that the sponge component quickly became contaminated and malodorous.
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Fauchard’s text gives clear instruction on the fabrication of five designs of obturators.10 The first two designs (Fig. 2) were made for dentate patients, and the third (Fig. 3) and fifth (Fig. 4) for edentulous patients. The oral component of the first two designs was metal, while that of the third and fifth was part metal and part ivory, to which prosthetic teeth were attached as required.
Fauchard generally used human, hippopotamus, or ox teeth, or tusks from the walrus or elephant as material from which prosthetic teeth could be made.5 The first three and the fifth designs essentially depend on the same retentive principle. Instead of relying on sponges to retain his prostheses, Fauchard used a design consisting of two metal wings that were inserted through the perforation in a vertically upright position. Borrowing an idea from his hobby of watch-making, the metal wings were then adjusted into a horizontal position by means of a threaded screw. These then engaged on the nasal side of the defect, providing retention for the prosthesis.
The fourth design (Fig. 4) was made for a patient who had lost her upper incisor teeth and had a defect that communicated with the floor of the nose. This prosthesis was made of ivory, which was shaped with ‘an elevation’ that extended into the defect and to which was attached a sponge.
The designs were crude, and it is difficult to imagine a modern patient tolerating one of Fauchard’s obturators. It is worth remembering that he had not developed impression techniques and could not make models of the defect. Neither did he have access to materials such as silicone, acrylic or gutta percha which are commonly used in the practice of maxillofacial prosthodontics today. But since the alternative was a prosthesis made from leather, gold, or ivory and retained by a sponge that quickly became fetid, then Fauchard’s designs must have appeared revolutionary in their day. The appliances would have conferred a significant improvement in the quality of life for his patients compared with the contemporary alternatives. He records his triumph with his obturator designs: ‘…these are not merely ideas … they have been brought into practice … with all the success that I could have hoped…’10
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