Cocaine and Achieving Rapid Pulpal Anesthesia Prior to Extirpation.

Prior to the effective use of local anesthetics to achieve profound pulpal anesthesia before extirpation, whether in the form of a nerve block or infiltration, or in some cases the use of intrapulpal injections,1, 2 the clinician was faced with a challenge to ensure that the patient would be pain free during the procedure. In these cases the use of nitrous oxide and oxygen was common. Not so common was the use of cocaine or a solution of cocaine hydrochloride that was advocated to penetrate the dentinal tubules and create pulpal insensibility in the late 1800s.3, 4.

Providing Anesthesia in the Oral and Maxillofacial Surgery Office: A Look Back, Where We Are Now and a Look Ahead.

Throughout its development the practice of oral and maxillofacial surgery has been richly associated with the provision of anesthetic services. Dentists and particularly oral and maxillofacial surgeons have advanced the science associated with anesthesia especially in the outpatient setting. This article will look back on the development of anesthesia as it relates to oral and maxillofacial surgery, discuss the current mode of anesthesia in the oral surgeon's practice and look ahead to what innovations are advancing this field.

Dental technology over 150 years: evolution and revolution.

A patient entering a dental office is often greeted and then checked in through the practice management system's digital appointment book. The provider is notified by an electronic signal that is visual, audible, or both. The patient is led to the treatment area and sits in a dental chair which is adjusted to the individual's size and position for the treatment, and the light is positioned. Sometimes a radiograph is taken, local anesthetic is delivered, and a handpiece--air turbine or electric--is used for the procedure. How different is this process today from a dentist treating a patient in 1864?

The nitrous oxide "dream" of Cora Gray: a dental anesthesia story of 1884.

In the September 1884 issue of Frank Leslie's Popular Monthly magazine, a fictional dramatic short story was published concerning the dental use of nitrous oxide. Entitled, "Cora Gray," it was written by the well-known American journalist and poet John Whittaker Watson (1815-1848), who authored hundreds of sentimental, tragic and dramatic poems, serials and stories concerning the destitute lives and deaths of downtrodden young women of that time. His greatest poetic effort, "Beautiful Snow," (1869) tells of a young prostitute who freezes to death in a snow bank. Watson, born in New York City, was educated at the University of New York, where he studied medicine. He also developed and used his skills as an engraver, journalist and writer. Watson obviously based his imaginative narrative on his medical knowledge of nitrous oxide and its physical and psychological side effects when inhaled. The story centers around the dreamlike romantic experiences of a 19-year-old female dental patient while she is under the effects of this gas. It explicitly depicts the administration of nitrous oxide and the resulting erotic visions and hallucinations that the young patient experiences. We make reference to other cautionary scientific writings from the late 1800s, in order to point out and clarify the potentially negative repercussions of nitrous oxide when administered to female dental patients without the presence of a third party. The ethics and propriety of anesthesia administration remain as perennial questions in dentistry to this day.

Horace wells' demonstration of nitrous oxide in Boston.

Horace Wells, a dentist in Hartford, Connecticut, first used nitrous oxide in dentistry in December 1844. A few weeks later he travelled to Boston, Massachusetts, to demonstrate to physicians and dentists the use of nitrous oxide in painful procedures. Wells' unsuccessful demonstration of nitrous oxide for the extraction of a tooth is well known, but other details of this trip are poorly understood. A description of Wells' visit to Boston was compiled using information from 21 statements and 5 newspaper notices. The precise date and location of Wells' demonstration could not be determined. There is no primary evidence that Wells' demonstration occurred in the surgical amphitheater (Ether Dome) at Massachusetts General Hospital. Wells' demonstration of nitrous oxide probably occurred around the end of January 1845, in a public hall on Washington Street, Boston.

[Ether Day--no laughing matter. The birth of modern anaesthesia]. / Ether Day--no laughing matter--Die Geburtsstunde der modernen Anästhesie.

Since centuries the first public demonstration of the anaesthetic properties of ether by William Thomas Green Morton at the Massachusetts General Hospital in Boston on October 16th 1846 is celebrated as "Ether Day" world-wide. The news of the beneficial effects, primarily disposed as a "Yankee Invention", spread over all continents quickly. This was the result of an article, published in the Boston Medical and Surgical Journal on November 18th, 1846. It is mentioning worth that this article was written when Morton had disclosed that the used "preparation", later named as "Nostrum" or "Letheon", was sulphuric ether. The important discovery later became a patent case and was overshadowed by a long lasting priority claim. Nevertheless the readers of the New England Journal of Medicine voted in a survey that this article was the most important publication in the 200 years journals history ever.

Cultivating a "chairside manner": dental hypnosis, patient management psychology, and the origins of behavioral dentistry in America, 1890-1910.

Discussions regarding the use of hypnotism in dentistry featured prominently in dental journals and society proceedings during the decades around the turn of the twentieth century. Many dentists used hypnotic suggestion either as the sole anesthetic for extractions or in conjunction with local and general anesthetics for excavation and cavity filling. With the heralding of humanitarian dentistry and improved local anesthesia around 1905, a number of dentists advocated using suggestion psychology to calm nervous patients and increase their comfort and satisfaction levels while undergoing dental procedures. The practice of hypnotic suggestion with local and general anesthesia in providing patients with increasingly painless procedures constituted the earliest variety of behavioral dentistry, a discipline not fully developed until the closing decades of the twentieth century. Hypnosis and suggestion became driving forces for psychological applications in the formative years of behavioral dentistry.

