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Latest Dental World

SEPT-OCT 2016

Dental Filling Materials in the Confederacy

By Richard A. Glenner, DDS & P. Willey, PhD - The mid-1800s were innovative and volatile times, both in the development of the United States and in dentistry. The political and social manifestation of this unrest was the Civil War. The strides in the country's dentistry are indicated by the founding of the first dental college, the first dental journal, and the first dental society during the two decades before the war.hronic pain control, e.g. psychotherapy, psychoanalysis, biofeedback, etc...


The mid-1800s were innovative and volatile times, both in the development of the United States and in dentistry. The political and social manifestation of this unrest was the Civil War. The strides in the country's dentistry are indicated by the founding of the first dental college, the first dental journal, and the first dental society during the two decades before the war.1

Before the Civil War, dentists in both the North and South were active in two national dental organizations: the American Dental Convention, founded in Philadelphia in 1855, and the American Dental Association, founded in New York in 1859. These organizations promoted education and research in all aspects of dentistry, including dental materials. Although these organizations remained active throughout the war, Southern dentists did not participate. Further, they failed to form separate organizations during the Civil War, but in 1869, with continued bitterness following the war, they created the Southern Dental Association, which finally merged with the American Dental Association in 1914. 2, 3

Dentistry began in the South during Colonial times. Most of the dentists in the North and South during the Civil War, who did not have a formal education, learned through apprenticeship with an established dentist. Formally trained dentists in both parts of the country graduated from Northern dental schools and used the same books and journals, published, for the most part, in the North. The one exception was The Southern Dental Examiner, a small journal published in Atlanta from May 1860 until January, 1863.4

When comparing the number of dentists in 1860, the Confederate states had the same proportion of dentists to population as the Union-0.2 dentists per 1,000 people.' This equal access to dentists suggests roughly the same quality and quantity of dental care, because practitioners in both areas underwent the same educational process. Since one would expect the same quality of dental care in civilian dentistry in the North and South, there is reason to believe that the quality of dental care in the military would be the same. The only difference would be in the accessibility of filling materials. The demand for dental care in both militaries was great. The Union army lacked a formal dental corps, so they hired civilian contract dentists to perform emergency dental care extractions, lancing gums, etc. The lack of a military dental corps placed demands on local dentists who filled the void. Besides those contract dentists, there were many dentists who had enlisted in state regiments and performed dentistry unofficially. Some of these men became line officers or hospital stewards. It was also quite common for military surgeons, assistant surgeons and stewards to practice dentistry, common enough for dental instruments to be included as a part of field kits.6

The Confederate army had a more formal dental system than the Union army. In addition to using civilian dentists to care for the soldiers, they had a dental corps, picked from the dentists available in the South. Dental surgeons were assigned to staffs or hospitals and combat regiments as medical surgeons.' The primary function of Southern military dentists was to examine teeth in hospitals where soldiers were being treated. Some soldiers were able to have teeth cleaned, filled and extracted by dentists who used their own instruments.' Dental filling materials used in the South during the Civil War is one aspect of dentistry which can be investigated to assess similarities and differences in the dentistry performed in the North and South. Historic documents and texts, as well as archaeological and anatomical specimens, are presented. The combination of these seemingly disparate sources provide a more complete perspective on filling materials than any one of these sources alone can present. 8

Contemporary Literature

There were two classic dental texts used during the Civil War by dentists of both the North and South. They were J. Taft's 1859 A Practical Treatise on Operative Dentistry' and Chapin A. Harris's 1863 The Principles and Practice of Dental Surgery.10

According to these texts and a discussion of them in a subsequent publication,11 simple metallic fillings were being placed and had been placed since the early 19th century. This process consisted of rolling the metal between one's fingers into a pellet larger than the cavity to be filled. The pellet was then condensed into place by one or two straight instruments and then shaped and polished with a burnisher. According to the above sources, a variety of dental materials were used during the war. Materials, such as lead, gold, tin, platinum, silver, aluminum, and amalgam, were placed in the form of pellets.

