Predictive factors for alveolar fenestration and dehiscence.

The purpose of this study was to evaluate the distribution and incidence of two forms of alveolar bone resorption known as fenestration and dehiscence across time and space. To accomplish this a Medieval French population was studied and the results were compared with other studies to examine incidence and distribution of alveolar bone resorption. Thus, 1175 teeth were analysed for 81 individuals, from an agropastoral Medieval (12th-14th century) archaeological site of Vilarnau located in the South of France. Tooth presence and absence as well as dental alveolar resorption were recorded. A new standardised methodological approach to record alveolar resorption is presented and can be used for any skeletonised series. Measurements of dehiscence were made in the midline on each root in relation to the cemento-enamel junction and fenestration was considered as resorption restricted to alveolar bone. Through analyses of the distribution and incidence of alveolar bone resorption over-time in a Medieval French population, along with nine other studies, we present a list of predictive factors for alveolar bone resorption. Among these factors tooth position and function were the most important; anterior teeth were more commonly affected, bone resorption was more common on the labial/buccal versus palatal/lingual surfaces, fenestration was also more common on the maxilla and dehiscence on the mandible (p≤0.001). These patterns do not vary through time or space, and therefore, provide predictive factors for health practitioners in oral therapy to improve patient recovery and post oral treatment success.

A study of the periodontal state of a late Medieval United Kingdom population.

OBJECTIVE: To study the severity of bone loss in a Medieval UK population, and compare this with other ancient UK populations from different time periods. DESIGN: Skulls from a burial site in York (XI-XV century) were investigated. Skulls with a minimum of 17 teeth were included and were divided from childhood into five age groups. Direct measurements from the cement enamel junction (CEJ) to the alveolar crest (AC) were undertaken at six points around each tooth with a UNC 15 probe. The mean bone loss was calculated for each tooth type. RESULTS: Seventy five skulls were included in the study (12-60 years of age). Bone loss was found to increase with age, but stabilized in older individuals (>45 years). The mean CEJ-AC distance varied from 2.1mm in the youngest group to a maximum of 4.1mm in 36-45 year olds. Results were compared with a Roman-British population (Whittaker et al., 1982) where comparable values for mean bone loss were 2.2mm and 5.4mm respectively, and a population of XVIII century Londoners (Whittaker et al., 1998) where bone loss of 1.1mm and 4.0mm was reported for the youngest and oldest age groups respectively. CONCLUSION: Measuring the CEJ-AC distance in dried skulls from ancient populations may be used as a proxy for the levels of periodontal disease irrespective of tooth wear. The findings from the current study suggest that the severity of periodontitis as determined by measurements of alveolar bone loss on dried skulls from this ancient population, seems to have declined in the United Kingdom from the III-V century to XVIII century. This may be due to changes in environmental factors including living conditions and diet, together with individual characteristics including systemic illness and genetic make up.

Oral pathologies of the Neolithic Iceman, c.3,300 BC.

The famous Iceman 'Ötzi' (South Tyrol Museum of Archaeology, Bolzano, Italy), a Neolithic human ice mummy, offers a unique opportunity to study evolutionary aspects of oral disease. The aim of this study was to assess, for the very first time, his oral cavity, which surprisingly had never been examined systematically. Based on several computed tomography (CT) scans from 1991 onwards and on macroscopic investigation, only a few findings, such as a central maxillary diastema, heavy abrasions, and missing wisdom teeth, were known. We re-evaluated the latest CT scans from 2005 and found various oral pathologies. In line with the increase of tooth decay in the Neolithic - because of diet change in this historic transition phase - several carious lesions were found, one of which penetrated into the dental pulp. In accordance with the Iceman's troubled life, as several injuries on his body and his violent death attest, mechanical trauma of one of his upper front teeth is evident. Finally, the poor periodontal condition of the Iceman's dentition (e.g. loss of alveolar bone), indicative of periodontitis, was assessed. These oral pathological findings in the Iceman's dentition provide a unique glimpse into the evolutionary history of oral conditions.

