Anthropol. Anz. 72/2 (2015), pp. 185–199 J. Biol. Clinic. Anthropol. published online 4 December 2014; published in print May 2015
Article
A panorama of tooth wear during the medieval period R´emi Esclassan1, 2, Djillali Hadjouis3, Richard Donat4, Olivier Passarrius5, Delphine Maret1, 2, Fr´ed´eric Vaysse1, 2 and Eric Crub´ezy2 1 Facult´e de chirurgie dentaire de Toulouse, Toulouse, France [email protected] 2 Laboratoire AMIS UMR 5288 CNRS, Universit´e Paul Sabatier, Toulouse, France 3 Centre National de Recherches pr´ehistoriques, anthropologiques et historiques, Alger, Alg´erie 4 Institut National de Recherche en Arch´eologie Pr´eventive (INRAP), France 5 Pˆole d’Arch´eologie, Perpignan, France
With 5 figures and 2 tables
Summary: Tooth wear is a natural phenomenon and a universal occurrence that has existed from the origin of humankind and depends on the way of life, especially diet. Tooth wear was very serious in ancient populations up to the medieval period. The aim of this paper is to present a global view of tooth wear in medieval times in Europe through different parameters: scoring systems, quantity and direction of wear, gender, differences between maxilla and mandible, relations with diet, caries, tooth malpositions and age. Key words: tooth wear, Medieval, diet, gender.
Introduction In anthropology and archaeology, it has been assumed for several decades that teeth provide interesting material for observation because of their high mineral content, which gives them strong resistance to post mortem taphonomic processes (Alt & Rossbach 2009). Tooth wear is of particular interest in the study of relationships between man, his environment and his pattern of subsistence (Herrscher 2001). The term tooth wear denotes the gradual loss of dental hard tissues and involves various processes: attrition, erosion and abrasion. Dental attrition is a physiological wearing of teeth resulting from tooth-to-tooth contact without the presence of foreign substances (Kaidonis 2008, Litonjua 2008). Tooth abrasion occurs by the friction of exogenous material forced over tooth surfaces, especially food and acidic substances. Finally, erosion is defined as the progressive, chemical dissolution of tooth surface without the presence of bacteria and plaque (Ady & Shelis 2006, Kaidonis 2008). When looking at teeth from all ages of human history, from antiquity to the Middle Ages, one can note that dental wear is a universal occurrence (Kaifu et al. 2003, Hillson 2003). The Medieval period covers a considerable time-span, over 1,000 years, and is divided into the Early (c. mid-fifth to mid-eleventh centuries) and Late 쏘 2014 E. Schweizerbart’sche Verlagsbuchhandlung, Stuttgart, Germany DOI: 10.1127/anthranz/2014/0442 eschweizerbart_XXX
www.schweizerbart.de 0003-5548/14/0442 $ 3.75
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(mid-eleventh to mid-sixteenth centuries) Medieval periods. Overall, this period encompasses numerous episodes of social and cultural change, which had varying degrees of impact on the populations of the time: the emergence of kingdoms, the evolution of social and administrative structures, changes in settlement and farming practices, the development of urbanization and trading networks, and the growth of the Christian Church (Caffell 2004). From the point of view of palaeopathology, the Middle Ages constitute an interesting period because of the numerous collections available and the fact that many authors have confirmed the existence of notable tooth wear on the populations studied (Belmont 2006) (Table 1). Brabant (1960, 1973a), one of the pioneers of dental anthropology in Europe, wrote that “tooth wear in the Middle Ages was much more accentuated than today”. In the medieval population of Valjevo (Serbia, 15th century), Djuric-Srejic (2001) estimated that “tooth wear was the most common finding”. Caglar et al. (2007) wrote, about a Byzantine medieval sample (12th century), that “in contrast with dental caries, tooth wear was remarkable in our sample”. More recently, Meinl et al. (2009) found “a very pronounced attrition” in an Austrian sample from Avar (11th century). In these anthropological and historical contexts, the aim of the present paper is to present a panorama of tooth wear in the medieval period in Europe by using various parameters: 1) scoring systems, 2) quantity of wear, 3) gender, 4) differences between maxilla and mandible, 5) diet, 6) caries 7) tooth malpositions and 8) age.
Scoring systems Tooth wear in medieval populations can be recorded using different anthropological classifications, all derived from the initial one put forward by Broca (1879). Depending on the medieval populations studied and the number of individuals, these anthropological classifications are often used for rapid coding of occlusal wear. They are mostly based on the amount of exposed dentine and it is difficult to distinguish between the first stages of enamel wear (D’Incau et al. 2012). The main problem with all these classifications is that different populations from different sites and different periods cannot be compared directly (Belmont 2006, D’Incau et al. 2012). Although some methods have been used more frequently than others in the literature (Murphy, Brothwell, Scott, Smith, Brabant), there is not actually a truly “consensual” scoring system for tooth wear in anthropology (Bartlett & Dugmore 2008, Van’t Spijker et al. 2009, Roberts 2010) (Table 2).
Quantity and direction of tooth wear The degree of wear observed on teeth varies among medieval populations. For many authors, the quantity of tooth wear most frequently found in the Middle Ages is partial wear of dentine (Fig. 1) (Twiesselman & Brabant 1960, Brabant 1962, Varrela 1991, Herrscher 2001, Djuric-Srejic 2001, Aubry 2003, Caglar et al. 2007, Esclassan et al. 2009). The most worn tooth is the first molar (M1), both in the maxilla and in the mandible. There is a decreasing gradient of tooth wear from the first to the third molar (M3) (Slaus et al. 1997, Djuric-Srejic 2001, Hillson 2003, Aubry 2003, D’Incau et al.
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Renaix (Belgium)
Plague Pits (England)
Turku (Finland)
XI–XIIth C.
