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The Roman Empire began to decline after the death of Marcus Aurelius in 180 A.D. and had completely fallen by 476 when Rome was sacked by the Vandals. Following the disorganization of the Roman Empire, most of the works of Aristotle, Hippocrates, Galen and other medical writers were lost for several centuries.

Beginning at the time of the death of Mohammed in 632 AD, the Muslims began conquering almost all the known world. By 750 AD they were the dominant culture and ruling power of the world. Their empire included India, Persia, Arabia, North Africa (including Egypt), Spain, Sicily (in 827) and eventually small portions of southern Italy, Asia Minor, and Greece.

A. Universities and preservation of Greco-Roman learning: Medical-Dental Education
In the capital city of Baghdad, the Muslim Caliph Ma«mun established the "House of Wisdom" in 830 AD, a center of learning with a library, a translation bureau, and a school. A story of the beginning of this center relates that Ma«mun was worried about applying reason to God's universe. One night, according to the story, Aristotle appeared to the Caliph in a dream and assured him that there was no conflict between reason and religion. With this he ordered the building of the center. "All true knowledge is of God."

The Caliph rewarded scholars handsomely and the center was like a magnet to some of the best minds in the world. Within 75 years after the House of Wisdom was established, the greatest works of the Greeks and other early peoples had been discovered and translated into Arabic. Among them were the books of Aristotle, Hippocrates, and Galen as well as some important Persian and Indian scientific works.

An example of this intellectual activity can be seen in the work of a Persian, Hunayn (c 830 AD). He studied medicine under a physician in Baghdad who had been trained in a famous medical school in Jundishajsur, Persia. Hunayn ran into a conflict with his teacher and was expelled. He found other medical teachers and also learned Greek. His ability and talents were recognized by some of the Arabic scholars who employed him to seek out Greek manuscripts -- especially the works of Galen. He pursued the Galen manuscripts into Mesopotamia, Palestine, Egypt and Syria. He finally found half the manuscripts in Damascus. He was then appointed to supervise 92 other translators. In order to obtain the most accurate results possible, some works were first translated from Greek into Syriac, in which Hunayn was most proficient, and then rendered into Arabic by one of his assistants who was especially gifted in that language.

By this kind of painstaking scholarship, the scientific writings of the ancient Greeks and Romans were retrieved, eventually translated into Latin and made their way west through Sicily and Spain. Centers of learning, like the House of Wisdom, were established throughout the Empire. One of the most prominent was in Cordova, Spain.

B. Advances in dental treatment
1. Specialization
The Islamic physicians did not develop a system of formal specialization with the exception of ophthalmology. Eye diseases were common among the Arabs. The first textbook on ophthalmology was written. Surgery was seen as a minor part of medicine. One of the greatest surgeon-physisians, Abulcasis, wrote extensively on dentistry and surgery, and in his practice was essentially a specialist in dentistry and surgery.

2. First Therapeutic Filling
One of the most famous Muslim clinicians was Rhazes (860 - 932). He wrote more than 200 books on subjects from alchemy and theology to astronomy and medicine. He is best known as the first person to differentiate smallpox from the many other eruptive febrile diseases. It is not as well known that he was the first, also, to recommend a therapeutic dental filling. It was not a very permanent filling, and perhaps this is why it is not more often mentioned. Rhazes recommended cleaning out all the carious material and then filling the cavity with a cement made of mastic and alum.

3. Other Treatments
For the treatment of periodontitis Rhazes recommended opium, oil of roses, scarification (making numerous small punctures or incisions) of the gums, application of a leech, or blood-letting from a vein.

In the history of surgery and dentistry, the greatest name in the Islamic period is Abulcasis of Cordova (1013 - 1106 A.D.). He was the first to write on the practical methods of treatment of deformities of the mouth and dental arches. His books contain numerous illustrations of dental and surgical instruments, some of which are still copied and only modified for modern surgery. He was the first to thoroughly discuss dental calculus from a theoretical and practical point of view in a chapter titled On the Scraping of the Teeth. He described its harmful effect on the gingiva and recommended its regular removal. His set of 14 scaling instruments is illustrated in one of his books. He also recommended, along with regular scaling, the polishing of teeth with fine abrasives until they were white.

Like all Arabian physicians, he considered it wrong to extract a tooth unless there was no other choice. Then he recommended a most careful and thorough procedure to avoid fracture. If the tooth fractured he insisted that the root fragment must be removed and he described an appropriate operation.

He described methods of splinting teeth and making bridges to restore function as well as appearance. His books are the first to show illustrations of dental instruments. He was the first to mention that some barbers had taken up the extraction of teeth and he condemned the practice because of their lack of training in either the theory or practice of surgery. They had also started practicing bloodletting and other surgical procedures.

