Insights into medieval rural lives: A paleo-odontological investigation of two central European communities.

OBJECTIVE: Oral status is an important indicator of past lifestyles. Determining the presence and extent of oral pathologies helps reconstruct average oral health, paramasticatory activities and diet of ancient and historical populations. DESIGN: In this study, the dental remains from the early medieval cemetery of Früebergstrasse in Baar (Canton of Zug, Switzerland) and the high medieval Dalheim cemetery (North Rhine-Westphalia, Germany) were analyzed. Caries, periodontal condition, periapical lesions, antemortem tooth loss, and enamel hypoplasia were assessed in 654 teeth (993 observable loci) from 68 individuals (Baar: n = 36; Dalheim: n = 32). RESULTS: The oral status of both populations was affected by age with higher values of tooth wear in advanced age individuals. High tooth wear values in both populations point towards the consumption of abrasive foods. Pronounced anterior tooth wear in Baar may also be due to non-masticatory tooth usage. Finally, possible nutritional deficiencies were hypothesized for the Baar population. A higher caries prevalence was observed in the Baar group, probably due to differences in carbohydrate intake. The oral conditions observed in the two studied populations exhibited several analogies, suggesting comparable lifestyles despite their separation in space and time. The only differences observed are related to the use of teeth as "tools" and are thus determined by behavioral choices rather than diverse socioeconomic factors. CONCLUSIONS: Using multiple dental parameters to examine the oral health of premodern individuals can provide useful insights into the interactions between humans and their environment, from dietary patterns to paramasticatory activities.

Temporal pattern of dental caries at the western flank of the Central Plateau of Iran, c. 2700 BCE - 1600 CE.

OBJECTIVE: To analyze the overall frequency and inter-tooth patterns of caries in three populations from ancient cemeteries located along the western border of the Central Iranian Plateau as a means to explore whether the populations of Iran had greater access to fermentable sugars after the establishment of the great empires. MATERIALS: Dental collections from Kafarved-Varzaneh (Early Bronze Age, MNI=66), Estark-Joshaqan (Iron Age, MNI=57), Tappeh Poustchi (Timurid and Safavid Period, MNI=34), together with comparative data from NE Syria. METHODS: Frequencies of dental caries per tooth categories, location and size of carious lesions are analyzed using Smith's Mean Measure of Divergence, Correspondence Analysis, χ2 and Kruskal-Wallis tests. RESULTS: There are minimal differences in overall frequencies of carious lesions at Iranian sites, regardless of the chronology, but notable differences at Syrian sites. The inter-tooth pattern at the Iron Age cemetery in Estark appears distinctly different than the other Iranian sites and the comparative samples from Syria. CONCLUSIONS: Divergent subsistence strategies may be linked with different inter-tooth patterns since people buried at Estark were mobile herders, while the other cemeteries were used by settled farmers. SIGNIFICANCE: This comprehensive research on dental caries in three chronologically diverse populations in Iran sheds light on the association between dental caries and subsistence strategies, and introduces the Smith's Mean Measure of Divergence to explore inter-tooth carious patterns, which may prove useful to other researchers seeking to understand the relationships between subsistence, diet, and the presence of carious lesions. LIMITATIONS: The studied sample size is relatively small and therefore its temporal/regional distribution produces low-resolution results. SUGGESTIONS FOR FURTHER RESEARCH: More systematic research on the patterns of dental caries is necessary to produce more fine-grained reconstructions of diet and subsistence in Iran and around the globe.

High frequency of dental caries and calculus in dentitions from a British medieval town.

