Understanding Causes of Tooth Crowding

Branch of medicine caring for children

This article is about the branch of medicine. For the journal, see Pediatrics (journal). For the branch of dentistry, see Pedodontics.

 

Medical specialty

Pediatrics

A pediatrician examines a neonate.
Focus	Infants, Children, Adolescents, and Young Adults
Subdivisions	Paediatric cardiology, neonatology, critical care, pediatric oncology, hospital medicine, primary care, others (see below)
Significant diseases	Congenital diseases, Infectious diseases, Childhood cancer, Mental disorders
Significant tests	World Health Organization Child Growth Standards
Specialist	Pediatrician
Glossary	Glossary of medicine

Pediatrics (American English) also spelled paediatrics (British English), is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, pediatrics covers many of their youth until the age of 18.^[1] The American Academy of Pediatrics recommends people seek pediatric care through the age of 21, but some pediatric subspecialists continue to care for adults up to 25.^[2][3] Worldwide age limits of pediatrics have been trending upward year after year.^[4] A medical doctor who specializes in this area is known as a pediatrician, or paediatrician. The word pediatrics and its cognates mean "healer of children", derived from the two Greek words: παῖς (pais "child") and ἰατρός (iatros "doctor, healer"). Pediatricians work in clinics, research centers, universities, general hospitals and children's hospitals, including those who practice pediatric subspecialties (e.g. neonatology requires resources available in a NICU).

History

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The earliest mentions of child-specific medical problems appear in the Hippocratic Corpus, published in the fifth century B.C., and the famous Sacred Disease. These publications discussed topics such as childhood epilepsy and premature births. From the first to fourth centuries A.D., Greek philosophers and physicians Celsus, Soranus of Ephesus, Aretaeus, Galen, and Oribasius, also discussed specific illnesses affecting children in their works, such as rashes, epilepsy, and meningitis.^[5] Already Hippocrates, Aristotle, Celsus, Soranus, and Galen^[6] understood the differences in growing and maturing organisms that necessitated different treatment: Ex toto non sic pueri ut viri curari debent ("In general, boys should not be treated in the same way as men").^[7] Some of the oldest traces of pediatrics can be discovered in Ancient India where children's doctors were called kumara bhrtya.^[6]

Even though some pediatric works existed during this time, they were scarce and rarely published due to a lack of knowledge in pediatric medicine. Sushruta Samhita, an ayurvedic text composed during the sixth century BCE, contains the text about pediatrics.^[8] Another ayurvedic text from this period is Kashyapa Samhita.^[9][10] A second century AD manuscript by the Greek physician and gynecologist Soranus of Ephesus dealt with neonatal pediatrics.^[11] Byzantine physicians Oribasius, Aëtius of Amida, Alexander Trallianus, and Paulus Aegineta contributed to the field.^[6] The Byzantines also built brephotrophia (crêches).^[6] Islamic Golden Age writers served as a bridge for Greco-Roman and Byzantine medicine and added ideas of their own, especially Haly Abbas, Yahya Serapion, Abulcasis, Avicenna, and Averroes. The Persian philosopher and physician al-Razi (865–925), sometimes called the father of pediatrics, published a monograph on pediatrics titled Diseases in Children.^[12][13] Also among the first books about pediatrics was Libellus [Opusculum] de aegritudinibus et remediis infantium 1472 ("Little Book on Children Diseases and Treatment"), by the Italian pediatrician Paolo Bagellardo.^[14][5] In sequence came Bartholomäus Metlinger's Ein Regiment der Jungerkinder 1473, Cornelius Roelans (1450–1525) no title Buchlein, or Latin compendium, 1483, and Heinrich von Louffenburg (1391–1460) Versehung des Leibs written in 1429 (published 1491), together form the Pediatric Incunabula, four great medical treatises on children's physiology and pathology.^[6]

While more information about childhood diseases became available, there was little evidence that children received the same kind of medical care that adults did.^[15] It was during the seventeenth and eighteenth centuries that medical experts started offering specialized care for children.^[5] The Swedish physician Nils Rosén von Rosenstein (1706–1773) is considered to be the founder of modern pediatrics as a medical specialty,^[16][17] while his work The diseases of children, and their remedies (1764) is considered to be "the first modern textbook on the subject".^[18] However, it was not until the nineteenth century that medical professionals acknowledged pediatrics as a separate field of medicine. The first pediatric-specific publications appeared between the 1790s and the 1920s.^[19]

Etymology

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The term pediatrics was first introduced in English in 1859 by Abraham Jacobi. In 1860, he became "the first dedicated professor of pediatrics in the world."^[20] Jacobi is known as the father of American pediatrics because of his many contributions to the field.^[21][22] He received his medical training in Germany and later practiced in New York City.^[23]

The first generally accepted pediatric hospital is the Hôpital des Enfants Malades (French: Hospital for Sick Children), which opened in Paris in June 1802 on the site of a previous orphanage.^[24] From its beginning, this famous hospital accepted patients up to the age of fifteen years,^[25] and it continues to this day as the pediatric division of the Necker-Enfants Malades Hospital, created in 1920 by merging with the nearby Necker Hospital, founded in 1778.^[26]

