Thomas E. Bond, Father of
Oral & Maxillofacial Pathology

   



Before Bond
The Golden Age
The Competition
 

    



Bond's Life
Bond's Book
References

Thomas E. Bond, Jr., A.M., M.D.; Baltimore, Maryland, USA





 


 



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Oral diseases 3,500 years ago

The first written reference to dentistry as a specialty of medicine appears to be the mention by Herodotus of Egyptian "physicians for the teeth," about 500 BC, and the earliest reports of oral diseases lie very far in antiquity.1-15 The Papyrus of Eber (circa 1550 BC), for example, discussed specific symptoms of odontogenic infection and periodontal abscesses.14,16 Some of the proverbs of Solomon allude to substances injurious to the teeth and Hippocrates wrote not only of the anatomy of teeth (he appears to have been the first to use the term "wisdom tooth") but of "diseases of the gums."1 Galen (circa 150 AD) was perhaps the first to emphasize the relationship between the teeth and the rest of the body, calling the teeth true bones and suggesting a common neural connection between them and the nerve branches to the eyes, leading him to coin the term "eye tooth" for the maxillary cuspid.4

No change for millennia

Despite these early attempts at understanding oral disease, however, there was little change between the time of Galen and the nineteenth century, with the obvious exceptions of the works of Pierre Fauchard,17 Jourdain,18 Bourdet19 and Hunter.20 Horace Hayden,21 one of the founders of modern dentistry and the first President of the Baltimore College of Dental Surgery, was so unimpressed by the dissertations on dentistry up to his lifetime that he considered the 1771 text by Hunter20 as the "only treatise of consequence" in the English language.

To put this in perspective, it should be remembered that such a lack of change was not unique to dentistry. Townsend,16 organizer of the national convention from which the American Dental Association emerged, in 1850 remarked that "it is curiously true, that every useful art, and every practical science which serves and adorns our actual existence, is, in its main features, of very modern growth." To compound this problem, until the 1830s "dentistry was practiced as a secret art; its disciples evinced great exclusiveness, and carefully hid from each other the methods by which they attained, or thought they attained, any individual superiority."16 The Society of Surgeon Dentists of the City and State of New York, organized in 1836 for the purpose of "mutual improvement," with annual "courses of lecture" on dental topics, may have been the earliest effort to share knowledge widely.22

Early books and treatises

This is not to say there were absolutely no attempts at sharing knowledge. The first textbook devoted exclusively to dentistry was published anonymously in Germany shortly after the invention of the printing press, and by 1800 there had been at least 178 tooth-related or oral cavity-related textbooks and tracts published.1,3,22,23 Most texts, however, related only to dental caries and restorative procedures and early treatises offered little of value relative to our understanding of those oral diseases now considered to lie within the domain of oral pathology and oral medicine, although a few odontogenic tumors and cysts had been touched on by the early dental investigators already mentioned.

It appears from a review of the literature that the short treatises by the Viennese physician Pasch24 and by Berdmore,25 surgeon-dentist to the British monarchy, were the only other texts published before the nineteenth century with significant information pertaining to oral pathological topics. According to twentieth century reviews, the Berdmore 1768 text, which went into five editions, was the first truly comprehensive textbook of dentistry, although the 1728 Fouchard17 text and the 1771 Hunter20 text are certainly better know and are, in fact, among the most famous texts in all of dentistry.22,26


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The Golden Age of Dentistry, or "Where it all began"

During the nineteenth century all that changed. The first Golden Age of dentistry, 1835-1860, coincided with one of the "Golden Ages of Science," and produced our modern or "organized" dental profession.27 According to E. H. Hatton14 of Northwestern University, introduced to the 1940 Dental Centenary Celebration in Baltimore as the "Dean of American Oral Pathologists," this period marked "the beginning of an outstanding epoch in dental education, literature and organization" and was greatly significant for the "science of oral pathology." During that time, an apparent fascination for pathologic processes, coupled with an evidently new belief that information should be openly and widely shared among health practitioners, was responsible for the inclusion of numerous articles in the developing dental literature which were related to pathologic conditions of the mouth and jaws.28,29 By the 1850s histopathology in the form of microscopic ambrotypes and photographs was being taught in the Baltimore College of Dental Surgery and was being learnedly discussed in journal articles.28-32

By 1870, shortly after this unprecedented growth, the American Dental Association was well established and there were 18 dental schools, all but one in the United States, with faculty actively publishing on oral diseases. At least 32 dental journals had begun publication, one as early as 1839, and "tumors, fungous growths, and lesions of the antrum" were being extensively discussed in these journals.1,4,22,23,28-30 Again, the United States so dominated the scene that Kurt Thoma31 in his 1957 review of the history of oral surgery felt free to state categorically that during "the last century America has led the world in dentistry."

Oral pathology joins the show

Oral pathology and oral medicine became integral parts of organized dentistry during this time period. Prior to the Golden Age the French dentist, LeMaire, taught a medicine-based course of dentistry to Americans before to the Revolutionary War, the French physician, Delabarre, offered a full course on "Dental Medicine" as early as 1817, and the British dentist, Bew, published his 1819 tract on diseases of the teeth and "gums."2,22,26,33,34 Nevertheless, James Taft,35 one of the most influential dentists of his time, mentioned in a rambling 1860 discussion of "Dental Medicine" that before his time "the knowledge of pathological conditions, beyond the immediate tissues of the teeth, was very limited indeed with the greater portion of the dental profession, and the consequence was that their treatment for these conditions was wholly at random and consequently inefficient, or was not attempted at all." He further believed that "no one is competent to treat any pathological condition without a thorough knowledge of that condition itself," and emphasized the role of the dentist in the clinical recognition of malignancy and the interactions between the mouth and the rest of the body.

By the end of the Golden Age oral pathology was so well established that the fledgling American Dental Association in its first meeting (1860, at the Smithsonian Institute, Washington, D.C.) had as one of its nine standing committees, the "Committee on Dental Pathology and Surgery."36 The five members of this committee, Drs. Allport, Atkinson, Flagg, Hunt and Suesserott, were charged with "everything that appertains to pathological conditions of the teeth and adjacent tissues."

