Early Americans had lousy teeth. The mouth, in the bodily scheme of things, didn't seem as important as other parts, such as feet or hands, which had to be put to work in a virgin environment. The loss of permanent teeth by extraction or gum disease occurred so frequently that an empty mouth was common by middle age.
George Washington, for example, had only one tooth when, at age 57, he became the nation's first President in 1789. When Gilbert Stuart painted his famous portrait of Washington six years later, he used cotton to give his subject a nobler mouth. Washington also wore dentures, as did some other colonists, but tooth loss was par for an aging mouth.
Our colonial forebears did not practice preventive dentistry. In fact, they carried over from England the myth that creatures called toothworms invaded the mouth and caused teeth to experience pain and even rot. At the time, few doctors associated teeth problems with mouth care in general or decay in particular. They blamed the stomach, eye and other distant body parts.
Another reason the colonists had nothing to smile about was the state of dentistry. In Europe, the field was monopolized by barbers. For a time, they belonged to the same guild as surgeons. They had razors, scissors, shaving brushes and the like, and as patrons visited their shops for hair and beard care, it seemed only natural to extend the utilization of their tools to the mouth.
So the barber-surgeons in America plied their trade by occasionally running down a toothworm or two, but mostly by extracting teeth. A few offered hard twigs or branches that were to be chewed or worked around the mouth, helping, like dog biscuits of our day, to keep teeth clean. These men were often itinerant, bringing their trade to individual homes much as a peddler sold pots door to door. And they found a receptive audience in places where homemade remedies -- tobacco, juices made from roots, and purgatives -- had failed to eliminate pain.
However, the number of barber-surgeons was never large enough to serve the entire population, and others entered the field, including blacksmiths -- who possessed even bigger and better tools for yanking teeth -- and silversmiths. One of the latter was Paul Revere, who learned his trade from an English barber-surgeon who filled decaying teeth with gold and silver. No one knew these metals better than Revere, and before long the man who would distinguish himself in the American Revolution was filling his days by filling teeth and making dentures.
The 19th century in America saw the rise of more professionally trained dentists who practiced preventive techniques and did battle with the much larger force of the untrained. There were important milestones.
First, the Baltimore College of Dental Surgery was established in 1840, the first of its kind in the world, which offered the degree still known as D.D.S. (Doctor of Dental Surgery). Similar colleges elsewhere soon followed.
Second, trained dentists were greatly helped by the development of anesthesia, which made tooth extraction much easier for the patient.
Third, the American Dental Association (ADA) was organized in 1859 and set standards for practitioners that could be achieved only by the few trained dentists.
Fourth, technology was on the side of the trained dentist: the development of better denture and restorative materials, drills and reclining dental chairs cost money, making it more difficult for the itinerant practitioner to compete. Then, the trained dentists obtained authority from their state legislatures to set standards and examinations for candidates. These state boards of dental examiners made sure that only the qualified were permitted a license to practice.
America's entry into World War I brought greater pressures on dental schools to improve standards; the same era saw the rise of paraprofessionals in the form of hygienists, and progress in the form of the discovery of fluoride and improved technology continued. World War II revealed shocking statistics as Selective Service requirements were eased, because of the poor dental health of America's recruits. In fact, the armed services required that inductees have only 12 teeth, a standard that 20 percent of otherwise eligible men failed to meet.
Only in the past three decades have Americans paid close attention to their teeth and gums. Just four years ago, the ADA pointed out that the number of cavities had reached record lows, with gum disease assuming greater importance. Even bumper stickers reflect the new consciousness: "Teeth: Ignore them and eventually they'll go away."
Yet after so long a fight to become professionals, American dentists face more problems. Some dental schools are closing their doors -- among them Georgetown University's -- because of high costs and the oversupply of dentists. Advertising has made the profession more competitive, and AIDS has made many dentists more concerned about their own health.
Depending upon what phobia survey one consults, fear of visiting a dentist ranks at or near the top, usually exceeding fear of flying. But perhaps the unkindest cut of all is that critics have coined a name for the somnolent tunes that one is likely to hear while waiting for a tooth to be filled. The ditties are called "dental music."
Thomas V. DiBacco is a historian at American University and author of "Made in the U.S.A.: The History of American Business" (Harper & Row, 1987).