In regard to the pathology and therapy of the teeth, Guy but rarely abandons the footsteps of the Arabian writers. Following the example of one of these, Ali Abbas, he admits five or six dental maladies: pain, corrosion, congelation, and agacement (teeth set on edge), limosity or fetidness, fall or loosening.[239] As to the cure, this is divided into universal and particular. The former includes, before all, hygienic rules, and then purgatives, bloodletting of the cephalic vein or the veins of the lips or tongue, revulsion, obtained by means of cupping glasses, friction, etc., and the remedies for curing the rheums of the head, or for throwing out the phlegmatic humors (pyrethrum, mastic, and the like).
The hygienic rules are the following: Not to eat food apt to putrefy, such as fish and milk foods; to avoid food or drink either too hot or too cold, and especially the rapid succession of cold and hot, or vice versa; not to bite hard things, nor to eat viscous food, such as figs and confectionery made with honey; to avoid certain foods which are known to be bad for the teeth, such as leeks; not to clean the teeth too roughly, but to rub them with honey and burnt salt, to which, very advantageously, may be added some vinegar.
Before speaking of the special methods of cure of single dental affections, Guy observes that operations on the teeth are particular (proper) to barbers and to “dentatores,”[240] to whom doctors have abandoned them. But it is safest of all, says he, to have such operations performed under the direction of doctors. These, however, to be in a position to give advice in regard to diseases of the teeth, must know the various methods of cure which are suited to these diseases, that is to say, mouth washes, gargles, masticatories, fillings, evaporations, anointments, rubbings, fumigations, cauterizations, sternutatories, instillations into the ears, and manual operations.
Lastly, Guy notes that the “dentator”[241] must be provided with all the appropriate instruments, that is, with “rasoirs, rapes, spatumes, droits et courbes, eslevatoires simples et à deux branches, tenailles dentelées, et diverses esprouvettes, cannules, deschaussoirs, tarieres, aussi des limes, et plusieurs autres necessaires a cette besogne” (in Latin: rasoriis, raspatoriis, et spatuminibus rectis et curvis, et levatoriis simplicibus et cum duobus ramis, tenaculis dentatis, et probis diversis, cannulis, scalpis et terebellis, et etiam limis.)[242]
Whilst Abulcasis bitterly declaims against the barbers, because they, in spite of their ignorance, permit themselves to perform operations on the teeth, and especially to extract them, Guy de Chauliac speaks in quite a different tone. He recognizes that such operations are particular, which is as much as to say, in modern language, that the practice of dental surgery constitutes a specialty. Guy, it is true, expresses his desire that dental operations be performed, for greater security, under the direction of doctors, but he does not use one word of blame or contempt against the dentatores, thus leaving it to be understood that, according to him, their art had every good reason to exist. Besides, from the enumeration of the surgical instruments which Guy says are necessary to them, we can easily argue that the dentatores of the fourteenth century were not, as at the very first one might be led to believe, mere “tooth-pullers,” but that, at least, the best among them cured teeth as well as the scanty knowledge and means of cure then available enabled them to do.
In the chapter on odontalgia,[243] Guy de Chauliac distinguishes between the pains, the point of departure of which is in the tooth itself, and those resulting from disease in other parts, for example, from apostema[244] of the gums; in these latter cases, in order to cause the pain to cease, it is necessary to cure the part from which the pain is derived, taking into account the nature of the disease and its causes.
When the pain is situated in the root of the tooth or in its nerve, it is necessary, says the author, to distinguish whether it is caused by an accumulation of morbid matter, or whether it is, instead, a simple pain without matter. Besides, it is necessary to distinguish, in the first case, whether the matter producing the pain is hot, cold, or windy; and also, in the second case, it is necessary to ascertain if the pain is of a warm, cold, dry, or humid nature. As may be seen, the principles and subtle distinctions of the pneumatic school were then in full vigor.
The treatment must vary according to all the aforesaid cases; but the means of cure advised by Guy de Chauliac do not present any special interest, as they are almost entirely taken from Galen and from the Arabian authors, and especially from Rhazes, Ali Abbas, and Avicenna.
On coming to speak of the looseness of teeth,[245] Guy says that this may depend on various causes: that is, on a fall or a blow; on humidity, which softens the nerve and ligament;[246] on dryness and lack of nourishment of the teeth; and lastly, on corrosion of the gums.
The looseness of teeth, which depends on dryness or want of nutrition, as in the old and in consumptive people, is incurable. In other kinds of looseness, astringents are useful; but it is also well that the patient should speak but little, that he should not touch or move the loose tooth, nor use it in masticating. In cases of corrosion of the gums, this disease must be cured.