Root canal therapy wasn't invented until the mid-18th century, so the only real treatment for severely decayed or abscessed teeth was to pull them.

In Europe, this was most often performed by a barber-surgeon and painkiller was limited to a swig of alcohol, if that. This is a quote from a popular history book about Catherine the Great's experience with dentists of her time:

>One day as a teenager, after suffering weeks from a decayed tooth, the future Catherine the Great agreed to have it pulled. A “surgeon” came to her room armed with a pair of pliers and yanked out the offending tooth—and a chunk of jawbone as well. Blood gushed all over her gown. The swelling and pain were so shocking that Catherine did not leave her room for a month, and even when the swelling went down, the dentist’s five fingers were imprinted in blue and yellow bruises at the bottom of her cheek.