History of Oral Hygiene Tools

History of the toothpick, dentifrice-toothpaste, mouthwash, toothbrush, dental floss, and tongue scraper.

by Andrew I Spielman

How to cite this paper: Spielman, AI. History of Oral Hygiene Tools. In: Illustrated Encyclopedia of the History of Dentistry, 2023. https://historyofdentistryandmedicine.com/

 

If one walks through the painting galleries of medieval masters, one feature strikes the viewer looking at human portraits: nobody smiles. Unless depicting a simpleton or the village idiot, every portrait shows a somber individual with pursed lips, without showing teeth. Victorians thought of smiling as obscene, inappropriate (1), nor did they have nice teeth to show for. The oral hygiene habits of yesteryears were so deplorable that foul-looking, foul-smelling, decaying teeth were the norm. When Elisabeth I, Queen of England, developed a “sweet tooth” for sugar, a newly imported luxury from South America, her teeth could not be saved. He blackened and broken-down front teeth were a source of shame for her, to the point of banning any portrait showing her smile. She, apparently, even covered the mirrors in her palace to avoid facing reality. Some of her courtiers, out of loyalty, painted their own teeth black, much like Ohaguro, the Japanese custom of dyeing one’s teeth black, fashionable until the end of the Meiji period.

Up until medieval times, oral hygiene was neither systematically practiced, clearly understood, encouraged, nor a subject to write about.  Occasionally we see Ancient Indian texts or Greek and Roman authors suggest one rinse one’s mouth to preserve teeth. The first to promote oral hygiene was Walter Hermann Ryff, a German surgeon from Strasbourg, who in 1548 published  Nützlicher Bericht, […] Wie man den Mundt, die Zän und Biller frisch, rein, sauber, gesund, starck und fest erhalten soll) – Useful report…how to keep your mouth, teeth and gums clean and fresh, work dedicated to the subject. However, it will take another 200 years before the subject is more systematically broached in 1743 by Robert Bunon, a French dentist. His publication, Essay sur les Maladies des Dents, (A study on the diseases of the teeth) earned him the moniker of Father of Oral Hygiene.

What kind of oral hygiene habits did our ancestors have? When were the tools of oral hygiene (toothpaste, toothbrush, mouthwash, dental floss, toothpick, tongue scraper) first introduced? The next few entries will address this.

The toothpick

The oldest oral hygiene tool is the toothpick. They have been around since the dawn of recorded time, either to simply remove food debris from the interdental space or as jewelry, which became fashionable during the Medieval period to demonstrate one’s social status. The earliest toothpicks, dating to the Neanderthal and Paleolithic periods, were probably made of bone or wood (1,2). Alone or in combination with an ear scoop, dental scraper, or even hunting whistle, made of a quill, wood, ivory, bamboo, bronze, iron, copper, silver, or gold, toothpicks have a rich history. In many instances, these tools were attached as a “grooming set” for personal use and displayed on one’s chest or belt.

Early evidence for such sets comes from grave sites where burial of one’s utilities to accompany the dead into the afterlife was common practice. In addition, wooden fibers found in grooves of lower teeth, facing the interdental space of early cavemen, indicate the use of toothpicks 1.2 million years ago (3).  The earliest grooming set dates from 3000 years BCE in Mesopotamia. (4) 

During the excavations conducted in 1847 at Nineveh by the British archaeologist Henry Layard, 660 tablets with cuneiform writing were uncovered. They were from the time of Enlil-Bani, King of Isin (1798-1775 BCE), and contained medical recipes and descriptions of toothpick use. The tablets also contained curative incantations for diseases of the mouth and teeth, as well as for halitosis and excessive salivation.

Some early toothpicks were not man-made. Rather, they were natural, obtained from the dried flowers of the Amni visnaga, a plant originally from the Nile Delta. Also known as “bushnika” in Morocco and commonly referred to as the “toothpick flower” plant, its medicinal use is mentioned in the Ebers Papyrus. (see Figure 1.)

 

In ancient Greece and Rome, the mastic tree (Pistuciu zenticus) that gave rise to the early toothbrush (miswak in the Middle East and Africa) was used to fashion wooden toothpicks. The Greek word used for toothpick was karphos, which translates as a “blade of straw.” (5)  In addition to wood, feather or silver toothpicks were also employed. For instance, Diodorus Siculus (6) described that Agathokles (317-289 BCE), the ruler of Syracuse, used a toothpick cut from a quill. Pliny advised, “picking the teeth with the quill of a vulture turns the breath sour while a porcupine’s quill makes the teeth firm.” He also recommended using a “needle-sharp hare’s bone” to prevent halitosis. Feathers were used both as toothpicks and toothbrushes; the cut end of the quill to pick, and the feather end to brush (7). Others, like Trimalchio, a character in Gaius Petronius Arbiter’s first-century work the Satyricon, “picked his teeth with a silver toothpick” (…dentes spina argentea perfodiebat). 

