The History of Orthodontics

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Speaker 1 Welcome to Stuff You Should Know, a production of iHeartRadio.

Speaker 3 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.

Speaker 4 Yeah, the history of orthodonture, which if I had been using my brain, I would have

Speaker 4 paired this with the history of dentistry.

Speaker 4 Because that's, you know, kind of makes sense.

Speaker 3 Sure. I feel like we would have had seen a real decline in listenership that week, but you know.
You think so?

Speaker 3 No, I'm just kidding. I'm just being a punk.
I remember our dentistry one was amazing.

Speaker 4 Well, and I think, I don't know, I think people are interested in their bodies,

Speaker 3 especially when you say it like that.

Speaker 4 Yeah, and then teeth and stuff.

Speaker 4 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.

Speaker 4 But I'd like to kind of break that cycle as well of kind of talking about it like that, because

Speaker 4 even 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 uh that we've seen over the past uh

Speaker 4 you know 20 years and really i feel like even the last 10 years where hollywood especially and people in the media all have perfect perfect perfect teeth And you don't have to have perfect teeth.

Speaker 4 I like teeth with a little personality. I like summer teeth.

Speaker 3 Yeah, I can't remember what they're, they're, what kind of teeth? Summer?

Speaker 4 Summer teeth.

Speaker 3 I've not heard that. You never heard that phrase? No, what does it mean?

Speaker 4 Summer teeth. Summer here, summer there.

Speaker 3 Oh, that's awesome, man. I love that.
That's like a, what kind of dog is that? Sooner? Sooner one kind is another?

Speaker 4 Yeah, exactly.

Speaker 3 Yeah, 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.

Speaker 3 Yumi has one, but there's a term for it, and it's like basically a term of endearment. They just find that very cute.
Here in the U.S., it'd be like

Speaker 3 you would be put in some sort of like home or asylum for that.

Speaker 4 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,

Speaker 4 you know, the expectation to look perfect.

Speaker 3 Right.

Speaker 3 And that's a big criticism of the

Speaker 3 entire field of orthodontics is, 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.

Speaker 3 But they're the ones who are there, like, hey, come on over. We're going to fix you up.
Tough to blame them for that.

Speaker 3 But the criticism goes even further because the field of orthodontics is like, forget about all that. We're actually helping cure health issues.
Right.

Speaker 3 And critics of the field are like, it's not even established that there are health issues from having wonky teeth.

Speaker 3 So you guys should probably stop saying all that. And the field of orthodontics said, no.

Speaker 4 Yeah, I mean, for sure, there can be health issues.

Speaker 4 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.

Speaker 4 You go to the dentist around six or seven years old. They say, all right, you need to go see your orthodontist now.

Speaker 3 I did not know that. That was not the way it was when we were young.

Speaker 4 No, I mean, i had braces twice uh did you yeah but you know

Speaker 4 i've got bad bite i have a host of problems um but yeah let's dive into it because this is not a new thing people have always had wonky teeth and um

Speaker 4 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 brain changed and that meant the size of our jaw got smaller to make room for our bigger brain.

Speaker 4 But it's not like they were like, all right, they, whoever decides this, you know, the panel.

Speaker 3 God.

Speaker 4 It's not like the God panel said, all right, let's take out five or six teeth because we don't have room for them now.

Speaker 4 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.

Speaker 3 Yeah. Just give it another 100,000 years, Chuck.
It'll work itself out. Exactly.

Speaker 3 Even more recent than that,

Speaker 3 the teeth or orthodontics was probably not an issue for hunter-gatherers because the diet they had was more, much more challenging to their teeth and jaw,

Speaker 3 the bone that held their teeth in place because of the chewing they had to do.

Speaker 3 Well, since we picked up agriculture and especially since the Industrial Revolution, where we started mass processing food, everything's gotten much softer.

Speaker 3 So we're challenging the bone in our jaw less. Therefore, our teeth are more prone to go wonky rather than coming in straight.

Speaker 4 Yeah, and less bone is happening there.

Speaker 4 So, I mean, that's the history of my teeth is bone loss and lack of bone.

Speaker 3 Hey, man, I just got two root canals.

Speaker 3 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.

Speaker 3 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

Speaker 3 i went to the endodontist and got root canals how about that yeah i've i've never had a root canal weirdly that's the one thing i haven't had they're they're not fun but they're well they're not fun yeah

Speaker 4 So early on,

Speaker 4 in ancient times, people started to kind of look at this issue.

