Disorders. We live in a disordered world of disorders. Depression and anxiety ones, bipolar, ischemic heart disease, diabetes mellitus all at epidemic levels amid a pandemic, and now orthodontic disorders make that list. It’s a bit like the 27 Club for disease.

Ninety percent of the population have teeth that are either slightly misaligned or maloccluded. Seventy-five percent of us have wisdom teeth that are impacted, crowded, or will never emerge.

As a species not only are we too big for our boots, but our jaw is too short for our teeth. It’s an imbalance of nurture and nature in a created oral environment our ancestors never had to contend with. In the case of teeth, environment includes the chemicals and bacteria of the mouth, as well as motion strain and tooth abrasion.

Charles Darwin made a connection between jaw size and stress in The Descent of Man (1871). However it is American Robert Spencer Corruccini (b. 1949), anthropologist, distinguished professor, Smithsonian Institution Research Fellow, Human Biology Council Fellow, and the 1994 Outstanding Scholar at Southern Illinois University-Carbondale who is among the first to find definitive evidence.

Corruccini had just started teaching at Southern Illinois when a student from Kentucky told him that in his community, seniors were raised on foods that needed lengthy mastication and muscle resistance. Within two generations and for the first time ever, processed, soft textured diets are the norm.

It prompted a study. What it showed, was that the older residents had better bites, despite having had almost no professional dental care, and certainly much less than their grandchildren.

For Corruccini, it explained that the dental differences were not genetic; the difference was the lack of chewing required before swallowing. It changes the digestion system. It changes the oral microbiome colonies. It disorders our health.

There were many examples of processed, convenience foods and traditional cuisine of rural peoples. The Pima of Arizona. The population of Chandigarh, India, whose diet of coarse millet and tough vegetables was compared with the soft breads and mashed lentils of urban dwellers.

Corruccini then reasoned that tooth size is preprogramed during growth – dependent on the subsequent levels of mechanical stress a natural childhood diet supposes. When the jaw doesn’t get proper stimulation during development, the front teeth become crowded and the back teeth impacted. This hypothesis was confirmed with experimental work on monkeys: those fed softer diets had smaller jaws and impacted teeth.

It certainly follows that change can result in a mismatch between behaviour and biology. Such is the case of the modern Western diet – now so completely unlike any other time in the entire history of the human race.

Famed Australian orthodontist Percy Raymond “Tick” Begg (1898-1983) recognised a mismatch in the 1920s. He found that First Nations peoples with traditional lifestyles wore their teeth down more than those of European ancestry did, and had perfect dental arches. Their front teeth were straight; their wisdom teeth fully erupted and functioning. Begg reasoned that nature expects wear between adjacent teeth to reduce space requirements in the mouth. His belief was that jaw length was predetermined by evolution where teeth evolved to take on tough foods in an abrasive environment. A hundred years ago, it was identified that a soft, clean diet upsets the balance of tooth size and jaw length.

Hence the ordered line of dental disorders at the oral surgeon’s office. Whether by wear or extraction, tooth mass has to go.

We are indeed too big for our boots. And our pants. And aircraft seats sometimes.

I thought that’s what jumbo jets were for, but they’re not.

They’re for getting more people to places they would never get to otherwise at unfeasible speeds and altitudes in terms of physiology, broadly enticed or persuaded to engage in tasks they’d rather not if they could, or do things they probably shouldn’t.

All because when the Walkman and modern era heart transplants emerged within a year of each other, technology KO’d evolution and left it down for the count.

How our teeth fall short on the adaptability scale also explains their strengths. Teeth are incredibly complex structures of living tissue that creates a substance that can withstand 2550 kilograms of pressure per 2.5 square centimetres. Tooth enamel is stronger than bone, and has the highest mineral percentage of any tissue in the human body – 96%. It can withstand temperature.

Its kryptonite is sugar and most everything on an average Western daily menu.

In the first decades of a new millennia, dental caries is the most common and pervasive chronic disease in the world. Basic biology is that within a specific range of environmental conditions, organic structures evolve to operate – and operate efficiently. Over three decades of hundreds of thousands of studies of fossilised and living animal species barely any tooth decay has been found at all.

This evolutionary perspective uncovers the consequence of ecological shifts, and guides researchers and clinicians on the root causes of dental disease. Fluoride remineralises and strengthens enamel. Sealants protect crowns. Veneers give us what nature didn’t.

However, no therapy or procedure usefully changes the conditions in the mouth that bring about decay. Antiseptic mouthwash kills cavity-causing bacteria and also kills beneficial strains, evolved to keep harmful bacteria in check. Recent innovations in microbiome therapies have researchers starting to focus on completely remodelling the dental plaque community.

Oral probiotics, targeted antimicrobials and microbiota transplants are in development.

Such a flurry of potential. Such hope in finding an easy, convenient cure.

All we need to know is macaques don’t eat Maccas.

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