OBJECTIVE: Dental pathology and tooth wear data can offer valuable insights into the diet and behaviour of past populations. This study aimed to investigate the presence of dietary continuity by examining different types of dental pathology and tooth wear in a medieval sample from the United Kingdom, comparing them to earlier and later samples from the same location. DESIGN: A comprehensive examination was conducted on 41 individuals (comprising 914 permanent teeth) retrieved from the medieval cemetery of St. Owens Church in Southgate Street, Gloucester, UK. The research focused on documenting and analysing various types of dental pathology and tooth wear, such as dental caries, calculus, and tooth chipping. The frequency of these specific pathologies and wear patterns was then compared to existing literature. Additionally, non-masticatory tooth wear was also evaluated as part of the study. RESULTS: The sample exhibits high levels of carious lesions and calculus (24 % and 74 % of teeth respectively). Anterior teeth also show an elevated chipping frequency, and along with occlusal notches on the maxillary central incisors suggest teeth were regularly used for non-masticatory purposes. CONCLUSIONS: Caries frequency is similar to sites from later periods and may relate to the early adoption of consuming refined carbohydrates. However, remains from the same area, but the earlier Roman period, also shows high rates of caries and calculus, suggesting a continuation of consuming certain cariogenic foods, or certain behavioural/environmental factors, may instead be responsible for these pathology and wear patterns.

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'.

Metagenomics of the modern and historical human oral microbiome with phylogenetic studies on Streptococcus mutans and Streptococcus sobrinus.

We have recently developed bioinformatic tools to accurately assign metagenomic sequence reads to microbial taxa: SPARSE for probabilistic, taxonomic classification of sequence reads; EToKi for assembling and polishing genomes from short-read sequences; and GrapeTree, a graphic visualizer of genetic distances between large numbers of genomes. Together, these methods support comparative analyses of genomes from ancient skeletons and modern humans. Here, we illustrate these capabilities with 784 samples from historical dental calculus, modern saliva and modern dental plaque. The analyses revealed 1591 microbial species within the oral microbiome. We anticipated that the oral complexes of Socransky et al., which were defined in 1998, would predominate among taxa whose frequencies differed by source. However, although some species discriminated between sources, we could not confirm the existence of the complexes. The results also illustrate further functionality of our pipelines with two species that are associated with dental caries, Streptococcus mutans and Streptococcus sobrinus. They were rare in historical dental calculus but common in modern plaque, and even more common in saliva. Reconstructed draft genomes of these two species from metagenomic samples in which they were abundant were combined with modern public genomes to provide a detailed overview of their core genomic diversity. This article is part of the theme issue 'Insights into health and disease from ancient biomolecules'.

Oral pathological conditions of an Early Epipaleolithic human from Southwest Asia: Ohalo II H2 as a probable case of intentional dental ablation.

OBJECTIVE: To describe the oral pathological conditions of Ohalo II H2, an Early Epipaleolithic human from southwest Asia. MATERIALS: The dentognathic skeleton of Ohalo II H2 and relevant comparative data from similar chronological and/or geographic contexts. METHODS: Gross and x-ray observations of oral pathological conditions and occlusal wear were made following published protocols. A differential diagnosis of antemortem tooth loss is provided. RESULTS: Ohalo 2 has two carious lesions on the right M3, pulpal exposure of left M1, and mild to moderate anterior alveolar bone loss. The right I1 was lost antemortem, and there is probably agenesis of the left M3. CONCLUSIONS: The pathological conditions noted are not exceptional for a Late Upper Paleolithic forager. However, the antemortem missing right I1 is most parsimoniously explained by intentional dental ablation. SIGNIFICANCE: Ohalo 2 could represent the oldest example of dental ablation from the Late Pleistocene circum-Mediterranean world - predating the earliest examples from both North Africa and southwest Asia by several thousand years. The similarity of the Ohalo 2 ablation pattern with later Natufians provides further evidence of potential long-term behavioral trends related to the embodiment of social identities through international body modification within the Epipaleolithic of southwest Asia. LIMITATIONS: The pre-Natufian (∼23,000-14,500 cal BP) human fossil record is relatively sparse, making comparisons with the Natufian (∼14,500-11,500 cal BP) phases of the Epipaleolithic difficult. SUGGESTIONS FOR FURTHER RESEARCH: Documentation of oral pathological conditions for other pre-Natufian fossils would provide greater resolution of the temporospatial patterning of oral health and embodied social identities during the Epipaleolithic of southwest Asia.

Comparison of dental caries in Croats from the early medieval period and the 20th century.

