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11/20/2001

Here's to More Enjoyable Brushing

Last week was not easy on the nerves, especially with the plane
crash in New York the morning of November 12. At the time of
the crash, I was in the waiting room on the third floor of New
York Presbyterian Hospital on East 68th Street. My wife''s
surgery had begun just 12 minutes earlier. New York''s bridges
and tunnels were closed, just a few hours after we had come
through the Holland Tunnel on our way to the hospital. It was
over three and a half hours before the surgeon appeared with the
news that the operation was over and that my wife was ok. I then
broke the news about the crash to him. By the time my wife got
to her room, I had spent 7 or 8 hours in the waiting room with
two TVs tuned to the crash developments. Others in the waiting
room were trying on their cell phones to contact friends who
lived in the crash site neighborhood. It was a stressful day.

During the four days spent in the hospital, one could not help
being impressed with the degree of computerization of the
procedures and record keeping. One could also not help being
depressed by the appalling state of patient care due to the
shortage of nurses. Equally appalling was the drive home with
my wife in the evening rush hour traffic. Those familiar with
New York might appreciate my concern when I got on a ramp to
the FDR Drive going south but somehow ended up on the FDR
Drive going north! But not to worry - the George Washington
Bridge route, though longer, could be faster. At least that''s what
I thought as we zipped along briskly. Then the FDR became a
parking lot and the trip took about two and a half hours,
compared to our 55-minute trip on the morning of the surgery.

Now in a caregiving mode at home, I was searching for a topic
that was not too technically demanding. One of my wife''s
experiences in the hospital spurred the choice. The morning after
the surgery, she had not received "morning care" even though her
chart was marked that she had. Morning care, for those fortunate
enough not to have been a patient in a hospital recently, is simply
someone giving the patient the opportunity to wash up a bit and
tend to such things as brushing his or her teeth. While assisting
my wife in the latter function, I wondered about the history and
technology of the toothbrush.

Certainly the technology of toothbrushing should be relatively
simple. On the Web site parentsplace.com, I was surprised to
find that there are over 3,000 patents on toothbrushes so it must
be more complex than I expected. I searched further and found
that even 25,000 years ago our Cro-Magnon ancestors suffered
from tooth decay. The most revealing account I found on the
toothbrush itself was in Charles Panati''s book "Panati''s
Extraordinary Origins of Everyday Things". The first known
toothbrush was the "chew stick". The chew stick was simply a
twig with a frayed end that one rubbed against the teeth.
Although the earliest known chew sticks were found in Egyptian
tombs of the 3,000 BC era, I personally would be surprised if
some earlier version of Homo sapiens had not discovered this
simple tool.

With all the promotion in the media of various exotic
toothbrushes and toothpastes, I don''t wonder that the case of one
man''s experience with chew sticks has not received wide
publicity. This senior citizen, living in Louisiana, used white
elm chew sticks all his life and had nary a trace of plaque, in
addition to sporting a set of healthy gums. It seems that others in
the more rural areas of the U.S. use chew sticks today, not to
mention many African tribes that use twigs from a certain kind of
tree known appropriately as the "toothbrush tree".

The ancient Egyptians were clever enough to decide that their
chew sticks could use a bit of help to accomplish the cleaning
job. About 4,000 years ago they came up with toothpaste, in the
form of ground pumice stone and a hearty wine vinegar. This
concoction certainly doesn''t sound as tasty as a minty blob of
Crest. From a chemist''s standpoint, those Egyptians were using
the acid approach, vinegar''s distinctive component being acetic
acid. The ancient Romans, on the other hand, employed a
toothpaste with an alkaline component - ammonia. In that, they
were in the forefront of modern household cleaning formulations
that employ those cleansing ammonia molecules.

Warning - the vehicle used as the source of the Romans''
ammonia may not be suitable for discussion if you have a queasy
stomach. You may want to skip this paragraph. The toothpaste
was made from human urine. It wasn''t clear from Panati''s
account whether the urine was used in the liquid state or whether
it might have been treated to yield urea. If the latter, not so bad;
however, it seems that liquid urine was also used as a
mouthwash! In fact, those Roman women of the upper crust
were willing to go to considerable expense to obtain Portuguese
urine, supposedly the strongest urine around. The speculation is
that the Portuguese urine was deemed stronger because it had to
travel some distance to get to Rome. During the trip some of the
water would have evaporated and the Roman women were
probably correct. Lest you think that urine disappeared with the
fall of the Roman Empire, it continued to be used in toothpastes
until only two or three hundred years ago.

