A light-hearted look at dentistry, then and now.
As someone whose first dental experiences were in the early ’70s—in the era of silver braces and outlandish headgear—I’m more than a little jealous of kids today. With digital x-rays, invisible braces and one-day crowns, technology has changed the game. To appreciate what we have today, let’s look back to see how far we’ve come.
Rise of Oral Health
Today, everybody you meet seems to have healthy, attractive teeth. But it wasn’t always so. In the early part of the 20th century, daily brushing, flossing and regular visits to the dentist were hardly the norm.
For many, “There was kind of an expectation that you were going to lose all your teeth eventually and everyone would end up with false teeth,” says Dr. Terry Dickinson, executive director of the Virginia Dental Association.
By mid-century, however, the American Dental Association was launching regular PSA campaigns to raise awareness about the importance of oral health and regular dentist visits. In the “Smile for Life” series of the 1960s—set in one of those charming picket fence-lined communities where everything is told in a voice over—“Dr. Bran” is the town dentist who patiently explains topical fluoride treatments and other recommendations from “scientists.”
Has it become more common to go to the dentist? “Without a question. People don’t even think twice when you tell them they have to come in twice a year. You tell some they need to come in four times a year and they accept it, because the dental education of people is so much higher,” says Dr. Robert Berman, a dentist in McLean, who graduated from dental school in 1963. “You see it in children. They don’t think anything of making a trip to the dentist anymore. Previously—and this was years ago—it was a big event. They only came when they had a toothache.”
“There’s been a dramatic shift over the years as people understand the disease process better,” says Dickinson. “We see more people expecting to keep their teeth for a lifetime.”
Fluoride Fever
To combat tooth decay, fluoridation of community water began in 1945. The town of Fries and the city of Lynchburg were the first to do so in Virginia, in 1952. Some of us recall the fluoride mouth rinse program, which started in Virginia in 1978, and ran through the 2009-10 school year. As a veteran of a similar “swish and spit” program in Texas, I still remember the rinse’s cloyingly sweet cherry taste (other programs offered bubble gum flavor).
Another public program to combat tooth decay is currently provided by the Virginia Department of Health— 2nd and 6th graders in the Free Lunch Program can receive dental sealants. Also available through private dentists, these thin, plastic coatings are painted on the surfaces of molars.
Many of these programs were met with resistance, but have led to astonishing improvements in dental health. “So many people come in now, and these kids don’t have any decay. Because of fluoride, because of oral health education, understanding the role of diet—it’s changed the whole picture of dentistry,” explains Dickinson.
Oh, That Sound!
In the early 20th century, the first electric drills were belt-driven, and could reach speeds of up to 3,000 rotations per minute. It wasn’t until the 1950s that the first air turbine drill arrived, which clipped along at up to 300,000 rpms.
This ushered in a new era of high-speed dentistry, replacing the old “grinding sound” with the more-familiar “whine,” according to Dr. J. Robert Eschleman, a retired dentist from Richmond, who was a student at MCV Dental School at the time. “It was much faster; in fact, that was the fear. The local dentists did not want the school to let us use it,” he says. “I think some of them were afraid of it.”
While fillings started out in silver amalgam, the 1990s saw the introduction of tooth-colored composite restorations. Many ’70s and ’80s kids—including yours truly—are now having their old fillings excavated and replaced with this more natural-looking color. So well do they blend in, that, when things go awry, “they’re the devil to get out,” says Eschleman.
Brace Yourself
With early braces, orthodontists had to anchor brackets to teeth by painstakingly winding wires around each tooth. The inventions of dental adhesives in the 1970s enabled the doctors to stick the braces to the surfaces of the teeth. Still, not a good look.
“We used to wear these full bands—railroad tracks is what they looked like—and that horrible head gear. It looked like some form of torture and boy, did it make you drool,” recalls Dr. Brenda J. Young, a Fairfax dentist. “Now we have these tiny little brackets or clear retainers so that no one even knows you are undergoing orthodontic treatment.”
Clear, plastic aligners took off with sales of Invisalign in 1999; many more manufacturers followed. Lingual braces, which are discreetly mounted on the backside of teeth, have become more popular in recent years. Developed by a Beverly Hills dentist in the 1970s, they have been famously worn by Miley Cyrus and even by Kate Middleton on her wedding day.
Brush Offs
Previously made with boar bristles, the first toothbrush with nylon bristles, Doctor West’s Miracle Toothbrush, was marketed in 1938; the electric toothbrush, invented in Switzerland in 1954, arrived in our country in 1960. A cordless, rechargeable model followed a year later—creating a perfect prop for future rom-coms with their buzzing, foamy, dialogue-impeding ways.
