Theodore Roosevelt's "presidential smile" and questionable dental health

Theodore ("TR" or "Teddy") Roosevelt (1858-1919), who served as the twenty-sixth President of the United States from 1901 to 1909, was an "Icon of the American Century." Characterized by immense energy, numerous skills, zest for life, and enduring accomplishments, he made an impressive ascent to political importance. However, he also experienced serious, chronic, oral and systemic health problems. In spite of these significant health obstacles, he chose "the strenuous life," and cultivated a lifetime of joy, laughter and humor. TR was known as "the first president that smiled," and he was typically photographed and illustrated grinning from ear to ear. His flashing white teeth, wide smile, and engaging openness became welcome symbols of national and international acceptance. When Roosevelt died, suddenly and prematurely at the age of 60, dentists and physicians of that time began to investigate the probable medical causes of his untimely demise. The "focal infection hysteria" of the early 1900s convinced some of these health professionals that "a bad tooth", that previously had been endodontically treated, was the probable cause of death. Much of the early 20th century evidence-supporting the notion that oral sepsis was a "cause" of local or systemic disease-has now been proven, on closer inspection, to be anecdotal or of questionable scientific merit. Nevertheless, during those early days, it was common practice to extract all endodontically or periodontally involved teeth to eliminate any possible foci of infection that many clinicians believed could cause disease.