History of the Department of Oral Pathology

[From the 1958-1959 Hya Yaka/Yearbook]

Oral Pathology

In olden times the subject covered the limited field of diseases of the teeth themselves and their immediate surrounding tissues—a scope more properly defined under the term dental pathology. Oral pathology has, for a long time, been a step-child in the dental curriculum, in not having a direct clinical counterpart. It has been customary to divide and leave its teaching to various clinical departments. This quite naturally resulted in omissions and inconsistencies. However, appreciation of the role of pathology in its true relationship to cinical practice has been recognized for many years by discerning and farsighted man, and the following quotation from the great German pathologist Julius Cohnheim, writing in 1889 is as timely today as it was seventy years ago.

"Pathology is, on the one hand, as it treats of symptoms, an application of morbid physiology, and, ont he other its hows how in the different diseases the varius [sic] derangements of physiological function of the individual mechanisms are combined ... it is precisely the pursuit of morbidy physiology which forms the best preparation for, and introduction to, clinical study; you will thus be enabled to understand very much which would otherwise be simply retained by memory."

For the past hundred years the emphasis in the practice of dentistry has been on the overwhelming backlog or restorative work. Much of this has involved problems of treatment planning more than diagnosis, but the undertaking of treatment presupposes a knowledge of the diseased state and the practitioner to know the sequence of events in a disease if he is to discharge his professional duties properly. Without this background, practice becomes no more than empiricism.

The tide has turned, however, in the last few years from emphasis on the restorative aspects towards a programme of preventive treatment in an attempt to intercept dental diseases, and, at the same time, broaden our interest and responsibility beyond the narrow confines of the dental tissues only. If we are to accept this wider field of responsibility, as the present trend would indicate, then we must have a knowledge of the aetiology and pathogenesis of the diseases to be foudn therein. This is tantamount to saying that we must have a working knowledge of pathology, because the two prime objectives of the science of pathology are just these two very points—the cause and progression of all diseases.

Pathology is a study that does not employ any disciplines peculiar to its own field, but utilizes those of the chemist, the anatomist, the bacteriologist, the physiologist, pharmacologist and geneticist. It is a blend of these basic sciences used to fulfill its above stated objectives.

The differences between a qualified dentist and a dental technician hinges largely on a knowledge of pathology for it determines the dentist's ability to make a diagnosis, state the prognosis and plan rational treatment. This is not to say that pathology has been ignored entirely. Interest in the diseases of the orofacial region goes back a long way, in fact, one of the first text-books on dental pathology was John Hunter's "Natural History of the Human Teeth," written in 1778. The quotation from Sir William Osler, used in the title, is further emphasis of pathology's importance. This, coming from one fo the greatest diagnosticians of all times, surely establishes its rightful position in the teaching curriculum. The principles of general pathology have shared a place in the undergraduate training programme for many years in our faculty, but the recognition of oral pathology as an integral part of a comprehensive teaching schedule for students of dentistry came into being a little more than ten years ago. This has been a logical and inevitable step in the endless transition from empiricisim to rational treatment.

In the past, the time devoted to problems of diagnosis occupied a very small proportion of a dentist's chairside time, since he was wholely occupied with restorative tasks demanding his immediate attention.

What of the future? For the past hundred years dentistry's main effort to cope with clinical problems has been emphasized through the restorative approach. This has been accomplished much, both in the volume of work done as well as the perfection of precise and intricate techniques. Nevertheless, these years have shown us that we are not gaining on the backlog of existing dental diseases. It is from a realization of this that we have recently turned our thoughts towards a concept of prevention as a more effective way to exercise control over disease. Surely, as soon as effective controls are put into action, the dentist's time will be spent, less on restoration, and more and more on problems of further preventive measures, public education and early interception of diseases. This will be the era of diagnosis, whose handmaiden is pathology.

[Dr. H. A. Hunter]