Making the American Mouth

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Making the American Mouth

Critical Issues in Health and Medicine
Edited by Rima D. Apple, University of Wisconsin–Madison,
and Janet Golden, Rutgers University, Camden
Growing criticism of the U.S. health care system is coming from consumers,
politicians, the media, activists, and health care professionals. Critical Issues in
Health and Medicine is a collection of books that explores these contemporary
dilemmas from a variety of perspectives, among them political, legal, historical,
sociological, and comparative, and with attention to crucial dimensions such as
race, gender, ethnicity, sexuality, and culture.
Emily K. Abel, Suffering in the Land of Sunshine: A Los Angeles Illness Narrative
Emily K. Abel, Tuberculosis and the Politics of Exclusion: A History of Public Health and
Migration to Los Angeles
Susan M. Chambré, Fighting for Our Lives: New York’s AIDS Community and the Politics
of Disease
James Colgrove, Gerald Markowitz, and David Rosner, eds., The Contested Boundaries of
American Public Health
Cynthia A. Connolly, Saving Sickly Children: The Tuberculosis Preventorium in American
Life, 1909–1970
Edward J. Eckenfels, Doctors Serving People: Restoring Humanism to Medicine through
Student Community Service
Julie Fairman, Making Room in the Clinic: Nurse Practitioners and the Evolution of
Modern Health Care
Jill A. Fisher, Medical Research for Hire: The Political Economy of Pharmaceutical
Clinical Trials
Gerald N. Grob and Howard H. Goldman, The Dilemma of Federal Mental Health Policy:
Radical Reform or Incremental Change?
Bonnie Lefkowitz, Community Health Centers: A Movement and the People Who
Made It Happen
Ellen Leopold, Under the Radar: Cancer and the Cold War
David Mechanic, The Truth about Health Care: Why Reform Is Not Working in America
Alyssa Picard, Making the American Mouth: Dentists and Public Health in the
Twentieth Century
Karen Seccombe and Kim A. Hoffman, Just Don’t Get Sick: Access to Health Care in the
Aftermath of Welfare Reform
Leo B. Slater, War and Disease: Biomedical Research on Malaria in the Twentieth Century
Rosemary A. Stevens, Charles E. Rosenberg, and Lawton R. Burns, eds., History and
Health Policy in the United States: Putting the Past Back In

Making the American Mouth
Dentists and Public Health in the
Twentieth Century
Alyssa Picard

Rutgers University Press
New Brunswick, New Jersey, and London

Librar y of C ongr e s s C a t aloging - in - Public a tion Da t a
Picard, Alyssa.
Making the American mouth : dentists and public health in the twentieth century /
Alyssa Picard.
p. ; cm. — (Critical issues in health and medicine)
Includes bibliographical references and index.
ISBN 978–0-8135–4535–6 (hardcover : alk. paper)
1. Dental public health—United States—History—20th century. 2. Dentistry—United
States—History—20th century. I. Title. II. Series.
[DNLM: 1. History of Dentistry—United States. 2. History, 20th Century—United
States. 3. Public Health Dentistry—history—United States. 4. Social Identification—
United States. WU 11 AA1 P5862m 2009]
RK52.2.P53 2009
362.19'7600973—dc22
2008035426

A British Cataloging-in-Publication record for this book is available from the British Library.
Copyright © 2009 by Alyssa Picard
All rights reserved
No part of this book may be reproduced or utilized in any form or by any means, electronic
or mechanical, or by any information storage and retrieval system, without written
permission from the publisher. Please contact Rutgers University Press, 100 Joyce Kilmer
Avenue, Piscataway, NJ 08854–8099. The only exception to this prohibition is “fair use” as
defi ned by U.S. copyright law.
Visit our Web site: http://rutgerspress.rutgers.edu
Manufactured in the United States of America

“[O]rganized dentistry had no power to influence . . . underwriters and
management, but when faced with the threat of a strike to enforce
the same demands from unions, they acquiesced.”
Joseph Yany Bloom, 1962

For GEO

Contents

List of Illustrations

ix

Acknowledgments

xi

Introduction
Chapter 1

Chapter 2

Chapter 3

Chapter 4

1

American Dental Hygiene: “Small Flags
Attached to Toothbrushes May Be Waved”

14

Diet and the Dental Critique of American Life:
“We Boast of Our Civilization, But We Starve Our Children”

42

“Like a Sugar-Coated Pill”:
Defining American Dentistry Abroad

72

“This National Stupidity”:
American Dental Economics in the 1930s and 1940s

99

Chapter 5

Behind the Fluorine Curtain

117

Chapter 6

The “Satisfaction of Dentistry” and the
End of Public Health

141

The Look of the American Mouth

158

Epilogue

175

Notes

183

Index

217

Chapter 7

vii

Illustrations

1.

Alfred Fones’s second class of dental hygienists, performing
cleanings on Boy Scouts

26

2.

The amphitheater in the Forsyth dental clinic, 1914

29

3.

Human profiles in relationships to apes’

45

4.

Teeth of Philippine Moro headhunters in 1904

89

5.

Children on the front lawn of the Kapaa School in a
“toothbrush drill,” 1930

6.

Before and after treatment for arthritis caused by dental infection

7.

“Mottled enamel” as portrayed in Frederick McKay’s 1925
article on fluoride

8.
9.

95
103

119

A lecture on “sexology” at a meeting of the National Dental
Association, 1977

149

Advertisement for Bioblend dentures, 1967

166

ix

Acknowledgments

A polymath community of friends and colleagues spread across several workplaces supported me in the writing of this book.
I had research help from the University of Michigan’s talented and
knowledgeable dental librarian, Patricia Anderson. At the Price-Pottenger
Foundation in La Mesa, California, activist and archivist Marion Patricia
Connolly set me loose in a gloriously (perhaps even perilously) freewheeling
collection of documents. Research assistant Sarah Katherine Miller culled
the fi les of the Wayne State University archives for news on the fluoridation
debates in 1960s Detroit.
Teachers and writers Martin Pernick, Joel Howell, Regina MorantzSanchez, and Daniel Wilson, and University of Michigan Dental School dean
Peter Polverini, each read this manuscript in early drafts; their wise comments
enriched and encouraged this project. Historian Terrence McDonald looked
puzzled at the idea, which improved it. Philosopher David Dick, sociologist
Cedric de Leon, historians Karen Miller and Amy Hay, and the members of
the University of Michigan American History Workshop contributed probing
questions and enthusiasm. Periodontist Jill Bashutski produced the X-ray
image of my mouth that appears on this book’s cover. I am also grateful to
Rutgers University Press editor Doreen Valentine, to copy editor Dorothy
Meaney, to the Press’s permissions manager, Christina Brianik, and to the
Press’s anonymous reader, for their direction and skillful work.
The image of the Kapaa School used in chapter 3 is with kind permission of the American Dental Association. The image of hygienists attending
the National Dental Association’s convention that is featured in chapter 6,
and the Bioblend advertisement that appears in chapter 7, are used with kind
permission of the National Dental Association. Materials in chapter 2 from
the personal papers of Weston A. Price are used with kind permission of the
Price-Pottenger Nutritional Foundation™, www.ppnf.org.
Financial support for this project came from Rackham Graduate School
at the University of Michigan, the Regents Fellowship program of Michigan’s
College of Literature, Science, and the Arts, and the vacation provisions of
the contract between the American Federation of Teachers’ Michigan state
affi liate and its staff union.

xi

xii

Acknowledgments

Staff, leaders, and activists at AFT Michigan and its locals gave me a
window on the power and potential of American public schools, and on the
strengths and weaknesses of the employment-based system of health insurance. Together with my fellow labor educators at Wayne State University,
they also shared with me their understandings of the ideals underpinning
some of the most memorable American programs of social reform. I am in
debt to my colleagues in both places for their support of me, and of the big
ideas that animate this book.
Ann Arbor
September 2008

Making the American Mouth

Introduction

I was sitting in a university dining hall one afternoon in 1999 when I found a
curious advertisement in a copy of the Wall Street Journal that I’d scavenged
from the building’s recycling bin to read over lunch. In it, a Lexus logo floated
in the middle of a small sea of blank newsprint. Above the logo was one line of
type: “Naturally,” it read, “all our children wear braces.” Beneath it was another,
the Lexus tagline: “The Relentless Pursuit of Perfection.” The ad accomplished
a lot with very little, and I was momentarily taken aback by how much its producers felt they could assume about Wall Street Journal readers.1
Where did the ad come from? How, in that time and in that place, did it
seem so obvious that getting one’s children’s teeth fixed was “natural”? How
could an ad seeking to trade on a shared stock of ideas for sales so comfortably assert that there was something normal, effortless, and socially sanctioned
about the “relentless pursuit of perfection,” and that such a pursuit ought to be
carried out not only in automotive engineering, but in the intimate interstices
of the human body? Why could the ad’s creators be so certain that it was clear
to every reader what counted as “perfection,” anyway? There was no doubt,
however, that the Lexus adwriter’s finger was on a pulse that beat steadily and
pervasively in American consumer culture at the end of the twentieth century.
The ad’s central assumptions about what Journal readers might consider “natural” were accurate, and this book is the story of how that came to be.
The Lexus ad, of course, was not the only place where late twentiethcentury American consumers could fi nd dental themes represented in advertising. Dentists themselves were aggressively marketing their orthodontic

1

2

Making the American Mouth

and tooth-whitening services in a wide range of popular forums, consistently
linking the promise of healthy, good-looking teeth with the prospect of future
success in all areas of life. A puff piece in a 1998 issue of Town & Country featured “smile designer” Larry Rosenthal describing his use of “ceramics, laser,
and NASA technology,” and counseling, “Think of it as a cosmetic smile
lift.”2 Between 1996 and 2000, the membership of the American Academy
of Cosmetic Dentistry doubled.3 With relatively little explanation, popular
news sources described the obsession with dental appearance as uniquely
American: a New York Times article on tooth whitening quoted a London
musician as saying “When I go on tour, I know which country I’m in because
of the smiles in the audience. You know you’re in America because of the
piano teeth.”4
Many of the foundational assumptions of the Lexus ad, like the surging popularity of aesthetic procedures and the reputation of late twentiethcentury Americans as being possessed of uniquely good teeth themselves,
would have surprised the dentists of the early twentieth century. These
early dental professionals shared the Lexus ad writers’ sense that good dental health could be properly read as a signal of other individual and national
characteristics. But they despaired of convincing Americans, whom they
regarded as having the worst teeth in the world, of the importance of good
dental care. They would have been pleasantly surprised to fi nd that their
services had become such a “natural” adjunct to American class aspirations. They would have been shocked by the unevenness of Americans’
access to dental care, however, and by the ways in which an income-linked
disparity in access to services both reflected and contributed to increasing
class stratification in the United States.
In the early twentieth century, Americans placed a low priority on
dental health. Particularly among the working and lower-middle classes, it
was common—and not considered particularly alarming—for tooth decay
and gum disease to result in missing teeth. Because dental practitioners
were comparatively few and surviving records of their work on individual
patients virtually nonexistent, it is hard to quantify the prevalence of tooth
loss. Military fitness examination records, however, provide some indication: in 1916 the army standard of dental health consisted of having “six serviceable double (bicuspid or molar) teeth,” with at least two sets of opposing
teeth on one side of the mouth and no less than one set on the other. Onethird of all applicants failed this standard, and were rejected from military
service as a result.5

Introduction

3

The commonness of tooth decay and gum disease, and resultant tooth
loss, meant that when early twentieth-century Americans thought about their
teeth, they were usually thinking about pain. The misery of toothache itself
paled in comparison to the iniquities visited upon a patient in the dental
office, where he could expect to fi nd dirt, blood, germs, an array of distressingly primitive instruments, and the occasional domestic animal. At the turn
of the century, private dental offices typically lacked electricity and hot water;
dentists used foot-treadle drills with slow mechanisms that made drilling
more time consuming—and more painful. Ether anesthesia was available, but
its side effects (most notably headache and vomiting) made it an unattractive
option. Though the tenets of modern bacteriology were known to dentists,
offices were rarely arranged in a way that made infection control possible.
Private dentists’ chairs were heavily padded with unsterilizable upholstery,
and the business aspects of practice—writing out of bills and collection of
payment—were often performed within feet of the dental chair. In 1907, a
Russian exile dentist described the sanitary conditions of the New York dental office in which he found employment. “There was a distinct absence of
disinfectory means,” he wrote. “I can hardly express my feelings and surprise
at seeing . . . absolute ignorance of asepsis and antisepsis. . . . My only answer,
when calling attention to the above conditions, was a laugh from the dentist
and his assistants.”6 Patients who lived in proximity to the few dental colleges of national renown could expect better sanitary conditions and more
advanced anesthetics at college clinics, but they would typically receive care
in large, open operatories where they were exposed to the agony of others’
treatment, and vice versa.
Together with the sparse distribution of dental care providers, the
unpleasantness of time in a dental chair made contact with dentists a rare
event for most. The resultant historical memory of toothache in this era—
epitomized by the image of a patient whose swollen jaw was bound up with a
rag or bandana—correctly reflects Americans’ propensity for self-care. Most
people treated toothache at home with poultices, or with widely advertised
patent nostrums—which, until the passage of the 1914 Harrison Act placing
narcotics under the control of physician prescriptions, frequently contained
enough opiates to make them very effective painkillers.7
Slowly, however, a variety of providers, of more or less reputable provenance, emerged to fill the unmet need for dental care. Legendary dental
practitioner Edgar Randolph “Painless” Parker, who had obtained a DDS
degree at the Philadelphia Dental College in the 1890s, grew a very successful

4

Making the American Mouth

business in the early decades of the century by exploiting both the shortage
of other trained dentists and patients’ fear of suffering. Parker invented and
then popularized hydrocaine, a cocaine-based topical anesthetic, but his real
appeal was aesthetic rather than anesthetic in nature. The practitioner, who
traveled widely across the United States, cut a flamboyant figure in his jaunts
around the country: he was well-known for his top hat and necklace made
of 357 extracted teeth, all of which he claimed to have removed in one day.
His entourage, which sometimes included a circus with acrobats, jugglers,
tap dancers, and magicians, was specially formulated to appeal to workingclass Americans, who had to take entertainment where they could get it.8
Parker’s brass band was particularly popular, though some speculated that it
was provided partly to cover the noise made by Parker’s own agonized dental patients.9 This merry coterie of providers and performers helped Parker
to collect millions in fees (at fifty cents per extraction) from patients who
sought pain-free dentistry—or at least distraction—in the dental chairs of
his traveling clinic. Later in his career, Parker established a national chain of
low-cost dental clinics, which mirrored his exuberant self-presentation with
alliterative signs describing the practices as “Philosophically Predisposed to
Popular Prices.” The Flatbush Avenue, Brooklyn clinic featured a block-wide
sign reading “I am positively IT in painless dentistry,” in which the word
“IT” was almost two stories high.10
Despite his appeal to patients, Parker rapidly found himself in the bad
auspices of the better-trained, less exuberant, and more reputable dentists
of the increasingly prominent National Dental Association (NDA, renamed
the American Dental Association in 1921), who regarded him as a charlatan and his conduct as a public health hazard. Partly because of Parker and
others who aspired to his popularity, the NDA aggressively promoted laws
and regulations restricting the practice of dentistry to licensed graduate dentists, and giving its affiliated dentists control over the licensure process. They
described Parker as a “menace to the dignity of the profession.” “Painless”
Parker was arrested many times, most frequently for fraudulent advertising
on the grounds that he was practicing under an assumed name, until in 1915
he legally changed his fi rst name to “Painless,” making it possible for him to
use the moniker in his publicity without fear of prosecution.11
It was not uncommon for those squeezed out of dental practice by the new
legislation and regulations promoted by the NDA to regard such measures as
the hallmarks of dangerous collusion among a prosperous elite. “Painless”
Parker, in his traveling lectures, frequently derided the NDA as a “trust”

Introduction

5

designed to ensure the maximum fi nancial benefit for its members at the
expense of dental patients. Parker’s sense that the restrictive policies of the
NDA were part of an apparatus devoted to the elimination of old-fashioned
entrepreneurial competition was widely shared. The American naturalist
writer Frank Norris, for one, regarded it as a fact so well-established that
he could thread it insidiously throughout his 1899 portrayal of a selftaught California dentist, the eponymous McTeague. Like “Painless” Parker,
McTeague was caught in the crossfi re between self-trained craftsmen and
better-educated advocates of a more regularized and scientific professional
practice. McTeague prided himself on his status as a provider of a specialized
service in a rough-and-tumble community, and on the increasing luxury of
his office appointments, symbolized most vividly by the enormous gilded
tooth his wife, Trina, purchased for display on McTeague’s office signage.
When served with notice that his early apprenticeship with “more or less of
a charlatan” was insufficient to qualify him as a dentist under California’s
new state licensing laws (a letter that had to be read to him by his wife,
owing to McTeague’s illiteracy), McTeague stammered to Trina: “Ain’t I a
dentist? Ain’t I a doctor? Look at my sign, and the gold tooth you gave me.
Why, I’ve been practising nearly twelve years.”12 Thwarted in his business
aims, McTeague later died in a showdown in the California desert, undone
by the lack of a legitimate outlet for his festering, toxic greed.
In the early twentieth century, however, luxuries like McTeague’s gold
tooth were no longer sufficient to establish one’s bona fides. The dentists
of the largest national dental organization read them as signs of a suspect
refusal to embrace the new standards of science and professionalism that
were increasingly influencing American health care. Like the physicians
of the American Medical Association, these dentists sought to incorporate
the insights of the germ theory of disease, the refi nement of aseptic surgical
technique, the improvement of anesthesia, and new developments in bacteriology, chemistry, and materials science into their practices. They promoted
preventative and reparative dentistry over the archaic standby, tooth extraction. Like their physician counterparts, dentists who had mastered these new
concepts hoped to raise meaningful barriers to entrance into the practice of
dentistry of those, like McTeague, who had not.13
Though they lagged behind physicians’ programs of professionalization
by more than a decade, efforts to standardize dental education and training in the United States roughly paralleled similar undertakings in medicine. Abraham Flexner’s report on the state of American medical education,

6

Making the American Mouth

commissioned by the Carnegie Foundation for the Advancement of Teaching
in 1910, helped buttress the case of reformers who advocated the closing of
proprietary medical colleges and the standardization of medical training in
the United States. As a result, the American Medical Association successfully advocated for the establishment of a four-year training period following two to four years of college as the standard for medical education.14 In
some respects, leading figures in early twentieth-century dentistry succeeded
in advocating for similar change: from 1891 to the early 1920s, the training
required of those seeking DDS degrees expanded from two years of practical
training with no educational prerequisite to three years—often, at the best
dental schools, with a prior year of college as a requirement.
However, debate within dentistry about how to standardize educational
requirements for licensure prevented decisive movement in any one direction.
There were three “reform” camps. “Stomatologists” argued for the establishment of dentistry as a medical specialty; advocates of the “level-technician”
plan posited that lesser-trained assistants supervised by medically trained
dentists should do most dental work; and proponents of the “reformed autonomous” plan advanced a more rigorous version of the existing standards for
entry into the profession. As a result of this disarray among advocates of
reform, dentists’ educational requirements continued to trail behind those of
physicians, and licensure to practice dentistry in most states did not require
graduation from dental college. Many practitioners got their training through
apprenticeships. Standards for the training of dentists and the practice of
dentistry remained varied until well after the Carnegie Foundation’s 1926
publication of William Gies’s report on dental education, which helped to
establish the “reformed autonomous” standard of a liberal arts degree followed by a period in professional school as the educational threshold for
entering dental practice.
The persistence of a system of training through apprenticeship made entry
into the profession particularly difficult for women, African Americans, and
some recent immigrants to the United States. Prevailing cultural beliefs about
the lack of mechanical aptitude—and low intellectual potential—of these
groups meant that existing professional networks rarely expanded to accommodate them in apprenticeships. Formalizing educational attainment as the
barrier to entry to the profession could make achievement of admission just as
difficult. The educational institutions where training could be had systematically excluded female, black, and Jewish applicants, and without a network of
amenable practitioners to depend upon, it was difficult for individuals from

Introduction

7

any of these groups to accumulate the professional endorsements needed for
licensure.15 The few women who were able to enter dental practice frequently
confi ned their practices to the treatment of children. A similarly small number of African American dentists received training at historically black colleges. Despite their qualifications, they were often denied membership in
state and local dental societies, particularly in the South. Because full membership in the National Dental Association, and later the American Dental
Association, required joining one’s local and state constituent groups, any
dentist who was excluded from full membership in a state or local association
was effectively excluded from the national group, though he was sometimes
allowed the hopelessly misnamed “courtesy membership” at one or more levels of the organization. As a result of this segregation, black dentists formed
their own associations at the local, state, and national levels.16
Debate within the profession about how—and how high—to raise the
requirements of those who sought to practice dentistry insistently refused to
acknowledge these omissions, focusing instead on the question of whether to
erect barriers that divided white men (who, the Irish Catholic McTeague notwithstanding, were generally Protestant) from one another. For example, in
1926, the editor of the Journal of the American Dental Association, C. N. Johnson, described efforts to establish full medical training as the educational
standard for dentists as the “pathetic apeing of those of supposed superior
position in life,” and proclaimed it “humiliating to the members of our profession who have any self respect.”17 In general, however, dentists regarded
legislation and regulations restricting entry to their field as salutary signals
of increasing professionalization in an occupation previously dominated by
hacks. To these practitioners, adoption of the accoutrements of science and
a resultant enjoyment of high social and economic status demonstrated a
dentist’s adherence to the emerging vision of “professionalism” in American
dentistry. Recognition as professionals, they felt, would enable dentists to
speak authoritatively to the public on matters of dental health and disease.
This was, they believed, a task that demanded both advanced training and a
sedate remove from the vagaries of commerce—something that “advertisers”
like “Painless” Parker lacked.
The idea of professionalism enticed dentists in the early twentieth century, and debate over what would defi ne the boundaries of professional status flourished even among those whom “Painless” Parker blithely dismissed
as “the ethicals.” Powerful voices militated not only in favor of qualifications like university training and state licensing, but for broader professional

8

Making the American Mouth

engagement facilitated by a proliferation of conferences and journals, and,
implicitly, for the high levels of literacy and shared bourgeois norms of public
interaction that facilitated such undertakings. Expectations for office behavior (of practitioners and patients) as described in major national journals
hewed toward the gentility of the middle class. Both salaries and job security
increased dramatically over this period, making dentistry a status pursuit on
par with medicine and theology.
Together with the idea of professionalism, the question of what norms
and practices would be defi ned as “American” interested early twentiethcentury dentists greatly, and influenced their positions for and against certain kinds of interventions. Like American physicians, American dentists in
the early 1900s participated consciously and overtly in an effort to distinguish American health care, including dental care, from that available elsewhere. In their view, a properly understood American version of health care
would prioritize specific, expert knowledge exercised by master practitioners
in clean, orderly, modern environments. The success of this sort of dental
care was predicated on compliance from patients in matters of treatment
and billing, but its providers also understood themselves to have affi rmative
professional and patriotic obligations to promote policies ensuring access to
essential health care, including dental services, for the American public—
and especially for children.
With very few exceptions, early twentieth-century American dentists
were not socialists. Like physicians of the era, most were entrepreneurs who
ran their own practices and felt strongly about their opportunities to command payment from patients, and to control the terms on which payment
was rendered. Indeed, they frequently described these opportunities as the
chief blessings of American citizenship. Therefore, like the architects of most
contemporary American programs for social betterment—whether public or
private—dentists aimed their activism not at leveling social conditions, but
at “helping those who helped themselves.”
Though dentists believed that government and private charities should
avoid unnecessary largesse, which threatened to “pauperize” individuals
who might be able to pay privately for their own care, they also believed that
the existence of a large population of Americans with untreated dental problems reflected badly on their profession and on the nation as a whole. As a
result, they often promoted measures that facilitated access to dental care in
a hands-on fashion—particularly for children, but even, when needed, for
poor adults.

Introduction

9

By the end of the century, however, dentists had largely succeeded in
their campaign for professional respect, and thereby had lost an important
motivation for making dental care readily accessible to patients. Most dentists, and the organizations and publications of the dental profession, were
fi rmly in the camp of individual responsibility for dental health care—
adults, they thought, had an obligation to plan and pay for both their own
dental care and that of their children. Dentists supported the fluoridation of
public water supplies partly in defense of their professional prerogatives to
make judgments in the area of dental public health. Yet they opposed dental
insurance programs, and militated against the establishment and expansion
of state and federal programs for the provision of free care to the impoverished. Instead, they promoted a new vision of dentistry as a method for
lifestyle improvement, and a site for conspicuous consumption. Slowly, a
consensus emerged—within and outside the profession—that Americans’
teeth could be used reliably as an index of their personal or familial adherence to a set of aspirational norms about socioeconomic status and personal
appearance.
As a result, by the end of the twentieth century, dentists increasingly
defi ned as “American” government and professional policies that maximized
individual providers’ abilities to build and maintain economically successful
practices, and promoted time-consuming, high-cost individual interventions
to patients able to pay individually for such procedures. Orthodonture and
tooth whitening could improve patients’ appearances, gaining them access to
the competitive, appearance-conscious upper socioeconomic strata. Even the
experience of sitting in the dentist’s chair was becoming the kind of indulgence previously enjoyed only by the very rich: in 2003, half of all dentists
surveyed by the American Dental Association “said they offered some sort
of spa or office amenity. Most common were neck rests, warm towels, and
complimentary snacks and beverages. Five percent offered massages, facials,
manicures and pedicures.”18
Like physicians, dentists had once considered the promotion of such luxury crass. Propriety, they felt, required them to strive for the common good
of the profession and the American people, rather than for narrow individual
gains. They endorsed the subtle promotion of dental services that could be
accomplished by a satisfied patient’s display of her healthy, beautiful mouth.
The direct solicitation of business, like that in which “Painless” Parker
engaged, would never do: advertising both signaled a betrayal of one’s professional peers and revealed that the advertising practitioner prioritized his

10

Making the American Mouth

fi nancial gains over his patients’ interests. During the course of the twentieth
century, however, dentists’ collective vision of how they ought to behave—as
professionals and as citizens—slowly changed focus. The outcome was the
conviction that both professionalism and Americanism required a system in
which patients, practitioners and government held paramount the pursuit of
the highest individual good.
The changes that took place within the dental profession during the
twentieth century were, at times, hotly contested ones. The relatively elite
group of dentists who controlled the major dental journals and professional
organizations throughout the twentieth century were heavily invested in
increasing the status of their profession, raising the standards of dental practice, and convincing patients of the importance of dental care. However, they
faced opposition not only from figures like “Painless” Parker, who feared for
their livelihoods, but from other licensed, reputable dentists who—while
agreeing with the aims of reformers—disagreed with the specific methods
the organization advocated for achieving them. After about the 1920s, for
example, practitioners who were published in major national dental journals
thought that annual tooth cleanings were essential, but dentists who read the
journals and wrote letters to their editors, or responded to public talks given
by advocates of dental hygiene, frequently disagreed. In the 1960s, professional journals urged dentists to become spokesmen for water fluoridation in
their communities, but relatively few practitioners followed this advice, and
some received it with open hostility. By the end of the century, authors and
editors routinely genuflected toward the social and economic importance of
orthodontics for those aspiring to the middle class, but dentists who served
low-income populations—particularly those with large cohorts of minority
patients—struggled to make basic preventative dental services available in
their communities, and sometimes resented the feel-good message of upward
progress articulated by the ADA.
Other workers in the dentists’ office had to be persuaded of the necessity for change, too. The increasing presence of female dental assistants,
hygienists, and lab technologists in dental offices reflected the growing specialization of dentists’ work in the twentieth century, and meant that these
auxiliaries’ cooperation with new modes of practice (and of business) would
be essential. In addition, other professionals needed to be deflected or rebutted when dentists proposed change that impinged upon their professional
prerogatives: pediatricians, for instance, objected to dentists’ claims that
dentists ought to prescribe children’s diets.

Introduction

11

Finally, of course, patients had to adjust to the changes that a small group
of comparatively high-status dentists sought to create. In the early decades
of the twentieth century, though dentists increasingly prioritized “defi nite”
and “orderly” systems of practice, patients continued to arrive late to appointments, object when they were asked to pay their bills “up front,” engage in
unseemly attempts to negotiate about fees, and question or reject dentists’
judgments about what ought to be done to their teeth and when. Individual
dentists—typically male, white, and Protestant—viewed these patient behaviors as annoying evidence of patients’ gender, racial, or ethnic idiosyncrasies,
focusing on the connections between patients’ clothing, ethnic characteristics, and markers of social class, and their willingness to cooperate with treatment. For instance, dentists and hygienists who treated young children in
publicly funded hygiene clinics in the nineteen-teens and -twenties frequently
noted the hostility of “slovenly” and “superstitious” immigrant parents to the
dentists’ insistence that they stop feeding their young children coffee and
garlic. Acceptance of such tenets, and alteration of a family’s lifestyle habits,
provided evidence that they had not only seen the wisdom of dental professionals’ advice, but moved one step closer to successful assimilation.
The pace of the change that elite dentists sought in the twentieth century was significantly affected by patients’ collective propensity to view dental health as important, dentists as admirable experts, and dental treatment
as a necessary expense. Rejection of these ideas by early twentieth-century
patients who were unconvinced of dentistry’s value, and by patients who
decided to defer or forgo needed dental care during hard economic times
throughout the century, meant less business and less income for dentists. In
turn, improvements in these areas helped to stoke the late-century increase
in individualist cosmetic dental interventions. The Wall Street Journal’s 1999
Lexus ad spoke volumes about dentists’ long-term success in convincing
patients of these claims. Its writers could depend on the existence of a pool
of customers (and aspiring customers) who had fully accepted the need for
advanced dental care. The ad they produced on the basis of this assumption
was a document rich with a language of mutual identification (addressing the
reader as part of “our” group) and the sharing of common preoccupations (the
“relentless pursuit of perfection” and the raising of children, for example).
At the end of the twentieth century, clothing, makeup, other bodily
interventions like plastic surgery and exercise, and even the choice of leisure
activities were sites for the communication of information about one’s social
standing.19 Readers of the Wall Street Journal might have been expected not

12

Making the American Mouth

only to know this fact but to embrace it. The advertiser might easily have
chosen to showcase instead the claims that “Naturally, all our wives have
had breast implants” or even “Naturally, we all go to Cabo San Lucas on
vacation.” One of the things the Lexus ad assumed—through its reflexive
deployment of this particular set of connections between cars and orthodontic care—was the existence of a shared stock of knowledge and beliefs
about dentistry, in particular, among readers of the ad. Dentists’ belief that
adherence to dentists’ advice was a sign of a patient’s good judgment and
social aspirations was reflected and reinforced by popular culture, as the
promotion of “smile design” in the tony Town & Country magazine illustrated. That shared popular culture, of course, was intensely circumscribed
by boundaries of class, race, and gender: it’s revealing not only that the Lexus
ad appeared at all, but where it appeared, and who might have been expected
to read and respond to it.
Whatever the Lexus ad writers might have thought, there was nothing
historically obvious or inevitable, and still less “natural,” about the understanding of the role of orthodontic care for children in creating and demonstrating socioeconomic status that was displayed in their work. Though
social pressure provided powerful impetus for Americans’ participation in
an increasingly costly culture of personal aesthetic improvement, dentists’
vigorous efforts to assert their own professional interests played the largest
role in bringing the new model of individualistic intervention to fruition.
You couldn’t have proven this by my own adolescent experiences, however:
I had eight years of orthodonture in a suburb of New Jersey where we teenagers could identify one another’s social status not only by clothing, parents’
occupation, and location of our homes in old or new developments, but also
by which of the two orthodontists in town our parents had chosen to fi x our
teeth. (My orthodontist, by virtue of having a second office located in nearby
Princeton, was considered the ritzier of the two.) These providers advertised
their services minimally, if at all. It would have surprised most of us, and our
parents, to hear that they and their professional organizations—and particularly the ADA—had played such an active role in shaping our shared belief
that it was important to have straight teeth. Nevertheless, reflection on popularculture manifestations of Americans’ thinking about dentistry can help to illuminate not only the moments at which dentists’ ideas about teeth and their care
were adopted and by whom, but also the moments at which those ideas were
contested, and how that contestation contributed to the stock of American
notions about dentistry and its importance.

Introduction

13

Ten years ago, as I chatted at a party with an acquaintance who had
grown up poor in Ireland, he remarked wryly about “you Americans and
your teeth!” I knew right away what he was talking about—those eight years
of visits to the orthodontist’s office were vivid in my mind—but I had not
thought about the ways in which inquiring into my own experience of dental
care as a marker of class, education, nation, and age might provide the basis
for an engaging or useful historical project. In this book, I try to demonstrate
how the connections I lived at the end of the twentieth century were formed,
while tracing the ways in which dentists used the opportunity to make and
re-make such linkages in order to build their self-images (and the lay public’s
image of them) as health care professionals. This book has things in common
with other histories of medicine and public health, and of the development
of the health professions, but it also seeks to engage with histories of consumer culture and behavior, and with work that explores the ways in which
American identities have been shaped and re-shaped in the twentieth century. It offers a new view of how these diverse bodies of literature connect,
and a history of the ideas that grew where these streams of American life
came together.

Chapter 1

American Dental Hygiene
“Small Flags Attached to Toothbrushes May Be Waved”

In 1910, the eyes of dentists around the country fi xed on Cleveland, Ohio,
and its suburbs. There, local officials, in cooperation with the Oral Hygiene
Committee of the National Dental Association, had begun a new program of
publicly funded oral hygiene education and dental prophylaxis for schoolchildren. Dentists hoped that the program would help to persuade Americans of the importance of preventative dental care and periodic consultation
with licensed dentists to overall good health. The results of this program
would profoundly shape Americans’ ideas about what could and ought to
be done for children’s dental health, as well as their ideas about what habits
of oral hygiene and health could be properly regarded as American. School
oral hygiene programs helped link national identity with good dental health
and an aesthetically pleasing appearance. Simultaneously, these programs
influenced contemporary ideas about the roles of the school and the state, the
constructions of childhood and citizenship, and the gender roles of dental
health care workers.
Cleveland, Ohio, offered several advantages to dentists hoping to demonstrate the value of a publicly supported oral hygiene campaign. It was a
thriving manufacturing city and an attractive place of landing for immigrant
workers, whom dentists regarded as particularly in need of dental care because
of their low incomes, poor health, and intransigent refusal to adapt to American ways of life. Among Cleveland’s immigrants were significant numbers of
Jews and Italians. Dentists, like turn-of-the-century social workers, regarded
these two groups as the most difficult to assimilate; if the hygiene program

14

American Dental Hygiene

15

worked in Cleveland, it could work anywhere. Cleveland had large and active
state and local dental societies whose members were willing to participate
in an oral hygiene campaign. The city was the home of several nationally
prominent dentists who held powerful positions in the increasingly visible
National Dental Association. Most importantly, the local school board and
government officials were cooperative. National dental leaders trusted them
to participate in the program without playing favorites or indulging in the
practices of corrupt government (like taking bribes or seeking kickbacks) so
common among early twentieth-century politicians, and so feared by scientifically minded bureaucrats everywhere.
Local planners expected the inauguration of the Cleveland campaign to
be an event of national significance. The President of the United States, William Howard Taft, and the governors of all the states were invited to attend
the March 1910 kickoff, which lasted for an entire afternoon and evening
and featured speeches by local, state, and national figures in politics and
dentistry, as well as musical performances by several groups of Cleveland
schoolchildren. Though Taft himself did not attend, he sent a former assistant surgeon general as his personal representative. The Dental Brief, one of
several prominent national professional journals, carried the entire proceedings of the opening rally in its May, June, and July issues, and referred to the
campaign as “the greatest ever organized for the abolition of disease.”1
There were several components to the program begun in Cleveland that
winter. Fifty-six thousand primary school students were to have their mouths
examined (“by a dentist and a lady assistant”),2 with reports on their dental
health to be sent to their parents, and free dental service was to be provided
to those whose parents indicated that they could not afford to pay for reparative work. To serve the latter purpose, four school-based clinics would be
established, and transportation provided to children from non-clinic elementary schools. “Best of all, if there is a best,” announced the superintendent of
Cleveland public schools, “is the lecture program, which proposes to place
before young and old the preventatives for many of the troubles which are to
be treated by this inspection and clinical service.”3
Cleveland dentists and school officials explicitly linked the new oral
hygiene program with their aspirations of inculcating good citizenship
in their youthful charges. “The children of to-day—the citizens of tomorrow,” rhapsodized the president of the Cleveland Board of Education, “by
health, vigor, and education, well balanced, will the preservation of all the
civilization and virtues, for which this government stands in the eye of the

16

Making the American Mouth

world to-day, be most surely conserved.”4 Several speakers commented on
the direct links between health, happiness, and domestic tranquility: the
assistant superintendent of schools even extended an oft-repeated dentists’
phrase about the importance of good teeth to good health, arguing that good
teeth were a preventative against bad politics. “Without good sound teeth no
mastication, without mastication no complete digestion, without digestion
no thorough assimilation, without assimilation what becomes of disposition?
It becomes degraded, it becomes harsh and sour, and the end thereof is not
sound government, is not nobility of life and character, but the end thereof
is anarchy, and all those things that men who do not feel good within themselves, are trying to put upon the world without.”5
There seemed to be no better place to test this latter proposition than in
the Marion Elementary School, “in the Ghetto of Cleveland”6 as one dental
journal put it, where bad dental health had plagued a group of almost nine
hundred students and their teachers for as long as anyone could remember.
“All of its pupils are the children of people in very moderate circumstances,”
one editor reported. “Many of them are the children of wretchedly poor parents. A large proportion of the children are of Hebraic extraction.”7 Because
Jews and the poor were widely believed to be prone to political radicalism
and other kinds of bad citizenship, the Marion School population was especially attractive to dentists who wanted to conduct a special study, a subset of
the larger Cleveland project, to determine exactly how much of an influence
bad teeth had on pupil behavior. After preliminary inspection of the teeth of
all the students in the school, dentists selected the forty students with the
worst dental health for inclusion in a group known as the Marion School
Dental Class (or Dental Squad). They offered these children free dental care
and a five-dollar gold piece, which students would receive on Christmas, if
they cooperated with all of their dentists’ and teachers’ directions, submitted
to complete dental treatment, and performed all the tasks required of them
“with proper spirit.”8
The results of the study were eye-opening. Twenty-eight students continued in the study long enough to be evaluated for their progress in December
of 1910: by the account of the Marion School dentist, their health and dispositions improved dramatically in the interim. Children who had been “ill-kept
. . . sallow . . . [with a general look of neglect]” became “clean, bright, and
healthy, with clearer complexions.”9 Extensive psychological testing of the
children revealed that their average intellectual improvement (as measured
by “increase in working efficiency”) was 54 percent: some students showed

American Dental Hygiene

17

gains even more astounding, of up to 426.9 percent as determined by tests
of memory, spontaneous association, addition, and “quickness and accuracy
of perception.”10 Most importantly, however, was the dramatic improvement
in the pupils’ classroom behavior: “A spirit of self-respect was engendered
that corrected disobedience, truancy, and incorrigibility,” the Marion School
principal reported.11 In her opinion, these students’ new self-respect and better attitudes made them better prepared for citizenship: “I cannot too strongly
recommend a prominent place to oral hygiene for all of us who are trying to
conserve the child physically, mentally, morally and fit him for his place as a
citizen of the United States.”12
A five-dollar gold piece would have been a formidable sum to a child in
1910, comparable to what was then perceived as the most generous weekly
salary available to a workingman, and a substantial incentive to participation
in the study. However, the Marion School dentist and dental hygienist took
great pride in reporting that, at the conclusion of the study, the pupils participating in it had “continued just as faithfully ever since”: that is, that they
had fully internalized the “gospel” of dental hygiene, and had in many cases
gone on to propagate that gospel in their own homes. Though the children’s
parents, in the opinion of the school dentists, had originally been “with the
exception of two or three, too ignorant to appreciate the value of the work
being done for their children,” at the end of the study some of them were following programs of oral hygiene too. In one family, “the mother is so delighted
with results in the child that she follows my instructions in mastication,
etc., and is improved,” reported the dental hygienist.13 One student relayed
that her “father and mother thank you most heartily for the efforts and devotions shown towards me.”14 The Marion School program seemed to be making
not just children, but also their parents, more perceptive and more grateful
for the ministrations of professionals. This was one of the fondest hopes of
the studies’ planners, who regarded children as the gateways to immigrant
households, and were optimistic about the prospect of changing the behavior
of all family members by improving children’s behavior fi rst.
The Marion School Squad catapulted to fame in the world of professional dentistry. Dentists and scientists from around the country visited the
school to witness the newly improved dental health and personal behavior
of the students. A wide range of journals reported on the amazing results
of their efforts, and in May of 1911 the Cleveland Press announced that the
twenty-eight children were scheduled to appear in person before the annual
meeting of the National Dental Association, “to show the results of the year’s

18

Making the American Mouth

experiment.”15 Several journals published statements from the students
themselves, and the Dental Digest ran essays by Marion School students
Lillian Gottfried, Ben Dimendstein, and Lillian Cohen, reflecting on their
experiences and on the importance of healthy teeth. “My parents have never
believed that an unhealthy mouth would make an unhealthy child,” Lillian
Gottfried said, “After I began to realize my faults, I have been faithful with
my tooth brush and powder, without any one urging me to do so. After these
results, I have turned a new leaf in my life . . . and many people are doing the
same thing. This will also change the whole history, and not many years from
now, all the people of the world will be doing the same thing as the Marion
Dental Class has been doing.”16
The Idea of Dental Hygiene

Among her other merits, young Lillian Gottfried was a keen spotter of trends.
The Marion School program, which burst onto the American scene roughly
concomitant with the founding of several other prominent dental hygiene
programs, would indeed prove a model for oral hygiene regimens in which
generations of public school students in the United States would be enrolled.
Within a decade or so, many more state and local dental societies, usually
working in collaboration with public schools, established dental hygiene programs for children consisting of some combination of prophylaxis, remedial
treatment, and health education. Private citizens and governments cooperated in the building of several much-heralded dental clinics or dispensaries.
The dentists who worked in these programs were typically paid to do so, but
the services they provided were often free to patients—and particularly to
those who were poor.
Lillian Gottfried did not need special perceptiveness to make such an
accurate guess. All around the country, and particularly in urban public
schools like Lillian’s, public health reformers of the early twentieth century
implemented programs designed to reduce the burden of disease and death
associated with personal and environmental uncleanliness.17 Indeed, the
children of the Marion School already participated in medical inspections
intended to halt the spread of communicable diseases like measles, ringworm, and lice. Programs like the Marion School’s medical screening system
targeted children, especially the children of poor immigrants, partly because
children were considered more likely than their parents to be successfully
assimilated into American life. Freedom from dental pain and the disability
it caused seemed to dentists to be essential to this end, as did conformity

American Dental Hygiene

19

with American aesthetic and hygienic standards and resultant opportunities
in professional and private life. Dentists often referred to the characteristics
of “confidence and self-respect” as being particularly American, and emphasized that by enhancing one’s looks and health, proper dental care could maximize these attributes and thereby make dental patients better Americans.
Describing a dental dispensary program in Rochester, New York, for example,
one dentist noted that “Quite a number of the applicants are the children of
our foreign population. We are helping to make them better citizens, better
men and women. The care of the teeth is a step toward the care of the body in
general, and with it increased confidence and self-respect.”18
Americans of the early twentieth century vigorously debated the responsibilities of government for the welfare of citizens, and frequently expressed
the fear that too much government largesse would “pauperize” adults, making them unwilling or unable to provide for themselves. At the same time,
however, Americans usually supported—or could be pressured into supporting—programs that provided for young people, who were not expected to be
economically self-sufficient, and who were increasingly excluded from paid
labor in this period. The “gospel of wealth” promoted by Andrew Carnegie
and other notable philanthropists of the early twentieth century taught that
charitable resources were most wisely directed toward those who might yet
turn themselves into productive citizens. Universal public schooling itself
proceeded from this notion, epitomizing the idea that it was important to
equip impressionable youth with the skills and knowledge necessary to
achieve economic independence and participate in democracy.19
School dental hygiene programs reflected this mixed set of ideas about
responsibility, which also animated the 1912 establishment of the US government’s Children’s Bureau, and, later, the Sheppard-Towner Infancy and
Maternity Protection Act, both of which focused on providing health screening and education to the worthy poor. Unlike physicians, who successfully
lobbied to restrict such programs from providing medical treatment, dentists
did not generally oppose the direct provision of free care to children. Rather,
the creation of a new category of care—the regular dental cleaning—reflected
their professional consensus that American children’s dental health was an
asset not just of individual children, but of the community itself. “In this land
of the brave, where all are supposed to be born ‘free and equal,’” one writer
asked, “have not these children a right to free dental service?”20
Though parallel programs existed in some American factories, most public and private dental hygiene programs did make children their primary

20

Making the American Mouth

clients. Though the political impetus for selecting children rather than adults
for free hygiene services was powerful, there were also important medical
and logistical reasons for this choice of the school as a site for the delivery of
care. The biology of tooth formation and eruption played a role: youngsters
of six or seven years of age were the new owners of teeth that would have
to serve them for the rest of their lives, and dentists believed strongly that
early intervention would best help to ensure that outcome. School hygiene
programs, like programs of school-based medical inspection, also maximized
the potential of compulsory school attendance to put children in contact with
dental care providers.
Dentists eager for an opportunity to impress the importance of dentistry
on American youth viewed the public school as the ideal medium for the
transmission of that message. Schoolchildren were massed together, away
from the pernicious influences of their home lives, for six or more hours per
day, and were already encouraged to regard the school as an authoritative
institution equal to or exceeding the church or the family. School medical
inspection invited children to regard their schools as places of valuable modern information about physical health—and this was information they were
unlikely to acquire at home. “As we cannot reach the home circles effectively
through contact . . . and cannot educate the parent to educate the child, why
not properly instruct the child in the schools?” one dentist asked.21 Dentists
thought of the leveling influence of American public schools as both medium
and message. “Whatever we wish to see introduced in the life of a nation, we
must fi rst remember, must fi rst be introduced into its schools. The school is the
one force to unify all conditions of society,” a Maryland dentist reflected.
Though there was an inexorable logic to school hygiene programs’ focus
on children, the success of such enterprises was by no means assured. To
begin with, even among dentists, the idea that brushing, flossing, and having one’s teeth professionally cleaned could reduce the rate of dental decay
and contribute to one’s general health was not widely accepted in the early
twentieth century. Many dentists considered what was in the teeth (their
chemical makeup, whether figured as a function of genetics or of maternal
and childhood diet) to be much more important than what was on them.
Though most dentists accepted that both factors were significant enough to
warrant attention, some leaned much more strongly in one direction than in
the other. For instance, one dentist who considered both possibilities argued
that he did not “imagine that dietary treatment will ever be as important a
factor in this work as will the manual cleaning and the chemical treatment.”22

American Dental Hygiene

21

Even some dentists who applauded public oral hygiene programs had doubts
about the wildly optimistic claims made for them. One Philadelphia dentist
opined that “Clean mouths and well-cared-for teeth will not make scholars
and angels of dullards and wayward children; neither will it lessen the taxpayer’s burdens.”23
School physicians shared this skepticism about oral hygiene, and therefore omitted it from their medical inspection programs. One of the factors that
fi rst roused dentists to the cause of publicly funded school dental hygiene
programs was the fact that screening systems to reduce the prevalence of
communicable diseases like measles, lice, and ringworm paid no heed to
the state of children’s teeth. Dentists were exasperated by physicians’ reluctance to include tooth decay on the list of conditions for which screening
was performed. A small minority of dentists believed that the bacteria present in decayed teeth were infectious, and could be spread from one child to
another in the environment of the schoolroom. No dentist doubted that dental
decay, whether communicable or not, posed a continuing threat to the overall
health of the affected child, and that physicians who ignored it were dangerously shortsighted. The Marion School itself had had a medical inspector for
more than three years when the dental inspection program was inaugurated.
He had, the school principal said, obtained “marvelous results,” but, as the
continued presence of ill health and discipline problems among the Marion
Squad members suggested, and as dentists themselves pointed out, not quite
marvelous enough.24
At the turn of the century, dentists also bemoaned their federal, state,
and local governments’ relative inattention to the problems of dental health.
“While the need for government attention to dentistry as a public health measure may seem clear to all those who, from a knowledge of the facts, realize
its importance, there are still some who for reasons best known to themselves
turn a deaf ear to the suggestions which in the interest of humanity are made
by those who foresee the results of this apathy,” an editorial in The Dental
Cosmos mourned in 1902.25 Governments that realized the importance of dental care, dentists speculated, could also reap significant savings in tax dollars
by reducing truancy and the need for children to repeat grades in school, as
well as by producing self-sufficient citizens who would require less help from
the state or from private charities in adulthood.
Finally, most Americans simply did not believe that the cleanliness
and health of their teeth were matters of urgent concern. Except among the
well-to-do, daily brushing and flossing were uncommon practices. Dentists

22

Making the American Mouth

complained constantly that their patients were prone to demand extraction
over fillings or root canals, and to refuse to pay the low cost of prophylaxis
because they simply didn’t consider their teeth worth the money. One writer
estimated that “regarding only those who systematically and regularly have
their teeth cared for by a dentist, we have from five to eight percent of our
entire population. . . . [People] could, and would, fi nd the means to pay for
dental work, if they fully realized its importance. Its necessity had not been
sufficiently impressed on their minds.”26
Attempts by dentists to convince everyday Americans of the importance
of good dental care reflected dentists’ sense of the urgency of the task. These
efforts also illustrated dentists’ disregard for the privacy and autonomy of
their educational targets and sometimes backfi red as a result, adding to the
opposition hygiene programs faced. The dentists who worked in the Marion
School scorned the religious beliefs, base occupations, and living conditions
of their young patients’ parents. The members of the Marion School Dental
Squad, nearly all of whom were Jewish, were identified in several widely
distributed dental journals by their full names. Dentists who described these
patients argued that the notorious parsimony and superstitiousness of Jews
hindered the students’ success. Frank Silverstein’s father was “a tailor, not
busy all the time”; the dental hygienist who visited Rose Lieberman’s house
had “considerable difficulty in persuading the mother not to give her sloppy
food.”27 Dentist William Ebersole, in describing one Marion School student,
noted that “the home is small and dirty; the family is large, the mother not
strong, and seems unable to take proper care of her children. They are surrounded by an atmosphere of fear and superstition.”28 Another pupil he
judged as “unreliable and careless. There was nothing in the home to help
her, her mother being sickly, nervous and superstitious, throwing about the
children the worst kind of atmosphere.”29 Several journals reprinted photographs of the Marion School children’s homes and neighborhoods, highlighting the students’ poverty and the seediness of their surroundings. School
hygiene programs encouraged children to rise above such constraints and
defy their superstitious, unscientific immigrant parents. The supervising
hygienist of a program in Locust Point, Maryland, wrote amusedly that “one
little chap told his teacher that when his mother, thinking him asleep, closed
his window, he always got up quietly and raised it again; another that now
that the kitchen seemed so hot and stuffy, she wrapped up and sat out in
the back yard to get air.”30 Though the parents of Marion School students
seemed to appreciate dentists’ ministrations to their children, such outside

American Dental Hygiene

23

innovations often sparked struggle and resentment between immigrant children and their parents—and prompted some parents to refuse to cooperate
with reform programs.31
Nevertheless, dentists thought that school hygiene programs could help
to persuade immigrant children and their parents of the importance of dental care. Their motives for seizing on American public schools as sites for
dental education were technological, logistical, and political, but they were
also entrepreneurial. Many advocates saw school hygiene programs as a way
to lead American schoolchildren into an adult life of spending on privately
provided, privately paid-for dental care. Though “ethical” dentists agreed
that individual advertising was unprofessional, and frequently scorned
those who engaged in it, most also agreed that advertising the concept of
preventative dentistry would be acceptable. School dental programs provided an important forum for the professionally appropriate drumming-up
of future business.
Dentists believed that the dissemination of information about proper
dental hygiene might strengthen not only individual dentists’ chances of
winning patients, but the prestige of the profession itself: they linked their
interest in school hygiene programs to their ongoing struggle to purge their
ranks of slackers and establish their vocation as a high-status profession.
They evinced a profound trust in the force of demand from an educated public to accomplish the regulation of their profession. Though school dental
hygiene programs were the cornerstones of the hygiene education efforts,
public-service style advertisements in newspapers and magazines also
played a role.32 “A public thus educated will demand intelligent, capable,
scientific dentists, and will also elevate the standard of the profession,” one
writer mused.33 Another hoped that if the public were better educated about
dentistry, “the cry for cheap work would cease. The conditions which make
the reign of the charlatan and quack would no longer exist. He would thus
be either whipped into line or relegated to the rear. The splendid results
would replenish our ranks with the choicest personnel from the scientific
realm.”34 Some dentists professed to have heard colleagues comment that
they “did not want the people to be possessed of knowledge in regard to
teeth”: 35 the implication was always that such reluctant individuals, perhaps
from a previous generation of dentists who lacked thorough college training,
feared for a professional status to which they were not entitled anyway. Few
detractors raised their voices at the meetings of major dental organizations:
the consensus reflected in both published articles and transcribed meeting

24

Making the American Mouth

proceedings was that the more patients knew about their own teeth, the
more they would demand the services of ethical dentists, and that this was
an outcome devoutly to be hoped for.
Dentists sought to parlay the rising entrance standards of the profession,
as well as the high status of contemporary science and widespread popular knowledge of new scientific discoveries, into national consensus about
the essential importance of good dental hygiene. New knowledge about germ
theory and the importance of personal cleanliness to avoiding infection figured heavily in dentists’ attempts to impress upon their patients, the public, and various levels of government the importance of having consistently
(sometimes professionally) cleaned teeth. Many argued to their colleagues
that dentists ought to present oral hygiene as a logical extension of other
personal habits: “You would not sit down to breakfast without washing
your hands and face,” one dentist claimed to have told his patients, “and
yet your mouth is dirtier than your hands or face. If you had not time to
wash your mouth you had not time to wash your hands and face, as one is as
necessary as the other.”36 Writers who advocated a focus on the bacterial origins of the bad smells coming from early twentieth-century children hoped to
build on other public-health successes, like the construction of human waste
and insects as dirty items that civilized people abhorred and disposed of as
quickly as possible.37 “The mores will eventually change until the unclean,
uncared-for mouth will be considered as much of a popular menace as the
open privy vault, the filthy garbage can, and the unswatted fly,” one man
wrote. He argued that existing public health powers ought to be applied to
the problem of dental hygiene: “Individuals have no more right to maintain
their mouths in a filthy condition than they have to throw bedroom slops into
the street.”38 Even dentists who did not agree that bacteria, rather than oral
filth itself, caused dental disease concurred that the habits of personal cleanliness that had already been successfully inculcated in many Americans—
like hand washing, use of sanitary toilets, and refraining from spitting in
public—would help to solve the problem of tooth decay, if Americans could
be persuaded to extend those habits to their teeth. “What has been done in
the treatment of zymotic diseases, namely, an improvement in the condition
of surroundings, is precisely what is required respecting the teeth,” US Navy
dentist Richard Grady argued.39
Early twentieth-century schools were filthy places. “The building and
the pupils must be clean,” one physician wrote, “Send the children home if
they smell, and clean the building by the vacuum system. In most schools a

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cloud of dust rises about three feet from the floor when the children run or
dance on it.” Other writers casually offered testimony as to why schools were
in such bad condition: even in Bridgeport, Connecticut, a thriving manufacturing city in this period, “no public school has hot water, and few have gas
or electric lights,” reported one observer.40 Turn-of-the-century classrooms
were, as a result, veritable hotbeds of miasma: “Have you ever frequented
the schoolroom and not had your olfactories set your thought factory in
motion as to the origin of the peculiar aroma in the atmosphere?” one dentist
demanded. “That aroma is largely caused by the exhalation of air through the
oral and nasal cavities and over their foul surfaces; it is freighted with the
very poison that, when it fi nds lodgement in fertile soil, precipitates the occasional epidemics of children’s diseases.”41 Another wrote: “Several teachers
in the primary grades have told me that even on the coldest days in winter it is
impossible to close the windows for five minutes on account of the odor from
the children’s bodies.”42 Some writers suggested that children’s bad breath
ought to be treated as evidence of a communicable disease, causing children
to be excluded from school until the odor had disappeared. “Parents will
send the children to school with their faces clean, if it is demanded,” one
dentist wrote, “Why should they not send them with clean mouths so that the
neighbor’s child will not have to breathe the vile atmosphere resulting from
rows of decaying teeth and abscessed roots?”43 Repeated reports of noxious
smells in public-school classrooms provided an opportunity to link the old
understanding of the toxicity of bad smells with the new knowledge that it
was germs that caused those odors, and suggested that the schoolroom would
be an important site at which dentists could establish in the popular mind the
importance of good dental hygiene.
Dentists also hoped to rely upon patients’ vanity to sell dental services,
including professional cleanings and instruction in home care. Complaining that many patients demanded that carious teeth be extracted rather than
filled, and seemed not to regard the loss of a tooth as problematic, California
dentist Russell Cool argued that “We should remind them that the loss of
a tooth has its effect upon the expression of the face; that it influences the
alignment of the other teeth; and that it destroys part of the vocal apparatus.”44 Over time, more dentists noted that in encouraging patients to seek
regular dental care, “the most salient force, both in working among children
and adults, was impressing the close relationship the subject had to question of personal beauty.”45 Dentists who made aesthetic arguments for dental
hygiene were not simply emphasizing the factor they felt was most likely

26

Making the American Mouth

Figure 1 Alfred Fones’s second class of dental hygienists, performing cleanings on
Boy Scouts. Dental Digest 34 (May 1928): 323.

to sway image-conscious patients: Russell Cool, for one, could rhapsodize at
length about “How often [we have], when charmed by a classic face that, in
repose, excited admiration on account of the symmetry and regularity of the
features and the purity of the skin, had this charm dispelled and a feeling of
loathing induced as a smile revealed, instead of the expected pearls, a shocking array of blackened and crumbling snags, or tawdry and self-assertive gold
fillings.”46 In fact, some dentists believed that keeping one’s teeth clean and
in good repair could actually improve one’s looks overall: if advice about the
care of the teeth were widely disseminated, one dentist speculated, “there
would be less need of so-called beauty hints as to the care of pimples and
facial blemishes.”47 He, like the advocates of the Cleveland and Marion School
hygiene campaigns, specifically linked the good looks that could be ensured
through good dental hygiene with success in life: “We can, if permitted, teach
them that soundness of teeth is one of the best evidences of general soundness
of body; that the care of the teeth pays in comfort, in beauty, in the conservation of health; that the care of the teeth tells of inborn politeness, and sustains
association with well-bred men and women.”48

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Dentists formed a thriving coalition around the concept of oral hygiene.
Debates about the influence of other factors, particularly diet and genetics,
on tooth decay would continue to rage more or less simultaneously with
the struggle to initiate publicly funded oral hygiene programs for children.
But by the time of the Marion School program almost no dentists—and, at
least as dentists told it, few properly educated laypeople—seriously doubted
that keeping one’s teeth clean could have a positive impact on one’s health
and appearance. Nor did they doubt that encouraging that cleanliness, and
the personal qualities that came with it, could be an important part of campaigns to Americanize immigrants, particularly immigrant children. Dentists’ growing professional authority and the success of their attempts to
market the idea of preventative dental care resulted in millions of tax dollars being spent to establish dental hygiene programs in public schools—and
millions of private dollars to found free or low-cost dental clinics. As early
as 1902, The Dental Cosmos jubilantly published a long list of “efforts in
behalf of disseminating oral-hygienic knowledge in schools,” which were
being made by an impressive array of state and local dental societies, as well
as by the National Dental Association itself—often, as in the Marion School,
with the cooperation of school authorities.49 Several school dental programs,
including those of the Rochester, New York, public schools and one paid for
by the Children’s Aid Society of New York City, received extensive coverage
in dental journals.50
Private Dental Philanthropy

In their native Boston and around the country, the generosity of the Forsyth
family received almost as much publicity as did any public clinic, perhaps
because the family’s magnanimity enabled the establishment of a dental facility far in excess of even the loftiest aspirations of most public programs. The
benefactors of the clinic were a group of brothers, one of whom, James Bennet
Forsyth, had attempted to make provisions for the clinic in his will before he
died in 1900; the document was later (for reasons that were not elaborated
upon in dental journals) declared void. Two of his surviving brothers, John
Hamilton and James Alexander Forsyth, decided to pursue their deceased
brother’s dream of founding a clinic to care for the children of the worthy
poor. The deceased brother, as they told it, had “had considerable trouble
with his teeth. The doctors who attended him told him if they had received
proper care during his childhood days they would have saved him considerable pain and trouble.”51 James Bennet Forsyth had planned to give $500,000

28

Making the American Mouth

of his considerable personal fortune to the clinic: John Hamilton and James
Alexander Forsyth tripled the sum.52
The Forsyth Infi rmary, which opened in 1915, was a veritable palace of
dentistry. The Forsyth brothers—and the editor of The Dental Brief—pointed
out that since the building was intended to serve both as a dental clinic and
as a memorial to James Bennet Forsyth, “the building on this account embodies many artistic features usually lacking in buildings intended solely for
hospital purposes.”53 The children’s waiting room, for example, contained
an aquarium of native fish, multiple artistic panels illustrating some classic
children’s tales (including “Rip Van Winkle” and “The Pied Piper”), and a
“well selected juvenile library,” in addition to tile floors, ceilings, and walls,
which could be “flushed with a hose from top to bottom, thus ensuring sanitation and cleanliness.”54 The main operatory had sixty-four fully equipped
dental chairs and room for forty more; there was a separate “extraction
room,” as well as a clinic “devoted to nose, throat and ear operations.”55 The
“marble-faced clocks” in each room were “controlled by the master clock in
the director’s room.”56 The building also featured a research laboratory and
an amphitheater that seated two hundred and fifty people: it was intended for
public lectures on oral hygiene, but it could also be used for the instruction
of dental students and clinicians and, owing to its tile construction, could be
flushed with “live steam or water after each operation.”57
Public and professional response to the majestic infi rmary building was
no less grandiose than the edifice itself. The editor of Oral Hygiene recommended that the fortunate trustees of the elaborate new building “should
enter on their duties with prayer and fasting,” as befit men who were taking
on such important roles in the public service.58 At the dedication of the clinic
on November 24, 1914, the mayor of Boston pointed out that the new Forsyth
clinic demonstrated the contrast between American values (of “toil, thrift,
and love of humanity”) and those of “the other side of the Atlantic” (where
World War I had just begun, and where “men are engaged in the destruction
of human life”). He declared that the clinic “should so tend to change the
current of public thought as to cause its donors, the Forsyth brothers, to outrank in the estimation of thinking men and women the greatest warriors of
our time.”59 Charles Eliot, president emeritus of nearby Harvard University,
argued that the clinic “illustrates one of the admirable traits of the successful
business men in the United States—the desire on their part to make use of
their private earnings and accumulations to advance some beneficial public
undertaking.”60 Thomas Forsyth, another Forsyth brother who would serve

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Figure 2 The amphitheater in the Forsyth dental clinic, 1914. Oral Hygiene 5 (January 1915): 15.

as a trustee of the clinic, explicitly articulated his hopes for a public benefit
from the clinic: he wanted children to be healthier and happier, and “by making them healthier and happier I hope it may make them grow to be better
citizens of our beloved Boston.”61
The Forsyth clinic was, therefore, a marker not only of the objective
importance of dental hygiene to good health, but of a confluence of individual
and national qualities and aspirations that were slowly but steadily becoming
attached to the concept of dental hygiene. The clinic enabled a wealthy family
to demonstrate its philanthropic bent by funding a forward-thinking enterprise, the presence of which “should change the current of public thought”
toward a greater appreciation of both oral hygiene and the Forsyth brothers
themselves. It became a place for the construction of an imputed set of shared
national values—“toil, thrift, and love of humanity”—and a vision of citizenship that took health and happiness as necessary prerequisites for becoming
“better citizens of our beloved Boston.” Most importantly to dentists, however,

