Original Articles

By Dr. William Maloney
Corresponding Author Dr. William Maloney
New York University, 345 East 24th Street - United States of America 10010
Submitting Author Dr. William J Maloney

Hemingway, Mark Twain, William Kennedy, Chaucer, Miguel de Cervantes, Karen Blixen, Frank Norris

Maloney W. A Tooth Is Worth A Treasure. WebmedCentral DENTISTRY 2010;1(9):WMC00576
doi: 10.9754/journal.wmc.2010.00576
Submitted on: 09 Sep 2010 09:25:16 PM GMT
Published on: 09 Sep 2010 09:36:58 PM GMT

Characters from the Pages of Literature Visit the Dentist


Dentistry has captured the hearts and minds of both the greatest masters of literature and their audiences throughout the ages.Like real-life dentistry, the characters of literature pose different diagnostic challenges, have different ideas of what they desire for their teeth, have various medical issues and conditions which have to be handled correctly.There are also some who might raise ethical issues or patient management concerns.
This paper portrays eight characters from the world of literature seeking treatment in the office of a dentist who is also a literary character. A section is devoted to each character.Every section provides the reader with 1) an imaginative rendering of a visit to the dentist by each character, 2) a quote or quotes from the individual piece of literature, 3) a brief history of the work of literature and 4) a brief examination of a topic in the dental literature which pertains to the dental issues of the character.It provides quotes from these literary works which provide a portal into the way in which dentistry has been viewed in various cultures at different times throughout history.
An explanation of the background behind the quotes pertinent to the practice of dentistry is provided as is an analysis of a modern-day response to the dental situation presented by the literary figure.


"A tooth is worth a treasure" exclaims Don Quixote (1).  This fictional chivalrous figure sums up literature's deep admiration and appreciation for not only nature's gift of one's teeth and their surrounding structures but to dentistry in general- the profession charged with the safekeeping, preservation, and restoration of nature's pearls.

The characters in this article, albeit taken from the pages of literature, present a wide scenario of diagnostic challenges, treatment issues and patient management concerns thanks, in part, to the wonderful imagination of their creators.
Alot can be learned about various societies views towards teeth and dentistry through literature. Such views are presented and explained in this work while being accompanied by a rational and modern dental resolution to the situation presented.
The very essence of dental practice is the adherence to a set of ethical and moral values while confronted with a wide range of personalities seeking our help in treating their array of dental issues.
In truth, how really different are our patients of flesh and blood compared to those of pulp and ink?
Dr. McTeague is a unique individual.  He practices dentistry in San Francisco and has many different talents.  His high degree of resourcefullness and resiliency are very useful characteristics in a dentist. He is about to embark on another day in his dental practice and will certainly, as always, need to rely on these strengths to a large degree.
"Mad because of his defeat at the hand of the  dentist ..."
McTeague: A Story of San Francisco is a novel by Frank Norris first published in 1899.  McTeague is a dentist married to a lady named Trina. The novel follows the trials and tribulations of the couple.
Today it is generally accepted that failing to operate a dental practice in an efficient manner or not providing excellent customer service can detract from the dentist's ability to provide excellent dental care and an overall positive patient experience (3).  
There are many excellent practice management resources available to today's dentist to help them in striving for excellence in their respective dental practices.
Dr. McTeague's first patient of the day is a seemingly old-fashioned British lady. Dr. McTeague asks her to enter the dental operatory and soon he realizes that she is much different than the dutiful British housewife- with a very peculiar British accent which Dr. McTeague just can not place-which he summed her up as being at first impression.                                                       The most noticeable trait about this individual is her wide diastema.  Dr. McTeague immediately thinks that she is desiring veneers or some cosmetic composite procedure -maybe even orthodontics- to close the large space between her maxillary central incisors.                                 But no, this seemingly demure British lady reacts with horror when Dr. McTeague suggests some of these aforementioned procedures.  She is very proud of her diastema.  She tells Dr. McTeague that it represents who she is as a person and not to dare think about closing up her space.  She sees it as an integral part of her identity.  She requests that Dr. McTeague only clean her teeth today. Dr. McTeague complies with her wishes and she is quite happy.                                                         As the dental visit draws to an end, she strangely inquires if Dr. McTeague's wife, Trina, is in the office today.  Dr. McTeague tells her that his wife should be arriving any minute now.  She tells Dr. McTeague that she'll call to set up her six month recall appointment rather than make it now.  She scurries off.
"I was forty then, to tell the truth.   But still I always had a coltish tooth.  Yes I'm gap tooth, it suits me well."
The Canterbury Tales was written in Middle English by Geoffrey Chaucer in the 14th century.  It is a collection of tales told within the framework of a larger tale.  It is told by a group of pilgrims as they set out on a pilgrimage from London to Canterbury.  The group of characters represent a wide range of individuals from the lower class to the upper class.
The pilgrims agree to tell tales as a sort of contest with the winner having his supper paid for by the rest of the group.  No winner is chosen in the end.
Throughout history, various societies have commented on the prominent spaces that are present in the dentitions of certain individuals.  The French have called the teeth on either side of the gap as "dents du bonheur" or "lucky teeth" while in Nigeria gaps between teeth are considered to be a very attractive physical trait (5).  In Great Britain, at the time of the Wife of Bath, such a gapped-tooth appearance was seen, in the female, as indicative of her lustful personality (5).


