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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 man‟s 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”

 Diseases were considered to be the possession of a patient by a demon.it‟s apparent that egyptian medical practice was strongly influenced by religion.is the most impressive of all in terms of approach to patient diagnosis &management.  from studies of the various papyri.primary a surgical treatise.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. .

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

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

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

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

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

Phoenician Specimen with gold wire Ligature to immobilize teeth .

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

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

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

 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. .

gingiva &oral mucosa. .  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 Middle Ages  Guy de Chauliac offers extensive medicaments for the t/t of various diseases of the teeth.  Pomegranate juice was an excellent astringent mouthwash  Tartar was removed by scalers since rinses rinses &tooth powders would not have any effect upon it.

which dried up or coagulated mucoid matter in food.The Modern Era  The renaissance:science &medicine advanced enormously &led to major discoveries.  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.  The first printed dental book was published in German in 1530 . .

. 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.

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

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

esp.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.b‟coz of Pierre Fauchard went through a period of great progress in this century. .The Eighteenth Century  Dentistry in general & periodontics in particular.  Fauchard was the one who had belief in the local etiology of periodontitis as opposed to the contemporary theory of a systemic causation. particularly scurvy .  Pierre Fauchard „the severe mouth diseases that sailors suffered.

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

.  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.  He described pocket formation &bone loss. John Hunter portrays the displacement of teeth as a consequence of the loss of adjacent or opposing teeth.

.not only for solving disease problems but also for esthetic &function.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.

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

irritational factors &bacteria in the etiology of pyorrhea alveolaris. 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.  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” .

 Mentions the careful removal of the tartar & the need of oral hygiene by the patient.  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.  Levi Spear Parmly is considered the inventor of dental floss.Clinical Periodontology  Leonard Koecker in 1821. from marginal gingivitis to periodontitis to tooth loss. .in the Philadelphia Journal of Medicine &Physical Sciences describes the inflammatory changes in the gingiva.

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

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

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

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

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

Periodonal probe ( Periodontometer) developed by Hanford & Patten .

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

W.  John.Riggs later designed a series of six instruments.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. .which were essentially sickles but were still large & clumpsy & not suitable for fine scaling.

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

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

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

Newmann’s Surgical Technique .

Mandible from 6th century A.D.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 b‟coz of a scarcity of documented case series to clearly establish the success rates and ascertain the causes of failure. .

 Implantology has become a widely used technique that has revolutionized the practice of dentistry . 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.

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