Chapter XII of the seventh book is, of all the work of Celsus, the one which presents to us the greatest interest, since there the author treats of the surgical operations required by the diseases of the dental apparatus.
He first speaks of the looseness of the teeth, caused by the weakness of their roots, or by the flaccidity of the gums, and says that in these cases it is necessary to touch the gums lightly with a red-hot iron, then to smear them with honey and wash them with mulse, and later on to strengthen them by means of astringent substances.
“When a tooth aches, and it is thought well to extract it, because medicaments are of no use, the gum must be detached all around, and then the tooth must be shaken until it is well loosened, it being very dangerous to draw a firm tooth, as this may sometimes give rise to a dislocation of the lower jaw. And greater still is the danger in regard to the upper teeth, as this might cause a shock to the temples and eyes. After having well loosened the tooth, it must be pulled out by the fingers, if this is possible; or if not, with the forceps.”
Dental and surgical instruments represented in a funeral marble of the Lateran Museum, Rome.
It is clear that this method of tooth drawing—so excessively cautious and timid—must have been very torturing to the poor patients. A thousand years and more after Celsus, Abulcasis still counsels the same exaggerated precautions, and says that the extraction of a tooth must not be performed in a rapid and violent way after the manner of the barbers. From this one may see that the operation spoken of was then very often performed by certain unprofessional persons, who, being very familiar with it, carried it out with great indifference and rapidity, thus sparing the patients the long-protracted martyrdom which the erudite doctors, followers of Celsus, thought necessary to make them endure. Very probably the same happened in the days of the wise Roman doctor.
When there is a large carious hollow in the tooth to be extracted, Celsus recommends that it should first be filled up either with lint or with lead, in order to prevent the tooth from breaking under the pressure of the instrument. “The latter,” he continues, “must be made to act in a straight direction, in order to avoid fracture of the bone. The danger of fracture is still greater in the case of short teeth; often the forceps, not being able to grasp the tooth well, takes hold of the bone with it and fractures the latter. When after the extraction of a tooth much blood flows from the wound, this indicates that some part of the bone has been broken. It is necessary then to search for the detached piece of bone with the probe and to extract it with the forceps. If this be not successful, an incision must be made in the gums just as large as is necessary for the extraction of the fragment. When this is not taken out, it often happens that the jaw swells in such a manner as to prevent the patient from opening his mouth. In such a case it is necessary to apply to the cheek a hot cataplasm of flour and figs, so as to induce suppuration, after which the gums must be lanced and the splinter of bone extracted.”