XVIth C.
XV–XVIth C.
XIV–XVIIth C. Nova Raca (Croatia)
Brabant (1960)
Lavelle (1970)
Varrela (1990)
Slaus et al. (1997)
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XI–XVth C.
Aubry (2003)
Chazel (2005)
Meinl et al. (2009)
IX C.
Avar (Austria)
Vilarnau d’Amont (France)
IX–XVth C.
th
Iznik (Turkey)
XIII C.
Caglar et al. (2007)
Esclassan et al. (2009)
th
XII –XIV C.
Tyrup (Denmark)
Saint-Pierre de l’Almanarre (France)
Notre Dame du Bourg (France)
XI–XIVth C.
Ganss (2002)
Boldsen (2005)
Griesheim and Sindelsdorf (Germany)
V–IXth C.
Herscher (2001)
th
Saint-Laurent (Grenoble, France)
XIII–XVth C.
Djuric-Srejic (2001)
th
Chevilly-Larue (France)
Valjevo (Serbia)
IX–XVII C.
XIV–XVth C.
Hadjouis (1999)
th
Population (origin)
Medieval period
Author/ (year of publication)
Table 1. Synthesis of different studies about tooth wear in medieval populations
136
58
52
149
77
194
102
252
105
422
68
410
178
159
Adult sample
2215
1395
280
Not precised
1183
3154
Not precised
1614
1680
Not precised
Not precised
4581
3564
2613
Number of teeth
Not precised
Brabant (Broca modified) (5)
Brabant (Broca modified) (5)
Murphy (9)
Brabant (Broca modified) (5)
Aubry (Brabant modified) (5)
Molnar modified (5)
Bouville (Brothwell modified) (6)
Lavelle (5)
P´erier (6)
Smith (8)
Carlsson (Brabant modified) (5)
Davies et Pedersen modified (5)
Brabant (Broca modified) (5)
Scoring system (Number of wear levels)
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Table 2. Anthropological scoring methods for tooth wear. Method (year) Broca (1879) Perier (1949) Murphy (1959) Brabant (1962) Scott (1979) Molnar (1981) Brothwell (1981)
Number of levels 4 5 9 5 10 8 7
2012) (Fig. 2). For Brabant, the first molars wear faster and more intensely than other teeth and have a higher prevalence of caries because of the tooth eruption chronology and because of the thinner enamel of M1 compared to M2 and M3. Schwartz (2000) tried to highlight a gradient in enamel thickness that might predispose to helicoidal wear, making this a structural aspect of the oro-facial skeleton of the Homo genus. Such a gradient has never been shown for upper molars (Spears & Macho1998). In the mandible, this gradient is considered as more limited. This difference between mandibular and maxillary molars could be explained by the different enamel distribution on the surface of the cusps and by the age of eruption. Wear is quite similar in premolars and molars, and incisor wear increases once the enamel has disappeared (Miles 1962). For De Bonis & Viriot (2002), the more severe tooth wear of M1 compared with M2 and M2 compared with M3 can be explained by the eruption periods. These intervals are on average 6.1 years between M1 and M2 and 7.5 years between M2 and M3. Taylor (1963) has tried to explain the faster wear of M1 during chewing.
Fig. 1. Heavy occlusal wear on a medieval maxilla (Vilarnau d’Amont’s collection).
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Fig. 2. Decreasing gradient of tooth wear, from the first molar to the third one. Note the scooping of the dentine and the way buccal cusps of the molars are wearing faster (Vilarnau d’Amont’s collection)
The direction of wear has not been extensively studied in the literature. According to Brabant (1962), the most frequent tooth wear direction in the Middle Ages was helicoidal (Fig. 3). He considered this wear direction to be the result of “slow mastication with a coarse diet, resistant to grinding”. On a medieval sample from Vilarnau (Esclassan et al. 2009), the most frequent direction was oblique and plane in men and horizontal and plane in women.
Differences between men and women Few studies have tried to assess gender differences in tooth wear during the medieval period. Within the medieval sample from Vilarnau (Esclassan et al. 2009), no differences were noted, but the sample was too small to be significant. Slaus (1997), Herrscher (2001) and Aubry (2003) found that tooth wear was greater in males than females in their sample and they linked this to a difference in diet. In a Croatian population dating from between the 16th and 17th centuries, Slaus (1997) reports that “males exhibited significantly more occlusal wear than females”). Aubry (2003) studied two medieval samples representing different social classes: male peasants and nuns. These results indicate less pronounced wear among the nuns. It is suggested that this difference may be explained by a different diet and less efficient chewing among the nuns. Herrscher (2001) also suggested that men had a more abrasive diet.
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Fig. 3. Helicoidal wear direction on medieval lower molars (Vilarnau d’Amont’s collection)
Otherwise, there is no significant difference (Lysell 1953, Brabant 1973b, Lunt 1978).
Difference in wear between maxilla and mandible Here again, there is no consensus (Lavelle 1970, Li & Ji 1995). A study of paired jaws from the Vilarnau sample did not show any wear difference between the maxillary and the mandibular teeth. Other studies have shown greater wear on the mandible (Aubry 2003, Molnar & McKee 1983) or on the maxilla (Mayti´e 1976, Herrscher 2001). For Mayti´e (1976) tooth wear generally predominates on the maxilla because it suffers more from the chewing effect of the teeth, like “an anvil relative to the hammer”. On more ancient material (prehistoric), Molnar (1971) explained differences between maxilla and mandible by “the variation in structural support for each tooth row”.