Mr. Phelan is the next patient.  He flew in early this morning from Albany, NY.
In reviewing the medical history of Mr. Phelan, it is revealed to Dr. McTeague that Mr. Phelan is an alcoholic.
As with all his patients, Dr. McTeague commences to do a thorough head and neck examination.  He finds a suspicious white lesion on the lateral border of Mr. Phelan's tongue.  Dr.  McTeague decides to biopsy the lesion and discusses the treatment with Mr. Phelan.
He advises Mr. Phelan to seek alcohol counselling and tells him that he will be in contact shortly to discuss the results of the biopsy.
"Francis felt healthy and he liked it. It's too bad he didn't feel healthy when he drank.  He felt good then but not healthy, especially not in the morning, or when he woke up in the middle of the night, say.  Sometimes  he felt dead."
Ironweed is a novel written by William Kennedy, a graduate of Siena College, which focuses on the story of Francis Phelan.
Phelan is an alcoholic vagrant who is originally from Albany, NY and leaves his family after accidentally killing his infant son while under the influence of alcohol.
Ironweed was awarded the 1984 Pulitzer Prize for fiction.
Alcoholism has been documented to cause many medical conditions which is of concern to the treating dentist. Amongst these are nutritional defeciencies, liver conditions, vitamin deficiencies, immune system deficiencies, gastro-intestinal disorders, cardiovascular effects, coagulation abnormalities, and drug interactions (7).
The next patient is an elderly man who seems full of life.  He is talking to anyone who will listen- and everyone is listening.
At least he made the previous patient, Mr. Phelan, laugh.  I heard him tell Mr. Phelan that he had once told a Mrs. R.B. Hayes that "total abstinence is so excellent a thing that it cannot be carried to too great an extent.  In my passion for it so far as to totally abstain from total abstinence (9)".
As Mr. Phelan leaves the office, Dr. McTeague asks Mr. Twain, or is it Mr. Clemens, to be seated in the operatory.  In reviewing the medical history form, Dr. McTeague, sees why it took this patient so long to complete this rather straightforward form.  He crossed out his response to the line asking for his address twice.  He started with some place called Hannibal, then wrote 'on the Mississippi' then finally settled for Hartford, CT.
 Under occupation he wrote 'miner, lecturer, printer, soldier (of three weeks duration), Mississippi River pilot but, presently an author of literature in a low form-humor.                                           Dr. McTeague starts to perform a periodontal examination on Mr. Twain while telling him little about the importance of brushing and flossing.  Mr Twain angrily and suddenly interrupts Dr. McTeague's progress. He states that "most cursed of all are the dentists who made too many parenthetical remarks - dentists who secure your instant and breathless interest in a tooth by taking a grip on it, and then stand there and drawl through a tedious anecdote before they give the dreaded jerk.  Parentheses in literature and dentistry are in bad taste(10)".  
Mr. Twain then goes on and states to Dr. McTeague that "all dentists talk while they work.  They have inherited this from their professional ancestors, the barbers (8)".
Dr. McTeague remains professional and states that he has periodontitis and that he will have to refer him to a periodontist.  Mr. Twain is agreeable to that and states that he has a friend back in Hartford, a Dr. Riggs, who is a great periodontist. 
"... a secretion decayed the bone-surface of the roots of the teeth, then the gums retreated from these surfaces, pus was   engendered in the gums, the teeth began to loosen, and the man's general health was injured."
Mark Twain, a pen name of the 'Father of Modern American Literature' Samuel Clemens, was born on November 30, 1835 in the town of Florida, Missouri as Haley's Comet passed overhead.  
He eventually became America's leading author of the time.  He helped to popularize a distinctive form of American literature.
Clemens passed away on April 21, 1910, a day after Haley's Comet passed overhead making its return trip above the western hemisphere- "I came in with Haley's comet in 1835.  It is coming again next year, and I expect to go out with it".
Until recently, little attention has been given to the role that chronic oral diseases, such as periodontal disease, have on systemic health.  There is evidence that periodontal disease might increase the risk of arteriosclerosis, myocardial infarction, stroke, and premature births. (11)
