A historical glimpse of toothpick use: etiquette, oral and medical conditions.

This article traces various historical and geographical aspects of multicultural toothpick use, dating back from prehistoric times to the present. This behavior appears to be one of the oldest and best documented of all human habits. Toothpicks (composed of bone, ivory, metal, plastic, quills, wood or other substances) have been used for ceremonial, oral hygiene and religious purposes. Throughout the ages, the act of toothpicking has been both encouraged and discouraged. In the 19-20th centuries, it was generally viewed as a disgusting breach of social etiquette and a significant threat to oral and general health. Authors of numerous dental articles have cautioned that indiscriminate toothpick use can lead to halitosis, dental caries, injury to the interdental papilla, mouth ulcers, allergic reactions, embedment of the device in the back of the mouth or throat, gingival abscesses, sensitive teeth, or abraded enamel, dentin or cementum of both permanent and primary dentitions. Additionally, both the dental and medical literature report anecdotal cases of life-threatening injuries and death caused by toothpick ingestion.