Imagine a trip to the dentist -- if there had been such a profession -- about 500 years ago. Your tooth is aching horribly, maybe rotten to the core. You have never brushed or flossed, never, because most people just didn't do that then.
The person attending to your poor mouth -- perhaps a barber but more likely a traveling charlatan -- will diagnose the problem and begin a course of treatment. Maybe he'll cauterize the infected area with a hot iron, boiling oil or a funnel full of acid. Or he might fill the cavity with raven manure, a recommended treatment. Most likely, though, your tooth is too wretched to save. It will have to come out.
Now you have to pray that the iron claws he produces will do the job quickly, that they won't inadvertently snap off your tooth, crush it to the sensitive pulp or, worst of all, yank out part of your jaw.
Oh, and one more thing: Forget Novocain. Dental anesthesia, aside from the traditional reliance on alcohol, would not be introduced until 1844.
That experience makes the dentist's office today seem like a little piece of paradise by comparison. But modernity was a long, long time coming. To learn more about dentistry through the ages, see Pages H4 and H5.
Dentistry as a distinct medical profession is less than two centuries old. Treatment of the mouth and teeth, however, dates back many millennia.
In ancient Egypt, physicians often worked only on specific regions of the body -- one just for the eyes, for example, another just for the bowels. A physician named Hesi-Re specialized in teeth about 3000 B.C. and was known as "Chief of the Toothers and the Physicians." The first dentist whose name we actually know, he was described in ancient inscription as "the greatest of physicians who treat the teeth."
In Hesi-Re's day, oral hygiene was not a priority, so even pharaohs suffered accordingly. An X-ray of Pharaoah Merenptah's skull, for example, reveals that he lost all of his posterior upper teeth in the 13th century B.C. when his gums receded.
Tooth extraction was the most frequent remedy for dental distress, although some recovered skulls indicate that drilling into the jawbone may have been used to relieve abscessed teeth.
Several skulls dating from about 2500 B.C. have teeth bound together with gold wire, but scholars debate whether this was performed on the living -- anchoring a weak tooth to a stronger one to save it -- or to the dead in order to keep the body as intact as possible for the afterlife.
In classical Greece, Hippocrates (460-c. 377 B.C.), known as the father of medicine, postulated a theory that would last for centuries. He said the body was composed of four cardinal humors: blood, phlegm, black bile and yellow bile, as well as four elemental conditions of cold, hot, dry and moist. Any imbalance in these humors and conditions, Hippocrates said, caused disease and illness.
He applied that theory to the teeth, noting at one point that "the bones, the teeth and the tendons have cold as an enemy, warmth as a friend; because it is from these parts that come the spasms . . . that cold induces, heat removes."
In his book On Affections, Hippocrates was a bit off the mark in observing that "pain derives from mucous insinuating itself under the roots of the teeth. Teeth are eroded and become decayed partly by the mucous, and partly by food, when they are by nature weak and badly fixed in the mouth."
While Hippocrates' observations often were erroneous, they weren't made carelessly. The great philosopher Aristotle, on the other hand, might well have opened a few mouths and counted before he made the grand pronouncement that men have more teeth than women.
Although ancient Romans became adept at filling cavities with gold, replacing missing teeth with bridgework, and held oral hygiene in high regard, ignorance continued to thrive.
The great naturalist Pliny the Elder, who died during the eruption of Mount Vesuvius in 79 A.D., suggested that a toothache could be cured by finding a frog in the light of the full moon, prying open its mouth and spitting in it while uttering the words, "Frog, go, and take my toothache with thee!"
Much of medieval Europe's knowledge of medicine, and with it dentistry, came from the ancients, often via Arab scholars. While the same errors were repeated, advances were made.
For example, Abu Qasim, the great Arab physician of the 10th century known in Latin as Albucasis, understood the importance of scraping tartar off the teeth and wrote that care should be taken in extracting teeth, especially in ascertaining the correct one because exact pain location could be deceptive.
The Islamic world itself was strongly influenced by Mohammad (570-632), the great prophet who was ahead of his time when it came to oral hygiene. Muslims were instructed to rinse their mouths as often as 15 times a day and to use a twig of the Salvadora tersica tree, whose wood contains sodium bicarbonate and other astringents beneficial to the gums, as a natural toothbrush. After being soaked in water for a day, the twig fibers separated into brush fibers.
Mohammad also recommended use of toothpicks and regularly rubbing the gums. The medieval world in the West was extremely slow to implement Mohammad's suggestions, however, and the benefits of a clean mouth remained largely unrecognized.
