You Are as Strong as Your Teeth

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

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Your teeth are strong.

How strong? You need an arsenal of kitchen tools to cut apart a tough steak, a refrigerated bagel, a piece of hard candy, or a soft-shell crab. But these foods—and other brawny bites, like almonds, toffee, pizza crusts, carrots—are no match for your teeth.

Teeth are strong because of enamel, the pearly outer layer that gives them their gloss and milklike opacity. Enamel is the hardest tissue in the body. It is stronger than the skull bones that protect your brain, stronger than the metal armor you’d wear to protect your skull. On the Mohs Hardness Scale, enamel scores harder than steel, silver, gold, iron, and platinum. Though this does not mean you would be able to chew up a gold nugget, it does mean your body has invested tons of biological energy to ensure you can tear through nearly anything with your teeth.

This investment in strength is not excessive. In the hostile and dynamic environment of the mouth, enamel needs to be able to weather all storms—from destructive chewing habits to an acidic diet of desserts and soda. If the stoic enamel ever yields (and it frequently does), catastrophe ensues. The teeth become hypersensitive, susceptible, and fragile. In other words, without their strength, teeth become inert. Unusable. Strength is vital to all levels of biological survival, from the microscopic cell to the mammoth whale. All species require their own versions of strength to compete for resources.

Human strength includes mental strength. This factors in quite heavily, particularly within the modern mires of contemporary stressors. Biology tells us “mentally strong” people, overall, live better. Though we’ve unfairly weaponized this to stigmatize mental health issues, a true understanding of strength actually opposes the stigma. A healthy brain is a strong brain, s0 any means toward “health” (be it through therapy, medication, neurofeedback, mindfulness, or otherwise) counts as strength too. Mental strength can include patience, adaptability, self-awareness, and balance.

Culturally, strength in all its forms can become allegorical, verging on paranormal: Oprah, Gilgamesh, Harry Potter, Socrates, and Britney Spears are “strong” in different ways, but strength is often what lies at the crux of their allure. We are invariably drawn to it.

Our admiration of strength is not a coincidence. Our caregivers were our first templates for strength. They can lift us on their shoulders and carry us to our beds. They know how to tie our shoes and knot the end of a balloon. They hold the ultimate authority over when playtime ends and bedtime starts, and they know how to deal with our fallout tantrums. Importantly, in our eyes, they understand how the world works better than we do, so their guidance is ironclad. We expect our parents to take us from helpless babes to hardy adults. Growth begets strength.

My father’s frequent advice to me and my sisters suggested patience and fortitude: “Stay strong like a mountain. Nothing can shake you.” But it also suggested impenetrability. For the angsty teenager or the bullied middle schooler, this meant bottling the waterworks. My mother reiterated his sentiment more bluntly in Arabic. She said strong soldiers could “bite the head off a snake.” She taught us to confront problems face-to-face. A late comeback “entered but died” if you weren’t quick on the defensive. She frequently recounted a story about my great-grandmother, a woman I never met but knew well from these tales: After nearly chopping off her thumb while in a tree, she tied a shred of fabric around the gushing wound and continued pruning.

You wouldn’t guess it from the tranquil lives they now lead in Ohio, where they sip coffee and crack jokes in their backyard garden, but my parents’ understanding of strength was incubated in war. Like many Lebanese of the 1970s, their upbringings were punctuated by displacement, bloodshed, invasions, and cease-fires. And like many Lebanese in general, they seem to take all that happened to them in stride, with a kind of good-natured, cynical gratitude. We can call it strength.

My mother once ran out of a bomb shelter during an Israeli air strike to fetch the pan of spaghetti her mother had prepared earlier that evening. (She jokes, “I was hungry!”) Another time, a car bomb was planted two buildings down, killing several and forcing a neighbor into a stillbirth. Wounded soldiers frequently limped down the main road in front of their door (“They were torn apart, missing limbs”). A fighter jet flew so close to their balcony that my mother could have reached out and touched it. Once, during an episode of manic fear, my mother dressed in her mother’s clothes and searched the deserted main street for her brothers. (“I thought they’d been killed,” she explained, “but they were just playing at another house.”)

