In an article on an 18th-century tooth-puller, historian Colin Jones claimed that "the list of Great Dates in Dentistry is largely unknown, I wager, outside the serried ranks of the dental profession". In subsequent work, Jones demonstrated the important relationship between beauty standards and the development of dentistry in 18th-century Paris. One of the great dates in dentistry seems of continued importance for the pursuit of the beautiful smile: when were braces for straightening teeth invented?
I started thinking about dental braces because it seems to me that they started appearing everywhere on adults. A friend celebrated her new job by shelling out her hard earned wages on a set. Two neighbours' smiles suddenly included a flash of steel. A student informed me that he was foregoing a summer holiday to pay for braces. Irish adults have been gripped by enthusiasm for that iconic American beauty ideal: the perfect smile of even, straight, white teeth. I had considered myself lucky to escape braces because in the United States more than 60 per cent of teens have them. But now I examined my rather buckled lower teeth and wondered.
Focus on extraction
While there is evidence that ancient peoples practised teeth extraction and even created false teeth, the science of dentistry as we know it expanded during the 18th century. The focus was on the extraction of bad or troublesome teeth which, as anyone who has experience an abscess knows, can cause excruciating pain.
French practitioners led the field, including in the development of techniques to adjust perceived oral imperfections such as the use of metal strips in the mouth to realign teeth in upper and lower jaws. French dental pioneer Pierre Fauchard described such a system of teeth correction as early as 1723.
Probably the first book to propose something that sounds like modern braces is the 1829 text, A System of Dental Surgery by American dentist Samuel Sheldon Fitch. Most of Fitch's advice concerning the treatment of "irregular teeth" involved standard extractions or filing edges. These procedures could be used on adults.
However, he also explained that an instrument made of gold, ivory, and silk thread could be fixed into the mouth to help rotate teeth into proper alignment. The silk thread ligature, which pulled teeth into place, would have to be replaced every few days as “the tooth will soon be perceived to move”. These luxurious early braces were only effective on children younger than 13 or 14 because after this age “the teeth are so fixed that they cannot be moved without much difficulty”.
Psychological problems
A more familiar system of metal braces existed by the start of the 20th century, perhaps popularised by the early American orthodontist
Edward Angle
. Nonetheless it was not until the 1940s and 1950s that braces began to be widely advocated for children. Braces were supposed to prevent dental problems caused by “malocclusion” or misalignment of the teeth but they were also proposed as a cure to social and psychological problems that might accompany sub-optimal teeth. Focus on the perfect American smile accompanied the development of the beauty industry more widely and was useful for selling toothpaste as well as dental and orthodontic treatments.
As Alyssa Picard has shown for the US and Melissa Micu and Catherine Carstairs have shown for Canada, the expansion of orthodontics was rapid in North America after the second World War. It was also directly related to wealth with practices more common in profitable urban areas. Parents were encouraged to have their children treated in order to avoid the social stigma and insecurity that might arise from imperfect smiles.
In 1962 Mary Stanley, an American nurse and advocate of adult cosmetic dental treatment, found herself "wishing my smile was more attractive". She wrote in the American Journal of Nursing to reassure others that "adult teeth can be straightened". Adjusting adult teeth with braces was a relatively new practice but one set to spread. Dentists and orthodontists began to see the adult's mouth as just as malleable as the child's. In the past 20 years the number of American adults choosing to have their teeth straightened has doubled; many opting for the new "Invisalign" system rather than traditional metal braces. Formerly a painful part of adolescence, braces are now being embraced by adults.
Dr Juliana Adelman lectures in history at Dublin City University