Ignorance, too, was rampant. As late as 1500, Christopher Wirtzung, a renowned German surgeon, was recommending that one malady of the soft palate be treated with a paste made of "album graecum, that is, a white dog's [excrement] (of a dog that eats naught but bones).
"If the patient has long hair, then let a strong man take hold of it and pull it upward violently, until one may perceive that the skin is severed or parted from the skull, then also doth the palate ascend, because it is fastened to the skin."
The Renaissance brought tremendous advances in anatomy and surgery attributable to Andreas Vesalius (1514-1564), a Flemish anatomist, and Ambroise Pare (1517-1590), a French surgeon, both of whom included dentistry in their studies.
Pare must have appeared as an angel of mercy at a time when oral surgery was still largely a barbaric ordeal. He cautioned against excessive force in extracting teeth and devised several instruments for the purpose.
"The extraction of a tooth should not be carried out with too much violence," he wrote, "as one risks producing [dislocation] of the jaw or concussion of the brain or eyes, or even bringing away a portion of the jaw together with the tooth, not to speak of other serious accidents which may supervene as, for example, fever, apostema [abscess], abundant hemorrhage and even death."
The roles of barber and surgeon became more clearly delineated during the Renaissance, although both continued to extract teeth, and oral hygiene started to become more popular. One English writer, for example, expounded on the benefits of rinsing:
Keep white thy teeth, and wash thy mouth
With water pure and cleane,
And in that washing, mannerly,
Observe and keep a meane.
Despite the great advances, old beliefs died hard.
Meet the Toothworm
For thousands of years until the 18th century, numerous savants attributed the agony of rotting, aching teeth to a hideous little creature that bored its way into the tooth and greedily devoured it from within. They called it the toothworm.
The belief in such a slimy, gnashing destroyer of teeth is traced at least to ancient Babylonia, where this dark discourse was inscribed in clay:
After Anu [had created heaven] . . .
The earth had created the rivers,
The rivers had created the canals,
The canals had created the marsh,
The marsh had created the worm.
The worm went weeping, before Shamas,
His tears flowing before Ea:
"What wilt thou give me for my food?
What wilt thou give me for my sucking?"
"I shall give thee the ripe fig and the apricot."
"Of what are they to me, the ripe fig and the apricot?
Lift me up and among the teeth
And the gums cause me to dwell!
The blood of the tooth I will suck,
And of the gums will I gnaw the roots!"
Scribonius Largus, personal doctor of the Roman Emperor Claudius in the 1st century A.D., prescribed this remedy for the worm:
"Suitable against toothache are fumigations made with the seeds of hyoscyamus [probably belladonna or henbane] scattered on burning charcoal; these must be followed by rinsings of the mouth with hot water; in this way, sometimes, as it were, small worms are expelled."
Saint Hildegard, the 12th century abbess of Bingen in Germany, also was an advocate of smoking out the worm, recommending holding one's head over burning aloe and myrrh. Another suggested remedy in the Middle Ages was slathering harsh acids and other caustic liquids over the infected tooth, while various folk remedies included everything from rinsing the mouth with urine to biting the heads off rodents.
Of course, in times when oral hygiene was practically nonexistent, people quite possibly did find worms in their mouths, from fruits and other foods. However, Anton van Leeuwenhoek (1632-1723), the Dutch microscopist, proved that these were not the fabled toothworms.
When the president of the Royal Society of Britain, a scientific organization, sent him several worms said to have been taken from a decayed tooth, Leeuwenhoek used his microscope to show that they were identical to maggots commonly found in overripe cheese.
Soon the "toothworm" became an endangered species.
Dentistry Comes of Age
Pierre Fauchard (1678-1761), regarded as the father of dentistry, published the first complete book on dental art and practice in 1728. The Surgeon-Dentist; or, Treatise on the Teeth synthesized all available knowledge of dentistry, from anatomy to the causes and prevention of tooth decay.
The epic book contained detailed illustrations of dentures, drills and extraction instruments and showed that Fauchard had skills and knowledge far ahead of his time. As Malvin E. Ring notes in his book Dentistry: An Illustrated History, many ideas and procedures advocated by Fauchard are used today.
The progress of dentistry continued unabated after Fauchard, particularly in the United States, where the world's first dental school, the Baltimore College of Dental Surgery, was founded in 1840. Ironically, the teeth of American colonists had been considered the world's worst less than two centuries previously.
One of the greatest advances in dentistry, especially from the patient's point of view, was the introduction of anesthesia by Horace Wells, an American dentist who allowed one of his teeth to be pulled after he inhaled nitrous oxide.
"I didn't feel it so much as the prick of a pin," Wells exclaimed after waking. "A new era in tooth-pulling has arrived!"