In other European countries, the Charité (a hospital founded in 1710) in Berlin established a separate Pediatric Pavilion in 1830, followed by similar institutions at Saint Petersburg in 1834, and at Vienna and Breslau (now Wrocław), both in 1837. In 1852 Britain's first pediatric hospital, the Hospital for Sick Children, Great Ormond Street was founded by Charles West.^[24] The first Children's hospital in Scotland opened in 1860 in Edinburgh.^[27] In the US, the first similar institutions were the Children's Hospital of Philadelphia, which opened in 1855, and then Boston Children's Hospital (1869).^[28] Subspecialties in pediatrics were created at the Harriet Lane Home at Johns Hopkins by Edwards A. Park.^[29]

Differences between adult and pediatric medicine

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The body size differences are paralleled by maturation changes. The smaller body of an infant or neonate is substantially different physiologically from that of an adult. Congenital defects, genetic variance, and developmental issues are of greater concern to pediatricians than they often are to adult physicians. A common adage is that children are not simply "little adults". The clinician must take into account the immature physiology of the infant or child when considering symptoms, prescribing medications, and diagnosing illnesses.^[30]

Pediatric physiology directly impacts the pharmacokinetic properties of drugs that enter the body. The absorption, distribution, metabolism, and elimination of medications differ between developing children and grown adults.^[30][31][32] Despite completed studies and reviews, continual research is needed to better understand how these factors should affect the decisions of healthcare providers when prescribing and administering medications to the pediatric population.^[30]

Absorption

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Many drug absorption differences between pediatric and adult populations revolve around the stomach. Neonates and young infants have increased stomach pH due to decreased acid secretion, thereby creating a more basic environment for drugs that are taken by mouth.^[31][30][32] Acid is essential to degrading certain oral drugs before systemic absorption. Therefore, the absorption of these drugs in children is greater than in adults due to decreased breakdown and increased preservation in a less acidic gastric space.^[31]

Children also have an extended rate of gastric emptying, which slows the rate of drug absorption.^[31][32]

Drug absorption also depends on specific enzymes that come in contact with the oral drug as it travels through the body. Supply of these enzymes increase as children continue to develop their gastrointestinal tract.^[31][32] Pediatric patients have underdeveloped proteins, which leads to decreased metabolism and increased serum concentrations of specific drugs. However, prodrugs experience the opposite effect because enzymes are necessary for allowing their active form to enter systemic circulation.^[31]

Distribution

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Percentage of total body water and extracellular fluid volume both decrease as children grow and develop with time. Pediatric patients thus have a larger volume of distribution than adults, which directly affects the dosing of hydrophilic drugs such as beta-lactam antibiotics like ampicillin.^[31] Thus, these drugs are administered at greater weight-based doses or with adjusted dosing intervals in children to account for this key difference in body composition.^[31][30]

Infants and neonates also have fewer plasma proteins. Thus, highly protein-bound drugs have fewer opportunities for protein binding, leading to increased distribution.^[30]

Metabolism

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Drug metabolism primarily occurs via enzymes in the liver and can vary according to which specific enzymes are affected in a specific stage of development.^[31] Phase I and Phase II enzymes have different rates of maturation and development, depending on their specific mechanism of action (i.e. oxidation, hydrolysis, acetylation, methylation, etc.). Enzyme capacity, clearance, and half-life are all factors that contribute to metabolism differences between children and adults.^[31][32] Drug metabolism can even differ within the pediatric population, separating neonates and infants from young children.^[30]

Elimination

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Drug elimination is primarily facilitated via the liver and kidneys.^[31] In infants and young children, the larger relative size of their kidneys leads to increased renal clearance of medications that are eliminated through urine.^[32] In preterm neonates and infants, their kidneys are slower to mature and thus are unable to clear as much drug as fully developed kidneys. This can cause unwanted drug build-up, which is why it is important to consider lower doses and greater dosing intervals for this population.^[30][31] Diseases that negatively affect kidney function can also have the same effect and thus warrant similar considerations.^[31]

Pediatric autonomy in healthcare

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A major difference between the practice of pediatric and adult medicine is that children, in most jurisdictions and with certain exceptions, cannot make decisions for themselves. The issues of guardianship, privacy, legal responsibility, and informed consent must always be considered in every pediatric procedure. Pediatricians often have to treat the parents and sometimes, the family, rather than just the child. Adolescents are in their own legal class, having rights to their own health care decisions in certain circumstances. The concept of legal consent combined with the non-legal consent (assent) of the child when considering treatment options, especially in the face of conditions with poor prognosis or complicated and painful procedures/surgeries, means the pediatrician must take into account the desires of many people, in addition to those of the patient.^{[citation needed]}

History of pediatric autonomy

[edit]

The term autonomy is traceable to ethical theory and law, where it states that autonomous individuals can make decisions based on their own logic.^[33] Hippocrates was the first to use the term in a medical setting. He created a code of ethics for doctors called the Hippocratic Oath that highlighted the importance of putting patients' interests first, making autonomy for patients a top priority in health care.^[34]  

