Prevalence and severity of periodontal disease in a historical Austrian population.

OBJECTIVE: To assess the prevalence and severity of periodontitis based on different diagnostic methods in a historical Austrian population from the early middle ages. BACKGROUND: The description of the oral health status of archaeological material can provide interesting insights into prevalence, severity, and extent of oral diseases. Herein, the periodontal health status of the skeletal remains of medieval Avars (700-800 AD), which were considered as one of the earliest Avarian settlements in Austria, was investigated. METHODS: The skeletal remains of 128 Avars were examined; age and gender were estimated by standard forensic methods and tooth loss and root caries were recorded. Periodontitis was assessed by (a) measurement of the alveolar bone levels (ABL) and (b) evaluation of the interdental septa. RESULTS: A mean ABL of 4.8 mm was determined, root caries tended to accumulate in teeth with a higher alveolar bone loss, and on average, 6.2 teeth were lost antemortem. Independent of the diagnostic method >90% of the subjects were judged as periodontally diseased, and age and tooth type were significant predictors. However, on the tooth level the presence of periodontitis varied considerably depending on the diagnostic method; that is, 7.6% versus 47.2% of the teeth were judged as healthy based on ABL or interdental septa, respectively. CONCLUSION: The periodontal status of the skeletal remains of medieval Avars revealed a considerable high prevalence of periodontitis (ie, >90% of this population displayed periodontal tissue breakdown). However, the diagnostic method, disease definition, and data presentation should be considered when comparing results of archaeological material.

Dental markers of poverty: Biocultural deliberations on oral health of the poor in mid-nineteenth-century Ireland.

OBJECTIVES: Despite subsisting on a low-cariogenic diet comprising virtually nothing more than potatoes and dairy products, poor oral health affected the quality of life for the poor of nineteenth-century Ireland. This study investigates potential biocultural reasons that may explain why this was the case. MATERIAL AND METHODS: A total of 6,860 teeth and 9,889 alveoli from 363 permanent dentitions from the skeletal remains of impoverished adult Irish males and females who died between 1847 and 1851 in the Kilkenny Union Workhouse were examined for evidence of dental caries, periodontal disease and ante-mortem tooth loss. Caries rates were quantified and assessed by crude prevalence, frequencies, corrected caries rates and a t-health index, and evaluated by sex and age groups. RESULTS: A higher rate of caries was present among 18-25-year-old males than females, while the opposite relationship was evident for older age groups. The prevalence rates of periodontal disease and ante-mortem tooth loss increased with age. When assessed by corrected caries rates, tooth decay is observed at a lower rate compared to contemporaneous lower to upper-class population samples from London. DISCUSSION: Despite being low cariogenic foods, the potato starch and milk lactose of a nineteenth-century Irish laborer's diet would have lowered oral pH-values thereby increasing the risk of bacterial fermentation in dental plaque resulting in caries. Nutritional features alone cannot explain the high rates of dental caries observed in the Kilkenny workhouse population sample, however, and lifestyle factors, particularly habitual clay-pipe smoking, is considered a significant cause of poor oral health.

Unlocking the past: The role of dental analysis in archaeology.

What can the study of ancient teeth tell us about the life style and dietary habits of our ancestors? Dental palaeopathology is particularly important as it can provide direct evidence of the type of diet an individual consumed during life. An analysis of the angle of tooth wear evident on the crown of the tooth can help to distinguish between early hunter-gatherers and later agriculturists, whilst microwear features on the occlusal surface can help to discern subtle dietary shifts. The distributions of stable isotopes in food webs make it possible to use them to reconstruct ancient diets as well as tracing the geographic origins and migrations of peoples. Plant microfossils have been isolated from calculus which can be identified using light microscopy. Teeth are particularly useful in ancient DNA studies due to the excellent preservation of biomaterials within the enamel shell of the tooth.

[Study of remains and dental wastes of a First World War German rest camp]. / Etude des restes et déchets dentaires d'un camp de repos allemand de la première guerre mondiale.

