One of the characteristics of Arabian medical art consists in the aversion to bloody operations and in the effort to avoid them. A like tendency shows itself also in the sphere of dentistry; the Arabians, even more than their Greek and Roman predecessors, were reluctant to extract teeth, and employed all possible means, in order to avoid the operation.
Rhazes (or more precisely, Abu Bekr Muhammed ben Zacarja er Rhazi) was born in Persia toward the middle of the ninth century, and gave himself up to the study of medicine when about thirty years of age, having previously been a musician. He wrote many works which, unfortunately, have, for the most part, been lost. Rhazes did not have recourse to the extraction of teeth, save as a last resource when every other attempt at cure had proved useless; which method would no doubt have deserved high praise, had the author been inspired by the principles of conservative surgery, rather than by unjustifiable fears. Caries of the teeth is, according to him, identical with that of the bones. To hinder its progress and propagation to the neighboring teeth, he advises the carious cavity to be filled with a “cement” composed of mastic and alum. We have here a laudable attempt at permanent stopping of decayed teeth, although it is clear that the duration of such stopping, owing to the nature of the materials employed, could not be a long one. Furthermore, he counselled the patient to abstain from the use of acid food or drink and to rub the teeth with powder of gall-nuts and pepper.
To strengthen loosened teeth, he recommended astringent mouth washes and sundry dentifrice powders. Others, partly taken from Galen, are recommended by him for prophylactic purposes and for cleansing and beautifying the teeth.
Against periodontitis and the pains produced by it, he sometimes had recourse to bleeding. He commended, besides, opium, oil of roses, pepper, and honey, and also the scarification of the gums and the application of a leech. If, however, these remedies did not succeed, he applied his theriac, which was composed of castoreum, pepper, ginger, storax, opium, and other ingredients, to the roots of the teeth. If even this method of cure failed, he touched the root of the diseased tooth with a red-hot iron, or sought to provoke its fall by the use of special medicaments, such as coloquintida and arsenic (a substance to which he had recourse, particularly in those cases where there was ulceration of the gums). It is no wonder that such means of cure would sometimes produce, as a final result, the actual falling out of the tooth; and this, as is natural, served to strengthen the belief that the same result could also be obtained with less energetic remedies, but which were supposed to be equally endowed with expulsory virtues.
Rhazes relates an interesting case of regeneration of a whole lower jaw; he, however, observes that the newly formed osseous mass was less hard than the original bone.[201]
Ali Abbas, another great Persian physician (who died in 994), wrote a lengthy treatise on theoretic and practical medicine, one chapter of which is dedicated to the diseases of the teeth. When a molar tooth is affected by caries, and the pain cannot be subdued in any other way, Ali Abbas applies, inside the carious cavity, the end of a small metallic tube, into which he repeatedly introduces red-hot needles, leaving them in the tube until quite cooled. Should even this have no effect, he tries to provoke the fall of the tooth by the application of asses’ milk with assafetida, or, finally, extracts it.[202]
He cures epulis, like Paul of Ægina, by excision. As to parulis, or abscess of the gums, he opens it with a lancet or a wooden stylus.
When the dental arch is deformed by the existence of supernumerary teeth, he removes these with an instrument in the shape of a beak.[203]
Serapion (Jahiak Ebn Serapion), who lived in the tenth century, and up to the beginning of the eleventh, contributed but slightly to the development of medicine and dentistry, as he was in his writings little more than a mere compiler. He indicates with great precision the number of dental roots, and expresses an opinion that the upper molars have need of their three roots in order to keep firm in spite of their pendent position, whilst two roots alone are sufficient to keep the lower molars in place, on account of the support which they receive from the jaw. Serapion, like Galen, admits the nutrition and continual growth of the teeth—a growth which is produced in the same proportion as the waste due to mastication—and he too makes the dental diseases depend upon an alteration in the nutritive process, either by excess or by defect.
Against dental pains of phlogistic origin, he recommends bloodletting, purgatives, and many local medicaments, reproduced in great part from Rhazes. In cases of persistent odontalgia due to caries, he advises, as an excellent remedy, the application of opium in the carious cavity. To strengthen loosened teeth, he first employs astringents, and if these are of no use, as often happens in the old, he binds the loose teeth together and to the neighboring healthy ones, by means of gold or silver wire.