Part 1
Dental Practice: From Antiquity to Empirics
Written by: Victor R. Valdez DDM, CPH, DPHD
Reference: 104th PDA Convention 2013
Whererever man goes he is hounded by illness, toothache included. Where illness abound healing craft crops to alleviate illness.The man in ancient times never stopped searching for medicines however crude to address the disease condition.
Over 28 thousand years back, the archipelago had been host to human inhabitants. This was amply exhibited by the discovery of Anthropologists (National Museum) of the skull remains in the Tabun Cave of Palawan. Aptly named Tabun Caveman for identity the first known Filipino so to speak it was established that the age of the Tabun Caveman through the relatively new technology of carbon dating to be no less than 28,000 years old. Until in 2007 a team of archaeologists led by Dr. Armand Mijares of the University of the Philippines-Diliman has confirmed that a foot bone they discovered in Callao Cave in the town of Pefrablanca Cagayan province was at least 67,000 years old, they were able to approximate Its age through a method called “uranium-series dating” Tabon Man’s remains were a relatively young 50,000 years old.
Tracts of Anthropology theorized that the Archipelago was peopled through waves of migration spanning the millennium. People of Southeast Asia land mass treaded on dry land bridges to reach our country land bridges connected the land mass of the Malay Peninsula and Indonesia. There are at least z identified groups that traversed the land bridges, the Malay’s and the Indonesian’s stock spreading all over the country overtime. It was surmised that not only humans crossed the land bridges it included animals wild and domestic.
ln the waves of migration people brought their culture means of livelihood and ways of dealing with illness and crafts of dental practice. ln place in the new country they continue to enrich their healing craft with the abundance of flora and fauna and products of the sea.
Later a cataclysm ensued to change the orders of things. The globe was overtaken by the ice meltdown in the polar ice cap. This raised the water level in the ocean to unprecedented heights; inundating bodies of land, submerging the land bridges. Creating archipelago where originally it bodies of land wherein its place. Climatologic conditions reversed migration abated from the Southeast.
Other groups of people were not deterred to reach our shores in their sea worthy ocean plying vessels. Chinese chronicles of the time earlier than the first century BC relates of the flourishing trade and commerce and interaction were made. Impressed by the simplicity, sincerity, honesty and candor of our people, the Chinese settle in our country, intermarried with our people at the period the Chinese have already a well- developed and advanced culture. They have a remarkable art and practice of the healing craft that covers dental health.
The Chinese introduced the chew stick, a plant stem frayed on one end used for cleaning of the teeth. The chew stick is said to be the forerunner of the modern toothbrush invented by the Chinese in 1498 (Bamboo stem as handle embedded with turfs of swine bristle). This type of chew stick has same concept as those of the sticks brought by Dr. Ariel Go when he returned from a short stint in Addis Abeba in zou where he brings samples of sticks known as Mefakya of Ethiopia adorned and designed from tree trunks and stem of Weyra tree (Olive tree). Designs of this Mefakya tooth cleaner defends on the stature of the person using it, the higher the stature in life the more design and best part of the tree he will get. To date Mefakya is still widely used by Ethiopians in cleaning their teeth. The Chinese brought with them the Ying and Yang concept of illness and health an imbalance of one element may give rise to a health condition or illness.
For thousands of years the Chinese used acupressure and acupuncture. The latter included 388 points of puncture, z6 of which were used as remedy for toothache with 6 others for curing pain in the gums. The puncture points were then cauterized. The Chinese brought with them various medicines extracted from minerals, herbs, tree parts, seaweeds animal parts. It is believed that Chinese introduced into the country the duckbill forceps (dubbed by the Spanish as “Boca y Pato”.
Seafarers from the Middle East the Arabians headed by religious leaders the Imams. Primarily their coming is to propagate the faith of Islam. Trade and commerce is only secondary. Their culture is so closely interrelated with the precepts of their religion. The virtues of the Koran urge their Father to live in healthful ways of living, observe regular ablution along with oral hygiene. Islam steadily took roots in the south, spread northward beyond Manila. When Spanish authorities took over administration, the Manila was ruled by a Muslim, Rajah Soliman.
