archives of oral biology 59 (2014) 1279–1300
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A comparison of female and male oral health in skeletal populations from late Roman Britain: Implications for diet L. Bonsall * University of Edinburgh, School of History, Classics and Archaeology, William Robertson Wing, Old Medical School, Teviot Place, Edinburgh, Mid Lothian EH8 9AG, United Kingdom
article info
abstract
Article history:
Objectives: Textual sources from the Roman period point to the existence of dietary differ-
Accepted 25 July 2014
ences between the sexes. The aim of this study was to assess the palaeopathological
Keywords:
the oral health of sexed individuals from two late Romano-British sites (Ancaster, Lincoln-
evidence for such gender differences in dietary habits in Roman Britain by comparing Dento-alveolar pathology
shire, and Winchester, Hampshire, England).
Diet
Materials and methods: Eighty-seven females (1243 teeth and 1950 sockets) and 112 males
Sex
(1984 teeth and 2903 sockets) were examined for the presence of five dento-alveolar condi-
Gender
tions, namely caries, calculus, periapical lesions, periodontal disease, and antemortem tooth
Roman Britain
loss. The frequency of each condition was calculated at the per individual and per tooth/socket level, and the results were compared between the sexes using Fisher’s exact tests. Results: Caries and antemortem tooth loss were slightly more common among women, but differences between the sexes were generally not significant. Males experienced higher rates of calculus and periodontal disease. There were no sex differences in the frequency of periapical lesions. Conclusions: Comparable rates of caries, periapical lesions and antemortem tooth loss in females and males indicate broad similarity in the diets of men and women. The greater levels of calculus and periodontal disease in males might point to some dietary differences, but could also be explained by non-dietary factors. Overall, the findings suggest that significant gender differences in diet, described in some contemporaneous textual sources, were not widely observed in Roman Britain. # 2014 Elsevier Ltd. All rights reserved.
1.
Introduction
Archaeologists have long been interested in studying ancient diets. At the broad scale, dietary habits are influenced by environmental and technological constraints, and palaeodietary studies provide insights into human–environment
interactions and socio-economic structures in the past.1–3 Many additional factors affect dietary choices at the withingroup level, including gender, class/status, ethnic affiliation and religious beliefs; thus, the study of ancient diets can also elucidate cultural dynamics.4,5 In relation to gender, many archaeological studies have examined dietary variations between the sexes as a means of
* Correspondence to: 10 Merchiston Gardens, Edinburgh EH10 5DD, Scotland, UK. Tel.: +44 131 346 2119. E-mail addresses: [email protected], [email protected]. http://dx.doi.org/10.1016/j.archoralbio.2014.07.019 0003–9969/# 2014 Elsevier Ltd. All rights reserved.
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exploring the roles and status of men and women in past societies. Studies of contemporary and recent historic populations have documented male-female dietary differences in both hunter-gatherer and agricultural societies, often reflecting gender divisions in labour and food procurement activities, and social status.6–8 Various archaeological and bioarchaeological studies have explored whether such differences existed in the past.9–12 In Roman society, biological sex, gender and status were closely intertwined. Literary, epigraphic and iconographic sources document the existence of pronounced differences in the socio-economic and legal status of men and women in the Roman world.13–16 Some texts from the period suggest the differing positions of men and women in Roman society could influence diet; in particular, it seems that men sometimes enjoyed greater access to ‘high status’ foodstuffs, particularly meat, fish and other marine sources. In addition, medical writers such as Galen advised men and women to consume different foods based on their views of variations between the sexes in energy and nutritional requirements, and erroneous beliefs about the impact of food on behaviour.17–18 In recent years, several palaeopathology and stable isotope studies of populations from Roman Italy have provided some corroborative evidence for dietary differences between the sexes such as those described in the aforementioned texts, and this could have had implications for health and nutrition.19–22 However, the Roman Empire was not necessarily homogenous in this respect, and gendered differences in diet might not have existed in all provinces. In the case of Roman Britain, relatively little is known about the existence or otherwise of gender-based dietary variations between the sexes. Very few relevant textual sources for the dietary habits of the general populace survive from this region of the Empire, and the extent to which the norms and ideals of medical writers