Abulcasis improved on many prior techniques. He improved the method for resecting an unsightly, supererupted tooth. He devised a tube to protect the surrounding tissues when cauterizing teeth. In addition to being an excellent scholar, he was a superb clinician. He stated that there were in existence at that time many more dental instruments than he could illustrate in his book and his illustrations were numerous including files for caries removal, saws and axes for crown resection, forceps for crown resection, forceps for extracting bone fragments and root tips, forceps for loosening teeth, varieties of forceps for extracting teeth, scrapers for calculus removal, cautery instruments, elevators and lancets. Unfortunately the Islamic religion forbade human dissection and no real progress was made by the Muslims in the science of anatomy.

C. Hygiene
The Muslims were the first to license physicians and require standards of cleanliness in their hospitals. They were the first to establish permanent general hospitals with dispensaries and libraries. The Romans had introduced the idea of military hospitals.

The chewstick used to clean teeth was known to the Muslims as the Miswak or Siwak. Mouth cleanliness was (and still is) part of their religion. Muslims who lived between 630 and 1200 A.D. probably had better teeth than most other peoples because of the daily religious use of the Siwak stick. If they had used dental floss, they would have been up with the 20th century in oral hygiene.

D. Alchemy
Alchemy combined the chemical craft with much religious mysticism. This form of mystical chemistry included elements of astrology, search for elixirs of youth and transmutation of substances into other substances (hopefully gold), but in the process many valuable chemical reactions and compounds were discovered and recorded. In particular the Muslims discovered the mineral acids and many volatile substances ("spirits"). One Muslim sect believed very strongly that all men were equal and extended educational opportunities to artisans and craftsmen such as alchemists. They also encouraged Islamic guilds including a guild of alchemists.

Muslim physicians added to the drugs used by Galen making medicine more complex. Many prescriptions had sixty to seventy ingredients -- mostly plant and animal preparations, but with some of the new mineral compounds developed by alchemists.

E. Avicenna's Cannon
Avicenna (980 - 1037 A.D.), called the "Prince of Physicians,Ó was one of the most prolific scientific writers. His ÒCanon of Medicine" was a collection of the findings of all the great physicians since Hippocrates. Although he was one of the most widely studied authorities for centuries, Avicenna's influence on medieval medicine and dentistry was in some ways detrimental. He reinforced the idea that reasoning from tradition and logic was better than first-hand investigation. He set back the progress of surgery by his attitude that the surgical art was an inferior and separate branch of medicine, and by his recommendation that cautery be substituted for the knife.

Avicenna listed many causes of toothache including the little worms that gnawed away the tooth substance. Part of the table of contents from his books dealing with dental maladies is included below.

Avicenna's Canon
(Contents of One Book Covering Dental Subjects)

Mouth & Tongue:

• Anatomy of the mouth & tongue
• Diseases of the tongue
• Loss of taste of the tongue
• Paresis of the tongue, and
• Paralysis of the tongue
• Macroglossia
• Tongue-tie
• Swellings of the tongue
• Defects of speech
• Ranula
• Glossitis
• Treatment of the fissures
• Protrusion of the tongue
• Mouth eruptions/difficulty of articulation
• Malignant ulcers
• Salivation
• Deodorants
• Hemorrhage
• Halitosis
• Mouth breathing

The Teeth:

• General discussion
• Dental hygiene
• Exhaustive discussion of the treatment of teeth
• Diseases of the teeth
• Substances used in the treatment of the diseases of the teeth
• Substances for pain
• The loose tooth
• Decay of the teeth
• Crumbling of the teeth
• Discoloration of the teeth
• Easing the eruption of teeth
• Extraction of teeth
• Painless extraction
• Toothworms
• Causes of gnashing of teeth
• Elongation of teeth
• Teeth on edge
• Sensitive teeth
• Weakness of the teeth

The Gums & Lips:

• Diseases of the gums
• Bleeding gums
• Gum fissures
• Ulcers of the gums
• Suppuration of the gums
• Recession of the gums
• Looseness of the gums
• Epulis
• The lips and their diseases
• Lip fissures
• Swellings and ulcers of the lips
• Varicose lips
• Lip tremor

F. Common misconceptions regarding barbers, surgury, and dentistry.
There is a common misconception that barbers were the first surgeons and dentists. They did practice some surgery and extract teeth from about 1100 until the late 1700s, but they were not the first to do so; and most of the dentistry even during this period was practiced either by physicians, surgeons, or beginning about 1700, by specialists known as dentists.

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