The History of Orthodontics

Crooked teeth have always been a thing, but it took us a long time to do something about it. Learn about the twisted history of orthodontics today! See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

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• 1:42Speaker 00

  Welcome to Stuff You Should Know, a production of iHeart Radio.

• 1:51Josh Clark?

  Hey, and welcome to the podcast. I'm Josh and there's Chuck. Jerry's here too. And we're just sitting around cutting the insides of our mouths up here on Stuff You Should Know.

• 2:02Speaker 02

  Yeah, the history of orthodonture, which if I had been using my brain, I would have paired this with the history of dentistry.

• 2:11Speaker 02

  Cause that's, you know, kind of makes sense.

• 2:13Josh Clark?

  Sure. I feel like we would have had seen a real decline in listenership that week, but you know.

• 2:19Speaker 02

  You think so?

• 2:20Josh Clark?

  No, I'm just kidding. Just being a punk. I remember our dentistry one was amazing.

• 2:25Speaker 02

  Well, and I think, I don't know, I think people are interested in their bodies.

• 2:32Josh Clark?

  Especially when you say it like that.

• 2:34Speaker 02

  Yeah, and then teeth and stuff, because we all have teeth. And it's interesting that bad, you know, teeth, I say bad teeth, I have bad teeth. But what I mean by bad teeth is teeth that grow in funky ways. But I'd like to kind of break that cycle as well of kind of talking about it like that. Because even though I have gotten my teeth fixed, it's just because they were falling out of my head. It's not because I wanted perfect white chiclets in my mouth. And I think there's a big trend that we've seen over the past, you know, 20 years. And really, I feel like even the last 10 years where Hollywood, especially people in the media, all have perfect, perfect, perfect teeth.

• 3:18Speaker 02

  And you don't have to have perfect teeth. I like teeth with a little personality. I like summer teeth.

• 3:23Josh Clark?

  Yeah, I can't remember what they're, what kind of teeth, summer?

• 3:26Speaker 02

  Summer teeth.

• 3:27Josh Clark?

  I've not heard that.

• 3:28Speaker 02

  You never heard that phrase?

• 3:29Josh Clark?

  No, what does it mean?

• 3:31Speaker 02

  Summer teeth, summer here, summer there.

• 3:33Josh Clark?

  Oh, that's awesome, man. I love that. That's like a, what kind of dog is that? Sooner? Sooner one kind is another?

• 3:39Speaker 02

  Yeah, exactly.

• 3:41Josh Clark?

  Yeah, they're in Japan, they have a name for like a wonky tooth. Usually it's one of your canines and it'll be like kind of pressed out or crooked or something like that. Yumi has one, but there's a term for it. And it's like basically a term of endearment, where they just find that very cute. Here in the US, it'd be like, you would be put in some sort of like home or asylum for that.

• 4:04Speaker 02

  Yeah, I mean, you get, as an actor, you get news articles written about you when you don't get your thing fixed. That's how commonplace it is to just, you know, the expectation to look perfect.

• 4:15Josh Clark?

  Right. And that's a big criticism of the, the entire field of orthodontics is,

• 4:22Speaker 02

  Yeah.

• 4:22Josh Clark?

  You know, they might not be the ones out there like, you know, pumping the media up like, yeah, keep, keep talking about how great teeth are supposed to be. But they're the ones who are there like, hey, come on over, we're gonna fix you up. Tough to blame them for that, but the criticism goes even further because the field of orthodontics is like, forget about all that, we're actually helping cure health issues.

• 4:45Speaker 02

  Right.

• 4:46Josh Clark?

  And critics of the field are like, it's not even established that there are health issues from having wonky teeth. So you guys should probably stop saying all that in the field of orthodontics said, no.

• 4:58Speaker 02

  Yeah, I mean, for sure, there can be health issues. We're not saying that's not possible, but I feel like it's almost a given now, especially now that I have a human child that like, yeah, you absolutely get braces. That's just what happens. You go to the dentist.

• 5:13Josh Clark?

  Really?

• 5:14Speaker 02

  Around six or seven years old, they say, all right, you need to go see your orthodontist now.

• 5:19Josh Clark?

  I did not know that, that, that was not the way it was when we were young.

• 5:23Speaker 02

  No, I mean, I had braces twice.

• 5:26Josh Clark?

  Did you?

• 5:26Speaker 02

  Yeah, but you know.

• 5:28Josh Clark?

  I never did.

• 5:28Speaker 02

  I've got bad bite, I have a host of problems. But yeah, let's dive into it because this is not a new thing. People have always had wonky teeth. And the reason why is because we have the same amount of teeth in our head that we did when we were still, you know, walking on all fours. And we began to walk upright and the size of our, our brain changed and that meant the size of our jaw got smaller to make room for our bigger brain.

• 5:59Josh Clark?

  Right.

• 5:59Speaker 02

  But it's not like they were like, all right, they, whoever decides this, you know, the panel.

• 6:04Josh Clark?

  God.

• 6:04Speaker 02

  It's not like the, the god panel said, all right, let's take out five or six teeth because we don't have room for them now. There were the same amount of teeth with less space to put them. And that's why they started coming in in all crazy ways.

• 6:17Josh Clark?

  Yeah, just give it another hundred thousand years, Chuck, it'll work itself out.

• 6:20Speaker 02

  Exactly.

• 6:21Josh Clark?

  Even more recent than that, the teeth were orthodontics is probably not an issue for hunter gatherers because the diet they had was more, much more challenging to their teeth and jaw, the bone that held their teeth in place because of the chewing they had to do. Well, since we picked up agriculture and especially since the Industrial Revolution, where we started mass processing food, everything's gotten much softer. So we're challenging the bone in our jaw less. Therefore, our teeth are more prone to go wonky rather than coming in straight.