regarding gender and diet were disseminated more widely is difficult to assess. Archaeological and palaeoenvironmental evidence document changes in subsistence practices and dietary habits in Britain following its incorporation into the Roman Empire, which included agricultural intensification, increased exploitation of fish and other marine resources, and greater consumption of ‘exotic’ imported foodstuffs.23–26 Research on Romano-British food-ways has increasingly emphasised the cultural, as well as economic and technological, significance of these changes,27–29 and it is possible that the ‘Romanisation’ of dietary habits included differences between the sexes, reflecting men and women’s changing roles and statuses.30,31 Most carbon (C) and nitrogen (N) isotope analyses of Romano-British populations have not observed statistically significant differences between the sexes.32–37 However, it should be noted that the majority of isotope studies considered bone collagen isotope ratios only, which reflect dietary protein rather than whole diet (as do bone apatite values).38 Additionally, C and N isotopes are only sensitive to quite significant differences in diet.35 This study explores whether gendered differences in dietary habits, such as those described in some Roman textual sources, existed in Roman Britain by comparing the oral health status of sexed individuals from late Romano-British cemeteries. While several studies of oral health in populations from this period exist,39–45 few have explicitly focused in detail on
male-female differences. The teeth and associated structures are directly exposed to foods consumed by an individual, and diet therefore influences oral health. The study of dentoalveolar pathology can provide important information on past dietary habits, especially since the teeth tend to survive relatively well in archaeological contexts.46,47 Numerous bioarchaeological studies have examined common dentoalveolar diseases as proxy indicators of past diets,48–67 and differences in oral health between the sexes have been interpreted with reference to diet.48,49,51,52,54,64,66,67
2.
Materials and methods
The materials used for the present study were examined during the author’s doctoral research, and derive from two RomanoBritish cemeteries in England – Ancaster, Lincolnshire, and Winchester, Hampshire (Fig. 1). Both assemblages predominantly date from the late Roman period (c. AD 270-410). The Roman settlement at Ancaster was a small, fortified site straddling Ermine Street, the main north-south road crossing the province. The associated cemetery was excavated between 1964 and 1973, during which the remains of over 250 individuals were recovered.68–70 Archaeological evidence suggests that the settlement’s economy was centred on a combination of small-scale trade and craft production, including potting and possibly stone masonry, as well as agriculture. There is little evidence for higher-order economic activities such as trade in luxury goods or mosaic production, which implies that the settlement at Ancaster served a primarily local, non-elite market.71–73 Evidence from the cemetery also points to a predominantly low-status population; while some individuals were interred in stone sarcophagi, signalling higher status, most graves were simple, unfurnished inhumations. The Ancaster population has not been subjected to stable isotope analyses to explore levels of mobility, but data from a site of comparable status (Catterick, North Yorkshire) suggest the populations of such sites were drawn almost entirely from the local area.74 Winchester (Venta Belgarum) was the fifth largest town of Roman Britain, and one of the main economic and administrative centres of the province’s south-central region.75 There is evidence for a wide range of commercial and craft activities at Winchester, typical of the major urban centres, including metal production, specialist butchering, bone working, and possibly weaving.76,77 Most of the inhabitants were probably traders and craftsmen72,78 although the discovery of large, well-appointed town houses points to the presence of higher status residents – perhaps members of the town’s ruling elite.79 Strontium and oxygen isotope analyses of individuals from Winchester and other major Romano-British urban centres suggest that a significant minority of people – up to c. 25% – residing in large towns were of non-local origin, and this almost certainly included individuals from the Mediterranean region and further afield.80–82 Extensive extramural inhumation cemeteries existed outside the town walls of Roman Winchester. Since the mid-twentieth century, rescue excavations carried out in advance of development have resulted in the discovery of around one thousand Roman burials (primarily unfurnished inhumations dating from the
archives of oral biology 59 (2014) 1279–1300
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Fig. 1 – Outline map of Britain (England and Wales), showing the locations of the study sites. Reproduced from Ordnance Survey map data by permission of Ordnance Survey# Crown copyright 2013.
