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The beginning of oral pathology
The beginning of oral pathology Part I: First dental journal reports of odontogenic tumors and cysts, 1839-1860 Jerry E. Bouquot, DDS, MSD,a and Elizabeth C. Lense, DDSb Morgantown, and Atlanta, Ga. THE MAXILLOFACIAL
CENTER
FOR DIAGNOSTICS
W.Va.
AND RESEARCH
Literature reviews of oral lesions frequently lack an appropriate historic perspective, presuming that the mid- to late-twentieth century reports are the first valid reports available. The mid-nineteenth century dental journals, however, are replete with clinical, surgical, and microscopic descriptions of oral tumors and cysts. Most of these have never been referenced during ithe present century. The purpose of this article is to report the earliest dental journal references for a variety of odontogenic tumors and cysts. These references are derived from a canvass of all dental journals published from the first journal (American )ournal of Dental Science) in 1839 to the appearance of Dental Cosmos and the organization of the American Dental Association in 1860. (ORAL SURG ORAL MED ORAL PATHOL 1!294;78:343-50)
Oral Pathology as a specialty of dentistry is traditionally presumed to have its origin in the 1930s and 1940s’ perhaps commencing with Bunting’s Textbook of Oral Pathology,2 Thoma’s Oral Pathology,3 or the first issues of the Archives of Clinical Oral Pathology,4 and O’ral Surgery, Oral Medicine, Oral Pathology.5 The American Academy of Oral Pathology and the American Board of Oral Pathology were formed during rhis time period, preceded slightly by the first organizations devoted exclusively to Oral Pathology, the New York Institute of Clinical Oral Pathology and the American Dental Association’s Registry of Dental and Oral Pathology.6, 7 An even earlier 1andma:rk was Bloodgood’s* comprehensive review of oral lesions in the second volume of the Journal of the American Dental Association. The first professorship of Oral Pathology, however, originated muclh earlier with the 1840 establishment of the Baltimore School of Dental Medicine.9 The first text dedicated to Oral Pathology as we know it today was published shortly thereafter by Bond,l” and, of course:, Fouchard,” Jordain,12 Hunter,13 BeILl and others had reported even earlier on a variety of tooth anomalies. In reality, it appears that the mid-nineteenth century was the time of the true birth of Oral Pathology (Table I). The age that saw an unprecedented, worldwide “mental stir” in consequence also saw the emergence of modern or organized dentistry.30 This first Golden Age of Dentistry, 18351860, began with aDirector, The Maxillofacial Center for Diagnostics and Research, Morgantown, WV; Visiting Senior Scientist, Mayo Clinic, Rochester, MN. bin private practice, Atlanta, Ga. Copyright @ 1994 by Mosby-Year Book, Inc. 0030-4220/94/$3.00+ 0 7/14/54866
dentistry “not a whit more respectable than the barber-surgeons of old times,” and concluded with its establishment as an organized, science-based health profession with te:chniques and therapeutic successes not unlike those of the twentieth century.30> 31 The face of dentistry was absolutely changed to something unrecognizable from that which came before.32 A fascination for pathologic processes was an integral part of modern dentistry at its inception, as was a strong and apparently new belief that information should be openly and widely shared.33 Approximately half of all scientific articles in the first volume of the earliest published dental journal were related to pathologic conditions of the mouth and jaws,34 and the first truly comprehensive text for the dental profession in the United States, the 1829 classic by Be&l4 dealt extensively with pathologic processes and included the first reports of numerous oral diseases. Lester Cahn’ believed that Sir Jonathan Hutchinson was the earliest Oral Pathologist, but the chairman of Baltimore’s Department of Special Pathology, Thomas E. Bond, MD, more correctly holds that distinction. Bond’s in.sight was so remarkable that he was able to hypothesize causes and pathophysiologies that are still valid today. Leonard Koecker, an influential dental surgeon from London, was the first professional to actually be designated a Dental Pathologist in print. 2oHe published an 1822 general text on dentistry, Principles of Dental Surgery, with observations said to be “based upon a correct knowledge of the laws of disease.“35 Interest in path’ology continued to grow as dentistry became a strong and independent health profession, and by 1860 many of today’s well-established oral lesions had been reported in the various dental journals then publishing (Table II). These accounts frequently 343
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le 8. Historic events that established Oral and Maxillofacial dentistry Year 1828 1839 1839 1839 1840 1840 1840 1841 1843 1845 1848 1849 1850 1852 1852 1856 1857 “Authors
Pathology as an integral part of organized Historic event
First First First First First First First First First First First First First First First First First
textbook devoted to diseases of the mouth journal report of oral pathologic entity (dilaceration)16 emphasis on systemic effects on oral tissuesI report of an hereditary effect on oral tissues’*- l9 use of term “dental pathologist” (for L. Koecker)20 report of specific systemic effect (menstruation) on oral lesion (pulp p01yp)~~ professorship of dental pathology (Baltimore)9 continuing education course in oral pathology*5 text devoted to head and neck tumorsz2* report of racial predilection for an oral diseasez3 text devoted to dental/oral pathologylo use of term “oral medicine”24 literature review of an oral pathologic entityz5 microscopic description of a lesion in dental journalz6 dental pathology lectureship in a U.S. medical schooi27 discussion of a differential diagnosisz8 series report of an oral pathologic entity29
are Burns and Pattison from the University
of Maryland
School of Medicine.
anteceded the usually quoted first reports by several generations. Oral pyogenic granulomas, for example, were not well understood until the 1951 analysis by Kerr,36 yet Simon P. Hullihen, the Father of Oral Surgery, described one succinctly in a 22-year-old pregnant woman as early as 1844.37 Hullihen documented a recurrence of his patient’s gingival “aneurysm” with her second pregnancy. During the same year Westcott38 described pregnancy gingivitis under the diagnosis of “uterine irritation”; HarrisI had described it earlier as “hemorrhoidal discharge in dysmenorrhea.” Oral pathology articles frequently begin with historic reviews of the lesion or disease under discussion, usually mentioning the first cases identified. It seemed appropriate therefore to document the first actual dental journal reports of such entities. The attempt to do so is considerably facilitated by the fact that American dentistry, through its free exchange of innovative technology and scientific inquiry, its journals, national organizations, and its schools of dentistry, dominated the profession throughout the nineteenth century. Consequently, virtually all of the earliest journals were published in English and almost always in the United States (Table H). Although persons from other countries published occasional textbooks of exceptional quality and insight, other countries lacked the cooperative spirit needed to assure a rapid expansion of professional knowledge. This first Golden Age of Dentistry was a truly remarkable and uniquely American phenomenon, as declared in 1851: “dental surgery, as at present practiced, is almost
an American creation, for although operations upon the teeth have been practiced since the days of the Pharaohs, and probably before, yet the rude and simple character of the early manipulations hardly give them a claim to be regarded among the effects of scientific art, and until comparatively lately, but very little improvement seems to have been made in this department of surgery.“39 Because of this American dominance it is presumed that references in early American dental journals are among the first reasonably accurate references to oral pathologic entities. It is hoped, however, that this article will stimulate additional investigation into early references of such lesions, especially in textbooks, which were much less widely circulated than journals and are much more difficult to obtain today. METHODS A listing of nineteenth century dental journals40 was supplemented by a 4-year systematic perusal of journals in the libraries of West Virginia University, the University of Minnesota, the Mayo Clinic, and the National Library of Medicine. Table II lists all dental journals published, in any language, between 1839 and 1860. Almost all English-language articles published in all volumes of each journal in Table II were reviewed for references to oral pathologic entities. Although most diagnoses were obvious, even though the lexicon was different from that in use today, approximations were occasionally made for lesions that lacked detailed histologic descriptions. Such cases are identified as such in the present text and tables. All
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II. The earliest published dental journals worldwide, 1839-1860. All are American titles, unless otherwise specified
Table
Year(s) of publication
Journal title American Journal of Dental Science Stockton’s Dental Intelligencer British Journal of Dental Science (London; intermittently The Forceps (London) The Dental Mirror New York Dental Recorder Dental Register of the West Dental News Letter (became Dental Cosmos in 1859) Dental. Times Dental Expositor Der Zahnarzt (Berlin) The Forceps (New York) The Dental Monitor Dental Obturator Transactions of the Odontological Society of London Dental Reporter Quarterly Journal of Dental Science (London) L’Art Dentaire (Paris)* Cincinnati Dental Lamp New York Dental Journal American Dental Review (intermittently published) The Dental Enterprise The Dental Register The Dental Review (London)* Dental Cosmos? Zeitschrift fur Zahn-Heilkunde (Hamburg)* Revue Odontotechnique (Paris)* Southern Dental Examiner*
1839-1915 1843-1:548 1843-1’939 1845-l 846 1845 1846-1856 1847-1923 1847-1859 1851 1853 1853-1860+ 1855 1855 1856-1859 1856-1907 1857-1859 1857-1859 1857-1860+ 1858 1858-1864 1858-1936 1858-1859 1858-1859 1859-1860+ 1859-1936 1860-? 1860-? 1860-?