The Latin name for toothpick was dentiscalpia (-um), and it is first defined in a 16th-century lexicon of Johannes Gorraeus (8) (Jean de Gorris, French Physician, 1505-1577) Definitionum medicarum Liber XXIIII  – 1564). The same lexicon of medical definitions also identifies auriscalpium, the ear pick, a tool often part of the personal grooming set (see Figures 2.3 and 2.4). 

Introduced to France by the Spanish minister Antonio Perez (9) at the end of the 16th century, toothpicks became highly fashionable.  Starting with the 17th century, for the more affluent, it was customary to wear a grooming set around one’s neck containing a toothpick, an ear pick, a nail cleaner, even a head scratcher, a set fashioned as jewelry. A particularly good example is seen in the Portrait of Lucina Brembati, a painting by the Italian High Renaissance painter Lorenzo Lotto, dating to c. 1521/23. Lorenzo Lotto painted a charming portrait of Lucina Brembati, who wears a large jeweled toothpick on a gold chain around her neck. (https://www.lacarrara.it/en/catalogo/58ac00068/).

At least four Shakespeare plays mention toothpicks (Much Ado About Nothing, King John, All’s Well that Ends Well and A Winter’s Tale). The last one depicts a person using a toothpick as a “great man”: 

“He seems to be the more noble in being fantastical: a great man, I’ll warrant; I know by the picking on’s teeth” [ Scene IV, The Sheppard’s Cottage, Shakespeare, A Winter’s Tale.]

 

In “All’s Well that Ends Well”, Act I, Scene I, toothpicks are depicted as a fashion item part of a brooch. 

“Virginity, like an old courtier, wears her cap out 

of fashion: richly suited, but unsuitable: just 

like the brooch and the tooth-pick, which wear not now.”

The Industrial Revolution increased the demand for toothpicks. That led to increased production of wooden toothpicks, primarily in Portugal, where nuns at the Larvao Monastery, south of Porto, used orange wood toothpicks to serve sticky confectionery. After consumption, the serving sticks were used as toothpicks.  Orange-wood handmade toothpicks were first imported from Brazil to Portugal. In 1850, Charles Foster, a Bostonian, returned from Brazil and secured the mass production of flat wooden toothpicks made from birch, mostly for the American market. Because the state of Maine had lots of birch trees and transport was too expensive, Foster set up its manufacturing locally in Strong, ME, “the toothpick capital of the US”, a city that in 1945 still produced 75 billion toothpicks.

Today, toothpicks are no longer favored by the oral healthcare community due to their potential damage to periodontal tissue. Instead, dental floss, regular toothbrushing, and professional cleaning took over.

1. Ricci
2. Lozano
3. Hardy, 104:2
4. Petroski
5. Wolf, p.54-63
6. Diodorus, Book 5
7. Christen, p.73.
8. Gorraeus, p. 376
9. Sachs, p.52.

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The dentifrice – toothpaste

From the dawn of civilization, men feared the tooth worm. An 18th-century representation of the tooth worm depicted it as a tormentor of Hell (10). As a result, early Indian, Babylonians, Egyptians, and Greeks recommended wiping one’s teeth with abrasive materials. Ancient Indian recipes included a mix of crushed charcoal and salt, as well as the use of a twig brush.  Red salt and juniper were pulverized, combined, and applied onto one’s teeth according to a Babylonian tablet inscribed in cuneiform writing (11). In 4th-century BCE Greece, Hippocrates suggested using a cloth or a woolen ball “dipped in honey” to wipe one’s teeth with tooth powder.  Galen, the 2nd-century Greek physician to several Roman emperors, recommends using radish powder dried in the sun, or white glass finely pulverized and mixed with the essential oil of the Indian spikenard (muskroot).

 

The content of tooth powder varied across centuries and cultures. They included crushed bone, eggshell or oyster shell, salt, alum, chalk, pumice, even soot or charcoal. In most instances, vinegar, wine, or honey were added to the mix. Romans used charcoal and bark, while Chinese added either mint or ginseng to improve the taste.

Early English literature contains recommendations for personal hygiene. William Vaughn, a doctor of Civil Laws in 1600, published Naturall and Artificial Directions for Health, a self-help text that includes detailed instructions on how to keep one’s teeth healthy and one’s breath “sweet” (12). Most of the recommendations were similar to those from Ancient times.  The literature uses the terms dentifrice and tooth powder to refer to tooth-cleaning agents from antiquity to the beginning of the 20th century, and toothpaste thereafter. The word “dentifrice” comes from Latin dentifricium, that is dens – “tooth” and fricare – “to rub.”