But I digress, the toothbrush, not toothpaste, is of prime concern
here. The chew stick began to give way to the bristle toothbrush
at about the time of Columbus. The Chinese took bristles from
hogs living in Siberia or other cold climes and stuck the bristles
in bamboo or bone. The hog bristles were quite firm. When
European traders brought the hog bristle toothbrush back to
Europe, the Europeans didn''t care for the firmness and decided
horsehair brushes were more comfortable to use. Apparently, the
brushing of one''s teeth was not really all that common. Many
preferred various forms of toothpicks - animal quills or metal
toothpicks of brass or silver.

With the discovery of all those pesky germs by Louis Pasteur, a
big problem with those hog or horsehair bristles was realized.
The bristles retained moisture and after prolonged use, they
harbored the growth of bacteria and fungi. If the bristle
penetrated the gum, infections could result. So those who picked
their teeth may have been in better shape. One could of course
sterilize the toothbrush by immersing it in boiling water but this
made the bristles too soft or did them in completely.

It came as a shock to me to find that I lived the first decade of
my life in this sad state of dental technology. The U.S. was
importing well over a million pounds of hog bristles a year. It
wasn''t until 1938 that Du Pont''s slogan about better living
through chemistry became a reality in the toothbrush. It was the
invention of nylon in the earlier 1930s that solved the bristle
problem. Nylon did not hold on to the water but dried
thoroughly and the bacterial or fungal growth was no longer a
problem. Except for one thing - the nylon bristles were really,
really stiff. I may have suffered personally from that stiffness. I
took to heart that you had to brush your teeth thoroughly and I
scrubbed them so hard with those hard nylon bristles that I
brushed away a good bit of tooth at the gumline. By the 1950s,
Du Pont had come up with a "soft" nylon and they sold the new
softer toothbrushes initially at a price five times the cost of the
old hard bristle variety.

The rest is history. The electric toothbrush came in 1961 from
Squibb and General Electric quickly followed with the cordless
battery-powered model. However, the old-fashioned hand-
operated nylon bristle brush is still the favorite around the world.
Except, of course, among those who still favor the truly old-
fashioned chew stick.

One parting thought for those of you who might want to try the
old-fashioned urine-based toothpaste approach. I was just
reading the November issue of the Johns Hopkins Medical
Letter, Health After 50 and came across a statement that urine, as
it emerges from the human body, is ordinarily sterile. In spite of
that comforting fact, I personally have no desire to try this
experiment and will stick to my Crest.

Allen F. Bortrum



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-11/20/2001-      
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Dr. Bortrum

11/20/2001

Here's to More Enjoyable Brushing

Last week was not easy on the nerves, especially with the plane
crash in New York the morning of November 12. At the time of
the crash, I was in the waiting room on the third floor of New
York Presbyterian Hospital on East 68th Street. My wife''s
surgery had begun just 12 minutes earlier. New York''s bridges
and tunnels were closed, just a few hours after we had come
through the Holland Tunnel on our way to the hospital. It was
over three and a half hours before the surgeon appeared with the
news that the operation was over and that my wife was ok. I then
broke the news about the crash to him. By the time my wife got
to her room, I had spent 7 or 8 hours in the waiting room with
two TVs tuned to the crash developments. Others in the waiting
room were trying on their cell phones to contact friends who
lived in the crash site neighborhood. It was a stressful day.

During the four days spent in the hospital, one could not help
being impressed with the degree of computerization of the
procedures and record keeping. One could also not help being
depressed by the appalling state of patient care due to the
shortage of nurses. Equally appalling was the drive home with
my wife in the evening rush hour traffic. Those familiar with
New York might appreciate my concern when I got on a ramp to
the FDR Drive going south but somehow ended up on the FDR
Drive going north! But not to worry - the George Washington
Bridge route, though longer, could be faster. At least that''s what
I thought as we zipped along briskly. Then the FDR became a
parking lot and the trip took about two and a half hours,
compared to our 55-minute trip on the morning of the surgery.

Now in a caregiving mode at home, I was searching for a topic
that was not too technically demanding. One of my wife''s
experiences in the hospital spurred the choice. The morning after
the surgery, she had not received "morning care" even though her
chart was marked that she had. Morning care, for those fortunate
enough not to have been a patient in a hospital recently, is simply
someone giving the patient the opportunity to wash up a bit and
tend to such things as brushing his or her teeth. While assisting
my wife in the latter function, I wondered about the history and
technology of the toothbrush.

Certainly the technology of toothbrushing should be relatively
simple. On the Web site parentsplace.com, I was surprised to
find that there are over 3,000 patents on toothbrushes so it must
be more complex than I expected. I searched further and found
that even 25,000 years ago our Cro-Magnon ancestors suffered
from tooth decay. The most revealing account I found on the
toothbrush itself was in Charles Panati''s book "Panati''s
Extraordinary Origins of Everyday Things". The first known
toothbrush was the "chew stick". The chew stick was simply a
twig with a frayed end that one rubbed against the teeth.
Although the earliest known chew sticks were found in Egyptian
tombs of the 3,000 BC era, I personally would be surprised if
some earlier version of Homo sapiens had not discovered this
simple tool.

