There are probably no instruments so far excavated which can be definitely considered to have been used for dental purposes, but one difficulty in identification of any such instruments is that they were never engraved with their purpose. An example that has been suggested which may show dental instruments is a large scene inscribed on one of the walls of the temple of Kom-Ombo. Here there is what appears to be a collection of nearly 40 surgical instruments, and although different interpretations have been suggested as to their purpose, it has been pointed out that many of the items shown are contemporary to numerous well authenticated depictions of Roman and Greek surgical instruments. Indeed, it has been suggested that there are representations of dental forceps depicted. However, as Ghalioungui points out, the building relates to the Greco-Roman era (332 BC – 394 AD) and is therefore usually considered to be related to medicine as originating from Alexandria rather than ancient Egyptian medicine.
The medical papyri are the written records of medical procedures and treatments that have been handed down to us from ancient Egypt, and although they have to be viewed with caution they do provide us with an important source of information as regards dentistry. Of the 12 papyri which can be regarded as medical texts, four (Ebers, Kahun, Berlin and Hearst) include prescriptions for the treatment of dental problems and a fifth papyrus (Edwin Smith) provides instructions for dealing with fractures and dislocations of the mandible and maxillary regions. Only therapeutic remedies are recommended, and importantly there is no reference to any type of prosthetic, surgical or conservative form of treatment. As some of the components of the various prescriptions are unknown to us, and there are translational uncertainties in the identification of others, it is not always possible to judge the effectiveness of a particular pharmaceutical remedy.
Of the approximately 18 cases in the papyri relating to prescriptions for disorders of the teeth and oral cavity, seven are for remedies to prevent tooth loss by packing various materials in paste form around the tooth and the surrounding gums. The theory seems to have been that these would harden and serve as a temporary means of stabilising teeth that were mobile, presumably due to periodontal disease. These seven remedies use words such as ‘set in place’, ‘make strong’, ‘if it wants to fall to the ground’ – all these wordings seem to imply a mobile tooth, and are fairly similar.
An example of such a prescription is Papyrus Ebers 739:
Beginning of the remedies to consolidate a tooth; Flour of emmer seeds; ochre; honey; made into a mass; and the tooth to be fattened therewith’.
Here the first constituent is emmer wheat, which would seem to have been used non-selectively, whereas ochres are iron oxides which have mild astringent and antiseptic properties. Ochres were used by the Aboriginals and even today are used medicinally by the Andaman tribes who live off the coast of Bengal. Honey, which is a binding agent, is used in more Egyptian medicines than any other ingredient and because of its hypertonicity kills micro-organisms by drawing water out of them through osmosis. Thus honey would have inhibited bacterial growth and helped reduce inflammation in infected gingival and mucosal areas.
The other prescriptions for the prevention of tooth loss are similar in their supposed mode of action and only differ in the types of material with which the teeth are packed. Examples of these being malachite and terebinth resin, both having antiseptic properties. Therefore a number of the components do have some medicinal value and may have temporarily relieved the painful symptoms in addition to splinting the mobile teeth, but for a number of others, their function is unknown. Importantly, only the symptoms of the disease process were being treated and not the source.
The second main group of prescriptions appear to be for treating various ulcers, abscesses or gum infections. An example of such a remedy is Ebers 742:
Another, for the treatment of a tooth that is eating in the opening of the flesh: cumin; terebinth; carob; to be made into a powder and applied to the teeth’.
It is not certain what is meant by ‘eating in the opening of the flesh‘ although it is often considered to be a dental abscess. Looking at the components of the prescription, cumin is a carminative and has antiseptic and local anaesthetic properties, whilst terebinth resin as previously mentioned is an antiseptic. Carob is a stabiliser and in addition possesses astringent and demulsifying properties. Consequently, such a material would be soothing and with antiseptic and astringent properties would provide some limited relief. Other constituents used in this type of prescription are sycamore fruit, celery, gum, oil as well as a number of materials yet to be identified.
Three prescriptions deal with oral pain and among the various components used to treat the condition was willow. Willow bark contains salicin, a chemical similar to acetylsalicylic acid, therefore having both analgesic and anti-inflammatory effects, although there is some doubt if the ancient Egyptians had discovered the true value of this plant.
The other remaining papyrus of dental interest, the Edwin Smith papyrus, is a well written and sophisticated example of medical literature, being the earliest known treatise dealing with surgery. This papyrus lists 48 mainly trauma cases and amongst them is one in which instructions are given for correcting a dislocated mandible. It shows a clear logical approach differing little from the method that is practiced today and importantly is the earliest description of a surgical procedure still in use.
