Podcast Summary: Stuff You Should Know – "The History of Orthodontics"

Hosts: Josh and Chuck
Episode Date: August 26, 2025
Main Theme:
A humorous and in-depth exploration of the history, science, and evolving social perceptions surrounding orthodontics and braces – from ancient times to modern-day trends.

Overview

Josh and Chuck dissect the story of orthodontics, tracing the path from ancient tooth adjustments to today’s $10-billion orthodontics industry. Along the way, they challenge popular narratives about the necessity and health benefits of orthodontic work, all while sprinkling personal anecdotes and classic SYSK humor.

Key Discussion Points & Insights

1. Why Are Crooked Teeth So Common?

• Evolutionary Roots:
  • "We had the same amount of teeth in our head that we did when we were still walking on all fours … And that meant the size of our jaw got smaller to make room for our bigger brain. But … there’s less space to put them, and that's why they started coming in in all crazy ways." – Chuck (05:08)
• Diet’s Influence:
  • Softer, processed foods (post-agriculture and industrial revolution) mean our jaws are less challenged, leading to increased orthodontic issues.
    • "We're challenging the bone in our jaw less. Therefore, our teeth are more prone to go wonky..." – Josh (05:48)

2. Stigma and Aesthetics: “Perfect” Teeth and Self-Esteem

• Media's Role:
  • "There's a big trend ... where Hollywood … all have perfect, perfect, perfect teeth. And you don't have to have perfect teeth. I like teeth with a little personality. I like summer teeth." – Chuck (02:33)
  • Explains “summer teeth”: "Some are here, some are there." (02:58)
• Global Perspective:
  • In Japan, a crooked canine ("yaeba") is considered cute, contrasting with American expectations of dental perfection. (03:07-03:30)
• Class Ties and Self-Esteem:
  • Straight teeth as a signifier of class, particularly in postwar America and among young girls: "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." – Chuck (44:15)
  • The role of orthodontics in fueling and responding to this pressure is debated throughout.

3. Health Claims vs. Reality

• Questioning Medical Necessity:
  • "Critics of the field are like, it's not even established that there are health issues from having wonky teeth." – Josh (04:12)
• Insurance and Medicalization:
  • Josh muses that health claims may exist in part to make braces insurable, not just cosmetic, but acknowledges it’s hard to study the actual health effects due to socioeconomic bias (45:06–45:38).

4. Orthodontics in Antiquity

• Ancient Practices:
  • References to Hippocrates and Pliny the Elder on crowded teeth and early remedies like tooth filing.
  • Mummified remains in Egypt show what looked like gold-band braces with cat gut cords. (07:11)
• Key Figures:
  • Pierre Fauchard (France, early 1700s):
    • Invented early braces and techniques still echoed today (like interproximal stripping – filing between teeth).
    • "He just laid it down...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." – Josh (14:18)
  • Other Ancient Methods:
    • Advice to pull faulty baby teeth and press adults into place (Celsus).
    • Filing as a remedy for misaligned teeth (Pliny).

5. Changing Cultural Attitudes

• 18th-19th Century:
  • In early modern Europe, it was impolite to show teeth at all in paintings; straight teeth only gradually grew in social importance (15:25).
  • The term "orthodontics" (originally "orthodonticy") coined by Pierre Joachim Lefoulon (mid-1800s); "ortho" = straight, "dont" = teeth (19:09).
• Dental Professionalization:
  • Orthodontics started as a subspecialty of dentistry, not becoming its own field until schools like the Angle School of Orthodontia (1900s). (20:02)

6. Technical Developments

• Early Devices:
  • The "wire crib" (Delabarre, early 19th c.) and the use of gold and metals in braces.
  • "Expander" appliances that widen the jaw are as relevant today as in the 1800s (24:41–25:18).
• Braces Evolution:
  • "Wrap around" bands (the old silver bands encircling each tooth).
  • Move from precious metal to stainless steel wires in the 1930s–1950s (Begg, Australia).
  • "Self-ligating braces"—modern, easier to clean and adjust with brackets that snap onto wires (36:59).
  • Colored braces, ceramic (clear) braces, and braces on the back of teeth are all recent stylistic developments.

