Curator's Choice

Episode 48: National Museum of Dentistry

• Ayla Anderson

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Embark on a journey into the heart of Baltimore where the first dental school took root, revolutionizing oral health care. We'll reveal the pivotal moments that sparked the dire need for dental regulation, from sideshow jaw hackers to educated dentistry professionals.

🔧 From Baltimore's Roots to Regal Dentures 🦷
With Scott Swank as our guide, we reveal the pivotal moments that sparked the need for regulation, professional associations, and medical journals, transforming the landscape of dentistry.  From extracting teeth from the mouths of the city's poorest to showcasing the most luxurious dental tools fit for royalty, we delve into the stark contrast between the struggles of early dental care and the opulence of elite dentistry.

😁 Teeth, Technology, and Oral Narratives 🧚‍♂️
Hear the captivating truth behind George Washington's dentures, a tale far removed from the myth of wooden chompers. Get the inside scoop on the intricate craftsmanship of these dental devices, made from materials like hippopotamus ivory, and the exclusive nature of dentures in the 18th century. We pay homage to John Greenwood, Washington's trusted dentist, whose skill with dentures proved indispensable to our nation's first president. Join us as we sift through the complex layers of this historic dental story, from the origins of oral folklore to stem cell innovations in tooth replacement.

🔗 Episode Links:
The Dr. Samuel D. Harris National Museum of Dentistry: www.dentalmuseum.com

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Ayla Sparks:

Why had no idea that Baltimore was so known for dentistry at all?

Scott Swank:

First, dental school in the world. That's crazy Dental college in the world in Baltimore, the Average Hall, and there were two professors there who were teaching what they called odontology lectures and the students didn't go. Sometimes they went, sometimes they didn't. The professors thought it was important enough. They were kind of ahead of their time really with this whole thing about oral health being important to your overall health and that kind of thing. So they thought it was important enough at the time that they petitioned the medical school to create a dental department.

Scott Swank:

And the medical school was going through some really, really hard times. They were arguing with the state of Maryland about who owned everything. They didn't have enough money. How they survived, I really don't know. So they didn't have the wherewithal at the time to put in a dental department. They also didn't have the space. Dentistry was a completely different method of learning really at the time. You went to medical school for the lectures and you did your hands-on training at clinics and hospitals and infirmaries and those kinds of things didn't exist then for dentistry. So they didn't have the space in the medical school to put in the dental facilities for people to learn the hand skills. So they just said no and the two professors did a petition in the state and got enough signatures to petition the legislature for to open a dental college and the legislature said yeah.

Ayla Sparks:

So without having any areas to really practice, it sounds like how different was dentistry as a profession back when they first started the first dentistry school dentistry as a profession back when they first started the first dentistry school.

Scott Swank:

Well, I mean, in terms of differences you had, I mean there were a lot of physicians that were in private practice and they had little. They had small offices and dentists were the same way, but the medical profession was licensed a long time before the dental profession. And I mean medical schools. Go back in Europe, you know forever. I mean you've got Padua and Bologna and Edinburgh and you know all those places. So physicians were, you know, professionally trained for a long long time, but they had all their clinical learning came from hospitals and infirmaries and those things just didn't exist for dentistry it was a cottage industry, small private practices. So the students, once the dental college opened, they didn't even have an infirmary themselves for a number of years. So the students would learn in the professor's practices, which is largely how dentistry was learned anyway.

Ayla Sparks:

I was wondering if it was like a trade, where you just go in and be an apprentice at someone who's already doing it.

Scott Swank:

You did. They called it preceptorship and that's the way dentists, you didn't have to do that. I mean you could buy the. You didn't even have to buy the books. I mean you could buy the instruments if you could find them and just start Just start whacking away yeah yanking people's teeth out, basically, and a lot of charlatans did I mean.

Scott Swank:

there are any number of images, not portraiture but paintings that depict, you know, this person. And they've got an assistant with a, you know, grinding an organ and they're making all kinds of noise to draw a crowd. And then they get a person from the crowd and they come up, they extract the tooth and they hold it up. And who knows if they had practiced with it, had preceptored under another dentist, if they had even read a dental textbook at that time, who knows?

Ayla Sparks:

I mean it was a lawless wasteland. Yeah, it could be Of showmanship.

Scott Swank:

And you know the reason. I had always wondered why dentistry? Why the profession kind of started in the mid-1800s and dentists at that time were starting to associate form associations, state associations, local associations. They knew the profession had to become professional, basically. So in order to do that, they knew they needed an organization, which they had been toying with for a while. They needed a journal, and the journal started in 1839. And they knew they needed professional training.

