When did a great smile become so important?
A great smile makes a huge difference to our personal and professional relationships. But when did having perfectly straight white teeth become the norm?
“A smile is the shortest distance between two people.” -Victor Borge
Babies typically start smiling from about 6 weeks of age, when they are able to recognise the people around them. It is a fundamental part of human development. That smile from a baby invariably elicits a smile response from the parent, and a flood of endorphins that boosts mood and wellbeing.
We all know the importance of a good smile. It is a fundamental part of our overall facial aesthetics, and it plays an important role in our wellbeing. Our smile influences confidence, self-esteem and interpersonal relationships, and exists beyond merely the physical appearance by impacting on psychological and emotional health. Indeed, much of our personal identity is wrapped up in, and portrayed by our smile.
When we have a good smile, one that we are happy with, it boosts self-image and therefore improves confidence. Conversely, a poor smile can lower self-esteem and contribute to negative emotions and the ability to engage positively with others.
But a smile is more than just the activation of muscles that result in an upward curving of the corners of the mouth. Increasingly when we talk about a healthy smile, we are actually referring to the appearance of the teeth.
Nearly 1 in 3 Australian adults currently reports feeling uncomfortable about their dental appearance, and this has been increasing over the past quart of a century, up from around 20% in 1994. Although it mirrors a trend in the proportion of people experiencing toothache or avoiding food because of dental problems, the trend is greater for feeling uncomfortable about appearance suggesting that poor appearance is related to more than just the presence of disease.
There is no doubt that a poor smile has significant impacts for individuals. The following excerpt is from a case study about a young man named Joshua from a report on oral health by the Brotherhood of St. Laurence in 2010:
I’m a pretty self-conscious kind of person anyway. Wherever I go I always feel awkward. So, I mean, your teeth being such a focal part of your face, when you open your mouth, even in the way you talk. If you don’t feel comfortable about your teeth and how your mouth looks, you move your mouth a lot different and you’ll really hide your personality and the way you express what you’re trying to say. So I guess it made me even more closed in and reserved…It made me feel just as awkward having to speak a lot to people I hadn’t seen in a long time, people I hadn’t seen since high school, running into these people in the street…You have to explain to people why you’ve got missing teeth. You just look a certain way when you’ve got missing teeth in the front there. Yeah, it means I’d wanna speak less, I suppose, and definitely not want to smile at all When you’re looking for jobs and things like that it was difficult. You’ve gotta be presentable even going for a job in a factory or any job. You’ve gotta look smart, I suppose, I couldn’t even do that. It came to the point where I just knew I looked terrible.
Joshua’s experience of starting a new job provides insight into the barriers facing long-term unemployed people in gaining employment, and the pivotal role of dental health.
It was overwhelming, I’ve never had to wear nice clothes. I’ve always had a shaved head or long hair. I’ve never had to wear a shirt or anything like that you know…It was really difficult for me to go to reception because for the first few months or so while I was there, I didn’t have the teeth in…And as a guy who probably already didn’t have such great self-esteem, to feel like I’ve gotta look extra smart and be extra nice to make up for feeling like I look really out of place…just looking like me and feeling like me, not being able to smile, even, or, if I did, I was always wondering if they could see it. There were times where maybe I may have laughed and I may have let it be obvious that I’ve got teeth missing…So having to greet people and smile and things like that without showing my teeth was difficult especially when I already felt like people were looking at me like, ‘What the hell’s he doing at reception?’ You look out of place, you know. Now with his dental treatment complete, Joshua talks about the difference it has made to his life. The main thing is that I feel comfortable in appearance. I mean, I still don’t feel comfortable because I’m still me but I feel a little less ugly. Just being able to talk freely and comfortably and not feel like people are looking at me in a negative way. I honestly don’t think about my teeth…That’s probably the best thing—that it’s not on my mind whereas it always was…I don’t even think about my teeth now.
When did a good smile become so important?
Take a stroll through an art gallery and it quickly becomes apparent that smiles are not nearly as commonly depicted as we might have thought, and certainly not smiles showing teeth. Any depictions of open mouths and teeth generally had negative connotations.
Was this because oral health was poor? Probably not. Certainly tooth decay and gum disease have existed through the course of human existence, but tooth decay in particular only became more prevalent after the Industrial Revolution in the late 18th and early 19th century with the widespread availability and affordability of sugar. So it seems that there was an artistic and cultural convention to not portray a smiling face.
So when Madame Vigee Le Brun first displayed a self-portrait in the Louvre in 1787 showing a smile with a hint of teeth, it apparently caused such a scandal at the time precisely because it bucked normal artistic conventions.
As influential as the Industrial Revolution was in ushering in an era characterised by an increase in dental disease, historians also describe two Smile Revolutions which transformed both the way that dentistry was practised, but also the way in which dentistry and oral health was perceived. The first of these revolutions occurred in 18th century Paris, and in part is the story of the father of modern dentistry, Pierre Fauchard. But there were others, such as Nicolas Dubois de Chemant who invented porcelain white dentures to replace missing teeth. The second Smile Revolution was, not surprisingly, in the United States of America in the mid-20th century, again fuelled by technological advancements in dentistry but also by cultural shifts driven by the popularity and growth of visual media. Future historians might well look back at this period in time and describe the early 21st century as the third wave of the Smile Revolution as social media and dentistry combine to commodify the smile in a way that Fauchard could not have imagined.
