In this episode of Stuff You Should Know, the hosts explore the history of orthodontics from its ancient beginnings to modern practices. The journey begins with early attempts at dental alignment in Egyptian and Roman civilizations, progressing through key innovations by pioneers like Pierre Fauchard in the 18th century and Edward Angle's establishment of American orthodontics in the late 19th century.
The episode examines how social attitudes toward teeth have shifted over time, particularly due to Hollywood's influence in the 20th century. It also addresses ongoing debates about orthodontic treatment's medical necessity and traces the evolution of orthodontic technology, from precious metals to modern innovations like self-ligating braces and Invisalign. The hosts discuss how these developments have affected treatment accessibility and professional oversight in orthodontic care.
Sign up for Shortform to access the whole episode summary along with additional materials like counterarguments and context.
The practice of orthodontics dates back to ancient civilizations. Hippocrates wrote about crowded teeth causing headaches, while Egyptian mummies show evidence of primitive braces using gold bands connected with cat gut. Roman writers Celsus and Pliny the Elder also documented early dental alignment techniques.
Pierre Fauchard, working in the early 18th century, revolutionized orthodontics by developing the first specialized appliances for moving teeth. He introduced innovative techniques like interproximal stripping and using waxed silk or wire to align teeth, laying the groundwork for modern braces.
In 1880, Norman Kingsley published "A Treatise on Oral Deformities," emphasizing both dental health and facial aesthetics in orthodontic care. Edward Angle, known as the father of American orthodontics, made significant contributions by developing the Angle system and occlusal classification in 1887. He founded the first orthodontic school and established the Society of Orthodontists, now known as the American Association of Orthodontists.
Social attitudes toward teeth have evolved dramatically. In the 18th-19th centuries, showing teeth was considered impolite, and portraits rarely depicted teeth except in depictions of social outcasts. Chuck Bryant notes that Hollywood's influence in the 20th century created new pressure for perfect teeth, leading to a doubling of Americans wearing braces between 1982 and 2008.
A significant debate exists regarding orthodontic treatment's medical necessity. Critics question whether crooked teeth pose significant health risks, while orthodontists argue their treatments prevent issues like headaches and jaw pain. Josh Clark points out that research on orthodontic benefits is complicated by selection bias, as patients typically come from higher socioeconomic backgrounds.
Modern orthodontics has progressed from precious metals to advanced appliances. Dr. Raymond Begg pioneered the use of stainless steel wire in the 1930s, making treatment more affordable. Current innovations include self-ligating braces and expanders for jaw widening. Invisalign, invented in 1997 by Zia Chishti and Kelsey Wirth, disrupted traditional orthodontics by offering treatment without continuous oversight, though this has created tension within the orthodontic community regarding treatment quality and professional supervision.
1-Page Summary
The roots of orthodontics trace back to ancient civilizations and early medical pioneers who recognized the importance of addressing crooked teeth. Hippocrates, the father of medicine, wrote about the potential for crowded teeth to cause headaches and palate problems. Egyptian mummies provide physical evidence of early orthodontic practices; gold bands around their teeth were connected with cat gut in a manner akin to modern braces. Roman writer Celsus advised the extraction of baby teeth and the daily pressure application to emerging adult teeth to guide them into proper alignment. Moreover, Pliny the Elder suggested that teeth could be filed to improve their arrangement, indicating an awareness of dental aesthetics and function.
In the pioneering world of modern orthodontics, Pierre Fauchard, a Frenchman at the dawn of the 18th century, distinguished himself through his dedicated work with misaligned teeth. Fauchard's profound contributions included designing some of the first appliances meant specifically for moving teeth into more desirable positions. Astutely assessing oral structures, Fauchard would measure teeth length and file them—a precursor to what's now known as bite adjustment or occlusal equilibration.
Furthermore, Fauchard advanced the concept of interproximal stripping, filing down teeth to create space, thus facilitating the natural or mechanically assisted straightening of crooked ...
