The ancient Egyptians were very comfortable with and knowledgeable about the human body. The ancient inhabitants of Egypt suffered from dental diseases just like us. The diet was full of fibers and raw vegetables. Besides, poor dental hygiene caused various oral diseases, including periodontitis and caries. They tried to treat these diseases by medical practices far transcended their time as the Egyptians were skilled and resourceful doctors. Dental surgery was invented and actively exploited medicines offered by nature. As old as when some of the first pyramids were built the first evidence of dentistry was found. Written Surgical Papyrus of The Edwin Smith had been found before 3000 B.C. instructions on how to heal and treat wounds in the mouth was given. They had started with Minor dental work performance, and slowly over time, it grows to be more complex procedures. The aim of this paper is focused on reviewing the role and creativity of ancient Egypt in the field of dentistry and dental surgery and dissecting the current clues on these queries of the presence of the dental profession in ancient Egypt.

Material and Methods: Databases of PubMed, Embase, and Cochrane Library were searched for literature published before March 2021. This narrative review was created from conscious dissection of different data obtained from the related articles. Careful categorical writing was done in an easy simple manner.

Keywords: Dentistry; Ancient Egypt; History of Dentistry; Dental Instruments

Ever since two teeth connected by gold wire was discovered by the Egyptologist Hermann Junker in an Egyptian tomb in 1914, was there a dedicated dental profession in ancient Egypt?, This topic has been debated by both dentists alike and Egyptologists, and even today the literature would seem to indicate that no clear consensus exists. it is mandatory to dissect the current clues on these queries from resources such as hieroglyphic inscriptions, ancient writings, various medical papyri, and other miscellaneous references to give satisfying answers [1].

Translation of hieroglyphic inscriptions found in tombs throughout Egypt revealed the occupation of the dead person, which was a medical or dental title. Hesyre, was not only chief of dentists but also chief of physicians as well as holding a number of other religious and secular titles, who lived about 2660 BC [Figure 1]. Also, Nyanksekhmet who was also a ‘chief of physicians’, and Khuwy who was the elder of the physicians of the palace, was also a dentist as well as specializing in gastrointestinal complaints. Whether these multiple titles indicated that the individual was engaged in several specialties or that the titles were perhaps administrative or ceremonial is unclear, but overall they do suggest a need for dental care [1].

Six exquisitely carved wooden panels discovered in Hesyre's tomb at Saqqara near modern-day Cairo are generally considered to be the finest wood artifacts passed down from him not only in Egypt but around the world [Figure 1].

Figure 1: Hesyre. Excavations at Saqqara - Quibell (1913).

Instruments

One difficulty in the identification of any such instruments is that they were never engraved with their purpose, so no instruments so far were excavated which can be considered to have been used for dental purposes. A large scene inscribed on one of the walls of the temple of Kom-Ombo, it has been suggested which may show dental instruments are. A collection of nearly 40 surgical instruments, with different interpretations, were suggested but, many of the items shown are contemporary to numerous well-authenticated depictions of Roman and Greek surgical instruments. it was suggested that there are representations of dental forceps depicted. However, it may be related to medicine as originating from Alexandria rather than ancient Egyptian medicine [2].

One difficulty in the identification of any such instruments is that they were never engraved with their purpose, so no instruments so far were excavated which can be considered to have been used for dental purposes. A large scene inscribed on one of the walls of the temple of Kom-Ombo, it has been suggested which may show dental instruments are. A collection of nearly 40 surgical instruments, with different interpretations, were suggested but, many of the items shown are contemporary to numerous well-authenticated depictions of Roman and Greek surgical instruments. it was suggested that there are representations of dental forceps depicted. However, it may be related to medicine as originating from Alexandria rather than ancient Egyptian medicine [2].

Many ancient authors described the illustrious position in which Egyptian medicine was achieved in the ancient world [1]. Herodotus, a Greek historian, and traveler, who visited Egypt in about 440 BC, and later wrote an account of the country and its history described specialization in the medical profession:

Herodotus, a Greek historian, and traveler, who visited Egypt in about 440 BC, and later wrote an account of the country and its history, described specialization in the medical profession:

'They divided up the practice of medicine into separate parts, each doctor focusing on one disease at a time. There are, in consequence, innumerable doctors, some specializing in diseases of the eye, others of the head, others of the teeth, others of the stomach, and so on' [3].

