Toothkey: What Was It and What Was It Used For?

Toothkey: What Was It and What Was It Used For?
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Toothkey: What Was It and What Was It Used For?Clinical Content Reviewed by Dr. Jay Khorsandi, DDS
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Table of Contents

  1. History
  2. Uses
  3. References

As with all medical practices, dentistry evolves over time. Innovation, better technology and more results-oriented data about instruments, procedures and processes lead to improved treatments.

That includes one that is intensely patient-centric: updated tools for extracting teeth.

The toothkey, or dental key, was once an essential tool in dentistry.

It was a tooth extraction instrument used in the 18th and 19th centuries after it replaced an earlier tool, the pelican, which dentists used from the 14th to 19th centuries.

Tooth extraction involved either a simple extraction or a surgical procedure. Either way, extraction was considered a last-resort procedure, and doctors turned to the toothkey after applying concoctions on a problematic tooth to loosen it.

Unlike previous instruments, the toothkey had a refined design that fit several tooth sizes. Modeled from the day’s door key shape, with a claw on one end, it was considered a refinement over previous extraction tools.

Regardless, its use came with issues, such as tooth breaks, roots that remained embedded, and damaged tissue or bone. Botched tooth extractions were common, and they sometimes contributed to fatalities.

History of the Toothkey

The first toothkey, or dental key, came into existence around 1740. It looked like a key designed to unlock a door, with one addition – a hinged hook, or claw, on the business end. Besides its similarity to a key in appearance, using it also involved turning it like a key in a lock. Doctors inserted the key into the mouth to capture the inflamed or infected tooth, then applied force and wiggled the tooth out.

Without refined knowledge, methods or antibiotics to control infections, healers and practitioners considered the process dangerous. Depending on their skills, there were limitations on how far a dental caregiver could go.

Dental caregivers in England were the first to use it before it spread to America in the 18th century. Once in use, the toothkey received a patent as a tooth extractor in 1797. From then on, it was the most preferred tool for extraction. Its preference was because it was quick and easy to use.

Any improvements to the dental key resulted in different angled shafts and varying handle shapes. Further, handles changed from wood to ivory to horns. In time, it also featured changes in fulcrum, size, and covering.

There were also changes in grasp and mobility over time. As relatively efficient as the tooth key was, it often resulted in broken teeth, tissue damage, and fractures in the jaw.

Uses of a Toothkey

The toothkey was designed and used for one thing, taking out bad teeth. Practitioners aimed to extract teeth with one slow (painful) turn of the key.

Before the toothkey’s existence, doctors who treated mouth and dental issues used plasters, cautery, purgatives and botanicals to cure toothaches and avoid extractions.

Extracting Forceps

Extraction forceps look like pliers, except that they have claws on the end. The design is so that they can grasp and remove teeth. The different extraction forceps come tailored to different teeth shapes and for applying multiple pressure levels.

The application process involves rotation and rocking the target root back and forth to detach it from the ligament. Blades vary in width, curvature and length to handle different tooth shapes.

  • Straight forceps: simplest design to handle front teeth.
  • Cow horns: designed to split the diverged roots of molars.
  • Bayonet forceps: they resemble the bayonet rifle attachment. That facilitates easy access to upper third molars.
  • Lower molar forceps: used on upper molar teeth with two mesial roots–fused and distal root.
  • Lower root forceps: the handles are roughly 90 degrees from the blades.  
  • Upper premolar forceps: designed to extract premolar teeth. The edges can reach the medial direction.
  • Upper Molar forceps handle upper molars with three roots–two buckle roots and one palatal root.

Dental Elevators

Dental elevators look like small screwdrivers. They’re used to reach between a tooth and surrounding bone.

A dental elevator has three components: handle, shank, and blade. Applying a dental elevator lowers the chances of tooth fractures. 

The primary difference between dental elevators and forceps that is less force is needed to use the elevators. Typically, a dentist forces the elevator into that space, twists it to press the tooth, and rocks it against the bone. The intention is to separate the tooth from its ligaments by expanding the socket.

Dentists favor dental elevators for extractions because:

  • They can extract root stumps easily
  • They help expand tooth sockets, making extraction easy
  • Elevators have a strong rip
  • Elevators are helpful in breaking the attachments tissues supporting the tooth

Similar to extraction forceps, there are various types of dental elevators. In general, there are straight elevators, triangle (or pennant-shaped) elevators, and pick type elevators.

The variations occur in the shape and size of the blades.

Straight Elevators

The straight elevator has a straight blade, shank, and handle, either small or large. The edge has a concave surface on one side, often placed towards the target tooth.

You can apply smaller straight elevators during luxation, while larger ones apply when displacing roots from the sockets and luxation of widely spaced teeth. In addition, since you can angle the shape of the blade from the shank, that makes it suitable for application in posterior aspects of the mouth.

Triangle (Pennant Shaped) Elevators
Triangle elevators are useful when extracting broken tooth remains in the tooth socket. Often, the mandibular molar is more likely to fracture, leaving the distal root behind. Extract molar remains by placing the tip in the socket, shank resting in the buckle plate, and turning the elevator in a wheel and axle direction.
Pick Type Elevators
Use pick-type elevators to engage root tips, which may also require using the drill. There are variations of pick-type elevators, crane pick elevators, and apex elevators applicable in removing deep root fragments.

Luxators

You can use a luxator in place of an elevator to cut down the ligament that holds the tooth in place. The only difference is that luxators have a weak working end, so you can’t use them for leverage. It is a much gentler tool for easing the tooth out of its socket, minimizing tissue damage.

References

Toothache and Trauma: A History of the Toothkey. (February 2019). The University of the Pacific, Arthur A. Dugoni School of Dentistry.

The dental key: a dangerous and barbarous instrument. (November 2005). National Library of Medicine.

Extraction. (Retrieved January 2022). Macaulay Museum of Dental History

Dental Keys. (January 2018). National Center for Biotechnology Information.

Use of elevator instruments when luxating and extracting teeth in dentistry: clinical techniques. (June 2017). National Center for Biotechnology Information.

Three-rooted mandibular first molar: A consideration in periodontal therapy. (April 2012). National Library of Medicine.

Disclaimer: This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to serve as dental or other professional health advice and is not intended to be used for diagnosis or treatment of any condition or symptom. You should consult a dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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