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Who is Father to the Specialty?

The recognized "Father of Oral and Maxillofacial Surgery," Simon P. Hullihen, M. D., of West Virginia, practiced throughout this Golden Age and was one of those most responsible for its excellence. He and several of his contemporaries were influential in establishing an important role for oral and maxillofacial pathology but few are remembered today and no single individual is recognized as the "Father of Oral and Maxillofacial Pathology."37-39 It is our present intent to propose such an individual.

Kurt Thoma is occasionally and informally thought of as the founder of oral pathology, largely because of his influence in establishing the American Academy of Oral Pathology and because of the vast influence of his textbooks.40-42 But several earlier oral pathology textbooks had been published (Table 1) and the subject had been taught as an independent curriculum in many dental schools for many decades before Thoma began writing.36,37 It appears that we must look to someone much earlier than Kurt Thoma to find a true father to the specialty. For additional possibilities, this section reviews the men who could, with some logic, compete for the title of Father of Oral Pathology.

Sir Jonathan Hutchinson (England)

Thus far only one person has been seriously proposed for this title. In 1959 Lester Cahn,37 an active founding member of the American Academy of Oral Pathology, suggested that Sir Jonathan Hutchinson be accepted as the Father of Oral Pathology on the basis of his interest and extensive researches into the oral manifestations of systemic diseases. Hutchinson is eminently known today, of course, for his work pertaining to congenital syphilis (Hutchinson's teeth, Hutchinson's triad) and the precancerous facial melanosis known popularly as Hutchinson's freckle. Much of his writing was published in the Transactions of the Pathology Society of London during the two decades following his landmark paper in 1861.60

These reports are most certainly among the most detailed and thoughtful of the early discussions pertaining to systemic and hereditary causes of enamel hypoplasia (Figure 1). They also make clear the fact that Hutchinson considered himself to be a physician of the whole body. He did not see himself as specializing in diseases of the oral cavity. His interest in dental anomalies was simply part of his overall interest in the human body. He associated seldom with the evolving dental profession of London, wrote little for the few dental journals then publishing in England, and most certainly did not have the training or the inclination to call himself a Doctor of Dental Surgery, as American physician-dentists had been doing for decades by the time of his professional activity.

J. B. Gariot (France, Spain)

It is our opinion that the nascent emergence of oral pathology occurred in France with the 1805 and 1806 publication of two rather unique and remarkable texts devoted in large part to topics pertinent to oral medicine/pathology (maladies de la bouche, Figure 2), authored by the French physician, J. B. Gariot, honorary surgeon and dentist to Spanish royalty and a faculty member of the Royal College of Surgery in Madrid.43,44 The section headings from the first text read much like those of a twentieth century textbook of oral medicine (Table 2) and clearly represent a remarkable departure from the discussion topics of previously published works of dentistry. But Gariot was a man ahead of his times and dentistry in France and Spain would not become organized for another 70 years. Because of this his treatises appear from the perspective of today to have had little impact. Despite the fact that one was translated into English and published in America, they are neither quoted nor referenced in any nineteenth century text or dental journal. The unformed field of dentistry was, apparently, not yet ready to be concerned with matters beyond the treatment of tooth decay and its sequelae.

Leonard Koecker (Germany, United States, England)

The advancement and dissemination of our understanding of noncarious oral disease processes appears to have begun in earnest in the United States in the 1820s with wide dissemination of the rather comprehensive works of the German-born American/British physician/dentist, Leonard Koecker,25,45,61,62 and the London researcher, Thomas Bell.46 American Doctors of Dental Surgery, in contradistinction to the more numerous itinerant "dentists," were applying these principles with more success than in any other country, and such American professionals as Chapin Harris, Horace Hayden, Parmley Brown, L. S. Parmly, and Thomas Bond quickly incorporated the ideas of Koecker and Bell, and successfully disseminated them throughout the United States and Europe.63,64

Most of these men were actively associated with the first dental school, in Baltimore, Maryland, but it is worthwhile to mention that they were physicians with a special interest in oral diseases and that the faculty of the nearby University of Maryland School of Medicine also showed an early interest in oral pathology: in 1843 Burns and Pattison of that school published the first text devoted exclusively to head and neck tumors.65

Born in Bremen in 1785, Koecker came to the U.S. in 1807 and began practicing dentistry shortly thereafter.6 Within five years he was so successful that he was earning $8,000 annually in Philadelphia, but health problems forced him to leave private practice in 1822, at which time he moved to London and eventually resumed practice for another 28 years.

Koecker "was quite celebrated" during the Golden Age. He especially was known for emphasizing the inter-relations of dental and systemic disorders and was the first to be referred to in print as a "Dental Pathologist."6,26,62,66 His value is exemplified by the fact that he took with him to England letters of recommendation from three U.S. presidents and by 1842 he had received three honorary doctoral degrees in medicine (Philadelphia College of Medicine, London Medical College) and dentistry (Baltimore College of Dental Surgery). He died in 1850.

In 1819 he published his first paper in Chapman’s Journal, entitled, "The devastation on the gums and alveolar processes."6 His major work and most popular text, however, would today be considered to be primarily devoted to restorative dentistry, even though its approach to dentistry was unique enough for Thorpe99 to say more than half a century later that it was "a complete work on dental science, pathology and therapeutics, far in advance of anything heretofore published in the English language." As with Gariot, his textbook differed significantly from previous dental texts in that it attempted to discuss the scientific basis for dental therapeutics.45 While he did discuss in some detail the diagnosis and management of several strictly pathologic entities, in particular "reactive growths," his oral pathology influence on the profession was largely overshadowed by Thomas Bell and Thomas Bond.