7. The Business and Science of Modern Orthodontics

• Industry Size:
  • In the US alone: ~$5.5 billion paid out-of-pocket annually, with insurance/Medicaid adding $4.2B – "a $10 billion industry" (43:13).
• Key American Figures:
  • John Nutting Farrar and Edward Angle (Angle system for standardized appliances and the “occlusal classification” system still in use).
  • Angle founded the first dedicated school, professional society, and first orthodontic journal. (27:36)
• Debates:
  • Ongoing rift: Should teeth be extracted to make room, or not? Still a divisive topic (29:27).
  • The necessity and ethics of "fashion" orthodontics and online/invisible aligners (38:10–39:16).

8. Recent Trends: Invisible Aligners & Fashion Braces

• Invisalign & Online Orthodontics:
  • 1997: Invisible plastic aligners invented; by 2000, Invisalign launches.
  • Online ordering bypasses orthodontists—"any orthodontist who is a critic … the orthodontic community will use their involvement with this industry to discredit them. That’s how reviled it is among mainstream orthodontics now." – Josh (38:30)
• Effectiveness:
  • Clear aligners work for minor issues, but braces more adjustable for complex cases (39:28–40:04).
• Fashion Braces:
  • Anecdotal reports (and skepticism) about braces being worn as a fashion accessory. Some “gap bands” to fix teeth at home—"the orthodontic community is like, don’t do those" due to extreme risk (40:50–41:50).

9. Anecdotes, Humor, and Memorable Quotes

• Summer teeth:

  • Chuck: "I like summer teeth."
    Josh: "What does it mean, summer teeth?"
    Chuck: "Some are here, some are there." (02:58)

• On Ancient Orthodontics:

  • “There’s good band and album name in there: Hippocrates and the Egyptian Mummies. The album is Discharge from the Ear.” – Josh (07:52)

• Regarding Angle’s Business Acumen:

  • "This guy had so many income streams...also a seemingly pretty savvy business guy." – Chuck (28:37)

• Modern Prevalence:

  • "It’s just basically part of being a kid today you get braces at some point." – Josh (43:02)

10. Current Orthodontics by the Numbers

• Prevalence:
  • 2022: 3.15 million kids (aged 8–17) receiving orthodontic care in the US; estimates vary that up to half of all kids get some form of treatment. (42:30–43:02)

11. Skepticism and Calls for Better Evidence

• Scientific Challenges:
  • Hard to conduct long-term, randomized studies for or against the health benefits of orthodontics due to selection and class biases. (45:06–45:53)

12. Personal Experiences

• Multiple stories about adult dental work, root canals, and types of braces. Chuck had both wraparound and ceramic braces, and a post-brace bar that broke and "just went for years with those metal stumps." (45:57)

Notable Quotes

• "You don't have to have perfect teeth. I like teeth with a little personality." – Chuck (02:33)
• "We're challenging the bone in our jaw less. Therefore, our teeth are more prone to go wonky..." – Josh (05:48)
• "Hippocrates and the Egyptian Mummies. The album is Discharge from the Ear." – Josh (07:52)
• On ancient French orthodontist Pierre Fauchard:
  – "He just laid it down...he was doing this in the early 1700s." – Josh (14:18)
• On the persistence of aesthetic pressures:
  – "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." – Chuck (44:15)
• On class and research bias:
  – "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." – Josh (45:38)

Important Timestamps

• 02:58 – “Summer teeth” joke explained
• 05:08–06:26 – How evolution and diet shape tooth alignment
• 07:11–09:04 – Ancient orthodontic devices (catgut, gold bands, tooth filing)
• 13:31 – The “pelican” and early tooth-moving devices
• 19:09 – The term “orthodontics” emerges
• 24:41–25:18 – The origins and persistence of palate “expanders”
• 26:06–27:41 – American orthodontic pioneers Farrar and Angle
• 33:07–37:42 – Modern braces: technical progress and variations (ceramic, colored, braces behind teeth)
• 38:10–39:16 – The Invisalign/invisible aligner innovation and professional backlash
• 42:30–43:02 – Modern prevalence statistics for braces among kids
• 44:15–45:38 – The psychology, class implications, and difficulties in orthodontic research

Conclusion

Josh and Chuck guide listeners through the intertwining history of orthodontics, health, and beauty standards, prompting skepticism about the industry’s medical claims and spotlighting the societal pressures that keep orthodontics booming. Their humor, insights, and memorable anecdotes make for both an informative and entertaining dive into the surprisingly complex world of braces.