Lead

98_46_2p72

In the 18th century Pierre Fauchard recommended the use of lead as a filling material. He sanctioned its use because it was soft, ductile and easily compressible. According to Harris and Taft, lead was rarely used in the 19th century, because it was so soft that it was quickly worn-down by mastication and had harmful health effects, which were known at that time. The concern was that the lead would be decomposed by the secretions of the mouth and enter the stomach, where it would adversely affect the patient's health.

Gold

The literature used by Northern and Southern dentists acclaimed gold foil as the best filling material. This preference was because it was strong, did not deteriorate in the mouth, was easily placed, and was compatible with the teeth and surrounding tissues. It was, therefore, believed that the patient's health was not undermined by its use. Gold fillings were first placed in America around 1800. The gold leaf, prepared by gold beaters, was inserted in the form of pellets. The most popular method of insertion was to place the pellet in the cavity and pierce it in the center with a sharp instrument, adding more gold to the center until the filling was firm. At times the filling was left high to be further condensed by mastication. Gold foil was eventually made thinner and formed into ropes. In the early 1840's, dentists coiled ribbons of gold on a winder, forming tightly wound cylinders. The problem with this form was that these cylinders were hard to compress. In 1846 C.T. Jackson first introduced sponge (crystal or crystalline) gold, which was easier to condense. The technique of filling with adhesive gold foil began in the mid-1850's when Robert Arthur of Baltimore introduced the technique of annealing pieces of sponge gold over a "spirit" lamp to make them cohesive and then welding them together with hand pressure using specially designed plugging instruments with serrated tips. The insertion of adhesive gold foil required a dry field and the placement of retention grooves.12

It is believed, based on the texts and other documents, that gold was the most popular filling placed during the Civil War period. Adhesive gold foil was probably the most popular, although non-adhesive gold foil fillings were probably also still being placed.

Tin

Tin, in the form of tin foil, was first used as a filling material in America in the 1820's and it is believed to have been a very popular filling material during the Civil War. Tin foil was recommended when a cheaper material than gold was requested by the patient. Because of its resilience, it could be placed in teeth where non-adhesive gold foil could not be placed, using similar condensation techniques. Tin foil, in fact, worked well because it was more adhesive than non-adhesive gold foil. Some authorities of the day believed that tin foil should be used when gold foil could not; others believed that any tooth which could be filled with tin should be filled with gold. Dentists, such as Chapin Harris, believed that if a tooth was worth filling properly and if the cost was more than the patient could afford, the dentist should share the expense rather than stoop to placing tin. In large cavities, some dentists placed gold over a layer of tin foil to use less of the more expensive gold. This procedure did not work because tin was softer than gold and did not withstand mastication. When the tin wore down, it could be replaced inexpensively, easily and rapidly. Even at that time, however, there was a concern that tin would oxidize in the mouth, turn black and cause a recurrence of caries. Due to the blackening, tin was only recommended for posterior teeth.

Platinum

While the pellet process was in vogue early in the 19th century, platinum was used occasionally as a filling material. According to Taft, it was used, although rarely, in the years before the Civil War, because it was hard, inflexible, and difficult to form into foil.

Silver

Taft states that although silver was a popular filling material during the early 19th century, it was rarely used in the years just preceding the Civil War because it was stiff and lacked ductility, besides oxidizing in the mouth. Although silver and platinum were rarely used as filling materials then, Harris states that there was experimentation with them. Unfortunately it was unsuccessful. These materials were difficult to condense, being less malleable than gold.

Asbestos

In the mid-1850's, Harris in Dictionary of Medical Terminology and Dental Surgery, states that asbestos, a known non-conductor, was a substance that could be placed under the filling in a sensitive tooth.13

Aluminum

According to Harris, aluminum was another experimental material which failed as a filling material, because it lacked malleability. It was impossible to weld aluminum, even by the pressure of the gold beater's hammer. It was, however, occasionally added to amalgam.

