ENDODONTIC HISTORICAL PERSPECTIVE This # the fi~st of a three-part series. Part 2 of this Historical Perspective will appear in next month's Journal. A historic review of endodontics, 1689-1963, part 1 William P. Cruse, DDS, and R. Bellizzi, DDS This review is not intended to add to icant accomplishments since 1963, way into the tooth structure from our technical repertoire but rather to but we have delegated to others the contaminated food, if, in fact, they aid in our current understanding of assignment of recognizing the con- did exist). endodontics. How can we appraise a temporary leaders in endodontia. In 1700, in a letter to the Royal new development or evaluate vol- Society of London, Anton von Leeu- umes of contemporary literature wenhoek, the "father of modern without placing them in their proper The Empirical era (1687-1805) microscopy," identified what he be- perspective? By reviewing and un- lieved was the source of such contam- derstanding the accomplishments of Charles Allen is credited with writ- ination: worm-infested cheese. 2 His our predecessors, perhaps we can ing the first book in English devoted findings did much to quash the expand our future development. exclusively to dentistry. Although "tooth worm" theory. The objective of this paper is to endodontics as we know it tody was In 1728, Pierre Fauchard, the review the written history of develop- not practiced at that time, Allen "founder of modern dentistry," ments in endodontic practice in discussed procedures for transplant- wrote The Surgeon Dentist. This book chronological order. We have chosen ing teeth in his third edition, pub- provided accurate descriptions of to begin our review with the year lished in 1687. However, he did not pulp cavities and root canals of Vari- 1687, when Charles Allen described record the pulpal procedure per- ous teeth. In it Fauchard described procedures for transplanting teeth in formed when "taking out the rotten the practice of opening teeth to the first English-language book de- teeth or stumps and putting in their relieve abscesses and to evacuate pus. voted entirely to dentistry. Although places some sound ones drawn imme- After leaving the tooth open for a some authors have cited accomplish- diately out of some poor body's period of two to three months he ments made in endodontics from head. ''1 filled the pulp chamber with lead ancients times, understanding these The "tooth worm" theory per- foil. Although he did not mention in light of the field of endodontics we sisted through the ages since Baby- root canal therapy, he described a know and practice today is some- lonian times. The tooth worm was pulp extirpation procedure using a times difficult. thought to reside in the hollow por- small pin. Fauchard also described This paper is not intended io tion of a tooth, where it would cause his treatment for deep carious review the recent history of endodon- a toothache by gnawing at the struc- lesions: application of the oil of ties. We have purposely ended the ture of the tooth. Even Pierre Fau- cloves or cinnamon to the affected chronology with the year in which chard would not publicly deny its area for several weeks. For a persis- endodontics achieved recognition as existence (although he said that the tent toothache, he mixed opium with a special area in dentistry. We do not tooth worms were not spontaneously the oiP (Neaverth, E.J., unpublished imply that there have been no signif- generated and must have found their material). 495 JOURNAL OF ENDODONTICS VO/6, NO 3, MARCH 19~ In 1756, Phillip Pfaff, the German oil, frequently gives relief, and if innovator for his time as he stressed dentist to Frederick the Great, first repeated for sometime, often destroys the importance of preserving natural mentioned a pulp-capping proce- the nerve." He also used repeated teeth.~l dure. He simply cut out a piece of applications of crude opium and John Callow, London, in his Opin- gold or lead to approximate the camphor to cauterize the nerve. 7 ions on the Causes and Effects of Diseases opening over the pulp and placed By the end of the 18th century, in the Teeth and Gums, published in this over the exposure so that the Frederick Hirsch, a noted German 1819, credited Charles Bew with de- surface nearest the PUlP was concave. practitioner, wrote of diagnosing scribing the flow of blood into the This prevented the metal from con- occult dental diseases by tapping the pulp through the apical foramen and tacting the exposed nerve. The tech- suspected teeth. He found that the out through the dentinal wall and nique was probably an improvement diseased tooth elicited pain on per- periodontal membrane. This placed over Fauchard's method of filling the cussion. The treatment he recom- Bew along others of his time who cavity directly over the