published)
*Last year of publication is unknown by authors. thcorporated
into Journal of American
Dental Association
in 1936.
lesions reported from 1839 to 1860 were placed in a database, whether first reports or not, and additional references are available upon request. ODONTOGENIC
NEOPLASMS
The first denial journal reports of oral pathologic entities dealt with odontogenic anomalies (Fig. 1). Dentists were beginning to share clinical information on a wide scale, and the odd case noted in clinical practice was specifically sought by editors. One of the most well-accepted anomalies, then called exostosis, was an enlargement at the apex of the root or “bone” of an extracted “fang.“41 Such lesions were thought to be a major cause of toothaches and inflammation of the “dental nerve” (pulp), a natural assumption considering that they were only found upon extraction of painful and cariously destroyed teeth.21,42-44By 1851 Vandenburgh4s hypothesized that pulpal inflammation caused this lesion and it was therefore not a true exostosis. Harris15 and Lee46 believed that multiple casesin one person were the result of constitutional causesrather than inflammation. Today we
refer to this as hypercementosis and know it to represent excessivecementoblastic activity as a result of hypereruption of a.tooth. We still accept one systemic cause, Paget’s diseaseof bone, for multiple hypercementoses.47 A few exostoseswere much too large to conform to a hypercementosis diagnosis and were obviously benign cementoblastomas. Several were reported to have completely obliterated the adjacent maxillary sinus.48,49 The very first dental journal reference to an odontogenic neoplasm was a 7 cm cementoblastoma of a maxillary molar, reported in the inaugural volume of the American Journal of Dental Science (AJDSJ, the official publication of the first national dental association and the only dental journal acceptedby the early American Medical Association as a legitimate medical journal.50, 51 This same entity became the first odontogenic lesion reported with microscopic confirmation (Fig. 2), almost a century before Norberg published the article most usually quoted as the first report of this lesion.
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Fig. 1. Case of dilaceration shown from three angles is the first picture of an orai anomaly reported in a dental journal.t6 Such cases were thought to result from the fusion of the remnants of fractured roots, as with bone healing, and were initially called “osseous union.”
Fig. 2. Gross and macroscopic appearance of a benign cementoblastoma of a maxillary bicuspid. The “considerable incrustation of hypertrophied tooth-bone” was destroying the normal tooth.52
Table III provides first reports of other odontogenit neoplasms. The first journal report of a complex odontoma was in a 25-year-old woman and was most unusual in that it erupted with the underlying tooth.42 Without such eruption, of course, this lesion would not have been noted at a time in which radiographs were not in use. The complex odontoma with the most definitive microscopic confirmation was not reported until the superb article by Forget,4g translated in the first volume of Dental Cosmos (Fig. 3). The first unequivocal cases of compound odontoma, one with at least 25 distinct teeth and another with a gross specimen drawing confirming the diagnosis were reported in 1854 and 1858, respectively.61,63 Although these
are the first journal reports of odontomas, it was probably Pierre Fouchard” who provided the first accurate description of these lesions. Qude?j4, in 1809, suggested that they were of dental origin, but the term odontome was not applied until 1868.65 They are undoubtedly the oldest recorded odontogenic neoplasms, having been reported in a 5OO,OQO-yearold fossilized horse.@ An earlier journal report of an intraosseous neoplasm might possibly have dealt with a complex odontoma discovered only because of its large size.59 But the surgical description is more appropriate to a central ossifying/cementifying fibroma. The first unequivocal case of the latter entity was one of considerable size, contained numerous microscopic foci of dark globular cementum, and was not published until 1865 (Fig. 4).67 The odontogenic (nonossifying) fibroma is an entity that until recently was frequently confused with simple fibrous hyperplasia of the parafollicular connective tissues,68 but Adams60 reported a circumscribed fibrous tumor around the crown of an impacted mandibular molar that seems large enough to justify it as the first report of a true odontogenic fibroma. Also, Fergusson62 reported a similar case that was gelatinous rather than fibrous and hence was likely an odontogenic myxoma. Other odontogenic neoplasms were difficult or impossible to identify without detailed microscopic description. It is probable that none were actually reported or were reported with so little descriptive detail as to defy proper diagnosis. Thorna listed only four types of odontogenic neoplasms as late as 1947, Ameloblastomas, which had been reported in Europe by 1827 and inspired hundreds of publications after the first Golden Age,68-70were not reported in dental journals between 1839 and 1860. Wed171provided the first histopathologic description in 1853 indicating that this “cystosarcoma or cystosarcoma adenoides” possibly originated from a tooth bud or dental lamina. The first histologic drawing of an ameloblastoma was not published until 1871 and ironically depicted one of the most recently delineated types, the unicystic
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Fig. 3. Gross and microscopic appearance of a complex odontoma in situ of the mandible.49 Dentinal tubules depicted here were a recently discovered phenomenon.
Table 111. First reports of odontogenic neoplasms and cysts in dental journals,
1839-1860
Today’s diagnosis
Year
Original diagnostic term(s)*
Benign cementoblastoma50 Periapical cyst” Enamel pear154t Dlentigerous cyst55 Gingival cyst of newborns6 O’dontogenic keratocysts7 Central ossifying fibroma58$ Eruption cyst59 Complex odalntoma4* Odontogenic fibroma60$ Compound ojdontoma61 Central cementifying fibroma49 Odontogenic myxoma6*f
1839 1839 1841 1842 1843 1844 1844 1847 1848 1853 1854 1860 1860
Exostosis; cancellated exostosis Sac; Saccular abscess Enamel pearl Distended capsule; osseous cyst; serious cyst; encysted tumor Gingival cyst Encystic tumor; Cystic carcinoma Fibrous tumor with calcium deposits Epulis; teething tumor Warty tooth; odontocele Circumscribed fibrous tumor
-
Osseous tumor Fibro-gelatinous
tumor; cyst with gelatinous center
*Some orignal terms are taken from other contemporary articles. fDevelopmenta1, not neoplastic mass. iExact diagnosis is in doubt.