In ancient times, society did not view pediatric medicine as essential or scientific.^[35] Experts considered professional medicine unsuitable for treating children. Children also had no rights. Fathers regarded their children as property, so their children's health decisions were entrusted to them.^[5] As a result, mothers, midwives, "wise women", and general practitioners treated the children instead of doctors.^[35] Since mothers could not rely on professional medicine to take care of their children, they developed their own methods, such as using alkaline soda ash to remove the vernix at birth and treating teething pain with opium or wine. The absence of proper pediatric care, rights, and laws in health care to prioritize children's health led to many of their deaths. Ancient Greeks and Romans sometimes even killed healthy female babies and infants with deformities since they had no adequate medical treatment and no laws prohibiting infanticide.^[5]

In the twentieth century, medical experts began to put more emphasis on children's rights. In 1989, in the United Nations Rights of the Child Convention, medical experts developed the Best Interest Standard of Child to prioritize children's rights and best interests. This event marked the onset of pediatric autonomy. In 1995, the American Academy of Pediatrics (AAP) finally acknowledged the Best Interest Standard of a Child as an ethical principle for pediatric decision-making, and it is still being used today.^[34]

Parental authority and current medical issues

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The majority of the time, parents have the authority to decide what happens to their child. Philosopher John Locke argued that it is the responsibility of parents to raise their children and that God gave them this authority. In modern society, Jeffrey Blustein, modern philosopher and author of the book Parents and Children: The Ethics of Family, argues that parental authority is granted because the child requires parents to satisfy their needs. He believes that parental autonomy is more about parents providing good care for their children and treating them with respect than parents having rights.^[36] The researcher Kyriakos Martakis, MD, MSc, explains that research shows parental influence negatively affects children's ability to form autonomy. However, involving children in the decision-making process allows children to develop their cognitive skills and create their own opinions and, thus, decisions about their health. Parental authority affects the degree of autonomy the child patient has. As a result, in Argentina, the new National Civil and Commercial Code has enacted various changes to the healthcare system to encourage children and adolescents to develop autonomy. It has become more crucial to let children take accountability for their own health decisions.^[37]

In most cases, the pediatrician, parent, and child work as a team to make the best possible medical decision. The pediatrician has the right to intervene for the child's welfare and seek advice from an ethics committee. However, in recent studies, authors have denied that complete autonomy is present in pediatric healthcare. The same moral standards should apply to children as they do to adults. In support of this idea is the concept of paternalism, which negates autonomy when it is in the patient's interests. This concept aims to keep the child's best interests in mind regarding autonomy. Pediatricians can interact with patients and help them make decisions that will benefit them, thus enhancing their autonomy. However, radical theories that question a child's moral worth continue to be debated today.^[37] Authors often question whether the treatment and equality of a child and an adult should be the same. Author Tamar Schapiro notes that children need nurturing and cannot exercise the same level of authority as adults.^[38] Hence, continuing the discussion on whether children are capable of making important health decisions until this day.

Modern advancements

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According to the Subcommittee of Clinical Ethics of the Argentinean Pediatric Society (SAP), children can understand moral feelings at all ages and can make reasonable decisions based on those feelings. Therefore, children and teens are deemed capable of making their own health decisions when they reach the age of 13. Recently, studies made on the decision-making of children have challenged that age to be 12.^[37]

Technology has made several modern advancements that contribute to the future development of child autonomy, for example, unsolicited findings (U.F.s) of pediatric exome sequencing. They are findings based on pediatric exome sequencing that explain in greater detail the intellectual disability of a child and predict to what extent it will affect the child in the future. Genetic and intellectual disorders in children make them incapable of making moral decisions, so people look down upon this kind of testing because the child's future autonomy is at risk. It is still in question whether parents should request these types of testing for their children. Medical experts argue that it could endanger the autonomous rights the child will possess in the future. However, the parents contend that genetic testing would benefit the welfare of their children since it would allow them to make better health care decisions.^[39] Exome sequencing for children and the decision to grant parents the right to request them is a medically ethical issue that many still debate today.

Education requirements

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The examples and perspective in this section deal primarily with United States and do not represent a worldwide view of the subject. You may improve this section, discuss the issue on the talk page, or create a new section, as appropriate. (September 2019) (Learn how and when to remove this message)

Aspiring medical students will need 4 years of undergraduate courses at a college or university, which will get them a BS, BA or other bachelor's degree. After completing college, future pediatricians will need to attend 4 years of medical school (MD/DO/MBBS) and later do 3 more years of residency training, the first year of which is called "internship." After completing the 3 years of residency, physicians are eligible to become certified in pediatrics by passing a rigorous test that deals with medical conditions related to young children.^{[citation needed]}

In high school, future pediatricians are required to take basic science classes such as biology, chemistry, physics, algebra, geometry, and calculus. It is also advisable to learn a foreign language (preferably Spanish in the United States) and be involved in high school organizations and extracurricular activities. After high school, college students simply need to fulfill the basic science course requirements that most medical schools recommend and will need to prepare to take the MCAT (Medical College Admission Test) in their junior or early senior year in college. Once attending medical school, student courses will focus on basic medical sciences like human anatomy, physiology, chemistry, etc., for the first three years, the second year of which is when medical students start to get hands-on experience with actual patients.^[40]

