The History of  Oral & Maxillofacial Pathology
©The Maxillofacial Center for Diagnostics & Research
Other Links Oral Pathology Page Dr. Bouquot's Work Bond's Book of Diseases Home Page		Introduction Odontogenic Lesions Other Tumors & Cysts Father of Oral Path Tables of First Reports Earliest Dental Journals Early Events R. J. Gorlin Registry
Skull with teeth revealed.  From: Fox, 1855.

Introduction

Oral Pathology appears to have had its origin during the first Golden Age of Dentistry, from 1835 through the organization of the American Dental Association in 1860. This era saw the establishment of organized, education-based dentistry and was integrally associated with an obvious fascination for pathologic processes and an inherent wish to share scientific and clinical knowledge with others in the dental profession. It encompassed the creation of the first professorship of "Dental Pathology," the publication of the first textbook dedicated to oral pathology/oral medicine as we know it today, and the first review of oral pathology cases in medical journals. It also included the initial reports, in the 28 dental journals then in print (Table 1), of many of today's well-established oral lesions.  By the end of this Golden Age, even the microscopic features of oral lesions were considered to important that attendees of annual state dental association meetings were asked to bring their microscopes and microscopic slides of interesting cases.[1]

The purpose of this website is to provide a brief review of the first reported cases in dental journals of oral pathologic entities, including oral malignancies. Such reports frequently antecede by several generations the reports usually quoted as being the first for these lesions. Several research papers relating to this topic have been published by Dr. Bouquot and are available on the web page reviewing his work (link on "Dr. Bouquot's work on the Home Page).

In the Beginning

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 Bloodgood's 1915 "everything-you-need-to-know" review of oral lesions in the second volume of the Journal of the American Dental Association.[8]

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 2). The age that saw an unprecedented, world-wide "mental stir" [31] in consequence also saw the emergence of "modern" or organized dentistry. This first "Golden Age" [32] 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.[33]

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.[34]  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,[35] and the first truly comprehensive text for the dental profession in the United States, Bell's 1829 classic,[15] dealt extensively with pathologic processes, including first reports of numerous oral diseases. Lester Cahn believed that Sir Jonathan Hutchinson was the earliest Oral Pathologist,[2] 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.

Koecker, although a less influential dental surgeon, was the first professional to actually be designated a "dental pathologist" in print.[20] He published a general text on dentistry, Principles of Dental Surgery, as early as 1822.[36]   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 the 1951 analysis by Kerr,[37] yet Simon P. Hullihen, the "father of oral surgery", described one succinctly in an 22 year-old pregnant woman as early as 1844.[38] Hullihen documented a recurrence of his patient's gingival "aneurysm" with her second pregnancy. During the same year Westcott[39] described pregnancy gingivitis under the diagnosis of "uterine irritation;" Harris[22] 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 1). 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."[40]

It is presumed that, because of this American dominance, references in early American dental journals are among the first reasonably accurate references to oral pathologic entities.  Because of this Dr. Bouquot has undertaken an ongoing research into the earliest dental journals and textbooks, i.e. those from the 1830s through the 1870s. His papers can be accessed by clicking on the main menu categories at the top of this page and the first reports of various oral pathologic entities are listed by broad categories in the following Tables 3-6.

Index of Tables of First Reports of Oral Lesions
(as Reported in Dental Journals)

[Click on the table number to view the table]

Table 1: The earliest published dental journals, worldwide, 1839-1860. All are American titles, unless otherwise specified. From Bouquot JE, Lense EC. Oral Surg Oral Med Oral Pathol 1994; 78:343-350.

* last year of publication is unknown by authors                                   
** incorporated into Journal of American Dental Association in 1936

Table 2: Historical events which established Oral Pathology and Oral Medicine as integral parts of organized dentistry.  From Bouquot JE, Lense EC. Oral Surg Oral Med Oral Pathol 1994; 78:343-350.

 

Year	Reference(s)	Historical Event
1828	15	First textbook devoted to diseases of the mouth
1839	16	First journal report of oral pathologic entity (dilaceration)
1839	17	First emphasis on systemic effects on oral tissues
1839	18,19	First report of hereditary effect on oral tissues
1840	20	First use of term "dental pathologist" (For L. Koecker)
1840	21	First report of specific systemic effect (menstruation) on oral lesion (pulp polyp)
1840	9	First professorship of dental pathology (Baltimore)
1842	22	First continuing education course in oral pathology
1843	23	First text devoted to head and neck tumors
1845	24	First report of racial predilection for an oral disease
1848	11	First text devoted to dental/oral medicine
1849	25	First use of term "oral medicine"
1850	26	First literature review in oral pathology
1852	27	First microscopic description of a lesion in dental journal
1852	28	First dental pathology lectureship in a U.S. medical school
1856	29	First discussion of a differential diagnosis
1857	30	First series report of an oral pathologic entity

Table 3: First reports of nonneoplastic, usually inflammatory benign oral masses in dental journals, 1839-1860; listed by year of publication.