In ancient Egypt the specialization was necessary, and it does imply that some form of dental care did exist.

From the tens of thousands of remains that have been examined from the entire 3,000-year period of Dynastic Egypt the evidence is limited, as it is in the Ancient Egyptian mummified and skeletal remains provide a point of reference for determining whether or not operative dental surgery occurred. However, a surgical approach for the treatment of abscesses dental is claimed to have been adopted, three cases of possible prosthetic work, and extraction may have occurred. This evidence proves the existence of an operative dental profession [4].

It was first raised by Hooton in 1917, Surgical treatment of dental abscesses was proved following his visual and radiographic study of an ancient Egyptian mandible, dating to about 2,500 BC. Considerable wear, with the lower right first molar having a pulpal exposure and an associated apical infection was observed in the teeth of the mandible. Two small holes were noted by Hooton penetrating the outer cortical plate above the mental foramen and in the direction of the anterior root of this tooth. Those holes, he asserted, were the result of man-made drillings performed to drain pus from the apical abscess because of their upward angulation, artificial symmetry, and thickness of bone transversed. Breasted, an Egyptologist later supported this view and suggested that they could have been created by a bronze instrument in a bow drill [5].

From ancient Egypt, the best-known example Of the so-called 'prosthetic appliances' consists of a mandibular second molar connected by gold wire to a worn third molar [Figure.2]. At Giza, near Cairo in a burial shaft, it was discovered and dating to approximately 2,500 BC and importantly not found attached to a skull. Judging by the color and anatomic form of the teeth they belonged to the same individual was established. As the roots of the third molar were very absorbed, due to a probable inflammatory process, the tooth had become mobile, and so atrial to stabilize it and had been attached to its neighboring tooth [6].

Figure 2: 'Giza bridge'. Courtesy of ©Roemer- und Pelizaeus-Museum, Hildesheim.

Overall, the indication would seem to be that the appliance was present during the lifetime of the individual, and the possible explanation could be that it was present into the mummified body in an attempt to make the body whole for the afterlife, a practice common in ancient Egypt. The teeth could have been worn as an amulet, with the owner perhaps hoping that they would afford some form of power or protection.

A second appliance was excavated at el-Quatta, near Cairo and again was not found in situ, similarly dated to about 2,500 BC, but retrieved from amongst the crushed bones of as kull. A double strand of gold wire was encircled around a maxillary right canine and finished in a knot on its distal surface [Figure 3 and 4]. Central and lateral incisors are connected by a gold wire, but at one time thought to have been attached to the right canine by a hooked wire, separate from the previous one. For the gold wire to pass through and around the clinical crown, the central incisor was drilled in a mesial- distal direction as well as a labial groove on the crown. In addition to wrapping gold wire around the lateral incisor, the roots of both teeth were scraped and polished to produce an artificial morphology [7].

Figure 3: 'el-Quatta Bridge'. Courtesy of Egyptian Museum, Cairo.

Figure 4: An example of teeth that had dental bridges.

The final appliance was excavated from Tura el-Asmant and was attached to a skull, the only one from ancient Egypt to be found in situ dating to the Greek (Ptolemaic) period of ancient Egypt (332-330 BC), and it was a bridge whose single pontic was a right maxillary central incisor. By a silver wire passing through two holes that had been drilled mesio-distally through the crown of the tooth, it was fixed into place whilst the exact means of connection to the adjacent teeth is unknown. There was no radiolucent area above the pontic, and the root was much shorter, which indicated that the tooth had been prepared outside of the body before insertion. The recontouring of the alveolar bone above the pontic also indicated that the tooth had been placed in situ after healing. The direction of the drill hole excluded the possibility of this procedure from being carried out in the mouth. The earliest one discovered from ancient Egypt dating to the Ptolemaic period would appear to be a true prosthetic device [8].

