DENTISTS, DENTISTRY AND DENTAL DISEASES IN ANCIENT EGYPT by CASPARUS JOHANNES GREEFF Submitted in accordance with the requirements for the degree of MASTER OF ARTS in the subject ANCIENT AND NEAR EASTERN STUDIES at the UNIVERSITY OF SOUTH AFRICA SUPERVISOR: PROFESSOR P S VERMAAK JULY 2013 DEDICATION I wish to dedicate this work to special people who have been instrumental in making my life what it is today and who are no longer with me. In loving memory then to: My mother (1920- 1962) who instilled love in me; My father (1910-1999) who instilled the love of books in me which ultimately also became my life; My only sister Marié (1939-2010) who showed me what a life of pure altruism is; My only son Willem (1976-2003) whose untimely death underlined the transience of life. I miss them all and I so wish them to have shared some special moments of my life with me, but alas, too late. To the living: I dedicate this dissertation to my three daughters (Tanya, Brittani & Romi) whose respect and unrelenting love I humbly relish. To three grandchildren (JP, Demi & Alexa-Jade) who are God’s gift to the elder: it will be the coolest thing ever if I could inspire them to ever explore the deep well of unconscious cerebration (Henry James 1843 - 1916). Lastly, I take pleasure to also dedicate this work to my previous promoters; Professors W S Boshoff and M le Roux, who squarely put me on the endless road of acquiring knowledge – the more you know, the more you know how little you know. I am most grateful to you. Casper Greeff i DECLARATION Student number: 34587950 I, CASPARUS JOHANNES GREEFF, declare that ‘DENTISTS, DENTISTRY AND DENTAL DISEASES IN ANCIENT EGYPT’ is my own work and that all the sources that I have used or quoted have been indicated and acknowledged by means of complete references. …………………...................... ………………………….. DR CJ GREEFF DATE ii ACKNOWLEDGEMENTS There are many people who have been a pillar of support throughout the research into this dissertation. I am first and foremost indebted to my supervisor, Professor Fanie Vermaak for his endless kindness, patience, professional guidance and academic expertise. My sincerest appreciation to Ms E Nell, my subject librarian, who proved to be a veritable Sherlock Holmes when it came to tracking down publications. She has again established herself as the very best there can be in the field. To the good lady, Ms Van Vuuren, receptionist to the professor, my heartfelt appreciation for always being friendly and who was a great help in the final editing of my dissertation. Other VIP people in my life and who were of great help making my dissertation what it is today are Ms Samantha Vetter (for language editing, all the way from Florida, USA), Adri Clayton as my IT specialist par excellence and friend and Stefaans Coetzee for his practical support. This dissertation has been made possible by the Meintjes family who have for many years been my financial supporters, to you all; I am most grateful. Last, but certainly not least, to my three daughters, Tanya, Brittani and Romi, who supported me with all the love I need to make every day special. Casper Greeff iii ABSTRACT Ancient Egyptian dentists come into the spotlight in this dissertation. While some scholars doubt their existence, it is indisputably shown that not only did they exist as a profession, but evidence is offered as to the various diagnoses and treatments they rendered. The Ebers medical papyrus together with other ancient similar medical ‘textbooks’ are analysed and prescriptions dealing with dental maladies are presented. Dentistry as a profession is elucidated in all its facets: diagnosing and treating dental diseases; prevention and care; and restorative and surgical treatment. This dissertation discusses dental anthropology as a vital part of bioarchaeology, which is the study of human remains in archaeological contexts in ancient Egypt. Dental enamel is the hardest material in the human body, and teeth are often preserved even when bones are not. Teeth are one of the most informative parts of the human body, and are incredibly well preserved archaeologically. Teeth provide insight into numerous issues that palaeodemography and historians are concerned with, including diet changes, general stress, how closely groups were related, and markers of social identity. Key terms: ancient Egyptian dentists, dentistry, medical papyri, dental diseases, dental wear. iv TABLE OF CONTENTS DEDICATION i DECLARATION ii ACKNOWLEDGEMENTS iii ABSTRACT iv TABLE OF CONTENTS v LIST OF TABLES xi LIST OF FIGURES xii GLOSSARY OF DENTAL AND MEDICAL TERMS xiv CHAPTER 1 1 INTRODUCTION 1 1.1 BACKGROUND 1 1.2 RESEARCH QUESTIONS 3 1.3 HYPOTHESIS 3 1.4 SOURCES 4 1.4.1 Primary literary sources 4 1.4.2 Secondary literary sources 7 v 