Philosophers of Decay: On the Prosaic Art of Dentistry

It took a dentist, apparently, to notice that Ambrosius Holbein’s woodcut map in the early editions of Thomas More’s Utopia conceals a death’s head. In 2005, the British Dental Journal published Malcolm Bishop’s careful examination of the woodcut as it appeared in the first three editions of More’s text. In the 1517 and 1518 editions, where Holbein’s illustration is vastly superior to what appears in the 1516 edition, the barely disguised presence of a skull is obvious as soon as one knows what to look for. Any question of the concealed image being apocryphal or accidental, a conclusion that might be drawn from the first edition, can be put to rest. So it seems odd that scholars of sixteenth-century art, or of Utopia, hadn’t noticed this or tried to make something out of it, especially given that Holbein’s brother, Hans, was responsible for arguably the most famous memento mori in European art: the anamorphic skull in the 1533 painting The Ambassadors. But perhaps, as Bishop’s essay suggests, scholars of sixteenth-century art don’t quite think like dentists. The identification of the skull is ‘now made easier’, he writes, ‘by the habits of interpretation with which all dentists are equipped thanks to their skill in dental radiology, and by the recognition of teeth appearing in an unlikely disguise’.

The radiological approach, we might say, is good at seeing through things: surfaces, appearances, disguises. The suggestiveness of Bishop’s essay, however, doesn’t simply rest on this x-ray vision and its identification of a visual motif that puns on More’s name. That the death’s head lingers behind one of Europe’s most representative geographical fantasies makes it especially topical. More’s island is deeply bound up with early modern ideas about travel and discovery. Holbein’s map suggests an allegorical framework, in which death stands as the central, albeit secret, organising figure of the impulse to create or imagine our world anew. Three centuries later, Charles Baudelaire will use this idea of allegory as a road map to the strange depths of a modern subject haunted by mutability. In this world, as lyrical as it is lurid, our hearts, ‘entombed in allegory’, journey across oceans, only to be confronted with the corpses of perverse longings and the realisation that, in fact, we have never left the swamps of our own stagnant imaginations. Baudelaire knew well enough that the journey to the island over the horizon takes place under the sign of the death’s head:

Oh Death, old captain, time to make our trip. This country bores us.

I don’t know whether Virginia Woolf had read Baudelaire’s poem – ‘The Voyage’ – when she described the experience of inhaling gas before a tooth extraction as putting ‘out to sea’:

one leaves the shore, one cleaves the hot waves of some new sulphurous dark existence in which one flounders without support, attended only by strange relics of old memories.

Regardless, her sense of dentists as figures who manage the ‘embarcations and disembarcations of the human spirit’, who ‘stand on the border line between life and death forwarding the spirit from one to the other with clean impersonal antiseptic hands’, seems to descend from a sense of the allegorical where the mythic intrudes into the everyday. But it is precisely the superimposition of this language of crossings and thresholds over what Woolf acknowledges ‘is a very common experience’ that seems so telling. Dentists might be as entitled to traffic in skulls as Danish princes, but their ordinariness can’t be wished away.

For most people the journey to the dentist’s chair isn’t a voyage across deserts or oceans or rivers that separate the living from the dead. There is little sense of the exceptional, at least for people in industrial societies with access to a basic level of health care. And if the journey finishes with blood, pain and, once we have reached a certain age, the surety of our bodies falling apart, it is also unredeemed by the lyricism that, in Baudelaire’s writing, grants mutability the status of an insight or a revelation. It is here, in the desert of the ordinary, that dentists come into their own. What we can look forward to is not so much the horror of mutability, but the tempering of that horror into the prosaic: regular visits, good hygiene, careful management.

