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Teeth in the medieval period were perhaps not as bad as Hollywood would have us believe. Brushes used for the specific cleansing of the teeth appear to be unknown although sticks for picking at food left between the teeth were widely used. Teeth still broke, got cavities and ulcers but decay from refined, processed sugars were significantly less than today.

Breath freshener
Ladies who were troubled with bad breath were advised to employ the use of anise, fennell and cinnamon as remedies. To chew on the leaves should alleviate the situation much in the same way that parsley is served on our plates today- not just a garnish, but also to remove any bad breath caused by odorous foods.

Whole bruised cloves syzygium aromaticum, shown at right, held in the mouth also sweetened the breath. Mouthwashes of vinegar along with various powders and the leaves of the mallow plant were employed to keep the breath sweet.

Other remedies include gargling birch and mint soaked in wine and rubbing the gums with a strong linen cloth until they bleed. Sage with rosemary and mallow is suggested to help with soreness of the mouth and along with salt and vinegar to ward off mouth cancer.

Hildegarde von Bingham, 1158, recommends this mouthwash and breath freshener-

One who wishes to have hard, healthy teeth should take pure, cold water into his mouth in the morning, when he gets out of bed. He should hold it for a little while in his mouth so that the mucus around his teeth become soft, and so this water might wash his teeth. If he does this often, the mucus around his teeth will not increase, and his teeth will remain healthy. Since the mucus adheres to the teeth during sleep, when the person rises from sleep he should clean them with cold water, which cleans teeth better than warm water. Warm water makes them more fragile.

Tooth whitening
Many herbal preparations were used to cleanse the teeth and preserve whiteness. The ashes of the burnt vine-tree or grapevine were thought to make teeth that are as black as coal to be as white as snow if you rub them every morning.

Trotula de Ruggiero, a woman physician from the 11th century, wrote in De Ornatu Mulierum (About Women’s Cosmetics)-

The teeth are whitened thus. Take burnt white marble and burnt date pits and white natron, a red tile, salt, and pumice. From all of these make a powder in which damp wool has been wrapped in a fine linen cloth. Rub the teeth inside and out.

The woman should wash her mouth after dinner with very good wine. Then she ought to dry very well and wipe with a new white cloth. Finally, let her chew each day fennel or lovage or parsley, which is better to chew because it gives off a good smell and cleans good gums and makes the teeth very white.

Other recipes for teeth whitening include herb elecampane inula helenium to scrub the teeth, or making a powder of sage leaves and salt.

A prescription for a tooth powder follows:

equal parts of cuttle bone, small white seashells, pumice stone, burnt stag's horn, nitre, alum, rock salt, burnt roots of iris, aristolochia, and reeds. All of these substances should be carefully reduced to powder and then mixed.

Toothache remedies
Toothache was seen as a punishment from God for the sufferers ill-doings or caused by worms burrowing into the gums and teeth. Roger Frugard's treatise, which was written in latin in Italy around 1180AD, suggests cauterising the skin behind the ears before heating henbane Hyoscyamus niger and leek seeds over hot coals and ensuring the patient inhales the smoke through a funnel.

As late as 1314, praying to St Apollonia on her feast day of February 9th was still recommended as a cure.

Welsh sources indicate the use of nightshade, Solanum nigrum , shown at right, although not in what form. Pellitory, anacyclus pyrethum was also used against bad breath, toothache and caries, as were opium, papaver somniferum and oil of cloves caryophyllus aromaticus.

A marginal note in the Lebar Brecc from the Revue Celtique V, edited and translated by Whitley Stokes gives us this prayer to heal his toothache:

Ordu Thomais togaide i toeb Crist cen chinaid
ron-ícca mo déta cen guba ar chruma is ar idhain.
(translation: May the thumb of chosen Thomas in the side of guiltless Christ
heal my teeth without lamentation)

Tooth decay
The lack of refined sugars that we know today assisted in less instances of tooth decay, although poor nutrition caused its own set of problems. It was believed that a decoction of the husks of Cayenne Pepper or Guinea Pepper made with water preserved the teeth from rottenness and the ashes of them being rubbed on the teeth will cleanse them and make them look white.

The blackened teeth we popularly see in movies when the middle ages are portrayed, is a product of Victorian imaginations, whose excessive sugar consumption caused tooth decay. Cooking in the middle ages used only a little sugar, like a spice. Honey was used as a sweetener, and clean teeth were valued over rotten ones.

There are records of acid being employed to pour into painful tooth cavities which destroyed the nerve endings and alleviated the pain but did nothing to re-enforce the tooth shell.

Material used for early fillings include sulphur, camphor, beeswax, arsenic, gall nuts, pig grease and myrrh.

Dentistry
For the lay populace dentistry was quite rudimentary and often extractions were performed by itinerants who traveled from town to town. One advises:

Take some newts, by some called lizards, and those nasty beetles which are found in fens during the summer time, calcine them in an iron pot and make a powder thereof. Wet the forefinger of the right hand, insert it in the powder, and apply it to the tooth frequently, refraining from spitting it off, when the tooth will fall away without pain. It is proven.

The wealthy often were afforded better and more specialised dental care. During the Middle Ages, a sponge with White Poppy papever somniferum juice, mandrake, hemlock and ivy was used as a form of anesthetic and it is possible that this was used by dentists.

Post extraction bleeding and infection often caused problems. The image at right is a detail from a French illumination from 1470 showing a tooth extraction.

Roger Frugard's text discusses oral cancer and recommends that in the acute stages it can be cured by cutting into the normal flesh around the cancer, cauterizing the wound and then sealing it with egg yolk before washing it with wine. After three days the wound should be rubbed with alum before applying a lotion made from wine and honey and infused with the roots of the herb Mullein, Honeysuckle, Pomegranate and Ginger.

Guy de Chauliac's text lists the items which a dentist should have. They include:

mouth washes, gargles, masticatories, anointments, rubbings, fumigations, cauterizations, fillings, filings, and the various manual operations and must be provided with the appropriate instruments: scrapers, rasps, straight and curved spatumina, elevators, simple and with two branches, small sealpels, tooth trephines, files, toothed tenacula, and many probes.

He recognized the presence of tartar which he called hardened limosity or limyness. He suggested the use of rasps and spatumina as a means of manually removing the tartar.

Dentures
Guy de Chauliac refers to false teeth made from 'oþer menis teeþ or of a kowes bone', the bones of a cow. If teeth loosen, he advises they be fastened to healthy ones with a gold chain. If the teeth fall out, they may be replaced by the teeth of another person or with artificial teeth made from oxbone, which may be fixed in place by a fine metal ligature. He says that such teeth may be serviceable for a long while.

Paul B Newman, author of Daily Life In The Middle Ages claims that gold caps were used as early as the 15th century.

A paper published in the British Dental Journal shows that some 12-14th century literature makes reference to creating false teeth.

A lecture given to the PHS in May 1993 by Dr David Brown, Head of the Department of Dental Materials Science, U.M.D.S. Dental School, Guys Hospital, London stated that:

Historically, a range of materials has been used for denture bases, including stone, wood, shell, bone, horn, ivory and metal. The Romans used bone and ivory (from the hippopotamus) including natural teeth in the dentures then subsequently ivory and later porcelain teeth. There appear to be no records of this technology being used in the middle ages however, so it is unknown whether these methods were known and employed or otherwise.

Johanues Arculanus, a professor of medicine and surgery at Bologna from 1412 to 1427 is the first we know who mentions the filling of teeth with gold.

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