Training of pediatricians

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Pediatrics

Occupation
Names	Pediatrician Paediatrician
Occupation type	Specialty
Activity sectors	Medicine
Description
Education required	Doctor of Medicine Doctor of Osteopathic Medicine Bachelor of Medicine, Bachelor of Surgery (MBBS/MBChB)
Fields of employment	Hospitals, Clinics

The training of pediatricians varies considerably across the world. Depending on jurisdiction and university, a medical degree course may be either undergraduate-entry or graduate-entry. The former commonly takes five or six years and has been usual in the Commonwealth. Entrants to graduate-entry courses (as in the US), usually lasting four or five years, have previously completed a three- or four-year university degree, commonly but by no means always in sciences. Medical graduates hold a degree specific to the country and university in and from which they graduated. This degree qualifies that medical practitioner to become licensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for "internship" or "conditional registration".

Pediatricians must undertake further training in their chosen field. This may take from four to eleven or more years depending on jurisdiction and the degree of specialization.

In the United States, a medical school graduate wishing to specialize in pediatrics must undergo a three-year residency composed of outpatient, inpatient, and critical care rotations. Subspecialties within pediatrics require further training in the form of 3-year fellowships. Subspecialties include critical care, gastroenterology, neurology, infectious disease, hematology/oncology, rheumatology, pulmonology, child abuse, emergency medicine, endocrinology, neonatology, and others.^[41]

In most jurisdictions, entry-level degrees are common to all branches of the medical profession, but in some jurisdictions, specialization in pediatrics may begin before completion of this degree. In some jurisdictions, pediatric training is begun immediately following the completion of entry-level training. In other jurisdictions, junior medical doctors must undertake generalist (unstreamed) training for a number of years before commencing pediatric (or any other) specialization. Specialist training is often largely under the control of 'pediatric organizations (see below) rather than universities and depends on the jurisdiction.

Subspecialties of pediatrics include:

(not an exhaustive list)

• Addiction medicine (multidisciplinary)
• Adolescent medicine
• Child abuse pediatrics
• Clinical genetics
• Clinical informatics
• Developmental-behavioral pediatrics
• Headache medicine
• Hospital medicine
• Medical toxicology
• Metabolic medicine
• Neonatology/Perinatology
• Pain medicine (multidisciplinary)
• Palliative care (multidisciplinary)
• Pediatric allergy and immunology
• Pediatric cardiology
  • Pediatric cardiac critical care
• Pediatric critical care
  • Neurocritical care
  • Pediatric cardiac critical care
• Pediatric emergency medicine
• Pediatric endocrinology
• Pediatric gastroenterology
  • Transplant hepatology
• Pediatric hematology
• Pediatric infectious disease
• Pediatric nephrology
• Pediatric oncology
  • Pediatric neuro-oncology
• Pediatric pulmonology
• Primary care
• Pediatric rheumatology
• Sleep medicine (multidisciplinary)
• Social pediatrics
• Sports medicine

(not an exhaustive list)

• Child neurology
  • Addiction medicine (multidisciplinary)
  • Brain injury medicine
  • Clinical neurophysiology
  • Epilepsy
  • Headache medicine
  • Neurocritical care
  • Neuroimmunology
  • Neuromuscular medicine
  • Pain medicine (multidisciplinary)
  • Palliative care (multidisciplinary)
  • Pediatric neuro-oncology
  • Sleep medicine (multidisciplinary)
• Child and adolescent psychiatry, subspecialty of psychiatry
• Neurodevelopmental disabilities
• Pediatric anesthesiology, subspecialty of anesthesiology
• Pediatric dentistry, subspecialty of dentistry
• Pediatric dermatology, subspecialty of dermatology
• Pediatric gynecology
• Pediatric neurosurgery, subspecialty of neurosurgery
• Pediatric ophthalmology, subspecialty of ophthalmology
• Pediatric orthopedic surgery, subspecialty of orthopedic surgery
• Pediatric otolaryngology, subspecialty of otolaryngology
• Pediatric plastic surgery, subspecialty of plastic surgery
• Pediatric radiology, subspecialty of radiology
• Pediatric rehabilitation medicine, subspecialty of physical medicine and rehabilitation
• Pediatric surgery, subspecialty of general surgery
• Pediatric urology, subspecialty of urology

• American Academy of Pediatrics
• American Osteopathic Board of Pediatrics
• Center on Media and Child Health (CMCH)
• Children's hospital
• List of pediatric organizations
• List of pediatrics journals
• Medical specialty
• Pediatric Oncall
• Pain in babies
• Royal College of Paediatrics and Child Health
• Pediatric environmental health

• BMC Pediatrics - open access
• Clinical Pediatrics
• Developmental Review - partial open access
• JAMA Pediatrics
• The Journal of Pediatrics - partial open access

Wikimedia Commons has media related to Pediatrics.

