The Etruscans and the History of Dentistry

The Golden Smile through the Ages

Marshall J. Becker, Jean MacIntosh Turfa

• Publisher: Routledge
• Year: 2017
• Print ISBN:
  9781138677913
• eBook ISBN:
  9781317194644
• Topic: History
• Subtopic: Ancient History
• Index: History

The Etruscans and the History of Dentistry offers a study of the construction and use of gold dental appliances in ancient Etruscan culture, and their place within the framework of a general history of dentistry, with special emphasis on appliances, from Bronze Age Mesopotamia and Egypt to modern Europe and the Americas. Included are many of the ancient literary sources that refer to dentistry - or the lack thereof - in Greece and Rome, as well as the archaeological evidence of ancient dental health. The book challenges many past works in exposing modern scholars' fallacies about ancient dentistry, while presenting the incontrovertible evidence of the Etruscans' seemingly modern attitudes to cosmetic dentistry.

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1 Dentistry in medical history

Classical roots

The main purpose of this book is to present to a variety of readers, experts and laymen, yet another invention or innovation that in a way we owe to the Etruscans: the dental appliance. Those found in the burials of ancient Etruscan women were the first such devices known; they were cosmetic in purpose, and not strong enough for heavy-duty everyday biting and chewing. They represent the main elements of dental prostheses: the insertion of replacement teeth, anchored to living teeth in the mouth, and the use of gold, which enabled them to be fitted, and happens to make them safe (non-toxic) in the mouth. Other cultures have given the modern world such inventions as amalgam fillings (China), but the Western world follows Etruscan design and goldsmiths’ innovations in the use of bridges and braces.

First, for full background, and an indication of how many centuries elapsed between the Etruscan appliances and the next time such prostheses (somewhat improved) appeared in Western society, we offer here a brief history of dental science and(/or) artistry, including the latest finds from archaeological sites across Europe and the Mediterranean world. The technological advances illustrated by ancient dental appliances, such as the “parting” (purification) of gold, will also be considered, for valuable new evidence has come from the excavations of Sardis, capital of the Lydian kingdom of the famous Croesus, and from new techniques of materials analysis such as XRF (X-ray fluorescence).

Ancient texts provide a considerable range of information regarding activities in the Classical world that today fall under the umbrella of dentistry. The most important of these are presented through direct quotes. These include oral hygiene, dental extractions, and the manufacture and use of dental prosthetics and/or braces. Claims of ancient Mesopotamian dentistry merit a separate line of research inasmuch as few modern scholars have provided more than a note concerning this subject (see Musitelli 1996: 213–217, notes 12–21). The Babylonian cuneiform texts contain no “indication that would suggest any form of replacement of teeth” (Hoffmann-Axthelm 1970: 81). Certainly there was never anything like the dental appliances, especially the bridges (“pontics” to use the Latin-derived term) that elite Etruscan and Italic women used during the seventh to first centuries BCE.

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Egypt, that source of so much technological development, seems never to have engaged in actual dentistry. Apart from magical or pharmaceutical treatments for toothache or sore gums, neither the Egyptian papyri nor the Egyptians’ mummies furnish any evidence of dental intervention. The first Egyptian examples of gold wiring for loose teeth were found in burials of Ptolemaic and Roman date from the region of Alexandria and Giza (see Catalogue nos. W-3 to W-5), thus many centuries after the Etruscan phenomenon of gold-band appliances had flourished in Italy. Still, the mystique of Egypt in the popular press has caused many people to believe that false teeth were known in Pharaonic Egypt—so we discuss that situation at length in Chapter 2.

In the Classical world of Greece, Rome and Etruria from about 700 BCE to 500 CE, oral hygiene, dental extraction and dental appliances appear to have been quite distinct areas of activity (Musitelli 1996: 217). At that time hygiene and extractions were more closely linked to each other than either was to the use of dental appliances. For each of these three areas of interest we now have more written resources than archaeological evidence such as actual appliances or skeletons with evidence of dentistry. The archaeological record continues to grow in quality and quantity, providing us with better means by which the ancient texts may be interpreted and distinctions among these medical specialties may be recognized.

