History of Dentistry

Phoenician Dental Art

- by Don Clawson.
Berytus Archaeological Studies
Published by The Museum of Archaeology of the American University of Beirut, Volume 1, The American Press, Beirut, 1934

Judging from existing archaeological evidence the dentistry of antiquity can be divided into three groups. Group I would seem to consist of the therapeutic or purely medical methods of combatting dental affections. Group II would seem to combine mechanical means of treatment with the earlier and purely medical treatments of Group I. This mechanical method characteristic of Group II will be called for convenience retentive prosthesis, or that type of dental art which has for its object the retaining of natural dental organs when the ravages of disease would otherwise have caused their loss. Group III is the highest stage of development reached in ancient dentistry: a definite improvement over Groups I and II, since it introduces true dental prosthesis, that is, the art of applying artificial substitutes for lost dental organs.

It is agreed that the oldest of those civilizations that knew something of dentistry was Egypt. The earliest indication of any such knowledge, in Egypt is found in the Edwin Smith Surgical Papyrus, interpreted by Dr. Breasted, the Director of the Oriental Institute of Chicago, and by him. It is dated in the 17th century B.C., even if the original author's first manuscript was produced at least a thousand years earlier, between 2500 and 3000 B.C. It contains detailed directions for the treatment of wounds about the mouth, but no mention is made of restoring lost teeth resulting from these or similar injuries. The hard tissues of the mouth were in general considered untreatable, if we are to judge from a case report from the above Papyrus in which a fracture of the mandible is described. In closing his discussion this ancient Egyptian surgeon says: "One having a fracture of the mandible over which a wound has been inflicted and he has fever from it, it is an ailment not to be treated. The surgery mentioned in this papyrus was most likely the war-time surgery of a physician who was following an army. In times of peace, however, it is reasonable to believe that many minor dental ills were treated. In a mandible of an Egyptian from the Old Kingdom (3000-2500 B.C.) described by Hootin, we have evidence of minor oral surgery, and in a later papyrus dating, it is believed, from 1550 B.C., we find many prescriptions for dental maladies, but in all the ancient Egyptian medical and dental writings no mention is made of mechanical dental appliances.

Schmidt, Virshow, Mummery, and other competent authorities on ancient Egyptian mummies find no trace of restorative dental art among the Egyptians, and contrary to the beliefs of various writers detached archaeological specimens of Egyptian prosthetic dentistry do not seem to exist. Whether there was a religious prejudice against artificial teeth or against the burying of them with the mummy we do not know, but "it is hard to believe" says Guerini, "that so refined and ingenious a people as the Egyptians should not have found the means of remedying the deformity resulting from the loss of one or more front teeth.

A vigorous development in the art of dentistry does not, however, seem to have come until the rise of the Etruscan civilization in Italy. The Etruscans were industrious, intelligent and artistic to the highest degree, fond of luxury in all its manifestations and took great care of their persons. At the same time they were a courageous people, skilled in arts and commerce and splendid navigators. In their long sea voyages they often visited Egypt, Phoenicia and Greece trading especially in the more flourishing cities, Memphis in Egypt, Tyre and Sidon in Phoenicia.

Thanks to this close and continuous intercourse, the Etruscans probably learned early what the Egyptians, Phoenicians, and Greeks could teach in the way of dentistry and developed the art. The numerous specimens of Etruscan dental art now in Italian and other museums allow us to observe the high standard of Etruscan dentistry in the 7th and 6th centuries B.C.

The appliance illustrated in Fig. 1 from the 7th century B.C. is one of the finest Etruscan specimens. Over the remaining natural teeth gold bands were fitted. The bands were then set in place, relations were then taken and maintained by solder. The patient's lost teeth were partially replaced by the teeth of human beings and in one space by the tooth of an ox. Such ingenuity in prosthesis (so far as archaeological evidence reveals) did not exist in Phoenicia and Greece even at a later date.

Traditions have it that Greek dentistry had its origin with Asklepios (Aesculapius) whose two sons, both physicians, took special part in the siege of Troy. All the physicians and dentists from that time up to and including Hippocrates (born 460 B.C.) were members of the sacerdotal caste of Asklepiadi. But examinations of their various writings do not reveal any record of mechanical dental appliances for lost or weakened teeth or instructions for their manufacture. Volumes of medical and dental advice were written during this time, but interference consisted mostly of simple medical prescriptions similar to those recorded in Egypt. Extraction was resorted to only when the teeth were extremely loose. The Greeks prided themselves in their ability to withstand pain, so possibly did not consider a toothache a thing painful enough to warrant elimination of an organ as necessary to appearance as a tooth. This, together with their physical fitness due to their great love of athletics and athletic games, may explain the very few examples of restorative dentistry among the well preserved archaeological remains of ancient Greece.

Hippocrates and other later writers describe methods of wiring the teeth into their normal relationship with gold wire in cases of fractures of the jaw until the bones are healed. But we have no proof that these few detached examples of ancient Greek prosthetic dentistry may not be from patients with fractured jaws who have succumbed before the retaining wires were removed.