30

Making the American Mouth

by addressing Boston children’s dental needs on such a magnificent scale,
the clinic elevated the status of dentistry to make it a peer of the other great
philanthropically funded needs of the early twentieth century—Andrew Carnegie’s libraries, for instance, which in a similar manner acknowledged the
importance of citizens’ literacy while endorsing the values of toil and thrift.
As the editor of Oral Hygiene gushed: “It is an uplift to the whole dental profession throughout the world.”62
The Bridgeport Campaign and the Birth of the Dental Hygienist

Though the Forsyth clinic and the Marion School hygiene campaign did
much to draw lay and professional attention to the cause of dental hygiene,
no events in dentistry would attract as much interest as the establishment of a
comprehensive, publicly funded dental hygiene program in Bridgeport, Connecticut, in 1914. The scale of the enormous Bridgeport campaign forced the
resolution of an issue that dentists had been debating for at least ten years—
whether specially trained women, rather than highly educated male dentists,
could be relied upon to do the rote work of cleaning Americans’ teeth. The
lead organizer of the Bridgeport campaign, a dentist named Alfred Fones, had
already incurred the scorn of his colleagues for having suggested, in several
professional meetings and published articles, that women could be trained
to do dental hygiene work without undergoing a complete dental education.
Detractors feared that allowing anyone but a properly trained dentist to take
on responsibility for Americans’ teeth would damage the professional status
for which dentists were still fighting. What constituted “proper” training was
anything but well-established in the 1910s, adding to the anxiety for those
who opposed the idea of the woman hygienist. Fones’s enormous personal
magnetism and the success of the ten-year Bridgeport hygiene program nevertheless produced a new professional role for women who might otherwise
have been nurses, social workers, or teachers, and a new challenge for dentists to contend with: the existence of the dental hygienist.
Alfred Fones was a native of Bridgeport. His father, Civilion Fones, had
been a remarkably well-trained dentist for his time (he graduated from the
Baltimore College of Dentistry in 1873), and Alfred followed in his footsteps,
graduating from the New York University College of Dentistry in 1890.63 In
1899, at a meeting of the Northeastern Dental Association, Fones heard a
Philadelphia dentist give a talk on what he referred to as “controlled practice”: he required his patients to visit him at regular intervals for professional
care and to clean their own teeth regularly at home.64 Fones was immediately

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persuaded by the genius of the Philadelphian’s system, which allowed for
preventive care instead of emergency repairs and resulted in more patients
retaining more of their teeth until late in life. However, Fones was troubled by
the one factor that seemed to militate against its widespread implementation:
professional dentists had increasingly become too well educated to spend
their valuable hours in the mindless (and low-paying) repetition of cleaning
teeth, and patients would not pay for cleaning at rates that would make the
task worth dentists’ time. Furthermore, if every American was to be placed
on a schedule of regular dental hygiene, there could never be enough dentists
to meet the projected need, particularly as barriers to entry into the profession grew ever higher.
Like many dentists of his time, Fones had long employed a woman assistant (also known as a “chair nurse” or “dental nurse”) to do his scheduling
and billing, greet patients, and assist him at the dental chair. He reasoned that
the repetitive work of dental hygiene fell well within the limits of responsibility that dental assistants had already assumed, and decided to train his
own assistant to perform hygiene treatments, which she did for the fi rst time
in 1906.65 Over a period of several years, he discharged from his practice
patients who were unwilling to follow a regular schedule of dental hygiene
treatments, until everyone who was left was having his or her teeth cleaned
every two months. Fones calculated that having his assistant regularly clean
his patients’ teeth actually saved both his own time and patients’ money: specifically, he figured that his hygiene plan cost patients 40 percent as much as
seeking dental treatment on an as-needed basis.66 On the other hand, because
he could maintain a larger roster of patients who needed less intensive care,
Fones’s own patient volume—and his income—rose during the same period.
Fones’s plan for training and using dental hygienists, which he articulated in many professional forums before successfully implementing it in the
Bridgeport schools, was a controversial one. The dental assistant had long
been constructed, both by dentists and by assistants themselves, as a sort of
office wife: she served the dentist’s interests, not her own, and she worked
entirely under his direction and at his pleasure. Her role was to provide a
buffer between the dentist and the more painful realities of entrepreneurial
individualism—the need to pursue patients who failed to pay, do business
with dental-supply salespeople, and deal with patients who insisted on too
much of the dentist’s time, or who developed inappropriate hypochondriacal attachments to their dentists. Alternatively, she could play the role of the
office mother—greeting and serving as a hostess to patients, ensuring the

32

Making the American Mouth

comfort of children whom the dentist might not be totally comfortable treating, and (as Juliette Southard, the founder of the professional dental assistant’s organization pointed out) by her own sterling presence, serving as a
guarantee against charges of sexual misconduct by the dentist.67 Though such
charges were uncommon, the possibility was of particular concern to dentists who practiced alone in private office settings.
The hygienist, on the other hand, was something of an unknown quantity. Dentists who wanted to be able to hire hygienists to work in their own
offices, or who favored having hygienists instead of dentists do the day-to-day
work of school and industrial hygiene programs, argued that women were
better suited than men to the fi ne, repetitive, mundane handwork required
for hygiene treatments. (If this contradicted the frequent claim that women
lacked the mechanical aptitude needed to make them successful dentists,
the practitioners who advocated for the role of the dental hygienist did not
notice it.) Some dentists had hired newly trained male “graduate dentists”
as junior partners and the primary providers of hygiene in their offices, only
to fi nd that these overly ambitious male colleagues broke ranks and started
their own offices after a few years—sometimes within a competitive distance
of their prior employer’s own shop. Women, advocates of the trained dental hygienist argued, would be less prone to want independence. They could
actually be legally restrained from seeking it by narrowly crafted—usually
sex-specific—hygiene practice acts that prevented hygienists from working
without the supervision of a dentist. The trained “dental nurse,” like a medical nurse, would clean body parts in preparation for the ministrations of the
doctor or dentist; there seemed, to advocates of the hygienist model, to be
ample precedent for her presence in the dental office.
From the hygienist’s fi rst appearance on the scene, however, dentists
feared the effect that the existence of trained women hygienists would have
on their own professional fortunes. Some doubted that truly intelligent, welltrained hygienists would be happy being restrained from performing more
complicated operations that were technically within the province of the dentist himself: “How could we ever give a legal standing to such persons, to
keep whom within the limits of their proper functions would probably be a
continual source of trouble?” asked University of Michigan dentist Neville
Hoff in 1912.68 Hoff, among others, feared that the elision of the boundary
between dentist and trained dental nurse would serve the cause of quackery,
dragging the status of the profession down with it: “Would not the advertising
quacks use this open door to fi ll their offices with unskilled and unlettered

American Dental Hygiene

33

employees, with greater injury to the people and to the utter confusion of
our professional standards?” he demanded.69 Ironically, the most vigorous
opponents of the hygienist concept were those who placed the most stock in
women’s ambitions—for the greater such ambitions were, the higher the likelihood that women hygienists would overstep their boundaries and do harm
to dentists’ professional status.
Like female physicians who preferred to work without nursing assistance,
the few women dentists who had struggled successfully to get professional
standing were among the loudest critics of the notion of bringing lessertrained auxiliaries into an office setting. Hygienist advocates sometimes
claimed that the work of cleaning teeth, like the work of cleaning hair or fi ngernails, was not sufficiently difficult to require much professional training,
but, as Detroit dentist Grace Rogers complained, they offered no explanation
for why a self-respecting woman would spend a year or more being trained
to hold “an irresponsible position.”70 “What object would any young woman
have in spending so much time in fitting herself for such an occupation?”
Rogers asked “She would have but one, and that, a higher salary than a person
with her qualifications could demand in any other position.”71
Tensions around money and professionals’ proper relationship to it
underlay much of the debate about the role of the dental hygienist. Though
dentists recognized the collection of fees as an important part of their practices, they categorized fi nancial management as falling outside their own
professional purview, which was precisely why so many of them preferred
to have dental assistants attend to their accounts. Suspicions ran high of
those who admitted to having entered the profession—or any profession—for
money, and Grace Rogers’s concern about the pecuniary motives of hygienists
resonated quite strongly with practitioners of the time. One opponent of the
dental hygienist specifically noted that all of the hygienists who had trained
at the Forsyth Infi rmary had entered private practice rather than “the field of
charity,” and that the private dentists who employed them made great—and
therefore suspicious—profits from their work. Another dentist wrote to The
Dental Cosmos the following month to dispute this claim, but did not challenge the premise that aspirations to fi nancial success would have been inappropriate, particularly for professional women. The director of a dispensary
in Rochester that trained hygienists claimed that 45 percent of them went on
to work in public institutions. “I have preferred to send graduates to public
rather than to private institutions,” he wrote, “because I have felt that their
work would demonstrate to the public the value of oral prophylaxis and in

34

Making the American Mouth

that way stimulate public authorities to make larger appropriations for dental work.”72 Income differentials within the profession of dentistry itself also
sparked resentment, and opposition to the dental hygienist: one New Jersey
dentist pointed out that the dentists who were the strongest advocates for
the use of trained dental nurses were also those with the largest and most
lucrative practices. “Granting, for the sake of argument, that the dental nurse,
fulfilling her duties in a proper manner, would be ideal; how many of the
men practicing dentistry in the United States could afford to employ such a
nurse? Most of them would be well content to be kept busy themselves . . .”
he observed.73
Hygiene and Americanism

Dentists who sought to build consensus within the profession about the merits of oral hygiene drew upon a vast popular and professional knowledge of
the importance of Americanizing, by flattery or by force, the hundreds of
thousands of immigrants who flocked to the United States each year before
the passage of national laws restricting immigration. This generally meant
persuading immigrants of the necessity of adopting white Protestant norms
of health, hygiene, cookery, gender behavior, business interaction and school
attendance, among other facets of early twentieth-century life in the United
States. An increasingly large and sophisticated infrastructure, both public
and private, emerged to accomplish this task. This apparatus, like the dental hygiene programs dentists advocated, was usually staffed by middle- to
upper-class women, who were believed to be particularly effective transmitters of cultural values, and who frequently welcomed the opportunity to fi nd
paid employment outside the home.
The debate about whether women should be trained as dental hygienists,
whether and how the law should recognize them as licensed professionals
in their own right, and in what settings their services should be employed
reflected dentists’ fears and hopes for their profession. However, it also demonstrated dentists’ sense that dentistry had something important to add to a
national discussion about what health practices could be regarded as “American.” One faction, skeptical that hygienists could be kept from encroaching
on dentists’ own turf and fearing for the impact of “unlettered” women doing
dental work on the status of the profession, opposed the training and licensing of hygienists. Advocates of this position also feared that in popularizing
dental hygiene as a means of Americanization, dentists might inadvertently
contribute to a dangerous corruption of American dental care. This group thus

American Dental Hygiene

35

opposed publicly funded dental hygiene programs, which they constructed
as un-American. “Does anyone believe that you could train and equip at the
present-day low standard of educational requirements a sufficient number
of dental hygienists to give personal care to the teeth of all children . . . and
all of this to be at public expense? That is a thought ‘made in Germany,’ and
much resembles paternalism and German ‘kultur’ and not at all likely in this
or any other state,” argued one Massachusetts dentist in 1919.74
Another faction hoped that public dental hygiene programs would
increase the demand for high-quality dental care and thereby increase the
status of the profession. They believed that such programs could not be carried out without the aid of trained hygienists, and maintained an ebullient
optimism about the potential of publicly funded dental hygiene programs
to serve as agents of Americanization for immigrants without endangering
American dental care itself. They rejected the accusation that such beliefs
and aspirations were un-American and actively promoted the dental hygienist as an instrument by which foreigners could be inculcated with Americanism. “In the mining districts of Luzerne County [Pennsylvania] hundreds
of foreigners are employed. I would like some of the opponents of the oral
hygienist to examine the mouths of these foreigners before the oral hygienist
had treated them, and then examine them again after her work was fi nished.
It would be a revelation to them,” one Pennsylvania dentist opined. “The children are so anxious to learn and take advantage of any opportunity given
them, and I know that a clean mouth and a talk on hygiene has started many
of them on the right road to good American citizenship.”75
Both factions agreed that increasing the status of the profession and promoting good citizenship were important goals, and saw those goals as being
inextricably linked. But they differed in their ideas about how to achieve
those goals, and about how to defi ne a properly American dental care policy.
Ultimately, opponents of the dental hygienists and the programs they staffed
were outnumbered, outgunned, and resoundingly trounced. The process of
legalizing the professional practice of dental hygienists was carried out state
by state, took several decades, and provided frequent opportunities for dentists at state and national conferences to object to the idea of the trained dental nurse. Not coincidentally, however, the prolonged nature of the campaign
to legalize the role of the dental hygienist also provided multiple opportunities for those who objected to the concept to have their resistance softened by
the smashing success of the hygienist-run programs. One measure of the prevailing point of view can be had in the 1922 decision of the American Dental

36

Making the American Mouth

Association to encourage dental hygienists, dental assistants, and dental
laboratory technicians to form their own independent organizations.76 Alfred
Fones’s Bridgeport hygiene campaign, among others, succeeded in swaying
the predominant opinion within the profession in favor of the hygienist and
all her works.
Fones, like other advocates of the dental hygienist concept, saw the
Bridgeport hygiene program as merging dentistry’s professional and civic
goals almost flawlessly. As one chronicler of the Bridgeport campaign pointed
out, Fones’s father Civilion had been a member (and, for one year, the president) of the Connecticut State Dental Commission, the president of his state
dental association, and a councilman, an alderman, and mayor of the city
of Bridgeport.77 The writer credited Civilion’s background in public service
for having spurred Alfred Fones’s interest in applying the principles of his
oral hygiene program to the schoolchildren of Bridgeport, a navy town whose
large population of munitions workers was dense with recent immigrants.
After several years of pestering local officials, Fones was able to convince
the Bridgeport Board of Health to allocate funds for the initiation of a school
hygiene program in 1914.78 He was so confident of his eventual success that he
had spent much of 1913 training the fi rst group of women dental hygienists,
who received lecture instruction from some of the most distinguished figures
in contemporary dentistry. The hygienists spent their fi rst year in practice
moving from school to school, cleaning children’s teeth, giving lectures on
oral hygiene, and distributing educational materials for the parents of Bridgeport schoolchildren. In the second year of the campaign, a woman dentist
also visited the schools, filling small cavities in children’s fi rst permanent
molars. The next year, a second dentist was added.79
School officials placed a high priority on the Bridgeport campaign.
Though, as one writer reported, “no public school [in Bridgeport] has hot
water, and few have gas or electric lights,” principals made extraordinary
efforts to provide Fones and his hygienists with suitable locations in which to
practice.80 In fact, two principals gave up their offices to the hygiene program,
moving their desks into corridors that were not light enough for hygiene work,
and may well have been barely light enough for administration work.81 Teachers, one hygienist said, “are eager to assist us in every way, questioning the
children between our visit [sic] as to the use of their tooth-brushes; also the
motions of the prescribed method of brushing.”82 At one school, the teachers’
lounge was used for dental cleanings because it had a two-burner hot plate
that could be used for boiling water to sterilize instruments.83

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37

Bridgeport proved an excellent laboratory for one of the central theories
of the oral hygiene movement—that children who were educated about the
importance of dental hygiene could become, as one writer put it, “missionaries to the home,” and to their larger communities, helping to inculcate the
“Gospel of clean mouths” in a population sorely in need of this Americanizing message.84 Like the Marion School program, the campaign produced many
success stories in this regard, which were widely reported and repeated, more
or less word for word, in several prominent dental journals. Children who
had feared the dentist and hygienists, it was said, came to beg for dental work
and place social premiums upon it. One boy, for instance, was reluctant to
come to school when he had lost his toothbrush—perhaps because his teacher
was the one who reportedly allowed her students the otherwise unheard-of
luxury of clapping their hands “when everyone reports ‘brushed teeth.’”85 A
“Jewish boy with a terrible mouth,” after asking many questions about the
oral hygiene program, recruited an entire clinic’s worth of children to participate in the program on a Saturday morning.86 In a vignette that suggested the
somewhat brutal mores of the contemporary American schoolroom, one child
who had failed to brush his teeth, when given a choice between going back to
his classroom without his teeth professionally cleaned and receiving both a
whipping and a hygiene treatment, chose the hygiene treatment. In the end,
the benevolent hygienist dispensed with the whipping.87 A group of older
boys who thought that they might not receive hygiene treatments because of
their advanced age broke into a storeroom in a Bridgeport school and stole
two dozen toothbrushes, which the hygienists took not as evidence of the
irremediable criminality of immigrants, but of their great—and justified—
enthusiasm for dentistry.88
Similarly, parents who had been “too little educated to understand American ideals or to care about physical cleanliness”89 appeared to hold dental care
in renewed regard. Some immigrant children began to appear in the Bridgeport school clinics with privately obtained dental work, and the parents “told
the teachers how the children are always brushing their teeth,” though the
hygienist who reported this gave no hint of whether the parents provided this
information with pride or bafflement.90 Others in the community, too, saw
the good results of the children’s hygiene treatments: a Bridgeport hygienist
related that “during one of our visits to a large school in a thickly populated
foreign district, one noon hour a small boy who had had his teeth cleaned
that morning was seen sitting on the sidewalk surrounded by six or eight
men, all talking and laughing in their excitable Italian way. On investigation

38

Making the American Mouth

it was found that the boy was holding his mouth open and turning his lips
back to show how clean his teeth were, and the men were delighted with the
results.”91 The posture in which the boy was holding his mouth was also the
position children were required to hold in order to have their teeth cleaned.
That the small boy might have been mocking the hygiene program rather than
flaunting its results apparently did not occur to the hygienist who reported
the story—or to the other writers who repeated it as evidence of the program’s
success in inculcating good hygienic values in immigrants.
Hygienists and dentists who reported on the successes of the Bridgeport
hygiene program frequently cast ambiguous evidence in the best possible
light, suggesting how thoroughly convinced they were that the wisdom of
the oral hygiene campaign was obvious, both to them and to its subjects. Over
time, propelled by this certainty and by the genuine acclaim the program
received from school officials, the scope of the campaign grew: more hygienists were hired, and Fones successfully shepherded through the Connecticut
state legislature enabling legislation giving dental hygienists legal recognition.92 In 1917, Fones offered the services of the program to clean and repair
the teeth of National Guardsmen who were stationed in Bridgeport awaiting their departure to join the Allied Expeditionary Forces in Europe, and
the commanding officer took him up on the offer: Fones and his hygienists
donated their services free of charge.93 In the winter of 1918–1919, when many
American schools closed because of the deadly influenza pandemic that swept
across the United States that season, the schools in Bridgeport, “almost alone
among big cities in the East,” stayed open, and the city “recorded the lowest
death rate of any city its size, 5.2 per 1000 people. The City Health Officer gave
the teaching of the dental clinic great credit for this result.”94
Dental Health as a National Asset

The centerpiece of dentists’ attempts to inspire public interest in dental
hygiene was their claim that because bad dental health could cause so many
diseases and so much lost time from school and work—as the example of
the 1918–1919 influenza epidemic demonstrated—the oral hygiene of citizens
was properly of great concern not only to individual patients, but also to the
state itself. “If bad teeth could be prevented,” one dentist pointed out, “the
gain to the State and the individual would be of enormous value, as it is
wonderful how many diseases can be traced indirectly to bad teeth.”95 To
contemporary observers, the stakes of the oral hygiene problem were extraordinarily high: some argued that when bad dental health resulted in time

American Dental Hygiene

39

lost from school, the foundations of democracy were imperiled. “The whole
theory of democracy,” one man sputtered, “is built on the assumption that
the voters shall be intelligent.” He noted that some 250,000 children a year
failed to achieve the contemporary standard of intelligence for democracy—
graduation from the eighth grade—often because their progress in school had
been retarded by poor health: “It is wasteful to the state and inhuman to the
child to have his progress in school blocked because he has some removable
defect,” he opined.96 Children who had to repeat grades in school cost taxpayers money: “The neglect of children’s teeth is increasing the taxes of the
United States many millions of dollars each year,” asserted prominent Los
Angeles pedodontist M. Evangeline Jordan.97 Those who flunked out of school
entirely remained burdens on the rest of society forever: “Neglected children
are apt later in life to become unproductive citizens who must be taken care
of by the productive units of society,” one writer warned.98 Some writers put
the matter more directly: if the poor health of citizens were a drain on the
state, then the propagation and maintenance of their good health must be a
positive asset. “Every normal child is an asset to its parents and the Government, State and Federal, and every possible means of protecting and developing this asset is worthy of our most careful consideration,” said the Ohio
governor’s representative at the 1910 oral hygiene kickoff rally.99
Propaganda directed at children on this point proliferated in the early
twentieth century. Dental hygiene training films were shown to young people
in school and before feature films in movie theaters, and dentists circulated
short stories and lectures to be delivered to school groups.100 One genre in
particular suggests the insistence with which dentists sought to propagate
the notion that children and their dental care were matters of public concern:
skits published in dental journals and intended for performance by children
sought to enlist children as both audience for, and purveyor of, the message
that healthy teeth and a healthy nation somehow went hand in hand. In 1913,
for example, the journal Oral Hygiene published a skit in which the lead
characters, to be played by preteen youngsters, were “Uncle Sam” and “Miss
Columbia.” The latter advised the audience that “if a deformed or unhealthy
tooth or the loss of a tooth keeps a boy or girl out of school or makes their
mouths a place for disease germs to grow fat in . . . Uncle Samuel cares.”101
Uncle Sam concurred: “We cannot afford to dally,” he opined, “we must do
something in every school district in the country.”102 The playlet anticipated
the objections that dental care was secondary to medical care, that no health
care ought to be provided through the public schools at all, or that physicians

40

Making the American Mouth

already working in the schools were adequately trained to diagnose and refer
dental disease, and it introduced characters who addressed all of these concerns. “Dr. Medico” argued that “We medical doctors and our brothers in the
profession, the dentists must work together for the public good and prevention is the key to success.”103 Teacher Miss Bright cited the favorable results
of the Marion School dental study, while Rev. B. Earnest declaimed that “we
cannot as Christian people fairly represent the Master who went about doing
good to the bodies of men as well as to their souls, unless we come in closer
sympathy with such work. I hope the day will come when every public school
shall have dental supervision.”104 Miss Esthetic commented that “we see miracles every day in the straightening of teeth . . . resulting in better health and
better looks.”105
More than just trying to convince the skit’s viewers of the need for government involvement in American children’s dental care, the statement that
“Uncle Sam cares” also embodied an existing truth. The success of the hygiene
programs helped to make a reputation for concern about dental health, or at
least for the existence of a thriving infrastructure dedicated to the promotion
of it, an important piece of American national identity. The playlet magnified
this connection in ways that would have seemed ludicrous had the link not
been so widely recognized already. Directions to the stage manager included
the suggestion that “A large American flag as a background [is] appropriate,”
and emphasized the proper placement of the singing of “America” in the piece
(“If announcements or collection follow the playlet, omit ‘America’ until dismissal”106) and the appropriate accompaniment for the singing of the requisite patriotic song: “If the Star Spangled Banner or other patriotic song than
America is chosen for closing, small flags attached to toothbrushes may be
waved by the entire cast.”107 “Master T. Ache,” a student, made an appearance to highlight the difficulty encountered by students in poor dental health
in learning the civics lessons essential to American citizenship. “For pity’s
sake,” he wails, “won’t some one take this awful ache out o’my head?/ How
do I know where the currents flow, or Hood from Poe or which is dead?/ What
do I care what’s in the air ‘r what rocks are bare in Idaho?/ What can I do in
school or pew?/ It’s up to you, unless you cage me in the zoo!”108
Programs of dental education and prophylaxis both reflected and contributed to the idea that the fate of the nation was somehow inextricably connected to the teeth of its people. Dentists pointed proudly to evidence that the
American public had come to accept the notion that children’s teeth were,
in some ways, the responsibility of the state: one Brooklyn Eagle editorial,

American Dental Hygiene

41

reprinted in The Dental Brief in 1911, conceded that “All [school hygiene]
work is totally at variance with the fundamental American idea that it is the
business of parents to provide for their own children. . . . But the fact is that,
whether we like it or not, we are accepting more and more the communistic
notion that it is the business of all the people of the city to care for all the
children of the city.”109 Another writer continued in the same theme in 1920:
“If that is socialism,” he thundered, “let us be quick to incorporate it in every
political creed. I am more willing to believe it is Americanism, and that it was
in the minds of the writers of our constitution when they prepared its preamble.”110 Early in the twentieth century, the efforts of dentists to improve the
status of their profession helped to draw good dentistry and good citizenship
closer together in the minds of Americans. But dentists’ enthusiastic professional nationalism contrasted sharply with darker fears about the cause of
Americans’ bad dental health. The question of why Americans needed dental
care so badly lurked just under the surface.

Chapter 2

Diet and the Dental Critique of
American Life
“We Boast of Our Civilization,
But We Starve Our Children”

The optimistic spirit that pervaded dentists’ activism for dental hygiene
programs masked a deeper, more pessimistic set of fears about what might
be causing the alarming rate of tooth decay in the United States. Dentists
believed that as much as 90 percent of Americans suffered from tooth decay,
and that as much as half of that decay had never been diagnosed or treated by
a dentist. Theories proliferated to explain why Americans were so prone to
tooth decay, and to the sorts of total-body derangements of health that “focal
infection” spreading from a tooth to the rest of the body could cause. Early in
the century, the dentists who designed and staffed public hygiene programs
typically attributed decay at least in part to the deleterious presence of food
debris, and bacteria that grew within it, on teeth. Yet some of their peers had
already come to the conclusion that while cleaning the teeth was important
for a variety of reasons, it was not a reliable preventative of cavities. Something else—perhaps the nature of the debris itself, or the nature of the teeth
upon which it accumulated—seemed to be exerting an independently controlling influence over the occurrence of tooth decay.
Some practitioners hypothesized that individuals’ inherent genetic tendencies controlled their dental health. Others argued the cases for a variety
of other causative mechanisms for tooth decay—excessive alkalinity of the
diet and/or the saliva, inadequate consumption of calcium, phosphorus, or
vitamin D, and, fi nally, the existence in the mouth of lactobacillus bacteria,
which flourished in sugar and attacked “susceptible” teeth to create cavities.
In short, dentists contemplating the problem of tooth decay in the fi rst half of

42

The Dental Critique of American Life

43

the twentieth century focused on two factors: what was in the teeth, and what
was on them. Arbiters of these two viewpoints shared their sense that the
prevalence of dental decay meant something bad about America. They differed in their assessment of whether or not that bad thing was remediable—
and, if so, how.
Tooth Decay as Genetic Degeneration

The preeminent theorist of genetic causes of tooth decay was Eugene Solomon
Talbot, a Chicago dentist who had entered dental practice as an apprentice in
1870 and subsequently undertook a full course of medical training, graduating from Rush Medical College in 1880. In the debate among dentists about
how to raise the status of the profession, Talbot was a lifetime advocate of
“stomatology,” which posited that dentists ought to imagine themselves as
practitioners of a medical subspecialty focused on the mouth. Talbot’s interest in human heredity, and his belief in its power, were widely shared in the
early twentieth century not only by other physicians and dentists but by sociologists (and particularly criminologists), psychologists, and politicians.1
Talbot, however, believed that dentists had something special to contribute to
the science of inheritance, because he believed that human teeth were among
the most sensitive markers of constitutional deterioration: in 1896, he wrote
that “the ear should be the most frequently affected by degeneracy; next . . .
come the jaws and teeth, and fi nally the head and face. Abnormal development of all is strong evidence of degeneracy.”2
Like other practitioners of his time, Talbot stood in a constantly changing
stream of knowledge about human heredity, and held accordingly complicated opinions about what traits could properly be classified as hereditary,
the mechanisms by which hereditary traits were transmitted, and what
counted as “degeneration” in the human body. “A degenerate, scientifically,”
Talbot said, “is a person whose brain and nervous system is unstable from
inherited or acquired taint in the parents, who has in consequence undergone
imperfectly the embryologic changes to a higher type in tissues or organs, and
therefore exhibits tendencies liable to extinguish the race, as a type, under
the usual conditions of the struggle for existence.”3 Unlike his contemporary,
noted phrenologist and criminologist Cesar Lombroso, Talbot did not believe
that degenerates constituted a separate race. Rather, he theorized that any
individual deprived of two healthy parents, a minimum threshold of nutrition before birth, and careful medical care at all of the crises of life (including
teething, puberty, and menopause) might develop weaknesses of the nervous

44

Making the American Mouth

system that would, in turn, affect all other structures and functions of the
body, including the teeth.
Though degenerates, in Talbot’s mind, were often beyond medical or
moral redemption, degeneracy itself was not always a bad thing. Indeed, as
the flawless dental health of many primitive peoples suggested to contemporary observers, perfect teeth could actually be a sign of inadequate evolutionary progress. Talbot believed that individual organs could degenerate for the
benefit of their parent organism: as examples, he cited “the muscles of the ear,
the vermiform appendix, the little toe, the false ribs, the pineal eye, but especially the face, including the nose, jaws, and teeth,”4 which latter structures
he believed to have deteriorated for the benefit of the human brain. Talbot
speculated that the human fourth molars had evolved to extinction because
nervous energy was required to more fully develop the human brain, thereby
diverting that energy from the development of the teeth. He also believed that
the fuller development of the nervous system meant that fewer teeth were
required to do the chewing and digesting that man had craftily replaced with
cooking and the use of mechanical implements. Third molars (or “wisdom
teeth”), he felt, would be among the next teeth to disappear as the human jaw
continued to shrink. As he put it, “As the race becomes more intelligent, the
jaw is not required to do so much labor.”5
Talbot’s beliefs about what degeneration of the jaws and teeth meant for
an organism as a whole were more complicated. He argued that “from a maxillary and dental stand-point man reached his highest development when his
well-developed jaws held twenty temporary and thirty-two permanent teeth.
Decrease in the numbers meant, from the dental standpoint, degeneracy,
albeit it might mark advance in the man’s evolution as a complete being.”6
To illustrate his notion that dental deterioration could serve as a marker of
more complete evolution, Talbot offered the example of Americans of African
ancestry, to whom he referred frequently throughout his career. “The evolution of the Negro in North America has been most wonderful, mentally and
physically,” he wrote, “In two hundred and fifty years he has developed from
primitive conditions to equal in many cases the Caucasian.”7 Talbot pointed
to the gradual recession of black Americans’ prognathic tendencies, and their
development of flatter and more European-looking facial profiles, as evidence
that “the jaw is degenerating for the benefit of the brain.”8
Talbot speculated that tooth decay and the resultant loss of teeth could
best be understood as “natural methods of hastening the process” of man’s evolution to a more brain-centered, less tooth-centered organism. As his example

The Dental Critique of American Life

45

Figure 3 This image placing human profiles in relationship to apes’ accompanied Eugene Talbot’s description of the dental anatomic changes that occurred during evolution.
Dental Digest 10 (December 1904): 1.

of the “whitening” of African Americans suggested, he considered this a good
thing. In fact, he suggested that it was possible that, although man “from a dental standpoint” had reached his highest state of being when thirty-two healthy
teeth were the norm, man as an entire organism might become a higher form
of life through the sacrifice of teeth: “A degenerate race,” he wrote, “may rank
higher in evolution because of the beneficial variations due to degeneracy.”9
Talbot’s professional peers concurred in this judgment: “These degenerative
changes that we find,” mused one commentator in 1902, “are not always for
the worst.”10 Using these standards of evaluation, tooth decay could be seen as
a positive sign of the progress of evolution in man. Talbot, for one, specifically
linked tooth decay with “civilization” more than once. “Notwithstanding all
the work that is done for the teeth,” he pointed out, “decay is greatly on the
increase. It is more common in those who are advanced in civilization and
brain development.”11 Several years later, he wrote that “Tooth-decay necessarily goes hand in hand with rise in evolution.”12
On the other hand, Talbot also believed that tooth decay could be a reliable
marker of some of the worst and most deleterious kinds of genetic change—
the marker that identified “degenerates” of all stripes. He found “stigmata” of
degeneracy, including high levels of tooth decay, among “the idiot, insane,
criminal, periodical drunkard, deaf-mute and congenital blind . . . [and] the
one-sided genius, the habitual liar, the ‘smart’ business man, the extreme egotist, the tramp, kleptomaniac, harlot and pauper.”13 Because Talbot thought
that the teeth were very sensitive markers of unhealthy degeneracy of the
human organism as a whole, he believed that “to alienists, biologists, criminal anthropologists, and sociologists the human jaw and teeth are of peculiar
interest, since their study establishes many points in evolution and environment not clearly determinable in other structures.”14 Talbot spent much of

46

Making the American Mouth

his career convincing these other professionals of the importance of teeth
as markers for a poor genetic endowment. Later, reflecting on his life’s work,
he mentioned that he had counseled many prominent European scientists,
including Cesar Lombroso, Austrian psychiatrist and sex theorist Richard
von Krafft-Ebing, and British physician and sex psychologist Havelock Ellis,
both learning from and influencing their ideas about the hereditary nature of
crime and sexual vice.15
As his reference to “environment” suggested, Talbot’s concept of what
was inheritable was a fluid one. He felt that inheritable damage could occur
through several mechanisms: “ordinary and socially consanguineous marriages, intermixture of races, climate, soil, food, etc.”16 He attributed the most
dramatic hereditary damage to nerve weakness in parent or child, which,
in turn, could have several discrete causes of its own: among them he listed
“excesses involving toxic agents” and “excesses in a social way.”17
The specific preventive measures Talbot recommended focused almost
exclusively on the need to protect one’s hereditarily transmissible genetic
endowments, or “germ plasm.” He recommended against consanguineous
marriage (whether “ordinary” or “social”), and against early or late reproduction (before age twenty, or after age forty). He counseled the avoidance
of narcotics, alcohol, dangerous occupations, and nervous strain for those of
reproductive age. He also warned of the genetic hazards of race-mixing and
uncontrolled reproduction, citing a 1652 document’s claim that “[in Scotland], if any were visited with the falling sickness, madness, gout, leprosy,
or any such dangerous disease which was likely to be propagated from the
father to the son, he was instantly gelded; a woman kept from all company of
men; and if by chance having some such disease she were found to be with
child, she with her brood were buried alive; and this was to be done for the
common good, lest the whole nation should be injured or corrupted. A severe
doom, you will say, and ought not to be used among Christians, yet more
to be looked into than it is.”18 Talbot was a cautious scholar, and it seems
possible that his inability to render this advice in his own authorial voice
reflected some uncertainty on his part as to either the scientific legitimacy or
the social justice of his policy recommendations. The skepticism with which
his research and recommendations were received suggests that others shared
this uncertainty.
Fellow practitioners challenged the links Talbot attempted to establish
between bad teeth and other types of degeneracy. For example, at a 1901 meeting of the American Academy of Dental Science, one dentist suggested that

The Dental Critique of American Life

47

Talbot had failed to provide an adequate control group of healthy “normal”
patients against whom he could compare the dental measurements he took
from institutionalized “degenerates,” and that Talbot might have misjudged
the origin of the poor dental health of those who were under state care. “How
would it do,” he asked, “to take a comparatively small number of clergymen
and measure them very carefully, and, if they presented certain peculiarities,
how would it do to conclude that all persons who presented about the same
measurements and peculiarities were clergymen?”19 The absurdity of the suggestion that one could identify clergymen, who acquired their status by dint
of long years of dedicated training and scholarship, by the measurements
of their teeth, which they acquired through some combination of heredity
and environment, highlighted the critic’s belief that Talbot had improperly
confused qualities which developed through the exercise of human volition
and those which were passively acquired. Into this latter category the commentator placed the high rates of tooth decay among the incarcerated: “In
speaking of the condition of the teeth that Dr. Talbot fi nds among the insane,
I do not think in my experience I have found that the teeth of the insane
are in very much worse condition than might possibly be expected from the
care which their teeth naturally receive,” he wrote. “You must remember that
these people take no care of their teeth, and taking into consideration also
the kind of food that they have in the public hospitals, what can you expect
under such conditions?” he demanded.20 Finally, he suggested that Talbot’s
tendency to regard degenerates as irretrievably bad overstated the case: “If
you are to decide that a man has certain mental or moral defects because by
your measuring instruments he presents certain asymmetries, you naturally
decide that it is a defect of evolution and there is nothing to be done for him,
and yet the good qualities in that individual may perhaps, as a matter of fact,
completely overshadow the bad.”21
Other contemporaries accepted Talbot’s linkage of bad teeth with other
manifestations of bad inheritance, and his belief that bad inheritance polluted absolutely, but rejected his proffered solutions to such ills. A Kansas
dentist identified as “F.G.” Corey suggested that race-mixing was not only not
deleterious, but actually had positive effects on both dental and overall physical health. “The nearer kin we marry the nearer to physical wreck we get,”
he gushed in 1906, “and that is my argument that the new blood or foreign
blood is what is saving our people physically, but it does seem a pity, to have
to commingle with some foreigners, but we must remember that we are all
the offspring of foreigners.”22 Corey chastised the members of ethnic groups

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Making the American Mouth

known for their reproductive insularity, especially Germans and Jews, and
gave recommendations for race mixtures that were likely to be particularly
successful: “The Iberic or Spanish people make a good cross with the people
in Southern United States, also the Semitic, the Jew especially,” he said.23
Corey contradicted contemporary fears about the impact of white Americans’
“race suicide,” arguing that better Americans were to be had from race mixture than from any other kind of reproduction. “We have always called that
American Indian the true American,” he mused, “but today I have another
true American, the Indian, Irish, Scotch, Iberic, Semitic, and all of their
descendants crossed. What could make a stronger race than a true American
from so many strains of blood?”24
Like others of his time, Corey believed that reproduction ought to be carefully, perhaps even legally, controlled; he just differed dramatically in his
opinion of the ways in which that control ought to be exercised. “If we could
control or educate our children as to what kind of people they should marry
to better their children’s condition, I think it would be a practical thing to do,”
he said. “In this way we could get any kind of beauty we might desire, any
kind of teeth we might require, and the strongest upon the earth.”25 Corey’s
association of beauty, good dental health, and the progress of civilization differed from Talbot’s insistence that tooth decay could actually be a sign of good
evolutionary progress. This alone, suggesting as it did that the 90 percent of
Americans who suffered tooth decay didn’t just have degenerating teeth, but
were actually degenerates, might have been seen as radical—especially while
persuading immigrants to become more like Americans remained so high
on the national agenda. It was clear however that Corey expected his revolutionary ideas about race and reproduction to engender the most dramatic
resistance: perhaps they already had. Near the end of one public talk on the
subject, he warned that “no foolish correspondence will be answered, as I
have taken up this theme only for pastime and not to lose my life.”26
The audience at Corey’s talk did not embrace his theory of race and
reproduction, though they did accept his association of good teeth with
good health. Another of the attendees at Corey’s lecture opined that “It is our
duty to preserve all the teeth possible; to develop the jaw by service and the
younger portion of the present generation will have the teeth so set in the arch
so that the contour and perfect formation of the arch will be preserved, and a
better physical condition will be the result, without any crossing with some
of the other races.”27 Talbot, convinced that dental degeneration and higher
brain development often occurred together, might have regarded this dentist’s

The Dental Critique of American Life

49

admonition to “preserve all the teeth possible” as regressive. It was far more
common for dentists to view good teeth as a marker of overall well-being.
Early twentieth-century dentists’ ideas about the role of inheritance in
producing bad dental health were complicated almost to the point of incoherence. Contemporary thinkers about the role of genetics in dental health
differed in their evaluation of the meaning of good (or bad) dental health, the
question of whether good dental health ought to be sought after, the means
by which it could be attained, and their beliefs about who ought to make
such decisions. This muddled intellectual context prevented dentists from
enthusiastically concluding that an individual’s genetic makeup fi xed his or
her prospects for dental health for life. Instead, a prevailing spirit of enthusiasm about the likelihood of successful health interventions, spurred in part
by the research successes of bacteriologists and the warm reception given to
pilot dental hygiene programs, provided a platform for a different theory of
dental decay. This school of thought looked to controllable diet rather than to
uncontrollable inheritance to explain where bad teeth came from. Like Talbot’s and Corey’s differing ideas about heredity, the early twentieth-century
arguments over diet provided a forum for multiple opinions about meaning,
causation, and responsibility. At its peak, the argument that diet controlled
dental health also gave rise to one of the most powerful and radical critiques
of American culture and politics to emerge from the health professions before
the middle of the century.
Tooth Decay as a Product of Diet

Scientific thought about eating changed dramatically in the early decades of
the twentieth century. Dentists in this period worked in the shadow of the
“New Nutrition,” an invention of home economists who had reacted to the
discovery of protein, fats, and carbohydrates by creating meals intended to
provide an ideal balance of the three. The home economists’ interest in promoting themselves as the practitioners of a scientific trade led them to ignore
taste and texture beyond the minimum attention necessary to produce meals
acceptable to American habits of the table.28 Standardization, more than any
other characteristic, exemplified the changes in Americans’ diets in the fi rst
half of the twentieth century. New technologies in canning, packing, and
hybridization, including the 1903 invention of the virtually indestructible
iceberg lettuce, had made American eating habits portable across state—and
class—lines. Delicacies, like salads, that had once been available only to the
wealthy few were increasingly to be seen on the tables of the bourgeois as

50

Making the American Mouth

well.29 Americans were, as food historian Harvey Levenstein puts it, “liberated from seasonality [by] improvements in transportation, preservation
and distribution. . . . The shelves of an A&P in Louisville, Kentucky, were
hardly distinguishable from the shelves of one in Utica, New York, or Sacramento, California.”30
Even the renowned nutritional rebels of the day were not immune to the
logic of dietary standardization, or to the home economists’ blithe unconcern
for the palatability of healthful food. Turn-of-the-century American nutritional faddist Horace Fletcher advocated chewing each mouthful of food no
less than one hundred times, “until it had absolutely no taste and was involuntarily swallowed.”31 Vegetarian John Harvey Kellogg, whose Battle Creek,
Michigan, company was to make its meat-replacing breakfast cereals a standard on American tables within twenty years, shared Fletcher’s belief that
“the decline of a nation commences when gourmandizing begins.” A nutritionist at the fourth conference of the American Home Economics Association lamented similarly in 1904 that “local tastes and family idiosyncrasies”
still exerted a powerful influence over the dinner table, preventing the development of “conscious standards” in meal planning. “The ‘breaking of bread’
is a universal sacrament and it is given to men primarily for the strengthening
of their bodies, not for the gratification of their palates. To make the choice
of food a matter of whims and unreasoning habit . . .—is this not to forget the
fi rst law of social righteousness, ‘Man shall not live unto himself alone’?”32
The combination of scientific and moral urgings toward dietary conformity, and the technological advances making such conformity possible,
extended into social workers’ attempts to Americanize the diets of the poor.
In the view of the leaders of this newly professionalized discipline, the only
trouble with the national standardization of eating habits was that it had
not progressed far enough down the economic ladder.33 Home economists
promoted dietary standardization as a means of mitigating the criminal and
revolutionary tendencies of some immigrant groups, particularly Italians,
Jews, and Mexicans.34 The combined efforts of social workers and advertisers, together with the assimilative pressure of the public schools and the
military, were widely successful in enforcing dietary conformity on all but
Southern Italian immigrants, whose native cuisines survived these forces
more or less intact.35
Physicians and home economists were particularly interested in standardizing the diets of infants. Shocked at the high rates of infant mortality
in the late nineteenth century, physicians had begun as early as the 1890s

The Dental Critique of American Life

51

to recommend formula or, in an earlier incarnation, “percentage” feeding
to mothers whose children failed to thrive on breast milk.36 While they recognized that the death rate for bottle-fed infants was actually higher than
that for breast-fed ones, physicians argued that this was because the living
conditions of bottle-fed infants of the time were frequently so much worse
than that of children who were breast-fed: in concert with social work, they
believed, science could solve these problems, too. Thus, physicians wary of
the nervous exhaustion of new mothers and of the moral qualifications of wet
nurses increasingly recommended that women unable or unwilling to nurse
their infants consider bottle feeding as a healthful alternative. Throughout
the 1920s, physicians struggled for dominance with manufacturers of patent
infant foods, who had taken to printing such clear instructions for use on
their packages that mothers could formula-feed their infants without medical
advice.37 Advocates of “scientific motherhood” argued that women’s maternal instincts needed to be generously supplemented with medical expertise
in order to ensure the health of children.38 “Modern” mothers chose bottle
feeding, frequently under pressure from physicians, increasingly throughout this period.
During this period of anxious focus on the standardization of the American diet, scientists and the American public became virtually obsessed with
vitamins. Contemporaneous with the discovery of these chemical substances
was the mass delusion that even Americans with calorically adequate diets
were usually not getting enough of them. Nutritionists and physicians argued
that ignorance and poverty led many Americans to make poor food choices;
even those who did choose correctly often destroyed the vitamin content of
what they ate through “modern” food processing techniques.39
Though everyone seemed to agree that a more standardized American
diet would be a positive change, there was much disagreement about who
ought to set the standards for that diet. In fact, the widespread belief that
one right way to eat would eventually be divined seemed to heighten the tension between and among professionals about whose job it would be to do it.
In 1905, for example, one dentist told the Odontographic Society of Chicago
that “Diet is certainly a very important and practical subject, one, it seems to
me, that we should discuss more frequently than we do in our meetings.”40
At the same meeting, another dentist closed the comment period by pointing
out that “We have had the pleasure this evening of listening to a paper which
some years ago might have been pronounced out of accord with our character
of work, and yet it is being recognized every day that the subject of dietetics

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Making the American Mouth

is an important part of our curriculum and work.”41 The speaker’s use of the
passive voice (“might have been pronounced”) makes it difficult to discern
precisely who it was who might have done that pronouncing—dentists themselves? Nutritionists? Physicians? Patients?
Dentists faced opposition from all four groups in their attempts to stake
a claim to professional expertise about diet. Like late nineteenth-century
public health officials who had moved slowly toward regulation of the food
supply, dentists were reluctant to sully their tenuous reputations for scientific authority by venturing into an area in which the state of the art was
so freshly developed. Food purity was generally understood as the province
of moral reformers rather than researchers.42 As with other moral reform
movements, some of the most vigorous advocates of dentists’ participation
in dietary reform were women, whose scarcity in the profession reflected
their perceived lack of scientific capacity—and therefore, the lack of scientific authority associated with positions they took. Dentists who advocated
dietary change had to expound the message to their peers repeatedly before
it stuck. One practitioner noted of a meeting of the Odontographic Society of
Chicago that “a large number of the dentists present, whom I met before the
meeting, felt that [diet] was scarcely a subject that pertains to dentistry, but
the discussion this evening has conclusively proven, if it has proven any one
thing, that it is primarily a dental subject.”43 Some dentists needed quite a bit
of prodding on this score. In 1919, one article on diet republished in a prominent dental journal was preceded with an editorial note: “Is it not about time
that YOU showed some interest in this matter?—Editor.”44 Despite more than
twenty years of commentary on the relationships between teeth and food, in
1922 pedodontist M. Evangeline Jordon, who wrote extensively about nutrition and dental health in the 1920s and 1930s, was still trying to convince
her fellows at an American Dental Association meeting that “the signs of the
times clearly point to the fact that the dentists of the country must organize
[around the subject of diet], for the care of the teeth of the pre-school child or
lose their professional standing.”45
Pediatricians viewed dentists’ interests in diet as illegitimate incursions into their own professional turf, and resisted dentists’ attempts to
prescribe diets to young patients. During the discussion of Jordon’s ADA
paper, a Portland, Oregon, dentist pointed out that one pediatrician attending the convention had argued in his own presentation that “Dentists have
no right to interfere in the selection of a child’s diet.”46 Another discussant
explicitly framed the confl ict as one of dentists’ own right to professional

The Dental Critique of American Life

53

respect: “We know that diet is the greatest factor in caries,” he said, “And it
does not seem to be consistent with our professional degree, that we should
not be allowed to prescribe diet.”47 A fi nal questioner asked Jordon herself to
comment on the proper limits of the dentists’ authority, entertaining a possibility that no doubt struck audience members as radical: “To what extent
is the dentist . . . warranted in prescribing diet in case we fi nd the pediatrician or general practitioner is not giving a proper diet according to our
viewpoint? Are we warranted in removing the case from their hands, if possible, or advising the removal and change to another pediatrician or another
practitioner?”48 Pediatricians’ seeming primacy in matters of childhood diet
prevented more dentists from embracing the subject as part of their own
professional domain—but some dentists, at least, were not ready to knuckle
under to pediatricians’ pressure.
The American public apparently also needed persuasion that their
dentists were appropriate sources of good nutritional advice—or, at least,
dentists thought they did. In this task, again, dentists frequently conceded
the feminization of concern for nutrition by having women characters and
narrators deliver nutritional advice. In 1922, for example, the Dental Digest
published a series of propaganda pieces for subscribers to submit to their
local newspapers as part of ongoing efforts to raise the visibility and status
of the dental profession. “A Dentist’s Wife and His Health” acknowledged
that the public was more ready to accept input on diet from the women associated with dentists than from dentists themselves. Written in the voice of
the dentist’s wife, the article described her phone conversation with “Mrs.
So and So,” who was concerned about her own run-down husband and had
called on the telephone to fi nd out what the dentist ate. The dentist’s wife told
“Mrs. So and So” that her husband ate lightly, drank no tea or coffee, smoked
“very little,” and “loves to be out of doors as much as possible.” This was all
a change, she observed, from when they were fi rst married, and the dentist’s
poor diet made him nervous, irritable, and less productive than he could have
been otherwise. The dentist’s rejuvenation was a personal triumph for both
husband and wife: the article concluded with the news that “Several months
ago he was ‘looked over’ by a physician and had his teeth X-rayed. The physician told him in medical terms that he had nothing the matter with him. . . .
Today if you happen to meet him and ask him how he felt he would answer,
‘Fine. Couldn’t feel better,’ or an equivalent for those words.”49 The item, part
of a “public education” campaign to “inform the public of the possible results
of dental ignorance or neglect,” sought to persuade its skeptical readers that

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Making the American Mouth

their dentists (and their dentists’ wives) were likely to have special dietary
knowledge that patients ought to seek out.50
Dentists’ earliest attempts to establish links between diet and dental
decay saw them turning to the well of comparison for evidence: international
travel in connection with military service, missionary work, and the vacationing in which dentists of rising affluence frequently engaged forced them
to observe the generally good dental health of the people in the places they
visited. Multiple observers pointed to the need for the kind of expert technical dental care in which American dentists increasingly took pride as prima
facie evidence that there was something deeply, and uniquely, wrong with
Americans’ teeth—and perhaps with America itself. In 1901, for example,
when dentists at the meeting of the Northeastern Dental Association discussed
a presentation on “Nutrition as a Tooth-Builder,” one Worcester, Massachusetts, dentist rose to point out that “In Calcutta there are only two dentists
to-day.” He interpreted the low priority that Indians placed on dentistry as
evidence of their abundant good health rather than of their disregard for scientific progress: he added that “They have no occasion for dentists, and, as I
understand it, this is their simple argument for a grain diet as tooth-builders
. . . I believe in one day’s time I saw more perfect teeth than in thirty years
of practice. It speaks something, certainly, for the practice of grain diet.”51
The nutritional bankruptcy of the American diet, some writers observed, was
contagious: in 1902, speaking at another meeting of the Northeastern Dental
Association, Boston dentist Gustave Wiksell objected to the notion that there
was something about the extremes of the American climate that caused teeth
to decay, pointing out that “if it is our climate, how do we explain that before
American-process flour was shipped to Sweden, two generations ago, two
dentists were enough for the whole city of Stockholm, whereas now they are
as thick as in an American city? My friends, God cannot make a four-year-old
colt in four minutes, nor can He make teeth out of starch.”52
Americans had come to believe that describing something as “American”
implied praise, not condemnation. Indeed, with their campaigns to increase
the level of education and training required for entry to their profession, and
with the Progressive-era vigor that characterized their hygiene programs,
American dentists themselves played a critical role in establishing the legitimacy of such a connection as it applied to dental care. Therefore, the idea that
there was something unusual about Americans’ eating habits, and that it was
that unique Americanness that caused dental decay and ill health, required
constant reinforcement; Americans frequently lost track of the notion when

The Dental Critique of American Life

55

emphasis shifted elsewhere. Throughout the early twentieth century, dentists
explicitly linked nationality and national eating habits with dental health
status. As early as 1898, for example, one New Hampshire dentist argued
that “Perhaps among no other people are dental lesions greater than with the
English-speaking races . . . but of the peasantry of Europe there seems good
ground for the opinion that they possess better teeth than the poorer people
of America.”53 Pointing to the growing number of “lunatics, drunkards, criminals and epileptics”54 in the United States, dentists found explanation for
their numbers in the knowledge that “In no land under the sun is there such
utter disregard of the standing resolutions of good health in regard to diet as
in the United States.”55
Perhaps this repetition was necessary because dentists themselves had
not come to a unanimous conclusion about the meaning of the term “American” with respect to the quality of food products or of diets more generally.
Their attempts to assign a nationality to the problem of food adulteration epitomized dentists’ confusion on this point. Dentists imagined themselves as
part of a national surveillance apparatus directed at the food industry: “We
should see that foods are stamped with the names of their ingredients,” one
dentist wrote in 1901, “and those which are adulterated and unfit for food
should be avoided and the sellers brought before the law and punished for
their crime—for I consider adulteration of foods nothing less than a crime.”56
The 1906 Pure Food and Drug Act mandated the accurate labeling of foodstuffs and made many commonly used food additives (like preservatives, coloring, or flavoring) illegal. Both before and after the passage of the act, the
addition of harmful chemicals to otherwise wholesome food proved a persistent concern. One story, reprinted in several nationally distributed dental
journals in 1921, described “A Chemist’s Adventure in ‘Jam,’” in which a curious chemist discovered that a jar of “strawberry” jam actually consisted of an
apple base blended with artificial color and strawberry flavor. Puzzled by the
jam manufacturer’s ability to create lifelike strawberry “seeds,” he took his
wife’s suggestion to plant the seeds and “see what comes up,” only to discover
that he “got a fi ne crop of clover!”57
Some dentists described food adulteration as one of the principal flaws
of the American diet, complaining that doctoring bread with sawdust, flour
with talc, and foods of all kinds with potentially toxic preservatives was so
common in the United States that it had come to be practically pathognomic
of the American way of eating—and, indeed, of the American way of living. “There seems scarcely a product that has escaped,” wrote A. B. Spach in

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Making the American Mouth

1905, “A cause of the much-talked-of race suicide can be found here.”58 But,
depending upon the prevailing political winds, dentists also constructed the
adulteration of food as a quintessential un- (or even anti-) American problem, as illustrated by a 1918 filler piece exhorting dentists to do their part for
national defense, and referencing the Germans’ reported wartime practice
of using wood-derived cellulose fibers instead of flour as a basis for breadmaking. “If we don’t want wooden bread, paper shoes, tin money, perpetual
militarism, systematic german atrocities in business, german ‘kultur,’ and a
german substitute for civilization, we’ve got to win this war!” it proclaimed.59
Peacetime complaints about the flaws of the American system sometimes evanesced under the pressure of war. There was, however, a persistent thread of
concern about the American diet, and its effects on other aspects of American
life, in dentists’ professional conversations.
The other particulars of dentists’ complaints about Americans’ eating
habits fell into several categories. The most often repeated was a concern
about the nutritional impoverishment of white “American-process” flour,
which had had the fibrous bran stripped from it, and which was increasingly
used not only in home baking but in store-bought breads and pastries.60 The
latter often merited a separate mention as items of particularly pernicious
influence. “White flour is adulterated food,” one dentist argued in 1901.61
Gustave Wiksell indulged in a vivid screed against white flour in 1902: “Abolish flouring mills and you will abolish dentistry and all nerve troubles,” he
proclaimed, “Gunpowder is less dangerous in the house than fi ne flour. . . .
Let me make the bread of the people, and I care not who makes the pills!”62
Though one of Wiksell’s colleagues rose to chide him for his extremism on the
issue of white flour (“I cannot think all of the sins of this earth to-day should
be laid upon the shoulders of those who grind flour,” a man identified as
“Dr. Barrett” griped63), and though other practitioners occasionally dissented
from the popular disdain of white flour, Wiksell had many allies in his professional suspicion of the product. Even “Dr. Barrett’s” crotchety objections
to anti-flour extremism seem to have been more to radicalism in general than
to the disparagement of white flour itself: he also mocked nutritional reformer
Alexander Graham, whose “very elaborate and astonishing theories concerning vegetarianism and unbolted flour have been the asylum and sanctuary for
every eccentric and extremist and reforming radical from the day in which
he wrote his fi rst pronunciamento down to the present time, and have probably saved the infl iction upon us of many a crude and undigested theory by
the long-haired men and short-haired women who have found satisfaction

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57

and rest as ‘Grahamites.’”64 In 1912, a dentist reported to the Maryland State
Dental Association that one of his patients had developed enormous cavities in his previously healthy teeth after eating bread from his own bakery,
despite having taken meticulous care of his teeth. This prompted the dentist
to study the connection between white bread and dental decay further. He
discovered “caries quite prevalent among the . . . individuals who ate bakers’
bread exclusively.”65
Like the consumption of refi ned flour, excessive consumption of refi ned
sugar also disturbed dentists. They posited several mechanisms by which
sugar could damage the teeth: one practitioner reported that Americans’
sugar consumption led to the creation of excess stomach acid, which traveled
up to the teeth and caused them to decay—an affl iction known in Europe as
“the Yankee disease.”66 A 1922 survey of American dentists found thirteen of
fourteen agreeing that candy was bad for the teeth and should not be sold to
children, though they differed about the means by which candy’s sugar content did its damage.67 The lack of clarity regarding sugar’s effects on teeth, and
the mechanism thereof, gave rise to several novel plans for studying the question: a Chicago dentist suggested that diabetics be used as a control group.
By the mid-1920s, common wisdom more frequently referenced Americans’
sugar habit as a cause of poor dental health. “I fi nd the greatest offense against
the laws of dietetics is the feeding of too much sugar,” M. Evangeline Jordon wrote in 1923.68 Slowly, practitioners came to the conclusion that excess
sugar, even in an otherwise balanced diet, could be profoundly injurious:
“Often when milk desserts are made,” complained one dietician who spoke
at a dental society meeting in the same year, “they are so sweet that much of
the nutritional value is counteracted by the effects of the all too prevalent
American high sugar diet.”69 Another complained that schools’ insistence on
selling candy to children undermined the food habits teachers and dentists
were trying to teach those children: “Eating candy,” he opined, “is a characteristically American habit, that is formed early in life.”70
Meat also preoccupied American dentists; its consumption seemed to
some to be among the most injurious of American dietary habits. Some early
twentieth-century dentists advocated vegetarianism, agreeing with John Harvey Kellogg that meat products were difficult to digest and prone to fermentation in the human intestinal tract, causing disease. “Flesh, together with
other indigestible foods . . . [are] the greatest causes of indigestion, which
nine-tenths of the American people are afflicted with to-day. Indigestion
is one of the greatest causes of constitutional deterioration, resulting in the

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Making the American Mouth

decay and loss of teeth,” argued an Ohio dentist, who believed that the structure of human teeth suggested that “man is not carnivorous by nature . . .
man’s mouth and teeth are a mill,” best suited for grinding grain products and
vegetable foods.71 An Arizona dentist advised readers of Oral Hygiene that he
would choose foods “from the fruit and vegetable class and leave out all the
animal products as immoral, unclean and disease-producing.”72 Meat’s contribution to poor digestion—and thereby, in the contemporary understanding, to disgruntledness and criminality—may have been on his mind when
he described it as “immoral.” On the other hand, the editor’s introduction
to the article suggests that readers might have been expected to connect the
author’s disdain for meat with other social and environmental causes of the
day: “Dr. Teufert has made an exhaustive study of diet and has come to practically the same conclusions reached by Upton Sinclair, Hereward Carrington
and hosts of others,” the editor wrote. “There is meat in his paper, if not in his
diet.”73 Oral Hygiene’s editors were particularly meat-averse: at the end of a
case report of a man who had swallowed his denture plate while eating meat,
suffered “coughing and expectoration of foul smelling pus” for two years,
submitted to two unsuccessful operative attempts to remove the plate (which
was “lodged in his oesophagus at the bifurcation of the trachea”), and fi nally
died, the author of the report advised that patients with partial plates ought
to be warned of those items’ dangers. The editor quipped: “Why not make the
moral, don’t eat meat?”74
Some dentists, however, recoiled at the thought of a meatless diet.
Another Oral Hygiene article reported that though Ralph Waldo Emerson was
said to have avoided meat in the interests of his poetry, the haler and heartier
evolutionist Herbert Spencer reportedly “lived for six months upon this [vegetarian] diet, [and] threw everything he had written during this period into
the fi re.”75 A Chicago dentist smugly said that that he knew a dentist who
had tried a vegetarian diet: “He is reported to have made many a meal upon
watermelon. . . . He died last winter from tuberculosis.”76 Ultimately, most
dentists rejected vegetarianism, but counseled moderation in the consumption of meat.
Dentists objected to the intake of too much meat or too much sugar, but
some were of the opinion that the real problem with the American diet was
simply that it provided too much food. These dentists believed that highcalorie diets, like those including meat, were suited only to those who required
large amounts of excess energy, which “city dwellers” did not. “The habits of
eating that a farmer can indulge in are not permissible to the bookkeeper or

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59

salesgirl,” one writer warned.77 Meat, as a particularly concentrated food, was
to be avoided not for its inherent defects but simply because it represented
too much of a good thing. “We, as American people, are too great eaters,”
another dentist observed, “We eat too much.” He speculated that “Our diet is
going to change materially during the next twenty-five years.”78 In wartime,
overeating was described by one commentator as “the Real American Peril”:
“The American dinner table is the most tempting in the world,” he sighed
in 1918, “It combines English bounty with French cooking and whereas the
Englishman is saved from excess by bad cooking and the Frenchman by small
portions, the American has mated the English table and the French cook and
the result is joy to his appetite and death to his arteries.”79 One writer construed
overeating as a product of both time and political priorities, contributing to
the construction of the United States as an exemplar of corrupt modernity:
“Gluttony is one of the worst and most pernicious habits of the times,” he
mused, “Though a difficult thing to do, for the benefit of public health, it
may become necessary to adopt a twentieth amendment to the Constitution to
regulate the eating as well as the drinking habit.”80
Throughout the early twentieth century, dentists pointed to the social
and scientific energy directed toward modern agriculture as a model to be
followed by Americans in pursuit of healthy teeth. These practitioners were
disgusted by the disjuncture between Americans’ attentiveness to their crops
and livestock and their inattention to their dental health. In 1905, an Illinois
dentist criticized farmers for limiting the quantity and types of food available
to their driving horses, but failing to exercise similar caution about the foods
they allowed their children to consume.81 The example of the stock animal
was widely used by dentists who may have been only very recently off the
farm themselves, though they were careful to explain agricultural references
for the benefit of those of urban lineage: “The progressive live stock breeder,
who wishes to produce in his young animal the greatest growth of muscle,
bone and constitution, feeds them middlings,” one dentist commented in
1905.82 He went on to define “middlings” (“the parts of the wheat which we
discard in making our flour”83).
The increasing participation of government in agriculture and urban
services in the early twentieth century outraged dentists who professed to
view human beings as more valuable resources than livestock or real estate.
Like the advocates of other contemporary movements for progressive reform,
dentists felt that children in particular were entitled to protection from poor
food and the dental damage it could cause. “What are the people of the United

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Making the American Mouth

States doing to combat [tooth decay] in public schools? Why, nothing! We
have plenty of money to fight doodle-bugs, foot and mouth disease among our
cattle and infectious disease among hogs, and money for forest preserves,” an
anonymous writer sputtered in 1911.84 He went on to describe the exorbitant
(in his view) amounts of money that New York City had spent on fi re services
in one year, asking “Would it not be an economy to spend less money on our
cattle and hogs and more on our greatest national asset, the boys and girls
of to-day, who are soon to be our rulers and law-makers?”85 Popular writers
echoed this concern, citing the frantic (perhaps, one even suggested, hysterical) efforts to protect crops from invasive insect pests as examples of Americans’ misplaced priorities: “In 1919 our agriculturists manifested great alarm
lest the European corn borer should spread from the limited regions where
it was discovered in New York State and infect other regions where corn is
grown,” one writer carped in a popular magazine, a portion of which was
reprinted in an American dental journal. “The machinery of government
was at once set in motion to check the ravages of the European corn borer.
Wise indeed is the state that permits itself to be agitated in the presence of
the European corn borer. But what about the food deviltries that have been
boring unmolested into the health and life of the child?”86 Dentists viewed
the problem of distorted priorities with respect to health and agriculture as
a uniquely American one: one writer compared the United States unfavorably with Germany (“a country where they are not only very much concerned
about the health of their cattle and hogs, but have the intelligence to look after
their school children as well”), Switzerland, and even Russia, where the existence of the St. Petersburg school dental clinic demonstrated Russians’ better
understanding of the importance of dental health.87
As their anger about the misdirection of public resources to animal
health and agriculture rather than human health demonstrated, some dentists experienced misgivings about the march of time and the progress of socalled “American civilization,” particularly its agricultural—and, relatedly,
dietary—manifestations. Eugenicists like Eugene Talbot marked the signs
of civilization and eagerly anticipated its furtherance—and were, at times,
even willing to sacrifice the health of human teeth and jaws in its service.
Others feared that those who lauded the process of civilization had judged
wrongly, placing their faith in a way of being that harmed human life more
than it enhanced it. One place where this tension played out was in dentists’
ongoing debate about the influence of civilization on human appetites and
desires. Another was in one prominent dentist’s trenchant—but ultimately

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61

unsuccessful—critique of American civilization, and particularly of the
American diet.
Civilization and Its Discontents

Like other scientists of human heredity, American dentists harbored mixed
feelings about the meaning of the term “civilization,” and about the effects
of civilization on the health of human beings. Charles Darwin and Francis
Galton, the preeminent theorists of human heredity, had portrayed civilization as a new cultural development, behind which human nature lagged
considerably, and dentists generally shared this view.88 They frequently contrasted “civilization” with “instinct,” as in observations about the difference
between a “civilized diet” and the foods to which Americans were drawn to
“naturally,” by “instinct,” or, occasionally, as a result of heeding “appetite.”
The value judgments implicit in these terms changed dramatically depending on who was using them as reference points.
Some writers used the word “civilization” as a stand-in for qualities that
were positive products of social, scientific, and artistic progress. An Ohio
dentist argued in 1899 that bad eating habits were a product of unchecked
instinct, suggesting that civilization might be a positive restraining force
on that instinct: “[T]hat through the depraved, gourmandizing appetite of
man, emanating from his debased lower animal nature, his evil habits of
life, have their origin I am fully convinced.”89 In this view, the order and
purpose imbued in modern life by the trappings of civilization could prove
to be a useful corrective to the otherwise injurious whims of the individual.
In 1905, dental luminary Frederick Noyes (one of at least three successive
generations of dentists in his family) told peers at a meeting of the Odontographic Society of Chicago that “a man who always eats a certain amount,
who leaves a clean plate at the end of the meal; always, as a rule, you fi nd that
man has lived with comparatively little sickness. On the other hand, a man
whose eating is dependent upon his appetite is almost always more or less
liable to short periods of sickness, for he will at times overeat, and at other
times undereat, and the result is a liability to certain diseased conditions
from both causes.”90 That one’s own appetite could lead one astray suggested
that discipline, in the form of civilized rules for eating, was necessary for
good health and long life. This logic helped to make the case for enforcing dietary change on immigrants, whose “instinctive” preferences for their
national cuisines was thought to cause poor health, insanity, and political
intractability.