Keeping ether "en-vogue": the role of Nathan Cooley Keep in the history of ether anesthesia.

In this report, we explore the little known role of Dr Nathan Cooley Keep in the dissemination of ether anesthesia in Boston. Keep was a prominent Boston dentist who, for a short time, taught and employed both William Morton and Horace Wells. He used ether anesthesia for a variety of dental and other surgical procedures requiring pain control. Keep administered ether to anesthetize Henry Wadsworth Longfellow's wife during the delivery of their daughter. This was the first use of ether for obstetric anesthesia. Dr Keep was also the first Dean of the Harvard Dental School and convinced the Massachusetts General Hospital to appoint a dentist to the staff of the hospital for the first time.

Stanley L Drummond-Jackson. Pioneer of intravenous anaesthesia in dentistry.

Stanley Lithgow Drummond-Jackson was born in Northumberland and qualified from Edinburgh University Dental School in 1931. Even in the early stages of his practice he devoted his energies to the problem of pain control in dentistry, publishing his first paper in 1935. In the early 20th century most dental anaesthetics were inhalational with nitrous oxide, ether, ethyl chloride and chloroform. The introduction of intravenous hexobarbitone in 1931 led to bold and enthusiastic researchers like Drummond-Jackson to pioneer its use in dental practice. He published his major work on intravenous hexobarbitone in 1952. In 1957, Drummond-Jackson and a group of colleagues formed the now well-known organisation called 'Society for the Advancement of Anaesthesia in Dentistry' or SAAD. SAAD has grown from a group of 40 to over 4000 members worldwide. In 1969, the BMJ published an article condemning Drummond-Jackson's technique of intermittent intravenous methohexitone. At his personal expense, Drummond-Jackson brought a libel action against the BMJ and authors of this paper. There were no winners as the case was settled after 38 days and earned the reputation for being the longest and most expensive libel case in the history of the London Courts. Despite this setback the founder of SAAD devoted the last days of his life in research, teaching and abolishing fear and pain in dentistry. He gained international reputation as a teacher in dental anaesthesia and was honoured with fellowships and awards. He died in 1975 at the age of 66. In the early 1900s dental anaesthesia was only inhalational with mainly nitrous oxide on one hand and ether, ethyl chloride and chloroform on the other. Induction was at times stormy and prolonged and recovery was delayed. The synthesis of barbiturates, especially intravenous hexobarbitone (1931), thiopentone (1932) and methohexitone (1959) opened new avenues for dental anaesthesia. Modern anaesthesia owes a lot to early pioneers, many of them being dentists and Drummond-Jackson was among them.

C.T. Jackson's 15 October 1846 letter to J.-B.A.L. Elie de Beaumont: Jackson's thoughts on Ether Day's Eve?

As did the previous letter on 30 November 1845 from Charles T. Jackson to J.-B.A.L. Elie de Beaumont, this 15 October 1846 missive underscores the cordial professional relationship between the two geologists. Remarkably, in this "Ether Day's Eve" letter, Jackson never reveals whether he had any clue that W.T.G. Morton would be publicly demonstrating ether anesthesia for surgery the next morning. More importantly, since Elie de Beaumont would play a future pivotal role in assigning initial credit for "discovering anesthesia" to his geological colleague Jackson, rather than to Morton, letters such as these from November of 1845 and October of 1846 can only raise more questions about the impartiality of Elie de Beaumont.

Local anesthetics, pulpal blood flow and C. Edmund Kells.

Historically there was an attempt by many dental practitioners to implicate anesthetic solutions in the death of the dental pulp. However, their implications may or may not have been valid, as damage to the dental pulp may have resulted from excessive and deleterious restorative procedures on teeth that were anesthetized. Unfortunately little was known about the anesthetic solutions at that time, their composition, which included vasoconstrictors, and their potential to alter pulpal blood flow. This paper will explore both the historical perspectives and concerns regarding the impact of anesthetic solutions on the dental pulp through the eyes of Dr. C. Edmund Kells, along with the contemporary perspectives and realities through the eyes of science, sound research data and clinical practice.

Elton Romeo Smilie, the not-quite discoverer of ether anesthesia.

Like William T.G. Morton, Elton Romeo Smilie (1819-1889) was raised in Massachusetts, attended medical school in New England, practiced dentistry there, strove for clinical invention, and moved to Boston. In October 1846, both announced that inhaled ethereal preparations achieved reversible insensibility in surgical patients. Smilie published a report in the Boston Med Surg J 3 wk before Bigelow used that forum to broadcast Morton's Ether Day. Smilie's preparation was an ethereal tincture of opium, and, as he mistakenly believed the opium to be volatile and important, he ceded priority to Morton for ether anesthesia. The two authors collaborated on chloroform, but Smilie soon headed off in the Gold Rush to California. It is tempting to speculate that Charles T. Jackson and Morton were indebted in part to Smilie.