In 1606, Peter van Foreest, a Dutch physician, described six dentifrices for the maintenance of dental health, against bad breath, and for tooth whitening. They contained cinnamon and mint water (for taste and active ingredient), Arabic gum (for consistency), pulverized bone, pumice, or salt (as abrasive agents), and rose water or white wine (as solvents). (13).

At the turn of the 20th century, tooth powder was replaced by softer toothpaste. Dispensed usually from a tin, porcelain or paper box, toothpaste was sold by dentists under the practice’s own brand (See Figure 6). Many advertised with outlandish claims about their ability to protect teeth. The 1888 Cressler’s Wild Rose Tooth Powder claimed to be used “for cleansing and preserving the teeth and purifying and perfuming the breath”(14). It contained borax, sodium bicarbonate, charcoal, and “soap”, a detergent. That was a precursor to sodium lauryl sulfate (SDS), the detergent introduced after WWII, which makes toothpaste foam. 

A major advance in toothpaste delivery occurred in 1881 when Dr. Washington Sheffield, a Connecticut dentist, adopted the painter’s collapsible tube. The idea came to his son, also a dentist, Lucius Tracy Sheffield, while watching Parisian painters use it on the bank of the Seine. Four years later, Colgate issued its first Ribbon Dental Cream, dispensed from a collapsible tube.

Today’s toothpaste cannot be imagined without fluoride. Its importance as a preventive agent was first described in 1843 by the French dentist Antoine Malagou Desirabode, as “fluate” (15). It was first marketed in 1895 by the Karl Frederick Toellner Company, of Bremen, Germany. Sold under the name Tanagra, fluoride was included in tooth powder, toothpaste, and mouthwash. Patented in 1915 in England, fluoride became widely available in mass-marketed toothpastes only in 1955. (16, 17, 18).

Today’s toothpaste contains many of the same ingredients recommended in ancient recipes, but they are far more effective. For instance, the active ingredient today is fluoride; abrasive agents include calcium carbonate, dehydrated silica gels, and hydrated aluminum oxides. To improve taste, sorbitol and saccharin are included; as humectants, glycol and glycerol are chosen; and as a detergent, SDS is added. Starting in 1961, agents for countering dentin hypersensitivity, such as potassium nitrate, were also added, and from 2009, arginine bicarbonate, amorphous calcium phosphate, and calcium carbonate were included.

• • 10. Hoffmann-Axthelm (b). p. 216, Fig 206.

• • 11. Ibid p. 30

• • 12. Vaughn p. 70-76.

• • 13. Foreest p. 216

• • 14. Croll p.16

• • 15. Desirabode p.409

• • 16. Lipert p1-14

• • 17. Roher p.104

• • 18. Meiers

 

The mouthwash

The history of mouthwash cannot be separated from that of tooth powder or toothpaste.

Cleaning one’s mouth has been advocated since ancient times, either by mechanical or chemical means. Rubbing with a cloth, a stick, or a brush, combined with an abrasive powder, was recommended.  The earliest evidence of mouthwash use dates to Ancient China and India. It contained an extract of the Barringtonia tree mixed with “mustard, Bengal pepper, ginger, alkaline ash and salt” (19,20). 

The Roman poet Gaius Catullus recommended daily gargling with one’s own urine, as both Diodorus Siculus (90-30 BCE) and Strabo (64 BCE-21CE) claimed that the Celtiberians living on the Iberian peninsula: “use urine to bathe the body and wash their teeth” (21,22).

A typical description of how to keep one’s mouth clean appears in Zene Artzney, the first book dedicated exclusively to dental remedies, published in 1530 (23). In  William Vaughn’s 1602 treaties on the “Naturall and Artificial Directions for Health”, these suggestions are made: “take a linen cloth, and rub your teeth well within and without, ….Take halfe a glasse-full of vineger, and as much of the water of the mastick tree of rosemarie, myrrhe, mastick, bole Armoniake, Dragons herbe, roche allome, of each of them an ounce (….) and wash your teeth therewithall as well before meate as after” (24).

The initial impetus for cleaning one’s mouth and teeth was primarily the prevention of bad breath rather than an understanding of a cause-and-effect relationship between bacterial byproducts and dental decay.  In 1683 Antoni van Leeuwenhoek, the discoverer of the microscope, in a letter to Francis Aston, secretary of the the Royal Society describes bacteria for the first time: “there are more animals in the unclean matter on the teeth in a man’s mouth than there are men in the whole kingdom – especially in those who don’t ever clean their teeth, whereby such stench comes from the mouth of many of them, that can scarce bear to talk to them” (25,26). It will take at least 200 more years to make the connection between bacteria and dental caries.