The crude Greek appliances now existing (Fig. 2), which date from the 4th Century B.C., give us little reason to believe that they were of any assistance or could even have been tolerated well during normal mastication.

Superior to the Greek dentistry are, however, the two remaining examples of Phoenician dentistry even if they do not by any means measure up to the achievements of the Etruscan dentist. Both examples come from tombs in the neighborhood of Sidon.

The first was found in 1862 by Renan's medical assistant, Gaillardot, and is now in the Louvre. It is described in the following way by Dr. Gaillardot: "A part of the upper jaw of a woman with two canines and the four incisors united with gold wire. Two of the incisors would appear to have belonged to another individual and to have been applied as substitute for lost teeth. This piece discovered in one of the most ancient tombs of the necropolis proves that dental art in Sidon was sufficiently advanced." But certain inaccuracies in the original description by Renan and Gaillardot, first noticed by Guerini coupled with the uncertainty of positively identifying an object which is found in an open grave with a given period, leaves one in doubt as to the period of origin of this remarkable dental specimen, even if as Renan states the grave was located in the oldest section of the necropolis. The inaccuracies referred to are based on the illustrations as well as the written description occurring in Renan's work. The teeth supported by the Phoenician dental appliance as they appear in the cut from Renan's book do not give the anatomical form characteristic of upper teeth. Therefore, either the figure has been badly drawn or the appliance was a restoration of two lost lower incisors and not the upper ones. The present author is also of the opinion that Fig. 3 showing the appliance inverted and seated on an imaginary mandible, gives a picture more nearly correct from an anatomical viewpoint than the Fig. 4, which is the one given in Renan's "Mission de Phénicie." Gaillardot mentions this appliance occurring on "a part of the upper jaw of a woman." It is equally hard to understand on what ground the doctor has based his statement that the appliance was on the teeth of a female skeleton, since it is well known that there is no characteristic difference in microscopical structure between a male and a female jaw. This, however, does not detract any value and prestige from the Gaillardot specimen as being the first specimen of ancient dental art unearthed in Phoenicia. It may or may not be as old as the necropolis in which it was found, but it does not seem to the present writer to be linked with Egyptian dentistry in any way.

The excavations of the 5th and 4th century Phoenician rock tombs, unearthed the second known specimen of Phoenician dental art, were conducted by the American School of Oriental Research of Jerusalem during the early months of 1901. The site of the excavations was an open field approximately a mile south-east of the city of Sidon in southern Lebanon, and just east and in full view of the necropolis from which the Gaillardot specimen was taken.

Through the kindness of Dr. Ingholt, the Director of the Museum of Archaeology of the American University of Beirut, it has recently been the writer's privilege not only to view this astounding bit of dental art but to hold it in his own hands and to thoroughly examine it from a dentist's viewpoint. It is, therefore, an added pleasure to be able to sketch and describe this specimen for the readers of the first Archaeological Annual of the University. In view of the great indebtedness the University feels toward the late Dr. and Mrs. Ford, by whose will the appliance came under their care, it shall be a privilege to hereafter refer to it as "The Ford Specimen of Retentive Prosthesis." It was found attached to the anterior teeth of the lower jaw of a male skeleton which was recovered from a massive anthropoid sarcophagus. Archaeologists state that this sarcophagus had remained unopened since the day of interment, probably early in the 5th century B.C.18.

The object of a retentive prosthetic appliance even today is to hold natural dental organs in their natural positions when otherwise they would have succumbed to the ravages of wasting diseases. A disease of this nature very frequently met in modern dental practices is Pyorrhea Alveolaris, in which there is a wasting away of the bone surrounding the teeth. Recent X-ray of the Ford mandible reveals the typical atrophy of Pyorrhea, the disease still progressing at the time of death of the patient, and proves conclusively that this disease existed among the ancient inhabitants of Sidon some 2500 years ago. That this retentive appliance was highly successful during the patient's lifetime there can be little doubt, for even now it serves its original purpose: that of holding the teeth securely in place in the mandible.

There has been some question concerning the location in the mouth which applications have occupied during the lifetime of their owners but there is certainly no such doubt in regard to the Ford specimen.

The appliance itself (Fig. 5) consists of a fine 24-gauge wire of pure gold ingeniously woven around and firmly binding together the six anterior teeth of the lower jaw (Fig. 6a). This ancient dentist's first step (Fig. 6b) in applying this brace was to take two complete turns with the gold wire around the group of six anterior teeth beginning at the lower left canine. Coming back to the starting point with the second turn of wire he has passed it through a loop on its free end and then doubled back making a knot (Fig. 6c) very similar to a "Bowline on a bight" so well known to sailors. From this knot the wire passed inward through the in terproximal space between the canine and the first approximating tooth to its right (left lateral incisor). As it passes through this space it curves downward, no doubt, below the gum in life. Circling the next tooth it rises through the interproximal space, making a similar curve upward from the level of the double retaining wires to as near the points of contact as possible, thus bracing, each tooth interproximally, over a surface nearly one-half of its full length. The wire continues thus weaving and out in a counter clockwise direction until all the interproximal spaces, except in the last, have been reinforced. It is due either to the existence of a natural brace, or more likely due to a shortage of wire, the appliance ends with a sort of "half hitch" around one of the retaining wires.