I am grateful that I have a dentist and a dental hygienist I trust. For years they have been calmly hovering over my open mouth with a combination of humour and concern that is adding years to my ability to masticate. I can remember sitting in their waiting room for the first time, shortly after my immigration to the United States (a place that takes dentistry very seriously), looking out onto a patch of verdant New Hampshire in mid-summer, thinking, my, isn’t this pleasant. When I look back on it, the ordinariness is what’s striking. At the time I probably found it oppressive. The poetic decays into the prosaic. We calmly encounter our mutability as an object of professional care, even as our eyes fearfully wander over wall charts illustrating how bacteria work their way through inflamed gums into the blood stream and on to our vital organs. In relationship to this uneasy repose, the full-blown allegorical horror of Baudelaire’s poetry feels histrionic.

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This reversion to the ordinary is one of the implications of Thomas Mann’s Buddenbrooks, a novel where the trials of dentistry are unusually prominent. The Buddenbrook family has fallen away from its former grandeur. It is a very modern sort of fall. Enfeeblement and a degree of madness are the hangovers of a late nineteenth-century, decadent sensibility. Little Hanno’s teeth are ‘soft and brittle’. They have come in all wrong. Had the novel been written a generation earlier he might have succumbed to hereditary syphilis. But in 1900 – and perhaps this is part of Mann’s genius – it is Herr Brecht’s dentist’s chair that looms large:

The man’s very name reminded Hanno of the horrible sound his jaw made when, after all the pulling, twisting, and prying, the roots of a tooth are wrenched out.

There is something mundane about these encounters that holds the foreboding at bay, if only just: the acrid smell of the waiting room, the illustrated magazines, the voice, ‘equally horrifying and polite’, calling ‘next please’. It is the sanatorium in The Magic Mountain writ small, and it’s also where Hanno’s father, Thomas, suffering from an infected tooth, meets his end. Herr Brecht, ‘looking like death itself’, attempts to extract the tooth which is, ominously, in ‘extraordinarily bad condition’. The crown breaks, leaving the roots in the gum. Done with the pain and pushing off the rest of the gruesome operation, Thomas leaves the office, feels his brain swing in ‘wide concentric circles’ and then collapses.

This is where the novel’s meditations on mortality leave us. Hitherto we’ve encountered thrilling passages on the ‘symbols of happiness’ that, traveling through the darkness like the phantom light of dead stars, only reach us once their source has ceased to exist, or on death’s utopian dimension, ‘the return home from long, unspeakably painful wanderings’. Herr Brecht’s office has no relationship with the self-evidently literary quality of these moments. Even when death is at stake, what we find there is almost unbearably prosaic:

A tooth – Senator Buddenbrook had died of a toothache, that was the word around town.

Almost nothing seems as antithetical to the literary as a trip to the dentist, and no end is quite as deflating as death by toothache. This partly explains the audacity of Martin Amis’s autobiography, Experience, which is also a tale of trans-Atlantic dentistry. Amis’s famously bad teeth drive him to New York, where the dentist Mike Szabatura, whose name strikes Amis as ‘masonically medical’, tells him that they are so bad they need to be removed:

The uppers are shot. At any meal you could be sitting there with your teeth in your hand.

Later, beholding himself in the mirror, missing an entire upper jaw of teeth, Amis recalls his mother saying that she’d lost all hers and now she knows what she’ll look like when she’s dead. ‘That was not yet my case,’ Amis writes. And yet the space that his teeth have vacated is ‘impossible to misidentify’. It is ‘a darkness, a void, a tunnel that led all the way to my extinction’.

Amis’s new set of dental implants return him to the world of the living, but not before he has experienced the abject intimation of his end, merged into the downtrodden ‘biomass’ of Second Avenue as he spits blood into the gutter, rhapsodised about the poetry of toothaches, and asserted his brotherhood with Joyce and Nabokov, two other literary giants who suffered ‘catastrophic tooth loss in their early-to-middle forties’. In the para-critical literature on writers and their teeth (found mostly in blogs, websites and professional publications), Joyce and Nabokov loom large as figures of anxiety and occasionally schadenfreude. Somehow the idea that geniuses lose their teeth too makes the whole idea a bit more bearable. We could add that both Joyce and Nabokov are already dead, but that seems to overshoot the mark. In the dentist’s chair, mortality is both obviated and underlined by the banality and the intensely personal quality of an experience that has almost no role to play in a narrative, other than to allow the banal and the personal to blunder tastelessly into the foreground. We are held back from platitudes about physical decay. There is simply no point, other than irony, in approaching the dentist with the mythical sense of crossing that grips Woolf as she breaths in the gas. The dentist is the everyday manifestation of our otherness to ourselves or, better put, the rearticulation of that otherness as a facet of the everyday.

