PERSPECTIVES IN DENTISTRY

• The study material is about the history of dentistry in the late Middle Ages and Renaissance periods
• Medieval Period


  Started in the 14th century, also called the Dark Ages, underwent a lot of wars and plagues, spanned for 1,000 years from 476 A.D to 1500, full of religious fanaticism with Christianity being rampant
• In the 12th century, King Edward the First told everyone that they should be killing the Jewish population
• Medical curriculum in the 13th century

  • Based on Roman, Greek, and Muslim beliefs, very primitive or archaic, not as advanced as modern medicine, no dissection until 14th century, only based on literature of Greeks, Romans, and Muslims
• The University of Bologna practiced dissection, but only to learn how the person died, not as part of the curriculum
• Plague Doctor


  Doctors who go out and help people during the Black Plague, wear a mask with a beak to mask the smell of the dead people, filled with flowers and herbs
• Theriac


  Universal antidote, a popular theriac of the 1600s contained 230 ingredients, including ants, worms, and dried vipers
• Tooth worm


  Believed to be the cause of toothache, removed with Aqua fortis (nitric acid) introduced into the pulp to kill it
• Cofferdam of wax


  Used to protect adjacent teeth when treating with nitric acid, similar to modern rubber dam assembly used to keep the tooth free from contaminants and make it sterile, mainly used during endodontics/root canal but recommended even during restoration and other procedures
• They believed they were killing the tooth worm, but they were actually killing the pulp that becomes necrotic
• Fumigation with henbane or leek seeds and sheep's fat


  Making sheep's fat into a ball then the smoke is introduced into the oral cavity
• There was a great reliance on plants for dental treatments in the Middle Ages
• Cauterization


  Used to relieve pain, similar to acupuncture points of the Chinese
• Mandrake/Mandragora officinalis


  Used as a narcotic or painkiller
• Liquor left after boiling little green frogs


  Believed to loosen the teeth and make them fall out
• Garlic


  Crushed and carried on the thumbnail, believed to cure toothache due to its inflammatory property
• Juice of pellitory, ivy, chicory, and rose petals

  Dropped into the ear or nostril on the side of the offending tooth to cure toothache
• A female practitioner places a bandage under the jaw of the patient possibly to stabilize a fracture or a reduced dislocation
• Barbers


  The ones who were doing extractions
• Barbitonsoribus


  Cut hair and shave beard of monks
• Balneator


  Keeper of the bathhouse, performed cupping and bloodletting
• Barbers vs Barber-surgeons vs Surgeons

  Barbers should not do extractions, surgeons are not allowed to do extractions, barber-surgeons are barbers who can do extractions as they are trained or assisted by surgeons
• In the 14th century, they started dissecting to teach how the body works
• Roger of Salerno and Roland of Parma


  • Advised against tooth extraction, used fumigation and cautery, treated mandibular fractures and dislocations, let blood from a vein under the tongue, inserted raven manure into a carious tooth

  
• John of Gaddesden


  • Wrote the Rosa anglica: practica medicinæ a capite ad pedes, used brains of a hare rubbed on the gums for teething, used an iron tool to force the tooth down as a forerunner of the pelican
• Teodorico Borgognoni


  • Treated syphilis with mercury, causing copious salivation of patients (sialorrhea)
• Bernard de Gordon


  • Identified internal and external causes for tooth ailments, including eating hot and cold foods, cracking hard foods, neglect of oral care, vigorous gum rubbing, and humors flowing down from the head and vomiting up stomach acids
• Guy de Chauliac


  • Discussed the anatomy of the teeth and their eruption, described maladies of the teeth including pain, corrosion, congelation, limosity (tartar) or fetidness (bad breath), agacement ("setting on edge"), and looseness, provided universal (systemic) and particular (local) cures, gave dental tips like avoiding certain foods and cleaning teeth with a mixture of honey, burnt salt, and vinegar
• Dentatores


  Specific group of practitioners that deals with teeth, similar to barbers but with more elaborate knowledge and use of specific instruments
• Anesthesiology


  Used opium, hyoscyamine, mandrake root, ivy, and hemlock as anesthetics, and sponges soaked in vinegar or juice of rue or fennel to wake the patient, similar to modern use of nitrous oxide
• Pietro D'Argelata


  • Emphasized the cleanliness of the teeth, removed dental tartar/calculus using scrapers, files, or strong dentifrice powders, used Aqua Fortis as a teeth whitening agent, treated dental fistulas with caustics and arsenic
• Bartolomeo Montagnano


  • Used an anti-odontalgic remedy of camphor and opium, recommended extraction as the best cure for toothache
• Giovanni Plateario


  • Cauterized carious teeth with kindled ash wood or a red-hot iron, introduced the sitting position for dental operations, emphasized the need for pure surrounding air during extractions
• Giovanni de Arcoli (Arculanus)


  • Described the number of roots for different teeth, used gold fillings, provided indications for tooth extraction, used the pelican and dental forceps for extractions

  
• Alessandro Benedetti


  • Recommended rubbing the teeth with tortoise blood to relieve toothache, recognized the harmful effect of mercury on the gums and teeth, emphasized the importance of accurate diagnosis before extraction
• Indication for tooth extraction

  • When the pain resists every other means of cure
  • When there is any danger of the disease spreading to the neighboring healthy teeth
  • Modern time: only done for wisdom teeth

  
• Tooth extraction


  • Removed even if it is not carious when the adjacent teeth is endangered
  • There is a portion of the teeth that is not easily cleansable = food impaction = caries
  • When the tooth is troublesome in speaking and in masticating
• The Pelican


  First forceps that they used to extract teeth
• Dental Forceps


  Similar to a cow horn forceps, extracts mandibular molar teeth
• Dental Forceps - "Stork's Bill"


  Used to remove roots or root fragments