First Dental Journal Reports of 
Odontogenic Tumors and Cysts, 1839-1860

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Introduction
 

Oral Pathology beginnings in the 20th century

Oral Pathology as a specialty of dentistry is traditionally presumed to have its origin in the 1930s and 1940s,[1] 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 Oral Surgery, Oral Medicine, Oral Pathology.[5] The American Academy of Oral Pathology and the American Board of Oral Pathology were formed during this 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 landmark was the 1915 comprehensive review by Bloodgood[8] of oral lesions, in the second volume of the Journal of the American Dental Association.

The first professorship, in the first dental school

The first professorship of "Dental Pathology", however, originated much 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,[10] and, of course, Fouchard,[11], Jordain,[12] Hunter,[13] Bell[14] 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 both Oral Pathology (Table 1). The age that saw an unprecedented, world-wide "mental stir" in consequence also saw the emergence of "modern" or organized dentistry.[30]  This first "Golden Age" of dentistry, 1835-1860, began with 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 techniques 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]

The first guy called a "Dental Pathologist"

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 Bell,[14] dealt extensively with pathologic processes, including first reports of numerous oral diseases. Lester Cahn[1] believed that Sir Jonathan Hutchinson was the earliest Oral Pathologist, but the chairman of Baltimore's Department of Special Pathology, Thomas Bond, more correctly holds that distinction. Bond's insight was so remarkable that he was able to hypothesize etiologies and pathophysiologies which 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.[20]  He 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]

Oral lesions were reported much earlier than usually suspected

Interest in pathology 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 2). These accounts frequently anteceded the usually quoted "first reports" by several generations. Oral pyogenic granulomas, for example, were not well understood until Kerr's[36] 1951 analysis, yet Simon P. Hullihen, the "Father of Oral Surgery", described one succinctly in an 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 Westcott[38] described pregnancy gingivitis under the diagnosis of "uterine irritation"; Harris[15] had described it earlier as "hemorrhoidal discharge in dysmenorrhea."

Oral pathology papers frequently begin with historical 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 2). While individuals 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]

Cysts                                

Odontogenic
Cysts








 

Odontogenic
Cysts








 

Odontogenic
Cysts
 

Periapical cyst

Cysts of the jaws were noted only when they produced cortical expansion or some other visible alteration of surface tissues. The single exception was also the first cyst reported in a dental journal: the periapical cyst (Table 3). 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 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 lesions were described as inflammations, granulations, abscesses, and suppurations, and it was well known that facial or alveolar fistulae could result from them (Figure 5).

Dentigerous cyst

Dentigerous cysts were described as early as 1778 in France,[67] but were not well delineated until 1842, and were not illustrated in a journal until 1859 (Figure 6).[49,55]  These cases were reported approximately a century after Scultet[75] first described jawbone cysts as "liquid tumors."  The concept of a benign, epithelial-lined cystic space with internal pressures capable of producing bony expansion was formed during those early years.[75]

Odontogenic keratocyst

Several cystic lesions were aggressive enough to be classified today as odontogenic keratocysts or unicystic ameloblastomas. The first large cyst was Dornbluth's[57] 1844 description of a multilocular dentigerous cyst or "encysted tumor" which had entirely filled the antrum and distorted the orbital floor. 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 contemporary diagnoses used, such as "cystic sarcoma" and "cystic carcinoma".[72] It is probable that the multilocular cyst found by Salama and Hilmy[76] in the mandibular ramus of a 2,800 B.C. Egyptian mummy was a keratocyst. It was not associated with an impacted tooth and had greatly expanded the overlying cortices, causing pathologic fracture. This skull also contained a dentigerous cyst around the crown of an impacted maxillary cuspid (Gorlin's syndrome, perhaps?).

