A Toothache Remedy You Don’t Want to Use!

As a full time general dentist in Orange, CT, I see lots of techniques patients use in attempts to relieve pain. The most famous one is part of my Dental MythBusters series and involves placing an aspirin next to the offending tooth. Hint: it doesn’t work! Other techniques I have seen, which vary in their efficacy, include garlic, oil of cloves, alcohol (both the rubbing kind and the drinking kind), lemons, and other items.

Pierre Fauchard portrait considered the father of dentistry

Portrait of Fauchard from his 1728 work.

One toothache remedy that is not well known was proposed by Pierre Fauchard (1678 – 1761). Fauchard was a prominent French physician who is often credited as “the father of modern dentistry.”  He authored the work Le Chirurgien Dentiste (English: The Surgeon Dentist) in 1728.

Fauchard wrote about a number of treatments and theories that are still applicable today in dentistry:

  • He theorized that sugars were responsible for cavities (and not tooth worms which was the prevailing theory).
  • He developed one of the first dental drills.
  • Fauchard proposed the placement of filling materials into teeth.
  • He developed new techniques for dentures.

All of these were quickly adopted by others and put into use. But there was one idea that did not take off.

An aPEEling Toothache Cure?

Fauchard made a startling proposition: rinsing with your own urine will cure a toothache!

Tooth with a cavity causing pain and toothache

Should you rinse with urine to cure a toothache in this tooth?

He even went so far as to say:

“One should retain it (urine) some time in the mouth and continue its use.”  

Not surprisingly, many of Fauchard’s medical colleagues and patients did not embrace his idea like they did his others. After all, it was 1728!

But Fauchard’s theory did have some credence behind it. Urine contains ammonia as well derivatives of ammonia. Ammonia had been used previously by the Romans as a detergent and to remove stains. Some people in France a century before Fauchard were known to bathe in urine because of its cleansing properties.  While ammonia was useful for many reasons, it helps with toothaches in part because it is a base and can neutralize the acids associated with the bacteria that cause tooth decay.

Definitive Toothache Remedies

The best remedy to a toothache is not urine but a trip to the dentist for a definitive diagnosis. In nearly all cases, pain in a tooth or a couple of teeth is due to either decay (cavities) or gum disease. But there are other factors that can mimic a toothache: sinus infections, jaw muscle discomfort or joint pain (called TMD), grinding, trauma, receded gums, cold sores (called aphthous ulcers), and many others.

I will never forget the day in my residency when a patient came in with lower left jaw pain that he thought was from a tooth but was really from an acute heart attack he was experiencing! See this page if you don’t believe me.

But remember, regardless of the source of the pain, there are much better techniques for teeth and gum pain than rinsing with your own urine!

Cocaine and Dentistry

Most people are unaware that cocaine was used in dentistry as a local anesthetic. During the height of its use, cocaine was considered remarkably effective for both dental procedures and curing toothaches.  Cocaine was a critical part of the history of local anesthetics in dentistry!

Cocaine and Dentistry in the 1800s

Print ad for Cocaine tooth drops used for teething pain

Print ad for Cocaine Tooth Drops for teething pain in children, circa 1885.

In 1860, a young German chemist named Albert Niemann isolated cocaine from the leaves of the South American coca bush.  He called the new compound “Cocain.” After his discovery, chemists in Europe and the U.S. began to experiment with it.  Sigmund Freud was an early proponent of its medicinal uses and encouraged a physician colleague Dr. Karl Koller to experiment with its analgesic properties.

Koller experimented with cocaine and then demonstrated the local anesthetics effects at an Ophthalmic meeting in 1884.  News spread quickly to the United States and only a couple of weeks of Koller’s demonstration, it was used in dentistry. William Haldsted MD injected cocaine into the lower jaw of a patient and then extracted a tooth with no pain or sensation felt by the patient. Thus marked the beginning of the use of local anesthetics in dentistry.

Drawbacks of Dental Use of Cocaine

News of this spread quickly and soon cocaine was widely adopted as an anesthetic by dentists and physicians starting in the late 1880s. It is important to remember that prior to the introduction of cocaine, dental procedures were done without any numbing at all!

Key properties of cocaine included:

  • Quick onset and short duration of action.
  • Localized effects.
  • Feelings of euphoria in the individual receiving the cocaine.
  • Certain cardiovascular effects such as increased heart rate.
Coca leaves used to make cocaine which was the first local anesthetic used in dentistry

Coca leaves used to make cocaine

The feelings of euphoria were not lost on those dentists and physicians administering the cocaine.  Soon, many dentists and physicians developed a dependency upon it, including Halsted himself. In fact, three of his colleagues actually died without recovery from the addiction of cocaine. Once this was observed on a large scale, chemists quickly sought to develop an alternative to cocaine for use as local anesthetic.