Thomas Bell (England)

Thomas Bell, Guy's Hospital Lecturer on the anatomy and diseases of the teeth, was among the most influential of those who stimulated the early development of oral pathology/oral medicine and made them fundamental to the practice of dentistry. His major book, The anatomy, physiology, and diseases of the teeth, was first published in 1828 and was primarily a science-based text on dental and periodontal disease, but it had entire chapters and sections relating to legitimate oral pathologic entities (Table 3).46 It was published in five editions in both England and the United States.

The influence of Bell’s text appears to have been profound, and more than two decades after its publication Robinson,67 dentist to the Royal Free Hospital in London, England, felt justified in stating that, with the exception of the earlier work of Hunter20 (1771) and Fox68 (1806), "it was not until the appearance of the scientific publication of Bell that Dental Surgery may be said to have engaged any particular attention, or to be studied as an important collateral branch of Medicine and Surgery." According to Robinson, Bell was the first to emphasize the fact that the teeth were an "integral part of the human economy, and as such entitled to form an important element of consideration." In his opinion, up to that point in time, "no work so comprehensive and perfect as that of Bell had yet been produced."

Unfortunately, Bell was, like Gariot before him, somewhat ahead of his time, publishing in his home country of England several decades before the dental profession formally established itself there. Robinson67 in 1850 indicated that "Falstaff himself never possessed a more heterogeneous or nondescript army than those who now compose the majority of dentists in England." He further stated their qualifications to practice dentistry could "be summed up in the remark, that, having failed in every other department, they consider themselves perfectly competent to practice as dentists." Bell’s influence was, in fact, greatest in the United States, where modern dentistry was emerging several decades before its European counterpart.
 


 

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The Man

Dr. Thomas Bond, Father of Oral Pathology


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The Father of us all: Thomas Emerson Bond, Jr., A.M., M.D. (United States)

The person whom the present authors believe to be the true "Father of Oral and Maxillofacial Pathology" is Thomas Emerson Bond Jr., A.M., M.D., of Maryland (Figure 3). In 1840 Bond became the first Professor and Chairman of Special Pathology and Therapeutics, with the opening of the first dental school in the world, the Baltimore College of Dental Surgery (Figure 4). He held that position for at least 30 years and appears to be one of the dozen most influential and recognized men of the nineteenth century dental profession.6,69-71 In fact, he has been described as one of the four Americans responsible for the "birth" of the modern dental profession.66

Even though others were writing on topics of oral pathology and oral medicine, and even though others had already specialized in "oral surgery" (Hullihen, for example), "the writing of Dr. Bond was the first indication of an extended sphere for general dentistry."6 His work was as well recognized in Europe as in the U.S., and in 1859 he was invited to become the first Corresponding Member of the Odontologic Society of London, the first national dental society organized outside of the United States.72 Thomas Bell was elected to membership in the same organization a year later.

Praise for the man and his book; the start of Oral Medicine

Bond's work was widely quoted by others and his 1848 textbook, A Practical Treatise on Dental Medicine, was the first English-language text devoted almost exclusively to oral and maxillofacial pathology as we know it today.47 At the time, his book was said to have "treated this subject [oral pathology] more fully than any previous American dental writer," and he was "the first American writer of note who incorporated, together with strictly dental lesions, a consideration of cases...which had before been considered to belong to general surgery."6 This text was, moreover, the first book to be described as a review of "oral medicine" in the dental literature.73 The term was not again used in print until 1868, when an editor used it as a section title for papers relating to the treatment of oral soft tissue diseases.74

A physician becomes a dentist

Bond was the first to report on several oral disease entities and he demonstrated insights into the etiology and pathophysiology of oral diseases which are still valid today. Altogether, his achievement was remarkable and his writing makes it abundantly clear that he thought of himself first and foremost as a Doctor of Dental Surgery (he was a physician with special training in dental surgery). He knew Simon Hullihen well and referred to him as "this ingenious surgeon," but he can equally be referred to as "this ingenious pathologist."75

Bond's life as a physician was almost completely dedicated to the fledgling profession of dentistry. Born in 1813 in Baltimore, Maryland, as the son of Thomas E. Bond Sr., physician and first President of the Board of Visitors of the Baltimore College of Dental Surgery, Bond Jr. received an A.M. degree from the Baltimore City College in 1830 and an M.D. degree from the University of Maryland Medical School (founded by his father, among others) in 1834. In 1838 he married Anne Morris of Baltimore and settled down in his father's practice but became immediately embroiled, with Horace Hayden, Chapin Harris and H. Willis Baxley, in the founding of the Baltimore College of Dental Surgery.6

His influence on the dental school venture cannot be underestimated. In fact, three-quarters of a century later, Thorpe6 considered that "his influence as a medical practitioner of standing in the establishment of the school, in the face of so much antagonism and opposition [from local physicians] was as great or greater than any other man connected with the institution." Bond continued to work throughout his life for the acceptance of trained dental surgeons as respected health professionals. As a delegate to the American Medical Association he contended unsuccessfully for the admission of dental delegates on equal terms with medical delegates. He published extensively in both medical and dental journals, and for many years held a joint appointment in the Washington Medical University of Baltimore.

A love for oral pathology and for teaching

Although Bond served as Dean of the Baltimore College of Dental Surgery for most of its first decade of existence (1842-1849), his real love was oral pathology, especially clinical oral pathology (oral medicine). He was the first Chairman of an oral pathology department, the school’s Department of Special Pathology and Therapeutics, and he remained in that position until his death in 1872. His was a hands-on, practical and clinical approach to oral pathology, and he was there to assist Chapin Harris when chloroform was first used in the school to extract a tooth.

Despite the very dour countenance displayed by his portraits (Figure 3), he was a very popular teacher and had a well developed sense of humor.79 He was, moreover, quick to quote others, especially Hullihen and Koecker, and to give them proper credit, although he was certainly not beneath the occasional pithy comment about the ideas of others: "Magendie, with his usual carelessness of facts, and boldness of theory...the latter part of this opinion is, of course, mere nonsense."47

And then he wrote a book...and what a book it was!