• 7:00Speaker 02

  Yeah, and less bone is happening there. So I mean, that's the history of my teeth is bone loss and lack of bone.

• 7:09Josh Clark?

  Hey, man, I just got two root canals. I was in the chair for two and the dentist was like, you could go either way on the one. It just got a lot of cold sensitivity and I was like, oh, I'll just get one. Spent the next couple of days like realizing how bad the cold sensitivity on the other one was. The following week I got the other one done. So two Fridays in a row, I went to the endodontist and got root canals. How about that?

• 7:36Speaker 02

  Yeah, I've never had a root canal. Weirdly, that's the one thing I haven't had.

• 7:40Josh Clark?

  They're, they're not fun, but they're, well, they're not fun.

• 7:45Speaker 02

  Yeah. So early on, you know, in ancient times, people started to kind of look at this issue. In fact, Hippocrates even wrote of crowded teeth, potentially producing headaches and problems with the palate and stuff like that, discharge from the ear, which is super gross. And there were, have been mummies, like Egyptian mummies, that looked like they may have had some kind of braces, like they had these gold bands around some of their teeth and they were connected with cat gut. And it appeared as if they were, you know, being kind of used like braces to pull the teeth in one direction or the other.

• 8:18Josh Clark?

  Yep. Which is, I mean, pretty interesting. Again, this is post agriculture, so don't, don't email us.

• 8:25Speaker 02

  Yeah.

• 8:26Josh Clark?

  And also there's good band and album name in there. Hippocrates and the Egyptian Mummies. The album is Discharge From The Ear.

• 8:35Speaker 02

  Okay.

• 8:36Josh Clark?

  Just waiting for us.

• 8:37Speaker 02

  Yeah, good one.

• 8:39Josh Clark?

  There was another couple of people from the ancient world, Celsus, who was a Roman writer. He talked about how if you were worried about adult teeth coming in, you pluck the baby tooth out and then press it with your finger every day.

• 8:53Speaker 02

  Yeah.

• 8:54Josh Clark?

  And it turned out that was a pretty good idea because that was adopted later on in orthodonter when it really became a thing. And even Pliny got in on it. Remember how much he used to visit us in our podcast?

• 9:04Speaker 02

  Yeah, I mean, I feel like Pliny used to be a firm entrant into the stuff you should know drinking game.

• 9:10Josh Clark?

  Yeah, well, he moved on to the doughboys.

• 9:12Speaker 02

  Okay.

• 9:13Josh Clark?

  But he said that if you don't like the alignment of your teeth, just file them.

• 9:18Speaker 02

  Yeah. Which is still a thing.

• 9:22Josh Clark?

  It is. That's another, I think, thing that I'm like, wait, really? You guys are still doing this? And it's true, like a lot of the inventions and techniques and ideas that came along from the very beginning of orthodonter are, I guess they got them right, right out of the gate because they're still doing them today.

• 9:38Speaker 02

  Yeah, for sure. I've had my teeth ground down in a lot of ways to keep the bite from pressing on other teeth to make them, you know, keep them from becoming weakened, you know? It's still a thing.

• 9:46Josh Clark?

  How is that?

• 9:49Speaker 02

  What, to get them filed?

• 9:51Josh Clark?

  Mm hmm. Does it hurt? Is it?

• 9:52Speaker 02

  Oh, no, no, no, it doesn't hurt at all.

• 9:54Josh Clark?

  Okay.

• 9:54Speaker 02

  It's just that.

• 9:57Josh Clark?

  Yeah.

• 9:57Speaker 02

  And then you smell the smoke and, you know, that part's all horrific, but there's no pain involved because they're not hitting nerves or anything.

• 10:03Josh Clark?

  Okay.

• 10:03Speaker 02

  Yeah.

• 10:04Josh Clark?

  Now imagine doing that through the middle interior of the tooth to scrape out the root to the nerve. That's a root canal.

• 10:14Speaker 02

  Oh, man. So sorry.

• 10:16Josh Clark?

  Sorry. So I guess really the first person, I mean, Pliny the Elder makes a pretty good case, but not really. It wasn't until the very beginning of the 18th century that a Frenchman, the French would actually really have a lot to do with establishing orthodonter. His name was Pierre Fochard. And he basically said, check this out, everybody. I'm going to work on wonky teeth. I'm going to make my name that for that.

• 10:41Speaker 02

  Yeah, for sure. And as it is today, children and young adults were kind of the likeliest candidates for that. And he designed the very first appliances for moving teeth around.

• 10:55Speaker 02

  The first thing he would do is measure the length of the teeth and file them down. If they were, you know, if he had one that was exceptionally longer than its little buddy next to it, he would file it down, then do so on the other side to kind of balance things out. That's called bite adjustment. Like I said, they still do those, including on me. That's an occlusial, occlusal, sorry. Equilibration, equilibration.

• 11:19Josh Clark?

  Yeah, that's not an easy one.

• 11:21Speaker 02

  And again, that's to, I mean, sometimes I guess it's to help out the aesthetic. But in my case, and in most cases, it's to keep teeth from grinding against another tooth in a way that causes harm.

• 11:34Josh Clark?

  Yeah. I've realized as an adult, my, my bite is way over to the, I guess the bottom is, yeah, the bottom's to the right and the top is to the left. Is that what it's called?

• 11:47Speaker 02

  I think so.

• 11:48Josh Clark?

  Oh, my man, I got a terrible cross bite. But I mean, I'm, I'm making my way in the world today. Takes everything I've got.

• 11:55Speaker 02

  That's true.

• 11:55Josh Clark?

  But I'm still able to chew pretty well.

