Traditional dentistry knowledge among Serbs in several Balkan countries

Abstract

Background/Aim:

There are still unrevealed treasures of traditional dental medicine, that is, the reason to investigate and present various ways in treatment of oral and orofacial tissues, as well as magic and religious elements involved in representative areas among Serbs.

Materials and Methods:

Information was collected from the elderly non-professional folk dentists and herbalists with the additional help of local physicians and dentists that was done through questionnaire and personal interviews.

Results:

Classified and prepared material consists of total 1038 inquiry sheets. The 41 data were averagely obtained by inquiry form, i.e. 41,984 information for the whole research. The most voluminous was the group of 64 recipes, including 39 for gums diseases and 25 for toothache, while only seven ones were mentioned for magic way of treatment. Among them, 18 prescriptions were of nonherbal origin. The study revealed 84 herbal original prescriptions, including 67 plant species (29 families) including local name, synonyms, and preparation mode. Traditional healers used predominantly herbal recipes to treat painful tooth, gum disease, blisters - herpetic ulcers/lips and mouth/, stomatitis/painful mouth, ptyalismus/, maxillary sinusitis, bad breath, teeth cleaning and bleaching. Very few methods of treatment appeared as inadequate (magical practice), whereas majority were noted as beneficial ones (herbal medicine). Still many people in distant nonurban areas use various plant recipes, especially as the first aid in oral disease healing.

Conclusions:

The significance of plants obtained from unpolluted areas, whose active ingredients have not yet been used in dental pharmaceutics, should be further investigated in the future.

INTRODUCTION

Plants and other natural means have been used in traditional dental medicine for several millennia in the Balkan countries, as well as other ways of treatment. In the Balkan countries ethnodentistry (ETD), part of the ethnomedicine has been developed simultaneously by ethnopharmacy and ethnoveterinary medicine, presenting the branches of folk health culture [1-4]. ETD is to be considered interdisciplinary and composite field of science. Data obtained from investigation should be assumed much wider, i.e. systematically through the prism of archeology, history, general medicine, pharmacy, sociology, and tradition of the Balkan regions [5]. Based on the clinical and laboratory tests on the scope of phytotherapy, ETD investigations have been performed all over the world, mostly collecting the folk prescriptions in the large and middle-developed, but densely populated countries (China, Brazil, and India). Two of these (China and India) had the strong influence on the rest of the world in regard to traditional medicine, as well as dental medicine, having a long recorded history in the field of materia medica [6]. The reason for doing so was still high participation of traditional dental medicine in everyday life there, still cheap and more important, reachable and very applicable even in urban areas, where a high level of dentistry exists nowadays [6-19]. Investigations in those countries encouraged scientists to study the hidden recipes and active substances in medicinal herbs, useful to the modern man exposed to stresses and suffering from incurable diseases throughout its entire life. Contemporary studies conducted in the previous decade (India, Pakistan, Saudi Arabia, China, Japan, South America, etc.,) were directed to assess the benefits of hundreds of traditional remedies, proofed by current medicine [6].

To study traditional medicine, as well as common customs of wild tribes and rarely investigated ethnical minorities of distant regions, comparative analysis can be applied around the globe. It was exposed as useful for the study in Eskimos, Papua Islands, East Africa, and Amazonian Brazil regarding ethnomedicine [11]. Although there were no comparative analyses among ETD studies done in the Balkan countries, unilateral studies provided encouraging results [20-22]. It was characteristic for all of them that people in rural areas would apply knowledge and experience of folk dentistry due to the lack of educated dentists [20-26], like in Serbia and Montenegro (SM), and areas where Serbs live [16,27,28]. Hence, compound interventions have been applied only on the establishment of independence of Serbia principality and wider where Serbs lived (middle of the 19^th century), when advanced culturally population and many educated doctors of dentistry schooled abroad began to return home [29].

In the past centuries, folk dentistry played an important role concerning many wars, wounds, diseases, and injuries left behind. Thus, the book The Serbian Dictionary described around 130 medicinal plants from the 19^th century [27]. However, the deeply studious and large pioneer investigation began only in 1972 through the Belgrade School of Dental Medicine (BSDM) [1].