Bond's text (Figure 5) became "a standard text book for dental students for many years and opened a new era in the history of dental surgery."6 The book was written especially for the American Journal of Dental Science, the first dental journal ever published, in its Library of Dental Science series of reprints of classic and standard works on dental theory and practice. His was one of only two books written on request for the series, all others were reprints of past publications, including two translated by himself from the French.76,77 As late as 1940, Robinson13 included his text among the books "that assisted materially in establishing dentistry permanently and acceptably as a scientific profession." The third edition in 1863 remained the only significant text of its kind until the 1898 book, Oral pathology and practice, by W.C. Barrett,57 another physician-dentist who was Professor of Oral Pathology and Dean of the University of Buffalo Medical Department (dental school).

Bond's book and journal articles repeatedly emphasized the pathologic relationship between diseased teeth and other parts of the body, and it was this, more than anything else, that led Thorpe6 to refer to him as "a far-seeing scientific man who was in advance of the medical concepts of his time, in recognizing the unity and interdependence of the whole human organism." The focus which he instilled into the "twelve apostles," his term for the students of the first graduating class of the Baltimore College of Dental Surgery, and later dental surgeons has today gained widespread acceptance in the dental profession and oral pathology is now a part of every dental school curriculum.78

He was a founder of modern dentistry

Bond worked closely with Chapin Harris, H.H. Hayden, and Simon Hullihen, three of the men most responsible for establishing a "scientific" foundation for the emerging dental profession. These men, along with four or five others, profoundly influenced the entire first generation of trained American dentists. This influence can best be appreciated when we remember that, of the 5,000 or so dentists practicing in the U.S. at the end of the Golden Age, only a few hundred were formally trained in dental schools.80 These few hundred, however, became the foundation of organized or modern dentistry; the other thousands of itinerant "dentists" or "barber-surgeons" eventually faded out of existence in all industrialized societies.

A preacher and a farmer as well

Not only was Bond an incredibly active medical/dental professional, including such esoteric activities as the translation of French texts on dentistry and the composition of the first dental college diploma, he was a profoundly religious man. Known in the Methodist Church as "Reverend Bond," he edited both The Episcopal Methodist national magazine and The Baltimore Christian Advocate, founded by him in 1870. He repeatedly declined the degree of Doctor of Divinity which his colleagues attempted to confer on him. Religion was, literally, a second profession for Bond, but between his two professions he somehow also found time to maintain a large farm, called "Kalmia" (outside Baltimore), until the end of his life.

He was not the first

Prior to a discussion of Bond's textbook, the present authors wish to emphasize that he was not alone in his thinking, but rather, he reflected the Golden Age of Science then underway in America and Western Europe. He was, in this regard, more fortunate than his earlier counterparts, Gariot and Bell, who, nevertheless, paved the way for his own great influence. Bond specifically emphasized that pathology was the "science of diseased conditions" and wrote his textbook in order that the dental profession could use it "to examine the etiology, pathology, and treatment of morbid conditions," with a special reference to practical dentistry.47

That there was a special need for his particular skills is reflected in the 1846 prospectus for the newly published New York Dental Recorder, wherein the influential J.S. Ware81 emphasized that "the failure of many dental operations which have been mechanically well performed, is undoubtedly owing to a want of pathologic knowledge." The Dental Recorder was the precursor to Dental Cosmos, begun in 1860, which in turn became incorporated into the Journal of the American Dental Association in 1936.2

His special interest: mouth -- body connections

As Dean of the first dental school, Bond published numerous pathology reports, the most important of which was his 1843 treatise on the "morbid sympathies" between the mouth and the rest of the body.75,82-89 This extraordinary paper was read at the fourth annual meeting of the American Society of Dental Surgeons, the first national dental organization in the world. He spoke of ‘a beautiful unity of purpose and dependence of parts," and emphasized the fact that it was absolutely necessary that "a certain organic understanding (so to speak) shall exist between the several parts, in order to enable them to act in concert, in carrying on the business of life."

He discussed, especially, those things which today we call oral manifestations of systemic disease. He reviewed, for example, the detrimental effects of scrofula and rickets on developing teeth (well before Hutchinson’s seminal work), the particularly severe damage wrought on gingival tissues by scurvy, and the alveolar alterations resulting from malignancy of the maxillary sinus. He also discussed the negative consequences which dental abscesses may have on the antrum and on more distant sites, especially the "painful affections of the nerves of the face" and "symptomatic fevers."

Even when discussing the routine topic of other authors, dental caries, he demonstrated considerable original thinking and insight. During a time when most dentists considered dental caries to be an unpresentable destruction arising from within individual teeth, he was proposing that it resulted from the influence of external acids on the enamel, and he dissolved enamel in lemon juice by way of demonstrating the feasibility of his theory.

And as part of his effort to emphasize mouth-body interactions he extensively discussed the spread of infection from teeth to other anatomic sites, especially to the brain, lungs, liver and bowels, and he discussed pain referred to the eye and ear and head (headache) from abscessed teeth. He did not hesitate to recommend extraction as an appropriate therapy for these systemic effects because, after all, "life is more important than teeth."

He broadly outlined other extra-dental effects of poor dentition, such as palatal and facial abscesses, traumatic ulcers, ischemic osteonecrosis ( "bone necrosis"), chronic osteomyelitis ("bone caries"), hypercementosis ("exostosis of the fangs"), and neuralgic pain from damaged or inflamed nerves ("neuralgia faciei").

He was the first textbook author to explain that cervical lymphadenopathy and tonsillar hyperplasia were frequently associated with mucosal inflammations, and his designation of enlarged cervical lymph nodes as "inflammation of submaxillary glands" was popularly accepted and is still in common use today as "swollen glands." His proposition that carcinoma of the lip and lateral tongue was produced by constant trauma from adjacent ragged tooth structures was a logical one at the time and was accepted until the early 1960s.