Speaker 4 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.

Speaker 4 And there 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.

Speaker 4 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. Yeah.

Speaker 3 Which is, I mean, pretty interesting. Again, this is post-agriculture, so don't email us.
Yeah, uh, and also there's a good band and album name in there, Hippocrates and the Egyptian Mummies. Right.

Speaker 3 And the album is discharged from the ear. Oh, God.

Speaker 3 Okay.

Speaker 3 Just waiting for us. Yeah, good one.

Speaker 3 There was another couple people from the ancient world, Celsus, who is a Roman writer.

Speaker 3 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. Yeah.

Speaker 3 And it turned out that was a pretty good idea because that was adopted later on in Orthodonta when it really became a thing. And even Pliny got in on it.

Speaker 3 Remember how much he used to visit us in our podcast?

Speaker 4 Yeah, I mean, I feel like Pliny used to be a firm entrant into the stuff you should know drinking game.

Speaker 3 Yeah. Well, he moved on to the Doughboys.
Oh, okay. But he said that if you don't like the alignment of your teeth, just file them.

Speaker 3 Yeah.

Speaker 4 Which is still a thing.

Speaker 3 It is. That's another, I think, thing that I'm like, like, wait, really? You guys are still doing this?

Speaker 3 And it's true.

Speaker 3 Like, a lot of the inventions and techniques and ideas that came along from the very beginning of Orthodonture are, I guess, they got them right right out of the gate because they're still doing them today.

Speaker 4 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.

Speaker 3 How is that?

Speaker 4 What, to get them filed?

Speaker 3 Does it hurt?

Speaker 4 Is it filed? No, no, no, no. It doesn't hurt at all.

Speaker 3 It's just that.

Speaker 4 And then you smell the smoke and

Speaker 4 that part's all horrific, but there's no pain involved because they're not hitting nerves or anything.

Speaker 3 Okay. Now imagine doing that through the middle interior of the tooth to scrape out the root to the nerve.
That's a root canal. Oh, man.

Speaker 4 So sorry. Sorry.

Speaker 3 So I guess really the first person, I mean, Pliny the Elder makes a pretty good case, but not really.

Speaker 3 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 orthodonture. His name was Pierre Fauchard.

Speaker 3 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.

Speaker 4 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.

Speaker 4 The first thing he would do is measure the length of the teeth and file them down.

Speaker 4 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.

Speaker 4 That's called bite adjustment. Like I said, they still do those, including on me.

Speaker 4 That's an occlusual, occlusal, sorry,

Speaker 4 equilibration. Equilibration.

Speaker 3 Yeah, that's not an easy one.

Speaker 4 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.

Speaker 4 Yeah.

Speaker 3 I've realized as an adult, my bite is way over to the, I guess the bottom is,

Speaker 3 yeah, the bottom's to the right. The crossbite is to the left.
Is that what it's called? I think so. Oh, my man.
I got a terrible crossbite. But I mean, I'm making my way in the world today.

Speaker 3 Takes everything I've got. That's true.
But I'm still able to chew pretty well. Yeah, yeah.
That's what matters. Sure.

Speaker 3 So let's talk a little bit more about Fauchard because he hasn't left yet. He really kind of got into this and laid the groundwork.

Speaker 3 He did the same thing that Pliny suggested that, like you said, that you went to the same procedure.

Speaker 3 He called it inner proximal stripping, which is essentially just filing down teeth to make more space between them.

Speaker 4 Yeah. Like if it's crooked, give it a little more space and maybe it'll be able to straighten itself out.

Speaker 3 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 got to make the space first. He came up with that.
Yeah.

Speaker 4 Or what he did was push on the teeth, just like Celsis suggested.

Speaker 4 Like every day, you know, and this, you know, this makes sense. It's essentially what rubber bands and braces do.

Speaker 3 Just you're applying pressure to your teeth at at a regular interval like so many times a day and so many the idea is that they will move right and it's true like that's one of the 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 yeah

Speaker 3 um so One of the other reasons why Fauchard is remembered is because he essentially came up with the idea for braces.

Speaker 3 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.

Speaker 3 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.

Speaker 3 And sometimes he would use a plate too to connect.

Speaker 3 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.

Speaker 3 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.

Speaker 4 Yeah, he also used a specific torture device called a pelican.