Scott Swank:

And I think the real impetus for that came with the collapse. There was economic collapse in the United States in the late 1830s, so a lot of men were out of work and apparently a bunch of them saw people they knew who were practicing dentistry and they were doing pretty well, and they said, well, heck, I'll just practice dentistry too. And the people that had been practicing dentistry and were doing it correctly had learned, you know, from other dentists and that kind of thing saw this as a huge problem in terms of whatever you want to call it with the population. I mean, they were, you know, going to see the status of this profession just drop like a rock and they wanted to take steps to prevent that. So I think that was part of the reason the dental school was founded there as well, gave that a big impetus.

Scott Swank:

And then you know, practice laws started early on. The dental school opened in 1840. Started early on. The dental school opened in 1840. I think Alabama had the first practice law in 1841. Of course, all those practice laws I think pretty much, if not all of them, the vast majority of them grandfathered in people that had been practicing dentistry for years. I think if you didn't have a complaint against you with anybody you were grandfathered in, but of course people that were new had to be licensed at those points.

Ayla Sparks:

Back in the 40s. I am curious was it just if you had a toothache you'd go to the doctor and they'd yank that tooth out, or was it a little bit more like a medical approach?

Scott Swank:

For a physician. A lot of physicians did dentistry because they had to. There weren't any dentists around, so if they had, you know, a patient that ended up with toothache, they many times took it out themselves. Now, if there was a dentist around they would have done that and they had the instruments for it. It was a lot cruder than it is now and of course, there wasn't any anesthesia.

Ayla Sparks:

I was gonna say it's just a jug of whiskey, right.

Scott Swank:

Well, yeah, until the advent of vulcanite as a material to use as a denture base, which is basically cured rubber, and that process was discovered in 1853, I believe. So it wasn't until after that. Pretty much I would say. There probably aren't that many vulcanite dentures made pre-Civil War. Then you know, of course the Civil War happens and everything kind of goes haywire and then things settle down after that. So really, you know, dentures didn't really become a thing until after the Civil War, I would say.

Ayla Sparks:

Speaking of dentures, you have one from probably the most recognizable person from US history George Washington's dentures.

Scott Swank:

I mean it's way cool, because you know, first president, in his mouth he, I mean it's such a personal thing, right, I mean it's a denture, it's not like your shoe, it's not like a belt, it's not like a sword. I mean you know, this was in his mouth.

Ayla Sparks:

I was there when he was giving speeches.

Scott Swank:

Yeah, it was probably the reason that you know his second inaugural address was the shortest in history, because if you see it, you'll understand that you didn't, you wouldn't, want that in your mouth. It couldn't be comfortable.

Ayla Sparks:

For his teeth is it kind of? He had one set of dentures that he used throughout his life.

Scott Swank:

He did not.

Ayla Sparks:

Or were there multiples?

Scott Swank:

Multiple dentures. We know there are one, two, three, four. There are four dentures, part of a denture or a denture set, extant. So the Royal London Hospital Museum and Archives has one half of one denture. It has been described as half of an upper. I don't believe it. We've got a model of it in the museum and I think it's half of a lower. The New York Academy of Medicine owns a lower denture, a full lower. It's not I say full, technically it's not a full denture. There's a hole in it that the denture went over Washington's last remaining tooth. So it was what modern dentistry would call an over denture. But it was basically a full denture, the upper to that set. I don't know where that would happen the upper to the set that London owns have no idea what happened. The Mount Vernon Ladies Association has at Mount Vernon Washington's estate. They have a full set of dentures. They have an upper and a lower. So that's the third. We have a lower. The upper to that set did exist. We have no idea where it is now because it disappeared and then it is rumored that Washington was buried with a set. So that would be the fifth set that we know of and I think there probably were other sets or parts of sets on top of that.

Scott Swank:

Washington was always he was never satisfied with his dentist. He was always complaining about the, about the, privately about the person, more publicly about the dentures, more publicly about the dentures. He utilized at least eight, the services of eight different dentists. John Greenwood ended up being his favorite in terms of dentures. We believe there may have been a set made for Washington by James LaMayer and nobody knows where that set is, and Washington described a set of dentures as being unwieldy, too large and too clumsy to use. We think that set may have been made by La Meilleur. But once Washington kind of discovered Greenwood, he stuck with him. Like I said, washington had one remaining tooth. Washington lost that tooth just before he was inaugurated president for the second time. So Greenwood had to make another set, which we think was the London set, and I think it was all one piece. The lower was all one piece of ivory, the base and the teeth. They were not different sections and I think Washington dropped it and broke it. That's why only half of it exists.

