Why Teeth Like to Touch

This is Demibone, a column by Ghinwa Jawhari that explores the stories our teeth tell.

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Your teeth like to touch.

Consider their surface anatomy. They fit together like a puzzle. We recreate similar zigzag grins on pumpkins in October. We recognize the perfect white blocks—one right next to the other—in a Cheshire cat’s smile. Much of what we consider attractive, trustworthy, youthful, sexy, and healthy in humans starts with harmonious teeth. When aligned correctly, they stand shoulder-to-shoulder (and head-to-head) amid lifelong neighbors.

For a tooth, the loss of a neighbor can be catastrophic. Adjacent teeth immediately begin to creep into the newly open space in search of the touch they remember. They tilt into the opening like miniature Towers of Pisa. Sometimes the entire tooth, root included, moves horizontally or “walks” there. They rotate, a curious head turning toward loss. The ache for a neighbor is so unrelenting that its resulting movements can have far-reaching, ruinous consequences for the jaw, joints, lips, and face.

The search is always futile, sometimes sacrificial. Occasionally, teeth that have moved into these spaces risk damaging themselves with new occlusal forces, fractures, and bone loss. When it’s bad enough, the quest for touch is suicidal.

Imagine asking your teeth to stay six feet apart.

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Throughout the pandemic, stories of people breaking distancing restrictions were unfortunately common. Reporters covered secret dance parties and indoor raves. People continued to board planes for vacations. Instagram was especially self-effacing: an unending feed of weddings, showers, graduations, unmasked groups holding liquors that glisten for the camera. Pod goals.

Online, it seemed the implications of Covid-19 were vastly different from our lived reality. I am a practicing dentist, and my employers, limited to emergency services by executive order and strapped for proper PPE, had to close their doors. The bakery on Driggs and the tiny brunch spot on Metropolitan were boarded up. Those early months left mattresses and other furniture on every other corner in Williamsburg. Among the notable remaining businesses, a few spoke to what was “unlivable without” in Brooklyn: bodegas, pizza shops, and wine stores.

My one consistent trip, meanwhile, has been to my own local bodega. The masked cashier hands me my bags beneath the plexiglass partition. Green electric tape marks off six-foot increments from the register. The line often extends into a tight aisle flanked by packed shelves. A sign on the door implores, “Masks Please!!!”

One day, early in the pandemic, the owner, Ayman, was arranging fruits in the display cooler. We recognized our masked, bundled forms and crinkled our eyes. Ayman’s brows lifted with a story he’d just remembered. “Ouf, can you believe it?” He told me about an underground hookah circle that was meeting up nightly in a shuttered club in Bay Ridge, another in Astoria.

The perpetrators? Not young philanderers or aloof teens, but their mothers.

“Covid won’t kill these women,” he marveled. “But the rules to stay apart definitely will.”

Our maddening craving for touch. I imagined the dark clubs, coals reddening on the foil as the women smoked and laughed. I was simultaneously furious and sentimental. I’d grown up in that culture that kisses cheeks in greeting and parting. We hug, clap shoulders, hold hands, link arms, sit in laps, and squeeze beside each other at gatherings. I’d been there before, passing the hose to the pair of lips beside me. In my journals, I’d coined it—affectionately at times and mockingly at others—“habibi culture.”

The quintessential Lebanese dance is dabke, where dancers hold hands and move in unison. The more talented lead the circle. They lean into one another before pouncing out on the beat—legs defying gravity, but hands stubbornly tethered to the group. Even if you don’t want to dabke, you find yourself dancing inside this human circle, its synchronous stomping keeping you in tempo. And even if you don’t want to dance at all, someone’s mother or sister will insistently pull at your wrists until you do.

Growing in that constant proximity to others forcibly socializes you. Ayman and his wife, both Palestinians, sported that same resigned look that had crept into the faces of my Lebanese parents in Ohio. On FaceTime, right beneath our optimism, speculation, and jokes, seethed a palpable boredom. It’s hard not to touch when that is all we’re used to.

“You need anything?” Ayman asked, motioning suddenly at the fruit. He crossed his hands over his jacket, unsure where to put them. “Let us know, okay? We’re family here.”

Last summer, I bought boxes of snacks from Ayman, strapped an N95 to my head, and drove to Cleveland with my little sister. For the first two weeks of our stay, we stubbornly maneuvered six feet away from our parents and siblings. It was crushing. Once, with my back turned in the kitchen, my father wrapped his arms around me and kissed me on the temple.

To my long and frantic list of protests, he smiled into his coffee. “Worth it.”

Imagine asking your teeth to stay six feet apart.

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Teeth exist in symmetrical pairs.

Every tooth has a nearly identical partner on the same arch (or jaw) and an opposing partner on the other. If you make a line from the tip of your nose to your chin, you bisect the smile into its reflective halves. Incisor to incisor, canine to canine, molar to molar. If you bisect each tooth, you’ll find symmetrical halves again. This balance gives the face its natural beauty.

Missing teeth disturb aesthetic harmony. Something looks wrong. Outside of toothless third graders still awaiting their grown-up sets, we associate missing teeth with unhuman magic (witches, gap-toothed ghouls) or the grotesquely drugged (“meth mouth”) or the excessively old (a bedside glass of dentures).

More than ruining the aesthetic norm, missing teeth seem to make a statement on character. Physical deformity excludes the affected from society. “We” distance from “them.” It is yet another unfair way we judge one another on appearance and ability.