Atrophy of the residual alveolar ridge following tooth loss in an historical population.

OBJECTIVES: To study the natural aetiopathology of jaw atrophy after tooth loss, unaltered by prosthetic procedures, an historical population without modern dental treatment was examined. METHODS: Based on the hypothesis that there are predictable changes in shape during jaw-atrophy, frequency and degree of atrophy as well as clinical aspects of bone quality and resorption were determined in the skeletal remains of 263 individuals. The potential association between age and frequency/severity of atrophy was analysed. RESULTS: Atrophy in at least one jaw segment was present in 45.2% of the analysed jaw specimens. The residual ridge underwent a series of changes in shape and height following the pattern of resorption described for modern populations. The severity of these alterations was associated with the age of the individual and the region within the jaw. Atrophy was frequently related to structural degradation of the covering cortical layer. CONCLUSIONS: These findings prove that atrophy of the jaw evidently does occur, displaying similar patterns of resorption in a population without modern prosthetics, where the negative effect of ill-fitting dentures is excluded. The basic information about alterations of shape and the cortical layer covering the residual crest might help to provide a deeper insight into aetiopathological mechanisms of this common oral disease.

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.

Relationship between root caries and alveolar bone loss in the first wet-rice agriculturalists of the Yayoi period in Japan.

OBJECTIVE: The people of the Yayoi period (5th C b.c.-3rd C a.d.), who were the first wet-rice agriculturalists in ancient Japan, had carious lesions that were most frequently located on the root surfaces of their teeth. Root surface exposure is a prerequisite for this type of decay, and alveolar bone loss is the main cause of such exposure. Therefore, we identify the factors associated with root caries, and examine the relationship between root caries and alveolar bone loss in the people of the Yayoi period. MATERIALS AND METHODS: This study was performed using 263 sets of ancient skeletal remains that are believed to be from the Yayoi period and that were excavated at 49 archaeological sites in western Japan. Using 5010 teeth found among the remains, we analysed the relationship between the prevalence of root caries and the cemento-enamel junction-alveolar crest (CEJ-AC) distance. RESULTS: The prevalence of root caries and the mean number of teeth with root caries per person were significantly correlated with age, the presence of coronal caries and the mean CEJ-AC distance per person. We also found that as the mean CEJ-AC distance per tooth surface increased, the percentage of the root surface affected by caries increased. Moreover, after excluding the lingual (palatal) side, the mean CEJ-AC distance per surface was significantly greater for those tooth surfaces with root caries. CONCLUSION: We present the first evidence that the occurrence of root caries correlated with the CEJ-AC distance in the Yayoi people of Japan.

Cementogenesis and the induction of periodontal tissue regeneration by the osteogenic proteins of the transforming growth factor-beta superfamily.

The antiquity and severity of periodontal diseases are demonstrated by the hard evidence of alveolar bone loss in gnathic remains of the Pliocene/Pleistocene deposits of the Bloubank Valley at Sterkfontein, Swartkrans and Kromdrai in South Africa. Extant Homo has characterized and cloned a superfamily of proteins which include the bone morphogenetic proteins that regulate tooth morphogenesis at different stages of development as temporally and spatially connected events. The induction of cementogenesis, periodontal ligament and alveolar bone regeneration are regulated by the co-ordinated expression of bone morphogenetic proteins. Naturally derived and recombinant human bone morphogenetic proteins induce periodontal tissue regeneration in mammals. Morphological analyses on undecalcified sections cut at 3-6 mum on a series of mandibular molar Class II and III furcation defects induced in the non-human primate Papio ursinus show the induction of cementogenesis. Sharpey's fibers nucleate as a series of composite collagen bundles within the cementoid matrix in close relation to embedded cementocytes. Osteogenic protein-1 and bone morphogenetic protein-2 possess a structure-activity profile, as shown by the morphology of tissue regeneration, preferentially cementogenic and osteogenic, respectively. In Papio ursinus, transforming growth factor-beta(3) also induces cementogenesis, with Sharpey's fibers inserting into newly formed alveolar bone. Capillary sprouting and invasion determine the sequential insertion and alignment of individual collagenic bundles. The addition of responding stem cells prepared by finely mincing fragments of autogenous rectus abdominis muscle significantly enhances the induction of periodontal tissue regeneration when combined with transforming growth factor-beta(3) implanted in Class II and III furcation defects of Papio ursinus.