Dr. McTeague  sits down at his desk and calls Dr. Riggs, a periodontist in Hartford, CT. Dr. McTeague explains to  Dr. Riggs the periodontal status of Mr. Twain. Dr. Riggs says he will be happy to examine Mr. Twain and thanks Dr. McTeague for the referral.
"He said I have a certain disease of the teeth which had a certain scientific name but was sometimes called 'Rigg's Disease' because Dr. Riggs had invented a method  of treating it  which cured it in some instances and arrested its progress and rendered it harmless in all;  whereas it had  formerly refused to succumb to dental science."
The references to Dr. Riggs in "Happy Memories of the Dental Chair" can be assumed to be from Samuel Clemens' personal contact and experiences with Dr. Riggs (12).  The short story provides a portal for the reader into the thoughts of "the father of periodontics" as related by Samuel Clemens. Of extreme historical importance is the reference which links periodontal health with overall or 'general'  systemic health as this literary work was completed in 1895.
Dr. John Mankey Riggs practiced dentistry in Hartford, CT.  He is considered to be the "Father of Periodontics".  He is also credited with performing the first successful surgery with the use of anesthesia when he extracted the third molar of Dr. Horace Wells under nitrous oxide inhalation anesthesia.
The next patient is a very astute-looking English gentleman who sems to be looking around the waiting room as if looking for some clue into the qualifications and ability of Dr. McTeague.  
Mr. Holmes is escorted into the patient treatment area. Dr. McTeague commences the visit by reviewing the patient's medical history with him.  Mr. Holmes acknowledges what he calls "the recreational use of cocaine".  When questioned as to the frequency of its use, Mr. Holmes states that he only uses it when there is a little lull in the normal excitement of his personal life.  
He asks Dr. McTeague if that is of importance in his dental treatment.  Dr. McTeague responds that, for starters, it will affect his choice of anesthetic.
Dr. McTeague continues the dental examination as the patient suspiciously eyes everything in the dental operatory.
"Sherlock Holmes took his bottle from the corner of the mantel-piece, and his hypodermic syringe from its neat morocco case.  With his long, white, nervous fingers he adjusted the delicate needle, and rolled back his left shirt-cuff.  For some little time his eyes rested thoughtfully upon the sinewy forearm and wrist, all dotted and scarred with innumerable puncture-marks.  Finally, he thrust the sharp point home, pressed down the tiny piston, and sank back into the velvet-lined arm-chair with a long sigh of satisfaction." 
Sir Arthur Conan Doyle was born in Edinburgh in 1859 and graduated from Edinburgh University with a degree in medicine. He used the diagnostic skills he acquired in medical school and gave them to the fictional Detective Sherlock Holmes who uses these skills of detecting fine details to solve mysterious crimes.
Cocaine users pose a special set of issues to the dental profession.  One of the major considerations is the cardiovascular complications of cocaine use.  It has been shown that the risk of acute myocardial infarction is increased by a factor of 24 during the first hour after the use of cocaine in people who would otherwise be considered low risk (14).
Now sitting in the waiting room are two gentlemen.  One of these men seems extremely distressed.  Dr. McTeague can hear the new patient nervously commenting to his companion that he hopes the doctor is able to replace his missing teeth because he so greatly values his teeth and so dearly wants them to be replaced.
" '... but reach hither thy hand, and feel with thy finger how many teeth I have lost on this side of my upper jaw, which is the place which gives me the greatest pain.' Sancho introduced his fingers, and having carefully examined his gums, 'How many teeth, said he, was your worship wont to have in this place?'
'Four, besides the dog tooth', answered Don Quixote, 'all of them sound and whole', 'Consider what your worship says?' replied Sancho. 'I say four, if not five', resumed the knight; 'for, in all my life, I never lost a tooth or fang, either by worm, rheum, or scurvy'.
'At present, said the squire, in that part of the lower jaw, your worship has but two grinders and a half; and above, neither half nor whole; all is as smooth as the palm of my hand'.
'Cruel fortune!' cried Don Quixote, hearing this melancholy piece of news, 'would they had rather demolished a limb, so it had not been the sword arm: for I would have thee to know, Sancho, that a mouth without grinders, is like a mill without a millstone: and a tooth is worth a treasure'.