Relations between tooth wear and medieval diet Food was the main cause of tooth wear in ancient populations (Alt & Rossbach 2009, D’Incau et al. 2012). In the Middle Ages, food certainly contained many abrasive elements. The Middle Ages was a period with many food shortages, which were accentuated by the differences between the rich and the poor. There were “medical recommendations” adapted to each social category (Laurioux 2002). Respectful of the “world order”, medical doctors estimated that it was necessary for the peasants to eat more vegetables and bread (Aubry 2003). Vegetables and bread were very abrasive,
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much more than the meat usually eaten by the rich. The high abrasion of the food bolus of the peasants depended on many factors, such as mineral particles from the querns, a diet rich in fibrous plants or the presence of plants rich in phytoliths (Hillson 1979, Gügel et al. 2001, Boldsen 2005, D’Incau et al. 2004, D’Incau et al. 2012). Incompletely washed plants, roots and vegetables were certainly responsible for considerable tooth wear. Bread was the most widely consumed food during the Middle Ages (up to one kilogram a day) (Laurioux 2002) and could represent up to 70 % of the total diet for the peasants (Marinval 2008). It was surely implicated in the tooth wear of medieval populations, especially peasants. Belmont (2006) explains in his book “La Pierre a` pain” (“The bread stone”) that the stone particles eroded from millstones that were not enough compact fell into the flour and became mixed into the bread. Only meticulous sifting could eliminate the splinters of stone but this was possible only for “prestigious customers”, such as clerics, the wealthy urban middle class or aristocrats. The rural population had to deal with rudely sieved flour and the large quantities of gravel it contained. Their daily intake of bread full of gravel meant that medieval peasants wore their teeth very rapidly and could easily break them on a bigger chunk of stone. In the Middle Ages, tooth wear varied according to the regions concerned. Salvage excavations carried out in Chevilly-Larrue revealed skeletons with only 20 % of very worn teeth. For Hadjouis (1999), this better “oral health” could have come from a diet rich in milk, meat and softer nutrients and a better quality of millstones. By the beginning of the 11th century, mills in the Paris region were equipped with good quality millstones with a high silica content that did not pollute the flour with gravel. Other works have suggested that differences could exist depending on the geography and social inequalities. Aubry (2003) noticed that peasants’ teeth were more worn than those of nuns because of a differentiated diet: nuns ate wheat bread while the peasants’ bread was made from barley. The differences in tooth wear reveal the socio-economic and diet hierarchy described by the physicians and agronomists of the 15th century (Belmont 2006). Subsequently, according to social categories and geographic particularities, tooth wear progressively decreased. A radical improvement occurred between the Middle Ages and the 17th century (Maat & Van der Velde 1987). The authors attributed this modification to a change in food consistency as flour became more refined. Kerr (1988) suggested that food habits were the main causes of severe tooth wear among British medieval populations. The British food economy was almost entirely rural until the 17th century. Poultry (turkeys, geese, and pigeons) made up a large part of the diet and the medieval British liked to suck or crunch the little bones to retrieve the bone marrow. For Kaifu (2003), molar tooth wear started to decrease only after the Middle Ages. In a medieval sample, tooth wear was equivalent to that of prehistoric farmers and the decrease in molar tooth wear is attributed to changes in culinary practices and in food products, especially with the generalization of the fork. In France, the fork appeared in 1574 at the royal court and was used only for eating cooked pears (Laurioux 2002). First introduced by Catherine de Medicis, it was only at the beginning of the 17th century that it progressively spread to the whole population, with four prongs instead of two. Prehistoric farmers ate with their hands and mostly used their front teeth but the use of a fork made it possible to put food further back in the mouth.
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Caries-attrition competition In the Middle Ages, modern oral hygiene was unknown and tooth wear may have provided a kind of “tooth protection” (Kerr 1998, Esclassan et al. 2009). Major tooth wear was assumed to prevent caries development and eliminate plaque (Kaifu 2003, Maat & Van der Velde 1987). Coarse food could eliminate plaque from the stagnation areas such as fissures and pits (Moore & Corbett 1973). Aubry (2003) has shown that the frequency of occlusal caries decreased with age and tooth wear. Furthermore, a coarse diet requires vigorous chewing that stimulates the flow of saliva, the buffer capacity of which reduces caries frequency. Similarly, it has been suggested that plaque accumulation appears to be greater in individuals with limited tooth wear than in individuals with serious tooth wear (Ainamo 1972, Newman 1974, Newman 1990). However, tooth wear alone is not sufficient to protect against caries. Caries exist even in populations with major tooth wear if they have a diet rich in carbohydrates (Larsen 1997).
Relations between tooth wear and dental crowding Observations of medieval mandibles suggest a low frequency of dental crowding (Brabant 1962) (Fig. 4). Third molars are frequently present and there is a small proportion of inclusion, malpositions or tooth-jaw disharmony. For Begg (1954), a dental arch with worn teeth does not present crowded teeth. In contrast, he estimated that many malocclusions occur when tooth wear is not strong enough. Begg supposed that a human mandible was programmed to grow with a “project” of tooth reduction due to wear, so its length is initially programmed to be smaller than the total sum of all the teeth when they are not worn. The Begg model does not completely explain the severe overlap case found in contemporary humans. His theory has been called into question by many authors (Hunt 1961, Corruccini 1990, Proffit & Fields 1993). They suggested that the modification of environmental factors (disappearance of nutritive sucking, diminution of chewing function, increase of breathing through the mouth) could entail reduced development of the maxilla, with dental crowding, especially of the front teeth. A recent paper by Rando et al. (2013) showed that medieval skulls were somewhat larger overall, relative to modern ones, with generally larger mandibles, wider dental arches, more prominent faces, and greater posterior facial height. Other authors confirm the fact that both maxilla and mandible are of more robust form in earlier populations (Goose 1962, Moore 1973). Because of better nutrition and better prenatal conditions (absence of stress, malnutrition and illness) modern tooth crowns are larger than those of the Middle Ages (Walker 1981, Lindsten 2002). However, the decrease in tooth wear seems to have increased third molar impaction (Odusanya & Abayomi 1991, Rajasuo et al. 1993, Beeman 1999). In very worn dentitions, the arch length from the second molar decreases rapidly because of mesial drift. When heavy interproximal wear accompanies this drift, the length of the dental arches decreases significantly. This link has been repeatedly demonstrated and quantified in past populations and, according to “Begg’s ‘‘attritional occlusion’’ model, absence of wear is responsible for the gradual development of malocclusions in present-day populations” (D’Incau et al. 2012).
