Dentistry, Far Beyond Drilling and Filling By NATALIE ANGIER August 05, 2003 Corbis Artists conveyed the agony of dental work long before root canals were invented. Dentistry may not be the oldest profession, but for reasons of sheer, tearful necessity it is surely right up there among the Top 10 of humanity's primal callings. Paleontologists have found Cro-Magnon skulls dating back 25,000 years that show evidence of tooth decay, and the incidence of cavities and other dental problems only mounted with the advent of agriculture and the increased availability of starchy grains and sweet fruits. The earliest dentists pulled teeth or, as demonstrated by 5,000-year-old skulls from Egypt, drilled holes in the jaw to allow abscesses to drain. Afterward, they very likely scolded their patients for their lax oral care, and handed them the era's equivalent of a toothbrush and toothpaste. The first toothbrushes were small twigs softened and flattened at one end to augment the cleaning surface. The Chinese invented the modern toothbrush about a thousand years ago, with bristles made from a horse's mane attached to handles of ivory. Toothpaste is likewise ancient, the earliest mixtures consisting of powdered fruit, talc and burnt shells, perhaps sweetened with honey and flavored with lizard livers, mouse parts and urine. In some parts of the world, early dentists became quite adept at making false teeth. In 700 B.C., the Etruscans carved beautiful fakes from ivory and bone, securing them to the patient's abutting teeth with gold bridgework. For those with few or no viable teeth remaining, dentists began designing dentures, the upper and lower plates held together with steel springs. Wealthy customers ordered flashy dentures with teeth of silver, gold, agate and mother of pearl, giving new meaning to the phrase conspicuous consumption. One persistent myth has it that George Washington wore wooden dentures, but in fact wood cannot weather the corrosive effects of saliva, and dental historians say the first president's falsies were fashioned from more durable materials, including teeth extracted from human and animal cadavers. Dentists have also been cleaning out decay and plugging up cavities for many hundreds of years, using as filling material stone chips, resin, cork, turpentine, gum, lead and gold leaf. With the invention of the dread power-driven dental drill in the 19th century, many more people could afford to get drilled and filled, and the demand rose for a standardized, relatively inexpensive filler, eventually resulting in a so-called amalgam like the one used today. Contemporary amalgam contains as a stabilizing ingredient small amounts of mercury, which some people prefer not having in their mouths and instead opt for fillings made of plastic. But Dr. Marjorie Jeffcoat, editor of The Journal of the American Dental Association, points out that the mercury is tightly encapsulated in the other components of the amalgam and on balance appears remarkably safe. Among the most striking developments in dental hygiene was the fluoridation of water beginning in the mid-20th century. Fluoride helps protect teeth by hooking onto enamel and enhancing its resilience against destructive acids from bacteria. Dentists first gleaned the power of fluoride when they noticed that some patients had oddly mottled teeth that were resistant to cavities. Both traits were soon traced back to local water supplies that had naturally high concentrations of fluoride, and when experiments suggested that small amounts of it could protect teeth without the spotty side effects, the push for fluoridation of the water supply was on. Today, about 60 percent of Americans drink fluoridated water, as do people in 30 other countries (although some debate remains over just what constitutes a safe long-term dosage). The effect of mass fluoridation has been socioculturally as well as dentitionally profound, and fear of dentists, along with lizard-livered toothpaste, the New York subway token and a decent bagel, may soon, yes, bite the dust.

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