Concerning methodology, a preliminary study was designed to find a good way for data collection. Students in their final years of BSDM were included into the research from 1976 onward, through the summer field work. Some of them collected the data used inquiry on return to their domicile regions. All activities were conducted and supervised by dentistry professors, including newly trained associate members (lecturer’s staff), where beginners’ mistakes were dismissed [30]. There was a need to record the ancestors’ dental medicine tradition as credibly as possible, due to the strong and modern influence of the West, East, and Mediterranean regions, which threatened to erase that ample canon of folk dentistry. Here was author Tucakov to say: “…It would be a great irresponsibility on history’s part not to collect such precious folk medicine treasure created through the sufferings, pains, and tears…[30].” Moreover, around developed countries, a great amount of medical and dentistry drugs were of herbal origin, as well as their extracts that exposed high financial benefit [3]. Concerning the aforementioned, the close aims of this study were:

• Collecting the folk tradition knowledge about mouth and tooth ailments and diseases (dental care, oral hygiene, and preventive deeds).

• Study of specific folk dental practice (professional traditional dentists, their curing doctrine and instruments, dentistry trade teaching, level of dental health culture, sorcerers and witch-doctors, patients’ attitude toward folk dentists and contemporary dentistry).

• Study of influence of magic and religious elements to the folk dentistry.

MATERALS AND METHODS

Study Area

Geographical area where Serbs live, i.e., SM lies between 46°11² to 41°52² North latitudes and 18°26² to 23°00² East longitude, encompassing area of 102350 km², embracing Mediterranean and continental climate types.

Data Collection

This research was conducted during June-September period from 1981 to 1991 on the small groups of domicile population, to whom traditional dentistry was not official profession, several folk herbalists/healers/, folk dentists, as well as old persons. Informants were 30-80 years old. They were from small towns and distant villages and settlements, who dealt with folk dentistry long in the past and at the moment of the study. Subjects were asked to show and describe the plants used (their parts) on site, explain the period of collection. The investigators collected information on local names of plants, preparation way, and administration. The herbs were identified through botanical taxonomy. Collected data from all of them were recorded from memory, i.e., through the family background, unfortunately without written papers, which means that data arised from their own practice and lessons from teachers. Data from certain regions gave doctors of dentistry, general practioners and pharmacists, who secondarily gathered them from local traditional healers and old experienced persons-patients, folk-dentists, and herbalists. This collecting method was proposed to be authentic enough for all studied regions.

The preliminary study pointed out that the most appropriate way of data collecting was immediate terrain method, whether it was individual or team work. That method assumed direct data obtaining from all of the pooled subjects through a previously designed questionnaire. The research was conducted with the help of the trained pollsters: Doctors of dentistry and students of BSDM (final academic years), where pharmacists participated in the plant identification. Data gatherers were warned about language during the poll, where inquiry answers should be respected in the sense of exact noting in the local dialect. Doing so, the original idioms could be regularly and linguistically interpreted and explained.

The data were obtained from 39 representative places around SM [Figures 1 and 2]. The neighboring regions of Serbia were also investigated by the same methodology where Serbs are prevailing, by the help of BSDM students who originated from those places for further comparative analysis [Figure 3].

Figure 1.

Map of studied places in Serbia (•) and headquarters (Belgrade, Krusevac, and Cuprija) (⋆)

Figure 2.

Inquired places (black crosses) in Montenegro (coastal and landlocked areas)

Figure 3.

Investigated areas around Balkan countries (small blue stars: BiH – Republika Srpska, FYROM) and headquarters spots - Serbia

The research is still in progress in the areas of East Serbia and Banat to accomplish the whole country. The study was conducted by a questionnaire (Sheet 1) contained plain Serbian folk language considered five groups.

Sheet 1 - Five groups of questions that were requested from the subjects:

1. Recipes about oral, teeth and gum hygiene, teeth bleaching, tooth eruption and replacement and correspondent folk terminology

2. Recipes about mouth sore (thrush, cold sore, aphthae, and herpes) diseases of the lips, the tongue and the skin around the mouth, and related folk expressions

3. Recipes and ways of treatment of tooth, gum and jaw diseases, and related folk terms

4. Data about profession of folk dentist, training and their instruments and practice

5. Magical (sorcery) rituals about tooth eruption care of sound and treatment of rotten teeth.

The filled in lists of questionnaire were classified by places [Table 1] displayed by Figure 1 (Serbia) and Figure 2 (Montenegro).

Table 1.

Distribution of 1038 classified questionnaires by enquired places around Serbia and Montenegro (Montenegrin places are underlined)

The most inquiry lists were harvested in the region of Sumadija highlands, where the highest number of research points were situated on, especially during summer training course and voluntary masses. The rest Serbian regions gave just a few inquiries of mostly plain terrains (Vojvodina).