But in reality, the majority of us will lose a tooth in this lifetime. Expelled from the mouth by a biking accident, a stale baguette, a quarterback’s tackle, or an unceremonious dentist’s forcep, a missing tooth leaves the homogeneity of its family. It becomes a singular icon separate from the body or face. We recognize it in dental branding: a two-rooted molar, usually sporting a shine diamond or a frothy squeeze of toothpaste. It is a cartoon, its realistic counterpart edging on macabre.

What happens to the patient who’s lost a tooth? We plan for a replacement (an implant, bridge, or partial denture) before taking anything out. If we can’t get a replacement in soon enough, the teeth are outfitted with a retainer. Metal, acrylic, or a rigid plastic keeps the neighboring teeth apart. Some people’s teeth move faster than others. Since we can’t predict the rate, we always act fast.

What happens to extracted teeth? Because they’re considered biomedical waste, we can’t give them back to patients. We typically dispose of them. Some dedicated practitioners will store them in jars of bleach for various research projects. In dental school, “good” extracted teeth were as valuable as Adderall. We fought and traded for those clean, undamaged jewels as if the practice they afforded us guaranteed an A.

Humans have been trying to successfully transplant teeth into new mouths as far back as ancient Egypt, but the science for this breakthrough remains in a stubborn, perpetual pause. Successful allotransplant cases were so rare (and transferred so much syphilis) that we no longer really attempt them. Teeth refuse to survive beyond a few years without their known neighbors. Resident immune cells reject new tissue, causing inflammation and resorption of the intruder. Forced into a new host and a foreign socket, a transplanted tooth instantly fails.

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Nonliving things are averse to touch. The gridlock of gravity and molecular lattices keep them fastened into close distances against their grain.

In undergrad, our professors used the “messy dorm room” to demonstrate the universe’s tendency toward disorder. A clean room takes significant energy to maintain. If nature takes the reigns, though, the room cascades easily into disarray. Clothes pile up on the chair, the bed remains unmade, take-out boxes litter the desk.

We sat in constellations of friend groups around the lecture hall. Popularity—fitting in—meant a full, raucous row. Those who sat completely alone either cared too much or too little.

We were tasked with coming up with our own examples. The “messy dorm room” branched into a pail of marbles spilling its contents, glass shattering, a sugar cube dissolving in hot tea, gas molecules spreading throughout a closed tank, planets expanding in the ink of space. All this to illustrate that the universe’s level of randomness and disorder, or entropy, steadily increases.

Half-serious, one student posed a question after considering this new principle: “If entropy is real, why do we go back to our exes?”

If the nonliving world is a chaotic sprint to spaced-out disorder, humans (and nearly all living things) are awkward outliers. We cluster in groups. We flock to the vibrancy of already-crowded cities. We build compartmentalized houses and arrange our workday into schedules. And yes, we make beelines to our exes despite the infinite odds of finding someone better.

Entropy predicts a grim “heat death” for the universe, in which energy transfers (like the sugar, glass, and marbles) totally cease. Once everything is the same temperature, random particle movement takes over. On the apocalyptic theme, entropy-based pandemic forecasting also helps scientists determine the time of maximum diffusion, or spread of infectious disease. We’ve already developed models for Covid-19.

“If entropy is real, why do we go back to our exes?”

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Teeth don’t mourn. Busy with their tilting and moving, they seem to exist in unresolved denial. That neighbor must be around here somewhere.

But it is the occlusal forces (chewing, grinding, clenching)—not innate sentimentality—that push our teeth to move. The brutal environment of the mouth is conducive to movement. Physics is responsible for “mesial drift,” where the teeth inch forward in the jaw even amid a full set of neighbors. We recognize overlapping lower teeth in older patients, a pattern we try to prevent early with retainers.

Crowding can set off an onslaught of dental issues. Bacteria coat the jammed touchpoints, now protected from toothbrush bristles and immunity components in saliva. Because they’re close enough, the surfaces of teeth trap food debris and share bacteria. New cavities, fractures, and bone loss can occur together. The relationship becomes toxic. Like any overcrowded space, pathology thrives alongside touch.

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Viruses are nonliving. Without a host, they cannot propagate. They are a marvel in the biological sciences: a nonliving entity whose existence hinges solely on our sociability. In other words, a nonliving thing that likes to touch.

I returned to New York from Ohio in July, last summer. The clinic was open again, but nothing was the same. We no longer whispered at the front desk, guffawed in hysterics, or shared snacks and makeup. We put the magazines away. Patients sat frigidly in the waiting room before us, scattered and spread out like stars.

Much of my ability to practice dentistry was an involuntary consequence of “habibi culture.” I connected with my patients by holding their hands, hugging them, patting their shoulders, making a joke, telling a story. I posed for their Snapchats as they told me about their favorite shows. Now, beneath thick layers of plastic and fabric, I felt inconsequentially small. Every word was a shout, so my words were sparse. I couldn’t smile reassuringly or make funny faces. I overcompensated with my hands, gesturing wildly as if we spoke alien languages.

Surprisingly, though, even these barriers are starting to (figuratively) dissolve. Our sociability adapts. We still find ways to touch. When I went in for my vaccine in January, the nurse administering it brushed my left shoulder with a cool alcohol pad.

“I used to sing for my patients during an injection,” I admitted. “It definitely doesn’t help them, but it helps me.”

“Dentist, huh?” She quickly poked my arm. I felt nothing, and I exhaled a sigh I felt I’d been holding since last spring. Her ears twitched in the loops of her mask. She was smiling. “I’m really glad you can’t see my teeth.”

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