Ruskin suffered a complete mental and physical breakdown 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 Woodhouses gold technique. A February
1873 letter reveals Ruskins sharing of his emotional turmoil with his dentist. Rose, to whom Ruskin had proposed, was in ill health after a 7-year wait to respond to
his proposal of marriage. She eventually died in 1875. Ruskin also exposed his financial affairs and deep emotional
life publicly, often embarrassing his friends. A letter from
Ruskins cousin Joan, who also saw Woodhouse as her
dentist, reveals that the two men discussed personal matters quite freely.
In 1878, Ruskin suffered a severe breakdown between
February and April. Diary entries a year later indicate that
Ruskin continued to need Woodhouses dental expertise,
documenting a toothache that was threatening but was
relieved. Ruskins 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 1889
and ended all his creative pursuits. He died on January
20, 1900, of Influenza and Syncope.

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. Ruskins dentist, Alfred James Woodhouse. Br Dent J
210:179-182, 2011.)

later invited Woodhouse over for dinner, showing that he

had no hard feelings concerning the uncomfortable mahogany bar and three extractions.

Clinical Significance.This account raises

several issues. First, it demonstrates some of
the factors that contribute to a long-term professional relationship. Second, we see a surprising
lack of patient confidentiality being practiced
early in the history of dentistry. Third, there is
an interesting contrast between the dental practices of the 19th century and those that we practice in the 21st century.

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

patient experience of Victorian dentistry. Ruskins dentist, Alfred
James Woodhouse. Br Dent J 210:179-182, 2011
Reprints available from M Bishop, Bulls Mill House, Hertford, SG14 3NS

Leonardo Da Vinci
Mona Lisa smile
Background.Leonardo da Vincis masterpiece The
Mona Lisa has been a source of much speculation regarding the subjects 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 light of recent

Volume 57

Issue 3

2012

123

information about the artist, his subject, and the clinical

presentation of Bells 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 Verrocchio, an artist who recognized the boys talent. Leonardo entered Andreas workshop and studied multiple
branches of artsculpture, drawing, and painting. He was
an excellent geometrician and showed talent for architecture as well. He was constantly pursuing new challenges
and often could not finish work that he felt had imperfections. Andrea assigned him to paint an angel in his work
Baptism of Christ and vowed never to paint again when
the students work was clearly superior to his masters. In
1482, Leonardo entered the service of the Duke of Milan, remaining with him for the next 17 years. His workshop in Milan was filled with apprentices and students, and he
demonstrated many advances in painting, architecture, mechanics, and human anatomy. Leonardo only completed six
works during this time, but these included The Last Supper and The Virgin on the Rocks. After the Duke fell
from 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.Lisa was born on June 15, 1479 in a 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, Francesco del Giocondo commissioned Leonardo to paint a portrait of his 24-year-old wife, perhaps to mark the birth of the
couples second son, born in December 1502.
Lisas wry smile has been attributed to being the result
of low spatial frequencies or missing teeth. The French Museums Center for Research and Restoration used laser
scanning of the portrait and found that the model was wearing 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 models hair was originally in a bun, which
was common for 16th century Italian women who were
pregnant 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 Bells
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.

124

Dental Abstracts

Bells Palsy.Bells palsy results from damage to one of

the two facial nerves and is a type of temporary facial paralysis.
It affects both genders and all ages, occurring in 20 to 32 persons per 100,000 population each year. No detectable cause
has been demonstrated, although theories abound. It is possible that the palsy results from reactivation of herpes simplex
virus in the geniculate ganglia, viral infection, vascular ischemia, or an autoimmune disorder. The facial nerve controls facial expressions such as smiling, frowning, and blinking. The
damage that causes Bells palsy can also lead to hyperacusis,
impaired taste, pain near the ear, decreased tearing, impaired
speech, dizziness, and difficulty eating or drinking.
The diagnosis of Bells palsy is often based on the clinical
appearance of a distorted facial expression and the inability
to move the muscles on the affected side. Electromyography can confirm its presence and severity. Usually, the condition improves within 2 weeks, with normal function often
restored in 3 to 6 months. However, some symptoms remain indefinite. Bells palsy has a much higher prevalence
among pregnant women than nonpregnant women, with
most cases developing in the third trimester and immediately postpartum. This higher prevalence may be linked to
increased maternal extracellular fluid volume or nerve compression syndromes that are more common in the later
stages of pregnancy. Bells 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 Bells
palsy during pregnancy or in the early postdelivery period.

Clinical Significance.It is possible that the

enigmatic smile of the Mona Lisa reflects the
smile of a new mother who exhibits Bells palsy
related to her recent pregnancy. Leonardo da
Vinci may have simply been accurately portraying the subjects medical condition. Rather than
hiding a secret message, the portrait may be revealing the truth. Interestingly, the alternate title for the work is La Gioconda, meaning
the joyous one, which lends support to the
claim that the portrait was commissioned by
a proud father to celebrate the birth of a son to
a beloved wife.

Maloney WJ: Bells palsy: The answer to the riddle of Leonardo da

Vincis Mona Lisa. J Dent Res 90:580-582, 2011
Reprints available from WJ Maloney, Dept of Cariology and Comprehensive Care, College of Dentistry, New York Univ, 345 E 24th St,
New York, NY 10010; e-mail: wjm10@nyu.edu