Conclusion

A thorough review of the health professionals who influenced the development of oral pathology in the early and mid-nineteenth century reveals a remarkably diverse activity in that arena, activity which was largely influenced by a small group of American, British, French and German physicians and dentists. Such a review, moreover, leads to the inescapable conclusion that Thomas E. Bond, Jr., M.D., of the Baltimore School of Dental Surgery, is indeed qualified to be called the true Father of Oral and Maxillofacial Pathology. His was the greatest and most long-lasting influence. His insights were innovative and thoughtful, and his writings were such that many of his proposed pathoetiologies and therapies are still valid today.
        


 


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A Practical Treatise on Dental Medicine, was published in the U.S. in 1848, with second and third editions published in 1850 and 1863.  The book was initially written by Dr. Bond at the request of the first national dental association, the American Association of Dental Surgeons.

The chapter titles of Bond's book demonstrate his interest in the broad scope of oral diseases, not simply dental caries and tooth anomalies (Table 4). They also reflect his differential diagnosis approach to pathologic entities. And his was one of the first dental textbooks published with an index, a clear indication of his methodical thinking and his attempt to make the book more useable to the reader.

Neuritis and teething

His text was also one of the first to emphasize the neural connection between the teeth and the central nervous system (CNS). Unfortunately, he commended the common practice of scarification, quickly incising the mucosa overlying erupting teeth to release their "tensions" and to allow their neural connections to the CNS to become less "irritated." He also echoed the contemporary belief that primary herpes simplex ("phlyctenae") and cholera often result from difficult teething, and he was writing so soon after the physical discovery of the trigeminal nerve connections that he mistakenly proposed that teething caused such CNS conditions as epilepsy, "somnolence," "stertor," coma, palsy, hydrocephalus, insanity, and "marasmus" (cachexia). All this because of the close temporal association between such diseases in childhood and the onset of teething difficulties.

Along these same lines, the terms "strophulus," "tooth rash" and "red gum" were used at the time to refer to inflamed gingivae secondary to tooth eruption, and impetigo was thought to result from eruption of the primary or "milk" teeth, as exemplified by its common name "crusta lactea" or "milk crust." Also in keeping with his times, Bond recommended that gingival inflammation "may be very much abated by the application of a leech."

Tumors and cysts

Bond discussed specific diseases of the gingiva or "gums" and was among the few to consider "epulis" to be of inflammatory origin, probably related to poor oral hygiene and bacteria (remember that this was almost two decades before the germ theory of disease came into existence). His descriptions were complete enough to be reasonably certain that he was among the first to describe pyogenic granuloma, peripheral giant cell granuloma, peripheral ossifying fibroma, and epulis granulomatosis of the gingiva.

He carefully outlined the characteristics of these and other benign neoplasms and soft tissue cysts or "encysted tumors," equating the latter with the common "wen" (epidermoid cyst, sebaceous cyst) of the periorbital skin and describing the keratinaceous contents variously as "melliceius" (thick yellow substance, like a "mixture of honey and whey") or "atheromatous" ("fluid cheese or pap"). He further distinguished the "periosteal exostosis" (buccal exostoses), the "medullary exostosis" (central ossifying fibroma?) and the "exostosis of the fang" (hypercementosis) from "osteo-sarcoma" with its "decidedly unfavorable prognosis." He further attempted to differentiate these from the various forms of carcinoma ("scirrhus," "fungus haematodes"), which he knew to be rare, and he was probably the first in the dental profession to recommend close follow-up of innocuous but suspicious lesions. Unfortunately, he also continued to perpetuate a strong point of confusion by using the term "sarcoma" for a number of benign tumors, despite the fact that he also recommended reserving it for malignant tumors of soft tissues.

Ulcers

Bond distinguished between a wide variety of nonmalignant ulcers. Traumatic or "callous" ulcers were, in his mind, associated with simple trauma from the teeth. He described them in detail and felt that they were especially associated with "varicose veins," possibly because they were so often seen on the lateral and ventral tongue surfaces in older patients, i.e. in those patients most likely to have developed substantial tooth damage over the years. He cautioned his reader to be careful with chronic traumatic ulcers, as they may mimic or transform into "cancerous" ulcers, especially on the tongue and lip vermilion.

He also differentiated the painful ulceration of scorbutic gingivitis from the painless"chancres" of syphilis and "tubercles" of tuberculosis, with emphasis placed on the importance of palatal perforation in the diagnosis of the latter two diseases. Bond clearly considered these ulcerations different from the soft tissue necrosis or "mortification" of "cancrum oris" and "phagedenic" (Greek for "I eat") or "devastating" ulcers (probably carcinomas). He also emphasized that the surface lesion may simply be a reflection of underlying dental or bone infections, i.e. parulis or fistula. He and his contemporaries reserved the term "aphthae" (Greek for "I burn") for "thrush" or candidiasis, a disease not normally associated with ulceration. Today, of course, "aphthous" is a term reserved for the painful ulcers of recurrent aphthous stomatitis and other look-alike conditions.

Saliva

His text discussed the analysis of saliva in various disease states ("morbid secretions"), including the ptyalism resulting from the overuse of mercury as a medicament ("mercurial salivation"). His discussion of ranula makes it very clear that ranula was not an uncommon event in the practice of dentistry and he suggested that marsupialization does not always work. In this discussion he may have been the first to describe a branchial cleft cyst (treated incompetently by others in 1799) and the first complete parotidectomy for adenocarcinoma of the parotid gland, performed by Professor Samuel White of Hudson, New York in 1808.