Eruption cyst

The eruption cyst held special significance for early dental surgeons.[59]   The anatomy of the trigeminal nerve had recently been described by the Englishman Charles Bell[77] and 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] Since 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, and particularly its "severe" forms (with eruption cysts), was the cause of "brain fever".[79] The universal acceptance of this concept is perhaps best illustrated in Charles Dicken's[80] Bleak House, wherein a sickly child is assumed to be dying from "a difficult teething". The logical treatment for convulsions and stuporous fevers became, quite naturally, the surgical incision of gingival tissues overlying eruption cysts and erupting teeth. This treatment appeared to be successful, of course, because brain fevers typically lasted 7-14 days, presuming death did not intervene. Such treatment came to be known as "scarification" and was used also on Epstein's pearls or gingival cysts of newborns.[56]

Neoplasms                                    

Odontogenic
Neoplasms









 

Odontogenic
Neoplasms









 

Odontogenic
Neoplasms









 

Odontogenic
Neoplasms

 

Odontogenic
Neoplasms
 

Odontogenic
Neoplasms
 

Hypercementosis

The first dental journal reports of oral pathologic entities dealt with odontogenic anomalies (Figure 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 was then called "exostosis," 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 tooth-ache pain and inflammation of the "dental nerve" (pulp), a natural assumption considering that they were only found upon extraction of painful, cariously destroyed teeth.[21,42-44] By 1851, Vandenburgh [45] hypothesized that pulpal inflammation caused this lesion and it was, therefore, not a true exostosis.

Harris[15] and Lee[46] believed that multiple cases in one individual were the result of "constitutional causes" rather than inflammation. Today we refer to this as hypercementosis and know it to represent excessive cementoblastic activity secondary to hypereruption of a tooth. We still accept one "constitutional" cause, Paget's disease of bone, for multiple hypercementoses.[47]

Cementoblastoma

A few exostoses were much too large to conform to a hypercementosis diagnosis and were obviously benign cementoblastomas. Several were reported to have completely obliterated the ipsilateral 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 (AJDS), the official publication of the first national dental association and the only dental journal accepted by the early American Medical Association as a legitimate medical journal.[50,51]  This same entity became the first odontogenic lesion reported with microscopic confirmation (Figure 2), almost a century before Norberg[53] published the paper most usually quoted as the first report of this lesion.

Odontoma

Table 3 provides first reports of other odontogenic neoplasms. The first journal report of a complex odontoma was in a 25 year old female 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 in a age without radiographs. The complex odontoma with the most definitive microscopic confirmation, however, was not reported until Forget's[49] superb paper translated in the first volume of Dental Cosmos (Figure 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]  While these are the first journal reports of odontomas, it was probably Pierre Fouchard[11] who provided the first accurate description of these lesions. Oudet[64], in 1809, suggested that they were of dental origin, but the term "odontome" was not applied until 1868.[65] They were undoubtedly the oldest recorded odontogenic neoplasms, having been reported in a 500,000 year old fossilized horse.[66]

Central ossifying fibroma

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 (Figure 4).[67]

Central odontogenic fibroma & odontogenic myxoma

The odontogenic (nonossifying) fibroma is an entity which, until recently, was frequently confused with simple fibrous hyperplasia of the parafollicular connective tissues,[68] but Adams[60] reported a "circumscribed fibrous tumor" around the crown of an impacted mandibular molar which seems large enough to justify it as the first report of a true odontogenic fibroma. Also, Furgusson[62] reported a similar case which was gelatinous rather than fibrous, hence was likely an odontogenic myxoma.

Ameloblastoma

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. Thoma[3] 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,[68-70] were not reported between 1839 and 1860. Wedl[71] provided 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 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 tumors,[70] even though Neumann[73] seems to have made that distinction in 1867 when he described the first ameloblastoma arising in a dentigerous cyst.

Teratoma

Although not true odontogenic neoplasms, ovarian teratomas or dermoid cysts were well known to frequently contain teeth, almost always 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.

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References

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

2. Bunting RW. A text-book of oral pathology, for students and practitioners of dentistry. Philadelphia: Lea & Febiger, 1929.

3. Thoma KH. Oral pathology. St. Louis: C.V. Mosby Co., 1941.

4. Cahn LR (editor). Arch Clin Oral Path 1937; 1:1-245.

5. Thoma KH (editor). Oral Surg Oral Med Oral Pathol 1948; 1:1-1162.

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

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

8. 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 Natl Dent Assoc (later the J Amer Dent Assoc) 1915; 2:3-19.

9. Lintolt WH. To the editor of the London Lancet: progress of dental science in America. Am J Dent Sc 1842; 2:300-301.

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

11. Fouchard P. Le Chirurgien Dentiste, on Traite des Dents. Paris; Pierre Jean Mariette, 1746.

12. Jordain E. Traite des Maladies Chirurgicales de la Bouche. Paris; 1778.

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

14. Bell T. The anatomy, physiology and diseases of the teeth. London; 1829.

15. Harris CA. A physiological and pathological inquiry concerning the physical characteristics of the human teeth and hums, the salivary calculus, the lips and tongue, and the fluids of the mouth. Am J Dent Sc 1841; 2:39-120.