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Making the American Mouth

On the other hand, many of the Social Darwinists of the turn of the century regarded civilized people’s accommodations of the weak—in institutions like public schools, and with measures intended to protect the sick, the
poor, or vulnerable recent immigrants—as undesirable interference with the
upward progress of human evolution. In this view, too much “civilization”
was something to be avoided; “instinct” was to be trusted rather than trained.
One Arizona writer admonished his patients to eschew dietary fashion and
“use good judgment and be guided by his appetite” when it came to choosing types and quantities of food (though, in case this advice did not suffice,
he also gave detailed instructions including the direction to “avoid salt, vinegar, and spices”).91 In these dentists’ minds, instinct existed as a permanent
subtext of both civilization and savagery, though it had different effects in
different conditions. One writer argued that the “preference for the succulent
and nutritious” had probably been evolutionarily advantageous for primitive
man, since it helped him to supplement an otherwise coarse and bulky diet
with more concentrated forms of nutrition.92 He also seemed to believe that
the human capacity to alter food had in fact outstripped the need for that food
to be altered—that the mechanical elimination of so much fiber and roughage
from the “civilized” diet had redounded in a negative way upon the health
status of civilized mankind, and particularly of Americans. “What was at one
time performed by the teeth and stomach is now too largely done by machinery
and cookery,” he wrote, “We may look forward to the time when the food of
the uncivilized is correct.”93 In the context of a growing national infrastructure
devoted to the production of sweet, sticky, nutritionally bankrupt foods like
candy, the instinctive desire to eat soft, sweet things seemed like a hindrance
to health rather than a help. Some felt that the dismantling of that infrastructure could restore human instinct to its role as a reliable dining guide.
Most practitioners regarded instinct as a vaguely positive force, though
their beliefs about how strong its influence over “civilized” human behavior could (or should) be differed widely. For example, a Copenhagen dentist
identified as “Professor Christensen” told a meeting of the International Dental Federation in 1913 that raw carrots were an especially important part of
children’s diets because they were “pleasant to chew, sufficiently hard while
being at the same time brittle enough, so that the child is anxious to overcome
the resistance . . . his natural instinct induces him to chew it as small as possible.”94 Chewing, everyone agreed, was a positive good, and any instinct that
promoted it would be by defi nition trustworthy. Yet the presence at the same
conference of dietary reformer Horace Fletcher, famed for his insistence that

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63

Americans had to be taught how to chew properly, served as a living example
of the proposition that instinct had been all but eliminated by civilization,
and that professional guidance was necessary to restore or replace it. This
change would take effort, its advocates thought, but it could be done: in his
1923 address to the American Dental Association, the president of that organization urged his listeners to “[have] the courage to change the acquired
dietetic habits of the times and recover the lost natural appetite and follow
this as their guide.”95
American dentists never came to a unified conclusion about the relative
merits of instinct and civilization. They believed that civilization had led
Americans’ eating habits astray, but that immigrants’ diets should be assimilated to American standards. Outside the context of discussions about the
Americanization of immigrants, almost everyone agreed that Americans’
diets were bad, but dentists’ profound disagreements about whether instinct
or civilization would prove a more trustworthy guide to the table gave rise to
startlingly divergent analyses of what should be done to improve them. In a
notable example of these differences, two women practitioners offered antithetical suggestions as to the merits of allowing young children to make decisions about their own diets. M. Evangeline Jordon commented in 1923 that
“the old habit of putting the child at the table in his high-chair, and forgetting
or not knowing that children should not eat the same food as their parents,
and letting him select his own diet, was followed by so much indigestion
and illness that the resistance to disease was greatly lowered and children
fell victims to epidemics of measles, scarlet fever, whooping-cough and diphtheria in large numbers. . . . At the present time [health officers’ efforts are]
being directed toward the forming of proper habits in the pre-school age.”96
Jordon believed that children had to be taught to choose what was healthiest
for them to eat, and that most dentists and physicians had accepted this reality and advised their patients to abandon the “old habit” of allowing children
to choose according to their tastes. Another article published in the same
year mourned the fact that not all parents had accepted this dictum wholesale: “Even Grandma humors the child. . . . restriction is needed,” pleaded its
author. “The child is irresponsible, its powers of judgment are undeveloped
and it yields to a well-developed but a perverted taste. . . . [It is] not a question of what the child wants, but what he needs and should have to properly
nourish him.”97
Ironically, despite Jordon’s insistence that the instincts of children could
not be trusted—and her claim that everyone else accepted this as a fact—one

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Making the American Mouth

Cleveland pediatrician would soon embark upon an experiment that seemed
to disprove both assertions. In 1926, Clara Davis began what she described
as a “self-selection diet experiment in infants and young children” at Mount
Sinai Hospital in her home city. Davis directed hospital nurses to offer unlimited quantities of more than twenty different foods to fourteen institutionalized babies at each of their daily meals. The foods were placed in individual
bowls, set on high-chair trays, and presented to the infants for their appraisal.
Attending nurses were instructed to periodically rearrange the bowls so as
to place each of the foods within an infant’s easy reach at some point during
each meal, but were otherwise “to sit quietly by and not to interfere with
anything the baby did. She might not speak to him, call his attention to any
food, offer him any or refuse him any for which he reached, comment on what
he did or attempt to teach him table manners. Only when he reached for or
pointed to a dish was she to take up a spoonful of the food and, if he opened
his mouth for it, put it in.”98
Somewhat to her own surprise, Davis discovered that the instincts of the
children in her study led them well. Their eating habits varied wildly, and
sometimes disturbingly: Abraham G.’s prolonged “egg jag,” culminating in
the two-and-a-half-year-old eating ten eggs for supper one night “with no ill
effects whatever,” particularly unnerved his nurses. But the children grew
healthier than they had been on admission to the institution, suffered few
common childhood illnesses, and gained weight appropriately—an important measure of child health, particularly among the poor.99 Davis concluded
that “there has existed in [the children] some mechanism made evident as
appetite, which, sensitive as a weather vane to every wind that blows, has
responded promptly to heat, cold, exercise, fatigue, and infection, and which,
when uninterfered with by emotional confl ict with elders or suggestions
from without, has functioned smoothly and efficiently as far as the simple
unmixed foods of this list go.”100 She recommended that parents spend less
time and energy “particularizing amounts” of food and coaching their children in eating habits and table manners (though she did concede that parents,
like the nurses in her study, might limit the kinds, if not the quantities, of
foods to which children had access). These parental—and especially maternal—behaviors, Davis seemed to argue, did harm rather than good to infants’
diets and health.
As Jordon’s and Davis’s differing assessments of instinct—and, by implication, of civilization itself—suggest, these radically opposed opinions could
give rise to equally divergent sets of recommendations to parents, patients,

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65

and fellow practitioners. If instinct was to be distrusted, and civilization to
be regarded as a positive good, then the individual (or the individual’s parent
or guardian) had a responsibility to ignore instinct and follow the rules of
civilization—particularly as handed down by dentists and physicians—as a
guide for life. Failure to do so could be interpreted as uncivilized.
Some dentists, like many physicians, considered mothers as technicians
in need of constant scientific advice, and regarded the “maternal instinct”
as a source of indulgence leading to infection, pain, and ill health. Mothers,
in this view, needed help determining not only what to feed their children,
but how to feed them. In 1899, dentist Claude Chick chided mothers for their
habit, in an age before electric blenders or food processors were available, of
pre-chewing their infants’ foods. Mothers’ ignorance of the harm this practice
could cause was an additional strike against them: Chick complained that
mothers often claimed not to know what caused their infants’ digestive problems, but, he said, “If the physician would examine the teeth of the mother
he might get a pointer as to the cause of the trouble. . . . When the mother
has several bad teeth broken down by decay, etc., it is very common for her
to have pyorrhea, at least her mouth is in a bad state, even for the general
health of the mother, leave alone the health of the delicate little child.”101 In
1910, a public-education item used in Rochester, New York, newspapers and
reprinted in the Dental Digest similarly warned patients and parents against
the fate of “Tim,” who suffered “numerous stomach disorders . . . generally
when his fond mother chewed some delicacy in her own mouth and placed
it in his.”102
Mothers were responsible not only for feeding their children (for good
or ill), but for following the rules dictated by science about diet in pregnancy. Some dentists viewed this responsibility as being connected to mothers’ responsibility to seek out eugenically sound marriages. Like physicians
with interests in eugenics, these dentists promoted the teaching of nutrition,
together with sex hygiene curricula, to high school girls, who could not be
expected (or allowed) to follow their instinctive preferences in either coupling or eating: “Every girl going through the junior and senior years of high
school must have the training in dietetics, especially as applied to prenatal
and pre-school feeding, before we will have strong teeth and healthy bodies,”
predicted one writer in 1923.103
On the other hand, if the abrogation of instinct in favor of civilization
was a bad thing, then parents, patients, dentists, and government had a whole
different set of responsibilities. In fact, if the badness of civilization was itself

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a cause of dental decay, the deterioration of health, and all other manner of
physiological and political ills, perhaps it would take a veritable revolution in
Americans’ ideas about civilization, and about eating, to reverse the damage
caused by progress. The foremost arbiter of this stance in the fi rst half of the
twentieth century was a Cleveland dentist named Weston Andrew Valleau
Price, the head of the American Dental Association’s Research Division and
a widely published writer whose works included a classic two-volume text
on the links between dental infections and systemic degenerative diseases.
Sometime in the 1920s, Price decided to spend much of his spare time traveling around the world to examine the teeth of peoples from a variety of racial
and ethnic groups. He believed that his travels could help him to elucidate
facts that would be useful for Americans, and for the profession as a whole.
Price, like Eugene Talbot, had begun his career as a vigorous critic of racial
miscegenation and its effects on human health. His early writings, including
a 1929 talk entitled “Our Children: How We May Add to Or Subtract From
their Inheritance,” invoked all the standard fears of advocates of eugenic sterilization, including prostitution, sex perversion, and the infamous Jukes family, whose notorious proliferation of ne’er-do-wells was generally regarded
as proof of the inherited nature of criminality. Explicitly Lamarckian, Price
wrote that “It is by now probably defi nitely established that it is possible to
transmit characters that have been built up by our ancestors. . . . Let’s take
that terrible picture of the Jukes family. . . . Poorness of those chromosomes
was present to this terrible extent that fifty-two percent of the women born
in that family [of] twelve hundred individuals were prostitutes, and it is estimated that something over ninety-five to ninety-eight percent of the men were
sex perverts.”104 Even as early as 1929, Price expressed some sympathy for the
victims of genetic determinism: “They weren’t necessarily poor people,” he
cautioned. “They just had that kind of determiner.” But he concluded, like
most of his contemporaries, that society had to be protected from the moral
and fi nancial consequences of the Jukes’ unrestrained reproduction. “Oh,
how hard it is,” he lamented, “for by law and by restriction we can’t eliminate
them, to make character. . . . The only way we can do that is to make these
people stop producing.” In 1929, Price concluded that while government
euthanasia campaigns were probably untenable, educational efforts aimed at
the marriageable young—as Price put it, “helping to bring God’s kingdom on
earth”—were not.
Price’s world travels turned him from a convinced eugenicist, secure in
the belief that human reproduction required scientific help, into the most

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67

prominent dietary reformer of his day—a critic of civilization, and a devout
believer in the positive power of human instinct. During travels through the
South Pacific, he found the locals of many areas possessed of great skill and
intelligence when set to work as dentists. In American Samoa, for example,
Price gave the natives “pieces of soap and asked them to carve a reproduction
of an extracted tooth which was given as a model . . . Their work would probably equal if not exceed in excellence the fi rst effort of 90 per cent of American dental students.”105 More important, though, was what he found when he
focused on the dental health of the native peoples of a wide range of locales,
most of which were tropical paradises that had been—or were in the process
of being—colonized by Western powers. The abundantly good dental health
of the locals of virtually everyplace he visited had deteriorated alarmingly
after they began eating a Western or “trade” diet—the very same diet that
Americans were consuming every day.
By the time he published his magnum opus, Nutrition and Physical
Degeneration, in 1938, Price had visited isolated groups of “primitive racial
stock” on at least four continents. His attentions lingered on the physical
condition of non-white natives before and after contact with Westerners. The
Samoan islanders were, to Price’s eye, fi ner specimens of humanity than their
white colonizers. “The characteristics of the Polynesian race included straight
hair, oval features, happy, buoyant dispositions and splendid physiques,” he
reported.106 The generations born in Samoa (and elsewhere) after contact with
whites suffered from tooth decay, chronic disease, and increased rates of
infant mortality. The natives themselves, he suggested, explicitly associated
their plight with the presence of whites. He had, as he put it, “found the primitives despising the ignorance of the white man and often endeavoring to shun
his influence, by retreating into the jungles or forests. They have observed
that the white man’s influence is destructive to native tribes.”107 Apparently,
the islanders shared some dentists’ belief that when health was the measure
it was the West, and civilization itself, that suffered in the comparison.
The most common popular explanation for the precipitous decline in
both natives’ and white colonists’ dental health was that race-mixing was
to blame. Like other Americans who were regularly exposed by contemporary eugenicists to the notion that the commingling of disparate races could
have catastrophic effects, Price had some level of innate sympathy for this
explanation, and he investigated it at length. In Fiji, Price reported, the labor
demands of sugar plantations resulted in the immigration of large numbers
of Indians and Chinese to the island. “This influx of Asiatics together with

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Making the American Mouth

that of Europeans has had an important influence on the purity of the native
race around the ports. This provided an opportunity to study the effects of
intermingling of races on the susceptibility to dental caries,” he reported,
“No differences due to ancestry were disclosed by the presence or absence of
tooth decay.”108 Price concluded that the only cause of the skyrocketing rates
of tooth decay among natives who engaged in trade and cultural amalgamation with whites was the insufficiency of the white diet. Like the natives
themselves, white colonials in the sundry locations Price visited in the early
twentieth century seemed to know this, and to feel shame about it. On Thursday Island, north of Australia, Price noted that “an embarrassing situation
was encountered with regard to the sensitiveness of the whites in the matter
of having their children examined for dental caries.”109 Price and his wife
(his constant travel companion, always photographed in seemingly stifl ing
Western dress) had to gauge the dental degeneracy of the colonists there from
a distance, by their “irregularities of facial and dental arch development.”110
Price’s discoveries, which convinced him of the singular importance of
diet in determining health, permanently changed his feelings about the racist strains of eugenics then in circulation in the United States. Correspondence with his family members suggests the scope and nature of this change.
After reading Nutrition and Physical Degeneration, which expounded Price’s
theories on diet and the decay of colonized peoples’ health, Price’s brother
Norman wrote him: “Why so pessimistic? I can’t believe mankind is going to
the dogs just yet, nor even degenerating so much. The white race is still the
most intelligent race; with its engenuity [sic] ways will be found to provide
necessary chemicals in our food so we may survive without all living near
the sea.”111 Norman Price appealed discreetly to his brother’s memory of their
shared childhood in rural Ohio: “Do you remember what happened to the boy
lambs when we were farm boys? Suggest a law for a similar process in imbeciles.”112 In reply, Price observed that with appropriate nutritional safeguards,
both sterilization and euthanasia would be unnecessary.
Nearing the end of his career, Price retained his Lamarckian bent: he
believed that the facial deformities and the attendant defects in personality
and intelligence caused by poor nutrition might be passed from parent to
child, but he also felt that they might be prevented through scrupulous attention to diet on the part of the affected parent. His understanding of heredity
was not that much different than Eugene Talbot’s: like Talbot, Price thought
of heredity as encompassing everything that had an impact on human “germ
plasm,” including chromosomes, excessive nervous strain, exposure to toxins,

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and diet. But from this similar conception of heredity, Price developed radically different ideas about “civilization” and its value, suggesting that the
political implications of early-twentieth-century ideas about heredity were
by no means inevitable.
Modern westerners, Price thought, grew, processed, and ate bad food,
and thrust that bad food upon the peoples with whom they came into contact
through trade and colonization. The impact of this dietary catastrophe so
overwhelmed any other factors influencing human heredity that their significance seemed to pale in comparison. It was the consumption of bad food, not
the existence of bad genes, which made the South Sea Islanders seem damaged, incapable of self-care, and in need of the help of white Westerners. In
short, Price’s analysis was that his contemporaries suffered from the worst
sort of observational fallacy. Their presence in unindustrialized areas of the
world had caused the illnesses that convinced them that trade and colonization were essential to the “progress” of colonized regions of the globe.
From these facts, one could conclude that the native peoples whom Price
studied didn’t need white Westerners’ help—that the helping relationship,
if there was to be one, should flow in quite the opposite direction. Back in
the United States, Price sought to convince his colleagues that the evidence
of his travels argued strongly for the implementation of “primitive” diets in
America. Crowded dental arches and stunted facial growth, he argued, “[had
been] wrongly attributed to a mixture of racial bloods” when it was the supplanting of native with white diets that was really at fault.113
Price’s seemingly simple critique of the dental impact of the modern
white diet on previously isolated tribal peoples shrouded his rejection of
virtually every major dietary trend of his time. His studies convinced him
that diets ought to be carefully chosen to match genetic heritage, which challenged social workers’, nutritionists’, and physicians’ growing belief in the
importance of dietary standardization. His observations about the superior
health of infants breast-fed by their mothers until one, two or even three
years of age ran counter to prevailing wisdom about breastfeeding itself, and
to middle-class women’s growing use of artificial birth control, rather than
extended breastfeeding, as a contraceptive measure. His objection to the use
of processed foods challenged the existence of the entire industry; the adoption of his argument for local diets, locally grown, had the potential to undermine the progress made possible by the increasing specialization of modern
agriculture. Price considered vitamin supplementation useless, and he posited that vitamin deficiencies originated not in poor foods, but in poor soil.

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Making the American Mouth

He advocated organic farming, which posed a threat to both the practice of
factory farming and the burgeoning agricultural chemicals industry.
With these other heresies, Price took a vigorous stance in the debate
raging in American life about who or what should be held responsible for
individuals’ health ills and woes. Unlike the pessimists who despaired of
changing Americans’ dietary habits—and still less their inherited genetic
traits—Price believed that American social and economic systems ought to
be the target of reformers’ outrage, and of focused efforts for change. In this,
he opposed those who argued that measures taken at the level of the individual or the household could effectively counteract the damage that might
inadvertently be done by the otherwise benevolent systems of capitalism
and democracy. Price challenged widespread popular assumptions about
the inherent fitness of the American system—the professional, scientific,
rational, civilized American system—to be applied to human beings, both
domestically and overseas. To Price, the dietary and cultural standardization wrought abroad by colonialism mirrored that which was underway in
the United States, and his opposition to one paralleled his opposition to the
other. “Surely,” he concluded in 1935, “our civilization is on trial both at
home and abroad.”114
Price’s research was widely published in the best American dental journals. He had given many years of service and much of great scientific value to
the profession before he dared to call into question the wisdom of the American way of life, and his preexisting professional prominence brought him the
respect and affection of his professional colleagues, including the journal
editors who disseminated his work. Yet his critique of Americans’ diets, and
of the larger systems of which those diets were a part, barely survived him.
After Price’s death in January of 1948, his will provided for the republication
of Nutrition and Physical Degeneration, and a small group of Price’s admirers
banded together to promote his research fi ndings in other ways. His fi ndings,
though, were only rarely mentioned in mainstream professional literature
after his death.115
In the fi rst half of the twentieth century, dentists increasingly placed the
blame for tooth decay, and for many illnesses proceeding from it, squarely
on the defects and deficiencies of the modern American way of life. Americans’ poor care of their teeth, lamentable habits of uncontrolled reproduction, and flawed dietary predilections each came in for extended criticism
by dentists—and, to a certain extent, by other professionals as well. Focus on
the volitional causes of poor dental health helped to further the notion that

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71

Americans could—and should—do something to prevent tooth decay, and
that it was a positive sign of social and professional progress to do so.
Though their nationalist fervor was challenged by Americans’ continued experience of bad dental health, dentists were increasingly convinced
that meritorious peoples and nations would share American dentists’ concern for the traits of scientific specificity, efficiency, and modernity, all of
which American dentists were increasingly coming to see as landmark
achievements of the profession. Many dentists, like Weston Price, traveled
extensively, and they took careful note of how their professional ideals were
received abroad. The other nations in which the United States took interest,
these dentists felt, could be assessed and ranked by their esteem for these
characteristic features of American dentistry—or by their rejection of them.
By the middle of the century, dentists described a high regard for American
dental practices as a threshold measure of the value and assimilability of
people around the world.

Chapter 3

“Like a Sugar-Coated Pill”
Defining American Dentistry Abroad

In 1921, an author who identified himself as “A Japanese Office Boy” wrote to
the editor of the Dental Digest to ask a series of impertinent questions about
the way Americans practiced dentistry. “Mr. Editor of Small but Helpless
Magazine of Toothsome Tendencies,” the letter began, “Somewhat Honorable Sir: Recently I have absorbed one complete course, by correspondence,
of English decomposition and letter write. . . . Having recently completed
all Money Orders, Mr. Editor, I now possess delicious abilities to express
thoughts occurring in brains or elsewhere in approximate English and
so similarly to all newly arrived Americans I hasten to news print wherever possible. Thank you. Natural comeback for you of Dental Magazine
Editorship is ‘Why pick on me?’” The author, who also referred to himself
as “Houseboy,” explained that his most recent jobs had been in dentists’
offices, and that he was confused about what he had witnessed there. For
example: “Why will ambidextrous tooth tormentor insist on placing Dams
composed of rubber and profane language over helpless teeth when cotton
rolls of entire whiteness will accomplish same purpose in many cases in
1/8 elapsed time while also allowing chair victims to completely retain
all Christian expressions formerly used during operations of open faced
nature? Answers should be tabulated when convenient.” The letter was
signed “Yours if necessary, TOGO.”1
The article appeared below an editorial note admonishing: “Even if this
hits you (which it is quite apt to do) you will like it. Like a sugar-coated
pill it will do you good—pleasantly—(Editor.)”2 The satire of “Togo’s” letter

72

“Like a Sugar-Coated Pill”

73

embodied the animus of its white author, and many of his race and social
class, toward the perceived infiltration of American public spaces by immigrants. Within three years of the publication of “Togo’s” missive, American
immigration law, already restrictive with respect to Asians, would be revised
so as to effectively exclude all Asian immigration to the United States. The
“letter,” therefore, cannot be understood apart from the history of increasing
anti-Asian nativism in the United States in the 1920s.
The document had a function beyond political commentary, though: it
parroted the voice of an immigrant who had no business offering a critique
of the United States or its dental practices in order to goad American dentists
into better behavior. Lacking formal education, English fluency, and wisdom,
even “Togo” could see that some American dentists’ practices made no sense.
“Togo’s” letter was funny not only because of its garbled English, but because
it inverted the social conventions of early twentieth-century American professional racism, and upended the conventions of a genre with which American dentists were extremely familiar: the dental travel essay.
In the fi rst few decades of the twentieth century, as the sectional tension
of the mid- to late nineteenth century gave way to the nationalist excursions
of the Spanish-American War and World War I, American dentists traveled
for military and missionary work that sought to spread the gospel, the arm
of the Republic, and an improved standard of dental treatment far and wide.
Their commitment to the political and military context for their journeys
meant that most dentists, unlike Weston Price, were proud of the qualities
they associated with Americanness; their travels caused them to more tightly
connect professional behavior with a positive national identity.
Dental travelers produced an enormous volume of writing describing
their experiences abroad and the conditions of dental practice in the places
they visited. They hoped to edify, to entertain, and to agitate their peers with
their writings. In so doing, they also imbued the term “American dentistry”
with specific meaning. The metropolitan American identity to which they
appealed was constructed in part by their surveillance and characterization
of American peripheries—often, locations that had been colonized by the
United States.3 An important effect of the travel writing published in dental journals in this period was to defi ne what people, and what dental and
societal practices, could rightfully be denominated “American,” particularly
as calibrated against people and practices that would fail of this aspiration.
Consistency, sophistication, specificity of diagnoses, remedies, and procedures, fi rm but fair licensing laws, temperate climates, efficiency in billing

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Making the American Mouth

and paying, cleanliness, promptness, commitment to meritocracy, and interest in appearance were American: their antagonists were not.
Of course, these qualities were not consistently present in the United
States, or in dentists who practiced there. The authors of dental travel essays
emphasized such traits partly because their existence in the United States
was so uncertain—and, at times, so bitterly contested. Yet dental travel writing, like other professional and popular discourse at home, militated toward
those attributes, and toward their cultivation in places abroad that came
under American purview. It thus contributed equally to burgeoning concepts
of what was “professional” in American dentistry. Eventually, description
and discussion of dental practice in areas occupied, annexed, or merely contemplated by the United States helped to inform discussions about what relationship the United States ought to have to those locations, and about how
successful such connections were likely to be.
The Role of Dental Journals and Dental Travel Writing

Early twentieth-century dentists eager to shape themselves to dentistry’s rising professional standards welcomed dental journals into their mailboxes as
valuable sources of information and guidance. Though dentists were separated from one another by their varying levels of education and aspiration,
as well as by geographic distance and the resultant shortage of opportunities
for communication in real time (like attending conferences, or even speaking to one other on the telephone), journal reading and writing helped to
create an imagined community of practitioners who increasingly shared a
professional identity as American dentists.4 Journals contained articles
describing the most basic of dental procedures in great detail, for the benefit
of those who were trying to teach themselves new techniques without the aid
of either schools or fellow dentists. Frequently, journals would reprint the
entire proceedings of especially noteworthy conferences, including complete
transcripts of question-and-answer periods after scholarly papers. They also
offered direct advice about office procedures and relationships with patients.
Journals worked to create a shared identity for dentists by making remarks
on national and international political concerns, providing descriptions of
appropriate “professional” behavior around patients, and periodically interjecting classical literary and artistic references, carefully but not condescendingly explained to the reader who lacked a liberal education.
The journals provided education and mutual uplift, and created a community of insiders that would constitute a profession: dental travel writing

“Like a Sugar-Coated Pill”

75

helped to accomplish all of these ends. The missteps of ill-informed dentists
abroad taught lessons about what was expected of dentists at home. For the
writer and the reader, travel writing had the special benefit of working to
raise the shared standard of professionalism without acknowledging the
wide divergence of conditions then prevailing in domestic dentists’ offices.
Direct reference to the fact that, for example, some American dentists failed
to sterilize their instruments was unnecessary when a writer could point to
the same omission by a foreign dentist, and then link foreignness with lack
of hygiene, unscientific practice, and poor professional judgment to make the
same point.
Published dental travel writing sought to enhance the cosmopolitanism
of American dentists, who could not be assumed to have acquired either a
comprehensive formal education or an international outlook. For example,
in 1927, the dental journal Oral Hygiene published a series of articles by
D. T. Parkinson, a Wichita dentist then engaged as a teacher and practitioner on a round-the-world trip with a “University Afloat.” Parkinson advised
readers that the trip was intended to “[add] to the usual curriculum of the
school the advantages of world travel”: the articles themselves were intended
to do the same for American dentists, and Parkinson saw no need to explain
what “the advantages of world travel” might be.5 Many of the American elite
aspired to a period of European travel before entering a profession, and journals tended to assume the prevalence of this standard—and, discreetly, to
provide remedial education for readers whose own experience had fallen
short of the norm. As a result, American dental journals occasionally ran
travel narratives whose sole purpose was diversion—these mentioned local
dental practices fleetingly, if at all, and often in ways that suggested that
such practices had been observed from a touristy distance rather than from
the professional point of view. Such articles appeared less frequently as
standards of education and licensing in the United States increased, and
as the doors of practice were slowly but fi rmly closed to those who lacked
comprehensive undergraduate education and its associated bourgeois tastes,
including the taste for foreign travel.
The authors of dental travelogues admired the teeth of the native peoples in the places they visited. They also generally shared Eugene Talbot’s
belief that excellent dental health signified delayed progress up the ladder
of evolution, and that it was usually accompanied by an unseemly disregard for the importance of civilization. Together with the advocates of public
dental hygiene programs and the dietary reformers who lauded civilization

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Making the American Mouth

over instinct, they took the position that whatever excess of dental defects
Americans suffered as a result of their advancement through the stages of
civilization could be remedied with uniquely American applications of dental training and ingenuity. This, they felt, was a sign of the superiority of the
United States and of the American way of life.
Dental travelogues implying or directly stating this most commonly came
from American writers, but American dental journals also regularly published missives sent by British and other English-speaking correspondents.
Whatever the nationality of their authors, such items focused almost exclusively on the question of how indigenous peoples’ dental health and dental
practices compared with those of Americans. The priority that American
journals placed on publishing these items suggests that the editors of these
journals—and, perhaps, their readers—saw this international agreement as
an important confi rmation of their own assessment of the matter.
Conquest, Conversion, and Dentistry

Most American dental travelers were connected, either formally or informally, to the US military. Army dentists reported from outposts in Cuba, the
Philippines, Puerto Rico, and Hawai’i in the early twentieth century—all had
been acquired, with greater or lesser degrees of formal connection, by the
United States as a result of the 1898 Spanish-American War.6 By mid-century,
reports emanated from the Soviet Union, Japan, China, and some locations
in Africa as well. Military dental practitioners provided valuable service to
American servicemen and their dependents, who might have been unable
to obtain satisfactory dental treatment otherwise: “The dental officer of the
navy . . . is the only dentist in American Samoa,” Lieutenant Commander
H. J. LaSalle reported in 1933.7 American dentists also treated the native peoples in the places they visited, and were viewed as important contributors to
the project of pacifying the locals in many regions. The military governors
of such locations saw the importance of having reputable dental care available: legislation signed by the military governor of the Philippines as early
as 1907 required the nation’s dental board to license three dentists who had
graduated from accredited dental schools in the United States. The dentist
who reported this observed that “when the fi rst expedition was sent to the
islands, the necessity of protecting the soldiers from empirical practitioners
and quacks was recognized.”8
Often following close behind military dentists were dental travelers
who worked as missionaries. They, too, believed that the ability to practice

“Like a Sugar-Coated Pill”

77

high-quality dentistry upon indigenous populations and on fellow evangelists was of critical importance. In 1921, the Dental Digest reported that “One
of the fi rst jobs of the American missionaries among the Awembi in Central
Africa is to handle the dental forceps . . . one of the best preparations for
successful missionary work is a good dental course, and one very useful gift
which can be bestowed upon the man departing for a foreign field is a wellequipped case of dental supplies.”9 The Digest, which headlined the item
“Winning Souls Through the Dental Forceps,” observed that dental care was
an important facet of a successful proselytization program: “The man who
is not armed with modern dental supplies has his chance of winning souls
lessened,” it claimed.10
Dental missionaries wrote enthusiastically of the importance of dental
work partly because they had difficulty persuading the religious sponsors of
missions of it. This difficulty reflected the resistance to dental care faced by
practitioners in the United States from their stateside patients, among whom
were the church leaders responsible for setting priorities in missionary work.
At times, missionaries complained frankly that dental work was the most
neglected aspect of evangelism. From India, one missionary wrote that “A
great many of our good people in America support missionaries in India,
maintain hospitals and do other useful work; but as far as I know nobody
has sent out a Dental Surgeon.”11 As a result, some letters detailing missionary activities sought to recruit new dentists: from Meshed, Persia, a physician missionary wrote that “The nearest dentist is Teheran, 600 miles (three
weeks’ journey) distant. . . . The essentials for such a dentist are that fi rst, he
or she should be a believing Christian, and, second, a well-trained capable
dentist. Will you not take the matter under consideration?”12 The Persian
missive was apparently part of a campaign by the Interchurch World Movement to recruit dentists to missionary work: in 1920, Oral Hygiene published
a similar press release from the Movement’s News Bureau, seeking someone
to introduce “American methods of dentistry” to China.13
American Dentistry Abroad

The most pervasive fi xation of dental travel writers, whether military or religious, was the state of “American dentistry” abroad. They regarded the esteem
in which American-style dental practice was held, the fees it commanded,
and the ease with which American-trained practitioners could be licensed,
set up their offices, and obtain patients in a foreign country as indicators of
national sagacity (or lack thereof) in the places they visited. They also used

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Making the American Mouth

their travels, and their experiences of dental care abroad, to help establish a
shared defi nition of what American dentistry was—principally by describing, with ever more precision, exactly what it was not.
The question of how American dentists themselves would be received in
any particular location was not academic. Some published items, intended
to help prospective travelers prepare for their stays elsewhere, consisted
entirely of summaries of local dental practice laws, with a special emphasis
on the possibilities for American practitioners: several prominent American
dental journals published periodic updates to their previous compilations of
such laws throughout the 1920s. Practice laws favorable to American-trained
dentists were remarked upon favorably, though writers disparaged countries
in which dental practice was too loosely regulated. “Anybody and everybody, with or without dental education or without any education at all, can
set up as a dentist wherever he likes in India,” grumbled one dentist. “There
is no ordinance nor authority controlling this profession and setting a standard or compelling it to adhere to some professional etiquette, which few
[dentists] do.”14 On the other hand, countries whose demanding laws posed
barriers to the entry of American practitioners were often openly derided
as unnecessarily—and unscientifically—provincial. In 1916, the Western
Dental Journal informed its readers grumpily that the “chief effect of the
new system” of dental licensing in Hong Kong “will be to compel American
practitioners to secure British license.”15 Indirectly, these critiques of foreign
licensing laws as either too restrictive or too lax helped to forge consensus on
the middle range of restraints on practice that might reasonably be applied
in the United States.
Dental correspondents often reported on the availability of supplies and
competent help abroad (or lack thereof). From Manila, one writer complained
of the expense of dental supplies: “There is no dental depot in Manila,” he
wrote, “but the ‘English Drug Store’ accommodates (?) the dentists, charging
$2.50 to $3.50 for gold and gold solders, $8 per 1/8 oz. for gold pellets, and
proportionately high prices for other materials and instruments. It is true that
they cost more over there, due to distance and duty charge, bring 20 per cent ad
valorem on all dental goods, materials, and instruments.”16 These items were
calculated to appeal to budget-minded American dentists, and frequently ran
side by side with columns giving advice on how to economize in a domestic
dental office. Their authors commented approvingly on countries where dental
supplies were reasonably priced, as long as they were also of high quality, or
where the locals were willing to fairly remunerate dental work.

“Like a Sugar-Coated Pill”

79

Dental travelogues that aimed at recruitment, or at least at getting information to prospective recruits, often concluded with the author’s judgment as
to the suitability of climate and political life for Americans, and recommendations as to what type of man would be best suited to practice in a particular
location. Sometimes the rigor and directness of such analyses undermined
recruiting goals: In 1919, for example, James H. Howell reported to the Michigan State Dental Society that “Russia would be a very good place to practice,
if, fi rst, you could pass the examination that is required (it must be written
in the Russian language); second, if you could speak the language so that you
could talk business with your patients; and third, if you could stand to live in
the unspeakable conditions in which the country now is.”17
Good Teeth and Bad Dentistry

Foreign travel frequently provoked dentists’ worries about the state of their
profession at home, and about the health of Americans’ teeth, which they
increasingly regarded as reflecting on them. Even the most vicious critics
of dental practices abroad had to concur with Weston Price’s judgment that
the native peoples of many colonized regions had remarkably strong and
healthy teeth. “They are in possession of a set of ‘ivories’ that excite unholy
envy in the breast of every white man who sees them,” one writer remarked.18
“A Returned Soldier” wrote in The Dental Brief that the Filipino natives had
primitive knowledge of dentistry at best, but “the only salvation of the race is
that they naturally have good teeth. One may look into the jaws of a hundred
natives and fi nd a full set of nice white and sound teeth in each,” except for
the teeth of women who followed the traditional practice of chewing the
betel nut, which stained the teeth red.19 The condition of Chinese teeth was
well known to dental journal readers: the state of the country’s dental profession was often commented upon, as in 1903, when The Dental Brief reprinted
an item from the Journal of the American Medical Association stating that
“The Chinese have excellent teeth and little use for dentists.”20 Among the
isolated natives of Raratonga, too, dental decay was almost unheard of: only
0.3 percent of the natives’ teeth had been, as Weston Price put it, “attacked
by dental caries.”21
Unlike Price, however, most dental travel writers focused on the poor
state of local dental care, rather than on the excellent health of native people’s teeth or the connection between their teeth and their diets. Most American writers agreed that the natives of the places they visited had great teeth
in spite of, not because of, the quality of the dental care to which they had

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access. Native dentistry was defi ned, in these travelers’ minds, by its lack
of the very qualities to which these American dentists most aspired—high
social and economic status, scientific antisepsis, specificity of remedies and
procedures, and efficient business practices—in short, all of the things that
made up the evolving vision of professionalism in American dentistry. Dispatches about dentistry abroad, whatever their origins, repeatedly lionized
the same American standards of practice, explicitly linking national identity
with the quality of dental care, and, eventually, entirely substituting national
signifiers for other ways of describing quality dentistry.
Travelers whose work was published in American dental journals complained repeatedly about the poor personal and office hygiene of native
dentists. South African dentists used no antiseptic, one writer observed.22
Native practitioners in India dressed unhygienically, the same correspondent
pointed out: during warm months, the native “accommodates himself with
a flowing turban, a long coat . . . and a pair of pyjama-like pantaloons. . . .
In the winter a thick blanket is added to the costume, this being wrapped
across the shoulders according to the method affected by the late Professor Blackie—a modern Greek student with original ideas upon the subject
of pronunciation.”23 The resident dentist in Gibraltar used unclean, outdated
instruments and seated his white patients in a plush, unhygienic dental chair
that “[looked] as though it might have come out of the Ark”; native patients
were relegated to a stool in the backyard, in the company of animals.24 On the
other hand, “A Returned Soldier” identified a periphery within a periphery,
noting differences between urban and rural dentists in the Philippines that
others did not see: “The native dentists in the cities and large towns keep
their offices in good order, as a rule, while those in the small towns and barrios are without order.”25
Criticism of the treatment native dentists doled out to their patients
focused heavily on the barbarity of tooth extraction. At home, new developments in bacteriology and materials science contributed to the increasing
success of fillings, root canals, and crowns, and to preventing decay from
occurring in the fi rst place. As a result, American dentists were coming to
see the extraction of diseased teeth as an archaic procedure that could be
performed even by the untrained or apprentice-trained, and that was thus
beneath the dignity of a truly skilled professional. Extraction represented the
failure of dentistry, not its fruition. Accordingly, travel writers stigmatized
extraction, and in particular those who seemed to take too much pleasure in
performing it. Zulu and Hottentot practitioners, a writer recorded with horror,

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combined bad hygiene with inappropriate pride in extraction: like “Painless”
Parker, they were known to wear the teeth they extracted as jewelry to “adorn
their dusky persons.”26 Chinese dentists did the same: “[A]lmost since time
immemorial the native operator has drawn attention to his calling by wearing
a necklace of teeth to which is attached a cluster of exceptionally formidable
molars. If anyone demands proof of the dentist’s ability, the operator merely
points to his trophies. ‘Volumes did not say more.’”27
Indiscriminate extraction of teeth offended American dentists as a particular example of native dentists’ general lack of commitment to scientific
specificity. Western travelers observed with dismay the failure of nonwhite
natives to embrace the professional norm of adherence to a specific reductionist school of scientific thought, in which every malady was imagined to have
one unique cause and one unique treatment. By comparison, the slipshod
diagnostic skills of the natives left Westerners aghast. The Zulu and Hottentot dentists who so proudly wore the results of their labors had frequently
extracted the wrong teeth from their patients’ mouths, the traveling dentist
reported. In such an event, he added, native dentists would then extract the
correct teeth for no additional charge. Worst of all, he believed, was that
native dentists’ lack of commitment to specificity in diagnosis and treatment
carried over into their professional self-concepts: in Malta, to his great distress, the native dentists supplemented their income by acting as manicurists, barbers, and chiropodists—the sort of extraprofessional behavior one
might have expected of an American dentist a generation before.
Commitment to scientific specificity and to an American-style equality
in matters of billing and patient scheduling struck dental travelers as particularly important. One of the most prolific spokesmen for this point of view
was British Army dentist George Cecil, who traveled extensively in the British colonies and frequently sent missives tattling on both native and British Army dentists’ professional missteps to American dental journals. Cecil
shared American dentists’ position that high status had to be earned rather
than inherited. His resultant support for measures intended to increase the
professionalism of dentists everywhere won him particular popularity with
American dental journal editors and readers. Over a thirty-year period, Cecil
wrote more dental travelogues than any other single author. Many of his
articles were reprinted in multiple publications—including some that were
republished as many as twenty years after their initial appearances.
Cecil complained bitterly about the languid schedules of native dentists,
and of some white dentists in foreign environments. Like many Americans,

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he was suspicious of “primitive” peoples’ alleged disrespect for measured
time and for money. On the natives’ part, this seemingly blithe disregard
for temporality may have been a calculated response to the presence of rude
interlopers who made their disrespect for the natives quite plain. During his
visit to an Indian dentist in 1891, Cecil was told that his wait for the dentist would be only five minutes, “a period which eventually lengthened into
about three-quarters of an hour.”28 On a subsequent visit, Cecil was made to
wait for an hour and a half while the dentist took a “siesta.”29 On the dentist’s
return, Cecil noted acidly, “he seemed considerably surprised that I should
have dared to require his services between any hours other than from eight
in the morning till midday and from four in the afternoon to seven o’clock in
the evening.”30 The reader was left to imagine the interaction that led to the
Indian dentist’s explanation of his working hours—or, perhaps more likely,
not to imagine it. “He is sometimes given to availing himself of holidays in a
somewhat unnecessary manner,” Cecil wrote of one Anglo-Indian dentist.31
Patients sometimes traveled great distances to fi nd that their dentist had
unexpectedly taken a day off.
Cecil and his American readers shared their perplexity at native dentists’
lackadaisical attitude toward the pursuit of profit, and resultant lack of rigor
in controlling their own schedules and patients’ experiences. When the dentist was present, the patient might be expected to have his treatment enjoyed
as a performance by spectators: Zulus and Hottentots extracted teeth from
their countrymen “in the presence of all the inhabitants for miles around.”32
Patients in many locales could expect to be dealt with in order of their social
prominence—a fact which particularly irked Cecil. “Any unfortunate native
patients who happen to be on the premises at the time are unceremoniously
bundled out into the street or told to wait until ‘His Greatness’ has been
attended to,” he complained.33 Cecil regarded attempts by dentists to treat
white patients preferentially with similar scorn, for they revealed the same
unprofessional tendency to discriminate between patients on the basis of
social power.
Cecil also expected patients to observe the modern American norms of
doctor-patient interaction, and found native patients—wherever he went—
deficient in this skill. In South Africa, Cecil observed that black Africans
with toothaches often combined their visits to the dentist with travels related
to trade. The Africans, he reported, felt free to “wriggle” off the dental stool
in the middle of treatment to transact their business with the white man
on whose veranda the itinerant dentist had set up shop.34 What non-white

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83

natives failed to complain about was just as significant a sign to Cecil: South
African patients, he imagined, greeted with excitement infection and pain
so excruciating that it interfered with alimentation. The “[Kaffi r] hails with
delight any opportunity of imbibing the cheap and poisonous whiskey which
is sold by the missionary element.”35 Cecil’s analysis found purchase with
American dentists who regarded people of African ancestry as insensate to
pain (or, alternatively—and incoherently—as persons who were constantly
looking for an opportunity to drug themselves into insensibility).36 He was
equally disquieted by natives’ casualness in paying for dental services. Rich
Indians, he observed, “are excellent customers to the dentist, [but] they are
not what may be described as ‘good pay.’ In point of fact they are the most
dishonest rascals conceivable. To lie and cheat appears to be part of their
religion, and as far as carrying out the observance in question is concerned
they may be said to be singularly pious.”37 The “Rajah,” Cecil commented,
would promise payment and fail to deliver, and the Indian bureaucracy—
both white and native—was so corrupt that it was impossible to use the law
to compel the wayward patient to pay. The patient might even pretend that
he had died in order to duck his bill, Cecil observed, and “one native being so
very like another that it is often a matter of difficulty to tell them apart,” the
dentist would not be able to provide proof to the contrary.38 Cecil therefore
grudgingly approved of demanding cash in advance of services rendered, a
practice widely regarded as the mainstay of charlatans in the United States,
and which Cecil might have received as evidence of the brutalizing influence
of the Indian environment had it not involved the securing of payment. Cecil
did note that the officers of native and British regiments were not much more
reliable debtors than non-military patients. Anglo-Indian officers’ wives, he
said, were in the habit of offering sex in lieu of payment for dental services,
so that they might be able to use the allowances their husbands gave them for
“the purchase of fi nery” instead of dental treatment.39 How he had come upon
this information was also left unsaid.
Cecil’s and other travelers’ observations on the widespread failure to
observe American professional norms indicted the British as well as the
colonized natives themselves. These writers’ excursions into colonized territories gave American dentists, as both writers and readers, the opportunity
to compare their practices not only with those of the natives but with those
of the British colonizers of those locales, staking out an imagined professional territory distant from either place. The British suffered in the comparison. American dentist Landis Wirt, reporting from Bangalore, observed that

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among the British, dentists’ social status was not appreciably better than that
of workingmen. “It is not generally admitted that British gentlemen’s sons
enter the dental profession as it would mean loss of cast [sic]. Therefore the
British profession depends for its recruits mostly on the inferior classes. But
in America, dentistry is held an honorable calling and the sons of many of
our best citizens enter it, thus bringing to it a high type of intellect.”40 In 1911,
the high social status of dentistry in the United States was by no means uniform; Wirt’s jingoism was as much an attempt to influence reality as to reflect
it. Then, too, he was participating in the popular American denigration of
British imperialism on the grounds of its alleged obsession with status and
class. American imperialism, such critics thought, was more rational, and
more just.
George Cecil echoed Wirt’s criticisms of British dentistry: the British
Army, he complained in 1913, accepted only recruits whose jaws were in
perfect condition, and then dedicated itself to their destruction. Soldiers,
required to keep their equipment and surroundings spotless, were never
asked to clean their teeth, and the barracks in which they lived were wet,
cold, and ill-ventilated, setting the stage for health disaster. Rough, unpalatable food magnified these troubles. Dental care was unavailable: “The average
army doctor has only one method of treating toothache. It is that of extraction.”41 Though Cecil claimed to be trying to change this state of affairs on his
own (in part, at least, through shining the purifying light of public attention
upon it), he asserted that the vanity and social climbing of Royal Army Medical Corps doctors made real change unlikely. “For, what time remains over
from taking care of his uniform, admiring his sword, brushing his moustache,
cultivating a military bearing and the acquaintance of his social superiors,
is not devoted by the medical man in question to studying his profession.”42
Local English doctors in India, in Cecil’s evaluation, had even more laughable
skills than their native dental professional counterparts: “The last-named,”
he noted with respect to these Englishmen, “in his general knowledge of dentistry, is rather less than primitive. An intelligent butcher would do almost
as well.”43
British and native dentists’ pretenses to dental skill did reveal one nugget of good judgment for which Cecil, like other dental travel writers, praised
them: everywhere, it seemed, dentists esteemed American dental practice.
Cecil observed that the native Indian population, and especially the AngloIndian population, was attracted (sometimes deceptively) by the promise of
American dental technology. “American dentistry is much in favor at the

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85

moment, the Anglo-Indian community becoming a convert to its advantages
every day.”44 And: “A considerable number of dentists practicing in India put
on their plates the title ‘American Dentist,’ thus hoping to catch those clients
who are likely to be attracted thereby. As a matter of fact their work does not
resemble that of America’s leading dental exponents.”45 By the nineteen-teens,
American dentistry was held in such high esteem that one Egyptian dental
practitioner could write that “Everyone knows that in Europe American dentistry stands for what is best and what is worst. The popularity and success of
the fi rst American dentists there brought out a crop of fake American dentists
who had never even seen the States.” He went further in his negative assessment of British dentists’ abilities: “I have had under my care English, Scotch,
and Irish soldiers and officers, Australians, New Zealanders, and Canadians
too, and I could easily tell at a glance—just a superficial survey of the mouth—
whether the patient hailed from the British colonies or the British Isles. The
latter presented as a rule the most appalling conditions. . . . this condition
is not to be blamed on the ‘high-class American dentistry,’ but on American
dentistry as practiced in England.”46 Even in backward China, the same held
true: “Despite their boasts, the Chinese have not been slow in recognizing the
superiority of American dentistry.”47
Explicit references to the superiority of American dental practice, as
judged either by the peoples on whom dental travel writers reported or by
the travelers themselves, constituted a genre within a genre. American dental travel writers described the history of professional dentistry (which one
writer identified as beginning with the 1839 establishment of the Baltimore
College of Dental Surgery) as a uniquely American story: “The efficient practice of dentistry, then as now,” wrote N. S. Jenkins in 1917, “required a high
standard of technical skill and resourcefulness. Owing to physical and social
conditions, Americans have always shown a special aptitude and inventiveness in the mechanic arts, and these hereditary qualities gave them for a
considerable time a superiority in the practice of dentistry.”48 Jenkins, drawing on his own fifty-year residence in Europe, explained that American dentists who practiced in Europe were at an advantage because of their progress
through the true meritocracy of the United States. “Coming from a country
where caste was unknown,” he wrote, “[their] social positions and influence
[were] entirely dependent upon [their] breeding and character.” Surveying
the range of travel undertaken and reported on by Americans, he concluded
that, despite the passage of immigration laws restricting the movement of
Europeans into the United States, the cross-fertilization of the profession in

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Europe by Americans and “the conditions which have made American dentistry such a power for good in the world will endure.”49
Later writers confi rmed the accuracy of his prediction, as they described
foreign dentists’ and governments’ promotion of American-style dentistry.
In 1923, the government-sponsored Military Dental Journal reported that the
recent Japan earthquake had decimated a burgeoning American-style dental
program: “It was only a little over a year ago that Prof. Chiwaki—who contributed nearly all of his personal fortune and a lifetime of energy toward
the establishment, along American lines, of the Tokyo Dental College—came
to this country in quest of fresh educational ideas.” the article mourned.
“Japan, Chiwaki says, owes many things to America, dentistry being one
of them. Japanese dentistry is an outgrowth of our own.”50 In 1920, E. C.
Kirk of Philadelphia reported to the Connecticut Dental Hygiene Association that the British had rebounded from the Great War and had dedicated a
large amount of public money to the establishment of oral hygiene programs.
“This old British world, which we have at times regarded as a little bit stodgy
and slower than ourselves, has wakened up, and is doing great things,” he
said. Then he interposed, reaffi rming the supremacy of American leadership
in dentistry: “America is after all the source, the origin, of many of the biggest things in dentistry.”51
Travel writers felt it a matter of great importance that the United States be
recognized for its peculiar dental prowess. They also did the important work
of reminding American dentists to adhere to the new professional practices
that were slowly but certainly making American dentistry so successful—
and so different from dentistry as it was practiced everywhere else. Their
penchant for portraying themselves as the arbiters of who or what could
be denominated “American” helped to cement the link between American
national identity and the pursuit of ever-improved, ever-complex dental interventions. Eventually, this connection helped to shape dentists’ responses to
the prospects of incorporating particular new territories and peoples into the
United States, and to influence popular ideas about what ideas and attitudes
about dentistry and teeth could be described as American.
The Philippines

The Philippines, colonized by the United States after the Spanish-American War, were an important destination for dental travelers. Most Philippine dental travelers were connected to the United States military or to the
civil government established in the Philippines, and headed by US elites

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87

including William Howard Taft, after the close of the war. The density of
the US military presence in the Philippines was due partly to the Filipinos’
continuing resistance to US occupation—between 1899 and 1902, Filipinos
fought a fierce guerrilla war against American forces, during which 220,000
Filipinos and 4,500 Americans were killed.52 The intensity of Filipino resistance, and the strategic importance of the Philippines to the United States,
resulted in a continual infusion of American troops—and dentists who
treated them—into the islands. There, the identification of dentistry with
Americanism would usually work to support arguments against annexation,
which were prevalent throughout popular commentary on the Philippines
at the time.
Dentist writers immediately complained of the degraded state of dental
practice in the Philippines. “A Returned Soldier” noted in 1902 that native
dentists in the Philippine countryside were part-time practitioners, “who
work in the fields, and practise their profession only when called upon to
do so.”53 Such dental workers, “many wearing the breech-cloth,” used crude
instruments: “Returned Solider” included a full page of sketched examples,
including an indicting example of the natives’ “advertising ideas,” a large
tooth made from wood and designed to clatter against the dentist’s signboard “to attract the attention of persons passing by.”54 As from so many other
locales, this dental traveler reported that despite the conditions of native dental practice, the Filipinos had beautiful and healthy teeth, only occasionally
marred by the chewing of betel nuts or the use of tobacco.
Dental travelers to the Philippines were soon to initiate a more colorful
and—from the standpoint of American imperialists—more ominous series
of reports. Like the Americans and Filipino collaborationist governors themselves, these writers discovered that among the knottiest problems in the
colonization of the islands was the lack of cooperation of the “savage” and
“barbaric” tribes living in parts of the Philippines.55 The guerrilla warfare
that plagued the cause of American imperialism was carried out in part by
these tribespeople, who had never been pacified by Spanish colonial rule and
resisted vigorously the prospect of pacification by Americans. Dental travel
writers pointed to the aesthetic appearance of the natives’ teeth, and their
attitudes toward American-style dentistry, as evidence of their lack of assimilability to American culture and ways of self-government. The tribesmen’s
teeth would provide, alternately, evidence of the need for American “help”
to the Filipino “little brown brother,” and proof that the US excursion in the
Philippines was ultimately futile.