Ayla Sparks:

So Greenwood had to make another entire set, and that's the set we own. Rumors kind of abound when it comes to George Washington's teeth, because you know, we've all heard the wooden teeth. And they were actually enslaved individuals' teeth and then that they were ivory teeth. So can you let us know what's going on with these rumors?

Scott Swank:

Let's go with wood first. No wooden dentures in the United States or Europe. So the people that were Greenwood was an American and had been trained in the US as a dentist. Some of the other folks had come over from France because France, during that revolutionary time period for the US, was the place putting out dentists. I mean, they were dentistry central for Europe at that point and some of those fellows came over with different groups during the revolution. They were assigned to different military groups or to the Navy, on a ship, that kind of thing, and they ended up staying, which is really kind of where US dentistry got its start. So they had no background in wooden dentures. They weren't making wooden dentures in Europe so they didn't make them here, I think primarily because the woods, the actual woods, were different. They did make wooden dentures in Japan but they used a very dense, very oily wood.

Ayla Sparks:

I was going to say the wood would swell in your mouth.

Scott Swank:

I'm not so sure the oil would help with the swelling, but the splinters you know, you can actually finish it smooth so that it didn't stick you.

Scott Swank:

And I also think that Europe had access to a huge amount of ivory. I think there was just ivory coming out of Africa like you wouldn't believe, and not necessarily elephant ivory that was going into, you know, into the fancy trades, but there was a huge amount of hippopotamus ivory coming out of Africa and that's what they were using primarily in the fabrication of dentures in both Europe and the United States. And you have to understand that dentures at that time were all handmade and hand-fitted to a plaster impression. So you had to take a piece of ivory and start carving it and keep fitting and carving and oh, this spot's too high, I'll carve that. Now, this spot's too high, I'll carve that.

Scott Swank:

So in terms of what a denture cost then would probably be in the neighborhood of just over $100,000 today. So only the elite of the elites could afford to have a denture made for them. Now, slave teeth on one of George Washington's denture. I'm not so sure. The New York Academy of Medicine denture has some human teeth on it. I'm not sure any of them would have been from Washington's slaves, for the reason that dentists were acquiring human teeth to use on dentures from various places and Greenwood made the denture. And Greenwood would have not had access to Washington's slaves, but he would have had access to the population of New York City and there were a lot, a lot of poor, very, very poor people in large metropolitan cities like London, paris, new York, all those kinds of places, and dentists would actually pay people for their teeth.

Scott Swank:

Oh, that is so sad. Yeah, sad story, but true. And you were hoping to get teeth from younger people females especially because you wanted teeth that looked good. You couldn't use a rotten tooth on a denture, you had to use teeth that looked good. So that's primarily where the teeth were coming from.

Ayla Sparks:

The dark dentistry trade.

Scott Swank:

Yeah, dentists would just pay or they would keep teeth that they. You've got to understand that periodontal disease was just as bad as decay at the time. So you're getting teeth that need to be taken out, not because they're decayed but because there's no bone left to hold them in. So Greenwood had an entire box full of teeth that he, you know, he could choose from to make to make to put on dentures. So I think the chance of the human teeth that are on the New York Academy denture being from Washington Slaves is very, very remote.

Scott Swank:

They used a lot of calves teeth, bovine teeth. You could. Apparently they were nice and white. You could carve them easily, especially for, like the larger anterior front teeth on the upper. Yeah, you could carve them easily. The teeth that were on our denture, they were all ivory. The upper ones used individual pieces of ivory, the lower ones used sections of ivory that are carved to look like individual teeth. But it's actually like three or four teeth in a row and then they hold on, they're onto the denture. That way the Mount Vernon denture has all kinds of stuff on it. It has what one person thinks is an elk's tooth used as one of the molars.

Ayla Sparks:

Because elk do have ivory in there.

Scott Swank:

Yeah, elk have vestigial tusk. Yeah, they call it elk ivories. Yeah, and one of them, apparently one of the teeth came off and it was repaired, and the repair was made with a nut. Yeah, I don't know what kind of, you know what kind of chestnut, or yeah, I don't have any idea, but it's, you know, it's got a couple X's in it and it's in one of the posterior teeth, so yeah, so that denture's got all kinds of stuff on it.