• 11:58Speaker 02

  Yeah, yeah, that's what matters.

• 12:00Josh Clark?

  Sure. So let's talk a little bit more about Fauchard, because he hasn't left yet. He's, he really kind of got into this and laid the groundwork. He did the same thing that Pliny suggested, that like you said, that you went to the same procedure. He called it interproximal stripping, which is essentially just filing down teeth to make more space between them.

• 12:23Speaker 02

  Yeah, like if it's crooked, give it a little more space and maybe it'll be able to straighten itself out.

• 12:28Josh Clark?

  Yeah, or like you can file it down for the space and then you apply some sort of appliance to it to straighten that tooth too, but you gotta make the space first. He came up with that.

• 12:39Speaker 02

  Yeah, or what he did was, was push on the teeth, just like Celsius suggested. Like every day, you know, and this, you know, this makes sense. It's essentially what rubber bands and braces do. Just you're applying pressure to your teeth at a regular interval, like so many times a day. And the idea is that they will move.

• 13:01Josh Clark?

  Right. And it's true. Like, that's one of the amazing things to me is like, if you apply even like a gentle bit of pressure over a long enough time span, your teeth will go where you want them to.

• 13:12Speaker 02

  Yeah.

• 13:14Josh Clark?

  So, one of the other reasons why Fouchard is remembered is because he essentially came up with the idea for braces. He basically used a waxed piece of silk or a wire or something, and he would wrap a tooth, let's say crooked, to the neighbor next to it, and that would apply pressure to straighten out the crooked tooth. I'm sure in the worst case scenario, it would make the other tooth crooked in the bargain, so you really had to keep an eye on it.

• 13:44Speaker 02

  Yeah.

• 13:45Josh Clark?

  And sometimes he would use a plate, too, to connect a crooked tooth to one that you wanted to use as pressure, or maybe a couple of them to use as pressure to straighten it out. And this eventually was like, this is the basis of what braces do for your teeth. This guy was inventing it in the, like, early 1700s.

• 14:05Speaker 02

  Yeah, he also used a specific torture device called a pelican. It had been around before, I think since the, at least the 14th century, it was used for pulling teeth, but he kind of rejiggered it and redesigned it to where it was basically a forcep that could pull a tooth, pull a tooth, like, not out of your body, but in a certain direction. And if it sounds like awful and could lead to bad things, it very much could, because at least once, on record, he fractured a tooth of a young woman that he was working on. And I imagine that was extremely unpleasant.

• 14:40Josh Clark?

  I can't believe there's just the one that people mention, you know?

• 14:43Speaker 02

  I mean, that's the one on record. I'm sure it happened more than that, you know?

• 14:45Josh Clark?

  Yeah. The girl was quoted as saying, "Yow."

• 14:49Speaker 02

  Yeah, exactly.

• 14:52Josh Clark?

  He also was smart enough to know that you could get infections from some of these techniques and procedures he was performing, so he recommended a mouthwash of wine and a specific kind of honey with some rose essence to it.

• 15:05Speaker 02

  Yeah.

• 15:06Josh Clark?

  He, I mean, this guy just- He just laid it down. And what's interesting is he was doing this in the early 1700s. And it wasn't really until the mid 19th century that it really started to become picked up again. And one reason why is because we viewed teeth much differently, at least in the West, than we do today. Like you were saying, thanks to Hollywood and magazines and all that, you want to show off your teeth and you're going to be perfect. Back then, you did not show off your teeth. It was grossly impolite to let anyone see your teeth. Go back and look at any portrait from the 18th century.

• 15:45Josh Clark?

  I will pay you a dollar 50 if you find one single portrait of a gentry or aristocrat, man or woman, who's showing their teeth in a painting. You can't find it because that was really rude and de classe.

• 15:59Speaker 02

  Yeah, I mean, almost any painting you think about, like it didn't occur to me until I, you know, did this research. And you go to any museum and if you see teeth, it's probably to depict someone who is unhinged, or like a prisoner escaping from prison, or someone-

• 16:17Josh Clark?

  Maybe a pirate.

• 16:18Speaker 02

  Yeah, a pirate or an asylum or something like that. And the teeth are all, you know, jacked up looking. Other than that, you don't see teeth in paintings.

• 16:26Josh Clark?

  You don't. A dollar 50, everybody, but just to one of you, not all of you.

• 16:31Speaker 02

  Oh, man, we're gonna get some, uh, it's gonna start rolling in, buddy. JPGs coming at you with toothy paintings. Should we take a break?

• 16:39Josh Clark?

  Yeah, we should take a break.

• 16:41Speaker 02

  All right, we'll take a break and we're gonna jump forward into the 1800s after this.

• 16:58Josh Clark?

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• 20:09Josh Clark?

  So like I said, Fouchard was working in the early 1700s. By the mid-19th century, I guess people's thoughts on teeth were changing. And they were like, okay, we can show our teeth, but they don't look good. So let's get back into orthodonture. Another Frenchman, Pierre Joachim Le Foulon, he's the one who came up with the word orthodontics. Actually, he called it orthodontacy. You have to say it like that. And in Greek, ortho means straight, daunt is teeth. So straight teeth is what the word orthodontics means.

• 20:42Speaker 02

  You know, I love that when that happens.

• 20:45Josh Clark?

  Pretty on the tooth.

• 20:46Speaker 02

  Yeah.

• 20:48Speaker 02

  I can't even follow that. Uh, so they didn't call themselves that yet in most cases at the time. That kind of caught on more and more as things went on. But dentists started to do this stuff. There weren't like specialists that only did orthodontics yet, which is part of dentistry. And tooth straightening was part of dentistry. And you were an apprentice who learned that kind of thing. Dental colleges started being organized in the mid 19th century. But, um, I mean, when was the first orthodonters, uh, orthodonture school? That was in the 20th century, right?

