Dental drugs in the Eastern Roman (‘Byzantine’) Empire

The study of the Byzantine medical texts reveals a great number of references about dental drugs. This frequency indicates that problems of oral health were common and part of the epidemiology of those times. In the extended medical compilations, the authors offer a variety of preventive and healing advices on teeth, adding in parallel some elements of magic that co-exist with the apparently scientific therapeutic methods. As Byzantine surgery is famous for the achievements in almost every specialty, the maxilla-facial and oral surgery has certain successful results to show. The prevention is another section of interest for the medical texts, because the physicians estimate the presupposition of oral health for the general well-being of the human body and its physiological function.

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The eminent Byzantine doctors and their texts were reviewed and commented: Oribasius (4th century), Aetius of Amida (6th century), Paul of Aegina (7th century), Michael Psellus (11th century) and John Actuarius (14th century). Dental practice seemed to be performed by physicians who could acquire the skills because specialized scientists performing exclusively Dentistry did not exist during Byzantine times. Procedures like cavity filling, new prostheses, artificial dentures, extraction of teeth and oral surgery were well-known. Surgical tools such as lancets and thrusters have been found, performing the respective applies. No mention exists about orthodontics and endodontics but some amalgam materials and methods for technical innovations are described. The most extended part of dental matters in the medical treatises belongs to Pharmacy.

The Byzantine physicians continuing the tradition of the Greek Classical era preserved the medical heredity and enriched the botanical knowledge of antiquity. The profession of herb-gatherer or root-gatherer (rizotomos) was highly respected and exercised by specialists with long training on the collection of plants and the extraction of the active substances according to the traditional ways (every part of the plant was corresponding to a unique and exact apply). The most common way of the drugs’ use was in the form of powder and their administration in the form of concoction.

The Byzantine dental drugs in the everyday practice can be classified in five great categories: a) oral health preventives b) teeth and supportive tissues cleaners c) teeth whiteners d) against malodor e) analgesic, controlling toothache. The same plant was often used for more than one purpose, possessing more than one quality.

All the drugs mentioned here derive from a great variety of Mediterranean fauna. The multi-factorial remedies containing several active substances contain a common base such as wine, olive oil and honey, the three most representative natural products of the Ancient Greek, Roman, and Byzantine world.

Prevention was not neglected during Byzantine times and physicians agree with ancient Greek medical writers on the diet, as a signifi cant factor of good oral health. There is a general preference for milky products, especially milk and cheese. The teeth brushing with dill (Anethum graveolens) and white wine was recommended, while the right way of brushing was described: teeth and gums must be cleaned from the internal and external side just after the meals.

Wine, rose water, and lilac chaste tree leaves were the most popular as cleaners. The egg yolk mixed with olive oil, myrtle (Myrtus communis) and honey was also recommended as effective cleaner.

Byzantine Dentistry emphasized on the cosmetic aspect and the white appearance of teeth was of great significance. A drug of plant origin, as the above mentioned lilac chaste tree leaves mixed with wine, used also as a preventive of the oral health, was the most common whitener. Besides, other substances of plant origin, and additionally baked and powdered sea shells and large squids (sepias) were a popular method of brushing the teeth for better results.

A significant problem for patients and physicians, who tried to face it, was the malodor of the mouth. The most common solution, remaining still popular in our days as aromatic chewing gums, was the use of perfumed essences, such as Arabian gum, saffron crocus (Crocus sativus) and myrrh tree (Commiphora myrrah) often combined with wine gargles. The medical treatises, however, underline that their combination gives a bitter taste and color to the tongue.

According to the physicians, eating barley (Hordeum sativum) with salt and honey offers a pleasant smell to the oral cavity. An additional advice recommended black helleborus (Helleborus niger) for chewing.

A great variety of substances of plant origin was used for pain relief. If the pain was localized at the oral mucous, then mouth washes with pine needles (Pinus pinea) or juniper leaves (Juniper communis) boiled in vinegar were recommended or a concoction from mulberries (Morus nigra) was administered. Other alternative mouth washes were the dried pumpkin (Curcubita maxima) and the creeping cinquefoil (Potentilla reptans). The different kinds of plants of the colchicum family (Colchicum parnassicum) although emerging toxic and narcotic activities, in small dosage were palliative to pain. The general practice for toothaches was the local application of warm concoctions. Other drugs of plant origin, appropriate for relieving toothaches are: bitter nightshade (Solanum dulcamara), marjoram (Origanum heracleioticum), acanthus (Acanthus mollis), caper (Capparis spinosa), and asparagus (Asparagus acutifolius. In cases of sensitivity of the teeth to the cold, root of fig-tree (Ficus carica) with nut grass or flat sedge (Cyperus longus) and honey or smoked rue (Ruta graveolens) with the addition of burning bush (Amaracus dictamnus) were considered as smoothing substances. In case of severe pain, anesthetic airs were inserted in the oral cavity by a tube for analgesic effect.

Finally, the preventive measures against toothache are mentioned. The most effective were the wine gargles enriched with roots of euphorbia or a popular mixture composed by horse beans (Vicia faba), myrrh and cypress leaves (Cupressus sempervirens) but doctors recommended the avoidance of swallowing this drug.

(Source: “Pharmacology in Byzantine dental practice”, by Poulakou-Rebelakou E. et al.)

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Research-Selection for NovoScriptorium: Maximus E. Niles

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