Blood, Sweat, and Teeth
Dental care has always been racially inequitable in the United States — ever since the teeth of enslaved Black people were extracted to restore George Washington’s smile.
A mark of wealth and privilege, restorative dentistry during the Colonial Era was a luxury afforded only by powerful White men like President George Washington. The most prevalent of all current health conditions, dental disease was as common in the 18th century. However, unlike the sophistication of modern dentistry, treatment was limited to extraction and tooth replacement, if even an option, entailed fabrication of a wooden denture. Most of us are familiar with the old tales about Washington’s struggle with dental disease — that he experienced frequent toothaches and was inaugurated as President with only one natural tooth remaining. However, what many may not know is that Washington’s dentures were not made of wood as commonly reported, but instead crafted from lead, brass, gold, and steel and had the natural detail of human teeth — which were taken from the people he enslaved. Alongside the many other atrocities of chattel slavery, the practice of White enslavers utilizing the healthy teeth of enslaved Black people as a dental resource demonstrates the inhumane treatment of Black people that lasted for centuries in the United States and the glaring reality that slavery and its legacy are the main culprits of persistent racial disparities in oral health.
As we often find when recounting the lives of our nation’s founding fathers, Washington’s dental history is quite complicated — beginning with the fact that he actually paid the enslaved for the teeth even though he didn’t arrange for their freedom until the end of his life. More troubling is that these teeth, which were extracted without anesthesia — were often healthy and undiseased. The historical record of President Washington’s denture tempts one to consider what other misconceptions exist about the roots of America’s oral health crisis.
The tragedy of slavery and its consequences must be confronted by all Americans as we strive for a more equitable society. The forced labor of Black people for 250 years was the human capital that physically and financially built the United States from its beginnings. Southern states benefited from the farmed labor performed by the enslaved and the Northern states reaped the rewards from the industries it created and sustained. Analysis of the cruel practice of slavery is difficult and taxing but it is imperative that we properly examine history to understand the construction of our nation and the significance of the racist practices that have plagued every facet of our country from wealth inequality and unequal treatment in the justice system to alarming disparities in health and life expectancies.
Why are Black men more than 3.5 times more likely to die from police violence than White males? Why do White Americans hold 8x times the wealth of Black Americans? Why do Black Americans disproportionately endure periodontal disease at a higher rate than any other ethnic group, which is a leading cause of early tooth loss? We often ponder why inequities exist as if they popped up out of nowhere. But, when you examine the factual history of the United States, it is clear that the long-lasting poor treatment of Black Americans enabled the longevity, wealth, and power of White Americans. Not considered human beings by their White enslavers, enslaved Blacks were subjected to uninhabitable living conditions, infrequent baths, and also limited dental care. As property, they were sold, tortured, whipped, and separated from their families.
In order to justify slavery, false medical theories about Black people were invented and unfortunately like most patterns of society, many of those beliefs are still widely held today. This is exhibited in studies showing that White laypeople and medical professionals commonly believe that there are biological differences between Black and White people and specifically that Black people have higher pain tolerance compared to Whites. These types of false beliefs not only impact treatment recommendations but patient outcomes and sustain the legacy of health disparities between Black and White patients.
Fear and mistrust of White dentists stem from slavery as well as the century-long era of racial segregation in the United States that followed — when most Black patients were limited to care from only Black providers or restricted from obtaining care from a dentist altogether. The legacy of racism actively presents today where racial bias has resulted in a greater likelihood of extractions in comparison to root canal treatment for Black patients presenting with a broken-down tooth and symptoms of irreversible pulpitis.
President Washington was known for his austere appearance — his likeness never displays even a grin although he had the luxury of oral care and even wore dentures garnished with the teeth of his slaves. As a nation, we have accepted that slavery was a horrific part of our past but the fact that we still live in an inequitable society is harrowing. It’s one thing to reflect upon the impressions of our founding fathers but the fact that we can’t properly advance equity all these centuries later certainly leaves a bad taste in your mouth.
Dr. Brigitte White is a cosmetic dentist in the Washington, DC metro area and adjunct faculty at University of Pennsylvania School of Dental Medicine. Follow her on Instagram, Spotify, and Youtube.