ameloblastoma.‘72 In fact, the early study of this entity was considerably hampered by the apparent inability of investigators to separate odontogenic cysts from odontogenic turnors70 even though Neumann73 seems to have made that distinction in 1867 when he described the first ameloblastoma arising in a dentigerous cyst. Although not true odontogenic neoplasms, ovarian teratomas or dermoid cysts were well known to frequently contain teeth, almost always embedded within bony sockets. 74 In his article, Cone also referred to the fact that Brodie had already reported a case of “a jaw with full grown teeth” by 1848. ODONTOGENIC CYSTS Cysts of the jaws were noted only when they produced cortical expansion or some other visible alteration of surface t.issues. The single exception was also the first cyst reported in a dental journal: the periapical cyst (Table III). These cysts were referred to simply as sacs and were a routine experience for busy dental surgeons extracting and examining carious
teeth. By the 1830s literate dentists were almost as familiar with periapical pathoses as we are today, although many believed that the periapical lesion produced tooth death, rather than vice versa.17 Noncystic periapical lesi’ons were described as inflammations, granulations, abscesses, and suppurations, and it was well known that facial or alveolar fistulae could result from them (Fig. 5). Dentigerous cysts were described as early as 1778 in France,65 but were not well-delineated until 184255 and were not illustrated in a journal until 185949 (Fig. 6). These cases were reported approximately a century after ScultetT5 first described jawbone cysts as “liquid tumors.” The concept of a benign, epitheliallined cystic space with internal pressures capable of producing bony expansion was formed during these early years. Several cystic le,sions were aggressive enough to be classified today as lodontogenic keratocysts or unicystic ameloblastomas. The first report of a large cyst was an 1844 description of a multilocular dentigerous cyst or “encysted tumor” that had entirely filled the
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Fig. 5. Multitude of periapicai pathoses depicted in this 1840 composite drawing includes fistula formation. Note the external caries of the teeth, exempiifying the new acceptance of an external cause for tooth decay.t7
d
Fig. 4. Gross specimenof central cementifying fibroma in a periapical location but not attached to the tooth. Microscopic drawings depict globular dark calcified structures, presumably cementum, in a dense fibrous stroma.
antrum and distorted the orbital flo~r.~~ This case has all the earmarks of an odontogenic keratocyst, but a microscopic description is lacking. The aggressive nature of such lesions is emphasized by the contemporary diagnoses used, such as “cystic sarcoma” and “cystic carcinoma.“72 It is probable that the multilocular cyst found by Salama and Hilmy76 in the mandibular ramus of a 2800 BC Egyptian mummy was a keratocyst. It was not associated with an impacted tooth and had greatly expanded the overlying cortices, causing pathologic fracture. This mummy also had a dentigerous cyst around the crown of an impacted maxillary cuspid (Gorlin’s syndrome perhaps?). The eruption cyst held special significance for early dental surgeons. 59 The anatomy of the trigeminal nerve had recently been described by the Englishman
c Fig. 6. Dentigerous cyst in situ of posterior mandibie.@ Distinction between cysts and neoplasms,especially malignant neoplasms, was unclear, hence hemimandibulectomy was the treatment of choice for large “cystic carcinomas.”
Charles l3e1177and a direct connection between teeth and the brain was proven for the first time, a connection first proposed by Aetius soon after Galen’s treatise on teeth.78 Because many children suffered from viral or other encephalitis and meningitis attacks at a period of life similar to the eruption of teeth, it was assumed that tooth eruption, particularly its “severe” forms (with eruption cysts), was the cguSe of “brain
ORAL SIJRCERY ORAL MEDICINE ORAL PATHOLOGY Volume 78, Number 3
fever.“:r9 The universal acceptance of this concept is typified, in the best-selling novel Bleak Home, by Charles Dicken,“o wherein a sickly child is assumedto be dying from “a difficult teething.” The logical treatment for convulsions and stuporous fevers became, quite naturally, the surgical incision of gingival tissuesoverlying eruption cysts and erupting teeth. This treatment appeared to be quite successful, of course, because brain fevers typically lasted 7 to 14 days presuming death did not intervene. Such treatment came to be known as scarification and was used aIso on Epstein pearls or gingival cysts of newborns.56
16 17
18
19
20. 21. 22.
CONCLUSION
It is hoped that the present article will prove to be a stimulant to more extensive and more in-depth historic reviews of oral pathologic lesions. At the very least it offers ea.rly references that can be used in introductions to clinicspathologic investigations, referencesheretofore difficult to identify becausethey were in print several decadesbefore Index Medicus began publication. *r As a further aid, the R.J. Gorlin databank of lesion-specific referenceshas beencreated for the years 1839-1860. This material is available upon request and will be extended into later years as time permits. Additional references from outside the dental journals of the first Golden Age are welcome and will be incorporated into the databank upon receipt.
23. 24. 25. 26. 27. 28.
29. 30.
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32.
2. Bunting RW. A textbook of oral pathology, for students and practitioners of dentistry. Philadelphia: Lea & Febiger, 1929. 3. Thoma KH. Oral pathology. St. Louis: C.V. MO&, 1941. 4. Cahn LR, ed. Arch Clin Oral Path 1937:1:1-245. Thoma KH, ed. ORAL SURG ORAL MED &AL PATHOL 1948; l:l-1162. Hillenbrand I-1. Twenty-five years in retrospect. ORAL SURG
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Bloodgood JC. What every dentist should know about surgical lesions of, and in the region of, the upper and lower jaw; with especial reference to the early recognition of the precancerous lesions. J Nat1 Dent Assoc 1915;2:3-19. Lintolt WH. To the editor of the London Lancet: progress of dental science in America. Am J Dent SC 1842;2:300-1. Bond TE Jr. A practical treatise on dental medicine. Philadelphia: Lindsay & Blakiston, 1848. Fouchard P. Le Chirurgien Dentiste, on Traite des Dents. Pa.ris; Pierre Jean Mariette, 1746. Jordain E. Traite des Maladies Chirurgicales de la Bouche. Paris; 1778. Hunter J. The natural history of the human teeth: explaining their structures, use, formation, growth, and diseases. London: J Johnson, 1771. Bell T. The anatomy, physiology and diseases of the teeth. London, 1829. Harris CA. A physiological and pathological inquiry concern-
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ing the physical characteristics of the human teeth and gums, the salivary calculus, the lips and tongue, and the fluids of the mouth. Am J Dent SC 1841;2:39-120. Baker E. Account of a remarkable tooth, with drawings. Am J Dent SC 1839;1:14-5. Brown AM. Review of Burdell and Burdell’s observations on the structure, physiology, anatomy and diseases of the teeth. Am J Dent SC 1839;1:19-24. Brown S. An extraordinary instance of the force of hereditary principle; in which is seen an example of the tendency of everythinginnaturetoproduceits like. Am J DentSc 1839;1:15-6. Brown S. Premature dentition. Am J Dent SC 1839;1:12. Harris CA. In: Koecker L. an essay on artificial teeth, obturators, and plates, with the principles for their construction [Editorial]. Am J Dent SC 1840;1:180-4. Hullihen SP. Observations on tooth-ache. Am J Dent SC 1840;1:105-11. In: Taylor J. Opening address delivered before the Mississippi Valley Association of Dental Surgeons. Am J Dent SC 1844;5:91-104. [Anonymous] Is the Negro subject to hair-lip? Am J Dent SC 1845;5:314. Harris CA. Dental medicine. Am J Dent SC 1849;10:139. Dickey SJ. Osseous union of the teeth. Dent News Letter 1850;3:60-1. Birkett. Carcinomatous tumor attached to the uvula and posterior pillar of the fauces; removal; recovery. Am J Dent SC (new series) 1852;2:124-7. Harris CA. New ‘York Medical College announcement, Am J Dent SC (new series) 1852;3:155. Richardson J. Gangrenous degeneration of the cheek and gums, with necrosis and exfoliation of the alveolar processes and maxillary bone. Dent Regist West 1856;10:16-26. Warren JM. Tumors of the parotid region. Am J Dent SC 1857;7:587-95. Piggot AS. Valedictory address to the graduating class of the Baltimore College of Dental Surgery. Am J Dent SC (new series) 1858;8:149-63. Foster JH. Address delivered before the Society of the Alumni of the Baltimore College of Dental Surgery, at their first annual meeting. Ann J Dent SC 1849;9:265-300. Pease WA. Is there a degeneration in the teeth? if so, to what is it attributable. Am J Dent SC (new series) 1855;5:605-14. [Anonymous] Dental exhibitions. Dent Regist West 1854;7:95101. Harris CA, ed. Amer J Dent SC 1839/40;1:1-292. In: Harris CA. Filling teeth when the lining membrane is exposed. Am J Dent SC (new series) 1851;2:72-91. __ -. Kerr DA. tiranuloma pyogenicum. ORAL SURG ORAL MEU ORAL PATHOL
1951;4:158-76.