It can be assumed that Arabians brought with them their own brand of healing and treatment of bodily illness that include dental problems. They most likely left their mark. Early in the 9th Century in Arabia, Razes, earliest of the importantArabian Physician, of the very first to recommend the use of mastic and alum to fill carious cavities. The most important Arabian author (c.1050-1122) Abulcasis in his book de Chirurgia, was the first book to include illustrations of a set of dental instruments, set of 14. The Arabian traveler may have had the opportunity to treat their local followers or even shared their local healing counterparts.
Long before the Spanish conquistadores set foot on Philippine soil least known in history in the shoreline of Agoo, La Union is a place called Puerto de Japon. This is a settlement of Japanese who came to do trade and commerce. In time their group swelled an settled, interaction with the people was positive led them to inter-marry with the local folks.
The shoreline of Agoo is known to be rich in gold mixed with the sand. This explains why they have gold miners among them artisans, iron smith, carpenters, fishermen, track gardeners and more importantly the healers. Their medicine men may have applied their healing craft with the local folk of Agoo or even shared there know how and skill with localfolk healers. Like the Chinese the Japanese have an array of medicinal herbs, processed sea products, pafts of trees, extracts from animal, minerals prepared as medicines. For trade the Japanese brought silk, art pieces, porcelain ware, tea and others.
Ayurvedic medicine that developed and flourished in India over the millennia steadily advanced over the years.The ayurvedic concept of the healing art deals generally with the health of the body and the treatment of illness. Some sections teach on the treatment of illness in the oral cavity. The Madjapahit empires of lndia at some point ruled over Indonesia and by extension of their power with political influence over the Philippines. Minions, officials of the empire and travelers from Indonesia who came to settle may have advocated ayurvedic medicine in the healing of illness among our people. Not much is known about remedies that treats dental disease.
In pre-Hispanic times our healers, herbolarios and medicine folks have already a collection of ways and remedies for treating illness conditions. Their exposure to the various ethnic groups coming to our archipelago over thousands of years has made their mark. What is seen as their healing craft is a composite of all what they learned and shared from the countries of origin of the traders, settlers, evangelizers.
Dr. Bienvenido Erafra, past PDA President, past official of FDI and APDC noted in his article in the PDA Journal 1960, the dental practitioners in early times in our country are those who had been acknowledge with strength and courage, skills and knowledge in the art of healing for illness and pain in the oral cavity. This is a deviation with our counterparts halfway around the hemisphere in Europe, Middle East, USA and elsewhere. Where the roving barber is the acknowledged dental practitioner, Erafra named the local folk healer, the Hilots (Midwife) who double as folk healer, local medicine men.
ln the eastern border of La Union are hill tribes of the Kankan-l group. The “Mandakdaoat” is the acknowledged local folk healer. The term implies one who prays in supplication to the Gods. lt is said that Kankan-I tribes venerates a hundred Gods one for each situation, condition, need or wish when the Mandakdaoat is called upon to cure a toothache, he invokes the God concerned with alleviating pain. He goes into deep communication and recites the ritual of “Ealemman Bokbok”. lt is generally accepted that a tiny worm with hard heads penetrate the tooth cause carious cavity. Others believe the Bokbok are minute insects.
Farther east the Cordillera country peopled by the Ifugao, Kalinga and Inabaloi tribes who pay reverence to a thousand Gods. Each God is represented by an idol. The “Mumbaki” is the respected authority of the healing craft the acknowledge gatekeeper for health in the community, Diseases of the oral cavity !s just one of his concern. The “Bagat” is a ritual dance accompanied by incantation prayers done by members of the tribe. Offerings to the Gods are a paft of the ritual asking for the return to health of their loved one. The “Caniao” is a community wide activity for a varied cause the more compelling ones is the healing of a member of the tribe among others the welcome of a VlP, local dignitary, Celebration of a finished project, expression of thanks of being spared by a calamity, a bountiful harvest, successful ‘)\nop” hunting. The Bagat is now a part of a “Caniao”. As offering, many animals are slaughtered as sacrifice, the family of the sick shares in offering the animals. The “Caniao” ritual may last for days. In the end, the animal meat is prepared and cooked; a feast ensues with drinks of Tapey fermented from rice or cassava.