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Fig. 4. a and b: Adult medieval lower mandibles with important occlusal and interproximal wear (Vilarnau d’Amont’s collection). Note the absence of crowding.
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Also, the growing frequency of dental crowding and third molar impaction or noneruption may be connected with a diet of soft foods. While several authors share these views, others are less sure and believe that the lack of space responsible for malocclusions is due to a reduction in masticatory strength, leading in turn, by mechanomorphosis, to a reduction in the basal bone of the arches. The larger size of teeth that are not worn would have no influence (D’Incau et al. 2012).
Age In anthropology, tooth wear is also considered as an ‘age-related’ phenomenon (Hilsson, 2003, Dawson 2013) and the analysis of rates of dental wear on permanent dentition has been used for many years as a way of assessing the age of adult skeletons (Murphy 1959, Miles 1963, Scott 1979, Brothwell 1981). For Hillson (2003), the most widely used systems for determining age from tooth wear are those of Miles (1963) and Brothwell (1963). They show the range of dentine exposure on the occlusal surfaces of permanent molars. Mays (2002) wrote that “the high rates of dental wear characteristic of most palaepopulations suggest that it should be a useful method of adult age estimation in archaeological groups” and estimation based on mandibular molars should be preferable, despite the inconsistency of the literature. In all past populations including those of the medieval period, tooth wear began in childhood (D’Incau 2014). For Kaidonis (2008), “it is well established that abrasion has a linear association with age”. However, the amount of tooth wear among children during the medieval period has not been much studied and no standard charts exist in the literature for recording wear on deciduous teeth (Dawson & Robson Brown 2013). No published research seems to have been carried out to explore the link between diet and status of children during the medieval period. Once a tooth has erupted and is in occlusion, the processes of wear will start. Small facets appear on the tooth enamel as the cusp tips are worn (Fig. 5). Once the cusps have flattened, the enamel of the tooth begins to wear, exposing the dentine underneath (Dawson 2013). This process of enamel wear continues over time until all the enamel of the tooth is worn away.
Summary and conclusion Finally, the main points concerning tooth wear in medieval populations are the followings: 앫 Tooth wear was very marked among medieval populations but started to become reduced in the 17th century because of refined food and the generalization of the use of forks. 앫 Tooth wear had a dietary origin and increased with age. 앫 It started at an early stage, and was intense and generalized. 앫 There were no significant differences between the genders even though it seems that males had more severe tooth wear. 앫 The Middle Ages was the last historic period linked to noteworthy tooth wear concerning the entire population.
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Fig. 5. Heavy tooth wear on a medieval child mandible’s teeth (Vilarnau d’Amont’s collection).
Studies of tooth wear in the Middle Ages provide evidence that it was rapid, intensive, and generalized, rapidly reaching levels no longer observed in modern populations with an industrialized way of life, even in older people, irrespective of any pathologic considerations.
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Molnar, S. (1971b): Sex, age and tooth position as factors in the production of tooth wear. – Am. Antiq. 36 : 182–188. Molnar, S. (1981): Physical Anthropology: Variation in Morphology of Teeth: Anthropologic and Forensic Aspects. – Am. Anthropol. 83 (1): 202–203. Molnar, S., McKee, J.K. & Molnar, I. (1983): Measurements of tooth wear among Australian Aborigines: I. Serial loss of the enamel crown. – Am. J. Phys. Anthropol. 61: 51–65. Moore, W.J. & Corbett, E. (1973): The distribution of dental caries in ancient British populations. II. Iron Age, Romano-British and Mediaeval periods. – Caries Res. 7: 139–153. Moore, W.J., Lavelle, C.L. & Spence, T.F. (1968): Changes in the size and shape of the human mandible in Britain. – Brit. Dent J. 125: 163–169. Murphy, T.R. (1959): Gradients of dentine exposure in human molar tooth attrition. – Am. J. Phys. Anthropol. 17: 179–186. Newman, H.N. (1974): Diet, attrition, plaque and dental disease. – Brit. Dent. J. 136: 491– 497. Newman, H.N. (1990): Plaque and chronic inflammatory periodontal disease. – J. Clin. Periodontol. 17: 533–541. Odusanya, S.A. & Abayomi, I.O. (1991): Third molar eruption among rural Nigerians. – Oral. Surg. Oral. Med. Oral. Pathol. 71: 151–154. P´erier, A.L. (1949): Usure, abrasion, erosion. – Pratique Odonto-Stomatologique 140: 1–7. Proffit, W.R. & Fields, H.W. (1993): Contemporary orthodontics, 2nd ed. – Mosby Year Book, St. Louis. Rajasuo, A., Murtomaa, H. & Meumann, J.H. (1993): Comparison of the clinical status of third molars in young men in 1949 and 1990. – Oral. Surg. Oral. Med. Oral. Pathol. 76: 694–698. Rando, C., Hillson S. & Antoine, D. (2014): Changes in mandibular dimensions during the mediaeval to post-mediaeval transition in London: A possible response to decreased masticatory load. – Arch. Oral. Biol. 59: 73–81. Roberts, C. & Manchester, K. (2010): The Archaeology of disease. 3rd ed. – The History Press, UK, pp. 1–337. Schwartz, G.T. (2000): Enamel thickness and the helicoidal wear plane in modern human mandibular molars.– Arch. Oral. Biol. 45: 401–409. Scott, E.C. (1979): Dental wear scoring techniques. – Am. J. Phys. Anthropol. 51: 213–218. Slaus, M., Pecina-Hrncevic, A. & Jakovljevic, G. (1997): Dental disease in the late medieval population of Nova Raca, Croatia. – Coll. Anthropol. 21: 561–572. Smith, B.G. & Knight J.K. (1984): An index for measuring the wear of teeth. – Brit. Dent. J. 156: 435–438. Spears, I.R. & Macho G.A. (1998): Biomechanical behaviour of modern human molars: implications for interpreting the fossil record. – Am. J. Phys. Anthropol. 106: 467–482. Taylor, R.M. (1963): Causes and effect of wear of teeth: further non metrical studies of the teeth and palate in Moriori and Maori skulls. – Acta Anatomica 53: 97–157. Twiesselmann, F. & Brabant, H. (1960): Observations sur les dents et les maxillaires d’une population d’ˆage franc de Coxyde. – Bull. Group. Int. Rech. Sci. Stom. 3: 99–204. Van’t Spijker A., Rodriguez, J.M., Kreulen, C.M., Bronkhorst, E.M., Bartlett, D.W. & Creugers, N.H. (2009): Prevalence of tooth wear in adults. – Int. J. Prosthodont. 22: 35–42. Varrela, T.M. (1991): Prevalence and distribution of dental caries in a late medieval population in Finland. – Arch. Oral. Biol. 36: 553–559. Walker, A. (1981): Diet and teeth. Dietary hypotheses and human evolution. – Phil. Trans. R. Soc. London Biol. Sci. 292: 57–64.