• 21:23Josh Clark?

  Yeah, either the very beginning of the 20th or the very early, um, or no, yeah, very late 19th century. I think it was, um,

• 21:32Speaker 02

  Now here it's not.

• 21:33Josh Clark?

  Edward Angle?

• 21:33Speaker 02

  Yeah, 1900s, the Angle School of Orthodontia was the first sort of standalone thing where it wasn't just part of a dental school.

• 21:40Josh Clark?

  Precisely.

• 21:41Speaker 02

  All right.

• 21:43Josh Clark?

  So some of the other advancements that the 19th century contributed can all be kind of lumped together under the umbrella term of hype gear.

• 21:51Speaker 02

  Yeah.

• 21:51Josh Clark?

  Or uh-uh, if you're a teenager.

• 21:55Speaker 02

  Yeah.

• 21:56Josh Clark?

  Which is you're using your skull and the substance of your skull as a, as a, um, oh man, I wish I knew classical physics terms a little better, but

• 22:06Speaker 02

  An anchor?

• 22:06Josh Clark?

  Essentially, sure, yes. An anchor, a counter, counterbalance. How about that?

• 22:11Speaker 02

  Okay.

• 22:12Josh Clark?

  To provide the pressure needed to pull, say, like your jaw back.

• 22:17Speaker 02

  Yeah.

• 22:18Josh Clark?

  There's something called a chin cup that you can use. I've actually seen modern pictures of it, still in use in some cases to where there's a, well, the cup for your chin. There's straps that go back to the back of your head and around it. And it's meant to just slowly over time, pull your lower jaw back toward your, well, your, the rest of your head.

• 22:40Speaker 02

  Yeah.

• 22:40Josh Clark?

  And it can correct an underbite. And that's as far back as I think 1802.

• 22:45Speaker 02

  Yeah, I love that idea though. They were like, oh, we need some kind of like, we need some leverage to pull this jaw back. And we can't just have a kid stand by a wall and attach them to a wall. And somebody's like, what about their skull?

• 22:58Josh Clark?

  Yeah.

• 22:58Speaker 02

  It's right there.

• 23:00Josh Clark?

  Somebody went bam.

• 23:02Speaker 02

  They don't use headgear as much anymore. Like you said, it still can be used, but not like it was used in the 80s. Luckily, I never had to go through the headgear

• 23:15Speaker 02

  trauma, but it was quite traumatic when you showed up to school having to wear one of those.

• 23:19Josh Clark?

  Yeah, remember Farmer Ted from 16 Candles? He had to wear one.

• 23:22Speaker 02

  Farmer Ted. And I think, oh no, Joan Cusack had the neck brace.

• 23:26Josh Clark?

  Yes.

• 23:27Speaker 02

  Yeah, okay.

• 23:28Josh Clark?

  I thought that too, but no, it was neck brace. There's a couple of other people we need to mention. Another French dentist, Christophe Francois Delabarre, he created the wire crib, which was, I think we said Fouchard was the one who really kind of started the idea of braces. There's a distinct progression, a linear progression from Fouchard onward. And Delabarre came up with the wire crib, which is essentially exactly what it sounds like. Like you take a piece of chicken wire, fold it over like the teeth in question, tighten it up the way you want it, and there's your wire crib. It's not exactly like the braces of today, but the outline, the contours are there in it for sure.

• 24:10Speaker 02

  Yeah. It started to become in the 19th, I guess the second half of the 19th century, a little more scientific and they started to kind of put a little more rigor into like, you know, figuring out how to do this the right way. A guy named Norman Kingsley from New York City was a very early, very popular orthodontist. He had a treatment for cleft palates that was very popular. And wrote a very influential guide called A Treatise on Oral Deformities in 1880. But, and this is something that you mentioned early on that we'll kind of keep talking about a little bit here and there, is that he was an artist and he was very interested in facial symmetry and aesthetic. So he was, if not the first, one of the sort of early leading guys that was like,

• 24:53Speaker 02

  we want you to look good and it may not just be about like your bite health.

• 24:58Josh Clark?

  Right, exactly, exactly. He was also supposed to be really nice. He had a compliment for everyone he met.

• 25:04Speaker 02

  Oh, that's nice.

• 25:06Josh Clark?

  So I just made that up, but I want to believe it about. So there's some other stuff that kind of came along little by little. They were like, oh, okay. Well, let's tackle this. One thing that you can be born with is a narrow maxillary arch. That is the jawline on the top of your mouth. Your top, the row of your, your row of top teeth are connected to your maxillary arch.

• 25:31Speaker 02

  Yeah.

• 25:31Josh Clark?

  About that.

• 25:32Speaker 02

  The roof of your mouth.

• 25:33Josh Clark?

  Yeah. The lower set of teeth is connected to the mandibular arch. Either way, you can be born with one or both of them narrowed. So they figured out you can put essentially an appliance of stick in between them and adjust it slowly but surely over time and press your jaw apart.

• 25:54Speaker 02

  Yeah. I mean, that is still a thing. My daughter has that. It's called an expander. I guess it was called that back then too, but um, and like her two friends at braces both had it too. So I think that may be way more regular now. I don't know anyone from my, our days in high school that had something like that.

• 26:11Josh Clark?

  So I think the original one was they would put the screw bar in between, say your back molars. Cause they're pretty substantial and just over time slowly adjust it. I guess probably every visit. And that would press the, the whole arch apart. Is that essentially what they're doing still today?