Extractions were performed in ancient Egypt as there is considerable evidence of ante-mortem loss of teeth; many of these teeth appear to have been periodontally involved and may therefore have been removed by simple digital pressure or displaced naturally. Simple elevation of a tooth by means of a primitive metal lever should be into consideration, and such a lever may well have been excavated in the past. Examinations of skeletal remains have led some workers to conclude that there were cases where extractions had been performed. This judgment was based on the inclination of the adjacent teeth, a consideration of the amount of space, and the contouring of the intervening alveolar bone in areas where there were missing teeth. There are many examples of periodontally involved teeth which could easily have been removed by finger manipulation or by means of a simple extraction procedure but have been left in situ. These extractions performed would undoubtedly have resulted in considerable pain relief. the sophistication of the ancient Egyptian civilization and their extensive knowledge of medicine and surgery should be considered [9].

The medical papyri are the written records of medical procedures and treatments that were handed down to us from ancient Egypt, and although they must be viewed with caution, they provide us with much important information as regards dentistry. Of the 12 papyri which were regarded as medical texts, four (Ebers, Kahun, Berlin, and Hearst) include prescriptions for the treatment of dental problems and a fifth papyrus (Edwin Smith) does provide instructions for dealing with fractures and dislocations of the maxillary and mandible regions. Only therapeutic remedies are recommended, and importantly there is no reference to any type of prosthetic, conservative, or surgical form of treatment.

As some of the components of the various prescriptions are unknown to us, and there are translational uncertainties in the identification of others, it may be uncertain to judge the effectiveness of a particular pharmaceutical remedy. Seven, of the approximately 18 cases in the papyri relating to prescriptions for disorders of the teeth and oral cavity, are for remedies to prevent tooth loss by packing various materials in paste form around the tooth and the surrounding gums. It seems to have been that these would harden and serve as a temporary means of stabilizing teeth that were mobile, presumably due to periodontal disease. [1] These seven remedies use words such as 'make strong', 'set in place', 'if it wants to falls to the ground' - all these wordings seem to imply a mobile tooth, and are fairly similar. a prescription for example in PapyrusEbers739 [8,10].

Extractions were performed in ancient Egypt as there is considerable evidence of ante-mortem loss of teeth; many of these teeth appear to have been periodontally involved and may therefore have been removed by simple digital pressure or displaced naturally. Simple elevation of a tooth by means of a primitive metal lever should be into consideration, and such a lever may well have been excavated in the past. Examinations of skeletal remains have led some workers to conclude that there were cases where extractions had been performed. This judgment was based on the inclination of the adjacent teeth, a consideration of the amount of space, and the contouring of the intervening alveolar bone in areas where there were missing teeth. There are many examples of periodontally involved teeth which could easily have been removed by finger manipulation or by means of a simple extraction procedure but have been left in situ. These extractions performed would undoubtedly have resulted in considerable pain relief. the sophistication of the ancient Egyptian civilization and their extensive knowledge of medicine and surgery should be considered [9].

'Beginning of the remedies to consolidate a tooth; Flour of emmer seeds; ochre; honey; made into a mass; and the tooth to be fattened therewith'.

Here the first constituent is emmer wheat, which was used non-selectively, whereas ochres are iron oxides which have mild astringent and antiseptic properties. Ochres have to be used by the Aboriginals and even still today are used medicinally by the Andaman tribes who live off the coast of Bengal. Honey is used in more Egyptian medicines than any other ingredient and because of its hypertonicity kills micro-organisms by drawing water out of them through osmosis, [9] and it would have to inhibit bacterial growth and helped reduce inflammation in infected mucosal and gingival areas.

The other prescriptions are similar in their supposed mode of action for the prevention of tooth loss and different types of material with which the teeth are packed. Examples of these being terebinth resin and malachite, both having antiseptic properties [11]. A few of the components have some medicinal value and may splint the mobile teeth and have temporarily relieved the painful symptoms, but for several others, their function is unknown. Importantly, only the symptoms of the disease process were being treated and not the source.

The second groups of prescriptions appear to be for treating various ulcers, gum infections, or abscesses. For example, a remedy is Ebers 742[10]:

'Another, for the treatment of a tooth that is eating in the opening of the flesh: cumin; terebinth; carob; to be made into a powder and applied to the teeth'.

