'Killing the Worm that Gnaws at the Tooth' by Karen Maitland

This is the time of year when dentist surgeries are filled with emergency patients with missing crowns and broken teeth from those seasonal nuts and the sixpences granny puts in her Christmas pudding. Although many of us dread the dentist, we often console ourselves by thinking about how much worse in must have been in the Middle Ages. But dentistry back then wasn’t quite as primitive as we sometimes imagine.

True, if you were poor and in agony with toothache, you’d have probably consulted one of the itinerant tooth pullers at the local fair who would advertise his services by wearing a necklace of teeth or a belt with teeth sown to it. The whole spectacle would be performed with a flourish for the entertainment of the crowd and the screams of the patient drowned out by jolly music. Claims by these men that it was quick and painless gave rise to the medieval insult – ‘you lie like a tooth-drawer.’

St Apollonia. Patron saint of toothache suffers and dentists.

These untrained tooth-pullers often dislodged other teeth in the process of extraction. They could even dislocate the jaw, break the bone or cause severe haemorrhaging. The victim would not only have to pay for their brutal ministrations, but would also be charged to buy his own tooth back. It was a widely held medieval superstition that if you got buried without all your teeth you’d be forced to spend the Day of Resurrection looking for them. Your teeth and hair combings could also be used against you in malicious spells if they fell into the wrong hands, so it was important to keep any removed teeth. If you were worried they might not be buried with you, you could send your teeth on ahead by casting them into the fire sprinkled with salt. It was believed that for each bad tooth you sent ahead in this way, you would receive a good tooth in your resurrected body.

But for those who could afford their services, there were professional tooth-drawers. In the early medieval period these specialists in dental work were mostly found in Europe, trained in European medical schools. They often included women, many of whom were Beguines, who were much sought after as it was known they relied on skill rather than brute strength. The principle male professionals, especially in England, were the members of the Guild of Barber-Surgeons. But there were some notable amateurs too. King James IV of Scotland (1473-1513) had a great interest in medicine and paid some of his subjects to allow him to extract their teeth and bleed them!

But if you had money in the Middle Ages, extracting a sore tooth was by no means the only cure. Tooth-ache was believed to be caused by a worm gnawing at the tooth, which does very much capture what it feels like. Many cures involved ‘killing’ this worm or putting it to sleep. Using cloves, peppers or herbs seeped in wine to ‘kill the worm’, would have had some useful effect since they must have helped to fight infection and numb pain.

Bad teeth could also be filled. Rhazes, a Persian physician (850-923), had perfected the art of drilling and filling teeth. His fillings of alum and mastic (a gum resin known as ‘Tears of Chios’) weren’t very strong, but by the Middle Ages, fillings which also contained ground sheep bone had been introduced which were much more durable. An Italian scholar, Arculanus (1412-1484), records that gold leaf made an excellent tooth filling, if pressed in little by little and this was still being used right up until the 20th century.

Dental Scrapers illustrated
by Abulcasis (1050-1122)

An Arabian surgeon, Abulcasis (1050-1122) illustrated 14 different dental scrapers and described their uses for scaling teeth and removing deposits which would otherwise ‘corrupt’ the gums. He scaled teeth by laying the patient’s head in his lap. He also recommended a slow extraction to avoid damaging other teeth by wobbling the bad tooth from side to side, instead of yanking it out. He bound loose teeth to good ones, using gold wire and employed the same method to insert false teeth carved out of animal bone into gaps where teeth had been lost or removed.

These days we are grateful for pain numbing gels and injections, but in the Middle Ages pain relief, or at least the dulling of pain, was also used in dentistry. Syrups made from various herbs such as the white marsh poppy, could be drunk before treatment and another popular method was to breath in the fumes of henbane which was heated over a small charcoal brazier.

A couple of decades ago Americans probably regard British dentistry as still being the Middle Ages, since professional teeth whitening took hold in American long before the British succumbed. But in the medieval and Tudor period they also made attempts at teeth whitening. The barber-surgeons cleaned the teeth of their patients with aqua fortis (diluted nitric acid), which effectively whitened teeth, but had the unfortunate effect of eating away at the tooth enamel, so if it was used too often it destroyed the teeth. A slightly safer medieval method of tooth whitening was boiling together equal parts of honey, vinegar and wine to brighten teeth, though that probably didn’t do the enamel much good in the long term either. Another tooth powder was made from ground up alabaster mixed with jelly that could be rubbed on the teeth, which sounds a little safer.

Monks carving a grotesque for an abbey
modeled on a man with toothache.

Teeth whiteners were also used in the home including the stems of the vine plant which were burnt to ashes then rubbed on teeth to whiten them. Chewing mastic (gum resin) was said to strengthen teeth and gums. Bistort or snake weed when boiled in white wine helped sore and loose teeth, as did wild tansy. Or if you really hated barber-surgeons and wanted a guaranteed pain-free extraction apothecaries recommended filling a clay crucible with ants, known as pismires, burning them and touch the ashes to the tooth, which was then supposed to fall out at once.