The Natural History of Periodontitis. Photo: C.R. Ramseier, under fair use
In 1970, four-hundred-and-eighty male employees of tea plantations in Sri Lanka had been examined for the first time by western periodontists in order to start a longitudinal study of the natural history of periodontitis. It was assumed that the cohort, who supposedly lived their entire life on the plantation, had been unaffected by any treatment of periodontitis and professionally recommended or supervised oral hygiene practices.
Several papers had been published already by the mid 1980s. The study went on, and after lots of turmoil and civil war in Sri Lanka, even the tsunami of 2004, an attempt was made in 2010 to contact all participants of 1970 (Ramseier et al. 2017). Seventy-five were still available.
Ramseier et al. (2017) emphasize, in the introduction to their paper that,
[h]ypothetically, studies following subjects over a number of decades may give better insight into undisturbed disease progression, particularly between subjects showing different disease susceptibility. In this context, the untreated Sri Lankan tea labourers provided a unique opportunity to further study periodontal disease progression in humans unaffected by professional or individual oral care. (Emphasis added.)
Hypothetically. In reality, it’s unethical (see below). At least, after new insights into the disease progression had been gained in 1986, participants (human beings after all) should have been offered thorough information about causal agents (then, without doubt, well-known), preventive measures (well established) and, yes, proper treatment.
It is reported that the study by Ramseier et al. (2017) was approved by the local dental school (apparently none of its administration qualified as co-author) and the Institutional Review Board of the University of Hong Kong SAR [sic]. No governmental ethical committee was consulted. As regards the participants (who were between 55 and 70 years of age when re-examined; note that Sri Lankans had, in 2010, a mean life expectancy of 77.9 years at birth), they were, in 2010,
informed in their native language (Tamil) by a medical doctor about the details of the study. They then gave consent by finger printing due to illiteracy.
In 2010, authors report that, fortunately,
[a]ccording to the Medical officer and the administration of the Estates [Dunsinane, Harrow and Sheen in Pundaloya], the subjects’ diet improved over the period of 40 years, and the salaries of the subjects increased continuously. Yet, the older generation analysed in this study did not communicate with the outside world and the majority remained illiterate.
On the other hand, subject interviews confirmed
persistent lack of professional preventive oral health care or cleaning devices other than occasional use of bare fingers and ashes.