AhfERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 83:69-76 (1990)
Caries Experience in Mediaeval Scots N. W. m R R , M. F. BRUCE, AND J. F. CROSS Department of Dental Surgery, Aberdeen Royal Infirmary, Aberdeen, Scotland A B 9 2ZB (N.W.K.); Department of Anatomy, University of Aberdeen, Aberdeen, Scotland AB9 1 A S (M.F.B., J.F.C.)
KEY WORDS distribution.
Mediaeval Scots, Dental caries, Prevalence and
ABSTRACT Dental caries prevalence, distribution, and site of attack was investigated in a Scottish Mediaeval population. The findings supported previous reports, which suggested that caries prevalence in Scotland was lower than in contemporaneous English populations. Attrition of the occlusal surface of the teeth with accompanying alteration of the anatomy of the interproximal space is suggested as the principal reason for the differences in the pattern of distribution of caries between this and modern populations. In a recent study of a Late Mediaeval population from Aberdeen on the northeast coast of Scotland, Kerr et al. (1988) observed that caries experience in that population differed in a number of respects from that reported in contemporaneous PO ulations in England and Sweden (Tattersal ,1968; Olsson and Sa e, 1976) but was broadly comparable to t$e only previous studies on Scottish historic dentitions (Lunt, 1972, 1974, 1986). In particular, the caries revalence in Scotland was less than in t ese other studies. Recently, the opportunity arose to investigate these differences further with the recovery of a substantial number of human skeletons from a rescue archaeological excavation at Linlithgow, near Edinburgh. Like the Aberdeen series referred to above, these remains were associated with the site of a Carmelite Friary. In both cases it appears that the general population of the town is represented, since individuals from all age groups and from both sexes were identified. This investivation was instituted to establish the prevalence and pattern of distribution by site and by age of carious lesions in this Mediaeval Scottish population.
P
R
MATERIALS AND METHODS
The remains of more than 150 individuals were recovered. However, some of the skeletons were incomplete and fragmentary with no dentitions present. Individuals with extensively damaged dentitions (e.g., chipped enamel or dentine that was disintegrating)
0 1990 WILEY-LISS, INC.
were excluded. There remained for inclusion in the stud dentitions representing 101 individuals. he associated skeletal material varied from almost complete skeletons with sufficient pelvic or cranial material for reliable determination of sex to isolated jaws with no accompanying skeletal remains. Sex determination Because of the number (27) of immature individuals (where sex determination is unreliable) and because of the number of incomplete or fragmentar associated skeletons, no attempt was ma e to distinguish the sexes for this study. Age at death determination This was based on a number of methods (Cross and Bruce, 1989). In immature individuals, dental development phases and eruption times were used (Ubelaker, 1978); in adults, both skeletal age indicators (Ubelaker, 1978) and molar occlusal wear (Miles, 1962; Scott, 1979) were used. Four broad age categories were used. These probably correspond to the age ranges given in parentheses. The age categories were as follows: child (6-15) years, subadult (16-25) years, adult (26-35)years, and mature adult (36-45 + ) years. Diagnostic criteria The resence of a carious lesion was assessed y naked eye and the use of a dental
.3:
B
E
Received March 21,1989; accepted November 30,1989
70
N.W. KERR ET AL
diagnostic probe. A lesion was considered to be present only if there was an obvious carious defect in the integrity of the enamel or of the root surface. In the case of so-called “sticky fissures,” the same criteria applied and they were excluded unless there was a necrotic carious lesion detectable by naked eye inspection. All caries recording was carried out by one observer (NWK). To check intraobserver reliability the material was re-examined after an interval of several weeks. Standard dental radiographs of the mandibular molars and premolars were taken to determine whether any carious lesions were missed using the above criteria. Location of lesions Carious lesions were noted and recorded as present in one of the categories listed below, according to tooth surface and location, following Moore and Corbett (1971): occlusal surface [(l)fissure, (2) cuspal, (3) gross: too large for the initial site to be decided with certainty]; approximal surface “4) contact point, (5) at or near the cementoenamel