Health: The pain has subsided in the dentist's chair

Today, of course, it can be easily put right, and teeth even emerge looking whiter and shinier than ever before, with a quick trip to the family dentist.

But back in Burns' day, an infected tooth could be - and often was - the death of you.

For if the tortuous pain wasn't enough to finish off sufferers, chances were that the backyard amateur tooth puller's rusty implements, typically made on a blacksmith's anvil and highly unlikely to have undergone too much in the way of sterilisation, probably would.

By 1860, few were more concerned about the dreadful state of Edinburgh citizens' rotten teeth than dentist Dr John Smith.

FILLING IN THE HISTORY

IT was the middle of the 19th century when Dr John Smith, the Edinburgh-born son of a dentist, became the first in Scotland to run a course on dentistry with clinical instruction for medical students at the Royal College of Surgeons of Edinburgh.

He opened the Edinburgh Dental Dispensary at 1 Drummond Street in 1860, along with colleagues Francis Imlach, Peter Orphoot and Robert Nasmyth.

At the same time dentistry in England was undergoing radical change: this year marks the 150th anniversary of the Licence in Dental Surgery, the first dental qualification issued in the UK.

In Scotland, the clinic helped inspire the Dentists Act 1878, which meant only those who had undergone recognised training could call themselves a "dentist".

Dr Smith also founded what was to become the Royal Hospital for Sick Children. He was made Surgeon Dentist to Queen Victoria and later became President of the British Dental Association.

Worried over the lack of any regulation surrounding dentistry and determined to improve locals' dental health, he and three colleagues launched Scotland's first ever dental clinic, the Edinburgh Dispensary for Disease of the Teeth.

The pioneering clinic at 1 Drummond Street in the Old Town opened its doors exactly 150 years ago this year.

Revolutionary at the time, its basic facilities were a far cry from today's dental surgeries, now rebranded as "smile clinics" or "spas" where patients searching Hollywood smiles go on "journeys" while resting on hi-tech chairs that mould into their bodyshape while they watch their favourite DVD.

While Dr Smith and his colleagues battled to ease patients' pain, their modern successors don't just fill and pull, they perform cosmetic wizardry, transforming gravestone gnashers into pearly whites, correcting squint teeth and replacing missing ones with expensive titanium implants.

And when they're not polishing incisors to perfection, they're administering anti-wrinkle treatments, fillers and botox, even curing your migraine by realigning your "bite".

Eventually they might even grow us new teeth from stem cells and deliver tooth polish made using nanotechnology, which can prevent teeth from ever rotting.

It all sounds light years away from the misery of the 19th century tooth key - a terrifying implement which, when rotated, would grip the rotted tooth tightly and yank it out often, unfortunately, along with gum and bone.

"Back then anyone could call themselves a dentist, and they often did," says Dr Rufus Ross, chairman of the History of Dentistry Research Group.

"In the 1850s people might go to a chemist and pay sixpence for a tooth extraction, but there'd also be people with no qualifications at all, gardeners, mechanics, people who shoed horses, who'd learned about dentistry from watching other people who didn't have any qualifications either.

"There'd be no sterilisation other than possibly some boiling water. So people died from blood poisoning."

That aside, the basic services they offered were not dramatically different from those of today.

"They would have done fillings using whatever amalgam they could - I've heard of things like silver thimbles being melted down and used.

"And they would have dentures too. In the mid-19th century they'd be made from Vulcanite, a hard rubber which would be coloured pink for the gums, with the "teeth" attached using gold pins.

"Anaesthetic was a huge breakthrough," he adds. "But probably the biggest step forward was in 1878, when the first register of dentists was formed. It didn't stop anyone who wanted to pull a tooth, but it meant they couldn't call themselves a dentist."

These days "dentists" come in many forms too. For a surgery is just as likely to boast a specialist in orthodontics who can straighten teeth, a prosthodontist to fill gaps with implants and a peridontist specialising in gums. But could surgeries soon also have their own stem cell specialist growing new teeth?

According to Dr Biju Krishnan, managing director of Leith-based surgery Lubiju, nanotechnology and cloned gnashers is still a distant dream, yet the modern practise is certainly a dramatically different place from 1 Drummond Street.

"One of the main things has been our understanding of decay and how to prevent it," he says. "When it comes to treatment, there is a whole range of modern materials which mimic the tooth, they're very aesthetic and extremely hard wearing.

"Today's procedures are so much less damaging to the natural tooth than ever before."

His patients undergo check-ups using a small laser beam which is run over each individual tooth, immediately revealing areas which require attention.

"It used to be difficult to tell what was a stain and what was decay. It could end up with a stain being mistaken and a tooth treated when it didn't need to be, or a tooth being left when it needed attention," he adds.

For teeth that do need treatment, the dentist is more likely to opt for a modern alternative to a mouthful of amalgam fillings with a mercury content which has been linked to gum disease, migraine, depression, Alzheimers, Multiple Sclerosis and kidney disease.

"Many dentists won't use amalgam and prefer to use alternatives. We use a composite made of glass and resin which is tooth coloured."

If a trip to the dentist still makes your toes curl in pain, advances in anaesthetic means today's treatment really shouldn't hurt a bit. Dr Krishnan uses a system known as "QuickSleeper" a needle and injection technique which means patients feel only a slight vibration and aren't left with numb face or tongue.

The biggest change, however, is the surge in demand for cosmetic dental treatment, from whitening discoloured gnashers to braces which can straighten teeth in less than six months and dental implants - a false tooth on a titanium post inserted directly into the jaw bone - to replace missing teeth.

Meanwhile thanks to people like Katie Price to Cheryl Cole, Brad Pitt to Simon Cowell sporting veneers, demand for the "stick on" falsies has soared.

"Veneers can be made just 0.3mm thick - that's tiny," says Dr Krishnan. "You still have to remove some of the natural tooth to attach them, but they are so thin it's hardly anything."

It's a world away from the days when anything from sheep and pigs' teeth, walrus and elephant tusks and even teeth salvaged from the dead were used to create dentures.

"When you look at dentistry over the past 150 years, the basics haven't changed that much," insists Dr Ross. "They were doing fillings, dentures and crowns. The advances are in the materials and the expertise and training that's now available.

"Of course the demand from patients has also changed. Dentures of the past were aesthetically very poor, nowadays people want implants which cost thousands of pounds but look entirely natural.

"Diet is the mainstay of good teeth: eat the right foods, avoid sugar and keep the teeth and gums clean and healthy," he adds. "Until people can get that right, they'll always need dentists."

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