An impressive inventory of gold dental appliances from the ancient Mediterranean world has been known for some time (Bliquez 1996; Becker 1994c).¹ These provide direct evidence for the Etruscan practice of cosmetic dentistry as early as the seventh century BCE (see also Johnstone 1932b, Tabanelli 1963, Scarborough 1969)—we use the term “dentistry” for the technical process without implying that it was identical to the modern, medical profession of dentistry. The archaeological evidence for Etruscan dentistry, however, is nowhere directly documented by the Etruscan written record, despite the claims of some authors (Corruccini and Pacciani 1989, 1991). We have lost virtually all of the rich literature that Etruria once produced. Somewhere in the dramas and histories that Romans knew as Etruscan, there were probably references to the repair of lost teeth, but we may never know since works in Etruscan failed to survive the takeover by Roman culture in the course of the first millennium BCE.² Etruscan books were written on linen and papyrus, and have not survived in the soils of Italy.

One rich resource is the body of medical literature attributed to the fifth-century BCE Greek physician and teacher, Hippocrates, although much of this was actually recorded or created well after his lifetime. The treatise On Joints (32–34), one of the works possibly written in Hippocrates’ own era (many others under his name are later additions), noted that teeth displaced or loosened through an injury to the jaw could be braced with gold (almost certainly wire) or thread (fiber) until they were firmly fixed in place (Hippocrates 1928: 258–265).³ The few examples of dental appliances now known from the Eastern Mediterranean (Becker 1997) confirm the use of tooth conservation techniques mentioned in this early literature—they originated at the end of the fifth century, however, and continued in the Hellenistic or Roman periods, and do not predate the corpus of Etruscan examples. In contrast, however, the Etruscan production of dental appliances appears to be a profession associated with goldsmiths, and quite distinct from dentistry as it was then practiced (and that involved only the removal of teeth). Skilled, or at least regularly active, dental technicians may have been practicing (extracting teeth presumably) considerably earlier, but no evidence for this has been detected anywhere. Direct evidence for the practice of tooth extraction in antiquity is extremely rare, until recently limited to references to dentists on tombstones with an occasional depiction of what some scholars believe may be a dental forceps (Lanciani 1892: 353, see below). Collections of medical curiosities often include such instruments, but cannot demonstrate their exact application (and usually lack context as well: cf. for example, Thompson 1921: 580–581). The following consideration of those aspects of dentistry that involve oral hygiene and extraction as they existed in the Classical world will serve as a useful point of departure from which we may examine the origins and development of dental appliances.

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The recent discovery of direct archaeological evidence for the practice of dentistry—tooth pulling—in a taberna (shop) within the podium of the Temple of Castor and Pollux in the Roman Forum provides evidence for the early history of this profession—but it was not early in human history, dating only to the first century CE (see Appendix VI). Associated artifacts suggest that a barbershop (or beauty salon?) and pharmacy were the principal trades plied at this location (Nielsen and Zahle 1987, Nielsen 1992: 109–111). The evidence from the human teeth in the shop’s drain shows clearly that one form of dentistry was an important adjunct to these other activities, and that the practitioners were rather successful at this aspect of their trade (Becker, 2000a).

The interpretation of the new archaeological data can be enhanced if we review critically the ancient literary evidence from authors who made reference to teeth and activities related to oral hygiene. Some texts are medical in nature, but many of the most useful ones are satirical or otherwise circumstantial in character. A few sources appear to refer to the use of dental appliances, which obviously were related to the preservation of loose teeth or the replacement of missing teeth. While these generally are the consequences of failed dental hygiene, or dental disease, some appliances in the form of simple bands may have been meant to stabilize teeth loosened by a blow rather than by periodontal disease. And we cannot discount the possibility that some such simple bands may have been purely ornamental.

Development of dentistry

Two basic histories of dental surgery and oral medicine in general (Guerini 1909, Hoffmann-Axthelm 1973) provide useful reviews of the earlier literature. The following information is intended to re-examine and expand upon these sources from the perspective of the period during which the shop in the Temple of Castor and Pollux was functioning, the early years of the Roman Empire. These data will be reviewed in the cultural context of Roman history, and compared with related developments in the care and preservation of teeth. This will enable us to scrutinize the origins and development of the technology of dental prosthetics. The first Western evidence for practitioners comes from Greece and Rome; other commentaries from Egypt or Mesopotamia are older but do not even encompass extractions, let alone other dental procedures.