Gargling with one’s own urine, twice a day, morning and evening, advocated in ancient times, is reinforced in Pierre Fauchard’s second edition 1746 work (27). The practice gradually fell out of favor with the invention of more appealing mouthwash, “l’Eau de Botot”, originally named L’Eau Balsamique et Spiritueuse”, an invention in 1755 of Dr. Julian Botot, physician to King Louis XV. It included gillyflower extract (clove), star anise, and cinnamon, and claimed to relieve dental pain and keep teeth and gums healthy (28).

It is remarkable that even the early formulations of the mouthwash included key components we still use today: antibacterial and antifungal agents (Barringtonia extract or ginger), minerals (Myrrh containing calcium and phosphate), antioxidants (mustard), essential oils (ginger, clove oil), and solvents.

The mouthwash as we know it today was introduced at the end of the 19th century, once the bacterial nature of caries, periodontal disease, and halitosis became understood. Its content included specific components to address the bacterial, fungal, or inflammatory nature of oral conditions. In 1879, Dr. Joseph Lawrence, a physician from St Louis, Missouri, in collaboration with Jordan W. Lambert, introduced Listerine as a surgical antiseptic named after Joseph Lister, the Scottish surgeon. It proved so successful that in 1895 Lambert agreed to advertise Listerine specifically for oral use, and in 1914 it became available over the counter.  It contained alcohol and four essential oils including menthol, thymol, methyl salicylate and eucalyptol. As knowledge of the nature and role of specific bacteria in the etiology of oral diseases became understood, specific antibacterial agents were added to mouthwash, including urea, dibasic ammonium sulfate (1949), sodium hexametaphosphate, hydrogen peroxide, chlorhexidine, zinc chloride, benzoic acid and, from 1955, as an anti-caries agent, sodium fluoride. 

Starting from humble beginnings, the toothpaste business in the US alone is estimated to reach $21.9 billion by 2027.

• • 19. Weinberger

• • 20. Hoffman-Axthelm (a)  p.36, p.189

• • 21. Diodorus, book 5

• • 22. Strabo, V II, book III ch. 4

• • 23. Die Zene Artzney

• • 24. Vaughn p. 57-63.

• • 25. Leeuwenhoek

• • 26. Lane

• • 27. Fauchard p.167

• • 28. Botot p.30

The toothbrush 

 

Cleaning one’s teeth goes back to ancient Babylonians, Indians, and Egyptians. During the reign of the 3rd Dynasty, 2680 BCE, Hesy-Ra was the first official  “dentist”  and ivory carver of Pharaoh Djoser. Both the Babylonians and Egyptians used a pointed piece of a special twig as a cleaning instrument. Made of a twig from the arak or licorice tree, the chewing stick became widely adopted in Africa, the Middle East, India, and the Far East (29). Known later as “miswak” or “siwak”, the aromatic tree twig turned out to contain fluoride, abrasive, and antibacterial agents that enhance its mechanical and chemical cleansing effect. The chew stick was so widespread that it is mentioned in the Koran (as miswak), in the Gospel of Buddha (received from god, Sakka), in Ayurvedic Texts and the Talmud (as quesem) (30). (See Figure 9).

The origin of the modern toothbrush is not entirely clear. Japanese Zen master in 1223 described Chinese monks using a toothbrush made of horse hair attached to a bamboo or bone handle. The toothbrush that we recognize today was probably invented in China during the end of the 15th Century. A 1498 Chinese woodcut depicts what appears to be a toothbrush similar to the one we use today. (31) 

In Europe, the toothbrush may have been introduced to France in 1590 by Antonio Perez, secretary of King Philip II of Spain. One of the earliest scientific descriptions comes from Christoph von Hellwig (a.k.a. Valentin Krautermann) in 1700 in Freuenzimmer – Apotheckgen – A woman’s bedroom toiletries (32). A more direct description comes from Thomas Berdmore, dentist to George III, King of England. In 1768 he describes the toothbrush “… the use of the straight tooth-brush, which has the hair fixed in the end, somewhat like a painter’s pencil. This sort of brush, if it be well made of short stiff hair, instantly removes whatever scraps of food have lodged between the Teeth.…” (33). This brush was made “of horse’s hair or hog’s bristle”, as Robert Woofendale, Berdmore’s pupil, explains in his 1783 work, Observations on the Teeth(34). This design, no doubt, matched that of the miswak used from antiquity throughout the Middle East, the Far East, and Africa.

In 1780, an Englishman, William Addis of Clerkenwell, created the first prototype of a multi-row toothbrush using a bone handle and rows of holes filled with wild boar tufts of hair as bristles. Addis mass-marketed this toothbrush design. His descendants were in the toothbrush manufacturing business under the same name, Addis, until 1996, when it was renamed Wisdom Toothbrushes. At the end of the 18th century, a toothbrush was not common. Among the nobility, one could see elaborately ornate toiletry, including Napoleon’s toothbrush from 1795. It had a gilded silver handle and 14 rows of horse-hair bristles (For a similar toothbrush, see Figure 8).