16. Baker E. Account of a remarkable tooth, with drawings. Am J Dent Sc 1839;

1:14-15.

17. 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.

18. Brown S. An extraordinary instance of the force of hereditary principle; in which is seen an example of the tendency of everything in nature to produce its like. Am J Dent Sc 1839; 1:15-16.

19. Brown S. Premature dentition. Am J Dent Sc 1839; 1:12.

20. Harris CA. Editorial comment to: Koecker L. An essay on artificial teeth, obturators, and palates, with the principles for their construction. Am J Dent Sc 1840; 1:180-184.

21. Hullihen SP. Observations on tooth-ache. Am J Dent Sc 1840; 1:105-111.

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

23. Anonymous. Is the Negro subject to hair-lip? Am J Dent Sc 1845; 5:314.

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

25. Dickey SJ. Osseous union of the teeth. Dent News Letter 1850; 3:60-61.

26. Birkett. Carcinomatous tumor attached to the uvula and posterior pillar of the fauces; removal; recovery. Am J Dent Sc (new series) 1852; 2:124-127.

27. Harris CA. New York Medical College announcement. Am J Dent Sc (new series) 1852; 3:155.

28. 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.

29. Warren JM. Tumors of the parotid region. Am J Dent Sc 1857; 7:587-595.

30. Piggot AS. Valedictory address to the graduating class of the Baltimore College of Dental Surgery. Am J Dent Sc 1858; 8(new series):149-163.

31. 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.

32. Pease WA. Is there a degeneration in the teeth? If so, to what is it attributable. Am J Dent Sc 1855; 5(new series):605-614.

33. Anonymous. Dental exhibitions. Dent Regist West 1854; 7:95-101.

34. Harris CA (ed). Amer J Dent Sc 1839/40; 1:1-292.

35. In: Harris CA. Filling teeth when the lining membrane is exposed. Am J Dent Sc 1851; 2 (new series):72-91.

36. Kerr DA. Granuloma pyogenicum. Oral Surg Oral Med Oral Path 1951; 4:158-176.

37. Hullihen SP. Case of aneurism by anastomosis of the superior maxillae. Am J Dent Sc 1844; 4:160-162.

38. Westcott A. Dissertation on the claims of the medical science upon the practitioner of dental surgey. 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, Inc., 1932:1-44.

41. Flagg JF. Dental exostosis. Dent News Letter 1859; 12:241-249.

42. Harris CA. Miscellaneous notes. Am J Dent Sc 1847/48; 8:106-112.

43. Hullihen SP. Abscess of the jaws, and its treatment. Am J Dent Sc 1847/48; 8:106-112.

44. Satter JA. Papers on dental pathology. Am J Dent Sc 1857; 7(new series): 14-31.

45. Vandenburgh D. Observations on exostoesis. Dent Regist West 1851; 4:194-198.

46. Lee J. Extraction of teeth. Am J Dent Sc 1847; 8:23-29.

47. Regezi JA, Sciubba JJ. Oral pathology, clinicopathologic correlations. Philadelphia: W.B. Saunders, 1989: pp. 427-430.

48. Thackston WWH, A dissertation on the diseases of the maxillary sinuses. Am J Dent Sc 1842; 2:279-291.

49. Forget A. Dental anomalies and their influence upon the production of diseases of the maxillary bones. Dent Cosmos 1860; 1:229-236, 283-289, 398-404, 451-457.

50. Rodriguez BA. Case of exostosis of the upper jaw. Am J Dent Sc 1839; 1:88-89.

51. Davis NS. Report of the Committee on Medical Literature. Tran Am Med Assoc 1853; 6:99-135.

52. Salter J. Cancellated or vascular exostosis on the fang of a bicuspid tooth. Trans Pathol Soc London 1855; 6:168-169.

53. Norberg O. Zur Kenntnis der dysontogenetischen Geschwalste3 der Kieferknochen. Vjschr Zahnheilk 1930; 46:321-355.

54. Jenks. Singular phenomenon. Am J Dent Sc 1841; 2:160.

55. Harris CA. Book review of Ashburn J. On dentition and some coincident disorders (published 1834). Am J Dent Sc 1842; 2:294-297.

