George R. R. Martin’s Game of Thrones novels and the HBO television series based on them have won high marks for their compelling stories and gritty realism. People talk about how the magic feels real because of the high costs and limits that border it. We see people at their worst as well as their best, and, of course, our main characters are not protected by the author’s loving hands from death or fates worse than.

But there’s one place where the realism falls short: the teeth of the characters. Based on what we know of Medieval dentistry (which, based on the technology in the Game of Thrones world is a pretty fair comparison), the characters should have numerous missing teeth, those that they have remaining should be stained (according to their age, which, admittedly they don’t live that long), and they should have swollen, bleeding gums, whereas the characters in the TV series all seem to benefit from regular visits to the dentist.

Medieval Dentistry and Oral Health

watch-game-of-thronesThere are some websites out there that would have you believe that Medieval medicine had oral health pretty well covered. They will tell you that they knew how to brush their teeth, make mouthwash, fill cavities, and even make dentures. However, this is far from the truth. In the Medieval period, people generally had bad teeth, and although there were many home remedies and spells for dealing with problems, these were often ineffectual. The only real effective dental treatment was extraction. If people made dentures, they weren’t very common and probably rotted quickly–few survive. Although people talked about filling cavities with gold or making dental crowns, these are exceedingly rare.

The remains of people from this period tell the story of their oral health pretty well. A survey of the oral health in skeletons at St. Mary Graces shows that 37% of the population had moderate or severe periodontitis (with noticeable bone loss) in their lower jaw, and 43% had it in their upper jaw. That compares to about 17% in the modern population.

At first glance, it may seem that dental caries were less common in this population, however. For example, only about 17% of skeletons had cavities in their upper or lower premolars. That compares to about 67% in modern populations.

But you’d be foolish to think that they had that much better cavity prevention than we do. Researchers say that they had 186 skulls to look at for periodontal disease, but only 114 with evidence relating to premolars. That means that one reason why we see fewer cavities is that 72 of the skulls had no premolars! In other words, 39% of them had lost all their premolars! And it just gets worse: only 97 had molars in their upper jaw, and 55% of them had cavities! Although some of these teeth may have been lost from skulls after death, it’s likely that many were pulled by dentists.

Some people make a similar claim that Vikings had good oral health. Don’t bet your horned helmet on it!

Although it’s true that this survey of remains notes “Few dental caries were found,” it notes that 45% of the skeletons had root abscesses, showing severe periodontal infections. Some of the images show severe bone recession due to periodontal disease, and although 51 skeletons were analyzed, there were only 1001 teeth available, or an average of 20 per individual. Some of the reduction is due to missing lower jaws, but every skeleton had lost at least one tooth before death, and some had lost 13. And the teeth that remained were ground down.

The Books Are More Realistic

So, it seems that our Games of Thrones characters should all be walking around with a mouth full of rotting teeth, or have significantly fewer teeth. What remains should be discolored, and orthodontic problems should be common. A far cry from the universally perfect dentition the HBO series shows.

To be fair, Martin’s books are a little more realistic. They make some references to oral health. For example, Jeor Mormont has a lemon with his beer each morning, which is why he supposedly has been able to keep his teeth. Although acid can damage teeth, it can also clean them. And eating citrus prevents scurvy, which can be responsible for lost teeth.

At one point, Jon Arryn is described as missing teeth, and having foul-smelling breath.

The character of Dywen is described as having wooden teeth.

Finally, some characters comments explicitly on the whiteness of Cersei’s teeth and Jaime’s. This says they’re exceptional, and implies that the normal condition is discolored teeth.

Why HBO Sacrificed Realism

Although the television series strives for realism in other places, this is one place where they probably decided wisely to steer clear. While it would be realistic to show characters with terrible teeth, these characters are just hard to sympathize with. We automatically react negatively to signs of poor health, and in this day and age, that includes poor oral health. Having a healthy smile is essential to making a positive impression, and HBO knew that showing characters with poor teeth would create a level of alienation that would be impossible to overcome.

If you are concerned your smile is making a very negative impression, we can help. Please contact Smile Columbia Dentistry in Columbia, SC today.