• 26:30Speaker 02

  Yeah. It's like a wire cage that lives on the roof of your mouth. It's attached to those rear molars. And they, yeah, you go in there and they crank it out and make more room like the, and it really works because the space between her front two teeth got comically large. Like you could fit a whole extra tooth in between.

• 26:49Josh Clark?

  Oh, wow.

• 26:49Speaker 02

  When this thing was at its most, but they're basically just creating room for the future.

• 26:54Josh Clark?

  Was the dentist like, or the orthodontist, like I've done too much?

• 26:58Speaker 02

  No.

• 26:58Josh Clark?

  There's no coming back now.

• 26:59Speaker 02

  He's like, I've got a new record. Everyone get in here. Look at this girl.

• 27:03Josh Clark?

  So I think you said, we talked about how the first orthodonture school was established by Edward Angle in 1900. Even before that, most of the people practicing orthodonture were now not only MDs, but also doctors of dental surgery, DDS. So they were really well-trained in medicine. And the reason why, not coincidentally, is this is because of a shift of direction that orthodonture went in to basically say like, let's get even more scientific about this. And well, they did.

• 27:37Speaker 02

  Yeah, there was a guy named John Nutting Farrar, who some people called the father of American orthodontics or modern orthodontics.

• 27:45Josh Clark?

  Not in the house I was raised in.

• 27:48Speaker 02

  He was a guy that was like, hey, let me do some actual experiments on animals and things. And let me see like that thing that we crank apart your teeth. Let me see how much the human body can, like how much pain they can endure to move those teeth. Like, and I'm kind of kidding, but basically like, let's find a happy medium between how far we can expand and how much like a child can take.

• 28:10Josh Clark?

  Yeah. What's worse though, is he wasn't experimenting on children. He was experimenting on animals, which I take to mean dogs.

• 28:17Speaker 02

  Yeah, I guess.

• 28:19Josh Clark?

  Yeah. So yeah, that's Farrar. What about Edward Angle, who we talked about? This guy is probably the one, I mean, my dad at least always called him the father of American orthodontics.

• 28:33Speaker 02

  Yeah. I mean, he's the guy that definitely made it such a bona fide business. And I think he found out like a lot of different ways to make a lot of money. And, you know, one way was like developing devices and patenting devices. Another way was creating like ready-made appliances. He created the Angle system in 1887. So it's like, instead of like building these things from scratch for every patient, like I can just sell you this system that has all these prefab parts that can be combined in different ways to suit your needs.

• 29:08Josh Clark?

  Yeah, because I mean, there's only so many ways that your teeth can be wonky, right?

• 29:12Speaker 02

  Totally.

• 29:12Josh Clark?

  Yeah, that's, that was revolutionary. I'm sure that just immediately pushed the field forward. And if that wasn't enough, he also came up with a measurement system called the occlusal classification system that's still in use today, 130 something years later, that they use as the basis, like that is the norm.

• 29:34Speaker 02

  Yeah.

• 29:34Josh Clark?

  And that that's what they use to measure anything in a patient's mouth that's deviated from the norm. He also, in addition to founding that first school of orthodontia, he founded the Society of Orthodontists, which is now the American Association of Orthodontists. He founded the first orthodontic journal, which is known today as Tooth Fancy.

• 29:59Speaker 02

  Oh, man. What a nightmare magazine for me.

• 30:02Josh Clark?

  It would be.

• 30:03Speaker 02

  Somebody just, you can punk me and give me a subscription to Tooth Fancy.

• 30:06Josh Clark?

  All right.

• 30:07Speaker 02

  This guy had so many income streams, who's, you know, clearly a great orthodontist and dentist, but also a seemingly pretty savvy business guy.

• 30:16Josh Clark?

  Yeah, for sure. But yeah, he was revered. I'm sure he's still revered in the halls of orthodontia.

• 30:22Speaker 02

  Certain halls.

• 30:25Josh Clark?

  Oh, there's another, this apparently is a debate that's still rages today. At some point, somebody said, hey, you know, we usually try to, to step in earlier in development, like to work on younger kids, I think is the way they put it. But sometimes adults need help, too. So a lot of us are just pulling teeth, maybe to make space or whatever. Should we be, should we be doing that?

• 30:51Speaker 02

  Yeah.

• 30:51Josh Clark?

  And some people said yes, some people said no. And a rift was formed that, again, still exists today in the orthodontic field.

• 30:58Speaker 02

  Yeah, a rift so wide, it was like the gap between my daughter's teeth at maximum expansion.

• 31:05Josh Clark?

  It's a record.

• 31:07Speaker 02

  Should we take another break?

• 31:08Josh Clark?

  Yeah.

• 31:09Speaker 02

  All right, we'll come back and finish up on braces right after this.

• 31:25Josh Clark?

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• 31:34Speaker 02

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• 31:47Josh Clark?

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• 32:03Speaker 02

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• 32:28Josh Clark?

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• 32:45Speaker 02

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• 33:01Josh Clark?

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• 33:13Speaker 02

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• 33:43Speaker 02

  All right, if we're talking modern tooth straightening, we're talking about braces generally. I mean, I guess they still have retainers and stuff, but I feel like I see less and less of that, and it's more just sort of straight into braces. I feel like when we were kids, it was like, yeah, we can probably fix this with a retainer.

• 33:59Josh Clark?

  I thought the retainer was like post braces. That was my experience.

• 34:03Speaker 02

  I think that can be true, too.

• 34:05Josh Clark?

  Okay.

• 34:06Speaker 02

  But I'm pretty like, my brother got a retainer and not braces.

• 34:09Josh Clark?

  Of course. I'm sure his retainer somehow like made him money too accidentally.

• 34:15Speaker 02

  Oh, man. God bless him. So a lot of people had kind of shipped in to come up with things were basically like braces. One guy that was pretty key was named Dr. Raymond Beg. His nickname was Tick. Do you know why? I didn't find out why.