It is uncertain what is meant by 'eating in the opening of the flesh' although it is often considered to be a dental abscess [8]. Looking at the components of the prescription, cumin is a carminative and has local anesthetic and antiseptic properties, whilst terebinth resin is an antiseptic as previously mentioned. Carob is a stabilizer and possesses astringent and demulsifying properties. So, such a material would be soothing and with astringent and antiseptic properties would provide some limited relief. Other constituents used in this type of prescription are sycamore fruit, gum, oil, celery as well as a number of materials yet to be identified. Among the various components used to treat the condition was willow which is present in three prescriptions dealing with oral pain. Willow bark contains salicin, a chemical similar to acetylsalicylic acid, therefore having both anti-inflammatory and analgesic effects [12].

Of great dental interest, the Edwin Smith papyrus is a well-written example of medical literature, being the earliest known treatise dealing with surgery. This papyrus lists 48 trauma cases and amongst them is one in which instructions are given for correcting a dislocated mandible. It is the earliest description of a surgical procedure still in use and is a clear logical approach differing little from the method that is practiced today.

'Instructions concerning the dislocation in his mandible: If you examine a man having a dislocation in his mandible [and] you find his mouth open [and] cannot close it for him, you should place your thumbs upon the ends of the two rami in the inside of this mouth [and] your two groups of fingers under his chin, and you should cause them to fall back so that they rest in their place.'

The Edwin Smith papyrus contains the first recorded use of absorbent lint made from vegetable fiber whilst splints and bandages are routinely used. The use of adhesive strips in dealing with wounds was described, and cases of complex suturing are detailed also. Surgery was known, understood, and practiced in ancient Egypt and some of this knowledge is still in use today [13].

Discussion of medical and dental practice in ancient Egypt could not be complete without considering the part that magic played in the various prescriptions in the papyri. For sure, the ancient Egyptians were intelligent observers and discovered empirically some effective drugs and rational healing methods, but magic undoubtedly had a part to play. 'Magical' and 'rational' treatments may be combined, in which case the two methodologies complement each other [14,18] .most of the dental prescriptions fitted into the rational scenario, with many of the components having a recognized pharmacological action. In spite of, the specific component is unknown it is possible that a magical element might play a role [18].

From them, little mention of dental diseases among the various popular literary texts handed down to us from ancient Egypt was delivered. In the many records of absenteeism kept by foremen at various building sites or workers villages, no records of absenteeism due to toothache can be found.no depictions of the ancient Egyptians experiencing toothache or receiving dental treatment in the various surviving wall paintings, certainly nothing comparable with late-medieval and the Byzantine illustrations showing teeth being extracted. Although, the papyrus Anastasi IV [15,17] refers to a worm as being the cause of a toothache. In this text an Egyptian official describes the suffering of a fellow scribe:

'A mns-scribe is here with me, every muscle of whose face twitches, the wStt-disease has developed in his eye and the fnt-worm into his tooth. I cannot leave him to his fate.'

Although the reference in the Anastasi IV papyrus is the only one suggesting it as being a cause of toothache, The worm is also referred to in the medical papyri as a disease agent, [1] the idea that a worm was responsible for dental disorders was widespread amongst other ancient cultures, however, the first documented case being a Sumerian text dating to about 5,000 BC. This belief continued throughout history and even as late as the eighteenth century an ivory carving of a tooth was produced showing inside it a tooth worm [15,16].

Among the earliest civilizations to practice care for the teeth was the ancient Egyptians. Dentists were considered very important health figures in ancient Egypt. They treated everything from loose teeth to surgical removals, using far more rudimentary methods than we have today but often utilizing themes we still hold onto. Any evidence that ancient Egyptian dentists routinely operated on patients is not supported by the available evidence. Almost all the dental treatment that appears to have been provided consisted of pharmaceutical preparations either applied to the gingiva and mucosa or used as a mouthwash. These remedies would not have retarded the progress of the dental disease, and at best may have only provided some short-term relief. Ancient Egyptians are known to have suffered from widespread dental disease, which the available treatments could have done very little to repair. The Egyptians, however, were very inventive and devised many practices and treatments, to treat their dental issues. Many of their earliest techniques helped shape the dental procedures still used today.

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