Wikibooks has a book on the topic of: Pediatrics

Look up paediatrics or pediatrics in Wiktionary, the free dictionary.

• Pediatrics Directory at Curlie
• Pediatric Health Directory at OpenMD

Branch of medicine

 

• Sub-Millimeter Surgical Dexterity
• Knowledge of human health, disease, pathology, and anatomy
• Communication/Interpersonal Skills
• Analytical Skills
• Critical Thinking
• Empathy/Professionalism

• Private practices
• Primary care clinics
• Hospitals

• Physician
• dental assistant
• dental technician
• dental hygienist
• various dental specialists

Dentistry

A dentist treats a patient with the help of a dental assistant.
Occupation
Names	Dentist Dental Surgeon Doctor [1][nb 1]
Occupation type	Profession
Activity sectors	Health care, Anatomy, Physiology, Pathology, Medicine, Pharmacology, Surgery
Description
Competencies
Education required	Dental Degree
Fields of employment
Related jobs

Medical intervention

Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the teeth, gums, and mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, disorders, and conditions of the mouth, most commonly focused on dentition (the development and arrangement of teeth) as well as the oral mucosa.^[2] Dentistry may also encompass other aspects of the craniofacial complex including the temporomandibular joint. The practitioner is called a dentist.

The history of dentistry is almost as ancient as the history of humanity and civilization, with the earliest evidence dating from 7000 BC to 5500 BC.^[3] Dentistry is thought to have been the first specialization in medicine which has gone on to develop its own accredited degree with its own specializations.^[4] Dentistry is often also understood to subsume the now largely defunct medical specialty of stomatology (the study of the mouth and its disorders and diseases) for which reason the two terms are used interchangeably in certain regions. However, some specialties such as oral and maxillofacial surgery (facial reconstruction) may require both medical and dental degrees to accomplish. In European history, dentistry is considered to have stemmed from the trade of barber surgeons.^[5]

Dental treatments are carried out by a dental team, which often consists of a dentist and dental auxiliaries (such as dental assistants, dental hygienists, dental technicians, and dental therapists). Most dentists either work in private practices (primary care), dental hospitals, or (secondary care) institutions (prisons, armed forces bases, etc.).

The modern movement of evidence-based dentistry calls for the use of high-quality scientific research and evidence to guide decision-making such as in manual tooth conservation, use of fluoride water treatment and fluoride toothpaste, dealing with oral diseases such as tooth decay and periodontitis, as well as systematic diseases such as osteoporosis, diabetes, celiac disease, cancer, and HIV/AIDS which could also affect the oral cavity. Other practices relevant to evidence-based dentistry include radiology of the mouth to inspect teeth deformity or oral malaises, haematology (study of blood) to avoid bleeding complications during dental surgery, cardiology (due to various severe complications arising from dental surgery with patients with heart disease), etc.

The term dentistry comes from dentist, which comes from French dentiste, which comes from the French and Latin words for tooth.^[6] The term for the associated scientific study of teeth is odontology (from Ancient Greek: ὀδούς, romanized: odoús, lit. 'tooth') – the study of the structure, development, and abnormalities of the teeth.

Dentistry usually encompasses practices related to the oral cavity.^[7] According to the World Health Organization, oral diseases are major public health problems due to their high incidence and prevalence across the globe, with the disadvantaged affected more than other socio-economic groups.^[8]

The majority of dental treatments are carried out to prevent or treat the two most common oral diseases which are dental caries (tooth decay) and periodontal disease (gum disease or pyorrhea). Common treatments involve the restoration of teeth, extraction or surgical removal of teeth, scaling and root planing, endodontic root canal treatment, and cosmetic dentistry^[9]

By nature of their general training, dentists, without specialization can carry out the majority of dental treatments such as restorative (fillings, crowns, bridges), prosthetic (dentures), endodontic (root canal) therapy, periodontal (gum) therapy, and extraction of teeth, as well as performing examinations, radiographs (x-rays), and diagnosis. Dentists can also prescribe medications used in the field such as antibiotics, sedatives, and any other drugs used in patient management. Depending on their licensing boards, general dentists may be required to complete additional training to perform sedation, dental implants, etc.

Dentists also encourage the prevention of oral diseases through proper hygiene and regular, twice or more yearly, checkups for professional cleaning and evaluation. Oral infections and inflammations may affect overall health and conditions in the oral cavity may be indicative of systemic diseases, such as osteoporosis, diabetes, celiac disease or cancer.^{[7][10][13][14]} Many studies have also shown that gum disease is associated with an increased risk of diabetes, heart disease, and preterm birth. The concept that oral health can affect systemic health and disease is referred to as "oral-systemic health".

John M. Harris started the world's first dental school in Bainbridge, Ohio, and helped to establish dentistry as a health profession. It opened on 21 February 1828, and today is a dental museum.^[15] The first dental college, Baltimore College of Dental Surgery, opened in Baltimore, Maryland, US in 1840. The second in the United States was the Ohio College of Dental Surgery, established in Cincinnati, Ohio, in 1845.^[16] The Philadelphia College of Dental Surgery followed in 1852.^[17] In 1907, Temple University accepted a bid to incorporate the school.

