Saturday, August 6, 2011

The History of Gum Disease

Luckily, many dentists have been true pioneers in the prevention
of tooth loss and have helped create the techniques
and instruments for scaling teeth that are used today.
Knowledge of gum disease dates back as far as 1746,
when Dr. Pierre Fauchard, a surgeon-dentist who is known
as the father of modern dentistry, wrote a paper titled Le
Chirurgien Dentiste that described gum disease. Dr.
Fauchard advised patients to wash out their mouths with
tepid water after having cleaned their teeth. After they
rinsed, he advised patients to rub the teeth from below upward, and from above downward—outside and inside—
with a little sponge dipped in water. He also claimed it was
good to use a half-round toothpick to remove what he called
the “fur” that collects on or between the teeth and gums during
the night. His advice to remove this sticky film with a
toothpick was very advanced for his time, and his ideas presaged
today’s use of picks to scale teeth.
In 1845 Dr. John Hankey Riggs was the first to call attention
to gum disease in America. Periodontal disease thus
became known as “Riggs disease.” Few professionals currently
refer to gum disease as Riggs disease, however.
Today’s terms are: gum disease, periodontal disease, or gingivitis.
My own approach is much the same as his: to treat
the condition as a curable disease by cleaning the pockets
surrounding the teeth. With a thorough cleaning, the bacteria
and toxins are removed from between the teeth and surrounding
bone, thus reversing gum disease.
Dr. Riggs is given credit for designing scalers and
curettes—instruments that we still use today to remove the
hardened stone (tartar) from the roots of our teeth and the
diseased layer of granular (thickened diseased tissue) that
sits next to the tartar. The roots of our teeth are not straight
up and down, but curve at angles under the gum tissue.
Thus the scalers and curettes were designed with contraangles
(curved angles) to conform to the roots and remove
any material in the pockets. A dental cleaning using these
instruments is the most important preventive treatment for
periodontal disease.
One of the first dentists in America to establish a preventive
dental practice was Dr. David Smith of Philadelphia in
1894. Prophylactic services (cleaning of teeth), although beneficial to patients, were time-consuming, and so reduced
the amount of time dentists were able to allocate to restorative
treatment. Thus there were fewer dentists back then who
performed preventive care. Most were restorative dentists,
who focused on fixing the nonregenerative enamel and
dentin, the hardened materials of our teeth. Dr. Alfred C.
Fones, another pioneer, believed that training auxiliary personnel
to provide prophylactic care was an efficient solution
to this problem. Dental hygiene thus can be traced back to
Dr. Fones, as he felt there should be a separation between
restorative care and gum disease, and he was the first to initiate
a program for dental hygiene. A dental hygienist is a
licensed professional who cleans away the tartar (hardened
plaque) from the teeth and roots under the gums. Dr. Fones
created a school for dental hygiene in Bridgeport,
Connecticut, in 1898.
It was understood even then that not enough emphasis
was put on educating children and teaching them the importance
of proper oral hygiene. It was known as far back as
1898 that a clean tooth would not decay. So dental hygiene
became an important profession in helping adults and children
prevent adult tooth decay and tooth loss. The dental
hygienist would clean teeth, educate and motivate the
patients in home care, and then recommend treatment for
restorative care by the dentist. The dental hygienist’s role
was an important one—even more than it is today—for there
were fewer dentists at that time.
In 1939 Dr. A. W. Byran tried to make the dental profession
aware of causative factors in gum disease and
attempted to have the profession focus on prevention and
diagnosis, rather than only on the symptoms of the disease.
He argued against drug treatment, maintaining that
unless the drugs were directed at a specific site of infection,
they were not treating the condition scientifically. He
was also against the surgical removal of unattached tissue
because it did not address the cause and only dealt with
Dr. Byran and Dr. Riggs had more insight into the subject
of the reversal of gum disease naturally than many gum
specialists (periodontists) do today, as cutting away at diseased
and unattached tissue is still widely practiced. While
surgical removal of gum tissue instantly shrinks the pocket
collecting bacteria, the tissue remains thinner at a higher
point on the tooth. And if the periodontist does not address
the cause and motivate the person to practice proper home
care and oral hygiene, the condition can appear again and
cause breakdown in a more vulnerable area.


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