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Submitted: 03 January 2014; accepted: 08 April 2014. Address for correspondence: R´emi Esclassan, Facult´e de chirurgie dentaire de Toulouse, 03 chemin des Maraˆıchers, 31 062 Toulouse cedex 09, France Laboratoire AMIS UMR 5288 CNRS, Universit´e Paul Sabatier, 118, route de Narbonne, 31 062 Toulouse Cedex [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]
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Article
A panorama of tooth wear during the medieval period R´emi Esclassan1, 2, Djillali Hadjouis3, Richard Donat4, Olivier Passarrius5, Delphine Maret1, 2, Fr´ed´eric Vaysse1, 2 and Eric Crub´ezy2 1 Facult´e de chirurgie dentaire de Toulouse, Toulouse, France [email protected] 2 Laboratoire AMIS UMR 5288 CNRS, Universit´e Paul Sabatier, Toulouse, France 3 Centre National de Recherches pr´ehistoriques, anthropologiques et historiques, Alger, Alg´erie 4 Institut National de Recherche en Arch´eologie Pr´eventive (INRAP), France 5 Pˆole d’Arch´eologie, Perpignan, France
With 5 figures and 2 tables
Summary: Tooth wear is a natural phenomenon and a universal occurrence that has existed from the origin of humankind and depends on the way of life, especially diet. Tooth wear was very serious in ancient populations up to the medieval period. The aim of this paper is to present a global view of tooth wear in medieval times in Europe through different parameters: scoring systems, quantity and direction of wear, gender, differences between maxilla and mandible, relations with diet, caries, tooth malpositions and age. Key words: tooth wear, Medieval, diet, gender.
Introduction In anthropology and archaeology, it has been assumed for several decades that teeth provide interesting material for observation because of their high mineral content, which gives them strong resistance to post mortem taphonomic processes (Alt & Rossbach 2009). Tooth wear is of particular interest in the study of relationships between man, his environment and his pattern of subsistence (Herrscher 2001). The term tooth wear denotes the gradual loss of dental hard tissues and involves various processes: attrition, erosion and abrasion. Dental attrition is a physiological wearing of teeth resulting from tooth-to-tooth contact without the presence of foreign substances (Kaidonis 2008, Litonjua 2008). Tooth abrasion occurs by the friction of exogenous material forced over tooth surfaces, especially food and acidic substances. Finally, erosion is defined as the progressive, chemical dissolution of tooth surface without the presence of bacteria and plaque (Ady & Shelis 2006, Kaidonis 2008). When looking at teeth from all ages of human history, from antiquity to the Middle Ages, one can note that dental wear is a universal occurrence (Kaifu et al. 2003, Hillson 2003). The Medieval period covers a considerable time-span, over 1,000 years, and is divided into the Early (c. mid-fifth to mid-eleventh centuries) and Late 쏘 2014 E. Schweizerbart’sche Verlagsbuchhandlung, Stuttgart, Germany DOI: 10.1127/anthranz/2014/0442 eschweizerbart_XXX
www.schweizerbart.de 0003-5548/14/0442 $ 3.75
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(mid-eleventh to mid-sixteenth centuries) Medieval periods. Overall, this period encompasses numerous episodes of social and cultural change, which had varying degrees of impact on the populations of the time: the emergence of kingdoms, the evolution of social and administrative structures, changes in settlement and farming practices, the development of urbanization and trading networks, and the growth of the Christian Church (Caffell 2004). From the point of view of palaeopathology, the Middle Ages constitute an interesting period because of the numerous collections available and the fact that many authors have confirmed the existence of notable tooth wear on the populations studied (Belmont 2006) (Table 1). Brabant (1960, 1973a), one of the pioneers of dental anthropology in Europe, wrote that “tooth wear in the Middle Ages was much more accentuated than today”. In the medieval population of Valjevo (Serbia, 15th century), Djuric-Srejic (2001) estimated that “tooth wear was the most common finding”. Caglar et al. (2007) wrote, about a Byzantine medieval sample (12th century), that “in contrast with dental caries, tooth wear was remarkable in our sample”. More recently, Meinl et al. (2009) found “a very pronounced attrition” in an Austrian sample from Avar (11th century). In these anthropological and historical contexts, the aim of the present paper is to present a panorama of tooth wear in the medieval period in Europe by using various parameters: 1) scoring systems, 2) quantity of wear, 3) gender, 4) differences between maxilla and mandible, 5) diet, 6) caries 7) tooth malpositions and 8) age.