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In 1904, “A Regular” informed readers of The Dental Review that the
“Mohammedan” chiefs of Mindanao, “heretofore invincible” headhunters,
“endeavor[ed] to make [their] features as disgusting and as frightful as possible, for the purpose of designating [their] ideas and for scaring and confusing
[their] foe[s] when the two meet in combat. The result is that you can meet with
some really frightful looking mouths.”56 “Regular” also included sketches of
teeth that had been filed to points, set with pearls, dyed black, bored through
and linked together with gold wire rings, or yanked from an enemy’s severed
head and worn as jewelry (in this instance, a molar mounted in a ring setting
with its roots protruding perpendicularly from the wearer’s fi nger).
A fi nal section of the text, optimistically titled “Americans Changing
These Ideas,” reported that American soldiers “desire that this head hunting
idea be stopped,” and had arrested some “fanatics.” The concluding paragraph
also made vague and brief references to “better order” and the establishment
of “trails to lake regions” to facilitate the extraction of natural resources:
there was no comment on American interest in (or success at) stopping tooth
decoration or mutilation practices.57
The community of American dentists in the Philippines was a close-knit
one, and their familiarity with one another’s reports to American dental journals was high. In 1905, Manila dentist Louis Ottofy, an American who practiced for twenty-three years in the Philippines and Japan, informed readers
of The Dental Cosmos that he had been “unable to confi rm” the reports of “A
Returned Soldier” and “A Regular” about the state of dentistry among the
native Filipinos and tribes. Ottofy emphasized instead the marginal success
of attempts to establish Western-style dental services in the Philippines. These
attempts, he felt, were impeded by warfare, linguistic and educational barriers, and natural disaster—not surprisingly, the same forces that hampered
US imperial aspirations in the region more generally. His cautious expression
of hopes for the future reflected the tenuousness of the American government’s hold on the situation in the Philippines. After a litany of the disasters
that had befallen the islands, he zeroed in on the effects of these disasters on
crops, which had “often [been] totally destroyed by a plague of locusts, and by
various insects attacking the coffee plant and other vegetation. Happily, the
Islands are now practically free from these scourges, and very little is now
feared, except possibly from the locusts. It is not too optimistic to predict that
the Islands are now entering on an era of prosperity.”58
Ottofy feared that the prosperity for which he hoped (barring a return of
the locusts) might be delayed or prevented by the lack of dental services in

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89

Figure 4 Teeth of Philippine
Moro headhunters, as portrayed
by “A Regular” in 1904. Dental
Review 18 (April 15, 1904): 319.

the Philippines. In fact, he took the comparatively radical step of suggesting
that, until a dental school could be established, “native young men” could
be trained “toward the giving of relief in remote sections of the country, the
introduction of simple fillings, and substitution of the teeth when lost.”59 In the
context of American dentists’ home-front anxieties about gaining and maintaining professional status, and particularly as part of a genre of literature
that repeatedly emphasized the importance of establishing American-style
dental practice regulations abroad, Ottofy’s willingness to entertain the idea
of training Filipino natives in some facets of dentistry was unusual and significant. Dentists like Ottofy conceived of American credibility and success
in its Pacific colonies as resting in part on the ability to disseminate American
dentistry, regardless of the cost to the image of American dentistry as being
exemplified by thorough education and training. Sometimes the imperatives
of colonialism won out over the imperatives of professionalization.
Ottofy himself seemed particularly invested in the notion that adherence
to American standards of dental appearance would be an important index of
the assimilability of the Filipinos to an American way of life. Three years later,

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he published a massive study of the dental status of a group of Bontoc Igorot
tribespeople of northern Luzon, entitled “Teeth of the Igorots.” The Igorot
were already familiar, not only to American dentists but to many American
laypeople. Several groups of them had been brought to the United States to
serve as exhibits in World’s Fairs, the most prominent and best-remembered
of them the Louisiana Purchase Exposition in St. Louis in 1904.60 Despite the
fact that the members of these excursion groups had been repatriated to the
Philippines (sometimes against their will), and other Igorot people had married Christian Filipinos, Ottofy insisted that the Igorot peoples of the Philippines “ha[ve] not been influenced by civilization and live today practically as
[they] did in ages gone by.”61
Ottofy was profoundly moved by contemporary anthropological theory.
He described his travels into the territory inhabited by the Bontoc Igorot as
a reversed recapitulation of the history of civilization, in which one could
observe an almost evolutionary regression from contemporary urban life to a
more primitive past lifestyle. He also fancied himself a scientist, or at least a
competent critic of science, arguing that “The dental profession cannot fully
justify its claim that dentistry is a science until it has determined what people, if any, possess the best teeth in the world.”62 One of the purposes of his
article was to cement the scientific credentials of the dental profession: the
most persistent theme of his report was that, despite difficulty in examining
Igorot children, he had become certain that “the Igorot has not only the best
teeth in the world, but far better ones than had been supposed to exist among
any people at the present time.”63
Ottofy’s most important role was as an ambassador between the Igorot
peoples and his own American readers, and he performed this function
avidly. He complained that other travel writers had misrepresented the Philippines and their inhabitants: “much that is erroneous and absolutely false is
spread broadcast by ignorant men, who visit the islands, live at Manila, seldom go anywhere else, and, when they do, have not the ability or intelligence
to carefully observe what they see.”64 He shared the belief that the respectful
observance of American norms of dental aesthetics was an important index of
civilization (or at least of the potential for it). He disagreed with other informants about the state of such observance in the Philippines. First among his
targets for debunking was the widely circulated claim that the “Igorot and
Negrito tribes of northwestern Luzon take special delight in fi ling their teeth
to a point.”65 Ottofy presented a series of objections to this claim: “In the fi rst
place, there are no Negritos in northwestern Luzon, secondly, Igorots do not

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mar their teeth in any manner.”66 Though he did concede that the Negritos
had been known to chip away (not file) sections of their teeth, he insisted that
the Igorots had never engaged in this, or any other, tooth-altering practice.
Ottofy believed that the Igorot people, though barbarian, had in common
with Americans their insistence on keeping their natural (and, in the case
of the Igorot, very healthy) teeth intact. The next section of his report on the
“Teeth of the Igorots” included a lengthy and seemingly out-of-place paean to
the geographic formations of the Philippines, which, he argued, were remarkably similar to those in the United States. “Much of it seemed to me like what
I have seen in the Alleghenies and the Cascades, and then again rugged like
the Rockies and the Sierra Nevadas, with spots of beauty like those in the
Blue Mountain range.”67 Taken together, these twin examples of forced comparison between the Philippines and the United States illuminate the project of Ottofy’s report: he was interested not only in documenting the dental
status of the Igorot, but also in contributing to a popular construction of the
Philippines as a place fundamentally similar to the United States. Many of
the military and civil governors of the Philippines had been “Indian fighters”
before being deployed abroad, and much of the discourse around the Pacific
colonies of the United States figured those colonies as representing transPacific extensions of Manifest Destiny. In the Philippines as in North America, this narrative suggested, Americans had subdued a diverse and beautiful
landscape, and had pacified noble yet barbaric peoples. Ottofy’s description
of the teeth of the Igorot was of a piece with this discourse, and suggests that
for him, embrace of Americans’ high standards of dental appearance was an
important index of this pacification, or susceptibility to it.68
Despite Ottofy’s claims, reports of dental depravity in the Philippines—
and, particularly, of dental decoration and mutilation in Luzon—persisted.69
Other writers insisted that the peoples of the Philippines were beyond the
reaches of missionary attempts to instill in them a healthy respect for the
Protestant work ethic. S. D. Boak snidely remarked that “’Our little brown
brothers’ have the art of living without work well brought down to a science.”70 Where the “little brown brother” trope included the possibility that
Filipinos, on maturing to “adulthood,” could be safely brought into the family
of the United States, Boak held out little hope for that eventuality. After telling a recalcitrant Filipino that “we Caucasians look upon work as the highest
and holiest thing there is, and the greatest purifier that the world has known,”
Boak was startled to be asked why, if Americans so prized work, “the workers
are the most despised and most miserable, and invariably receive their share

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of worldly wealth and goods from the small end of the horn? . . . If manual
labor, or work. . . . is so purifying and exalting, why is it that the one ambition
of the Caucasian is to acquire enough wealth so as he can live without laboring?”71 Boak reported that “[this] philosophy took [his] breath.” Boak’s attention—and his readers’—was distracted from this question and its critique of
the American socioeconomic system by the sense of righteous vindication
he experienced when the questioner proceeded to catch and eat a locust that
had just flown by, “calmly [remarking], ‘The Lord always provides.’”72 Such
reports, touching as they did on Americans’ most diligently observed taboos
(including the taboo against ingesting the flesh of certain animals; many writers titillated their readers by announcing the Igorots’ alleged predilection for
eating dog) highlighted the radically unassimilable culture of the natives of
the Philippines.
Later writers did file cautiously optimistic reports about the accommodations being struck between American dental practices and those of Philippine natives. The allegedly fierce Islamic Moro tribesmen, for example, had
by 1922 “relax[ed] somewhat in some of their radical practices,” and had
“added the tooth brush and a tube of paste to their list of toilet articles.”73
At least for a time, relations between the Americans and the Moros (some
of whom served in the American-led military of the Philippines) did soften.
Christian Filipinos settled in Moro lands, and the presence of Americans
apparently served to repress conflicts between the two groups. But the Americans’ insistence on segregating the Christians and the Moros led to disaster
after the establishment of the Philippine Commonwealth in 1935. After years
of separation, Moros thought of themselves as fundamentally different from
Christian Filipinos and objected to being ruled by them.74
American dental travel writers in the Philippines considered both the
dental health and the dental practices of Filipinos to be useful indices of
the success, or likelihood of success, of US imperialism in the Pacific. They
peppered their descriptions of the natives’ teeth with observations on the
cultural, dietary, and labor practices of the Philippines because they thought
of these things as being fundamentally related to one another. A long-running
tension between those who thought of US imperialism as the natural outgrowth of Manifest Destiny and those who considered the Filipino peoples
themselves immovable obstacles to American aspirations in the Pacific, and
racially unassimilable, played itself out in the way that American dental travelers wrote about the islands and their inhabitants. The writing of most dentists who spent time in the Philippines bore the markings of a profound sense

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of despair about the possibility that the Philippines could become American. Racially, culturally, geographically, and dentally, the people of the Philippines were simply not similar enough to the people of the United States.
These writings, by defi ning what was not, and could never be, American,
helped to defi ne what was American in the process. Though US domination
of the Philippines continued, objections like the ones raised by these travel
writers would play a part in scuttling the annexation of the Philippines to the
United States.
Hawai’i

Like the Philippines, the islands of Hawai’i were the focus of much American
interest in the early decades of the twentieth century. The islands had been colonized in the late 1800s by American sugar companies and, after the 1898 USsponsored overthrow of the Hawai’ian monarch Queen Lili’uokalani in 1900,
by the US government itself.75 One of the earliest American dentists to travel
to colonial Hawai’i reported extensively in 1901 about the perils of the journey
(chiefly seasickness) and about the beautiful natural features of the islands he
visited. In keeping with the American tradition of minimizing the visibility
and significance of the locals who had inhabited areas that would become
American states, Sacramento dentist F. H. Metcalf commented only that “The
people are most hospitable and vie with each other in giving the tourist a
good time.”76 It may have been that Metcalf was referring to white inhabitants
of Hawai’i rather than to native Hawai’ians themselves, however, for his next
sentence read: “I found my professional brethren progressive, up to date, and
a bunch of good fellows.” Metcalf also minimized the subject of the professional meeting he attended in Hawai’i, describing it only as “alive with interest and good fellowship, and a programme of which will be sent to you by
the secretary.”77 His report was part of the subgenre of dental travel writing
that sought to promote class-appropriate vacations for American dentists, but
it was also among a steady stream of dental travel writing specifically concerned with Hawai’i. Unlike Metcalf’s, however, almost all of the later reports
from Hawai’i by dentists contained much more extensive meditations on the
differences between Hawai’i and the United States, and speculation about
whether and how those differences could be bridged.
The racial similarities and differences between Hawai’i and the United
States were foremost among the concerns of dentists who traveled and practiced in the islands. In fact, some speculated that the multi- but not interracial character of Hawai’ian society made it an ideal laboratory for the testing

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of contemporary dental and social theories. Three American dentists living in Hawai’i introduced a five-part series of articles on dental disease in
the islands with the proviso that “It seems to us that the most promising
approach to problems concerning dentition is through comparative studies
of racial groups living under comparable hygienic conditions. Hawai’i offers
a rare opportunity for study of this kind. . . . Many races are residents on the
islands and live together in close proximity, yet to a large extent maintain
their racial customs and food habits. . . . The social service work of the territory is highly organized and through the various centers entrée can be had
to every village and to practically every home.”78 Their words gestured to the
importance of race to contemporary Americans, as well as to the writers’ optimism that the Hawai’ian experiment of careful racial mingling of persons of
Native Hawai’ian, Japanese, Chinese, Filipino, and European descent might
hold valuable lessons for the similar American experiment underway on the
mainland, particularly in the American West. Most importantly, the articles
referenced the writers’ solidarity with, and intent to make use of, the “social
service work of the territory,” including a centralized system of primary and
secondary education, all aimed at uplifting and improving the lives of native
Hawai’ians, willingly or no.
This commingling of Americanization campaigns and professional
American dentistry would continue on the Hawai’ian islands throughout
the fi rst half of the twentieth century. In Honolulu, the Palama settlement
included a well-funded and much remarked-upon dental clinic, and other
Americanization regimens incorporated dental care as a prominent part of
their programs. Dental travelers to Hawai’i often pointed to the Palama (or
“Paloma”) settlement’s dental clinic, which ran from 1914 until 1921 when
it was replaced by the Honolulu Dental Infi rmary for Children, as a model
for future clinic projects. In 1930, supervising dental hygienist Helen Baukin
reported on the Kapaa school dental program at Kauai, listing among the
school staff not only teachers and principals, but a “nutrition worker,” dentist
and dental hygienist, government physician, deputy sheriff, probation officer,
sanitation officer, and juvenile court judge. (Baukin offered no comment as to
why the school required such a strong police presence; mainland schools of
comparable size did not typically host such an array of law enforcement personnel.) Her article, published in the Journal of the American Dental Association, highlighted the establishment of a daily “toothbrush drill” (illustrated
by a photograph in the article) as among the most important innovations of
the curriculum. In the photo, native Hawai’ian students stood in uneven lines

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Figur e 5 Children on the front lawn of the Kapaa School participate in a “toothbrush drill,” 1930. Journal of the American Dental Association 17 (February 1930):
359. Copyright © 1930 American Dental Association. All rights reserved. Reprinted
by permission.

on the front lawn of their school building, leaning gamely into all the various
attitudes of toothbrushing.
The toothbrush “drill” was not the only Kapaa School manifestation
of coercive American colonialism in Hawai’i. The school lunch program,
described in the lunchroom bulletin as “Army Chow,” also bore explicit hallmarks of military posturing. The lunchroom was crowded, one issue of the
bulletin acknowledged, but the situation called for everyone’s patience and
obedience: “Order Best,” read the headline on the item. The principal had
banned the use of white rice in the school kitchen, preferring the more nutritious brown rice though “the storekeepers could not understand how anyone
could possibly prefer the brown rice to the clean white kernels, nor did the
parents see the wiseness of the change.”79 Students were provided with hot
lunches at the school, the better to “teach them the use of table utensils as
well as proper table manners.”80 The lunchroom flyer also extolled the virtues
of the Vocational Homemaking Class, which had recently graduated seven
young women. “We hope them further success in life. They know how to cook
and sew—that’s a great deal.”81

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In their attempts to inculcate American values through Hawai’i’s public schools, dentists and dental hygienists took their places beside a variety
of other professionals bent on the same end. Hawai’i’s white teachers were,
according to a 1923 item in the Hawaii Educational Review, expected to emphasize “traits of character which have received least attention at home. They can
encourage good health habits, cleanliness, and neatness, and modest, simple
dressing; they can instill a regard for civic beauty, a respect for human values
in law and order and property rights, and they can hold up high standards of
living.”82 Patriotic rituals figured heavily into these school-based Americanization campaigns: teachers who worked in Hawai’ian schools in the 1920s
and 1930s led “school assemblies emphasizing loyalty, saluting the flag and
singing patriotic songs.”83 As in the mainland school hygiene programs, in
Hawai’i the principles of the dental hygiene and health programs made natural counterparts to the civic virtues schools sought to inculcate in their students. “Loyalty to his fellowmen as well as to his country, is greatly stressed,”
Helen Baukin said, “Each morning, the entire school stands at attention as
the Stars and Stripes are raised, and with unfaltering voices, these children
of numerous races pledge allegiance to Old Glory. For the outsider, whose
privilege it is to be present at the Flag raising exercises, the heart beats faster
to hear the many children of many ages and races slowly and emphatically
pledge.” Baukin ended her report with the text of the Pledge of Allegiance.84
Kapaa School students were being introduced to American nationalism and
American dentistry with the same educational program: loyalty to “his country” [the United States] was explicitly linked for the Kapaa student with the
use of the toothbrush.
As the inauguration of Hawai’ian statehood approached, dental travel
writers grew even more optimistic about the prospects for the seamless
incorporation of the territory into the fabric of the American nation. H.
Dorothy Dudley wrote to Michigan dentists in 1936 that “Dental practice
is no different in Hawaii from dental practice in Michigan. Caries, malocclusions and periodonticlasia are universal, as recent surveys in all parts
of the world have established. In civilized communities the statistics for the
different age-groups vary very little. And Hawaii is civilized. (I have seen
grass skirts only in shop windows for tourists, and it is said they are made
in Grand Rapids.)”85 Dudley’s use of the term “civilized” was clarified by her
description of the changes wrought on traditional Hawai’ian eating practices
by dental public health nurses: “Some portion of the high rice diet eaten by
most Oriental families has been replaced by other foods which contain more

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of the food elements necessary for building and maintaining good teeth. The
Classical Public Health teaching of: More milk, more fruit, more vegetables
and whole grain bread has had a demonstrable effect.”86 Her emphasis on the
modification of Hawai’ian eating practices to a more Western model suggests
that she meant not that Hawai’i was, inherently, a civilized place, but that it
had been civilized (by American intervention). Her comparison of dentistry
in Hawai’i to dentistry in Michigan was calculated not only to appeal to the
readers of the Michigan state dental journal, but, by its claim that Hawai’i
was no different from an existing American state, to advance the case for
Hawai’ian statehood.
A 1938 item in the merged Journal of the American Dental Association/Dental Cosmos presented evidence of a fully operational school dental hygiene program being implemented in Hawai’ian schools on the model
of the best of civilized “American” dentistry. Dental hygienists were being
trained “after the Bridgeport, Conn. Plan,” receiving two years of essential
“basic cultural and scientific background” followed by two years of dental
hygiene education and a fi nal year of public health training. The hygienists
had been properly authorized by Hawai’ian law to practice in the territory’s
public schools, and twenty-five were working in those schools at the time of
the article. Hygienists used modern, portable equipment, and kept “defi nite
records of each child.” An award program had been developed to recognize
school classes with the fastest achievement of “100 percent dental correction.”87 These formalities of law and professional practice were of central
importance to American dentists, and the American Dental Association’s
report that they were being observed in Hawai’i signaled the organization’s
belief that the imposition of a rational, scientific, American model of dental practice—and political life—was not only possible, but well underway,
which boded well for the cause of statehood.
Interest in the success of Americanization in Hawai’i persisted until well
beyond Hawai’i’s admission to the union in 1959. In 1964, for example, an
article in Dental Students’ Magazine marked the transition visually, showcasing photographs of the modern Ala Moana building, “a popular location
for dental offices,” as well as of a Honolulu dentist’s modern “operatory,” and
a tastefully decorated Honolulu reception room where “live bamboo and
orchids accentuate the Polynesian décor.” Hawai’ian dentists, James Voigt
wrote, were rigorously trained and tested, and later enrolled responsibly in
their state and county dental associations, which “[enjoyed] a 98 per cent
participation.” There was, he wrote, “no dental advertising in the state.” Such

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advertising would have been superfluous, Voigt suggested: “Hawai’i’s present dental needs,” he assured student readers, “are adequately met with the
modern techniques that are practiced in the Islands’ many private offices and
dental clinics.” In physical plant as in business and professional practice,
Hawai’ians had exceeded the threshold of Americanness.88
The writings generated by American dental travelers to Hawai’i formed a
narrative of cautious optimism leading to a joyful intertwining of American
and Hawai’ian identities and interests. Of course, the process of colonization in Hawai’i was far more complicated—and more contested—than articles
written from the haole (white) point of view tend to suggest. But these items
illustrate how American dentists thought of their roles in the propagation
of American values and American culture in this American territory. These
writers used the indices of American dentistry—measures of professionalization like recordkeeping and licensure, and standards of bourgeois American
taste as applied to office décor and participation in public political ritual—
to gauge the potential and actual success of Hawai’ians in living up to the
American standards set by their colonizers. Given the involvement of other
professionals, like teachers, in such enterprises, dentists’ interest in encouraging and charting Americanization should not be surprising. It illustrates
with specificity the function of American dental travel writing: such texts
worked to facilitate the symmetry of American identity with a positive vision
of dental practice and patienthood.
It was hard for dentists to explain, to themselves or to anyone else, why
a country with the best, most scientifically advanced dental profession in the
world remained populated by people with such terrible teeth. Americans’
continued bad dental health severely tested claims of their genetic, cultural,
and political superiority to other nationalities, and seriously disrupted the
idea that “American” always meant something positive. In the middle of
the twentieth century, it also caused Americans to press for dental care that
was more accessible and affordable, heightening the national clamor for the
socialization of health care costs and posing a threat to the fi nancial success
and professional autonomy dentists had so recently won.

Chapter 4

“This National Stupidity”
American Dental Economics in the 1930s and 1940s

“Gentlemen,” one Boston dentist admonished his colleagues at a professional
conference in 1949, “I believe that the seductive delusion and blandishments
of a ‘heaven on earth’ philosophy is intriguing and undermining the traditional sane thinking of America.” The Truman administration’s postwar plan
for national health insurance, he thought, was leading Americans down a
primrose path to socialism. “Only by aggressively applying your superior talents and the knowledge acquired through your education in the fight against
this national stupidity,” he counseled, “can you settle your balance with your
community, your state and your nation.”1
By the middle of the twentieth century, American dentists generally
shared their Boston colleague’s sense of the profession as a justifiably elite
occupation and of its practitioners as men of special intelligence and perspicacity. Dentists took pride in the technical achievements of the discipline,
and in their voluntary contributions to the health of American children
through school hygiene programs and recommendations about diet. In raising the status of the profession, they had also increased their ability to command payment. Dentists’ incomes rose accordingly. When dental care was
provided to a patient for free, the dentist involved had either been paid
from public coffers or made a voluntary decision to be charitable. As the
Boston dentist warned, however, dentists faced mounting anger from fellow citizens who were angered by their lack of access to dental services
during the Depression, and by the inadequate number and distribution of
dentists during the boom in demand for services caused by World War II.

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State and federal legislators reacted to these failures of the market by proposing plans of health and dental insurance that caused dentists to fear for
their professional autonomy. Together with the example of physicians who
successfully organized against such programs, this fear helped to persuade
most dentists that maintaining the cherished system of private payment
against the “national stupidity” of dental insurance was not only possible,
but essential. As a result, federal and state efforts to provide a safety net of
guaranteed health and dental benefits to children, the elderly, and the poor
met with vehement opposition from the dentists of the ADA.
Charity Care

Both physicians and dentists had long tried to limit the opportunities for
Americans to receive health care outside of the private-payer system. Physicians were particularly successful in opposing programs for free care to the
indigent. Though poor health among the impoverished, particularly among
women and children, inspired the creation of the federal Children’s Bureau
in 1910 and the 1921 passage of the Sheppard-Towner Act which provided
for health screenings and education oriented towards maternal and child
health, the AMA’s lobbying prevented either program from including funding for direct medical care. In the nineteen-teens, the American Association
for Labor Legislation aggressively promoted plans of income protection for
industrial workers sidelined by illness or injury, pointing to the notorious
bad health of applicants for military service as a way to justify such plans as a
national interest. Partly in order to avoid the AMA’s opposition to these plans,
however, the AALL did not contemplate the payment of physician bills.2 Physicians frequently staffed free or low-cost dispensary clinics, either on a volunteer basis or for pay; but they insisted that dispensary services be made
available only to the very poorest Americans, reasoning that those who could
afford to pay for medical care ought to be made to do so.
Early twentieth-century dentists faced a professional climate somewhat
more hostile than the one physicians confronted. Unlike physicians, they
had not yet succeeded in consolidating in the mind of the public the image of
their profession as the high-status provider of an invaluable health service.
The broad popular following of “Painless” Parker, who derided the ADA as
a trust designed to create a monopoly market for American dentists, threatened dentists’ hopes to create a climate of exclusivity around the profession,
and dentists were willing to provide a certain amount of free care to keep
anti-monopolists off their backs. School dental hygiene programs were an

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important part of this effort, but the limitation of their services to children
left a large gap in available care for adults.
Like physicians, many dentists attempted to address the shortfall in care
available to adults by contributing their time, sometimes without pay, to free
or low-cost public dispensaries. Even the most fervent proponents of dentists’
participation in such arrangements agreed that free care should be available
only to the very poorest patients. In 1913, for example, Boston dentist Frederick Keyes told the members of the Guild of St. Apollonia that physicians had
erred in making dispensary care too freely available, and that dentists ought
to guard their own charitable contributions of time more closely. “The free
dental dispensary is just as essential for the health of the public as the free
medical dispensary,” he wrote. “Similarly, the work should be done gratis. But
its scope should be limited as far as possible to the treatment of the worthy
poor.”3 Others shared Keyes’s conviction that free care ought to be focused on
those whose poverty was through no fault of their own, “so as not to interfere with the legitimate rights of private practitioners or to compromise those
people so bitterly opposed to any form of socialistic measures,” and argued
that the dentists providing it ought to be paid consultants rather than volunteers.4 This, they felt, would help to avoid “any disorderly arrangement of
operations as is wont to occur when volunteers give their time spasmodically
and work in a haphazard manner,” and to promote the competitive selection
of candidates for dispensary employment, which would help to improve the
state of dentistry overall.5
Industrial Dental Hygiene Programs

Because dentists generally preferred opportunities to work for pay, they usually avoided low- or unpaid dispensary work, focusing their energies on more
remunerative programs. Among the most vaunted were industrial hygiene
programs providing dental service to American workers. In the early decades
of the twentieth century, as the American industrial economy exploded,
manufacturing employers hoped to prevent the disruptions of production
that ensued when employees suffering dental pain failed to appear for work,
or worked less efficiently than they might have had they been healthy. Slowdowns like these posed particular problems for American employers during
years in which preparation for and prosecution of war meant that American factories were otherwise operating at full capacity. To remediate this
problem, dentists promoted campaigns of dental inspection and treatment
sponsored by employers for workers. Thaddeus P. Hyatt, the dental director

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of Metropolitan Life Insurance Company, argued that health problems of all
sorts, and resultant time away from work, were significantly decreased by
such programs. “There is no question but what industrial dental clinics will
prove of great value to the country,” he wrote, “The only question that it is
necessary to fi rmly establish is the fact that it is good business for large companies to establish these dental clinics.”6 In Cleveland, Weston Price produced a copiously illustrated talk directed at company managers, intended
to persuade them of the necessity of providing dental care in their facilities
and featuring before-and-after photographs of a young man crippled by dental disease and then cured through a dentist’s intervention. “Can we say of
this generation that management was not responsible because they did not
know?” he demanded. “While you, who have the responsibility of the people
in your care, have a glorious opportunity for saving money for your corporation by conserving working efficiency through the prevention of focal infections . . . you shall be held in large part responsible for not only the physical
efficiency but for the morbidity and tenure of life as well.”7
Partly at Hyatt’s and Price’s urging, major employers including Armour &
Co., H. J. Heinz, John Wanamaker, Kimberly-Clark, B. F. Goodrich, Sears Roebuck & Co., Macy’s, Montgomery Ward, Lord & Taylor, International Harvester,
and Colgate established dental clinics for their employees in the 1910s and
1920s.8 “It has been my experience that ninety-nine percent of the employees
of a large business house need both . . . examination and instruction,” one
dentist who participated in an industrial dental clinic program wrote, “and
. . . only two out of seven thousand cases objected to what they called an
infringement of their personal rights, when called upon to be examined.”9
Even those who subscribed to the dental version of welfare capitalism,
however, emphasized the importance of communicating to patients the value
of individual effort, and of preserving for local dentists the opportunity to
succeed in private practice. “The writer does not believe,” one such proponent of the industrial hygiene clinic chided, “that under any consideration
should a system be inaugurated which would give dental services absolutely
free of charge. The fi nancial expenditure for dental work received is an added
incentive to better care of the mouth in the future, while anything which is
given free is considered to be of little or no value.”10 Many companies offering
dental services to their employees provided limited care, as at the Heinz Company, where “when more elaborate work is required, the patient is advised
to consult outside dentists.”11 Other programs, like school hygiene clinics,
offered only cleaning and examination, and similarly referred patients to

Figure 6 Before and after treatment for arthritis caused by dental infection. This image
illustrated Weston Price’s address to industrial managers on the benefits of employee
dental hygiene programs. Dental Items of Interest 47 (December 1925): 890.

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private dentists for restorative treatment. A few allowed employees to visit
company dentists on company time, but at the employees’ own expense.
Dentists who promoted industrial hygiene programs were careful to
point out that, particularly in programs that did not provide restorative dental care, the provision of dental education and training in self-care helped the
employees who received it to better understand and value the dental services
they would seek out privately. This was, they felt, an advantage to the community dentists who provided the additional care. “The patient presents a
clean, healthy mouth for his own dentist to work in,” wrote the director of the
Armour & Co. dental clinic in 1920, “and the dentist, realizing that his patient
appreciates the necessity and value of the work to be done, approaches his
task in a much more sympathetic frame of mind that [sic] is the case where
he has to do all the explaining himself and at the same time sell a bill of dentistry to the prospective patient with a mouthful of bad teeth that are painful, diseased, and very often foul with heavy deposits of tartar.”12 Like the
advocates of school clinics, advocates of the industrial hygiene concept felt
that a proliferation of well-informed patients would help to hasten the retirements of poorly trained practitioners, benefiting the profession as a whole. At
the Kimberly-Clark Company, in Neenah, Wisconsin, the company dentist
reported that “a much better service is being given by outside dentists due
to the fact that the latter now know that their work is being inspected.”13 In
1918, a speaker told attendees at the annual convention of the National Dental
Association that industrial clinic programs “[tend] to do away with bad work
on the part of dentists in their localities, because those dentists realize that if
they wish to retain their clientele they must do better work.”14
Market Forces and Market Disruptions

The system of private dental practice, generously supplemented by dispensaries and school and industrial hygiene clinics, sufficed to provide for Americans’ most urgent dental needs through the 1920s. But the massive market
failures and the terrible privation of the Depression posed new challenges to
dentists’ insistence that the private market, combined with the availability of
charity care, could do enough for Americans’ dental health. American dentists recognized that many people required dental services for which they
were unable to pay. Furthermore, they acknowledged that their own attempts
to limit entry to the profession had resulted in a shortage of dentists, which
particularly affected rural areas of the United States and which reflected
badly on the profession as a whole. Their suggestions about how to remediate

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105

these problems emphasized the voluntary, the temporary, and—whenever
possible—programs paid for by someone other than the government.
Physicians, too, faced the accusation that their monopoly on health services placed crucial health care out of Americans’ reach. Because of the same
market pressures, New Dealers were intensely interested in creating a program for the socialization of health care costs in the United States. By 1935,
the Roosevelt administration’s Committee on Economic Security described
health insurance as “the most immediately practicable and fi nancially possible form of economic security.”15 The reaction of American physicians to
New Deal–era proposals for national health insurance was swift and direct.
Denouncing compulsory insurance plans as socialist, the American Medical
Association objected even to voluntary plans on the grounds that they often
served as a route to compulsory, perhaps government-subsidized, insurance.
Attempts to appeal to the fi nancial interest of physicians by emphasizing the
potentially income-stabilizing effects of health insurance failed dismally
with an audience that, for the most part, no longer feared personal financial
instability. As the Depression worsened, and demand for medical care fell, the
AMA began to accept the idea that voluntary health insurance plans could be
advantageous for both physicians and patients.16 But the AMA’s opposition to
compulsory insurance plans—and particularly for those administered by the
government—remained vigorous.
Many dentists had similar misgivings about the prospect of insurance.
As with physicians, however, their initial distaste for all plans of third-party
payment was softened somewhat by the economic instability they experienced during the Depression. Dentists had long believed that working-class
Americans undervalued dental services, but the Depression placed dental
care out of the fi nancial reach of even those who had been able to afford
it, and who had actively sought it in the past. The stopgap of the industrial
dental clinic failed, as millions of Americans were thrown out of work and
out of proximity to such programs. “Today it is not the poor child who is
always with us,” wrote A. C. Wherry, the president-elect of the ADA, in 1933,
“but it is the boy and the girl from the average home whose parents yesterday were classed as the esteemed patients of our average dental office, who
is deprived of dental care.”17 Wherry argued that the cumulative nature of
dental impairment, which would persist long after the economic contraction
that had caused it, made dentists’ commitment to get Americans through the
Depression with healthy teeth particularly important. Failure would mean
that Americans suffered worse dental health for decades to come. And the

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increasing prevalence of untreated dental decay made dentists look bad: in
the New Deal era, opposition to even comparatively drastic programs for the
distribution of vital resources could be construed as opposition to the reinvigoration of the catastrophically failed American economy.
Patient demand for dental services lay, tantalizingly, just beyond dentists’
reach. Everywhere they turned—in popular magazines, advertisements, and
the movies—dentists were reminded that Americans maintained an active
interest in health care interventions promising improvements in personal
appearance. The idea that an “inferiority complex” about appearance might
impede a person’s success in both public and private life carried particular
currency for Americans continually encountering the economic catastrophes
of the 1930s and early 1940s. One way to improve one’s outlook and thereby
retake control of one’s personal fortunes, this theory suggested, was to work
on one’s external physical qualities. The new ethos that resulted manifested
itself not only in Americans’ interest in dentistry, but in plastic surgery and
in the culture of “personal improvement” that sprang up in the form of exercise fads, pop psychology, and Americans’ heightened concern about the
appearance of their teeth.18
Personal-care product manufacturers aggressively promoted the idea
that having a pleasant mouth was critically important to one’s social and
psychological success, and receptive Americans flocked to purchase products intended to enhance their attractiveness. Listerine advertisements, for
example, simultaneously reflected and created the fear that aesthetic flaws
might have social consequences. In a June 1930 ad published in Good Housekeeping, a stylish young woman stared bleakly into her empty dance card.
She was surrounded by the comments she had overheard from fellow dancegoers: “They never invite her twice,” “She’s a nice girl, but—” “Has she always
been that way?” and, more ominously, “I don’t blame him for breaking the
engagement,” and “She simply cannot hold onto a fellow.”19 The text below the
graphics read: “Halitosis (unpleasant breath) is too high a hurdle for sensitive
people. You yourself cannot be sure that at this very moment you are free of
halitosis. . . . The swift, certain way to put your breath beyond suspicion is
to rinse your mouth with full strength Listerine.”20 Fresh breath, the ad suggested, was important to the self-confidence and social success that eluded so
many Americans during the Depression.
Dentists helped to keep Americans’ underlying interest in dentistry high
by promoting it as a salve for all manner of personal and national ills. Popular
literature and short films aimed at American youth advertised orthodontics,

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increasingly facilitated by war-era improvements in materials science, as a
way to ensure social success. The social benefits of orthodontics were typically presented in a fashion that balanced them judiciously with other health
concerns, but it was clear to patients that they could expect great social results
from their time in the dental chair. For example, after the protagonist’s visit to
the orthodontist in Betty’s Crooked Teeth (circa 1937), her teacher said “Betty,
your schoolwork is improving. Last year your average was N minus, now it is
S.” The school nurse, too, had good news: “Betty, you have gained in weight,
your health is better.” At the end of the film, the narrator announced that
“Betty’s straight teeth will increase her self-confidence as she grows older.
Straight teeth aid in developing a pleasing appearance, expression and personality, in business and social life.” The fi lm cut to one example of the powerful effect of straight teeth—in the person of the orthodontist’s receptionist,
a welcoming young woman with a brilliant—and straight—smile.21 Such presentations of the benefits of dentistry were calculated to appeal to Americans
seeking ways of taking fi rmer control of their personal fortunes, but they also
helped to keep patients’ underlying interest in dental care high.
Socializing Dental Costs

It was not an absolute decline in demand, but the gap between patients’
desire for service and their ability to pay, that so bedeviled dentists who
faced declining business in the 1930s and 1940s. The possibility of closing
this gap prompted a few dentists to seriously propose the socialization of
dental care in the early 1930s. Their fi rst concern was for children: many
dentists pointed out the curious discrepancy between Americans’ acceptance
of socialized education and their rejection of socialized medical and dental
service. “Why does it pauperize a child to give it health service and not when
giving it education?” demanded the editors of the Journal of the Michigan
State Dental Society.22 Ever-mindful of contemporary arguments for economy,
they pressed the claim that “education that does not include health service
is wasteful, for education depends for its usefulness on health . . . the present method of prodigality in education and parsimony in health service is
untenable.”23 Others noted that the socialization of education had improved
the status of teaching as a profession and the literacy of the population as a
whole, suggesting that dentists and the broader American public could hope
for similar outcomes from socialized health and dental care.24
The example of the military provided a ready reference for those who
argued that socializing health care could work in the United States. During

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and after World War I, highly trained physicians and dentists provided care
to American troops under the administration of a centralized command. A
quasi-military system would eliminate patients’ ability to choose their care
providers, these advocates admitted—but then, “is it not a fact that the selecting of a doctor has for years been denied those charity patients who have
availed themselves of the advantages of the larger, better-organized hospitals
where scientific medicine has prevailed? . . . Today this freedom to choose a
doctor may actually redound to the disadvantage of the patient not knowing
where to procure the best advice.”25 The military system was also an advantage for dentists, they argued, because it provided income stability and better living conditions than the vagaries of private practice. “Physicians and
dentists work at defi nite yearly salaries, are amply provided with food, shelter, and clothing, a home and maid service—and retire at night with greater
mental calm, awake at reveille to face more sunshine than comes into the
lives of our glorified individualists in private practice.”26 A military system of
employment for dentists would, they felt, cost less per capita than the existing hodgepodge of private, charity, industrial and school care. “ ‘We have
found an army post at Fort Benning, Georgia, spending thirty-five dollars
per capita for a service which in most respects seems ideal in quality.’ Is this
not enough testimony for the necessity of completely socializing medicine
upon a naval or military foundation?” one demanded.27 Directing a barb at
the American Medical Association’s claim that government-funded health
care removed individual practitioners’ incentives for professional excellence,
proponents of a military system pointed out that the AMA had admitted to
membership “every medical officer in the navy and army” for more than
twenty-six years.28
More frequently, however, those who argued for socialization of American dentistry gestured not towards the military but toward other countries
to illustrate the benefits of socialized health and dental care. “We have but to
look beyond the borders of our country to fi nd about twenty countries with
medicine in varying states of stages of socialization,” one writer mused.29 Such
writers debated whether compulsory social insurance, to which they sometimes referred as “partial socialization,” or the direct employment of dentists
by government, or “full socialization,” would be preferable. They generally
agreed that the inaccessibility of dental care in the Depression-era United
States contrasted poorly with the free availability of a basic standard of dental treatment in countries with either fully or partially socialized medicine
and dentistry. Health outcomes were better when medicine was socialized,

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they argued, and the opportunities for malfeasance by unscrupulous or inept
physicians and dentists were reduced.
Comparison to conditions of health and dental care elsewhere immediately opened the rhetorical door to reminders of the deficiencies of British
dentistry, and—more frequently and pervasively—to the defects of the Soviet
system of socialized medicine and dentistry. Reference to dental practice in
Russia, like other examples of dental practice abroad, had long provided a
way for American dentists to discuss their hopes and fears about their professional status. As early as 1919, James H. Howell of the Michigan State Dental
Society reported, in a comment that damned through faint praise, that “as
good, if not better, dentistry is seen in Russia as I have seen done in our
sister country, England.”30 American dentists credited the ministrations of
professional dentists with helping to stem the tide of political radicalism at
home: the journal Oral Hygiene reported “one of London’s leading men in the
dental world” as saying that he had “never seen a Bolshevist with other than
bad teeth. Proper care of the teeth obviates the mental explosions that cause
Bolshevism.”31 They hoped that the presence of a small group of professional
dentists in Russia might help to, as the writer of one caption to an image of a
Russian peasant being attended to by a dentist put it, “‘restrain’ the Bolsheviki.”32 But by the 1930s, as Communist party rule in the Soviet Union hardened, it was clear to American dentists that dental care in the USSR had gone
horribly wrong. “One hasty glance into the mouth of any person coming to us
from any country in the world which ‘enjoys’ state or insurance dentistry is
all a dentist needs to determine its ‘blessings,’” a Los Angeles dentist wrote
in 1933. “So, before we allow our people to be propagandized into once more
following Europe’s lead into disaster, let the American dental profession once
more take the lead . . . by solving conclusively this vexed problem as to how to
make the necessity for dentistry plain to every worthy member of society.”33
Soviet dentists argued—often in the pages of American dental journals—
that the socialization of dental care had improved both the state of the profession and Soviet citizens’ dental health. In 1929, I. A. Gershanski, a dentist
from Odessa, commented that “during the reign of czardom, dentistry was in
a state of extreme debasement in Russia. . . . At the present time, the profession
of the dentist in Russia is delivered from the yoke of serfdom.”34 Gershanski
was emphatic about the positive impact of categorizing dentistry as a branch
of medicine, and requiring medical training of prospective dentists—a move
that many American dentists opposed, but which had the advantage of promising to elevate the public image of dentistry. However, Gershanski spent the

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largest portion of his article describing the institutions of state dentistry in
Russia, where more than 60 percent of ten thousand dentists were government employees and where, as he wrote approvingly, “Private dental practice
is small and is steadily decreasing year by year.”35 Gershanski argued that
nationalization of dental care had raised the professional status and quality of
life of Russian dentists, who worked an average of five hours per day.36 Reports
emphasizing the positive health impact of these changes were also common:
in 1930, Leningrad dentist George Randorf observed that the percentage of
carious teeth in the mouths of Odessa children had decreased from between
72–95 percent before the Revolution to 5–8.6 percent after. “Surely,” he wrote,
“this comparatively small percentage of carious teeth of the children of the
post-Revolution period must be due largely to the more satisfactory health
of the mouth cavity and the modern prophylactic measures, which, as some
of the actual aspects of social dental treatment, contribute to the decrease of
the development of caries.”37 Randorf, too, regarded the state’s assumption
of responsibility for the provision of dental care as a positive move, and he
hoped that his readers would agree.
American dentists, however, expressed hesitation about any system of
paying for dental treatment that removed dentists from the stimulating rigor
of direct engagement in commerce. Reflecting on the incorporation of dental
care into the national health program of Britain, for example, New York dentist
Solomon Gross wrote that “the entrance of a cold impersonal third party into
the relations between dentist and patient has had a deadening effect upon the
professional ardor and zeal of the members of the profession.”38A 1932 item
in the Dental Digest, addressing frequently asked questions about dentistry
in the Soviet Union, devoted several inches of column space to answering
the question “What stimulus is there for a dentist to work under the Soviet
System?” The respondent, native Chicagoan Peter Swanish, answered that
“one can live with less anxiety and fear as a state dentist than as a private
practitioner.”39 Swanish considered the diminution of anxiety that came with
state-controlled practice a bad sign: he believed that it marked a dangerous
subversion of the healthy anxiety of the profit motive.
Swanish’s interest in the systemic encouragement or discouragement of
work in the Soviet Union mirrored the concern of American dentists about
the existence of such incentives or disincentives in other national economies.
In studying the USSR, rather than citing the influences of climate or genetic
inheritance, they placed blame for the discouragement of work exclusively
on the Soviet economic system. Though they believed that “real Americans”

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could be identified partly by their avid commitment to work, they feared providing un-American slackers with any temptation to shirk labor. Therefore,
many Americans—including many dentists—believed that the American
economic system had to be arranged so as to continually inspire Americans’
productive efforts. Socialized medical and dental care would, they felt, “substitute for the will to get well and the will to work, the will to stay sick and the
will to loaf.”40 The African American dentists of the National Dental Association took a less pessimistic view, counseling that American innovation could
produce a system of socialized health care that would protect the impetus to
work: “We do not anticipate an imitation of either the Soviet or the British
pattern . . . [we promote a] form adopted to our American needs and democratic way of life,” one black dentist wrote.41 The notoriety of poor dental care
in the British and Soviet systems of socialized medicine was a serious psychological obstacle for other American dentists. One Chicago writer urged
his peers to observe carefully the results of socialized care in those locations,
speculating in January 1933 that if Americans could successfully “stave off
these schemes for another ten years, we will be spared them, because they
will prove to be so harmful to medical practice and so destructive to national
character that we will escape their blight.”42
Meeting the Demands of War

The ten years that followed the New Deal brought complications that dentists hoping for the opportunity to recover from the Depression and return to
normal life could barely have imagined. Chief among them were a startling
increase in demand for dental care, accompanied by a precipitous decline
in the national supply of dentists. The wartime economic boom increased
Americans’ disposable incomes, and restrictions placed on many commodities helped to direct consumer spending towards other goods and services—
and especially toward dental care. “Women who never did a thing but go to
card parties and take care of their homes, are now working in war industries
of the nation drawing weekly wages that run from fi fty dollars up to incredibly high sums,” warned one California dentist. “Most of these people put off
their dentistry during the depression years. Now, with inflated wages, they
are crowding the dental offices of our country. Dentistry is one service the
government hasn’t restricted.”43
Dentists contributed to the war effort by encouraging young men and
women to become dentally “fit to fight.” In 1944, for example, a skit promoting
“A War Angle in Dental Health Teaching” emphasized the national-security

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ramifications of dental decay, giving a “happy-looking” Hitler these nefarious
lines: “My spies tell me that the American school children don’t want good
teeth. That pleases me. I want all American school girls and boys to have bad
teeth. Then we’d conquer them without a shot. . . . You see those boys and girls
have turned against their flag and are helping me, the great Hitler. . . . We’ll
conquer America because the children don’t care.” The skit recommended
that children avoid spending money on candy and movies and purchase war
stamps and bonds instead, or that they “have a parade with banners saying
we’re going to have good teeth to chew Hitler to pieces.”44
These blandishments about dentistry stimulated patient demand for dental services that were already scarce. According to a survey sponsored by the
office of the Surgeon General in 1943, more than half of all dentists under the
age of thirty-five served in the military during World War II, leaving a dangerous shortage of practitioners at home. Though those who remained stateside
increased their efforts, there were simply not enough dentists to meet Americans’ rising demands for dental care. The resultant shortfall between demand
and supply left many Americans with the impression that the dental profession could not be relied upon to consider national needs above individual
pecuniary interests.
Dentists recognized that Americans’ alienation from the system of privatepractice dentistry boded badly for the future of their profession. During the
war years, they debated a variety of measures for increasing the availability of
quality dental service. Some—like the suggestion that dentists increase their
night office hours and focus their work on the adolescents who might soon be
marching off to war—caused little controversy.45 Other plans touched on more
closely held facets of dentists’ professional self-concept, and drew much more
opposition. One faction, led by New York dentist Charles Hyser and Claude
Pepper, the US senator from Florida, promoted a renewed consideration of
the “level-technician” plan in which a small cadre of highly educated dentists supervised the work of a larger group of lesser-trained service providers.
Opponents of the plan protested that it would damage the unity of the profession and subject Americans to poor-quality care. “The so-called ‘Hyser Plan,”
thundered Alfred Asgis, a faculty member at the New York University College
of Dentistry, “is a dismemberment plan of dentistry. . . . It is our obligation to
those who will return from the field of battle to provide them with high quality
dental service,” not the ministrations of lesser-trained assistants.46 Some stateside military dentists began sending patients who needed relatively uncomplicated prosthetic work directly to dental laboratories to be fitted for dentures

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and partial plates. “Such detestable practice has too many complications for
comfort,” retorted the editor of the Texas Dental Journal. “However, such is
being forced upon [the laboratories] by unthinking members of the profession,” who failed to appreciate the importance of dentists’ professional control
over all phases of dental service.47 New Jersey dentists reconsidered legislation
allowing dental hygienists to practice without dentists’ supervision, though
they ultimately rejected the idea of permitting hygienists to “compete with the
ethical dentist who has spent years and thousands of dollars in an effort to be
competent and maintain a professional high standing.”48
Dentists from many locales complained that the lack of reciprocity in
state licensing laws restricted their ability to move to the places where more
dentists were needed: these laws, they felt, reflected the unseemly interest of
state dental society leaders in ensuring their personal fortunes at the expense
of others. “It is high time the public was rescued from the clutches of a few
‘closed shop’ dentists who prate of dental standards. . . . If we had full and
nation-wide reciprocity in the dental profession, there would be a more equal
distribution of dentists throughout the country,” one argued, “There would be
less demand for socialized dentistry.”49 In a similar vein, the editors of Dental
Survey urged willing dentists to consider establishing practices in rural areas
that lacked dentists. “Shortage of dentists, bad distribution of dentists—those
are the explosion caps that can set off the powder of demands for socialization legislation,” the writers warned. Indeed, they suggested, dentists’ own
efforts to disseminate dental health education had only made the problem
more acute, since Americans who knew the facts about the need for regular
dental care “feel their lack more keenly.”50
African American dentists, who treated some of the most underserved
patients in the United States, shared the sense that the socialization of health
and dental care costs would be a positive good. There was roughly 1 dentist
per 7,000 black Americans in 1930, and 1 per every 9,000 in 1940.51 Dentists
and patients alike suffered because of the discrepancy between the amount
of care needed and the availability of money and manpower to provide it.
Black Americans’ continued experience of domestic racism cloaked in arguments for regional and local uniqueness also helped to persuade them of the
importance of intervention that occurred at the federal level. As a result, the
National Dental Association generally favored plans for federally provided
health and dental insurance. “We cannot stop a trend so well founded upon
public needs when the public is aroused,” the editors of the Bulletin of the
National Dental Association counseled.52

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The American Dental Association, however, was desperate to avoid solutions imposed from without: the number and diversity of plans dentists considered to remediate the dental manpower shortage highlighted this. One
particularly eager Chicago dentist suggested that dentists “Look into This
Unionism Business,” as a means for fighting to retain—and even improve—
dentists’ professional prerogatives. He pointed out that “at present there is
not one organized craft whose members do not receive more money than the
dentists in our state and county institutions,” and suggested that organizing
into unions might provide dentists with the opportunity to command better
pay.53 Though his idea fell on unreceptive ears, it was clear to all observers
that some change in the American system of health care distribution was in
the offi ng. Dentists hoped to maintain as much control as possible over what
happened to their profession, and when.
The Threat of Dental Insurance

As the Allied victory approached, and as calls for some form of national
health insurance at home increased, most dentists came to accept the notion
that insurance would play a permanent role in their professional practices.
Dentists who treated low-income patients actually welcomed the idea, and
urged their colleagues to act selflessly for the greater good. Addressing the
commencement ceremony of Meharry Medical College in 1943, for example,
Howard University Dental School Dean Dixon implored graduates: “Have
you ever thought that you as the more fortunate members of a minority group
enjoy a rare privilege—a privilege of reaching out and rendering an unrestricted good for the helpless and appreciative masses whose dependence
upon you is like that of an innocent child, who looks to a parent with unfailing faith?”54 Other dentists, with somewhat less public spirit, merely sought
to head off more drastic proposals for state control of dental service by putting
forward an agreeable plan that would insure a threshold level of dental care
for all. Alfred Asgis, for instance, conceded that in addition to the traditional
nostrums of providing for children’s dental health, promoting additional
dental health education and securing funding for advanced dental research,
“compulsory social insurance on a national scale (with proper safeguards for
quality and quantity of services) should be established as a social means of
providing dental health care to the low income groups.”55 Asgis complained
when initial Congressional attempts to enact national health care omitted provisions for dentistry, and recommended that fellow dentists write to the legislators involved to remind them of “the importance of quality dentistry.”56

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Unfortunately for the cause of Asgis’s letter-writing campaign, however, most American dentists, like their physician counterparts, opposed
Congress’s postwar moves towards national health insurance legislation.
Though its Congressional proponents had already seen their proposals for
the expansion of Social Security’s limited health programs defeated in
two previous incarnations, the 1945 version of the Wagner-Murray-Dingell
bill sought to capitalize on the pro-democracy rhetoric of the war era by
again attempting to enact socially insured health coverage. Physicians campaigned furiously against the legislation, which they claimed would make
them “slaves.”57 Similarly, seventy-seven percent of white dentists opposed
the measure.58 (Despite the resounding success of “slavery” rhetoric with
white health professionals, the National Dental Association favored WagnerMurray-Dingell.)
Dentists generally feared that dental insurance, whether voluntary or
compulsory, would restrict their professional autonomy and eat into their
profits. Then, too, they had sincere concerns about being asked to provide
remedial dental care under any insurance plan to patients who had gone
years—perhaps a lifetime—without dental treatment. “It would be like starting a new life insurance company that was to pay policies to the heirs of
every man, woman and child who died in the last fifty years, and for whose
insurance no premiums had been paid,” one wrote.59 Consistent with the
increasingly strident anti-Communism of the postwar years, they also harbored more grandiose anxieties about the impact of socialized health expenditures on the American national character. One Iowa dentist projected that
the Truman administration’s health insurance plan would fail in fewer than
five years because employees who were taxed for dental insurance would
“grumble at slow service and for that reason many will quit their jobs rather
than pay for something they are not getting.”60 Even the usually staid University of Michigan dental school professor Kenneth Easlick claimed that “a
little social security, like a little morphine, may become habit forming,” leading addled Americans to favor socialist policies for national health insurance. “The challenge to clear thinking, to unemotional scientific planning
and to reasoning cooperation by dentists is obvious,” he concluded.61 In 1950,
with bills for compulsory national health insurance again languishing in
Congress, the president of the American Association of Orthodontists told
a meeting of that organization that “compulsory health insurance, together
with all other socialistic tendencies, will result in a further increase of autocratic power, granted to centralized government, to interfere in the private

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affairs of citizens and to regulate their daily lives, and will further curtail
their freedom and liberty. . . . We should keep in mind that dental needs and
service are, fi rst of all, problems of the individual.”62
Several independent forces helped to rescue American dentists from the
horns of their postwar dilemma. Because of resounding physician opposition,
and particularly because of the rising currency of arguments that opposed
social insurance programs on the grounds of their similarity to Communism,
Wagner-Murray-Dingell and similar plans were continually defeated in Congress. At the same time, labor unions made a tactical decision to support the
growth of a private welfare state instead of public programs of social insurance: health benefits, unlike salary increases paid in cash, were not taxable,
and both labor and management hoped that private insurance programs
would command the loyalty of American workers. The voluntary insurance
of health-care costs, including dental costs, surged in popularity, enhancing
Americans’ access to health care and relieving some of the pressure on Congress and the health professions to provide dental and health insurance.63
Dentists still hoped to convince a distrustful public that they had Americans’ best interests at heart, and that the profession would not leave untreated
patients in need of dental care. “The ultimate remedy” to the discrepancy
between the supply of dentists and the demand for dentistry, the senior dental officer of the US Public Health Service wrote in 1944, “is the reduction of
the dentists’ patient-load through reduction of the incidence of dental disease. There is promise in that direction and much upon which to base our
hopes. This statement is based on recent information on the prophylactic
effects of the fluoride compounds.”64 In fluoride, dentists were on the verge of
a discovery that would reduce the demand for reparative dental services, help
keep dental costs within limits acceptable to the public, and provide dentists
themselves with an opportunity to renew their images as the benevolent arbiters of modern, scientific dental research.

Chapter 5

Behind the Fluorine Curtain

Today, mid-twentieth century opposition to the fluoridation of public water
supplies is widely remembered as the province of kooks. In Stanley Kubrick’s
1964 post-nuclear classic Dr. Strangelove, or: How I Learned to Stop Worrying
and Love the Bomb, General Jack D. Ripper, his name and character a caustic
send-up of Vietnam-era anticommunist militarists, worried that “a foreign
substance is introduced into our precious bodily fluids without the knowledge of the individual. Certainly without any choice. That’s the way your
hard-core Commie works.” In the view suggested by Kubrick’s portrayal of
opposition to water fluoridation—and in the minds of many observers before
and since—the addition of fluoride to Americans’ drinking water was a selfevident good, opposed only by the irredeemably paranoid.
Dentists and many popular writers have portrayed water fluoridation as a
necessary, welcome, and even inevitable step on the path toward late twentieth-century Americans’ near-maniacal obsession with their teeth. In this view,
fluoride was an obvious improvement to Americans’ lives, and the fetishization of aesthetic interventions that followed it an inexorable result of Americans’ improved dental health. This vision of the debate over fluoride, and what
came after it, contains some grave errors. Its proponents have an incomplete
view of dentists’ motives for advocating water fluoridation—and of the basis
for other Americans’ opposition to it. More importantly, they ignore the ways
in which the fight over fluoride helped dentists to view collective action for the
public good with increasing skepticism, and thereby contributed to the rise of
an individualist ethos about dental care at the end of the century.

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Fluoride and Dental Aesthetics

Most twentieth-century hygiene campaigns portrayed good dental health and
a pleasing facial appearance as critical to both individual achievement
and the broader success of the American economy. From the outset, public
and professional concern about the presence of fluoride in public drinking
water hinged on this preexisting, active, and at times intense concern for the
appearance of Americans’ teeth. The fi rst confi rmed reports about the influence of chemical compounds in water on dental appearance came in 1925,
when prominent New York dentist Frederick McKay described his travels
to Benton, California, a town in the northern portion of the Mojave Desert,
where users of water from the local hot spring developed brown mottling
on their teeth. McKay felt certain that the hot springs were the source of the
unsightly brown stain. Like most of his professional peers, he was already
familiar with “Texas stain,” an underdevelopment of the enamel associated
with hard water, and eventually accompanied by a secondary brown, yellow,
or pearly white mottling of the surface of the teeth. McKay’s work in Benton
was part of an emerging research project that would, within twenty years,
identify the cause of the stain as an overabundance (more than one or two
parts per million) of naturally occurring fluoride in the water supplies of
areas where mottled enamel occurred.1
McKay reported that denizens of Benton, “a few scattered families on the
adjacent ranches and a collection of Piute Indians on the hillside,”2 had no
other source of water. By way of contrast, he cited events in Oakley, Idaho,
where dental mottling had led the local Women’s Civic League to campaign
for a bond referendum “from the proceeds of which the present source of
water supply from the warm spring was to be discarded, and a new supply
from a different source substituted.”3 McKay counted the situation as “the
fi rst instance where a policy of municipal economics of such magnitude as
is involved in the abandonment of a water system and requiring a tax of the
people, has been determined solely by and upon a dental aspect.”4 McKay
pointed this out partly because it illustrated Idaho dentists’ success at establishing themselves as authorities on science, and thus constituted a victory
in dentists’ ongoing campaign to raise the status of their profession. McKay
had also been personally involved in spurring the passage of the bond referendum: “prominent and influential citizens” had argued that the link
between the local water supply and dental mottling had not been clearly
established, and McKay had addressed a town meeting the night before the

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Figure 7 “Mottled enamel” as portrayed in Frederick McKay’s 1925 article on fluoride. Dental Cosmos 67 (September 1925): 851.

election, “presenting the evidence which has been gathered during the past
ten or more years . . . defi nitely connecting the water . . . with the existence
of mottled enamel.”5
McKay reported that the locals of Oakley, whom he described as both
“citizens” and “taxpayers,” “were convinced, after mature consideration of
this fundamental and compelling point, that they had not the ethical right as
parents and citizens to unload this blight upon the present generation of children of the community, nor upon generations yet unborn.”6 Oakley citizens’

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teeth were not more prone to decay or fall out as a result of the staining, but
Oakleyites considered brown stains on their teeth a problem that required
urgent attention, and this had a powerful impact on Oakley residents’ thinking about what ought to be done about the town’s water supply.
Mottled and stained enamel, they thought, was a blight on humanity.
The best scientific explanation of the causative mechanism for mottled
enamel suggested that it was too late to remediate the damage to adults’
teeth. Generations to come, however, could be protected by the passage of
the water supply bond. These facts, together with broader American sympathies for the protection of children, explained the locals’ insistence on
couching the bond issue in terms of their roles as parents. Their belief—and
McKay’s—that citizenship could and should play a role in the debate is more
tantalizing. Oakleyites thought of the bond issue as a matter of citizenship
partly because it was citizenship that conferred upon them the right to vote.
They also imagined that there was something about the particular nature
of the damage done by the local water that had bearing on the question of
citizenship—that there was some way in which good-looking teeth and good
citizenship were linked.
The class and regional dynamics of the mottled enamel problem, which
primarily affl icted communities in the American West, played a role in this
conviction. McKay concluded that the citizens of Oakley were to be praised
for having “spared [future generations] the disfiguring appearance of this
blight . . . [which] would advertise to the world that such persons were the
products of a given community.”7 Most naturally fluoridated water supplies—
almost eighty percent by the estimate of the American Dental Association’s
Bureau of Public Relations in 19438—were in the West, a place where recent
American immigrants frequently traveled to slip the bonds of their existing class and racial status. McKay alluded gently to the widespread popular suspicion that the Americans who populated the rural and hardscrabble
West had something to hide about their backgrounds. Rural Westerners who
attempted integration into American city life might, he thought, fi nd themselves marked by their mottled teeth and therefore socially handicapped by
the visible evidence of their geographic origins. Like immigrants, Americans
from the rural West faced the real prospect of reduced class mobility because
of their failure to conform to the increasingly shared image of what Americans’ teeth should look like.
The US Public Health Service quickly developed an interest in fi nding
out what was causing mottled enamel—and in eliminating whatever the

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offending factor might be.9 In the early 1930s, dental surgeon H. Trendley
Dean traveled extensively under the auspices of the US Public Health Service,
investigating the connections between cases of “mottled enamel” in children
and the existence of fluorospar mines (in this period, usually operated by the
Aluminum Corporation of America) near those children’s water supplies.
The rapidity and expansiveness of the federal government’s expression
of concern proceeded partly from contemporary attempts to establish a clear
field of endeavor for dentists—of similar influence and prestige to the position held by physicians—in the Public Health Service. In 1927, Senior Dental
Surgeon C. T. Messner wrote an eight-page missive to Surgeon General Hugh
Cumming, arguing for the organization of an independent Dental Section of
the PHS. Messner felt that the new structure was necessary because “the field
is so broad for this sort of work, and the possibilities of its expansion so great,
that it can justify a section to itself, and in this way will be able to render
service to the limits of its appropriation, which might not be the case were it
tied with other interests equally as important.”10 Messner’s correspondence
repeatedly referenced the deplorable state of American children’s dental
health, usually focusing on the functional losses that resulted. Messner did
also point out that the loss of a fi rst permanent molar could create “a deformity of the face and cranium,” which suggests that aesthetic concerns were
not absent—though, meriting only one line of an eight-page single-spaced letter, neither were they prominent.
However, the fi rst target of the new dental section of the Public Health
Service was not a functional but an aesthetic concern. Despite the occasionally shocking appearance of teeth damaged by an excess of naturally occurring fluoride, the mottled enamel problem was strictly aesthetic—most teeth
affected by the presence of natural fluoride in water supplies were stronger
and more resistant to decay than teeth that had not been exposed to fluoride
during the critical childhood years, when the enamel of permanent teeth was
forming. As one writer pointed out, reflecting in 1965 on the early history of
fluoridation research, “It was a hope to improve an undesirable appearance
that prompted Black [another early researcher] and McKay, and later Dean,
to study the relationship between fluorides in drinking water supplies and
a condition termed ‘mottled enamel.’”11 The federal government’s interest in
the problem of mottled enamel was not an inevitable outgrowth of the Public
Health Service’s interest in dental health, narrowly defi ned as the preservation of functional dentition. Public Health Service officers like H. Trendley
Dean studied the problem of mottled enamel because the federal government

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considered the “blight” that stained Americans’ teeth a matter of national
concern all by itself.
The discovery of fluoride compounds as the cause of both mottled
enamel and improved resistance to decay led a decades-long debate over the
propriety of artificially fluoridating public water supplies. The Bureau of
Public Relations of the American Dental Association reported in 1943 that
“the continuous use throughout the formative period of the tooth of water
containing about 1 part per million of fluorine will result in an incidence
of approximately 10 per cent of the mildest forms of dental fluorosis. Thus,
the logical approach from a public health standpoint to the prevention of
this disease is the avoidance of the use of domestic water containing fluorine much in excess of this amount. . . . Reduction of the fluoride content,
however, much below 1 part per million of fluorine may not be advisable, in
view of the recent epidemiologic evidence concerning the low dental caries
experience rates associated with the use of domestic water containing this
approximate fluoride concentration.”12 Though the staining caused by excess
fluoride was clearly unsightly, the strengthening of dental enamel caused by
low concentrations of fluoride in drinking water struck dentists—and many
laypeople—as highly desirable.
Accordingly, dentists began a locality-by-locality campaign for the fluoridation of public water supplies at appropriate levels. During these years, both
advocates and detractors of the practice made frequent, and contradictory,
reference to the aesthetic effects of fluoride on human teeth. The development
of an unambiguous aesthetic justification for—or argument against—fluoridation was hampered from the outset by the fact that diagnosis of “mottled
enamel” was sometimes a subtle one. Though high levels of naturally occurring fluoride could produce dark brown stains that no dentist (or layperson)
could miss, lower levels of fluoride might produce no aesthetic changes, or
only very subtle ones. H. Trendley Dean’s correspondence with Surgeon General Hugh Cumming was rife with examples of reported cases which, upon
investigation, proved to have been “mistaken for ‘calcium deficiency spots’
on the enamel surface of the teeth,” and of towns in which “there were three
or four cases which might be considered questionable, but not a single case
where a diagnosis of even a mild type of mottled enamel could be made.”13
The difficulty of diagnosing dental fluorosis was compounded by disagreement over whether all fluoride-mediated aesthetic changes to the teeth
were bad changes. Most American dentists and dental researchers claimed
that at the low level at which public water supplies would be fluoridated,

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mottled enamel would be of little, if any, concern. One author reported in
1966 that “the only proven detriment of fluoridation that may occur is enamel
mottling (It has not occurred with any degree of consistency). The degree of
mottling is extremely variable and is purely an esthetic disadvantage, showing no harmful effects on the tooth structure itself. Against this is to be
placed a mass of evidence gathered by the American Dental Association . . .
showing conclusively that the incidence of dental caries can be reduced by
up to 60 per cent by a controlled program of water fluoridation. The scales
do not balance.”14 Some writers acknowledged the possible occurrence of
mottled enamel, but claimed that it was “generally not an esthetic problem”;
whether they claimed this because it appeared infrequently or because, in
its milder forms, some experts actually considered it an aesthetic advantage
is unclear.15 A few writers did explicitly try to turn the likelihood of dental fluorosis into an asset by claiming that mild fluorosis enhanced, rather
than diminished, one’s appearance. “The milder forms of fluorosis produce
a tooth enamel with a high luster which enhances the beauty of teeth rather
than disfigures them,” claimed David Ast, New York State Director of Dental
Health, in 1957.16
The most vigorous advocates of water fluoridation portrayed its aesthetic
benefits to individuals as virtually unlimited. Beyond its effects on the enamel
of the teeth, they felt, fluoride could prevent tooth loss, which occasioned aesthetic, social, and fi nancial problems of its own. Partisans of fluoride argued
that more decay-resistant teeth stayed in the mouth more reliably and made
their possessors more attractive people. Most studies claimed a 60 to 65 percent reduction in dental caries as a result of “optimal” water fluoridation. An
item from a Detroit-area newspaper of the 1960s summarized the pro-fluoride stance: “”Fluoridated water results in the formation of beautiful white
teeth highly resistant to decay. . . . Speech defects, facial deformities, crooked
teeth, disfigurement and pain, all result from dental decay.”17 During debate
over a proposed 1963 antifluoridation legislative measure to require a popular vote before water fluoridation could occur in Detroit, speakers against the
proposal included Kalamazoo pediatrician Frederick Margolis, who reported
that the “change in children’s teeth since the city’s water supply had been
fluoridated had been ‘simply fantastic—they’re beautiful.’”18
The aim of looking beautiful was widely understood to have freestanding merit. Dentists, in particular, increasingly considered Americans’ loyalty
to the goal of personal comeliness as an important adjunct to their efforts
to insist on individual responsibility—and not dependence on a caretaker

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state—as the wellspring of American greatness. Consistent with this view,
dentists who advocated water fluoridation frequently attempted to quantify the specific cash advantages of being better-looking. The director of the
Michigan Department of Public Health, explaining to the state’s Pure Water
Council why the department advocated fluoride supplementation, argued
that, with water fluoridation, “Not only is a more resistant tooth developed,
but also a better appearing tooth is formed. . . . Decayed teeth may lead to
disability and deformity. An aching tooth and a swollen face demolish the
sense of mental, social and physical well being. The consequences of tooth
decay can deter an individual from gainful pursuit or effective performance
in earning a living.”19 Supporters of fluoridation in Detroit linked good dental
health and freedom from pain with success at school and in work, but they
also highlighted the importance of having a good-looking mouth to social
acceptance and, thereby, to economic success. “Dental decay is painful, disfiguring, causes absenteeism from school and can prevent job placement and
procurement,” proclaimed the members of the Health Subcommittee of the
Mayor’s Committee for Total Action Against Poverty in 1965. The subcommittee voted to support fluoridation of public water supplies in Detroit.
Despite their reputation for obsessive interest in the political and environmental consequences of water fluoridation, antifluoridationists were also
gravely concerned about the aesthetic impact of water fluoridation on Americans’ teeth. Their aesthetic objections to even “optimal” levels of water fluoridation occurred early in public debates about fluoride, and were remarkably
persistent. In fact, because the question of whether or not mild fluorosis was
ugly was largely a matter of aesthetic preference rather than scientific judgment, the specter of bad-looking teeth was one of the most powerful arguments against fluoridation. Curiously, antifluoridation tracts usually did
not include photographs of teeth affected by fluorosis: readers were left to
imagine for themselves just how bad the problem could get. They were also
encouraged to regard the debate among dentists about whether or not fluorosis was ugly as evidence of incompetence and perfidy. An item in the National
Fluoridation News, an antifluoridation newspaper, reported that fluoridationists had fi rst argued that no aesthetic change to the teeth would be wrought
by fluoride supplementation: “Later, when fi rst reported in Newburgh, NY,
the fluoridationists cried, ‘no disfiguring mottling can occur!’ It has fi nally
evolved promotionally that mottling in the test cities is now declared a
‘cosmetic enhancement’ making the teeth ‘more beautiful.’”20 Another flyer
barked: “The P.H.S. expected and now reports mottling (white spots which