Don Quixote is a novel written by the Spanish author Miguel de Cervantes.  Don Quixote, the central figure, is a middle-aged man from central Spain.  He is obsessed with chivalric virtues and values.  He is accompanied by his squire, the kind, faithful and cowardly Sancho Panza.
Partial dentures have provided generations of patients a solution to replacing their missing teeth.  Many dentists, throughout the years, have contributed to the removable partial denture literature.  
The design of the partial removable prosthesis has always been viewed as being of the utmost importance (15).
The next patient is a beautiful young Hispanic lady, Maria.  When asked what her chief complaint is, she stated that she wanted her teeth whitened.  Dr. McTeague explained to her the various methods and she decided that she would have Dr. McTeague do in-office whitening.  She also wanted custom trays made so she could continue the whitening process when she arrived back in her own country.
"Her teeth were white in her brown face and her skin and her eyes were the same golden tawny brown.  She had high cheekbones, merry eyes and a straight mouth with full lips ... She has a beautiful face, Robert Jordan thought."
For Whom the Bell Tolls was first published in 1940 by Ernest Hemingway.  It tells the story of a young American, Robert Jordan, during the Spanish Civil War.  Maria is the young lover of Robert Jordan.
A variety of tooth-whitening methods are available today.  The patient has the option of using custom trays loaded with a bleaching agent or by use of the peroxide bleaching procedures completed by the dentist.  When under the supervision of a dentist, both methods are safe and effective. (17)
The next patient of the day is a young boy from a place in Africa called Buramur.  He was accompanied by an elegant European woman named Karen Blixen.
The boy had been in a fight and had lost his two front teeth.  Ms. Blixen, living at the time in Nairobi, had heard of this sad case and had volunteered to pay for the boy's treatment and accompany him to San Francisco for the state-of-the-art dental treatment which is provided in Dr. McTeague's practice.  The boys parents consented to the plan.
Dr. McTeague, always on the cutting edge of dentistry, is known for his spectacular results of placing implants and the final restoration in the same visit.
The sad, shy boy reluctantly sat in Dr. McTeague's dental chair.
Before long, Dr. McTeague was showing the boy his new teeth in a mirror.
The boy was ecstatic- he shouted out something about not needing those 'fifty camels' anymore. Dr. McTeague didn't know what the boy meant by that comment but, knew that it was a positive comment as the boy ran out to Ms. Blixen thanking her for bringing him to the great Dr. McTeague.
"Once the news came to Nairobi of how Farah's little brother, who was ten years old, in a place called Buramur, had taken up a stone and thrown it at a boy of a different tribe, knocking out two of his teeth.  Over this matter representatives of the two tribes met at the farm to sit upon the floor of Farah's house and talk, night after night.  Old lean men came, who had been to Mekka and wore a green turban, arrogant young Somalis who, when they were not attending to really serious matters, were gunbearers to the great European travellers and hunters, and dark-eyed, round faced boys, who were shyly representing their family and who did not say a word, but were devoutly listening and learning,  Farah told me that the matter was considered so grave because the boy's looks had been ruined, he might find it difficult, when his time came, to get married, and would have to come down in his pretensions as to birth or beauty in his bride.  In the end the penance was fixed at fifty camels, which means half waregilt, full waregilt being one hundred camels.  Fifty camels were then bought, far away in Somaliland,to be, ten years hence, laid on to the price of a Somali maiden, and to turn her eyes off the missing teeth of her bridegroom; perhaps the foundation of a great tragedy was laid.  Farah himself considered that he had got off lightly."
Out of Africa recounts the seventeen years when Karen Blixen lived in Africa.  She wrote this book- more precisely a memoir-using the nom de plume, Isak Dinesen.  It was first published in 1937.  The book conveys her efforts to run a coffee farm in what was then known as British East Africa between 1914 and 1931.  The story is significant for its lyrical description of Africa and the friends which she had there.
Dental implants have provided a great service to patients for the past few decades.  As with all areas of dentistry, it is ever-evolving.  