Scoring systems Tooth wear in medieval populations can be recorded using different anthropological classifications, all derived from the initial one put forward by Broca (1879). Depending on the medieval populations studied and the number of individuals, these anthropological classifications are often used for rapid coding of occlusal wear. They are mostly based on the amount of exposed dentine and it is difficult to distinguish between the first stages of enamel wear (D’Incau et al. 2012). The main problem with all these classifications is that different populations from different sites and different periods cannot be compared directly (Belmont 2006, D’Incau et al. 2012). Although some methods have been used more frequently than others in the literature (Murphy, Brothwell, Scott, Smith, Brabant), there is not actually a truly “consensual” scoring system for tooth wear in anthropology (Bartlett & Dugmore 2008, Van’t Spijker et al. 2009, Roberts 2010) (Table 2).
Quantity and direction of tooth wear The degree of wear observed on teeth varies among medieval populations. For many authors, the quantity of tooth wear most frequently found in the Middle Ages is partial wear of dentine (Fig. 1) (Twiesselman & Brabant 1960, Brabant 1962, Varrela 1991, Herrscher 2001, Djuric-Srejic 2001, Aubry 2003, Caglar et al. 2007, Esclassan et al. 2009). The most worn tooth is the first molar (M1), both in the maxilla and in the mandible. There is a decreasing gradient of tooth wear from the first to the third molar (M3) (Slaus et al. 1997, Djuric-Srejic 2001, Hillson 2003, Aubry 2003, D’Incau et al.
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Renaix (Belgium)
Plague Pits (England)
Turku (Finland)
XI–XIIth C.
XVIth C.
XV–XVIth C.
XIV–XVIIth C. Nova Raca (Croatia)
Brabant (1960)
Lavelle (1970)
Varrela (1990)
Slaus et al. (1997)
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XI–XVth C.
Aubry (2003)
Chazel (2005)
Meinl et al. (2009)
IX C.
Avar (Austria)
Vilarnau d’Amont (France)
IX–XVth C.
th
Iznik (Turkey)
XIII C.
Caglar et al. (2007)
Esclassan et al. (2009)
th
XII –XIV C.
Tyrup (Denmark)
Saint-Pierre de l’Almanarre (France)
Notre Dame du Bourg (France)
XI–XIVth C.
Ganss (2002)
Boldsen (2005)
Griesheim and Sindelsdorf (Germany)
V–IXth C.
Herscher (2001)
th
Saint-Laurent (Grenoble, France)
XIII–XVth C.
Djuric-Srejic (2001)
th
Chevilly-Larue (France)
Valjevo (Serbia)
IX–XVII C.
XIV–XVth C.
Hadjouis (1999)
th
Population (origin)
Medieval period
Author/ (year of publication)
Table 1. Synthesis of different studies about tooth wear in medieval populations
136
58
52
149
77
194
102
252
105
422
68
410
178
159
Adult sample
2215
1395
280
Not precised
1183
3154
Not precised
1614
1680
Not precised
Not precised
4581
3564
2613
Number of teeth
Not precised
Brabant (Broca modified) (5)
Brabant (Broca modified) (5)
Murphy (9)
Brabant (Broca modified) (5)
Aubry (Brabant modified) (5)
Molnar modified (5)
Bouville (Brothwell modified) (6)
Lavelle (5)
P´erier (6)
Smith (8)
Carlsson (Brabant modified) (5)
Davies et Pedersen modified (5)
Brabant (Broca modified) (5)
Scoring system (Number of wear levels)
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Table 2. Anthropological scoring methods for tooth wear. Method (year) Broca (1879) Perier (1949) Murphy (1959) Brabant (1962) Scott (1979) Molnar (1981) Brothwell (1981)
Number of levels 4 5 9 5 10 8 7
2012) (Fig. 2). For Brabant, the first molars wear faster and more intensely than other teeth and have a higher prevalence of caries because of the tooth eruption chronology and because of the thinner enamel of M1 compared to M2 and M3. Schwartz (2000) tried to highlight a gradient in enamel thickness that might predispose to helicoidal wear, making this a structural aspect of the oro-facial skeleton of the Homo genus. Such a gradient has never been shown for upper molars (Spears & Macho1998). In the mandible, this gradient is considered as more limited. This difference between mandibular and maxillary molars could be explained by the different enamel distribution on the surface of the cusps and by the age of eruption. Wear is quite similar in premolars and molars, and incisor wear increases once the enamel has disappeared (Miles 1962). For De Bonis & Viriot (2002), the more severe tooth wear of M1 compared with M2 and M2 compared with M3 can be explained by the eruption periods. These intervals are on average 6.1 years between M1 and M2 and 7.5 years between M2 and M3. Taylor (1963) has tried to explain the faster wear of M1 during chewing.
Fig. 1. Heavy occlusal wear on a medieval maxilla (Vilarnau d’Amont’s collection).
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Fig. 2. Decreasing gradient of tooth wear, from the first molar to the third one. Note the scooping of the dentine and the way buccal cusps of the molars are wearing faster (Vilarnau d’Amont’s collection)
The direction of wear has not been extensively studied in the literature. According to Brabant (1962), the most frequent tooth wear direction in the Middle Ages was helicoidal (Fig. 3). He considered this wear direction to be the result of “slow mastication with a coarse diet, resistant to grinding”. On a medieval sample from Vilarnau (Esclassan et al. 2009), the most frequent direction was oblique and plane in men and horizontal and plane in women.
