The History of Orthodontics | STUFF YOU SHOULD KNOW

Welcome to Stuff You Should Know, a. production of iHeart Radio. Hey, and welcome to the podcast. I'm. Josh and there's Chuck. Jerry's here, too. We're just sitting around cutting. the insides of our mouths up here on. Stuff You Should Know. >> Yeah. The history of orthodont, which if. I had been using my brain, I would have. uh paired this with the history of. dentistry.

because that's, you know, kind of makes. sense. >> Sure. I feel like we would have had seen. a real decline in listenership that. week, but you know, >> you think so? >> No, I'm just kidding. I'm just being a. punk. I remember our dentistry one was. amazing. >> Well, and I think I don't know. I think. people are uh interested in their. bodies, >> especially when you say it like that. >> Yeah. And then teeth and stuff. Uh cuz. we all have teeth and it's interesting. that bad, you know, teeth. I say bad.

teeth. Yeah, I have bad teeth, but what. I mean by bad teeth is teeth that grow. in in funky ways. Uh but I'd like to. kind of break that cycle as well of kind. of talking about it like that because uh. even though I have gotten my teeth. fixed, it's just because they were. falling out of my head. It's not because. I wanted perfect white chicklets in my. mouth. And I think there's a big trend. >> uh that we've seen over the past uh you. know 20 years and really I feel like. even the last 10 years where Hollywood.

especially and people in the media all. have perfect perfect teeth and you don't. have to have perfect teeth. I like teeth. with a little personality. I like summer. teeth. >> Yeah. I can't remember what they're What. kind of teeth? Summer. >> summer teeth. >> I've not heard that. >> You never heard that phrase? >> No. What does it mean? >> Summer teeth. Some are here, some are. there. >> Oh, that's awesome, man. I love that. That's like a What kind of dog is that? Sooner. >> Sooner. One kind is another. >> Yeah, exactly.

>> Uh, yeah. There in Japan, they have a. name for like a wonky tooth. Usually, it's one of your canines and it'll be. like kind of pressed out or crooked or. something like that. Yumi has one, but. there's a term for it and it's like. basically a term of endearment. They. just find that very cute. Here in the. US, it'd be like we you would be put in. some sort of like home or asylum for. that. >> Yeah. I mean, you get as an actor, you. get news articles written about you when. you don't get your thing fixed. That's.

how common place it is to just, you. know, the expectation to look perfect, >> right? Um, and that's a big criticism of. the uh the entire field of orthodontics. is, >> you know, they might not be the ones out. there like, you know, pumping the media. up like, "Yeah, keep keep talking about. how great teeth are supposed to be." Um, but they're the ones who are there like, "Hey, come on over. We're going to fix. you up." Tough to blame them for that. But the criticism goes even further. because the field of orthodontics is. like, "Forget about all that. we're.

actually helping cure health issues, >> right? >> And critics of the field are like, it's. not even established that there are. health issues from having wonky teeth. Um, so you guys should probably stop. saying all that. And the field of. orthodontics said, "No.". >> Yeah. I mean, for sure there can be. health issues. Uh, we're not saying. that's not possible, but I feel like. it's almost a given now, especially now. that I have a human child, that like, yeah, you absolutely get braces. That's.

just what happens. You go to the dentist. around six or seven years old, they say, "All right, you need to go see your. orthodontist now.". >> I did not know that. That That was not. the way it was when we were young. >> No, I mean, I had braces twice. Um, >> did you? >> Yeah. But, you know, I never did. I've. got bad bite. I have a a host of. problems. Um but yeah, let's dive into. it because this is not a new thing. People have always had wonky teeth. And. um the reason why is because we have the.

same amount of teeth in our head that we. did when we were still, you know, walking on all fours and we began to. walk upright and the size of our our. brain changed and that meant the size of. our jaw got smaller to make room for our. bigger brain. But it's not like they. were like, "All right, they whoever. decides this," you know, the panel, >> it's not like the the God panel said, "All right, let's take out five or six. teeth because we don't have room for. them now." Uh there were the same amount.

of teeth with less space to put them, and that's why they started coming in in. all crazy ways. >> Yeah. Just give it another 100,000. years, Chuck. It'll work itself out. >> Exactly. Uh even more recent than that, um the teeth orthodontics was probably. not an issue for hunter gatherers. because the diet they had was more much. more challenging to their teeth and jaw, the their the bone that held their teeth. in place because of the chewing they had. to do. Well, since we picked up.

agriculture and especially since the. industrial revolution where we started. mass processing food, everything's. gotten much softer. M. >> So, we're challenging the bone in our. jaw less. Therefore, um our teeth are. more prone to go wonky rather than. coming in straight. >> Yeah. And less bone is is happening. there. Uh so, I mean, that's the history. of my teeth is bone loss and lack of. bone. >> Hey, man, I just got two root canals.