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may gradually become ugly brown or black stains) in the experimental town
of Newburgh, N.Y. Health officers call these teeth ‘beautiful.’”21
Like those who advocated for fluoride, antifluoridationists saw the effects
of aesthetic damage to one’s appearance as long-lasting and potentially quite
severe. One antifluoridationist appealed to readers’ sympathy for a girl who had
been crippled by “fluorosis” (which the writer viewed as a full-body disease
rather than as localized damage to tooth enamel): “Jennifer is a good looking
girl with above average intelligence, but she is suffering from a disease that
will not only affect her physically, but could very well submerge an alreadyshy personality. Jennifer has fluorosis. . . . Those of us in the neighborhood
who have children with fluorosis are torn between the urge to show everyone
the damage fluoride can do, and the desire to spare the children’s feelings by
not asking them to show their diseased teeth to the world.” Another wrote:
“Young girls are very conscious of their appearance, and disfigured teeth will
give them feelings of inferiority that will remain with them all their lives. . . .
It is pitiful that the poor little children must drink fluoridated water and bear
this disfigurement and embarrassment while water works officials, such as
in Newburgh, New York, have their own non-fluoridated artesian wells.”22
The linkage between dental appearance and psychological health seemed
perfectly natural to these writers, and they expected it to seem just as natural
to their readers.
Costs and Risks in the Fluoridation Debates

Partisans on both sides of the debate over the fluoridation of public water
supplies agreed that Americans would want teeth that were healthy, intact,
and free of unsightly stains. They differed in their aesthetic judgments about
what was “unsightly,” in their technical judgment about what would produce
or protect against unsightliness, and, particularly, in their weighting of the
costs involved to the public and the individual in achieving the aim of good
teeth. It was this latter dispute that most clearly defi ned the ideological differences between the two groups.
Though dentists who advocated for fluoride hoped to use it in part to
deflect demands for the socialization of health care costs, they understood
that many Americans who were receptive to fluoride felt that way partly
because of its potential to reduce overall health care expenditures. Therefore,
they repeatedly emphasized the total dental savings that could be had for the
low price of water supplementation: their research suggested that those savings were considerable. Studies of the two cities in New York State in which

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water had been fi rst fluoridated in 1945 “established that dental costs are
lower for children aged 6 and 7 years who have had fluoridated water all their
lives. Initial dental care costs were $14.16 in Newburgh [the fluoridated city]
and $32.38 in Kingston [the unfluoridated control]. Maintenance care the following year cost $5.90 in Newburgh against $11 in Kingston.”23
Antifluoridationists, on the other hand, cited the high personal cost of
remediating the damage done to human enamel by excessive, and sometimes
even by “optimal,” amounts of fluoride. Remediation of the severe staining
that could accompany mottled enamel was possible: in 1942, two Arizona
dentists reported that the use of a solution of superoxol (a 30% solution of
hydrogen peroxide) and ether seemed to be effective against the stains that
accumulated on mottled teeth, though it sometimes resulted in what one
writer had referred to as a “ghastly” paper-white appearance.24 Harold B.
Younger, a Texas dentist, reported in the same year that the bleaching technique he advocated—one similar to the Arizona dentists’—would “be found
to fill a long felt need for the relief of those cases to which it is particularly
applicable and which otherwise must submit to tedious and annoying operative procedures, or go through life with disfiguring stains.”25
Those who opposed water fluoridation usually shared dentists’ commitment to the ideology of personal fi nancial responsibility for health. More
importantly, however, they prioritized avoiding negative health effects of government action over the danger of experiencing negative health effects from
government inaction. They thus found the thought of having to pay individually for dental damage done by a public health program both economically
undesirable and politically offensive. The Medical-Dental Committee on the
Evaluation of Fluoridation, an antifluoridation organization, wrote: “Even if
only one in 100 of the anticipated individuals suffers a severer degree of mottling, this will amount to about 200 such cases per 100,000 population, which
is not insignificant either in terms of the number of individuals embarrassed
by this affl iction or the considerable dental costs entailed in attempting to
correct it.”26
Antifluoridationists sometimes positioned aesthetic damage as a mere
index of less visible—but equally unacceptable—risk that they believed
could be posed by the fluoridation of public water supplies. Because it was
technically possible for high concentrations of fluoride to cause toxic effects
in humans, many of fluoride’s detractors considered it an environmental contaminant whose aesthetic effects at lower concentrations—however desirable
on the surface—were properly regarded as evidence of pervasive harm. One

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antifluoridation organization pointed out that cows that consumed fluoridated water also developed mottled enamel, and that “a cow with mottled
teeth is a poisoned cow, just as a child with mottled teeth is a poisoned child.
Neither will ever be as well as if it hadn’t happened.”27 Fluoride’s opponents
sometimes positioned their aesthetic claims as one of a concatenation of environmental, political, and medical arguments against fluoridation; a news item
from 1963 included a ditty, allegedly sung to the tune of “Yankee Doodle”:
“Fluorides give you mottled teeth/ And they don’t look so pretty/ They also
clog up Mother Earth/ And make our water dirty.”28
The choice to set these objections to the tune of a famous, almost instinctively recognizable patriotic song was a significant one. Participants in the
fluoridation debates were not just arguing about the scientific and aesthetic
wisdom of water fluoridation; they were also invoking a centuries-old dispute
about the proper relationship between government authority and political
liberty, between social systems and individual agency. The central domestic
political issues of the 1960s raised the same questions in ways that helped to
create a climate for a particularly bitter proxy fight over fluoride. What ought
to be done for those left behind by American postwar prosperity? Would a
“rising tide lift all boats,” or would programs targeted to improve the condition of the poor be required—or justified? Would the poor “always be with
us,” or could a truly great society expect to eradicate poverty entirely? How
could the interests of individuals and those of government and industry best
be balanced?
During the peak years of the fluoridation debates, General Jack D. Ripper’s certainty that Communists were out to “sap and impurify all of our
precious bodily fluids” represented the belief, common on the political right,
that large-scale state interventions intended to improve Americans’ health
could both literally and figuratively poison the body politic. Among Republicans and Southern Democrats, resistance to publicly funded programs for
Americans’ health and welfare was common, and helped to stymie congressional efforts to establish national health insurance.29 Americans on the
political right professed not to despise the poor themselves—in fact, they
argued that their own resistance to state solutions helped to protect the interests of those most vulnerable to unintentional harm from “big government”
programs like fluoride.
Concern about risks posed by government laxity or ineptitude existed on
the political left as well. Leftist antifluoridationists charged that fluoridation
was a plot orchestrated by aluminum companies to enable them to dispose of

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materials that would otherwise be considered toxic waste. In 1955, these accusations drove the Aluminum Company of America to issue a letter “deny[ing]
that sodium fluoride is a waste product of aluminum manufacture” in order
to combat such claims.30 Because leftists were particularly attuned to the difficulty low-income Americans faced in evading threats without government
assistance, concern about the risks fluoride posed to the poor continued to
percolate in environmentalist circles.
The Nature of Citizenship and the Role of the State

Advocates of fluoridation argued that good teeth were critical to good citizenship. The public promotion of good dental health through the fluoridation of
public water supplies would not only prevent individual suffering, they felt:
it would also increase the percentage of Americans who were available to
serve the nation’s military and economic interests. The continued problem of
fi nding draftees and volunteers for military service who were dentally fit to
fight helped to shape these beliefs. As in World War I, the Second World War
provided abundant example of the consequences of government inaction with
respect to Americans’ dental health. One writer reflected that “Even though
the Armed Forces required that only six upper teeth make contact with six
lower teeth, nearly 10 per cent of the men between 18 and 35 years of age did
not qualify.”31 Accordingly, in 1943, a columnist in Dental Health magazine
issued a “Challenge to High School Students,” demanding: “Are you going to
be one of the thousands of young people who, in the prime of their lives, cannot fulfill all the duties of citizenship because they neglected to make timely
corrections of physical defects? What you do about correcting dental, eye,
and other defects now, will be your answer to this challenge. It will be your
answer to yourself, to your government, and to your future dependents.”32 The
memory of negative answers to this challenge lingered in dental public health
propaganda in favor of fluoride: “the largest cause for rejection of the fi rst
two million men examined in World War II,” wrote one Detroit newspaper
reporter in 1962, “was dental defects.”33
By the 1960s, though, the rationale for the importance of good dental
health had changed slightly. Actual physical ability to engage in combat lost
significance. Much more important to fluoride’s advocates was the symbolic
success of the American economic system—particularly, in response to continued Communist claims to the contrary, in its ability to provide something
approaching a fair chance of success for all. During Richard Nixon’s 1959
debate with Nikita Khrushchev, the vice president taunted the Soviet premier

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with the claim that the American economic system made consumer goods
like color televisions available to all who wanted them. Like Nixon, other
adherents of the ideology of the liberal state hoped urgently for capitalism to
create a “level playing field” such that communism and other forms of political radicalism would hold no appeal. Many Americans thus saw fluoridated
water not only as an important public health reform, but as a way of demonstrating the fairness and equity of the American system itself.
This prompted interest in fluoridation from a wide range of individuals
who were invested in the success of the American way of life. Particularly
in cities notorious for their growing racial segregation, fluoride seemed like
a way for government to evince the sort of benevolent interest in improving
conditions that would head off more radical proposals for change. In 1963,
for example, with Detroit’s city budget in disarray, Juvenile Probate Court
judge James H. Lincoln wrote to then-mayor Jerome P. Cavanaugh that “Taking the long view, fluoridation of the water supply will undoubtedly be the
most important and far-reaching accomplishment during your administration. It is more important that the next generation have good teeth in the years
to come than that Detroit have fiscal reform today.”34 Lincoln, who had served
on the Detroit city council before becoming a juvenile court judge, wrote that
“It would have been better to have delayed the Expressways, Cobo Hall, the
Redevelopment programs, etc., for a few months and given the children of
Detroit fluoridated water five or six years ago.”35
In their arguments in favor of fluoridation, Detroit dentists, too, claimed
that good teeth were an important part of good citizenship: “Dentists find it
difficult to understand why some people would make second class citizens of
their children by denying them good teeth through the simple, inexpensive
and modern health procedure of water fluoridation,” wrote fluoridation activist William Travis, a Detroit dentist who headed the Detroit District Dental
Society’s fluoridation campaign in the early 1960s, in a letter to the editor
of a Detroit newspaper.36 Travis, predictably, tried to position fluoridation as
the scientific choice by referring to it as “modern” and stating that “dentists”
could not understand why “some people” (i.e., not dentists) opposed it. He
also argued that children who grew up without fluoridated water were, or
would become, “second class citizens.” The implication was twofold: bad dental health inevitably relegated one to “second-class status” not only because it
was a sign that one’s government disregarded one’s suffering, but also because
having unhealthy or ugly teeth had an impact on one’s fitness for political participation. Dentists who advocated for fluoride cared deeply about this.

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Opponents of water fluoridation worked from a very different understanding of the relative roles of the citizen and the state—and, relatedly, from
a different understanding of the proper relationship between individual and
public measures taken for the protection of health. They clearly feared the
threat of Communism to the American system—indeed, as Kubrick’s fi lm
portrayal of General Jack D. Ripper suggests, this was at times the most vivid
aspect of their arguments against fluoride. They argued that the highest value
of American politics was the protection of minority rights—and for them,
the minority to be protected could be as small as one. Good citizenship, in
this view, consisted in opposing measures that would jeopardize the rights
of individuals to be free from coercion, and specifically to avoid the deleterious physical and aesthetic effects of state-sponsored health programs. The
availability of a minimum standard of care to all was a far lower priority
than preventing the unwanted interference of the state in individual decisions about health.
Antifluoridationists—even laypeople—deployed the language of citizenship just as regularly and vehemently as did those who advocated for fluoride. When they used the word “citizen,” however, they meant someone who
was entitled to protection from public-sector interference, and not someone
who could reasonably lay claim to the positive provision of a minimum standard of health. “I do not believe any citizen should have to drink water contaminated by a drug that is dangerous to health,” wrote Mrs. McRouth, of
Detroit, to Mayor Cavanaugh in 1962.37 Americans like McRouth pointed to
the unknown effects of fluoridated water on individuals with kidney disease,
diabetes, and allergies; many antifluoridationist materials cited the cases of
citizens who claimed to be allergic to elemental fluorine itself, and all of its
compounds, including those used for water fluoridation. “Even if one person
cannot take fluoride or object to having it in his drinking water he should not
be forced to take it,” argued a 1965 pamphlet published by Detroit Citizens
Studying Fluoridation.38 They viewed the fluoridation of public water supplies as a breach of the proper behavior of public health authorities, in which
public health powers could be exercised only when a contagious disease
threatened a larger population. They did not think that fluoridating water for
dental health was analogous to chlorinating it to kill infectious organisms:
they regarded chronic illnesses like dental decay, which they did not consider contagious, as inappropriate subjects of government intervention.
Notably, those who argued against fluoridation hewed to a commonly
held defi nition of citizenship that resolutely excluded children. Citizens were

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those who could vote and were entitled to full autonomy over their bodies;
public health programs benefiting those of whom that was not true were even
more suspect. As the Detroit Citizens Studying Fluoridation pointed out,
“no benefit [of fluoridation is] claimed to people over 10 years of age.”39 Even
the most ardent fluoridationists did not believe that fluoride could improve
adults’ dental health; though some speculated that fluoride might lower the
risk of osteoporosis in old age, research about this proved inconclusive. These
facts emboldened antifluoridationists to deploy arguments highlighting the
refusal rights of autonomous adult citizens at full force.
Compounding the antifluoridationists’ arguments, those who advocated
for fluoride failed to connect the fate of Detroit’s children with the interests of
the aged, thereby ceding some ideological ground in the war to defi ne American citizenship. Dentist William Travis’ belief that children could be even
loosely described as citizens marked a distinctively profluoridation way of
thinking about the public’s responsibility to the young: typically, those who
supported fluoride went out of their way to illustrate the long-term social
benefits of investment in young people’s health. Yet one of the major means
of organizing voters to cast ballots in favor of fluoridation in Detroit was the
dissemination of literature through the public schools. This tactic virtually
ensured that older Detroiters would not only miss out on hearing a profluoridationist message, but could easily come to view fluoridation as a children’s—
and, therefore, not a citizens’—issue.40
Fluoridation-resistant American adults were particularly provoked by the
invitation to view the interests of children as separate from, and sometimes
in opposition to, their own. During the youth and adolescence of baby boomers, one could hardly fail to notice the presence of an unprecedented population of youth—the American landscape was literally rebuilt for their benefit,
with construction of suburban homes and schools and other physical sites for
young people surging during this period. The baby boom was accompanied
by large new federal commitment of funds to programs for the elderly, but
debate about Social Security and Medicare helped to persuade senior citizens
that their interests hung tenuously in the balance, and that the aged couldn’t
afford the luxury of solidarity with the young. Backlash against the demographic transition thus helped to undergird arguments against public-sector
health and welfare interventions, particularly when they were portrayed as
beneficial to children.
Advocates on both sides of the fluoridation question exploited the tension
that resulted. Skeptical Detroiters, for instance, were targeted for organizing

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on the basis of age: one pro-fluoride writer identified the anti-fluoride campaign there as “[preying] on the fears of the unsuspecting, the uninformed,
and the elderly.”41 Similarly, a profluoridation dentist reported in a 1964 volume of the Journal of the American Dental Association that “it is the elderly
who are concerned about the ‘waste’ of fi nancing fluoridation for benefit of
the young with possible ill effects on themselves.”42 In 1963, Mrs. Roy Percy,
a resident of Detroit, sent Mayor Jerome Cavanaugh a pamphlet from the Ohio
Pure Water Association, arguing that “One tenth of 1% of the water is consumed by children who may benefit from it. More than 99% of the tax money
spent on fluoridation goes down the drain.”43 Mrs. Percy’s accompanying letter read, in part: “I’m sure nobody is going to vote for the once [sic] that voted
it in. I know so many on this street said the same thing. Clear our City Hall,
the once that want to spin [sic] our money. Can’t make ends meet now, with
all the taxes we have to pay.”44 The public statements of health commissioners in fluoridated towns like New York City, who “lauded the [City Council’s
vote for fluoridation] as ‘a priceless gift to the children and parents of New
York City,’” didn’t help: the question of who was paying for that gift was all
too much on the minds of the older Americans who opposed fluoridation on
fi nancial grounds.45
Profluoridation publications, in reply, drew unflattering comparisons
between the older public’s receptivity to Medicare and their resistance to
fluoridation. Advocates of fluoride attempted to convince voting adults of the
need for fluoridation on economic grounds—whether or not the aged benefited personally from fluoride, dentists pointed out, their taxes would pay for
either it or the much more expensive remedial dental care provided through
publicly funded programs of dental care, which were under historic population strain. In so arguing, dentists only succeeded in more deeply ingraining
the notion that taxation, the socialization of health care expenditures, and
government as a whole profited the young at the expense of the old.
Those who advocated fluoridation and those who opposed it could not
agree about whose needs ought to be regarded as compelling to the state.
They also disagreed about what the state, even when compelling need
existed, ought to be allowed to do. Yet every credible participant in political arguments about fluoride—and indeed, most fringe participants as well—
agreed that Communism was a bad thing, and that there was an extreme of
Communist-seeming “big government” that ought to be avoided. This belief
was particularly strong among Southerners, who were already accustomed
to thinking of states’ rights as fundamental goods that were threatened by

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federal government action. The long-established tradition of local autonomy
in American government—particularly with respect to public health measures like liquor laws, and the establishment of institutions, like schools,
intended to benefit youth—resonated everywhere. Early in the efforts to fluoridate public water supplies, even most of those who favored fluoridation
emphasized that it was politically and morally important for the decision to
fluoridate water to be made locality by locality. “Such a decision must be made
by public health officials and the public,” opined one Wisconsin dentist, “It
is important that the decision is made at the local level, not at the national
level.”46 Dentists’ commitment to this principle helped to assuage the fears of
many Americans—even those who came down on the side of fluoridation—
that the fluoridation of public water supplies would set off a “domino effect”
transferring local power to “big government.”
Nevertheless, water fluoridation proposals particularly irked those who
were already embroiled in debates about state power and authority. In 1963,
Houston attorney W. Hume Everett addressed that city’s chapter of a dental fraternity on the topic of “Your Fraternity and Your American Heritage,”
arguing that the Founding Fathers “endeavored to and did establish a constitutional republic and not a democracy. A democracy would have meant
rule by the majority with no protection for the rights of the minority or the
individual. . . . Today there are many nice, cultured people—our friends and
neighbors—and even you and I at times—who harbor the pagan belief that
sacrifice of the individual serves some higher good. . . . Too many Americans
believe that simple enactment of a law by the Legislature (or by the Supreme
Court) makes the acts permitted legitimate without recognizing that things
are not necessarily just and right because the law declares them to be so.”47
Everett made no direct comment on particular pieces of legislation and litigation, though any number of proximate examples of undue transgressions
by Congress and the courts might have sprung readily to the minds of his
Southern audience. Nor did he directly comment on water fluoridation. His
address gracefully connected the two issues for Houston dentists without
crassly mentioning either.
The insistent anticommunism of the campaign against water fluoridation built on this logic. Detroiters who opposed fluoride deployed rhetoric
loaded with the psychological weight of the connection between the actions
of a centralized state and the threat of Communism: the advocates of fluoride,
they argued, were greedy political aggrandizers of turf, pursuing a “domino
effect” that would fluoridate the growing suburban territory outside the city

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proper. “Since 1962, the Detroit Department of Water Supply does not recognize signs proclaiming ‘City Limits.’”48 Letters to Mayor Jerome P. Cavanaugh
from local antifluoridationists were even more direct: one concluded “‘Children’s teeth’ is only a smokescreen behind which the promters [sic] hide,
the real purpose is to make us docile and subservient. I’m tired of socialistic schemes!”49 Technical objections to fluoridation, on the grounds that
the concentration of fluoride in public water supplies would be difficult to
control, drew on the popular understanding of Communism as a stealthy
threat to remind Detroiters that fluoride “becomes more hazardous to all of
us because it is colorless, odorless and tasteless.”50 At legislative hearings
about fluoride, one speaker argued that an “‘iron curtain’ had been dropped
around Grand Rapids to hide the [negative] effects of fluoridation.”51 The
notorious secrecy of the USSR was powerfully present in the minds of fluoride’s opponents. One antifluoridation item in a magazine published by the
Roman Catholic Scarboro Missions cited dentist J. E. Waters in Dental Survey claiming that “Truth will out, as even those who maintain the ‘Iron Curtain’ are discovering. It is to be hoped that a minimum of harm will have
been done before the ‘Fluorine Curtain’ has been torn down and the truth
given fully to the profession and the public.”52 At moments of extreme provocation, antifluoridationists argued that fluoride wasn’t just metaphorically
similar to Communism, but that it was actually part of a Communist plot
to take over the United States. “‘Dental caries’ is merely a ‘front’ to conceal
the devilish machinations of a handful of evil conspirators,” wrote one in
1953. “Fluoridation has been used in countries taken over by dictators to
immobilize the people’s will and ability to think.” Fluoride, he theorized,
was being used to make port cities in the United States docile and vulnerable
to Communist attack. “Inland communities that have been fluoridated are,
on the whole, small towns and more easily approached by the fluoridators.
This was necessary in order to avoid the appearance of attacking strategic
locations only.”53
Attitudes toward Activism

Particularly in retrospect, it is easy to mock those who opposed fluoride for
their obsessiveness about Communism and their paranoia about threats to
the American way of life: the unsympathetic image of General Jack D. Ripper looms large in the history of American popular culture. Other contemporaries, including many sociologists, commented more demurely on the
“alienation” they imagined antifluoridationists to be experiencing. Often,

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135

they posited that sense of alienation—by which they meant a belief that one
lacked effective control over one’s surroundings—as the reason for the antifluoridationists’ suspicion of the motives of the government.54
When the moment suited them, however, antifluoridationists were
as enthusiastic—and as capable—as anyone of using political activism to
manipulate the mechanisms of representative democracy, suggesting that the
condescending “alienation” explanation was inappropriately applied. Antifluoridationists felt invested enough in the American political system to make
able use of its tools—when fluoridation was put to a vote, it was defeated more
than six times out of ten.55 In Detroit, those who opposed fluoride mounted
an aggressive campaign to defeat it in the 1965 city elections: their literature
revealed that they expected representative government to function as advertised. “To stop the fluoridation campaign the mayor and council of Detroit
and the officials of the 51 communities must have evidence that there are
many people who know all the facts and don’t want their drinking water
medicated,” one flyer argued.56 Flyers asked citizens of Detroit and its surrounding suburbs to organize “friends and associates” against fluoridation,
using the traditional instruments of American civic participation—the PTA,
“civic, religious and business organizations,” and contact with local officials—to try to defeat fluoridation on the 1965 ballot. Antifluoridationists’
environmental arguments against fluoride, too, were calculated to invite contemporary clean-water and anti-pollution activists into the campaign against
water fluoridation.
Faced with such an empowered opposition, dentists and others who
advocated water fluoridation had to re-examine their tactics. The arguments
they made, and strategies they chose, typically proceeded from their sense
that dentists were experts whose judgments about measures affecting Americans’ teeth ought to be trusted. Derision of people who feared negative health
effects from fluoride was a popular strategy among dentists who were willing
to use advanced knowledge and technical expertise as a weapon against the
ill-informed rabble. In 1945, one writer reported that “An amusing example of
the power of the imagination came to light when plans for placing fluorine in
the water supply of one of the experimental cities were fi rst announced. . . . A
few days after the scheduled date, the city water department began to receive
complaints that they were suffering from sore mouths and their teeth were
changing color. City officials were sympathetic and advised the complainers
to visit their dentists. Whatever was happening to their teeth had nothing to
do with fluorine in the water, because no fluorine had yet been used. There

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had been a slight hitch in the plans, and it had been impossible to start the
experiment on the date announced!”57
In the 1960s, this general scorn for the ill-informed was supplemented
by direct ad hominem attacks on particular individuals who opposed fluoridation. At several junctures, the Journal of the American Dental Association published updated lists of “Comments on the Opponents of Fluoridation,”
which compiled the writings of antifluoridation individuals and groups in
other forums for the convenient reading of ADA members. In 1965, the listing
for Royal Lee, the publisher of one particularly rabid antifluoridationist’s writings, included news of the Seventh Circuit Court of Appeals’ upholding of his
sentence for the interstate shipment of “falsely and fraudulently” labeled vitamin products. The item also cited a University of Pittsburgh dentist who said,
of Lee, “I can assure you that every point made by Lee [about fluoridation] can
be met with many facts, and every twist that he has given can be untwisted.”58
Partisans like Royal Lee, as the standard bearers of the antifluoridation movement, were particularly attractive targets for dentists convinced of their own
professional expertise. Dentists’ claim to possess elite knowledge often disgusted fluoride’s opponents, who believed strongly that lay Americans were
the best judges of matters affecting their own health, and rejected the idea that
special expertise was necessary to produce and interpret scientific evidence,
or to apply that evidence in real life. Attacks upon prominent antifluoridationists on the grounds of their lack of specialized scientific knowledge, and resultant good judgment, served to further repel those who opposed fluoride.
Fluoride’s proponents, like its opponents, sought to capitalize on existing
anticommunist sentiment by describing their political foes using terminology that invoked the prevailing suspicion of ideological extremism. When
it worked, this strategy helped to rebut the claim that fluoride advocates
were Communists themselves. During the Detroit fluoridation debates, for
example, William Travis argued that opponents of fluoridation were political reactionaries who were “immune to education—totally unimpressed by
scientific evidence advanced in [fluoridation’s] behalf.”59 Travis also appealed
to Americans’ image of themselves as a modern people uniquely open to new
ideas and salubrious change. Antifluoridationists, he argued, were motivated
by their “dislike of change” and tendency to “always suspect the worst. Seldom has any cause rallied so many different kinds of supporters to its banner,
ranging from skeptical doctors and hard-boiled citizens who just don’t want
their water tampered with, to a weird array of anti-Semites, charlatan diehard McCarthyites and flustered old ladies.”60

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137

Travis and others were particularly troubled by the highly organized
nature of the anti-fluoride campaign in Detroit, where activism and political
upheaval of all types were dangerously destabilizing the tense racial standoff
that had prevailed in the city. They, and other dentists, were suspicious of
individuals who devoted disproportionate energy to political participation.
California dentist John Knutson described antifluoridationists as “professional antis”; Tennessee dentist William Wicker called them “professional
‘againsters’”—with “professional,” in both instances, understood as a term
of derision rather than one of acclaim.61 This characterization of antifluoridationists suggested that they had secret backing making their organizing efforts possible: “Directing the forces of the opposition are the career
antifluoridationists who spread their gospel of fear of fluoridation through
extensive travel and through seemingly unlimited printed matter,” mused
one writer in 1965.62 This terminology resonated with the existing discourse
of anticommunism, which conjured up the specter of paid agitators being
deployed by the Soviets to wreck the American way of life. As a side benefit, it also invoked the image of “outside agitators” destabilizing the segregated South in this period.63 Like Communists, antifluoridationists were
described, variously, as irresponsible, deceitful, devious, frenzied, cruel, and
implacable: their organizing impetus knew no ends. Many writers cautioned
their audiences that antifluoridationists had been known to continue organizing opposition to fluoridation even after ballot measures had seemingly
settled the question.
The effort to associate those who opposed fluoridation with ideological extremism met with limited success: the aggressive anticommunism of
fluoride’s opponents was just too prominent to be overlooked. As the decade
wore on, dentists who experienced persistently successful arguments against
fluoride as threats to the supremacy of their professional judgment began to
agree that the lay public could not be relied upon to resist the pressure of antifluoridation organizers, to objectively evaluate existing scientific evidence,
and to arrive at logical conclusions. “The lay public caught in the crossfi re
of confl icting charges,” William Travis wrote in 1966, “is very often bewildered and confused. To the uninformed, both sides may sound reasonable
enough, so whom is one to believe?”64 An Oregon dentist, reflecting on a similar local controversy, made a halfhearted attempt to separate a “small but
vocal minority” of antifluoridationists from the mass of the lay public who
could be reached with education and political organizing. He admitted that
because of the former group, organizing would need to be continuous: “The

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story of fluoridation’s effectiveness must continue to be told no matter how
impressive our victories may seem,” he wrote.65 One public health officer ventured that “If the fluoridation leaders know how people feel and what they are
willing to do about what they feel, then, as the community organizers are so
fond of saying, they would ‘start where the people are.’”66 But starting where
the people are is time-consuming and costly, and dentists’ patience with the
public was waning.
Dentists’ frustration with the intransigence of laypeople mirrored the
discontent of other medical experts whose authority was frequently attacked
by contemporary activists—feminists who argued against medical control of
childbirth, for example, and black activists who portrayed medicine as the
tool of a racially oppressive state.67 The contemporary climate of increasing
public skepticism about medical judgment helped persuade dentists that it
was wasteful to spend prodigious amounts of time and money convincing
laypeople that fluoridation was a good idea. As a result, they began to argue
for removing the question of whether to fluoridate public water supplies from
the hands of the public entirely, through the passage of “state-level legislation to make fluoridation mandatory in all communities.”68 In Detroit, William Travis promoted a bill removing the responsibility for decision making
about fluoride from the hands of the lay public and placing it in the office of
the Department of Public Health, “instead of passing the decision on to the
butcher, baker, and candlestick maker!”69 One Pennsylvania dentist wrote:
“The answer is compulsory fluoridation enacted or enforced on the state
level. It is inconceivable that fluoridation ever got to be considered for public debate and referenda in the fi rst place. . . . If all the other public health
measures, now commonly accepted today, were left up to each community
to be settled by referenda and communal debates, a conservative estimate is
that the health of the nation would be 50 years behind where we are now.”70
Advocates of fluoride agreed that decisions should be made by experts, not by
members of an untrustworthy public.
Similar skepticism of lay wisdom underlay dentists’ opposition to the
arguments that use of fluoridated dentifrices alone could protect the American public, and that milk, instead of water, should be fluoridated on the
grounds that it was easier than water for the dissenting minority to avoid.
“Who is going to fluoridate the milk?? . . .” William Travis asked. “If the housewife is expected to fluoridate the milk, then we are promoting just another
personal public health measure!! Time and experience have adequately demonstrated that any health measure requiring any degree of inconvenience,

Behind the Fluorine Curtain

139

cost, or persistent participation on the part of the individual is doomed to
failure!!! I feel it is unfair, unnecessary and illogical to expect the American
housewife to assume the additional chore of fluoridation of milk.”71 Travis’s
ire was directed in large part against the notion that fluoridation ought to be
an individual choice. However, it was difficult for contemporary opponents
of fluoride to separate his exasperation with this notion from his low opinion
of the intelligence of the American housewife.
Dentists’ belief in their professional authority, and resultant willingness to embrace statist authoritarianism as a means of promoting fluoride,
enraged fluoride’s opponents. It also chafed uncomfortably against dentists’
longstanding commitment to the sanctity of individual effort and decisionmaking in matters of health care fi nance. The ADA claimed that government
could not be trusted to provide health insurance no matter how badly the
public wanted it, but should be trusted to fluoridate water no matter how vigorously the public opposed it. Some dentists found the cognitive dissonance
produced by these contradictory positions difficult to tolerate, and a small
chorus of protest against the prevailing negative opinion of the public arose
among a tiny minority of dentists who argued that the necessity of organizing the community around fluoridation actually improved democracy in the
United States. The public health officer who advocated meeting the people
“where they are” speculated that “It could be that, through all the duress
on fluoridation, we are learning something about introducing extra fiber in
the processes of Democracy.”72 From Trenton, New Jersey, came the report
that the capital city had been named an “All-American City” for 1965 by the
National Municipal League in part because of the mobilization of more than
2,000 people “to do battle in the fluoridation war. . . . They are justifiably
proud of the award which shows the way other cities and towns can become
All-American.”73 In this view, it was not only fluoridation itself, but the political process of achieving it, that entitled Trenton to such a title.
Dentists and others who advocated water fluoridation longed for a world
in which a health intervention that was such a self-evident scientific good
would be uncontroversial. As their patience with the actual political climate
with which they had to contend wore thin, humor emerged: in 1968, reporters
for the Dental Students’ Magazine reported on their “pilgrimage” to Newburgh,
New York, highlighting the acceptance of fluoridation there by recounting
their attempts to fi nd “plaques or markers in town commemorating fluoridation.” “We asked the pretty desk clerk at the motel if there were any. . . . She
was genuinely puzzled. ‘Flora Who?’ . . . So we asked the maid—a beaming,

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motherly type—if she knew that fluoridation occurred here as early as 1946.
Immediately her demeanor changed. ‘I don’t know anything about anybody’s
defloration,’ she said with fi nality.”74 Another tack sought to minimize the
question by inserting the drama of fluoride refusal into a cliché domestic
scenario: a 1965 cartoon in the Journal of the American Dental Association
depicted a businessman, just home from work and reading the evening paper,
gruffly telling his hovering wife “I will NOT drink a fluoridated martini.”75
These attempts at minimization through humor fell short, however,
because the subject they sought to trivialize was so inextricably bound up
with contested ideas about science, aesthetics, and politics. Would fluoride
harm Americans’ teeth or help them? What counted as help—and what as
harm? Who could demand help—and from whom? Who should decide? These
questions, vigorously debated but never resolved, would re-emerge in other
debates about dental care and the state of the dental profession near the end
of the twentieth century.
The relative success of campaigns for the fluoridation of public water supplies marked the apex of dentists’ drive for professional legitimacy as guardians of public health. Their influence over an important public health policy
meant that their battle for status equal with that of physicians was closer than
it had ever been to fruition. To achieve that success, dentists had been forced
to cooperate with state authority in a way that made them uncomfortable. The
vehement anti-statist analysis articulated by antifluoridationists hewed close
to the positions dentists had traditionally taken about state interventions in
dental care—and particularly dental care fi nancing. Dentists’ frustrating
encounters with the rough-and-tumble of electoral political battles over fluoride offended their belief that scientific expertise and training ought to be
the tickets to participation in scientific debates, souring them further on the
wisdom of a centralized governmental power that could so easily be manipulated by populist demagogues. Together with dentists’ anger over increasing
governmental incursions into their entrepreneurial opportunities, the fluoride debates set the stage for a backlash against public health dentistry, and
dramatically increased interest in individual aesthetic interventions, both
within and outside the profession.

Chapter 6

The “Satisfaction of Dentistry” and the
End of Public Health

Fluoride left dentists facing the prospect of markedly reduced income from
restorative work. Studies showed that the reduction of tooth decay not only
led to fewer fillings and extractions but, with less room for teeth to move
about haphazardly in Americans’ mouths, to lower rates of malocclusion,
suggesting that Americans’ need for orthodontic services might also drop in
fluoride’s wake.1 Some dentists were optimistic that a lowered need for reparative care might mean that they would have more time to engage in planned
preventative treatment. More powerful figures perceived the possibility of
a lowered volume of business as a serious threat. It was, they felt, of a piece
with other, more pernicious changes marking the efforts of non-dentists to get
something for nothing—and usually at dentists’ expense.
In the decades that followed the widespread fluoridation of public water
supplies, these dentists found themselves retrenching against a barrage of
internal and external challenges to the viability of “American dentistry” as a
profession of high social, economic, and scientific standing. The relationship
between these challenges and the idea of collective action for the public good
further encouraged American dentists to see the notion of collective public
engagement itself as a threat, rather than an opportunity. Social movements
questioning or rejecting existing race and gender relationships plagued dentists, and the license for unfettered action they believed they had won for their
profession. Their female assistants, long conceived as subservient helpmeets,
started to seem like potential or actual advocates of feminist liberation on the
job—or, still worse, as organizers of unions. The historical white dominance

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Making the American Mouth

of the dental profession was challenged by black dentists’ efforts to achieve
fully equal treatment within the ADA. Black dentists, through their own
national organization, opposed the ADA’s resistance to programs like Medicare and Social Security. To the leaders and active members of the ADA, this
portended the ways in which the policy positions of a fully integrated ADA
might have to change, softening toward undesirable “big government” social
programs in order to reflect the opinions of an integrated membership.
Most importantly, renewed proposals for publicly provided health insurance seemed to use the notion of shared risk and responsibility in ways that
would impinge on dentists’ professional prerogatives and success. The lived
reality of even voluntary insurance, dentists felt, was already proving damaging. By the early 1960s, over one million Americans were enrolled in dental insurance plans;2 nearly one-third of all American medical expenditures
were paid for through insurance.3 Increasingly aggressive legislative efforts
to ensure government provision of health care to the needy struck fear in the
hearts of dentists. The advent of Medicare and Medicaid, resisted by—but
thrust upon—their physician counterparts, gave them grave concerns about
the future of their income streams and their standing as autonomous entrepreneurs. Like physicians, they vigorously opposed the prospect of systematic
change that threatened the basic economic organization of their profession.
Dentists’ renewed insistence on the primacy of private practice was of a
piece with more widely embraced changes in the concept of American citizenship, which was increasingly linked in the postwar period with status
as a consumer of both private enterprise and government.4 Arguments for
patients’ self-reliance, and against the expansion of free or subsidized dental care, sprang from dentists’ genuinely held sensibilities about the proper
scope of government and the role of the private citizen, increasingly represented by the New Right’s opposition to New Deal expansion of government
involvement in Americans’ lives. Such arguments also reflected more cynical
interests in preserving the race, gender, and entrepreneurial prerogatives of
mostly white, and overwhelmingly male, dentists.
At the end of the twentieth century, the dentists represented by the
American Dental Association quietly withdrew their support of most nonfluoride public health programs, and articulated a reconfigured discourse of
Americanism in dentistry. In this new ideological schema, the fact that even
a socially and professionally conservative organization like the ADA had
once considered Americans’ dental health a proper subject for community
concern and intervention would have no place. Dentists shuttered school and

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143

industrial dental hygiene programs, as they had closed most public dental
dispensaries decades before. They had delivered to Americans the great gift of
fluoride. By the middle of the 1960s, threats to their income and professional
prerogatives seemed like a snub to the profession’s earlier largesse. As one
ADA film for dentists observed: “Mindblower . . . Dentists Under Siege.”5
The Rebellion of the Office Wife

Among the trends that distressed dentists was their sense that they were losing the control they had once enjoyed over their offices—and particularly over
their office personnel. Increasingly, the technical, business, and demographic
demands of the postwar period required that dentists employ assistants and
hygienists to work in their offices. There were new office machines to be operated, and an ever-diversifying range of supplies and equipment to be selected,
ordered, and maintained: dentists considered these tasks both bewildering
and degrading. The surge in the population of youth caused by the postwar
baby boom also seemed to call for more paraprofessional assistance from dental hygienists and assistants, who were reputed to be particularly effective
managers of children. At times, these auxiliaries took their place by the sides
of women receptionists or billing clerks, who were already familiar faces in
the dental suite. In 1960, one Akron dentist reported that a study of dental
practices had yielded the news that 88 percent of dentists employed “auxiliary help,” in numbers ranging from one person (in 44 percent of offices) to
five (in 3 percent).6 These “auxiliary helpers” provided an enormous competitive advantage to their employers, increasing the net income of their offices
on an almost one-to-one basis (such that “the dentist with four and a half
assistants has a net income almost four times greater than the dentist who
works alone”7). Very few dentists quibbled with the proposition that having
a woman employed as an assistant or a hygienist was important to effective
practice management.
Dentists

had

long

considered

women—particularly

good-looking

women—to be the ideal candidates for dental assistant and dental hygienist
positions. In the late twentieth century, dentists’ construction of auxiliary
dental personnel as comely customer service providers, combined with the
currency of the gender analysis proffered by second-wave feminism, resulted
in new tensions on the job. Dental assistants and hygienists were expected to
emphasize their pulchritude at work. A 1967 article discussing the characteristics of the “ideal D.A.” listed “Attractiveness” and “Femininity” as the
fi rst and second most important qualities, before “Efficiency,” “Brains,” or

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“Education,” which were listed fourth, sixth, and last.8 One writer encouraged
women assistants to contemplate the sorry case of “Carlotta,” who arrived late
to work one day “muttering apologies and breathlessly explaining that the
doctor would be along in a moment. . . . [The] patient looked at her again and
shook his head fi rmly. ‘This is not the type of girl,’ he said to himself, ‘that I
would choose to put her fi nger in my mouth.’” The author, a dentist, mused:
“Since this is one criterion whereby nearly all adult male patients judge the
delectableness of a dental assistant, let us discuss how a confl ict of images
has caused Carlotta to be rejected so decisively.”9 Some dentists congratulated
one another for having managed to hire particularly attractive office personnel: writing to dentists of his experience at the annual New Orleans Dental
Conference, George Crane said that he had “long noted the good eyesight of
you dental surgeons when it comes to picking wives, dental assistants, and
dental hygienists.”10
The elision of the boundaries between office staff and spouses created friction in the workplace. Consistently sexualized on the job, women
employed by dentists found themselves the objects of concern from dentists’
wives, who were offered columns of their own explaining how to deal with
“The Other Women in Your Husband’s Life!”11 Even as they were being jealously watched as threats to dentists’ marriages, they were expected to use
their feminine dignity to throw a cloak of purity around otherwise prurientseeming situations, as when a woman was placed under anesthesia by a lone
male dentist. However, the knotty problem of delicate women assistants’ vulnerability to the sexual advances of male patients was typically ignored.12
To the contrary, some sources seemed to suggest that the presence of women
in the office could be sexually unsettling to male patients: one cartoon, for
example, showed a timid-looking man in a dental chair with his head cradled
between the breasts of a stoic-looking assistant. Gesticulating toward a broken headrest, the dentist said “I’m sorry, Mr. Crumbly, our head rest won’t be
repaired until next week.”13 No dental journal, and no publication for dental assistants, ever addressed what assistants ought to do if they were being
harassed by their male employers.
Despite this hodgepodge of mutually contradictory perceptions of women’s sexual power—or perhaps because of it—they were regularly enjoined to
avoid asserting themselves as non-sexual professionals at work. Women dental employees who did so could expect to be the targets of derision for their
overdeveloped senses of self-importance. In one cartoon in CAL, a magazine
produced by the Coe Alginate Laboratories dental supply company for dental

The “Satisfaction of Dentistry”

145

assistants, for example, women in nursing attire stood by the door of a dental
office, which was marked “J. W. Grom, DDS” in small type and “Miss Jones,
CDA.” in a much larger font. “I understand she’s a rather forceful dental assistant,” one woman observer said to the other. Encouraged to avoid directness,
dental assistants in the late twentieth century agonized over how to raise matters such as salary and vacation time. One who identified herself as “Fran”
complained to an advice column for dental assistants that her employer, who
was also part owner of a beauty shop, paid her only sixty dollars a week
and the beauticians ninety dollars a week—because, he said, “Those beauticians have to work so hard!”14 Fran asked the readers of the “Problem of the
Month” column to send her advice through the journal: “If my doctor ever
learned I wrote to CAL I’d die,” she wrote.15 The fi rst-prize advice published
four months later (whose author received ten dollars) admonished Fran to
consider her own culpability in her low pay: because women often expected
to quit work after marriage, “we may not always prepare for our profession
as carefully as we should,” she wrote. She advised Fran to have “a heart-toheart” talk with her employer, and then to consider quitting her job.16 The
second-prize winner advised Fran to discuss her salary with her employer
in a straightforward and direct manner, keeping in mind that “an employee
has only to accept or reject,” not to negotiate.17 Not all dental assistants were
as conciliatory as those whose advice was published in CAL: the intransigent
opinions of experienced dental assistants, and their propensity for expressing
those opinions directly, caused dentists throughout the twentieth century to
advise hiring completely inexperienced assistants whenever possible.18
Dentists attempted to keep women employees dependent upon them
for compensation and information. But the increasingly visible challenges
posed by feminism, the advent of the sex-discrimination protections in the
1964 Civil Rights Act, and the boom in the unionization for collective bargaining of women employees in traditionally female occupations like teaching, nursing and secretarial work in the 1960s and 1970s had major impacts
on women’s expectations about how they would be treated on the job.19 Dentists feared the prospect of losing control over employees who felt justified
in demanding more equitable treatment. They objected to the federal government’s attempts to force the issue of gender equity at work: contemplating the
“shock” that might affl ict someone who found him or herself being treated by
a male dental assistant, one dental journal editor mused that “it would have
been better if Congress had just abolished sex itself”—a prospect which, by
its very impossibility, seemed to highlight the ludicrousness of legislative

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attempts to ensure equity in hiring and treatment by employers.20 Dentists
lodged equally strong objections to the prospect of their employees organizing into unions: in 1965, for example, a lawyer from the union-busting Los
Angeles fi rm Iverson and Hogoboom was brought in to present to the Southern California State Dental Association on “what you as employers can do to
combat unionism within the letter and spirit of public policy.”21 Dental office
employees rarely attempted to organize, but the prospect that they would do
so scared dentists enough to prompt changes in their behavior as managers. One California dentist promoted generous employee benefit plans for
hygienists and assistants as a means of “excluding union interference.” The
article in which he outlined his plan featured a sketch, in ominous marker
strokes, of a dental nurse in white, looming over the viewer while carrying a
picket sign that read “unfair.”22
Together with new federal attention to workplace equity issues, the
threat of union organizing by dental auxiliaries changed the employment
practices of dental offices. Slowly, articles counseling dentists to avoid hiring women who wore too much makeup, or whose uniforms showed “panty
lines,” were replaced by descriptions of the most legally unimpeachable
ways of conducting annual salary reviews of dental hygienists. When labor
strife in the dental office persisted, employees had a new way to redress their
grievances: in 1977, “Anonymous” reported to Dental Economics, in much
the style of the tabloid women’s magazines, that “A Disgruntled Employee
Took Me to Labor Court.”23
Political Activity by African American Dentists

Like women dental auxiliaries, black dentists of the late twentieth century
organized to bring more equity to the dental workplace, making the longstanding racial segregation of the dental profession less and less tenable.
The racial discrimination in the application of the GI bill that occurred
in the wake of World War II heightened the disparity of views and experiences that perennially attended the racial divide in the profession. During the 1950s, the journal of the National Dental Association periodically
reported on the policies of the state and local dental societies that constituted the ADA: in 1954, for example, the Kansas City District Dental Society
rejected the applications of six black NDA members for local membership.
(The white president of the society, asked to comment, reportedly said that
the vote “speaks for itself,” a comment which was apparently intended to
communicate endorsement of the prevailing policy of racial segregation.24)

The “Satisfaction of Dentistry”

147

In the same year, an item titled “Great Expectations?” heralded the Georgia
Dental Association’s decision to invite “the Negro dentists of Georgia” to
attend scientific sessions of the annual meeting—though not to be admitted
to membership. “Twenty-five of these dentists did attend the meeting,” the
journal reported, “with benefit to themselves and without incident or interference with anyone else in attendance.”25 Black dental leaders were careful
to admonish readers to do their part for integration by being well prepared
for the meetings and conferences they attended. “It seems appropriate in
the light of these happenings to reemphasize the fact that it is absolutely
essential for those dentists belonging to minority groups to be prepared and
familiar with current scientific thought, with organizational methods, with
professional trends and with inter-professional policies.”26
In the 1960s, black dentists who had been fi rm but cautious advocates
for integration greeted the promises of the Great Society and the civil rights
movement with enthusiasm. Their activism in these matters received a lukewarm reception among whites. Like the American Medical Association, the
predominantly white ADA called upon the “American” values of individualism and entrepreneurship in opposition to Medicare, Medicaid, affi rmative
action in dental school admission, and federal aid for dental school education. In contrast, the predominantly black National Dental Association cited
the American ideals of inclusiveness and equality in its support of the very
same programs.27 For example, white dentists in Texas in 1962 were treated
to the reprinting of a pamphlet titled “Social Security: Facts and Fantasy”
by their state dental association, including the dire prediction that “Most
persons in the lower income brackets will by 1970 be paying higher taxes for
Social Security than for income.”28 Black dentists who read the Bulletin of
the National Dental Association in 1958 were informed, in optimistic contrast, that Social Security “provides a basis or foundation upon which one
can build toward freedom of worry.”29
Black dentists had always conceived of the scope of their professional
responsibilities broadly. In their minds, the professional skills of those who
had to struggle so mightily for education and professional acceptance should
be used not only to diagnose dental disease, but to identify social sickness and
to advance the status of black Americans as a group. When the Quarterly’s editor, prominent black dentist Clifton Dummett, memorialized Martin Luther
King Jr. in July of 1968, he argued that “As a member of the health professions
it seems to me that his message and legacy are crystal clear. With acute perception and without rancor, he diagnosed the all-pervading sickness gnawing

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at the very vitality of this land he loved deeply.”30 The journal clearly conceived of itself as an organ of racial uplift as well as of professional correspondence, and often published political items of interest to black professionals,
including, at times, the addresses of major black American political figures to
the association’s meetings. In 1970, civil rights activist Julian Bond addressed
the NDA, urging that “The day must come when government ensures that
every person has guaranteed medical and dental care, and that every person
in need has a hospital bed.”31 The Quarterly reprinted this section of Bond’s
speech, describing Bond favorably as “the dynamic, young Georgian,” and
offering its readers the opportunity to identify with Bond’s position as that of
the association itself.32 In 1972, similarly, Michigan congressman John Conyers appeared before the association to map out “Black Political Strategy for
1972,” calling on black professionals to “unify the black community and to
develop a strategy to effect a permanent cure for a sick nation.”33
The “sick nation” rhetoric of the civil rights and black power movements
helped to mark the divide between the law-abiding, God-fearing Americans
who voted for Richard Nixon and the young idealists who populated the
social-justice movements of the era. In their aspirations to middle-class status, black dentists straddled the gap between the two groups, sometimes awkwardly. In the 1960s and 1970s, the journal of the NDA was tightly controlled
by Clifton Dummett, who articulated a philosophy of professional engagement that hybridized Booker T. Washington’s vision of racial self-reliance
with W.E.B. Du Bois’s plan for racial integration as achieved by a “talented
tenth.” Dummett believed that each individual black practitioner of dentistry
was responsible for the success or failure of the whole body. He demanded
strict personal discipline from individual dentists in the service of the profession, the race, and the nation, whose interests he saw as congruent. In
October 1971, for example, a testy Dummett dressed down the journal’s readers, pointing out that press coverage of that year’s annual convention featured
them discussing the potential fi nancial gain to be had from taking on welfare
patients, and not reflecting on how to “help people to help themselves. . . . The
responsibility for this adverse publicity must be borne by those black dentists
whose remarks provided the basis for the news stories.”34 He considered it
important that the NDA stand for a particular kind of citizenship—one of
group struggle toward success.
Black professionals of all sorts, but particularly in health care, shared
Dummett’s sense of individual responsibility for the fate of the larger group.35
The social expectations that prevailed as a result could prove particularly

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Figure 8 Dental hygienists looked unhappy with the content of a lecture on “sexology” at a meeting of the National Dental Association, 1977. Quarterly of the National
Dental Association 36 (October 1977): 25.

stifl ing to professional black women, who were expected to achieve a racially
transgressive level of success while abiding by middle-class gender norms.
Though the NDA’s journal promoted the advancement of black women in
dentistry, published items, particularly about professional conferences that
brought together black dentists and dental hygienists, consistently sexualized and patronized women. In 1977, the photo layout of four black women
dental hygienists at the annual NDA conference was subtitled: “The Dental
Hygienists went to school. They took a course in sexology and paid serious
attention to the speaker who told them to ‘assert yourself.’”36 In the following
year, a photo of two young black women in evening wear was titled: “Bubbling Brown Sugar! We’re glad you came!”37
When the imperatives of racial equality and gender equity clashed in the
NDA journal, it mirrored the “double bind” that black women experienced
elsewhere in American culture, and particularly the version of that bind that
prevailed on middle-class black women. Elsewhere in the black media, professional black women were often positioned as the arbiters of a higher, more
“scientific” standard of living for black Americans in general. The bourgeois

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black magazine Ebony, for instance, periodically profiled black medical and
dental practitioners, repeatedly mentioning their frustration with black
Americans’ poor understanding of the principles of good health. One feature
article on dentist Linda Smith announced: “She tries to raise ‘dental IQ’ in
Black people.”38 In return for the respect they were accorded as professionals,
women like Linda Smith were expected to demonstrate proper respect for the
middle-class gender values to which Ebony editors imagined that their readers aspired. The profile of Dr. Smith was careful to point out that she spent her
(admittedly limited) leisure time “relaxing quietly with a young doctor whom
she dates,” and commented approvingly on the tasteful décor of her apartment.39 A similar profile of Northwestern University School of Dentistry dean
Juliann Bluitt opened: “She doesn’t look like a dentist,”40 and concluded with
Bluitt’s observations that “a woman has a responsibility in the home,” that
she was “not a women’s liberationist, believe me, although my life seems to
contradict this,” and that in matters of dental school administration, “a bit of
‘feminine maneuvering’ brings results.”41 Implicit in such items was the message that professional success could be received as a positive good, as long as
the women who achieved it were sure to pay due respect to gender norms.
Black and white male dentists struggled to make sense of the increasing
presence of women in professional life, but the intractable differences between
the two groups on the subjects of racial integration and politics far outweighed
the similarity of their experiences around gender. These differences were
rarely reflected in direct public dispute about dental topics: the ADA and its
constituent societies had more money and greater access to the media than did
the NDA, and the NDA could hardly hope to mount a successful opposition to
such a powerful organization on matters of policy. The differences between
the two groups were, however, played out in challenges to the discriminatory
practices of the ADA in the 1950s, 1960s, and 1970s. Individual black dentists
began questioning, and then litigating, the ADA-affiliated state societies’ policies of racial exclusion.42 The pages of major national dental journals—both
black and white—reflected the tension that resulted.
In June of 1964, for example, the Journal of the American Dental Association published a filler item, titled “The Color Guard,” disparaging a dentist “in one of the nation’s large cities, who refused emergency treatment to
a young Negro woman.”43 This was a comparatively bold move on the part
of JADA’s editors, who had also quietly begun to insert photographs featuring black members—and joint meetings of ADA and NDA leaders—in the
journal. In response to the letter about the dentist who had refused to treat

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the young black woman, one Ohio reader wrote to concur that “the incident
described in your editorial is not uncommon; rather it occurs frequently and
in most communities at one time or another.”44 But James Webb of Lamarque,
Texas, returned his copy of the June volume of JADA to the editorial office,
writing: “As I began to read the Reports of Councils and Bureaus and the
News of Dentistry Sections, I was confronted with a succession of pictures
of our officers and fellow dentists eating, visiting, awarding, and in general
making up to Negroes of various minor positions. Then, to cap it off, I was hit
with an editorial trying to tell me whom I can and cannot treat in my office.
I believe this organization is supposed to represent the feelings of the majority of dentists in this country, and I can’t believe we are all in accordance
with the kind of stuff you are printing. When the ADA publication returns to
being a professional journal instead of a monthly newsletter for the NAACP,
start sending it again.”45
Webb’s letter touched off a fi restorm of comment that persisted into the
October issue of the journal. Another Texas reader wrote, sympathetically,
that dentists who felt they could not render their best service, for any reason
including their own intolerance, were entitled to turn away patients.46 Others
replied that they regretted seeing the two Texans’ letters in the Journal at all,
and that the sentiments expressed therein highlighted the need for the profession to develop an enforceable code of ethics that would forbid racial discrimination by dentists. Some state and local societies were, at the same time,
actively defending their rights to discriminate. In 1964, for example, North
Carolina dentist Reginald Hawkins, who was the chairman of the civil rights
committee of the NDA, sued the North Carolina Dental Society (a constituent of the ADA), which had refused him membership because he was black.
Hawkins argued that the dental society, because it effectively appointed
the members of the state’s Board of Dental Examiners, was an agency of
the state, and therefore subject to the provisions of the Fourteenth Amendment.47 Rejecting tolerance for slow change, Hawkins described the ADA as
“aloof. . . . They’ve allowed these eleven states [which excluded black dentists
from membership] to send delegates and help make ADA policy for all other
states, knowing full well that Negroes were not adequately represented. Oh,
yes, the ADA has made pronouncements. But there’s a difference between
pronouncements and action.”48
The racial politics of the ADA liberalized over time, particularly after
the assassination of John F. Kennedy. That change in mores, together with
Hawkins’s lawsuit and other similar legal challenges, prompted the ADA’s

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House of Delegates to forward to the 1965 annual convention the identical proposals advanced by the Michigan and New York state dental societies “requesting the elimination of discrimination against Negro dentists
who apply for membership in organized dentistry.”49 Sentiment about the
integration of the profession was by no means unified. The editors of JADA
hoped to take a position that would alienate as few dentists as possible. In
an attempt to pacify integrationists, they endorsed the proposal. They made
a conciliatory gesture toward segregationists who blamed blacks for their
own social isolation from whites, counseling that, should the proposal pass,
“nonmember dentists who reside in states, including those in the North,
where discriminatory practices do not exist . . . [should] exhibit their sincerity by becoming active members of organized dentistry.”50 The proposals
passed, and the following year, the president of the ADA appeared at a banquet dinner at the NDA’s annual meeting to “bring cordial greetings from the
American Dental Association, its officers and trustees,” and to invite NDA
members who visited Chicago to “plan a tour of the magnificent new home of
the ADA . . . I am certain it will impress you with its functional design and
architectural splendor.”51
Despite such overtures by the ADA, black dentists clearly did not trust
that their political positions would be fairly represented in the integrated
organization. In 1967, when the dean of the Howard University College of
Dentistry proposed that the NDA “cease to exist as we know it today” on the
grounds that the ADA had fi nally been integrated, he suggested not that the
organization dissolve but that it give up its “scientific” functions and “continue to exist . . . as a strong social and political action force in the mainstream.”52 The minority of black dentists who were “fi nancial members”53
of the NDA, and who were the implied audience of its publications, either
did not support, or were not understood by NDA leaders as supporting, the
turn toward political and economic conservatism under way in the ADA during the same period. The NDA sustained a strong organizational interest in
addressing the health effects of poverty and racism; in the second half of the
twentieth century, the ADA rarely entertained such questions.
The Involvement of Government and
Insurance Companies in Dental Care

Like the struggle for the fluoridation of public water supplies, second-wave
feminism and the encroaching demands of the civil rights movement gave
the dentists represented by the ADA reason to question the logic of collective

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action. It was the growth of public- and private-sector programs for thirdparty payment of dental care that sealed their distaste for community-level
solutions to individual problems. Such programs struck at dentists’ shortand long-term fi nancial interests, and at their cherished image of themselves
as independent entrepreneurs. They feared and opposed the restraints on
dental practice that they believed would come with dental insurance, and
with increasing government involvement in providing it.
Though medical and dental opposition to national health insurance
had halted a broad socialization of health and dental care costs in the postwar period, American workers in the 1950s and 1960s continued to demand
health and dental benefits from their employers. Some experts believed that,
by 1970, half of all of the dental care provided in the United States would be
paid for through dental insurance plans.54 The employee-benefits providers’
fi rst efforts in the direction of dental insurance consisted of what dentists
referred to, disparagingly, as “closed-panel” dentistry: certain providers “participated” in the insurance plan, and employees could visit those providers,
but not others, for their dental care. Dentists objected to these plans because
unions and employers, not dentists, determined which providers were qualified to participate in any given plan, thereby eroding the professional autonomy of dentists. Joseph Bloom, a New Jersey dentist who authored an exposé
of a local dental insurance plan titled “I Resigned from the Group Health Dental Insurance Program,” complained that he had experienced a great deal of
difficulty convincing the insurance company’s underwriters to make appropriate allowances for complicated surgeries. “However,” he noted, “when the
problems were presented to the responsible officers of the union, the entire
matter was corrected to the satisfaction of dentistry within a short time. It is
an unfortunate truth that to correct this inequity, organized dentistry had no
power to influence reasonable demands on underwriters and management,
but when faced with the threat of a strike to enforce the same demands from
unions, they acquiesced.”55 The fact that labor power worked more effectively
than professional authority to sway third-party payers rankled Bloom. When
the naked pecuniary self-interest of labor unions received more consideration
than the objective professional judgment of a licensed dentist, things were in
a sorry state indeed.
In an attempt to short-circuit the demand for “closed-panel” systems, state
dental associations spent much of the early 1960s designing “dental service
corporations”—prepaid service plans, modeled on Blue Cross and Blue Shield,
whose provider pools mirrored the membership of the state association.