Ayla Sparks:

So if someone were to come and visit the museum, what can they expect to see? What kind of exhibits do you guys have?

Scott Swank:

Well, the exhibits at the dental museum kind of run the gamut. I mean it starts out with teeth in popular culture. Kind of run the gamut. I mean it starts out with teeth in popular culture because we were really trying to get away from that whole idea of dentistry and pain. Those two have been associated for way too long, and so the first part of the museum talks about teeth in popular culture, different cultural traditions with teeth, smiles, toys, films, commercials, that kind of thing. And then it goes into prevention.

Scott Swank:

We've got information on fluoride when that first came out and the controversy you know the big controversy about putting fluoride in water and that kind of thing. We've got Queen Victoria's dental instruments oh wow, and that kind of thing. Got Queen Victoria's dental instruments oh wow, during the Victorian era, if you were wealthy enough, you had your own personal dental scalers that you took to the dentist who then used them to scale your teeth, as opposed to the scalers he owned or she owned mostly he that he owned to scale teeth, so that you weren't having your teeth scaled by instruments that had scaled somebody else's teeth, which at the time probably wasn't the worst idea in the world. I mean, we assume that the instruments were being cleaned. I don't think there was really anything, nothing antiseptic going on. I mean, there wasn't even anything antiseptic going on at that time in hospitals.

Ayla Sparks:

And probably just wiped off on the apron and then next patient.

Scott Swank:

Yeah, so if you could afford your own, you took them. So of course Queen Victoria could afford her own, so she had her own.

Ayla Sparks:

I'm sure they were gold encrusted or something.

Scott Swank:

They're quite fancy, they're plated silver, gold plated silver, when mother of pearl handles, quite nice. I've seen a fancier set, pictures of a fancier set. Apparently one of the queens of spain had a very similar set, but on the crowns each of queen victoria's has a crown at the end of the handle, and where there would be gems on a real crown are just, you know, like bumps in the gold, whereas the spanish queen had little, teeny, tiny pieces of gemstones put there, like sapphires and rubies and that kind of thing.

Ayla Sparks:

So I was slightly hoping it was going to be the bones of conquered foes, but yeah, no, I don't think so.

Scott Swank:

But um, so we've got queen and, uh, prince albert's personal dental scalers were just up for auction not long ago. Yeah, that was something we we didn't didn't have the funds to bid on, but it would kind of been nice to have them both together. And his weren't as fancy as hers.

Ayla Sparks:

I'm also curious in your opinion over the course of dentistry in its entirety. What are some of the most influential or important? Either discoveries or inventions have been made that kind of revolutionized the dentistry game.

Scott Swank:

Well, dentistry for a long, long time was basically extractions. Now you go back to the late 1700s and things are getting more complicated in terms of extractions, fillings, dentures, surgeries to remove different things, even to deal with some periodontal disease. But the things and the instrumentation was relatively simple. So you really have to get into a more, almost a more modern time to really see things. That revolutionized dentistry I mean anesthesia, revolutionized dentistry, I mean anesthesia, of course, revolutionized dentistry and general anesthesia in terms of ether, nitrous oxide, chloroform, they all. Nitrous oxide was first in 1842, then you had ether in 1844. And chloroform came right close to that, maybe another two or four years after that. That's extremely important. But other than, you know, taking out teeth that are difficult to get out, you really don't want to put people out with ether and chloroform. They're dangerous, especially ether in terms of the transition from being unconscious to non-breathing and dead. It's very small with ether, which is why chloroform took over, you know, as soon as they showed that it would work. But local anesthesia isn't discovered and proven until 1895. So that's, you know, like 50 years before you get local anesthesia, which is what dentistry revolves around today. I mean right, so we've got local anesthesia in 1895.

Scott Swank:

And then in the early 1900s Dr GV Black perfected the formulation for dental amalgam and that revolutionized restorative dentistry in terms of being able to cut a tooth so that you get out all the decay and then fill it with a material that's going to last a while and isn't injurious. You know that kind of thing. And the problem with early silver amalgams was, upon setting, you know, getting hard, they expanded instead of shrunk. So you were having these charlatan guys going around and they would. They weren't even really taking the decay out of teeth. If a tooth had a hole in it. They would mix up this, you know silver paste and put it in a tooth and they would be in you know a city this week and gone the next and by the time the fillings had set and expanded and cracked the tooth and made it worse than it was before they started they were gone.