[Click on left-hand diagnosis for reference.]

Today's Diagnosis	Year	Ref.	Original Diagnostic Term(s)*
Pulp polyp	1840	41	Nerve fungus; bluish excrescence; erectile tissue; tumid pulp; polypus
Parulis	1840	41,42	Gum boil; liquid tumor; abscess; fistula; tubercle; paroulis
Periodontal abscess	1841	43	Conjoined suppuration; pyorrhea
Pseudocyst of maxillary sinus	1842	44	Retention of mucus
Pyogenic granuloma	1844	45	Aneurism; epulis; fungous granulation; erectile tissue
Pregnancy gingivitis	1844	46	Uterine irritation; positive inflammation of the gums
Pericoronitis	1844	47	Painful affection
Peripheral ossifying fibroma	1844	48	Osseous epulis; bony epulis; alveolar exostosis
Acute parotitis	1844	49	Acute inflammation
Irritation fibroma	1845	50	Fibrous epulis; fibroid; fibrous polyp; polypus
Ranula **	1848	51	Acute inflammation of gland; sublingual cyst
Peripheral giant cell granuloma **	1848	52	Fungus flesh; epulis
Gumma	1848	53	Indurated knot (of syphilis)
Papillary hyperplasia, palate	1851	54	Hyperplasia
Mucocele	1857	55	Salivary retention cyst; serous cyst
Epulis fissuratum	1858	56	Mamillated epulis; simple epulis

      * some original terms are taken from other contemporaneous articles
     ** exact diagnosis is in doubt                  

Table 4: First reports of nonodontogenic benign neoplastic and developmental oral masses and cysts, as reported in dental journals, 1839-1860; listed by year of publication.
                                                 [Click on left-hand diagnosis for reference.]

Today's Diagnosis	Year	Reference(s)	Original Diagnostic Term(s)
Hemangioma	1841	57	Bluish excrescence; erectile tissue
Gingival fibromatosis	1842	44	Fungus excrescence; hypertrophied gums
Osteoma	1842	44	Exostosis; osteoid
Arteriovenous malformation	1844	58	Anastomosing aneurism
Fibrous dysplasia **	1845	50	Fibrous tumor of jaw
Teratoma (Ovarian)	1848	58	Encysted tumor; dermoid cyst
Exostosis	1848	59	True exostosis
Papilloma	1848	52	Wart
Lipoma	1849	60	Fatty tumor; yellow epulis; adipose tumor
Cutaneous horn	1849	61	Horny growth; horny tumor
Lymphangioma **	1850	62	Chronic clustered vesicles
Warthin's tumor **	1852	63	Enlarged lymphatic gland
Epidermoid cyst **	1852	64	Painless abscess; wen; sublingual cyst
Pleomorphic adenoma	1852	65	Fibro-cartilaginous tumor; soft enchondroma
Enchondroma	1856	66	Chondroma
Parotid cyst	1856	67	Cyst in duct of Steno
Lymphoepithelial cyst **	1857	55	Hydatid cyst
Torus palatinus	1857	55	Medio-palatine exostosis
Rhabdomyoblastoma	1858	68	Muscular hypertrophy
Cystic hygroma	1858	69	Hydrocele
Neuroma **	1858	69	Neurofibroma
Central giant cell granuloma	1858	69	Myeloplaxes tumour
Teratoma (Cervical)	1860	70	Foetal inclusion

* some original terms are taken from other contemporaneous articles
** exact diagnosis is in doubt

Table 5: First reports of odontogenic tumors and cysts in dental journals, 1839-1860.

                 * some original terms are taken from other contemporary articles
               ** exact diagnosis is in doubt

Table 6: First reports of oral and maxillofacial malignancies, as reported in dental journals, 1839-1860; listed by year of publication.

[Click on left-hand diagnosis for reference.]

Today's Diagnosis	Year	Reference(s)	Original Diagnostic Term(s)
Carcinoma of maxillary sinus	1842	82	Fungus haematodes
Intraoral carcinoma	1842	49	Cancerous ulcer; Cancer; Carcinoma
Soft tissue sarcoma	1842	83	Fungus haematodes; Sarcoma
Osteosarcoma	1842	49,82	Osteo-sarcoma; Fungus exostosis
Lip carcinoma	1849	84	Cancerous ulceration
Chondrosarcoma	1848	85	Cartilage cancer
Adenocarcinoma	1849	85	Glandular cancer

References

 1. Chase HS. Iowa State Dental Society. Am J Dent Sc 1868; 1(series 3):104.

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

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

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

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

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

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

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

 9. 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.

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

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

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

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

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

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

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. 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.

23. Burns, Pattison (University of Maryland School of Dentistry. Mentioned in: Taylor J. Opening address delivered before the Mississippi Valley Association of Dental Surgeons. Am J Dent Sc 1844; 5:91-104.

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

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

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

27. 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.

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

29. 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.

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

31. 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.

32. 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.

33. 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.

