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THE NATURAL AND ANCIENT HISTORY OF THE TEETH Smile_Stealers_pp1-247.indd 29 24/11/2016 18:0
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By comparison with the rest of the animal kingdom, human teeth are, it seems, fairly dull. As the British archaeologist Simon Hillson has observed, we find the most striking and strange examples of dentition in the mouths of other mammals: WHO COULD RESIST, FOR EXAMPLE, THE ELEgANT UPPER MOLARS OF A RHINOCEROS, OR THE FINE LINES OF MICROCHIROPTERAN BAT TEETH? NOT TO MENTION THE ASTONISHINg INTRICACY OF THE COMPLEX-TOOTHED SQUIRREL TROGOPTERuS , WHICH PROBABLY HAS THE MOST COMPLICATED TEETH IN THE MAMMAL WORLD, AND THE COMPUTER-CHIP-LIKE DETAIL OF [THE WOODLAND JUMPINg MOUSE] NAPAEOzAPuS , WHICH IS DIFFICULT TO BELIEVE WHEN SEEN FOR THE FIRST TIME UNDER THE MICROSCOPE. 1 Whether they grow in the jaws of a rhinoceros or a mouse, mammalian teeth share a common basic structure. A crown of hard, vitreous enamel above the gums provides resilient surfaces for cutting and grinding, and a root anchors the tooth in the jawbone. Beneath the crown is a plug of dentine, more familiar to us in the form of walrus or elephant ivory – ironically, one of the most common materials from which early false teeth were made. Running up through the dentine is a soft pulp of blood vessels and nerves – the conduits of so much human suffering – and each tooth is held in its socket by cement and a tough, fibrous, periodontal ligament. Within this basic form, the teeth of mammals vary widely, but almost all can be classified (running from the front to the back of the mouth) into incisors, canines, premolars and molars. Almost every mammal has two sets of teeth, deciduous and permanent, both of which grow from buds within the infant’s jawbone. The environment into which these teeth erupt is a kind of jungle: warm, wet, ecologically diverse and often hostile. Indeed, the human mouth hosts one of the richest arrays of microscopic flora in the body, and colonies of bacteria, viruses, yeasts and protozoa all flourish in this sheltered, nutrient-rich cavity. As in any ecosystem, different niches favour different forms of life: streptococci dominate the valleys of the molars, whereas the gaps between the teeth are home to colonies of anaerobic Actinomyces. Plates from The Natural History and Diseases of the Human Teeth (1914) by Joseph Fox. ① The developmental changes in human teeth and the formation of permanent teeth in the jaw at age six [A], age eight to nine [B], the appearance of second molars [C] and as an adult [D]. ② Examples of teeth affected by absorption, decay and disease. ③ Examples of permanent teeth with irregular growth. Smile_Stealers_pp1-247.indd 30 24/11/2016 18:0
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Because of this, even the most well-maintained mouth will likely have spots of plaque in inaccessible places. Like teeth, plaque owes its strength to its composition: a mixture of proteins from saliva, polymers produced by bacteria and crystals of calcium phosphate. Plaque itself does not damage teeth, but it shelters bacteria that metabolize carbohydrates – especially sugars – and excrete acids as a waste product. These plaque acids are largely responsible for dental caries, demineralizing the enamel and the underlying dentine, eroding cavities and generating abscesses. If it is not removed, plaque can build up into painful and disfiguring concretions, as described in this grim example from the London dentist Thomas Berdmore’s A Treatise on Disorders and Deformities of the Teeth and Gums (1768): A gENTLEMAN OF THE BANK, NOT ABOVE TWENTY-THREE YEARS OF AgE , APPLIED TO ME FOR ADVICE CONCERNINg HIS TEETH … WHICH gAVE HIM CONSTANT PAIN. I FOUND THEM PERFECTLY BURIED IN TARTAR, BY WHICH EACH SET WAS UNITED IN ONE CONTINUOUS PIECE, WITHOUT ANY DISTINCTION, TO SHOW THE INTERSTICES OF THE TEETH, OR THEIR FIgURE OR SIZE. THE STONY CRUST PROJECTED A gREAT WAY OVER THE gUMS ON THE INNER SIDE, AS WELL AS ON THE OUTER, AND PRESSED UPON THEM SO HARD AS TO HAVE gIVEN RISE TO THE PAIN HE COMPLAINED OF. ITS THICKNESS AT THE UPPER SURFACE WAS NOT LESS THAN HALF AN INCH. For