Waterloo Teeth

Battlefields, Sugar, and the Origins of Modern Dentistry

An 18th-century dentist showing a set of human-tooth dentures to a wealthy patient. Image conceived by the author; created with AI in the style of a copperplate engraving.

In eighteenth-century England, tooth decay had become a widespread source of misery, especially among the prosperous classes. Sugar, once a rare luxury but increasingly present on elite tables, left its mark on the teeth of the well-to-do. Examination of skeletal remains from the period reveals striking levels of cavities and missing teeth, with the problem becoming noticeably more pronounced after the mid-eighteenth century as sugar consumption continued to climb. By middle age, many adults had lost multiple teeth, and chronic dental pain was a familiar companion of daily life.

In ironic contrast, poorer people — whose diets contained far less sugar — often retained healthier teeth despite the many hardships they endured.

Dentistry at the time was rudimentary, painful, and often dangerous. The profession itself was only beginning to emerge, and most procedures were performed by barber-surgeons, itinerant tooth-drawers, or physicians with a passing interest in diseases of the mouth. Their principal service was simple: removing the tooth that hurt.

In towns and marketplaces across Europe and North America, tooth-drawing was often a public spectacle. Traveling practitioners set up chairs at fairs or in tavern yards, advertising their skill with bold signs or the clamor of musicians meant to attract crowds. Contemporary observers sometimes described these scenes as a kind of rough theater, with the patient seated before a ring of spectators while the tooth-drawer displayed his instruments like props before the performance began.

Their instruments were crude but effective. The pelican, used from the fourteenth through the eighteenth centuries, removed teeth with a hooked “beak” that gripped the tooth while a padded base acted as a lever against the gums — sometimes tearing soft tissue or even fracturing the jaw. By the eighteenth century the dental key had largely replaced it. Widely used into the nineteenth century, this instrument clamped a claw around the tooth and twisted it from the socket, a maneuver more likely to break the tooth itself than the bone that held it. At best a patient might be offered a dram of whiskey, a dose of opium, or simply encouragement to hold fast while the operator worked.

By the mid-nineteenth century both the pelican and the dental key were gradually replaced by improved dental forceps that allowed more controlled extractions.

In the eighteenth century an option emerged for the wealthy: replacement teeth intended to restore both function and appearance. Dentures were fashioned from ivory — often hippopotamus or walrus — or from carefully carved bone. In practice, however, these devices usually restored appearance better than chewing ability. Ivory bases could warp over time, and the mounted teeth often loosened with use.

In some cases the replacement teeth came not from ivory or bone but from another human mouth.

The most prized dentures incorporated human teeth, painstakingly drilled and wired into carved plates to form convincing rows of replacements. These teeth were sometimes purchased from the poor or taken from the recently dead. Grave robbers occasionally supplied another source by removing teeth from freshly buried corpses.

After the great battles of the Napoleonic Wars in the early nineteenth century, collectors scoured the fields for intact teeth from the dead. Youth often meant strong teeth, and thousands were gathered in this way, cleaned, sorted, and sold to dentists in London and Paris. The macabre trade became widely known as “Waterloo teeth,” named for the Battle of Waterloo in 1815. In this way, the teeth of soldiers who had fallen in war sometimes appeared in the smiles of strangers. By the time of the American Civil War, however, this grim commerce was already in decline as new materials gradually replaced the older trade in human teeth.

A well-known example reveals how widely human teeth were used in early dentistry. The dentures worn by George Washington were long rumored to have been carved from wood, but surviving specimens show otherwise. His dental appliances were complex constructions made from ivory, gold springs, and human teeth. Surviving financial records indicate that teeth were purchased from enslaved people at Mount Vernon.

On occasion dentists offered an even more extraordinary — and unsettling — solution: tooth transplantation. In this procedure a healthy tooth was removed from a young donor, often a servant or impoverished laborer, and inserted into the socket of a wealthy patient who had lost one of his own. If the transplant initially took hold, it could give the appearance of success.

The surgeon John Hunter described the procedure in his 1771 treatise The Natural History of the Human Teeth. Hunter observed that transplanted teeth could sometimes attach securely and perform “every purpose of the natural one,” though most eventually loosened and were lost. Despite these uncertainties, the procedure became fashionable among affluent patients seeking a more natural appearance than dentures could provide.

These transplants captured both the inventive spirit of early dentistry and the stark inequalities of the age, in which the teeth of the poor could end up in the mouths of the rich.

In the early nineteenth century dentistry began its gradual transformation from trade into profession. Scientific attention to diseases of the teeth increased, influenced in part by the work of Pierre Fauchard. In 1728 he had published the landmark treatise Le Chirurgien Dentiste (The Surgeon Dentist), describing dental anatomy, techniques for filling cavities, and improved instruments. His work helped establish the idea that dental disease could be studied systematically rather than treated only by extraction.

As the century progressed dentistry acquired the institutions and tools of modern medicine. Dedicated dental schools began to appear. The Baltimore College of Dental Surgery, founded in 1840, became the first institution to offer a formal dental curriculum and confer the Doctor of Dental Surgery degree. Similar institutions soon followed in Europe.

New materials and techniques expanded what dentists could offer their patients. Gold foil fillings allowed damaged teeth to be preserved rather than removed. The development of anesthesia transformed the experience of dental treatment. In 1846 William T. G. Morton publicly demonstrated ether anesthesia — first for tooth extraction and soon afterward for surgery — marking a turning point in the control of surgical pain. Later in the century nitrous oxide, the so-called “laughing gas,” became widely used in dental practice.

Dentures improved as well. Earlier artificial teeth carved from ivory or bone were uncomfortable and unreliable. A major advance came in the 1850s with vulcanized rubber, developed by Charles Goodyear. Adapted by dentists as vulcanite, the material produced denture bases that were lighter, more stable, and far less expensive than ivory. Combined with porcelain teeth, vulcanite dentures made artificial teeth increasingly accessible to the growing middle classes.

Mechanical dental drills, introduced in the 1860s, further improved the treatment of cavities and restorative work.

By the late nineteenth century dentistry had become a recognized profession with journals, licensing systems, and standardized training. Yet memories of earlier practice lingered. Within living memory of the Victorian age, dental care had often meant little more than a pair of iron instruments, and a strong hand pulling hard.

The transformation of dentistry from the rough trade of tooth-drawers into a modern medical discipline stands as one of the remarkable revolutions of medicine. It carried the practice from the marketplace chair and the battlefield harvest into laboratories, clinics, and schools. A shift from extraction toward preservation, and from spectacle toward science.

previously published on Substack