Dental Aids

ANIMAL, VEGETABLE, MINERAL? CONSTRUCTING ARTIFICIAL TEETH

Today, dentures tend to be constructed from a combination of acrylic and metal due to the affordable, lightweight, and malleable nature of those materials. However, it was not until the 1930s that neo-hecolite, a kind of acrylic resin, was first used in dentistry (we can see an example of this in the 1931-32 Bulletin of the North Carolina Dental Society, in which a conference programme lists a clinic to be delivered by J. W. Whitehead titled ‘Hecolite Dentures – Advantages and Disadvantages’, p. 39). So what were people using to construct dentures before this point?

Gold

False teeth, or dentures, have ancient origins. Some of the earliest surviving examples were produced by the Etruscans (people who lived in Etruria – a historical region of central Italy) c. 700 BCE. These dentures were made by riveting either human or animal teeth into an oval shaped golden band, which would be held in place by the individual’s surviving teeth. Gold was also used to create dentures in the medieval Islamic world; however, rather than using bands and rivets, thinner golden wires were inserted through holes drilled in the dentures (again, made from human or animal teeth) before being wrapped around the surviving teeth to hold the denture in place. This method was outlined in detail by Albucasis c. 1100 CE, and was later adopted by surgeons such as Guy de Chauliac in the medieval West. Since this point, gold has continued to be a popular choice of material in dentistry, and is still used for fillings and crowns today! 

Wood

Some of the earliest evidence for the use of wooden dentures comes from Japan in the sixteenth century. One surviving example, made of wood from the Japanese box tree, was said to have been worn by a priestess of the Ganjyoji Temple (Kii Province) named Nakaoka Tei. These kinds of wooden teeth continued to be produced in Japan until the late nineteenth century. They were generally carved by expert craftsmen such as Negoro Sokyu (an artist and artificial tooth-maker based in mid-eighteenth-century Osaka), and could be finished with ivory crowns or lacquer. However, finding hardwoods strong and non-porous enough to be used for the construction of dentures was difficult, and wooden teeth did not have a lot of popularity outside Japan. “But what about George Washington?!” I hear you ask. Well, unfortunately, the pervasive myth that Washington wore wooden denture is just that – a myth. Whilst Washington certainly possessed and wore multiple sets of false teeth, they were constructed from metal, ivory, and porcelain – which brings us onto our next section… 

Ivory

Perhaps the most popular material in the construction of early dentures was ivory – more specifically, hippopotamus ivory. Hippopotamus ivory was denser and more hardwearing than elephant or walrus ivory, and would therefore have been more suitable for use as dentures (such as those listed in the Switzerland entry of the Great Exhibition catalogue). However, ivory was still an organic material and had a tendency to stain, smell, and ultimately rot. It was also quite difficult and dangerous to acquire hippopotamus tusks, so these kinds of ivory dentures would have been rare and expensive to purchase. 

Human teeth, on the other hand, were much easier to come by. ‘Waterloo Teeth’ for example, were named for the soldiers who had died at the Battle of Waterloo and who had subsequently had their teeth pulled and sold by battlefield scavengers. The removal and sale of dead soldiers’ teeth also took place throughout the Crimean War and in the aftermath of the Battles of Bull Run and Gettysberg. A much more sinister example of this can be seen in George Washington’s financial records. In 1784, Lund Washington (George Washington’s cousin and steward of the Mount Vernon plantation) recorded ‘cash pd on acct of Genrl. Washington [to] Negroes for 9 teeth, on acct of the French Dentis [sic] Doctr Lemay’ – thereby demonstrating Washington’s ‘purchase’ of teeth from enslaved peoples for the purposes of dentistry. For more on the subject of race and equity in health and healthcare, please see the work of our Educational Resources Fellow, Aja Lans. 

Porcelain 

Towards the end of the eighteenth century, dentists began experimenting with porcelain as a material for the construction of dentures. The first porcelain dentures were made by the French dentist Alexis Duchateau, who had grown tired of wearing hippopotamus ivory teeth and wanted to create something more durable. However, Duchateau had a problem – whenever he fired the porcelain (to set the material in shape) the teeth he had constructed would shrink! As such, he teamed up with Nicolas Dubois de Chémant, to solve the problem of shrinkage. Dubois de Chémant subsequently secured a British patent for the construction of porcelain teeth, and went on to write his Dissertation on Artificial Teeth in General, which sought to expose ‘the defects and injurious consequences of all teeth made of animal substances’. 

However, although porcelain dentures were thought to be an improvement on earlier ivory models, they were still very expensive and had a tendency to chip – meaning that they had to be repaired or replaced relatively frequently. In the 1820s, Claudius Ash (a goldsmith and jeweller) began to manufacture porcelain dentures mounted on gold plates, which improved their durability (if not their price!) Claudius Ash went on to found the company ‘Ash & Sons’, which became Britain’s leading supplier in dental appliances.

Vulcanite 

From the mid-nineteenth century, dentures began to be constructed from Vulcanite – a material discovered by Charles Goodyear in 1843 (you can find Goodyear’s original patent for Vulcanite here). Vulcanite was a hard, but flexible, rubber that could be produced relatively cheaply. For the first time, this meant that dentures could be made available to people with lower incomes. However, the introduction of Vulcanite was not entirely smooth sailing. Due to the growing popularity of Vulcanite, the Goodyear Dental Vulcanite Company demanded that dentists had to obtain licences to use their material. Many dentists opposed this licence and the Goodyear Dental Vulcanite Company pursued litigation against any unlicensed practitioners. Fortunately, Charles Goodyear’s patent only lasted for twenty-five years and, in 1881, Vulcanite could be used and produced without a license. 

