The Toothless: Dental Neglect and Disease

In Lithuania as well as throughout Europe the most common dental disease in the middle Ages was dental decay or caries. Anthropological material shows that at the time about 80% of adults in Lithuania were suffering from it. Caries morbidity in children was lower – about 30%. The main reason for the prevalence of caries was starchy foods with a high carbohydrate intake. Ordinary residents in the Middle Ages ate mainly plant-based foods – bread, turnips, cereal, porridge made of beans or peas; honey was also part of the diet. These food products are less cariogenic than sugar; however, their continuous use and poor oral hygiene would eventually lead to caries.

Medieval remedies for toothache pain

Oral hygiene in the Middle Ages was very primitive (toothbrushes appeared in Europe only at the end of the 18th century). In written sources we find recommendations to rinse the mouth with water, wine or herbal decoction, to clean the teeth with a piece of linen cloth or with powder made of rosemary ash. These remedies, however, did not clear the mouth of food residue, plaque would build up in which bacteria depleting the surrounding tissues accumulated. The poor oral hygiene is also evidenced by abundant dental tartar. Food residue caused bad breath, which, as it was believed, could be eliminated by chewing laurel, mint or sage leaves.

If left untreated, tooth decay progressed damaging the deeper tissues of the tooth and would result in pulp infection. The infection spreading further, it caused a pussy tooth abscess, which could be very painful. According to popular belief, caries was caused by a tooth worm. It was thought that a toothache could be cured by putting a centipede to the painful tooth or by eating wormy apples. In popular medicine many therapies were applied in order to eradicate the tooth-worm, such as herbal infusions and powders, fumigations with henbane seeds, hot oil or wax, clove oil, tincture of opium (the latter remedies were expensive and only the rich could afford them).

As these remedies did not cure caries, the rotten teeth would eventually have to be pulled out. The task would be performed by barber-surgeon guild members.

Alcohol served as a painkiller. Various charlatans offered tooth extraction services for a lower price, which were made use of by ordinary residents.

When holes outnumber teeth

The fact that caries was the most frequent cause of teeth loss in the Middle Ages is also evidenced by the anthropological data on Lithuanians. On reaching the age of 40, an ordinary town dweller in the 16th-17th centuries would have lost about one fifth of their teeth (the most sensitive lateral teeth would be the first to go); the remaining two thirds would be damaged by tooth decay. Every fourth damaged tooth showed severe erosion extending into the pulp (complication of caries). The prevalence of caries was conditioned by the social class a person belonged to. Representatives of the nobility used more protein foods, which were less cariogenic, and their teeth were less damaged. It is quite possible that noblemen took better care of their teeth. Therefore, a 40-year-old representative of the nobility would have lost only 5% of their teeth, 13% would be damaged by caries.

Even though surgical treatment (gold and lead dental fillings, dentures made from ivory or human teeth) had been practiced in Europe since the 16th century, no such cases have been found in the anthropological data of Lithuania.

Locked in a losing battle with caries

Compared to the present times, the localization of caries was different. In the Middle Ages the quality of food was poorer, it was much coarser, which is evidenced by the worse wear of teeth. Due to coarse food and rapid wear most cavities are found not on the chewing but on the interdental surfaces of teeth and in the tooth neck. The teeth wear among noblemen, who used softer food of better quality, was lower than that among ordinary people.

The state of teeth in males and females was similar; more pronounced sex-related differences in dental diseases were observed only in several mediaeval communities. For example, women buried in the Trakai churchyard had more caries-damaged teeth, they had lost more teeth before death and their teeth were more worn out than those of men‘s. These differences could have been caused by their different eating habits (it is believed that women used more low quality vegetable food). Another possible cause could have been physiological characteristics: due to hormonal changes and the loss of calcium during pregnancy and menopause the bone tissue thins faster in women, which increases the risk of loss of teeth.

“Gain a child, lose a tooth” was a popular saying in medieval Europe.

Žydrūnė Miliauskienė