Oldest example of restorative dentistry in Scotland found in parish church bone

A bridge made of gold thread found on the skull of a man who died between 1460 and 1670 is the oldest example of restorative dentistry in Scotland. It long predates the advent of professional dentistry in the 19th century, and given the precious material

The gold ligature was found in the East Kirk of St. Nicholas Kirk in Aberdeen. It was discovered during a 2006 salvage excavation before redevelopment that unearthed the remains of around 900 people and tons more disarticulated bones. The mandible with the ligature was part of the disarticulated skeletal material. The remains from the St. Nicholas Kirk excavation were reexamined as part of a recent study of health trends in Scottish history.

The mandible contained nine teeth still in situ. There was enough of it remaining that researchers were able to determine the individual was male and the wear on the teeth indicates he was middle-aged. He had significant tooth decay on the surviving teeth. The cavities in three of the teeth were so large more than 50% of their crowns were destroyed.

A fine gold wire was wound around his right lateral incisor and his left central incisor. The gap where the missing right central incisor had been was bridged by the wire, held in place by a tight knot on the side of the left central incisor. Analysis of the metal composition found that it is 20 carat gold, created by pulling gold through a graduated series of ever smaller holes. The ends of the wire at the knot are flattened, likely from the use of pliers.

There is a furrow on the tooth left by prolonged wear of the wire, evidence that the ligature was in place for a long time before the person died. The shape of the wire drawn across the gap indicates it was tied there after the tooth was lost, and was probably either intended as an anchor to prevent the loss of the right lateral incisor, or as a bridge on which to install a prosthetic tooth (either a human donor tooth or carved from animal bone).

Attempts at restorative dentistry — the repair of damaged or missing teeth — have been found going back to the Neolithic era. Evidence of fillings and dental drilling have been found in remains going back to as much as 6,,500 years ago. Gold wires used as dental ligatures have been found in mummified remains from Old Kingdom Egypt, but appear to have been placed after death as part of the mummification process. The earliest confirmed ligature bridge meant to restore function (rather than as a cosmetic replacement or post-mortem ritual to make the body complete again) dates to Ptolemaic Egypt (303-30 B.C.).

By the Middle Ages, some medical treatises recommended the use of gold or silver wire to stabilize a loose tooth or to fix a replacement tooth into place, but oral care in general was barely touched upon in medical literature. It wasn’t until 1530 that the first dentistry book was published in Germany. Between the limited expertise available to people and the expense necessary to secure precious metals for oral care, dental ligatures on human remains before the 17th century are rare finds, and only a handful of gold ones are known from Portugal and France.

The study authors believe this fine gold wire was installed by the jeweler who made it, although it could have been sourced separately and placed by a barber, barber-surgeon, dentatore, itinerant tooth-drawer or general community healer, all of whom offered some forms of dental treatment before the advent of professionally qualified dentists in the 1860s. They weren’t so adept at the kind of fine-tuned wire knotting work seen in this repair, however.

For certain ailments, specialist materials or appliances were required. As is seen in this case, gold alloy wire was, and still is, a preferred material in restorative and conservative dentistry due to its resistance to corrosion and tarnishing and biocompatibility. Given the materials involved a 20-carat gold, silver and copper alloy, a goldsmith was most likely sought out to craft and possibly even fit the ligature. Between 1460–1670 CE, at least 22 goldsmiths were operating in Aberdeen. Any number of these craftsmen were likely capable of producing a simple gold wire (as described above) and creating the observed tightening knot.

Of the 100 individuals that were excavated from inside the East Kirk of St Nicholas that dated to the Early Modern period, the individual presented here was the only one with clear evidence of dental work. The rarity of this find indicates that such procedures were out of reach for most of the inhabitants of Early Modern Aberdeen. It is likely that the cost of the gold was a barrier to most. It is also possible this individual had this work done elsewhere. Unfortunately, there is no way to be certain of this. […]

Though it was not possible to determine where this individual would have received this treatment, the location of burial (i.e., inside the East Kirk of an affluent parish church) indicates he was a relatively wealthy member of the community. Given the social importance of one’s appearance during the Late Medieval and Early Modern era, as an outward expression of their moral character, it is likely the reasons for undergoing this procedure extended beyond retaining masticatory abilities and oral function.

* This article was originally published here