With all the promotion in the media of various exotic
toothbrushes and toothpastes, I don''t wonder that the case of one
man''s experience with chew sticks has not received wide
publicity. This senior citizen, living in Louisiana, used white
elm chew sticks all his life and had nary a trace of plaque, in
addition to sporting a set of healthy gums. It seems that others in
the more rural areas of the U.S. use chew sticks today, not to
mention many African tribes that use twigs from a certain kind of
tree known appropriately as the "toothbrush tree".

The ancient Egyptians were clever enough to decide that their
chew sticks could use a bit of help to accomplish the cleaning
job. About 4,000 years ago they came up with toothpaste, in the
form of ground pumice stone and a hearty wine vinegar. This
concoction certainly doesn''t sound as tasty as a minty blob of
Crest. From a chemist''s standpoint, those Egyptians were using
the acid approach, vinegar''s distinctive component being acetic
acid. The ancient Romans, on the other hand, employed a
toothpaste with an alkaline component - ammonia. In that, they
were in the forefront of modern household cleaning formulations
that employ those cleansing ammonia molecules.

Warning - the vehicle used as the source of the Romans''
ammonia may not be suitable for discussion if you have a queasy
stomach. You may want to skip this paragraph. The toothpaste
was made from human urine. It wasn''t clear from Panati''s
account whether the urine was used in the liquid state or whether
it might have been treated to yield urea. If the latter, not so bad;
however, it seems that liquid urine was also used as a
mouthwash! In fact, those Roman women of the upper crust
were willing to go to considerable expense to obtain Portuguese
urine, supposedly the strongest urine around. The speculation is
that the Portuguese urine was deemed stronger because it had to
travel some distance to get to Rome. During the trip some of the
water would have evaporated and the Roman women were
probably correct. Lest you think that urine disappeared with the
fall of the Roman Empire, it continued to be used in toothpastes
until only two or three hundred years ago.

But I digress, the toothbrush, not toothpaste, is of prime concern
here. The chew stick began to give way to the bristle toothbrush
at about the time of Columbus. The Chinese took bristles from
hogs living in Siberia or other cold climes and stuck the bristles
in bamboo or bone. The hog bristles were quite firm. When
European traders brought the hog bristle toothbrush back to
Europe, the Europeans didn''t care for the firmness and decided
horsehair brushes were more comfortable to use. Apparently, the
brushing of one''s teeth was not really all that common. Many
preferred various forms of toothpicks - animal quills or metal
toothpicks of brass or silver.

With the discovery of all those pesky germs by Louis Pasteur, a
big problem with those hog or horsehair bristles was realized.
The bristles retained moisture and after prolonged use, they
harbored the growth of bacteria and fungi. If the bristle
penetrated the gum, infections could result. So those who picked
their teeth may have been in better shape. One could of course
sterilize the toothbrush by immersing it in boiling water but this
made the bristles too soft or did them in completely.

It came as a shock to me to find that I lived the first decade of
my life in this sad state of dental technology. The U.S. was
importing well over a million pounds of hog bristles a year. It
wasn''t until 1938 that Du Pont''s slogan about better living
through chemistry became a reality in the toothbrush. It was the
invention of nylon in the earlier 1930s that solved the bristle
problem. Nylon did not hold on to the water but dried
thoroughly and the bacterial or fungal growth was no longer a
problem. Except for one thing - the nylon bristles were really,
really stiff. I may have suffered personally from that stiffness. I
took to heart that you had to brush your teeth thoroughly and I
scrubbed them so hard with those hard nylon bristles that I
brushed away a good bit of tooth at the gumline. By the 1950s,
Du Pont had come up with a "soft" nylon and they sold the new
softer toothbrushes initially at a price five times the cost of the
old hard bristle variety.

The rest is history. The electric toothbrush came in 1961 from
Squibb and General Electric quickly followed with the cordless
battery-powered model. However, the old-fashioned hand-
operated nylon bristle brush is still the favorite around the world.
Except, of course, among those who still favor the truly old-
fashioned chew stick.

One parting thought for those of you who might want to try the
old-fashioned urine-based toothpaste approach. I was just
reading the November issue of the Johns Hopkins Medical
Letter, Health After 50 and came across a statement that urine, as
it emerges from the human body, is ordinarily sterile. In spite of
that comforting fact, I personally have no desire to try this
experiment and will stick to my Crest.

Allen F. Bortrum