Unfortunately, Wells committed suicide after failing to receive credit for his discovery. Recognition was accorded posthumously by the American Dental Association and the American Medical Association.
Nitrous oxide was followed by ether and, for years, cocaine was used as the first local anesthetic, blocking pain to only one part of the body. Gone were the days of biting bullets and swigging alcohol to dull pain.
After anesthesia, in quick succession came dental drills, X-rays, advances in cavity filling and dental reconstruction. During the 20th century, revolutionary advances have been made in preventive and prosthetic dentistry. This century also saw introduction of flouride, a compound that prevents cavities, into most public water systems in the nation.
Teeth have never looked better.
About George Washington's Teeth
Among the most enduring legends surrounding the Father of Our Country -- ranking with the downed cherry tree and never telling a lie -- is that behind the president's sometimes dour expression lurked an ill-fitting set of wooden teeth.
Like so many stories about the first president, that's a myth. Yet it contains elements of truth. Though Washington's teeth weren't wooden, they were most definitely false and often excruciatingly painful.
Washington suffered from dental disease for most of his life and, one by one, lost his teeth. By 1790, in his first term as president, only one remained. Dentures became the bane of his life.
"I must again resort to you for assistance," he wrote in 1797 to his favorite dentist, John Greenwood, about his dentures. "The teeth herewith enclosed have by degrees worked loose and, at length, two or three of them have given away altogether. I send them to you to be repaired . . . they are both uneasy on the mouth and bulge my lips out."
Made from hippopotamus, walrus and elephant ivory and other materials such as cow's teeth, and fastened with unwieldy springs attaching the upper and lower portions, Washington's dentures were primitive contraptions. To the modern eye, they look as if they belong in a novelty shop.
Greenwood made several sets for Washington, including the one he was buried with, but not all of them fit well. Washington often ordered modifications or tinkered with them himself. He was wearing one poorly fitted set when Gilbert Stuart painted the famous portrait adapted for the $1 bill.
Little wonder that he looks like such a sourpuss.
A set of pearly white teeth set neatly in a row is not a universal ideal. In other cultures around the world, following ancient practices, teeth are routinely blackened, sharpened into points or knocked out for aesthetic and ritualistic reasons.
The Maya of Central America were early practitioners of dental alteration, becoming adept at drilling neat holes into the teeth and filling them with colorful minerals. A round, hard tube, almost like a drinking straw, was spun against the tooth while a mixture of powdered quartz and water was used as an abrasive to cut the round hole into the enamel.
The stone was then cemented in place. An unfortunate side effect sometimes occurred when the hole went too deep and penetrated the tooth's pulp. This often resulted in death of the tooth or formation of an abscess.
The Maya also blackened and filed their teeth, still a practice in other cultures around the world. Some South American Indians, for example, seek to look like fierce piranha and sharpen their teeth accordingly, while in some African communities, teeth are knocked out -- with a rock -- as a mark of beauty.
Any museum featuring Andy Warhol silk screens of Saint Apollonia -- the patron saint of dentistry who had all her teeth yanked out by anti-Christian persecutors in the 3rd century -- Queen Victoria's gilded tooth-cleaning equipment and George Washington's dentures is bound to be unique. Indeed, the National Museum of Dentistry in downtown Baltimore is.
Its vivid and entertaining displays -- ranging from a video jukebox shaped like a giant mouth and playing vintage dental commercials to primitive tooth extraction instruments that scream of a more barbaric era -- celebrate the history and development of dentistry.
Who knew that a museum devoted to the treatment of teeth could be so entertaining?
Established in 1996 on the campus of the University of Maryland in Baltimore, home of the world's first dental school, the museum collection is vast and eclectic. It features everything from antique dental-office furniture to the world's largest assembly of dental poster art, all made enticing for children and informative for adults.
In the manageable space of two floors, it's as quick and pleasant as a dose of ether.
The Samuel D. Harris National Museum of Dentistry, at 31 S. Greene St., is open Wednesday to Saturday, 10 a.m. to 4 p.m., and Sunday from 1 to 4 p.m. It's closed on major holidays. Admission is $4.50 for adults, $2.50 for students and senior citizens and free for children six and under.
From I-95, take Route 395 (downtown Baltimore) and exit onto Martin Luther King Jr. Blvd., staying in the right lane. At the fourth light, turn right onto Baltimore Street. Turn right at the first light onto Greene Street. The museum is on the left. On-street, metered parking is limited, but a parking garage and a metered parking lot are nearby.
Student tours are conducted Wednesdays through Fridays, and educational programs are scheduled regularly. A special exhibit on veterinary dentistry is schedule to open Saturday, Sept. 25 through next February. 410-706-0600.