KEEP YOUR TEETH CLEAN! THE USE AND MANAGEMENT OF ARTIFICIAL TEETH

In 1851, John Tomes (surgeon dentist to Middlesex Hospital, England) published a lecture titled Instructions in the Use and Management of Artificial Teeth. In this lecture, Tomes states that, if you don’t take care of your false teeth, they will ‘sooner become offensive’. ‘The wearer’ he says, ‘often seems singularly unconscious of the offensive odor which arises from neglected teeth, – not so, however, the bystander; he is almost poisoned by the offensive breath of his neighbour’. To save these poor bystanders, Tomes offers three main pieces of advice: 

Brush the teeth once or twice a day and rub with a soft dry towel

First of all, Tomes advised that dentures be brushed twice a day and rubbed dry with a soft towel. Although written in 1851, this kind of advice is not so far removed from medieval treatises on dental hygiene. Gabriele Zerbi’s Gerontocomia, for example, was published in 1489 and suggested that ‘the teeth can be cleaned with a linen cloth dipped in rose water or wine (not sweet) and rubbed with a powder that restores their powers’. (Zerbi, Gerontocomia, trans. L. R. Lind, p. 258). Similarly, the twelfth-century De ornatu mulierum [On Women’s Cosmetics] suggested that women should wash their teeth with wine after meals before cleaning them with an abrasive powder and drying them with a linen cloth. This kind of abrasive tooth-cleaning powder remained popular well into the nineteenth and twentieth centuries. Multiple types of tooth powders, pastes, perfumes, soaps and tablets can be found in Peter MacEwan’s Pharmaceutical Formulas of 1908. However the use of these treatments was often condemned by dentists. For example, in his New System of Treating and Fixing Artificial Teeth, Frederick Eskell claimed that ‘all acids, gritty powders, are injudicious and prejudicial to the teeth’. Tomes tries to strike the middle ground in this debate, suggesting that dentures can be cleaned with ‘a little precipitated chalk’ when necessary.

Take the teeth out of your mouth

Secondly, Tomes explains the importance of removing dentures from the mouth. He states that the mouth and gums cannot remain healthy if they are continuously covered, and graphically claims that, if continually worn, the base of the dentures will become ‘coated with a highly offensive white cheese-like matter’. To avoid this, he argues that dentures should be taken out for at least eight hours a day (ideally overnight) and properly cleaned. In this sense, Tomes’s work builds upon the advice of the Royal College of Physicians of Edinburgh who, in their Practical Treatise on the Most Frequent Diseases of the Mouth and Teeth (1823), state that the ability to remove dentures from the mouth, gives users the ‘additional advantage of having it in their power to keep them clean’ – so no excuses!

When not in the mouth, keep the teeth in a ‘well-stoppered’ glass jar

Finally, Tomes advised that, when not in the mouth, dentures should be kept in a ‘well-stoppered glass jar’ filled with two-thirds of spirits of wine, and one-third of water. Whilst wine might not seem like a natural choice of cleaner to a modern reader, both red and white wines have antibacterial properties. Subsequently, a mixture of wine spirits and water would have helped to disinfect and clean a set of dentures.

However, liquid suspension was not the only way to store dentures. In 1871, Claudius Ash & Sons produced a range of cases in which people could keep their dentures. These boxes were available in square, half-oval, and oval designs, and could be constructed in different materials, including leather, metal, wood, and cardboard. For people with a larger budget, these cases could also be made to include a glass display tray and a locking system with a key. 

DENTURE DANGER! THE PROBLEM OF SWALLOWING DENTURES

For all the good that dentures could do, they could also be a serious hazard to a person’s health if they were swallowed! In 1854, S. D. Gross published A Practical Treatise on Foreign Bodies in the Air-Passages. In this work, Gross claimed that the subject of swallowed objects had not received ‘any adequate share of attention’ from the medical profession and set out to remedy this. In this book, Gross discusses the case of a man who died thirteen years after accidentally inhaling four porcelain teeth during a coughing fit. During the man’s autopsy, the artificial teeth were found ‘in the right thoracic cavity, [when] sponging out the blood, and replacing the lung. They were covered with a brownish crust, and furnished with silver rivets, by which they had been adapted to the upper jaw’. It was decided that the man had died from pleurisy triggered by the presence of the teeth in his lung. In the same year, Dr. James Phillips of Nashville also found himself treating a patient who had swallowed a partial denture consisting of four teeth. Fortunately for this patient, ‘two days and eighteen hours from the date of the accident, he passed the plate per anum, with but little pain’.

However, with the rise of Vulcanite as an inexpensive material for the construction of dentures, and the subsequent accessibility of dentures to the masses, more medical professionals found themselves dealing with swallowed teeth. A comprehensive example of this can be seen in a Royal College of Surgeons of England tract concerning ‘cases where artificial teeth have been swallowed, or have become impacted in the pharynx’. This tract describes eight cases where artificial teeth had been swallowed and ‘passed’; eight cases where swallowed teeth had been removed with forceps; three cases where surgery was needed to remove dentures from the throat or stomach; and just one case in which inhaled dentures had resulted in death.