37. Hullihen SP. Case of aneurism by anastomosis of the superior maxillae. Am J Dent SC 1844;4:160-2. 38. Westcott A. Dissertation on the claims of the medical sciences upon the practitioner of dental surgery. Am J Dent SC 1844;5:3-31. 39. Harris CA. Historical review of the progress of dental surgery in the United States, with reflections upon the causes that have accelerated it, and the means necessary for its further advancement. Am J Dent SC (new series) 1851;2:92-101. 40 Johnson EA, O’Rourke JT, Partridge BS, et al. The status of dental journalism in the United States. Baltimore, MD: Waverly Press, 1932:1-44. 41. Flagg JF. Dental exostosis. Dent News Letter 1859;12:241-9. 42. Harris CA. [Miscellaneous notes]. Am J Dent SC 18471 48;8:106-12. 43. Hullihen SP. Abscess of the jaws, and its treatment. Am J Dent SC 1847/48;8:106-12. 44. Satter JA. Papers on dental pathology. Am J Dent SC (new series) 1857;7:14-31. 45. Vandenburgh D. Observations on exostosis. Dent Regist West 1851;4:194-8.
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46. Lee J. Extraction of teeth. Am .I Dent SC 1847:8:23-Y. 47. Regezi J.4. Sciubba JJ. Oral oatholocv. clinicooatholoeic correlgtions. Philadelphia: W.U.’ Saund& 1989:;27-30.48. Thackston WWH. A dissertation on the diseases of the maxillary sinuses. Am J Dent SC I842:2:279-9 I. 49. Forget .A. Dental anomalies and their influcncc upon the production of diseases of the maxillary bones. Dent Cosmos 1860;1:229-36, 283-89, 398-404. 451-7. 50. Rodriguez BA. Case of exostosis of the upper jaw. Am J Dent SC 1839;1:88-9. 51. Davis NS. Report of the Committee on Medical Literature. Tran Am Mcd Assoc 1853;6:99-135. 52. Sahcr J. Cancellated or vascular exostosis on the fang of a bicuspid tooth. Trdns Pathol Sot London 1855;6:168-9. 53. Norberg 0. Zur Kenntnis der dysontogenetischcn Geschaalste der Kicferknochcn. Vjschr Zahnheiik lY30:46:321-55. 54. Jenks, Savier. Singular phenomenon. Am J Dent Sc I841 ;2: 160. 55. Harris CA. Book review of Ashburn .I On dentition and some coincident disorders (published 1834). Am J Dent SC 1842: 21294-i. 56. Grey WH. Lancing the gums in stridulous convulsions. Am J Dent SC 1843;3:228. 51. Dornhluth. Cyst in the orbital cavity. Am J Dent SC 1844; 4~296-7. 58. llawkins JW. Cases of fibrous tumors of the upper jaw-epulis. Am .I Dent SC 1844:7:77-X4. 59. Tomes J. A course of lectures on dental physiology and surgery (lectures I-XV). Am .I Dent SC l846-1848:7:1-68. 121-34; 8:33-54, I 20-47, 3 13-50. 50. .Adams. tibrous tumors of the lower jaw: removal of the portion of boric involved in the disease: recovery. Dent News Lettcr 1853;6:246-50. 61. Talms AF. Memoirs on a few fundamental points of dental medicine, considered in its application to hygiene and thcrapeutics. Am .I Dent SC (new series) 1854;4:294-302. 62. Fergusscn. Resection of portions of the lower jaw on account of tumor. Am J Dent SC (new series) 186O:lO:l 12-7. 63. Andre-s EH. Extraordinary successive development of teeth. Am J Dent SC (new seriesj 1858:X:16. 64. in: Sorawson E. Odontomes. Br Dent J 1937:62:177-201 65. Broca I’. Rccherches sur un nouveau groupc de tumeurs designc sous Ic nom d’odontomes. GU hebd. de med. et de chir. (Paris) I868:5: 19.70, I 13.
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66. Owen R. A history of British fossrl mammals and birds. Idondon; 1846:388-9. 67. Shillitoe B. Fibrous tumor from near the angle of the lower jaK. Trans Pathol Sot London 1865: I6:223-4. 68. Waldron CA. Odontogcnic tumors and selected jai\ cysts. In: Gncpp DR ed. Pathology of the head and neck. New k’ork: Churchill-Livingstone, 198X;403-5X. 69. Cusack JW. Report of the amputation of portions of the lower jaw. Dublin Hosp Rcc 1827;4:1-3. 70. Baden E. Terminology of the ameloblastoma: history and current usage. .I Oral Surg 1965;23:40-9. 71. Wedl C. Pathologie dcr Zahnc mit besondcrcr Rucksicht auf Anatomic und Physiologic. Leipr.ig: A. Felix, 1870. 72. WagstalTc WW. Case of cystic sarcoma of lower jaw. Trans Pathol Sot London I871:22:249-53. 73. Neumann E. Ein Fall von Untcrkiefergeschwulst bedingt durch Degeneration eines Zahnsackcs. Langcnbccks Arch f Chir 1867;9:221-3. 74. Cone CO. Report on practical dentistry. Am J Dent SC 1848;9:3-X2. 75. Scultet I. L’Arcenal de Chirurgie. Lyon: Antoine Celleler: 1671. 76. Salama N, Hilmy A. An ancient Egyptian skull and a mandible showing cysts. Br Dent J lY5l:YO: I i-8. 71. Bell C. The nervous system of the human bodl;. London. 1830. 78. In: Allen J. Address delivered before the Mississippi Valley Association of Dental Surgeons. Am J Dent SC 1844:5:30512. 79. Canton A. On leaching. From a treatise on the teeth. Am J Dent SC (new series) 1851;1:131-8. 80. Dickens C. Bleak House. London: Folio Society, 1985. Originally published in 1853. XI. Billings .JS. Flctchcr R, eds. Index mcdicus. a monthly classified record of the current medical literature of !he world, vol I; 1879. Reprinr rryuesls. Dr. J. E. Bouquot The Maxillofacial Center 583 Tibbs Rd. RR. 7 Morgantown, WV 26505-91 I4
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W.Va.