OBJECTIVE: To compare dental caries frequency in the Croatian population exhumed from two archeological periods and compare two methods: International Caries Detection and Assessment System (ICDAS) and DMFT (Decayed-Missing-Filled-Tooth) index. MATERIALS AND METHODS: The study included 279 teeth from 69 human remains: Set I of 30 remains and 126 teeth dated from 9th to10th centuries A.D. and Set II of 39 remains and 153 teeth from the recent 20th century. Methods used for caries prevalence were ICDAS and DMFT. Tooth wear was recorded according to the Brabant index. RESULTS: ICDAS scoring system showed significantly higher caries frequency in Set I of 64.34% and in Set II 59.47%, compared to DMFT method with 16.52% for Set I and 28.75% for Set II. Dental wear in Set I showed 73.91% and in Set II 73.15%, so no significant difference was observed. CONCLUSIONS: Depending on the ICDAS or DMFT method used for caries detection, different results have been obtained whereby the ICDAS system has a more precise and advanced approach for caries lesions.

Root caries on a Paranthropus robustus third molar from Drimolen.

OBJECTIVES: Dental caries is often perceived as a modern human disease. However, their presence is documented in many early human groups, various nonhuman primates and, increasingly, our hominin ancestors and relatives. In this study, we describe an antemortem lesion on the root of a Paranthropus robustus third molar from Drimolen, South Africa, which likely represents another example of caries in fossil hominins. MATERIALS AND METHODS: The molar, DNH 40, is dated to 2.0-1.5 Ma and displays a lesion on the mesial root surface, extending from the cementoenamel junction 3 mm down toward the apex. The position and severity of the lesion was macroscopically recorded and micro-CT scanned to determine the extent of dentine involvement. RESULTS: A differential diagnosis indicates root caries, as the lesion is indistinguishable from clinical examples. Although necrotic in appearance, external tertiary dentine is evident on a micro CT scan. Gingival recession and/or continuous eruption of the tooth as a result of extensive occlusal wear would have occurred to facilitate caries formation. Therefore, the lesion is likely linked to relative old age of this individual. DISCUSSION: This new example increases the total number of carious lesions described in P. robustus teeth to 10, on occlusal, interproximal, and now, root surfaces. Beyond the consumption of caries-causing food, caries formation would have also required the presence of requisite intraoral cariogenic bacteria in this individual and the species. Of interest, the presence of tertiary dentine on the outward surface suggests the DNH 40 lesion may have been arrested, that is, no longer active, perhaps relating to a change in diet or oral microbiome just prior to the individual's death.

Diet variability among pre-Dogon and early Dogon populations (Mali) from stable isotopes and dental diseases.

AIMS AND OBJECTIVES: This article reports on diet variability in the Dogon Country (Mali) through a bio-archeological study of pre-Dogon and early Dogon human remains (7th century to 19th century AD) from collective burial caves in the Bandiagara Escarpment. MATERIALS AND METHODS: Two hundred and twenty crania from collections curated in Leiden, Paris, and Bamako were studied for dental diseases. In a subset of teeth (n = 175), δ13 C and δ15 N were measured in bulk dentine samples. RESULTS: δ13 C and δ15 N values vary widely (-15.4 to -6.0‰ for δ13 C, 6.0-14.8‰ for δ15 N, n = 175), and indicate diets dominated by C4 -based foods with a focus on plants; animal products played a minor role. There are significant differences between the δ13 C values from older (pre-Dogon) and younger (Dogon) periods. Frequencies of caries, antemortem tooth loss, and abscesses increase significantly through time. Individuals from northern caves have more positive δ13 C and δ15 N values than southern ones. DISCUSSION AND CONCLUSIONS: The temporal shifts are probably due to progressive diversification of foods, consistent with archeological evidence showing the addition of rice and vegetables to pearl millet. The geographical disparity is explained by a combination of climatic, environmental, and cultural factors. Last, intersite differences imply that different communities (or subsections thereof) disposed of their dead in different caves. Based on a large sample extending over a wider area and longer time frame than previous work, our study shows that diets in the Dogon Country were neither uniform nor continuous through time, as previously proposed. Our results attest to a complex history of settlement and foodways.