archaeologists, fossil teeth have cast light on the deep history of humanity. They endure longer in the ground than even the largest bones, and because they are laid down in childhood and change very little after they erupt, they encode information about the growth of an individual. Perikymata – tiny concentric ripples on the permanent teeth, visible under an electron microscope – are laid down at regular intervals as a tooth forms, and variations in their spacing can indicate periods of stress or malnutrition, or the influence of diseases such as congenital syphilis. By comparing the teeth of living humans with those of other great apes and fossil hominids, archaeologists have clarified the branching of our evolutionary family tree – and teeth have Plates from Fox’s The Natural History and Diseases of the Human Teeth. ④ A permanent set of human teeth. The full illustration shows the difference between the temporary and the permanent teeth of the upper jaw and lower jaw. ⑤ Further examples of teeth affected by absorption, decay and disease. ⑥ The teeth marked with ‘a’ are temporary teeth and should be extracted to correct the growth pattern. Smile_Stealers_pp1-247.indd 31 24/11/2016 18:0
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also illuminated some of the turning points in the emergence of modern humans. Hillson points out that the appearance of the genus Homo, with its smaller molars, could be interpreted as a move away from the omnivorous foraging of the great apes and towards meat-eating and ‘persistence hunting’ – wounding prey in a surprise attack, then chasing it until it is exhausted. Teeth from more recent archaeological sites have been used to date the next great shift, from nomadic hunter-gathering to farming and a more settled lifestyle, and also to provide evidence of the changing burden of dental disease. Most prehistoric peoples suffered comparatively little caries, but a diet full of grit from quernstones and pots caused extensive wearing of molar enamel and dentine. Teeth with exposed pulps bear mute witness to the pain that must have burdened our ancestors if they survived into their thirties or forties. What we do not find in the archaeological record and in the earliest surviving texts are the roots of a story that leads directly and inexorably to modern dentistry. Modification of the teeth may have many meanings and contexts, and indigenous cultures around the world – from Australia and Papua New guinea to the Americas – have marked rites of passage or expressed their notions of beauty and belonging by chipping and filing teeth, and inlaying them with rock crystal, gold or obsidian. However, we do find a diverse and culturally embedded set of myths and stories woven around the suffering and disfigurement caused by bad teeth, and a collection of rituals and practices intended to mitigate or correct them. The most widespread and enduring of these stories, discovered in sources across the Middle East and Asia, explained toothache as the work of a malevolent worm. A vivid version of this tale was inscribed on a clay tablet in the library of King Ashurbanipal in Nineveh some time in the seventh century BC. A worm comes crawling out of the marshes to demand food from the gods, but is outraged by their offer: FOR ME ! WHAT IS THIS? DRIED FIgS OR APRICOTS? LET ME INSERT MYSELF INTO THE INNER OF THE TOOTH AND gIVE ME HIS FLESH FOR MY DWELLINg. OUT OF THE TOOTH I WILL SUCK ① In Bopoto, Northern Congo, it is customary to sharpen the upper teeth with a small chisel at the age of about fifteen, when the patient is able to bear the pain. ② A cedar panel from the mastaba of Hesi-Re, chief of dentists under Djoser, 3rd dynasty king of Egypt. ③ An Ottoman miniature depicting the anatomical view of a tooth. The source of toothache is shown as demons of hell. Smile_Stealers_pp1-247.indd 32 24/11/2016 18:0
