The President's Mouth: Edentulism, Prosthetic Rehabilitation, and the Provenance of Human Teeth in the Craniofacial History of George Washington.

OBJECTIVE: To reconstruct the oral and craniofacial disease trajectory of George Washington (1732-1799) from primary documentary, artefactual, and iconographic sources, and to interpret his prosthetic rehabilitation against contemporary prosthodontic and craniofacial principles. METHODS: Three classes of source were examined. The manuscript record comprised the correspondence with his dentists, the diaries, and the financial ledgers, consulted through Founders Online and the Financial Papers Project. The artefactual record comprised the 4 surviving prostheses and their documented composition. The iconographic record comprised portraits executed before and after complete edentulism. Interpretation was restricted to observations supported by at least 2 independent sources. RESULTS: Tooth loss began at age 24 and progressed over 4 decades, reaching near-complete edentulism by 1789 and complete edentulism in 1796. The prostheses combined hippopotamus, walrus, and probably elephant ivory, bovine, equine, and human teeth, and lead, brass, silver, and gold, retained by helical springs without adhesive. The patient's own letters document progressive loosening, mucosal discomfort, labial protrusion, and altered speech, corresponding to residual ridge resorption, uncontrolled occlusal vertical dimension, and excessive labial support. A financial entry of May 1784 records payment for 9 teeth obtained from enslaved persons at Mount Vernon. CONCLUSIONS: This case documents, with unusual completeness, the functional and facial cost of complete edentulism before the era of biocompatible materials and adhesive retention. It also raises a question that remains open, namely, the provenance and consent status of human biological materials used in dental and craniofacial rehabilitation.