INTRODUCTION: This article presents the analysis of dental remains and waste from the dental office of a German rest camp of the First World War in order to study the living conditions of the soldiers, the care policy and the prosthetic rehabilitation techniques used in this context. MATERIALS AND METHODS: The study included both dental and prosthetic remains, revealed during the excavation. The criteria to determine dental and periodontal health were the presence or absence of caries, wear, tartar and periodontal lesion. Location, severity and frequency of each of these parameters were examined. Regarding the prosthetic remains, the type of prosthesis and the materials used were determined. RESULTS: Three hundred and twenty seven (327) dental remains were analyzed. A high prevalence of large caries, especially in the molar areas, was highlighted. The incisal areas had however more wear and tartar. 183 casts of plaster dental arcade allowed to highlight a significant proportion of posterior edentulous. Prosthetic remains and laboratory waste revealed the use of vulcanite and porcelain for making dentures.

Historical insights in the progression and development of gingivectomy.

During the last three centuries since the identification of periodontal disease, various non-surgical and surgical forms of periodontal therapy have been described and documented in the dental literature. The main objective of periodontal treatment has been initially the removal of "diseased gingiva," either through the implementation of various surgical techniques, or through the application of caustic drugs or pressing patches. Although the differences in the suggested techniques created significant controversies between some of the greatest clinicians and researchers in dentistry, their main goals remained the rehabilitation of the oral cavity and the therapeutic management of the problems sustained from periodontal disease.

Dental disease in a 15th-17th centuries skeletal sample of enslaved Africans (Lagos, Portugal).

OBJECTIVE: Dental disease is frequently used as a proxy for diet and overall health of individuals of past populations. The aim of this study is to investigate dental disease in a sample of enslaved African individuals recovered from an urban dump (15th-17th centuries) in Lagos, Portugal. DESIGN: In all, 81 African individuals (>12 years old) were analysed (19 males, 49 females, and 13 of unknown sex), in a total of 2283 alveoli, 2061 teeth, and 2213 interdental septa. Analysed oral pathologies include dental caries, periodontal disease, and ante-mortem tooth loss. Dental wear was also recorded. RESULTS: Dental caries affected 52.0 % of the teeth, although only 31.9 % were cavitated lesions. In all, 96.3 % of the individuals presented at least one cariogenic lesion. Gingivitis and periodontitis were recorded in 56.7 % and 19.0 % of the septa, respectively. Only one male individual had all septal areas healthy. Ante-mortem tooth loss was recorded in 38.3 % of the individuals, in a total of 96 teeth lost (4.2 %). Regarding occlusal wear, 70.8 % of the surfaces were recorded with grades 1-3. CONCLUSIONS: The frequencies of the oral pathological conditions observed may not only reflect a cariogenic diet (rich in starches and with a high frequency of meals) but also the conditions during the maritime voyage of the first victims of the North Atlantic slave trade (xerostomia due to lack of water, sea sickness and vomiting, vitamin C deficiency, poor hygiene), and also the impact intentional dental modifications had on the dentitions.

Learned and unlearned concepts in periodontal diagnostics: a 50-year perspective.

In the past 50 years, conceptual changes in the field of periodontal diagnostics have paralleled those associated with a better scientific understanding of the full spectrum of processes that affect periodontal health and disease. Fifty years ago, concepts regarding the diagnosis of periodontal diseases followed the classical pathology paradigm. It was believed that the two basic forms of destructive periodontal disease were chronic inflammatory periodontitis and 'periodontosis'- a degenerative condition. In the subsequent 25 years it was shown that periodontosis was an infection. By 1987, major new concepts regarding the diagnosis and pathogenesis of periodontitis included: (i) all cases of untreated gingivitis do not inevitably progress to periodontitis; (ii) progression of untreated periodontitis is often episodic; (iii) some sites with untreated periodontitis do not progress; (iv) a rather small population of specific bacteria ('periodontal pathogens') appear to be the main etiologic agents of chronic inflammatory periodontitis; and (v) tissue damage in periodontitis is primarily caused by inflammatory and immunologic host responses to infecting agents. The concepts that were in place by 1987 are still largely intact in 2012. However, in the decades to come, it is likely that new information on the human microbiome will change our current concepts concerning the prevention, diagnosis and treatment of periodontal diseases.

Periodontal disease epidemiology - learned and unlearned?