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Proponents argued that because dental insurance of some sort was a foregone
conclusion, dentists should work to be certain they would control the terms
on which it was offered. Yet even these moderate movements away from feefor-service practice angered some dentists who were members of the state
dental associations. They assailed the “political leadership” of the state and
national organizations for abandoning their commitments to American dental
entrepreneurship. For example, a Californian blamed the ADA and its constituent state societies for having failed to articulate arguments against service corporations: “The powerful union trusts demanding a dental care plan,”
he wrote, “were like bringing up the artillery, and the barrage staggered the
officers of the day who immediately retrenched into their cloister and nepotism and autocracy.”56 One Texas dentist wrote: “I am opposed to the Dental
Service Corporation for many reasons, but primarily because it marks a deviation away from the private enterprise system of health service which has been
responsible for developing the highest level of dentistry the world has ever
known toward a form of socialized health service. . . . Service Corporations,
like governments, can become hydra-headed monsters enslaving the dentist
rather than serving him.”57 In response to his state dental association’s movements to form a service corporation, one California dentist proclaimed: “I love
to be my own boss. I love the free enterprise system. I love Americanism. I paid
the price in full to be my own boss. I don’t want to work for a corporation. . . .
I do not believe the general membership of the American Dental Association
who are aware of the truth will want to support this organization.”58
Dentists’ concerns about insurance reflected their ideological interest in
entrepreneurial independence and their more mundane pecuniary interest
in fi nancial success. Those concerns also reflected their genuine preferences
for retaining control over their day-to-day work lives and over the terms of
their relationships with patients. In the 1960s, they expressed contempt for
a variety of modern measures that put distance between patients and health
care providers—not just those that carried a direct potential for impact on
their own incomes. The modern hospital, some speculated, could force an
unnatural schism between the dentist and his patient just as effectively as
the health insurance company could. In 1963, one writer chided dentists to
avoid practicing in hospital settings, cautioning that “dental surgeons are the
last bulwark of private medical practice, for the dental surgeon still teaches
his patients to come to a private office located in some downtown building
or suburban office suite [instead of to a hospital, which] ‘presages a shift in
public allegiance to ‘buildings’ instead of ‘men,’ which precedes socialized

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medicine. . . . continue to make your patients obey your dictates and come
to your private office!’” 59 Other contemporary conveniences, in this view,
could be every bit as dangerous: in 1968, the new journal Dental Management
published an article on the “Cause and Cure of the Cash Register Complex,”
arguing that the sacred dentist-patient relationship was being eroded by
such pernicious modern inventions as the clipboard (which smacked of the
“employment office”), the appointment-confi rmation telephone call (which
“eliminates the patient’s responsibility for his own care”), and high reception
room counters sized for the convenience of patients who wrote checks for
dental service while standing—the author argued that it would be much more
courteous, and therefore more reflective of the traditional dentist-patient relationship, for the patient to be invited to sit.60 The author of “Cause and Cure
of the Cash Register Complex” explicitly connected her advice about practice
management with the rhetoric about contemporary battles over insurance:
“It’s time that everyone in the profession recognized the dehumanization process now going on,” she proclaimed, “and made a full effort to keep dental
care on a people-to-people basis.”61 Try as they might to turn back the tide,
however, dentists in the 1960s and 1970s found themselves facing a colder,
more impersonal world on all fronts. Patients increasingly regarded their
services as necessary evils which were to be paid for out of pocket only in
cases of extreme necessity. Meanwhile, insurance companies and government demanded accountings of professional services that dentists had once
delivered, and of prices that they had once set, without interference.
One of the reasons dentists in the 1960s and 1970s found these trends
so disturbing was because they were under the mistaken impression that
increasing patients’ access to dental care by reducing their out-of-pocket
costs was a new idea. In the years after the widespread fluoridation of public
water supplies, school dental hygiene programs ground to a halt: alarmed by
threats to their incomes and professional autonomy, dentists erased from the
shared memory of the profession the history of public health promotional
campaigns, led by luminaries of the field, which had cooperated with schools
and city governments to give away dental care for free. Many writers who
tried to sketch out the history of dentistry—and particularly the history of
dental public health—erroneously argued that government interest in providing for Americans’ dental health was a new phenomenon. “It is only since
the mid-1960s that the growth of government supported dental programs and
the advent of proposals for national health insurance that there has been an
increased awareness by private practitioners of the activities of public health

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dentists [sic],” one professor of dental public health proclaimed.62 The winning entry in one dental-student essay contest argued that “traditionally, the
role of dentistry has been to provide a service to the individual through a private and personal interaction between doctor and patient. . . . The practitioner
. . . based his practice on the premise that ‘the responsibility for the health of
the American people is fi rst of the individual, the community, the state, and
the nation, in that order.”63
Dentists’ positive attitude toward individual entrepreneurial spirit was
consistent with their earlier advocacy against “big government” solutions to
Americans’ health care needs. In the late twentieth century, new hostility
toward collective engagement animated dentists’ opposition to health and
dental insurance. “From infancy,” the president of the Great Lakes Society
of Orthodontists wrote, “this has been a vigorous nation—made strong by
millions of people who have made every possible effort to gain the rewards
of self-reliant living. It is apparent on all sides that our inner strength has
started to ebb. A sickness threatens to drain the character of the American
people. It has been stated that this is our real health problem. We are letting
a sorry wish for care-by-government deaden the urge for self-care.”64 It was
almost as though the publicly funded dental hygiene programs of the 1910s,
1920s and 1930s—and the even more recent fight for the fluoridation of public
water supplies in the 1950s and 1960s—had never existed. In the surging economic environment of the postwar years, dentists felt that they could count
on sufficient income from private-pay patients; there no longer seemed to be
any fi nancial reason to strike the balance between “free enterprise” and free
access to health care on the patients’ side. The idea that it had ever been otherwise seemed, if not a nightmare, then a distantly receding dream.
Unfortunately for dentists, the “sorry wish for care-by-government”
was contagious. As witnessed in part by their insistence on government- or
employer-provided health care, patients were feeling less and less inclined
to pay out of pocket for any kind of health care, dentistry included. “There
is a growing belief,” one dental student wrote, “that everyone who needs it
is entitled to at least minimal dental care.”65 Patients’ sense that the government had a special obligation to provide them with health and dental care
(or at least health and dental insurance) seemed coupled with a dangerous
demystification of dentistry’s importance. Dentists complained that patients
put dental care on a par with other commercial goods, rather than giving it
the pride of place—and budget—to which it was entitled. “On entering dental
school, I was instilled with the idea that dentistry was a health service and

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not a commodity to be ‘sold’ like refrigerators,” one dentist griped. “Is it below
the dignity and ethics of the profession to place dental services in the category of commercial products? I think so.”66 Some writers who commented on
practice management issues argued that dentists’ insistence on attending to
the business side of dental care—by demanding that patients fill out multiple
forms or submit to credit checks, or by adopting the structural implements
of the modern business office—had incorrectly given patients the sense that
the dental office was primarily a place of business rather than a site for the
provision of health care, a place of industry rather than craft. “This is not a
business office where the receptionist screens out overbearing salesmen,” one
writer complained, “This is a dentist’s office. . . . In no way should it look like,
function like, or be like a business office.”67 Others believed that the deep
recession of the early 1970s was having an impact on patients’ appraisal of all
purchasing decisions—and that health care, particularly in such a feeble economic environment, simply moved from being a “need” to being an optional
“want” for most patients.
Whatever the reason for patients’ intransigence, dentists were faced with
a quandary. Forces from within and without threatened the control they had
managed to achieve over their professional lives. The social movements of the
1960s and early 1970s altered social norms around such contentious issues as
gender and race, and challenged the status quo within dentistry. Those movements reflected a broader resurgence of Americans’ sympathy for systematic
solutions to problems that dentists had increasing motive to regard as individual concerns. But opposition to social change sparked countermovements
that gave dentists the language with which to resist dramatic alteration in the
economics of their profession.
Insurance, whether privately provided or sponsored by the government,
endangered dentists’ incomes and their control over dentistry. Nearing the end
of the century, dentists who hoped to stave off insurance programs—whether
public or private—confronted an array of pressing questions. How could
patients be convinced to value dental care more highly? What might make
them more willing to seek and pay out of pocket for expensive dental services? How could patients be “reminded”—if they had ever really known it to
begin with—that dental care was the responsibility of the individual first, and
the state last? And what dental interventions could help to “sell” a vision of
Americanism in which the individual, rather than the group, bore the burden
for his own dental health—indeed, for almost all of his needs and desires?

Chapter 7

The Look of the American Mouth

As dentists groped for measures that would restore dentistry’s status and
the financial potential of dentistry as a business, catering to late-twentiethcentury Americans’ ever-heightening interest in personal appearance seemed
like a wise business decision. For these practitioners, offering high-end prosthetic services, tooth whitening procedures, and especially orthodontic care
appeared an obvious choice. While the technological and cultural underpinnings of orthodontics existed early in the twentieth century, the sheer volume
of reparative dental service that was necessary in the years before fluoride made
orthodontic care, and the aggressive manipulation of already-available ideas
about beauty and success, a low priority for both dentists and patients. Just as
important as the effects of fluoridation, however, were the other reasons why
orthodontics was marketed more enthusiastically, and embraced with more
fervor, after the middle of the century. Until the middle of the 1950s, dentists
hoped that they could demonstrate the value of their expertise through more
broadly-ranging public health interventions. Political and cultural conditions
unique to the end of the century, and dentists’ renewed fears for their income
stability, militated in the direction of stepping up the sale of orthodontics.
The postwar population boom resulted in an unusually large number of
children of prime orthodontic age: their youth made them more susceptible
both to orthodontic care and to the gospel of a lifetime of dentistry, inculcated in the orthodontist’s chair. Surveying the demographic shift, many
commentators even foresaw a time when a future glut of adult patients might
make a mockery of dentists’ fears about reduced demand for dental care. They

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The Look of the American Mouth

159

argued that because of the pressure that the baby boom would put on “traditional” fee-for-service dentistry, providing comprehensive care for children
and reducing the need for dental care in adults of the future was the only
way to protect dentists’ entrepreneurial prerogatives and incomes in both the
short and the long term.1
Though dentists disdained insurance, some dental insurance plans covered, or partially covered, orthodontic care. Despite dentists’ fears about the
possibility that patients would undervalue care for which they did not pay,
insurance coverage served to normalize orthodontic care, stimulating patient
and parent interest in it. Reflecting the fi nancial interests of insurers, however, almost no dental plan covered the entire cost. The practice of orthodontics was thus one of the few specialties in which dentists could anticipate
having, at least for some portion of treatment, a “traditional” fee-for-service
relationship with their patients. Dentists highly prized the private payment
of dental bills because they believed that it would help patients to understand
the true value of dentists’ services. Orthodontics exceeded even the benefits
of private payment itself in this regard, requiring protracted attention and
participation on the part of the patient—and, often, his or her parents. There
was virtually no specialty better designed to impress upon the patient that he
was primarily responsible for his or her own dental health.
Orthodontics also had the distinct advantage of drawing on a long
American history of linkage between appearance and individual sense of
self-worth, which reached fruition in the personal-improvement culture of
the late twentieth century. Orthodontists were not merely engaged in a cynical marketing ploy; they sincerely believed that good teeth contributed to a
healthy psyche. In 1948 one writer argued that “the consciousness of dental
beauty adds to lightness of spirit, encourages the smile of inner satisfaction,
and promotes that comfortable feeling that makes life pleasant.”2 The following year, some dentists contemplated having patients with severely crooked
teeth declared “dental cripples” by the state of New York, so that their orthodontic treatment could be paid for by public funds. Among the reasons cited
for such a move was the stymieing impact of knowledge of one’s own dental
imperfection on employability and marriageability. If New York children’s
teeth could be improved enough to make them self-confident candidates for
employment or for marriage, those children might be removed from the state’s
welfare rolls in adulthood.3
Most, however, saw orthodontics as a money-making opportunity for dentists in private practice. In the 1950s, the ADA began circulating to dentists

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a pamphlet entitled “Orthodontics: Questions and Answers.” The pamphlet
was intended for distribution by dentists seeking to bring parents up to speed
with the importance of orthodontic care for their children, and thereby to
drum up business for the dentists who distributed it. Consistent with the
pop-psychology parlance of the day, its authors argued that “the teeth may
be too conspicuous. . . . Such a condition detracts from the appearance and
may produce a defi nite feeling of inferiority in some children and also in
adults. A person’s mental attitude and personal appearance can be altered.”4
This line of reasoning, familiar from its popularity early in the century, was
common among orthodontists; one wrote that “a deformity of this nature is
frequently associated with other problems such as: psychic disturbances,
introverted personality, inferiority complex, moroseness, interference with
normal employment, lack of social success, and general mental anguish.”5
Despite their professed nostalgia for an earlier, less commercial era of
dentistry, American dentists seized on orthodonture as a way of selling dental services. Unlike the sale of reparative or preventative dental care intended
to treat or prevent pain, however, selling orthodontics to parents was a touchy
enterprise. It required that the orthodontist point out children’s aesthetic
flaws without alienating them and their parents: one journal advised that
orthodontists try to avoid “[pointing] out any discrepancies in a way that
might make the parent feel that we think Mary is a freak of any sort.”6 Perhaps
for this reason, in the early years of the orthodontics boom, orthodontists
tried to emphasize the non-aesthetic benefits of orthodontics, which included
more comfortable chewing, easier breathing (once the nasal passages, with
the upper jaw, were appropriately widened), and teeth that were easier to
keep clean and less likely to decay.
What orthodontists were really selling was an improved personal appearance—and, insofar as appearance was connected to success in business and
romantic life, improved chances at both these things. The achievement of an
anatomically perfect bite, which often required surgery and a lengthy period
in appliances, proved an elusive dream in most cases. But increasingly, orthodontists noted that patients and families were seeking improvements that
fell far short of technical correctness. They observed that “lessening of the
aesthetic deficiency without a long-time effort applied to seeking perfection
might suffice, or at least give satisfaction to the parents of our patients.”7
Orthodontists, patients, and their parents began to overtly declaim the benefits of aesthetic improvement with or without the technical perfection of a
patient’s bite. “I consider optimum facial esthetics a primary treatment goal,”

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one dentist wrote in 1968.8 Dentists continued to promote the health benefits
of orthodontics to parents who seemed likely to pay for it on those grounds,
but the major pitch more commonly had to do with appearance.
“Optimum facial esthetics” differed dramatically depending on one’s
personal characteristics—gender, for instance, was widely understood to be a
particularly salient clinical category. Orthodontists believed that there were
typically “masculine” and “feminine” tooth shapes and arrangements, which
ought to be the goal of their treatment programs for young men and women,
respectively. A “masculine” tooth was squarer, a “feminine” one more
rounded. Some studies implicitly acknowledged the subjectivity of aesthetic
appeal: for example, in one study that tried to determine the ideal relationship between teeth and the soft tissues of the face, researchers obtained their
“ideal” samples by having a panel of judges “at different social status levels”
choose the one hundred most attractive people (fifty men and fifty women)
from a group of one thousand subjects. They then analyzed the facial angles of
these “most attractive” subjects to determine what the “norms” should be.9
The study design seemed to concede that gender and social class could
play powerful roles in shaping one’s sense of what facial characteristics were
beautiful. In fact, some orthodontists, by describing their work in patients’
mouths as “art,” implicitly admitted that there was little but the vagaries of
personal taste guiding the aesthetic decisions they made.10 However, many
practitioners believed that the norms they promoted reflected a scientific
basis for reaching an aesthetic judgment. Journals for orthodontists were
filled with photographs and line drawings illustrating the proper angles to
be formed between patients’ noses, upper lips, chins, cheekbones, and teeth.
Though the input of Americans from a broad range of white ethnic and socioeconomic backgrounds might be considered in determining norms, no one
believed that the norms applied to individual patients ought to differ according to those patients’ socioeconomic standings. While the range of possible
outcomes might be limited by the patient’s anatomy, or by her or her parents’
willingness to pay, it was understood that orthodonture was aspirational.
There was a narrow range of desirable looks, and orthodontists would choose
from among them for each patient.
White orthodontists typically omitted mention of the role that race or
ethnicity might play in making particular aesthetic standards desirable
or achievable. Almost none frankly discussed the perceptions of race that
influenced their perceptions of what was “attractive,” and worth working to
achieve in patients’ mouths. They frequently promoted to middle-class black

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patients and their parents the achievement of a “more European” profile,
which featured a more vertical profi le line between the bottom of the nose
and the edge of the chin than typically occurred naturally in black patients.
One black professional from Ann Arbor, Michigan, drove his daughter into
Detroit to see a black orthodontist after the white practitioners with whom
he discussed his daughter’s care all outlined treatment plans including the
explicitly stated goal that his daughter would look “less black,” which they
imagined he and his child would share.11
The cooperation of parents was essential to orthodontists’ business. Writers who described the “case presentation” phase of the dentist-patient relationship, in which the orthodontist analyzed his patients’ teeth and made
recommendations for their care, emphasized that it was critically important
to win the confidence of both parent and child immediately. Children had to
be made to feel at ease with the orthodontist, and parents had to be convinced
that orthodontic care was worth their hard-earned money. Most writers recommended greeting the parent fi rst, then the child—both with hearty handshakes and warm use of proper names.12 Though orthodontists recognized
that their child patients were likely to fear treatment, and therefore cling to
their parents, most advised their peers to get the parent (usually the mother)
out of the treatment room as soon as possible.13 On the other hand, they recognized that—as one 1976 study demonstrated—parents were the ones who
made decisions about whether or not to get their children’s teeth fi xed, and
about how much money to spend in doing it. In the 1976 survey, sixty-two
of eighty-nine parent-child pairs agreed that orthodontic care had been primarily the parent’s idea. “This emphasizes,” the study’s authors concluded,
“the fact that only rarely is the child consulted or involved in the decision
about seeking treatment.”14 Therefore, parents had to be assiduously courted.
Slowly, American parents came to accept orthodontics, and to pursue it for
their children. Parents’ readiness to believe that orthodontic treatment would
pay off, perhaps even in dollars, was reflected in the advice that one practitioner gave to his fellows about how to discuss payment with patients’ parents;
he suggested that they speak of the parent’s “investment” rather than of the
treatment’s “cost.”15
One means of courtship was an appeal to parents’ status-consciousness.
Increasingly, orthodontics provided physical manifestation of one’s possession of disposable income and aspirations to a “bright future.” Orthodontists
themselves were among the most highly compensated of dentists, and they
were conscious of the advantages of class.16 In their references to employability

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and marriageability, they consciously promoted aesthetic norms intended to
gain for patients the fi nancial and social stability that characterized life in
the middle or upper-middle classes. In the competitive world of the postwar
economic boom, aspirations of advancement were themselves an important
part of class identity. In fact, some dentists commented that while they rarely
belabored with patients or their parents “the social and economic values of
good dental health,” they did “[attempt] to subtly point out that the good
results of professional care as seen by friends, coworkers and employers are as
much a status symbol as the big car in the driveway.”17 Others pointed to the
“desire of the American parent to do well for his children” as an important
predictor of heightened demand for orthodontic services.18 A few orthodontics researchers considered “motives involving a conspicuous achievement
orientation on the part of the parents” to be a minor factor in causing a family
to seek orthodontic care for one of its younger members, but others thought
that such motives were so deeply rooted that they existed on an almost subconscious level. “It is very doubtful,” one wrote, “that many parents are sufficiently aware of and sufficiently comfortable about their narcissistic needs
and tendencies, and enough at ease about revealing their status insecurities
to others, to be open about motives for orthodontic treatment that involve
status and achievement issues. Conspicuous consumption is, after all, something more engaged in than readily admitted to.”19
Aesthetic Concerns among Black Dentists and Patients

In the 1960s and 1970s, “conspicuous consumption” was not only a class but
a race prerogative. Black dentists and their patients, like whites, did manifest individualist aesthetic concerns. However, the aesthetic preoccupations
of black patients were much more tightly circumscribed by the underlying
racial inequities in Americans’ access to health care.
Black patients suffered significantly worse dental health than did whites.
By 1967, the ratio of black dentists to patients had worsened: there was reportedly one dentist per 1,750 patients in the US population as a whole, but only
one black dentist per 10,000 black patients.20 The chronic shortage of black
practitioners meant that black dentists filled their patient rosters without
much need to promote additional services. Many of their patients would have
had difficulty paying for them: though the federal government mandated
certain basic services or “core components” as part of state Medicaid dental
plans, the chronic underfunding of Medicaid meant that many states chose
to omit these required elements, and they typically suffered no penalty for

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doing so.21 Because of inadequate insurance coverage of dental care and a
longstanding shortage of dentists in urban and rural areas, black patients
typically waited longer than did whites to seek restorative care when it was
needed. As a result, black schoolchildren suffered more untreated dental
decay and more missing teeth because of decay than white children of the
same ages.22 Black dentists also had markedly less affection than did whites
for the ideology of independence from government intervention that kept
white dentists on the lookout for ways to promote private payment. For all
these reasons, black dentists were relatively unconcerned with convincing
patients to “invest” in the correction of malocclusion early in life.
Because black patients were so much more likely than whites to lose
teeth, the aesthetic concern most commonly mentioned by black dentists at
the end of the twentieth century was ensuring that dentures constructed
to replace lost natural teeth featured gingival bases that were pigmented to
match black patients’ gums. In 1968, Clifton Dummett wrote that “The everincreasing demand for a pleasing personality and good looks in every walk
of life, has made people conscious of the broad black zone of pigmentation
on the facial aspects of the gingivae.”23 Dummett reported that black Americans’ estimation of the beauty of their mouths had increased in the wake of
the “black is beautiful” movement. He argued that more work needed to be
done by dentists to encourage African Americans to appreciate the natural
state of their gingival tissue and to make possible the replication of racially
typical gingival pigmentation in dentures. “There has been a need, from
an esthetic viewpoint,” he asserted, “for the development of artificial dentures which more nearly simulated the colors of the underlying tissues in
instances where these tissues possessed pigmentations initially. This need
for a pigmented resin for dentures in non-Caucasians cannot be underestimated.”24 Dummett commented especially on the importance of developing
a pigmented resin that could be mass-produced less expensively than the
hand-pigmented plastics then in use. Conscious of the growing racial disparity in wealth and in access to health care in the United States, he wrote that
“economics would be a most important factor among the special people who
would be using these resins.”25
Within a decade, Dummett would have his wish: by 1971, Coe Laboratories was citing Dummett’s development of a “scientific method for assessing
intraoral pigmentation” as the research backing its introduction of “Natural
Coe-lor” denture resin.26 A 1972 advertisement for the product specifically
mentioned the interest of “Africans, East and West Indians, Chinese, and

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other people of color” in replicating a “life-like” and “natural” look in their
mouths.27 In 1974, a lovely young black woman, her image captioned, “Beautiful!” gazed out from an advertisement for Hy-Pro Lucitone Fibered Dark
dental resin. “True, you’ll occasionally fi nd a laboratory wizard who can take
a pink denture base material and stain it to match pigmented oral tissue,” the
ad observed, “But it’s a custom job. At a custom price. And time-consuming.
Caulk’s new resin shade, Hy-Pro Lucitone Fibered Dark, solves this problem
for you.”28
A series of advertisements for Bioblend porcelain teeth in the Quarterly
of the National Dental Association struck similar notes, placing their emphasis on the importance of appearance to personal and career success, with an
eye toward the cost sensitivity of older denture patients. These advertisements
often appeared simultaneously in white dental journals, and usually used stock
photographs of white subjects, but they demonstrated awareness of Clifton
Dummett’s observation that cost would be an important factor for audiences
made up of people of color. A 1967 ad featured a white woman in a fur coat
trying on a bracelet in a department store: “Are Bioblend Teeth just for patients
who wear mink?” it asked. “No. Bioblend Teeth are for any patient who uses
lipstick, goes to the hairdresser and tried her hardest to look her best. . . . In her
mind the success of the denture will depend on how it looks.”29
The ad gestured toward both the received standards of femininity that
continued to be popular among black dentists with middle-class aspirations
(presumably the Bioblend Teeth were not appropriate for women who did not
wear lipstick) and the price sensitivity of women’s interest in maintaining
that standard. “The small difference in cost,” the ad concluded, “is more than
offset by the great difference in patient appreciation.”
Advertisers in black dental journals clearly believed that a general concern for aesthetics was shared by both white and black Americans. They
repeatedly chose white models for products promising aesthetically positive
effects, demonstrating that they expected black dentists to adopt and promote at least some aesthetic standards in a “color-blind” fashion. Personalcare product manufacturers also perceived that black consumers, like white
ones, could be sold on products using aesthetic appeals. Though the rising
tide of the postwar economy lifted white Americans’ boats farther and faster
than it did blacks’, the economic boom did leave black Americans with more
disposable income than they had previously enjoyed. Racial integration and
the advent of affi rmative action also helped to create a class of black consumers who sought to use their purchasing power to demonstrate their class

Figure 9 Advertisement for Bioblend dentures, 1967. Quarterly of the
National Dental Association 26 (December 1967): back cover.

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affiliations. Advertisements drawing on consumers’ shared understanding
of the importance of dental care and dental attractiveness thus appeared in
black periodicals much as they did in white ones. In a 1960 Ebony Listerine
ad titled “Protection-In-Depth,” for example, a black man and woman smiled
broadly as they examined fabric samples, ostensibly planning the decoration
of their shared home—the ad suggested the domestic bliss that could be had
by users of the product.30 Advertisers wielded the stick as well as the carrot: in a Colgate advertisement titled “No One Wants to Go Round with Me,”
a young woman’s brother informed her that she was unpopular because of
her bad breath.31 A series of Gleem toothpaste ads featuring prominent black
Americans like jazz musician Lionel Hampton and journalist Carl Rowan
appealed to the bourgeois strivings of Ebony readers.32
Advertisers clearly believed that they could assume a shared body of
knowledge about bourgeois dental norms among black readers: even advertisements for products that had nothing to do with teeth reflected this conviction. A New York Life ad in 1972 pictured a cartoon black dentist and
patient (the latter with a big smile) in an office setting with the caption “Your
dentist can help you most if you see him regularly. The same goes for your
New York Life Agent.”33 Cartoons in the magazine’s long-running “Strictly for
Laughs” section, too, drew upon a presumed shared experience of dentistry
and its costs, and shared values about dental appearance, for their humor. In
one 1975 cartoon, a black couple sat at the desk of a home improvement loan
officer. The husband addressed the banker, saying “It’s for my wife. I want
to send her to a plastic surgeon.” The cartoon signs of his wife’s ostensible
ugliness were her two bucked front teeth.34 In a 1976 image, a youngster with
a similar dental malady stood in front of his father (who was reading a newspaper) and mother, who had just delivered the news that the child needed to
see an orthodontist. “Why does he need to have his teeth straightened?” the
father asked. “According to our grocery bill, they seem to be working pretty
good.”35 Both cartoons gestured not only at the currency of ideas about dentistry in the black community, but at the tension between the maintenance
of a high standard of aesthetic appearance and the fi nancial strain that black
Americans frequently experienced.
The marketing of aesthetic dental interventions to black patients demonstrated dentists’ and consumer-products manufacturers’ understanding that
race and class influenced Americans’ ability to participate in the evolving
norms of good looks. However, such campaigns also demonstrated that dentists and advertisers expected these new norms to be adopted as touchstones

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by all patients, whatever their cultural or fi nancial circumstances. Discussion of new and higher standards of personal appearance only suggested how
pervasive their influence was: even those who couldn’t really afford to participate in the new norms would have to contend with them. Black dental
patients experienced both fi nancial and structural limitations on their access
to new dental technologies, and to the status those technologies’ use carried with them. Meanwhile, the promotion of orthodontic services, mostly to
whites, worked to construct in the minds of American dentists and patients
a world view in which individual markers of aspiration were also important markers of willingness to participate in the competitive world of latetwentieth-century American capitalism. Orthodontic patients, in paying for
the services they received out of their pockets, visibly expressed their commitment to a politics of personal advancement by choosing to perfect their
bodies. They thus also expressed some level of fealty to the entrepreneurialcapitalist vision of “Americanism” to which late-twentieth-century dentists
hoped Americans would hew.
For most black dental patients, however, these visual markers of Americanness were out of fi nancial reach. Dentists and advertisers encouraged
them to pursue aesthetically pleasing mouths insofar as fi nances allowed,
but both professionals and arbiters of popular culture sensed tension within
the community of black consumers about whether, and to what extent, the
new standard of personal appearance would hold sway. As they had contended with the relative scarcity of health and dental care throughout the
century, black Americans coped with these aesthetic norms in varied and
creative ways. Members of—and aspirants to—the black middle class clearly
adopted some of the aesthetic norms being promoted most vigorously by
white dentists. Working-class and rural poor blacks made use of the limited dental services offered by a disproportionately small number of black
dentists. And a small but increasingly visible subset of hip-hop artists and
aficionados adorned their teeth, temporarily or permanently, with precious
metals and gemstones. The practice of tooth decoration was an old one: the
cohort of black jazz and blues musicians who had worn gold or diamonds in
their teeth in the early twentieth century understood it as a way to engage
with the values of the white culture they chronicled, mourned, laughed at,
and criticized in song. At the end of the century, hip-hop artists and their
acolytes renewed the use of tooth decoration as a critique of whiteness,
wealth, and power, and of the aesthetic norms being propagated to and by
those who aspired to them.

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Rob the Jewelry Store and Tell ’em “Make Me a Grill”

Early- and mid-twentieth-century traveling dentists believed that tooth decoration was a particularly fascinating vestigial element of the tribal cultures
they visited in connection with military and missionary work.36 Most mentions of tooth decoration in the dental and popular-culture literature of the
late twentieth century also linked it—implicitly or explicitly—with the toothdecoration practices of some tribal peoples in Asia and Africa. Though it is not
entirely clear how tooth-decoration practices survived the journey to North
America, many early-twentieth-century black jazz and blues performers made
flamboyance, including the use of gold and diamond tooth inlays, an important part of their stage personas. Classic blues singer Ma Rainey, for example,
was renowned for her lyrical descriptions of black women’s lives, particularly
their conflicted intimate relationships with men and with other women. Born
in 1886, she was described by one contemporary, pianist Mary Lou Williams,
as “loaded with real diamonds . . . her hair was wild and she had gold teeth.
What a sight! To me, as a kid, the whole thing looked and sounded weird.”37
Ma Rainey’s style of personal dress and decoration, and the attention it drew to
her lyrical message, contributed to her success as an early-twentieth-century
black feminist, highlighting—and sometimes excoriating—the racial and gender dynamics of black life in twentieth-century America.38
Jazz great Jelly Roll Morton likewise was renowned for his flamboyant
dress and self-decoration, including numerous pieces of diamond jewelry and
a gold-and-diamond inlay on one of his front teeth. The presence or absence
of diamonds among Morton’s personal belongings served, in his own mind
and in others’, as an index of his professional success. “I had plenty clothes,
plenty diamonds,” he reported about one flush period.39 Or, conversely, after
a bad run at gambling: “I had lost $20,000 and all my diamonds.”40 Though
Morton adopted his diamond tooth decoration to signal his wealth, in later
years it worked at least partly to emphasize the vanishingly small distance
between the depredations of black working-class life and his own rather tenuous fi nancial success. At the end of his career, fortunetellers and unscrupulous music executives bilked him repeatedly, and when he died, his
diamond tooth decoration was stolen by the mortician who prepared his
body for burial.
Both Jelly Roll Morton and Ma Rainey used tooth decoration for artistic
effect, gesturing at what William Eric Perkins, describing rap, and later hiphop, has referred to as black popular music’s “ongoing and bewildering love/

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hate relationship with American society.”41 For both Rainey and Morton, gold
and diamonds cemented links to the mainstream society (with its fetishism
of wealth and the conspicuous display thereof) while opening opportunities
for the musical critique of it. Late-twentieth-century hip-hop fashion, including rappers’ penchant for quantities of gold and diamond jewelry (often fake),
was similarly an attempt to “appropriate and critique through style” the
wealth fetishism of white America—particularly the white America of the
Reagan years. Rappers’ appropriation of these fashions mocked the Western
gold fetish (the source of much suffering in Africa) while affi rming it.42
At the end of the twentieth century, black sellers and wearers of tooth
jewelry explicitly emphasized its usefulness as a signifier of wealth: “People
do it because they’re trying to bling,” reported Scott Kublin, the owner of a
website that sold gold dental caps, in 2002. In an interview in the same year,
rapper Darryl McDaniels of Run-DMC elaborated on what it meant to “bling”
when he described why he and his fellow artists had chosen to wear such prodigious amounts of jewelry and brand-name fashion in the 1980s and 1990s.
McDaniels told National Public Radio host Terry Gross: “What it actually did,
[it] showed that we had money, showed that we had the big gold chain and the
fancy car, and we were truly the superstars of the neighborhood. You know, if
you got a big chain and the other guy don’t, you must be doing something.”43
By the turn of the twenty-fi rst century, hip-hop artists used gold teeth, and
commentary on them, to create narrative voices that simultaneously reified
wealth and status and parodied white critics’ prim objections to hip-hop
culture. Rapper Nelly’s 2005 song “Grillz,” for instance, featured the song’s
narrator explaining the social functions of his highly decorated teeth. “I put
my money where my mouth is and bought a grill/ 20 karats 30 stacks let ’em
know I’m so fo’ real/ My motivation is the 30 pointers VVS/ the furniture in
my mouthpiece simply symbolize success. . . . Rob the jewelry store and tell
’em ‘Make me a grill.’”44
Dentists and pop-culture commentators grasped that hip-hop artists
intended to offer comment on the tight connection between dental appearance
and social and economic success. But white media coverage of tooth decoration at the end of the twentieth century erred in taking hip-hop’s fetishization
of wealth too seriously. It responded to the literal claims of hip-hop, and not
to the broader critiques of white culture often being levied. Such coverage
prudishly argued that the appearance of wealth associated with tooth decoration was misleading, and disparaged the practice on the grounds that it made
people with gold teeth look scary and unemployable. Tooth decoration was

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linked to blackness, poverty, and bad judgment in a number of high-profile,
and widely reprinted, articles in the late 1990s and beyond. One item, originally published in the Houston Chronicle and reprinted in the Raleigh News
and Observer, featured a full-color photo of a black man with gold dental
work: the headline on the piece read “Gold in the Mouth, but None in the
Pocket: Employers Turned Off by Youth Fad.”45 A career counselor advised
one Houston woman to have the gold decorations in her teeth removed, and
a local dentist recruited a sponsor to pay the costs of replacing the gold tooth
with a “normal-looking cap.”46 The director of the Texas School of Business
told the reporter who interviewed her about the case that “gold is a barrier.
People make instant judgments when they meet someone.”47
The safety of tooth decoration was mentioned in only four paragraphs at
the end of a forty-one-paragraph article. Other white media coverage emphasized the danger of dental decay and erosion caused by tooth decoration,
implicitly or explicitly accusing those with gold teeth of bad judgment or inadequate concern for long-term dental health. One item in New York’s Newsday
characterized gold caps as “a dentist’s nightmare. They are placed directly
over the tooth by a jeweler and lack the careful fitting of crowns prepared
by licensed dentists.”48 The article mentioned Brooklyn dentist Ann Linton,
a black woman, for her campaign to stamp out the practice of tooth decoration among the city’s youth. “She has handed out fl iers at health fairs and
at events that draw large black youth populations,” the article concluded.49
Other observers of the practice went farther: in Louisiana, State Representative Ed Murray, a Democrat, proposed a bill that “would make it a crime for
a dentist to put gold teeth, fillings or crowns in the mouths of persons under
18 without the consent of their parents.” To the New Orleans Times-Picayune,
Murray described the bill as “an effort to keep dentists from exploiting young
people trying to follow a fad.”50 Such coverage capitalized on the popular
understanding of African American youth as status-seeking, uneducated,
perhaps even anti-intellectual—in short, as uncritical thinkers, and as slow
responders to scientific logic about the wisdom of altering one’s teeth.
Though white people wore gold tooth decorations, most journalistic coverage of the trend cast it as exclusively black. White dentists who confronted
gold dental work in the mouths of black patients struggled to contend with the
confl icting demands of cultural sensitivity and professional orthodoxy about
aesthetics. An article in the Atlanta Journal and Constitution concluded with
Dr. Richard Smith, of the Georgia Dental Association, making a weak gesture in the direction of cultural relativism. “Any of the reputable dentists I

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know wouldn’t do it,” he said. “Cosmetically, I don’t see where it has a place.
But in a certain culture, if people want to do it, I can’t say it’s not valid.”51
An editorial in the Baltimore Sun commented more directly on the racialized perception of gold teeth in black mouths by a white audience. Its author
observed the irony of a recent item on gold caps having appeared next to an
article on the “preponderance of black students who get suspended from public school.”52 “We’re not inferring that white teachers see a black student with
a gold tooth and haul him to the principal’s office,” the article cautioned, “but
you can’t deny cultural differences based on race. You see someone wearing
an adornment that seems peculiar, affecting a machismo that’s intimidating,
and the relationship descends from there.”53 The editorial argued that the “cultural difference” of black students’ preference for gold dental adornment, and
white teachers’ aversion to that aesthetic, was “based on race.” Gold teeth, its
author felt, had become so strongly associated with blackness—and therefore, in
the minds of white teachers, with criminality and the need for discipline—that
dental “adornments” served primarily to alienate black students from the white
mainstream. The idea that news items like the one titled “Gold in the Mouth,
but None in the Pocket” might have helped to create or reinforce the association
of gold teeth with blackness, poverty, and shiftlessness in the minds of newspaper readers apparently did not occur to him.
The argument that children, in particular, needed to be protected from
bad decision-making about dental health and personal appearance recapitulated one of the central themes of twentieth-century American thinking
about community responsibility for individuals’ dental health. Free enterprise, most agreed, had to be allowed to flourish—but the young, who could
not be expected to make good decisions for themselves (or to be able to access
dental care or services consistent with the good decisions they might happen to make) usually deserved government protection from the hazards of
the marketplace. Most tooth decoration at the end of the twentieth century
was done by jewelers who were not trained in dentistry. The rare coverage of
dentists who did install tooth decorations—thereby, presumably, decreasing
the risk that they would damage the natural teeth—treated the practitioners
as delusional: the Wall Street Journal, profiling the career of white “Rapper Dentist Daddy” Ronald Cunning, quoted rapper C-Murder (“a 26-yearold New Orleans rap artist [also known as Corey Miller, ‘but you can call
me Murder’]”) commenting that Cunning was “the real.”54 The article initially conceded that there might be some broader cultural point being made
by tooth decoration, describing gold and diamond tooth implants as “long a

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fashion accessory in certain African-American circles of the Deep South.”55
But the narrator made both C-Murder and his dentist Cunning into figures
of comic attention rather than studied respect. Cunning lacked even the cultural knowledge necessary to identify the format of his patients’ products (he
called CDs “little records”), naively came to the conclusion that his replacement of C-Murder’s healthy natural teeth with gold and diamond crowns
looked “just beautiful,” and said that notorious rap artist Eminem (at the
time, much discussed in the news for his lyrical threats to kill his mother
and his ex-wife, Kim Mathers) “seem[ed] like a real nice guy.” C-Murder, on
the other hand, planned to memorialize Dr. Cunning in an upcoming album:
“It’ll be real clean, of course,” the article concluded.56
The article’s author clearly conceived of C-Murder’s choice to decorate
his teeth as a sign of his individual aspirations and commitments, which
the piece sought to portray as antithetical to the values of Wall Street Journal readers. The disparaging tone the writer adopted in this effort contrasted
dramatically with the two-line ad for a Lexus automobile published in the
Wall Street Journal not long before. Like the article, the Lexus ad, pairing
the sentence “Naturally, all our kids wear braces,” with a smaller-font rendering of the Lexus motto (“The Relentless Pursuit of Perfection”),57 drew
on values that Lexus marketers assumed were shared by Wall Street Journal
readers. Straight teeth—teeth, in fact, that were visibly in the process of being
straightened—were understood to be an important (even “natural”) marker
of high social and economic status. Children and automobiles, as appropriate sites for the affectionate display of conspicuous consumption, were also
both recognized as sites for the demonstration of one’s consumer capacity—
and, thereby, one’s standing in American society. “The Relentless Pursuit of
Perfection” was understood to be an aspiration properly shared not only by
Japanese automobile manufacturers, but by upper- and upper-middle-class
American parents—and by orthodontists.
Like the profile of Dr. Cunning and C-Murder, the ad implicitly assumed
that its readers shared, and regarded as important, values about the appearance of one’s teeth. The editors of, and advertisers in, the Wall Street Journal clearly believed that readers would understand orthodontics and tooth
decoration to be completely unrelated—that, in fact, readers would regard the
values they represented as being in opposition to one another. The Lexus ad
argued for a class consciousness of one’s children’s teeth as a marker of social
standing. C-Murder’s gold grill, by contrast, was portrayed as demonstrating
his bizarre lack of awareness that such consciousness was desirable.

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The belief that C-Murder’s and Lexus’s target audiences were living in
different cultural, esthetic, and moral worlds was certainly widespread, but
it was, in important ways, inaccurate. Late-twentieth-century Americans’
renowned obsession with the straightness and whiteness of their teeth was—
as is true of almost any expensive hobby—a product of ideas about race and
class, and the way those ideas influenced aesthetic values. For the white dentists who promoted orthodontics, the specialty represented an opportunity
to emphasize the American values of ambition and individual responsibility. For white commentators on tooth decoration, the racialized attribution
of poverty, sloth, and bad taste to those who decorated their teeth with gold
and diamonds helped to reinforce the idea that a mouth full of clean, healthy,
straight teeth was an appropriate aspiration for Americans at the turn of the
twenty-fi rst century. But black Americans who decorated their teeth weren’t
ignorant of these norms: rather, they sought to challenge them. Tooth decoration critiqued the prevailing construction of the mouth as a place where
an American might—and ought to—demonstrate high social standing, good
judgment, and easy access to high-quality dental care.

Epilogue

“Brits resort to pulling own teeth,” trumpeted CNN.com in October 2007. The
article went on to explain that a shortage of dentists in the National Health
Service was driving patients to take treatment into their own hands. “I took
most of my teeth out in the shed with pliers,” one unhappy interviewee said.
“I have one to go.”1 In June 2008, the television channel BBC America began
running a documentary called Britain’s Worst Teeth, which emphasized the
two-year wait for some kinds of dental procedures in the United Kingdom.
Scary reports from locales in which dental care was inaccessible—particularly because of the widely scorned insufficiencies of programs of social
insurance—reinforced the consensus among American dentists and patients
that bad dental care, and the poor personal appearance that could result from
it, were horrors to be avoided at all costs. The belief that dentistry was important, and that it ought to be delivered more or less in the way that dentists
said it should, represented a signal success for organized American dentistry
in the twentieth century.
Consumer-products advertising certainly helped to promote the new aesthetic norms to which patients and prospective patients were increasingly
expected to adhere. Likewise, the surging popularity of “reality” television
programs encouraged Americans to think of themselves as persons constantly
on the verge of great notoriety, who needed to maintain Hollywood standards
of personal beauty at all times. American Idol winner Carrie Underwood, an
exemplar of this imminent visibility, told Us Weekly in 2008: “I like my teeth.
Sometimes I wonder if my orthodontist realizes how important he was.”2

175

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Making the American Mouth

Patients’ increasing demand for aesthetic services reflected their rising disposable incomes, their freedom from the dental decay and pain that had been
partially alleviated by fluoride, and an escalating tendency to regard personal
style as a statement of one’s political, economic, and social affi liations and
aspirations. But the most powerful and intentional force militating in the
direction of the new norms of dental appearance was the activism of American dentists themselves. In the late twentieth and early twenty-fi rst centuries,
dentists fearing real and imagined threats to their incomes and professional
autonomy sought to inculcate Americans with an aspirational vision of dental health and appearance that depended on extensive individual investment
of time and money into dental treatment, and they were largely successful in
doing so.
As a result, the market for aesthetic dental services like orthodonture
and tooth whitening ballooned. “A trip to the dentist used to mean standard
cleaning, drilling and filling,” explained one Newsweek writer in 1998, “But
thanks to fluoridated water and better dental hygiene, Americans’ oral health
has vastly improved. Now dentists—drilling for new revenue sources—are
mingling words like ‘self-esteem’ with ‘gingivitis.’ Like surgery, dentistry is
going cosmetic.”3 In 2005, the “consumer advisor” for the American Dental
Association estimated that dentists were performing “twice as many cosmetic procedures as they were just three years ago . . . and companies have
sprung up to offer special fi nancing for those who’d like to remodel their
mouths.”4 Popular news sources reporting on the trend identified it as a new
and uniquely American one: “With the vast majority of celebrities sporting
blinding-white smiles, and shows like ‘Extreme Makeover’ bringing da Vinci
veneers to Everyman, Americans have grown tooth-obsessed,” Newsweek
proclaimed in 2005.
Americans’ worldwide reputation as a people possessed of unique fastidiousness about the appearance of their teeth was not as new as media coverage made it seem. In the late 1960s, for instance, renowned British cellist
Jacqueline DuPre ranted to her sister Hilary about a characteristic she had
noted in her American audiences: “I’m fascinated by American mouths. . . .
Rows of perfect teeth, set in a hideous grin, and a gushing ‘aren’t we pals’
expression.”5 DuPre’s comments would be echoed three decades later by the
London-dwelling musician who said he could tell when he was performing in
the United States by the “piano teeth” in the audience.6 The tone of comment
on Americans’ uniquely perfect teeth reflected political and cultural conditions that changed over time. In the terror-war climate of the post-9/11 era,

Epilogue

177

for instance, one urban legend suggested that having distinctively American
teeth might pose a risk to either personal safety or national security. “A few
months ago I was reading an article about the structuring of overseas US
intelligence,” one blogger wrote. “There was a piece about a new recruit who
showed up, accompanied by his blinding white smile. A seasoned veteran
took a look at his pearly whites and told him he’d have to put a hammer to his
dental work before he could accompany him on his missions . . . his brilliant,
perfect dental work would have them identified and killed immediately.”7
In general, however, popular commentators on Americans’ internationally renowned dental obsession at the turn of the twenty-fi rst century
figured it as a combined product of historically unequalled national prosperity and the perennial American propensity to pursue all opportunities
to their farthest extremes of fruition. Comedy, in particular, depended on
these associations for its currency. In April 2003, for instance, the satirical
newspaper The Onion reported that “US Dentists Can’t Make Nation’s Teeth
Any Damn Whiter.” “The typical ADA dentist,” the health-column send-up
informed readers, “is irked by customers who come in for routine bleaching and leave disappointed because ‘their teeth don’t infl ict retinal damage
when you look directly into them. . . . When someone creates a better toothwhitening procedure, we’ll slap an ‘ultra’ on it and get it out on the market as
fast as the FDA allows. Until then, be happy with what you have. Americans
really need to learn to live with almost-total perfection.”8 In 2007, the comic
strip “Bizarro” featured a woman whose teeth were emitting a blinding glare
telling a man that “Whitening strips are SO last year. Now it’s all about halogen implants.”9
The comic trope of the tooth-obsessed American—and her perennial antagonist, the Briton heedless of the importance of good dentistry—
extended far beyond the funny pages. In a 1993 episode of The Simpsons,
for instance, Springfield dentist Dr. Wolf intimidated young patient Ralph
Wiggum into committing to brush his teeth more often by showing him the
Big Book of British Smiles.10 Comedian Mike Myers’s series of Austin Powers fi lms repeatedly used the eponymous hero’s teeth as indicators of both
historical time and Powers’s nationality. When British hipster/ international
spy Austin Powers fi rst burst into theaters in 1997, he had just been reanimated after a thirty-year stay in cryogenic storage. His love interest, played
by the famously gorgeous Elizabeth Hurley, complained to her mother about
Powers’s crooked, cruddy teeth, only to be told that “in Britain, in the sixties,
you could be a sex symbol and still have bad teeth!” Powers subsequently

178

Making the American Mouth

saved humanity from the machinations of his aptly named nemesis, Dr. Evil,
by swinging over a moat on a rope of dental floss conveniently produced by
the hygiene-conscious Hurley at the pivotal moment. In the second fi lm in
the trilogy, in which the action shifted back and forth between the UK in
1969 and the US in 1999, Powers’s teeth—crooked and stained in the former,
and straight and shiny in the latter—were even more important markers of
both modernity and nation, letting viewers know when, as well as where,
Powers was. After preventing Dr. Evil from annihilating Washington, DC,
with a blast from a giant laser, Powers was rewarded with the affection of
another love interest—a blonde, blue-eyed American CIA agent played by
Heather Graham. Her romantic capitulation to Powers as the fi lm closed and
Lenny Kravitz’s funk-infused version of the Guess Who classic “American
Woman” played communicated that Powers’s straight, shining teeth were
part of a uniquely American package of social and sexual success. Bad teeth,
the fi lms indicated, were an outdated British phenomenon; good teeth were
modern, American, and heroic.
In real life, political gadfly Christopher Hitchens, a Briton who was naturalized in the United States in April 2007, described his acquisition of new
dental veneers that fall as “part of my new passport to Americanization.”
His dentist’s colleague, he reported, came by to see Hitchens’s teeth before
the procedure began, because he “wanted to see with his own eyes that my
teeth were really as ‘British’ as they looked in the ‘before’ photograph.” Hitchens’s six hours in the dental chair not only took away the “stains and the
shame” of his native dentition; they also provided him with an opportunity
to appreciate the tightening link between personal aesthetic aspiration and
access to the luxury and the pampering afforded to the very rich. During his
treatment, Hitchens listened to music from the dentist’s “massively accoutred
Sonos sound system . . . [and] a foot masseur was thoughtfully provided to
alleviate the tedium.”11
The widespread adoption of the aesthetic norms promoted by dentists
reflected patients’ genuine interests in personal appearance. As Hitchens’s
reference to “stains and shame” suggested, though, it also helped to create a
climate of aesthetic expectation that was stifl ing for the many who did not,
or could not, conform. Reflecting on the chronic undersupply of basic dental
care in rural Kentucky, New York Times writer Ian Urbina reported that Barbourville dentist Edwin E. Smith “has seen the shame of a 14-year-old girl
who would not lift her head because she had lost most of her teeth from malnutrition.” The director of an employment placement program in Appalachia

Epilogue

179

similarly challenged Urbina: “Try fi nding work when you’re in your 30s or
40s and you’re missing front teeth.”12
Heightened aesthetic expectations themselves combined with the popular association of bad dental health with tobacco and methamphetamine
use, malnutrition, and poverty made unattractive teeth a source of humiliation. The fi nal link in the chain of association was the shared belief that all
of these characteristics—ugliness, bad health choices, and personal impoverishment—could be correctly attributed to a failure of personal ambition.
The social prohibition on openly admitting that one judged acquaintances
by their appearance—always more honored in the breach than in the observance—was quickly being erased, and in ways that made refusal to engage
with the new dental aesthetic norms increasingly untenable. In 2003, New
York Times writer Natalie Angier conducted an “informal e-mail tooth survey of twenty-seven colleagues and friends [asking] . . . whether they noticed
other people’s teeth.” Two-thirds told Angier that they did. One historian
reported to Angier: “I’m put off by bad teeth. They give a low-life impression. Dental elitism, that’s me.”13 Individuals’ failures to maintain good dental health and appearance were commonly understood to represent lack of
personal drive or efficacy, normalizing the pursuit of good looks. In 2008,
60 percent of respondents to a survey on the website of the upscale men’s
magazine Best Life said that they considered tooth whitening “normal”; only
6 percent called it “excessively vain.”14 People with bad teeth could be safely
judged—or, as in the Myers films, mocked.
Dentists’ moves to promote patient aspiration to high aesthetic standards
had an impact not only on the patients who adopted or contended with those
norms, but on the larger cultural, professional, and political worlds of which
dentists were a part. As they abandoned their previous commitment to public-health strategies to lift health standards on a community basis, dentists
also jettisoned the notion that Americans—and particularly wealthy, welleducated Americans—had any obligation to work for social change. Dentists’
resistance to a national program of dental insurance meant that federal funding for dental care ultimately occurred through the chronically underfunded
Medicaid system administered by individual states. Though the federal government set minimum standards for state dental plans, many states failed to
meet the required thresholds, and many dentists chose not to accept Medicaid recipients as patients at all, leaving poor adults and children without
access to needed services.15 In Maryland, for example, only 900 of the 5,500
dentists in the state accepted Medicaid in 2007.16

180

Making the American Mouth

Early in the twenty-fi rst century, the results of these inequities in access
began to show in Americans’ mouths and bodies. For the fi rst time in fifty
years, the CDC announced in 2007, the percentage of Americans with untreated
cavities was rising.17 That year in Maryland, twelve-year-old Deamonte Driver
died of meningitis after a tooth abscess spread to his brain. The Washington
Post reported that Driver’s mother, Alyce, had experienced extreme difficulty
keeping her children enrolled in Medicaid and fi nding a dentist who would
provide services under the plan. Because of the resultant delays in his care,
her son was hospitalized for two weeks and underwent brain surgery costing
approximately $250,000 before he died.18
The New York Times reported that despite the large unmet need for basic
dental services, and the excessive health care spending that could result after
lapses in essential care, the ADA continued to oppose increasing the size of
the pool of dental health care providers, agitating against the opening of new
dental schools and the training of advanced-practice dental hygienists. The
ADA’s opposition, news coverage hypothesized, was directly linked to dentists’ interest in maintaining their personal incomes. “Dental fees have risen
much faster than inflation,” the Times article concluded. “In real dollars, the
cost of the average dental procedure rose 25 percent from 1996 to 2004.”19
Dentists, the Times said, were reaping enormous fi nancial rewards for their
diligence in protecting the elite status of the profession: “[Their] incomes
have grown faster than that of the typical American and the incomes of medical doctors. Formerly poor relations to physicians, American dentists in general practice made an average salary of $185,000 in 2004. . . . Dental surgeons
and orthodontists average more than $300,000 annually.”20
Some dentists who responded to the report in the Times’ editorial pages
pointed to the need for an increase in Medicaid, State Children’s Health Insurance Program, and insurance reimbursements in order to provide dentists
with an incentive to provide more basic dental care. But one letter writer provided a pessimistic satire of what could be accomplished through government
intervention with his proposal for a “No Dental Patient Left Behind plan.” He
imagined that such a program might ape the worst features of the famously
imprecise testing and “accountability” measures introduced into Title I of
the Elementary and Secondary Education Act (popularly known as “No Child
Left Behind”) when it was reauthorized in 2001. In the letter writer’s dystopian vision, “All American residents will be assigned to a public dental
clinic, which will be fi nanced primarily by local property taxes. That will
ensure that the quality of dental care available in every jurisdiction will be

Epilogue

181

roughly proportional to real estate values. . . . Dentists’ renewed commitment
to eradicate tooth decay, the revealing light cast by systematic testing, and
the superior management that will come with state takeovers will combine
to make America decay-free by 2014, at which time we will look back on the
benighted era of c. 2007 with disbelief,” he concluded.21 The contrast between
his cynical skepticism of socially shared solutions and the optimism that had
undergirded the Cleveland and Bridgeport dental hygiene campaigns early in
the twentieth century could hardly have been starker.
The anxieties about professional status and autonomy that had animated
many of dentists’ behaviors throughout the 1900s drove their desires to keep
the pool of dental care providers small in the twenty-fi rst century. Complaints and concerns about insurance programs and their effects on dental
practice featured prominently in dentists’ responses to criticism from outside
the profession. Most of all, the rightward political shift that had prompted
dentists’ late-century skepticism of “big government” and their turn away
from public health solutions continued to shape their sense of what was possible, and desirable, for American dental patients. This rightward shift in
dentists’ thinking mirrored the increasingly entrenched American belief that
comparatively few individual health expenses ought to be socially shared,
and that individuals who failed to provide adequately for their own health
expenses could be ignored or reviled with impunity. The climate produced by
this confluence of forces helped to ensure the continued power and prestige
of dentists, but it also guaranteed that inequity in access to dental care would
continue, increasing the distance between Americans and the dream of the
American mouth.

Notes

Introduction
1. Lexus advertisement, Wall Street Journal, Wednesday, October 27, 1999.
2. Janet Carlson Freed, “Word of Mouth: Cosmetic Treatments for Teeth,” Town &
Country 152 (August 1998): 54.
3. Elizabeth Hayt, “Blinding Them with Smiles,” New York Times, September 18,
2000.
4. Ibid.
5. “Dental and Oral Conditions of Recruits,” Dental Cosmos (September 1916):
1071–1075.
6. A. Lehrmann, “A Few Words about the Practice of Dentistry Here with That in
Russia,” Western Dental Journal 21 (January 1907): 10.
7. For a short description of the effects of the Harrison Act and its enforcement, see
Margaret Battin et al., Drugs and Justice: Seeking a Consistent, Coherent, Comprehensive View (New York: Oxford University Press, 2008), 34.
8. See, for example, Kathy Peiss, Cheap Amusements: Working Women and Leisure
in Turn-of-the-Century New York (Philadelphia: Temple University Press, 1986).
9. Elizabeth Giangrego, “The Life and Times of Painless Parker,” as published by
the Pierre Fauchard Academy on its website, www.fauchard.org/inquiries/
museum/07/PP/index.htm (accessed May 19, 2008).
10. Malvin Ring, Dentistry: An Illustrated History (St. Louis: Mosby, 1985), 4.
11. James Wynbrandt, The Excruciating History of Dentistry (New York: St. Martin’s
Press, 1998), 146
12. Frank Norris, McTeague: A Story of San Francisco (1899; repr., New York: Penguin
Books, 1982), passim.
13. The figure of McTeague played powerfully in dentists’ minds as an example of
inadequate ambition. One writer summoned up the character to dismiss other
dentists who failed to adapt to new social and economic conditions this way:
“Standards had changed. McTeague’s inability to grasp the fact of change, to reconcile himself to its logical inevitability, and to adapt himself to a new order of
events, far removed from the grooves in which he had spent his daily life for
fifteen years, is strikingly comparable, it seems to me, to the perturbed effusions
concerning social changes today. Too many of us have believed we have made
vocational adjustments whereas in reality we have merely fitted ourselves into
grooves . . .” “E.H.D,” “Beneath It All,” Dental Digest 40 (August 1934): 281.
14. On the process of raising educational standards within medicine, see Kenneth
Ludmerer, Learning to Heal: The Development of American Medical Education
(Baltimore: Johns Hopkins University Press, 1985). In dentistry, see Norman
Gevitz, “Autonomous Profession or Medical Specialty: The Stomatological Movement and American Dentistry,” Bulletin of the History of Medicine 62 (1988): 410.
15. In 1918, a B’nai Brith survey suggested that 23.4 percent of all dental students in
the United States were Jewish (Hasia Diner, In the Almost Promised Land: American Jews and Blacks, 1915–1935 [Westport, Conn.: Greenwood Press, 1977], 5). But,

183

184

16.

17.

18.
19.

Notes to Pages 7–16

as Edward Halperin has demonstrated elsewhere, the statistical overrepresentation of Jews in professional schools in the 1900s and 1910s upset Protestant university leaders, who responded by instituting quotas on Jewish admission in the
1920s. See Halperin, “The Jewish Problem in US Medical Education, 1920–1955,”
Journal of the History of Medicine and the Allied Sciences 56 (2001): 140–167.
The National Dental Association renamed itself the American Dental Association
in 1921. Black dentists later adopted the name the white organization had abandoned; their organizations were affi liates of the larger entity, the National Dental
Association (NDA).
C. N. Johnson, “Stomatology or Dentistry?” Journal of the American Dental Association 13 (1926): 371–372, as cited in Norman Gevitz, “Autonomous Profession
or Medical Specialty: The Stomatological Movement and American Dentistry,”
Bulletin of the History of Medicine 62 (1988): 407–428.
Amy Green, “Tooth and Nails,” Southwest Airlines Spirit (in-fl ight magazine),
August 2005, 82.
On homes and other consumer goods, see, for example, Lizabeth Cohen, A Consumer’s Republic: The Politics of Mass Consumption in Postwar America (New York:
Knopf, 2003), and Jeffrey Hornstein, A Nation of Realtors: A Cultural History of the
Twentieth-Century American Middle Class (Durham, N.C.: Duke University Press,
2005). On bodies, see Elizabeth Haiken, Venus Envy: A History of Cosmetic Surgery
(Baltimore: Johns Hopkins University Press, 1997), and Kathy Peiss, Hope in a Jar:
The Making of America’s Beauty Culture (New York: Metropolitan Books, 1998).

Chapter 1 — American Dental Hygiene
1. “Oral Hygiene to Become a National Movement at Cleveland, Ohio, March 18,
1910: President Taft and the Governors of the United States to Be Invited to Attend
the Opening,” The Dental Brief 15 (March 1910): 212.
2. W. G. Ebersole, “Report of the Proposed Dental, Educational, and Hygienic Work
in the Cleveland Public Schools,” as published by The Dental Brief 15 (March
1910): 215. Ebersole, a Cleveland native, was the chairman of the National Dental
Association’s Committee on Oral Hygiene. I have indicated when I am citing a
paper initially presented in public and later reprinted by a professional journal
by describing it “as published by”: comments on public presentations are listed,
commenter’s name fi rst, followed by “comments on” (or “commenting on”) and
the rest of the citation.
3. W. H. Elson, “Address of Welcome,” as published by The Dental Brief 15 (May
1910): 390.
4. G. C. Ashmun, “Opening of the National Campaign on Oral Hygiene,” as published by The Dental Brief 15 (May 1910): 389.
5. Henry C. Muckley, “Our Interest in the Work,” as published by The Dental Brief 15
(May 1910): 394.
6. “The Marion School Squad,” Oral Hygiene 1 (July 1911): 506
7. Ibid., 506.
8. The logic behind the decision to award this fi nancial incentive on Christmas is
difficult to discern. It may have reflected the planners’ own sense that special
fi nancial considerations, like employment bonuses, were most properly awarded
during the Christian holiday season—or it may have represented an explicit
attempt at religious and/or cultural conversion. The school dental nurse, in her

Notes to Pages 16–19

9.
10.
11.
12.
13.
14.
15.
16.
17.

18.

19.

185

report on the hygiene activities she carried out with the students, listed the Jewish High Holy Days together with electrical service outages as causes of slowed
progress on the project. “Report on the Activities of the Dental Nurse in Marion
School, Cleveland, Ohio,” Dental Digest 16 (February 1911): 144.
Ibid., 143.
William G. Ebersole, “The Human Mouth and Its Relation to the Health, Strength,
and Beauty of the Nation,” The Dental Cosmos 53, date unknown: 798.
Cordelia O’Neill, “Oral Hygiene: An Important Factor in the Conservation of the
Child,” Oral Hygiene 1 (October 1919): 736.
Ibid., 734.
“Report of Activities,” Dental Digest 16 : 144.
Lillian Cohen, “What the Marion School Squad Did for Me,” Dental Digest 17 (September 1911): 508.
“Incorrigible Pupils Now Well Behaved,” The Dental Brief 16 (June 1911): 439.
Lillian Gottfreid, “What the Marion School Squad Did for Me,” Dental Digest 17
(September 1911): 506.
On the ideology of the germ and the public health campaigns that resulted, see
Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American
Life (Cambridge: Harvard University Press, 1998), and Richard Meckel, Save the
Babies: American Public Health Reform and the Prevention of Infant Mortality,
1850–1929 (Baltimore: Johns Hopkins University Pres, 1990). On school medical
inspection programs, see Howard Markel, “For the Welfare of Children: The Origins of the Relationship between US Public Health Workers and Pediatricians,”
in Howard Markel and Alexandra Minna Stern, eds., Formative Years: Children’s
Health in the United States, 1880–2000 (Ann Arbor: University of Michigan Press,
2002), especially pages 57–61.
William Belcher, “God’s Poor and a Few ‘Poor Devils’: An Address on Free Dispensary Service,” as published by The Dental Cosmos 52 (April 1910): 450. A dentist
from the US Indian Service Field Dental Corps made a similar point with respect
to dental service the government provided for the estimated 300,000 Natives then
living on reservations: “This requires the annual expenditure of a large appropriation having for its ultimate end the preparation of the remnants of this once
strong and vigorous race for the privileges of citizenship,” he wrote. Fdo. Rodriguez, “The United States Indian Service Field Dental Corps: A New Field of Activity in Which Physician, Dentist and Teacher Collaborate,” as published by Dental
Items of Interest 39 (May 1917): 364.
This logic guided the spending of wealthy philanthropists like Carnegie, who
spent millions on libraries and educational institutions during the same period,
but who typically refused to endow a library until its home community or institution had raised as much money as Carnegie himself was asked to donate. On the
conditions for Carnegie’s endowments, see Donna K. Cohen, “Andrew Carnegie
and Academic Library Philanthropy: the Case of Rollins College,” Libraries and
Culture 35 (Summer 2000): 389–415. Even the physical layout of the Carnegie
libraries, which innovated in making open stacks of books available to the public,
was intended to promote self-sufficiency. See Abigail A. van Slyck, “ ‘The Utmost
Amount of Effectiv [sic] Accommodation’: Andrew Carnegie and the Reform
of the American Library,” Journal of the Society of Architectural Historians 50
(December 1991): 359–383.

186

Notes to Pages 19–24

20. Belcher, “God’s Poor,” The Dental Cosmos 52: 456.
21. George Hardisty, “Oral Hygiene in Our Public Schools,” as published by The Dental Cosmos 43 (August 1901): 951.
22. George Edwin Hunt, “Oral Hygiene,” as published by Dental Digest 11 (July 1905):
653. Hunt would go on to become editor of his own journal, the Indianapolisbased Oral Hygiene, in 1911.
23. William Trueman, commenting on Alphonso Irwin, “Oral Prophylaxis as a
Municipal Problem,” as published by Dental Brief 18 (September 1913): 633.
24. O’Neill, “Oral Hygiene: An Important Factor,” Oral Hygiene 1: 734. George Edwin
Hunt, the editor of Oral Hygiene, wrote: “And mind you, Cleveland has had medical inspection of its school children for the past three years, so the physician has
had his ‘whack’ at them before the dentists came along” (George Edwin Hunt,
“The Marion School Squad,” Oral Hygiene 1 [July 1911]: 507).
25. “A ‘Mischief-Breeding Neglect,’” The Dental Cosmos 44 (March 1902): 296.
26. “Iconoclast,” “Dentistry—Duty and Opportunity,” The Dental Brief 14 (September
1909): 642.
27. “Report of Activities,” Dental Digest 16: 144–145.
28. Ebersole, “The Human Mouth,” The Dental Cosmos 53, 794.
29. Ibid., 797.
30. Charlotte Fitzhugh Morris, “Oral Hygiene at Locust Point,” Dental Digest 24 (1),
January 1918, 3.
31. See, for instance, Selma Berrol, “Immigrant Children at School, 1880–1940: A
Child’s-Eye View,” in Elliott West and Paula Petrik, eds., Small Worlds: Children and
Adolescents in America, 1850–1950 (Lawrence: University Press of Kansas, 1992),
42–60. On Italian immigrants’ attitudes toward prolonged schooling, see Stephen
Lassonde, “Should I Go, or Should I Stay?: Adolescence, School Attainment, and
Parent-Child Relations in Italian Immigrant Families of New Haven, 1900–1940,”
History of Education Quarterly 38 (Spring 1998): 37–60. On Jewish mothers’ attitudes
toward American medical care, see Jacquelyn Litt, “Mothering, Medicalization, and
Jewish Identity, 1928–1940,” Gender and Society 10 (April 1996): 185–198.
32. These notices were often produced by state or local dental societies and distributed either under the byline of an individual dentist or anonymously. A local
newspaper editor in Crawfordsville, Indiana, objected to both the notices themselves (which he considered unethical attempts to bilk newspaper editors out of
advertising space) and to the practice of publishing them without bylines, “indicating that it is the purpose of the society to deceive the public as well as the
publisher.” The editor proposed that dentists advertise openly instead. (George
Edwin Hunt, “The Public Be Damned,” Oral Hygiene 1 [August 1911]: 592.)
33. Russell Cool, “Popular Dissemination of Dental Knowledge,” as published by The
Pacific Stomatological Gazette 4 (August 1896): 349.
34. J. Percell Corley, “Popular Dental Education,” as published by The Dental Cosmos
43 (January 1901): 33.
35. C. E. Post, commenting on Frank Platt, “Dentists as Public Educators,” as published by The Pacific Stomatological Gazette 4 (October 1896): 446.
36. E. M. Wolfe, commenting on H. H. Harrison, “Popular Dental Education,” as published by The Ohio Dental Journal 16 (August 1896): 381.
37. On human waste and insects, see Tomes, The Gospel of Germs.