I I was in the chair for two and the. dentist was like, "You could go either. way on the one. It just got a lot of. cold sensitivity and I was like, "Oh, I'll just get one.". >> Spent the next couple days like. realizing how bad the cold sensitivity. on the other one was. The following week. I got the other one done. So, two. Fridays in a row. Oh, god. >> I went to the endodontist and got root. canals. How about that? >> Yeah. I've I've never had a root canal, weirdly. That's the one thing I haven't. had. They're they're not fun, but.

they're well, they're not fun. >> Yeah. So, early on, you know, in ancient. times, people started to kind of look at. this issue. Uh, in fact, Hypocrates even. wrote of crowded teeth, uh, potentially. producing headaches and problems with. the pallet and stuff like that, discharge from the ear, which is super. gross. And there were have been mummies. like Egyptian mummies that looked like. they may have had some kind of braces. like they had these gold bands around. some of their teeth and they were. connected uh with cat gut and it.

appeared as if they were you know being. kind of used like braces to pull the. teeth in one direction or the other. >> Yeah. Uh which is I mean pretty. interesting. Uh again this is post. agriculture so don't don't email us. >> Yeah. >> Uh and also there's good band and album. name in there. Hypocrates and the. Egyptian mummies, right? >> The album is discharged from the ear. >> Oh, God. Okay. >> Just waiting for us, John. >> Yeah. Good one. >> There was another couple um people from.

the ancient world, Celsius, who was a. Roman uh writer, he um talked about how. if you were worried about adult teeth. coming in, you pluck the baby tooth out. and then press it with your finger every. day. >> Yeah. And it turned out that was a. pretty good idea because that was. adopted later on in Orthodontra when it. really became a thing. And even Ply got. in on it. Remember how much he used to. visit us in our podcast? >> Yeah. I mean, I feel like Ply used to be. a firm entrant into the stuff you should. know drinking game. >> Yeah. Well, he moved on to the Dough.

Boys. >> Oh, okay. >> Um, but he said that if you don't like. the alignment of your teeth, just file. them. >> Yeah. Which is still a thing. >> It is. That's another I think thing that. I'm like, "Wait, really? You guys are. still doing this?" Um, and it's true. Like a lot of the inventions and. techniques and ideas that came along. from the very beginning of orthodoner. are I guess they got them right right. out of the gate because they're still. doing them today. >> Yeah, for sure. I've had my teeth ground.

down in a lot of ways to keep the bite. from pressing on other teeth to make. them, you know, keep them from becoming. weakened. You know, it's still a thing. >> How How is that. >> uh what to get them filed? >> Mhm. Does it hurt? Is it? >> Oh, no, no, no. It doesn't hurt at all. Um, it's just that. >> Yeah. >> And then you smell the smoke and you. know that part's all horrific, but. there's no pain at all cuz they're not. hitting nerves or anything. >> Okay. >> Yeah. >> Now, imagine doing that through the. middle of the tooth to to scrape out the.

root to the nerve. That's a root canal. >> Oh, man. So, sorry. >> Sorry. So I guess really the first person I. mean Pler makes a pretty good case but. not really. It wasn't until the very. beginning of the 18th century that a. Frenchman um the French would actually. really have a lot to do with. establishing orthodonture his name was. Pierre Fosard and he basically said. check this out everybody. I'm going to. work on wonky teeth. I'm going to make. my name that for that.

>> Yeah for sure. And um as it is today, uh. children and young adults were kind of. the the likeliest candidates for that. >> And he designed the very first uh. appliances for moving teeth around. >> Um the first thing he would do is is. measure the length of the teeth and file. them down. If they were, you know, if he. had one that was exceptionally longer. than its little buddy next to it, he. would file it down, then do so on the. other side to kind of balance things. out. Um that's called uh bite. adjustment. Like I said, they still do.

those, including on me. Um, that's an. acclusial acclusal, sorry. Uh, equilibration equilibration. >> Yeah, that's not an easy one. >> Uh, and again, that's to I mean, sometimes I guess it's it's to help out. the aesthetic, but in my case, and in. most cases, it's to keep uh teeth from. grinding against another tooth in a way. that causes harm. >> Yeah. Uh, I've realized as an adult my. my bite is way over to the I guess the.

bottom is. >> Yeah. The bottom's to the right and the. crossbite is to the left. Is that what. it's called? >> I think so. >> Oh my man. I got a terrible crossbite. >> But I mean, I'm I'm making my way in the. world today. Takes everything I've got. >> That's true. >> But I'm still able to chew pretty well. >> Yeah. Yeah. That's what matters. >> Sure. Uh so let's talk a little bit more. about uh Fosard because he hasn't left. yet. He's he really kind of got into. this and laid the groundwork. Um he did.