When her family migrated to Venezuela for a few years, two masked robbers tried to kidnap my mother and her young siblings. At fourteen, she single-handedly fought them off and was left with recurring night terrors, missing patches of hair. Back in Lebanon, their ransacked childhood home bore shrapnel and scorch scars across its frame; the damage suggested that emigrating for a few years was a safe move. All the furniture and belongings—photo albums, clothing, lightbulbs, heirlooms, dishware—were stolen, the windows warped or shattered. This brief, diluted list of her experiences sets the gist. In a war zone, you don’t elect strength. You are either strong or you die.

In a war zone, you don’t elect strength. You are either strong or you die.

No big presentation, ugly bathing suit, chemistry test, or schoolyard bully garners the same ultimatum. So my mother’s take on our American childhoods was quite uniform: You’re afraid? Of what?

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Fear, like strength, is intimately linked to our survival.

But in our bodies, fear is the one that elicits a measurable, immediate response. A frightened brain signals for the release of stress hormones: cortisol and adrenaline. Heart rate increases. Breathing quickens and shallows. Blood floods your limbs to prepare you for a fight or an escape. Our fear reactions are all instinct. Hardwired.

Our species has mutated strength into something synthetic, catastrophic. We are “strong” well beyond our biological need: Deadly weaponry wipes off entire sections of the globe in demonstrations of power, justified by self-defense. But our fear reactions haven’t caught up the same way. We are still afraid. And our stress reactions, stubbornly, have not changed.

Your body doesn’t know that you’ve evolved out of the jungle, so abstract and psychological stressors can induce the same cold sweat as a roaring bear. A looming deadline or job interview is enough to get cortisol pumping.

In landscapes that mimic those primordial, predatory ones—like war zones—our fear response is heightened. Anxiety becomes chronic. Heightened cortisol is useful in the moment, but when it’s constantly pumping, it’s dangerous. Stress is responsible for digestive issues, poor sleep habits, chest pain, weight gain, headaches, depression, and an absent sex drive (there’s no time for pleasure or procreation!). If we don’t address chronic stress, it is quick to consume our subconscious. The mind can ruin the body.

During a visit to see my grandparents in Lebanon in 2006, Israeli air strikes and cluster bombs obliterated roads, buildings, shops, bridges, and other civilian infrastructure. The thirty-four-day massacre killed over 1,200 Lebanese and wounded another 4,300. These figures included children. One million Lebanese were displaced, suddenly homeless. Israel’s bombing of the airport runway kept visitors stranded. We were evacuated by a navy ship, the USS Nashville, before the cease-fire took hold.

In Arabic, this was called “Harb Tammuz,” the July War. It is a misnomer for two reasons: July makes it seem as though war is as ordinary or immanent as a summer month on our calendar, and War makes it seem as if two governments were fighting on equal grounds. Neither are true. At night, I sat across from my mother on the cool floor of her childhood bedroom, my drenched palms in hers, my ears to the whining planes. She recited prayers from the holy book her uncle had transcribed by hand. Asynchronous blasts kept raining down until dawn. I leapt and held my breath with each one. I saw it glint in my mother’s eyes, that animal fear I felt. But she kept calm. She’d been through worse before. It still surprises me, even now: witnessing my strong mother turning to softness in the eye of the storm.

For years after our safe return, the air strikes smuggled their way into my dreams. I would hold my mouth over the sink and watch my teeth crumble out. Tiny pearly cluster bombs. The house would shake until it turned to rubber. Even along the verdant shore of a lagoon in Florida or Greece, Israeli planes whirred in the distance. They dropped leaflets with my family’s name. An IDF soldier on the other end of the phone knew who I was. An endless supply of dust-coated child corpses waited to be pulled from the rubble by the Red Cross. Their Lebanese faces resembled my own.

The body sleeps. The mind, never.

The body sleeps. The mind, never.

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Before I approach a nervous patient for the first time, their body frequently tells me what their voice won’t: The spine is upright, knuckles white on the armrest, ankles in a jiggling knot. The mouth is open, but the body warns (and the blood pressure confirms), “Don’t touch.”