junction, (6) gross: initial site uncertain]; buccal, lingual surfaces [(7)confined to the enamel surface, ( 8 ) at or near the cemento-enamel junction, (9)gross: initial site uncertain]. Where a gross cavity extended onto more than one surface, a lesion was scored for each surface. Two or more cavities on one surface were scored as one affected surface; however, the number of separate carious lesions per tooth was also recorded. A carious tooth was considered to be a tooth with one or more carious cavities. Teeth missing ante- and postmortem were also recorded. Where there was doubt as to which type of loss had occurred, it was recorded as antemortem loss. Caries prevalence Caries prevalence was expressed as the prevalence of caries in individual tooth types
and as the percentage of individuals with carious lesions. RESULTS
Age profile of the skeletal series The age profile of the skeletal series is shown in Table 1. Intraobserver re1ia bil ity There was no difference in the number of carious lesions noted on the first and subsequent analysis. Radiographic examination confirmed that no lesions had been missed on visual examination. Antemortem and postmortem tooth loss Table 1 shows the number of teeth available for examination (n = 1,869) with the numbers lost antemortem (153) and postmortem (212). Antemortem loss increased from nil in the younger age group to 15.9%in the oldest age group. Postmortem loss was broad1 similar in all age groups (&lo%). Overa 1, postmortem tooth loss (9.5%) was slightly greater than overall antemortem loss (6.8%). Single rooted incisors and canines made up almost two thirds (63%)of all teeth lost postmortem. Caries experience Related to individuals. Almost 45% of all individuals exhibited one or more carious lesions (Table 2). While only 15% of the youngest age group had caries, 41% of the subadult and almost 60% of the adults and mature adults were affected. Related to teeth. The prevalence of carious teeth was expressed as a percentage of all teeth available for examination; 2 4 of all teeth in the youngest age group were affected compared with almost 11%of teeth in the adult group (Table 3). Overall, 7.4% of teeth were carious. Related to individual tooth type. No carious lesions were found in the incisors or
f
TABLE 1. Teeth Present, Teeth Lost Anti- and Postmortem.’ Age
eroun
6-15 16-25 26-35 36-45+
Total
No. of individuals
Teeth orescn t
Teeth present t AM t-PM loss
Antemortem loss
Postmortem loss
27 11 36 21 __ 101
255 411 836 367 _____ 1,869
279 453 1,008 497 __.2,237
Nil 3 (0.7%1) 74 (7.3%) 79 (15.9%) lr;6 (7.0%)
24 (8.6%) 39 (8.6%) 98 (9.7%)) 51 -(10.3‘XI) 212 (9.
Caries Experience in Mediaeval Scots N. W. m R R , M. F. BRUCE, AND J. F. CROSS Department of Dental Surgery, Aberdeen Royal Infirmary, Aberdeen, Scotland A B 9 2ZB (N.W.K.); Department of Anatomy, University of Aberdeen, Aberdeen, Scotland AB9 1 A S (M.F.B., J.F.C.)
KEY WORDS distribution.
Mediaeval Scots, Dental caries, Prevalence and
ABSTRACT Dental caries prevalence, distribution, and site of attack was investigated in a Scottish Mediaeval population. The findings supported previous reports, which suggested that caries prevalence in Scotland was lower than in contemporaneous English populations. Attrition of the occlusal surface of the teeth with accompanying alteration of the anatomy of the interproximal space is suggested as the principal reason for the differences in the pattern of distribution of caries between this and modern populations. In a recent study of a Late Mediaeval population from Aberdeen on the northeast coast of Scotland, Kerr et al. (1988) observed that caries experience in that population differed in a number of respects from that reported in contemporaneous PO ulations in England and Sweden (Tattersal ,1968; Olsson and Sa e, 1976) but was broadly comparable to t$e only previous studies on Scottish historic dentitions (Lunt, 1972, 1974, 1986). In particular, the caries revalence in Scotland was less than in t ese other studies. Recently, the opportunity arose to investigate these differences further with the recovery of a substantial number of human skeletons from a rescue archaeological excavation at Linlithgow, near Edinburgh. Like the Aberdeen series referred to above, these remains were associated with the site of a Carmelite Friary. In both cases it appears that the general population of the town is represented, since individuals from all age groups and from both sexes were identified. This investivation was instituted to establish the prevalence and pattern of distribution by site and by age of carious lesions in this Mediaeval Scottish population.