the same thing that uh Ply suggested. that like you said that you went to the. same procedure. Um he called it inner. proximal stripping which is essentially. just filing down teeth to make more. space between them. >> Yeah. Like if if it's crooked, give it a. little more space and maybe it'll be. able to straighten itself out. >> Yeah. Or like you can file it down for. the space and then you apply some sort. of appliance to it to straighten that. tooth too, but you got to bake the space. first. He came up with that. >> Yeah. Or what he did was was push on the.

teeth just like Celsius uh suggested. >> Um like every day at, you know, and. this, you know, this makes sense. This. essentially what rubber bands and braces. do. um just you're applying pressure to. your teeth um at a regular interval like. so many times a day and the idea is that. they will move, >> right? And it's true. Like that's one of. the the amazing things to me is like if. you apply even like a gentle bit of. pressure over a long enough time span,

your teeth will go where you want them. to. >> Yeah. Um so one of the other reasons why uh. Foschard is is remembered is because he. essentially came up with the idea for. braces. Um he basically used a waxed. piece of silk or a wire or something and. he would wrap a tooth that's say crooked. to the neighbor next to it and that. would apply pressure to straighten out. the crooked tooth. I'm sure in the worst. case scenario it would make the other.

tooth crooked in the bar again. So you. really had to keep an eye on it. Yeah. >> Um and sometimes he would use a plate. too to connect a crooked tooth to one. that you wanted to use as pressure or. maybe a couple of them to use as. pressure to straighten it out. And this. eventually was like this is the basis of. of what braces do for your teeth. This. guy was inventing it in the like early. 1700s. >> Yeah. He also used a a specific torture. device called a pelican. Uh, it had been. around before, I think since the at.

least the 14th century. It was used for. pulling teeth, but he kind of um. rejiggered it and redesigned it to where. it was basically a forcep that could. pull a tooth um pull a tooth like not. out of your body, but in a certain. direction. And if it sounds like awful. and could lead to bad things, it very. much could because at least once um on. record, he fractured a tooth uh of a. young woman that he was working on. And. I imagine that was extremely unpleasant.

>> I can't believe there's just the one. that people mention, you know. >> I mean, that's the one on record. I'm. sure it happened more than that, you. know. >> Yeah. The girl was um quoted as saying, "Yeah.". >> Yeah. Exactly. >> Uh he also was smart enough to know that. you could get infections from some of. these techniques and procedures he was. performing. So, he recommended a. mouthwash of wine and a specific kind of. honey with some rose essence to it. Yeah. Um he I mean this guy just he he. just laid it down. And what's.

interesting is um he was doing this in. the early 1700s and it wasn't really. until the mid 19th century that it. really started to become picked up. again. And one reason why is because. we viewed teeth much differently, at. least in the West, than we do today. Like you were saying, thanks to. Hollywood and magazines and all that, you want to show off your teeth, and. you're gonna be perfect. >> Um, back then, you did not show off your. teeth. It was grossly impolite to let.

anyone see your teeth. Go back and look. at any portrait from the 18th century. I. will pay you a$1.50. If you find one. single portrait of a gentry or. aristocrat, man or woman, who's showing. their teeth in a painting, you can't. find it because that was really rude and. um, day class A. Yeah, I mean almost any. painting you think about, like it didn't. occur to me until I, you know, did this. research and you go to any museum and if. you see teeth, it's probably to depict.

someone who is unhinged. >> or like a prisoner escaping from prison. or someone pirate. >> Yeah. A pirate or an asylum or something. like that and the teeth are all, you. know, jacked up looking. Other than. that, you don't see teeth in paintings. >> You don't $150, everybody. Yeah. But. just a one of you, not all of you. >> Oh man, we're going to get some uh it's. going to start rolling in, buddy. JPEGs. coming at you with with toothy. paintings. >> Should we take a break? >> Yeah, we should take a break.

>> All right, we'll take a break and we're. going to jump forward into the 1800s. after this. stuff. [Music]. So, like I said, um, Fchard was working. in the early 1700s. By the mid 19th. century, I guess people's thoughts on.

teeth were changing and they were like, "Okay, we can show our teeth, but they. got to look good. So, let's get back. into orthodoner." another Frenchman uh. Pierre Wim Leulon he's the one who came. up with the word orthodontics actually. he called it orthodontic. you have to say it like that. >> and in Greek uh ortho means straight. dant is teeth so straight teeth is what. the word orthodontics means. >> you know I love that when that happens. >> pretty on the tooth.