The notion of periodontal disease being the major cause of tooth loss among adults was rooted in the focal infection paradigm that dominated the first half of the 20th century. This paradigm was established largely by personal opinions, and it was not until the development of periodontal indices in the mid-1950s that periodontal epidemiology gained momentum. Unfortunately, the indices used suffered from a number of flaws, whereby the interpretation of the research results took the form of circular reasoning. It was under this paradigm that therapeutic and preventive intervention for periodontal diseases became entirely devoted to oral hygiene, as poor oral hygiene and older age were understood to explain nearly all the variation in disease occurrence. In the early 1980s, studies appeared that contradicted the concepts of poor oral hygiene as the inevitable trigger of periodontitis and of linear and ubiquitous periodontitis progression, whereby periodontal epidemiology was led into a relatively short-lived high-risk era. At this time, it became evident that old scourges continue to haunt periodontology: the inability to agree in operational clinical criteria for a periodontitis diagnosis and the inability to devise both a meaningful and a useful classification of periodontal diseases based on nominalist principles. The meager outcome of the high-risk era led researchers to resurrect the focal infection paradigm, which is now dressed up as periodontal medicine. Unfortunately, these developments have left the core of periodontology somewhat disheveled and deserted.

Sex differences in periodontal disease in catastrophic and attritional assemblages from medieval London.

Periodontal disease is one of the most common chronic diseases in living populations, and most studies that have examined sex differences in periodontal disease have found higher frequencies in men compared to women. This study examines sex differences in periodontal disease in two cemeteries from medieval London: the East Smithfield cemetery (c. 1349-1350), an exclusively Black Death cemetery that represents catastrophic mortality (n = 161), and the St. Mary Graces cemetery (c. 1350-1538), a post-Black Death attritional assemblage that represents normal medieval mortality (n = 100). The results reveal a significantly higher frequency of periodontal disease, independent of age, among males compared with females in St. Mary Graces, but no significant difference between the sexes in East Smithfield. The sex differences in the attritional assemblage might reflect heightened susceptibility to periodontal disease in the living population or sex differences in frailty. The differences in the sex patterns of periodontal disease between the two cemeteries might be the result of disproportionately negative effects of the Great Bovine Pestilence and consequent decreases in dairy availability on female oral health among victims of the Black Death.

Periodontal disease in a Portuguese identified skeletal sample from the late nineteenth and early twentieth centuries.

Periodontal status was investigated in 600 adult dentitions belonging to the identified osteological collections curated at the University of Coimbra, Portugal. These collections date to a point temporally intermediate between the large epidemiological studies of the 20th century and archaeological collections that antedate the 19th century. The aim of this study is to compare periodontal data derived from contemporary samples with statistics compiled from epidemiological studies to determine if factors such as age-at-death, sex, and tooth type are essential or not to account for in future archaeological studies of periodontitis. Periodontal disease status was assessed based on the textural and architectural variations of the interdental septum and the extent of bone loss. Overall, the frequency of periodontitis within the Coimbra collections is 73.8%. Men were more susceptible to periodontal disease than women. Gingivitis was widespread in the younger age groups. Destructive periodontitis was observed early in adulthood, rising steadily with age. The most susceptible sites to periodontal breakdown were located in the posterior region of the upper jaw. Some variation in reported frequencies of periodontitis was found in epidemiological reports, which might result from variation in methods for identifying the pathology, differences in the age composition of the samples examined, variation in oral hygiene and/or diet, or some other factors. Regarding the pattern of distribution of periodontal disease, Coimbra results were similar to comparable modern epidemiological surveys, making clear the importance of considering sex, age, and oral distribution of periodontitis in future archaeological studies.

The association between periodontal disease and periosteal lesions in the St. Mary Graces cemetery, London, England A.D. 1350-1538.

Numerous studies have demonstrated significant associations between periodontal disease and many other diseases in living populations, and some studies have shown that individuals with periodontal disease are at elevated risks of mortality. Recent analysis of a medieval skeletal sample from London has also shown that periodontal disease was associated with increased risks of mortality in the past. This study examines whether periodontal disease is associated with periosteal lesions in a skeletal sample from the urban St. Mary Graces cemetery (n = 265) from medieval London. The results reveal a significant association between periodontal disease and periosteal lesions in the St. Mary Graces sample (i.e., individuals with periodontal disease were also likely to have periosteal lesions), and the association between the two is independent of age. The association between the two pathological conditions might reflect underlying reduced immune competence and thus heightened susceptibility to pathogens that cause periodontal disease or periosteal lesions, exposure to an environmental factor, or underlying heightened inflammatory responses.

A chronological classification of periodontal disease: a review.

