Medieval dental care was far more than desperate yanking of rotten teeth. Between roughly the fifth and fifteenth centuries, practitioners across Europe and the Islamic world developed herbal pain remedies, rudimentary fillings, tooth-cleaning powders, and even gold wire restorations, some of which have surprising echoes in modern dentistry. The picture that emerges from medical manuscripts, archaeological finds, and ancient DNA is one of pragmatic ingenuity working within a flawed but internally consistent theory of disease.
The Tooth-Worm and How Medieval People Understood Decay
For most of the medieval period, the dominant explanation for toothache was the “tooth-worm,” a tiny creature believed to gnaw through enamel and irritate the nerve. The idea was not uniquely European; it appeared across cultures and centuries, from ancient Mesopotamian texts onward. The gnawing worm was held responsible for caries-related pain in particular, and many treatments were designed around the goal of killing, smoking out, or trapping the worm.1PubMed. The tooth-worm: historical aspects of a popular medical belief This framework shaped everything from the herbs chosen for poultices to the rituals performed alongside them. A practitioner might pack henbane seeds onto a hot coal near an aching tooth, then hold a bowl of water beneath the patient’s chin to “catch” the worms as they supposedly fled the smoke.
The tooth-worm theory persisted so long partly because it was unfalsifiable in a pre-microscopic world. A cavity looks eaten. Patients who received treatments sometimes improved, which was taken as proof the worm had been expelled. It was not until the eighteenth and nineteenth centuries that the germ theory of disease and microscopic observation of oral bacteria finally displaced the worm for good. But the treatments built around the theory were not all useless: many herbal remedies chosen to “kill the worm” happened to contain genuinely analgesic or antimicrobial compounds, a coincidence modern pharmacology has begun to confirm.
Herbal Remedies That Actually Worked
Medieval medical writers across traditions compiled extensive lists of plant-based treatments for toothache and oral disease. In the Islamic medical tradition, the Persian physician Avicenna catalogued dozens of botanical remedies in his Canon of Medicine. Modern laboratory testing has shown that many of the plants he recommended do possess real anti-inflammatory, analgesic, and antimicrobial properties, along with the ability to inhibit the bacterial biofilms that cause plaque and gingivitis.2Journal of Reports in Pharmaceutical Sciences. A Review on the Medicinal Plants for the Management of Toothache in Avicenna’s Canon of Medicine Clove oil, which contains eugenol, is the best-known survivor of this tradition and remains a staple in emergency dental kits today. But clove was only one ingredient in a much larger pharmacopoeia that included myrrh, pepper, camphor, and various resins.
English medical texts from the twelfth through fourteenth centuries similarly leaned heavily on herbal cures. Remedies for toothache and the tooth-worm were based on plant preparations applied as poultices, rinses, or pastes packed directly into cavities.3British Dental Journal. Dental treatment in Medieval England Broader research into medieval recipe books has found that ingredient choices were not random. When researchers screened selected ingredients from a medieval medical text for antimicrobial activity, they found that some ingredients potentiated each other’s effects while others interfered, suggesting the recipe writers had arrived at functional combinations through trial and observation over generations.4ASM Journals / mBio. Data Mining a Medieval Medical Text Reveals Patterns in Ingredient Choice That Reflect Biological Activity against Infectious Agents
This line of investigation has practical implications. One modern research team drew explicitly on medieval and early modern medicinal knowledge to develop a fully herbal mouthwash, testing it against common oral bacteria and even SARS-CoV-2.5PubMed Central. Development of a novel, entirely herbal-based mouthwash effective against common oral bacteria and SARS-CoV-2 The project reflects a broader trend in which researchers mine historical texts not for quaint curiosities but for leads on plant compounds that might form the basis of eco-friendly oral care products.
Pain Management Before Modern Anesthesia
If you needed a tooth pulled or an abscess lanced in the medieval period, pain control was a real and recognized problem. The most sophisticated approach was the soporific sponge, a sea sponge soaked in the juices of sedative plants and held under the patient’s nose before surgery. Mandrake root was the key ingredient. Medical writers including Isidore of Seville, Theodoric of Cervia, Gilbertus Anglicus, and William of Varignana all described researches on sponges soaked with mandrake juice, used as a sedative tool before surgical interventions.6PubMed. From “Circe’s Root” to “Spongia Soporifera”: The Role of the Mandrake as True Anesthetic of Ancient Times Mandrake contains tropane alkaloids, which genuinely produce sedation and analgesia, though the dosing was imprecise and the line between effective sedation and dangerous poisoning was thin.
For less dramatic pain, practitioners relied on topical remedies applied directly to the tooth or gum. Opium-based preparations circulated in some contexts, while alcohol served as an ever-present alternative. Bloodletting was also advised for certain types of toothache, following the humoral medical logic that pain resulted from an excess of blood or other fluids pooling near the affected area.3British Dental Journal. Dental treatment in Medieval England To a modern reader this sounds counterproductive, but lancing a swollen gum abscess does relieve pressure and pain, so bloodletting in the mouth area could occasionally have had a real therapeutic effect, even if the underlying theory was wrong.