>> yeah when you. I can't even follow that uh so they. didn't call themselves that yet. Uh, in. most cases at the time that kind of. caught on more and more as things went. on. >> Um, but um, dentists started to do this. stuff. There weren't like specialists. that only did orthodontics yet. It was. just part of dentistry and tooth. straightening was part of dentistry and. you were an apprentice who learned that. kind of thing. Um, dental colleges. started being organized in the mid 19th. century. But um I mean when was the.

first orthodont. orthodont school? That was in the uh. 20th century, right? >> Yeah. Either the very beginning of the. 20th or the very early um or no yeah. very late 19th century. I think it was. um angle. >> Yeah. 1900s the angle school of. orthodontia was the first sort of. standalone thing where it wasn't just. part of a dental school. >> Precisely. >> All right. Um, so some of the other advancements. that the 19th century contributed can.

all be kind of lumped together under the. umbrella term of headgear. Yeah. >> Or uh-uh. >> if you're a teenager. >> Yeah. >> Um, which is you're using your skull and. the substance of your skull as a as a um. >> Oh man, I wish I knew classical physics. terms a little better, but anchor. essentially. Sure. Yes. An anchor, a. counter counterbalance. How about that? >> Okay. >> To provide the pressure needed to pull,

say like your jaw back, there's. something called a chin cup that you can. use. I've actually seen modern pictures. of it still in use in some cases to. where there's a well the cup for your. chin. There's straps that go back to the. back of your head and around it. And. it's meant to just slowly over time pull. your lower jaw back toward your well. your the rest of your head. >> Yeah. and it can correct an underbite. And that's as far back as I think 1802.

>> Yeah. I love that idea though. They were. like, "Oh, we need some kind of like we. need some leverage to pull this jaw back. and we can't just have a kid stand by a. wall and attach them to a wall." And. somebody's like, "What about their. skull?". >> Yeah, >> it's right there. >> Somebody went bam. >> Uh they don't use headgear as much. anymore. Like you said, it it still can. be be used, but not like it was used in. the 80s. Um, luckily I never had to go. through the headgear um trauma, but uh.

it it it was quite dramatic when you. showed up to school having to wear one. of those. >> Yeah. Remember Farmer Ted from 16. Candles? He had to wear one. >> Farmer Ted. And I think Oh, no. John. Kusac had the neck brace. >> Yes. >> Yeah. Okay. >> I thought that too, but no, it was neck. brace. >> There's a couple other people we need to. mention. Another French dentist, Kristoff Francois Deabar. He created the. wire crib, which was um I think we said. Fousard was the one who really kind of. started the idea of braces. There's a a. a distinct progression, a linear.

progression from Fousard onward and. Delabar came up with the wire crib, which is essentially exactly what it. sounds like. Like you take a a piece of. chicken wire and fold it over like the. teeth in question, tighten it up the way. you want it, and there's your wire crib. >> It's not exactly like the braces of. today, but the the outline, the contours. are there in it for sure. >> Yeah. Um it started to become in the. 19th, I guess the second half of the. 19th century, a little more scientific.

and they started to kind of put a little. more rigor into like, you know, figuring. out how to do this the right way. uh a. guy named uh Norman Kingsley from New. York City was a very early um very. popular orthodontist. Um he had a. treatment for cleft pallets that was. very popular and wrote uh a very. influential guide called a treatise on. oral deformities in 1880. Um but and. this is something that you mentioned. early on that we'll kind of keep talking. about a little bit here and there is. that he was an artist and he was very.

interested in facial symmetry and. aesthetics. So he was um if not the. first one of the sort of early leading. guys that was like we want you to look. good and it may not just be about like. your bite health. >> Right. Exactly. Exactly. Um he was also. supposed to be really nice. He had a. compliment for everyone he met. >> Oh that's nice. >> Uh so I just made that up but I want to. believe it about him. Uh so there's some. other stuff that kind of came along. Little by little they were like oh okay. well let's tackle this. One thing that.

you can be born with uh is a narrow. maxillary arch. That is the jawline on. the top of your mouth. >> Mhm. >> Your top the row of your your row of top. teeth are connected to your um maxillary. arch. How about that? >> The roof of your mouth. >> Yeah. The lower um set of teeth is. connected to the mandibular arch. Either. way, you can be born with one or both of. them narrowed. So they figured out you. can put essentially an appliance a a. stick in between them and adjust it.

slowly but surely over time and press. your jaw apart. >> Yeah. I mean that is still a thing. Uh. my daughter has that uh it's called an. expander. >> I guess it was called that back then. too. But um and like her two friends. that had braces both had it too. So I. think that may be way more regular now. I don't know anyone from my our days in. high school that had something like. that. >> So, I think the original one was they. would put the screw bar in between say.

your back mers. >> Uhhuh. >> Cuz they're pretty substantial and just. over time slowly adjust it. I guess. probably every visit and um that would. press the the whole arch apart. Is that. essentially what they're doing still. today? >> Yeah. It it's like a a wire cage that. lives on the roof of your mouth that's. attached to those rear molers. >> Mhm. Uh, and they, yeah, you go in there. and they crank it out and make more. room. Like the And it it really works. because the space between her front two. teeth. >> got comically large. Like you could fit.

