Some modern dental procedures are done almost exclusively for appearance. These would include tooth whitening, veneers, and some bonding. However, most dental procedures serve to improve both a patient’s appearance and his or her prospects for health. Procedures often viewed as cosmetic, such as tooth crowning and dental implants as well as older methods of tooth restoration such as dentures, actually promote dental and general health as well as creating a more attractive appearance. The reason for this coincidence of results lies partly in our modern dental aesthetic. The sight of a natural-looking, well-aligned, and complete set of teeth is deemed attractive by our society. Not all societies have felt this way.
Many societies of the past have condoned evulsion (extraction) of healthy teeth. One dental practice, widespread for thousands of years in ancient China, Japan, and Hawaii, involved such evulsion. The teeth extracted in this practice were the visible incisors or canines, usually from subjects in their pre-teen or early teen years. Scholars believe that the extractions formed part of the rituals surrounding marriage and marriageable status. Though the motivations for the practice may be deemed cultural, rather than purely cosmetic, the resulting appearance of the teeth, affecting as it did most of the young adult population, must have been viewed favourably.
Intentionally produced tooth evulsion was also practiced by the Etruscans, an ancient group whose work was responsible for much of the skill displayed by dentists in imperial Rome. Evidence from the Etruscan civilization, from about 630 BC, indicates that it was fashionable for upperclass Etruscan women to have their healthy front upper incisors extracted for cosmetic reasons. Great dental skill was used in creating gold teeth, or gold fittings for real or artificial teeth, to be placed as substitutes. Unfortunately, for these women, obedience to the beauty standards of the day resulted in an immediate loss of tooth function as well as an almost inevitable shifting of the remaining teeth over time.
Marco Polo noted a less destructive example of cosmetic tooth practice in 1295 on a visit to southern China. There, both men and women wore thin, removable, gold caps over their normal teeth, purely for ornamentation.
Another custom, common in the past, was that of tooth staining. Although the stains used to dye teeth black sometimes served the function of bacteria reduction in the mouth, it is clear from historical accounts that much of the attraction of this habit was linked to fashion, rather than health. An example of this link can be seen when women in late nineteenth-century Japan were convinced to give up tooth staining immediately after the empress showed herself in public without the darkened teeth. Staining of the teeth was also once widespread amongst women of the Russian nobility. Peter the Great outlawed the practice in the early eighteenth century, but, up to this time, Russian noblewomen stained their teeth black and then kept them carefully polished in that condition. In some areas of the world, notably parts of Thailand and Vietnam, small groups of people continue to blacken their teeth. Indeed, some are even calling for a revival of the practice.
Tooth filing for aesthetic reasons has also formed part of many cultures. The Vikings filed their front teeth to produce horizontal patterns of lines which, some argue, were then coloured for effect. Africans also have a history of tooth filing, presumably for decorative purposes. An interesting culture, one which is known historically and has been photographed repeatedly, is that of the Iban people of Borneo. The culture features not only tooth filing and staining, but also ornamentation, such as brass studding, on the front teeth. Additionally, men of this group often give showings of tooth strength by holding large, heavy objects in the teeth while performing, a fact which suggests that pride of body is a strong motivation in their dental decoration.
Other groups, especially in the Americas, once filed teeth to points, created cross-hatched patterns on front teeth, or took out sections of material to reshape visible teeth for appearance. Additionally, some Mesoamerican skeletons show intricate inlays in the teeth. These probably began in the Pre-Classic period from about 100 BC to 300 AD, though the most famous of those studied come from the period 700 to 900 AD. The inlays would have produced an effect similar to that of jewelry displays in the mouth. To produce this ornamentation, indentations were first drilled in the teeth. Then, each one was fitted with a carefully shaped bit of jade, turquoise, mother of pearl, rock crystal, iron pyrite, or other decorative material. Intentionally created perforations in the enamel of the upper incisors, which were then filled with gold, were also popular in this culture. Again the motivation seems to have been primarily a display of status through bodily ornamentation.
Even currently, there are the interesting developments in youth subcultures which represent a return to decorative practices in and around the mouth. These developments would include the wearing of jewelry for tongue, lip, and cheek piercings. Additionally, some people are choosing to have gold tooth crowns, rather than white ones, placed in visible mouth areas to give a look of wealth and show. Even more ostentatious is the current fashion of wearing a piece of oral jewelry known as a grill. This is a kind of evening dental attire which fits over the teeth like a removable brace and features a display of gold and precious gems. Obviously, none of these practices conform to the modern dental aesthetic of a natural and healthy looking mouth.
It should be noted, of course, that these modern trends, though interesting and even attractive, are unlikely to take over general dental fashion in the near future. Neither should they be encouraged to do so. While showy crowns and grills are fairly neutral in their effects on dental health, the increasingly popular mouth jewelry in piercings can impede dental function and even damage dental structures. Hopefully, most people will continue to prefer the mix of health, good function, and natural attractiveness for teeth that our mainstream dental aesthetic so strongly promotes.