For all their strength, teeth are a source of immense fear. Dental phobias are so common that working around them has become the standard for good practice. Most new inventions focus on patient comfort: mouthprops to ease joint pain, cavity liners that quell sensitivity after fillings, even small vibrators that lessen the sting of an anesthetic injection. We are taught to assume that every patient is afraid unless they tell us (and prove) otherwise.

Where does that fear come from? Often, experience. Toothaches are uniquely painful. It is not uncommon to “feel” a toothache in your ears, jawline, chin, or neck. An infected or broken tooth can feel like a hot knife in the jaw. Ample innervation in the head and neck can make it completely debilitating.

Teeth have layers, and this structure pressurizes pain. Far beneath that tough enamel is a mushy “heart,” a blood-rich nerve chamber known as the pulp. Each tooth has its own. It keeps the tooth responsive and sensitive: It can throb, smart, or ache. Its relatively isolated circulation can make it unresponsive to pain pills. It is also dramatic. Pulps resort to suicide when pain isn’t resolved, and a “dead” pulp continues to cause pain long after it necroses.

Though we think of them as bones, your teeth are actually organs. They’re classified with the ectodermal system—skin, sweat glands, and hair follicles. This distinction is important because bones can heal themselves. Teeth cannot. Enamel—like cells in the nervous system, heart, and retina—does not regenerate after damage. When it’s gone, it’s gone.

How does it go? Teeth don’t know their own strength. If you grind or clench frequently, your teeth damage each other. Think “diamond cutting diamond.” Teeth are physically capable of filing each other down to yellow nubs.

Chronic teeth grinding is called bruxism, and when it’s pathologic it can cause irreparable damage. Now, in the aftermath of Covid-19, much of our practice addresses this destructive tendency. Bruxing is one of the most common subconscious outlets for stress. It happens while you dream.

Still, dental pain rarely arrives overnight. It can take months or years before the tooth becomes intolerable. Only then do the vexed seek a dentist, and often the issue is so far gone that it’ll require multiple complicated visits. That initial fear of visiting the doctor keeps the patient away, and the resulting pain from waiting just reinforces that fear. It is a painful paradox: fearing the healer.

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At a Fourth of July picnic years ago, just as the first fireworks streaked over the lake, I scrambled beneath a plastic bench and held my ears. My frantic whimpering went unnoticed by the adults, who marvelled at the display until the powerful, deafening showstopper. The air stank of new smoke when my father fished me out. He held me to his shoulder. “Nothing to be afraid of, silly,” he said. Nearby, satisfied spectators were packing up their folding chairs. “What a show,” my mother beamed from the blanket, a little sad that I had missed it.

I was a kid then; this was years before I experienced Lebanon under fire, before I understood that a blast meant death. But I was viscerally afraid. Later, I found ways to justify my aversion to the Fourth of July: It was hot and crowded, the blanket on the grass never comfortable, the stink of sweat inviting mosquitoes. Across the park, drunk adults messily flirted with one another, munching on blistered hotdogs. But all of this paled to the rockets, their screeching whistle before the blast, the black night harshly illuminated. The crimson light across our sprawled bodies. Right over the lake, the show seemed impossibly close. Dangerous. What had told me so?

Your traumas can be born in you, according to a growing body of epigenetic research. Put simply, trauma can alter the cells that will go on to create us while they are still in our parents’ bodies. Your mother’s and father’s lived experiences become heritable for generations to come, the response like falling dominos or a room of mirrors. The findings validate what many of us have felt since early childhood, particularly in diaspora as our parents navigate a new country: What scares my mother scares me.

But our survival through the ages—as a species, as families, as individuals—insists that we can overcome. Research has backed this idea too. Mental toughness is also genetic. Strength is as transmissible as brown eyes, an ability to curl the tongue, a gap in the teeth.

In our ancestors, now fossilized beneath the earth, enamel remains ever valuable. Archeologists look hopefully into the mouths of skeletons for intact teeth; enamel keeps them insulated through the centuries, preserving pulpal DNA inside for excavation. After the rest of the body has decayed, teeth remain salvageable. There is a clear lesson in that—that strength preserves, is everlasting—but more so that it is the softest part of the tooth that becomes the most valuable, the mushy and sensitive insides a much-sought-after thing.

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