The results of the collected and partially worked out data were stored at the Department for History of Dentistry (FSB). The classified and prepared material consisted of total 1038 inquiry sheets - 1025 for Serbia and 13 for Montenegro, collected during the investigation period. 41 pieces of data were obtained on average per inquiry form, i.e., 41984 pieces of information for the whole research.

Upon deep and patient analysis of herbal names (synonyms) obtained from various regions, the list of corresponding botanical names was arranged, which were previously translated into English.

Taxonomic identification was conducted by the authors, and plant nomenclature followed the Flora Europaea [31], the Angiosperm Phylogeny Group III system, and the plant list database (The Plant List [Version 1.1] 2013) [32].

RESULTS

Recipes of Mostly Nonherbal Origin

Analyzing seven categorized groups of oral ailments/diseases, eighteen prescriptions were noted mostly for toothache (five) as dominant mouth problem, that was expected [Table 2 and Figure 4].

Table 2.

Established recipes of mostly nonherbal origin

Figure 4.

Prescriptions of dominant nonherbal origin’’

Prescriptions Consist of Mostly Herbal Origin

The list of collected traditional recipes includes the used plant parts, modes of preparation and usage, and vernacular names (English and Serbian), displayed in Table 3.

Table 3.

List of 84 herbal prescriptions including 61 plant taxa from 27 families

The survey presented 84 herbal original prescriptions, including overall 61 plant taxa from 27 families, which are listed by alphabetical order, including local name and synonyms, as well as preparation mode and usage. Some of them were reported for use concerning two or more oral ailments/diseases (for an example toothache and gum bleeding). The most frequently used plants belong to family Compositae (10), Lamiaceae (9), Rosaceae (7), Leguminosae (4), Amaryllidaceae (3), and Amaranthaceae (3), like all others they were presented with two or one species. The first three families cover 42.6% from established plants. Half of the plants is cultivated (C), 39.6% from wild localities (W), and 10.3% may be collected whether as wild or cultivated (W/C). This study did not identify the folk names that directly show the use of plants in the care of teeth.

Traditionally used medicinal plants were within reach from early spring to the end of autumn as fresh ones and in conservated form for the winter season (dry, cream, tincture, etc.). According to traditional beliefs, picking up the herbs was done only during the daylight period.

The most frequently used part of plants for medicinal preparations were their leaves, as well as the other parts (bark, fruit, seed, flower, stems, and roots).

The preparation mode for dental treatment in descending order teas was decoction, infuse, maceration, juices, dishes, pastes, as well as fresh plants. The noted mode of use was drinking/gargling, rubbing into the gums, inserting into the tooth cavity, inhalation, etc.

Some plants, such as Achillea millefolium and Hypericum perforatum, were noted as panacea for many diseases (not only oral).

A lot of recipes consisted of herbal parts mixed with other artificial materials, unvivid or inorganic substances (alcohol, clay, wood derivatives, salt, spiritus, milk, CuSO₄, excrements, honey, propolis, baking soda, etc.), enabling adjuvant and corrective function.

The storage of materia medica was done by woolen textile, paper, leather or linen bags, and clay, wooden or glass vessels.

The common mouth and teeth problems for treatment were dental pain, swelling around tooth, gums bleeding/swelling, and painful tooth eruption.

The most inquiry lists were harvested in the region of Sumadija (Serbia), where the highest number of research points were situated, especially during summer training course and voluntary masses - 1000 (96.3%). Precisely, the most plentiful Sumadija spots, i.e., headquarters were Krusevac (649) and Cuprija (297) that involved mostly woodland areas [Figure 3]. The plain Vojvodina region gave just a few inquiries - 2.7%.

Montenegrin research locations were just a few, presenting 13 inquired subjects - 1.3% out of all inquiries [Table 1 and Figure 2].

Data for the Five Groups

The most answers (27 from Group I) were more or less similar by their ingredients. These recipes and those from Group II and III could be summarized as tea (decoction, infusion, and macerate), extract, herbal mixture with or without combination of edible fruits, tea combined of mineral ingredients and/or woody parts of plants, herbal mixtures with addition of pure chemicals (alcohol and methylated spirit) or Mediterranean or subtropics fruits (lemon, lavender, rosemary, clove, coffee grains, and cinnamon) and some animal products (milk, honey, and cattle excrement).

The ample sources of stomatitis treatment exhibited Group II - 26 recipes. Those were healing recipes of herbal mixtures and dietetic dishes. They were required to be the longer, the better in contact to oral mucosa to expose salutary remedy effect. Many idioms were recorded for variants of mouth sore conditions.