Speaker 4 It had been around before, I think, since at least the 14th century, it was used for pulling teeth, but he kind of

Speaker 4 rejiggered it and redesigned it to where it was basically a forcep that could pull a tooth,

Speaker 4 pull a tooth, like not out of your body, but in a certain direction.

Speaker 4 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.

Speaker 4 And I imagine that was extremely unpleasant.

Speaker 3 I can't believe there's just the one that people mention, you know?

Speaker 4 I mean, that's the one on record. I'm sure it happened more than that, you know.

Speaker 3 Yeah. The girl was quoted as saying, yeah.

Speaker 4 Yeah, exactly.

Speaker 3 He also was smart enough to know that you could get infections from some of these techniques and procedures he was performing.

Speaker 3 So he recommended a mouthwash of wine and a specific kind of honey with some rose essence to it.

Speaker 3 I mean, this guy just,

Speaker 3 he just laid it down. And what's interesting is

Speaker 3 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

Speaker 3 we viewed teeth much differently, at least in the West, than we do today.

Speaker 3 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.

Speaker 3 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.

Speaker 3 I will pay you $1.50 if you find one single portrait of a gentry or aristocrat, man or woman, who's showing their teeth in in a painting. You can't find it because that was really rude and de classe.

Speaker 3 Yeah, I mean,

Speaker 4 almost any painting you think about, like it didn't occur to me until I, you know, did this research. And

Speaker 4 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 in a pirate.

Speaker 4 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 don't see teeth in paintings.

Speaker 3 You don't. $1.50, everybody.
Yeah. But just to one of you, not all of you.

Speaker 4 Oh, man. We're going to get some.

Speaker 4 It's going to start rolling in, buddy.

Speaker 4 JPEGs coming at you with toothy paintings. Should we take a break?

Speaker 3 Yeah, we should take a break.

Speaker 4 All right, we'll take a break and we're going to jump forward into the 1800s after this.

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Speaker 3 So, like I said, Fouchard was working in the early 1700s.

Speaker 3 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 got to look good. So, let's get back into orthodonture.

Speaker 3 Another Frenchman, Pierre-Joachim Les Foulon, he's the one who came up with the word orthodontics. Actually, he called it orthodontic.

Speaker 3 You have to say it like that. And in Greek, ortho means straight.
Dant is teeth. So straight teeth is what the word orthodontics means.

Speaker 4 You know, I love that when that happens.

Speaker 3 Pretty on the tooth. Yeah.

Speaker 4 I can't even follow that.

Speaker 4 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.

Speaker 4 But

Speaker 4 dentists started to do this stuff. They weren't like specialists that only did orthodontics yet.
It was just part of dentistry and tooth straightening was part of dentistry.

Speaker 4 And you were an apprentice who learned that kind of thing. Dental colleges started being organized in the mid-19th century.
But,

Speaker 4 I mean, when was the first

Speaker 4 orthodontist school? That was in the 20th century, right?

Speaker 3 Yeah, either the very beginning of the 20th or the very early

Speaker 3 or no, yeah, very late 19th century. I think it was

Speaker 3 Engel.

Speaker 4 Yeah, 1900s, the Engel School of Orthodontia was the first sort of standalone thing where it wasn't just part of a dental school.

Speaker 3 Precisely. All right.

Speaker 3 So, some of the other advancements that the 19th century contributed can all be kind of lumped together under the umbrella term of hebgear. Yeah.
For uh-uh.

Speaker 3 If you're a teenager,

Speaker 3 which is you're using your skull and the substance of your skull as a as a,

Speaker 3 oh man, I wish I knew classical physics terms a little better, but an anchor. Essentially, sure, yes.
An anchor, a counterbalance. How about that? Okay.

Speaker 3 To provide the pressure needed to pull, say, like your jaw back. Yeah.
There's something called a chin cup that you can use.

Speaker 3 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 yeah and it can correct an underbite and that's as far back as I think 1802.

Speaker 4 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.

Speaker 4 And somebody's like, oh, what about their skull?

Speaker 3 Yeah. It's right there.
Somebody went, bam!

Speaker 4 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.

Speaker 4 Luckily, I never had to go through the headgear

Speaker 4 trauma, but it was quite traumatic when you showed up to school having to wear one of those.

Speaker 3 You remember Farmer Ted from 16 Candles? He had to wear one.

Speaker 4 Farmer Ted. And I think, oh, no, Joan Cusack had the neck brace.