Studies show that dentists that graduated from different countries,^[18] or even from different dental schools in one country,^[19] may make different clinical decisions for the same clinical condition. For example, dentists that graduated from Israeli dental schools may recommend the removal of asymptomatic impacted third molar (wisdom teeth) more often than dentists that graduated from Latin American or Eastern European dental schools.^[20]

In the United Kingdom, the first dental schools, the London School of Dental Surgery and the Metropolitan School of Dental Science, both in London, opened in 1859.^[21] The British Dentists Act of 1878 and the 1879 Dentists Register limited the title of "dentist" and "dental surgeon" to qualified and registered practitioners.^[22][23] However, others could legally describe themselves as "dental experts" or "dental consultants".^[24] The practice of dentistry in the United Kingdom became fully regulated with the 1921 Dentists Act, which required the registration of anyone practising dentistry.^[25] The British Dental Association, formed in 1880 with Sir John Tomes as president, played a major role in prosecuting dentists practising illegally.^[22] Dentists in the United Kingdom are now regulated by the General Dental Council.

In many countries, dentists usually complete between five and eight years of post-secondary education before practising. Though not mandatory, many dentists choose to complete an internship or residency focusing on specific aspects of dental care after they have received their dental degree. In a few countries, to become a qualified dentist one must usually complete at least four years of postgraduate study;^[26] Dental degrees awarded around the world include the Doctor of Dental Surgery (DDS) and Doctor of Dental Medicine (DMD) in North America (US and Canada), and the Bachelor of Dental Surgery/Baccalaureus Dentalis Chirurgiae (BDS, BDent, BChD, BDSc) in the UK and current and former British Commonwealth countries.

All dentists in the United States undergo at least three years of undergraduate studies, but nearly all complete a bachelor's degree. This schooling is followed by four years of dental school to qualify as a "Doctor of Dental Surgery" (DDS) or "Doctor of Dental Medicine" (DMD). Specialization in dentistry is available in the fields of Anesthesiology, Dental Public Health, Endodontics, Oral Radiology, Oral and Maxillofacial Surgery, Oral Medicine, Orofacial Pain, Pathology, Orthodontics, Pediatric Dentistry (Pedodontics), Periodontics, and Prosthodontics.^[27]

Some dentists undertake further training after their initial degree in order to specialize. Exactly which subjects are recognized by dental registration bodies varies according to location. Examples include:

• Anesthesiology^[28] – The specialty of dentistry that deals with the advanced use of general anesthesia, sedation and pain management to facilitate dental procedures.
• Cosmetic dentistry – Focuses on improving the appearance of the mouth, teeth and smile.
• Dental public health – The study of epidemiology and social health policies relevant to oral health.
• Endodontics (also called endodontology) – Root canal therapy and study of diseases of the dental pulp and periapical tissues.
• Forensic odontology – The gathering and use of dental evidence in law. This may be performed by any dentist with experience or training in this field. The function of the forensic dentist is primarily documentation and verification of identity.
• Geriatric dentistry or geriodontics – The delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal aging and age-related diseases as part of an interdisciplinary team with other health care professionals.
• Oral and maxillofacial pathology – The study, diagnosis, and sometimes the treatment of oral and maxillofacial related diseases.
• Oral and maxillofacial radiology – The study and radiologic interpretation of oral and maxillofacial diseases.
• Oral and maxillofacial surgery (also called oral surgery) – Extractions, implants, and surgery of the jaws, mouth and face.^{[nb 2]}
• Oral biology – Research in dental and craniofacial biology
• Oral Implantology – The art and science of replacing extracted teeth with dental implants.
• Oral medicine – The clinical evaluation and diagnosis of oral mucosal diseases
• Orthodontics and dentofacial orthopedics – The straightening of teeth and modification of midface and mandibular growth.
• Pediatric dentistry (also called pedodontics) – Dentistry for children
• Periodontology (also called periodontics) – The study and treatment of diseases of the periodontium (non-surgical and surgical) as well as placement and maintenance of dental implants
• Prosthodontics (also called prosthetic dentistry) – Dentures, bridges and the restoration of implants.
  • Some prosthodontists super-specialize in maxillofacial prosthetics, which is the discipline originally concerned with the rehabilitation of patients with congenital facial and oral defects such as cleft lip and palate or patients born with an underdeveloped ear (microtia). Today, most maxillofacial prosthodontists return function and esthetics to patients with acquired defects secondary to surgical removal of head and neck tumors, or secondary to trauma from war or motor vehicle accidents.
• Special needs dentistry (also called special care dentistry) – Dentistry for those with developmental and acquired disabilities.
• Sports dentistry – the branch of sports medicine dealing with prevention and treatment of dental injuries and oral diseases associated with sports and exercise.^[29] The sports dentist works as an individual consultant or as a member of the Sports Medicine Team.
• Veterinary dentistry – The field of dentistry applied to the care of animals. It is a specialty of veterinary medicine.^[30][31]

