A short history of periodontics
Paleopathologists have found evidence of bone resorption in early hominids. This tells us that periodontal diseases have affected our ancestors for thousands of years, even before current morphology became established, and do not appear linked to changes in diet, like the prevalence of caries. Wire ligatures made of gold or silver have been found in dental remains in many early civilisations.
Gum problems were generally attributed to an imbalance of humours. This theory persisted through many eras and is found in many cultures from the Hindu to ancient Greece, Phoenicians and Romans. While obviously incorrect, we can recognise in the humours theory the early understanding of that systemic connection in periodontal inflammation, which has been debated almost to this day.
The Sushruta Samhita (Suśrutasaṃhitā), the ancient Sanskrit text on ayurvedic medicine provided recipes for conditions when 'the gums of the teeth suddenly bleed and become putrefied, slimy and emit fetid odor'.
The Ebers Papyrus, dating 1550 BCE circa, is considered one of the first to mention periodontal disease and gum disease among medical texts from antiquity that reached us. Remedies for these ailments, ‘to strengthen the flesh’ (gums) include chewing a compound of corn, fresh dates and milk nine times.
Albucasis (Abū ʻl-Qāsim, 936-1013), an eminent Islamic scholar, suggested cauterisation with hot red arsenic, and the use of scraping instruments to remove calculus, which he believed as the cause of gum disease.
Ancient Chinese medical texts add what seems to be periodontal disease to a list of nine ‘typical’ toothaches. In a European compendium of Asian medicine, reported by Guerini, the disease is thus described: ‘In such cases the teeth often fall out, the breath becomes fetid, and if the patient eats hot food, the empty alveoli as well as the cheeks are painful’. The solution? A poultice of mice bones or a purgative of rhubarb and mint. Acupuncture is also mentioned.
The Hippocratic corpus takes what appears a somewhat misogynistic approach to gum disease, listing relevant remedies in the section for ‘diseases of the women’, rather than toothache:
‘ When a woman’s mouth smells and her gums are black and unhealthy, one burns the head of a hare, and three mice, after taking out the intestines of two of them, one pounds in a stone mortar some marble or white stone and passes it through; sieve, mixing it equal part and with this mixture rub teeth and gums, and again with unwashed wool’.
However, this could be simply show an early understanding of pregnancy effect on gum health.
In the Hippocratic corpus we also find quite accurate descriptions of perio disease: ‘the gums are detached from the teeth and smell bad’. The cause is specified as ‘accumulation of pituita’, or calculus.
Throughout Roman times, soaking or boiling frogs in oil, wine or vinegar remained popular remedy to make loose teeth firm. The frog would help regenerate the gum and restore harmony in bodily humours.
In medieval times, Arab medicine (Albucasis, Avicenna) suggests arsenic was often added to poultices and remedies. Cauterisation right into the pocket would ensure ‘ the corrupted moisture will dry up, the flaccid gums will regain tone, and the tooth its firmness’.
The Renaissance would bring the end of the Theory of Humours and challenged the Galenic system of medical knowledge and surgery.
As early as 1683, Anthony van Leeuwenhoek (1632-1723) used his microscope to study his own saliva and the ‘little white matter as thick as wetter flower [flour]’ sticking to his teeth. He was able to see ‘very small living animals, which moved themselves very extravagantly’, in the ‘scurf of the teeth’. The importance of Leeuwenhoek’s discovery remained hidden until germ theory took over Western medicine and dentistry.
THE MICROBIOLOGICAL CONNECTION
The German physician Robert Ficinus may be credited for first describing bacterial intervention in periodontal disease and tooth loss (1847).
In 1890, Willoughby Miller published The Microorganisms of the Human Mouth, commonly regarded as the first oral microbiology text. Miller’s studies led him to consider the etiology of pyorrhea alveolaris, and formulated the so-called ‘non-specific plaque hypothesis’: multiple bacteria, interacting with poor hygienic conditions and other factors likely caused the disease.
Unfortunately, Miller’s work is also the origin of the theory of focal infection that resulted in decades of indiscriminate extractions and unwarranted surgery to eradicate systemic illness.
While Miller and others zeroed in the causes, Dr John Makey Riggs perfected what is still integral part of modern periodontal therapy (1856).
Dr. Riggs is widely considered the first dentist to dedicate himself to periodontics. His work therefore marks unofficially the start of periodontics as a separate specialty of the dental profession. Periodontitis was for a while known as Riggs’ disease.
The following description of his conservative approach is found in his obituary:
‘His treatment was wholly surgical, working in the dark with instruments, with remarkable skill and deftness of touch, down to the extreme points of the roots of the teeth, removing the cause of the trouble, and stimulating the gums to healthy action.’
Riggs’ approach included a strong belief in prevention and the role of oral prophylaxis, and a rejection of the then popular gingivectomy. While it is quite hard to find Riggs’ original notes, we know from other articles published in the 1870-1880 that he designed his own scrapers for removing calculus and necrotic bone.
Anecdotally, Riggs was the dentist who extracted Horace Wells’ tooth in what was to be the first recorded successful use of anaesthesia in surgery. He was also Mark Twain’s personal dentist. In Happy Memories of the Dental Chair, we find Twain’s description of his experience under Dr Riggs’ care:
‘Then he put his tool into my mouth, rooted it up under a gum and began to carve. He seemed to fetch away chips of bone the size of my hand. In truth, what he removed could hardly have been seen without a microscope. […] I could not touch anything to my teeth for several days, they were so supernaturally sensitive. But after that they became as tough as iron, and a thorough comfort. If by some blessed accident my conscience could catch the Riggs disease, I know what I would do with it’.
In addition to germ theory, there are two more important scientific advances that helped establish modern periodontics: the discovery of anaesthesia and x-rays. Radiography enabled more sophisticated understanding of periodontal diseases and their progression. Anaesthesia permitted the development of surgical techniques.
THANKS TO
Em Prof John Brown BDSc MS PhD, University of Texas Health Science Centre, San Antonio, for donating this and many other dental history objects and books to ADAQ in the last few years.
REFERENCES
Albucasis (al-Zahrāwī,) (1532). Chirurgicorum Libri Tres. Strassbourg, p.173-175p.173-175 – description of dental forceps and surgical instruments.
Czarnetzki A, Jakob T, Pusch CM. (2003). Palaeopathological and variant conditions of the Homo heidelbergensis type specimen (Mauer, Germany). J Hum Evol 2003: 44: 479–495.9.
Guerini V. (1909). A History of Dentistry from the most Ancient Times until the end of the Eighteenth Century. Lea & Febiger: Philadelphia.
Ripamonti U. (1989). The hard evidence of alveolar bone loss in early hominids of southern Africa. A short communication. J Periodontol. 1989 Feb;60(2):118-20. doi: 10.1902/jop.1989.60.2.118. PMID: 2656976.
Shklar, G; Carranza, FA. (2002) The Historical Background of Periodontology. In Newman, MG; Takei, HH; Carrana FA, editors: Carranza’s Clinical Periodontology, 9th Edition. Philadelphia: W.B. Saunders Company.
Spielman, AI. (2023). History of Periodontics. In: Illustrated Encyclopedia of the History of Dentistry. https://historyofdentistryandmedicine.com/