A History of Dentistry from the most Ancient Times until the end of the Eighteenth Century

by Vincenzo Guerini

According to him there is not the least doubt that the teeth grow during the whole lifetime, thus repairing the continual waste caused by use; and among other proofs he adduces that, whilst in the old all other organs shrink and waste away through lack of nourishment, the teeth, on the contrary, show very frequently an increase in length.

For the preservation of teeth—considered by him, quite rightly, a matter of great importance—Giovanni of Arcoli repeats the various counsels given on the subject by preceding writers, but he gives them as ten distinct canons or rules, creating in this way a kind of decalogue of dental hygiene. These rules are: (1) It is necessary to guard against the corruption of food and drink within the stomach; therefore, easily corruptible food—milk, salt fish, etc.—must not be partaken of, and after meals all excessive movement, coition, bathing, and other causes that impair the digestion, must also be avoided. (2) Everything must be avoided that may provoke vomiting. (3) Sweet and viscous food—such as dried figs, preserves made with honey, etc.—must not be partaken of. (4) Hard things must not be broken with the teeth. (5) All food, drink, and other substances that can set the teeth on edge must be avoided. (6) Food that is too hot or too cold must be avoided, and especially the rapid succession of hot and cold, and vice versa. (7) Leeks must not be eaten, as such a food, by its own nature, is injurious to the teeth. (8) The teeth must be cleaned, at once, after every meal, from the particles of food left in them; and for this purpose must be used thin pieces of wood somewhat broad at the ends, but not sharp pointed or edged; and preference should be given to small cypress twigs, to the wood of aloes, of pine, rosemary, of juniper, and similar sorts of wood which are rather bitter and styptic; care must, however, be taken not to search too long in the dental interstices and not to injure the gums or shake the teeth. (9) After this, it is necessary to rinse the mouth, using by preference a vinous decoction of sage, or one of cinnamon, mastich, gallia, moschata, cubeb, juniper seeds, root of cyperus, and rosemary leaves. (10) The teeth must be rubbed with suitable dentifrices before going to bed, or else in the morning before breakfast. Although Avicenna recommended various oils for this purpose, Giovanni of Arcoli appears very hostile to oleaginous frictions, because he considers them very injurious to the stomach. He observes, besides, that whilst moderate frictions of brief duration are helpful to the teeth, strengthen the gums, prevent the formation of tartar, and sweeten the breath, too rough or too prolonged rubbing is, on the contrary, harmful to the teeth and makes them liable to many diseases. As a dentifrice, he recommends a mixture of two parts of honey to one of the best sugar; or the ashes of the burnt head of a hare; or burnt salt made into an electuary by the addition of honey. To use the last two dentifrices, a quantity about equal in volume to a filbert must be wrapped and tied inside a thin, loosely woven piece of linen cloth, and with this the teeth must then be rubbed. Finally, theriac, too, is considered by him a very good dentifrice. According to Arculanus, dental pains are sometimes situated in the very substance of the tooth, at other times in the nerve, and at others in the gums.

The dental substance may become painful, owing to bad “complexion” (viz., constitution), without there being any morbid matter in it. When, however, such matter exists, it may proceed from the head or from the stomach, and in certain cases it gives rise to an apostema of the tooth; in other cases it corrodes the latter; and at other times generates (!) in it a worm, which in its turn corrodes the tooth.

In regard to the diagnosis of dental pains, it is necessary first of all to examine the state of the gums, that is to say, to observe whether these, in the aching spot, appear healthy, or whether, on the contrary, they are discolored or tumid, sanguinolent, suppurating, or the seat of corrosion or putrefaction, or if, when pressure is put upon them, an exit of matter is produced. In such cases it may be considered that the gums are the seat of the pain. But if none of these symptoms are observed, and if, on comparing the gums of the aching spot with the other gingival regions, no difference is observed, this means that the cause of the pain exists either in the substance of the tooth itself, or else in its nerve. In this latter case the pain is usually very violent, and principally localized in the root of the tooth, but also extending along the jaw, and the tooth itself is often, as it were, benumbed. When, however, the pain is not situated either in the gums or in the dental nerve, but in the very substance of the tooth, this latter is very often corroded (carious), and very often in the hollow there exists a worm; and this may be deduced from the fact that during the intervals of calm the patient sometimes feels a peculiar sensation, the movement of the worm in the diseased tooth; when, however, these signs are wanting, we shall find at any rate that the whole tooth is painful in the direction of its length, instead of the pain being localized in the root of the tooth and radiating along the jaw.

When the cause of the pain resides in the gums the extraction of the tooth is neither necessary nor beneficial, but is, on the contrary, always harmful, since, in spite of the loss of the tooth, the cessation of the pain is not obtained; when the pain is situated in the tooth itself, the removal of the latter always makes the pain cease; lastly, when the dental nerve is the seat of the evil, the removal of the tooth sometimes takes away the pain, at other times it does not.

Among the many anti-odontalgic remedies, Arculanus enumerates pepper mixed with tar, pepper with asafetida, mustard seeds with asafetida, and the like. When a tooth is to be cauterized, it is necessary to protect the healthy teeth with bits of cloth dipped in rose water or else with some kind of paste. Sometimes it is useful to drill the tooth with a small trephine so that the cautery may act more deeply, thus giving better results.

In regard to the filling of decayed teeth, Giovanni of Arcoli says that, in the choice of the substances to be used, the complexion (constitution) of the teeth must be taken into consideration; and according as this is cold or warm, it is necessary to perform the filling with substances which are, by their own nature, warm or cold, thus acting in opposition to the dyscrasia of the tooth:

“Eligantur calida aut frigida secundum opportunitatem, in contrarium dyscrasiæ dentis.”

As to the quality of the complexion, this might be deduced, says the author, from various signs, among which the color of the gums, these being red in the warm and humid complexion, yellowish in the warm and dry, brownish in the cold and dry, and whitish in the cold and humid complexion. When, however, the complexion does not show any distinct characteristic, and varies but little from the average, Arculanus advises the teeth being filled with gold-leaf: “Ubi non fuerit multus recessus a mediocritate, impleatur cum foliis auri.”

Although Arculanus is the first writer who alludes to the filling of teeth with gold, nevertheless it is by no means admissible that he was himself the inventor of gold filling. His words do not at all sound to us as the announcement of a new discovery, as the enunciation of a new fact, in which the author himself had had, at least, a part, be it great or small. Nothing of all this; the advice as to filling the teeth, in certain cases, with gold leaf is given quite impersonally, and is found, as if it were a point of minor importance, at the end of a long paragraph, which includes various other counsels in regard to the filling of teeth, one of which is, that this operation should not be performed with too great violence.[265] In short, the writer does not show the least intention of putting in evidence the aforesaid fact, or of giving to it any special importance. We must, therefore, hold that gold filling had already been in use for a long time among dentists, and that Arculanus simply mentions what was done by the dentists of those days. (See note page [164.]) It is evident, on the other hand, that he had no special competence in dental art, when we consider that he was even ignorant of the exact number of dental roots. Naturally, the question here arises: At what period did gold begin to be used for the filling of teeth? But unfortunately history has not, up to the present, furnished us any evidence which may lead to the solution of this problem.