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manoeuvers. No one can assert for sure whether
these treatments had been made to relieve
$QFLHQW 2ULHQW GHQWLVWU\ ZDV XQGHU WKH LQÁXHQFH RI
patient’s pain, to enhance the aesthetical
magic by means of various symbols: animals (worms and
PLFHSODQWVÀJWUHHRUFRVPLFHOHPHQWVWKH6XQWU\LQJ appearance or to dismiss evil spirits [1].
to oust the harmful elements through ritual or family
The present study approaches the aspects of
habits. In doing so, the myth of “dental worm” became a
religious and spiritual concepts in the ancient
possible cause of dental decay met at most ancient Eastern
Oriental dental space. The topic is a provocative
civilizations. The results of this study overview the
importance of spiritual symbolism in dentistry, on the
and interesting one, if considering the absence of
basis of the existing historical documents.
documentation, the scarce information provided
.H\ZRUGV religion, dentistry, history, ancient Orient
by medical papyri and historical studies of
various authors, offerring only a general
,1752'8&7,21
framework, and making difficult an exact
establishment of the historical moment in which
In its rudimentary form, dentistry has been
GHQWLVWU\EHFDPHDQLQGHSHQGHQWPHGLFDOÀHOG
practised since earliest times, as attested by
In ancient times, diseases were considered to
various archaeological and literary sources.
EHWKHUHVXOWRIPDOHÀFIRUFHVVRWKDWWKHPHGLFDO
5HVHDUFKLQWKHÀHOGRIPDODFRORJ\GHPRQVWUDWHG
practice was combined with religious rituals.
the existence of concerns for aesthetic dentistry,
Demons were considered a major cause for all
since most ancient times: intended dental
diseases, including the dental ones. To banish
mutilations, adornments or anterior level changes
demons and any hostile entity from patient’s
were practised in many cultures, either for
body, divinities were invoked to defend man
assuring aesthetical pleasing or as religious
and his health condition [2].
rituals. The oldest known evidence of dental
treatments dates 7,500-9,000 years back. In the
7+(0,''/(($67
Neolithic city of Mehrgarh, in Pakistan, 11
(*,37
crowns of permanent molars, of which nine came
from adults, presenting traces of dental
treatments, were discovered. The trepanation
The ancient, mystical and religious Egyptian
holes had a depth between 0.5 and 3.5 mm and PHGLFLQH ZDV V\VWHPDWL]HG DQG FRGLÀHG LQ
a diameter between 1.3 and 3.2 mm, which ancient papyri and transmitted to the medical
demonstrates the existence of special tools for temples schools, as a valuable source of
dental interventions. Location of the rear information for people [3]. Its concepts were a
riddlings has generated controversy on the - mix between religious elements, represented by
religious or therapeutic - motivation of these magic, quite various medical procedures [4], the
International Journal of Medical Dentistry
255
Diana DIACONU, Anca VITALARIU, Gheorghe COTAIE, Andrei MELINTE, Monica TATARCIUC
treatments being closely related to magic.
Whatever the real etiology of the disease, it has
been always thought that the main cause was an
evil force disturbing the harmony of the body.
Egyptian doctors were part of the caste of priests,
trying to cure by means of spells, talismans and
incantations [5], each disease having its own
VSHFLÀF KHDOHUV ´VRPH FXUH H\HV RWKHU WHHWK
other womb, some other hidden diseases” [6].
The education of ancient doctors was done in
schools belonging to temples, a proof of this
aspect being the evidence found on the wall of
the Kom Ombo Temple, where some surgical
instruments, including dental ones, are carved.
Archaeological evidence attests that the
Egyptians were the first to use surgical
LQVWUXPHQWV KHDWHG LQ ÀUH IRU WKH LQFLVLRQ RI
DEVFHVVHV 0HGLFDO ZULWLQJV KDG D VLJQLÀFDQW
importance for Egyptians healers, medical books
being appreciated as a gift from the God of
health, Thot [7]. Viewed as intermediaries
between God Thoth and the illness, physicians
were required to keep secret the treatment
procedures because of their sacred origin [8]. The
Egyptian manuscripts known as the Ebers
Papyrus, dating around 1,500 BC, provide very
early information on dental diseases, such as
GHQWDO SDLQ LQÁDPHG JXPV DEFHVVHV DQG DOVR
various remedies [9]. The mummies and skulls
discovered in the archeological sites attest that
Egyptians’ teeth were in a very bad condition,
the main causes of alteration being dental caries
and abrasion. The general belief was that caries
and abscesses were produced by a “dental
worm”. This belief was based on the fact that,
during dental treatments, consisting in vital
tissue removal, the dental nerves had the shape
of a “worm” [10]. Teeth pain, with acute periods
and spontaneous remissions, was blamed on the
intervention of divinity. The Egyptians believed
that the mouse was under the direct protection
of God Sun, so that it was used in dental
treatments by applying a “mouse still warm” on
the affected area [11]. If the doctor was helped in
his action by a supernatural force (gods or
spirits), the empirical remedy applied was
considered as more effective, while the magic
formula applied for curing dental absccesses was
accompanied even by a therapeutic procedure.