Prevalence of dental paleopathology in a peruvian pre-hispanic population / Prevalencia de paleopatologías dentales en una población prehispánica peruana

Objective: To determine the prevalence of dental paleopathologies in a Peruvian prehispanic population. Material and Method: A descriptive, observational and transversal study was carried out. The sample consisted of 106 skeletal remains of pre-hispanic inhabitants, over 18 years of age, found in the El Brujo - Magdalena de Cao Archaeological Complex, Lambayeque - Peru. The selection criteria were defined and the presence of dental caries, malocclusion, crowding, dental anomalies of direction and site, age and sex of each bone was assessed using a data collection instrument designed for that purpose. Results: The sample showed presence of dentin caries (62.3%), enamel caries (37.7%), Class I malocclusion (76.4%), Class II malocclusion (4.7%), Class III malocclusion (4.7%), maxillary crowding (15.1%), mandibular crowding (19.8%), crowding in both jaws (13.2%), gyroversion (20.8%), vestibule-versions (15.1%), linguo-versions (17.9%) and dental transposition (5.7%). Conclusion: The results show a high prevalence of caries and malocclusions in this Peruvian pre-hispanic population.

Objetivo: Determinar la prevalencia de paleopatologías dentales en una población prehispánica peruana. Material y Método: Se realizó un estudio descriptivo, observacional y transversal cuya muestra estuvo conformada por 106 restos óseos de habitantes prehispánicos, mayores de 18 años, hallados en el Complejo Arqueológico El Brujo ­ Magdalena de Cao, Lambayeque ­ Perú. Se definieron los criterios de selección y se evaluó la presencia de caries dental, maloclusión, apiñamiento, anomalías de dirección, anomalías de sitio, edad y género de cada uno de los restos óseos utilizando un instrumento de recolección de datos destinado para tal fin. Resultados: La muestra mostró presencia de caries de dentina (62.3%), caries de esmalte (37.7%), maloclusión clase I (76.4%), maloclusión clase II (4.7%), maloclusión clase III (4.7%), apiñamiento en el maxilar superior (15.1%), apiñamiento mandibular (19.8%), apiñamiento en ambos maxilares (13.2%), giroversiones (20.8%), vestíbulo-versiones (15.1%), linguo-versiones (17.9%) y transposición dental (5.7%). Conclusión: Los resultados demuestran una alta prevalencia de caries y maloclusiones en la población peruana prehispánica.

Prevention of Dental Caries by Silver Diamine Fluoride.

The use of silver diamine fluoride (SDF) for management of dental caries has gained considerable attention due to recent regulatory clearance in the United States. The primary focus of policies, presentations, and publications has been the arrest of caries lesions (cavities) because of the material's unique ability to non-invasively achieve this elusive and clinically important goal. However, SDF also has proven efficacy in prevention, ie, decreasing the incidence of new caries lesions. Analysis of nine clinical trials in children shows that SDF prevented 61% of new lesions compared to controls. To prevent one new caries lesion, clinicians need to treat four primary teeth (one patient) or 12.1 permanent molars (three patients) with SDF. The preventive effect appears to be immediate and maintains at the same fraction over time. Direct comparisons of SDF applied once per year with alternative treatments show that SDF is more effective than other topical fluorides placed two to four times per year and more cost-effective than dental sealants. Enamel lesions may be even more responsive than cavitated dentin lesions. Annual application of SDF to high-risk surfaces (eg, mesial surfaces of permanent first molars where the distal surface of the second primary molar is carious) in patients with any risk of new caries lesions appears to be the most cost-effective approach available to prevent dental caries. SDF is an underutilized evidence-based preventive agent for dental caries.

Assessing subsistence and its relationship to cultural complexity in the late prehistoric upper Midwest: A new perspective provided by dental health.

