8/17/2019 1-s2.0-S0011848611003712-main

1/2

later invited Woodhouse over for dinner, showing that he

had no hard feelings concerning the uncomfortable ma-

hogany bar and three extractions.

Ruskin suffered a complete mental and physical break-

down in the summer of 1871, but resumed treatment after 

recovering in 1872 and visited Woodhouse at least once

a year. Ruskin had an interest in all types of craftsmanship

and mentioned Woodhouse’s gold technique. A February 

1873 letter reveals Ruskin’s sharing of his emotional tur-

moil with his dentist. Rose, to whom Ruskin had pro-

posed, was in ill health after a 7-year wait to respond to

his proposal of marriage. She eventually died in 1875. Rus-kin also exposed his financial affairs and deep emotional

life publicly, often embarrassing his friends. A letter from

Ruskin’s cousin Joan, who also saw Woodhouse as her 

dentist, reveals that the two men discussed personal mat-

ters quite freely.

In 1878, Ruskin suffered a severe breakdown between

February and April. Diary entries a year later indicate that

Ruskin continued to need Woodhouse’s dental expertise,

documenting a toothache that was ‘‘threatening’’ but was

relieved. Ruskin’s last entry regarding dental matters was

made in November 24, 1883, when Ruskin was 64 years of 

age. Ruskin suffered a final attack of mania in August 1889and ended all his creative pursuits. He died on January 

20, 1900, of ‘‘Influenza and Syncope.’’

Clinical Significance.—  This account raisesseveral issues. First, it demonstrates some of the factors that contribute to a long-term profes-sional relationship. Second, we see a surprising lack of patient confidentiality being practicedearly in the history of dentistry. Third, there isan interesting contrast between the dental prac-

tices of the 19th century and those that we prac-tice in the 21st century.

Bishop MGH: Eminent Victorian dentistry. 1. John Ruskin and the

patient experience of Victorian dentistry. Ruskin’s dentist, Alfred

James Woodhouse. Br Dent J  210:179-182, 2011

Reprints available from M Bishop, Bulls Mill House, Hertford, SG14 3NS

Leonardo Da VinciMona Lisa smile

Background.— Leonardo da Vinci’s masterpiece ‘‘TheMona Lisa’’ has been a source of much speculation re-

garding the subject’s enigmatic smile. Many theories

have been put forward to explain it, often based on

the fact that da Vinci was not only a master artist but

also a mathematician, an inventor, an architect, and an

anatomist. A new interpretation was suggested after 

a careful analysis of the smile in l ight of recent

Fig 2.—Alfred James Woodhouse. By kind permission, the British

Dental Association. (Courtesy of Bishop MGH: Eminent Victorian

dentistry. 1. John Ruskin and the patient experience of Victorian

dentistry. Ruskin’s dentist, Alfred James Woodhouse.   Br Dent J 

210:179-182, 2011.)

 Volume 57   Issue 3   2012   123

8/17/2019 1-s2.0-S0011848611003712-main

2/2

information about the artist, his subject, and the clinical

presentation of Bell’s palsy.

The Artist.— Leonardo was born the illegitimate son of 

a notary on April 15,1452 in Vinci, Italy. Some of his youthful

drawings were brought to the attention of Andrea del Ver-

rocchio, an artist who recognized the boy’s talent. Leo-

nardo entered Andrea’s workshop and studied multiple

branches of art—sculpture, drawing, and painting. He wasan excellent geometrician and showed talent for architec-

ture as well. He was constantly pursuing new challenges

and often could not finish work that he felt had imperfec-

tions. Andrea assigned him to paint an angel in his work

‘‘Baptism of Christ’’ and vowed never to paint again when

the student’s work was clearly superior to his master’s. In

1482, Leonardo entered the service of the Duke of Milan, re-

maining with him for the next 17 years. His workshop in Mi-

lan was filled with apprentices and students, and he

demonstrated many advances in painting, architecture, me-

chanics, and human anatomy. Leonardo only completed six 

 works during this time, but these included ‘‘The Last Sup-

per’’ and ‘‘The Virgin on the Rocks.’’ After the Duke fellfrom power in 1499, Leonardo worked for various patrons,

including Cesare Borgia, Niccolo Machiavelli, the Pope, and

Giuliano de Medici. His final patron, Francis I, King of 

France, held Leonardo in his arms as he died on May 2,

1519.