P
R
MATERIALS AND METHODS
The remains of more than 150 individuals were recovered. However, some of the skeletons were incomplete and fragmentary with no dentitions present. Individuals with extensively damaged dentitions (e.g., chipped enamel or dentine that was disintegrating)
0 1990 WILEY-LISS, INC.
were excluded. There remained for inclusion in the stud dentitions representing 101 individuals. he associated skeletal material varied from almost complete skeletons with sufficient pelvic or cranial material for reliable determination of sex to isolated jaws with no accompanying skeletal remains. Sex determination Because of the number (27) of immature individuals (where sex determination is unreliable) and because of the number of incomplete or fragmentar associated skeletons, no attempt was ma e to distinguish the sexes for this study. Age at death determination This was based on a number of methods (Cross and Bruce, 1989). In immature individuals, dental development phases and eruption times were used (Ubelaker, 1978); in adults, both skeletal age indicators (Ubelaker, 1978) and molar occlusal wear (Miles, 1962; Scott, 1979) were used. Four broad age categories were used. These probably correspond to the age ranges given in parentheses. The age categories were as follows: child (6-15) years, subadult (16-25) years, adult (26-35)years, and mature adult (36-45 + ) years. Diagnostic criteria The resence of a carious lesion was assessed y naked eye and the use of a dental
.3:
B
E
Received March 21,1989; accepted November 30,1989
70
N.W. KERR ET AL
diagnostic probe. A lesion was considered to be present only if there was an obvious carious defect in the integrity of the enamel or of the root surface. In the case of so-called “sticky fissures,” the same criteria applied and they were excluded unless there was a necrotic carious lesion detectable by naked eye inspection. All caries recording was carried out by one observer (NWK). To check intraobserver reliability the material was re-examined after an interval of several weeks. Standard dental radiographs of the mandibular molars and premolars were taken to determine whether any carious lesions were missed using the above criteria. Location of lesions Carious lesions were noted and recorded as present in one of the categories listed below, according to tooth surface and location, following Moore and Corbett (1971): occlusal surface [(l)fissure, (2) cuspal, (3) gross: too large for the initial site to be decided with certainty]; approximal surface “4) contact point, (5) at or near the cementoenamel junction, (6) gross: initial site uncertain]; buccal, lingual surfaces [(7)confined to the enamel surface, ( 8 ) at or near the cemento-enamel junction, (9)gross: initial site uncertain]. Where a gross cavity extended onto more than one surface, a lesion was scored for each surface. Two or more cavities on one surface were scored as one affected surface; however, the number of separate carious lesions per tooth was also recorded. A carious tooth was considered to be a tooth with one or more carious cavities. Teeth missing ante- and postmortem were also recorded. Where there was doubt as to which type of loss had occurred, it was recorded as antemortem loss. Caries prevalence Caries prevalence was expressed as the prevalence of caries in individual tooth types
and as the percentage of individuals with carious lesions. RESULTS
Age profile of the skeletal series The age profile of the skeletal series is shown in Table 1. Intraobserver re1ia bil ity There was no difference in the number of carious lesions noted on the first and subsequent analysis. Radiographic examination confirmed that no lesions had been missed on visual examination. Antemortem and postmortem tooth loss Table 1 shows the number of teeth available for examination (n = 1,869) with the numbers lost antemortem (153) and postmortem (212). Antemortem loss increased from nil in the younger age group to 15.9%in the oldest age group. Postmortem loss was broad1 similar in all age groups (&lo%). Overa 1, postmortem tooth loss (9.5%) was slightly greater than overall antemortem loss (6.8%). Single rooted incisors and canines made up almost two thirds (63%)of all teeth lost postmortem. Caries experience Related to individuals. Almost 45% of all individuals exhibited one or more carious lesions (Table 2). While only 15% of the youngest age group had caries, 41% of the subadult and almost 60% of the adults and mature adults were affected. Related to teeth. The prevalence of carious teeth was expressed as a percentage of all teeth available for examination; 2 4 of all teeth in the youngest age group were affected compared with almost 11%of teeth in the adult group (Table 3). Overall, 7.4% of teeth were carious. Related to individual tooth type. No carious lesions were found in the incisors or
f
TABLE 1. Teeth Present, Teeth Lost Anti- and Postmortem.’ Age
eroun
6-15 16-25 26-35 36-45+
Total
No. of individuals
Teeth orescn t
Teeth present t AM t-PM loss
Antemortem loss
Postmortem loss
27 11 36 21 __ 101
255 411 836 367 _____ 1,869
279 453 1,008 497 __.2,237
Nil 3 (0.7%1) 74 (7.3%) 79 (15.9%) lr;6 (7.0%)
24 (8.6%) 39 (8.6%) 98 (9.7%)) 51 -(10.3‘XI) 212 (9.
