HISTORY OF PERIODONTOLOGY

EVOLUTION OF PERIODONTOLOGY
The prehistoric era and early Civilizations Classical and medieval ages The Modern Era The Nineteenth century The Twentieth century

The Prehistoric Era and the Early Middle Eastern & Egyptian Civilizations
Widespread existence of oral diseases in early humans has well been established through the recovery &study of human skeletal remains. Study of dental tissues was called as paleostomatology or paleopathology of the teeth &jaws. Evidence of chronic periodontal disease &chronic abscess has been found in the extensive paleolithic material available.

Sumerians,Assyrians&Babylonian
Sumerians is one of the three oldest civilizations. Religion was strong & pervasive in these early societies. The cure of any disease,to a large extent,depended on driving out the demons thought to cause the disease. Almost all of our knowledge of Babylonians & Assyrian medicine comes from the clay tablets of the great library of Ashurbanipal(king of Assyria) Includes a no. of remedies for periodontal disease if a mans teeth are loose and itch a mixture of [myrrh,asafetida,and opopanax as well as pineturpentine]shall be rubbed on his teeth until blood comes forth & he shall recover

Ancient Egypt
The fame of Egyptians as physicians is recorded in numerous epics & texts Based on magic &religion Medical treatises were written on papyrus The Edwin Smith papyrus,primary a surgical treatise,is the most impressive of all in terms of approach to patient diagnosis &management. from studies of the various papyri,its apparent that egyptian medical practice was strongly influenced by religion. Diseases were considered to be the possession of a patient by a demon.

 Little is known about the practice of dental medicine in ancient Egypt. Prescriptions to strengthen the teeth refer to periodontally diseased teeth. One part each of powder of the fruit of the palm,green lead and honey One part each of powder of flint stones,green lead &honey.to be rubbed on teeth.

Ancient India
Indian medicine-Vedic period(1500-800bc),Invasion by Hindus,Brahman period(800bc-1000ad),Mongol period,starting in 1000ad. Brahman period-Susruta Samhita & Charaka Samhita. Susruta-describes a disease;the gums of the teeth swell & become putrified ,black &slimy,& emit a fetid smell. Also devotes a section to proper toothbrushing &the use of mouthwashes to cleanse the tongue. Charakas work is less interesting ,a mixture of magic &religion,with disease treated by charms & incantations. Devotes several sections to the mouth,oral hygiene,and the management of oral diseases.

China
Medicine became more sophisticated. Well organized protocol including patients name,disease and circumstances under which it was contracted,treatment prescribed. T/t of oral diseases either by drugs or acupuncture. Locally drugs were applied in powders,tablets,ointments or lotions . Various mixtures of herbs,minerals or often,esoteric agents such as ground-up mouse bones &urine of a child.

Later middle eastern & Mediterranean civilizations

Hebrews Dentistry comes from the old testament and the later Talmud,the rabbinical laws founded on tradition. The teeth are often mentioned in the talmud by various commentators. when a man looses his teeth ,his nutrition is diminished,as said by prophet Camos Until 40yrs solid nourishment is primary,after this age it is drink(liquid)that is primary, This is due to early loss of teeth &inefficient mastication or to periodontal disease &tooth mobility requiring a soft diet.

The Phoenicians
Excelled in working with gold,and teeth bound together by gold are described,to support loose, periodontally involved teeth.

Phoenician Specimen with gold wire Ligature to immobilize teeth

Classical & Medieval Ages Greece,Rome &Byzantium

Greece:most significant figure was Hippocrates(460-377bc) Aristotle investigated oral disease,talks about the causes of periodontal disease &discusses the nature of occlusion & the shape of teeth . why do figs,which are soft &sweet,destroy the teeth?do they,owing to their stickiness,penetrate into the gums,and, being hot,quickly cause decay?perhaps also,owing to the hardness of the seeds ,the teeth are quickly caused to ache in the process of chewing them up.

Rome
Celsus(25bc-50ad) offers t/t for a no. of periodontal conditions. Byzantium: Byzantine era-Oribasius,Aetios of Amida,Alexander of Tralles,and Paul of Aegina. Oribasius has a no.of sections on toothache &gingival inflammation

Arabian Medicine
Three great names-Abu Bakr Muhammed,Ibn Zakariyya Al Razi,Al Ibnul Abbas Al Majusi and Abu Ali Al-Hussain Ibn Sina known in western literature as Rhazes,Haly Abbas ,and Avicenna Haly Abbas recommends methods for cleaning the mouth Avicennas contributions consisted primarily of diagnosis &systemization of oral disease. Used extensive materia medica for oral &periodontal diseases &rarely restored to surgery.