third to early fifth century AD) at numerous sites in the modern city. Skeletal material included in this analysis derive from six sites (Andover Road, Hyde Street, Victoria Road, Chester Road, Carfax and New Road).83 For the present study, only individuals with intact or partially intact dentitions (at least one surviving tooth/socket) for whom sex could be determined with a relatively high degree of accuracy were considered. Thus, juveniles (defined as individuals aged less than c. 18 years) were excluded, since immature individuals cannot be sexed reliably using commonly applied morphological and metric methods.84 In accordance with recommended standards for British skeletal populations, sex was determined from pelvis and skull morphology, and postcranial metrics.85–89 Without the widespread application of ancient DNA analysis, an error margin exists when sexing skeletal remains from morphological and metric features. However, the pelvis is widely considered to
provide a relatively reliable indicator of sex (in excess of 90% accuracy).90,91 Consequently, only individuals with intact innominate bones that indicated female or male sex were included in this study. Age-at-death was estimated from pubic symphysis and auricular surface morphology, molar attrition, and skeletal maturation.92–96 Individuals were assigned to one of the following age categories: young adult (18–34 years), mature adult (35–49 years), elderly adult (50+ years) and unaged adult (18 years). The final sample comprised 87 females (46 from Ancaster and 41 from Winchester) and 112 males (66 from Ancaster and 46 from Winchester). The demographic composition of the study sample (individuals, teeth, and sockets) is summarised in Tables 1 and 2. For the combined Ancaster and Winchester sample, the age distribution of males and females across the young, mature and elderly adult age categories was not significantly different (x2 = 3.504, df = 2, p = 0.173).
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Table 1 – Composition of the study sample by sex and age. Age (years)
F (N, %) Ancaster
M (N, %)
Winchester
Number of individuals with at least one surviving tooth/socket 18–34 20 (43.5) 21 (51.2) 12 (26.1) 5 (12.2) 35–49 50+ 10 (21.7) 11 (26.8) 4 (8.7) 4 (9.8) Unaged 46 (100.0) 41 (100.0) Total
Total F
Ancaster
Winchester
Total M
a
41 17 21 8 87
(47.1) (19.5) (24.1) (9.2) (100.0)
26 22 15 3 66
(39.4) (33.3) (22.7) (4.5) (100.0)
18 14 13 1 46
(39.1) (30.4) (28.3) (2.2) (100.0)
44 36 28 4 112
(39.3) (32.1) (25.0) (3.6) (100.0)
Number of individuals with at least sixteen surviving teeth and socketsa 18–34 13 (81.3) 15 (88.2) 28 (84.8) 2 (12.5) 1 (5.9) 3 (9.1) 35–49 0 (0.0) 1 (5.9) 1 (3.0) 50+ 1 (6.3) 0 (0.0) 1 (3.0) Unaged 16 (100.0) 17 (100.0) 33 (100.0) Total
16 10 2 1 29
(55.2) (34.5) (6.9) (3.4) (100.0)
16 9 4 1 30
(53.3) (30.0) (13.3) (3.3) (100.0)
32 19 6 2 59
(54.2) (32.2) (10.2) (3.4) (100.0)
Number of teeth (in situ and loose)b 18–34 408 (67.3) 111 (18.3) 35–49 50 (8.3) 50+ 37 (6.1) Unaged Total 606 (100.0)
470 62 53 52 637
(73.8) (9.7) (8.3) (8.2) (100.0)
878 173 103 89 1243
(70.6) (13.9) (8.3) (7.2) (100.0)
532 392 119 33 1076
(49.4) (36.4) (11.1) (3.1) (100.0)
451 272 161 24 908
(49.7) (30.0) (17.7) (2.6) (100.0)
983 664 280 57 1984
(49.5) (33.5) (14.1) (2.9) (100.0)