Speaker 3 Yes. Yeah, okay.
I thought that too, but no, it was was neck brace. There's a couple other people we need to mention.
Another French dentist, Christophe François Delabar.

Speaker 3 He created the wire crib, which was,

Speaker 3 I think we said Fouchard was the one who really kind of started the idea of braces. There's

Speaker 3 a distinct progression, a linear progression from Fouchard onward. And Delabar came up with the wire crib, which is essentially...
exactly what it sounds like. Like you take

Speaker 3 a piece of chicken wire and fold it over like the teeth in question, tighten it up the way you want it, and there's your wire crib.

Speaker 3 It's not exactly like the braces of today, but the outline, the contours are there in it for sure.

Speaker 4 Yeah.

Speaker 4 It started to become in the 19th, I guess the second half of the 19th century, a little more scientific.

Speaker 4 And they started to kind of put a little more rigor into like, you know, figuring out how to do this the right way.

Speaker 4 A guy named Norman Kingsley from New York City was a very early, very popular orthodontist.

Speaker 4 He had a treatment for clef palates that was very popular and wrote a very influential guide called A Treatise on Oral Deformities in 1880.

Speaker 4 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 aesthetics.

Speaker 4 So he was,

Speaker 4 if not the first, one of the sort of early leading guys that was like, we want you to look good and it may not just be about like your bite health.

Speaker 3 Right. exactly, exactly.
Um, he was also supposed to be really nice, he had a compliment for everyone he met. Oh, that's nice.
Uh, so I just made that up, but I want to believe it about it.

Speaker 3 Uh, 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.

Speaker 3 That is the jawline on the top of your mouth.

Speaker 3 Your row of top teeth are connected to your maxillary arch. How about that? The roof of your mouth.
Yeah. The lower set of teeth is connected to the mandibular arch.

Speaker 3 Either way, you can be born with one or both of them narrowed.

Speaker 3 So they figured out you can put essentially an appliance, a stick in between them and adjust it slowly but surely over time and press your jaw apart.

Speaker 4 Yeah, I mean, that is still a thing.

Speaker 4 My daughter has that. It's called an expander.
I guess it was called that back then, too.

Speaker 4 And like her two friends that have braces both had it, too. So I think that may be way more regular now.
I don't know anyone from our days in high school that had something like that.

Speaker 3 So I think the original one was they would put the screwbar in between, say, your back molars because they're pretty substantial. And just over time, slowly adjust it, I guess probably every visit.

Speaker 3 And that would press the whole arch apart. Is that essentially what they're they're doing still today?

Speaker 4 Yeah, it's like a wire cage that lives on the roof of your mouth. It's attached to those rear molars.

Speaker 4 And they, yeah, you go in there and they crank it out and make more room.

Speaker 4 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

Speaker 4 when this thing was at its most. But they're basically just creating room for the future.

Speaker 3 Was the dentist like or the orthodontist like, I've done too much? No, he's coming back now.

Speaker 4 He's like, I've got a new record. Everyone, get in here.
Look at the scroll.

Speaker 3 So

Speaker 3 I think you said we talked about how the first orthodontic school was established by Edward Engel in 1900.

Speaker 3 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

Speaker 3 the reason why, not coincidentally, is this is because of a shift of direction that Orthodonta went in to basically say, like, let's get even more scientific about this. And, well, they did.

Speaker 4 Yeah, there was a guy named John Nutting Farrar, who some people call the father of American orthodontics or modern orthodontics.

Speaker 3 Not in the house I was raised in.

Speaker 4 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.

Speaker 4 Let me see how much the human body can, like how much pain they can endure to move those teeth.

Speaker 4 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.

Speaker 3 Yeah. What's worse, though, is he wasn't experimenting on children.
He was experimenting on animals, which I take to mean dogs.

Speaker 3 Yeah, I guess. Yeah.

Speaker 3 So, yeah, that's Farrar.

Speaker 3 What about Edward Engel, who we talked about? This guy is probably the one, I mean, my dad, at least always called him the father of American orthodontics.

Speaker 4 Yeah, I mean, he's the guy that definitely

Speaker 4 made it such a bona fide business. And I think he found out a lot of different ways to make a lot of money.

Speaker 4 And, you know, one way was like developing devices and patenting devices.

Speaker 4 Another way was creating

Speaker 4 like ready-made appliances. He created the Engel system in 1887.

Speaker 4 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.