Maxillary sinus and bone diseases

Maxillary sinus diseases were extensively discussed by Bond, including "dropsy," a term which he suggested replacing with " retention of mucus." Several cases of worms in the maxillary sinus, one with worms more than an inch long, were mentioned, as well as bone inflammations secondary to severe or recurring sinusitis. Relative to the latter, Bond distinguished between chronic osteomyelitis ("bone caries") and "bone necrosis" (ischemic osteonecrosis), mentioning that "necrosis may be caused by any means which destroys the nutrition of the bone or any part of it," usually from "constitutional vitiations, or defects of nutrition consequent upon general pravity." He defined bone necrosis as "complete death of bone" and indicated that infection or "bone caries" need not be part of it. He recommended that "when necrosis has taken place, the bone must be removed," a treatment still in use today.90

His discussion of osteonecrosis occurred almost seven decades before G .V. Black91 distinguished it from osteomyelitis in his influential 1915 textbook, and 150 years before it was determined to be primarily an ischemic phenomenon rather than infection.92

Common sense

Bond argued against certain popular beliefs by the simple use of common sense. For example, he did not agree with the maxim that "for every child a tooth [is lost]," using as his strongest argument the fact that "pregnancy is not a disease." He felt that during pregnancy there was "more liability to pain than at other times; and less patience to endure it. There is occasionally a sympathetic toothache, which, though it cannot be directly traced to the uterus, appears to depend upon its gravid condition, and not upon disease of the tooth itself." This phenomenon he attributed to the fact that "the blood is more highly charged with fibrine," a concept only recently confirmed as an explanation for certain cases of "idiopathic" maxillofacial pain and estrogen-induced ischemic bone changes.93,94

 


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2. Richardson BW. On the medical history and treatment of diseases of the teeth, and the adjacent structures. London: H. Bailliere; 1860.

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9. Pierce AL. Origin of modern dentistry in the United States. Dental Cosmos 1932; __:1-12.

10. Anderson GM (editor). Proceedings, dental centenary celebration. Baltimore: Maryland State Dental Assoc. (Waverly Press); 1940.

11.Asgis AJ. Dentistry in American Society. New York, New York: Clinical Press; 1941.

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17. Fauchard P. Le Chirurgeon dentiste, ou Traité desdents. Paris: Pierre Jean Mariette; 1728.

18. Jourdain ATL. Traité des maladies et des operations reéllement chirurgicales de la bouche et des parties qui y correspondent. Paris; 1756.

19. Bourdet. Recherches et observations Sur toutes les parties de l’art du dentiste. Paris, 1757.

20. Hunter J. The natural history of the human teeth: explaining their structures, use, formation, growth, and diseases. London: J. Johnson; 1771.

21. Hayden HH. Opening address before the second annual meeting of the American Society of Dental Surgeons. Am J Dent Sc 1842; 3:1-28,77-78.

22. Trueman WH. History of dental periodical literature in the English language from 1839-1875. In: Black AD. Index of the periodontal dental literature published in the English language. Chicago: Dental Index Bureau, 1923: XXV-XXX.

23. Johnson EA, O’Roarke JJ, Partridge BS, et al. The status of dental journalism in the United States. Baltimore, Maryland: Waverly Press; 1932, p.1-44.

24. Pasch JG. Abhaudlung von der Zahnen, des Zahnfleisch, der Kiefer, Kraukheiten und heid art. Vienna; 1766.

25. Berdmore T. A treatise on the disorders and deformities of the teeth and gums, illustrated with cases and experiments. London; B.White; 1768. (Reprinted in 1844 by the Amer Soc Dental Surgeons.)

26. Hoffmann-Axthelm W. Die Geschichte der Zahnheilhunde. Berlin; Die Quintessenz, 1973:210.

27. Foster JH. Address delivered before the Society of the Alumni of the Baltimore College of Dental Surgery, at their First Annual Meeting. Am J Dent Sc 1849; 9:265-300.

28. Bouquot JE, Lense EC. The beginning of oral pathology, Part I: First dental journal reports of odontogenic tumors and cysts, 1839-1860. Oral Surg Oral Med Oral Path 1994; 78:343-350.

29. Bouquot JE, Lense EC, Whitaker SB. The beginning of oral pathology, Part II: First dental journal reports of nonodontogenic tumors, cysts and cancers, 1839-1860. Oral Surg Oral Med Oral Pathol, in press.

30. Black AD. Index of the periodical dental literature published in the English language, 1839-1875. Buffalo, NY: Dental Index Bureau; 1923.

31. Thoma KH. The history of oral surgery (the oldest specialty of dentistry). Oral Surg Oral Med Oral Pathol 1957; 10:1-10.

32. Johnston C. Letter to the editor. Am J Dent Sc 1857; 7(new series):66-68.

33. Delabarre. Discourse d’ouverture d’un cours de medecine dentaire (An introductory lecture to a course of dental medicine). Paris; 1817.

34. Bew C. Opinions on the causes and effects of diseases of the teeth and gums. London; 1819.

35. Taft J. The province of the dentist. Dent Reg West 1860; 14:313-316.

36. Anonymous. Proceedings of the American Dental Association. Dent Reg West 1860; 14:232-237.

37. Cahn LR. Contributions to the development of oral pathology. Oral Surg Oral Med Oral Path 1959; 12:3-13.

38. Hillenbrand H. Twenty-five years in retrospect. Oral Surg Oral Med Oral Path 1959; 12:62-65.

39. Bernier JL. The birth and growth of oral pathology. Oral Surg Oral Med Oral Path 1972; 34:224-230.

40. Thoma KH. Clinical pathology of the jaws, with a histologic and roentgen study of practical cases. Baltimore, Maryland: Charles C. Thomas; 1934.

41. Thoma KH. Oral and dental diagnosis, with suggestions for treatment. Philadelphia: W.B. Saunders; 1936.

42. Thoma KH. Oral pathology. St. Louis: C.V. Mosby; 1941.

43. Gariot JB. Traite des maladies de la bouche, d!après l!etal actuel des connoissances en medicine et en chirurgie. Paris: L. Duprat-Duverger; 1805. (Translated into English by J. B. Savler in 1841 for the Amer Soc Dental Surgeons.)

44. Gariot JB. Système de la physiologie, pathologie et therapeutique de la bouche avec des notes Leips: d’Angermann; 1806.

45. Koecker L. Principles of dental surgery, exhibiting a new method of treating the diseases of the teeth and gums. London; 1826, and Baltimore, Maryland: Amer Soc Dental Surgeons, 1842.