Instructions concerning the dislocation in his mandible: If you examine a man having a dislocation in his mandible [and] you find his mouth open [and] cannot close it for him, you should place your thumbs upon the ends of the two rami in the inside of this mouth [and] your two groups of fingers under his chin, and you should cause them to fall back so that they rest in their place.’
Also of note is that the Edwin Smith papyrus contains the first recorded use of absorbent lint made from vegetable fibre whilst splints and bandages are routinely used. It describes the use of adhesive strips in dealing with wounds, and cases of complex suturing are described in detail. It is clear from this papyrus that surgery was known, understood and practised in ancient Egypt and that some of this knowledge is still in use today.
Perhaps no discussion of medical and dental practice in ancient Egypt could be complete without considering the part that magic played in the various prescriptions in the papyri. Certainly, the ancient Egyptians were intelligent observers and discovered empirically some effective drugs and rational healing methods, but magic undoubtedly had a part to play. There are cases where the use of ritual and magical spells is suggested as a sole remedy, and in other instances ‘magical’ and ‘rational’ treatments are linked, with the two methodologies being complementary to each other. It would seem that the majority of the dental prescriptions fitted into the rational scenario, with many of the components having a recognised pharmacological action. However, for those where the specific component is unknown it is possible that there may have been an associated magical element. Equally so there does not appear to be any obvious reference to recited spells directed for the relief of oral problems.
Many ancient authors such as Homer, Pliny the Elder, and Herodotus described the illustrious position in which Egyptian medicine achieved in the ancient World. In particular Herodotus, a Greek traveller and historian, who visited Egypt in about 440 BC, and later wrote an account of the country and its history, described specialisation in the medical profession:
The practice of medicine they split into separate parts, each doctor being responsible for the treatment of only one disease. There are, in consequence, innumerable doctors, some specialising in diseases of the eye, others of the head, others of the teeth, others of the stomach, and so on.
Whilst it may be wrong to interpret this passage with the notion that medical knowledge was so advanced in ancient Egypt that specialisation was necessary, much as occurs today in the modern world, it does nevertheless imply that some form of dental care did exist.
Reliefs, Paintings And Non-Medical Texts
There seems to be little mention of dental diseases among the various popular literary texts handed down to us from ancient Egypt. Also there seems to be no records of non-attendance from work due to toothache from the many details of absenteeism kept by foreman at various building sites or workers villages. There are no depictions of the ancient Egyptians experiencing toothache or receiving dental treatment in the various surviving wall paintings, certainly nothing comparable with the Byzantine and late-medieval illustrations showing teeth being extracted.
However, one Ramesside text, the papyrus Anastasi IV refers to a worm as being the cause of toothache. In this text an Egyptian official describes the suffering of a fellow scribe:
A mns-scribe is here with me, every muscle of whose face twitches, the wStt-disease has developed in his eye and the fnt-worm into his tooth. I cannot leave him to his fate.’
The worm is also referred to in the medical papyri as a disease agent, although the reference in the Anastasi IV papyrus is the only one suggesting it as being a cause of toothache. However, the idea that a worm was responsible for dental disorders was widespread amongst other ancient cultures, with probably the first documented case being a Sumerian text dating to about 5,000 BC. This belief continued throughout history and even as late as the eighteenth century an ivory carving of a tooth was produced showing inside it a tooth worm.
In the late 1960s the University of Michigan in co-operation with Alexandria University radiographed the Royal mummies in Cairo Museum. Mummies of several of the pharaohs, notably those of Amenhotep III and Ramesses II, perhaps two of the greatest Pharaohs of ancient Egypt, revealed dentitions showing extremely worn teeth, periapical abscesses and advanced periodontal disease. The radiographs showed no evidence of any form of dental treatment, and surely if anyone was to receive oral care it would have been these powerful rulers. Certainly, if they did not then the peasants, the vast majority of society, would unlikely to have done so.
The conclusion seems to be that operative dental treatment if it did exist at all was extremely limited, and any suggestion that the ancient Egyptian dentist operated on patients routinely is not supported by the available evidence. Most of the dental treatment that appears to have been provided was restricted to pharmaceutical preparations that were either applied to the gingival and mucosal tissues or used as mouthwashes. These remedies would not have retarded the progress of the dental disease, and at best may have only provided some short term relief. It seems clear that many ancient Egyptians suffered from widespread and painful dental disease, which the available treatments can have done relatively little to alleviate.