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HIS BLOOD, AND FROM THE gUM I WILL CHEW THE MARROW. SO I HAVE ENTRANCE TO THE TOOTH! A few lines later, the tablet combines prayer and the power of a medicinal plant to provide a remedy: ‘You shall pulverize henbane and knead it with gum mastic and place it in the upper part of the tooth, and three times you shall recite this incantation.’ When Ashurbanipal’s scribe set down this story, the notion of the tooth worm had been common currency for more than two thousand years in cultures across the Middle East and Asia. The authors of early Chinese medical texts such as the Pen Ts’ao (c. 3700 BC) and the Canon of Medicine (c. 2700 BC) argued over whether toothache was caused by tooth worms or by a humoral imbalance, and recommended a pungent medicine for relieving it: ROAST A PIECE OF gARLIC AND CRUSH IT BETWEEN THE TEETH, MIX WITH CHOPPED HORSERADISH SEEDS OR SALTPETRE, MAKE INTO A PASTE WITH HUMAN MILK; FORM PILLS AND INTRODUCE ONE INTO THE NOSTRIL ON THE OPPOSITE SIDE TO WHERE THE PAIN IS FELT. In these societies, greater power went hand in hand, generally speaking, with poorer teeth. The mummies of Egyptian Middle Kingdom priests and aristocrats are riddled with tooth cavities and abscesses, and in life dental care became something of an obsession for them. Some employed servants specifically for cleaning the teeth, and when King Djoser’s ‘chief toother’, Hesi-Re, died in c. 2600 BC he was immured in his own well-appointed tomb. Around the same time, Indian court jewellers were securing the loose teeth of their wealthy clients with threads of silk or gold. Two and a half thousand years later, Roman dentistry had equalled and even surpassed this technical sophistication. Thanks to the early Roman habit of removing jewelry and dental work before cremating a body, then mixing them with the ashes for burial, we know that Roman practitioners could create elegant gold crowns, bridges and false teeth in ivory or boxwood. As was so often the case in Classical culture, Roman thought and practice drew heavily on greek antecedents. The authors of the Hippocratic Corpus (c. 400 BC) concluded that the immediate cause of ④ In the Philippines, the Bagobo modify their teeth by sharpening them into points. ⑤ Detail of the head of an Egyptian mummy, with teeth preserved, Museo Egizio, Turin. ⑥ The Tooth Worm as Hell’s Demon, eighteenth-century ivory carving showing the infernal torments of a toothache depicted as a battle with the ‘tooth worm’, complete with mini skulls, hell fire and naked humans wielding clubs. Smile_Stealers_pp1-247.indd 33 24/11/2016 18:0
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caries was particles offood trapped between the teeth, but that an individual’s particular balance of humours might strongly predispose them to bad teeth. The leading physician in Rome, Claudius galen, took this further, arguing that toothaches were caused by ‘acrid and corroding humours’ irritating the sensitive dental pulp. According to the fifth-century North African writer Caelius Aurelianus, the standard Roman tool for extraction – a pair of pincers known as a dentiducum – was a direct copy of the greek odontagogon. Both the dentiducum and the odontagogon were made of soft lead, introduced in response to the problem of pulling teeth without shattering them and leaving fragments of root stuck in the jaw. In his encyclopaedic De Medicina, compiled in the first century AD, Aulus Cornelius Celsus recommended that carious teeth should be filled temporarily with lead and felt, to strengthen them for extraction. Celsus also proposed a less violent, though more protracted, method of removing bad teeth, using a lancet to cut the gum away from around the tooth before easing it out of its socket by hand – a technique said to have been the preference of ancient Japanese tooth-pullers. In Classical Rome, as for centuries to come, extraction was the most common response to the torment of toothache – although there were other options. Scribonius Largus, physician to the emperor Claudius, advised his patients to fumigate their mouths with the smoke of henbane seeds, in the hope that this would drive out the tooth worms responsible for decay. He also recorded a recipe for tooth powder favoured by Messalina, Claudius’ empress, composed of ammonium chloride, mastic resin and antler ashes. A near contemporary of Largus, the Syrian-greek Archigenes, described a hand-powered trephine (hole saw) for boring into a bad tooth to release the accumulated humours. But a constant