a whole extra tooth in between. >> Oh wow. >> When this thing was at its most, but. they're basically just creating room for. the future. >> Was the dentist like or the orthodontist. like I I've done too much? >> No, he's coming back now. >> He's like, I've got a new record. Everyone get in here and look at this. girl. >> Right. So um I think you said we talked about. how the first orthodont was um. established by Edward Angel in 1900. Even before that most of the people. practicing orthodoner were now um not.

only MDs but also doctors of dental. surgery DDS. So they were really well. trained in medicine. And um the reason. why not coincidentally is this is. because of a shift of direction that um. Orthodontra went in to basically say. like let's get even more scientific. about this and well they did. >> Yeah. There was a guy named John Nutting. Ferrar who some people call the father. of American uh orthodontics or modern. orthodontics. >> Not in the house I was raised in.

He was the guy that was like, "Hey, let. me do some actual experiments and on. animals and things and let me see like. that thing that we crank apart your. teeth. Let me see how much the human. body can like how much pain they can. endure to move those teeth." Like uh and. I'm kind of kidding, but basically like. let's find a happy medium between how. far we can expand and how much like a. child can take. >> Yeah. What's worse though is he wasn't. experimenting on children. He was. experimenting on animals, which I take. to mean dogs.

Yeah, I guess. >> Yeah. So, uh, yeah, that's Ferrar. Um, what. about Ed Edward Angel who we talked. about? This guy is probably the one I. mean my dad at least I would call him. the father of American orthodontics. >> Yeah. I mean, he's the guy that. definitely um made it such a a bonafided. business and I think he he found out. much like a lot of different ways to. make a lot of money. Mhm. >> Um and you know one way was like uh.

developing uh devices and patenting. devices. Uh another way was creating um. like ready-made appliances. Uh he. created the angle system in 1887. So. it's like instead of like building these. things from scratch for every patient. like I can just sell you this system. that has has all these prefab parts that. can be uh combined in different ways to. suit your needs. >> Yeah. Because I mean there's only so. many ways that your teeth can be wonky, right? So Totally. Yeah, that's that was. revolutionary. I'm sure that just.

immediately pushed the field forward. Um, and if that wasn't enough, he also. came up with a measurement um system. called the acclusal classification. system that's still in use today. 30 something years later um that they. use as the basis like that is the norm. Yeah. >> And that that's what they use to measure. anything in a patient's mouth that's. deviated from the norm. Um he also in. addition to founding that first school. of orthodontia he founded the society of.

orthodontists which is now the American. association of orthodontists. Uh he. founded the first orthodontic journal uh. which is known today as tooth fancy. Uh. >> oh man what a nightmare magazine for me. >> It would be awesome. >> Somebody just you can punk me and give. me a subscription to Tooth Fancy. >> All right. >> Uh this guy had so many income streams. who's, you know, clearly a great. orthodontist and dentist, but also a. seemingly pretty savvy business guy.

>> Yeah, for sure. But, yeah, he was. revered. I'm sure he's still revered in. the halls of orthodont, >> certain halls. >> Uh oh, there's another This apparently. is a debate that still rages today. At. some point somebody said, "Hey, you. know, we usually try to to step in. earlier in development." Um, like to. work on younger kids, I think is the way. they put it. Um, but sometimes adults. need help too. Um, so a lot of us are. just pulling teeth maybe to make space.

or whatever. Should we be should we be. doing that? And some people said yes, some people said no. And a rift was. formed that again still exists today in. the orthodontic field. Yeah. A a rift so. wide it was like the gap between my. daughter's teeth at maximum expansion. >> It's a record. >> Uh should we take another break? >> Yeah. >> All right. We'll come back and finish up. on braces right after this.

stuff. [Music]. All right. If we're talking modern uh. tooth straightening, we're talking about. braces generally. Uh I mean, I guess. they still have retainers and stuff, but. I feel like I see less and less of that. and it's more just sort of straight into. braces. >> Mhm. >> Uh I feel like when we were kids, it was.

like, "Yeah, we can probably fix this. with a retainer." I thought the retainer. was like post braces. That was my. experience. >> I think that can be true too. >> Okay. >> But but I'm pretty like my brother got a. retainer and not braces. >> Of course. >> Yeah. >> I'm sure his retainer somehow like made. him money too accidentally. >> Oh man. Oh, God bless him. So, uh, a lot. of people had kind of chipped in to come. up with um things were basically like. braces. Uh, one guy that was pretty key.

was named, uh, Dr. Raymond Beg. His. nickname was tick. Do you know why? I. didn't find out why. >> I could not find other than that he was. Australian. That's the best I can come. up with. >> All right. Uh but he was a student of um. of Angle and I guess at that school of. Orthodontia. Orthodontia. Yeah, Orthodontia. >> And he moved to Australia or I guess. went back to Australia where he. practiced in uh Adelaide. Lovely area. And this was in the 1930s. And he. developed like um using stainless steel.

wire instead of precious metals. And I. think didn't they use precious metals. because they were malleable, but that. caused problems. >> Uh yeah. Well, they're they're very. expensive. And gold, like you can't make. a crown out of gold because eventually. it'll it'll mash. But they were they. were prized because they don't react um. with other stuff. Like you can eat all. the Cheetos you want and your gold's not. going to rust. Um it's not poisonous. like mercury, which apparently they. still use in fillings in some places.