Notes to Pages 24–31

187

38. George Edwin Hunt, “The Economic Value of Clean Mouths,” as published by Oral
Hygiene 2 (November 1912): 861.
39. Richard Grady, “Cooperation of the Public Schools in Teaching ‘Good Teeth, Good
Health,’” as published by The American Journal of Dental Science 35 (August
1904): 143.
40. Mrs. Hubert W. Hart, “Working Out the Details of a Preventive Dental Clinic for
School Children,” as published by The Dental Cosmos 57 [October 1915]: 1129.
41. Hardisty, “Oral Hygiene in Our Public Schools,” 951.
42. Alfred Fones, “A Plan that Solves the Fundamental Problem in School Hygiene,”
as published by Oral Hygiene 4 (January 1914): 10.
43. E. Burton Newell, “A General Appeal to Citizens For Cooperation In Restoring to
Health the Diseased Mouths of Our School Children,” as published by The Dental Brief 17 (September 1912): 704. On “schoolroom poisoning” as described by
school medical inspectors, see Richard Meckel, “Going to School, Getting Sick:
The Social and Medical Construction of School Diseases in the Late Nineteenth
Century,” in Markel and Stern, eds, Formative Years, especially pages 195–198.
44. Cool, The Pacific Stomatological Gazette 4: 346.
45. “The First ‘Mouth Hygiene’ Mass Meeting in History Held at Convention Hall,
Rochester, NY,” The Dental Brief 16 (January 1911): 61.
46. Cool, Pacific Stomatological Gazette 4: 347. For more on gold dental work and
dentists’ beliefs about it, see chapter 7.
47. Richard Grady, “Oral Hygiene for the School Boy and Girl,” as published by The
Dental Cosmos 46 (February 1904): 133.
48. Ibid., 134–135.
49. “National Dental Association Committee on Oral Hygiene in Public Schools: An
Appeal for Co-Operation,” The Dental Cosmos 44 (April 1902): 401.
50. See, for example, “ ‘Mouth Hygiene’ Mass Meeting,” 60–63, and Arthur H. Merritt, “The Dental Clinics of the Children’s Aid Society,” Oral Hygiene 1 (December
1911): 911–918.
51. “The Forsyth Dental Infi rmary for Children,” The Dental Brief 16 (April 1911):
266.
52. Ibid., 264
53. “Dedication of the Forsyth Dental Infi rmary,” Oral Hygiene 5 (January 1915): 15.
54. Ibid., 18.
55. Ibid., 20.
56. Ibid., 21.
57. Ibid., 21.
58. Ibid., 13.
59. Ibid., 14.
60. Ibid., 15.
61. Ibid., 17.
62. Ibid., 21.
63. George Wood Clapp, “The Rise and Fall of Oral Hygiene in Bridgeport (First Article),” Dental Digest 34 (January 1928): 2.
64. Ibid., 5.
65. Ibid.
66. Ibid., 7.

188

Notes to Pages 32–37

67. Southard, the mother of dental assisting, managed to seal her reputation as a dental assistant of unquestionable loyalty and devotion to the profession by dying of
a heart attack while attending a banquet of the Florida Dental Assistants’ Association on November 12, 1940. The ADAA commemorated her birthday for many
years thereafter. “A Gallant Little Lady Passes On,” The Dental Assistant 10 (January-February 1941): 3.
68. Neville S. Hoff, “How Shall the Profession Meet Its New Obligations Resulting
from Its Propaganda for Popular Education in Oral Hygiene and Preventive Dentistry?” as published by The Dental Cosmos 54 (July 1912): 784.
69. Ibid.
70. Grace P. Rogers, “The Graduate Dentist Versus the Dental Nurse,” Dentist’s Magazine 1 (June 1906): 649.
71. Ibid.
72. Thomas Barrett, “A New Species of Dentist: Do We Want It?” as published by The
Dental Cosmos 61 (December 1919): 1207, and H. J. Burkhart, cited by Harry Beck in
his letter to the editor of The Dental Cosmos 62 [March 1920]: 387, respectively.
73. Raymond Albray, “Do We Need a Dental Nurse or Something to Talk About?” New
Jersey Dental Journal 1 (September 1912): 274–275.
74. Barrett, “A New Species of Dentist: Do We Want It?” 1207.
75. Beck to the editor of The Dental Cosmos 62: 387.
76. Dental assistants did so in 1924; hygienists, in 1923.
77. George Wood Clapp, “The Rise and Fall of Oral Hygiene in Bridgeport (Second
Article),” Dental Digest 34 (February 1928): 91
78. George Wood Clapp, “The Rise and Fall of Oral Hygiene in Bridgeport (Third Article),” Dental Digest 34 (March 1928): 172
79. George Wood Clapp, “The Rise and Fall of Oral Hygiene in Bridgeport (Fourth
Article),” Dental Digest 34 (April 1928): 252–253.
80. Hart, “Working Out the Details,” 1129
81. Ibid., 1130.
82. Ibid., 1130.
83. Rose House, “Work of the Preventive Dental Clinic in the Bridgeport Public
Schools,” as published by The Dental Cosmos 57 (October 1915): 1133. There was
no indication of whether the teachers had volunteered, or the school principal
had commandeered, the room for this use.
84. For “missionaries to the home,” see Clapp, “Rise and Fall (Fourth Article),” 258.
For “the Gospel of clean mouths,” see Hart, “Working Out the Details,”1131.
85. Hart, “Working Out the Details,” 1130–1131.
86. Clapp, “The Rise and Fall (Fourth Article),” 258.
87. House, “Work of the Preventive Dental Clinic,” 1135.
88. Ibid., 1136. The New York City children serviced by the Children’s Aid Society
clinic, “whose parents are too poor to send them to the public schools,” were
similarly appreciative. One “was a small, bright-looking boy, who pleaded so hard
to be taken in that he was told that if he would wait until all the other children
in attendance that day had been cared for . . . he might receive treatment. This
boy lived in the Bronx and traveled nearly ten miles each way in coming to the
clinic.” Arthur H. Merritt, “The Dental Clinics of the Children’s Aid Society,”
Oral Hygiene 1 (December 1911): 911–918. (914)
89. Clapp, “The Rise and Fall (Fourth Article),” 258.

Notes to Pages 37–43

189

90. Hart, “Working Out the Details,” 1130.
91. Ibid., 1131–1132.
92. George Wood Clapp, “The Rise and Fall of Oral Hygiene in Bridgeport (Fifth Article),” Dental Digest 34 (May 1928): 320–321
93. Ibid., 322.
94. George Wood Clapp, “The Rise and Fall of Oral Hygiene in Bridgeport (Eleventh
Article),” Dental Digest 34 (November 1928): 781.
95. Richard Grady, “Cooperation of the Public Schools in Teaching ‘Good Teeth, Good
Health,’” as published by American Journal of Dental Science 35 (August 1904):
141.
96. Luther Gulick, “Why 250,000 Children Quit School,” Oral Hygiene 1 (January
1911): 20, 22.
97. M. Evangeline Jordan, “Teeth and Taxes,” Dental Digest 20 (February 1914): 114.
98. Otto King, “Oral Hygiene and Its Relation to Public and Individual Health,” as
published by the Journal of the National Dental Association 4 (February 1917):
149.
99. H. C. Brown, “Attitude of the State Government toward Public Health,” as published by The Dental Brief 15 (July 1910): 575.
100. Other examples of stories directed at children included George Cunningham’s
lecture, “My Hobby,” in which he proposed that members of his child audience
consider making a hobby of dental care. “One good thing about making a hobby of
your teeth,” he said, “is you always carry your collection about with you” (George
Cunningham, “My Hobby,” Oral Hygiene 4 [December 1912]: 1036). The production of materials in this genre extended over an extremely long interval; see, for
example, not only the playlets listed here, but the stories “The Cave People” and
“The Twins” (the latter about central incisors), published in 1932, and the playlet
“Grandfather Molar,” of the same year. (Elma Miller, “The Cave People,” Dental
Digest 38 (February 1932): 71–72; “The Twins,” Dental Digest 38 (March 1932):
pages unknown; and Lon Morrey, “Grandfather Molar: A Dental Health Playlet,”
Dental Digest 38 (July 1932): 244–249.)
101. Evelyn Wright Nelson, “Mouth Hygiene: A Health Symposium Playlet for Young
People,” Oral Hygiene 3 no. 12, (December 1913): 969.
102. Ibid., 970.
103. Ibid., 970.
104. Ibid., 973
105. Ibid.
106. Ibid., 968.
107. Ibid.
108. Ibid., 971.
109. “Good Teeth for School Children,” as reprinted in The Dental Brief 16 (March
1911): 219.
110. Charles Wolff, “Dentistry for the Rich and the Poor,” Dental Digest 26 (March
1920): 139.
Chapter 2 — Diet and the Dental Critique of American Life
1. As Diane Paul argues, “In the United States, Canada, Britain, and much of Europe,
the concept of genetic perfectibility underlay some of the most sharply defi ned
fissures in the intellectual and moral landscape. . . . We now know that eugenics

190

2.
3.
4.
5.
6.
7.
8.
9.

10.
11.
12.
13.
14.
15.
16.

Notes to Pages 43–46

was a more diverse movement, enjoying much broader political support, than
one would imagine from conventional accounts” (Diane Paul, Controlling Human
Heredity: 1865 to the Present [Atlantic Highlands, NJ: Humanities Press, 1995]: 2,
19). For more on the scientists who were involved in the study of human heredity,
and on the political, cultural, and health-care manifestations of this interest, see
also Daniel J. Kevles, In the Name of Eugenics: Genetics and the Uses of Human
Heredity (Cambridge, MA: Harvard University Press, 1985), Alan M. Kraut, Silent
Travelers: Germs, Genes, and the “Immigrant Menace” (Baltimore: Johns Hopkins
University Press, 1994), and Martin S. Pernick, The Black Stork: Eugenics and the
Death of “Defective” Babies in American Medicine and Motion Pictures Since 1915
(New York: Oxford University Press, 1996).
Eugene Talbot, “Dental and Facial Evidences of Constitutional Defect,” as published in The International Dental Journal 17 (May 1896): 269.
Ibid., 263.
Eugene Talbot, “Laws Governing Eugenesis: A Thirty-five Years’ Study of Developmental Pathology,” The Dental Era 4 (June 1905): 298.
Eugene Talbot, “Stigmata of Degeneracy in Relation to Irregularities of the Teeth,”
as published by Dental Review 16 (March 15, 1902): 192.
Eugene Talbot, “The Degenerate Jaws and Teeth,” as published by The International Dental Journal 18 (February 1897): 80.
Eugene Talbot, “Anatomic Changes in the Head, Face, Jaws, and Teeth in the Evolution of Man,” as published by Dental Digest 10 (December 1904): 1422.
Talbot, “Stigmata of Degeneracy in Relation to Irregularities of the Teeth,” 192.
Talbot, “Anatomic Changes in the Head, Face, Jaws, and Teeth,” 1430. At other
times, Talbot added “hysterics, liars, pessimists, and sentimentalists” to the list.
See, for example, Talbot, “Stigmata of Degeneracy in Relation to Irregularities of
the Teeth,” 191.
O. A. Weiss comments on Talbot, “Stigmata of Degeneracy in Relation to Irregularities of the Teeth,” 219.
Eugene Talbot, “Constitutional Causes of Tooth Decay,” as published by Dental
Digest 9 (December 1903): 1436.
Eugene Talbot, “Developmental Pathology and Tooth Decay,” as published by The
Dental Cosmos 47 (December 1905): 1436.
Talbot, “Laws Governing Eugenesis,” 299.
Talbot, “The Degenerate Jaws and Teeth,” 76.
Eugene Talbot, “My Fifty-three Years of Professional Life,” The Pacific Dental
Gazette 30 (July 1922): 391.
Talbot, “Anatomic Changes in the Head, Face, Jaws, and Teeth,” 1424. “Ordinary”
consanguineous marriage, Talbot believed, could be practiced without impunity
if one were confident that one’s genetic inheritance was absolutely sound: otherwise he considered it wiser to seek a mate outside of one’s own family tree.
“Socially” consanguineous marriages, in which partners had been “living under
similar conditions, habits, and surroundings, laboring at the same occupation,
[and] indulging in the same dissipation . . . [which] tend to engender like diseases and degenerations irrespective of any blood relationship,” could be just
as unwise as “ordinary” consanguineous marriages, and Talbot advised against
them. “[Social consanguinity] has largely aided real or family consanguinity in
the production of the diseases and degenerations which have so heavily fallen

Notes to Pages 46–50

17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.

28.

29.
30.
31.

32.
33.

34.

191

upon the aristocracies and royal families of Europe.” (Eugene Talbot, “Social Consanguinity, Near Kin, Early and Late Marriage,” International Dental Journal 22
[May 1901]: 299.)
Talbot, “Anatomic Changes, in the Head, Face, Jaws, and Teeth,” 1426.
Hect Boethius quoted by Burton (Anatomy of Melancholy, 1652), as cited by Talbot, “Anatomic Changes in the Head, Face, Jaws, and Teeth,” 1425.
“Dr. Channing,” comments on Talbot, “Social Consanguinity, Near Kin, Early and
Late Marriage,” 449.
Ibid., 451.
Ibid., 450.
F. G. Corey, “Physical Conditions,” Western Dental Journal 20 (December 1906): 836.
F. G. Corey, “ ‘Making Good,’ (The Physical Conditions of the Teeth),” as published
by Western Dental Journal 20 (August 1906): 536.
Ibid., 535.
Ibid., 535.
Ibid., 539.
C. A. Martin, comments on F. G. Corey, “’Making Good,’” 540. The dentist ceded
absolutely no ground on the issue of miscegenation, though: “For myself,” he concluded, “I think there are plenty of physically perfect people of my own race and
color to take car [sic] of my posterity, and I do not care to have my blood mixed up
with a little off-color.”
As Laura Shapiro has observed of a weekly menu devised by such zealots, “To
balance a meal by numbers alone, ignoring taste and texture, meant that creamed
potatoes, creamed vegetable soup, macaroni with cream sauce, salad with a
creamy dressing, and gelatin with cream were all listed on the menu [on the same
day].” Mathematical thinking about food—together with an acknowledgment of
Americans’ world-renowned taste for sweets—also led the Boston Cooking School
Magazine to recommend frosting sandwiches for children’s lunchboxes in 1898.
Laura Shapiro, Perfection Salad: Women and Cooking at the Turn of the Century
(New York: Farrar, Straus, Giroux, 1986): 209, 211.
Harvey Levenstein, Revolution at the Table: The Transformation of the American
Diet (New York: Oxford University Press, 1988): 31.
Harvey Levenstein, Paradox of Plenty: A Social History of Eating in Modern America (New York: Oxford University Press, 1993): 27.
Levenstein, Revolution at the Table, 87. Widely acclaimed for his physical stamina
(in 1902, “the five-foot-six Fletcher had climbed the 854 steps of the Washington
Monument and then bounded down them without resting”), Fletcher won the
attention of many prominent Americans, including the Army Chief of Staff and
the eminent Yale professor of physiology Russell Chittenden, to whom Fletcher
sent his odorless stools through the US mail (evidence, he alleged, of the particularly complete digestion begun by thorough chewing). Ibid., 88.
As cited in Shapiro, Perfection Salad, 213.
See, for example, Regina Kunzel, Fallen Women, Problem Girls: Unmarried Mothers and the Professionalization of Social Work, 1890–1945 (New Haven: Yale University Press, 1993).
“A prime objective,” Levenstein writes of the social workers’ approach to Mexican
Americans, “was to convince them to abandon the traditional Mexican sauces
(whose tomatoes and chiles provided vitamins and whose nuts and cheese pro-

192

35.

36.

37.

38.
39.
40.
41.
42.
43.
44.

45.
46.
47.
48.
49.
50.

Notes to Pages 50–54

vided protein, calcium, and vitamins) in favor of only two sauces: White Sauce,
consisting of flour, butter and milk, and Hard Sauce, mainly sugar and butter.”
Levenstein, Revolution at the Table, 157.
This was at least partly because of the centrality of food to Italian Americans’
ethnic identity, and partly due to nutritionists’ promotion of pasta as an economical source of protein during the Depression. On the resistance to assimilation
of Italians, see Hasia R. Diner, Hungering for America: Italian, Irish, and Jewish
Foodways in the Age of Migration (Cambridge: Harvard University Press, 2001),
especially the comment of Saul Alinsky that “these Welfare workers would get
upset because poor Italian families insisted on buying very good olive oil to cook
with . . . Italians have to have olive oil . . . it’s something much more important
than budgets or stuff like that” (56). Nevertheless, as Harvey Levenstein points
out, “The versions [of Italian foods] served were very much adapted to American tastes. Rarely did recipes for tomato-based sauces call for even a scrap of
the dreaded garlic clove. Good Housekeeping’s recipe for spaghetti and meatballs
called for beef suet, horseradish, and ‘bottled condiment sauce’ in the meatballs,
but no garlic in the accompanying tomato sauce. . . . For its version of that dish,
American Cookery had cooks flavor two cans of tomato soup with a tablespoon of
Worcestershire sauce. . . . Some people . . . even used ketchup as the tomato sauce,
as did the US Army” (Levenstein, Paradox of Plenty, 30).
On infant feeding and its relationship to infant mortality, see Richard Meckel,
Save the Babies: American Public Health Reform and the Prevention of Infant Mortality, 1850–1929 (Baltimore: Johns Hopkins University Press, 1990), especially
chapter 3, “Pure Milk for Babies: Improving the Urban Milk Supply.”
Mellin’s Food even advertised to physicians its “NEW labels . . . NO directions” in
a 1932 volume of the Journal of the American Medical Association. Rima Apple,
Mothers and Medicine: A Social History of Infant Feeding, 1890–1940 (Madison:
University of Wisconsin Press, 1987): 91.
Ibid., 107.
Rima Apple, Vitamania: Vitamins in American Culture (New Brunswick, NJ: Rutgers University Press, 1996): 6.
T. E. Powell, comments on A. B. Spach’s “Diet in Health and Disease,” as published by Dental Review 19 (June 15, 1905): 564.
B. J. Cigrand, comments on Spach’s “Diet in Health and Disease,” 571.
On public health officials and food regulation, see Meckel, Save the Babies, 67.
B. J. Cigrand, “Diet, Dentures and Disposition,” Dental Review 18 (February 15,
1904): 147.
Alfred W. McCann, “Agriculture or Human Culture—Which?” as republished by
Dental Digest 25 (August 1919): 505. (Originally published in the New York Globe,
no date given.)
M. Evangeline Jordon, “Feeding the Child from the Standpoint of a Dentist,” as published by the Journal of the American Dental Association 10 (August 1923): 743.
Guy A. Woods, discussion of Jordon, “Feeding the Child,” 748.
W. H. Card, discussion of Jordon, “Feeding the Child,” 749.
Paul A. Barker, discussion of Jordon, “Feeding the Child,” 749.
(Author’s name withheld), “A Dentist’s Wife and His Health,” Dental Digest 28
(November 1922): 741–743.
“Educating the Public,” Dental Digest 28 (November 1922): 740.

Notes to Pages 54–57

193

51. C. Frank Bliven, comments on H. D. Perky’s paper “Nutrition as a Tooth-Builder,”
as published by The Dental Cosmos 43 (June 1901): 671.
52. Gustave Wiksell, “Hammer and Nails,” as published by The Dental Cosmos 44
(August 1902): 869.
53. C. P. Webster, “One Cause of Dental Degeneration: The Physical Relation of Food
to the Teeth,” The Dental Cosmos 40 (February 1898): 139.
54. H. T. Harvey, “Toothless Twentieth Centenarians; or, Vegetarianism, Which?”
Ohio Dental Journal 19 (February 1899): 119.
55. Cigrand, “Diet, Dentures and Disposition,” 108.
56. H. D. Perky, “Nutrition as a Tooth-Builder,” as published by The Dental Cosmos 43
(June 1901): 671.
57. “A Chemist’s Adventure in ‘Jam,’” Dental Digest 28 (May 1922): 340.
58. Spach, “Diet in Health and Disease,” 529.
59. “We Must Win!” Dental Digest 24 (June 1918): 449. The failure to capitalize the
initial “g” in “german” was intended as an intentional snub.
60. Wiksell, “Hammer and Nails,” 869.
61. C. Frank Bliven, comments on Perky, “Nutrition as a Tooth-Builder,” 671.
62. Wiksell, “Hammer and Nails,” 870.
63. “Dr. Barrett,” comments on Wiksell, “Hammer and Nails,” 872. Barrett pointed
out, with some disdain, that a late member of the Northeastern Dental Society had
made a similar presentation on the evils of refi ned flour at every meeting of the
organization.
64. Ibid., 871. Complaints about dietary faddism recurred frequently, sometimes
inspiring harsh words at dental society meetings. In 1905, one dentist decried the
“raw food mania,” saying that “Some freak like Dowie or Mrs. Eddy had a dream
that raw food is the thing and nature’s only way, tried it upon himself and thought
he found it good, and induced others to do the same” (Spach, “Diet in Health and
Disease,” 527). In response, another dentist demanded to know “what relation
Mrs Eddy bears to the subject-matter of the paper,” and whether Spach had ever
actually read Mary Baker Eddy’s magnum opus, “Science and Health.” (“(These
questions were not answered),” the editors reported.) (C. F. Hart, comments on
Spach, “Diet in Health and Disease,” 570.)
65. Albert B. King, “Bakers’ Bread as a Factor in Inducing Dental Caries,” as published
by The Dental Cosmos 55 (May 1913): 510.
66. Cigrand, “Diet, Dentures, and Disposition,” 102. Another writer described his
hope that a change in the American diet would cause Americans to “lose our
reputation abroad as being people who are suffering from dyspepsia, or the ‘Yankee disease’”: it is not entirely clear whether it was the dyspepsia or the decay
itself that was known as the “Yankee disease” (Ibid. 138). Arthur D. Black, son of
the legendary Illinois dentist Greene Vardiman Black (who had innovated new
methods of preparing cavities for fi lling, and who invented the foot-treadle dental
drill), disputed Cigrand’s claim that dyspepsia could cause tooth decay: “I do
not believe that eructations of acids into the mouth, no matter how frequently,
would be a primary cause of caries of the teeth,” Black argued. He endorsed H. T.
Harvey’s earlier and less direct connection between dyspepsia, a poor constitution, and dental decay: “Caries of the teeth in such cases occurs more particularly
from the general condition of the body, making the person more susceptible to the
disease” (Arthur D. Black, comments on Cigrand, 146).

194

Notes to Pages 57–59

67. “Candy on the Grill: Enquiry by Dr. H. G. Harvitt Decries Candy-Eating as Dangerous,” Dental Digest 28 (April 1922): 273–274. The Digest described Harvitt’s
survey, which was mailed to twenty American dentists, as “unbiased in its wording, covering these two questions: 1. What does your experience show to be the
effect of excessive candy-eating on teeth not cared for regularly? 2. What can you
suggest to offset the evil inherent in the situation?” Two specialists nevertheless
found room to express their opinion that “candy is an important element of the
diet and is conducive to general and dental health,” a fact which the Digest editors
reported without comment other than its placement in the midst of an otherwise
resounding verbal trouncing of the candy habit. (Ibid, 274).
68. Jordon, “Feeding the Child,” 746.
69. Anna De Planter, “Nutrition: Its Relation to Mouth Hygiene,” as published by The
Dental Cosmos 65 (November 1923): 1177.
70. Lou Lombard, “Spare the Sweets and Save the Teeth,” Journal of the American
Dental Association 11 (December 1924): 1246–1247. Public schools’ practice of
permitting the sale of candy—in some cases, it seems, the school doing the selling itself—seemed to Lombard to require explanation. Then as now, the need to
raise money for the school was the chief justification for the practice: Lombard
listed “playground apparatus; victrola; money for graduation; milk for children
who cannot afford to buy it; tables and chairs for use in the lower grades; a trip
to Washington; a medicine cabinet” as among the schools’ needs. “These may all
be very desirable and necessary, but is there no other way to get them?” he asked.
(Ibid, 1248.) Modern schools have been every bit as unsuccessful in fi nding “some
other way to get” such items: for more on public schools’ collaboration with producers of junk food in the 1990s, see Marion Nestle, Food Politics: How the Food
Industry Influences Nutrition and Health (Berkeley: University of California Press,
2002), especially chapter 9, “Pushing Soft Drinks,” in which Nestle describes the
“pouring rights” contracts that major soft drink producers have negotiated with
American school districts.
71. Harvey, “Toothless Twentieth Centenarians,” 120–121.
72. J. F. Teufert, “Diet,” Oral Hygiene 1 (September 1911): 655.
73. Editor’s introduction to Teufert, “Diet,” 654.
74. G. A. Ostermeier, “One Swallow Made an Eternity,” Oral Hygiene 1 (September
1911): 666.
75. Spach, “Diet in Health and Disease,” 526.
76. Ibid., 527.
77. Charles Cochrane, “The Crime of Uneducated Eating,” Western Dental Journal
21 [orig. Metropolitan Magazine] (October 1907): 738. Dentists also considered
farmers’ “habits of eating” off-limits to dentists themselves: “The dentist should
take a light lunch, and, in my judgment, a comparatively light breakfast; but he is
free to take the greater part of his food at the evening meal, when he is supposed
to have his evening free from the more strenuous activities of mind and body,”
argued Frederick Noyes in 1905. “They need something, but they do not need a
heavy meal at noon, because they must go back to the acute concentration of mind
necessary for the rapid execution of detailed performance, which is impossible
without a strong supply of blood in the central nervous system” (Frederick B.
Noyes, comments on Spach, “Diet in Health and Disease,” 567–568).

Notes to Pages 59–67

195

78. C. P. Pruyn, comments on Cigrand, “Diet, Dentures and Disposition,” 143.
79. “Prof. Sedgwick,” “The Real American Peril,” Dental Digest 24 (July 1918):
448–449.
80. J. P. Buckley, “Address of the President of the American Dental Association,” as
published by the Journal of the American Dental Association 10 (November 1923):
994.
81. S. C. Sims, “The Importance of Diet in the Maintenance of a Healthy Condition of
the Oral Cavity,” as published by Dental Review 19 (January 15, 1905): 18
82. Clarence H. Wright, comments on Spach, “Diet in Health and Disease,” 571.
83. Ibid., 571.
84. “A Member of the Rochester Dental Society,” “The Story of Tim (Continued from
January Issue),” Dental Digest 17 (February 1911): 116.
85. Ibid., 116.
86. McCann, “Agriculture or Human Culture—Which?” 506.
87. “The Story of Tim,” 116.
88. On Darwin’s and Galton’s views, see Paul, Controlling Human Heredity, especially
chapter 2, “Evolutionary Anxieties.”
89. Harvey, “Toothless Twentieth Centenarians,” 120.
90. Frederick B. Noyes, comments on Spach’s “Diet in Health and Disease,” 566.
91. Teufert, “Diet,” 655.
92. Sim Wallace, “Why Our Civilization Has Given Us Poor Teeth,” American Dental
Journal 10 (January 15, 1913): 328.
93. Ibid., 328, 330.
94. “Raw Carrots as an Important Factor in Dental Hygiene,” The Dental Cosmos 55
(February 1913): 208.
95. Buckley, “Address of the President,” 995.
96. Jordon, “Feeding the Child,” 743.
97. L. O. Frech, comments on Lydia Roberts, “Better Nutrition of Children,” as published by the Journal of the American Dental Association 10 (December 23): 1134.
98. Clara Davis, “A Report on the Self-Selection Diet Experiment in Infants and Young
Children,” Journal of the American Dental Association 18 (June 1931): 1144.
99. Ibid., 1148, 1151–1152. On weight gain as a measure of infant and child health, see
Jeffrey P. Brosco, “Weight Charts and Well Child Care: When the Pediatrician Became
the Expert in Child Health,” in Stern and Markel, Formative Years, 91–120.
100. Davis, “Report on the Self-Selection Diet Experiment,” 1153.
101. Claude C. Chick, “Thoughtless Mothers,” American Journal of Dental Science 32
(March 1899): 524.
102. “The Story of Tim,” 52.
103. Alfred Fones, “Prenatal Diet and Its Relation to the Teeth,” as published in the
Journal of the American Dental Association 10 (November 1923): 1029
104. Weston Price, “Our Children: How We May Add to or Subtract from Their Inheritance,” unpublished lecture, circa 1929, pages 7, 18. Price-Pottenger Foundation
Archive, La Mesa, CA. This and all materials from the PPNF archive used with
kind permission of The Price-Pottenger Nutrition Foundation™ Board of Directors, www.ppnf.org.
105. Weston Price, Nutrition and Physical Degeneration (New York: Paul B. Hoeber,
Inc., 1935): 127.

196

Notes to Pages 67–77

106. Ibid., 116.
107. Weston Price, “Manual for Lecture #2, Descriptive Text for Numbered Illustrations, Lecture Series Reporting Light from Primitive Races on Modern Degeneration” (Cleveland: Dental Research Laboratories [self-published], no date available):
12.
108. Weston Price, “Why Dental Caries with Modern Civilizations? Field Studies
among the Polynesians and Melanesians of the South Sea Islands,” Dental Digest,
May 1935: 164.
109. Price, Nutrition and Physical Degeneration, 193.
110. Ibid., 193.
111. Letter of Norman Price, MD, to Weston Price, July 11, 1939, File: “Price Correspondence,” Price-Pottenger Foundation Archive, La Mesa, CA.
112. Ibid.
113. Price, Nutrition and Physical Degeneration, 211.
114. Price, “Why Dental Caries with Modern Civilizations?” 193.
115. More recently, renewed interest in the deficiencies of the American diet, and
Michael Pollan’s book The Omnivore’s Dilemma, which mentions Price’s work,
have facilitated a small boom in Price-related scholarship and advocacy. Pollan,
The Omnivore’s Dilemma (New York: Penguin, 2006).
Chapter 3 — “Like a Sugar-Coated Pill”
1. “A Japanese Office Boy Writes,” Dental Digest 27 (March 1921): 194–185.
2. Ibid., 194.
3. Dental travel writing thus reflected the characteristics that literary critic Mary
Louise Pratt has identified in travel writing more broadly: “While the imperial
metropolis tends to understand itself as determining the periphery (in the emanating glow of the civilizing mission or the cash flow of development, for example), it habitually blinds itself to the ways in which the periphery determines
the metropolis—beginning, perhaps, with the latter’s obsessive need to present
and re-present its peripheries and its others continually to itself. Travel writing,
among other institutions, is heavily organized in the service of that imperative.”
Mary Louise Pratt, Imperial Eyes: Travel Writing and Transculturation (New York:
Routledge, 1992): 6.
4. In this respect, they served a function similar to that of medical journals. See
Kenneth Ludmerer, Learning to Heal: The Development of American Medical Education (Baltimore: Johns Hopkins University Press, 1985): 87.
5. D. T. Parkinson, “Dentistry Around the World,” Oral Hygiene 17 (March 1927):
444. Parkinson was the lone dentist in the tour group, comprised of 450 undergraduates (including 50 “girls and young women”).
6. I have followed modern practices in the spelling of place names which were often
Anglicized (e.g., “Hawaii” and “Porto Rico”) by contemporaries, but have left contemporary usages intact when I have excerpted them directly.
7. H. J. La Salle, “Dental Conditions in Samoa,” Northwest Journal of Dentistry 21
(July 1933): 17.
8. S. D. Boak, “Some Observations during Three Years’ Service in the Tropics,” Dental Summary 27 (May 1907): 330.
9. “Winning Souls Through the Dental Forceps,” Dental Digest 27 (April 1921):
229–230.

Notes to Pages 77–83

10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.

30.
31.
32.
33.
34.
35.
36.

197

Ibid., 230.
“From Far India,” Dental Summary 41 (September 1921): 810.
“Wanted, Dentists in Persia,” The Dental Cosmos 63 (November 1921): 1150.
“Chinese Dentists Use Unique Methods,” Oral Hygiene 10 (June 1920): 854.
Walther Buchler, “Dentistry in India,” Dental Digest 37 (March 1931): 170.
“Dentistry in Hongkong,” Western Dental Journal 30 (May 1916): 49.
Boak, “Some Observations during Three Years’ Service in the Tropics,” 257.
James H. Howell, “Dentistry in Northern Russia,” Bulletin of the Michigan State
Dental Society 1 (March 1919): 6.
George Cecil, “The Kaffi r Dentist,” The Dental Brief 8, no. 9 (September 1903):
528.
“A Returned Soldier,” “Filipino Dentistry,” The Dental Brief 7, no. 1 (January
1902): 76.
“Medical and Dental Practice in China,” The Dental Brief 8, no. 1, (January 1903):
32.
Weston Price, Nutrition and Physical Degeneration (New York: Paul B. Hoeber,
Inc., 1935): 118.
Cecil, “The Kaffi r Dentist,” 528.
George Cecil, “India: The Native Dentist,” The Dental Brief 7, no. 12 (December
1902): 694.
George Cecil, “Dentistry in Gibraltar and Malta,” The Dental Brief 9, no. 6 (June
1904): 355.
“A Returned Soldier,” “Filipino Dentistry,” 77.
Cecil, “The Kaffi r Dentist,” 529.
George Cecil, “Dentistry in China,” Dental Digest 28, no. 8 (August 1922): 515.
George Cecil, “Dental Surgery in India: An Awful Experience,” The Dental Brief 8,
no. 12 (December 1903): 711.
Cecil traveled widely, and spent time in several countries where the Spanish
word “siesta” would have been used to describe a midday nap. It would not have
been used by either Englishmen or Indians in this time period, however, so Cecil’s
insistence on it here suggests again his tendency to link brownness with disrespect for time—and to homogenize brownness itself quite dramatically.
Ibid., 712.
George Cecil, “The European Dentist in India and the Prospects Awaiting Him,”
The Dental Brief 7 (October 1902): 548.
Cecil, “The Kaffi r Dentist,” 529.
Cecil, “Dentistry in Gibraltar and Malta,” 355.
Cecil, “The Kaffi r Dentist,” 528.
Ibid.
The ideas that “savages” were generally less susceptible to pain than were the
“civilized” had its origins in nineteenth-century medicine: see, for example, Martin Pernick, A Calculus of Suffering: Pain, Professionalism, and Anesthesia in
Nineteenth-Century America (New York: Columbia University Press, 1985), especially chapter 7, “They Don’t Feel It Like We Do: Social Politics and the Perception
of Pain.” Alcohol use was widely understood to exert an anesthetic effect, though
greater sensitivity to pain was said to prevail among habitual inebriates deprived
of alcohol. By either theory, the “Kaffi r” would have been entitled to less sympathy from his dentist, and from Cecil.

198

37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.

52.

53.
54.
55.

56.
57.
58.
59.
60.

61.

Notes to Pages 83–90

Cecil, “The European Dentist in India,” 543.
Ibid., 544.
Ibid., 548.
Landis Wirt, “Observations of an American Dentist in India,” Dental Digest 17, no.
10 (October 1911): 621.
George Cecil, “Dentistry in the British Army,” The Dental Brief 19, no. 11 (November 1913): 625.
Ibid., 628.
George Cecil, “European Dentists in India,” Oral Hygiene 18, no. 9 (September
1928): 1692.
Cecil, “The European Dentist in India,” 549.
George Cecil, “Concerning Dentists in India,” The Dental Brief 8 (January 1903):
8.
Albert Nahas, “A Plea on Behalf of American Dentistry,” The Dental Cosmos 61,
no. 3 (March 1919): 222.
“Chinese Dentists’ Dark Ways,” Dental Digest 25 (November 1919): 675.
N. S. Jenkins, “The Influence of American Dentists upon Europe,” The Dental Cosmos 59 (February 1917): 179.
Ibid., 184.
“The Japanese Situation,” Military Dental Journal 6 (December 1923): 216.
Transcribed address of E. C. Kirk in the “Proceedings of the Connecticut Dental
Hygiene Association Fifth Annual Meeting, Bridgeport, CT, May 23–24 1919,” The
Dental Cosmos 62 (May 1920): 657.
Some historians place the Filipino death toll as high as one million, including
war-related civilian deaths due to illness, injury, and displacement. See Matthew
Frye Jacobson, “Imperial Amnesia: Teddy Roosevelt, the Philippines, and the
Modern Art of Forgetting,” Radical History Review 73 (1999): 119.
“A Returned Soldier,” “Filipino Dentistry,” 73.
Ibid., figures p. 75, 77.
“Barbarism” was one step above “savagery” in the hierarchy imagined by US
imperialists. Louis Ottofy, “The Teeth of the Igorots,” The Dental Cosmos 50 (July
1908): 687.
“A Regular,” “Teeth of the Head Hunters of Mindanao—Fantastic Designs and
Grewsome Effects,” Dental Review 18 (April 15, 1904): 319.
Ibid., 324.
Louis Ottofy, “History of Dentistry in the Philippine Islands,” The Dental Cosmos
57 (September 1905): 1098.
Ibid., 1100.
For more on the role of the Igorots in the St. Louis Exposition, see Paul Kramer,
“Making Concessions: Race and Empire Revisited at the Philippine Exposition,
St. Louis, 1901–1905,” Radical History Review 73 (1999): 74–114.
Ottofy, “Teeth of the Igorots,” 670–671. On the World’s Fair participants’ unwilling repatriation to the Philippines, see Kramer, “Making Concessions,” especially
page 106. After the St. Louis Exposition, a group of Igorot and Moros expressed,
through a translator, their interest in remaining to tour the United States in
exchange for Exposition wages and three hours of school per day. World’s Fair
officials rejected this suggestion, and tricked the group into boarding a train to
Seattle “under the guise of an outing” to the Midway at the fair.

Notes to Pages 90–93

199

62. Ottofy, “Teeth of the Igorots,” 684.
63. Ottofy reported that “It was almost impossible to secure the girls, who would run
and scream and hide.” Ibid., 674–675.
64. Ibid., 694.
65. Ibid.
66. Ibid.
67. Ibid.
68. On the origins of military governors as “Indian fighters,” see Federico Magdalena,
“Moro-American Relations in the Philippines,” Philippine Studies 44 (Third Quarter, 1996): 430. Ottofy’s commitment to the propagation of American dental standards continued after his return to the United States in 1920, when he co-founded
the International College of Dentists, an organization that sought to “study the
progress of the dental profession and distribute the information to all countries
of the world.” International health and government officials were invited to nominate for membership in the college “the ablest, most progressive, best educated,
ethical practitioner in [each] country, regardless of his place of domicile, nationality, race, color or religion.” As the College reported, “the request was so faithfully
carried out that in many instances no nomination could be made on the grounds
that, ‘There is no dentist practicing in the country who can be recommended in
accordance with the high ideals of the College.’” http://www.icd.org/history.htm,
accessed May 24, 2008.
69. See, for example, Boak, “Some Observations during Three Years’ Service,” 260–
268, especially his tale of a removable gold dental decoration being shared among
family members in Tarlac.
70. Ibid., 264.
71. Ibid.
72. Ibid.
73. Lewis Maly, “Dentistry in Morodom,” Military Dental Journal 5 (September 1922):
140.
74. Magdalena, “Moro-American Relations in the Philippines,” 437. Magdalena argues
that the Moros actually objected to Americans’ withdrawal from the Philippines
(as, he claims, did Christian Filipinos in Moro territory), and locates in the Moros’
resistance to Christian Filipino rule the origins of what he calls “the Wild, Wild
West in Mindanao” today. What was once known as Moroland is now the seat of
the Islamic fundamentalist Abu Sayyaf rebel movement.
75. The dominant “sugar factors” were the five large corporations engaged in the fractioning of Hawai’ian sugar cane into its factorial parts—molasses and a variety of
purified cane sugars. John Whitehead writes that by the 1930s, these five corporations controlled “96 percent of Hawai’i’s sugar crop as well as a substantial portion of the pineapple industry. They dominated shipping to and from the islands
through the Matson Line, and they also controlled the major wholesale and retail
mercantile functions in the islands. In addition to their dominance of the economic sphere, the Big Five exerted substantial political influence in territorial
Hawai’i through the Republican Party, which dominated the territorial legislature prior to World War II. Many of the appointed territorial governors had a connection to the Big Five fi rms as officers or investors.” John S. Whitehead, “Western
Progressives, Old South Planters, or Colonial Oppressors: The Enigma of Hawai’i’s
‘Big Five,’ 1898–1940,” Western Historical Quarterly 30 (Autumn 1999): 297.

20 0

Notes to Pages 93–101

76. F. H. Metcalf, “Honolulu as I Found It,” Pacific Dental Gazette 17 (January 1901):
20.
77. Ibid., 21.
78. Martha R. Jones, Nils P. Larsen, and George P. Pritchard, “Dental Disease in Hawaii—
Odontoclasia: A Clinically Significant Unrecognized Form of Tooth Decay in the
Pre-School Child of Honolulu,” The Dental Cosmos 72 (May 1930): 439.
79. Helen Baukin, “Kapaa School, Kauai, Hawaiian Islands,” Journal of the American
Dental Association 17 (February 1930): 360.
80. Ibid., 361.
81. Ibid., 362.
82. Hawaii Educational Review 12 (1923): 21, as cited in B. K. Hyams, “School Teachers as Agents of Cultural Imperialism in Territorial Hawai’i,” Journal of Pacific
History 20 (October 1985): 217.
83. Ibid., 205.
84. Ibid., 362. Hawai’i was neither a sovereign nation nor a state in this period, but
Baukin apparently regarded its status as a US territory as temporary: hence her
belief that the United States was, for purposes of patriotic displays, the “country”
of Hawai’ian schoolchildren.
85. H. Dorothy Dudley, “Dental Practice in Hawaii,” Journal of the Michigan State
Dental Society 18 (April 1936): 95. For more on the expropriation of Hawai’ian
culture, and particularly Hawai’ian music and dance, see Elizabeth Buck, Paradise Remade: The Politics of Culture and History in Hawai’i (Philadelphia: Temple
University Press, 1993).
86. Dudley, “Dental Practice in Hawaii,” 95.
87. “Bureau of Public Relations: Dental Health Education and Service for the Children
in Hawaii,” Journal of the American Dental Association 25/The Dental Cosmos
80 (November 1938): 1864–1867. The Journal of the American Dental Association
and The Dental Cosmos, the two most venerable of American dental magazines,
merged in 1937. Volume numbering and pagination, as I have used them here,
continued in series with past issues of the Journal of the American Dental Association, though 1938 issues included both sets of volume and page numbers.
88. James Voigt, “Dentistry in Hawaii,” Dental Students’ Magazine 43 (November
1964): 119–121.
Chapter 4 — “This National Stupidity”
1. Frank W. Rounds, “Democracy at the Crossroads,” New England Dental Journal 2
(April 1949): 14–15.
2. On American programs of social insurance, see Theda Skocpol, Protecting Soldiers and Mothers: The Political Origins of Social Policy in the United States
(Cambridge: Harvard University Press, 1992). On physicians’ responses to such
programs, see Paul Starr, The Social Transformation of American Medicine: The
Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Basic
Books, 1982).
3. In Roman Catholic iconology, St. Apollonia is the patroness of those with toothache. Frederick A. Keyes, “Dental Philanthropy; Its Uses and Abuses,” Oral
Hygiene 4 (February 1914): 104–105.
4. Joseph Herbert Kaufman, “Government Dentistry,” Dental Digest 25 (November
1919): 647.

Notes to Pages 101–109

201

5. Ibid., 646–647.
6. T. P. Hyatt, “The Economic Value of the Industrial Dental Clinic,” Journal of the
National Dental Association 5 (October 1918): 1050–1052, and Thaddeus P. Hyatt,
“Industrial Dentistry,” Dental Digest 26 (April 1920): 248–249.
7. Weston A. Price, “The Responsibility of the Management for the Effect of Focal
Infection (Especially Dental) on the Life, Health, and Efficiency of the Employee,”
Dental Items of Interest 47 (December 1925): 899.
8. Lee K. Frankel, “Dental Work in the Industries,” Dental Digest 23 (July 1917):
452–457.
9. George J. Krakow, “Dental Inspection of Employees in Large Corporations,” The
Dental Cosmos 58 (December 1916): 1384.
10. Ibid., 1386.
11. Frankel, “Dental Work in the Industries,” 454.
12. Louis P. Cardwell, “Industrial Dentistry,” Dental Digest 26 (June 1920): 336.
13. Frankel, “Dental Work in the Industries,” 455.
14. Arthur Williams, “Industry and the Health of the Employe,” as reprinted in the
Journal of the National Dental Association 5 (September 1918): 954.
15. As cited in Colin Gordon, Dead on Arrival: The Politics of Health Care in TwentiethCentury America (Princeton, NJ: Princeton University Press, 2003): 16.
16. For more detail on the development of health insurance plans in the 1920s and
1930s and the role of the AMA in that process, see Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making
of a Vast Industry (New York: Basic Books, 1982), especially book 2, chapter 1,
“The Mirage of Reform.”
17. A. C. Wherry, “Dentistry’s Duty to Humanity,” Dental Items of Interest 55 (July
1933): 505.
18. Elizabeth Haiken, Venus Envy: A History of Cosmetic Surgery (Baltimore: Johns
Hopkins University Press, 1997): 92. On the substitution of body modification for
religious ritual, also see Joan Jacobs Brumberg, Fasting Girls: The Emergence of
Anorexia Nervosa as a Modern Disease (Cambridge: Harvard University Press,
1988), and The Body Project: An Intimate History of American Girls (New York:
Random House, 1997).
19. Good Housekeeping 40 (June 1930): 153.
20. Ibid.
21. Betty’s Crooked Teeth (Producer unknown, circa 1937).
22. Editorial, “Pauperized by Health Service Not by Education,” Journal of the Michigan State Dental Society 15 (February 1933): 25.
23. Ibid., 26.
24. Rubin Slater, “Medicine and Dentistry, as Education, Should Be Socialized,” Dental Outlook 20 (September 1933): 391.
25. G. W. Haigh, “State Medicine: A Vanishing Bogey,” Dental Outlook 20 (October
1933): 431.
26. Slater, “Medicine and Dentistry, as Education, Should Be Socialized,” 393.
27. Haigh, “State Medicine,” 435.
28. Ibid.
29. Slater, “Medicine and Dentistry, as Education, Should Be Socialized,” 391.
30. James Howell, “Dentistry in Northern Russia,” Bulletin of the Michigan State Dental Society 1 (March 1919): 5

202

Notes to Pages 109–113

31. “Bolshevism Due to Teeth, Says Dentist,” Oral Hygiene 13 (May 1923): “Sepia Section,” unpaginated.
32. “American Dentistry in Siberia,” Dental Digest 25 (June 1919): 372.
33. Charles H. H. Ritter, “The American Plan to Guarantee Everybody Equal Opportunity to Enjoy the Blessings of Scientific Dentistry,” Journal of the American Dental
Association 20 (February 1933): 318.
34. I. A. Gershanski, “The Present State of Dentistry in Soviet Russia,” Journal of the
American Dental Association 16 (October 1929): 1871. Gershanski was a dentist
who, by 1930, was serving as fi rst assistant in the (Ukraine) Department of Social
Odontology. (George Randorf, “Odontology and Stomatology in Soviet Russia for
the Past Decade [fi fth in a series],” Dental Digest 36 [December 1930]: 784.)
35. Gershanski, “The Present State of Dentistry in Soviet Russia,” 1873.
36. Ibid.
37. Randorf,” Odontology and Stomatology in Soviet Russia,” 786.
38. Solomon Gross, “Health! Toward Economic Security,” The Dental Cosmos 78
(August 1936): 875–876.
39. Interview with Peter Swanish, “Dentistry in Soviet Russia,” Dental Digest 38 (January 1932): 27.
40. Edward Ochsner, “Social Insurance,” Northwest Journal of Dentistry 21 (January
1933): 23.
41. “Socialized Medicine,” Bulletin of the National Dental Association 8 (October
1949): 37–38. The journal of the National Dental Association was titled, variously,
the Bulletin of the National Dental Association, the Quarterly of the National Dental Association, and the NDA Journal.
42. Ochsner, “Social Insurance,” 23.
43. Douglas W. Stephens, “After We’ve Fought and Won,” Dental Items of Interest 66
(February 1944): 159–160.
44. “A War Angle in Dental Health Teaching: Danville, Pennsylvania Public Schools,”
The Journal of the American Dental Hygienists’ Association 18 (January 1944):
12.
45. Thomas L. Hagain, “Dentistry for Civilians in Wartime,” Journal of the American
Dental Association 31 (June 1944): 847, and Stephens, “After We’ve Fought and
Won,” 163.
46. Alfred J. Asgis, “Inimical to the Best Interests of the Public and the Science and
Practice of Dentistry,” Texas Dental Journal 61 (October 1943): 393. At his death,
Asgis was described as a “dynamic adversary of lower-level dentistry” and an
“opponent of commercialism.” Joseph H. Kauffman, “Alfred J. Asgis, 1893–1979,
Devoted Life to Dental Profession,” New York State Dental Journal 45 (August/
September 1979): 341.
47. Editorial, “Inimical,” Texas Dental Journal 61 (August 1943): 303.
48. Charles Hardy, “Something to Think About,” Journal of the New Jersey State Dental Society 15 (January 1944), 34.
49. Columbus Giragi, “Dental Licensing Versus Democracy,” Oral Hygiene 38 (October 1948): 1561.
50. Editorial, “Wanted: Pioneers for Dentistry’s Frontier, the Small Towns of America,” Dental Survey 22 (September 1946): 1687.
51. Dean Howard, “The Aftermath” (Meharry Medical School Commencement
Address of June 1943), as published by the Meharri-Dent 2 (December 1943): 32.

Notes to Pages 113–120

203

52. “Socialized Medicine,” Bulletin of the National Dental Association, 37–38.
53. William R. Gubbins, “Let’s Look Into This Unionism Business,” Oral Hygiene 32
(January 1942): 43.
54. Howard, “The Aftermath,” 32.
55. Alfred Asgis, “Postwar Dentistry: A Program,” Dental Items of Interest 65 (May
1943): 467.
56. Alfred Asgis, “Quality Dentistry for American Labor,” Oral Hygiene 35 (July
1945): 1193.
57. On AMA opposition to Wagner-Murray-Dingell and the Truman administration’s
health care plan, see Starr, The Social Transformation of American Medicine,
especially pages 280–289.
58. Alfred Asgis, “American Labor Wants Dental Care,” Oral Hygiene 34 (September
1944): 1459.
59. George Schneider, “A New Approach to Federal Dental Health Insurance,” Oral
Hygiene 39 (July 1949): 1068.
60. R. B. Moore, “Will Compulsory Health Insurance Fail?” Dental Students’ Magazine 27 (June 1949): 26.
61. Kenneth A. Easlick, “Milestones: A Resume of Health Laws Passed and Proposed
During the Past 40 Years,” Journal of the American Dental Association 38 (April
1949): 484, 491.
62. Max Ernst, “President’s Address, American Association of Orthodontists,” as
reprinted by the American Journal of Orthodontics 36 (November 1950): 809. The
legislation was a drastically reduced version of Wagner-Murray-Dingell. Though
some increases to a tightly circumscribed program of health insurance for the aged
were passed in 1950, Medicare would not be created as a separate program until fifteen years later (Starr, The Social Transformation of American Medicine, 280–286).
63. On postwar health-care bargaining, see Gordon, Dead on Arrival,especially pages
60–67.
64. Henry Klein, “Civilian Dentistry in War-Time,” Journal of the American Dental
Association 31 (May 1944): 660. Wartime productivity guru W. Edwards Deming,
then employed by the federal Bureau of the Budget, assisted in Klein’s research.
Chapter 5 — Behind the Fluorine Curtain
1. The characteristic stain of fluorosis was also, much less frequently (and almost
never after about 1925), referred to as “Naples stain,” because a group of Italian
immigrants from Pozzuoli, a community outside of Naples, had demonstrated
signs of the condition as early as 1901 (Bureau of Public Relations, “Endemic Dental Fluorosis or Mottled Enamel,” Journal of the American Dental Association 30
[August 1943]: 1278).
2. Frederick McKay, “Mottled Enamel: A Fundamental Problem in Dentistry,” The
Dental Cosmos 67 (September 1925): 848.
3. Ibid., 852.
4. Ibid.
5. Ibid.
6. Ibid.
7. Ibid., 855, 857.
8. “Endemic Dental Fluorosis or Mottled Enamel,” Journal of the American Dental
Association,1279.

204

Notes to Pages 121–126

9. The earliest federally funded dental research, as Ruth Roy Harris has pointed out,
was spurred by widespread interest in the phenomenon of mottled enamel. Ruth
Roy Harris, Dental Science in a New Age: A History of the National Institute of
Dental Research (Rockville, MD: Montrose Press, 1989): 45–50.
10. Letter of C. T. Messner to Hugh Cumming, July 6, 1927, National Archives and
Records Administration, RG 90 Records of the Public Health Service, Box 890,
File 0412 General (1921–1934).
11. Viron Diefenbach et al., “Fluoridation and the Appearance of Teeth,” Journal of
the American Dental Association 71 (November 1965): 1129.
12. “Endemic Dental Fluorosis or Mottled Enamel,” Journal of the American Dental
Association,1282–1283.
13. Letter of H. Trendley Dean to Hugh Cumming, December 9, 1932, National
Archives and Records Administration, RG 90 Records of the Public Health Service, Box 890, File 0412 General (1921–1934).
14. Gary Regenbaum, “The Water Fluoridation Controversy,” Dental Students’ Magazine 45 (October 1966): 88.
15. Paul Morgan, “Public Drinking Water May Fight Tooth Decay,” Dental Health 1
(November 1942): 7.
16. Committee to Protect our Children’s Teeth, Our Children’s Teeth: A Digest of
Expert Opinion Based on Studies of the Use of Fluorides in Public Water Supplies
(New York: CPOCT, 1957): 21. This disagreement about what aesthetic changes
counted as problems in need of resolution persisted. Contemplating the increase
of the Environmental Protection Agency’s “maximum allowable” fluoride level
from two to four parts per million in 1985, US Surgeon General C. Everett Koop
admitted that fluoride at such a concentration could cause aesthetic damage, but
concluded that: “It’s only cosmetic.” Dorothy Link Donohoe and Thomas L. Donohoe, Fluoride/Fluoridation: Understanding It, Updating, and Getting it Together
Now, 2nd ed. (Self-published, 1988): 93.
17. “Citizen Groups, Doctors Speak Out On Fluoridation,” Week of December 12,
1962, Wayne State University Archives of Labor and Urban Affairs and University
Archives, Cavanaugh collection, Box 82, Cavanaugh folder.
18. “Suburbs Seek to Cut City’s Water Authority,” Detroit News, March 8, 1963.
19. Speech of Maurice Reitzer, April 22, 1976, reprinted in Dental Division, Michigan
Department of Public Health, Fluoridation: Resource Guide for Speakers (Lansing:
Michigan DPH, 1981): C-6, C-2.
20. A. A. London, “Speaking Out,” National Fluoridation News 11, no. 4 (July-August
1965): 3, as cited in Gretchen Reilly, “This Poisoning of Our Drinking Water”
(Ph.D. dissertation, George Washington University, 2001).
21. Ohio Pure Water Association, “Facts about Fluoridation: Your Health and Your
Human Rights Are at Stake,” pamphlet, Wayne State University Archives of
Labor and Urban Affairs and University Archives, Cavanaugh collection, Box 82,
Folder 12.
22. Fanchon Battelle, Fluoridation Unmasked (Wisconsin, Royal Lee, 1953): 16.
23. Mary Berhnardt, “Fluoridation: How Far in 20 Years?” Journal of the American
Dental Association 71 (November 1965): 1117. See also David Ast et al., “Time
and Cost Factors to Provide Regular, Periodic Dental Care for Children in a Fluoridated and Nonfluoridated Area: Final Report,” Journal of the American Dental
Association 80 (April 1970): 770–778.

Notes to Pages 126–131

205

24. For “ghastly,” see “Endemic Dental Fluorosis or Mottled Enamel,” Journal of the American Dental Association, 1278. For reports of superoxol bleaching, see H. V. Smith
and John W. McInnes, “Further Studies on Methods of Removing Brown Stain from
Mottled Teeth,” Journal of the American Dental Association 29 (April 1942): 575.
25. Harold B. Younger, “Bleaching Mottled Enamel,” Texas Dental Journal 60 (December 1942): 469.
26. Medical-Dental Committee on Evaluation of Fluoridation, Current Status of the
Fluoridation Discussion, 2nd ed. (Boonton, NJ: MCDEF, 1963): 33.
27. F. B. Exner, “Fluoride: A Protected Pollutant/Economic Motives behind Fluoridation,” address to the Western Conference of Natural Food Associates, Salt Lake
City, Utah, October 27, 1961, as reproduced at http://www.fluoridation.com/exner.
htm, accessed July 13, 2000, emphasis in original.
28. “Two Views on Fluoridation,” circa 1963, no publication information available,
located in Wayne State University Archive of Labor and Urban Affairs and University Archive, Cavanaugh collection, Box 257, Folder 8.
29. For details, see Paul Starr, The Social Transformation of American Medicine: The
Rise of a Sovereign Profession and the Making of a Vast Industry (New York: HarperCollins, 1982).
30. “Denies Sodium Fluoride is Industry’s Waste Product,” Journal of the American
Dental Association 51 (September 1955): 373.
31. Richard Buck, “Fluoridation Education,” Dental Students’ Magazine 45 (November 1966): 140.
32. Leon R. Kramer, “A Challenge to High School Students,” Dental Health 2 (February 1943): 2.
33. “Citizen Groups, Doctors Speak Out On Fluoridation,” unidentified source
recorded in handwriting as “Week of December 12, 1962,” Wayne State University
Archives of Labor and Urban Affairs and University Archives, Cavanaugh collection, Box 82, Cavanaugh folder.
34. Letter of James H. Lincoln to Jerome P. Cavanaugh, January 2, 1963, Wayne
State University Archives of Labor and Urban Affairs and University Archives,
Cavanaugh collection, Box 82, Folder 12. On racial tension in postwar Detroit, see
Thomas Sugrue, The Origins of the Urban Crisis: Race and Inequality in Postwar
Detroit (Princeton, NJ: Princeton University Press, 1996).
35. Letter of James H. Lincoln to Jerome P. Cavanaugh, January 2, 1963.
36. William Travis, “Fluoridation Travesty,” undated news item cut from unidentified
source, Wayne State University Archives of Labor and Urban Affairs and University Archives, Cavanaugh collection, Box 257, Folder 8.
37. Letter of Mrs. McRouth to Jerome P. Cavanaugh, February 13, 1962, Wayne
State University Archives of Labor and Urban Affairs and University Archives,
Cavanaugh collection, Box 25, Folder 2.
38. “Citizens of the City of Detroit, Wayne, Oakland and Macomb Counties: Unless
You Act Promptly You Will Be Drinking Water With a Poison Chemical Whether
You Like It Or Not!” Detroit Citizens Studying Fluoridation, circa 1965, Wayne
State University Archives of Labor and Urban Affairs and University Archives,
Cavanaugh collection, Box 25, Folder 21.
39. Ibid.
40. “The P.T.A. Council and the Board of Education distributed via the school children approximately 380,000 flyers alerting parents to beware” of the confusing

206

41.
42.

43.
44.

45.
46.
47.
48.

49.

50.
51.
52.

53.

54.

Notes to Pages 132–135

wording of the ballot question on fluoridation (which would have prohibited the
fluoridation of public water supplies, meaning that a “no” vote was necessary to
express a favorable attitude towards fluoride) in Detroit in 1965. Proponents of
fluoridation won the referendum by about 6,000 votes. (William Travis, “Detroit
Gains Fluoridation,” Journal of the Michigan State Dental Association 47 [December 1965]: 355, and Martin Naimark, “Not to Be Denied,” Detroit Dental Bulletin
34 [December 1965]: 6.)
Travis, “Detroit Gains Fluoridation,” 361.
F. L. Losee, “Fluoride, Good or Bad?” Journal of the American Dental Association
69 (August 1964): 254. For more discussion of Social Security and Medicare, see
Chapter 5, and Starr, The Social Transformation of American Medicine, especially
pages 367–378, on “Redistributive Reform and Its Impact.”
Ohio Pure Water Association, “Facts About Fluoridation: Your Health and Your
Human Rights Are At Stake”.
Letter of Mrs. Roy Percy to Mayor Jerome Cavanaugh, Wayne State University
Archives of Labor and Urban Affairs and University Archives, Cavanaugh collection, Box 82, Folder 12.
“Fluoridation Wins in New York City,” Journal of the American Dental Association 68 (January 1964): 105.
F. A. Bull, “Water Fluorination Proves Its Value,” Dental Digest 55 (June 1949):
257.
W. Hume Everett, “Your Fraternity and Your American Heritage,” Texas Dental
Journal 81 (July 1963): 10, 11.
“Citizens of the City of Detroit, Wayne, Oakland and Macomb Counties.” Detroit
Citizens Studying Fluoridation. And, of course, anxiety about Detroit’s failure
to “respect city limits” reflected fears that the city’s growing racial tension and
resultant disorder would spill over into the Wayne, Oakland, and Macomb County
suburbs where former white residents of the city had fled.
Undated letter of (Mrs.) Elma Ambrose to Jerome P. Cavanaugh, Wayne State University Archives of Labor and Urban Affairs and University Archives, Cavanaugh
collection, Box 25, Folder 2.
“Citizens of the City of Detroit, Wayne, Oakland and Macomb Counties,” Detroit
Citizens Studying Fluoridation.
“Suburbs Seek to Cut City’s Water Authority,” Detroit News, March 8, 1963.
J. E. Waters in Dental Survey 29 (November 1953), as cited in William McGrath,
“The Fallacy of Fluoridation,” (Scarboro Missions pamphlet circa 1956), located
in Wayne State University Archives of Labor and Urban Affairs and University
Archives, Cavanaugh collection, Box 25, Folder 20.
Fanchon Battelle, Fluoridation Unmasked (Wisconsin: Royal Lee, 1953): 5, 7. The
specificity of Battelle’s fears, and their failure of fruition, makes them seem ludicrous in retrospect. The general suspicion that the US government might contemplate the use of chemicals for mind control was not: the Central Intelligence
Agency was then undertaking experiments with lysergic acid dimethylamine
(LSD) in an attempt to fi nd a “truth serum” that could be used on Communist
informants. (See Martin Lee, Acid Dreams: The CIA, LSD and the Sixties Rebellion
[New York: Grove Press, 1985].)
Historical, sociological, and political science studies examining the bases of
opposition to water fluoridation constituted something of a cottage industry in

Notes to Pages 135–137

55.

56.

57.

58.

59.
60.
61.

62.
63.

