It is in the skeletal and mummified human remains that if any operative dental surgery did occur in ancient Egypt, then it is here that we might expect to find some conclusive confirmation. However, from the tens of thousands of remains that have been examined from the entire 3,000 year period of Dynastic Egypt the evidence is very limited. There are a few instances where a surgical approach for the treatment of dental abscesses is claimed to have been adopted; there are only three cases of possible prosthetic work, and some examples where an extraction may have occurred. Much has been made of these cases with some authors claiming, quite categorically in some cases, that this evidence proves the existence of an operative dental profession, but equally so other workers have doubted this.

Surgical treatment of dental abscesses was first raised by Hooton in 1917, following his visual and radiographic study of an ancient Egyptian mandible, dating to about 2,500 BC. The teeth of the mandible showed considerable wear, with the lower right first molar having a pulpal exposure and an associated apical infection. Hooton noted two small holes penetrating the outer cortical plate above the mental foramen and in the direction of the anterior root of this tooth. He claimed that due to the upward angulation of the holes, their artificial symmetrical appearance and the apparent thickness of bone they had transversed, the holes were the result of man-made drillings, affected in order to drain the pus from the apical abscess.

Breasted, an Egyptologist later supported this view and suggested that they could have been created by a bronze instrument in a bow drill. Certainly the bow drill was in use in ancient Egypt for carpentry and stone work, as evidenced by various wall paintings in tombs, such as that seen in the 18th Dynasty tomb of Reckmire at Luxor.

However, Wingate-Todd considered that one of Hooton’s holes was an accessory mental foramen whilst the other a pathological cavity formed by the abscess. Leek when examining a comparable ancient Egyptian mandible found a similar situation of tooth wear and abscess formation, also having circular holes that were extremely cleanly cut and penetrating through sound tissue. He also noted that the direction of the hole was from behind forward, a direction impossible to perform with a straight drill due to the presence of the intervening soft tissues. Such a hole could only have been drilled with a right angled drill, technology that was not available in Dynastic Egypt. He concluded that these holes were not drilled in an operative procedure but were the result of a pathological process caused by the dissolution of bone by pus. Additionally, his examinations of large number of skulls revealed that the path an abscess takes varies and the earlier suggestion that an upward direction must implicate a surgical procedure could not be considered valid. Such canals occur frequently, in many different positions and are related to every tooth in the dentition, thus indicating that they could be the result of apical infection.

Other arguments against a surgical interpretation were put forward by Nickol et al. in which they considered that for such treatment to have occurred, an awareness by the ancient Egyptians of the process and pathological anatomy of apical periodontitis would be required, which would seem unlikely. Also, that perhaps Hooton’s conclusion was based on the dental techniques and understanding existing in the early part of the twentieth century. Then it was not uncommon to treat dental abscesses by a similar procedure known as ‘apical airing’, a practice long since discontinued.

The Famous Giza Bridge

Of the so-called ‘prosthetic appliances’ that have been documented from ancient Egypt, the best known example consists of a mandibular second molar connected by gold wire to a worn third molar (above). It was discovered at Giza, near Cairo in a burial shaft dating to approximately 2,500 BC and importantly not found attached to a skull. The dental report at the time stated that judging by the colour and anatomic form of the teeth they belonged to the same individual. Additionally, as the roots of the third molar were very absorbed, due to a probable inflammatory process, the tooth had become mobile, and so in an attempt to stabilise it, it had been attached to its neighbouring tooth.

SOURCE: R. J. Forshaw Dr. Roger Forshaw, Bramblewood, Park Gate, Park Road, Guiseley, West Yorks, LS20 8EN

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