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We might have expected a discussion of such matters in the early Greek medical texts, attributed to the great healer of Kos, Hippocrates—but in vain. The almost complete absence of data concerning diseases of the gums or teeth in the original Hippocratic works, assembled between 425 and 300 BCE,⁴ reflects ancient Greek attitudes towards oral health as a category distinct from other aspects of medicine. Ancient Greeks saw tooth loss as a minor problem associated with the normal process of aging, a view held by many people in the modern world. This ancient conceptual separation of dentistry from internal medicine appears to have continued until modern times. Nevertheless, medical observers did recognize quite early that periodontal disorders were a principal cause of tooth loss, and devised numerous treatments for diseased gums. Treatments for dental decay, as indicated by the compilations of Pliny (first century CE, see Appendix V), also were numerous, but probably few if any of them were efficacious.

The dominant theory of dental decay in the ancient world seems to have been the “tooth worm” theory (see Gorelick and Gwinnett 1987b; Ghalioungui 1973: 117, fn. 181). Dental practitioners as well as the ancient public believed that small worms eating the teeth caused decay and pain, and assumed that killing these worms would stop the pain. Leek (1967b: 51) documents the presence of the tooth worm theory in Egypt as early as the nineteenth century BCE. While drilling techniques similar to those used in modern dentistry were well known throughout the ancient world for making artifacts (Gorelick and Gwinnett 1987a; Bennike and Fredebo 1986; also Gwinnett and Gorelick 1979), they were never applied to the physical removal of these theoretical worms. The use of gold foil techniques of considerable complexity also existed in antiquity (for constructing jewelry), but the merger of drilling and foil use within the realm of dentistry is a very recent phenomenon. In fact, except for extractions there were no remedies for dental decay before the relatively modern procedure of drilling and filling of carious teeth emerged in the 1870s (see Künzl and Weber 1991).⁵

Since the removal of teeth could, in theory, be effected by almost anyone with a pair of pliers and the inclination to attempt the procedure, extractions may have been performed quite frequently by people who were not trained in any particular aspect of the medical arts. The procedures developed in ancient Greece for the extraction of teeth were quite basic and probably extremely effective. Only advances in tools (see Bliquez 1994, 1996, 2015), and possibly in the related use of anesthetics, have improved upon knowledge that must have been common to the more skilled of these ancient practitioners. The use by early dental specialists of ancillary and effective surgical procedures, together with the application of ointments such as were part of the pharmacists’ trade, created a natural affinity, which must have emerged quite early. Pharmacy, barbering, and what is now called cosmetology in America (hair, face, and general care of the skin), may all have been part of the same trade, just as it was conducted in the shop excavated in the Temple of Castor and Pollux in Rome.

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Dental extractions in antiquity

For obvious practical reasons basic dental anatomy has been known by all skilled practitioners of dental extractions since at least the fifth century BCE. These skills probably developed hundreds of years before the appearance of the written records that note observations relating to this part of dentistry. On the other hand, recorded information about shape variations, numbers, and other features associated with the teeth was slow to develop as a scholarly pursuit (see Lindsay 1953). We do not know at what date specialized ...

Table of contents

• Cover Page
• The Etruscans and the History of Dentistry
• Routledge Monographs in Classical Studies
• Title
• Copyright
• Dedication
• Contents
• List of Illustrations
• Preface
• Acknowledgments
• Background: The Main Ancient Cultures Associated With Dental Appliances Listed in Alphabetic Order
• Introduction
• 1 Dentistry in Medical History: Classical Roots
• 2 Evidence From the Ancient Near East: Correcting Misconceptions
• 3 The Dental Prosthesis: A Lost Etruscan Invention
• 4 Dental Appliances and Dentistry After the Etruscans, to the Present Day
• 5 Catalogue of Etruscan and Roman-Era Dental Appliances
• 6 Concluding Remarks
• Appendix I: Uncertain Examples of Etruscan Dental Appliances
• Appendix II: Modern Copies of Etruscan Dental Appliances
• Appendix III: Spurious Examples of Dental Implants or Appliances
• Appendix IV: Amulets and VotIVes Resembling or Incorporating Teeth
• Appendix V: Pliny on Cures for Oral Pathologies
• Appendix VI: Evidence for Dental Extractions in Ancient Rome: A Summary of the Analysis of Teeth Excavated at the Temple of Castor and Pollux in the Roman Forum
• Appendix VII: Report on Analysis of Gold Bands in LIVerpool Appliances (Nos. 13 and 14)
• Bibliography
• Index