Toothpaste isn’t actually necessary for basic teeth hygiene.
Dental caries are caused by exposing your teeth to sugary/starchy substances, and then the acids in those substances feed bacteria which slowly eat away at your teeth. It tends to happen patchily because starchy substances tend to clump in little gaps and crevices in your teeth.
The worst foods fall into two categories – stuff that’s strongly acidic and sugary to begin with, like soda or orange juice, or stuff that easily leaves small, stubborn clumps on your teeth, like potato and bread, where it can sit unnoticed and work over time.
You maintain your teeth by a) eating less of the above kinds of foods and b) removing food buildup in your teeth as soon as possible.
Ancient people did both of the above.
You can scrub your teeth free of mushy potato leftovers just as easily with a finger, a coarse leaf, a plain bristled brush, or any number of other things.
Modern toothpastes are more about polishing, stain removal, smell and flouride than actually cleaning your teeth. And the latter is largely irrelevant if you live in an area with flouridated public water supplies.
Here’s a Latin poem from mid-1st century BCE Rome (poem 39 by Catullus) with one answer:
Egnatius, because he has bright white teeth,
always smiles: If someone comes to the defendant’s
bench, when the speaker arouses weeping,
he grins; If there is mourning at the funeral pyre of
a dutiful son, when the bereaved mother weeps for her only son,
he grins. Whatever it is, wherever he is,
whatever he is doing, he grins: he has this disease,
neither elegant, I think, nor refined.
Therefore I must warn you, my good Egnatius.
If you were a city man or a Sabine or a Tiburnan
or a thrifty Umbrian or a fat Etruscan
or a swarthy and toothy Lanuvian or
a Transpadane, to touch on my own people as well,
or anyone you like who cleans his teeth with clean water,
I still should not want you to smile on all occasions:
for nothing is more silly than a silly smile.
Now you are a Celtiberian: in the land of Celtiberia,
whatever each man has urinated, with this he is accustomed
in the morning to rub his teeth and his red gums,
so that the more polished those teeth of yours are,
the more urine they proclaim you to have drunk.
Besides the other explanations of how toothpaste was nice but not needed, another major thing is the relative amount of sugar in our diets today. The average westerner, especially American, gets *way* more sugar in their diet than ever before in history. The more obvious results include spiking obesity rates, but another one is that bad germs in our mouth, teeth, gums, etc. absolutely thrive on sugar, contributing to a higher rate of cavities and infections than there would be without such high intake of sugars.
And then add in the harsh acids and such of pops, sodas, and other drinks on top of the sugar, and your teeth have a hard time ahead of them if you have an unhealthy diet.
In Arabia and the Levant (and I think other areas around it as well) [swak (or miswak)](https://en.wikipedia.org/wiki/Miswak) was used for over 7000 years (without toothpaste or anything), some people rarely still use it these days as well (though more of a tradition than hygiene only I think). Other areas around the world would’ve probably used something similar I would assume!
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