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It is in the dentist’s chair, or at least the literature of the dentist’s chair, that the ordinary can reappear as a rebuke to an established set of literary and political sensibilities. Günter Grass’s Local Anaesthetic, a book based largely around the narrator Eberhard Starusch’s extended conversations with his dentist, plays this out in a way that turns the conventions of the novel form on their head. Foreground and background, fatality and banality, switch places not simply in the interests of defamiliarisation, but to announce an epochal shift from a conception of the political based on the drama of protest and, potentially, revolutionary upheaval, to one based, as Grass’s dentist puts it, on ‘worldwide and socially integrated sickcare’. This, the dentist insists, ‘has nothing to do with any ideology; it is the base and superstructure of our human society’. ‘But sickcare is only for sick people,’ Grass’s exasperated narrator objects in between rinses, casts, and the clatter of steel scalers. ‘All people are sick, have been sick, get sick, and die,’ his dentist tells him.

At least initially, this sort of dialogue seems to be ironised by the presence of a television set that the dentist uses to distract his patients. So while the narrator, a schoolteacher preoccupied with the potentially dangerous radicalism of his favorite student, is slowly having his conception of the political corrected along with his misaligned jaw, he is also descending into anaesthetic-induced hallucinations that integrate commercial advertising with his experiences of the war and its aftermath. These visions of home appliances, detergents, cosmetics and all manner of other consumerist gadgets forming oppressive piles of ruin bring the reader back into a more familiar framework that juxtaposes interiority and the banality of the material.

But while we are led to think that the novel’s focus on dentistry might simply be supplying a metaphor – repressed guilt resurfaces like an abscess erupting from an infected root – the opposite turns out be the case. The culture of political rebellion, the new left, and the forms of critique that the novel constantly attributes to the figure of ‘Marxengels’, are gradually displaced by the flatter, two-dimensional forms of care that simply try to universalise health. And so the student Scherbaum, who writes ‘anti-napalm’ poetry and is planning to incinerate his dachshund in front of the cake-guzzling matrons of the Kufürstendamm in order to protest the war in Vietnam, also finds himself in the dentist’s chair, where his desire for spectacular protest is smoothed out by the critical theory of dentistry: moderation and ‘confidence in the continuous evolutionary process’.

In this way, Local Anaesthetic rewrites the drama of Bildung that was central to the development of the novel in the nineteenth century. Grass’s text is populated by character types who signal disidentifcation with the polity: disgruntled students, a vaguely resentful, middle-aged teacher, and his companion, who is tormented by her guilt at having participated in a fascist youth organisation during the final days of the war. They are all wrestling with, or bristling against, the locally anaesthetising culture of a consumerist modernity that would have them forget the traumas of the past. But nothing dramatic or decisive ever really happens. Instead, social disidentification is replayed as a comedy that is gradually reconciled with an ethos of care that is simply fixated on fending off decay. The startling moments of self-discovery or self-realisation that once might have been the hallmarks of a certain sort of literary experience are replayed in an entirely different key:

And so I sat silenced in the dentist’s chair and saw myself: silenced in the dentist’s chair.

In a 1976 essay on literature and dentistry, Theodore Ziolkowski describes dentists as ‘philosophers of decay’. This essay, the only sustained discussion of literature and teeth I know of that has managed to take its topic seriously, has a lot to say about both Grass and Mann, among some other great moments into the poetics of tooth decay. Although it has no interaction with the developing discourses about modern politics as the organised management of bodies, its concluding remarks on organic visions of the social anticipate this biopolitical turn. Ziolkowski is committed to the idea that teeth function as metaphors and that the tissue connecting the cultural and the natural is essentially figurative. He distinguishes between the ‘psychodontic’ and the ‘sociodontic’, between bad teeth as a way of figuring the private struggles of the individual, and bad teeth as a broader figure for the social. Society, he suggests, is like an organism; the management of the body can signify the management of the polity.

