When one or more teeth, in consequence of a trauma, or from other cause, become loose and project above the level of the others, Galen removes the whole exuberant part by means of a small iron file. In performing this operation, after having covered the gums with a soft piece of cloth, he holds the tooth to be filed steady with the fingers of the left hand, using the file in such a way as not to give the tooth any shock. Besides, he does not complete the operation at one sitting, but rather interrupts it as soon as the patient feels any pain, and continues it after one or two days. In the meanwhile, he makes use of remedies suited to strengthen the loosened teeth, and bids the patient remain silent and nourish himself with liquid or soft food.
When the teeth, without the action of external causes, become loosened, Galen holds that this is due to a relaxation of the dental nerve in consequence of an excessive abundance of humors. In such cases he counsels the use of desiccative remedies.
Galen, like ancient authors in general, is not very favorable to the extraction of teeth with the forceps. Even he seems convinced that a tooth may be made to fall out, without pain, by means of the application of certain remedies, to which we have already alluded. However, in one of the Galenic books[183] we find the precept already given by Celsus, that before extracting a tooth the gums must be detached all around; from which one may argue that, at least in certain cases, instrumental extraction was considered inevitable. Galen even alludes to the pain which sometimes remains after the extraction of a tooth, and is of the opinion that this depends upon an inflammatory condition of the stump of the dental nerve.
In Galen are found recorded many means of cure, recommended by celebrated doctors of ancient times. Elsewhere we have already spoken of some remedies counselled by Damocrates, by Andromachus the elder, and by Archigenes. Apollonius, as a medicament against odontalgia, advised that the juice of the beet root be dropped into the nostrils, or else a liquid prepared from cumin seed, myrrh, cucumber, and woman’s milk. Heraclides of Tarentum recommended against the pains and looseness of teeth that a vinous decoction of black veratrum, mandrake, and hyoscyamus root should be kept in the mouth. Criton prescribed, for strengthening loose teeth, that the mouth should be frequently washed with a vinous decoction of lentisk, myrtle, and gall-nuts.
Celius Aurelianus. In the book De morbis acutis et chronicis, written by Celius Aurelianus (who lived, according to some, in the third century, according to others, in the fourth or at the beginning of the fifth), a very interesting chapter on odontalgia is found. He shows himself to be, for the most part, a follower of Celsus. During the violence of the pain he advises abstinence from food and rest in bed with the head somewhat raised. As remedies he recommends several mouth washes (infusions or decoctions made with wine or vinegar and with various drugs: ironwort, acacia, mercury herb, mandrake, cinquefoil, poppy, verbascum, hyoscyamus, figs, stag’s horns, etc.), and besides, the application of wool soaked in hot oil on the cheek of the affected side, or the application of little warm bags, and also that some hot oil, or the juice of fenugreek,[184] should be kept in the mouth, or milk with honey. When the pain is excessively violent, he has recourse to bloodletting, and after two days’ fasting, he begins to feed the patient with liquid and warm food. If the bowels are closed he prescribes the use of clysters, and when, in spite of all, the pain persists, he has recourse to scarified cuppings on the cheek, in correspondence with the pain. In certain cases he also proceeds to scarification of the gums, or else he detaches them all around from the tooth, by means of a special instrument called a pericharacter. It would often turn out useful to apply to an aching tooth a grain of incense warmed by the fire and wrapped in a thin piece of cloth, or to press between the teeth, where the pain is situated, several pieces of cloth, in succession, in which some powder of incense has been wrapped, and which are dipped into hot oil before being used. The author, moreover, commends external fomentations made by means of sponges soaked with emollient decoctions and afterward squeezed; and also the application of moderately hot cataplasms.
Roman dental forceps found (1894) at Hamburg, Germany, in the ancient Roman castle Saalburg. (Geist-Jacobi.)
When the odontalgia has already become inveterate and recurs in paroxysms, separated by intervals of calm, Celius Aurelianus counsels, among other things, that the general health be strengthened by temperate living, exercise, rubbing of the whole body (an ancient practice, now revived under the name of massage). He recommends, besides, special rubbing of the cheeks (to be carried out with a rough cloth), and also of the gums and teeth, and indicates a great number of medicaments, some of which are to be used during the paroxysms and others during the periods of calm. In regard to the use of narcotics, he very shrewdly observes that such remedies take away sensibility but not pain. Some doctors of those days, for the cure of odontalgia, had recourse to sternutatories, or to the dropping of special medicaments into the nose or into the ear, but Celius Aurelianus seems to have put but little faith in such means of cure. He, moreover, solemnly reproaches those who, to cure odontalgia, are too hasty in having recourse to the extraction of the aching tooth. To remove a part, says he, is not to cure it; and if every tooth that aches has to be extracted, it would be necessary to draw them all out when they all ache. Therefore, before having recourse to extraction, every other means of cure should first be tried. If the removal of the tooth becomes indispensable, he advises that it should never be performed during the violence of the pain, for from this serious consequences might arise (a prejudice which has not yet entirely vanished, and which is met with, sometimes, not only among common people, but even among physicians); and a still greater danger would be the extraction of teeth neither carious nor loose, seeing that, by consensus, the muscles, the eyes, and the brain might suffer. The author, on this point, quotes Herophilus and Heraclides of Tarentum, who related some cases in which the extraction of a tooth was followed by death. He alludes, moreover, to a passage of Erasistratus, regarding the “odontagogon of lead” (plumbeum odontagogum) which was exposed in the temple of Apollo at Delphi; as much as to show that it was not lawful to extract teeth other than those which were so loose that an instrument of lead was sufficiently strong to extract them.
When the looseness of the teeth seems to depend upon the flaccidity of the gums, Celius Aurelianus recommends astringent mouth washes: decoctions of rind of pomegranate, of gall-nuts, of acacia, of quince, of myrtle berries, etc.; and besides these, lentiscine oil and asses’ milk, which latter was also believed to possess astringent virtues. Against hemorrhages of the gums, he advises the use of very fine coral powder, or of alum with honey.