The first keys were unique but by 1830 a number of dental instrument makers had set up business. Amongst these were Claudius Ash, John Weiss and Jean-Marie Evrard. With the advent of mass-production methods, they began to produce stock instruments which practitioners could purchase off-the-shelf.
The key consisted of a shaft, a bolster and a claw. To pull a tooth the bolster was placed against the root of the tooth and the claw over the crown. The key was then turned, dislocating the tooth.
Early keys had straight shafts, which thickened towards the end to terminate in a bolster. Claws were fixed to the shaft by a screw enabling the claws to be interchangeable. This early design tended to require leverage against the gum during extraction resulted in extensive damage to the gums and the jawbone. It also had a tendency to accidentally extract adjacent teeth at the same time. In 1765 a curve was introduced on to the end of the straight shaft, which lessened the extracted tooth from pushing against adjacent teeth. A further development was introduced in 1796, when the claw was fixed via a swivel enabling it to be fixed in various positions by a spring-catch. In 1795, a second, right-angled bend was introduced which allowed the shaft to cross the mouth to the opposite side and extract teeth with less damage to the jaw.
By the end of the 18th century the toothkey in professional hands was a proficient instrument and was the leading edge of advances in dental surgery. Keys were last advertised for sale in the dental catalogues in the late 1870s, as forceps superseded the tooth key as the main extraction instrument.