It is possible that one drug or another to be
256
HIÀFLHQW LQGHSHQGHQWO\ RQ WKH PDJLF IRUPXOD
used, even when the patient forgot the words or
hesitated to utter them [12].
Other historical proofs were found in the
ancient necropolis of Saida or Saidon, namely
parts of a woman maxilla, with a prosthetic
appliance formed of two canines and four
incisors, joined by a common thread of gold. Two
of the incisors seemed to belong to another
person, being applied as a substitute for the lost
ones. Besides bone fragments, two copper coins,
(J\SWLDQVFDUDEVDQGVPDOOIDLHQFHÀJXULQHV
were also found, which directed the archeologists
toward the Egyptian origin and illustrated the
importance of various religious objects used in
burial rituals to identify the origin of old dentures.
[13]
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In ancient times, Mesopotamian medicine, as
customary in all countries of the Orient,
represented a more wizardry practice, based on
magic meant at chasing the evil forces and at
healing various diseases. Sumerian texts (ritual
chants) dated around 5,000 BC, including
suggestive illustrations of the therapeutic
purposes had in view, developed the idea that a
“dental worm” would be the cause of tooth
decay. ”After Anu had created heaven,/ Heaven had
created the earth,/ The earth had created the rivers,/
The rivers had created the marsh,/ And the marsh had
created the worm—/ The worm went, weeping, before
6KDPDVK +LV WHDUV ÁRZLQJ EHIRUH (D ´:KDW ZLOO
\RXJLYHPHIRUIRRG":KDWZLOO\RXJLYHPHWRVXFN
RQ"µ´,ZLOOJLYH\RXWKHULSHÀJDQGWKHDSULFRWµ
´:KDWJRRGDUHWKHULSHÀJDQGWKHDSULFRW"/LIWPH
XSDQGDVVLJQPHWRWKHWHHWKDQGWKHJXPV,ZLOO
VXFNWKHEORRGRIWKHWRRWKDQG,ZLOOJQDZLWVURRWV
at the gum!”/ Because you have said this, O worm,/
0D\(DVWULNH\RXZLWKWKHPLJKWRIKLVKDQG”
These texts highlight some important stages:
creation of the world, birth of the worm and
disease, the primordial and paradigmatic
gestures (destruction of the worm by Ea). The
therapeutic effectiveness of the chant lays in the
fact that, used as a ritual, it recalls the mythical
origin of the world, as well as the origin of teeth
pain [14]. As evidenced by this text, the deity
9ROXPH‡,VVXH2FWREHU'HFHPEHU‡
RELIGIOUS AND SPIRITUAL CONCEPTS IN DENTAL PRACTICES IN ANCIENT ORIENT
who had contributed to the emergence of such
“dental worms” was Anu (in Sumerian: AN).
,Q DQFLHQW WLPHV QR VFLHQWLÀF H[SODQDWLRQ
existed for dental diseases, considered simply as
an imbalance in the harmony of body and spirit
[15]. Similarly with the Egyptian culture, ancient
Sumerians believed that it had been a worm that
created a “hole” in the tooth, causing dental
pain. Another explanation of the “tooth worm”
myth lies in the fact that dental caries look like
“holes” made by woodworms in wood.
Testimonials on dental decay causes can be
found at the British Museum where, on a tablet
of Ninevah, the tooth worm and the healing
recipe are drawn [16]. The oldest written source
that refers to dental diseases, discovered by
archaeologists on the lower Euphrates Valley,
dated around 5,000 BC, is a clay tablet containing
cuneiform inscriptions, about a “worm”
responsible for dental pain [17]. The “tooth
worm” was the creature that explains how even
a sound tooth can be invaded and destroyed
[18].