One of the areas of improved patient satisfaction is the time requirements for loading the implants.  The immediate loading of endosseous implants has become much more widespread recently (19).
What a commotion is being caused by the next patient- a young, adventurous boy with his aunt who is trying to control him but, to no avail.  They travelled to Dr. McTeague's dental office today from a small town in rural Missouri.  It seems that this boy needs a deciduous tooth extracted but he absolutely refuses to sit in the dental chair- he is very original in the excuses he makes up.  It seems like he has a dental phobia.               &nb sp;                & nbsp;                 ;                &nb sp;                & nbsp;            When asked if he ever had a bad experience at the dentist.  He says not at the dentist but he did at home. Young Tom will not be able to be seen today.  Dr. McTeague refers him to a dentist, Dr. Wells, who is certified in dental anesthesia and practices in Hartford, CT.  Tom's Aunt Polly says they will visit Mr. Clemens in Hartford, CT when they go for the appointment with Dr. Wells.
"Aunt Polly, it seemed mortified, and it hurt so I never minded my tooth at all."
"Your tooth, indeed!  What's the matter with your tooth?"
"One of them's loose, and it aches perfectly awful."
"There, there, now, don't begin that groaning again.  Open your mouth.  Well-your tooth is loose, but you're not going to die about that.  Mary, get me a silk thread, and a chunk of fire out of the kitchen."
Tom said: "Oh, please auntie, don't pull it out.  It don't hurt any more. I wish I may never stir if it does.  Please don't auntie.  I don't want to stay home from school."
"Oh, you don't, don't you?  So all this row was because you thought you'd get to stay home from school and go a-fishing?  Tom, Tom, I love you so, and you seem to try every way you can to break my old heart with your outrageousness."  By the time the dental instruments were ready.  The old lady made one end of the silk thread fast to Tom's tooth with a loop and tied the other to the bedpost.  Then she seized the chunk of fire and suddenly thrust it almost into the boy's face. The tooth hung dangling by the bedpost, now.
The Adventures of Tom Sawyer is a series of adventures and pranks in the life of the quintesential young American boy, Tom Sawyer.  In the background, is the blossoming romance with Becky Thatcher as young tom continues to mature.
The Adventures of Tom Sawyer, published in 1876, was Samuel Clemens' first novel.  It has been universally loved by generations of readers.
Clemens gives us a glimpse into how an overworked aunt in the Mississippi Valley of the nineteenth century might attempt to extract a tooth on her nephew who is consistently inventing new stories to miss a day at school.
There are many modalities available today for helping the anxious or phobic dental patient.  They range from various relaxation techniques to pharmocological interventions.  It is of utmost importance to deal with the anxiety of dental patients as dental anxiety is a significant cause of poor dental health (21).
Dr. McTeague places a call to a Dr. Wells of Hartford, CT.  He says that he is referring a very anxious boy to him for the extraction of a deciduous tooth.  Dr. McTeague goes on to tell Dr. Wells that the young boy, Tom, will be in town next week visiting a relative and he thought he should have the tooth extracted at that time because of Dr. Wells' great reputation concerning anesthesia and sedation techniques.
"The doctor was a young dentist, then, and had just set up his shingle with young Wells.  They visited a traveling laughing-gas exhibition one winter night, and were consumed with laughter over the grotesque performances of some of the Hartford youth while under the happy dominion of the gas."
Dr. Horace Wells was a dentist practicing in Hartford, CT.  As he passed away in 1848 he was never in the company of Samuel Clemens who didn't even visit Hartford for another twenty years.  In "Happy Memories of the Dental Chair" (8) Clemens speaks of a mesmerism show of which he had heard the details related many times.  It was during this mesmerism show  that Dr. Wells started grasping the possibilities of nitrous oxide as an anesthetic agent for use during dental extractions.  During the mesmerism show, a man under the effects of nitrous oxide injured his leg but was not experiencing any pain.  
Dr. Horace Wells was born on January 21, 1815.  He did much research into the administration of nitrous oxide to prevent pain during dental extractions.  
 Dr. Wells has been inducted into the Pierre Fauchard International Hall of Fame of Dentistry. (22)


