Periodontal disease epidemiology - learned and unlearned?

The notion of periodontal disease being the major cause of tooth loss among adults was rooted in the focal infection paradigm that dominated the first half of the 20th century. This paradigm was established largely by personal opinions, and it was not until the development of periodontal indices in the mid-1950s that periodontal epidemiology gained momentum. Unfortunately, the indices used suffered from a number of flaws, whereby the interpretation of the research results took the form of circular reasoning. It was under this paradigm that therapeutic and preventive intervention for periodontal diseases became entirely devoted to oral hygiene, as poor oral hygiene and older age were understood to explain nearly all the variation in disease occurrence. In the early 1980s, studies appeared that contradicted the concepts of poor oral hygiene as the inevitable trigger of periodontitis and of linear and ubiquitous periodontitis progression, whereby periodontal epidemiology was led into a relatively short-lived high-risk era. At this time, it became evident that old scourges continue to haunt periodontology: the inability to agree in operational clinical criteria for a periodontitis diagnosis and the inability to devise both a meaningful and a useful classification of periodontal diseases based on nominalist principles. The meager outcome of the high-risk era led researchers to resurrect the focal infection paradigm, which is now dressed up as periodontal medicine. Unfortunately, these developments have left the core of periodontology somewhat disheveled and deserted.

Theodore Roosevelt's "presidential smile" and questionable dental health.

Theodore ("TR" or "Teddy") Roosevelt (1858-1919), who served as the twenty-sixth President of the United States from 1901 to 1909, was an "Icon of the American Century." Characterized by immense energy, numerous skills, zest for life, and enduring accomplishments, he made an impressive ascent to political importance. However, he also experienced serious, chronic, oral and systemic health problems. In spite of these significant health obstacles, he chose "the strenuous life," and cultivated a lifetime of joy, laughter and humor. TR was known as "the first president that smiled," and he was typically photographed and illustrated grinning from ear to ear. His flashing white teeth, wide smile, and engaging openness became welcome symbols of national and international acceptance. When Roosevelt died, suddenly and prematurely at the age of 60, dentists and physicians of that time began to investigate the probable medical causes of his untimely demise. The "focal infection hysteria" of the early 1900s convinced some of these health professionals that "a bad tooth", that previously had been endodontically treated, was the probable cause of death. Much of the early 20th century evidence-supporting the notion that oral sepsis was a "cause" of local or systemic disease-has now been proven, on closer inspection, to be anecdotal or of questionable scientific merit. Nevertheless, during those early days, it was common practice to extract all endodontically or periodontally involved teeth to eliminate any possible foci of infection that many clinicians believed could cause disease.

The focal infection theory: appraisal and reappraisal.

This paper discusses the past, present, and future of the focal infection theory of disease. A focal infection is a localized or general infection caused by the dissemination of microorganisms or toxic products from a focus of infection. The resurgence of the focal infection theory of disease has been greeted with great enthusiasm in some quarters; however, the present evidence for the relationship of oral microorganisms and systemic disease is very limited due not only to a dearth of prospective studies and a complete lack of interventional studies but also to very significant methodological difficulties associated with the clinical studies that have been performed.

The person behind the eponym: Wilhelm Frederick von Ludwig (1790-1865).

In 1836, Wilhelm Frederick von Ludwig described a fast-spreading, nearly always fatal infection involving the connective tissues of the neck and floor of the mouth. Named after this Stuttgart physician, the condition has been known since as "Ludwig's angina". This biographical sketch highlights the life and times of the man behind the eponym, who was lauded for his surgical prowess at the age of 19, went on to become president of the Württemberg Medical Association, and whose name and the condition he described continue to be recognized today.

[The x-ray picture of chronic odontogenic osteomyelitis of the mandible in adults in the past and today]. / Rentgenologicheskaia kartina odontogennogo khronicheskogo osteomielita nizhnei cheliusti u vzroslykh v proshlom i v nastoiashchee vremia.

Analysis of mandibular roentgenograms of 286 patients with odontogenic osteomyelitis has lead the authors to a conclusion on the predominance of diffuse forms of the condition with marked sequestration in the 30's and 40's. Currently hyperplastic osteomyelitis occurs in 12% of cases.

Medical theories and professional development. The theory of focal sepsis and dentistry in early twentieth century Britain.

This paper traces the history of the theory of focal infection--which related a number of general conditions to septic foci from which toxic products spread to different parts of the body--and its application to dental diseases in early 20th century Britain. Bad teeth were said to be one of the major sources of infection and a cause of many diseases. The paper focuses on the social and professional context in which the theory emerged and flourished. It shows that in spite of its lack of scientific foundation, the theory of focal sepsis was readily accepted by the dental profession and used to advance its claims for professional recognition. Thus the paper attempts to illustrate the point that the acceptance of a medical theory by health practitioners is as much determined by social and economic factors as by its therapeutic potential or its scientific validity.

A personal history of dental practice: 1920-1980.

The progress that has been made in dentistry during the past 60 years is reviewed by Dr. Grossman, who has been a member of the profession since 1923 and whose experience has covered both the purely academic and practical application of current theory.

Endodontics 1776-1976: a bicentennial history against the background of general dentistry.

During 200 years of progress in endodontics, various sciences have contributed to our understanding of the physiology and pathology of the dental pulp. Early treatment included cauterization of the pulp, the use of poultices or leeches, and tooth transplantation or replantation. Various methods of pulp devitalization are reviewed. Near the turn of the century, the discovery of X rays made diagnosis more accurate and the discovery of local anesthetics eliminated pain during endodontic treatment. Although the focal infection theory slowed the acceptance of endodontic treatment in this century, the biomechanical concept of treatment and research have recently opened new avenues for treatment and have initiated improvements in medicaments and filling materials.