Charms, Prayers, and the Boundary Between Medicine and Magic
Medieval dental care did not draw a clean line between physical treatment and spiritual intervention. Charms and spoken prayers were a standard part of the practitioner’s toolkit, and not only among folk healers. Four academically trained English medical writers, Gilbertus Anglicus, John Gaddesden, John Arderne, and Thomas Fayreford, all recorded verbal therapies in their medical texts, treating them as legitimate forms of treatment grounded in the scholastic medical framework of the time.7Oxford Academic. Charms and Prayers in Medieval Medical Theory and Practice Amulets were another common prescription for toothache. A patient might be told to carry a specific stone, herb, or inscribed token to ward off the tooth-worm.
This blending of the physical and the verbal feels alien to modern readers, but it made internal sense within a medical system that saw disease as influenced by cosmic, spiritual, and bodily forces simultaneously. A charm recited over a poultice was not understood as superstition layered onto medicine; it was part of the medicine. The distinction between “real” and “magical” treatment is a modern imposition on a system that did not recognize the boundary.
Who Performed Medieval Dental Work
There was no dedicated “dentist” profession for most of the medieval period. Dental care was split among several overlapping groups. University-trained physicians might advise on toothache remedies but rarely performed manual procedures. Barber-surgeons handled extractions alongside haircuts and minor surgery. Itinerant tooth-pullers worked fairs and markets, often with dramatic showmanship to attract customers. And monasteries, which housed much of the era’s medical knowledge, provided care to their communities as well.
By the later medieval period, some regulation had emerged. In England, the cost of professional medicine was high enough that patients and communities pushed for accountability. Swindlers who posed as physicians without real credentials faced legal consequences. One well-documented case from 1382 involved Roger Clerk of Wandsworth, indicted before the mayor’s court of London for practicing medicine fraudulently.8Florilegium. Medicine on Trial: Regulating the Health Professions in Later Medieval England Cases like Clerk’s reveal that medieval society was not as credulous as stereotypes suggest. People wanted competent care and were willing to use the legal system to punish those who failed to provide it.
Extraction Instruments and Surgical Techniques
When a tooth had to come out, the instruments available were crude by modern standards but showed a clear evolutionary logic. Archaeological collections include elevators (used to loosen teeth in the socket), pelicans (a claw-like lever named for its resemblance to a bird’s beak), dental keys (which gripped and twisted the tooth), forceps, and pincers. These instruments were produced by unidentified makers and, later, known firms, and they demonstrate a progression from simple designs toward tools recognizable as ancestors of modern extraction instruments.9PubMed Central. Some early dental extraction instruments including the pelican, bird or axe? The naming conventions are revealing: instruments were named for their method of use or for the everyday objects and animals they resembled, which gives a sense of how practitioners and patients visualized these tools.
Beyond extraction, English medical texts document attempts at surgical intervention for oral cancer and facial fractures, suggesting that oral surgery, while limited, was not confined to tooth-pulling.3British Dental Journal. Dental treatment in Medieval England Cautery, the application of a heated instrument to tissue, was used to treat abscesses and stop bleeding. It was painful and carried infection risk, but in the absence of antibiotics, searing a wound shut was sometimes the most effective way to prevent it from festering.
Fillings, Gold Wire, and Cosmetic Dentistry
Medieval dentistry was not purely about pain relief and extraction. There is documentary evidence for powders used to clean teeth, and for attempts at filling carious cavities with various materials.3British Dental Journal. Dental treatment in Medieval England These early fillings were not the durable restorations we know today, but they represent a conceptual leap: the idea that a damaged tooth could be repaired rather than simply removed.
Some wealthier patients received more sophisticated work. An archaeological find from early modern Scotland provides direct physical evidence of a gold wire ligature used to stabilize teeth. Analysis using electron microscopy revealed the wire was an alloy of roughly 82% gold, 10% silver, and 2.5% copper, which would be classified as 20-carat gold.10Nature (British Dental Journal). Restorative dentistry in Early Modern Scotland: archaeological evidence of the use of a gold ligature Gold was chosen for the same reasons it remained a dental material into the twentieth century: it is biocompatible, resistant to corrosion in the mouth, and malleable enough to shape precisely. The Scottish find dates to the early modern period rather than the deep medieval era, but it sits at the end of a long tradition of using precious metals in oral restoration that stretches back to Etruscan and Roman goldwork.