AND RESEARCH
Literature reviews of oral lesions frequently lack an appropriate historic perspective, presuming that the mid- to late-twentieth century reports are the first valid reports available. The mid-nineteenth century dental journals, however, are replete with clinical, surgical, and microscopic descriptions of oral tumors and cysts. Most of these have never been referenced during ithe present century. The purpose of this article is to report the earliest dental journal references for a variety of odontogenic tumors and cysts. These references are derived from a canvass of all dental journals published from the first journal (American )ournal of Dental Science) in 1839 to the appearance of Dental Cosmos and the organization of the American Dental Association in 1860. (ORAL SURG ORAL MED ORAL PATHOL 1!294;78:343-50)
Oral Pathology as a specialty of dentistry is traditionally presumed to have its origin in the 1930s and 1940s’ perhaps commencing with Bunting’s Textbook of Oral Pathology,2 Thoma’s Oral Pathology,3 or the first issues of the Archives of Clinical Oral Pathology,4 and O’ral Surgery, Oral Medicine, Oral Pathology.5 The American Academy of Oral Pathology and the American Board of Oral Pathology were formed during rhis time period, preceded slightly by the first organizations devoted exclusively to Oral Pathology, the New York Institute of Clinical Oral Pathology and the American Dental Association’s Registry of Dental and Oral Pathology.6, 7 An even earlier 1andma:rk was Bloodgood’s* comprehensive review of oral lesions in the second volume of the Journal of the American Dental Association. The first professorship of Oral Pathology, however, originated muclh earlier with the 1840 establishment of the Baltimore School of Dental Medicine.9 The first text dedicated to Oral Pathology as we know it today was published shortly thereafter by Bond,l” and, of course:, Fouchard,” Jordain,12 Hunter,13 BeILl and others had reported even earlier on a variety of tooth anomalies. In reality, it appears that the mid-nineteenth century was the time of the true birth of Oral Pathology (Table I). The age that saw an unprecedented, worldwide “mental stir” in consequence also saw the emergence of modern or organized dentistry.30 This first Golden Age of Dentistry, 18351860, began with aDirector, The Maxillofacial Center for Diagnostics and Research, Morgantown, WV; Visiting Senior Scientist, Mayo Clinic, Rochester, MN. bin private practice, Atlanta, Ga. Copyright @ 1994 by Mosby-Year Book, Inc. 0030-4220/94/$3.00+ 0 7/14/54866
dentistry “not a whit more respectable than the barber-surgeons of old times,” and concluded with its establishment as an organized, science-based health profession with te:chniques and therapeutic successes not unlike those of the twentieth century.30> 31 The face of dentistry was absolutely changed to something unrecognizable from that which came before.32 A fascination for pathologic processes was an integral part of modern dentistry at its inception, as was a strong and apparently new belief that information should be openly and widely shared.33 Approximately half of all scientific articles in the first volume of the earliest published dental journal were related to pathologic conditions of the mouth and jaws,34 and the first truly comprehensive text for the dental profession in the United States, the 1829 classic by Be&l4 dealt extensively with pathologic processes and included the first reports of numerous oral diseases. Lester Cahn’ believed that Sir Jonathan Hutchinson was the earliest Oral Pathologist, but the chairman of Baltimore’s Department of Special Pathology, Thomas E. Bond, MD, more correctly holds that distinction. Bond’s in.sight was so remarkable that he was able to hypothesize causes and pathophysiologies that are still valid today. Leonard Koecker, an influential dental surgeon from London, was the first professional to actually be designated a Dental Pathologist in print. 2oHe published an 1822 general text on dentistry, Principles of Dental Surgery, with observations said to be “based upon a correct knowledge of the laws of disease.“35 Interest in path’ology continued to grow as dentistry became a strong and independent health profession, and by 1860 many of today’s well-established oral lesions had been reported in the various dental journals then publishing (Table II). These accounts frequently 343
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le 8. Historic events that established Oral and Maxillofacial dentistry Year 1828 1839 1839 1839 1840 1840 1840 1841 1843 1845 1848 1849 1850 1852 1852 1856 1857 “Authors
Pathology as an integral part of organized Historic event
First First First First First First First First First First First First First First First First First
textbook devoted to diseases of the mouth journal report of oral pathologic entity (dilaceration)16 emphasis on systemic effects on oral tissuesI report of an hereditary effect on oral tissues’*- l9 use of term “dental pathologist” (for L. Koecker)20 report of specific systemic effect (menstruation) on oral lesion (pulp p01yp)~~ professorship of dental pathology (Baltimore)9 continuing education course in oral pathology*5 text devoted to head and neck tumorsz2* report of racial predilection for an oral diseasez3 text devoted to dental/oral pathologylo use of term “oral medicine”24 literature review of an oral pathologic entityz5 microscopic description of a lesion in dental journalz6 dental pathology lectureship in a U.S. medical schooi27 discussion of a differential diagnosisz8 series report of an oral pathologic entity29
are Burns and Pattison from the University
of Maryland
School of Medicine.
anteceded the usually quoted first reports by several generations. Oral pyogenic granulomas, for example, were not well understood until the 1951 analysis by Kerr,36 yet Simon P. Hullihen, the Father of Oral Surgery, described one succinctly in a 22-year-old pregnant woman as early as 1844.37 Hullihen documented a recurrence of his patient’s gingival “aneurysm” with her second pregnancy. During the same year Westcott38 described pregnancy gingivitis under the diagnosis of “uterine irritation”; HarrisI had described it earlier as “hemorrhoidal discharge in dysmenorrhea.” Oral pathology articles frequently begin with historic reviews of the lesion or disease under discussion, usually mentioning the first cases identified. It seemed appropriate therefore to document the first actual dental journal reports of such entities. The attempt to do so is considerably facilitated by the fact that American dentistry, through its free exchange of innovative technology and scientific inquiry, its journals, national organizations, and its schools of dentistry, dominated the profession throughout the nineteenth century. Consequently, virtually all of the earliest journals were published in English and almost always in the United States (Table H). Although persons from other countries published occasional textbooks of exceptional quality and insight, other countries lacked the cooperative spirit needed to assure a rapid expansion of professional knowledge. This first Golden Age of Dentistry was a truly remarkable and uniquely American phenomenon, as declared in 1851: “dental surgery, as at present practiced, is almost
an American creation, for although operations upon the teeth have been practiced since the days of the Pharaohs, and probably before, yet the rude and simple character of the early manipulations hardly give them a claim to be regarded among the effects of scientific art, and until comparatively lately, but very little improvement seems to have been made in this department of surgery.“39 Because of this American dominance it is presumed that references in early American dental journals are among the first reasonably accurate references to oral pathologic entities. It is hoped, however, that this article will stimulate additional investigation into early references of such lesions, especially in textbooks, which were much less widely circulated than journals and are much more difficult to obtain today. METHODS A listing of nineteenth century dental journals40 was supplemented by a 4-year systematic perusal of journals in the libraries of West Virginia University, the University of Minnesota, the Mayo Clinic, and the National Library of Medicine. Table II lists all dental journals published, in any language, between 1839 and 1860. Almost all English-language articles published in all volumes of each journal in Table II were reviewed for references to oral pathologic entities. Although most diagnoses were obvious, even though the lexicon was different from that in use today, approximations were occasionally made for lesions that lacked detailed histologic descriptions. Such cases are identified as such in the present text and tables. All
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II. The earliest published dental journals worldwide, 1839-1860. All are American titles, unless otherwise specified
Table
Year(s) of publication
Journal title American Journal of Dental Science Stockton’s Dental Intelligencer British Journal of Dental Science (London; intermittently The Forceps (London) The Dental Mirror New York Dental Recorder Dental Register of the West Dental News Letter (became Dental Cosmos in 1859) Dental. Times Dental Expositor Der Zahnarzt (Berlin) The Forceps (New York) The Dental Monitor Dental Obturator Transactions of the Odontological Society of London Dental Reporter Quarterly Journal of Dental Science (London) L’Art Dentaire (Paris)* Cincinnati Dental Lamp New York Dental Journal American Dental Review (intermittently published) The Dental Enterprise The Dental Register The Dental Review (London)* Dental Cosmos? Zeitschrift fur Zahn-Heilkunde (Hamburg)* Revue Odontotechnique (Paris)* Southern Dental Examiner*
1839-1915 1843-1:548 1843-1’939 1845-l 846 1845 1846-1856 1847-1923 1847-1859 1851 1853 1853-1860+ 1855 1855 1856-1859 1856-1907 1857-1859 1857-1859 1857-1860+ 1858 1858-1864 1858-1936 1858-1859 1858-1859 1859-1860+ 1859-1936 1860-? 1860-? 1860-?