OBJECTIVE: Previous researchers have assumed that the Late Prehistoric Oneota were less reliant on maize agriculture than their Middle Mississippian neighbors to the south. This assumption is based on the idea that intensive maize agriculture is related to sociopolitical complexity, and that the climate of the Great Lakes region was less conducive to full-scale agriculture than that of the American Bottom. Here, we assess the diet of the Oneota using dental pathology to test the hypothesis that the Oneota in Eastern Wisconsin were highly reliant on maize agriculture. MATERIALS AND METHODS: To test our hypothesis, skeletal remains representing 187 individuals and 1,102 teeth were examined from nine Oneota sites from the Middle Fox and Koshkonong Localities, as well as the Late Woodland/Middle Mississippian site of Aztalan. Dental caries, antemortem tooth loss (AMTL), and dental abscesses were assessed for each individual in the sample. Dental pathologies in the Oneota groups were compared to each other based on Locality and to the Aztalan population using chi-squared tests. RESULTS: Dental caries rates for the Oneota, based on the tooth count approach, were observed at 16.8% for the Middle Fox Locality, and 49% for the Koshkonong Locality. Comparatively, the Late Woodland/Middle Mississippian population from Aztalan had a tooth count rate of 19.5%. AMTL rates were similar across samples. Dental abscessing was universally low. DISCUSSION: The relatively high rate of dental caries among the Oneota is comparable to Middle Mississippian populations from throughout the Midwest, suggesting similar reliance on maize between the groups.

Diagnodent and VistaCam may be unsuitable for the evaluation of dental caries in archeological teeth.

OBJECTIVES: The aim of the study was to compare the usefulness of fluorescence-based caries detection systems (Diagnodent and VistaCam) for the assessment of carious lesions on archeological molars. MATERIALS AND METHODS: The study material consisted of teeth from the Cemetery of St. Mary Magdalene (Cmentarz sw. Marii Magdaleny) in Wroclaw, Poland. A sample of 178 permanent molars from 38 skulls were examined. Five surfaces of teeth (occlusal, mesial, distal, buccal, and lingual) were assessed on either basically cleaned or sandblasted teeth. Six diagnostic methods were used to detect carious lesions: the visual classification of the International Caries Detection and Assessment System (ICDAS II), fluorescent methods (Diagnodent and VistaCam), X-ray, cone beam computed tomography and histological sections. The sensitivity and specificity of the methods were determined using receiver operating characteristic (ROC) curves and the correlation between the severity of dental caries and the readouts obtained with each method. RESULTS: In most cases, Diagnodent and VistaCam yielded unsatisfactory specificity and sensitivity values. The area under curve (AUC) values in ROC curves for Diagnodent and Vistacam were lower than the AUC values obtained for the ICDAS II visual classification. CONCLUSIONS: According to our results, in the case of archeological teeth, neither Diagnodent nor VistaCam can be regarded as a better diagnostic method than the ICDAS II visual classification of caries.

A singular case of advanced caries sicca in a pre-Columbian skull from East Tennessee.

OBJECTIVE: Documentation of an advanced case of tertiary stage treponemal disease. MATERIALS: The well-preserved cranium and mandible of an adult male (Burial G) from the Early Woodland period (900 BCE-200 CE) Wilhoite site (40GN10) from east Tennessee. METHODS: Macroscopic examination of the cranio-facial periostosis on Burial G for pathognomonic indicators of treponemal disease. RESULTS: There are extensive contiguous nodular lesions on the frontal, parietals, temporals, and occipital bones. The frontal squama additionally exhibits radial scaring and circumvallate cavitating lesions. Radial scars are also present on both zygomatic bones and the endocranial surface of the calotte. There is rounding of the nasal margins in addition to periostosis on the palate. CONCLUSIONS: Burial G unequivocally exhibits the pathognomonic reactive changes of caries sicca, radial scarring, and cavitating lesions. SIGNIFICANCE: The Early Woodland date in combination with the advanced degree of pathognomonic reactive change is exceptional, and to date, without parallel in the pre-Columbian archaeological record of North America. Any case approaching the severity displayed here is invariably late prehistoric. LIMITATIONS: The absence of postcrania does not permit assessment of frailty or synergism of secondary conditions. SUGGESTIONS FOR FURTHER RESEARCH: More comprehensive documentation of pre-Columbian treponemal cases is merited.

Historical perspectives on advertising and the meme that personal oral hygiene prevents dental caries.