The Subject.— Lisawas bornon June15,1479 ina house

used as a workshop by local wool artisans in Florence, Italy.

In 1495, at age 16 years, she married a merchant, Francesco

del Giocondo, who was 16 years older than Lisa. She gave

birth to five children and died at age 63 years. In 1503, Fran-

cesco del Giocondo commissioned Leonardo to paint a por-

trait of his 24-year-old wife, perhaps to mark the birth of the

couple’s second son, born in December 1502.

Lisa’s wry smile has been attributed to being the result

of low spatial frequencies or missing teeth. The French Mu-

seum’s Center for Research and Restoration used laser 

scanning of the portrait and found that the model was wear-

ing a very fine gauze veil on the dress, usually indicative of 

a woman who was either pregnant or had recently given

birth. The National Research Council of Canada also used

laser and infrared scans to reveal previously hidden details,

finding that the model’s hair was originally in a bun, which

 was common for 16th century Italian women who werepregnant or had recently delivered a child. The theory 

 was developed that the smile was an artistic representation

of the facial muscular contracture that develops with Bell’s

palsy. When this develops, the facial nerve has undergone

partial Wallerian degeneration and has regenerated. For 

two decades, the medical community has speculated about

this possibility, noting its high degree of scientific credibility.

Bell’s Palsy.— Bell’s palsy results from damage to one of 

the two facial nervesand is a type of temporary facial paralysis.

It affects both genders and all ages, occurring in 20 to 32 per-

sons per 100,000 population each year. No detectable cause

has been demonstrated, although theories abound. It is pos-

sible thatthe palsy results fromreactivation of herpes simplex 

 virus in the geniculate ganglia, viral infection, vascular ische-

mia, or an autoimmune disorder. The facial nerve controls fa-

cial expressions such as smiling, frowning, and blinking. Thedamage that causes Bell’s palsy can also lead to hyperacusis,

impaired taste, pain near the ear, decreased tearing, impaired

speech, dizziness, and difficulty eating or drinking.

Thediagnosis of Bell’s palsyis often based on the clinical

appearance of a distorted facial expression and the inability 

to move the muscles on the affected side. Electromyogra-

phy can confirm its presence and severity. Usually, the con-

dition improves within 2 weeks, with normal function often

restored in 3 to 6 months. However, some symptoms re-

main indefinite. Bell’s palsy has a much higher prevalence

among pregnant women than nonpregnant women, with

most cases developing in the third trimester and immedi-ately postpartum. This higher prevalence may be linked to

increased maternal extracellular fluid volume or nerve com-

pression syndromes that are more common in the later 

stages of pregnancy. Bell’s palsy may also be associated

 with preeclampsia, sometimes occurring immediately after 

birth when the woman has mild preeclamptic symptoms.

Gestational hypertension may also be associated with Bell’s

palsy during pregnancy or in the early postdelivery period.

Clinical Significance.— It is possible that theenigmatic smile of the ‘‘Mona Lisa’’ reflects thesmile of a new mother who exhibits Bell’s palsy related to her recent pregnancy. Leonardo da 

 Vinci may have simply been accurately portray-ing the subject’s medical condition. Rather than hiding a secret message, the portrait may be re-

 vealing the truth. Interestingly, the alternate ti-tle for the work is ‘‘La Gioconda,’’ meaning ‘‘the joyous one,’’ which lends support to theclaim that the portrait was commissioned by a proud father to celebrate the birth of a son toa beloved wife.

Maloney WJ: Bell’s palsy: The answer to the riddle of Leonardo da

Vinci’s ‘Mona Lisa.’ J Dent Res  90:580-582, 2011

Reprints available from WJ Maloney, Dept of Cariology and Compre-

hensive Care, College of Dentistry, New York Univ, 345 E 24 th St,

New York, NY 10010; e-mail:  wjm10@nyu.edu

124   Dental Abstracts

mailto:wjm10@nyu.edumailto:wjm10@nyu.edu