The design error known as our teeth could be remedied by getting rid of, say, half of them

Robert E. Horseman, DDS

There is one thing on which dentists and hygienists all seem to be in accord. Meaning no disrespect to Higher Authority, but human dentition is definitely a huge design error, one that could have easily been corrected in the first prototype (Adam). Had one of us dental professionals been consulted early on during the mock-up stage, say, Wednesday of Creation Week, there`s no doubt we could have avoided some of the flawed concepts that have plagued us ever since.

Take deciduous teeth, for example. Every child gets 20 teeth. Along about five or six years of age, these teeth start migrating to a place under the kid`s pillow until the supply is exhausted at age 12 or so. The parents have bought back the originals from the Tooth Fairy for an amount equal to the child`s first semester at Yale.

The loss of these first teeth may seem like a good thing, bathed as they have been by daily applications of Popsicles and Gummy Bears for a decade. But is it really? Why didn`t these teeth grow bigger along with the jaws? The kid`s arm didn`t exfoliate at age 11 to be replaced by a bigger arm and a hand whose fingers reached beyond the top of his head when fully extended. You never hear of a Foot Fairy leaving cash under the covers in exchange for a foot that has outgrown a pair of $50 shoes every three months for the last 10 years.

So the baby teeth are now replaced by what? Thirty-two new and bigger teeth, which as we all know, are way too many. Does anybody really need 12 molars? I think not. We have been told by anthropologists that Paleolithic man required all these teeth to cope with his meat-intensive, bone-crushing diet so popular at the time. Couldn`t Divine Providence have foreseen that phasing out this roughage in favor of mashed potatoes and Boston Cream pies would most certainly result in impacted third molars and $5,000-a-week fat farms. Is this clear only to me?

Only oral surgeons have benefited from this faulty design. They have also profited from the discovery by their colleagues, the orthodontists, that eight pre-molars are too many by half. Some maintain that, if all these teeth were not necessary in the scheme of things, God would not have invented dentists, who, in turn, invented fluoride, which nearly put them out of business. It`s a moot point.

The real tragedy is that all this new dentition is wasted on prepubescent children who couldn`t care less, except as a Tooth Fairy scam. I contend that by age 50, a third set of natural teeth would be embraced with open arms (or mouths) by the geriatric set. It is fed up with its old, worn-out, patched up teeth that dentists over the years have ground down to powder and rebuilt with whatever was in favor at the moment. I don`t see how a benefit like this could have been overlooked or why a full head of hair couldn`t have been guaranteed up to age 85.

What is perfectly clear, however, is the fact that incisors for Homo Sapiens have fallen far short of the mark. Why the heck is this such a problem? They are too thin for one thing. Eight times out of 10, the lower ones are crooked and they break easily when the owner`s face comes in contact with swings, baseball bats, and fists. Animals have emerged with the long end of the stick in this regard. Have you ever seen a tiger or a lion with a six-unit bridge or a dopey-looking beaver with a missing central incisor?

And whose idea was it that we needed 32 individual teeth? This led, of course, to interproximal cavities, 9 mm perio pockets, places to stock meat between meals and - you guessed it - orthodontists. What would have been wrong with one big tooth that ran from the distal of #2 clear around to the distal of #15 and another from the distal of #18 around to #31? Sure, it would put a dent in a crown-and-bridge practice. I didn`t say my idea was perfect, but listen - no interproximal caries, no nagging people about flossing, and no problem with a half a dozen systems of numbering teeth. We could have just called them #1 and #2, or if that would be confused with other bodily functions similarly named, simply "A" and "B."

My ideal dentition, had I been asked for advice, would feature pulpless teeth. To endodontists who get rid of them as fast as they can, nothing is more useless and causes more trouble than a pulp. Do we really need such a thing? Is this part of the punishment for the Original Sin? A compassionate endodontist took the pulp out of one of my molars years ago, replacing it with a much more sensible material, gutta percha. I have 27 other teeth with pulps. If I ever hear a peep out of any of them, they get the same treatment. I say we have no more need of pulps than genital warts or punk hairdos.

So there you have it - my nomination for a trouble-free oral cavity. Two teeth, one upper, one lower in either shade B1, or for the more conservative, A2. No pulps, no endodontists, no gum problems, no periodontists, and no prosthodontists either. Just us GP guys and gals inlaying an occasional diamond or ruby for the flamboyant patient and doing prophys with a big rag wheel. But then, nobody asked me.

Robert E. Horseman, DDS, is a general practitioner in Whittier, Calif. He is a frequent contributor to the Journal of the California Dental Association.