• 34:33Josh Clark?

  I could not find, other than that he was Australian, that's the best I can come up with.

• 34:37Speaker 02

  All right. But he was a student of angle. I guess at that school of orthodontia. Orthodontia? Yeah, orthodontia. And he moved to Australia, or I guess went back to Australia, where he practiced in Adelaide, lovely area. And this was in the 1930s. And he developed like using stainless steel wire instead of precious metals. And I think, didn't they use precious metals because they were malleable, but that caused problems?

• 35:06Josh Clark?

  Yeah, well, they're very expensive. And gold, like you can't make a crown out of gold because eventually it'll it'll mash. But they were they were prized because they don't react with other stuff. Like you can eat all the cheetos you want, and your gold's not going to rust. It's not poisonous, like mercury, which apparently they still use in fillings in some places.

• 35:28Speaker 02

  Oh, okay.

• 35:29Josh Clark?

  Yeah.

• 35:31Josh Clark?

  So but they're they're expensive. So people came up with alloys now today. Although sometimes you still will see like gold or platinum or silver alloy, sometimes fused with ceramic for implants and stuff.

• 35:44Speaker 02

  Yeah, well, the stainless steel, I mean, that's still, that came about in, what, 1956 here in the States? And braces became, you know, really more popular over that time, kind of starting in the 50s, but really in the 70s and 80s. I think an estimate from the AAO found the number of Americans who wear braces doubled between 82 and 2008.

• 36:06Josh Clark?

  Yeah.

• 36:07Speaker 02

  And, you know, they've evolved over the years. They had, I was one, not one of the first, but it was pretty early on. My second set of braces were ceramic, like the clear braces.

• 36:17Josh Clark?

  Those are nice.

• 36:18Speaker 02

  It's a little bit better, but it was not, you know, you still had brace face. Just a little less obvious. It's not like, you know, you couldn't tell or anything like that. Whereas my first braces were, it was early enough where they, they were the wraparound, like an entire silver band around each tooth. It wasn't like glued on. Yeah.

• 36:37Josh Clark?

  Right. One thing, though, about that huge increase, the doubling of people with braces between 82 and 2008. I was like, that doesn't track with my experience. For me, it was the 80s where everybody's wearing braces. And then I realized that that's because I knew the most people wearing braces in the 80s because that's when I was in elementary and middle school.

• 36:57Speaker 02

  Oh, well, yeah, sure.

• 36:58Josh Clark?

  Yeah. It was just a kind of bias I thought was great.

• 37:01Speaker 02

  Proximity bias?

• 37:03Josh Clark?

  I looked and I could not figure out which one it was. Maybe the frequency illusion is the best I could come up with.

• 37:09Speaker 02

  That makes sense. I didn't, is proximity bias even a thing? Did I make that up?

• 37:15Josh Clark?

  If it's not, it should be because it's got a great, great name. It really has legs.

• 37:19Speaker 02

  They also have braces that go in the back of your teeth. One of my good friends had those. And those, you know, can't be used in all cases, but that's the ones where you really score as a teenager.

• 37:28Josh Clark?

  For sure. And then I guess, those aren't invisible liners. Those are just rear braces, right?

• 37:34Speaker 02

  Yeah, part in the rear.

• 37:36Josh Clark?

  Well, before we get on to invisible liners, which also created quite a rift in orthodontics. There's something that I, I guess it's the new standard maybe today called self ligating braces. So with traditional braces, you have that wire. It's been around since Fouchard. You have the brackets that actually attach to your teeth. And then you have little tiny rubber bands that attach the brackets to the wire, right? With self ligating braces, there's just the wire and the brackets. And apparently it makes it way easier to clean. It makes it way easier to adjust when you switch out the wire for a thicker wire over time. Cause there's a little snap in the bracket that holds that wire in place. And they just look like the future to me.

• 38:19Speaker 02

  Yeah, you can also get colored braces now too, which is a big thing. If you get them young, like my daughter, she has purple braces.

• 38:27Josh Clark?

  Oh, that's cool. Loud and proud. I guess now on to invisible aligners because this, this was kind of a big deal to Caltech. They might've been students at the time. Zia Chishti and Kelsey Worth invented them all the way back in 1997. And within just three years, we had Invisalign on the market.

• 38:46Speaker 02

  Yeah, my brother used these for a while too. And this is something that you, it's to avoid going to the orthodontist, I guess, and paying like a lot of money for permanent or not permanent, but you know, temporarily glued on braces. This is something that you can, you know, it fits over your teeth and you can take them on and off.

• 39:03Josh Clark?

  Sure. Any involvement in this industry, it's been pushed so far outside of traditional orthodontics that any orthodontist who is a critic of orthodonture and it's like questionable scientific basis. They, they, the orthodontic community will use their involvement with this industry to discredit them. That's how, that's how reviled it is among mainstream orthodontics.

• 39:30Speaker 02

  Now, is that because they genuinely think it's no good or it's genuinely no good for their practice?

• 39:35Josh Clark?

  No good for their practice because it's not so much the invisible aligners. It's the fact that you can order them yourself online and they'll like, they're just totally cut out of the, the loop. So it's that's, it's specifically the online ordering version that they have such an aversion to.

• 39:52Speaker 02

  I'm surprised they didn't think of a way to get a piece of that business.

• 39:56Josh Clark?

  It happened, it happened while they were sleeping.

• 39:59Speaker 02

  Yeah, and I need to ask my brother how well they worked for him because I know he worn for a little while.

• 40:04Josh Clark?

