Transplants are an amazing feat of medical science. From kidneys to hands to eyeballs, various parts of the body can be transplanted from a donor into a recipient in need – but have you ever wondered why you never really hear about teeth from human donors being transplanted? It turns out the history of this procedure, known as a tooth allotransplant, is actually pretty gruesome.
When did tooth transplants first emerge?
“It’s hard to say when tooth transplants first occurred. But transplants in general are one of the world’s oldest forms of surgery and come to us from horticulture,” Dr Paul Craddock, a cultural historian with expertise in the history of transplant surgery and author of the book Spare Parts: An Unexpected History of Transplant Surgery, told IFLScience.
“They’re so old, they’re almost primal. Bottom line is that binding living things to one another so they grow together as one body has been a part of surgery for as long as anyone can remember. At least as far back as the sixth century [BCE] in the form of skin grafts, but almost certainly much earlier.”
Tooth replantation, where a lost tooth is put back where it originally was, was described by physician Abulcasis, aka al-Zahrawi, around the 11th century CE. Surgeon Ambroise Paré also wrote about a tale of a woman of nobility receiving a tooth taken from a maid in the 16th century.
However, “not many tooth transplants seem to have been recorded until the eighteenth century,” Craddock explained, “And, to my knowledge, it’s the only period tooth transplants were said to have been common, and even popular.”
How did tooth transplants work?
So, how did dental surgeons of yore go about this procedure?
In Spare Parts, Craddock recounts Charles Allen’s proposed method that involved an animal donor, such as a baboon, rather than human donor: both were restrained, the donor tooth was carved out with some gum attached, the recipient’s tooth was removed, and the donor tooth was jammed on in there in the hope that it would fuse into the site eventually.
Surgeon John Hunter, an advocate of tooth transplantation, conducted an experiment to prove the procedure’s viability in which he removed a person’s tooth, cut open a cockerel’s comb, pressed the tooth into the comb, and fastened it with thread.
Some months later, the cockerel was killed and Hunter thought that he observed “the vessels of the tooth well injected, and also observed that the external surface of the tooth adhered everywhere to the comb by vessels, similar to the union of a tooth with the gum and sockets.” However, this probably wasn’t actually the case – plus, Hunter did note that “this experiment is not generally attended with success. I succeeded but once out of a great number of trials.”
This didn’t dent Hunter’s confidence, though, and he continued to carry out human tooth allotransplants, describing how silk and seaweed could be used to secure a donor tooth, pushed into the socket, until the two joined together.
While today – if you take the right course of action very quickly and carefully – your own knocked-out tooth can be replanted after being put into its socket by a dentist and splinted in place, allotransplanted teeth were often rejected back in Hunter’s day.
“You might get a few months, or at most a few years, out of a tooth, but you’d invariably need another when that fell out (and if there was no compatibility between donor and recipient it wouldn’t take at all),” said Craddock.
How were donor teeth sourced back then?
“I don’t suppose there would have been a viable tooth transplant trade without a rich and poor, and without a sense of one set of people being inferior to another. It absolutely depended on a rich set of people concerned about their appearance, and a poor sort desperate for money,” explained Craddock.
Teeth were pulled from the mouths of people in need of money – often children – and placed into the mouths of wealthy folk with the means to pay for these human body parts. This exploitative dynamic was famously caricatured in a 1787 etching by Thomas Rowlandson.
Craddock highlights a quote from Allen’s Operator for the Teeth, 1685, the first known English-language work on dentistry: “I do not like that method of drawing teeth out of some folks heads, to put them into others, both for its being too inhumane, and attended with many difficulties; and then neither could this be called the Restauration of Teeth, since the reparation of one, is the ruine of another: it is only robbing of Peter to pay Paul.”
Teeth were also taken from dead bodies – including those who died in conflicts such as the Battle of Waterloo, giving rise to the term “Waterloo teeth”.