46. Bell T. The anatomy, physiology, and diseases of the teeth. Philadelphia: Carey, Lea & Blanchard, London; 1829.

47. Bond TE Jr. A practical treatise on dental medicine. Philadelphia: Lindsay & Blakiston; 1848.

48. Goddard PB. The anatomy, physiology and pathology of the human teeth. New York: S. S. & Wood, 1855.

48b. Richardson BW. On the medical history and treatment of diseases of the teeth, and the adjacent structures. London: H. Bailliere, 1860.

49. Garretson JE. A treatise on the diseases of the mouth, jaw and associated parts. Philadelphia: J. B. Lippincott, 1869.

50. Wedl C. The pathology of the teeth, with special reference to their anatomy and physiology. Philadelphia; Lindsay & Blakiston; 1872. (Translated from 1870 German text by W. E. Boardman)

51. Phelps HJ. Pathology and therapeutics of dentistry: with miscellaneous essays on dental subjects. St. Louis: James Hogan; 1874.

52. Salter SJA. Dental pathology and surgery. New York. William Wood & Co, 1875.

53. Gorgas FJ. Dental medicine, a manual of dental medica and therapeutics for practitioners and students. Philadelphia: P.B. Blakiston & Son; 1881.

54. Coleman A. Manual of dental surgery and pathology. Philadelphia: Henry C. Lea’s Son & Co.; 1882. (revised from the British edition)

55. Blodgett AN. A handbook of dental pathology. Philadelphia: Blakiston & Son; 1888.

56. Bödecker CFW. Anatomie und Pathologie der Zähne. Philadelphia: S. S. White Dental Manufacturing Co, 1894 (English translation).

57. Barrett WC. Oral pathology and practice. Philadelphia: S.S. White Co.; 1898.

58. Burchard HH, Stellwagen TC. A textbook of dental pathology and therapeutics, including pharmacology, for students and practitioners, being a treatise on the principles and practice of dental medicine. Philadelphia: Lea Brothers & Co.; 1898.

59. Eames GF. The practice of dental medicine. Philadelphia: S.S. White Dental Mfg Co.; 1899.

60. Hutchinson J. On the influence of hereditary syphilis on the teeth. Trans Odont Soc London 1861; 2:95-106.

61. Koecker L. An essay on artificial teeth, obturators, and palates, with the principles for their construction. Philadelphia; 1822.

62. Harris CA. Introduction to L. Koecker's "An essay on artificial teeth, obturators, and palates, with the principles for their construction and application. Am J Dent Sc 1840; 1:180-184.

63. Harris CA. A physiological and pathological inquiry concerning 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.

64. Taylor J. Opening address delivered before the Mississippi Valley Association of Dental Surgeons. Am J Dent Sc 1844; 5:91-104.

65. Reported in: Taylor J. Opening address delivered before the Mississippi Valley Association of Dental Surgeons, Am J Dent Sc 1884; 5:91-104.

66. Cheaney P. The early heroes of dentistry. Am Dent Surg 1926; 46:138-142.

67. Robinson J. An address to the Society of the alumni of the Baltimore college of Dental Surgery. Am J Dent Sc 1850; 10:223-256.

68. Fox J. The history and treatment of diseases of the teeth. London; 1806

69. Gorgas FTS. Advertisement for the 29th Annual session (1868-69) of the Baltimore College of Dental Surgery. Am J Dent Sc (2nd series) 1868; ___:628.

70. Anonymous. Obituary. Am J Dent Sc 1872-73; 6 (3rd series):286-287.

71. Anonymous. In memoriam. Am J Dent Sc 1872-1873 6 (3rd series):384.

72. Anonymous. Meeting minutes. Trans Odont Soc London 1860; 2: _____.

73. Harris CA. Dental medicine. Am J Dent Sc 1849; 10:139.

74. Anonymous. Dental medicine. Am J Dent Sc (3rd series) 1868; __:320.

75. Bond TE. Dissertation on the morbid sympathies between the mouth and other parts of the body. Am J Dent Sc 1844; 4:23-31.

76. Baumes M. A treatise on first dentition, and the frequently serious disorders which depend upon it. Baltimore, Maryland: Am Soc Dental Surgeons, 1841. (Translated from the French by T. E. Bond, Jr.)

77. Lefoulon J. A new treatise on the theory and practice of dental surgery. Baltimore, Maryland: Am Soc Dental Surgeons 1844. (Translated from the French by T. E. Bond, Jr.)

78. Bond TE Jr. Valedictory address. Am J Dent Sc 1839-41; 1:249-257.

79. Piggot AS. Commencement week at the Baltimore College of Dental Surgery. Am J Dent Sc 1868; 1(3rd series):620-623.

80. Polk RL. Dental Register of the United States, vol I. 1893; 28-40.

81. Ware JS. Prospectus. NY Dental Recorder 1846; 1:1-4.

82. Bond TE Jr. Introductory lecture, delivered before the class of the Medical Dept. of the Washington University. Am J Dent Sc 1849; 9:169-190.

83. Bone TE Jr. Wounds of the mouth and face. (Fractures – dislocations.) Am J Dent Sc 1850-51; 1 (2nd series):209-220.

84. Bond TE Jr. Diseases of the gums. (Epulis) Am J Dent Sc 1850-51; 1 (2nd series):220-231.

85. Bond TE Jr. Hare-lip. Am J Dent Sc 1850-51; 1 (2nd series):231-239.

86. Bond TE Jr. Disease of the glands and gland-ducts. Ranula. Am J Dent Sc 1850-51; 1 (2nd series):240-256.

87. Bond TE Jr. Tumours requiring amputation of a part or the whole of the upper jaw. Am J Dent Sc 1850-51; 1 (2nd series):256-266.

