The epulis, according to Ætius, is a fleshy excrescence of the gums, brought on by inflammation. To cure it, he uses, during the inflammatory period, emollients, and then, when the inflammation has subsided, astringents and weak caustics. Lastly, if the epulis resist these remedies, he takes hold of it with a vulsella and proceeds to remove it with a small scalpel.[194]
When the incision of a fistula of the gums and the use of appropriate remedies are not sufficient for curing it, Ætius advises the extraction of the diseased tooth, from which the fistula has its origin.[195]
Apart from what has been mentioned, Ætius does not tell us, in regard to dental diseases, anything worthy of note, and in many places he only repeats Galen’s observations.
Paul of Ægina (seventh century) establishes a very clear distinction between epulis and parulis. The epulis is a fleshy excrescence of the gums in the neighborhood of a tooth; the parulis is an abscess of the gums. To cure the former affection it is necessary, says the author, to seize and stretch the tumor with a vulsella or with a hook and to perform its excision. As to the parulis, although not unfrequently it is sufficient, for curing it, to give an exit to the pus by means of a slight incision, the author, however, usually prefers the method of cure recommended by Ætius, viz., excision. After such operations he orders the patient to rinse his mouth with wine and on the morrow with hydromel.[196] From the third day onward he sprinkles the wound with a cicatrizing powder, until a complete cure is obtained. But if the wound, instead of healing, be transformed into a putrid ulcer resisting all the ordinary means of cure, it is necessary to cauterize the part affected with an oval-shaped cautery.[197]
In extracting a tooth, the operation is begun by detaching the gum all around it as far as the alveolar border; then the tooth is seized with the forceps, shaken loose, and drawn out. Paul of Ægina, like Celsus, recommends that before extracting a tooth deeply attacked by caries, the cavity be filled up with lint, in order to avoid the crumbling of the tooth under the pressure of the instrument. On the other hand, he too is convinced that a diseased tooth can be made to fall out without pain, by the use of suitable remedies.
When supernumerary teeth cause an irregularity of the dental arches, this must be corrected, says the author, either by resection of such teeth, if they are very firm, or by their extraction.
If a tooth projects above the level of the others, the protruding part must be removed with the file. This instrument must also be employed to remove the sharp edges of broken teeth.
Tartar incrustations must be removed either with scrapers or by means of a small file.[198]
During the period of dentition one must not give children any food which requires mastication, and to soften the gums they must be anointed with hen’s fat or with hare’s brain.[199]