Scott Swank:

So you know, the scientific formulation for amalgam coming out in the early 1900s revolutionized that part of dentistry. And then hand pieces. The first rotary driven hand piece that was commercially available didn't come out until like 1877. So before that if you wanted to put a hole in a tooth or take decay out of a tooth, they had come up with all kinds of mechanical means to do that. None of them really worked that well.

Ayla Sparks:

I'm picturing those old egg beaters. They did do that.

Scott Swank:

Yeah, we've got one of those at the museum. They came up with a like a clock mechanism. You wind it up and the spring, you know, turned the, turned the burr. Um, that was really heavy, that didn't work well. Bow drills, oh you know, like you've seen, you know, um, you know naked and afraid with her? Yeah, exactly and and you're trying to start a fire with them.

Ayla Sparks:

Yeah.

Scott Swank:

Well, they use those to put you know preparations in teeth.

Ayla Sparks:

It sounds very precise.

Scott Swank:

They're difficult to use, of course, and you can't get them. You know they're very hard to use in the back teeth. So the foot treadle dental engine that had a handpiece with a small burr, that you actually made move with your foot, revolutionized dentistry. That made cutting teeth. I mean the time savings and ability to cut tooth was just remarkable.

Ayla Sparks:

Oh, that's cool too. Is there anywhere in the museum that you touch on the tooth fairy?

Scott Swank:

We used to. We put in a big exhibit. We changed exhibits years ago. We took out the information on the tooth fairy and then we had another exhibit. That was an exhibit basically on children's dental literature, but of course that had books and things on tooth traditions for children and that included the tooth fairy. But the tooth fairy is just an English thing.

Ayla Sparks:

So the Tooth Fairy is particularly popular in Western folklore, but it is not very well documented as the true origins. However, one of the earliest references to a tooth deity similar to the tooth fairy can be found in Norse mythology. So in Norse culture, children would offer their lost baby teeth to the Norse god, odin, and it was believed that Odin would then bless the children in return for their teeth. There are many other tooth traditions throughout the world, like in most Hispanic countries there's a small mouse who comes and takes your teeth and leaves candies. In Asia, especially in Japan, there's a tradition where if your child loses an upper tooth, then you're supposed to throw the tooth somewhere on the ground. If they lose a bottom tooth, you're supposed to throw them somewhere high, like up on a roof, and the reasoning behind that is whatever direction you throw that tooth is the direction it's going to grow in. So if you want them to have nice straight teeth you do the top ones should grow straight down on the floor, vice versa with the roof.

Ayla Sparks:

So, at the risk of showing off how macabre my mother and I were while I was growing up, I have all of my baby teeth and I even have my adult teeth that had been removed, like my wisdom teeth. I kept them all. I was even able to keep some of my puppy's baby teeth, which was remarkable to find. I was lucky enough to find them on the floor. But when I was telling this to Scott, he told me that I am not the only one. He discovered that some scientists are actually doing the same thing, but perhaps for a much nobler reason. Here's Scott.

Scott Swank:

But now the bioengineering exhibit. I don't know if it brings this out specifically, but while we were doing that exhibit it came up that they're working on the ability to use semi-differentiated stem cells, so not pluripotent stem cells that you would obtain from an embryo, but there are other stem cells in the body that are what they call semi-differentiated. So for teeth, there are stem cells that will produce any kind of tooth. I mean, you can't get an entire organism out of them, but they'll produce a tooth. So scientists have been working on the ability to grow teeth from these partially differentiated stem cells. Wow, and you can get them from baby teeth.

Ayla Sparks:

That is incredible.

Scott Swank:

Especially baby teeth, molars.

Ayla Sparks:

So this is making me sound actually more of a scientist than a crazy person who saved all of my teeth. Yeah, I'm really thinking ahead, actually Way ahead of the time.

Scott Swank:

And I did not read in putting that exhibit together, I didn't read anything about longevity. So, in terms of and how day where you actually save those teeth on purpose, and then, if you lose a tooth for some reason, perhaps you'll be able to use stem cells obtained from those teeth to grow a new one.

Ayla Sparks:

That's amazing.

Scott Swank:

Yeah, that would be amazing. That would be the ultimate tooth replacement is if you could replace your own teeth with your own teeth.

Ayla Sparks:

Well, I have learned a lot about dentistry that I had no idea about. Tooth replacement is if you could replace your own teeth with your own teeth. Well, I have learned a lot about dentistry that I had no idea about Some really dark things, some really exciting and new things. So thank you so much for meeting with me. No-transcript.