 Abulcasis understood that calculus deposits on the teeth were the major etiologic factors in periodontitis. Described in detail the technique of scaling the calculus deposits from the teeth with a set of instruments he developed.

The Middle Ages

Guy de Chauliac offers extensive medicaments for the t/t of various diseases of the teeth, gingiva &oral mucosa. Pomegranate juice was an excellent astringent mouthwash Tartar was removed by scalers since rinses rinses &tooth powders would not have any effect upon it. In fact the materia medica of Guy de Chauliac was a significant advance from witches brew types of medicaments with truly disgusting &weird ingredients that have no rationale whatever.

The Modern Era

The renaissance:science &medicine advanced enormously &led to major discoveries. The first printed dental book was published in German in 1530 , Artzney Buchlein or Zene Artzney(the physician of the teeth) Paracelsus developed an engrossing hypothesis of disease the doctrine of tartar. Claimed pathologic calcification occurs in a variety of organs &attributes it to a metabolic disturbance Tartar could be precipitated by the action of salt, which dried up or coagulated mucoid matter in food.

 Eustachius published in 1563 the book Libellus de Dentibus Offered modern treatment for periodontal disease-scaling &curettage of granulation tissue to allow reattachment of the gingival & PDL tissues.

The Seventeenth Century

Dentistry made little progress in the 17th century. Surgeons &barber surgeons were considered inferior &were self taught. But the most important dental book of the 17th century was Charles Allens,The operator for the teeth. Swammerdan &Malphigi made the most imp. findings in microbiology &histology. Antony van Leeuwenhoek- most imp. discovery was the existence of micro organisms in the oral cavity.in addition gave the term dental plaque.

 He &Marcello Malphigi are two key figures in the development of sciences that later would become fundamental to PERIODONTOLOGY. Malphigi too,broke new ground,performed the initial microscopic studies of tissues, organs &oral structures. Leeuwenhoeks Drawing of Bacteria from human mouth

The Eighteenth Century

Dentistry in general & periodontics in particular,esp.bcoz of Pierre Fauchard went through a period of great progress in this century. Pierre Fauchard the severe mouth diseases that sailors suffered, particularly scurvy ,may have induced him to specialize in the t/t of the diseases of the mouth Fauchard was from the outset considered a surgeon dentist &probably the first to receive the title. Fauchard was the one who had belief in the local etiology of periodontitis as opposed to the contemporary theory of a systemic causation.

 He introduced five instruments-his own innovations calling them the rabbit chisel,parrots bill,graver with three facets,hook like a Z, and a knife.

 John Hunter portrays the displacement of teeth as a consequence of the loss of adjacent or opposing teeth. He described pocket formation &bone loss. Differentiated scurvy from other gum diseases including ANUG Thomas Berdmore published A Treatise on the disorders &deformities of the teeth & gums. Used surgery when necessary to remove hyperplastic gingival tissue once the tartar has been removed.

The Nineteenth Century

In the second half of the 19th century three major developments in medical science had a particular impact on periodontics The discovery of anesthesia Germ theory of disease Discovery of x-rays With this periodontal surgical techniques became more complex &sophisticated,not only for solving disease problems but also for esthetic &function.

Periodontal Microbiology
In the 1880s the germ theory of disease,recently proven by Pasteur & Koch ,suggested that pdl disease was also caused by germs. Adolf Witzel in 1881 presented clinical manifestations of pdl disease(infectious alveolitis),describing gingival recession, pocket formation,calculus deposits &suppuration. He differentiated bone loss caused by senile atrophy of the alveoli & described t/t for alveolar pyorrhea.