Speaker 3 Yeah, because I mean, there's only so many ways that your teeth can be wonky, right? So

Speaker 3 yeah, that's that was revolutionary. I'm sure that just immediately pushed the field forward.

Speaker 3 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 years later, that they use as the basis, like that is the norm.

Speaker 3 Yeah. And that that's what they use to measure anything in a patient's mouth that's deviated from the norm.

Speaker 3 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.

Speaker 3 He founded the first orthodontic journal, which is known today as Tooth Fancy.

Speaker 4 Oh, man. What a nightmare magazine for me.

Speaker 3 It would be awesome.

Speaker 4 Somebody just, you can punk me and give me a subscription to Tooth Fancy.

Speaker 3 All right.

Speaker 4 This guy had so many income streams. He was, you know, clearly a great orthodontist and dentist, but also a seemingly pretty savvy business guy.

Speaker 3 Yeah, for sure. But yeah, he was revered.
I'm sure he's still revered in the halls of orthodonture.

Speaker 4 Certain halls.

Speaker 3 Oh, there's another, this apparently is a debate that still rages today.

Speaker 3 At some point, somebody said, hey, you know, we usually try to step in earlier in development, like to work on younger kids, I think is the way they put it.

Speaker 3 But sometimes adults need help too.

Speaker 3 So a lot of us are just pulling teeth, maybe to make space or whatever.

Speaker 3 Should we be doing that? And some people said yes. Some people said no.
And a rift was formed that, again, still exists today in the orthodontic field. Yeah.

Speaker 4 a rift so wide it was like the gap between my daughter's teeth at maximum expansion it's a record uh should we take another break yeah all right we'll come back and finish up on braces right after this stuff stuff

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Speaker 4 All right, if we're talking modern tooth straightening, we're talking about braces generally.

Speaker 4 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.

Speaker 4 I feel like when we were kids, it was like, yeah, we can probably fix this with a retainer.

Speaker 3 I thought the retainer was like post-braces. That was my experience.

Speaker 4 I think that can be true, too.

Speaker 3 Okay.

Speaker 4 But I'm pretty, like, my brother got a retainer and not braces.

Speaker 3 Of course. Yeah.

Speaker 3 I'm sure his retainer somehow like made him money too, accidentally. Oh man.

Speaker 4 God bless him. So a lot of people had kind of shipped in to come up with things were basically like braces.

Speaker 4 One guy that was pretty key was named Dr. Raymond Begg.
His nickname was Tick. Do you know why? I didn't find out why.

Speaker 3 I could not find, other than that he was Australian, that's the best I can come up with.

Speaker 4 All right. But he was a student of

Speaker 4 Angle,

Speaker 4 I guess, at that school of Orthodontia. Orthodontia? Yeah, Orthodontia.

Speaker 4 And he moved to Australia, or I guess went back to Australia where he practiced in Adelaide, lovely area. And this is in the 1930s, and he developed like

Speaker 4 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?

Speaker 3 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 um with other stuff like you can eat all the cheetos you want and your gold's not going to rust um it's not poisonous like mercury which apparently they still use in fillings in some places oh okay yeah um

Speaker 3 So it but they're they're expensive.

Speaker 3 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.

Speaker 4 Yeah, well, the stainless steel, I mean, that's still,

Speaker 4 that came about in, what, 1956 here in the States.

Speaker 4 And

Speaker 4 braces became, you know, really more popular over that time, kind of starting in the 50s, but really in the 70s and 80s.

Speaker 4 I think an estimate from the AAO found the number of Americans who wear braces doubled between 82 and 2008.

Speaker 3 Yeah.

Speaker 4 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,

Speaker 4 which is a little bit better, but it was not, you know, you still had brace face,

Speaker 4 just a little less obvious. It's not like, you know, you couldn't tell or anything like that.

Speaker 4 Whereas my first braces were, it was early enough where they were the wraparound, like an entire silver band around each tooth.

Speaker 4 It wasn't like glued on.

Speaker 3 Yeah. 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.

Speaker 3 For me, it was the 80s where everybody's wearing braces.

Speaker 3 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.

Speaker 4 Oh, well, yeah, sure.

Speaker 3 Yeah. It was just a kind of bias I thought was great.

Speaker 4 Proximity bias?

Speaker 3 I looked and I could not figure out which one it was. Maybe the frequency illusion is the best I could come up with.

Speaker 4 That makes sense.

Speaker 4 Is proximity bias even a thing? Did I make that up?