Based on the gathered data, the most voluminous was Group III (64 recipes). That goes without saying if consider the great significance of dental/gingival pain for common peasant, who was away even from provincial city and occupied by everyday farmer chores, having no time for a qualified dentist visit. Although the most of those remedies just numb the pain and do not point to the cause, they used referred recipes to help them even for a while. This group consisted of the recipes mostly for gum diseases (39) and toothache (25). Those pathologies were noted as dominant for traditional healers in the study around Burkina Faso [13].

Considering Group IV, nine folk dental therapists (men) were enquired about their way of treatment. They were classified into four character types: (a) Dental trade that was a well-kept secret learned from their ancestors, handing on to succeeding generation within the family (4 subjects). They are believed that trade secret discovering out of the family would bring the loss of curing power; (b) dental trade learned from the “teacher,” handing down to the others (one answer); (c) type was like type b, but it kept healing secret only for itself (three enquired persons); (d) self-taught dental skillfulness, where “secret of treatment” confided only to its close relatives (one inquired). If someone else had discovered the secret of dental trade, the power was believed to vanish.

Some of them learned dental treatment interventions during war or military service, especially extractions in position of doctor’s assistant (apprentice). In peacetime, at homeland, they used their own instruments (forceps) made of iron or combined with wooden handle, or equipment brought from military ambulance. There were “operators” who charged for the services by reasonable prices, some used compensation payment, while others treated free of charge.

Group V contained only seven different “recipes of magic power” (5.5% out of all). Some of those included: Buying a white present (upon first milky tooth eruption), or placing the first milky extracted tooth under the home bearing beam, or white pillow, giving it to a dog to eat it, etc., All those habits were to stress the whiteness as sound tooth color and home beam and dogs as symbols for power. The majority of those answers pointed out to the high rate of failure by that way of treatment, among the people who was more and more enlightened, even in isolated spots. They gave up more and more magic remedies, accepting new therapy methods, but still preserved the custom of folk traditional substantial prescriptions (Group I, II, and III recipes) empirically approved as beneficial ones.

DISCUSSION

The authors of this study put the great effort into the interpretation of medicinal herbs names and their synonyms, as well as for classification on the similar, slightly varied prescriptions by composition and preparation mode that might be useful for botanical classification/systematization of the species possessing phytotherapeutical role.

Considering the study as a whole, the aim of this research was to explain the good and bad ways of traditional treatment and remedies used throughout the centuries and to distinguish the medically correct doctrine from what was unscientific, wrong and harmful to one’s health inefficient, even toxic.

Sorcery and magic rituals could be noted as bad ways of treatments. These options have been used only if the substantial (mostly herbal) or operative mode failed. Precisely, dysfunction of feeding (chewing and swallowing), as well as accompanied pain of well innervated orofacial region was often unbearable for the patient, who then decided to ask for suggestive/hypnotic episodes by the help of sorcerers. Having been alleviated of oral troubles by these ways just for a while, the end solution would be extraction or incision of pus collection.

The copious resulting material might be of confidential origin, due to voluminous results and the direct method of data collecting, immediately obtained from the subjects such as “folk therapists” - healers and common people, often illiterate ones, even from isolated highlanders, and plainsmen.

The contemporary dental pharmacology and pharmacognosy should benefit from recorded recipes, using herbs from still unpolluted areas of investigated regions. The similar situation has already occurred in India on completion of ETD research done in 2004, where 16 brand new herbal species were discovered for the treatment of dental pain, aphthae, alveolar pyorrhea, dental plaque, and dental caries prevention. Those plants, up to that time, had not been recognized and classified in Indian ethnobotanical and phytotaxonomical literature [14,33].

Usefulness of comparative analysis showed the ethnomedicinal studies in the regions of Eskimos, Papua Island’s tribes, East Africans, Amazonian Brazilians, etc., [6,12]. Hence, the similarity in dental recipes was found in literature: Italian ethnologists conducted the same work recorded several herbal recipes in Albanian immigrant population in South Italy, unknown up to then. The added animal constituents, what they used [9], were similar to the Serbian mixture prescriptions which probably came from the Albanian nation from Kosovo into central Serbian regions. The second example was the case when plain population, mostly villager and farmers, were compelled to use cheap and “within reach” medicaments, what was amazingly similar between Serbian [34] and Dinka population (African mostly Christian Ethiopian tribe). (To remember that Orthodox Christianity in Ethiopia was established in the 4^th century). Both populations used ash mixture of burned cow dung for teeth cleaning by fingers. The third case was copper sulfate mixed by herbs powder as a common recipe for toothache and painful gums relief in Serbia [34], as well as in India [14,33].