Differences between men and women Few studies have tried to assess gender differences in tooth wear during the medieval period. Within the medieval sample from Vilarnau (Esclassan et al. 2009), no differences were noted, but the sample was too small to be significant. Slaus (1997), Herrscher (2001) and Aubry (2003) found that tooth wear was greater in males than females in their sample and they linked this to a difference in diet. In a Croatian population dating from between the 16th and 17th centuries, Slaus (1997) reports that “males exhibited significantly more occlusal wear than females”). Aubry (2003) studied two medieval samples representing different social classes: male peasants and nuns. These results indicate less pronounced wear among the nuns. It is suggested that this difference may be explained by a different diet and less efficient chewing among the nuns. Herrscher (2001) also suggested that men had a more abrasive diet.
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Fig. 3. Helicoidal wear direction on medieval lower molars (Vilarnau d’Amont’s collection)
Otherwise, there is no significant difference (Lysell 1953, Brabant 1973b, Lunt 1978).
Difference in wear between maxilla and mandible Here again, there is no consensus (Lavelle 1970, Li & Ji 1995). A study of paired jaws from the Vilarnau sample did not show any wear difference between the maxillary and the mandibular teeth. Other studies have shown greater wear on the mandible (Aubry 2003, Molnar & McKee 1983) or on the maxilla (Mayti´e 1976, Herrscher 2001). For Mayti´e (1976) tooth wear generally predominates on the maxilla because it suffers more from the chewing effect of the teeth, like “an anvil relative to the hammer”. On more ancient material (prehistoric), Molnar (1971) explained differences between maxilla and mandible by “the variation in structural support for each tooth row”.
Relations between tooth wear and medieval diet Food was the main cause of tooth wear in ancient populations (Alt & Rossbach 2009, D’Incau et al. 2012). In the Middle Ages, food certainly contained many abrasive elements. The Middle Ages was a period with many food shortages, which were accentuated by the differences between the rich and the poor. There were “medical recommendations” adapted to each social category (Laurioux 2002). Respectful of the “world order”, medical doctors estimated that it was necessary for the peasants to eat more vegetables and bread (Aubry 2003). Vegetables and bread were very abrasive,
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much more than the meat usually eaten by the rich. The high abrasion of the food bolus of the peasants depended on many factors, such as mineral particles from the querns, a diet rich in fibrous plants or the presence of plants rich in phytoliths (Hillson 1979, Gügel et al. 2001, Boldsen 2005, D’Incau et al. 2004, D’Incau et al. 2012). Incompletely washed plants, roots and vegetables were certainly responsible for considerable tooth wear. Bread was the most widely consumed food during the Middle Ages (up to one kilogram a day) (Laurioux 2002) and could represent up to 70 % of the total diet for the peasants (Marinval 2008). It was surely implicated in the tooth wear of medieval populations, especially peasants. Belmont (2006) explains in his book “La Pierre a` pain” (“The bread stone”) that the stone particles eroded from millstones that were not enough compact fell into the flour and became mixed into the bread. Only meticulous sifting could eliminate the splinters of stone but this was possible only for “prestigious customers”, such as clerics, the wealthy urban middle class or aristocrats. The rural population had to deal with rudely sieved flour and the large quantities of gravel it contained. Their daily intake of bread full of gravel meant that medieval peasants wore their teeth very rapidly and could easily break them on a bigger chunk of stone. In the Middle Ages, tooth wear varied according to the regions concerned. Salvage excavations carried out in Chevilly-Larrue revealed skeletons with only 20 % of very worn teeth. For Hadjouis (1999), this better “oral health” could have come from a diet rich in milk, meat and softer nutrients and a better quality of millstones. By the beginning of the 11th century, mills in the Paris region were equipped with good quality millstones with a high silica content that did not pollute the flour with gravel. Other works have suggested that differences could exist depending on the geography and social inequalities. Aubry (2003) noticed that peasants’ teeth were more worn than those of nuns because of a differentiated diet: nuns ate wheat bread while the peasants’ bread was made from barley. The differences in tooth wear reveal the socio-economic and diet hierarchy described by the physicians and agronomists of the 15th century (Belmont 2006). Subsequently, according to social categories and geographic particularities, tooth wear progressively decreased. A radical improvement occurred between the Middle Ages and the 17th century (Maat & Van der Velde 1987). The authors attributed this modification to a change in food consistency as flour became more refined. Kerr (1988) suggested that food habits were the main causes of severe tooth wear among British medieval populations. The British food economy was almost entirely rural until the 17th century. Poultry (turkeys, geese, and pigeons) made up a large part of the diet and the medieval British liked to suck or crunch the little bones to retrieve the bone marrow. For Kaifu (2003), molar tooth wear started to decrease only after the Middle Ages. In a medieval sample, tooth wear was equivalent to that of prehistoric farmers and the decrease in molar tooth wear is attributed to changes in culinary practices and in food products, especially with the generalization of the fork. In France, the fork appeared in 1574 at the royal court and was used only for eating cooked pears (Laurioux 2002). First introduced by Catherine de Medicis, it was only at the beginning of the 17th century that it progressively spread to the whole population, with four prongs instead of two. Prehistoric farmers ate with their hands and mostly used their front teeth but the use of a fork made it possible to put food further back in the mouth.