published)
*Last year of publication is unknown by authors. thcorporated
into Journal of American
Dental Association
in 1936.
lesions reported from 1839 to 1860 were placed in a database, whether first reports or not, and additional references are available upon request. ODONTOGENIC
NEOPLASMS
The first denial journal reports of oral pathologic entities dealt with odontogenic anomalies (Fig. 1). Dentists were beginning to share clinical information on a wide scale, and the odd case noted in clinical practice was specifically sought by editors. One of the most well-accepted anomalies, then called exostosis, was an enlargement at the apex of the root or “bone” of an extracted “fang.“41 Such lesions were thought to be a major cause of toothaches and inflammation of the “dental nerve” (pulp), a natural assumption considering that they were only found upon extraction of painful and cariously destroyed teeth.21,42-44By 1851 Vandenburgh4s hypothesized that pulpal inflammation caused this lesion and it was therefore not a true exostosis. Harris15 and Lee46 believed that multiple casesin one person were the result of constitutional causesrather than inflammation. Today we
refer to this as hypercementosis and know it to represent excessivecementoblastic activity as a result of hypereruption of a.tooth. We still accept one systemic cause, Paget’s diseaseof bone, for multiple hypercementoses.47 A few exostoseswere much too large to conform to a hypercementosis diagnosis and were obviously benign cementoblastomas. Several were reported to have completely obliterated the adjacent maxillary sinus.48,49 The very first dental journal reference to an odontogenic neoplasm was a 7 cm cementoblastoma of a maxillary molar, reported in the inaugural volume of the American Journal of Dental Science (AJDSJ, the official publication of the first national dental association and the only dental journal acceptedby the early American Medical Association as a legitimate medical journal.50, 51 This same entity became the first odontogenic lesion reported with microscopic confirmation (Fig. 2), almost a century before Norberg published the article most usually quoted as the first report of this lesion.
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Fig. 1. Case of dilaceration shown from three angles is the first picture of an orai anomaly reported in a dental journal.t6 Such cases were thought to result from the fusion of the remnants of fractured roots, as with bone healing, and were initially called “osseous union.”
Fig. 2. Gross and macroscopic appearance of a benign cementoblastoma of a maxillary bicuspid. The “considerable incrustation of hypertrophied tooth-bone” was destroying the normal tooth.52
Table III provides first reports of other odontogenit neoplasms. The first journal report of a complex odontoma was in a 25-year-old woman and was most unusual in that it erupted with the underlying tooth.42 Without such eruption, of course, this lesion would not have been noted at a time in which radiographs were not in use. The complex odontoma with the most definitive microscopic confirmation was not reported until the superb article by Forget,4g translated in the first volume of Dental Cosmos (Fig. 3). The first unequivocal cases of compound odontoma, one with at least 25 distinct teeth and another with a gross specimen drawing confirming the diagnosis were reported in 1854 and 1858, respectively.61,63 Although these
are the first journal reports of odontomas, it was probably Pierre Fouchard” who provided the first accurate description of these lesions. Qude?j4, in 1809, suggested that they were of dental origin, but the term odontome was not applied until 1868.65 They are undoubtedly the oldest recorded odontogenic neoplasms, having been reported in a 5OO,OQO-yearold fossilized horse.@ An earlier journal report of an intraosseous neoplasm might possibly have dealt with a complex odontoma discovered only because of its large size.59 But the surgical description is more appropriate to a central ossifying/cementifying fibroma. The first unequivocal case of the latter entity was one of considerable size, contained numerous microscopic foci of dark globular cementum, and was not published until 1865 (Fig. 4).67 The odontogenic (nonossifying) fibroma is an entity that until recently was frequently confused with simple fibrous hyperplasia of the parafollicular connective tissues,68 but Adams60 reported a circumscribed fibrous tumor around the crown of an impacted mandibular molar that seems large enough to justify it as the first report of a true odontogenic fibroma. Also, Fergusson62 reported a similar case that was gelatinous rather than fibrous and hence was likely an odontogenic myxoma. Other odontogenic neoplasms were difficult or impossible to identify without detailed microscopic description. It is probable that none were actually reported or were reported with so little descriptive detail as to defy proper diagnosis. Thorna listed only four types of odontogenic neoplasms as late as 1947, Ameloblastomas, which had been reported in Europe by 1827 and inspired hundreds of publications after the first Golden Age,68-70were not reported in dental journals between 1839 and 1860. Wed171provided the first histopathologic description in 1853 indicating that this “cystosarcoma or cystosarcoma adenoides” possibly originated from a tooth bud or dental lamina. The first histologic drawing of an ameloblastoma was not published until 1871 and ironically depicted one of the most recently delineated types, the unicystic
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Fig. 3. Gross and microscopic appearance of a complex odontoma in situ of the mandible.49 Dentinal tubules depicted here were a recently discovered phenomenon.
Table 111. First reports of odontogenic neoplasms and cysts in dental journals,
1839-1860
Today’s diagnosis
Year
Original diagnostic term(s)*
Benign cementoblastoma50 Periapical cyst” Enamel pear154t Dlentigerous cyst55 Gingival cyst of newborns6 O’dontogenic keratocysts7 Central ossifying fibroma58$ Eruption cyst59 Complex odalntoma4* Odontogenic fibroma60$ Compound ojdontoma61 Central cementifying fibroma49 Odontogenic myxoma6*f
1839 1839 1841 1842 1843 1844 1844 1847 1848 1853 1854 1860 1860
Exostosis; cancellated exostosis Sac; Saccular abscess Enamel pearl Distended capsule; osseous cyst; serious cyst; encysted tumor Gingival cyst Encystic tumor; Cystic carcinoma Fibrous tumor with calcium deposits Epulis; teething tumor Warty tooth; odontocele Circumscribed fibrous tumor
-
Osseous tumor Fibro-gelatinous
tumor; cyst with gelatinous center
*Some orignal terms are taken from other contemporary articles. fDevelopmenta1, not neoplastic mass. iExact diagnosis is in doubt.