The myth of “tooth Worm” continued to be
considered the main cause of toothache until the
18th century, when the “father of dentistry”,
Pierre Foucard, gave a simple scientific
explanation of dental pain: tooth decay.
the Samurai daughters to paint their teeth in
order “to make them less desirable for rape or
kidnapping.” Later on, even the early samurai
and noblemen began to paint their teeth in black
[20]. In the beginning, many women would paint
their teeth for symbolizing their coming of age.
This practice was only taken up by the wealthy
DQGDULVWRFUDWLFRQHVEODFNWHHWKDOVRUHÁHFWLQJ
decay. Decay was a luxury if only the wealthy
ones could afford sugar and sweets, which made
it also a status symbol. Some studies evidenced
WKDW 2KDJXUR DOVR KDG PHGLFDO EHQHÀWV DV DQ
ancient dental treatment against tooth decay and
SHULRGRQWLWLV)HUURXVDFHWDWHLURQÀOLQJVEURNHQ
down in vinegar) is thought to be the key
ingredient for preventing tooth decay. Tooth
blackening enhanced teeth health, modern
studies showing that this custom maintained the
integrity of the dental arch for a long time.
&+,1$
The ancient history of dentistry emphasizes
the same Chinese Oriental belief of the “tooth
worm” producing dental cavities. The worm was
the symbol of life, recreated from decomposition.
In spiritual terms, the Chinese people
recognize two principles of vitality: Yin and
Yang, spirits represented by blood and air - the
7+()$5($67
vehicles of these two essential principles of life,
-$3$1
occurring in constant balance and perfect union.
[21].
A widely used therapy in China was
Data related to this topic are very scarce, due
to the absence of literary sources, which is the acupuncture; there were twenty-six therapeutical
result of the traditionalism that has characterized points where needles were applied to quell the
and still characterizes this country. One of the pain caused by dental caries, and other six points
ancient Japanese practices related with the dental for treating gum pain. The healing mode
ÀHOGZDVWKHWHHWKEODFNHQLQJFXVWRP2KDJXUR depended on the relationship between one of
(in Japanese, the word “ohaguro” literally means these points and the channels of communication
black teeth). The ohaguro practice, going back and transmission through blood circulation and
thousands of years, since prehistorical Japan, vital spirits. These channels served as a
was originally done mainly by the members of transmission path for all parts of the body,
the imperial family and by aristocrats [19]. including the teeth, according to the two vital
According to Angus Trumbles, it had originated principles, Yin and Yang [22].
Another aspect of the ancient Chinese dentistry
in the Buddhist idea that white teeth “reveals the
nature of animal in humans and that civilized was represented by the mutilations and dental
people should hide them, not by any other means decorations made for religious, ritual-aesthetic
than by a black coat of paint”. The same author reasons, or for representing a symbol of prestige,
has speculated that they put their wives and also or as a sign of membership to a particular social
International Journal of Medical Dentistry
257
Diana DIACONU, Anca VITALARIU, Gheorghe COTAIE, Andrei MELINTE, Monica TATARCIUC
group. Different forms of dental mutilation and
decorations were discovered in some of the most
ancient civilizations of China, India and SouthEast Asia [23].
Various religious books of ancient China
showed that, for assuring tooth hygiene, Buddha
himself (VIth century BC) used various “little
wood sticks soaked in water” to clean the teeth
[24]. As to the material used for dental treatments,
it was thought that mercury, a component of
dental amalgam, was able to extend tooth life,
probably due to its protective properties. The
ÀUVW HPSHURU RI &KLQD 4LQ 6KL +XDQJ 'L WKH
RQHZKRXQLÀHG&KLQDEHWZHHQDQG%&
tried to swallow a few pills of mercury, for
becoming immortal, which caused his death.
There is a mythology of mercury entering the
composition of dental amalgam, a homogeneous
PL[WXUH RI DOOR\V XVHG LQ GHQWDO ÀOOLQJV 7KH
mythology of mercury was known in Babylonia
as Nebo (Nabi), son of God Marduk. Mercury
was a metal also known in other parts of ancient
East, not only in China, in India or Egypt, where
several different mercury samples have been
found in a tomb dating around 1,500 BC.
Another method to neutralise dental diseases
was a powder mixture of arsenic and water made
into a pill placed near the painful tooth or ear.
,1',$
Ancient Indian medicine included three
distinct periods, the most important one being
the second, placed between 100 and 400 BC,
represented by the Hindu and brahman priests
[25]. According to the laws of Manu, they were
part of the old Indian society, together with
warriors (kshatriya), manufacturers (vaisya) and
servants (sudra).