Grass’s novel, by contrast, sees the management of the body as the essence of the political. In Local Anaesthetic, it’s not that dental care has a figurative relationship to dreams of a better world; dental care is the practice – or one of them – out of which this better world will be built. The drama of radical transformation, the urge to cross the threshold and encounter the possibility of reinvention in the lap of the other: none of it has any real role to play, except insofar as it harbors the secret sign of our sickness.

Enter dental radiology, which sees through our surfaces, our illusions, our poetic ideals. In the utopia of ‘worldwide and socially integrated sickcare’, the death’s head is never far away, but it is also tempered into the prosaic: a wearisome inevitability rather than a revelation.

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O Death, old captain, time to make our trip! This country bores us, Death!

Roberto Bolaño, in an essay entitled ‘Literature + Illness = Illness’, describes Baudelaire’s ‘The Voyage’ as the ‘most clear-eyed poem of the entire nineteenth century’ and the most ‘lucid diagnosis of the illness of humanity’, which consists in the flight from boredom towards horror. It feels like a long way from the dentist’s office. But as Bolaño also shows us, in one of the most clear-eyed short stories of the twentieth century, the dentist’s office is never quite what it seems to be.

I teach this story – ‘The Dentist’ – regularly. I don’t think I have ever succeeded in conveying the depths churning beneath its inscrutable surfaces, at least not to groups of undergraduates, most of whom have still have luminous pearl-like teeth untouched by coffee, red wine, cigarettes, receding gums and other enamel-staining or tooth-chipping ravages of times. That Bolaño was pretty much toothless by the time he died of liver disease at the age of fifty seems relevant, but I don’t mention it for fear of coming across as morbid or obsessive.

The narrator of ‘The Dentist’ is visiting an old university friend who lives in a provincial Mexican town. This friend is only ever identified as a dentist, much like the dentist in Grass’s novel. He works in a private clinic, but he also volunteers for a cooperative that provides dental care to the ‘poor and the needy’. It’s an echo of Grass’s universal ‘sickcare’. As the story opens, the dentist friend tells the narrator that he has just killed a patient. An ‘old Indian woman’ with an abscessed gum had gone through a botched operation carried out by one of his students. When the dentist arrived on the scene, he found ‘a cancerous gum, clumsily incised’. The old woman was sent to a hospital, where she died a week later. It’s all very matter-of-fact, despite the suggestion that the dentist has been unhinged by the experience.

The narrator keeps thinking about the dead woman and ‘the cancer gnawing at her gums’. The two friends go drinking. As they move from bar to bar, her story comes up again, the dentist becomes melancholic, and the conversation veers into a retelling of a mortifying encounter between the dentist and a famous artist the dentist admires: ‘What the fuck do dentists know about art? he said.’ This moment culminates in a mysterious excursus on what the dentist calls the ‘secret story’:

the one we’ll never know, although we’re living it from day to day, thinking we’re alive, thinking we’ve go it all under control and the stuff we overlook doesn’t matter.

At this point, the story seems to bifurcate. In a drunken fog on the edges of a town that seems to be in the middle of nowhere, a youth appears, an ‘Indian boy’. The dentist knows him. His name is José Ramírez. He is a writer, a gifted writer, perhaps even a genius. When the narrator shakes his hand it is like ‘a hand emerging from parts unknown, like the tentacle of a storm’. Over the course of the next couple of nights, the narrator and his dentist friend, who is fixated on Ramírez and the uncertain potential concentrated in him, rekindle something of their youth: dreams of bohemia, of the avant-garde, flights across thresholds. The prosaic world of dental care seems to fade into this quixotic, alcohol-fueled encounter with the other.