ameloblastoma.‘72 In fact, the early study of this entity was considerably hampered by the apparent inability of investigators to separate odontogenic cysts from odontogenic turnors70 even though Neumann73 seems to have made that distinction in 1867 when he described the first ameloblastoma arising in a dentigerous cyst. Although not true odontogenic neoplasms, ovarian teratomas or dermoid cysts were well known to frequently contain teeth, almost always embedded within bony sockets. 74 In his article, Cone also referred to the fact that Brodie had already reported a case of “a jaw with full grown teeth” by 1848. ODONTOGENIC CYSTS Cysts of the jaws were noted only when they produced cortical expansion or some other visible alteration of surface t.issues. The single exception was also the first cyst reported in a dental journal: the periapical cyst (Table III). These cysts were referred to simply as sacs and were a routine experience for busy dental surgeons extracting and examining carious
teeth. By the 1830s literate dentists were almost as familiar with periapical pathoses as we are today, although many believed that the periapical lesion produced tooth death, rather than vice versa.17 Noncystic periapical lesi’ons were described as inflammations, granulations, abscesses, and suppurations, and it was well known that facial or alveolar fistulae could result from them (Fig. 5). Dentigerous cysts were described as early as 1778 in France,65 but were not well-delineated until 184255 and were not illustrated in a journal until 185949 (Fig. 6). These cases were reported approximately a century after ScultetT5 first described jawbone cysts as “liquid tumors.” The concept of a benign, epitheliallined cystic space with internal pressures capable of producing bony expansion was formed during these early years. Several cystic le,sions were aggressive enough to be classified today as lodontogenic keratocysts or unicystic ameloblastomas. The first report of a large cyst was an 1844 description of a multilocular dentigerous cyst or “encysted tumor” that had entirely filled the
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Fig. 5. Multitude of periapicai pathoses depicted in this 1840 composite drawing includes fistula formation. Note the external caries of the teeth, exempiifying the new acceptance of an external cause for tooth decay.t7
d
Fig. 4. Gross specimenof central cementifying fibroma in a periapical location but not attached to the tooth. Microscopic drawings depict globular dark calcified structures, presumably cementum, in a dense fibrous stroma.
antrum and distorted the orbital flo~r.~~ This case has all the earmarks of an odontogenic keratocyst, but a microscopic description is lacking. The aggressive nature of such lesions is emphasized by the contemporary diagnoses used, such as “cystic sarcoma” and “cystic carcinoma.“72 It is probable that the multilocular cyst found by Salama and Hilmy76 in the mandibular ramus of a 2800 BC Egyptian mummy was a keratocyst. It was not associated with an impacted tooth and had greatly expanded the overlying cortices, causing pathologic fracture. This mummy also had a dentigerous cyst around the crown of an impacted maxillary cuspid (Gorlin’s syndrome perhaps?). The eruption cyst held special significance for early dental surgeons. 59 The anatomy of the trigeminal nerve had recently been described by the Englishman
c Fig. 6. Dentigerous cyst in situ of posterior mandibie.@ Distinction between cysts and neoplasms,especially malignant neoplasms, was unclear, hence hemimandibulectomy was the treatment of choice for large “cystic carcinomas.”
Charles l3e1177and a direct connection between teeth and the brain was proven for the first time, a connection first proposed by Aetius soon after Galen’s treatise on teeth.78 Because many children suffered from viral or other encephalitis and meningitis attacks at a period of life similar to the eruption of teeth, it was assumed that tooth eruption, particularly its “severe” forms (with eruption cysts), was the cguSe of “brain
ORAL SIJRCERY ORAL MEDICINE ORAL PATHOLOGY Volume 78, Number 3
fever.“:r9 The universal acceptance of this concept is typified, in the best-selling novel Bleak Home, by Charles Dicken,“o wherein a sickly child is assumedto be dying from “a difficult teething.” The logical treatment for convulsions and stuporous fevers became, quite naturally, the surgical incision of gingival tissuesoverlying eruption cysts and erupting teeth. This treatment appeared to be quite successful, of course, because brain fevers typically lasted 7 to 14 days presuming death did not intervene. Such treatment came to be known as scarification and was used aIso on Epstein pearls or gingival cysts of newborns.56
16 17
18
19
20. 21. 22.
CONCLUSION
It is hoped that the present article will prove to be a stimulant to more extensive and more in-depth historic reviews of oral pathologic lesions. At the very least it offers ea.rly references that can be used in introductions to clinicspathologic investigations, referencesheretofore difficult to identify becausethey were in print several decadesbefore Index Medicus began publication. *r As a further aid, the R.J. Gorlin databank of lesion-specific referenceshas beencreated for the years 1839-1860. This material is available upon request and will be extended into later years as time permits. Additional references from outside the dental journals of the first Golden Age are welcome and will be incorporated into the databank upon receipt.
23. 24. 25. 26. 27. 28.
29. 30.
31. REFERENCES 1. Cahn LR. Contributions to the development of oral pathology. ORAL SURC ORAL MED ORAL PATHOL 1959;12:3-13.
32.
2. Bunting RW. A textbook of oral pathology, for students and practitioners of dentistry. Philadelphia: Lea & Febiger, 1929. 3. Thoma KH. Oral pathology. St. Louis: C.V. MO&, 1941. 4. Cahn LR, ed. Arch Clin Oral Path 1937:1:1-245. Thoma KH, ed. ORAL SURG ORAL MED &AL PATHOL 1948; l:l-1162. Hillenbrand I-1. Twenty-five years in retrospect. ORAL SURG
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Bernier JL. The birth and growth of oral pathology. ORAL SURG ORAL hIED ORAL PATHOL
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Bloodgood JC. What every dentist should know about surgical lesions of, and in the region of, the upper and lower jaw; with especial reference to the early recognition of the precancerous lesions. J Nat1 Dent Assoc 1915;2:3-19. Lintolt WH. To the editor of the London Lancet: progress of dental science in America. Am J Dent SC 1842;2:300-1. Bond TE Jr. A practical treatise on dental medicine. Philadelphia: Lindsay & Blakiston, 1848. Fouchard P. Le Chirurgien Dentiste, on Traite des Dents. Pa.ris; Pierre Jean Mariette, 1746. Jordain E. Traite des Maladies Chirurgicales de la Bouche. Paris; 1778. Hunter J. The natural history of the human teeth: explaining their structures, use, formation, growth, and diseases. London: J Johnson, 1771. Bell T. The anatomy, physiology and diseases of the teeth. London, 1829. Harris CA. A physiological and pathological inquiry concern-
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ing the physical characteristics of the human teeth and gums, the salivary calculus, the lips and tongue, and the fluids of the mouth. Am J Dent SC 1841;2:39-120. Baker E. Account of a remarkable tooth, with drawings. Am J Dent SC 1839;1:14-5. Brown AM. Review of Burdell and Burdell’s observations on the structure, physiology, anatomy and diseases of the teeth. Am J Dent SC 1839;1:19-24. Brown S. An extraordinary instance of the force of hereditary principle; in which is seen an example of the tendency of everythinginnaturetoproduceits like. Am J DentSc 1839;1:15-6. Brown S. Premature dentition. Am J Dent SC 1839;1:12. Harris CA. In: Koecker L. an essay on artificial teeth, obturators, and plates, with the principles for their construction [Editorial]. Am J Dent SC 1840;1:180-4. Hullihen SP. Observations on tooth-ache. Am J Dent SC 1840;1:105-11. In: Taylor J. Opening address delivered before the Mississippi Valley Association of Dental Surgeons. Am J Dent SC 1844;5:91-104. [Anonymous] Is the Negro subject to hair-lip? Am J Dent SC 1845;5:314. Harris CA. Dental medicine. Am J Dent SC 1849;10:139. Dickey SJ. Osseous union of the teeth. Dent News Letter 1850;3:60-1. Birkett. Carcinomatous tumor attached to the uvula and posterior pillar of the fauces; removal; recovery. Am J Dent SC (new series) 1852;2:124-7. Harris CA. New ‘York Medical College announcement, Am J Dent SC (new series) 1852;3:155. Richardson J. Gangrenous degeneration of the cheek and gums, with necrosis and exfoliation of the alveolar processes and maxillary bone. Dent Regist West 1856;10:16-26. Warren JM. Tumors of the parotid region. Am J Dent SC 1857;7:587-95. Piggot AS. Valedictory address to the graduating class of the Baltimore College of Dental Surgery. Am J Dent SC (new series) 1858;8:149-63. Foster JH. Address delivered before the Society of the Alumni of the Baltimore College of Dental Surgery, at their first annual meeting. Ann J Dent SC 1849;9:265-300. Pease WA. Is there a degeneration in the teeth? if so, to what is it attributable. Am J Dent SC (new series) 1855;5:605-14. [Anonymous] Dental exhibitions. Dent Regist West 1854;7:95101. Harris CA, ed. Amer J Dent SC 1839/40;1:1-292. In: Harris CA. Filling teeth when the lining membrane is exposed. Am J Dent SC (new series) 1851;2:72-91. __ -. Kerr DA. tiranuloma pyogenicum. ORAL SURG ORAL MEU ORAL PATHOL
1951;4:158-76.