The consensus of a leading scientific panel in 1930 was that oral hygiene products could not prevent dental caries. Their view was that dental caries prevention required the proper mineralisation of teeth and that vitamin D could achieve this goal. Over a hundred subsequent controlled trials, conducted over seven decades, largely confirmed that this scientific panel had made the right decisions. They had, in 1930, when it comes to dental caries, correctly endorsed vitamin D products as dental caries prophylactics and oral hygiene products as cosmetics. And yet, despite this consistent scientific evidence for close to a century, an opposing conventional wisdom emerged which thrives to this day: oral hygiene habits (without fluoride) protect the teeth from dental caries, and vitamin D plays no role in dental caries prevention. This historical analysis explores whether persistent advertising can deeply engrain memes on dental caries prevention which conflict with controlled trial results. The question is raised whether professional organisations, with a dependence on advertising revenues, can become complicit in amplifying advertised health claims which are inconsistent with the principles of evidence-based medicine.

Caries, antemortem tooth loss and tooth wear observed in indigenous peoples and Russian settlers of 16th to 19th century West Siberia.

OBJECTIVE: Increased prevalence of dental caries evidently is correlated with increasing intake of sugar and carbohydrate-rich foods. Preceding and accompanying this dietary alteration might have been a shift from a hunting-and-gathering subsistence strategy to one based on agriculture. We corroborated this conjecture by means of a study on the prevalence of caries, antemortem tooth loss (AMTL) and tooth wear among 16th to 19th century hunter-gatherers and agriculturalists who co-existed in West Siberia. DESIGN: Indigenous skeletons (n = 75) exhumed from Tatar, Selkup, Khant, and Nenet graves along with Russian settler skeletons (n = 79) from Izyuk were examined. The prevalence of caries, AMTL and tooth wear among the indigenous peoples were compared with those among the Russian settlers. The resulting statistical inferences were tested using package R. RESULTS: The agriculturalist Russian settlers showed a significantly higher prevalence of dental caries (11.88%) than did the non-agriculturalist indigenous Siberian people (3.85%). Among the latter, the prevalence was the lowest in the Khanty and the highest in the Tatars, suggesting that caries differently affected each sub-group of indigenous Siberian people. Correspondingly to the case of dental caries, the Russian settlers' AMTL prevalence also was higher than that of the indigenous Siberians, regardless of age. On the other hand, the native Siberians and the Russian settlers did not show statistical differences in tooth wear. CONCLUSION: In the study on 16th to 19th century West Siberian populations, we were able to corroborate our presumption that agriculturalists ingesting a carbohydrate-rich diet would have higher rates of dental caries and AMTL than would hunter-gatherers.

'One tooth one child': evaluating the effects of diet and fertility on the oral health of women from archaeological sites in South America.

Women from ancient societies have shown a higher prevalence of dental caries in comparison with men. Recent research has shown that the relationship between increased oestrogen production during pregnancy and decreased salivary flow is a possible cause for the higher levels of caries in women, which is in contrast to the traditional view of sexual division of labour resulting in unequal access to cariogenic food. In order to test these two hypotheses, individuals exhumed from 12 South American archaeological sites were examined for markers of oral health (caries, ante mortem tooth loss, deep caries, and enamel hypoplasia) and compared in terms of fertility (Crude Birth Rate) and subsistence systems. Our results suggest that diet and other cultural practices remain the most important factors affecting oral health and that the effects of hormones can be masked by them. Such findings add to the discussion regarding the availability of micronutrients in such societies affecting caries experience in pregnant women, because of their special nutritional requirements.

[Caries prevention in historical perspective. Social factors]. / Serie: Cariëspreventie in historisch perspectief. Maatschappelijke factoren.

At the beginning of the twentieth century, children from poor families had less caries than children from affluent families. Later this changed: as the socio-economic status of the parents was higher, the children had less dental caries. The same relationship between socio-economic status and caries prevalence was later evident in adults. Throughout the twentieth century, in individuals with a low socio-economic status more teeth were extracted than in individuals with a high socio-economic status. At the end of the twentieth century, oral health in general was much better than at the beginning. That change is partly due to increased prosperity, increasing attention to oral hygiene, the introduction of fluoride toothpaste and the strong increase in the number of professionals in oral care. Increased knowledge of the causes and prevention of caries also played a role, if a less prominent one.

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.