>> Oh, okay. >> Yeah. Um so it but they're they're. expensive. So people came up with alloys. now today. Although sometimes you still. will see like gold or platinum or silver. alloy sometimes fused with ceramic for. um implants and stuff. >> Yeah. Well, the stainless steel I mean. that's still uh that that came about in. in what 1956 here in the States. >> Mhm. And uh braces became, you know, really more popular over that time, kind. of starting in the 50s, but really in.

the 70s and 80s. I think an estimate. from the AAO found the number of. Americans who wear braces uh doubled. between 82 and 2008. >> Yeah. >> And you know, they've evolved over the. years. They had uh I was one, not one of. the first, but it was pretty early on. My second set of braces were ceramic, the like the clear braces, >> those are. >> which is a little bit better, but it was. not, you know, you still had brace face. >> Um, just a little less obvious. It's not. like, you know, you couldn't tell or. anything like that. Whereas my first.

braces were it was early enough where. they they were the wraparound like an. entire silver band around each tooth. >> Mhm. >> It wasn't like glued on. Yeah. >> Right. One thing though about that huge. increase, the doubling of people with. braces between 82 and 2008, I was like, that doesn't track with my experience. For me, it was the 80s where everybody's. wearing braces. And then I realized that. that's because I knew the most people. wearing braces in the 80s because that's. when I was in elementary and middle. school.

>> Oh, well, yeah, sure. >> Yeah. It was just a kind of bias I. thought was great. >> Proximity bias. >> I looked and I could not figure out. which one it was. Maybe the frequency. illusion is the best I could come up. with. >> That makes sense. I didn't Is proximity. bias even a thing? Did I make that up? >> If it's not, it should be because it's. got a great great name. It really has. legs. >> Uh they also have braces that go in the. back of your teeth. One of my good. friends had those and those, you know, can't be used in all cases, but that's. the ones where you really score as a. teenager.

>> for sure. Um and then I guess those. aren't invisible aligners. Those are. just rear braces, right? >> Yeah. Part of the rear. Well, before we. get on to invisible aligners, which also. created quite quite a rift in. orthodontics, um there's something that. I I guess it's the new standard maybe. today called selfating braces. So, with. traditional braces, you have that wire. >> It's been around since Fushard. >> You have the brackets that actually. attach to your teeth. >> and then you have little tiny rubber. bands that attach the brackets to the.

wire. Right. With self-ligating braces, there's just the wire and the brackets. And apparently, it makes it way easier. to clean. It makes it way easier to. adjust when you switch out the wire for. a thicker wire over time because there's. a little snap in the bracket that holds. that wire in place. And they just look. like the future to me. >> Yeah. Uh you can also get colored braces. now, too, which is uh a big thing if you. get them young like my daughter. She has. purple braces. >> Oh, that's cool. Loud and proud. I guess.

now on to invisible aligners because. this this was kind of a big deal. Two. Caltech um they might have been students. at the time. Zia Chishti and Kelsey. Worth um invented them all the way back. in 1997 and within just three years we. had Invisalign on the market. >> Yeah. My brother used these for a while. too. And this is something that you it's. to avoid going to the orthodontist I. guess and paying like a lot of money for. um permanent or not permanent but you. know temporarily glued on braces. This.

is something that you can you know fits. over your teeth and you can take them on. and off. >> Sure. um any involvement in this. industry, it's been pushed so far. outside of traditional orthodontics that. any orthodontist who is a critic of. orthodoner and it's like questionable. scientific basis um they they the. orthodontic community will use their. involvement with this industry to. discredit them. That's how that's how. reviled it is among mainstream.

orthodontics. Now, is that because they. genuinely think it's no good or it's. genuinely no good for their practice? >> No good for their practice because it's. not so much the invisible aligners. It's. the fact that you can order them. yourself online and they'll like they're. just totally cut out of the the loop. So, it's that it's specifically the. online ordering version that they have. such an aversion to. >> I'm surprised they didn't think of a way. to get a piece of that business. >> You know, it happened it happened while.

they were sleeping. Yeah. And I need to. ask my brother how well they work for. him because I know he he wore them for a. little while. >> I think they work if you have just. slight adjustments you need to make, but. if you have like a a really like a big a. big deal in the wonky um department, then you you should go with braces. One. other big um check in the favor of. braces over invisible liners, you can um. adjust the braces throughout the. treatment to I need a little more. pressure here, a little less here. You. can't do that with invisible liners.