Number of socketsc 18–34 35–49 50+ Unaged Total
546 81 228 75 930
(58.7) (8.7) (24.5) (8.1) (100.0)
1080 298 411 161 1950
(55.4) (15.3) (21.1) (8.3) (100.0)
667 560 333 43 1603
(41.6) (34.9) (20.8) (2.7) (100.0)
541 386 345 28 1300
(41.6) (29.7) (26.5) (2.2) (100.0)
1208 946 678 71 2903
(41.6) (32.6) (23.4) (2.4) (100.0)
826 153 94 76 1149
(71.9) (13.3) (8.2) (6.6) (100.0)
530 381 114 29 1054
(50.3) (36.1) (10.8) (2.8) (100.0)
440 260 154 24 878
(50.1) (29.6) (17.5) (2.7) (100.0)
970 641 268 53 1932
(50.2) (33.2) (13.9) (2.7) (100.0)
534 217 183 86 1020
(52.4) (21.3) (17.9) (8.4) (100.0)
Number of teeth and sockets (i.e. sockets with teeth in situ)d 18–34 390 (67.5) 436 (76.4) 106 (18.3) 47 (8.2) 35–49 45 (7.8) 49 (8.6) 50+ 37 (6.4) 39 (6.8) Unaged 578 (100.0) 571 (100.0) Total
F – females; M – males; N – number of individuals/teeth/sockets examined; % – percentage of individuals/teeth/sockets examined. Used to calculate per individual frequency. b Used to calculate per tooth frequency of caries. c Used to calculate per socket frequency of periapical lesions and antemortem tooth loss. d Used to calculate per socket frequency of periodontal disease. a
It is evident from Table 1 that the total male-to-female ratio (112:87 or 1.3) is higher than an expected sex ratio of 1.0, although not significantly so (x2 = 2.894, df = 1, p = 0.089). High sex ratios have been reported for other Romano-British sites, especially towns.97 The study sample’s high sex ratio could be the result of male-biased sexing error, due to the methods employed being inappropriate for the population.87,98 However, the morphological features from which sex was assessed in the present study are the same as those used by other researchers in sexing contemporaneous Romano-British populations, in which both balanced and high sex ratios have been observed.99,100 Furthermore, limiting the sample to individuals with pelvic features indicating male or female sex should have reduced the extent of sexing error. While some degree of sexing error cannot be ruled out, cultural factors (e.g. migration and differential burial treatment), as well as preservation bias, seem more likely to explain high sex ratios in the study sample and other Romano-British cemeteries.97,101,102 The intra-oral distribution of pathology by tooth category tends to follow certain trends.103 As a result, any difference between the sexes in the relative proportions of anterior and
posterior teeth/sockets surviving for analysis, e.g. owing to differences in post-mortem tooth loss, could bias results when all tooth types are combined in calculating per tooth/socket frequencies. To assess whether this is an issue for the present study, the relative proportions of incisor, canine, premolar and molar teeth and sockets (Table 2) were compared between the sexes using chi squared tests. Among females, incisors, canines, premolars and molars comprised 22.9% (285), 14.6% (181), 27.3% (339) and 35.2% (438) of 1243 surviving teeth, respectively. The same figures for males (1984 teeth) were 23.2% (461), 14.7% (292), 28.7% (569) and 33.4% (662). The difference between the sexes in the proportions of incisors, canines, premolars and molars was not statistically significant (x2 = 1.366, df = 3, p = 0.714). Among 1950 female sockets, there were 514 (26.4%) incisor, 261 (13.4%) canine, 519 (26.6%) premolar and 656 (33.6%) molar sockets. The distribution of 2903 male sockets was similar, with incisor, canine, premolar and molar sockets comprising 25.8% (750), 13.2% (383), 26.4% (765) and 34.6% (1005) of all surviving sockets. Again, the difference between the sexes was non-significant (x2 = 0.512, df = 3, p = 0.916), meaning comparisons of total