Tooth decay was low in pre-agricultural societies, but the advent of farming society about 10,000 years ago correlated with an increase in tooth decay (cavities).^[32] An infected tooth from Italy partially cleaned with flint tools, between 13,820 and 14,160 years old, represents the oldest known dentistry,^[33] although a 2017 study suggests that 130,000 years ago the Neanderthals already used rudimentary dentistry tools.^[34] In Italy evidence dated to the Paleolithic, around 13,000 years ago, points to bitumen used to fill a tooth^[35] and in Neolithic Slovenia, 6500 years ago, beeswax was used to close a fracture in a tooth.^[36] The Indus valley has yielded evidence of dentistry being practised as far back as 7000 BC, during the Stone Age.^[37] The Neolithic site of Mehrgarh (now in Pakistan's south western province of Balochistan) indicates that this form of dentistry involved curing tooth related disorders with bow drills operated, perhaps, by skilled bead-crafters.^[3] The reconstruction of this ancient form of dentistry showed that the methods used were reliable and effective.^[38] The earliest dental filling, made of beeswax, was discovered in Slovenia and dates from 6500 years ago.^[39] Dentistry was practised in prehistoric Malta, as evidenced by a skull which had a dental abscess lanced from the root of a tooth dating back to around 2500 BC.^[40]

An ancient Sumerian text describes a "tooth worm" as the cause of dental caries.^[41] Evidence of this belief has also been found in ancient India, Egypt, Japan, and China. The legend of the worm is also found in the Homeric Hymns,^[42] and as late as the 14th century AD the surgeon Guy de Chauliac still promoted the belief that worms cause tooth decay.^[43]

Recipes for the treatment of toothache, infections and loose teeth are spread throughout the Ebers Papyrus, Kahun Papyri, Brugsch Papyrus, and Hearst papyrus of Ancient Egypt.^[44] The Edwin Smith Papyrus, written in the 17th century BC but which may reflect previous manuscripts from as early as 3000 BC, discusses the treatment of dislocated or fractured jaws.^[44][45] In the 18th century BC, the Code of Hammurabi referenced dental extraction twice as it related to punishment.^[46] Examination of the remains of some ancient Egyptians and Greco-Romans reveals early attempts at dental prosthetics.^[47] However, it is possible the prosthetics were prepared after death for aesthetic reasons.^[44]

Ancient Greek scholars Hippocrates and Aristotle wrote about dentistry, including the eruption pattern of teeth, treating decayed teeth and gum disease, extracting teeth with forceps, and using wires to stabilize loose teeth and fractured jaws.^[48] Use of dental appliances, bridges and dentures was applied by the Etruscans in northern Italy, from as early as 700 BC, of human or other animal teeth fastened together with gold bands.^[49][50][51] The Romans had likely borrowed this technique by the 5th century BC.^[50][52] The Phoenicians crafted dentures during the 6th–4th century BC, fashioning them from gold wire and incorporating two ivory teeth.^[53] In ancient Egypt, Hesy-Ra is the first named "dentist" (greatest of the teeth). The Egyptians bound replacement teeth together with gold wire. Roman medical writer Cornelius Celsus wrote extensively of oral diseases as well as dental treatments such as narcotic-containing emollients and astringents.^[54] The earliest dental amalgams were first documented in a Tang dynasty medical text written by the Chinese physician Su Kung in 659, and appeared in Germany in 1528.^[55][56]

During the Islamic Golden Age Dentistry was discussed in several famous books of medicine such as The Canon in medicine written by Avicenna and Al-Tasreef by Al-Zahrawi who is considered the greatest surgeon of the Middle Ages,^[57] Avicenna said that jaw fracture should be reduced according to the occlusal guidance of the teeth; this principle is still valid in modern times. Al-Zahrawi invented over 200 surgical tools that resemble the modern kind.^[58]

Historically, dental extractions have been used to treat a variety of illnesses. During the Middle Ages and throughout the 19th century, dentistry was not a profession in itself, and often dental procedures were performed by barbers or general physicians. Barbers usually limited their practice to extracting teeth which alleviated pain and associated chronic tooth infection. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac most probably invented the dental pelican^[59] (resembling a pelican's beak) which was used to perform dental extractions up until the late 18th century. The pelican was replaced by the dental key^[60] which, in turn, was replaced by modern forceps in the 19th century.^[61]

The first book focused solely on dentistry was the "Artzney Buchlein" in 1530,^[48] and the first dental textbook written in English was called "Operator for the Teeth" by Charles Allen in 1685.^[23]

In the United Kingdom, there was no formal qualification for the providers of dental treatment until 1859 and it was only in 1921 that the practice of dentistry was limited to those who were professionally qualified. The Royal Commission on the National Health Service in 1979 reported that there were then more than twice as many registered dentists per 10,000 population in the UK than there were in 1921.^[62]

It was between 1650 and 1800 that the science of modern dentistry developed. The English physician Thomas Browne in his A Letter to a Friend (c. 1656 pub. 1690) made an early dental observation with characteristic humour:

The Egyptian Mummies that I have seen, have had their Mouths open, and somewhat gaping, which affordeth a good opportunity to view and observe their Teeth, wherein 'tis not easie to find any wanting or decayed: and therefore in Egypt, where one Man practised but one Operation, or the Diseases but of single Parts, it must needs be a barren Profession to confine unto that of drawing of Teeth, and little better than to have been Tooth-drawer unto King Pyrrhus, who had but two in his Head.

