Since ancient times, the pearl has been a symbol of unblemished perfection. It is the oldest known gem, and for centuries it was considered the most valuable. A fragment of the oldest known pearl jewelry, found in the sarcophagus of a Persian princess who died in 520 BC, is displayed in the Louvre in Paris. To the ancients, pearls were a symbol of the moon and had magical powers. In classical Rome, only persons above a certain rank were allowed to wear pearl jewelry. The Latin word for pearl literally means "unique", attesting to the fact that no two pearls are identical.

Pearls have been considered ideal wedding gifts because they symbolize purity and innocence. In the Hindu religion, the presentation of an undrilled pearl and its piercing has formed part of the marriage ceremony.

In the romance languages (Spanish, French, Italian), margarita means pearl. The word pearl appeared in the English language in the fourteenth century. In the thirteenth and fourteenth centuries, pearls were very fashionable in Europe as personal ornaments. The clothing of both men and women were embroidered with them.

In the Americas, both the Incas and Aztecs prized pearls for their beauty and magical powers. Spanish explorers of the New World found the natives in possession of rich pearl fisheries. For many years, the New World was best known in European cities like Seville and Cadiz as the land where pearls came from.

Most European countries in the thirteenth and fourteenth centuries had laws regarding who could and could not wear pearls. Teachers and lawyers, for example, could not wear fringes or chains with pearls.

Native Americans of the Atlantic Coastal areas and the Mississippi River Basin were the first to collect and use U.S. freshwater mussel pearls and shells. Pearl pendants and ear pendants were worn by both sexes and both pearl and shell were used for decorative purposes on articles of clothing. Some of the tribes used pearls as tributes, reportedly Powhattan (Pocahontas' father) had large stores of pearls received as tribute. Additionally, armlets, pendants, and gaming pieces were made from mussel shell.