Unusual foreign metallic object (nail) in the dentition of a skull from the anthropological collection of Rudolf Virchow (Berlin).

Foreign bodies in the dentition of present day patients are frequently diagnosed. They are more rare in mediaeval and anthropological specimens. Rudolf Virchow, the doyen of pathology in Germany formed a huge collection of anthropological specimens in the 19th century. Among these specimens one skull from Tiflis (Tbilisi, Georgia) found its way into the collection of Virchow in 1881. The skull is that of a prisoner of war who died in 1877 due to dysentery. The skull is remarkable in that a metallic nail was adapted around the second right maxillary molar. Both radiological and clinical findings indicate that the nail was adapted to the tooth while the individual was still alive. In particular, erosion of the cortical bone plate in the affected area and osseous healing between the first and second maxillary molar may be taken as proof of adaptation of the nail in vivo. The reasons why the nail was applied, however, are difficult to explain. The authors assume that the nail was applied not by the individual himself. Probably, the nail was adapted as an amulet to protect the individual from injury or death.

Pattern of bone loss in dry mandibles of individuals who died before 1957.

OBJECTIVE: To map out the pattern of periodontal disease in individuals who died before 1957 and were not exposed to formal dental services. DESIGN: Descriptive cross-sectional study. SETTING: National Museums of Kenya. SUBJECTS: The skeletons of people who died before independence are preserved at the National Museums of Kenya in Nairobi. Sixty four out of the 170 dry mandibles stored at the Museum were assessed for periodontal bone loss using a calibrated ruler. RESULTS: All the 64 mandibles assessed were of individuals who died before 1957. Two thousand two hundred and seventy four sites were examined. Most of the subjects were adults aged 30-45 years and the age range was 18-80 years. Majority of the mandibles examined were of the ethnic group from Central Kenya. Of the teeth examined, premolars and molars were the teeth most frequently preserved intact in the sockets. The total mean bone loss for all teeth was 2.51 (SD 1.15) with a range of 0.85-5.80. When the different sites were examined, values for bone loss were 2.59 for mesial surfaces; 2.55 buccal surfaces; 2.38 for distal surfaces. Three categories were identified as follows:- 70% of the individuals had minimal or no bone loss, 26.5% had 3-4 mm or moderate bone loss and 3.5% had >5 mm bone loss or advanced bone loss. Further analysis showed that when bone loss of >3 mm was examined, only 28.12% of the individuals were in this group, 10.93% had >4 mm bone loss and 3.12% had 5 mm or more bone loss. The first molars were the teeth most commonly affected by bone loss of 3mm or more followed by second molars then the premolars. CONCLUSIONS: In this group of individuals mainly from Central Kenya, the bone loss pattern showed that only a small number had experienced periodontal destruction as recorded by bone loss levels. Three groups were identified; those who had no or minimal destruction, those who had experienced moderate destruction and those where obvious bone destruction was evident. Thus susceptibility to periodontal disease is evident in a small proportion of individuals even in populations not exposed to modern diet and formal dental services. Periodontal destruction seems to affect a fraction of the population even when older populations are examined, thus it would save on resources both human and physical if these susceptible individuals could be identified early and treatment provided.

Proposal of a data collection form to record dento-alveolar features--application to two Roman skeletal samples from Italy.

Bones and teeth are an important source of information about the lifestyle, health status and dietary habits of past populations. Modifications and lesions of the periodontal tissues also provide information about the health status and behavior of an individual or of an ancient population. In this paper a method to record some dento-alveolar features of both deciduous and permanent teeth is described. The forms that we propose make it easy to record the data in a Microsoft Excel sheet. The form for adults has been applied to two Roman Imperial age skeletal samples from northern Italy - Casalecchio di Reno (II-V c. AD, Bologna) and Emilia Romagna, and central Italy - Quadrella (I-IV c. AD, Isernia, Molise).