Craddock notes that the German textbook Langenbeck’s Archiv für Chirurgie 4 (1865) “saw tooth transplants as a peculiarly English thing, calling it ‘English trafficking in the teeth of living persons.’ […] When German surgeons started to transplant teeth themselves, they took the moral high ground by using only the teeth of ‘young and healthy subjects who have died by violence’… which makes everything alright, doesn’t it?”
How did tooth transplants fall out of favor?
“I’d have to say that until the early 20th century, the words ‘advances’ and ‘transplants’ shouldn’t really go together,” Craddock stated. “They were for centuries brutal and simple, and the tooth transplant in particular became popular because of a very specific set of social circumstances, which included dentists (a new kind of scientist for the eighteenth century) promoting them as a beauty treatment. But they weren’t regulated, and in the absence of regulation, ‘safety’ comes a distant second to profitability!”
There a plethora of downsides to the procedure: “Medically, there was the transmission of disease – mainly syphilis,” Craddock noted. One account describes a woman from Southampton who received a tooth deemed “very safe” by “some eminent surgeons”, but was “soon affected with the venereal disease, which destroyed all that side of her face, and she very shortly died.”
“Of course, the most glaring complication is that they didn’t really work,” explained Craddock.
Dentures made of porcelain often took the place of tooth transplants as the 18th century became the 19th, and as Craddock quipped, “I suppose you could say that the advance that improved safety was the one that made them obsolete!”
Do tooth transplants happen in modern times?
Modern case reports documenting human tooth allotransplants do exist, though. A 1987 retrospective study of 73 allotransplants conducted between 1956 and 1980 put the mean functional time of these grafts at 6.8 years – although one was still functioning after 28.5 years! “No signs of pulpal survival were found in any graft. Root resorption was found in 91.6 percent of grafts within a mean of 8.8 months after transplantation, causing a high frequency of graft loss within the first 2 years (34.1 percent),” wrote the authors.
One 1977 paper contains a report of a young girl with congenitally missing teeth who had her brother’s teeth transplanted into her mouth (he had to have some of his teeth taken out prior to orthodontic treatment in a case of “fortuitous circumstance”). The procedure was attempted in May 1973, with the transplanted tooth having to be removed in November – but a second attempt in December 1974 ended up being successful. However, this paper notes, “In general, the current body of dental literature reflects a distinctly pessimistic attitude toward allogeneic tooth transplants.”
All is not necessarily over for human tooth transplants, though – a patient might just need to be their own donor, given the right circumstances. Autotransplantation of teeth is a procedure that was first reported in the 1950s, where a tooth (such as a wisdom tooth) is taken out and re-implanted in another location in the same mouth.
As one 2018 literature review on tooth autotransplantation notes, “Although today the dental implant is the preferred choice of treatment, this is not always appropriate in the paediatric patient.” Although the studies that the review looked at indicated a success rate for the procedure of around 81 percent, the authors note that “larger and better designed studies are needed”.
In 2018, the University of North Carolina (UNC) School of Dentistry announced that they were introducing autotransplants for children. “This procedure just didn’t have a home in the U.S., and we want to be that home and be the people who are able to launch this,” said Jessica Lee, distinguished professor and chair of the pediatric dentistry department at the UNC School of Dentistry, in a statement.
Ideally, an autotransplanted tooth would be better equipped to handle a child’s growing mouth than an implant and encourage bone growth. “That’s the truly amazing part of it, because we don’t have a lot of good ways to induce bone growth in medicine,” said Lee.
Medical science has come far since the heyday of tooth allotransplants, but we should take the history of the procedure as a cautionary tale.
As Craddock told IFLScience, “[T]ooth transplants were brutal operations from a non-scientific past. They were clothed in scientific language, but I think that was a marketing ploy; science started to mean legitimacy in the eighteenth century, and that meant business. So, you’ll find that if you look at dentists’ adverts and other beauty adverts from the time, it’s full of scientific language and claims, and the titles/scientific credentials of the authors are really prominent.”
“But, as a surgical procedure, tooth transplants had deep cultural roots reaching back centuries and were really, back then, no more technically advanced than they ever had been.”
The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.