56. Grey WH. Lancing the hums in stridulous convulsions. Am J Dent Sc 1843; 3:228.

57. Dornbluth. Cyst in the orbital cavity. Am J Dent Sc 1844; 4:296-297.

58. Hawkins JW. Cases of fibrous tumors of the upper jaw-epulis. Am J Dent Sc 1844; 7:77-84.

59. Tomes J. A course of lectures on dental physiology and surgery (lectures I-XV). Am J Dent Sc 1846-1848; 7:1-68, 121-134; 8:33-54, 120-147,313-350.

60. Adams. Fibrous tumors of the lower jaw; removal of the portion of bone involved in the disease; recovery. Dent News Letter 1853; 6:246-250.

61. Talma AF. Memoirs on a few fundamental points of dental medicine, considered in its application to hygiene and therapeutics. Am J Dent Sc 1854; 4 (new series):294-302.

62. Fergussen. Resection of portions of the lower jaw on account of tumor. Am J Dent Sc (new series) 1860; 10:112-117.

63. Andrews EH. Extraordinary successive development of teeth. Am J Dent Sc 1858; 8(new series):16.

64. In: Sprawson E. Odontomes. Brit Dent J 1937; 62:177-201.

65. Broca P. Gaz Leb de Med et de Chir (Paris) 1868; 5:19,70,113.

66. Owen R. A history of British fossil mammals and birds. London; 1846:388-389.

67. Shillitoe B. Fibrous tumor from near the angle of the lower jaw. Trans Pathol Soc London 1865; 16:223-224.

68. Waldron CA. Odontogenic tumors and selected jaw cysts. In : Gnepp DR. Pathology of the head and neck. NY: Churchill-Livingstone, 1988:403-458.

69. Cusack JW. Report of the amputation of portions of the lower jaw. Dublin Hosp Rec 1827; 4:1-3.

70. Baden E. Terminology of the ameloblastoma: history and current usage. J Oral Surg 1965; 23:40-49.

71. Wedl C. Pathologie der Zahne mit besonderer Rucksicht auf Anantomie und Physiologie. Leipzig: A. Felix, 1870.

72. Wagstaffe WW. Case of cystic sarcoma of lower jaw. Trans Pathol Soc London 1871; 22:249-253.

73. Neumann E. Ein Fall von Unterkiefergeschwulst bedingt durch Degeneration eines Zahnsackes. Langenbecks Arch f Chir 1967; 9:221-223.

74. Cone CO. Report on practical dentistry. Am J Dent Sc 1848; 9:3-82.

75. Scultet I. L'Arcenal de Chirurgie. Lyon: Antoine Cellier, 1671.

76. Salama N, Hilmy A. An ancient Egyptian skull and a mandible showing cysts.

Brit Dent J 1951; 90:17-18.

77. Bell C. The nervous system of the human body. London, 1830.

78. In: Allen J. Address delivered before the Mississippi Valley Association of Dental Surgeons. Am J Dent Sc 1844; 5:105-112.

79. Canton A. On teaching. From a treatise on the teeth. Am J Dent Sc (new series) 1851; 1:131-138.

80. Dickens C. Bleak House.

81. Billings JS, Fletcher R (eds). Index Medicus, a monthly classified record of the current medical literature of the world, vol 1; 1879.
 

1828

First textbook devoted to diseases of the mouth (by Thomas Bond)[10]

1839

First journal report of oral pathologic entity (dilaceration)[16]

1839

 First emphasis on systemic effects on oral tissues [17]

1839

First report of an hereditary effect on oral tissues [18,19]

1840

First use of term "dental pathologist" (for Leonard Koecker) [20]

1840

First report of specific systemic effect (menstruation) on oral lesion (pulp polyp) [21]

1840

First professorship of dental pathology (Baltimore) [9]

1842

First continuing education course in oral pathology [15]

1843

First text devoted to head and neck tumors [22] *

1845

First report of racial predilection for an oral disease [23]

1849

First use of term "oral medicine" [24]

1850

First literature review in oral pathology [25]

1852

First microscopic description of a lesion in dental journal [26]

1852

First dental pathology lectureship in a U.S. medical school [27]

1856

First discussion of a differential diagnosis [28]

1857

First series report of an oral pathologic entity [29]