Human skull from the Taza locality, Jijel, Algeria.

Archaeological excavations were carried out in 1990 in prehistorically inhabited caves sites in the Taza locality along the eastern Algerian coast. Recovered materials included stone and bone artifacts, faunal remains and a single human skull (Taza 1). A radiocarbon date for the upper cave level from which the skull was found was 16,100 B.P. While the skull, which is likely female, is very small overall, its shape compared closely with other North African cranial series. The obtained date and archaeological materials are characteristic of the Iberomaurusian industry of the Late Paleolithic period of North Africa.

Prevalence of dehiscences and fenestrations in modern American skulls.

BACKGROUND: The purpose of this study was to examine the prevalence, distribution, and features of alveolar dehiscences and fenestrations in modern American skulls and correlate their presence with occlusal attrition, root prominence, and alveolar bone thickness. METHODS: A representative sample of 146 dentate modern American skulls from a collection at the National Museum of Natural History were examined. RESULTS: The skulls were from subjects ranging in age from 17 to 87 years old (mean 49.1 years). The mean number of teeth per skull was 22.7 and the mean number of either dehiscence or fenestration defects per skull was 3.0. Of the 3,315 individual teeth examined, 4.1% (135) had dehiscences and 9.0% (298) had fenestrations. A dehiscence was present in 40.4% of the skulls, and a fenestration was present in 61.6% of skulls. Mandibular canines were most often affected by dehiscences (12.9%), while maxillary first molars were most often affected by fenestrations (37.0%). Sixty-seven percent of dehiscences were found in the mandible, and 58% of fenestrations were found in the maxilla. CONCLUSIONS: The presence of dehiscences and fenestrations were positively correlated with thin alveolar bone and negatively correlated with occlusal attrition. African-American males and Caucasian females were significantly more likely to have dehiscences, while African-American females were significantly more likely to have fenestrations.

Factors affecting the lifespan of the human dentition in Britain prior to the seventeenth century.

OBJECTIVE: To confirm that compensatory eruption (supereruption) of teeth past a stable periodontium occurs in response to severe occlusal attrition. DESIGN: Regression analysis study from radiographs and direct measurements. SETTING: Archaeological material at the University of Aberdeen. SUBJECTS: 47 individuals > 21 years old and dating from Late Mediaeval times (1300-1600 AD). MAIN OUTCOME MEASURES: Occlusal attrition was recorded on the first permanent mandibular molars. Measurements on radiographs of the teeth from the fixed point of the inferior dental canal were taken to the occlusal surface, the alveolar crest and the tooth apex. Regression analysis was undertaken between these variables and related to attrition (age). RESULTS: Continuous eruption of the permanent human dentition past a stable periodontium does occur in response to tooth height lost by wear, despite the fact that supereruption may lead to the eventual self destruction of the dentition. This mechanism was primarily responsible for the early loss (at 40-45 years of age) of dentitions in Mediaeval times. CONCLUSIONS: Stability of occlusal height appears to be an important function of the dentition and if triggered by severe wear will lead to increasing root exposure and eventual exfoliation of the teeth. It is important not to confuse bone loss due to periodontitis with root exposure due to supereruption of the teeth.

Calculus deposits and bone loss on the teeth of Romano-British and eighteenth-century Londoners.

The relation between dental calculus and periodontal disease is not clear but it is generally recognized that calculus is a significant pathogenetic factor. Skeletal material has previously been used to study some aspects of chronic adult periodontitis but few studies have quantified the extent of calculus in ancient populations and its relation to changes in alveolar bone height. This study records the presence and extent of calculus and its relation to alveolar bone loss in a Romano-British and eighteenth-century London population. There were significant differences in calculus deposition in the two populations but this appeared to have little effect on changes in alveolar bone contour. It is suggested that the amount of calculus may be related to diet but that changes in alveolar bone height seem to be independently controlled.