ancient history of periodontics

GOOD MORNING

“ HISTORY AND BACKGROUND OF PERIODONTICS”

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

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”.

The dental caries and enamel hypoplasia have been found in the oldest paleolithic remains and evidence of chronic periodontal disease as well as developmental malformations has been found in the extensive paleolithic material available.

Through pictorial representation researches have also begun to obtain evidence of disease and possible medical practice in paleolithic humans.


Neolithic Period

From the neolithic period there has been extensive evidence of trepanning which was carried out to permit evil spirits to escape from the skull.

Evidence of any periodontal inventions during this period has not been found.


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.

Many early sumerian societies in some way had made the association between the brain and the vitality, or even the personality, of the individual.


Babylonians over took the sumerians around 1830 to 1531 B.C.

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.

Ex. Fees for successful surgical treatment and penalty for unsuccessful treatment depending on the social status of the patient.


Almost all of our knowledge of this civilization comes form the clay tablets of the Great Library of Ashurbanipal, King of Assyeria.

Of the 30,000 tablets, some 800 are either medical texts or incantations for relief of disease.


Thompson was able to translate many of the drugs and the ingredients mentioned in the Ashurbanipal’s library.

Dental caries was thought to be caused by a tooth worm, a concept also found in ancient Indian and Chinese civilizations.

His library includes a number of remedies for periodontal diseases.

example “If a man’s teeth are loose and itch (painful) a mixture

of myrrh, asafetida and opopanax as well as pine turpentine shall be rubbed on his teeth until blood comes forth and he shall recover”.


Ancient EgyptIt has been considered classic ancient civilization.Hippocrates and his school were aware of egyptian

medical practice, and we know that many of their remedies and surgical approaches were copied from egyptian practices of the time or from egyptian text that was available to them.

From studies of the various papyri, it is apparent that egyptian medical practice was strongly influenced by religion in terms of its theoretical understandings of the disease.

Diseases were considered to be “possession” of a patient by a demon.


Diseases were treated by medicaments which include plant remedies such as acacia, anise, barley, caster bean, coriander, cucumber, fig, lotus, saffron, sun flower, wheat and wormwood.

Products such as beer, milk, wine were commonly used as vehicles or binding substances for plant or mineral remedies.

Much of this materia medica form the basis of later Greek and Roman theories.


The Ebers Papyrus presents a more complicated but better picture of egyptian medicine.

Some remedies were rational, such as astringent mouth rinses for gingival diseases and others were merely magical and have little or no rational basis for their use.

ExampleA prescription to strengthen the teeth : One part each of powder of the fruit of palm, green lead and honey to be mixed and the teeth rubbed with it.


Ancient Indian and Chinese CivilizatonsIndian medicine has been divided into 3 periods :

- Vedic period (1500 – 800 B.C.)

- Brahman period (800 B.C. – 1000 A.D.)

- Mongol period (1000 A.D.)


Vedic periodMedicine in this period was primarily magic or

supernatural with diseases treated by prayers and incantations.

Physicians mentioned in Rig veda

had medicine chests and herbal remedies. There were also surgoens.

Atharva veda mentions various diseases including tumors, abscesses, convulsions and diseases ot the teeth were mentioned.Artificial teeth and eyes were also mentioned,

indicating the existence of prosthetic therapy.


Brahman periodThis was the great age of the Indian medicine

and 2 major books have survived to give us some idea of the heights reached by brahman physicians and surgeons.

The books are the:


- Susruta samhita - Charaka samhita

Susruta samhitaThis is the greatest medical work in sanskrit and

probably dates to the 6th century B.C. Particularly interesting for its surgical

sections.Susruta himself was known primarily as a surgeon.

He studied anatomy using dissection of human cadavers.

His physiological sections reveal his concept of the body as composed of various humor that produce the important fluids and secretions.

He describred his surgeries in details including the instruments used and the actual technical procedures.


Susrutas sections on oral diseases where he describes “the gums of the teeth suddenly bleed and become putrefied,black and slimy, and emit fetid smell”

Although this description suites ANUG but it is known to be his understanding of scurvy.

He offers an accurate description of periodontitis,referring to tooth mobility and suppuration from gingiva.

He also described instructions for proper tooth brushing and use of mouthwashes to cleanse the tongue.


Charaka samhita

Charaka’s medicine is often a mixture of magic and religion,with disease treated by charms and incantations.

He devoted several sections to the mouth,oral hygeine and management of oral diseases.

He advocated tooth brush to clean teeth and mouthwashes for treatment of periodontal diseases.


Chinese civilizationChinese medicine can be divided into - Ancient or legendary period (3000-1122

B.C.) - Historical period(1121 B.C.-960 A.D.)

Han dynasty followed age of science and medicine.

Medicine came into the realm of science, and direct observation of patients was emphasized

Gradually medicine became more sophisticated, and individual physicians of note have been identified and written about.


Surgery was practiced and tooth extraction was often advised for tooth ache, particularly if the tooth was loose and gums were swollen

Following are the few descriptions of periodontal diseases in terms of Chinese civilization:Ya heou was a condition with red, soft and swollen

gums and a fetid, purulent material exuding from them (the description is suggestive of ANUG)

Ja seun was a condition in which the gums were swollen, but gradually destroyed by ulceration, leaving the roots of the tooth exposed (description is suggestive of chronic periodontitis)


Tchuen-ya-kan was a condition of swollen gums without ulceration lasting for a few days in children (description is suggestive of herpetic stomatitis)

Ya-ting was described as a localised swelling of the gingiva with the formation of tumor like mass and exudes blood (suggestive of periodontal abscess)

Tso-ma-ya-kan was described as severe ulceration of the gums with black color in children following small pox (suggestive of gangrenous stomatitis)


Late Middle Eastern and Mediterranean civilizationThe Hebrews

All we know about Hebrew medicine and dentistry comes from the old testament and the later Talmud founded on tradition

The background of Hebrew medicine was probably instrumental in determining that many Jews in later years would become famous physicians

The teeth and digestion are often mentioned in the Talmud by various commentators


Rabbis describe periodontal disease, with some of its features

The Hebrew materia medica for disease was relatively primitive, but pepper, salt, ginger, and cannel were used to calm dental pain.