The subject of classification may be considered to be dull by some people, even contentious by others, but it does afford us a means to an end. The evolution of the history allows us to see how our predecessors thought and how periodontal disease has extended itself as an important entity into many aspects of the medical field. A good classification system allows us to understand the complexity of the disease that we are attempting to treat. This is a subject that Drs. I Glickman, I Weinmann, B Orban and the 1987 and 1999 American Academy of Periodontology have tried to teach. This paper presents a review of both historical and modern classification systems for periodontal disease.

Aggressive periodontitis: the historic quest for understanding.

Aggressive periodontitis has had many names as well as theories behind its etiology. The current paper looks to investigate this history and show the evolution of both nomenclature and understanding. Going beyond academic debates, emerging trends and conventions are also examined and placed into a clinical perspective. The aim of the paper is to recognize the origins of the elusive disease in order to form a concrete understanding of this multifactorial phenomenon.

Oral health and frailty in the medieval English cemetery of St Mary Graces.

The analysis of oral pathologies is routinely a part of bioarcheological and paleopathological investigations. Oral health, while certainly interesting by itself, is also potentially informative about general or systemic health. Numerous studies within modern populations have shown associations between oral pathologies and other diseases, such as cardiovascular disease, certain types of cancer, and pulmonary infections. This article addresses the question of how oral health was associated with general health in past populations by examining the relationship between two oral pathologies (periodontal disease and dental caries) and the risk of mortality in a cemetery sample from medieval England. The effects of periodontitis and dental caries on risk of death were assessed using a sample of 190 individuals from the St Mary Graces cemetery, London, dating to approximately AD 1350-1538. The results suggest that the oral pathologies are associated with elevated risks of mortality in the St Mary Graces cemetery such that individuals with periodontitis and dental caries were more likely to die than their peers without such pathologies. The results shown here suggest that these oral pathologies can be used as informative indicators of general health in past populations.

Investigating the demographic history of Japan using ancient oral microbiota.

While microbial communities in the human body (microbiota) are now commonly associated with health and disease in industrialised populations, we know very little about how these communities co-evolved and changed with humans throughout history and deep prehistory. We can now examine these communities by sequencing ancient DNA preserved within calcified dental plaque (calculus), providing insights into the origins of disease and their links to human history. Here, we examine ancient DNA preserved within dental calculus samples and their associations with two major cultural periods in Japan: the Jomon period hunter-gatherers approximately 3000 years before present (BP) and the Edo period agriculturalists 400-150 BP. We investigate how human oral microbiomes have changed in Japan through time and explore the presence of microorganisms associated with oral diseases (e.g. periodontal disease, dental caries) in ancient Japanese populations. Finally, we explore oral microbial strain diversity and its potential links to ancient demography in ancient Japan by performing phylogenomic analysis of a widely conserved oral species-Anaerolineaceae oral taxon 439. This research represents, to our knowledge, the first study of ancient oral microbiomes from Japan and demonstrates that the analysis of ancient dental calculus can provide key information about the origin of non-infectious disease and its deep roots with human demography. This article is part of the theme issue 'Insights into health and disease from ancient biomolecules'.

Prevalence of oral pathologic findings in an ancient pre-Columbian archeological site in the Atacama Desert.

OBJECTIVE: To determine the prevalence of oral pathologic findings in an ancient culture that inhabited the Atacama Desert. MATERIALS AND METHODS: A systematic examination was performed on the remains of 83 individuals unearthed from a prehistoric burial ground. A total of 57 skeletal remains achieved appropriate inclusion criteria, from which estimated age at death, gender, ante- and postmortem tooth loss, prevalence and location of caries, apical periodontitis sequela, alveolar bone resorption and attrition were recorded. RESULTS: From the analyzed skeletal remains (13 male, 22 female and 22 not identifiable), the mean age estimated was 29.9 +/- 13.8 years. A total of 89.4% of them presented permanent dentition with a mean ante-mortem tooth loss of 9.0 teeth and a postmortem mean tooth loss of 14.4 teeth per subject. In all, 46.4% of the postmortem remaining permanent teeth (n = 237) showed caries lesions. Interproximal caries was most frequently observed (31.5%), followed by occlusal (25.9%) and cervical caries (19.4%). Root remnants were found in 23.1% of the cases. In addition, 58.0% of the adults presented attrition, 26.0% signs of apical periodontitis and 44.0% loss of alveolar bone support >5 mm. CONCLUSION: The remains of jaws and teeth of the individuals examined in this study presented sequelae of severe oral health damage due to caries and periodontal disease.