theme in early treatises on the teeth was the intractability of toothache, the drawn, haggard faces of those who suffer it over weeks or months and the great difficulty of relieving it. Celsus prescribed a soothing tonic containing mandrake root, opium and cinnamon, and galen recommended the application of pickled chrysanthemum root directly to painful teeth; practitioners in other parts of the world tried henbane, hashish and therapies such as acupuncture. ① Roman terracotta votive (200 BC–AD 200). Such objects were left at religious sites as offerings to gods such as Asklepios, the greco-Roman god of medicine. It was intended to indicate the part of the body that needed help or as thanks for a cure. ② Toothache, detail of a carved wooden roof boss at Lincoln Cathedral, UK. ③ Anon, Torture of St Apollonia (c. 1515, detail), hand-coloured woodcut. Smile_Stealers_pp1-247.indd 34 24/11/2016 18:0
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given this enduring association between the teeth and excruciating pain, it is scarcely surprising that we can trace a parallel history of tooth extraction as torture and punishment. Perhaps the most notorious instance is the story of St Apollonia, who lived and died in Egypt in the second century AD. Almost everything we know of Apollonia comes from later hagiographies, and the details – that her mother had prayed to the Virgin Mary for a child, that Apollonia became a disciple of St Anthony of Egypt, that it was her father, a magistrate, who condemned her to death – seem like pious embroidery. But the earliest versions of her life have her meeting her end in an outbreak of anti-Christian persecution in Alexandria in 248–49. Shortly afterwards, Dionysius, bishop of Alexandria, recorded the manner of her death in a letter: AT THAT TIME APOLLONIA , PARTHéNOS PRESByTIS [LITERALLY, ‘SACRED VIRgIN ’, A PRIEST] WAS HELD IN HIgH ESTEEM. THESE MEN SEIZED HER ALSO AND BY REPEATED BLOWS BROKE ALL HER TEETH. THEY THEN ERECTED OUTSIDE THE CITY gATES A PILE OF WOOD AND THREATENED TO BURN HER ALIVE IF SHE REFUSED TO REPEAT AFTER THEM IMPIOUS WORDS. gIVEN, AT HER OWN REQUEST, A LITTLE FREEDOM, SHE SPRANg QUICKLY INTO THE FIRE AND WAS BURNED TO DEATH. In the macabre manner of medieval Catholicism, St Apollonia was taken up as the patron saint of tooth-pullers and those suffering toothache. In icons and stained-glass windows, she is depicted with the instrument of her suffering – typically a long, blunt pair of blacksmiths’ pincers – and the cathedral of Porto in Portugal possesses a jewel-encrusted reliquary said to hold a tooth torn from her jaw. ① Simon Hillson, Teeth, Cambridge Manuals in Archaeology, Cambridge University Press, 2005, p. 6. ④ A mole’s foot amulet (1890–1910). Mole’s feet have a long and wide tradition as an amulet against toothache. They were recommended by the Roman writer Pliny in the first century AD. ⑤ Toothache, detail of a carved stone roof boss at Wells Cathedral, UK. ⑥ Anon, St Apollonia (1516, detail), from Hortulus Animae, hand-coloured woodcut, heightened with gold. Smile_Stealers_pp1-247.indd 35 24/11/2016 18:0
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ABOVE | Etruscan two teeth lower denture. Copy of a gold setting with human teeth, discovered in a tomb in Etruria, Italy, in c. 700 BC. BELOW | Roman lower bridge. Copy of a gold setting with filed-down ox tooth, discovered in a tomb in Satricum, Latium (Lazio), Italy, in c. 700 BC. Smile_Stealers_pp1-247.indd 36 24/11/2016 18:0
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ABOVE | Metal bridge with replacement teeth, fixed with a metal pin. The original dental bridge was found in Teano, southern Italy. BELOW | gold setting fitted with replacement animal tooth. The bridge would have been fitted around the remaining teeth by a physician. Smile_Stealers_pp1-247.indd 37 24/11/2016 18:0
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ABOVE | Woman with Halitosis (left) and Man with Loose Teeth (right), from the series yamai no Soshi (Diseases and Deformities), illustrated paper handscrolls, copies of twelfth-century originals made by Odate Takakado in the Kansei Era (1789–1801) of the Edo Period. Smile_Stealers_pp1-247.indd 38...
