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Figure 1: A Venetian woman uses a toothpick at the dinner table. Detail from Paolo Veronese’s  (1563) The Wedding Feast at Cana. Oil on canvas.  6.77 m × 9.94 m (267 in × 391 in). Louvre Museum, Paris.

Claire Litt //

By the end of the 16th century sugar prices were within reach of the European middle class, and a dental crisis was upon them. The Portuguese colonized Brazil in 1516, establishing a sugar industry through the enslavement of African and Indigenous peoples. The effect was a dramatic fall in sugar prices in Europe. By the early 1500s sugar was already only 3 soldi per pound of sugar, a drop from the 20 soldi per pound it cost a century earlier (Shaw and Welch, 193). That sugar entered Europeans’ diets in a substantial way is detectable through forensic analysis. The historian Suzanah Lipscomb’s side-by-side comparison of the skulls of medieval and early-modern individuals reveals the nearly perfect dental health of the former, while the latter suffered several abscesses resulting in lost teeth (Lipscomb, “How Sugar Killed the Tudors”). Sugar was not, however, understood to be the scourge of teeth. Instead, sugar, along with pearls, dog’s teeth, and bejewelled toothpicks – was at the centre of early moderns’ dental hygiene practices. 

     Although the price of sugar dropped throughout the sixteenth century, it retained a place of high value in the medical world for its supposedly restorative and healthful qualities. Sugar was a primary ingredient in Acqua gli denti (water for teeth), a mouthwash that was meant to improve dental health and ‘sweeten’ the breath. The personal physician to the Grand Duke of Tuscany Francesco I de’Medici, Giovanni Nardi, had a recipe for Acqua gli denti that called for crushed rock alum (a white, transparent stone), tree resin, fine sugar, and rose water (water made of red roses and sugar), among other ingredients (BNCF Maglia. cl.XV.cod.142 Part 1.c.34v). The result would have been a pink sugary syrup that may have temporarily masked the stench of decay while contributing to its underlying cause.

Pulverized stones such as rock alum and crushed pearls were sometimes also rubbed directly onto the teeth in order to remove plaque. Not only did this practice give a literal meaning to the term ‘pearly whites’ but it also, unfortunately, removed tooth enamel. The use of white tooth-like minerals for this purpose was a type of ‘sympathetic’ medicine (or magic, if you prefer) that sought to use materials that visually corresponded to the affected body part. Sympathetic medicine was also at the core of a particularly gruesome practice suggested by a recipe that called for a tooth to treat a toothache. Dating, from the look of the almost illegible handwriting, to a century earlier in the 1400s, the instructions read: “For bad teeth” one should “take the tooth of a hungry dog” (BNCF, Maglia, cl.XV, v.79, c.2v).

Piglia dente di chane [cane] famie

polvere e mettlia in sul tuo dentte [dente]

e toglie lodo lore.””

“Take the tooth of a hungry dog
crush it, and put it on your tooth,
and take praise.”

(BNCF) Magliabechiano, cl.XV, v.79, c.2v)


Given the use of sugar and abrasive materials in daily hygienic practice, the prevalence of dental complaints amongst the sweet-toothed elites comes as no surprise. In one instance, the Grand Duke of Tuscany Ferdinand I wrote to his wife Christine of Lorraine to congratulate her on being “free forever” from a particularly bad toothache. Ferdinand I was not being hyperbolic in his choice of words. Rather, his language provides some insight into the extent to which dental maladies infringed on daily life. 

If such attestations to dental complaints in surviving correspondence were not enough, a team of forensic radiologists set out to find the truth straight, as it were, from the Medici’s mouths. The aim of the project was to “verify the efficacy of hygiene methods of the time” and was carried out on the remains of twelve Medici family members exhumed from the Chapel of the Princes (Colagrande, Stefano et al., 193). The study found that the Medici family’s dental health was in crisis, even in comparison to the dental decay found on the remains of a contemporary ruling family in Naples, the Aragons. This could be due to the Medici’s habitual consumption of sugar as a status symbol, which signalled both their immense wealth and the wondrous creativity of their artists and cooks who could turn sugar into almost anything . The wedding banquet of Maria de’Medici to Henry IV of France involved a number of almost life-sized sculptures made entirely of sugar: one of herself and her new husband Henry IV, and a second of Henry IV on horseback (Lawrence, 128). At any rate, the Acqua gli denti made by Francesco I de’Medici’s doctor was clearly not effective. He appears to have lost six teeth during his lifetime (Colagrande, Stefano et al., 195). 

The Medici’s teeth also showed groove marks that confirm their frequent use of metal toothpicks. A detail of Paolo Veronese’s The Wedding Feast at Cana (1563) shows a young Venetian woman engaging in this practice at the dinner table (Figure 1). Toothpicks were not only hygienic tools, but were also made into sumptuous pieces of jewellery that were worn as pendants around the neck. The Grand Duchess with the toothache, Christine of Lorraine, owned such a pendant herself. Her toothpick was in the form of a falcon, and was decorated with gold (ASF. MM. F.474 c.4v). Another particularly luxurious example survives in the collections of the British Museum (Figure 2). The pendant toothpick is in the form of a merman and is made of a baroque pearl, gemstones, colourful enamel, and gold. Covering the toothpick with jewels was perhaps a way of gilding an unsightly reality of personal hygiene in a way that made it appropriate for public view, similar to how sugar masked bad breath and pearls were rubbed into the teeth. Spoiled by sugar, elites’ dental problems and practices were covered up by precious materials. Still, some saw through the facade. Giovanni Della Casa’s Il Galateo, written in 1558, was a treatise on manners that vehemently argued “to weare a toothpicke, about your necke: of all fashions that is ye worst” (Della Casa, 109). 

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Figure 2: Toothpick pendant. Baroque pearl and enamel. Second half of the sixteenth century. German or Italian. British Museum.  Registration number: WB.188. CC BY-NC-SA 4.0

Works Cited:

Primary Sources:

Archivio di Stato Firenze (ASF). Miscellanea Medicea (MM). F.474, Insert 9, c.4v.

BIA: Medici Archive Project (MAP). Doc. ID# 29252, Vol. 5961, F.521. Dated June 1st 1598.

“Collection of Medical Secrets, Many of Which are Superstitious […]” Biblioteca Nazionale Centrale Firenze (BNCF) Maglia. cl.XV, f.79, c.34v.

Della Casa, Giovanni. A Renaissance Courtesy-Book: Galateo of Manner and Behaviours Ed. Lewis Einstein. Grand Richards LTD. London. Accessed through Projet Gutenberg on une 3 2020.

Secondary Sources:

Colagrande, Stefano and Natale Villari, Felicita Pierleoni, Domizia Webr, Gio Fornaciari, Donatella Lippi. “Teeth of the Renaissance: A Paleopathological and Historic-medical study on the jaws of the Medici family.Journal of Forensic Radiology and Imaging Vol 1 Issue 4. October 2013, pp.193-200.

Lawrence, Cynthia M. Women and Art in Early Modern Europe: Patrons, Collectors, and Connoisseurs. University Park, Pa: Pennsylvania State University Press, 1997.

Lipscomb, Suzannah. How Sugar Killed The Tudors. YouTube, uploaded by Absolute History, 11 April 2019,

Shaw, James and Evelyn Welch Making and Marketing Medicine in Renaissance Florence. Amsterdam: Rodopi, 2011.




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