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Table 2 – Numbers of teeth and sockets in the study sample by sex and tooth position. Tooth/socket
Ancaster (N, %) Teeth
Females Mx I1 Mx I2 Mx C Mx PM1 Mx PM2 Mx M1 Mx M2 Mx M3 Total Md Md Md Md Md Md Md Md
I1 I2 C PM1 PM2 M1 M2 M3
Total Males Mx I1 Mx I2 Mx C Mx PM1 Mx PM2 Mx M1 Mx M2 Mx M3 Total Md Md Md Md Md Md Md Md
I1 I2 C PM1 PM2 M1 M2 M3
Total
23 31 43 47 41 44 37 23
(8.0) (10.7) (14.9) (16.3) (14.2) (15.2) (12.8) (8.0)
289 (100.0) 32 44 51 48 36 32 41 33
(10.1) (13.9) (16.1) (15.1) (11.4) (10.1) (12.9) (10.4)
317 (100.0)
49 54 69 70 57 38 48 40
(11.5) (12.7) (16.2) (16.5) (13.4) (8.9) (11.3) (9.4)
425 (100.0) 65 79 86 88 91 83 88 71
(10.0) (12.1) (13.2) (13.5) (14.0) (12.7) (13.5) (10.9)
651 (100.0)
Sockets 67 64 65 64 62 57 54 33
(14.4) (13.7) (13.9) (13.7) (13.3) (12.2) (11.6) (7.1)
466 (100.0) 69 70 73 73 73 73 72 51
(12.5) (12.6) (13.2) (13.2) (13.2) (13.2) (13.0) (9.2)
554 (100.0)
92 94 97 97 96 90 89 59
(12.9) (13.2) (13.6) (13.6) (13.4) (12.6) (12.5) (8.3)
714 (100.0) 113 113 114 114 114 114 114 93
(12.7) (12.7) (12.8) (12.8) (12.8) (12.8) (12.8) (10.5)
889 (100.0)
Winchester (N, %)
Teeth and sockets 23 30 40 44 40 41 34 22
(8.4) (10.9) (14.6) (16.1) (14.6) (15.0) (12.4) (8.0)
274 (100.0) 29 40 48 46 36 32 40 33
(9.5) (13.2) (15.8) (15.1) (11.8) (10.5) (13.2) (10.9)
304 (100.0)
45 50 66 70 56 38 48 40
(10.9) (12.1) (16.0) (16.9) (13.6) (9.2) (11.6) (9.7)
413 (100.0) 62 76 84 87 91 82 88 71
(9.7) (11.9) (13.1) (13.6) (14.2) (12.8) (13.7) (11.1)
641 (100.0)
Teeth 38 36 40 34 37 42 36 33
(12.8) (12.2) (13.5) (11.5) (12.5) (14.2) (12.2) (11.1)
296 (100.0) 32 49 47 48 48 41 48 28
(9.4) (14.4) (13.8) (14.1) (14.1) (12.0) (14.1) (8.2)
341 (100.0)
53 59 66 68 59 54 47 33
(12.1) (13.4) (15.0) (15.5) (13.4) (12.3) (10.7) (7.5)
439 (100.0) 44 58 71 71 65 51 57 52
(9.4) (12.4) (15.1) (15.1) (13.9) (10.9) (12.2) (11.1)
469 (100.0)
Sockets 57 57 58 58 57 53 53 35
(13.3) (13.3) (13.6) (13.6) (13.3) (12.4) (12.4) (8.2)
428 (100.0) 65 65 65 67 65 69 68 38
(12.9) (12.9) (12.9) (13.3) (12.9) (13.7) (13.5) (7.6)
502 (100.0)
82 84 85 86 86 83 76 51
(13.0) (13.3) (13.4) (13.6) (13.6) (13.1) (12.0) (8.1)
633 (100.0) 86 86 87 86 86 87 87 62
(12.9) (12.9) (13.0) (12.9) (12.9) (13.0) (13.0) (9.3)
667 (100.0)
Teeth and sockets 35 32 37 30 34 37 33 27
(13.2) (12.1) (14.0) (11.3) (12.8) (14.0) (12.5) (10.2)
265 (100.0) 30 42 42 43 40 37 44 28
(9.8) (13.7) (13.7) (14.1) (13.1) (12.1) (14.4) (9.2)
306 (100.0)
48 57 63 66 59 52 45 32
(11.4) (13.5) (14.9) (15.6) (14.0) (12.3) (10.7) (7.6)
422 (100.0) 41 55 71 69 64 51 56 49
(9.0) (12.1) (15.6) (15.1) (14.0) (11.2) (12.3) (10.7)
456 (100.0)
N – number of teeth/sockets examined; % – percentage of teeth/sockets examined; mx – maxilla; md – mandible; I1 – central incisor; I2 – lateral incisor; C – canine; PM1 – first premolar; PM2 – second premolar; M1 – first molar; M2 – second molar; M3 – third molar.
