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Roots and All: A History of Teeth
August 5, 2003
By NATALIE ANGIER
One morning, three days into a throbbing toothache that
even a few silos of Advil could not muzzle, I realized I
had no choice but to inflict myself on a dentist.
I was too humiliated to call my previous dentist's office,
where my behavior had inspired staffers to put up a little
sign that essentially compared abusive patients to
cavities: you need them like you need another hole in the
head. So I hauled out the Yellow Pages and found an
unsuspecting practitioner who agreed to see me that
afternoon.
I barely had time to sneer at the spalike touches of the
waiting room - low lighting, aromatic candles, a Japanese
fountain bubbling and New Age music burbling - when a
dental technician bounded over and asked, "How're you doing
today?"
"I'm here, aren't I?" I snapped. "How do you think I'm
doing?"
Observing that it was my first visit, he offered me a tour
of the office.
"A guided tour of a dentist's office!" I brayed. "Is that
your idea of showing me a good time?"
"Oh-kay," he said slowly. "How about if you take a seat in
this chair, and I'll go get the dentist right away?" A few
moments later, the dentist entered the room. I burst into
tears.
I have always had terrible teeth, much worse than any of my
siblings. I was barely out of diapers when I started having
cavities, and I remember the ghastly visit in grade school,
when the dentist found 22 new ones, seeming to defy all
known laws of topology.
As an adult, I have been fitted with more crowns than the
Hapsburg dynasty, and I have celebrated many a wondrous
event - my 30th birthday, the day I won a big journalism
prize, the morning of my honeymoon - by getting a root
canal.
Through my sobs, I confessed all this, and more, to the
dentist. I told him that I hated and feared my teeth and
that I hated and feared him and that I knew the minute he
began poking around with that satanic metal "probe," I'd
need another root canal.
To my surprise, he said two things that calmed me down.
First, he told me his own sad dental history and conceded
that until the age of 47, just a few years earlier, he had
suffered from tooth pain.
"I was a dentist, and my own teeth were in terrible shape,"
he said. But he had them fixed, or "stabilized," as he put
it, and he could do the same for me. That afternoon, in
fact, he repaired the toothache problem by simply grinding
down a couple of surfaces on a back molar that had been
throwing off my bite. The pain soon vanished, no root canal
needed.
Of greater importance to my sense of well-being, the
dentist broached the subject of the deeper meaning of
teeth, and he made me realize that teeth are more than a
personal pack of pestles with three-quarter-inch roots.
Psychically, metaphorically, evolutionarily, teeth go way
down and way back and carry multiple, paradoxical meanings.
The tale of teeth is the ultimate oral history, and if it
is only by coincidence that tooth rhymes with truth, the
words still make a pretty good team.
Teeth allow us to eat, and so are emblematic of life. Teeth
resemble bone, protruding visibly from an otherwise
skin-veiled skull, and so remind us of death. Teeth are
ornamental, a significant aspect of appearance and sexual
appeal. Nothing can look more menacing or bestial than
fully bared teeth. Yet nothing is more inviting, more
deeply human, than a bright open smile that lights up the
room.
Keeping those pearls pretty and in place is a booming
multibillion-dollar industry. There are about 3,000
patented toothbrushes on the market, with handles that look
like running shoes and heads like precious power tools; and
some that squirt, and others on timers, and some that
"deplaque" with sonic whiners.
And toothpastes, how vast are their powers, freshening the
foul, fortifying the weak, soothing the sensitive. Throw in
the flosses of every conceivable flavor, color, girth and
slipperiness, the fluoride and antimicrobial rinses, the
rubber tips, the dental gums and the whitening strips, and
you have a veritable shrine to St. Apollonia of Alexandria,
the patron saint of dentistry, who lived so long ago she
did not even have to grapple with the question, Tube or
pump?
Yet, even as a spin down the oral-care aisle can inspire a
slight tartar buildup of skepticism, the explosion in
products is not entirely from market forces going mad. The
business of tending teeth has markedly changed in a
generation or two, dentists say. The fluoridation of water
and improved dental hygiene mean that cavities are no
longer a childhood staple.
"Today, 50 percent of all children reach the age of 10
without having any cavities, and a third of 18-year-olds
are cavity-free," said Dr. Matt Messina, a consultant for
the American Dental Association and a dentist in the
Cleveland area. "That's an amazing feat compared to 40 or
50 years ago."
"People used to assume that they'd lose their teeth at some
point," he said. "Now, the vast majority of Americans will
keep most, if not all, their natural teeth. So the approach
to treating them is different," requiring as much sustained
supervision of the gums as the teeth.
Keeping one's indigenous teeth is not just a matter of
convenience or nostalgia. Dentures reduce chewing power
about 20 percent, depriving their owners of many foods that
may be healthy like apples, corn on the cob and tree bark.
In addition, swollen, bloody gums and periodontal disease
have been linked to a host of systemic ailments like
coronary heart disease and stroke.
Dr. Marjorie K. Jeffcoat, dean of the University of
Pennsylvania School of Dental Medicine, reports in The
Journal of Periodontology that pregnant women with
untreated periodontal disease are three to eight times as
likely to give birth prematurely as women without the
disease. By cleaning the diseased teeth and gums, Dr.
Jeffcoat also reports, the risk of premature birth is
markedly reduced.
Couple the advantages of lifelong tooth retention with
longer life and the emphasis on finding the perfect brush
and paste no longer looks so trivial.
And if health is not enough of a spur to tooth care, how
about vanity? In an informal e-mail tooth survey of 27
colleagues and friends, I asked, among other things,
whether they noticed other people's teeth, and two-thirds
said forsooth.