Some of the recorded plants in our ETD study had the similar beneficial effect like sage. What a pity they are still not in use, concerning the presence of sage extracts in many dental products for oral care, exposing even six useful effects, such as antioxidant, antimicrobial, antifungal, astringent, anti-inflammatory, and odorant drugs. Those plants might be categorized into several pharmacological groups, namely, sialogogues, antisecretolytics, tonics, adstringents, styptics, antiseptics, sedatives, antineuralgics, anesthetics, vulneraries, antibiotics, and corrigenses. They exposed useful effect in dental medicine through the following active principles: Alkaloids, heterosides, saponins, essential oils of aromatic herbs, tannins, flavonoids, mucinous matters, phytocides, vitamins, etc., most of them demonstrated antioxidant, immunostimulate, and anticancer effects.

According to our best knowledge, beside mineral substances, the following plant species were noted in this ETD study: Broom, rosemary, coltsfoot flower, yellow iris, licorice, marigold, black grapes, cranberry, spinach, henbane, celandine, walnut leaf, onion, petal and oil of red rose, immortelle, garlic, root/leaf of blackberry, dandelion juice, yarrow, nettle, plantain, basil, chips of pine log, madder, common mallow, radish, grape hyacinth, rue, bilberry, blueweed, barberry, elder, calamus, hedge bindweed, pine marten resin, grain brandy, and incense. These species have not been yet applied nor their derivatives in the recent dental phytotherapy. The benefit of the study might be attributed to botany, botanic terminology, pharmacognosy, and ethnopharmacy.

As far as the wrong mode of traditional dental treatment, the most of sorcery and magic curing was noted in rural and isolated places. Nowadays, in those regions more and more experienced advantageous herbal prescriptions are in use even near contemporary dental offices. However, traditional dental recipes are often adjuvant and even competitive to modern ones, because they are cheap and previously experienced as very effective ones.

Unfortunately, there are still no ways to collect the ETD treasure from Kosovo and Metohija region. That region would be of great interest due to the existence of numerous isolated settlements with preserved customs in time interval too distant from contemporary life, concerning ethnical and religious aspect of mixed population situated there.

It is appropriate to quote the urgent and pressing words of Serbian pioneers in ETD, ethnomedicine and ethnopharmacy directed to generations to come. They pointed out even in 1976 of necessity to speed up the data analysis of ETD research in much detail because “…there is a need to record the grandfather’s medicine as soon as possible and authentically because accelerating urban changes threaten all of that heritage bring out of oblivion up to the end of the 20^th century….” The confirmation of aforementioned note could be found in Prof. K. Todorovic foreword of book “700 years of medicine in Serbs.” Here he wrote “…Serbs were going through the history through the different phases of military glory and power, advanced social structure and cultural ascent, then fall and internal trouble, discord, and mutual rivalry and clashes, military ups and downs as well as long slavery, migrations and suffering where even bare existence of the nation was sometimes endangered…[30].”

Besides mainly biological aspects of ETD in this study, sociocultural focus might be of great importance for social science (ethnolinguistics, history, etc.) analyzed by professional persons in those fields. The recorded data in our investigation frequently showed the union of religious elements and herbal healing treatment. Overall mentioned points to the significance of performed ETD research and data operations, what altogether calls for further extension of our study, encompass the multidisciplinary approach and comparative analysis thoroughly.

The above-mentioned findings should be supported for industrial utilization of some herbs, which can be useful for dental pharmaceuticals due to the opulent biodiversity of Balkan regions. They might present a significant source of export earnings. Having in mind that around 80% of the world’s population use herbal-based recipes, this cheap way of treatment, especially in the Third World countries, should be stressed.

The majority of collected interesting folk terminology data (“folk dental idioms”) have still not worked out and should be classified by specific methodology (further research is under way).

Furthermore, there were many folk jargons recorded about anatomical dental terms in all questionnaire groups, as well as for diseases and medicinal plants [34] that are interesting material for further ethnolinguistical research.

The obtained data from the neighboring countries (Republika Srpska, FYROM – Macedonia), i.e., spots where Serbs are prevailed, have not yet been operated in the scope of comparative analysis. That would be useful for the study of immigrant change of life conditions and adaptation to new environments, similarity and differences of folk dental medicine knowledge in the studied areas and abroad where Serbs live, among neighboring nations, ethnic, and religious groups.

CONCLUSION

We should emphasize the significance of plants obtained from unpolluted areas, whose active ingredients have not yet been used in dental pharmaceutics, which can be a promising field for further researches.