per tooth/socket prevalences for all tooth-types combined should be valid. All dental remains were examined macroscopically, and with the aid of a hand-held magnifying glass when required. The following pathological conditions were examined: caries, calculus, periapical lesions, periodontal disease and antemortem tooth loss. Caries is defined as ‘focal demineralisation of the dental hard tissues’ owing to the presence of bacteria in the mouth that ferment dietary carbohydrates, especially sucrose, producing organic acids in the process.53,104 Caries frequencies in archaeological populations are generally considered to be related to levels of carbohydrate consumption, with higher caries rates usually observed in populations that consumed significant quantities of
carbohydrates, e.g. many agrarian communities.46,58–61,105 In the present study, caries was identified where focal demineralisation penetrated the enamel. Caries were divided into crown (coronal caries) and root caries. Coronal caries were further classified by tooth surface, i.e. occlusal, interproximal (mesial/distal approximal), or smooth surface (buccal/labial or lingual). Root caries were subdivided into those affecting the cemento-enamel junction (CEJ), or root proper. In some cases, the original initiation site could not be determined (‘gross caries’).106 Calculus is mineralised bacterial plaque.107 In palaeodietary studies, high calculus rates associated with low caries rates have been linked to high protein consumption, but high rates of calculus and caries are thought to indicate high
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Table 3 – Per individual frequency (1) of dento-alveolar pathology by sex and age. Age (years)
F (n/N, %) Ancaster
Winchester
18–34 35–49 50+ Unaged
Caries 12/20 (60.0) 8/12 (67.7) 4/10 (40.0) 3/4 (75.0)
Total
M (n/N, %) Total F
Ancaster
Winchester
16/21 (76.2) 5/5 (100.0) 4/11 (36.4) 1/4 (25.0)
28/41 (68.3) 13/17 (76.5) 8/21 (38.1) 4/8 (50.0)
16/26 (61.5) 12/22 (54.5) 7/15 (46.7) 2/3 (66.7)
12/18 (66.7) 8/14 (57.1) 6/13 (46.2) 1/1 (100.0)
28/44 (63.6) 20/36 (55.6) 13/28 (46.4) 3/4 (75.0)
27/46 (58.7)
26/41 (63.4)
53/87 (60.9)
37/66 (56.1)
27/46 (58.7)
64/112 (57.1)
18–34 35–49 50+ Unaged
Calculus 11/20 (55.0) 3/12 (25.0) 1/10 (10.0) 3/4 (75.0)
11/21 (52.4) 3/5 (60.0) 1/11 (9.1) 1/4 (25.0)
22/41 (53.7) 6/17 (35.3) 2/21 (9.5) 4/8 (50.0)
20/26 (76.9) 18/22 (81.8) 5/15 (33.3) 2/3 (66.7)
9/18 (50.0) 11/14 (78.6) 6/13 (46.2) 1/1 (100.0)
29/44 (65.9) 29/36 (80.6) 11/28 (39.3) 3/4 (75.0)
Total
18/46 (39.1)
16/41 (39.0)
34/87 (39.1)
45/66 (68.2)
27/46 (58.7)
72/112 (64.3)
18–34 35–49 50+ Unaged
Periapical lesions 5/20 (25.0) 1/12 (8.3) 4/10 (40.0) 0/4 (0.0)
4/21 (19.0) 0/5 (0.0) 2/11 (18.2) 1/4 (25.0)
9/41 (22.0) 1/17 (5.9) 6/21 (28.6) 1/8 (12.5)
5/26 (19.2) 4/22 (18.2) 2/15 (13.3) 0/3 (0.0)
3/18 (16.7) 3/14 (21.4) 4/13 (30.8) 0/1 (0.0)
8/44 (18.2) 7/36 (19.4) 6/28 (21.4) 0/4 (0.0)
Total
10/46 (21.7)
7/41 (17.1)
17/87 (19.5)
11/66 (16.7)
10/46 (21.7)
21/112 (18.8)
18–34 35–49 50+ Unaged
Periodontal disease 5/20 (25.0) 5/21 (23.8) 4/12 (33.3) 3/5 (60.0) 3/10 (30.0) 6/11 (54.5) 2/4 (50.0) 1/4 (25.0)
10/41 (24.4) 7/17 (41.2) 9/21 (42.9) 3/8 (37.5)
9/26 (34.6) 11/22 (50.0) 6/15 (40.0) 2/3 (67.7)
4/18 (22.2) 7/14 (50.0) 8/13 (61.5) 0/1 (0.0)
13/44 (29.5) 18/36 (50.0) 14/28 (50.0) 2/4 (50.0)
Total
14/46 (30.4)
29/87 (33.3)
28/66 (42.4)
19/46 (41.3)
47/112 (42.0)
18–34 35–49 50+ Unaged
Antemortem tooth loss 7/20 (35.0) 8/21 (38.1) 9/12 (75.0) 3/5 (60.0) 9/10 (90.0) 11/11 (100.0) 2/4 (50.0) 3/4 (75.0)
15/41 (36.6) 12/17 (70.6) 20/21 (95.2) 5/8 (62.5)
12/26 (46.2) 15/22 (68.2) 14/15 (93.3) 3/3 (100.0)
9/18 (50.0) 7/14 (50.0) 13/13 (100.0) 1/1 (100.0)
21/44 (47.7) 22/36 (61.1) 27/28 (96.4) 4/4 (100.0)
Total
27/46 (58.7)
52/87 (59.8)
44/66 (66.7)
30/46 (65.2)
74/112 (66.1)
15/41 (36.6)
25/41 (61.0)
Total M
F – females; M – males; n – number of individuals affected; N – total number of individuals with at least one surviving tooth/socket observed; % – per individual frequency (n/N).
