Poor ill-treated, ill-fated Fantine. "She had," wrote her creator Victor Hugo, "gold and pearls for her dowry; but the gold was on her head and the pearls in her mouth."
Nor, apparently, did Hugo exaggerate when he described in "Les Miserables" how circumstances forced her to sell her pearls -- her two front teeth -- to the "teeth puller," the itinerant "juggler and traveling dentist," for two gold Napoleons. (This episode, commented actress Julie Harris, narrator of the current public broadcasting radio serialization of "Les Miserables," was considerd among the book's most shocking.)
But it was true. Where indeed did those dentist-jesters of the early 19th century find dentures for the rich -- but in the mouths of the poor?
No one, of course, is getting anybody else's two front teeth for Christmas anymore, but, as a matter of fact, dentists still are juggling -- and hypnotizing and joking and performing magic tricks -- to lessen the traditional anxiety of their patients. And some might even be called, if not actually itinerant, at least evangelical.
Take, for instance, Dr. Howard L. Ward, specialist in gum disease, professor of dentistry at the New York University College of Dentistry.
Whereever he goes, he tries to get someone to listen to how he'd like to make his profession obsolete. And what he says sounds a lot like holistic dentistry.
"No longer," he was saying recently, "can a patient walk into the office and lean back, and just say, 'Here I am. Treat me.' They have to be a party to that treatment." It must be the patient's responsibility to say to the dentist not "Do I have any cavities," but "How's my mouth? How are my gums? Cheeks? Tongue? Palate?"
It isn't just a matter of brushing right and flossing right, although that is certainly important. But, Ward feels, the patient has to understand the importance of good nutrition, for example, or being able to cope with stress -- and of understanding how these things are related to the teeth.
Poor Fantine, indeed. Given the state of her health -- she was already ravaged by TB, never had enough to eat and certainly Hugo gave her plenty of other reasons to be one of his miserables -- she wouldn't have kept her "pearls" much longer anyway.
Many of ours are endangered as well. The villians, contrary to Hugo's, have no special class-consciousness. They are simply persistent, fast-growing, everchanging sugar-loving bacteria which, on contact with the sugar you eat, produce a gummy substance the dentists call plaque. That yukky stuff adheres to your teeth, creating a perfectly lovely environment for the bacteria to thrive and multiply.
The interaction of these germs with sugar also produces acids which eat away the enamel of the teeth. Hardened plaque turns into tarter or calculus which gets between the gum and the tooth and causes irritation, but worse, creates another surface for plaque and yet another crop of destructive bacteria. Eventually, the bacteria and acids get at the fibers that hold the gum to the tooth and to the bone itself, causing abcesses and loose -- and lost -- teeth.
It doesn't have to be that way, for the most part, maintains Dr. Ward. If only people would understand and, as he puts it, "get the religion." Of course, brushing and flossing meticulously -- but not so hard as to erode the enamel -- are crucial to healthy teeth, keeping the plaque-forming bacteria at bay. Even better would be a healthful, well-balanced sugar-free diet.
And a stress-free life style. Not only do "the flora in the mouth" change in character when the person is under stress, says Dr. Ward, "but they become suddenly very virulent . . . damaging places they never reached before."
What's more, stress precipitates habits like teeth-clenching and jaw-clamping and, at night, teeth-grinding. "These result in the thickening of the membrane that supports the tooth and eventually the loosening of the tooth," says Ward. Often, "The patient doesn't recognize he's doing anything wrong."
"I've seen patients," he recalls, "sitting in the chair, talking and all the time biting on eyeglasses, chewing pencils, wedging fingernails between the teeth, biting cuticles and I say, 'Do you do anything harmful to your teeth?' and they say, 'Oh, heavens, no.'"
Warning signs that should get you to a dentist fast, says Dr. Ward, include bleeding gums, swelling, misshapen gums, inexplicable odor, pain or, more seriously (because it means the gum disease is farther along), loose teeth or pus from the gums.
Dentists are making headway with research on tooth implants and, perhaps, a vaccine to wipe out the plaque-creating bacteria. Fluoride is a help. But the main thing now, says Dr. Ward, is to get the 90 or so percent of people who have some gum disease to take the rsponsibility for conducting their own at-home germ warfare. The earlier it is caught, of course, the easier -- and the least costly -- it is to control.
And don't worry about the poor dentist, adds Ward. "We'll have plenty to do for generations to come."