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Caries-attrition competition In the Middle Ages, modern oral hygiene was unknown and tooth wear may have provided a kind of “tooth protection” (Kerr 1998, Esclassan et al. 2009). Major tooth wear was assumed to prevent caries development and eliminate plaque (Kaifu 2003, Maat & Van der Velde 1987). Coarse food could eliminate plaque from the stagnation areas such as fissures and pits (Moore & Corbett 1973). Aubry (2003) has shown that the frequency of occlusal caries decreased with age and tooth wear. Furthermore, a coarse diet requires vigorous chewing that stimulates the flow of saliva, the buffer capacity of which reduces caries frequency. Similarly, it has been suggested that plaque accumulation appears to be greater in individuals with limited tooth wear than in individuals with serious tooth wear (Ainamo 1972, Newman 1974, Newman 1990). However, tooth wear alone is not sufficient to protect against caries. Caries exist even in populations with major tooth wear if they have a diet rich in carbohydrates (Larsen 1997).
Relations between tooth wear and dental crowding Observations of medieval mandibles suggest a low frequency of dental crowding (Brabant 1962) (Fig. 4). Third molars are frequently present and there is a small proportion of inclusion, malpositions or tooth-jaw disharmony. For Begg (1954), a dental arch with worn teeth does not present crowded teeth. In contrast, he estimated that many malocclusions occur when tooth wear is not strong enough. Begg supposed that a human mandible was programmed to grow with a “project” of tooth reduction due to wear, so its length is initially programmed to be smaller than the total sum of all the teeth when they are not worn. The Begg model does not completely explain the severe overlap case found in contemporary humans. His theory has been called into question by many authors (Hunt 1961, Corruccini 1990, Proffit & Fields 1993). They suggested that the modification of environmental factors (disappearance of nutritive sucking, diminution of chewing function, increase of breathing through the mouth) could entail reduced development of the maxilla, with dental crowding, especially of the front teeth. A recent paper by Rando et al. (2013) showed that medieval skulls were somewhat larger overall, relative to modern ones, with generally larger mandibles, wider dental arches, more prominent faces, and greater posterior facial height. Other authors confirm the fact that both maxilla and mandible are of more robust form in earlier populations (Goose 1962, Moore 1973). Because of better nutrition and better prenatal conditions (absence of stress, malnutrition and illness) modern tooth crowns are larger than those of the Middle Ages (Walker 1981, Lindsten 2002). However, the decrease in tooth wear seems to have increased third molar impaction (Odusanya & Abayomi 1991, Rajasuo et al. 1993, Beeman 1999). In very worn dentitions, the arch length from the second molar decreases rapidly because of mesial drift. When heavy interproximal wear accompanies this drift, the length of the dental arches decreases significantly. This link has been repeatedly demonstrated and quantified in past populations and, according to “Begg’s ‘‘attritional occlusion’’ model, absence of wear is responsible for the gradual development of malocclusions in present-day populations” (D’Incau et al. 2012).
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Fig. 4. a and b: Adult medieval lower mandibles with important occlusal and interproximal wear (Vilarnau d’Amont’s collection). Note the absence of crowding.
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Also, the growing frequency of dental crowding and third molar impaction or noneruption may be connected with a diet of soft foods. While several authors share these views, others are less sure and believe that the lack of space responsible for malocclusions is due to a reduction in masticatory strength, leading in turn, by mechanomorphosis, to a reduction in the basal bone of the arches. The larger size of teeth that are not worn would have no influence (D’Incau et al. 2012).
Age In anthropology, tooth wear is also considered as an ‘age-related’ phenomenon (Hilsson, 2003, Dawson 2013) and the analysis of rates of dental wear on permanent dentition has been used for many years as a way of assessing the age of adult skeletons (Murphy 1959, Miles 1963, Scott 1979, Brothwell 1981). For Hillson (2003), the most widely used systems for determining age from tooth wear are those of Miles (1963) and Brothwell (1963). They show the range of dentine exposure on the occlusal surfaces of permanent molars. Mays (2002) wrote that “the high rates of dental wear characteristic of most palaepopulations suggest that it should be a useful method of adult age estimation in archaeological groups” and estimation based on mandibular molars should be preferable, despite the inconsistency of the literature. In all past populations including those of the medieval period, tooth wear began in childhood (D’Incau 2014). For Kaidonis (2008), “it is well established that abrasion has a linear association with age”. However, the amount of tooth wear among children during the medieval period has not been much studied and no standard charts exist in the literature for recording wear on deciduous teeth (Dawson & Robson Brown 2013). No published research seems to have been carried out to explore the link between diet and status of children during the medieval period. Once a tooth has erupted and is in occlusion, the processes of wear will start. Small facets appear on the tooth enamel as the cusp tips are worn (Fig. 5). Once the cusps have flattened, the enamel of the tooth begins to wear, exposing the dentine underneath (Dawson 2013). This process of enamel wear continues over time until all the enamel of the tooth is worn away.
Summary and conclusion Finally, the main points concerning tooth wear in medieval populations are the followings: 앫 Tooth wear was very marked among medieval populations but started to become reduced in the 17th century because of refined food and the generalization of the use of forks. 앫 Tooth wear had a dietary origin and increased with age. 앫 It started at an early stage, and was intense and generalized. 앫 There were no significant differences between the genders even though it seems that males had more severe tooth wear. 앫 The Middle Ages was the last historic period linked to noteworthy tooth wear concerning the entire population.
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Fig. 5. Heavy tooth wear on a medieval child mandible’s teeth (Vilarnau d’Amont’s collection).
Studies of tooth wear in the Middle Ages provide evidence that it was rapid, intensive, and generalized, rapidly reaching levels no longer observed in modern populations with an industrialized way of life, even in older people, irrespective of any pathologic considerations.
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Submitted: 03 January 2014; accepted: 08 April 2014. Address for correspondence: R´emi Esclassan, Facult´e de chirurgie dentaire de Toulouse, 03 chemin des Maraˆıchers, 31 062 Toulouse cedex 09, France Laboratoire AMIS UMR 5288 CNRS, Universit´e Paul Sabatier, 118, route de Narbonne, 31 062 Toulouse Cedex [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]
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