The French surgeon Pierre Fauchard became known as the "father of modern dentistry". Despite the limitations of the primitive surgical instruments during the late 17th and early 18th century, Fauchard was a highly skilled surgeon who made remarkable improvisations of dental instruments, often adapting tools from watchmakers, jewelers and even barbers, that he thought could be used in dentistry. He introduced dental fillings as treatment for dental cavities. He asserted that sugar-derived acids like tartaric acid were responsible for dental decay, and also suggested that tumors surrounding the teeth and in the gums could appear in the later stages of tooth decay.^[63][64]

Fauchard was the pioneer of dental prosthesis, and he invented many methods to replace lost teeth. He suggested that substitutes could be made from carved blocks of ivory or bone. He also introduced dental braces, although they were initially made of gold, he discovered that the teeth position could be corrected as the teeth would follow the pattern of the wires. Waxed linen or silk threads were usually employed to fasten the braces. His contributions to the world of dental science consist primarily of his 1728 publication Le chirurgien dentiste or The Surgeon Dentist. The French text included "basic oral anatomy and function, dental construction, and various operative and restorative techniques, and effectively separated dentistry from the wider category of surgery".^[63][64]

After Fauchard, the study of dentistry rapidly expanded. Two important books, Natural History of Human Teeth (1771) and Practical Treatise on the Diseases of the Teeth (1778), were published by British surgeon John Hunter. In 1763, he entered into a period of collaboration with the London-based dentist James Spence. He began to theorise about the possibility of tooth transplants from one person to another. He realised that the chances of a successful tooth transplant (initially, at least) would be improved if the donor tooth was as fresh as possible and was matched for size with the recipient. These principles are still used in the transplantation of internal organs. Hunter conducted a series of pioneering operations, in which he attempted a tooth transplant. Although the donated teeth never properly bonded with the recipients' gums, one of Hunter's patients stated that he had three which lasted for six years, a remarkable achievement for the period.^[65]

Major advances in science were made in the 19th century, and dentistry evolved from a trade to a profession. The profession came under government regulation by the end of the 19th century. In the UK, the Dentist Act was passed in 1878 and the British Dental Association formed in 1879. In the same year, Francis Brodie Imlach was the first ever dentist to be elected President of the Royal College of Surgeons (Edinburgh), raising dentistry onto a par with clinical surgery for the first time.^[66]

Long term occupational noise exposure can contribute to permanent hearing loss, which is referred to as noise-induced hearing loss (NIHL) and tinnitus. Noise exposure can cause excessive stimulation of the hearing mechanism, which damages the delicate structures of the inner ear.^[67] NIHL can occur when an individual is exposed to sound levels above 90 dBA according to the Occupational Safety and Health Administration (OSHA). Regulations state that the permissible noise exposure levels for individuals is 90 dBA.^[68] For the National Institute for Occupational Safety and Health (NIOSH), exposure limits are set to 85 dBA. Exposures below 85 dBA are not considered to be hazardous. Time limits are placed on how long an individual can stay in an environment above 85 dBA before it causes hearing loss. OSHA places that limitation at 8 hours for 85 dBA. The exposure time becomes shorter as the dBA level increases.

Within the field of dentistry, a variety of cleaning tools are used including piezoelectric and sonic scalers, and ultrasonic scalers and cleaners.^[69] While a majority of the tools do not exceed 75 dBA,^[70] prolonged exposure over many years can lead to hearing loss or complaints of tinnitus.^[71] Few dentists have reported using personal hearing protective devices,^[72][73] which could offset any potential hearing loss or tinnitus.

There is a movement in modern dentistry to place a greater emphasis on high-quality scientific evidence in decision-making. Evidence-based dentistry (EBD) uses current scientific evidence to guide decisions. It is an approach to oral health that requires the application and examination of relevant scientific data related to the patient's oral and medical health. Along with the dentist's professional skill and expertise, EBD allows dentists to stay up to date on the latest procedures and patients to receive improved treatment. A new paradigm for medical education designed to incorporate current research into education and practice was developed to help practitioners provide the best care for their patients.^[74] It was first introduced by Gordon Guyatt and the Evidence-Based Medicine Working Group at McMaster University in Ontario, Canada in the 1990s. It is part of the larger movement toward evidence-based medicine and other evidence-based practices, especially since a major part of dentistry involves dealing with oral and systemic diseases. Other issues relevant to the dental field in terms of evidence-based research and evidence-based practice include population oral health, dental clinical practice, tooth morphology etc.

Dentistry is unique in that it requires dental students to have competence-based clinical skills that can only be acquired through supervised specialized laboratory training and direct patient care.^[75] This necessitates the need for a scientific and professional basis of care with a foundation of extensive research-based education.^[76] According to some experts, the accreditation of dental schools can enhance the quality and professionalism of dental education.^[77][78]