The Origins and Early History of Orthodontics
Orthodontics has evolved significantly over the centuries, thanks to pivotal figures and their groundbreaking innovations. The dedicated work of early orthodontists in the 19th century refined previous techniques with rigor and an eye for aesthetics, while the standardization of orthodontic practice began in earnest in the 1900s.
Norman Kingsley from New York City marked an early popular figure in the field of orthodontics. In 1880, Kingsley wrote "A Treatise on Oral Deformities," elucidating his dual focus on dental health as well as facial symmetry and aesthetics. His approach signalled a nuanced understanding that orthodontic care had implications beyond functional dental correction, influencing the overall facial harmony and appearance of patients.
Josh Clark referred to Edward Angle as the father of American orthodontics for his profound contributions to the field. Angle was instrumental in transforming orthodontics into a specialized, professional discipline.
In 1887, Angle developed the Angle system, which included prefabricated parts designed for use with various patients. Further advancing his approach to orthodontics, he introduced the occlusal classification system, a still-utilized measure today, to diagnose deviations from the norm in a patient's dentition.
Angle also fou ...
Key Figures and Innovations That Shaped the Field
Over time, societal attitudes towards tooth exposure and orthodontic treatment have shifted significantly, from an era where showing teeth was impolite to a modern focus on perfect orthodontic appearances.
During these times, the social norms in the West regarded the display of teeth as impolite and socially inappropriate.
Portraits from the 18th century seldom depicted the teeth of gentry or aristocrats, as it was considered rude. The only instances in art where teeth were on display involved those considered outside of societal norms, such as pirates or asylum patients.
As time progressed, the influence of Hollywood became evident in shaping societal attitudes towards oral aesthetics.
Chuck Bryant points out the influential trend of people in Hollywood and the media having perfect teeth over the last 10 to 20 years, suggesting that this has created societal pressure to achieve ...
Changing Societal Attitudes Towards Orthodontic Treatment
The medical necessity of orthodontic treatments has become a point of debate, with critics challenging the purported health risks of crooked teeth and orthodontists defending their treatments as prevention for various health issues.
Critics argue that there are not established health issues resulting from having crooked teeth and suggest orthodontists should refrain from indicating there are. The podcast hosts reflect this skepticism, proposing that the health benefits of such treatments might be overstated. They suggest this could be part of a narrative to convince insurance companies to cover procedures that would otherwise be categorized as cosmetic.
Clark highlights the problem of selection bias in research studies on orthodontic benefits. Joint issues like preventing headaches or jaw pain are difficult to study robustly, because those who can afford braces tend to come from higher socioeconomic backgrounds, which can skew results.
Debate on Medical Necessity of Orthodontics
Orthodontics has come a long way from the use of precious metals to advanced modern appliances like self-ligating braces and invisible aligners. In this segment, we delve into the historical advancements and the controversial rise of Invisalign.
Stainless steel braces, which became popular in the 1970s and 1980s, marked a significant evolution from early braces that used a wrap-around silver band for each tooth. Now, braces incorporate innovations like ceramic brackets, which provide a less conspicuous option for patients.
Dr. Raymond Begg, a student of Dr. Edward Angle, was instrumental in the development of using stainless steel wire for braces. He worked in Adelaide during the 1930s and discovered the advantages of this material over precious metals. Although gold was non-toxic and didn't react with other materials, it was expensive, prompting orthodontists to develop affordable alloys that are in use today.
The hosts discuss headgear as a historic advancement in orthodontics from the 19th century. It relies on the skull as an anchor to move teeth, though its popularity has waned since its peak use in the 1980s.
Currently, self-ligating braces represent a leap forward in orthodontic technology. Unlike traditional braces, which use elastics to attach the brackets to the wire, self-ligating braces have a built-in mechanism that holds the wire in place, offering more targeted and gradual tooth movement.
Orthodontists also now utilize expanders, devices inserted into the mouth's roof, to widen the jaw over time. These devices have proven to be effective in making room for teeth growth, as Chuck Bryant notes from his daughter's experience.
Since being invented in 1997 by Zia Chishti and Kelsey Wirth and subsequently int ...
The Evolution of Orthodontic Techniques and Technologies
Download the Shortform Chrome extension for your browser