1.5 METHODOLOGY 7 1.6 OUTLINE OF DISSERTATION 9 CHAPTER 2 12 PALAEODONTOLOGY – MACROMORPHOLOGY OF TEETH 12 2.1 INTRODUCTORY REMARKS 12 2.2 TEETH AS ARCHAEOLOGICAL ARTEFACTS 13 2.2.1 Palaeopathology versus palaeodontology 18 2.2.2 History of palaeodontology in ancient Egypt 19 2.2.3 The rationale of palaeodontology 21 2.3 TOOTH MACROMORPHOLOGY 23 2.3.1 The primary dentition 24 2.3.2 The intermediate dentition 24 2.3.3 The permanent dentition 25 2.3.4 The tooth numbering system 26 2.4 TOOTH HISTOLOGY 27 2.4.1 Enamel 28 2.4.2 Dentine and the dental pulp 29 2.4.3 Cementum and the periodontal ligament 30 2.5 DENTAL DISEASES IN GENERAL 31 2.5.1 Dental caries 31 2.5.2 Dental wear 32 2.5.3 Dental abscess 33 2.5.4 Calculus 34 2.5.5 Periodontal disease 35 2.5.6 Enamel hypoplasia 36 2.5.7 Other dental enamel maladies and associated diseases 37 2.6 DENTAL PALAEOBIOCHEMISTRY 38 2.7 CONCLUSION 39 CHAPTER 3 42 DENTISTS AND DENTISTRY IN ANCIENT EGYPT 42 3.1 INTRODUCTORY REMARKS 42 3.1.1 The sources 43 vi 3.2 PHYSICIANS AND DENTISTS IN ANCIENT EGYPT 43 3.2.1 Imhotep, the first physician 50 3.2.2 Hesi-re, the first dentist 52 3.2.3 Other references to dentists in Egyptian palaeography 54 3.3 CONFIRMATION OF DENTAL PRACTICES 55 3.3.1 Physical evidence of dentistry in ancient Egypt 56 3.3.2 Prosthodontic evidence of dentistry in ancient Egypt 59 3.3.3 Surgical procedures in ancient Egypt 62 3.4 THE MEDICAL PAPYRI 66 3.4.1 Background to the Medical Papyri 66 3.4.2 The hieratic medical papyri of the New Kingdom 67 3.4.3 Ebers papyrus 68 3.4.4 The Secondary medical papyri mentioning teeth 79 3.5 CONCLUSION 84 CHAPTER 4 108 DENTAL DISEASES IN ANCIENT EGYPT 87 4.1 INTRODUCTORY REMARKS 87 4.2 DENTAL DISEASES IN ANCIENT EGYPT 88 4.2.1 Caries in ancient Egypt 89 4.2.1.1 The tooth-worm 92 4.2.1.2 Aetiology of caries 94 4.2.2 Periodontal disease in ancient Egypt 95 4.2.3 Hypoplasia and other insults to amelogenesis in ancient Egypt 96 4.2.4 Dental wear in ancient Egypt 103 4.2.4.1 General remarks on dental wear in Egypt 103 4.2.4.2 The rationale of dental wear 107 4.2.4.3 Diet and dental wear 107 4.2.4.4 Estimation of age and dental wear 108 4.2.4.5 Dental wear in ancient Egypt 112 4.2.4.6 Positive attributes of dental wear 113 4.2.4.7 The temporomandibular joint and dental wear 113 vii 4.2.4.8 The effects of dental wear and the significance thereof 115 4.2.5 Aches and pain of the oral cavity in ancient Egypt 116 4.2.6 Oral hygiene and preventative dentistry in ancient Egypt 123 4.2.7 Diet and dental disease in ancient Egypt 126 4.2.7.1 Diet of the ancient Egyptians 128 4.2.7.2 Bread as staple food in ancient Egypt 132 4.2 CONCLUSION 135 CHAPTER 5 138 TEETH AND PALAEODEMOGRAPHY IN ANCIENT EGYPT 138 5.1 INTRODUCTORY REMARKS 138 5.1.1 Palaeodemography of ancient Egypt 140 5.1.1.1 The racial history of ancient Egypt 142 5.1.1.2 Age determination and teeth 143 5.1.1.3 The mandible as indicator of age 146 5.1.1.4 Racemisation of aspartic acid in dentine as an indicator of age 146 5.1.1.5 Tooth root colour as indicator of age 147 5.1.1.6 Cementum annulation as indicator of age 147 5.1.3 Sex determination from oral structures 147 5.1.2.1 Mandibular ramus flexure in sexual dimorphism 148 5.1.3.2 Tooth size in sexual dimorphism 148 5.1.2.3 Using DNA in sexual dimorphism 149 5.2 METRICAL ANALYSIS OF THE PERMANENT DENTITION 149 5.3 NON-METRICAL DENTAL VARIATIONS 150 5.3.1 The rationale of non-metrical dental trait data 151 5.4 THE VALUE AND USES OF PALAEORADIOLOGY 153 5.5 CONCLUSION 159 CHAPTER 6 162 CONCLUSION 162 6.1 INTRODUCTION 162 6.2 RESEARCH OVERVIEW 162 viii 6.3 ON ACHIEVING THE GOAL OF THIS RESEARCH 166 6.3.1 A dental profession in existence in ancient Egypt 166 6.3.2 Resource material availability 167 6.3.3 The extent of dental diseases in ancient Egypt 168 6.3.4 Restorative and surgical procedures in ancient Egypt 169 6.3.5 Primitive medical and dental disciplines 169 6.4 THE SIGNIFICANCE OF THIS STUDY 171 6.5 FUTURE RESEARCH QUESTIONS 172 APPENDIX I COMPARISON BETWEEN MEDICAL PAPYRI 174 APPENDIX II TIMELINE 175 APPENDIX III DENTAL DEVELOPMENT CHARTS 178 APPENDIX IV STATISTICAL INFORMATION RE DENTAL DISEASES 180 BIBLIOGRAPHY 183 ix LIST OF TABLES Page Table 1: Life expectancy table for populations 111 Table 2: Comparison of medical papyri 174 Table 3: Chronology of ancient Egypt 175 Table 4: Dental development charts 178 Table 5: Frequencies of dental caries 180 Table 6: Teeth present 181 Table 7: Dental wear 181 Table 8: Caries and consequent pathology 181 Table 9: Periodontal and alveolar conditions 182 Table 10: Absence and impactions 182 Table 11: Osteopathology and impaction 182 x LIST OF FIGURES Page Figure 1: Depiction of ancient Egyptian dentist at work (anon 2012:1) v Figure 2: The discovery of the missing body of Queen Hatshepsut 17