Amalgam

The most popular amalgam filling during the Civil War, at least according to the literature, was of silver, tin and mercury. This filling material was placed where it was difficult to insert gold. It set very hard and lasted for many years, the major contradiction being that it oxidized in the mouth, turning teeth black. Also the mercury contained in the amalgam was thought at that time to be harmful. 14

Before and possibly during the war, there was experimentation with a variety of other amalgams, combining many different metals with mercury. In 1848, Thomas Evans of Paris introduced an amalgam of pure tin with a small amount of cadmium. After experimentation, it was found to have excessive shrinkage and discoloration and as a result was not advocated.15

Temporary Filling Materials

Hill's stopping (which contained gutta-percha, quick lime, quartz and feldspar) and guttapercha were advocated by Taft and Harris as temporary filling materials during the Civil War. Another filling material discussed by them, which was basically for temporary purposes, was a mixture of zinc chloride and zinc oxide, known as oxy-chloride of zinc.

Fusible Metals

98_46_2p73b

Harris states that D'arcet's metal, consisting of a tin alloy, lead and bismuth, was used in the early 19th century. It melted at 212 degrees F and was then poured into the cavity. Wood's metal, used as late as 1860, was another fusible metal discussed by Harris. It was placed in the cavity cold and became plastic when a hot instrument raised the temperature of the metal to 140 degrees F.

Anatomical and Archaeological Specimens

Dental fillings from archaeological and anatomical specimens provide another view of the dental filling materials used during the Civil War. They provide an opportunity to compare and contrast materials and techniques recommended in the dental texts of the day with actual practices. Dental fillings are known from seven Confederate specimens. The first four specimens were collected for their anatomical and pathological value, and the filling materials have been chemically analyzed. Three of these four specimens were from the Battle of the Wilderness and one from Bull Run. These dentitions were curated in the collections of the National Museum of Health and Medicine, Armed Forces Institute of Pathology (AFIP).' The first anatomical specimen (AFIP 1001810) from the Battle of the Wilderness had a filling in tooth no. 2. The filling is thorium, which was radioactive, and lesser amounts of other elements. The dentist who placed the thorium, radioactivity being unknown at that time, may have thought that he was working with a variety of tin. The second anatomical specimen (AFIP 1000788) was from Bull Run. It had lead and tungsten pellet fillings in the bottom of the no. 7 tooth socket. The pellets were probably shotgun pellets. The third anatomical specimen (AFIP 1000999) was from the Battle of the Wilderness. The filling in tooth no. 3 was of tin with lesser amounts of iron. The material was probably placed as a tin foil filling. The final anatomical specimen (AFIP 1000184) was also from the Battle of the Wilderness. The fillings in teeth no. 14 and 15 were of mercury and tin with lesser amounts of other elements also present. They were amalgam fillings. The remaining three specimens were all Confederates from the Battle at Glorieta Pass, New Mexico. These specimens were archaeologically excavated, analyzed, the filling materials visually identified, and then the bones were reburied. 16 The first archaeological specimen (Burial 2B) had two gold fillings. One filling was in tooth no. 2 and the other in tooth no. 31. The second archaeological specimen (Burial 2H) had three gold fillings. One filling was in tooth no. 19 and apparently the other two were in tooth no. 31. The final archaeological specimen (Burial 2X) had nine fillings in seven teeth: one each in teeth no. 4, 6, 7, 14 and 31; and two each in teeth no. 2 and 12. These fillings, as all of those in the other archaeological specimens from Glorieta Pass, were apparently placed as gold foil.