A previous writer has described this, appliance as consisting of two lengths of gold wire forming, inner and outer splints. On close examination after its removal it was revealed that have been in error. The whole appliance was one continuous splint made by the remarkable weaving of this one length of wire.

The whole appliance weighs slightly more than grams, which is less than a modern large gold inlay when we that this was distributed over six teeth, we have reason to believe that the patient experienced little or no inconvenience from the appliance. The close adaptation of the wire to the necks of the teeth is also remarkable. This adaptation was so perfect of the lower right canine during life that salivary deposits had overlain the appliance at this point and had to be scaled away before the tooth could be taken from the splint. This proves that this appliance was not inserted after death as has been suspected of some other ancient bits of dental art. These deposits would also indicate that the appliance was in use over quite a period of time and was serving its owner, not alone for esthetic purposes but was aiding also in the processes of incision and mastication. From the abrasion of the teeth on their masticating and incisive surfaces one can see that this middle aged man gave his teeth hard usage, and any retentive appliance less well made would certainly not have enjoyed a very long existence.

The mandible itself is of unusually large dimensions and presents marked prominence for heavy muscular attachments. The bony process of the chin is over-developed. No doubt, this was the mandible of a veritable giant. The remaining teeth are in their normal position including the wisdom teeth which are smaller than the other molar teeth, a tendency noted by some authors as more typical of modern civilized man than of ancients.

The mandible, in fact we are told the whole skeleton, was wonderfully preserved and exhibits a greenish coloration described by some as being due to the effects of the embalming materials, probably iron or copper salts used on this man of high rank.

Along with tile skeletal remains already described, many other valuable articles were revealed when this massive sarcophagus was opened. These articles include a gold finger ring and twelve small statuettes of Egyptian faience representing Egyptian deities pierced for stringing. Another article of interest was a richly carved toilet tray. formed from a peculiar green stone. One handle of this was broken, but even so it is a very fine example of Phoenician art.

The sarcophagus itself is of beautiful Parian marble. The cover is beautifully proportioned and carefully adjusted to the lower part of the sarcophagus. It stands about 2.7 meters high, with handles at shoulder and feet. The head presents curly "red" hair, wide set eyes, drooping lips. The chin is massive and determined, exactly, the manner of man who in life one would expect to find built around the massive mandible and skeleton interred under this beautiful lid. All this would seem to indicate that the cover was posed for by the subject himself before death.

The Ford specimen was an attempt to keep diseased teeth in the mouth by, retentive prosthesis, and not an attempt to replace lost dental organs, as is very evidently the purpose of the Gaillardot and Etruscan specimens. If the Ford and the Gaillardot appliances are both specimens of purely Phoenician dental art it would seem to any dentist that the Ford specimen was the older of the two for the bridging in of lost teeth as observed in the Gaillardot specimen, shows a more highly developed dental art than that which placed the retentive appliance which we know as the Ford specimen. The cruder appearance of the two Phoenician specimens as compared to Etruscan call possibly be ascribed to the fact that gold soldering was unknown in Phoenician dentistry even as late as the 5th Century.

Wire making is certainly more difficult than band making, but all Etruscan appliances were of gold hands which they, were able to use because of their knowledge of soldering

In concluding the discussion of ancient dentistry, it would seem safe to say that Phoenicia borrowed only her therapeutic and not her mechanical knowledge from Egypt. She added to it the simplest forms of retentive prosthesis, mechanical proceedings different from those employed by the Etruscan.

In closing, the writer wishes to explain on what lie bases the importance attributed to the Ford specimen of retentive prosthesis.

• It is one of the few existing dental appliances from antiquity in which we can plainly, see that the owner derived service as well as esthetics by its application
• The skeletal remains and the appliance are in such a splendid state of preservation that we do not have to draw upon our imagination to understand its function.
• Pyorrhea, a disease most dreaded by the dental profession even 'low was existing and more or less successfully dealt with by dentists some 2500 years ago.
• This dental appliance can, for archaeological reasons, fair accuracy to the 5th century B.C. be dated with The Ford mandible is now permanently displayed in Beirut, in the Museum of Archaeology, and serves as an inspiration for dental practitioners and students alike, to uphold the high standards of art and craftsmanship established for them so long ago by, the Phoenician dentist of ancient Sidon.

The Ford mandible is now permanently displayed in Beirut, in the Museum of Archaeology, and serves as an inspiration for dental practitioners and students alike, to uphold the high standards of art and craftsmanship established for them so long ago by, the Phoenician dentist of ancient Sidon.

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