207

the 1960s and 1970s (though, perversely, relatively few researchers ever set out to
determine why someone might approve of water fluoridation). Two examples of
studies that include the consideration of both positions are: John E. Mueller, “The
Politics of Fluoridation in Seven California Cities,” The Western Political Quarterly 19 (March 1966): 54–67, and A. Stafford Metz, “The Relationship of Dental Care Practices to Attitude toward Fluoridation,” Journal of Health and Social
Behavior 8 (March 1967): 55–59.
In 1970, John Knutson reported that “the antifluoridationists won in almost two
thirds of the approximately 900 public referendums held in communities to determine the fate of water fluoridation” between 1955 and 1965. John Knutson, “Water
Fluoridation after 25 Years,” Journal of the American Dental Association 80 (April
1970): 767.
The claim was rendered completely in capitalized type. “Citizens of the City
of Detroit, Wayne, Oakland and Macomb Counties,” Detroit Citizens Studying
Fluoridation.
Randolph Bishop, “What Can the Public Expect of Fluorine?” Dental Health
(August, 1945): 11. The occurrence of ills attributed by an anxious public to the
effects of fluoridated water was frequently cited, always with amusement, by profluoridationists. “Almost traditional in fluoridation,” remarked Mary Bernhardt
in the Journal of the American Dental Association in 1965, “are the imaginary
ailments that affl ict persons in a community before the fluoride has been put in
the water. Complaints range from nausea to bad-tasting coffee. Even the deaths of
goldfish have been blamed on fluoridation.” [Bernhardt, “Fluoridation: How Far in
20 Years?” 1120.]
Bureau of Public Information, “Comments on the Opponents of Fluoridation,”
Journal of the American Dental Association 71 (November 1965): 1172–1173. The
list of fluoridation opponents in the article was quite comprehensive, including
both individuals and organizations, and catalogued objections to fluoridation
raised by everyone down to the John Birch Society and the Ku Klux Klan, whose
presence on the list seems to have been intended to tar everyone else by association (as the Klan was not, as even the article itself admitted, a particularly potent
antifluoridation force).
William Travis, “What Do They Say?” Detroit Dental Bulletin 34 (April 1965): 8.
William Travis, “Who Are They?” Detroit Dental Bulletin 34 (January 1965): 11.
Knutson, “Water Fluoridation after 25 Years,” 766, and William Wickers, “The
Affi rmative Case for Fluoridation,” Journal of the Tennessee State Dental Association 43 (July 1963): 221. The derisive use of the term “professional” to describe
anti-fluoridation activists suggests how fi rmly the word had become associated
with high educational and social status: antfluoridationists could be mockingly
described as “professional” precisely because they were understood by dentists to
lack hard-earned “professional” qualities, and the good judgment that came with
them.
Bernhardt, “Fluoridation—How Far in 20 Years?” 1117.
As David Chappell has demonstrated, quiet white Southern support for the
civil rights movement was critical to the movement’s success, and the influence of white and black “outside agitators,” though bitterly resented by segregationists, has been overestimated. At the time, however, the currency of the
reference was extremely powerful. See David Chappell, Inside Agitators: White

208

64.
65.
66.
67.

68.
69.
70.
71.
72.
73.
74.
75.

Notes to Pages 137–143

Southerners in the Civil Rights Movement (Baltimore: Johns Hopkins University
Press, 1994).
William Travis, “Whom Do You Believe?” Journal of the Michigan State Dental
Association 48 (April 1966): 182.
Maynard K. Hine, “Address by Dr. Maynard K. Hine, President, ADA,” Oregon
State Dental Journal 35 (June 1966): 9.
Emma Carr Bivins, “People Are Giving Us the Answers,” Journal of the American
Dental Association 71 (November 1965): 1151.
On feminist opposition to medical authority, see The Boston Women’s Health
Book Collective, Our Bodies, Ourselves: A Book By and For Women (New York:
Simon and Schuster, 1971).
Hine, “Address by Dr. Maynard K. Hine, President, ADA,” 9.
Travis, “Whom Do You Believe?” 182.
H. William Gross, “How To Take the Controversy Out of Fluoridation,” Pennsylvania Dental Journal 31 (May 1964): 144.
William Travis, “Why Not Fluoridate Milk?” Detroit Dental Bulletin 31 (July 1962):
6, emphasis in original.
Bivins, “People Are Giving Us the Answers,” 1151.
“Trenton—The All-America Fluoridated City,” Journal of the New Jersey State
Dental Society 38 (September 1966): 28–29.
“’Flora Who?’” Dental Students’ Magazine 47 (November 1968): 140.
“News of Dentistry,” Journal of the American Dental Association 71 (November
1965): 1203.

Chapter 6 — The “Satisfaction of Dentistry” and the End of Public Health
1. J. A. Salzmann and David B. Ast, “The Newburgh-Kingston Fluorine Study, IX:
Dentofacial Growth and Development—Cephalometric Study,” American Journal of Orthodontics 41 (1955): 674, as cited in J. A. Salzmann, “Fluoridation and
Changes in Orthodontic Practice,” American Journal of Orthodontics 52 (October
1966): 780.
2. Nelson Cruikshank, “Labor Looks at Dental Prepayment,” Journal of the American Dental Association 69 (August 1964): 88.
3. Colin Gordon, Dead on Arrival: The Politics of Health Care in Twentieth-Century
America (Princeton, NJ: Princeton University Press, 2003): 30.
4. See Lizabeth Cohen, A Consumer’s Republic: The Politics of Mass Consumption
in America (New York: Knopf, 2003), especially pages 408 and 409: “Increasingly
over this century, the economic behavior of consumption has become entwined
with the rights and obligations of citizenship. . . . In America . . . it was the private
consumer economy—not a welfare state, though on many occasions government
assisted—that was charged with the responsibility of fulfilling the nation’s economic obligations to its citizens.”
5. Mindblower: Dental Profession under Siege (Produced by the American Dental
Association, 1978). The film, which was under four minutes in length, consisted
of a rapidly changing montage of newspaper and magazine headlines trumpeting public anger about the high cost and low quality of health care. The musical
accompaniment was “Dueling Banjos,” a song already well-known to Americans
for its role in the soundtrack of the 1972 film Deliverance, in which the competitive

Notes to Pages 143–145

6.

7.

8.

9.
10.
11.

12.

13.
14.
15.
16.
17.
18.

19.

209

playing of the song served as a harbinger of the conflicts between civilization and
savagery that would occur later in the movie.
Robert Stinaff, “Effect of Dental Hygienists and Dental Assistants on the Production of Dental Care,” Journal of the American Dental Association 60 (January
1960): 54.
George Ward Glann, “Effect of Dental Hygienists and Dental Assistants on the
Economics and Management of the Dental Practice,” Journal of the American Dental Association 60 (January 1960): 61.
Albert Peyraud, “Glamour for the Dental Assistant,” CAL 30 (July 1967): 8–10. A
year earlier, in his address to the Wisconsin Dental Study Club, Peyraud listed
“femininity” fi rst, “education” fourth, and “good appearance” eleventh. (Albert
Peyraud, address to the Wisconsin Dental Study Club, August 17, 1966, as published by CAL 29 (October 1966): 23–24.
Peyraud, “Glamour for the Dental Assistant,” 7.
George Crane, “Are You Guilty of Psychological Malpractice?” CAL 25 (February
1963): 17.
Betty Gray, “The Other Women in Your Husband’s Life!” CAL 30 (July 1967): 20.
Gray authored a running column for dental wives that included advice on how
women could positively affect their husbands’ attitudes (and, thereby, their productivity at work and the success of their practices): one such column advised
wives to “show your affection and intelligence by looking kissable and cheerful
in your breakfast attire. If there are children to consider, keep them orderly and
agreeable. Avoid arguments and dissensions. It is your duty, dear wife, to see to
it that the family breakfast is pleasant as well as nourishing.” (Betty Gray, “The
Happy Home,” CAL 30 [November 1967]: 10.)
One exception came in 1979, in “Your Aide vs. ‘The Octopus’: How to Fend off
Unwanted Advances without Offending Patients,” which was addressed to dentists, not their assistants. (Dental Management 19 [January 1979]: 22–24.)
Cartoon, CAL 30 [July 1967]: 11.
“The Case of Fran and the Beautician’s Pay,” CAL 29 (January 1967): 21.
Ibid.
“Who Deserves More? Beautician or D.A.?” CAL 29 (May 1967): 1.
Ibid.
For examples that bracketed a forty-year span: “Previous experience in another
dental office is considered a disadvantage rather than an advantage” (C. Edmund
Kells, The Dentist’s Own Book [St. Louis: C. V. Mosby Company, 1925]: 290). And:
“If you hire a person with previous dental office experience, you may be unhappy
with her” (Harold J. Ashe, “Search for These Traits in an Assistant,” Oral Hygiene
55 [October 1965]: 49).
On teachers, for example, see Marjorie Murphy, Blackboard Unions: The AFT and
the NEA, 1900–1980 (Ithaca, NY: Cornell University Press, 1990), especially page
209: “By the late seventies, 72 percent of all public school teachers were members
of some form of union that represented them at the bargaining table. Before 1961
unions in less than a dozen school districts could claim they represented only a
small fraction of teachers.” On clerical workers, see John Hoerr, We Can’t Eat Prestige: The Women Who Organized Harvard (Philadelphia: Temple University Press,
1997).

210

Notes to Pages 146–149

20. Cyril Kanterman, “De-Sexing the Dental Office,” Dental Students’ Magazine 44
(December 1965): 223. Kanter, drawing on the extreme example of the “Playboy
bunny” to demonstrate that not all jobs ought to be open to all people, predicted
that “dentistry’s bunny problem may or may not be solved to everyone’s full satisfaction. We doubt if anybody’s bunny problem will be of easy solution” (223).
21. John C. Cushman, “Relations between Dentistry and Organized Labor—Do’s and
Don’ts in Labor Relations,” as published by the Journal of the Southern California
State Dental Association 33 (July 1965): 293.
22. Keith Sutherland, “Your Employees Need Planning—Not Unionization,” Oral
Hygiene 57 (May 1967): 59.
23. “Anonymous,” “A Disgruntled Employee Took Me to Labor Court,” Dental Economics 67 (April 1977): 91–100. “As a dentist,” he wrote, “the job of being an employer
has potential risks as threatening as negligence at the chair in the operatory. The
employee you hire could take you to court faster than any patient you will ever
see” (100).
24. “Miscellaneous,” Bulletin of the National Dental Association 12 (April 1954): 99.
25. “Great Expectations?” Bulletin of the National Dental Association 12 (January
1954): 60.
26. Ibid.
27. On affi rmative action, see Harvey Webb, “Problems and Progress of Black Dental
Professionals,” Quarterly of the National Dental Association 34 (July 1976): 148.
On Medicare, Medicaid, and federal educational aid, see James C. Wallace, “The
National Dental Association and Its Contribution to American Dentistry,” Quarterly of the National Dental Association 24 (January 1966): 44.
28. Texas Health Council, “Social Security: Facts and Fantasy,” Texas Dental Journal
80 (December 1962): 17.
29. Lloyd French, “Dentists and Social Security,” Bulletin of the National Dental
Association 16 (July 1958): 99.
30. “Editorial: For the Health Professions, A Legacy,” Quarterly of the National Dental
Association 26 (July 1968): 89.
31. “1970 NDA Annual Meeting,” Quarterly of the National Dental Association 29
(October 1970): 15.
32. Ibid.
33. John Conyers, “Black Political Strategy for 1972,” Quarterly of the National Dental
Association 30 (January 1972): 35.
34. Clifton O. Dummett, “Editorial: Professional Irresponsibility,” Quarterly of the
National Dental Association 30 (October 1971): 5.
35. See, for instance, Darlene Clark Hine’s characterization of black nurses as “more
so than any other black health-care professional, [bearing] the bulk of the responsibility to provide health-care services for, and to lift up from the bottom of the
American social scale, the entire black race.” (Darlene Clark Hine, Black Women
in White: Racial Conflict and Cooperation in the Nursing Profession 1890–1950
[Bloomington: Indiana University Press, 1989]: xvii.)
36. Caption, “Association News,” Quarterly of the National Dental Association 36
(October 1977): 25.
37. Caption, “Association News,” Quarterly of the National Dental Association
36 (April 1978): 97. The women in question may have been cast members of

Notes to Pages 150–154

38.
39.
40.
41.
42.

43.
44.
45.
46.
47.
48.
49.
50.

51.
52.
53.

54.
55.
56.
57.

211

Bubbling Brown Sugar, a musical portraying Harlem’s golden years that opened on
Broadway in 1976, but the caption did not identify the women as actresses, and
its wording seemed calculated to invoke the popular understanding of “bubbling
brown sugar” as a descriptor of black women’s sexual charm—or, indeed, of their
genitalia proper.
“She Tries to Raise “Dental IQ” in Black People,” Ebony 33 (August 1978): 138.
Ibid., 139.
“Dental Dean,” Ebony 28 (March 1973): 85.
Ibid., 85, 88, 90.
As late as 1976, Harvey Webb reported that “Despite [the ADA’s 1961 nondiscrimination directive]. . . . vestiges of racial discrimination still persist in chapters [of
the ADA] in many areas throughout the country. Some constituencies have never
accepted a Black dentist to their membership.” (Webb, “Problems and Progress of
Black Dental Professionals,” 152.)
“The Color Guard,” Journal of the American Dental Association 68 (June 1964):
136.
Richard Basch, Letter to the Editor, “On ‘The Color Guard,’” Journal of the American Dental Association 69 (August 1964): 162.
James Webb, Letter to the Editor, “A Reader Objects,” Journal of the American
Dental Association 69 (August 1964): 162.
Roger Spencer, Letter to the Editor, “Intolerance,” Journal of the American Dental
Association 69 (September 1964): 132.
Interview with Reginald Hawkins, “The Way the Color Line Cuts in Dentistry,”
Dental Management 5 (July 1965): 41.
Ibid., 46.
Editorial, “Negro Membership,” Journal of the American Dental Association 71
(August 1965): no page number.
Ibid. Of course, many of the black dentists who might have applied for membership in the ADA were, by virtue of their involvement in the NDA, already “active
members of organized dentistry.”
William Garrett, “Intraprofessional Cooperation,” Quarterly of the National Dental Association 25 (October 1966): 5–6.
Joseph L. Henry, “Where Do We Go from Here?” as published by the Quarterly of
the National Dental Association 26 (October 1967): 6.
Joseph Henry used this term to differentiate the one third of black dentists who
were paying members of the NDA—and who received its journal as part of their
membership subscriptions—from a larger imagined population of those who
merely sympathized with the organization’s aims. Henry, “Where Do We Go from
Here?” 5.
Robert Eilers, “An Independent National Agency for Dental Service Corporations?” Journal of the American Dental Association 69 (August 1964): 79.
Joseph Yany Bloom, “I Resigned from the Group Health Dental Insurance Program,” The Journal of the New Jersey State Dental Society 34 (September 1962): 17.
Ramon Tappero, “Till All Liberty Shall Be Lost,” Journal of the California Dental
Association 441 (February 1965): 23.
Wayne Speer, “The Dental Service Corporation,” Texas Dental Journal 80 (November 1962): 19.

212

Notes to Pages 154–160

58. Arthur Takamoto, Letter to the Editor, “National Association of Dental Service
Plans,” Journal of the California Dental Association 41 (February 1965): 32–33.
59. George Crane, “Are You Guilty of Psychological Malpractice? Adopt Four Sets of
‘Twins’ to Strengthen the Bulwark of Your Private Dental Practice,” CAL 25 (February 1963): 17–18.
60. Jean Waller, “Cause and Cure of the Cash Register Complex,” Dental Management
8 (December 1968): 38–41.
61. Ibid., 43.
62. H. Barry Waldman, “Must 8 specialties = 7 specialists + 1 traitor?” New York Journal of Dentistry 43 (December 1973): 315.
63. Walter Wilson, “The Future Role of Government in Dental Practice and Education,” Journal of the American College of Dentistry 40 (April 1973): 111–116, as
cited by Robert Wollman, “Current Socio-Economic and Political Changes and
Their Effects on the Future Practice of Dentistry,” Illinois Dental Journal 45
(November 1976): 561.
64. Wilson R. Flint, “President’s Address,” as published by the American Journal of
Orthodontics 36 (March 1950): 166.
65. Wollman, “Current Socio-economic and Political Changes and Their Effects,”
561.
66. Wayne Speer, “The Dental Service Corporation,” Texas Dental Journal 80 (November 1962): 19.
67. Waller, “Cause and Cure of the Cash Register Complex,” 38.
Chapter 7 — The Look of the American Mouth
1. See, for example, Sidney Kohn, “Pedodontic Progress and Cultural Advancement,” Journal of the New Jersey State Dental Society 33 (January 1962): especially
page 182, where Kohn argues “Careful attention to the dental needs of tomorrow’s
adults implies a cultural awareness on the part of a progressive profession. . . .
it becomes incumbent upon us, if we are to maintain our autonomy and rights
of self determination as a profession, to make the wisest and best possible use of
our present resources in manpower, knowledge and abilities.” Also, John Abel,
“Socioeconomic Trends Relating to Orthodontics,” as published by the American
Journal of Orthodontics 48 (December 1962): 893–899.
2. Edward Podolsky, “Teeth and Behavior in Children,” Dental Items of Interest 70
(October 1948): 1051.
3. J. A. Salzmann, “Orthodontics as a Public Health Activity,” American Journal of
Orthodontics 35 (March 1949): 180.
4. “Orthodontics: Questions and Answers,” as published by the American Journal of
Orthodontics 36 (August 1950): 621.
5. Clair Picard, “Surgical Correction of Mandibular Prognathism,” Dental Survey 40
(March 1964): 35. To the best of my knowledge, I am unrelated to this author.
6. Harold Born, “Aids in Case Presentation,” as published by the American Journal
of Orthodontics 46 (February 1960): 110. Born recommended that orthodontists
try to fi nd at least one of the child patient’s facial features to compliment. “When
you really get hard up with respect to fi nding some nice feature to mention, other
than to say that the patient has two eyes or a head, you can always fi nd a feature
that is simliar [sic] to either the father or the mother and mention it. This does not

Notes to Pages 160–163

7.
8.
9.
10.

11.
12.

13.

14.
15.
16.

17.
18.
19.
20.

213

necessarily mean that you like the feature, but you can rest assured that it will not
displease the parent you are referring to” (111).
Ibid., 111.
Henry Lerian, “Facial Esthetics in Orthodontic Treatment,” International Journal
of Orthodontics 6 (December 1968): 99.
Neil Sushner, “A Photography Study of the Soft-Tissue Profi le of the Negro Population,” American Journal of Orthodontics 72 (October 1977): 373.
For example, see interview with Charles Post, “Art, Children, Dentistry: A Satisfying Combination,” Dental Student 52 (December 1973): 48. “There’s something
artistic about dentistry,” said Post, an orthodontist, “and that ties in with my
natural proclivity towards art.”
Personal communication to the author.
“A cheerful greeting should be extended to the child and the parent, and the
youngster is greeted by his fi rst name.” Jacob Stolzenberg, “Suggestion: An
Adjunct in Orthodontic Treatment,” American Journal of Orthodontics 36 (March
1950): 201.
In the 1950s and 1960s, a large body of writing formed around the intersection of
dentistry and psychoanalytic theory. In this analysis, work in the mouth threatened the child’s most primal means of obtaining pleasure, and children’s fears of
the dentist were caused by imagined psychosexual threats rather than by genuine
fears of pain. Theorists who held this view considered it especially important to
keep parents out of sight when children were receiving treatment. For example,
see Sanford Lewis, “Psychosomatic Formulations in Dentistry,” Journal of the
American Dental Association 63 (November 1961): 626–632.
R. S. Callender et al., “Orthodontic Feedback,” Journal of Clinical Orthodontics 10
(August 1976): 597.
George Anderson, “Years of Change,” as published by the American Journal of
Orthodontics 50 (July 1964): 526.
For orthodontists’ affluence, see the address of University of North Carolina
School of Dentistry Dean James Bawden, “An Outsider Looks at Orthodontics,”
as published by the American Journal of Orthodontics 53 (November 1967): 858–
859. “In looking at the specialty of orthodontics,” Bawden said, “I see a proud
tradition of men who have enjoyed a high degree of success, not only in the
treatment of their patients but also in terms of personal affluence and status.
In fact, statistics show them to have been the most affluent of all the dental
specialists.”
Charles Fitz-Patrick, “Is Dental Appearance Important in Business?” Oral Hygiene
53 (August 1963): 53–54.
Anderson, “Years of Change,” 525.
Ian Story, “Psychological Issues in Orthodontic Practice,” American Journal of
Orthodontics 52 (August 1966): 597.
“Thus, Negroes are more than 500 percent worse off in the dentist:population
ratio than the total population generally.” Joseph Henry, “Where Do We Go from
Here?” as published by the Quarterly of the National Dental Association 26 (October 1967): 7. According to figures provided by the NDA and ADA, in 2007, there
was approximately one NDA member dentist per 5,000 black Americans, and two
dentists per 5,000 persons in the American population as a whole.

214

Notes to Pages 164–169

21. US Congress, Office of Technology Assessment, “Children’s Dental Services under
the Medicaid Program—Background Paper,” OTA-BP-H-78 (Washington, DC: US
Government Printing Office, October 1990): 2–3.
22. Ibid., 1.
23. T.J.S. Ginwalla et al., “Surgical Removal of Gingival Pigmentation,” Journal of
the Indian Dental Association 38 (June 1966): 147–150, in Clifton Dummett, “Psychogenic Concomitants of Oro-Mucosal Melano-Pigmentation,” Quarterly of the
National Dental Association 27 (October 1968): 14.
24. Dummett, “Psychogenic Concomitants of Oro-Mucosal Melano-Pigmentation,”
17.
25. Ibid.
26. Advertisement: “Take a Good Look at Natural Coe-Lor,” Quarterly of the National
Dental Association 29 (April 1971): front advertising section.
27. Advertisement: “The Look is Natural When the Denture Base is Natural Coe-Lor,”
Quarterly of the National Dental Association 31 (October 1972): front advertising
section.
28. Advertisement: “New Caulk Hy-Pro Lucitone Fibered Dark,” Quarterly of the
National Dental Association 32 (April 1974): advertising section.
29. Advertisement: “Are Bioblend Teeth Just for Patients Who Wear Mink?” Quarterly
of the National Dental Association 26 (October 1967): back cover.
30. “Protection in Depth,” Ebony 16 (November 1960): 5.
31. “No One Wants to Go Round with Me,” Ebony 16 (December 1960): 7.
32. “Brush My Teeth after Every Meal?” Ebony 16 (January 1961): 29, and “Gleem,”
Ebony 16 (February 1961): 29.
33. “Your Dentist . . .” Ebony 27 (April 1972): 9.
34. “Strictly for Laughs,” Ebony 30 (March 1975): 123.
35. “Strictly for Laughs,” Ebony 31 (July 1976): 64.
36. There is also a long history of religious interest in spontaneous tooth adornment.
Reformation Christians hailed gold teeth that appeared without the ministrations
of a dentist as signs of divine intervention. And in the late twentieth century, a
group of (mostly white) charismatic Christians in Toronto seized upon the appearance of gold dental work in the mouths of some 300 of its members as evidence of
God’s special favor on both its pastor and those blessed by dental transformation.
Citing Psalm 81, verse 10 (“Open your mouth, and I will fi ll it”), Toronto Airport
Christian Fellowship Pastor John Arnott told a reporter from Christianity Today
that “this is a miracle that you don’t have to be sick to get. Almost every person
could use a little dental work of one kind or another.” (James A. Beverley, “Dental
Miracle Reports Draw Criticism,” Christianity Today 43, May 24, 1999, 17.) Arnott
allowed that some people had even been blessed with dental gold while watching
videos of the revival, which were on sale in the church’s gift shop. (CN$19.99)
(“Go For the Gold,” Toronto Airport Christian Fellowship, 1999.)
37. Hettie Jones, Big Star Fallin’ Mama: Five Women in Black Music (New York: Viking
Press, 1974): 38.
38. See, for example, Angela Y. Davis, Blues Legacies and Black Feminism: Gertrude
‘Ma’ Rainey, Bessie Smith, and Billie Holiday (New York: Pantheon Books, 1998).
39. Alan Lomax, Mister Jelly Roll: The Fortunes of Jelly Roll Morton, New Orleans
Creole and the “Inventor of Jazz” (New York: Grove Press, 1950): 154.
40. Ibid., 155.

Notes to Pages 170–177

215

41. William Eric Perkins, “The Rap Attack: An Introduction,” in Perkins, ed., Droppin’ Science: Critical Essays on Rap Music and Hip Hop Culture (Philadelphia:
Temple University Press, 1996): 2.
42. Tricia Rose, Black Noise: Rap Music and Black Culture in Contemporary America
(Middletown, CT: Wesleyan University Press, 1994): especially pages 36–38.
43. November 8, 2002, as heard on 91.7 FM WUOM.
44. “Grillz,” by D. Carter, C. Gipp, G. Hamler, C. Harris, R. Harrison, C. Haynes, A.
Jones, B. Knowles, J. Mauldin, J. Phillps, P. Slayton, and T. Williams. Copyright
© 2005 by 2 Kingpins Publishing, Air Control Music, Basajamba Music, Beyonce
Publishing, EMI April Music Inc., Hitco South, Jackie Frost Music Inc., Paul Wall
Publishing, Sam Swap Publishing, Shaniah Cymone Music, Sony/ATV Tunes
LLC, TMWilliams Publishing, Universal Music Corporation, Universal Music–
MGB Studios, and WB Music Corp.
45. Andrew Guy Jr., “Gold in the Mouth, but None in the Pocket: Employers Turned
Off by Youth Fad,” Raleigh News and Observer, October 27, 2002, page E1.
46. “That Golden Smile Likely a Drawback,” Houston Chronicle, June 15, 2001, 1.
47. Ibid.
48. “The Truth about Teeth: Gold Caps May Look Cool, But They Hide Real Trouble,”
Newsday, August 5, 1992, 25.
49. Ibid.
50. “Bill to Take Bite Out of Dental Fad,” New Orleans Times-Picayune, February 2,
1995, B4.
51. “Many Metro Teens Seek a 24K Smile: Gold Caps Popular, But Dentists Warn of
Health Concerns,” Atlanta Journal and Constitution, A1.
52. “Gold Teeth and School Decay,” Baltimore Sun, December 20, 1994, 22A.
53. Ibid.
54. “Word of Mouth Helps ‘Rapper Dentist Daddy’ Corner Flashy Market,” Wall Street
Journal, July 19, 2001, A1, A4.
55. Ibid.
56. Ibid.
57. “Naturally, All Our Kids Wear Braces,” Wall Street Journal, October 27, 1999:
A4. The ad recalled the dental journal article in which one orthodontist advised
others to “subtly point out that the good results of professional care as seen by
friends, coworkers and employers are as much a status symbol as the big car in the
driveway.” (Fitz-Patrick, “Is Dental Appearance Important in Business?” 53–54.)
Epilogue
1. “Brits Resort to Pulling Own Teeth,” http://edition.cnn.com/2007/WORLD/
europe/10/15/england.dentists, accessed October 15, 2007.
2. “Loose Talk,” US Weekly 692 (May 19, 1008): 22.
3. Claudia Kalb, “Move Over, Mona Lisa,” Newsweek, December 14, 1998, 94.
4. Karen Springen, “Million Dollar Smile,” Newsweek, March 7, 2005, 59.
5. Hilary and Piers DuPre, A Genius in the Family (New York: Vintage Press, 1998).
6. Elizabeth Hayt, “Blinding Them with Smiles,” New York Times, September 18,
2000.
7. www.blondebutbright.blogspot.com/2004_07_20_archive.html.
8. “US Dentists Can’t Make Nation’s Teeth Any Damn Whiter,” The Onion 39 (No.
15), April 23, 2003.

216

Notes to Pages 177–181

9. “Bizarro,” as published by the Ann Arbor News, October 27, 2007.
10. “Last Exit to Springfield,” original air date March 11, 1993.
11. Christopher Hitchens, “On the Limits of Self-Improvement, Part II,” Vanity Fair
(December 2007): 174–175.
12. Ian Urbina, “In Kentucky’s Teeth, Toll of Poverty and Neglect,” New York Times,
December 24, 2007, accessed on www.nytimes.com.
13. Natalie Angier, “Roots and All: A History of Teeth,” New York Times, August 5,
2003.
14. “Readers’ Poll,” Best Life (May 2008): 18.
15. As Elizabeth Haiken writes: “We have encouraged the belief that the only practical solution is the individual one. Our increasing tendency to individualize social
problems of inequality suggests just how fundamentally we have lost faith in the
possibility that commitment and collective action can transform the society in
which we live.” Elizabeth Haiken, Venus Envy: A History of Cosmetic Surgery
(Baltimore: Johns Hopkins University Press, 1997): 15.
16. Mary Otto, “For Want of a Dentist: Prince George’s Boy Dies after Bacteria from
Tooth Spread to Brain,” Washington Post, February 28, 2007.
17. Alex Berenson, “Boom Times for Dentists, But Not for Teeth,” New York Times,
October 11, 2007.
18. Otto, “For Want of a Dentist.”
19. Berenson, “Boom Times for Dentists.”
20. Ibid.
21. Steven Lauridsen, “Time for ‘No Teeth Left Behind’?” Letters, New York Times,
October 15, 2007.

Index

1918–1919 influenza pandemic, 38
acid reflux. See dyspepsia
activism, 8, 42, 134–138, 141–142, 176; of
black dentists, 147–148, 152; and collective action, 152–153
advertising, 4, 9–10, 23, 32, 85, 87, 97–98,
175, 186n32
Africa, 77, 80, 81, 82, 83, 85
African Americans, 6–7, 44–45, 111, 113,
146–152, 163–174, 180
agriculture, 59–60, 69–70
alcohol, 46, 133, 197n36
Alinsky, Saul, 192n35
Allied Expeditionary Forces, 38
Aluminum Corporation of America, 121
American Academy of Cosmetic Dentistry,
2
American Academy of Dental Science, 46
American Association for Labor Legislation, 100
American Association of Orthodontists,
115
American Dental Assistants’ Association,
36, 67, 188n76
American Dental Association, 4, 7, 9, 10,
52, 63, 66, 146, 147, 159, 176, 184; and
dental insurance, 100, 105, 114, 143, 147,
154; and fluoride, 122–123, 136, 139;
racial segregation of, 142, 146, 150–152
American dentistry, 72–74, 77–80, 141; and
business practices, 3, 9, 81–83, 98; and
colonialism, 88–92, 98; international
acclaim of, 77–78, 84–87, 175–178; and
social status of dentists, 84
American Federation of Teachers, xi–xii,
209n19
American Home Economics Association,
50
American Idol (TV show), 175
Americanization: of immigrants, 14–15, 17,
22–23, 27, 34–35, 37–38, 50, 61–62, 178

(see also assimilation of immigrants); of
Native Hawai’ians, 94–98
American Medical Association, 5–6, 100,
105, 108, 147, 201n16
Americans: attitudes toward work, 91–92,
110–111; dental health habits of, 14, 19,
39–41, 111–112, 128–129; genetic heritage of, 44, 47–48, 65; poor dental health
of, 2, 41–42, 48, 54, 79, 98; reputation for
good dental health of, 2, 39–41, 175–178
American Samoa, 67, 76
American social and economic systems,
70, 128–129, 156, 168, 170, 172–174,
208n4
anesthesia, 3, 4, 144, 197n36
Angier, Natalie, 179
Ann Arbor (Mich.), 162
anti-Communism. See Communism
anti-Semitism. See Jews
antisepsis, 3, 80
appearance, 2, 9, 14, 25–27, 74, 87, 89, 91,
106–107, 118, 120–126, 158–174; and
race, 161–174; and self-worth, 18–19,
106–107, 125, 159–160, 178–179
appetite, 59–64
apprenticeship, 5–7, 43, 80
Armour & Co., 102, 104
Asgis, Alfred, 112, 114, 115, 202n46
Asians. See Chinese; Filipinos; Indians,
Asian; Japanese
assimilation of immigrants, 11, 18, 191–
192n34, 192n35. See also Americanization
assistants, dental. See dental assistants
Ast, David, 123
atavism. See degeneracy
Atlanta Journal and Constitution (newspaper), 171
Austin Powers (fi lm series), 177–178
Australia, 68, 85
baby boom, 131, 143, 159
bacteriology, 3, 24, 49, 80

217

218

Index

Baltimore College of Dentistry, 30, 85
Baltimore Sun (newspaper), 171
Battelle, Fanchon, 206n53
Baukin, Helen, 94, 96, 200n84
Bawden, James, 213n16
Benton (Calif.), 118
Best Life (magazine), 179
Betty’s Crooked Teeth (fi lm), 107
billing, 8, 31, 73, 81, 143
Bioblend, 165–166
birth control, 68–69
Black, Arthur D., 193n66
blacks. See African Americans
Bloom, Joseph, 153
Blue Cross and Blue Shield, 153. See also
insurance
Bluitt, Juliann, 150
Boak, S. D., 91
bolshevism, 109
Bond, Julian, 148
Born, Harold, 212n6
Boston Cooking School (magazine), 191n28
Boston Women’s Health Book Collective,
208n67
braces. See orthodontics
bread, 50, 55–57, 97
Bridgeport (Conn.), 25, 30, 31, 36, 37, 38,
97, 181
Bridgeport Board of Health, 36
Britain, 110, 177, 189–190n1
Britain’s Worst Teeth (TV documentary),
175
British Army, 81, 84
British dentistry, 78, 83–86, 109, 111, 175,
177–178
Brooklyn Eagle, 40
Brumberg, Joan Jacobs, 201n18
brushing, 20–21, 36–37, 95
Bubbling Brown Sugar (musical), 210–
211n37
CAL (magazine), 144–145
candy, 57, 62, 112, 194n67, 194n70
caries. See cavities
Carnegie, Andrew, 19, 30, 185n19
Carnegie Foundation for the Advancement
of Teaching, 6
Carrington, Hereward, 58

Cavanaugh, Jerome P., 129, 130, 132, 134
cavities, 36, 42, 53, 57, 68, 79, 96, 110,
122–123, 134, 180, 193n66. See also
decay, tooth
Cecil, George, 81, 82, 83, 84, 197n29,
197n36
Central Intelligence Agency, 178, 206n53
Chappell, David, 207–208n63
charity. See philanthropy
Chick, Claude, 65
children, 1, 8–12, 14–41, 48, 51, 57, 59–66,
68, 90, 94–100, 107, 110, 112, 114, 128–
132, 143, 158–164, 172–174, 179–180; as
worthy beneficiaries of social programs,
8–9, 19, 27, 39–41, 59–60, 100–101, 107,
114, 120, 129–132, 159, 172, 179–181. See
also citizens: children as
Children’s Aid Society (New York City), 27,
188n88
Children’s Bureau, US, 19, 100
China, 76–77, 79, 81, 85
Chinese, 67, 79, 85, 94, 164
Chittenden, Russell, 191n31
citizens: children as, 15–19, 21, 130–132;
dentists as, 10, 84; literacy of, 30; obligations of, 128, 208n4; relationship to
government and philanthropy, 38–39,
109, 116–120, 129–131, 135–136, 142
citizenship, 8, 14–21, 29, 35–41, 120,
128–132, 148, 185n18, 208n4
Civil Rights Act of 1964, 145
civil rights movement, 147–148, 151–152,
207–208n63
civilization, 45, 48, 60–71, 75–76, 90,
208–209n5; American, 15, 56, 60
class, 2, 4, 8–12 passim, 34, 49, 69, 73, 84,
93, 105, 120, 148–150, 161–174 passim.
See also conspicuous consumption;
income; poverty; professionalism:
and behavior; unions; wealth; work;
workers
cleanings. See dental hygiene
Cleveland (Ohio), 14, 15, 26, 64, 66, 102, 181
Cleveland Press (newspaper), 17
clinics, industrial, 19, 32, 100–105, 108,
143. See also dental hygiene
clinics, private, 18, 27–30. See also dental
hygiene

Index

clinics, school, 11, 15, 18, 27, 37, 60, 94, 98,
102, 104. See also dental hygiene
C-Murder (Corey Miller), 172, 173
Coe Alginate Laboratories, 144, 164
Cohen, Lillian, 18
Cohen, Lizabeth, 184n19, 208n4
Colgate, 102, 167
comedy, See humor
Committee on Economic Security, 105
communicable disease, 18, 21, 25
Communism, 115–116, 129–130, 132–134,
137. See also socialism
competition, 5
conferences, 8, 35, 74, 147, 149. See also
professional associations
Connecticut Dental Hygiene Association,
86
Connecticut State Dental Commission, 36
consumer products, 106, 129, 156–157, 163,
165, 167, 175. See also Colgate; Gleem;
Listerine
consumers, patients as, 1, 13, 111, 129, 142,
156–157, 165–168, 173, 176, 184n19
consumption, conspicuous, 9, 11–12, 163,
170, 173, 184n19, 208n4, 215n57
contraception. See birth control
Conyers, John, 148
Cool, Russell, 25, 26
Corey, F. G., 47, 48, 49, 191n27
cosmetic dentistry, 2, 11, 124, 176. See also
orthodonture; tooth whitening
cosmetic surgery. See plastic surgery
Crane, George, 144
criminality, 37, 45, 50, 58, 66, 172
crown. See restoration
Cuba, 76
Cumming, Hugh, 121, 122
Cunning, Ronald, 172, 173
Cunningham, George, 189n100
Darwin, Charles, 61
Davis, Clara, 64
Dean, H. Trendley, 121, 122
decay, tooth, 2–3, 25, 79, 106, 112, 124, 130,
160, 165, 171, 176; causes of, 27, 42–49,
54, 57–71, 171, 193n66; prevention of,
20–21, 24, 80, 120–124, 141, 160, 181;
treatment of (see cavities; restoration)

219

degeneracy, 43–49
Deliverance (fi lm), 208–209n5
Democrats, 127. See also New Deal;
Roosevelt administration; Truman administration; Wagner-Murray-Dingell
dental assistants, 10, 15, 31–32, 36, 141,
143–147, 188n67, 188n76, 209n18
Dental Brief, The (journal), 15, 41, 79
Dental Cosmos, The (journal), 21, 27, 33,
88, 97, 200n87
Dental Digest (journal), 53, 65, 72, 77, 110
Dental Economics (journal), 146
dental education, 5–7, 30, 35, 54, 74–75,
78, 89, 99, 147, 207n61, 210n27. See also
dental schools
Dental Health (journal), 128
dental hygiene, 10, 14–42, 49, 75, 96, 100,
103, 143, 155–156, 176
dental hygienists, 10–11, 26, 31–38, 96–97,
113, 143–146, 149, 180, 188n76
dental journals. See journals, role of
Dental Management (journal), 155
Dental Review (journal), 88
dental schools, 6–7, 74, 76, 89, 147, 150,
156, 180, 183–184n15; Baltimore College
of Dentistry, 30, 85; Howard University College of Dentistry, 152; Meharry
Medical College, 114; New York College
of Dentistry, 30; New York University
College of Dentistry, 112; Northwestern
University School of Dentistry, 150;
Philadelphia Dental College, 3; University of Michigan, 32, 115, University of
North Carolina, 213n16. See also dental
education
dental societies. See professional associations
Dental Students’ Magazine (journal), 97, 139
Dental Survey (journal), 113, 134
dentists’ offices: behavior in, 9, 11, 72,
74, 154–155, 157; condition of, 3, 5,
97–98; employees in, 143–146, foreign,
77–78, 80–83, patient experiences in, 9,
111–112; portrayals of, 167
dentures, 113, 164–166
Depression, 104, 105, 106, 108, 111
Detroit (Mich.), 123–124, 129–137, 162,
205–206n40

220

Index

Detroit Citizens Studying Fluoridation,
130–131
Detroit District Dental Society, 129
diet, 20, 27, 42, 49–71; “American” as
evaluative term, 54–55; of children, 9,
20, 52–53, 63–65; excesses in, 58–59;
flour in, 56; of infants, 50–51, 63–65,
69; meat in, 57–58; purity of, 52, 55–56;
sugar in, 57; standardization of, 49–51,
61, 69–70. See also Western diet
digestion, 16, 58, 65, 191n31. See also
dyspepsia
Dimendstein, Ben, 18
Diner, Hasia, 183n15, 192n35
disability, 18, 102–103, 124–125, 151
dispensaries, 18–19, 33, 100–101, 108, 143
Dr. Strangelove, or: How I Learned to Stop
Worrying and Love the Bomb (fi lm), 117,
130
drilling, 3, 176, 193n66
Driver, Deamonte, 180
Du Bois, W.E.B., 148
Dudley, H. Dorothy, 96
Dummett, Clifton, 147–148, 164–165
DuPre, Jacqueline, 176
dyspepsia, 57–58, 63, 193n66
Easlick, Kenneth, 115
Ebersole, William, 22, 184n2
Ebony (magazine), 150, 167
Eddy, Mary Baker, 193n64
education, 6, 12, 15, 73–75, 78, 94, 107,
136–137, 144, 180, 185n19, 209n19;
dental (see dental education); health, 19,
100; hygiene, 14, 18, 23, 36, 40, 53, 97,
104, 113–114
elderly, 100, 131–132
Elementary and Secondary Education Act,
180
Eliot, Charles, 28
Ellis, Havelock, 46
Emerson, Ralph Waldo, 58
Eminem (Marshall Mathers), 173
England, 109. See also Britain
entrepreneurship, 5, 8, 23, 31, 140, 142, 147,
153–156, 159, 168
environmentalism, 58, 126–128, 135,
204n16

ethical dentistry, 7, 23–24, 113, 199n68
eugenics, 65, 68. See also genetics
euthanasia, 66, 68. See also genetics
evasiveness, of patients, 68, 90
Everett, W. Hume, 133
extraction, 4, 22, 28, 80–81, 141; reduction
in rate of, 2, 128, 141, 164
false teeth. See dentures
fears: about American character, 41–42,
48, 60, 66, 130, 132; dentists’, 10, 23, 30,
32, 34, 88, 100, 105, 109–111, 115, 142,
145, 153, 158–159, 176; about government, 15, 19, 133, 148, 206n53; of suffering, 4, 22, 37, 106, 135, 162, 213n13
fees, 4, 11, 33, 77, 180
feminism, 138, 141, 143, 145, 152, 169,
208n67
Fiji, 67
Filipinos, 79, 87–92, 94, 198n52, 199n74.
See also Philippines
fi lling. See restoration
fi lm, 39, 106, 112, 117, 130
Fletcher, Horace, 50, 62, 191n31
Flexner, Abraham, 5
flossing, 21
fluoride, 116–140; ailments attributed to,
135, 207n57; and appearance, 118–125;
and Communism, 117, 130, 132–134,
136–137; sociology of opposition to,
206–207n54, 207n55, 207n58
fluorosis, 118–125
focal infection, 42, 102
Fones, Alfred, 30–31, 36, 38
Fones, Civilion, 30, 36
food. See diet; Western diet
Forsyth family, 27, 28
Forsyth Infi rmary, 28, 29, 30, 33
Galton, Francis, 61
gender. See men; women
genetics, 20, 27, 42–49, 61, 65–70, 98, 110,
190–191n16
Georgia Dental Association, 147, 171
Germans, 48, 56, 193n59
Germany, 35, 60
germ theory, 5, 24–25
Gershanski, I. A., 109, 110, 202n34

Index

Gevitz, Norman, 183n14
GI Bill, 146
Gies, William, 6
Gleem, 167
gold, 5, 16–17, 26, 78, 199n69, 214n36. See
also tooth decoration
Good Housekeeping (magazine), 106,
192n35
Goodrich, B. F., 102
Gordon, Colin, 201n15
Gottfried, Lillian, 18
Grady, Richard, 24
Graham, Alexander, 56–57
Graham, Heather, 178
Great Lakes Society of Orthodontists, 156
“Grillz” (song), 170
Gross, Solomon, 110
Haiken, Elizabeth, 201n18, 216n15
halitosis, 106
Hampton, Lionel, 167
Harris, Ruth Roy, 204n9
Harrison Act, 3
Harvard University, 28
Hawai’i, 76, 93–98, 199n75
Hawai’ians, 92–98
Hawaii Educational Review (journal), 96
Hawkins, Reginald, 151
Heinz, H. J., 102
heredity. See genetics
Hine, Darlene Clark, 210n35
Hitchens, Christopher, 178
Hoerr, John 209n19
Hoff, Neville, 32
home economics, 49–51
Hong Kong, 78
Honolulu Dental Infi rmary for Children,
94
Hornstein, Jeffrey, 184n19
Hottentot people, 180–182
Houston Chronicle (newspaper), 171
Howard University College of Dentistry,
114, 152
Howell, James H., 79, 108
humor, 117, 139–140, 167, 173, 177–178
Hunt, George Edwin, 186n22
Hurley, Elizabeth, 177–178
Hyatt, Thaddeus P., 101

221

hygiene, dental. See dental hygiene
hygienists, dental. See dental hygienists
Hyser, Charles, 112
Hyser-Pepper Plan, 112
Igorot people, 90, 91, 198n61
immigrants, 6, 11, 14–15, 17–18, 22–23, 27,
34–38, 48, 50, 61–63, 73, 120, 203n1. See
also Americanization: of immigrants;
assimilation of immigrants
immigration, 14–15, 17, 22–23, 27, 34–35,
37–38, 61–62, 67, 73, 85
imperialism: British, 78, 81–86; US, 76, 78,
85–98, 196n3, 198n55
income: of dentists, 8, 11, 31, 34, 81,
141–143, 147, 154, 156–159, 176, 180 (see
also wealth); of patients, 2, 10, 14, 22,
100, 111, 114–114, 128, 162, 165, 176 (see
also poverty); of physicians, 105
India, 77, 80, 82, 83
Indians, American. See Native Americans
Indians, Asian, 54, 67, 82–84, 164, 197n29
infant mortality, 50–51, 67
infection, 3, 24, 42, 64–66, 83, 103
instinct, 61–65, 67, 76; maternal, 51
instruments, 3, 36, 75, 78, 80, 87
insurance, 200n2, 201n16, 203n62;
“closed-panel,” 153–154; dental service
corporations, 154; dentists’ interest
in, 107–109, 114–115; dentists’ opposition to, 9, 100, 105, 109–111, 114–116,
152–154; effect of coverage on market
for services, 159, 164, 175, 180–181; national health, 99, 105, 109–111, 114–116,
127, 139, 153, 155–156, 179; and patients’
willingness to pay, 155–157; voluntary,
142, 152–154. See also Medicaid; Medicare; socialized dentistry; socialized
medicine; State Children’s Health Insurance Program; unions; Wagner-MurrayDingell
integration. See civil rights movement
intelligence: of dentists, 6, 23, 84, 90, 99; of
patients, 16–17, 39, 68, 125; of peoples,
44, 60, 67–68, 171; of women, 32, 139,
209n11
International College of Dentists, 199n68
International Dental Federation, 62

222

Index

International Harvester, 102
Iran (Meshed, Tehran), 77
Italians, 14, 37–38, 50, 186n31, 192n35,
203n1
Iverson and Hogoboom, 146
Jacobson, Matthew Frye, 198n52
Japan, 72, 76, 86, 88, 94
Japanese, 72, 173
Jenkins, N. S., 85
Jews, 6, 14, 16, 22, 37, 48, 50, 183–184n15,
184–185n8
Johnson, C. N., 7
Jordon, M. Evangeline, 39, 52, 53, 57, 63, 64
Journal of the American Dental Association (journal), 7, 94, 97, 132, 136, 139,
150, 151, 152, 200n87
Journal of the American Medical Association (journal), 79, 192n37
Journal of the Michigan State Dental Society (journal), 107
journals, role of, 8, 10, 73–76, 78; in racial
integration of profession, 148–151
Jukes family, 66
Kansas City District Dental Society, 146
Kapaa school, 94, 95, 96
Kellogg, John Harvey, 50, 57
Kennedy, John F., 151
Kevles, Daniel, 190n1
Keyes, Frederick, 101
Khruschev, Nikita, 128
Kimberly-Clark, 102, 104
King, Martin Luther, Jr., 147
Kingston (N.Y.), 126
Kirk, E. C., 86
Knutson, John, 137
Kohn, Sidney, 212n1
Koop, C. Everett, 204n16
Krafft-Ebing, Richard von, 46
Kramer, Paul, 198nn60–61
Kraut, Alan, 190n1
Kubrick, Stanley, 117, 130
labor. See unions; work; workers
Lamarckianism, 66, 68
LaSalle, H. J., 76
Lee, Royal, 136

level-technician plan, 6, 112, 180
Levenstein, Harvey, 50, 191n31, 192n35
Lexus automobiles, 1, 11, 12, 173–174
licensure, 4–7, 10, 14, 34, 73, 75, 76–78,
98, 113
Lieberman, Rose, 22
Lili’uokalani, Queen, 93
Lincoln, James H., 129
Linton, Ann, 171
Listerine, 106, 167
Locust Point (Md.), 22
Lombroso, Cesar, 43, 46
Lord & Taylor, 102
Louisiana Purchase Exposition (St. Louis,
1904), 90, 198n61
low-income patients. See income: of
patients
Ludmerer, Kenneth, 183n14, 196n4
Luzerne County (Pa.), 35
Macy’s, 102
magazines, 23, 60, 72, 106, 134, 146, 208n5
Magdalena, Federico, 199n68, 199n74
malocclusion, 141, 164. See also orthodontics
Manifest Destiny, 91, 92
Margolis, Frederick, 123
Marion Elementary School (Cleveland),
16–18, 21–22, 26, 30, 37
Markel, Howard, 185n17
marriage, 46, 48, 65, 144–145, 159,
190–191n16
marriageability, 65–66, 159, 163
Martin, C. A., 191n27
Maryland State Dental Association, 57
materials science, 5, 80, 107
McDaniels, Darryl, 170
McKay, Frederick, 118, 119, 120
McTeague (Norris), 5, 183n13
Meckel, Richard, 185n17, 187n43
Medicaid, 142, 147, 163–164, 179–180
medical education, 5–7, 43, 109
medical inspection. See school medical
inspection
Medical-Dental Committee on the Evaluation of Fluoridation, 126
Medicare, 131, 132, 142, 147, 203n62
Meharry Medical College, 114

Index

men: ambitions of, 32; “long-haired,” 56–57
Messner, C. T., 121
Metcalf, F. H., 93
methamphetamine, 179
Metropolitan Life Insurance Company, 102
Mexican Americans, 50, 191–192n34
Michigan Department of Public Health,
124, 138
Michigan State Dental Society, 79, 108, 152
Military Dental Journal (journal), 86
military, 2, 50, 54, 73, 76–77, 83, 86–87, 91–
92, 95, 100, 107, 112, 128, 169, 199n68,
199n74; military intelligence, 177
Mindblower . . . Dental Profession Under
Siege (fi lm), 143, 208–209n5
miscegenation, 44–48, 66–68, 93–94,
191n27
missionaries: to the home, 37; religious,
54, 73, 76–77, 83, 91, 169
Montgomery Ward, 102
Moro people, 92, 199n74
Morton, Jelly Roll, 169, 170
mothers, 17, 22, 31, 51, 69, 162, 167, 173, 180,
212–213n6; “Mother Earth,” 127. See also
parents; “scientific motherhood”
Mount Sinai Hospital, 64
movies. See fi lm
Murphy, Marjorie, 209n19
music, 2, 15, 167, 208–209n5, 210–211n37;
Hawai’ian, 200n85; hip-hop, 168–174,
176, 178
Myers, Mike, 177–179
NAACP, 151
National Dental Association (black organization), 111, 113, 115, 146, 147, 148, 149,
150, 151, 152, 184n16, 202n41
National Dental Association (white organization), 4–5, 7, 14, 17, 27, 35, 104, 184n16
National Fluoridation News, 124
National Health Service (UK), 175
National Municipal League, 139
Native Americans, 48, 91, 118, 185n18,
199n68
Nelly (Cornell Haynes, Jr.), 170
Nestle, Marion, 194n70
Newburgh (N.Y.), 124, 125, 126, 139
New Deal, 105, 106, 111, 142

223

New Orleans Times-Picayune (newspaper),
171
New Right, 142
Newsday (newspaper), 171
newspapers: in shaping public opinion
about dentistry, 23, 53, 65, 172, 186n32,
208–209n5
New York Times (newspaper), 2, 178–181
New York University College of Dentistry,
30, 112
Nixon, Richard, 128, 129, 148
Norris, Frank, 5
North Carolina Dental Society, 151
Northeastern Dental Association, 30, 54
Northwestern University School of Dentistry, 150
Noyes, Frederick, 61, 194n77
nurses, 32–33, 64, 96, 107, 145, 210n35
Nutrition and Physical Degeneration
(Price), 67, 68, 70
nutrition. See diet
nutritionists, 51–52, 69, 192n35
Oakley (Ida.), 118–120
Odontographic Society of Chicago, 51, 52, 61
Ohio Pure Water Association, 132
Onion, The (newspaper), 177
oral hygiene. See dental hygiene; education: hygiene
Oral Hygiene (journal), 28, 30, 39, 58, 75,
77, 108, 186n22
orthodontics, 1–2, 9–10, 12, 106–107, 115–
116, 141, 156, 158–163, 167–168, 173–176,
180, 212–213n6, 213n10, 213n16, 215n57
orthodonture. See orthodontics
Ottofy, Louis, 88, 89, 90, 91, 199n68
Our Bodies, Ourselves: A Book By and For
Women (Boston Women’s Health Book
Collective), 208n67
pain, 3–4, 18, 27, 65, 83, 101, 104, 123–124,
160, 176, 197n36, 213n13
Palama (Paloma) dental clinic, 94
parents, 11–12, 15, 17–18, 20, 22–23, 25,
36–39, 41, 43–44, 46, 63–65, 68, 95, 105,
114, 119–120, 132, 159–163, 171, 173,
188n88, 205–206n40, 213nn12–13. See
also mothers; “scientific motherhood”

224

Index

Parker, Edgar Randolph “Painless,” 3–4, 7,
9, 10, 81, 100
Parkinson, D. T., 75
patients: behavior of, 8, 11, 22, 31, 53–54,
58, 74, 82–83; demands of, 3, 23–25,
37, 101–104 passim, 107, 156–158, 176;
sexual advances of, 144, 209n12. See
also consumers, patients as
patriotism, 8, 40, 96, 127, 200n84
Paul, Diane, 189–190n1
payment, 3, 8, 83, 99–100, 105, 153, 159,
162, 164
pediatricians, 10, 52–53, 63–64, 123
pedodontics, 7, 39, 52, 212n1. See also children; dental hygiene; orthodontics
Pepper, Claude, 112
Perkins, William Eric, 169
Pernick, Martin, 197n36
Philadelphia Dental College, 3
philanthropy, 8–9, 19, 27–30, 33, 100, 104,
108, 185n19
Philippines, 76, 78, 79, 80, 86–93. See also
Filipinos
physicians, 5–6, 8–9, 21, 33, 39, 43, 50–52,
63, 65, 69, 100–101, 105, 108–109, 121,
140, 142, 180, 192n37
plastic surgery, 11, 106, 176
Playboy bunny, 210n20
Pollan, Michael, 196n115
popular culture, 12, 40–41, 106–107,
111–112, 130, 149–150, 175–178. See also
advertising; fi lm; humor; magazines;
music; newspapers
poverty, 22, 51, 101, 124, 127, 152, 171–172,
174, 179
practice management, 143. See also billing; fees; payment
Pratt, Mary Louise, 196n3
preventative dental care, 5, 10, 14, 21–23,
27, 42, 141, 160. See also decay, tooth;
dental hygiene; prophylaxis
Price, Norman, 68
Price, Weston Andrew Valleau, 66, 67, 68,
69, 70, 71, 73, 79, 102, 103, 196n115
productivity, 19, 39, 53, 101–102, 111,
203n64
professional associations: role of, 8, 35,
74, 147, 149; American Academy of

Cosmetic Dentistry, 2; American Academy of Dental Science, 46; American
Association of Orthodontists, 115;
American Dental Assistants’ Association, 188; American Dental Association,
4, 7, 9, 10, 52, 63, 66, 100, 105, 114, 122,
123, 136, 139, 142, 143, 146, 147, 150, 151,
152, 154, 159, 176, 184n16; Connecticut Dental Hygiene Association, 86;
Connecticut State Dental Commission,
36; Detroit District Dental Society, 129;
Georgia Dental Association, 147, 171;
Great Lakes Society of Orthodontists,
156; International Dental Federation,
62; Kansas City District Dental Society,
146; Maryland State Dental Association,
57; Michigan State Dental Society, 79,
108; National Dental Association (white
organization), 4–5, 7, 14, 17, 27, 35, 104,
184n16; National Dental Association
(black organization), 111, 113, 115, 146,
147, 148, 149, 150, 151, 152, 184n16,
202n41; North Carolina Dental Society,
151; Northeastern Dental Association, 30, 54; Odontographic Society of
Chicago, 51, 52, 61; Southern California
State Dental Association, 146
professionalism, 5, 8, 10, 74, 109–110; and
behavior, 7, 74–75, 80–81, 98; and colonialism, 89; dentists’ resistance to, 3–5;
and education, 6; and market forces,
112–114; and money, 33–34, 99–101, 110;
patients’ resistance to, 11; public image
of, 104, 106, 116; and science, 7; as a term
of derision, 207n61; and travel, 75, 93
propaganda, 39, 53, 109, 128
prophylaxis, 14, 18, 22, 33, 40. See also
dental hygiene
public health, 4, 9, 13, 18, 21, 59, 116, 121,
129–130, 133, 138, 140, 142, 155–156,
158, 181
Puerto Rico, 76
Pure Food and Drug Act, 55
race: of dentists, 6–7, 73, 141–142, 146–152,
157; human, 43–45, 55, 67–68, 79, 148; of
patients, 12, 73, 94, 96, 161, 163–174. See
also African Americans

Index

race suicide, 56. See also miscegenation
racism, 73, 115, 132. See also African
Americans; American Dental Association: racial segregation of; Americanization; assimilation of immigrants; civil
rights movement; immigrants; immigration; Jews
radicalism, 16, 56, 109, 129. See also activism; Communism; socialism
Rainey, Ma (Mary Lou Williams), 169,
170
Raleigh News and Observer (newspaper),
171
Randorf, George, 110
“reformed autonomous” plan of dental
education, 6
regulations, 4, 7, 23, 78, 89; of food supply
56, 59
religion: Christianity, 46, 72, 77, 90, 92,
184–185n8, 199n74, 214n36; Hinduism,
83; Protestantism, 7, 11, 40; Roman Catholicism, 7, 134, 200n3. See also Jews;
missionaries: religious
Republicans, 172, 199n75. See also New
Right; Nixon, Richard; Taft, William
Howard
restoration, 22, 80, 104, 141, 164, 171, 173,
176
rights: civil, 145, 147–148, 151–152,
207–208n63; of dentists, 101, 151, 212n1;
of individuals, 102, 130–132; pouring,
194n70; property, 96; states’, 132
Ripper, General Jack D. (fictional character), 117, 127, 130, 134
Rochester (N.Y.), 19, 33, 65
Rogers, Grace, 33
Roosevelt administration, 105
root canal. See restoration
Rosenthal, Larry, 2
Rowan, Carl, 167
Run-DMC, 170
Rush Medical College, 43
Russia, 79, 108, 109, 110
salaries: of dentists, 101, 180; of dentists’
employees, 33, 145–146; of patients, 17,
116
school administrators, 17, 36, 188n83

225

schoolchildren, 14–15, 20, 22, 23, 36, 60,
112, 164, 186n24, 200n84. See also children; schools
school medical inspection, 18, 20–21,
186n24
schools, 14–27, 30–32, 36–61, 50, 57, 60,
62–63, 65, 94–97, 99–100, 124, 128, 131,
133, 155, 172, 188n88, 194n70, 209n19;
funding of, 194n70
science, 5, 7, 24, 43, 51, 65, 136, 140; dentistry as a, 90, 118. See also bacteriology; germ theory; genetics; materials
science
“scientific motherhood,” 50–51, 64–65
Sears Roebuck & Co., 102
segregation. See civil rights movement
sex: appeal, 177–178 (see also marriageability); offered by patients, 83;
psychology of, 46; sexual misconduct
by dentist, 32; sexual perversion, 46, 66;
women employees as objects of sexual
interest, 144, 149, 210–211n37
shame, feelings of, 68, 125–126, 159,
178–179
Shapiro, Laura, 191n28
Sheppard-Towner Infancy and Maternity
Protection Act, 19, 100
Silverstein, Frank, 22
Simpsons, The (TV show), 177
Sinclair, Upton, 58
Skocpol, Theda, 200n2
Smith, Edwin E., 178
Smith, Linda, 150
Smith, Richard, 171–172
socialism, 8, 41, 99, 101, 105, 115–116. See
also Communism
“socialized dentistry,” 107–109, 111, 113,
115, 154. See also insurance
“socialized medicine,” 107–109, 111, 115,
154. See also insurance
Social Security, 115, 131, 142, 147
social workers, 14, 30, 50, 69, 191–192n34
Southard, Juliette, 32, 188n67
Southern California State Dental Association, 146
Soviet Union, 109, 110
Spach, A. B., 55, 193n64
Spanish-American War, 76, 86, 198n52

226

Index

Spencer, Herbert, 58
Starr, Paul, 200n2, 201n16, 203n57, 206n42
State Children’s Health Insurance Program, 180
stomatology, 6, 43, 109
sugar. 199n75. See also diet
supplies, dental, 77–78, 143
surgeon general, US, 15, 112
Swanish, Peter, 110
Taft, William Howard, 15, 86–87
Talbot, Eugene Solomon, 43–49, 60, 66, 68,
75, 190n9, 190–191n16
taxes, 21, 27, 39, 115–116, 118, 132, 147,
180
taxpayers, 21, 39, 119
teachers, 16, 22, 25, 30, 36–37, 40, 57, 75,
94, 96, 98, 107, 172, 188n83, 209n19
Texas Dental Journal (journal), 113
Thursday Island, 68
Tomes, Nancy, 185n17
tooth decay. See decay, tooth
tooth decoration, 88–89, 91, 168–174,
199n69
toothpaste, 92, 167
tooth whitening, 2, 9, 158, 176–177, 179
Town & Country (magazine), 2, 12
travel: of activists, 137; of dentists, 54,
66–69, 73–98, 118, 121, 169; of “Painless” Parker, 4–5; of patients, 120,
188n88; writing, 73–77, 79–81, 84–87,
90, 93, 98, 196n3
Travis, William, 129, 131, 136, 137, 138
Trenton (N.J.), 139
Truman administration, 99, 115
Underwood, Carrie, 175
unions, 114, 116, 141, 145–146, 153–154,
209n19
University of Michigan, 32, 115
Urbina, Ian, 178–179
US Indian Service Field Dental Corps,
185n18
US Public Health Service, 116, 120–122, 124
Us Weekly (magazine), 175
vacations, 12, 93, 145
vegetarianism, 50, 56–58

vitamins, 42, 51, 69, 191–192n34
Voigt, James, 97, 98
Wagner-Murray-Dingell, 115, 116, 203n62
Wall Street Journal (newspaper), 1, 11,
173–174
Wanamaker, John, 102
Washington, Booker T., 148
Washington Post (newspaper), 180
water supplies. See fluoride
Waters, J. E., 134
wealth, 92, 165, 168–170, 179; gospel of, 19,
185n19; of orthodontists, 213n16
Webb, James, 151
Western Dental Journal (journal), 78
Western diet, 67–70, 96–97. See also diet
Wherry, A. C., 105
Whitehead, John S., 199n75
Wicker, William, 137
Wiksell, Gustave, 54, 56
Wirt, Landis, 83, 84
wisdom teeth, 44
wives, dentists’, 53–54, 144, 209n11
women: African American, 149–150, 165–
166, 169, 210–211n37; appearance of,
161, 165–166; as civic activists, 118; as
dental hygienists, 30–33, 36; as dentists,
6–7, 32–33, 63, 150; as dietary reformers, 52–53, 56; as employees of dentists,
143–146 (see also dental assistants; dental hygienists); as mothers and potential
mothers, 51, 69, 95, 100; as prostitutes,
66; “short-haired,” 56; as transmitters of
cultural values, 34; as workers, 111. See
also wives, dentists’
work, 16, 91–92, 101–102, 105, 108–111,
124, 140, 143–146, 154, 179, 209n11,
209n18
workers, 14, 36, 91–92, 100–102, 116, 153
World War I, 28, 73, 108, 128
World War II, 99, 111–112, 128, 146, 199n75
World’s Fair. See Louisiana Purchase
Exposition
“Yankee disease.” See dyspepsia
Younger, Harold B., 126
Zulu people, 80–82

About the Author

Alyssa Picard is a graduate of the University of Michigan, where she received
a PhD in history. She works as a negotiator for the American Federation of
Teachers’ Michigan state affiliate, and as an instructor in the history of social
movements at Wayne State University’s Labor School in Detroit.

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