Historical background of periodontia

Based on Carranza,9th and 11th edition

1. “ HISTORY AND BACKGROUND OF PERIODONTICS”

2. Periodontics: May be defined as “the clinical science that deals with the periodontium in health and disease is called periodontology, the practice of which is periodontics.” (by Grant, Stern, Listgarten ) History of Periodontics can be divided into 5 parts: -Pre historic era & Early civilizations -Classical and Medieval ages -Modern era -Nineteenth century -Twentieth century

3. HISTORY OF PERIODONTICS….. PREHISTORIC ERA & EARLY CIVILIZATION Wide spread existence of oral diseases in early humans has been well established through the recovery and study of human skeletal remains in many regions of the world. The study of dental tissues in prehistoric humans has also developed into a special discipline called “ Paleostomatology” or “ Paleopathology”.

4. Evidence of chronic periodontal disease as well as developmental malformations has been found in the extensive paleolithic material available. HISTORY OF PERIODONTICS…..

5. Neolithic Period Evidence of any periodontal inventions during this period has not been found. HISTORY OF PERIODONTIC

6. Early Civilization Sumerian civilization is one of the oldest and worked with developing glazes to be used on pottery and tiles. Skeletal studies disclosed the presence of osteoarthritis of the TMJ, fractures, periodontal infections, possible jaw tumours and cysts. Babylonians over took the sumerians around 1830 to 1531 B.C. HISTORY OF PERIODONTICS…..

7. Assyrians co-existed with the babylonians for over 7 centuries. The most significant work of babylonian and assyria that has been preserved is the “ CODE OF LAWS OF HAMMURABI “, the oldest known codification of laws. These laws were related to the practice of medicine, indicating that physicians and surgeons were practicing their arts at this time. Almost all of our knowledge of this civilization comes form the clay tablets of the Great Library of Ashurbanipal , King of Assyeria . HISTORY OF PERIODONTIC

8. GREECE, ROME AND BYZANTIUM Greece Remains to be an astonishing achievement. Medicaments were sought to counter the nature of imbalance. The most significant figure in ancient greek medicine was Hippocrates (460-377 B.C.) He has been revered as “ The Father Of Medicine”. HISTORY OF PERIODONTIC THE CLASSICAL WORLD

9.  Hippocrates contribution to modern medicine are 3 folds: - The importance of clinical observation. The value of letting nature help the healing process rather than instituting various procedures that may be damaging. The concept of disease prevention through proper nutrition and a healthy environment. He described jaw dislocations and fractures. Also observed mouth ulcers in many types of systemic diseases. HISTORY OF PERIODONTIC

10. Rome Roman civilization was based mainly on practical considerations of governing and maintaining an empire. Celsus (25B.C.-50A.D.) Wrote a large work on medicine and named it “ Celsus De Re Medicina ”. He offered treatment for a number of periodontal problems. HISTORY OF PERIODONTIC

11. If blood escapes from the gums Chew purslane If it does no good then vinegar. Also chew pears and apples. HISTORY OF PERIODONTIC

12. Byzanthium There were 4 major medical writers of this era: Oribasius Aetios of Amida Alexander of Tralles Paul of Aegina Information rendered by them include treatment of tooth ache (hypersensitive tooth) through myrrh mouthwash and tubes of cinquefoil. Information regarding a dentrifice was also mentioned. Burnt roots of birthwort and white salt mixed with honey and wrapped in the leaves of fig tree were used. HISTORY OF PERIODONTICS…..

13. The Middle Ages… Historians have used the term Middle ages to refer to the period between the decline and fall of Rome (410 A.D.) a n d rebi rt h of c i vi l izatio n i n th e b e gi n n in g of 1 5 th c e n tu r y . f o u n d in g the 1 st Science and medicine developed slowly L a t e m i ddl e a g es w e r e m a r k ed by schools . M ed ici ne in th e e a r l y m i ddl e a g es w as p r act i c ed by educated monks who were essentially herbalists. universities and medical

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16. Had clear understandings of major etiologic role of calculus deposits and described the techniques of scaling teeth with a set of instruments which he developed. HISTORY OF PERIODONTICS

17. Also practiced orthodontics correcting gross occlusal abnormalities. Replacement of teeth by using bone of cattle carved to exact shape and size. Gave the descriptions of frenectomy, mucous cysts and tumor like growth of gingiva. HISTORY OF PERIODONTICS…..

18. HISTORY OF PERIODONTICS….. Theodoric (1205-1296 )  Understood the difference between the flow of blood in arteries and veins. Recommended f i r m bin d in g of w ounds t o s t op hemorrhage Als o r e c o m m en d ed suturing o f w ounds t o p r e v ent contamination. Used soporofic sponge to relieve the pain of surgery. Used advanced techniques for setting of f r actures. Particularly in fracture mandible suggested binding of teeth with gold wire/silk ligature.

19. The renaissance or rebirth of classical civilization and culture spanned for 3 centuries ( 14 th – 17 th ). Science and medicine advanced enormously. Leading to major discoveries in the modern era. Significant contribution were made to anatomy and surgery. HISTORY OF PERIODONTICS…..