Indian medicine distinguishes itself by the
attention granted to hygienic measures, in the
form of prescribed religious broadcast. One of
the steps taken referred to the way in which the
individual was supposed to focus on personal
hygiene, a special aspect being tooth cleaning.
From a social point of view, an important aspect
is the fact that the recommendations concerning
hygienic measures were addressed especially to
the privileged castes.
258
Joseph Murphy wrote in his paper, entitled
“The natural history of human tooth clipping”,
published in London in 1811, that brahmans paid
special attention to their dental fittings
maintenance, rubbing their teeth for an hour
ZLWKDÀJVWHPZKLOHORRNLQJWRZDUGVWKHULVLQJ
sun, and reciting prayers and summoning. This
was a usual practice in the old codes and religious
writings from India, demonstrating the
importance given since ancient times by the
people of this country, and especially those of
Brahma caste, to dental hygiene and beauty.
Teeth were considered one of the main faces of
ornaments, bearing a religious subtext.
Another important aspect is related to tooth
cleaning: in the morning, at sunrise, appearing
as a manifestation of divinity, conceived as the
son of the Supreme God, the symbol of light, heat
and life. Hindu texts consider the Sun the origin
of everything that exists on earth, the beginning
and end of any events, the feeding being (savitri).
In the present case, we are witnessing a sort
of “food for thought” of the teeth, through the
Sun.
:LWKUHJDUGWRGHQWDOK\JLHQHWKHÀJZDVQRW
chosen by chance. As in the case of the ancient
Egyptians, which played an illuminist role in
IDURV PHGLFLQH WKH ÀJ WUHH SOD\V DQ LPSRUWDQW
role, in the case of brahmans, as well. This tree
was considered as being the India Vishnu and
Shiva’s tree, the symbol of power and life.
The ancient Indian medicine, also including
the dental branch, played an important role in
$VLDDJUHDWVLJQLÀFDQFHEHLQJWKH$\XUYHGLFV
teachings imported from India by the Buddhist
monks and spread in Indo-China, Indonesia,
Tibet, Central Asia, up to Japan.
On Bali Islands, there were various dental
ritual interventions. Thus, there was a ceremony
LQZKLFKWKHDQWHULRUKHDOWK\WHHWKZHUHPRGLÀHG
by grinding, for marking the transition from
adolescence to adulthood. The ceremonial
intended to symbolize the spiritual development
of the individual and to eliminate passion, nature
and wildness of arrogance.
'HQWLVWU\ ZDV DQ LPSRUWDQW ÀHOG GDWLQJ DV
an independent profession as early as the third
millennium BC, although it may not have never
been prominent. The roots of dentistry run
deeper than we ever realize. Consider, for
9ROXPH‡,VVXH2FWREHU'HFHPEHU‡
RELIGIOUS AND SPIRITUAL CONCEPTS IN DENTAL PRACTICES IN ANCIENT ORIENT
example, that researchers discovered a skull in
Pakistan with perfectly drilled holes in the teeth
and a supporting bone structure, carbon dated
between 7,000 BC and 5,500 BC. This discovery
proved that dentistry has been practised in some
form for at least 4,000 years earlier than it was
previously thought.
From the simple fabrication of retention
appliances in the Bronze Age to the 21st century
advances recorded in the design, fabrication, and
materials, the technologies being developed
today are products of trial, error, and
experimentation of the past 9,000-plus years.
Of course, dental care was delivered much
differently back then, and the understanding of
what caused tooth decay and pain was limited.
For instance, many cultures believed in the
´OHJHQG RI WKH ZRUPµ D WKHRU\ ÀUVW QRWHG
approximately around 1,000 BC, according to
which tooth decay, pain, and gum disease were
caused by a worm sent by demons to drink the
blood from human teeth. That idea progressed
for nearly 2,000 years—into the Middle Ages—
XQWLO $UDELF FXOWXUHV FRUUHFWO\ LGHQWLÀHG WRRWK
pain and decay as being caused by unknown
substances in the oral cavity.
&21&/86,216
The study attempted at tracing the roots of
dentistry and at providing a frame of reference
as we search for new ways to push dentistry
forward. Knowing where we came from can help
us build on the knowledge we already possess,
continue the advancement of our profession, and
settle our own place in the history of dentistry.
5HIHUHQFHV
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