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Photos: Wellcome Collection
Ancient Origins
3000–1500 BCE: Early Egyptian writings reference treatments for oral diseases, including gum ailments. The Edwin Smith Papyrus, one of the oldest medical texts, includes descriptions of oral care.
400–300 BCE: Greek physicians like Hippocrates and Aristotle mentioned gum diseases and methods to clean teeth, such as using powders.
100 CE: The Romans, particularly Celsus, documented procedures like scraping teeth to remove tartar.
The Edwin Smith Papyrus, dating to around 1600 BCE, is among the oldest known medical texts, focusing primarily on trauma surgery. While it predominantly addresses injuries to the head, neck, and upper body, it also provides insights into ancient Egyptian approaches to oral and maxillofacial conditions.
Mandibular Dislocation Treatment
One notable section describes the management of a dislocated mandible:
"If you examine a man having a dislocation in his mandible and you find his mouth open and his mouth does not close for him, you then place your fingers on the back of the two rami of the mandible inside his mouth, your two claws under his chin, you cause them to fall so they lie in their correct place."
Hippocrates (c. 460–377 BCE):
Often referred to as the "Father of Medicine," Hippocrates is believed to have recommended dental powders for cleaning teeth. His work De Morbis Mulierum (On the Diseases of Women) is cited as containing such recommendations. However, direct excerpts are limited. Secondary sources note:
"Hippocrates (460-377 BCE) is generally considered to be the first physician to recommend the use of dentifrice in his text De Morbius Mulierum."
Aristotle (384–322 BCE):
Aristotle's extensive writings touch upon various aspects of human anatomy and health, including dental structures. While specific references to gum diseases and dental powders are not directly quoted, his observations on teeth and oral hygiene practices are acknowledged in historical studies.
For instance, a historical overview mentions:
355 B.C.E. – Hippocrates, a Greek doctor, invented a powder to clean teeth."
These insights highlight the early recognition of oral hygiene's importance in ancient Greek medicine, even if direct textual evidence is limited.
In ancient Rome, dental care practices included procedures akin to modern tooth extractions, emphasizing the importance of separating the gum from the tooth before removal. Aulus Cornelius Celsus, a Roman medical writer from the 1st century CE, detailed such methods in his work De Medicina.
Celsus on Tooth Extraction:
Celsus described the process of extracting a painful tooth when medicinal treatments failed:
"But if a tooth gives pain and it is decided to extract it because medicaments afford no relief, the tooth should be scraped round in order that the gum may become separated from it; then the tooth is to be shaken. And this is to be done until it is quite moveable: for it is very dangerous to extract a tooth that is tight, and sometimes the jaw is dislocated."
This passage highlights the meticulous approach Roman physicians took to dental extractions, emphasizing the need to carefully separate the gum tissue to prevent complications such as jaw dislocation.
Gum Disease Treatments:
Roman medical writers also addressed gum diseases. They believed that teeth could become loose due to root weakness or gum disease and treated this by cauterizing the gums, then covering them in honey swilled with mead. Afterwards, medication was placed on the teeth. If the tooth became painful, it would be extracted. This procedure involved "scraping" the tooth in "round order" and then shaking the tooth until it could be safely removed.
These practices underscore the advanced understanding Roman physicians had of dental health and their efforts to treat oral ailments effectively.
For a comprehensive exploration of Celsus's work, the Perseus Digital Library offers the full text of De Medicina, including Book VII, Chapter 12, which discusses dental procedures.
These historical insights reveal the foundational role ancient Roman medical practices played in the evolution of dental care, with techniques that resonate with modern periodontal and prosthodontic procedures.
Medieval Period (500–1500 CE)
Dentistry was largely performed by barbers and general physicians. Gum disease was treated with rudimentary methods like herbal poultices and cauterization.
Avicenna, a Persian polymath, described gingival diseases and their management in his Canon of Medicine.