There is no doubt that social media is a key driver of cosmetic dentistry, with good evidence that social media influences patient decisions with respect to aesthetic treatment choices. Some of that is no doubt organic, with platforms like Facebook and Instagram encouraging people to share photographic evidence of their daily lives, allowing us to see our friends and colleagues (and many more people) up close and personal. But social media has also allowed for dentists to more effectively market themselves to patients in an increasingly crowded marketplace. And the use of social media influences through either paid or contra deals further blurs the marketing line even further.
The technological timeline from the 18th century portraiture to Instagram tells an interesting story. Capturing the intricacies of a smile on canvas was difficult, and the slow shutter speeds of the early cameras forced the stilted frowns that we see in many of the pictures of that era. Camera technology advanced sufficiently to allow the snapshot of a moment in time, through to cameras embedded in mobile phones which provided the opportunity for every event to be captured. Front-facing cameras gave us the selfie, and this placed even greater emphasis on our own appearance. The COVID-19 pandemic also saw many people in online meetings, faced with seeing their own smiling face day in and day out. The net result is that we see more faces now than at any point in human history.
How has dentistry commodified the smile?
Oral health is more than the absence of disease, and encompasses aspects of wellbeing which include the ability to function and convey a range of emotions through facial expression, including smiling. The images that we use in dentistry and the messages that we promote about a healthy smile are reinforced by companies such as toothpaste manufacturers who show us what a normal health smile looks like.
However, there are many people who do not conform to that ideal. And so we have created solutions to these problems – whitening and straightening teeth in a variety of different ways to help people conform to these social norms. In essence, we have pathologised a crooked or broken smile and then provided a treatment solution to that problem.
Why white teeth?
Khalid and Quinonez postulated that the North American ideal of straight, white teeth in North America is one of many beauty ideals propagated by media using celebrities as spokespeople, although the media influence really serves to perpetuate existing social norms, ideals and stereotypes. They argue that there is significant symbolism attached to the colour white in Western culture, from its association with cleanliness and purity, as a symbol of peace (white dove) or healing (a doctor’s white coat), or as a symbol of status and wealth stemming from Queen Victoria’s all-white wedding dress. There is also an negative association between ageing and darkened or discoloured teeth, so white teeth are a symbol of youth. In a society that is both ageing and also places great value on a youthful appearance, white teeth become even more important.
It is easy to ascribe at least part of the blame in the rise of cosmetic dentistry on Hollywood. Indeed, there is even a term for it – the Hollywood smile. And there is a history that traces back to the 1930s when dentist Charles Pincus from Beverley Hills developed porcelain veneers for Hollywood actors. These were not like the permanent veneers of modern dentistry, but were only temporarily bonded to natural teeth to improve appearance and enhance onscreen confidence. Dr Pincus, known as the dentist to the stars, worked with Hollywood heavyweights including James Dean and Joan Crawford, but was perhaps best known for providing temporary veneers for a young Shirley Temple when she started to lose her baby teeth to maintain the appearance of a perfect smile.
It is not surprising that the ideals of a Hollywood smile that began in the 1930s have taken hold around the world. Globalisation has delivered enormous benefits through technological advancements and economic growth, which has helped to improve the quality of dentistry and make it more accessible. But it has also resulted in a degree of cultural homogenisation – replacing local culture and tradition with a dominant global culture, which in many instances means American. Travel to any part of the world now and you see the same brands everywhere, from Coca Cola and McDonalds to Nike and Apple. Much of this is actually a direct consequence of the domination of Hollywood, given the clever product placement in movies that encouraged others to desire these brands, as well as a growing consumer culture. But we are also seeing this now depicted in the homogenisation of the smile. The faces that we see on social media, on television or the movies or in the street are increasingly becoming the same.
The predominantly private nature of dentistry has become more aligned to free-market values, and we see this expressed in the way in which the dental profession advertises commercially to create the demand for services. Since few people are born with a celebrity smile, and since everyone deserves to have a celebrity smile, then there is a need to achieve this through cosmetic dental treatment. Modern day dental practices in Australia still refer to the Hollywood smile in their marketing, for example:
So, what exactly is a Hollywood smile?
A Hollywood smile is a spectacular set of straight, white, perfectly-shaped teeth – the kind you’d see on your favourite celebrities. Of course, very few people are born with a celebrity smile, so it’s typically achieved with cosmetic dental treatments.
So when we talk about the commercial determinants of oral health and pathologising a crooked or broken smile, this is precisely what we mean. But it’s also worth reflecting that as cultural norms, values and expectations continue to shift, is the dental profession responding to societal demands, or are we driving them?
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Love the term pathologising the crooked smile. Great historical dive into what I call aesthetic versus cosmetic.