Healing in antiquity may take the form of applying no strums, herbal medicines, praying, sacrifice, burning incense,oi aromatic matter, using “Linta” to suck bad blood, using vinegar in the temple to relieve headache and muscular pain, minced garlic packed in cavity to relieve toothache, also Silit Diablo for toothache. Mashed gumamela flowers applied in swelling to induce pointing. Mouth rinses from boiled Guava leaves, Duhat bark, Tsaang Gubat leaves and many others. ln the company of rituals our folks subscribe and believe in such as; Deity Worship – veneration of a God or Gods that may have been displeased, supplication to that can cure and relieve aches and illness. There is a God for every reason and season. Animism – is the worship of animals to represent certain power to cure illness, power to grant locker reverse misfortune. Spiritism – may believe that people co-exist in a spirit world, spirits they may call upon to give them assistance and support protection to draw good fortune, to invoke their
to return to health. To get harmful spirits out of a human body ancient folks see spirits in the departed kins, spirit of a tree, spirits in the body of water, wind, heavenly bodies, spirit of ‘Apo Init”, even representation of Ligaw na Spiritu, spirits of innominate object.
Divine healing, faith healing, healing thru Christ, is practice by persons blessed with capacity and power to health by invoking the power of a supreme being.
It is regrettable that dental practice is not well known before the mid-19th Century. What information we can gather are Vignettes of Lore and Legend Handed Down by our forebears through the chain of generations over the millennium. Common complaints observed and identified in the mouth and surrounding area are decayed teeth, traumatized teeth, infected teeth, bleeding gums, loosened tooth, suppuration and swelling in the jaw and some other vague reference to some vague condition.
A loose tooth may be removed with bare fingers the more embedded ones are abused with a narrow blades chisel lightly tapped with wooden mallet. The use of a duckbill forceps are with hands of our foreign migrants. Anesthetics are not known when we needed a patient maybe plied with the local brew like Lambanog and Gin to prop his bravado and pull his senses. For bleeding several mouthwashes are available, decoctions of leaves and barks of plant. For pain following extraction, not one informant came forward to tell.
Nothing is head of asepsis and antiseptics. All the folks admit that the hilots, herbolarios, folk healers wash their hands with water before and after a given procedure. lt was probably in the mid-term of the Spanish rule that soap appeared in the scene. Granting that soap is available, it is doubtful that washing the hands with soap and water for the healers became the standard measure for dental care. Alcohol with high percentage is locally available in the form of Gin and Lambanog for use as disinfectant of instrument was not mentioned as antiseptic in the area of operation.
The concept of microorganism as it relates to disease was not known until schools (lower grades) were established in select places in the countryside by the Spanish authorities in the Mid-18th Century. Infection and contagion then were not understood but were dealt within their way of thinking as superstition. In this period, boiling of implements used in the mouth began to be appreciated. In lieu of the toothbrush we have the counterparts of the Chinese chew stick. The beetle nut husk and the frayed Guava twig as toothbrush. Pine salt sand or green immature Mango seed substitutes for dentifrice.
Early Filipinos are known to be scrupulously clean taking a bath once or twice a day and no doubt clean and rinse their mouth as often. Books, reading materials started to filter through the settlements and communities, mostly Hispanics but someone is there to spread the translation. These words began in roads to remote places started to shed light among the folks hungry for knowledge. They have better understanding of what is new and what is happening beyond their “world” is fast getting assimilated, our medicine men, herbolarios, folk healers, hilots. Babaylan and Baglan and the rest all in the healing craft also became conscious and alert. Healing from the state of crudity in antiquity we have now reached the stage of empirics. This is short of breaking through the zone of science and modern technology. The University of Sto.Tomas in the mid 1800 has opened a special course. The Cirujano Ministrante” the equivalent of a male nurse. Graduates are taken to the San Juan De Dios Hospital to train further under preceptorship to qualified medicos. “The Licenciado En Medicina” trained at UST and others graduating in the course ‘.Doctor of Medicine” from Europe. In addition to ministering to general medical needs of patients it includes dental care and oral surgery. The Cirijuano Ministrante making close observation and under supervision of the medicos learned dental procedures then later operated in the communities much later the Spanish authorities imposed registration for those engaged in the practice of dentistry and to pay a fee for the privilege to practice. Authorities issued a Certificate of Registration which called “Patente”.
The year 1859 is a banner year for the practice of Dentistry in the Archipelago, Monsieur M. Fertri, a Frenchman, relocated his practice from Hongkong to Calle Barbosa, Ouiapo District Manila. By reckoning M. Fertri was the first formally trained Dentist to practice his profession in the Philippines. He was also the pioneer in preceptorship training that spawned a chain of preceptors to begin their practice.