"I'm often amazed at what poor condition people's teeth and
gums are in," Daniel Gluck, a New York lawyer, said. "I see
lots of people with incredibly crooked or discolored teeth,
lots with heavily ground down incisors and lots with `tall
teeth' gum recession."
Rachel Maines, a medical historian, said: "I'm ashamed to
say I'm put off by bad teeth. They give a low-life
impression. Dental elitism, that's me."
Small wonder that people can suffer dental mortification
and feel that the state of their teeth says something
fundamental about themselves.
"Having had so much dental work makes me feel embarrassed,
ashamed," said Wesley Clark, a women's health analyst for
the World Health Organization in Geneva. "Like I've been
caught fat and eating cookies on the couch, watching TV.
Like I've failed."
Small wonder, too, that tooth dreams are a familiar theme
in the annals of Nod. Rita Montone, a personal trainer and
former actress, often dreamed about her teeth becoming
loose right before she was to appear on stage.
John Rubin, a filmmaker in Cambridge, Mass., loves his
teeth, has had almost no problems with them and yet still
has had dental nightmares about damage and loss, in one
case of his entire upper palate falling out, teeth
attached.
Freud suggested that tooth-loss dreams were about -
surprise! - castration. But Dr. Susan G. Lazar, a
supervising and training analyst at the Washington
Psychoanalytic Institute, emphasized that the meaning of a
tooth dream, like that of any dream, must be viewed in the
context of the dreamer's life.
"The general theme may have to do with a lack of
cohesiveness or sense of safety, or a fear of a loss of
self-sufficiency," Dr. Lazar said. "But for any individual,
it will have a uniquely colored meaning."
Dr. Lazar points out that everybody has memories of losing
teeth in childhood. Indeed, the gradual shedding of the 20
baby teeth, which begins around age 5 or 6, is a kind of
extended "daymare," no matter how adults gloss it over with
tales of the tooth fairy.
If children only knew just how worthy teeth are, they might
demand more than a fairy's spare change. The millimeter or
so of enamel that makes up the outermost layer of a tooth
is the hardest substance in the body. As a result, an
interred tooth can outlast the skeleton.
"The oldest things in the vertebrate fossil record are
teeth," said Dr. Michael Novacek, senior vice president,
provost and curator in paleontology at the American Museum
of Natural History in Manhattan. "They go back 500 million
years."
The comparative abundance of teeth in the fossil record led
some paleontologists to focus on them so obsessively, said
Dr. Novacek said, that their colleagues derided them for
seeing life as a process in which "teeth mated with teeth
and begat other teeth."
The earliest teeth were little more than small, sharp
conical structures, and for many animals of the so-called
lower classes, including fish, amphibians and reptiles,
teeth remain fairly simple and unspecialized. These
primitive creatures have an enviable dental talent,
however. Sharks, piranhas, crocodiles, lizards and the like
can shed and grow new teeth throughout their lives.
With the advent of mammals came two major dental overhauls.
Mammals are born with a limited set of so-called milk
teeth, or baby teeth, that may be more or less erupted
through the gums at birth. Those baby teeth are replaced by
a larger set of permanent teeth, numbering in the two- to
four-dozen range. Humans have 32.
Permanent is an optimistic term, and many an elderly lion,
hyena or zebra can be seen skulking across the savanna with
broken, missing and abscessed teeth. A hallmark of tribal
loyalty among African wild dogs is the willingness of
younger adults to prechew and regurgitate meat for their
toothless elders, who otherwise might die of starvation.
Mammaldom also gave rise to tooth specialization and the
precision architecture of incisors, canines, premolars and
molars, said Dr. Melinda A. Zeder, a curator at the
Smithsonian.
A mammal's dental tableau offers clues to the creature's
diet. As a pure carnivore, a cat has scissorlike incisors
and canines designed for tearing meat and almost no flat
molar surfaces for grinding. Its eating style is kill,
shear, gulp.
As an omnivore, a bear has formidably sharp canines and
incisors to partake of fish and meat, but also molars for
chewing fruits and other plant foods. The hippopotamus has
a pair of boxy front teeth with flat ax-blade edges that
serves as a threshing machine to yank up long grasses and
hay. A grazer like a horse has an array of big broad molars
that grow slowly throughout adulthood to compensate for the
wear and tear of the silica that inevitably comes with the
grass.
Teeth are not just about dinner, though. Some are for show.
Male baboons have hypertrophied canines, along with
modified lower premolars on which they can sharpen their
canines.
"Males sit in front of each other and grind their canines
ostentatiously, as though they were taking a knife to a
whittling stone," said Dr. Richard Wrangham, a professor of
anthropology at Harvard. Among many primates that live in
rigidly despotic groups like rhesus monkeys, the pulling
back of the lips and the bearing of teeth in a smilelike
_expression_ is a sign of fearfulness or submission flashed
by a subordinate when confronted by anybody higher in the
pecking order. But in those primate species with more
relaxed hierarchies, according to the primatologist Signe
Preuschoft, the smile has been emancipated from the context
of fear, and dominants smile at subordinates, males smile
at females, and mothers smile at their young.
Humans have taken the smile to an even friendlier format,
through the reduction in tooth size between archaic and
modern hominids, most notably of the canines. Just as we
domesticated the dog by breeding those with affable faces
and comparatively compact dentition, Dr. Wrangham said, so
we may have domesticated ourselves in part by choosing
mates with sweet, nonthreatening smiles. Or if nothing
else, the name of a very good dentist.
http://www.nytimes.com/2003/08/05/health/05TEET.html?ex=1061095503&ei=1&en=284fba34d99ef978
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