Dental floss was created by a New Orleans dentist in 1815, who directed his patients to clean between their teeth with a silk thread. It wasn’t until the 1940s that nylon replaced silk as the go-to material for floss. Waxed floss was also invented in the ’40s, while the always-a-bridesmaid dental tape came on the scene in the ’50s. Pre-threaded flossers arrived later, along with flavored dental floss, which comes in flavors ranging from “makes sense” (mint, cinnamon) to “uh, no thanks” (fennel, bacon).
Breath-Forward
Early Americans brushed with tooth powder until the more convenient tube toothpaste became widely available in the 1880s. Fluoride toothpastes were introduced in the 1950s, around the time that more people began buying televisions. This led to the birth of toothpaste ads, a strong childhood memory for many of us. Who could forget the one with the little boy waving his dental report card, “Look Ma—no cavities,” or Ultra Brite, the “sex appeal” toothpaste?
Breath-freshening products date to ancient times—including charcoal, fruit and dried flowers—but mouthwash as we know it today emerged in the late 1880s. Back then, the rinses contained alcohol; today, alternative ingredients (Colgate uses etylpyridinium chloride, or CPC) offer other ways of killing germs as well as whitening, controlling tartar and attending to sensitive or dry mouths (some products are gluten-free).
Shine On
With whitening now so ubiquitous, it’s hard to believe that we once lived without products like Crest Whitening Strips. Commercial whitening products for home use were first marketed in the U.S. in 1989. Today, patients can take part in office bleaching with lasers and lights or in-home whitening that uses trays, strips and even pens.
One new over-the-counter product, KöR Whitening Deep Bleaching, targets especially tough stains, including teeth turned grey by the antibiotic tetracycline—the bane of many a Baby Boomers’ existence.
Make a Good Impression
Until recent years, if you needed a dental impression of any kind, that meant sinking your teeth into squishy goo. Digital scanners have been “a huge game-changer for orthodontics,” says Richmond orthodontist Dr. Erika Sachno. “Rather than having to take a putty mold of patients’ teeth, which was then poured in stone, and sent to a lab for appliance fabrication, now a digital scan can be made with an intraoral camera.”
The camera takes multiple photographs to create a digital 3D replica of the patient’s mouth, which can be used for clear aligners, dentures, implants and other products. “The image can then be sent directly to the lab as a file, and the lab will use a 3D printer to print the image. Once the file is saved, the digital model is safe. There is no fear that the model will be broken or distorted while being produced,” she says. Procedures are faster, appliances fit better, and, perhaps best of all “no gagging on the impression material.”
The advent of the digital scanner has also led to the “one-hour crown,” where dentists can do their own milling to create a custom-made crown in a single visit. This compares to the more traditional method, which involves two visits, often weeks in between, and the use of a temporary crown until the final fitting.
Say ‘Cheese’
Intraoral cameras have improved patient education. “We can digitally take pictures of your mouth and show them on a screen,” says Dr. Marci Guthrie, a Richmond dentist. “A lot of times, ignorance is bliss, especially in my world. More often, people come in and they say, ‘Nothing hurts … What do you mean I have 10 cavities in my mouth?’ Now, I can take an intraoral picture so they can clinically see what I’m seeing and we can work together to tailor a treatment plan that meets their personal goals. Patient education and prevention is key in dentistry and waiting until something becomes painful is usually more costly emotionally and financially. We work hard to prevent these situations for our patients.”
True or False?
Implant dentistry, as an organized area of practice, dates to the mid-1960s. Implants are titanium posts placed into the jawbone, to which the dentist can attach replacement teeth and bridges. They are particularly effective for securing dentures.
“When I started, dental implants were a somewhat exotic treatment and applicable only in a few select cases. With advancement in technique and materials, implant dentistry is now routine dentistry and our first choice to replace a missing tooth,” says Dr. Ted Corcoran, an oral surgeon in Falls Church and Arlington, who has practiced for 26 years.
In the early years, the placement of the posts and the replacement teeth often required two surgeries. “It could take nearly a year to complete treatment,” he says. “Today, in specific circumstances, a tooth can be removed and an implant and a temporary restoration placed at the same visit.”
The Future is Now
Increasingly, dental practices are incorporating more technologies from medicine. Cone beam CT scans, for instance, allow dentists and orthodontists to visualize anatomic structures in three dimensions. This has greatly helped with diagnosis and treatment, says Sachno. “With three-dimensional technology, the proximity of teeth to each other and other structures, bone thickness, and root morphology can all be clearly seen.”
Dickinson speculated that another medical advance—Da Vinci Robotics—may find its way into dentistry. He also pointed to other recent developments, including the growing field of salivary diagnostics, jaw restorations for cancer patients created by 3D printers, and antibiotics that are delivered directly into the oral cavity to treat periodontal disease.
“It’s almost like there’s something’s new every day,” he says. “I just kind of sit back and think, ‘Oh gosh, I can’t believe it—the dramatic changes that I’ve seen since I started practicing years ago.”