The everyday practice of general dentistry forces the practitioner to use his wide range of skills.  These characters of literature  show not only the wide breadth of diagnostic challenges but also the wide range of patients who seek treatment in our offices.
These patients and their ailments consistently challenge us and our profession to new heights.           Our profession has been seen throughout history, in all cultures, as a respected and integral part of society.  This respect flows, in large part, from the dental profession's adherance to certain ethical standards.  As one wise man once said "Always do right.  This will gratify some people and astonish the rest (23)".


1. de Cervantes M. Don Quixote. Dublin: John Chambers,1796.
2. Norris F. McTeague: A Story of San Francisco. New York: Grosset and Dunlap Publishers,1899.
3. Levin R. The correlation between dental practice management and clinical excellence. J Am Dent Assoc 2004;135(3):345-346.
4. Chaucer G. The Canterbury Tales. New York: Thomas Y. Crowell and Company Publishers,1900.
5. Sesemann MR. Treatment options for the significant dental midline diastema. Inside Dentistry 2009;5(5):50-55.
6. Kennedy W. Ironweed. United States of America: Penguin Books,1984.
7. Ranka MS, Ranka S, Kharat R. Chronic alcoholism and dental practice. BHJ Reviews;2009: Available at www.bhj.org/journal/2000_4204_oct00/review_600.htm.
8. Twain M. Who is Mark Twain? New York: Harper Studio,2009.
9. Clemens, S. Autograph inscription in album to Mrs. Rutherford B. Hayes, reported in The Washington Post, June 11, 1881.
10. Twain M. A Tramp Abroad, Appendix D, "The Awful German Language. Hartford,CT:American Publishing 1880.
11. Garcia IR, Henshaw MM, Krall EA. Relationship between periodontal disease and systemic health. Periodontology 2000 2001;25:21-36.
12. Hirst, Robert."Happy Memories" e-mail to William Maloney. May 11, 2009.
13. Doyle AC. THE sign of four. London:Penguin Classics,2001.
14. Lange RA, Hillis LD. Cardiovascular complications of cocaine use. N Engl J Med 2001;345(5):351-359.
15. Steffel VL. Clasp partial dentures. J Am Dent Assoc 1963;66:803.
16. Hemingway E. For Whom the Bell Tolls. New York: Scribner Book Company, 1968.
17. Sarret DC. Tooth Whitening Today. J Am Dent Assoc 2002; 133(11):1535-1538.
18. Blixen K. Out of Africa. London: Putnam,1937.
19. Testori T, Del Fabro M, Galli F, Francetti L, Taschieri S, Weinstein R. Immediate occlusal loading the same day or the day after implant placement:comparison of 2 different time frames in totally edentulous lower jaws. Journal of oral Implantology 2004;30(5):307-313.
20.Twain M. The Adventures of Tom Sawyer. New York and London: Harper's Modern Classics,1875.
21. Lahmann C, Schoen R, Henningsen P, Ronel J, Muehlbacher M, Loew T, Tritt K, Nickel M, Doering S.Brief relaxation versus music distraction in the treatment of dental anxiety. J Am Dent Assoc 2008;139(3):317-324.
22. PFA International Hall of Fame of Dentistry. Dr. Horace Wells;2009. Available at www.fauchard.org/awards/fame3.htm.
23. Mark Twain [Samuel Langhorne Clemens] (1835-1910), U.S. author. Note, February 16, 1901, to Young People's Society, Brooklyn.Mark Twain in Eruption, frontispiece, ed.Bernard De Voto, Harper (1940).

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WebmedCentral Article: A Tooth Is Worth A Treasure

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