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.1 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."2 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,3 we have evidence of minor
oral surgery, and in a later papyrus dating, it is believed,
from 1550 B.C.,4 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,5 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 writers6 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."7
A vigorous development in the art of dentistry does not, however,
seem to have come until the rise of the Etruscan civilization
in Italy.8 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.9 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.10
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:11 "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 Guerini12 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.13
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 1901.14 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 art15 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 sketch16 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.17 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 owners19 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 writer20 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.21 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 authors22
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.23
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.