Discussion

The dental fillings in the seven Confederate casualties allow us to examine the dental filling materials used at that time as well as infer the techniques used to place them. These materials and techniques can be compared with the dental literature of that time to see how accurately practice followed prescription. The expense of the filling material was a consideration. In the eastern Confederate anatomical series, none contained gold. None contained silver, not even in amalgam form. The one amalgam filling was of tin, lacking silver. Each of the eastern Confederate individuals had a different material. One filling was lead, whose use, at least according to the literature, had been abandoned more than a decade and a half earlier. In the western Confederates, those from New Mexico, only gold fillings were found. Gold appears to have been available and preferred by the Confederates in the west. These regional differences may indicate varying access to different dental materials. Gold foil fillings were recommended throughout the 19th century dental literature, including articles published in the South during the war. The Southern Dental Examiner, which was the only Southern dental publication, contains advertisements from Brown and Hape, a dental supply company in Atlanta, for gold foil, porcelain teeth and supplies. Because of the Northern blockade, the cost of dental supplies, especially gold, was high. Brown and Hape mined gold and manufactured what is believed to be the only gold foil available in the South during the war. It is said that J.P.H. Brown, a dentist, editor of the Southern Dental Examiner, and co-owner of the firm, was responsible for this.17,18

It is possible that there were other undocumented sources of gold foil. The cost of gold was so high that in the depreciated Confederate currency the cost of a filling was $120 more than six months' pay for a private. Although gold was the material of choice, it appears to have been in short supply and expensive in parts of the South. A material was sought that was inexpensive, could be easily manipulated and inserted and would preserve teeth, perhaps until gold could be substituted. According to an article written after the war in 1867, amalgam was such a material. This confirms that there was a search for gold substitutes.19 This was also stated in an article written in 1887 by W. Leigh Burton, who was the first dentist commissioned by the Confederacy.20 The literature indicates that amalgam filling materials were used throughout the 19th century, the most popular form being silver amalgam, although amalgams of gold and other metals were also used .21 In fact, from one of the anatomical specimens, we know that amalgams without silver were used. This example indicates the experimentation with filling materials and perhaps the dentists' adaptability in the South much more than can be surmised from the literature of the time.

Summary and Conclusions

There are two ways of assessing the history of dentistry. One way is through historical documents and the other is through anatomical and archaeological specimens. Dental texts and journals provide a detailed perspective on the techniques and materials recommended, but they give only a partial story. Anatomical and archaeological specimens show what was actually being done rather than what was dictated by texts and authorities. These specimens, however, are rare and often poorly studied. The literature of the time states that gold, tin and silver amalgam were almost exclusively used as filling materials in the 19th century. Tin foil was held in lower regard than gold and amalgam in lower regard than gold or tin. The archaeological and anatomical specimens, however, indicate more complexity and variety in filling materials than the period's dental literature.

This variety in materials may have been influenced by material availability, old techniques and materials employed beyond their official usefulness, or perhaps as experimentation. Another possibility for the use of some of these "outdated" materials, is that they were placed decades earlier when the materials were recommended. It is important to note that the war had an impact on what dental restorative materials were used. In the South, in particular, there was a need for cheaper materials, due to the scarcity and increased cost of gold. With the advent of war it was also necessary to have materials that could be easily manipulated.11 Filling materials used during the Civil War are discussed in the literature, with gold foil, tin foil, and amalgams being most frequently mentioned. Amalgam fillings, containing mercury, silver and tin, are still being placed today, the primary difference between them then and now being the proportions of materials used. Gold foil fillings, used into the 20th century, were replaced by composite resin restorations and have been infrequently placed during the last 30 years. Tin foil filling material was discontinued late in the 19th century. And of the temporary filling materials, only gutta-percha was commonly used until the late 1950s. The skulls of seven Confederate casualties are important. Their filling materials included gold, tin foil, lead, tin amalgam, and radioactive thorium. Although this sample is small, the filling materials provide insights into dentistry as it was actually practiced in the South and in the Confederacy before and during the Civil War. Dentists at the time were rising to the challenges by experimenting with materials and techniques beyond those recommended in textbooks and journals. Many questions remain: Were these fillings placed before or during the war? Were they typical of dentistry in the South? Were dentists in the North also exploring gold substitutes? And were these fillings placed in a military or civilian setting? Answering these and the many other questions common to dentistry and anthropology requires close cooperation. Only through this collaboration among archaeology, anthropology, chemistry and historical dentistry can a more accurate picture of the developments in dentistry be gained.