Diet, Sugar, and Social Class
One of the biggest differences between medieval and modern mouths is diet. Before refined sugar became widely available, the carbohydrates people consumed were mostly complex starches from grains. Cavities still occurred, but at much lower rates than today. Bioarchaeological evidence from early medieval Ireland shows a population whose diet was rich in carbohydrates with only occasional meat consumption. Women in these populations tended to show more dental disease than men, suggesting different nutritional patterns, with women consuming more carbohydrate-heavy foods.11PubMed. Dental health and diet in early medieval Ireland
Social status shaped oral health in ways that sometimes defied simple expectations. In early medieval Switzerland, researchers found that caries rates were generally low across the population, and grave status, a proxy for wealth, did not significantly influence decay rates.12Journal of Archaeological Science: Reports. Social status and oral health in early medieval Switzerland: The case of the Baar-Früebergstrasse site (Canton Zug, Switzerland) In other words, when refined sugar was absent from everyone’s diet, rich and poor mouths looked broadly similar. The picture changed dramatically where sugar became available. In medieval southern Spain, where sugarcane cultivation was introduced under Islamic rule, caries rates climbed, and the effect tracked social class. Sugarcane was initially consumed mainly by elites, but its use became relatively widespread during the Nasrid Kingdom period, and caries rates rose accordingly, higher in populations with greater access to sugar.13International Journal of Osteoarchaeology. Introduction of sugarcane in Al‐Andalus (Medieval Spain) and its impact on children’s dental health
This pattern offers a useful corrective to the assumption that medieval people all had terrible teeth. Many did not. The real driver of widespread dental disease was not poor hygiene or primitive care but dietary change, specifically the introduction of refined sugars. Medieval people with low-sugar diets often had healthier teeth than modern populations eating processed foods, despite having no fluoride toothpaste, no dental floss, and no regular checkups.
Teeth as Tools
Archaeological evidence reveals something else about medieval mouths: many people used their teeth for tasks that had nothing to do with eating. Analysis of skeletal remains from a Portuguese medieval-to-modern rural population found distinctive patterns of dental wear and trauma concentrated on the front teeth, consistent with habitual use of teeth as a “third hand” in routine work.14International Journal of Osteoarchaeology. More than they could chew: Activity‐induced dental modifications in a Portuguese medieval–modern rural population Textile workers, leather workers, fishers, and craftspeople all left characteristic marks on their teeth from gripping thread, softening hides, or holding nails. These occupational signatures are useful to archaeologists trying to reconstruct the daily lives of people who left no written records, but they also remind us that dental health in the past was shaped by labor as much as by diet or medical care.
What Ancient Dental Calculus Is Teaching Us
One of the most productive intersections of medieval history and modern science involves dental calculus, the mineralized plaque that builds up on teeth over a lifetime. Because calculus traps bacteria, food particles, and even airborne debris, it acts as a time capsule of an individual’s oral environment. Researchers can now extract and sequence ancient DNA from calculus preserved on skeletal remains, reconstructing the oral microbiomes of people who lived centuries ago.
This work has produced a striking finding: some microbial species, especially the periodontal pathogens responsible for gum disease, appear not to have changed much over the course of human history. The bacteria attacking your gums today are close relatives of the ones attacking medieval gums. Other species, particularly those connected to caries or general oral health, have shifted over time in ways that track human lifestyle changes like diet, urbanization, and the industrialization of food.15PubMed Central. A Journey into the Evolution of Human Host-Oral Microbiome Relationship through Ancient Dental Calculus: A Scoping Review Metagenomic analysis of dental calculus has also been applied across mammalian species, allowing researchers to detect oral pathogens, assemble near-complete bacterial genomes from historical specimens, identify antibiotic resistance genes, and even reconstruct components of the host’s diet from a single calcified deposit on a tooth.16Molecular Biology and Evolution. Dental Calculus as a Tool to Study the Evolution of the Mammalian Oral Microbiome
The practical payoff is not just historical curiosity. Understanding how oral microbiomes shifted in response to dietary and environmental changes helps researchers model what drives dysbiosis, the microbial imbalance behind modern dental disease. If certain pathogen lineages have been stable for millennia while others expanded only after industrialization, that distinction matters for targeting interventions. Medieval mouths, preserved in calcified plaque, are turning out to be an unexpectedly rich resource for twenty-first-century microbiology.
The Limits of Romanticizing the Past
It is tempting, given these findings, to swing from one misconception to another: from “medieval people had horrible teeth and no dental care” to “medieval people were healthier and wiser than we give them credit for.” The truth sits between these poles. Medieval dental practitioners were resourceful, and some of their plant-based remedies had genuine pharmacological merit. But mortality from oral infections was real. An untreated abscess could lead to sepsis and death, and without antibiotics or sterile surgical technique, even a routine extraction could turn fatal. The soporific sponge was better than nothing, but it was not general anesthesia; patients undergoing jaw surgery or abscess cautery endured enormous pain.
The tooth-worm theory, for all its longevity, actively hindered progress by misdirecting attention away from sugar, bacteria, and hygiene toward an imaginary parasite. Charms and amulets provided psychological comfort but no bactericidal effect. And gold wire ligatures were available only to the wealthy, while the average peasant’s options were limited to herbal poultices, prayer, and endurance. Medieval dentistry is worth studying not because it was secretly better than modern care, but because it reveals how people solve medical problems with the tools and knowledge they have, and because a surprising number of those solutions contain kernels that modern science is still finding useful.