Speaker 3 If it's not, it should be because it's got a great, great name. It really has legs.

Speaker 4 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.

Speaker 3 For sure. And then I guess those aren't invisible aligners.
Those are just rear braces, right? Yeah. Part of the rear.

Speaker 3 Well, before we get on to invisible aligners, which also created quite a rift in orthodontics,

Speaker 3 there's something that 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.

Speaker 3 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?

Speaker 3 With self-ligating braces, there's just the wire and the brackets. And apparently, it makes it way easier to clean.

Speaker 3 It makes it way easier to adjust when you switch out the wire for a thicker wire over time because there's a little snap in the bracket that holds that wire in place.

Speaker 3 And they just look like the future to me.

Speaker 4 Yeah. You can also get colored braces now too, which is a big thing if you get them young, like my daughter.

Speaker 3 She has purple braces. Oh, that's cool.
Loud and proud. I guess now on to invisible aligners because this was kind of a big deal.
Two Caltech,

Speaker 3 they might have been students at the time, Zia Chishti and Kelsey Wirth invented them all the way back in 1997. And within just three years, we had Invisalign on the market.

Speaker 4 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

Speaker 4 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.

Speaker 3 Sure.

Speaker 3 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 its like questionable scientific basis,

Speaker 3 the orthodontic community will use their involvement with this industry to discredit them.

Speaker 3 That's how reviled it is among mainstream orthodontics.

Speaker 4 Now, is that because they genuinely think it's no good or it's genuinely no good for their practice?

Speaker 3 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 you're 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 i'm surprised they didn't think of a way to get a piece of that business you know it happened it happened while they were sleeping Yeah, and I need to ask my brother how well they worked for him because I know he wore them for a little while.

Speaker 3 I think they work if you have just slight adjustments you need to make, but if you have like a really like a big, a big deal in the wonky department, then you should go with braces.

Speaker 3 One other big check in the favor of braces over invisible aligners, you can adjust the braces throughout the treatment. So I need a little more pressure here, a little less here.

Speaker 3 You can't do that with invisible aligners. Once you send them the mold of your mouth, they send you the braces back, and that's that.

Speaker 3 I think you get multiple ones, but it's much less precise over time as braces. All right.

Speaker 4 Livia found this,

Speaker 4 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.

Speaker 3 Yeah. I saw some article written by some square that said non-prescription glasses and fashion braces are the big things right now.
Wow, man.

Speaker 4 Oh, man. I mean, I wore, you know, very famously wore fake glasses to seem smarter when I was younger.

Speaker 4 But you couldn't have caught me dead with fake braces.

Speaker 3 No, it doesn't make any sense. And I also kind of suspect it might be an urban legend.
I do too. One thing that doesn't seem to be an urban legend that I saw, though, was gap bands.

Speaker 3 Apparently, people have learned this kind of, but with an S on the end of band. Oh, okay.

Speaker 3 Where you use use like a

Speaker 3 kind of like a really strong

Speaker 3 rubber band, you put it on 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.

Speaker 3 Again, the orthodontic community is like, don't do those.

Speaker 3 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 these people, he didn't notice.

Speaker 3 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.

Speaker 3 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.

Speaker 4 I could see that. I mean,

Speaker 4 you probably use rubber bands along with your braces, right?

Speaker 3 I never had braces.

Speaker 4 Oh, you never had them at all?

Speaker 3 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.

Speaker 4 You got pretty good teeth, though. I've never noticed your teeth being

Speaker 3 crooked or whatever. 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.

Speaker 3 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,

Speaker 3 they're like, yeah, I thought a lot on there, just kind of.

Speaker 3 That was pretty good play acting, too, by the way. Yeah, it was good.

Speaker 4 All right, so let's talk about some stats. A few years ago in 2022,

Speaker 4 3.15 million kids between 8 and 17 were getting orthodontic treatment.

Speaker 4 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.

Speaker 4 That seems low to me too, just based on anecdotal what I'm seeing around me.

Speaker 3 But, you know, maybe right so kids like you were saying it's just basically part of being a kid today you get braces at some point it seems like it i just uh i feel like ruby and most of her friends have braces i mean that tracks i found a a statistic that in the u.s alone um out-of-pocket spending amounts to five almost five and a half billion dollars a year on orthodonture and then insurance and medicaid covers an additional 4.2 billion so it's like a 10 billion dollar industry just in the United States alone.

Speaker 3 Yeah.

