Dr. Golden's Blog

Let’s recap:

Previously on The History of Orthodontics: Humans, a species of clever bipeds hailing from Africa, spent their first million-ish years on the planet suffering from, and thus surely noticing, the fact that some of their teeth were not like the others, but not doing a heck of a lot about it. A few thousand years ago, it began to dawn on a few of them that teeth can gradually be moved into their proper place by applying light, constant pressure. Unfortunately, the only mouths to benefit from this idea were owned by dead people who, naturally, had very little use for a proper bite. (Also, George Washington’s teeth weren’t made of wood.)

That brings us to…

THE INVENTION OF ORTHODONTICS

The first two recognizable steps in modern orthodontics came from 18th Century France. Why was France the ideal setting for the birth of orthodontics? It’s hard to give a concrete answer, other than to say France was particularly rich, particularly conscious of aesthetics, and it had to happen somewhere.

But the timing does make sense. The 18th Century was the tail end of the Age of Enlightenment and the Scientific Revolution. Wealth and power could be rewarded to people who embraced reason and the scientific method. The printing press flourished in Europe, allowing people in the medical community to share ideas via medical journals. Dentists could finally fund research and explain their findings in books.

One of these books was Pierre Fauchard’s 1721 treatise “The Surgeon Dentist.” Fauchard was a remarkable man and could quite fairly be called the father of modern dentistry. Among the novel ideas Fauchard put forward in his book: Cavities are not caused by invisible “tooth worms” (which, you’ll remember from Part I, was the prevailing theory) and sugar is the more likely culprit; teeth have roots; everybody has two sets of teeth in their lives and teeth do not generate spontaneously; and, most memorably, cavities can be drilled out of teeth and replaced with metal fillings.

But, for our purposes, the most important part of “The Surgeon Dentist” was the chapter dedicated to straightening teeth. Most of the chapter focused on Fauchard’s use of a device called the Bandeau, a horseshoe-shaped piece of iron that was inserted into the mouth to expand the arch.

In 1757, Etienne Bourdet published “The Dentist’s Art.” Bourdet was the dentist to the king of France and was greatly inspired by Fauchard’s work. Bourdet saw the great potential of the Bandeau, and his ruminations on ways to perfect it were among the lasting contributions of his book. Another was the idea that overcrowding could be prevented by extracting wisdom teeth, the main cause of tooth misalignment. (We now know this not to be the case.)

Bourdet was actually the dentist to two kings of France, Louis XV and Louis XVI. He died in 1789, the same year the French Revolution began and four years before Louis XVI’s teeth, along with his head, were separated from the rest of his body via guillotine. I think it’s safe to assume that among the many qualities the people of France disliked about Louis XVI, his impressive smile was not one of them.

Next time, we’ll try to answer one of the more contentious issues in the History of Orthodontics: Who’s your daddy?

In Part I, we followed the long and painful fits and starts of dentistry, beginning with the earliest humans and ending with some mummies in Egypt who were found sporting something resembling braces. In part II, we'll work our way up to the 18th Century, by way of Greece, Rome and Virginia. (We're making great time!)


MOVING MEDITERRANEAN MOUTHS

Egypt's ancient counterparts across the Mediterranean were also working on their smiles. Some of the greatest minds in Greece contemplated cures for various oral ailments, including Aristotle and Hippocrates (the father of western medicine and author of the eponymous Hippocratic Oath). Meanwhile, the Etruscans (the forerunners of the Romans) developed spacers and bridges, but probably only affixed them to the dead as they prepared bodies for the afterlife.

Right before the beginning of the Common Era, a man named Aulus Cornelius Celcus described what may have been the first proper bit of orthodontics (by which I mean, moving the teeth of living people). Celcus documented a process of moving teeth by applying finger pressure at regular intervals, slowly moving them into place. This is what today's braces do, though through vastly superior means (no offense to Mr. Celcus).

Sadly, more than a millennium and a half passed before orthodontics had another real breakthrough. But, in the 1700s, these ancient ideas finally codified into what could fairly be called the dawn of modern orthodontics. But before we get into that, let's clear up some confusion about the composition of a certain first president's dentures.


EVERYBODY KNOWS GEORGE WASHINGTON'S FALSE TEETH WERE MADE OF...

