However much you dislike going to the dentist now, you’ve got it good.
Like surgery, this is a field that has benefited immeasurably from the widespread use of anaesthetic. Imagine your dentist drilling out a cavity, pulling a tooth, or draining an infected abscess with you feeling every moment of it — or better yet, don’t. (I recall once reading an account from a dentist who mentioned that some of her macho-men patients declare that they don’t need numbing . . . and then seriously regret their choices a couple of minutes in.) Dentists basically used to be torturers you avoided if at all possible.
Now, the good news for people in the past was that the problems we most commonly deal with today, namely cavities, were actually rarer. Still absolutely a thing, mind you — we’ve found examples going back to the days of our hominid ancestors a million years ago — but the bacteria that cause tooth decay particularly feed on simple sugars, and in the days of yore, those were much harder to come by. The incidence of dental caries (cavities) increases visibly with the beginning of agriculture, because then we were eating more carbohydrates, but our sugar-heavy modern Western diet is paradise for those bacteria.
On the other hand, we don’t suffer nearly as much wear and tear on our teeth. These days, “stone-ground” is an advertising hook for fancy flour; I presume they’ve found a way to keep it from being full of minuscule pieces of grit. That was a major issue back in the day, and it contributed to people’s teeth getting badly worn down during the course of their lives, often to the point where the the pulp became exposed and the tooth had to be pulled. People also used their teeth as tools much more frequently, e.g. chewing tanned leather to soften it, contributing to the loss of enamel.
Before we knew that bacteria caused tooth decay, cavities were often attributed to the action of a “tooth worm,” a concept we find across the Eurasian continent. But although we may not have realized the importance of tooth-cleaning for stopping the worm in its tracks, we certainly understood the relationship between the state of the mouth and the sweetness of the breath. Even the Neanderthals used toothpicks, which in other eras could be anything from disposable wood to fancy metal like silver. (Dental floss, however, was a nineteenth-century invention; you need fine, strong thread to make it work. Which certainly existed before then, but who was going to use it in their mouth?) Mouthwashes of assorted kinds are found from ancient Ayurvedic texts onwards, with Hippocrates prescribing a mixture of salt, alum, and vinegar, while Native Americans employed a plant sometimes called “canker-root” due to its utility in oral hygiene.
For brushing the teeth, the oldest method is a “chew stick,” a twig you gnaw on until one end is frayed, which you can then use to scrub your pearly whites. But not just any twig: you want something rich in tannins or other chemicals that can help kill the bacteria. Scores of trees have been pressed into service, whether that’s hazel and oak in Europe, neem in India, or Salvadora persica in Africa. That last, called arāk in Arabic, is used to make miswak, which Muslims are encouraged to use at various times, particularly before religious practice. Cloves don’t do anything to stop decay, but if you chew on them, not only will your breath smell better, but the anaesthetic in their oil will help to mute any tooth pain.
Actual toothbrushes, in the sense that we think of them today, were first invented in Tang Dynasty China. They apparently liked theirs extra firm: they not only used hog bristles, but preferred hogs from the cold north, who grew stiffer bristles. Tender-mouthed Europeans in the seventeenth-century readily adopted this import, but opted for horsehair bristles instead. As for toothpaste (or usually tooth powder), that goes back thousands of years, though we aren’t certain whether it was rubbed on with a finger or rag, applied to a chew stick, or what. People absolutely were trying to take care of their teeth!
. . . because living without them was pretty awful. Nowadays, if you get a cavity, your dentist will drill out the decayed material and fill it with one of a variety of materials that will be comfortable, durable, and safe. Gold has long been a popular choice, because it’s so non-reactive. In the past, though, that was mostly the rich person’s option. The average person just had to live with the pain until the tooth was too far gone, at which point it would be pulled. The so-called “wisdom teeth” or third molars are also common targets for extraction, because there often isn’t quite enough enough room in the jaw for them. Blame evolution: over the millennia our jaws have gotten shorter, both as a genetic matter and in response to our softer, more chewable diet. But the number of teeth in the jaw doesn’t change easily at all, so we’re cramming more into less space.
Lose too many teeth, and you either adopt a diet of mush or start looking for replacements. Surprisingly, these might take the form of implants, whether crafted from bamboo (Chinese), sea shell (Mayan), or precious metals or ivory (both Egyptian). They could even be somebody else’s teeth! For them to count as implants, they have to be driven into the bone of the jaw, which I can only imagine was excruciating. Easier to go for dentures, prosthetics which can be either removable or fixed in place. These can be made from wood (though contrary to legend, none of George Washington’s were), but bone, ivory, and horn were more common. You can also use human teeth again, or some taken from animals, sculpted to more accurately mimic our own dentition. Porcelain models were invented in the eighteenth century. Most of these relied on metal frames to affix them to the rest of the teeth, but Tokugawa-era Japanese dentists apparently did such a good job of taking beeswax molds of their patients’ mouths that their wooden dentures could adhere in place without wire.
And on the topic of wiring teeth . . . orthodontics (adjusting tooth alignment and bite pattern) are a relatively new field, less than two hundred years old. In the U.S. it’s become extremely prevalent — having braces is practically a rite of passage for teenagers here — but elsewhere, it’s reserved more for fixing actual problems, and not just making aesthetic adjustments. On the aesthetic front, though, you might think that grills are new — the dental jewelry often associated with hip-hop — but the pre-colonial Maya elite were known to inlay their front teeth with jade or turquoise. It’s the polar opposite of tooth-blackening, which you find in Southeast Asia, Oceania, and pre-modern Japan, which aims to make the mouth look like it doesn’t have teeth at all. The dyes used to blacken the teeth, though, can act like a sealant, helping to protect against tooth decay.
Dentistry is one area where I’m curious what the future will look like. Even now, we prefer to keep people’s natural teeth in their jaws for as long as possible, using fillings and onlays and crowns to extend their life. But sometimes, when the dentist is reaching for the drill, I find myself wishing I could just remove them all and replace them with some high-tech substitute that won’t ever get a crack or a cavity.
Maybe someday we’ll have that. In the meanwhile, brush and floss well.