exposure.' mended was perforation of the tooth subscribed to the "vitalistic theory" Bourdet, the dentist to Louis XV at its neck followed by repeated of teeth. ~ Of France, in 1757 described a proce- insertion of a red-hot probe. He con- A young German immigrant, born dure for extracting carious teeth, fill- sidered the tooth cured after the in 1785, came to this country and ing the root canals with gold or lead, cavity was filled with lead? failed in his efforts to become a and replanting them. He also salesman. In 1807, with little or no described an "intentional" endodon= The Vitalistic era (1806-1878) formal background in dentistry, he tic treatment in which he dislocated opened a Philadelphia dental office. a symptomatic tooth in order to sever In 1805, J. B. Gariot became one Eleazar Parmly, the founder and co- the nerve, and then immediately of the first to recognize the problem editor of the first dental journal, placed it back in its socket? This of vitality in connection with pulp described the young man's first practice had been described treatment, in Traitk des Maladies de la extraction this way: "He grasped the hundreds of years earlier by the Ara- Bouche, he declared that destruction tooth with an instrument, shut his bian physician Avicenna? of the pulp does not destroy the eyes, and turning his head from the The first recorded description of vitality of the tooth. 8 patient, made a strong effort which an endodontic procedure in this Although Bourdet has been cred- dislodged the tooth." This was an country has been attributed to ited by some as the first to have used inauspicious beginning for Leonard Robert Woofendate, who came to an impervious root canal filling, the Koecker, who became a successful New York from England in 1766. He specimen he used was probably a dentist and wrote Principles of Dental brought with him a method of alle- displaced tooth that he reimplanted Surgery in 1826, an excellent text that viating pain by cauterizing the pulp or transplanted. Therefore, the roots became a standard work for 50 with a hot instrument. He concluded were probably not "in situ" while years.1 the treatment by stuffing cotton in being filled? -~ Koecker believed that, when a the open canals? ~ In 1802, B. T. Longbothom, pulp was destroyed by disease or by (Of course, the Greeks and Ro- Charleston, SC, recommended filling artificial means, the whole dentinal mans had used cautery earlier. In the roots of teeth when it was core of the tooth immediately died. addition to hot instruments, they deemed inadvisable to extract them? The tooth then became a foreign also used boiling oil, herbs, opium, However, Edward Hudson, an Irish- body, which necessitated extraction and arsenic to desiccate the dental man practicing in Philadelphia, is to.prevent inflammation and subse- pulp)? generally given credit for having quent suppuration and death of the In his publication Practical Observa- been the first to place fillings in root vital tissues around it. tions on the Human Teeth, Robert Woo- canals in 1809. He packed the canals In an effort to avoid loss of the fendale described his method for with gold foil, using instruments of tooth, Koecker popularized the pulp treating a nerve exposure. "When his own design? 1~ Hudson was an capping procedure. Athough he is the nerve is exposed, a small bit of exceedingly thorough and successful sometimes given credit for introduc- lint, dipped in the oil of cinnamon, clinician in his use of gold as a ing and even for inventing the cap- cloves, turpentine, or any chemical restorative material. 7 He was an ping operation, it was essentially the 496 JOURNAL OF ENDODONTICS VOL 6, NO 3, MARCH 1980 ~me treatment that Pfaff described ic pulp was cauterized with a hot canals2 .13 However, he became most in 1756- 7~ Koecker believed that liv- instrument, or corrosive acids such as famous for the Maynard Rifle, which hag tissue could not remain healthy sulfuric or nitric were used to destroy he designed and which was used by mad viable beside dead tissue. the pulpal tissue. Then, Shearjashub armies all over the world (Milas, Although not all of his successors Spooner, New York, used a proto- V.B., personal communication, Oct, subscribed to this principle, it domi- plasmic poison (arsenic trioxide) to 1974). nated pulp treatment procedures for devitalize the pulp before removing In 1839, Baker wrote in the Ameri- over 50 years, s it 5 (Neaverth, E.J., unpublished ma- can Journal of Dental Science that his Although the "vitalistic" or "dou- terial). Spooner was not the first to treatment for an exposed nerve was ble membrane" theory dates to the use arsenic, however, as the practice to remove the nerve, clean the canal, beginning of the 19th century, it was dates back to the ancient Chinese and fill the canal with gold foil.