37. Hullihen SP. Case of aneurism by anastomosis of the superior maxillae. Am J Dent SC 1844;4:160-2. 38. Westcott A. Dissertation on the claims of the medical sciences upon the practitioner of dental surgery. Am J Dent SC 1844;5:3-31. 39. Harris CA. Historical review of the progress of dental surgery in the United States, with reflections upon the causes that have accelerated it, and the means necessary for its further advancement. Am J Dent SC (new series) 1851;2:92-101. 40 Johnson EA, O’Rourke JT, Partridge BS, et al. The status of dental journalism in the United States. Baltimore, MD: Waverly Press, 1932:1-44. 41. Flagg JF. Dental exostosis. Dent News Letter 1859;12:241-9. 42. Harris CA. [Miscellaneous notes]. Am J Dent SC 18471 48;8:106-12. 43. Hullihen SP. Abscess of the jaws, and its treatment. Am J Dent SC 1847/48;8:106-12. 44. Satter JA. Papers on dental pathology. Am J Dent SC (new series) 1857;7:14-31. 45. Vandenburgh D. Observations on exostosis. Dent Regist West 1851;4:194-8.
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46. Lee J. Extraction of teeth. Am .I Dent SC 1847:8:23-Y. 47. Regezi J.4. Sciubba JJ. Oral oatholocv. clinicooatholoeic correlgtions. Philadelphia: W.U.’ Saund& 1989:;27-30.48. Thackston WWH. A dissertation on the diseases of the maxillary sinuses. Am J Dent SC I842:2:279-9 I. 49. Forget .A. Dental anomalies and their influcncc upon the production of diseases of the maxillary bones. Dent Cosmos 1860;1:229-36, 283-89, 398-404. 451-7. 50. Rodriguez BA. Case of exostosis of the upper jaw. Am J Dent SC 1839;1:88-9. 51. Davis NS. Report of the Committee on Medical Literature. Tran Am Mcd Assoc 1853;6:99-135. 52. Sahcr J. Cancellated or vascular exostosis on the fang of a bicuspid tooth. Trdns Pathol Sot London 1855;6:168-9. 53. Norberg 0. Zur Kenntnis der dysontogenetischcn Geschaalste der Kicferknochcn. Vjschr Zahnheiik lY30:46:321-55. 54. Jenks, Savier. Singular phenomenon. Am J Dent Sc I841 ;2: 160. 55. Harris CA. Book review of Ashburn .I On dentition and some coincident disorders (published 1834). Am J Dent SC 1842: 21294-i. 56. Grey WH. Lancing the gums in stridulous convulsions. Am J Dent SC 1843;3:228. 51. Dornhluth. Cyst in the orbital cavity. Am J Dent SC 1844; 4~296-7. 58. llawkins JW. Cases of fibrous tumors of the upper jaw-epulis. Am .I Dent SC 1844:7:77-X4. 59. Tomes J. A course of lectures on dental physiology and surgery (lectures I-XV). Am .I Dent SC l846-1848:7:1-68. 121-34; 8:33-54, I 20-47, 3 13-50. 50. .Adams. tibrous tumors of the lower jaw: removal of the portion of boric involved in the disease: recovery. Dent News Lettcr 1853;6:246-50. 61. Talms AF. Memoirs on a few fundamental points of dental medicine, considered in its application to hygiene and thcrapeutics. Am .I Dent SC (new series) 1854;4:294-302. 62. Fergusscn. Resection of portions of the lower jaw on account of tumor. Am J Dent SC (new series) 186O:lO:l 12-7. 63. Andre-s EH. Extraordinary successive development of teeth. Am J Dent SC (new seriesj 1858:X:16. 64. in: Sorawson E. Odontomes. Br Dent J 1937:62:177-201 65. Broca I’. Rccherches sur un nouveau groupc de tumeurs designc sous Ic nom d’odontomes. GU hebd. de med. et de chir. (Paris) I868:5: 19.70, I 13.
I994
66. Owen R. A history of British fossrl mammals and birds. Idondon; 1846:388-9. 67. Shillitoe B. Fibrous tumor from near the angle of the lower jaK. Trans Pathol Sot London 1865: I6:223-4. 68. Waldron CA. Odontogcnic tumors and selected jai\ cysts. In: Gncpp DR ed. Pathology of the head and neck. New k’ork: Churchill-Livingstone, 198X;403-5X. 69. Cusack JW. Report of the amputation of portions of the lower jaw. Dublin Hosp Rcc 1827;4:1-3. 70. Baden E. Terminology of the ameloblastoma: history and current usage. .I Oral Surg 1965;23:40-9. 71. Wedl C. Pathologie dcr Zahnc mit besondcrcr Rucksicht auf Anatomic und Physiologic. Leipr.ig: A. Felix, 1870. 72. WagstalTc WW. Case of cystic sarcoma of lower jaw. Trans Pathol Sot London I871:22:249-53. 73. Neumann E. Ein Fall von Untcrkiefergeschwulst bedingt durch Degeneration eines Zahnsackcs. Langcnbccks Arch f Chir 1867;9:221-3. 74. Cone CO. Report on practical dentistry. Am J Dent SC 1848;9:3-X2. 75. Scultet I. L’Arcenal de Chirurgie. Lyon: Antoine Celleler: 1671. 76. Salama N, Hilmy A. An ancient Egyptian skull and a mandible showing cysts. Br Dent J lY5l:YO: I i-8. 71. Bell C. The nervous system of the human bodl;. London. 1830. 78. In: Allen J. Address delivered before the Mississippi Valley Association of Dental Surgeons. Am J Dent SC 1844:5:30512. 79. Canton A. On leaching. From a treatise on the teeth. Am J Dent SC (new series) 1851;1:131-8. 80. Dickens C. Bleak House. London: Folio Society, 1985. Originally published in 1853. XI. Billings .JS. Flctchcr R, eds. Index mcdicus. a monthly classified record of the current medical literature of !he world, vol I; 1879. Reprinr rryuesls. Dr. J. E. Bouquot The Maxillofacial Center 583 Tibbs Rd. RR. 7 Morgantown, WV 26505-91 I4