During his second night in the company of Ramírez, the narrator feels himself approaching the ‘unknown slopes of the night’ shortly before he immerses himself in Ramírez’s prose. Reading a short story of four pages feels like reading an entire novel. Time seems to contract or expand. Is the writing genuinely good? Is the alcohol warping the narrator’s view of things? The narrator can’t really decide whether the encounter is significant or utterly ephemeral. Neither can we. Later, the narrator dreams ‘of young Ramírez’s house’:

I saw it standing in the middle of Mexico’s wastelands, plains, and garbage dumps, exactly as it was, bare of all ornamentation. Just as I had seen it, a few hours before, at the end of that supremely literary night. And for barely a second I understood the mystery of art and its secret nature. But then somehow the corpse of the old Indian woman who had died of gum cancer came into the dream, and that’s the last thing I remember. I think her wake was being held in Ramírez’s house.

That the story partly turns on the relationship between ‘sad white’ Mexicans (the narrator and the dentist) and indigenous Mexicans (Ramírez and the old woman) supplies a compelling decolonial framework for Bolaño’s debunking of the ‘supremely literary’, which seems both deluded and trivial when measured against the old woman’s oral cancer. But I can’t help feeling that there is also something else going on. Whatever it is, it hinges on Bolaño’s ability to evoke the undulating mental states of excessive drinking. The story has the rhythm of a series of drunken binges followed by anxiety-laden hangovers. And in those hungover states, the reality of the dentist’s office seems to return: mundane, forlorn, but also somehow uncanny.

At one point, in the interim between drunken nights out with Ramírez, the narrator experiences a moment of panic in an empty waiting room. The anxiety, his dentist friend explains, stems from the certainty that ‘there is no such thing as an empty building, in every so-called empty building someone is hiding, keeping quiet, and that’s the terrifying thing’. In the story’s concluding moment, the narrator, his dentist friend and a student are in the clinic waiting for cooperative patients to show up. None come. Both moments – the hidden presence in the empty waiting room, and the absence of patients that ensures the persistence of this emptiness – feel terminal. The story’s enigmatic opening line – ‘He wasn’t Rimbaud, he was just an Indian boy’ – finds its proper context here in the uncanny return to the prosaic, where the strangeness of the everyday has displaced the fetishisation of difference on which the ‘supremely literary’ seems to depend.

Bolaño’s work routinely stakes out these uncanny returns to the everyday: moments when alterity shuttles across the border between the poetic and prosaic, leaving shadows and voids in the most ordinary scenarios. But unlike Grass, Bolaño doesn’t parse the worldview offered by the dentist with any real certainty. There is no clear movement from one set of ideas to another. Instead, his story constitutes alterity as an unstable entity that is never where we think it is going to be. As a result, though the story is about a voyage towards the other, we never know which direction we’re heading in. Towards the slopes of the night, or the dentist’s waiting room? Into the fragmented prose of a teenage genius, or towards cavities and gum disease?

I said it’s one of the most clear-eyed stories of the century. In fact, it’s utterly disorienting. Banality and fatality, the everyday and the abyss, dental hygiene and the drunken romance of a newly discovered Rimbaud, the story we think we know and the one we’ll never know are all slipping into each other. The narrator is aware that the whole thing remains inscrutable, that somehow language and experience have been sundered. And in this respect the territory the story maps is fairly familiar. It is, quite literally, a story about visiting a dentist, and like all encounters with dentistry, it implies the ubiquity of physical mutability. This is not illness in the sense of an imaginative flight from boredom, but illness in a much more mundane sense – let’s just call it decay – that takes us beneath the threshold of literary representation to a world in which we begin not quite to know ourselves. In this everyday realm, where bacteria face off against tooth enamel and gum tissue, literature should offer us a way back to ourselves, or at least back to the categories and dynamics that literature has taught us to recognise.

It works well enough until we encounter a dentist, at which point categories collapse, and the utopia of sickcare calls us towards the death’s head, which is artfully hidden, yet still somehow in plain sight. And so we find ourselves, like Grass’s narrator, ‘silenced in the dentist’s chair’, from which we can see the simple truth of Bolaño’s formulation that literature and illness still equals illness. For most of us the dentist’s chair will simply be the most prosaic, which is to say palatable space in which to encounter this diagnosis.