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21. Andreas Vesalius (1514-1564) Anatomist considered as “ Father of Modern Anatomy ” Performed human dissections and wrote a book on anatomy with excellent illustrations. HISTORY OF PERIODONTIC

22. Bartholomaeus Eustachius (1520-1574) - Another outstanding anatomist. -Wrote a small book on dentistry Libellus de dentibus (a little treatise on teeth) in 30 chapters. -This was the 1 st original book on teeth and offered many new descriptions and concepts based on research and clinical studies which include description of periodontal tissues, diseases of mouth their treatment modalities and rational of treatment. -To treat periodontitis he advised both scaling of calculus and curettage of granulation tissue.

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24.  Th e bo o k w hich i s spe c i f ica l l y de v o t e d to A r tzne y Bu c h l ei n o r Zene Artzeny (Medicine of Teeth) was published in Leipzig in 1530. D e n tal p r acti c e, name d The book contains 3 chapters devoted to periodontal problems, including a crude concept of systemic and local factors of periodontal diseases. The presence of local infective agents or worms also is named. A variety of ointments often astringent in nature are suggested. Binding of loose teeth to sound ones with silk or gold, cauterizing the gingiva with hot iron is mentioned.

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27. 18 th Century Pierre Fauchard in his book, The Surgeon Dentist, published in 1728, gave respectability to dentistry and developed a wide appreciation for the technical and surgical skills of the dental practitioner. John Hunter wrote an excellent treatise on dentistry entitled The Natural History of the Human Teeth with clear illustrations of the anatomy of the teeth and their supporting structures. He also described the features of periodontal diseases and enunciated the concept of active and passive eruption of teeth. A contemporary of Hunter, Thomas Berdmore (1740-85 ), was considered the outstanding dentist in England . He published the Treatise in the Disorders and Deformities of the Teeth and Gums in 1770, with several chapters devoted to periodontal problems

28. 19 th Century Leonard Koecker – Use of astringent powder and tooth brush to maintain hygiene after every meal Levi Spear Parmly – Father of Oral hygiene and inventor of dental floss John W. Riggs ----- Periodontitis as Riggs disease Horace Wells – Discovered Anaesthesia Carl Koller – LA (Cocaine) Thomas Bell Aldrich and Jokichi Takamine – Adrenline Louise Pasteur – Germ theory of disease

29. The concepts of Pasteur were initially transferred to the clinical and surgical practice by Joseph Lister (1827-1912 ) of England, and thus the era of antisepsis (and later, asepsis) in surgery was born. Pasteur , Koch, and their collaborators and followers discovered the bacterial etiology of numerous diseases (e.g., pneumonia, cholera, puerperal fever, diphtheria, meningitis, plague, dysentery, syphilis ) and gave birth to two sciences that became basic to periodontics: bacteriology and immunology . Discovery of radiographs by the German physicist Wilhelm Rontgen (1845-1923).

30. Virchow – Microscopic changes in inflammation ---- Pathogenesis of periodontal diseases Adolph Witzel – First to identify bacteria as source of periodontal disease WD Miller – Nonspecific plaque hypothesis concept Leon Williams – Plaque G.V. Black coined the term gelatinous microbial plaque Moritz Karolyi – TFO

31. NUG : Recognized in the 4th century BCE by Xenophon, who mentioned that Greek soldiers were affected with " sore mouth and foul-smelling breath .“ In 1778, Hunter had described the clinical features of this disease and differentiated it from scurvy and chronic periodontitis . Jean Vincent described the spirillum and fusiform bacilli associated with what later became known as Vincent's angina, and in 1904 Vincent described these organisms in acute ulceronecrotic gingivitis

32. 20 th Century VIENNA Gottlieb published extensive microscopic studies of periodontal diseases. Orban – Histologic studies on periodontal tissues BERLIN Weski – Pioneer studies correlating radiographic and histopathologic changes in periodontal diseases Neumann – Principles of periodontal flap surgery, including osseous recontouring

33. US and other countries: Hirschfeld – NSPT Alfred Fones – First school for Dental Hygienists in Connecticut Probably the most comprehensive book on periodontics published in the first half of the 20th century was El Paradencio , Su Patologia y Tratamiento, by the Uruguayan F. M. Pucci , which appeared in 1939.

34. Focal Infection : Sir William Hunter indicted dentistry as being the cause of oral sepsis, which in turn caused rheumatic and other chronic diseases. This idea was taken up by Billings, Rosenow , and many others, who advocated extractions of all teeth with periodontal or periapical infections to prevent systemic diseases. The focal infection theory fell into disrepute when it was found that extractions failed to eliminate or reduce the systemic diseases to which the infected teeth were supposed to be linked. However, the concept has been revisited in the 1990s, this time with a more solid research foundation.

35. Dental Implants : M. Maggiolo – solid – gold roots in human jaws A.E. Strock – Implanted Cobalt Chromium screws in tooth sockets Per Ingar Branemark – Titanium screw implants----- Concept of Osseointegration