References

  1. Glenner RA.,WilleyP.,Sledzik,P.,Junger E.Dental Fillings in Civil War Skulls: What Do They Tell Us?, JADA, 1996, Nov; 12 7: 1671, 1675-6.
  2. Anthony, L.P Influence of the South on the development of dentistry in America, Dent Cosmos, 1931, Apr; 73:360.
  3. Asbell,MiltonB. Dentistry A Historical Perspective, Bryn Maws PA, Dorrance & Co., Inc. 1988, pp. 220-221.
  4. Brown, J.PH. Fouke, Geo. The Southern Dental Examiner, 1860, May; No. 1.
  5. United States census report 1860.
  6. Hyson, John M., Whitehorne, Joseph WA. The Soldier Dentist: Colonel John R. Lewis of the 5th Vermont, Bull Hist Dent, 1995,43(2):55.
  7. Asbell, Milton. Dentistry, A Historical Perspective, Bryn Maws PA, Dorrance & Co., Inc., 1988, p. 205.
  8. GlennerRichardA.,Davis,AudreyB.,Bums,Stanley. The American Dentist, Missoula, MT, Pictorial Histories Pub. Co., pp. 129.
  9. Taft, J.A. A Practical Treatise on Operative Dentistry, Philadelphia, Lindsay & Blakiston, 1859, pp. 75-93.
  10. Harris,ChapinA.ThePrinciplesandPracticeofDental Surgery, Philadelphia, Lindsay & Blakiston, 1863,266-272.
  11. Samuel S. White, A History of Dental and Oral Science in America, Philadelphia, 1876, pp. 51-73.
  12. Glenner, Richard A. Gold Fillings, Bull Hist Dent, 1994, Nov; 42 (3): 129-30
  13. Harris, Chapin A., A Dictionary of Medical Terminology, Dental Surgery, and Collateral Sciences, Philadelphia, Lindsay & Blakiston, 1855, p.6.
  14. Harris, Chapin A., The Principles and Practice of Dental Surgery, Philadelphia, Lindsay and Blakiston, 1863, pp. 266-272.
  15. Samuel S. White A History of Dental and Oral Science in America. Philadelphia,, 1876, pp. 61-62.
  16. Owsley, Douglas, W. Bioarchaeology on a Battlefield: The Abortive Confederate Campaign in New Mexico, Archaeology Notes 142, Santa Fe, 1994.
  17. Schwartz, Laslo. War problems of dentistry: the South in the Civil War, JADA, 1945, Jan; 32(l): 37-8.
  18. Anthony, L.P. Influence of the South on the development of dentistry in America, Dent Cosmos, 1932, Apr; 73: 473.
  19. Dental Surgery as Applied in the Armies of the Late Confederate States. Dent Quarterly, 1867; 6: 85, 87.
  20. Burton, W. Leigh. Dental Surgery as Applied in the Armies of the Late Confederate States. Amer. J. Dent. Sci., 3rd Series: 1887, Aug; 180-9.
  21. Pigott, A. Snowden. Chemistry and Metallurgy, Philadelphia, Lindsay & Blakiston, 1854, p. 44.
  22. Bober-Moken, I. War's Impact on Dental Materials, Ball Hist Dent, 1992, Oct; 40(2): 95-97.

DR. GLENNER is past Historian of the American Academy of the History of Dentistry;
DR. WILLEY is Associate Professor of Anthropology, Chico State University, Chico, CA.

Article orginally published in the Journal of the History of Dentistry
Vol. 46, No. 2/July 1998 pp 71-75 copyright ©1998, all rights reserved

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