carbohydrate, low protein diets.52,107 Recording and interpreting data on calculus rates in curated osteological collections is problematic, since deposits can be dislodged from teeth during post-excavation cleaning and examination. This is especially likely when dealing with skeletal material from older excavations, as in the case of the present study.108 For this reason, it is probable that per tooth frequency rates for the study population would be inaccurate, and only per individual prevalence rates are presented here.109 A periapical lesion (PL) is a void extending around the apex of a tooth’s root(s). Lesions are usually categorised into three types: granulomas, apical cysts and chronic abscesses.110–112 All arise from infection and inflammation of the tooth pulp (‘pulpitis’) leading to necrosis. Caries is a common cause, but severe attrition and trauma resulting in pulp exposure can also lead to lesions.103 Granulomas represent the formation of a granulomatous tissue mass at the root apex in response to tooth pulp necrosis, which causes the surrounding alveolar bone to resorb. Apical cysts develop when existing granulomatous tissue is replaced by fluid build-up. Chronic abscesses
are caused by pyogenic infection; pus accumulates, the pressure of which eventually produces a fistula in the alveolar bone through which it is discharged. Granulomas and apical cysts are benign, subclinical features, while chronic abscesses are often painful and require treatment.111 Periodontal disease (PD) is an inflammatory condition of the supporting structures surrounding the teeth. PD can involve localised (vertical) and/or generalised (horizontal) alveolar bone loss.103,110 Bacterial plaque is the primary cause.113 In dry bone specimens, PD is sometimes diagnosed based on an increase in the distance between the alveolar crest (AC) and cementoenamel junction (CEJ) above c. 2 mm.114 Strictly speaking, ACCEJ distance alone is unreliable for diagnosing PD, since age and attrition-related continuous eruption also affect this parameter.110,115 For the present study, PD was identified when the following features were present: porosity and lipping of the alveolar crest, thinning of the interdental plates, and ‘trough’ formation around tooth roots.103,110 Pathologically-induced porosity was distinguished from post-mortem damage from evidence for fine pitting exhibiting remodelling, using a
archives of oral biology 59 (2014) 1279–1300
hand-held magnifying glass.116 Periodontal disease was only recorded for sockets with in situ teeth. Antemortem tooth loss (AMTL) refers to loss of the teeth during life. In skeletal remains, it can be recognised from alveolar remodelling (resorption). AMTL has several causes, including caries, PLs, periodontal disease, severe attrition, continuous eruption, scurvy, intentional extraction, and traumatic avulsion.108 When examining skeletal remains, it is sometimes not possible to identify the cause of AMTL with certainty. A positive correlation between caries prevalence and AMTL has been observed in some ancient populations,60,63 suggesting that caries was a significant contributor to premature tooth loss in the past. For the Roman period, there is both textual and archaeological evidence for intentional extraction of carious teeth.117,118 Periodontal disease is also likely to have been a major cause of tooth loss in ancient populations.103 Discerning AMTL, as opposed to congenital tooth absence (non-eruption or agenesis), is aided by the observation of contact-point facets on adjacent teeth and attrition on the occlusal partner.108 To assess and compare the oral health status of males and females in the study sample, two principal measures of disease frequency were used: (1) per individual frequency (number of individuals affected/total number of individuals observed 100); and (2) per tooth or socket frequency (number of teeth or sockets affected/total number of teeth or sockets observed 100). Per individual frequencies were calculated in the first instance using the total number of individuals with at least one surviving tooth/socket (i.e. the total number of individuals in the study sample) as the denominator (Table 3). However, per individual prevalences calculated in this way are potentially problematic, since differential preservation of skeletal remains from archaeological contexts means many individuals will not possess complete dentitions. Consequently, when individuals with relatively few surviving teeth/sockets are included in per individual frequencies, results may be less