 B/w 1871-1907 Miller published his classic book the microorganisms of the human mouth. Described the features of pdl disease &considered the role of predisposing factors,irritational factors &bacteria in the etiology of pyorrhea alveolaris. Believed that the disease was not caused by a specific bacterium but by a complex array of bacteria normally present in the oral cavity. This theory came to be known as the non-specific plaque hypothesis

Clinical Periodontology
Leonard Koecker in 1821,in the Philadelphia Journal of Medicine &Physical Sciences describes the inflammatory changes in the gingiva. Mentions the careful removal of the tartar & the need of oral hygiene by the patient. Levi Spear Parmly is considered the inventor of dental floss. The leading authority on pdl disease &its t/t John Riggs Riggs can be considered the first periodontist in history Described different stages in pdl disease, from marginal gingivitis to periodontitis to tooth loss.

John Riggs

Riggs & his disciples were the proponents of the conservative approach to periodontal therapy & developed th econcept of oral prophylaxis &prevention. William Younger,designed the scaling instruments which have been the basis for modern instruments used till this date. G.V.Black in the U.S made imp. Contributions to periodontology describing two types of periodontal disease. At the same time Bonwill considered that dental occlusion might play a role in the etiopathogenesis of pdl disease.

Twentieth Century
Hopewell-Smith described massive bacterial invasion of the gingival tissues & concluded thatpyorrhea alveolaris doesnot begin as gingivitis .&it is essentially dependant upon an osseous lesion

ETIOLOGY OF PDL DISEASES

From fauchard in the early 18th century to the beginning of the 20th century ,many systemic diseases were considered the cause of pdl disease. Systemic diseases included nutritional ,metabolic diseases and arthritis.

 Calculus had been recognised as an etiologic factor of gingival &periodontal disease .the mechanism of its formation were thought to be physical,bacterial & systemic. PERIODONTAL MICROBIOLOGY Barrett,Bass &Johns blamed a protozoan organism,Endameba Buccalis(today c/as Entamoeba gingivalis) Spirochetes &fusiform bacilli were also considered in the search for an etiologic agent in the pdl disease.
Hatzell &Henrici described the presence of streptococcus viridans in all pdl infections.

Diagnosis
Gingiva: It was with the advent and subsequent improvement of electrical lightning in dental offices in the 20th century, help in detecting gingival changes &analysing their imp. Pocket probing: The periodontal probe &its use was described by F.V.Simonton,of the univ. of california,san francisco 1925. Simonton insists that the only way to determine the existence &extent of pyorrhea is the measurement of the of the pockets,either instrumentally,roentgenographically, or both.

Periodonal probe ( Periodontometer) developed by Hanford & Patten

Radiographic examination
The first use of radiograph for Pdl diagnosis was by William Herberst robins in Dec1896.

Non surgical therapy

Instrumentation:the importance of removal of all accretions fro the tooth surface had been recognised &practiced for centuries. James Snell in 1832 recommended a set of six scalers mostly spear shaped &of different sizes &explains the technique for their use requires placing the tip of the instrument under the calculus &dislodging it with a flipping motion. John.W.Riggs later designed a series of six instruments,which were essentially sickles but were still large & clumpsy & not suitable for fine scaling.

 William.J.Younger devised a set of instruments that represented real improvemenet over those of his mentor John Riggs. It included curette style instruments with more delicate blades &slender shanks,but they lacked contra-angle.

The hoe scalers were developed by Henry Tompkins but they also lacked a contra-angle. Periodontics began in this period to attain the relevance of a true specialty,and numerous practitioners started to limit their practice to it.

Periodontal surgery
Pdl surgical techniques used in the 19th century were essentially gingivectomies,with a straightline incision followed by aggressive curretage to remove the crestal bone and thorough scaling of the root surface. The advantages provided by L.A and knowledge of the underlying bone topography,as obtained with the advent of radiographs led to the use of flap surgery. Most of the progress in pdl surgery came from Germany and other central european countries as associated with three names: Robert Newmann, Leonard Widman &A.Cieszinski

Newmanns Surgical Technique

Implant Dentistry
The replacement of human teeth by implants placed in the alveolar process has been attempted for more than two thousand years. Various materials have been experimented by workers in the past but none gained wide usage bcoz of a scarcity of documented case series to clearly establish the success rates and ascertain the causes of failure.

Mandible from 6th century A.D.

 Branemark &co-workers demonstrated in dogs & in humans that the implants achieved osseointegration which they defined as the absence of interposed tissue b/w fixture &bone. The system developed by Branemark &co-workers was marketed by Biotes and is based on the use of commercially pure titanium implants with a two-stage surgical procedure. Implantology has become a widely used technique that has revolutionized the practice of dentistry

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