  I think they work if you have just slight adjustments you need to make, but if you have like a a really like a big, a big deal in the wonky department, then you, you should go with braces. One other big check in the favor braces over invisible liners. You can adjust the braces throughout the treatment. So I need a little more pressure here, a little less here. You can't do that with invisible liners. Once you send them the mold of your mouth, they send you the braces back and that's, that's that. I think you get multiple ones, but it's much less precise over time as braces.

• 40:40Speaker 02

  All right. Livia found this, and I didn't know this is a thing, but apparently she found that there is some anecdotal evidence, at least of young people wanting braces as a fashion statement, like a decorative fashion brace that you can get online.

• 40:58Josh Clark?

  Yeah, I saw some article written by some square that said non-prescription glasses and fashion braces are the big things right now.

• 41:07Speaker 02

  Wow, man, oh, man. I mean, I were, you know, very famously wore fake glasses to seem smarter when I was younger. But you couldn't have caught me dead with fake braces.

• 41:19Josh Clark?

  No, it doesn't make any sense. And I also kind of suspect it might be an urban legend.

• 41:25Speaker 02

  I do too.

• 41:26Josh Clark?

  One thing that doesn't seem to be an urban legend that I saw though was gap bands. Apparently people have learned this. Kind of, but with an S on the end of band.

• 41:34Speaker 02

  Oh, okay.

• 41:36Josh Clark?

  Where you use like a, kind of like a really strong rubber band. You put it on the, the tooth you want to straighten out and then connect the other one to a straight tooth to use it as leverage. And apparently it works really fast. Again, the orthodontic community is like, don't do those. There supposedly was some eight-year-old boy in Greece who had done this himself, but the rubber band went up into his gums. And according to these people, he didn't notice. And it just ate away at the tissue up there and he ended up losing the very teeth, I think his front teeth, that he was trying to straighten in the first place.

• 42:18Josh Clark?

  That too, sounds a bit like an urban legend, but I saw it in enough places that I wonder if it might be based on some sort of legitimate story somewhere.

• 42:26Speaker 02

  I could see that. I mean, I, you know, you probably use rubber bands along with your braces, right?

• 42:32Josh Clark?

  I never had braces.

• 42:33Speaker 02

  Oh, you never had them at all?

• 42:34Josh Clark?

  I did not need them as a kid. It wasn't until I was an adult that I started to kind of need them for my lower teeth.

• 42:41Speaker 02

  You got pretty good teeth, though. I don't, I've never noticed your teeth being crooked or whatever.

• 42:45Josh Clark?

  That's because I don't smile and show my lower teeth. Number one, because I'm not insane, but number two, because those are the ones that are crooked. Luckily, it's my top row that's pretty straight. So when I smile, it looks like my teeth are great. But if I, look, can you see? They're like, you know, I thought on there just kind of. That was pretty good play acting, too, by the way.

• 43:06Speaker 02

  Yeah, it was good. All right, so let's talk about some stats. A few years ago in 2022, 3.15 million kids between eight and 17 were getting orthodontic treatment. This sounds way low to me. 7.4% of that age group is all that was. There were other estimates that say about half of kids receive some kind of orthodontic treatment at some point. That seems low to me, too, just based on anecdotal what I'm seeing around me. But, you know, maybe that's right.

• 43:38Josh Clark?

  So kids, like you were saying, it's just basically part of being a kid today. You get braces at some point.

• 43:43Speaker 02

  It seems like it. I just, I feel like Ruby and most of her friends have braces.

• 43:49Josh Clark?

  I mean, that tracks. I found a statistic that in the US alone, out-of-pocket spending amounts to five, almost five and a half billion dollars a year on orthodonture. And then insurance, Medicaid, covers an additional 4.2 billion. So it's like a $10 billion industry just in the United States alone.

• 44:10Speaker 02

  Yeah, I mean, and you know, kind of going back as we'll finish up here to the beginning of like, is this a medical issue? Or is it just to create like, you know, kids without self-esteem problems because they're maybe have crooked teeth? And certainly the rise of Hollywood and it used to say something sort of about class. I think it still, still can, unfortunately. And, you know, with, with movies and advertisements and TV and stuff like that, YouTube, social media, straight teeth is the thing. And, you know, starting in the post-war era, like especially with young girls, they were saying, hey, you got low self-esteem, it's probably because of your teeth.

• 44:52Josh Clark?

  I, I wonder though, so that, that class thing, socioeconomic part of it, that actually makes it hard to study orthodontics because if you want to study people with, say braces or something like that, you're automatically working from another kind of bias, a selection bias, because they are probably from a higher socioeconomic class than the average person who doesn't have braces because so much of it is paid for out of pocket. But it occurred to me just now, Chuck, while you were saying that, that I wonder if that whole thing about them fixing health issues or whatever is essentially made up to get insurance companies to cover what otherwise would be considered cosmetic. So they're actually doing it strictly for aesthetic purposes, but they're trying to

• 45:36Josh Clark?

  make it so you, the parent, don't have to pay for all of it out of pocket. Maybe that's what's going on here.

• 45:42Speaker 02

  Maybe, I mean, it's, it's, this is the kind of thing that's really hard to study as far as whether or not there is a medical benefit or need because, and Livia points this out, you know, you've got to conduct randomized trials. So you have to find a large group of people who were, have, you know, pretty similar dental profiles and you've got to have one group that you give braces to and then a control group that you don't, and then follow them over a long period of time to see what kind of problems develop, like headaches or something. And that's just, that's just really, that's a tough study to pull off.

• 46:15Josh Clark?

  Yeah. And again, I mean, the, the study population you're drawing from, like, nobody's going to do that. So if you're studying people who already have braces, you're automatically working with that selection bias because they're more likely to be from a higher socioeconomic group.