Avicenna, known as Ibn Sina (980–1037 CE), was a Persian polymath whose seminal work, The Canon of Medicine, profoundly influenced medical science, including dentistry. In this comprehensive encyclopedia, Avicenna addressed various oral health issues and their treatments, reflecting an advanced understanding of dental care for his time.
Dental and Oral Health in The Canon of Medicine
Avicenna's Canon encompasses discussions on oral diseases, dental hygiene, and therapeutic interventions. He identified over 80 herbal remedies for managing oral and dental conditions, emphasizing the importance of natural substances in treatment protocols.
Specific Treatments and Remedies
Avicenna recommended various natural substances for dental care, including:
Herbal Remedies: He introduced more than 80 herbal treatments for oral diseases, utilizing plants rich in essential oils.
Analgesics and Anti-Inflammatories: Avicenna's Canon lists numerous substances with analgesic and anti-inflammatory properties, derived from plants, animal products, and minerals, tailored for dental pain and inflammation.
Early Modern Period (1500–1800 CE)
Pierre Fauchard (1678–1761): Known as the "Father of Modern Dentistry," Fauchard described periodontal diseases and their link to tartar in his seminal work, Le Chirurgien Dentiste. He advocated for tartar removal to maintain gum health.
Periodontal instruments were refined during this era for scaling and cleaning teeth.
19th Century
The Industrial Revolution brought advancements in dental instruments and understanding.
John Riggs (1811–1885): An American dentist, Riggs, popularized treatments for "Riggs’ disease," now known as periodontitis.
The first periodontal schools and societies were established, like the American Academy of Periodontology (AAP) in 1914.
Pierre Fauchard (1678–1761), often hailed as the "Father of Modern Dentistry," made significant contributions to various dental disciplines, including periodontology. His seminal work, Le Chirurgien Dentiste ("The Surgeon Dentist"), published in 1728, laid the foundation for contemporary dental practices.
Contributions to Periodontology:
Understanding Periodontal Disease: Fauchard provided detailed descriptions of periodontal diseases, particularly pyorrhea (gum disease), recognizing the importance of healthy gums in maintaining overall oral health. He emphasized the need for early detection and treatment to prevent tooth loss.
Scaling and Root Planing: He advocated for the removal of dental tartar and plaque through scaling, understanding that debridement of root surfaces was essential in treating gum diseases. This practice is a cornerstone of modern periodontal therapy.
Preventive Care and Oral Hygiene: Fauchard emphasized the importance of preventive care and oral hygiene, providing a basis for modern dental hygiene protocols.
John Mankey Riggs (1811–1885), an American dentist from Hartford, Connecticut, is widely recognized as a pioneer in the field of periodontology. His innovative approaches to diagnosing and treating periodontal disease significantly advanced dental science in the 19th century.
Contributions to Periodontology:
Identification and Treatment of Periodontal Disease: Riggs specialized in treating what was then referred to as "pyorrhea alveolaris," a severe gum infection leading to tooth loss. His effective treatments led to the condition being commonly known as "Riggs' disease."
Advocacy for Oral Hygiene: Riggs emphasized the importance of maintaining oral hygiene to prevent gum diseases, laying the groundwork for modern preventive dentistry.
Historical Context:
During Riggs' era, the understanding of periodontal diseases was limited. His work brought attention to the significance of gum health and its impact on overall dental well-being. Notably, he was associated with Horace Wells, a pioneer in the use of anesthesia in dentistry, and was present when Wells tested laughing gas for tooth extraction. Riggs was the dentist who performed the extraction during this demonstration.
20th Century
1950s–1970s: Research identified bacterial plaque as the primary cause of periodontal disease. Treatments shifted from purely mechanical approaches to a combination of scaling, root planing, and systemic antibiotics.
Advances in surgical techniques like flap surgery and guided tissue regeneration emerged.
21st Century
Innovations in laser-assisted periodontal therapy, regenerative biomaterials, and minimally invasive techniques continue to shape the field.
A focus on the systemic links between periodontal disease and conditions like diabetes and cardiovascular diseases underscores its importance in holistic health care.
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