With the Industrial Revolution, demand for improved oral hygiene also grew. The first patent for a modern toothbrush was awarded on November 17, 1857, to H. Nichols Wadsworth of Washington, DC (See Figure 10).  His was not an original design. Charles F. Maury, a French dentist, published his work, Traité complet de l’art du dentiste d’après l’état actuel des connaissances, in 1841, in which he depicts several toothbrushes that look exactly like the one Wadsworth claimed to have invented (See Figure 11).  Nevertheless, Wadsworth’s patent set the stage for the mass production of the toothbrush in the US. With the Industrial Revolution, demand for oral products stimulated innovations and improvements in toothbrush design. In the 100 years following the first toothbrush patent in 1857, the US issued 618 toothbrush patents (35). The first mass-produced toothbrushes had bristles made of horse or wild boar hair. Handles were bone, wood, or ivory. Finally, in 1938, with the invention of nylon, DuPont mass-marketed a toothbrush under the name “Dr. West’s Miracle Tuft” made entirely of plastic bristles and a plastic handle.

The first electric toothbrush was patented in 1932 by Clement Lieux of Lafayette, LA. It was a battery-operated rotary brush with interchangeable brushes. It did not catch on. The modern electric toothbrush was invented in 1954 by Phillip Wong of Switzerland under the name of Broxodent. The next advance, the cordless electric toothbrush with a rechargeable battery, was introduced in 1955 by General Electric.

Today, toothbrushes come in a staggering array of variations in softness, size, shape, bristle length, and color, but all have the same basic design: a handle/support and a brush. The basic design has not changed fundamentally.

 

 

• • 29. Nunn p.124

• • 30. Khatak

• • 31. Hyson

• • 32. Hellwig p.39

• • 33. Berdmore p.259

• • 34. Woofendale p.153.

• • 35. Toothbrush patents 

The dental floss

Oral hygiene was not a priority before the end of the 19th century, with the realization of the harm oral bacteria can cause. And yet, as early as 1815 Levi Spear Parmly, a dentist and “father of oral hygiene” advocated cleaning the interdental spaces using waxed silk threads. Parmly came from a successful family of dentists, and he practiced in New Orleans. In his 1818 book, A Practical Guide to the Management of the Teeth, he suggested the need to brush, use a dentifrice polisher, and a “waxed silken thread …placed .. through the interstices of the teeth, between their necks and the arches of the  gums to dislodge that irritating matter which no brush can remove….(36,37,38)

 

Dental “floss silk” was first mass-marketed by the S.S. White Company of Philadelphia in 1866. (39) The first patent for dental floss was awarded in 1898 to the Johnson and Johnson Co. Initially, dental floss was sold in small glass, paper, or metal tubes/boxes. Dr. Charles C. Bass, a medical doctor, introduced nylon dental floss in the early 1940s to replace silk, a more economical solution.

Today, floss comes as nylon thread or as tape made of polytetrafluoroethylene (PTFE), rubber, or plastic. Most of the floss no longer comes with wax. As an alternative to dental flossing, an interdental brush was introduced in 1980. Flossing is still practiced by only 30% of the population. 

• • 36. Parmly p.73

• • 37. Sanoudos p.3

• • 38. Chernin p.15

• • 39. S.S.White p.215

Tongue scrapers and other methods to combat halitosis

1847 was an exciting time to be an archeologist.That year Henry Layard, a British archeologist at Nineveh, former capital of the Assyro-Babylonian empire, uncovered 660 tablets with cuneiform writing, some containing medical recipes. According to R. Campbell Thompson, a noted Oxford University scholar of Mesopotamian history, these tablets were at least 3,800 years old, probably dating to the reign of Enlil-Bani, King of Isinth (1798-1775 BCE). It described the use of toothpicks and contained curative incantations for diseases of the mouth and teeth, halitosis, and salivation. It was one of the first documents to describe oral care, and it was no surprise that halitosis was considered objectionable even then.

A tongue scraper made of gold, silver, copper, tin, lead, or iron was known to Ancient Indians (40). Described in the Charaka Samhita (circa 1500 – 800 BCE), numerous oral hygiene tools (sticks for brushing teeth and tongue scrapers) were included in this ancient Sanskrit work. Bad breath is also mentioned in the Talmud. One could divorce his wife if she had bad breath that could not be treated, but not the other way around.(41)

The Romans were aware of the need for oral hygiene. Gaius Plinius Secundus (23-79 CE), also known as Pliny the Elder, a Roman Senator, military commander, philosopher, naturalist, and author of an encyclopædia, recommended washing one’s mouth every morning with fresh water. Quintus (Sammonicus) Serenus a 3d c., Roman savant and tutor to emperor Caracalla, suggests mastic and myrtle to improve bad breath (phoetor oris): “Lentiscus myrtus emendant oris odorem” (42).

