There’s a joke on the internet that illustrates a curious irony of progress. It goes:

"Doctor, I have an earache."

2000 BC: "Here, eat this root."

1000 BC: "That root is heathen. Say this prayer."

1850 AD: "That prayer is superstition. Drink this potion."

1940 AD: "That potion is snake oil. Swallow this pill."

1985 AD: "That pill is ineffective. Take this antibiotic."

2000 AD: "That antibiotic is artificial. Here, eat this root."

University of California prosthodontist Gordon Douglass likewise sees dentistry’s progress not as a straight line, but as a loop. In prehistory, he observes, before refined- sugar modern eating habits (read: constant snacking) began dissolving enamel and ruining dinner, dentistry was mostly a round of traumatic tooth damage and subsequent attempts at repair. The twentieth century brought science and specialties, in giant leaps of biological, chemical, surgical and orthopedic knowledge. Yet in the future, as preventive measures continue to curb dental morbidity and DNA manipulation takes us closer to tissue and organ regeneration and other genetic triumphs, Dr. Douglass believes much of dentistry’s energies will go back to where they probably began: repairing trauma.

Douglass’s circularity argument strikes a resonant chord. Dentistry is full of circularities. There are at least two kinds: Sisyphean, and paradoxical.

Sisyphean circularity has to do with a certain redundancy inherent in dental care. In Greek mythology Sisyphus was a king of Corinth whose punishment in Hades was to push a stone uphill, which rolled down again as soon as he reached the top. A Sisyphean task is one that is repetitive and endless. Many people might think dentistry represents a modern Sisyphus. Third molars, despite the claims of a number of my patients to the contrary, don’t grow back when they’re pulled. But a tooth restored begins a lifelong treadmill of replacement and repair.

Anthropologist Horace Miner, in his 1956 tongue-in-cheek work, Body Rituals Among the Nacirema, described American oral hygiene as if scrutinizing a primitive tribe. Miner wryly pointed out, "The extremely sacred and traditional nature of the rite [of dental care] is evident in the fact that the natives return to the holy-mouth-men year after year, despite the fact that their teeth continue to decay."

The circularity involved here may also take on a layered aspect, like a spiral. Dentistry may seem to go around, and around, and around again. Art historian David Kunzle, in his monograph The Art of Pulling Teeth in the Seventeenth and Nineteenth Centuries, concluded that patients traditionally have interpreted the ignominy of dental treatment as duplicative: "Normally the patient pays [for dental problems] thrice over, with pain, tooth and money."

The second kind of circularity has to do with the paradoxes related to dentistry. A paradox is a statement seemingly contrary to common sense, yet possibly true. A paradox is significant at least in part because of its contradictory qualities. Dentistry is full of apparent contradictions, such as the old observation that dentists work to put themselves out of business. A catch-22, the paradoxical rule famously described by Joseph Heller, occurs when a problem exists for which the situation itself denies the only solution. Yet even before Heller’s novel of the same name, Ogden Nash, in his poem "This Is Going To Hurt Just a Little Bit," clearly described dentistry’s own catch-22: "And this, O Fate, is I think the most vicious circle that thou ever sentest, That man has to go continually to the dentist to keep his teeth in good condition when the chief reason he wants his teeth in good condition is so that he won’t have to go to the dentist."

The paradoxical circularity in dentistry may be illustrated in specialist referrals. Patients suspect that while specialists exist to handle complications, they may also create or perpetuate them. For example, there is a joke about a dentist who, as he extracts a slippery molar, accidentally drops the tooth down the patient’s throat. "I’m sorry," he tells the patient, "but the tooth is lodged in your esophagus. I’ll have to send you to the ear, nose and throat doctor to get it out." At the otorhinolaryngologist’s office, though, the patient sits down too abruptly, and the molar drops into the stomach. The ENT doc says, "I’m sorry, but you’ll have to see the internist now." The internist gets out an endoscope to fish out the molar, but discovers it has already passed into the intestine. So the patient is passed along to the proctologist, who gets out his instruments and peers into the colon of his long-suffering charge. "By golly, you’ve got a tooth up there," the proctologist exclaims. "You’ll have to see a dentist!"

And so this circuitous essay comes full circle. The more things change, as they say, the more things stay the same. In summary: If you don’t want to go to the dentist, do. If you go, go again. And watch what you eat. As the Lion King sang, it’s the circle of life.

From Inscriptions, Journal of the Arizona Dental Association, 12(1):5, July 1998.  Dr. Eric Curtis is author of Hand to Mouth: Essays on the Art of Dentistry, Quintessence, 2002

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