Speaker 4 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?

Speaker 4 Cause they're maybe have crooked teeth. And certainly the rise of Hollywood and

Speaker 4 it used to say something sort of about class. I think it still can,

Speaker 4 unfortunately. And, you know, with movies and advertisements and TV and stuff like that,

Speaker 4 YouTube, social media, straight teeth is the thing. And,

Speaker 4 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.

Speaker 3 I wonder, though, so that class thing, the socioeconomic part of it, that actually makes it hard to study orthodontics.

Speaker 3 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.

Speaker 3 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.

Speaker 3 So they're actually doing it strictly for aesthetic purposes, but they're trying to 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.

Speaker 4 Maybe.

Speaker 4 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, if you got to conduct randomized trials, so you have to find a large group of people who have, you know, pretty similar dental profiles.

Speaker 4 And you 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 yeah and again i mean the the study population you're drawing from

Speaker 3 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 yeah totally

Speaker 3 You got anything else about braces?

Speaker 4 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

Speaker 4 that span like the front five, and that was supposedly to keep them in place. Neat.

Speaker 4 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.

Speaker 3 Yeah. I'm guessing college years and maybe immediately after.

Speaker 3 Bing, bing, bing.

Speaker 3 That's how it goes, man.

Speaker 3 Let's see. Well, you don't have anything else about braces.
I don't either. Thanks to all the orthodontists out there for listening.

Speaker 3 And everyone, if I turn up assassinated in the next couple weeks, it's because I did figure out the big secret to orthodontics and insurance. Yeah.

Speaker 3 And Chuck said, yeah, so that means it's time for listener mail.

Speaker 4 You're going to wake up and Steve Martin's going to be over you with a dental drill.

Speaker 3 Oh, God.

Speaker 4 By the way, highly, highly, highly recommend the two-part documentary on Steve Martin.

Speaker 3 Okay. It is great.

Speaker 3 I didn't even know it was out.

Speaker 4 Yeah, it's been out for a little bit. It's really, really good, and it kind of makes me realize what a...

Speaker 4 I mean, I've always been a Steve Martin fan, but it really knocks home what a treasure he is as a human.

Speaker 3 I bet.

Speaker 4 Yeah, it's fun.

Speaker 4 And I just recently re-watched Three Amigos showed Ruby for the first time, which she thought was very fun.

Speaker 3 I've never seen that one. Oh, really?

Speaker 4 Yeah. That seems like it would have been one on your list.

Speaker 3 I don't, well, actually, I do know

Speaker 3 Why?

Speaker 4 Because Joshua. Oh, you don't watch Heavy Chase.

Speaker 4 Of course.

Speaker 4 He's the least funny part of the movie. You need to watch it for Martin Short and Steve Martin.

Speaker 3 I'll do my best. I'd rather watch Only Murders in the Building.

Speaker 4 No, I'm with you. I'm with you.
All right. Hey, guys.
This is, what is this about? This is, well, this is kind of about medical school, so it fits.

Speaker 4 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

Speaker 4 and immoderate users of snuff and Josh interprets this as puffy, pussy lumps in their noses.

Speaker 4 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 appears rather crass when written out.

Speaker 4 Instead, we use the word P-U-R-U-L-E-N, purulent, to avoid any potential misunderstanding if a patient reads the notes.

Speaker 4 Obviously, it's a little different in a podcast setting, which I doubt listeners are often reading in episode transcript.

Speaker 3 Oh, yeah, well, you'll look that up.

Speaker 4 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.

Speaker 4 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, and pathology.

Speaker 4 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.

Speaker 4 And that is from Gabe, who says, Hey, come to Ann Arbor, Michigan for a live show, and and we're maybe trying to work that out, Gabe.

Speaker 3 Yeah, we're batting it around, Gabe. Good idea.

Speaker 4 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.

Speaker 4 You know, not like 20 people, but you can get on the guest list.

Speaker 3 Yeah. Good idea, Chuck.
That's a foolproof plan. There's no possible way for identity theft.

Speaker 4 That's right.

Speaker 3 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.

Speaker 3 Send it off to stuffpodcast at iHeartRadio.com.

Speaker 1 Stuff You Should Know is a production of iHeartRadio. For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

Speaker 3 Everybody knows Shaq, but off camera, he's just a regular guy.

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Speaker 3 This information is provided by Lilly, a medicine company.

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Speaker 3 Listen to Untold Stories on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

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