A remarkably modern recipe is found in a Syrian (anonymous) manuscript from the early Islamic period (8-9th c.?) translated from Greek into Syriac. The author, among several recipes, recommends for bad breath: Salsola fructicosa, Nuts of incense, Betel nut, Caryophyllus aromaticus, Camphor, Cinnamon, Galanga, each 4g (1 drachma), and Musk 8g (2 drachma), pulverized and mixed with wine and turned into pills, to be used as needed. What is remarkable is its active ingredients. For instance, Salsola fructicosa has antibacterial and antioxidant activity, Nuts of incense (probably Frankincense), is a stabilizer, Betel nut –stimulates the nervous system, Caryophyllus aromaticus is clove which has anesthetic and anti-inflammatory activity; camphor has analgesic and antifungal effects, Cinnamon is a major anti-oxidant but has anesthetic, antiseptic, and soothing effects, Galanga has anti-cancer, anti-inflammatory and antibacterial effects, and Musk provides a pleasant odor to the mix. This 1200-1300 old recipe has everything one would need today to combat and mask halitosis. (43)

At the turn of the 17th century, in 1606, Peter Foreest, “the Dutch Hippocrates,” recommends 6 dentifrice recipes to combat halitosis. It contained acacia (Arabic) gum or mastic as a stabilizing agent, myrrh as an active ingredient, nutmeg (has isoeugenol), “aqua menthae” (from dried leaves of menthe), and cinnamon to mask halitosis, and solvents that included white vine and rose water. Notably, this 17th-century recipe is remarkably similar to the one described in the Syriac “Book of Medicine”.

In parallel with masking halitosis, since ancient times attempts have been made to clean the surface of the tongue with a knife or a shovel-shaped tool. These items were frequently used as part of a personal grooming kit and included a toothpick, a nail clip and/or an ear pick, mounted on a ring and worn on one’s belt. In ancient India, a knife used as a tongue scraper also doubled as a toothpick (44).

That design seems to have lasted well into the 17th-18th centuries, when we start to see individual tongue cleaners/scrapers (45).

Large-scale demand for personal oral hygiene tools only started in the late 18th and early 19th century.  The first patent was issued in 1877 to Lazarus Morgenthau of New York(46). The design was a flexible blade that could be folded into a U-shape and held with two hands to scrape the tongue’s surface. Over the next 130 years, more than 135 tongue-cleaner patents were issued in the US alone. The design of the cleaners varied little. 

• • 40. Shklar and Chernin, p.46

• • 41. Shklar and Chernin, p.62

• • 42. Dionysius p.134

• • 43. Budge p.192

• • 44. Hoffman-Axthelm (c) p.40.

• • 45. Bennion p.137

• • 46. Morgenthau

Evolution of oral hygiene management

Oral hygiene is the practice of maintaining one’s oral structures clean, healthy, esthetic, and devoid of disease, breakdown, debris, accumulation, discoloration, or foul odor. Oral hygiene also encompasses the tools at the disposal of dentists and other oral healthcare providers, as well as patients, to maintain healthy, esthetic oral structures that function properly. 

Throughout history, delivery or practice of oral hygiene was fragmented, haphazard, and opportunistic primarily due to the fog of ignorance. In its first phase, it was individual and reactive to tissue damage, breakdown, pain, loose teeth, bleeding, accumulation of debris, calculus, pathogens, or foul odor. Self-management, almost always rudimentary and superstitious, was gradually substituted by emergency management, traditionally delivered by unqualified individuals. 

Notwithstanding quacks or tooth-drawers of medieval times, the absence of oral care providers was substituted by the broadly educated physician. Just looking at the subject indices of many 15-17th century texts published by medical experts, one can see treatments offered for dental pain, caries, tartar, whitening and filling teeth, bad breath, and general oral hygiene. 

Notwithstanding Ryff’s (1548) oral hygiene instructions (47), only in the 18th century do we see the first work dedicated to oral hygiene instruction and maintenance of oral health (48). Only in the mid-19th century do we witness the birth of Oral Hygiene. The many tools, mouthwash solutions, and cleaning methods that helped keep oral tissues healthy coalesced into a more unified specialty, promoted by an emerging oral health industry. A systematic approach to understanding the reasons behind tissue breakdown or the patho-mechanism of oral diseases helped create oral health products, including ingredients to address specific needs: demineralization of enamel and dentin, reduction or prevention of caries, reduction of tooth sensitivity, prevention of plaque accumulation, elimination of halitosis, or all of the above.