Once you send them the mold of your. mouth, they send you the braces back and. that's that's that. I think you get. multiple ones, but it's much less. precise uh over time as braces. >> All right. Uh Livia found this and I. didn't know this is a thing, but. apparently uh she found that there is. some anecdotal evidence at least of uh. young people wanting braces as a fashion. statement, like a decorative fashion. brace that you can get online.

Yeah, I saw some article written by some. square that said um non-prescription. glasses and fashion braces are the big. things right now. >> Wow, man. Oh, man. I mean, I wore, you. know, very famously uh wore fake glasses. to seem smarter when I was younger. >> Mhm. >> But, uh you couldn't have caught me dead. with fake braces. >> No, it doesn't make any sense. And I. also kind of suspect it might be an. urban legend. >> I do too. One thing that doesn't seem to.

be an urban legend that I saw though was. gap bands. Apparently, um people have. learned this. >> kind of but with an S on the end of. band. >> Oh, okay. >> Um where you use like a a kind of like a. really strong um rubber band, you put it. on the the tooth you want to straighten. out. >> and then connect the other one to a a. straight tooth to use it as leverage. >> And apparently it works really fast. Again, the Orthodontra community is. like, "Don't do those." There supposedly.

was some 8-year-old boy in Greece who. had done this himself, but the rubber. band went up into his gums and according. to these people, he didn't notice and it. just ate away at the tissue up there and. he ended up losing the very teeth, I. think his front teeth that he was trying. to straighten in the first place. That. too sounds a bit like an urban legend, but I saw it in enough places that I. wonder if it might be based on some sort. of legitimate story somewhere. >> I could see that. I mean, I you know,

you probably use rubber bands along with. your braces, right? >> I never had braces. >> Oh, you never had them at all? >> I did not need them as a kid. It wasn't. until I was an adult that I started to. kind of need them for my lower um teeth. >> You got pretty good teeth, though. I. don't I've never noticed your teeth. being uh crooked or whatever. That's. because I don't smile and show my lower. teeth. Number one, because I'm not. insane. But number two, because those. are the ones that are crooked. >> Luckily, it's my top row that's pretty. straight. So, when I smile, it looks. like my teeth are great. But if I Hey,

look. >> Can you see? >> They're like, "Yeah, I thought on there. it just kind of. That was pretty good play acting, too, by the way.". >> Yeah, it was good. Uh, all right. So, let's talk about some stats. Um, a few. years ago in 2022, um, 3.15 million kids between 8 and 17. were getting orthodontic treatment. >> Mhm. >> Um, this sounds way low to me. 7.4% of that. age group is all that was. There were. other estimates that say about half.

>> of kids receive some kind of orthodontic. treatment at some point. >> Mhm. >> Uh, that seems low to me, too, just. based on anecdotal what I'm seeing. around me. But, you know, maybe that's. right. So, kids, like you were saying, it's just basically part of being a kid. today. You get braces at some point. >> It seems like it. I just uh I feel like. Ruby and most of her friends have. braces. >> I mean, that tracks I found a a. statistic that in the US alone um out of. pocket spending amounts to five almost.

five billion dollars a year on. orthodont. And then insurance and. Medicaid covers an additional 4.2. billion. So it's like a10 billion dollar. industry just in the United States. alone. >> Yeah. I mean and you know going kind of. going back as we'll finish up here to. the beginning of like is this a medical. issue or is it just to create like you. know uh kids without self-esteem. problems because they're maybe have. crooked teeth and uh certainly the rise. of uh Hollywood and um it used to say.

something sort of about class. I think. it still still can. >> um unfortunately and you know with with. movies and advertisements and TV and. stuff like that uh YouTube, social. media, uh straight teeth is the thing. and uh you know starting in the post-war. era like especially with young girls. they were saying hey you got low. self-esteem it's probably because of. your teeth. I I wonder though, so that. that class thing, the socioeconomic part. of it, that actually makes it hard to.

study orthodontics, because if you want. to study people with um say braces or. something like that, >> you're automatically working from. another kind of bias, a selection bias, because they are probably from a higher. socioeconomic class than the average. person who doesn't have braces because. so much of it is paid for out of pocket. But it occurred to me just now, Chuck, while you were saying that that I wonder. if that whole thing about them fixing. health issues or whatever is essentially. made up to get insurance companies to.