Halitosis was considered a severe problem that required treatment: pepper was suggested among other remedies


The Phoenicians

Phoenician artifacts indicate that they excelled in working with gold, and teeth bound together by gold wire described, the latter appliance presumably constructed to support loose, periodontally involved teeth.

The Etruscans

Dental appliances have been found in Etruscan tombsGold frames were constructed to hold loose teeth, to

steady others, and to contain artificial teeth.

HISTORY OF PERIODONTICS……

The Scythians

The Scythians are notable for their elaborate tombs in Cermea and their magnificent gold weapons and ornaments

A Scythian vase of electrum (gold-silver alloy was discovered in Crimea and appears to depict a physician or dentist examining the mouth of a patient.


Pre-Columbian AmericaMayas and Aztecs

The Mayan record can still be seen on many stone monuments in Copan and Palenque

Medicine, as in other early societies, was closely allied to religion, and disease was considered a form of punishment, for one’s transgressions and unkind diety

It was written by Martinus de la Cruz, a physician and was referred to as Aztec Herbal


Inca empire

Inca medicine and Science may have been fairly advanced but research reveals little of it.

Dental studies of Inca empire revealed careful drilling of the cavities to permit the insertion of Jade or gold fillings.

Absence of caries in anterior teeth suggested a

cosmetic rather than a therapeutic purpose for these inlays.


Greece, Rome and Byzantium GreeceRemains 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”.


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.


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.


If blood escapes from the gums

Chew purslane

If it does no good then vinegar.

Also chew pears and apples.


ByzanthiumThere 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…….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.) and rebirth of civilization in the beginning of 15th century.

Science and medicine developed slowly

Late middle ages were marked by founding the 1st universities and medical schools.

Medicine in the early middle ages was practiced by educated monks who were essentially herbalists.

Arabic Medicine

saw the Rise of Islamand was also the golden age of Arabic science and medicine.

Medieval and renaissance stomatology and dentistry was derived directly from Arabic writings, particularly from the treatises of Ibn Sina (Avicenna) and Abu I Qusim ( Albucasis). These Arabic treatises derived their medical information from Greek medical treatises but added many refinements and novel approaches particularly in surgical procedures.


Albucasis (936-1013)

Outstanding contribution to dentistry and periodontology.

Wrote on extraction of teeth.Splinting of loose teeth with gold wire Filling of occlusal abnormalities.Discolored teeth to be treated with abrasive pastes.Used various combinations in dentifrices and mouth rinses.Use of anesthetic drug for tooth ache.


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.


Avicenna(982-1037)

Great Arabic physician.Used extensive materia medica for oral and periodontal disease…… rarely resorted to surgery.

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.



Theodoric (1205-1296)Understood the difference between the flow

of blood in arteries and veins.Recommended firm binding of wounds to stop

hemorrhageAlso recommended suturing of wounds to

prevent contamination.Used soporofic sponge to relieve the pain of

surgery.Used advanced techniques for setting of

factures. Particularly in fracture mandible suggested binding of teeth with gold wire/silk ligature.

Published a book which was a definitive for several surgical procedures.

Book outlined importance of surgery, various surgical procedures and instruments.

Writing on dental medicine, dentistry and oral surgery were of interest.

Explained tooth caries, variety of diseases of tongue, frenectomy, pain of pulpitis, development of draining dental abscess which he considered as a positive sign of healing.


THE RENAISSANCE….

The renaissance or rebirth of classical civilization and culture spanned for 3 centuries ( 14th – 17th).Science and medicine advanced enormously.Leading to major discoveries in the modern era.

Significant contribution were made to anatomy and surgery.


Paracelsus (1493-1591)

Developed interesting and unusual theory of disease “ The Doctrine of Calculus”.

Stated that pathologic calcification occurred in variety of organs and considered to be a result of metabolic disturbances where by body takes nourishment from the food and discards the refuse as Tartarus, a material that cannot be broken down which is the “ultimate matter” or “material ultima.”He recognized the extensive formation of tartar on teeth and related this to tooth ache.


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


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 1st 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.

Ambroise Pare (1509-1590)

His contributions to dental surgery were: gingivectomy for hyperplastic gingival tissues.He also understood etiologic significance of calculus.


The book which is specifically devoted to dental practice, named Artzney Buchlein or Zene Artzeny (Medicine of Teeth) was published in Leipzig in 1530.

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.

Girolamo Cardano (1501-1576)

1st to differentiate types of periodontitis. Made a publication in 1562, where he mentioned one type of disease that occurs with advancing age and leads to progressive loosening and loss of teeth, as well as second very aggressive types that occurs in younger.

In late 20th century this classification was rediscovered & became widely accepted.


Anton Van Leeuwenhoek (1632- 1723)

Developed the microscope.Used it to discover microorganisms, cellular structures, blood cells and microscopic structures including tubular structure of dentin.Using material from his own mouth he 1st described oral bacterial flora.His drawings of oral spirochetes and bacilli received reasonably good acknowledgment.He performed anti plaque experiments in his own mouth using vinegar and in vitro on bacteria in a dish.


ancient history of periodontics

Education

early humans

evidence of disease

background of periodontics

periodontal diseases

oldest paleolithic

paleolithic humans

early sumerian societies

periodontal infections