While the initial sale of these products was through dentists or pharmacists, as the dental industry took off in the middle of the 19th century, more and more items were commercialized through dental suppliers rather than dentists. The production of toothbrushes, toothpaste, mouthwash, floss, toothpicks, and tongue cleaners all became part of a single industry, and their use was heavily promoted as part of one’s daily oral hygiene routine. In 1955, to these oral hygiene tools used at home, the Cavitron was added for use in a dental office setting.

In 2017, the global oral care market was valued at $28 billion and is estimated to reach $40.9 billion by 2025 (49). William Addis of Clerkenwell, who created the prototype toothbrush from a leftover bone shank and wild boar hair and started mass-marketing the modern toothbrush design, would be shocked by how much has changed in 240 years. 

• • 47. Ryff

• • 48. Bunon

• • 49. Grand View Research

 

References on oral hygiene tools

Bennion, Elisabeth (1986). Antique Dental Instruments. Sotheby’s Publications, London. p.137

Berdmore, Thomas (1768). – A treatise on the disorders and deformities of the teeth and gums, p.259.

Botot, Julien (1783) Moyens sur pour conserves des dents. pp.30.

Budge, E. A. Wallis (1913. The Book of Medicines” or Syrian Anatomy, Pathology and Therapeutics (Anonymous); Vol II. p.192. translated by Budge, E. A. Wallis (Ernest Alfred Wallis), Sir, 1857-1934. https://archive.org/details/syriananatomypat02budgiala/page/192/mode/2up/search/caryophyllus

Bunon, Robert (1743). Essay sur les maladies des dents. Paris: Briasson Chaubert; De Hansy. p.237.

Chernin, D and Shklar G. (2003). Levi Spear Parmly: father of dental hygiene and children’s dentistry in America. J Hist Dent. 2003 Mar;51(1):15-8.

Christen, AG, Christen, JA.  (2003). A historical glimpse of toothpick use: etiquette, oral and medical conditions. J Hist. Dent. Vol. 51:2, 61.

Croll, T.P. and Swanson B.Z. (2000) 19th Century Dentistry Advertising Trade Cards: No 4. J. Hist. Dent. 48 (1):16.

Die Zene Arznei (1530) [Artzney Buchlein wider allerlei kranckheyten und gebrechen der tzeen, getzogen auß dem Galeno Avicenna Mesue Cornelio Celso und andern mehr der Artzney doctorn seher nützlich tzu lesen].

Diodorus Siculus: The Library of History. Loeb Classical Library 1939, Book 5.  http://penelope.uchicago.edu/Thayer/E/Roman/Texts/Diodorus_Siculus/5B*.html#note42

Dionysius Duvallius (1590). Epigrammata et poematia vetera, edited Pierre Pithou, p.134. (The volume includes Serennus Sammonicus’s  Liber Medicinalis under title De medicina praecepta saluberima, (p.126-164). https://books.google.com/books?id=jTIv2eC1ZqoC&printsec=frontcover&dq=Epigrammata+et+poematia+vetera&hl=en&newbks=1&newbks_redir=0&sa=X&ved=2ahUKEwiP1cyP-JroAhW_lnIEHaEfAP0Q6AEwAXoECAQQAg#v=onepage&q=Epigrammata%20et%20poematia%20vetera&f=false

Desirabode, Malagou-Antoine (1843). Nouveaux elements complets de la science et de l’art du dentiste. p.409

Fauchard, Pierre (1746). Le Chirurgien Dentist. Volume 1. 2d Ed. , p. 167.

Foreest, Peter van (1609). Observationum et curationum medicinalium ll. XXXII Petrus Forestus. Ex Officina Palatiniana Raphelenghi 1606. p. 216.

Gorraeus, Johannes (Jean de Gorris). Definitionum medicarum Liber XXIIII,  1564. p 376 (Lat: dentiscalpia – Gr: οδοντογλυφα – odontoglypha)

Grand View Research (2020). Oral Care Market Size, Share & Trends Analysis Report By Product (Mouthwash/Rinse, Toothbrush, Toothpaste, Denture Products, Dental Accessories), By Region, And Segment Forecasts, 2018 – 2025. https://www.grandviewresearch.com/industry-analysis/oral-care-market (accessed, 2020, March 20).

Hardy, K., Radini, A., Buckley, S. et al. (2017). Diet and environment 1.2 million years ago revealed through analysis of dental calculus from Europe’s oldest hominin at Sima del Elefante, Spain. Sci Nat 104, 2. https://doi.org/10.1007/s00114-016-1420-x

Hellwig, Christoph, von (1700). Freuenzimmer-Apotheckgen. Groschuff, XXXI, p.39. (First scientific description of modern toothbrush).

Hoffmann-Axthelm, Walter – a. (1981). History of Dentistry, Quintessence Publishing 1981, Chicago, Berlin, Rio de Janeiro, Tokyo, p. 36 and 189.