88. Bond TE Jr. Disease of the antrum or maxillary sinus. Am J Dent Sc 1850-51; 1 (2nd series):267-295.

89. Bond TE Jr. Diseases of the palate. Am J Dent Sc 1850-51; 1 (2nd series):295-307.

90. Bouquot J, Christian J. Long_term effects of jawbone curettage on the pain of facial neuralgia. J Oral Maxillofac Surg 1995; 53:387-397.

91.Black GV. A work on special dental pathology. Chicago: Medico-Dental Publ Co.; 1915.

92. Bouquot JE, McMahon. Neuropathic pain in maxillofacial osteonecrosis (NICO). J Oral Maxillofac Surg 2000; 58: 1003-1020.

93. Gruppo R, Glueck CJ, McMahon RE, et al. The pathophysiology of osteonecrosis of the jaw: anticardiolipin antibodies, thrombophilia, and hypofibrinolysis. J Lab Clin Med 1996; 127:481-488.

94. McMahon RE, Bouquot JE, Glueck CJ. Exogenous estrogen may exacerbate thrombophilia, impair bone healing and contribute to development of chronic facial pain. J Craniomand Pract 1998; 16:143-153.
 


 

Table 1

 

Table 1: Oral pathology texts published prior to the twentieth century, listed in chronologic order of publication date.

Return to Text 

Author(s) Year Country Title of Text

Jean Gariot43

1805

France

Traite des maladies de la bouche.

Jean Gariot44

1806

France

Système de la physiologie, pathologie et therapeutique de la bouche avec des notes d’Angermann.

Leonard Koecker45

1826

England

Principles of exhibiting a new method of treating the diseases of the teeth and gums.

Thomas Bell46

1829

England

The anatomy, physiology, and diseases of the teeth.

Thomas Bond Jr.47

1848

U.S.

A practical treatise on dental medicine.

P. B. Goddard48

1855

U.S.

The anatomy, physiology and pathology of the human teeth. *

B. W. Richardson48b

1860

England

On the medical history and treatment of disease of teeth, and the adjacent structures. *

J. E. Garretson49

1869

U.S.

A treatise on the diseases of the mouth, jaw and associated parts.

Carl Wedl50

1870

Germany

The pathology of the teeth. *

Hibler Phelps51

1874

U.S.

Pathology and therapeutics of dentistry.

S. J. A. Salter52

1875

U.S.

Dental pathology and surgery.

F. J. Gorges

1881

U.S.

Dental medicine, a manual of dental medica and therapeutics.#

Alfred Coleman54

1882

U.S.

Manual of dental surgery and pathology. *

Albert Blodgett55

1888

U.S.

A handbook of dental pathology. *

C. F. W. Bödecker56

1894

Germany

The anatomy and pathology of the teeth. *

William Barrett57

1898

U.S.

Oral pathology and practice.

Henry Burchard & Thomas Stellwagen58

1898

U.S.

A textbook of dental pathology and therapeutics. *

George Eames59

1899

U.S.

The practice of dental medicine.

* pathology discussion deals primarily with tooth diseases.

# dealt almost exclusively with medications used for dental and oral diseases.


Return to Text 


 

Table 2

 

Table 2: Oral pathology subject headings in the 1805 text by Gariot, excluding sections not pertaining to pathology, i.e. oral anatomy (representing 21% of all pages), prevention and treatment of dental caries (15% of total) and oral surgical procedures (29% of total).43

 Return to Text 

Sections I:

  • Maladies de la membrane muqueuse de la bouche (maladies of the oral mucous membranes)
  • Gerçure des lèvres
  • Aphthes des lèvres
  • Scorbut
  • Angine
     
    •

    Section II:
  • Maladies qui ont leur siége dans l’epaisseur des diverses parties de la bouche et de l’arrière-bouche
    Des épulies
  • De l’ozène du sinus maxillaire
  • Polypes ou fongus du sinus maxillaire
  • Plaies, ulcères, tumeurs et autres alterations de la structure des différentes parties de la bouche
  • Imperforation de la bouche
  • Rétrécissement de la bouche
  • Bec de lièvre
  • Intumescence des lèvres
  • Affection du filet de la langue
  • Affections de la langue
    •
  • Intumescence de la langue
  • Renversement de la langue
  • Coups de feu dans la bouche
  • Plaies compliquées
    •

    Section III:
  • Maladies des glandes et conduits salivaires, et des affections particulières aux glandes lymphatiques
  • De la grenouillette
  • De l’affection des glandes lymphatiques qui entourent les mâchoires
  • Du skirrhe et du cancer qui surviennent à quelques parties de la bouche
  • Bouton cancéreux a la lèvre
  • Cancer à la joue
    •

    Section IV:
  • De quelques affections purement nerveuses ou de nature rhumatismale
  • De l’odontalgie
  • Tics de la face
  • Traitement de divers tics de la face
     
    •

    Section V:
  • Maladies des os de la mâchoire
  • Luxation de la mâchoire inférieure
  • Fracture de la mâchoire inférieure
  • Maladies du tissu propre des os
  • Mortification ou nécrose
  • Mortification partielle et externe ou exfoliation
  • Necrose totale du corps de l’os
  • Tumeurs osseuses
  • Carie [osseuses]
    •

    Section VI:
  • Maladies des dents
  • Formation du tartre
  • Usure des dents
  • Luxation des dents
  • Fracture des dents
  • Carie des dents
    •


     Return to Text 


     

    Table 3

     

    Table 3: Bell’s chapter headings, 1829.46


     

    Return to Text


    Table 4

    Table 4: Chapter titles in the classic Bond47 text, A Practical Treatise on Dental Medicine, taken from the second edition, published in 1850. These titles demonstrate Bond's emphasis on non-tooth-related topics and the close association of the mouth with the rest of the body.

     Return to Text  

    Ulcers
    Tumours
    Inflammation of the several parts composing the mouth
    Diseases of the lips
    Diseases of the gums
    Diseases of salivary glands
    Diseases of the maxillary sinus
    Diseases of the palate
    Neuralgia
    Morbid secretions of the mouth
    Morbid effects of first dentition
    Effects of diseased teeth


     Return to Text