History of Period Ontology Dr Sujan

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HISTORY OFHISTORY OFPERIODONTOLOGYPERIODONTOLOGY

DR SUJAN SHETTY

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Details 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 ondriving out the demons thought to cause the disease.

Almost all of our knowledge of Babylonians & Assyrianmedicine comes from the clay tablets of the great library of Ashurbanipal(king of Assyria)

Includes a no. of remedies for periodontal disease

³if a man¶s teeth are loose and itch a mixture of [myrrh,asafetida,and opopanax as well as pine-turpentine]shall be rubbed on his teeth until blood comesforth &he shall recover´



Ancient Egypt

The fame of Egyptians as physicians is recordedin numerous epics & texts

Based on magic &religion

Medical treatises were written on papyrus

The Edwin Smith papyrus,primary a surgicaltreatise,is the most impressive of all in terms of approach to patient diagnosis &management.

from studies of the various papyri,it¶s apparent

that egyptian medical practice was stronglyinfluenced 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 &China

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.

Charaka¶s 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 patientsname,disease and circumstances under which it wascontracted,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 achild.



Later middle eastern

&Mediterranean civilizationsHebrews

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 variouscommentators.

³when a man looses his teeth ,his nutrition isdiminished,as said by prophet Camos

Until 40yrs solid nourishment is primary,after this age itis drink(liquid)that is primary,

This is due to early loss of teeth &inefficientmastication or to periodontal disease &tooth mobilityrequiring a soft diet.



Phoenician Specimen with gold

wire Ligature to immobilizeteeth



The Phoenicians Excelled in working with gold,and teeth

bound together by gold are described,to

support loose, periodontally involved teeth.



Classical & Medieval Ages

Greece,Rome &Byzantium Greece:most significant figure was H ippocrates(460-377bc)

Aristotle investigated oral disease,talks about thecauses of periodontal disease &discusses thenature of occlusion & the shape of teeth .

³why do figs,which are soft &sweet,destroy

the teeth?do they,owing to their stickiness,penetrate into the gums,and, beinghot,quickly cause decay?perhaps also,owing tothe hardness of the seeds ,the teeth are quicklycaused to ache in the process of chewing themup.



Arabian Medicine Three great names-Abu Bakr Muhammed,Ibn

Zakariyya Al Razi,Al Ibnu¶l Abbas Al Majusi andAbu Ali Al-Hussain Ibn Sina known in westernliterature as Rhazes,Haly Abbas ,and Avicenna

H aly Abbas recommends methods for cleaning themouth

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 hedeveloped.



The Middle Ages

G uy de Chauliac offers extensivemedicaments 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 rinsesrinses &tooth powders would not have anyeffect upon it.

In fact the materia medica of G uy deChauliac was a significant advance from³witches brew´ types of medicaments withtruly 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 theteeth)

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 Allen¶s,The operator for theteeth.

S wammerdan &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.



H e &Marcello Malphigi

are two key figures in thedevelopment of sciencesthat later would becomefundamental toPERIODONTOLOGY.

Malphigi too,broke newground,performed theinitial microscopic studiesof tissues, organs &oralstructures.

Leeuwenhoek¶s

Drawing of Bacteria

from human mouth



The Eighteenth Century

Dentistry in general & periodonticsin particular,esp.b¶coz of P ierreFauchard went through a period of great progress in this century.

P ierre Fauchard -

µthe severe mouth diseases that

sailors suffered, particularly scurvy,may have induced him tospecialize in the t/t of the diseasesof the mouth¶

Fauchard was from the outsetconsidered a surgeon dentist&probably the first to receive thetitle.

Fauchard was the one who had belief in the local etiology of periodontitis as opposed to thecontemporary theory of a systemiccausation.



He introduced five

instruments-his own

innovations calling them the

rabbit chisel,parrot¶s bill,graver with three facets,hook like a Z,

and a knife.



J ohn H unter portrays the displacement of teeth as aconsequence of the loss of adjacent or opposing teeth.

He described pocket formation &bone loss.

Differentiated scurvy from other gum diseases includingANUG

Thomas Berdmore published µA Treatise on the disorders&deformities of the teeth & gums.

Used surgery when necessary to remove hyperplasticgingival 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 becamemore 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 P asteur & Koch

,suggested th

at pdl disease was also caused bygerms.

Adolf Witzel in 1881 presented clinicalmanifestations of pdl disease(infectiousalveolitis),describing gingival recession, pocketformation,calculus deposits &suppuration.

He differentiated bone loss caused by senileatrophy of the alveoli &described t/t foralveolar pyorrhea.



B/w 1871-1907 Miller published his classic book ³the

microorganisms of the human mouth´.

Described the features of pdl disease &considered therole 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 ³the non-specific plaque

hypothesis´



Clinical Periodontology

Leonard Koecker in 1821,in the Philadelphia Journal of Medicine &Physical Sciences describes the inflammatorychanges in the gingiva.

Mentions the careful removal of the tartar & the need of oral hygiene by the patient.

Levi S pear P armly is considered the inventor of dentalfloss.

The leading authority on pdl disease &its t/t ± J

ohn Riggs Riggs can be considered the first periodontist in history

Described different stages in pdl disease, from marginalgingivitis to periodontitis to tooth loss.



Riggs & his disciples were the proponents of the conservativeapproach to periodontal

therapy & developed theconcept of oral prophylaxis&prevention.

William Younger ,designedthe scaling instruments whichhave been the basis for

modern instruments used tillthis date.

G.V.Black in the U.S madeimp. Contributions to periodontology describing twotypes of periodontal disease.

At the same time Bonwill considered that dentalocclusion might play a role inthe etiopathogenesis of pdldisease.

John Riggs





Calculus had been recognised as an etiologic

factor of gingival &periodontal disease .themechanism of its formation were thought to be

physical,bacterial & systemic.

PER IODONTALMICR OBIOLOGY

Barrett, Bass & J ohns blamed a protozoanorganism,Endameba Buccalis(today c/as

Entamoeba gingivalis)

S pirochetes &fusiform bacilli were also

considered in the search for an etiologic agent in

the pdl disease.

H atzell & H enrici described the presence of streptococcus

viridans in all pdl infections.



Diagnosis

G ingiva: 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.

P ocket probing : The periodontal probe &its use wasdescribed by F.V.Simonton,of the univ. of california,san

francisco 1925.

S imonton 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 H erberst robins

in Dec1896.



Non surgical therapy Instrumentation:the

importance of removal of allaccretions fro the toothsurface had been recognised&practiced for centuries.

J ames S nell in 1832recommended a set of six

scalers mostly spear shaped&of different sizes &explainsthe technique for their userequires placing the tip of theinstrument under the calculus&dislodging it with a flipping

motion. J ohn .W . Riggs later designed

a series of sixinstruments,which wereessentially sickles but werestill large & clumpsy & not

suitable for fine scaling.



William .J.

Younger devised a set of instruments that representedreal 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 H enry 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 wereessentially gingivectomies,with a straightline incisionfollowed 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 adventof radiographs led to the use of flap surgery.

Most of the progress in pdl surgery came from Germanyand other central european countries as associated withthree names: Robert Newmann, Leonard Widman&A .Cieszinski



Newmann¶s Surgical Technique



Implant Dentistry

The replacement of human teeth by implants

placed in the alveolar process has beenattempted for more than

two thousand years. Various materials have

been experimented byworkers in the past butnone gained wide usage

b¶coz of a scarcity of documented case series toclearly establish thesuccess rates andascertain 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 wasmarketed 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



THANK YOUTHANK YOU

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