Hoffmann-Axthelm, Walter – b. (1981). History of Dentistry, Quintessence Publishing 1981, Chicago, Berlin, Rio de Janeiro, Tokyo p. 30 and p. 216.

Hoffmann-Axthelm, Walter – c. (1981). History of Dentistry, Quintessence Publishing 1981, Chicago, Berlin, Rio de Janeiro, Tokyo, p.40.

Hyson, John H. (2003). History of the toothbrush. J Hist Dent. 51(2):73-80.

Khatak, M (2010) Salvadora Persica, Pharmacogn Rev. 2010 Jul-Dec; 4(8): 209–214. doi: 10.4103/0973-7847.70920

Lane, Nick (2015). The unseen world: reflections on Leeuwenhoek (1677) Concerning little animals. 370Phil. Trans. R. Soc. B.  http://doi.org/10.1098/rstb.2014.0344

Leeuwenhoeck, Antoni Van (1952).The Collected Letters of Antoni van Leeuwenhoek, Vol IV (1683-1684) (in Dutch). C.V.Swets and Zeitlinger, Amsterdam 1952. (http://dbnl.org/tekst/leeu027alle04_01/leeu027alle04_01_0012.php

Lippert, Frank, (2013) An Introduction to Toothpaste – Its Purpose, History and Ingredients. In Toothpastes. Monogr Oral Sci Basel, Karger, Van Loveren C (ed),  2013, Vol 23, pp 1-14. DOI: 10.1159/00350456

Lozano M, Subirà ME, Aparicio J, et al. (2013). Toothpicking and Periodontal Disease in a Neanderthal Specimen from Cova Foradà Site (Valencia, Spain). PLOS ONE 8(10): e76852. https://doi.org/10.1371/journal.pone.0076852

Meiers, Peter. Early dental fluoride preparations. http://www.fluoride-history.de/p-dentifrice.htm.

Morgenthau, Lazarus (1877). Tongue scraper Patent # 194364, Aug 30, 1877.

Nunn, John F. (2002). Ancient Egyptian Medicine. Oklahoma Press, Norman 2002, ISBN 0-8061-3504-2, page 124.

Parmly, Levi Spear (1818). A practical guide to the management of the teeth. London, 1818, p.73. (The passage explains the three steps to preserve the teeth: 1. Toothbrush, 2. Dentifrice polisher and 3. Waxed silken thread.)

Petroski, Henry (2007). The Toothpick. Alfred Knopf, New York, pp.443.

Ricci S. Capecchi G. Boschini S. et al., (2014). Toothpick use among Epigravettian Humans from Grotta Paglicci (Italy). Int J Osteoarchaeol

Rohrer, Albert (1910) Zahnpulver und Mundwässer, Verlag von Georg Siemens, Berlin, p. 104.

Ryff, Walther Hermann (1548?): Nützlicher Bericht, […] Wie man den Mundt, die Zän und Biller frisch, rein, sauber, gesund, starck und fest erhalten soll (How to keep your mouth, teeth fresh, pure, clean, healthy, strong and firm for less). Johann Myller, Würzburg.

Sachs, Hans. Der Zahnstocher und seine Geschichte. Hermann Meuser, Berlin, 1913, pp. 52. (The toothpick and its history). Translated by Anna C. Souchuk, Published by Steven R Potashnick, 2010, ISBN-13: 978-1456494179).

Sanoudos M, Christen AG. 1999. Levi Spear Parmly: the apostle of dental hygiene.  J Hist Dent. 1999 Mar;47(1):3-6.

Shklar, Gerald and Chernin, David. A Sourcebook of Dental Medicine, 2001, Maro Publications, p.46 (tongue scraper), p.62 (halitosis and Talmud).

S.S.White Dental Catalogue of Dental Materials Furniture and Instruments. 1867, p.215.

Strabo: The Geography of Strabo. The Library of History. Loeb Classical Library 1923, Volume II, Book III, Chapter 4.  http://penelope.uchicago.edu/Thayer/E/Roman/Texts/Strabo/3D*.html#4.16.2

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Tremble, Angus (2005). A Brief History of the Smile. Basic Books. p.288.

Vaughan, William (1600). Naturall and Artificial Directions for Health, derived from the best philosophers, as well moderne as auncient. R. Bradocke, London, pp. 70-76.

Vaughan, William (1602). Naturall and Artificial Directions for Health. R. Bradocke, London, p 57-63. 

Weinberger, Bernhard W. (1948). – An Introduction to the History of Dentistry in America. CV Mosby, 1948.

Wolf, W. (1966). A history of personal hygiene customs, methods and instruments yesterday, today, tomorrow. Bull Hist Dent, 14: 54-63.

Woofendale, Robert (1783). Observations on the Teeth. p. 153 (toothbrush).

 

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