We've already covered tooth filing as a means of physical and spiritual modification, but what about the outright removal of human teeth? While exodontia is often necessary from a dental health perspective -- and has been practiced throughout history -- there's another side to the coin: the deliberate removal of teeth as a means to sculpt the individual's soul, spirit or mental state.
Traditional Healers and Haunted Teeth
While we could certainly venture down the rabbit hole of dental superstition and symbolism across numerous cultures, the actual practice of ritual extraction seems to come down to what writer Brendan Borrell refers to as a "sense of impotence in the face of bodily mysteries." Specifically, Borrell refereed to the plight of Ebiino or 'false-tooth disease' in Uganda [Source: Aeon Magazine]. Essentially, the superstition holds that a sick infant may have a "false tooth." If left in the child's head, this cursed tooth may result in the emergence of gum maggots -- and the "causes" range from infected maize to bewitchment. The only answer is to pay a traditional healer for the tooth's removal.
It's important to understand the contributing factors here. We're talking about individuals in an impoverished region where available Western medicine is still distrusted. High mortality rates, corruption, expense and facility shortcomings all result in a modern health system that feels alien and even a bit dangerous to someone accustomed to cultural-ingrained traditional healers. Elsewhere, in South Africa, the extraction of incisors is associated with race and social class -- their removal tied to the same sort of aesthetic tooth augmentations (sharpening, filing, etc.) found throughout Africa and Asia.
That's not to say traditional healers aren't also effective in the treatment of actual health concerns. In Cameroon, for instance, traditional healers do a decent job at tooth extraction -- and most extractions profiled in a 2011 Journal of Ethnobiology and Ethnomedicine paper stemmed from legitimate concerns such as tooth pain, looseness or "holes." While criticizing a lack of standard infection control methods and proper dental anatomy among traditional healers, the paper suggested mutual cooperation and collaboration between traditional healers and modern dentists, rather than a full-scale overwrite of traditional medicine.
But it all depends on how far one strays from dependable diagnosis into the realm of superstition and untested theory. Some of the more troubling examples of ritualized or otherwise unnecessary extraction come to us not from traditional African or Asian societies, but from North America.
Canadian Prenuptial Tooth Extraction
While rare, prenuptial tooth extraction practices still occur among Acadians (decedents of 17th-18th century French colonists) in regions of the Canadian provinces of New Brunswick, Prince Edward Island and Nova Scotia [Source: Gordon, et al]. In these cases, the women undergo (or seek to undergo) the extraction of all upper and/or lower teeth and obtain dentures prior to marriage. The reasoning for such an extreme procedure? In French-Canadian Prenuptial Dental Extractions in Acadian Women: First Report of a Cultural Tradition or Quebec Practice, the authors interviewed several regional dentists and Acadian locals to obtain some answers.
At least one account attributed the tradition to an alleged (and, frankly, dubious) British practice by which a colonist prepared for the wilds of the New World -- and its lack of dental care -- by removing one's teeth and replacing them with dentures. Other accounts suggested that dentures may have become a traditional dowry for young women in Acadian communities. But why? Why would a lack of natural teeth in a 16-year-old female equate reproductive superiority?
The authors' core argument is that it all comes down to an uncertain grasp of the connections between oral health problems, pregnancy and overall health. Certainly, before the advent of antibiotics, various medical conditions were blamed on chronic tooth infections. Can't figure the source of an ailment? Just remove that troublesome tooth. So what began as a half-blind attempt to ensure mother and child survival in a harsh environment may have become a brutal social norm.
In other words, we return once more to a "sense of impotence in the face of bodily mysteries."
Henry Cotton's Cure
Finally, viewers of Steven Soderbergh's "The Knick" likely remember the character Dr. Henry Cotton (John Hodgman), a turn-of-the-century psychiatrist who prescribes full dental extraction for not only his mental patients, but also his own children. While fictionalized, the writers based the character on an actual individual.
The real Dr. Henry Cotton (1876-1933) was a respected academic psychiatrist and served as superintendent of New Jersey's Trenton State Hospital. He was a huge proponent of modern medical practices, but when established methods proved ineffective in the physical treatment of mental illness, he turned to the bacteriological theory of disease. This was a promising area of early-20th century medicine. Doctors and scientists had identified the underlying biological causes for several major illnesses such as cholera and malaria. As a result of these gains, other professionals sought the biological underpinnings for a variety of conditions -- and some of them pursued their goal in desperation and folly.
We've already touched upon the correlation between oral infection and bodily illness -- and indeed, modern scientists continue to unravel the apparent connection between dental and heart health. In Cotton's day, however, a prominent theory by a pair of British surgeons linked untreated infections in the gums and intestines to toxified blood, resulting in pathological brain alterations [source: Ramchandani]. Cotton took this theory and ran with it.
In 1916, Cotton extracted the infected teeth from 50 mental patients -- and when this didn't help, he just removed all the remaining teeth for good measure [source: Ramchandani]. When this didn't work, he decided to chase the decay. The patients had clearly swallowed tainted saliva stemming from the oral infection, so he systematically removed tonsils, spleens and stomachs, colons and cervixes. Amid all this butchery, Cotton reported 85 percent cure rates for mental illness -- and was celebrated for it -- though the increased mortality rates (30-40 percent) seemed to have eventually curbed enthusiasm for Cotton's cure [source: Wessely]. Eventually, psychoanalysis gained steam while colectomies continued only at Trenton asylum until Cotton's death in 1933.
Is there a connection between oral hygiene and overall health? Undoubtedly. Studies have even linked tooth loss to changes in memory and overall health. But lacking proper scientific understanding and ethical vigor, the mere correlation opens the door for a lot of unnecessary and even ritualized dental extraction.
Higher Human Forms is an ongoing blog series profiling the many fascinating ways in which humans have reshaped their bodies throughout human history. To quote plastic surgeon Joe Rosen, "The body is a conduit for the soul, at least historically speaking. When you change what you look like, you change who you are."