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

35. Harris CA (ed). American Journal of Dental Science. Amer J Dent Sc 1839/40; 1:1-292.

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

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

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

39. Westcott A. Dissertation on the claims of the medical science upon the practitioner of dental surgey. Am J Dent Sc 1844; 5:3-31.

40. 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.

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

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

43. Hayden HH. On conjoined suppuration of the gums and alveolus. Am J Dent Sc 1841; 2:214-297.

44. Harris CA. Dissertation on the diseases of the maxillary sinus. Am J Dent Sc 1842; 3:20-132,153-189.

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

46. Westcott A. Dissertation on the claims of the medical sciences upon the practitioner of dental surgery. Am J Dent Sc 1844; 5:3-31.

47. Gunnel JS. A remedy for the painful affection produced from cutting the lower dens sapientia or wisdom tooth, etc. Am J Dent Sc 1844; 4:43-44.

48. Shepherd SM. Alveolar exostosis. Am J Dent Sc 1844; 4:46-47.

49. Lethbridge S. Transactions of the Virginia Society of Surgeon Dentists. Am J Dent Sc 1844; 5: 120-123.

50. Hodgson. Fibrous tumor of the inferior maxilla. Am J Dent Sc 1845; 5:319.

51. Boykin EM. A case of acute inflammation of the sublingual glands. Dent Regist West 1848/49; 2: 97-100.

52. 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.

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

54. Berry A. A partial set of teeth sustained by air chambers instead of clasps. Dent Reg West 1851; 9: 114-116.

55. Parmentier. Essay on tumors in the palatine region. Am J Dent Sc 1857; 7(new series):324-339, 456-465,545-561.

56. Saurel L. Memoirs upon the tumors of the gums, known under the name epulis. Am J Dent Sc 1858; 8(new series):33-43,212-231.

57. 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.

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

59. Roux M. On exostoses: their character. Am J Dent Sc 1848; 9:133-134.

60. Liston. Gum boils--fungous growth of the gums-epulis. Dent Regist West 1848/49; 2:191-195.

61. Blasbury. Horny growth from the head in the human subject. Am J Dent Sc 1849; 9:388.

62. Castle AC. A novel case of aneurism from my notebook. NY Dent News Letter 1850; 3:91-92.

63. Canton. Removal of a tumor embedded in the parotid gland. Am J Dent Sc (new series) 1852; 2:312.

64. [1852, epid cyst (painless abscess)]

65. Gross SD. Observations on excision of the superior maxillary bone: illustrated by seven cases. Am J Dent Sc (new series) 1852; 3:131-151.

66. Giraldes JA. Diseases of the maxillary sinus. Am J Dent Sc 1856; 6(new series):482-497.

67. Rudolfi M. The treatment of salivary fistula. Dent News Letter 1856; 9:125-126.

68. Culter. Glossal papillary tumor. Dent News Letter 1858; 11305-306.

69. Nelatin M. Tumors of the lower jaw. Am J Dent Science 1858; 8 (new series): 325-331. (translated from the French without reference to original article)

70. Guersant. Clinical remarks upon congenital cysts. Dent Cosmos 1860; 1:498-499.

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

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

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

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

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

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

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

78. 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.

79. 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.

80. 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.

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

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

83. Paget J. Cancer following ichthyosis of the tongue. Trans Clin Soc Lond 1870; 3:88.

84. Baillie, Simms, Willan, et al. Queries and responses from The Medical Committee of the Society for Investigating the Nature and Cure of Cancer. Edinburgh Med Surg J 1806; 2:382-389.

85. Hayden HH. On conjoined suppuration of the gums and alveolus. Am J Dent Sc 1841; 2:214-297.

Dr. Bouquot's Publications Relating to the History of Dentistry

1. Bouquot JE, Lense E. The birth of oral pathology: part I, first dental journal reports of benign oral tumors and cysts, 1839-1859. Oral Surg Oral Med Oral Pathol 1992; 74: 599. (abstract)

2. Bouquot J, Whitaker S. The birth of oral Pathology. Part II: Thomas Bond, the true father of oral pathology? Proceedings of annual meeting American Academy of Oral Pathology, Philadelphia, Pennsylvania, 1993. (abstract)

3. 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 Pathol 1994; 78:343-350.

4. Bouquot JE, Lense EC, Whitaker SB. The beginning of oral pathology, Part II: First dental journal reports of nonodontogenic oral tumors and cysts, 1839-1860. (submitted for publication)

5. Bouquot JE, Gundlach KKKH, Morgan P, Monteil RA. The beginning of oral pathology, Part III: Thomas Emerson Bond -- Father of Oral Pathology?

The R. J. Gorlin Registry of Historical Oral Pathology

The R. J. Gorlin Registry of Historical Oral Pathology is a collection of published reports of oral and maxillofacial lesions and diseases published in the dental literature from the first dental journal in 1839 to 1870.  More recent papers are also in the Registry, as are texts and reports of oral diseases in the medical literature.  While much of the Registry is completed, it is not in a finished enough form to place on the web.  If you have a specific request for old references, contact Dr. Bouquot at MFC@aol.com.