Next Step: Novocaine

In 1905, a new local anesthetic, Procaine, was introduced. Procaine had all the desired effects of cocaine as a local anesthetic, but did not posses the addictive potential nor the other negative side effects. Procaine then quickly replaced cocaine as the local anesthetic of choice in dentistry.  One company then made the fateful decision to market procaine under a new brand name: Novocain. From that point on, the name Novocaine has become synonymous with “the shot you get at the dentist”, a phenomenon I documented in this Dental MythBuster post.

Carpule of lidocaine and epinephrine the most popular dental local anesthetic used in dentistry for numbing

Lidocaine with epinephrine

Novocaine had its own drawbacks so a new generation of local anesthetics were then developed many years later. Today, lidocaine (pictured on the left) is the most popular local anesthetic used in dentistry in the United States. I routinely use lidocaine and another local anesthetic, articaine (brand name septocaine), on a daily basis in my practice in Orange, CT. Both are extremely effective and it is rare that I observe any complications.

Interestingly, redheads have a well documented resistance to dental local anesthetics, research I documented in one blog post about redheads and then another recent article.  I always explain to red haired patients the research on this subject and they are fascinated to learn about it.  It is likely that red haired individuals would have a resistance to the anesthetic properties of cocaine as well.

But all patients – regardless of hair color – are glad that they do not have to be injected with cocaine in order to have dental procedures done!

4-F: Unfit for Service because of your Teeth?

Rejected Due to lack of four front teeth 4-F or 4FMany civilians as well as military personnel are familiar with the term 4-F (also called 4F).  4-F is a classification given to a new U.S. military registrant indicating that he or she is “not acceptable for service in the Armed Forces” due to medical, dental, or other reasons.

Most people do not know that the term 4-F (or 4F) originated in the Civil War and was used to disqualify army recruits who did not have four front teeth with which to tear open gunpowder packages.

History of the term 4F or 4-F

The term 4F or 4-F started in the Civil War.  As both Confederate and Union soldiers were being recruited, there were very few medical or dental reasons for rejection.  Quite simply, the battery of tests and screening tools available today simply did not exist back then.

Photo of Union Soldiers in Civil War and they each had their four front teeth and were not 4F nor 4-F

Photograph of Union Soldiers in the Civil War. On enlisting, they were not classified as 4-F since they had at least four front teeth. Source unknown.

It was noted, however, that in order to properly load a rifle quickly, the gun powder cartridge needed to be ripped open with the teeth. Molars and premolars in the back of the mouth were not sufficient for this task. Only the incisors and canine teeth in the front could be utilized.

Photo of Civil War Dentist evaluating a soldiers teeth to see if he is 4F or 4-F

Civil War Dentist examines a soldier’s teeth. Courtesy Association of Army Dentistry, San Antonio, TX.

Back then, routine dental care did not exist, and many people in their late teens and 20s were missing several teeth. If a recruit could not open the gun powder cartridge with his teeth, he would not be able to reload quickly, placing himself and his fellow soldiers at greater risk.

So, while evaluating new registrants, a dental exam was performed to see if each young man had at least four front teeth. The dentist would examine the young man and evaluate the front teeth (or lack thereof). Those young men without four front teeth were disqualified and not permitted to enlist.

Naturally, a “code” was needed to designate why the registrant was unfit for service. So someone (presumably a Union Officer) came up with:

4-F (lacks 4 Front Teeth)

And from that point forward, the term 4-F was used in this manner.

Use of 4-F in the Military Today

Photo of four front teeth 4F or 4-F and this patient could serve in Army in Civil War

Front teeth of a military patient of mine. He could have served in the Civil War and would not be assigned 4F or 4-F.

After the Civil War, the term 4-F (4F) continued to be used to disqualify possible recruits for medical, dental, or other health reasons.  As time progressed and more was learned about medicine and dentistry, new screening criteria was developed.  In addition, with the development of new rifle technology, one no longer needed four front teeth to efficiently fire and re-load a rifle.  So the “four front teeth” criteria was eliminated.  The term 4-F was used by the Selective Service System extensively in World War II and that is when it entered the vocabulary of most Americans.

As a general dentist in private practice, I have the privilege of treating all types of members of the Armed Services. Frequently I have to examine a patient and complete a Pre-Deployment Dental Screening Form and certify that the patient has no acute dental problems that would interfere with his/her ability to serve in the military. I feel honored to have this privilege and I take this responsibility quite seriously.  As of this day, I have yet to see a patient about to deploy without at least 4 front teeth. But if so, it would not disqualify them from service. But I hope I never see that!