• 46:29Speaker 02

  Yeah, totally.

• 46:31Josh Clark?

  You got anything else about braces?

• 46:33Speaker 02

  The only thing I'll add, I had the two kinds of braces. Oh, for many years after the braces, I had this bar put on the back of my lower teeth that spanned like the front five, and that was supposedly to keep them in place.

• 46:49Josh Clark?

  Neat.

• 46:50Speaker 02

  And that eventually broke off, and I just went for years with those metal stumps there because I've spent quite a few years without going to the dentist at one point.

• 46:59Josh Clark?

  Yeah. I'm guessing college years and maybe immediately after.

• 47:05Speaker 02

  Bing, bing, bing.

• 47:06Josh Clark?

  That's how it goes, man. Let's see, well, you don't have anything else about braces?

• 47:12Speaker 02

  No.

• 47:12Josh Clark?

  I don't either. Thanks to all the orthodontists out there for listening. And everyone, if I turn up assassinated in the next couple of weeks, it's because I did figure out the big secret to orthodontics and insurance.

• 47:23Speaker 02

  Yeah.

• 47:25Josh Clark?

  And Chuck said yeah, so that means it's time for listener mail.

• 47:29Speaker 02

  You're gonna wake up and Steve Martin's gonna be over you with a dental drill.

• 47:32Josh Clark?

  Oh, God.

• 47:34Speaker 02

  By the way, highly, highly, highly recommend the two-part documentary on Steve Martin.

• 47:39Josh Clark?

  Okay.

• 47:40Speaker 02

  It is great.

• 47:41Josh Clark?

  I didn't even know it was out.

• 47:43Speaker 02

  Yeah, it's been out for a little bit. It's really, really good, and it kind of makes me realize what a, I mean, I've always been a Steve Martin fan, but it really knocks home what a treasure he is as a human.

• 47:52Josh Clark?

  I bet.

• 47:53Speaker 02

  Yeah, it's fun. And I just recently rewatched Three Amigos, showed Ruby for the first time, which she thought was very fun.

• 48:00Josh Clark?

  I've never seen that one.

• 48:02Speaker 02

  Oh, really?

• 48:03Josh Clark?

  Yeah.

• 48:03Speaker 02

  That seems like it would have been one on your list.

• 48:05Josh Clark?

  I don't, well, actually, I do know why.

• 48:08Speaker 02

  Why?

• 48:09Josh Clark?

  Because Chevy Chase is in it.

• 48:09Speaker 02

  Oh, you don't like Chevy Chase?

• 48:12Speaker 02

  Of course. He's the, he's the least funny part of the movie. You need to watch it for Martin Short and Steve Martin.

• 48:17Josh Clark?

  I'll do my best. I'd rather watch Only Murders in the Building.

• 48:20Speaker 02

  No, I'm with you. I'm with you. All right. Hey, guys, this is, what is this about? This, well, this is kind of about medical school, so it fits. Been listening for nearly a decade, was very excited to have an occasion to write in. During the episode on cigarettes, you mentioned an early physician who observed nasal swellings and excretions and moderate users of snuff, and Josh interprets this as puffy, pussy lumps in their noses. I recently graduated from medical school and it's a rite of passage for medical students to describe a wound with pus as pussy, only to realize this word, "uh" appears rather crass when written out. Instead, we use the word, P-U-R-U-L-E-N, purulent, to avoid any potential misunderstanding if a patient reads the notes.

• 49:06Speaker 02

  Obviously, it's a little different in a podcast setting, which I doubt listeners are often reading an episode transcript.

• 49:11Josh Clark?

  Oh, yeah, we'll have to go look that up.

• 49:13Speaker 02

  I figured this little nugget of knowledge might be helpful. I'm sure you hear this every day, but I want to say thanks for all the great work you do. Stuff You Should Know has been a constant source of joy for me as I've navigated college, med school, marriage, fatherhood, and now residency, training in pathology. You broaden my perspective on a vast array of issues and I always look forward to listening to new and old episodes alike on my commute. And that is from Gabe, who says, hey, come to Ann Arbor, Michigan for a live show. And we're maybe trying to work that out, Gabe.

• 49:40Josh Clark?

  Yeah, we're batting it around, Gabe. Good idea.

• 49:42Speaker 02

  Yeah, and I tell you what, Gabe, if we come to Ann Arbor, write us back from that very same thread and you and your friends and family or whatever. You know, not like 20 people, but you can get on the guest list.

• 49:53Josh Clark?

  Yeah, good idea, Chuck. That's a foolproof plan. There's no possible way for identity theft.

• 49:59Speaker 02

  That's right.

• 50:00Josh Clark?

  And congratulations, Gabe, on all of your academic and medical success. And thanks for listening to us that entire time. If you want to be like Gabe and send us a cool email, you can do that, too. Send it off to [email protected].

• 50:18Speaker 00

  Stuff You Should Know is a production of iHeartRadio. For more podcasts, iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

• 50:34Josh Clark?

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• 51:17Josh Clark?

  these perspectives highlight that life is more than a moment, a condition, or a tough day. Living with a rare disease can be challenging, but it does not define the Voices of Vivgard. In these episodes, they share their stories, from diagnosis to working with their care team on their treatment plan. Listen to Voices of Vivgard on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts. Hey everybody, I am here to talk to you about Dude Wipes, who offer fragrance-free wipes that are made with 99% water and plant-based ingredients. So they're gentle enough for sensitive skin, but they're tough enough for even the worst messes. Water cleans better, and Dude Wipes flushable wipes deliver textbook freshness and ultimate clean. And just like human body molecules, Dude Wipes are made with 99% water,

• 52:00Josh Clark?

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• 52:08Speaker 00

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