cover what otherwise would be considered. cosmetic. So, they're actually doing it. >> strictly for aesthetic purposes, but. they're trying to make it so you, the. parent, don't have to pay for all of it. out of pocket. >> Maybe that's what's going on here. >> Maybe. I mean it's it's this is the kind. of thing that's really hard to study as. far as whether or not there is a medical. benefit uh or need because uh and Livia. points this out you know you got to. conduct randomized trials. So you have. to find a large group of people who were.

have you know pretty similar dental. profiles and you got to have one group. that you give braces to and then a. control group that you don't and then. follow them over a long period of time. to see what kind of problems develop. like headaches or something. And that's. just that's just really that's a tough. study to pull off. >> Yeah. And again, I mean, the the study. population you're drawing from like. nobody's going to do that. So if you're. studying people who already have braces, you're automatically working with that. selection bias because they're more. likely to be from a higher socioeconomic.

group. >> Yeah, totally. >> Uh you got anything else about braces? >> Uh the only thing I'll add, I had the. two kinds of braces. Oh, for many years. after the braces, I had this uh bar put. on the back of my lower teeth. >> Mhm. >> Uh that span like the front five, and. that was supposedly to keep them in. place. >> Neat. >> And that eventually broke off and I just. went for years with those metal stumps. there cuz I spent quite a few years.

without going to the dentist at one. point. Yeah, >> I'm guessing college years and maybe. immediately after. >> Bing bing bing. That's how it goes, man. Uh, let's see. Uh, well, you don't have. anything else about braces? I don't. either. Thanks to all the orthodontists. out there for listening. Uh, and. everyone, if I turn up assassinated in. the next couple weeks, it's because I. did figure out the big secret to. orthodontics and insurance. >> Yeah. >> Uh, and Chuck said, "Yeah." So, that. means it's time for listener mail.

>> You're going to wake up and Steve. Martin's going to be over you with a. dental drill. >> Oh god. Uh, by the way, highly highly. highly recommend the two-part. documentary on Steve Martin. >> Okay. >> It is great. >> I didn't even know it was out. >> Yeah, it's been out for a little bit. It's It's really really good. And it. kind of makes me realize what a I mean, I've always been a Steve Martin fan, but. it really knocks home what a treasure he. is as a human. >> I bet. >> Yeah, it's fun. Um, and I just recently. rewatched Three Amigos showed Ruby for.

the first time, which he thought was. very fun. >> I've never seen that one. >> Oh, really? >> Yeah. That That seems like it would have. been one on your list. >> I don't Well, well, actually, I do know. why. >> Why? >> Cuz Chvy Chase. >> Oh, you don't like Chvy Chase? Of course. He's the He's the least funny. part of the movie. You You need to watch. it for Martin Short and Steve Martin. >> I'll do my bet. So, I'd rather watch. Only Murders in the Building. >> No, I'm with you. I'm with you. >> All right. Hey guys. Uh, this is What is. this about? This Well, this is kind of. about medical school, so it fits. I've. been listening for nearly a decade. Was.

very excited to have an occasion to. write in. Uh during the episode on. cigarettes, you mentioned an early. physician who observed nasal swellings. and uh excretions. >> Mhm. >> Uh and im moderate users of snuff. And. Josh interprets this as puffy. lumps in their noses. I recently. graduated from medical school and it's a. right of passage for medical students to. describe a wound with pus as Uh. only to realize this word appears rather. crass when written out. Uh instead we. use the word uh p u r u l e in uh.

purulent. >> to avoid any potential misunderstanding. if a patient reads the notes. Obviously. it's a little different in a podcast. setting which I doubt listeners are. often reading an episode transcript. >> Oh yeah, we'll have to go look that up. >> I figured this little nugget of. knowledge might be helpful. I'm sure you. hear this every day, but I want to say. thanks for all the great work you do. stuff you should know has been a. constant source of joy for me as I've. navigated college, med school, marriage, fatherhood, and now residency, training, and pathology. You broaden my. perspective on a vast array of issues.

and always look forward to listening to. new and old episodes alike on my. commute. And that is from Gabe who says, "Hey, come uh to Ann Arbor, Michigan for. a live show." And uh we're maybe trying. to work that out, Gabe. >> Yeah, we're batted around, Gabe. Good. idea. >> Yeah. Yeah. And I tell you what, Gabe, if we come to Ann Arbor, uh, write us. back from that very same thread and you. and your friends and family or whatever, you know, not like 20 people, but you. can get on the guest list. >> Yeah, good idea, Chuck. That's a. foolproof plan. There's no possible way.

for identity theft. >> That's right. >> And congratulations, Gabe, on all of. your uh academic and medical success. And thanks for listening to us that. entire time. And if you want to be like. Gabe, and send us a cool email, you can. do that, too. Send it off to. stuffodcast@ iheartradio.com. >> Stuff you should know is a production of. iHeart Radio. For more podcasts, iHeart. Radio, visit the iHeart Radio app, Apple. Podcasts, or wherever you listen to your. favorite shows.

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