...lots of things, none of them wood. That's right, George Washington, the paterfamilias of the Founding Fathers, never EVER had wooden teeth. Neither his dentures, nor those of his contemporaries, contained the slightest bit of wood – American dentists didn't make dentures out of wood, though Japanese dentists did.

Washington was a dental disaster long before the battles of Lexington and Concord. There were very few dentists in the colonies, and the practice was in the heyday of its brutal needle-nose-pliers approach to tooth pain. Pictures of Colonial Era dental tools might make us sympathetic to Washington's apprehension, but non-treatment took the same torturous toll then as it does today.

To be fair to the General, gingivitis was not the greatest foe he would face. But there were casualties. By the time he took office, Washington had retained only one of his original teeth, and that lone holdout would not accompany him to the end of his presidency. Of course, the leader of this new nation was expected to speak on behalf of an entire people, not lisp and sputter through rotted gums. So Washington got the finest dentures of his day.

According to the Mount Vernon Museum, which still has a pair of Washington's dentures on display, “Washington's dentures represented the latest advancements in dental technology.” The base was made of lead, and used brass wires and steel springs. Wood is actually a terrible material for teeth; it's weak, soft and needs to be treated with toxic chemicals. Instead, Washington's teeth came from other humans, cows, hippopotamuses and elephant ivory.

This was the best the world had to offer. But these dentures were still entirely uncomfortable. His oral discomfort is perhaps the best explanation for the dour expression we've come to know from his portraits. The face on your dollar bill is also a portrait of the earliest works in modern orthodontics.


In Part III, we'll visit 18th Century France and meet the two men most responsible for the development of modern orthodontics.

It’s easy to overlook the importance of orthodontics in human history. There were no great wars fought over overbites and, from what I understand, none of the seven wonders were built in homage to healthy smiles (though no one can prove the Colossus of Rhodes didn’t wear braces).

But the truth is that humans have been working on a better bite for most of recorded history, and our great advancements in orthodontic practices and technologies have allowed us to live longer, happier lives.

For most of human history, the health of one’s teeth was quite literally a matter of life or death. For roughly the first 99 percent of the time humans have tromped about the globe, life expectancy was about 25 years. (Compare that to today’s global average of 67 or the U.S. average of 79.) Obviously dental problems weren’t the leading cause of death — what with rampant diseases and the occasional war — but it certainly took its toll. People used to die from their teeth. That was a thing.

A bad bite or broken teeth couldn’t properly chew the tough meat that was central to the hunter-gatherer diet, which meant eating less and getting fewer nutrients out of what was swallowed. Besides making it easier to swallow, chewing food makes digestion much more efficient and effective. For hunter-gatherers, who occupied about 90 percent of human history, every nutrient was crucial.

The agricultural revolution didn’t make life any easier for the teeth. The Neolithic grindstones used to process cereal grains often left bits of sand and stone in the food, which eroded enamel and wore down teeth. Despite having diets free of pop and candy, early humans still got plenty of cavities. Left untreated, cavities can spread to other teeth and leave one toothless, or lead to a potentially fatal abscess.

But agriculture allowed people to develop other skills, which led to…


THE FIRST DENTIST!

Evidence of dentistry first appears in the Indus Valley Civilization at about 7000 B.C.E. (These impressive people also built cities with sanitation systems long before Europe and invented the flush toilet… in the 26th Century B.C.E.!) The first dentists operated on teeth with a bow drill, which sounds painful, but was clearly preferable to the alternative.

It’s impossible to know what, exactly, inspired these first dentists to treat painful tooth problems by counter-intuitively drilling into the teeth. Of course, now we know that they were right, but we all owe a debt of gratitude to the brave individual who agreed to be the first patient. We also know, thanks to a Sumerian text from 5000 B.C.E., that many ancient people believed dental problems were caused by “tooth worms.” Luckily for us all, they were wrong.

The Egyptians shared this belief, but, lest you think they were oral slouches, they also gave us… wait for it…


THE FIRST BRACES! (kind of)

Egyptian mummies have been found with metal bands wrapped around their teeth (they likely used catgut for orthodontic wires) and some even show signs of oral surgery. Pyramids, shmyramids. What has the Sphinx done for me lately? In my book, braces were one of Egypt’s greatest contributions to the world.


So, that’s how it all began. In Part II, we’ll check in with a couple of Greeks and have a much-needed conversation about George Washington.

Pages