accurate. This can be militated against to a certain extent by including only individuals with a minimum level of dental preservation in calculations of per individual prevalence. Therefore, as well as calculating per individual frequencies for all individuals examined, a second measure of per individual frequency was used that gives prevalence rates as the proportion of affected individuals with at least sixteen surviving teeth and sockets, i.e. individuals with dentitions at least 50% intact (Table 4). This second measure of per individual prevalence should be less affected by inter-individual and inter-site preservation biases,116 but inevitably includes fewer individuals (especially elderly adults, owing to antemortem tooth loss). In terms of per tooth/socket frequencies, the denominator (N) differed according to the condition being assessed. For caries, per tooth prevalences were calculated as a percentage of all teeth present (in situ and loose). Periapical lesion and AMTL frequencies were calculated as percentages of all preserved sockets with or without teeth. Periodontal disease prevalence was calculated from the percentage of all sockets with in situ teeth. The numbers of teeth/sockets used to calculate these prevalences are provided in Tables 1 and 2. Per tooth/socket prevalences are not, strictly speaking, valid for use in statistical comparisons between groups. This is
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because dental disease often affects multiple tooth positions in a single individual and, ‘observations on several . . . teeth from a given individual cannot be considered independent for statistical purposes’.119 Nevertheless, per tooth/socket frequencies can be important in adjusting for differential skeletal preservation. Pathology frequencies were compared between the sexes using Fisher’s exact tests. The significance level was set at 5%, meaning a p-value less than 0.05 indicated a 95% probability that any difference between the sexes was not due to chance.119,120 Table 11 contains the results of significance tests comparing Ancaster females and males, Winchester females and males, and all females and males combined.
3.
Results
3.1.
Caries
Tables 3 and 4 present data for the per individual frequency of caries in the study sample. According to both measures of per individual prevalence, more females than males were affected. Among individuals with at least one surviving tooth, caries affected 60.9% (53/87) of females and 57.1% (64/112) of males (Table 3). When only individuals with at least sixteen teeth and sockets were considered, per individual frequencies were slightly higher, with 72.7% (24/33) of females and 69.5% (41/59) of males affected (Table 4). Ancaster females (11/16, 68.8%) were less affected than Ancaster males (21/29, 72.4%), while Winchester females (13/17, 76.5%) had a higher per individual frequency compared to Winchester males (20/30, 67.7%) (Table 4). However, there were no significant differences between the sexes in caries rates, either for the total sample or within sub-samples (Table 11). The per tooth caries frequency was higher for females (117/ 1243, 9.4%) compared to males (173/1984, 8.7%), and women were also more affected than males in both sub-samples (Table 5). In the case of mature adults, females had a significantly greater caries rate compared to males, but no other significant differences were observed (Table 11). The posterior teeth (premolars and molars) were significantly more affected than the anterior teeth (incisors and canines) among females and males, both overall and within each sub-sample (Table 6). For the total sample (Ancaster and Winchester combined), females had a prevalence of 2.1% (10/ 466) for the anterior teeth, compared to 13.8% (107/777) for the posterior teeth (Fisher’s p < 0.0001). Among males in the combined sample, prevalence rates for the anterior and posterior dentitions were 1.5% (11/753) and 13.2% (162/1231), respectively (Fisher’s p < 0.0001). When prevalences were compared between the sexes by tooth category (anterior vs posterior), there were no statistically significant differences (Fisher’s p: anterior = 0.3744; posterior = 0.7367) (Table 6). Among females, the mandibular teeth (10.0%, 66/658) were more frequently carious than the maxillary teeth (8.7%, 51/585), while males had a slightly higher rate of maxillary caries (9.4%, 81/864), compared to the mandibular dentition (8.2%, 92/1120) (Table 6); however, the difference between maxillary and mandibular caries rates was not significant for either sex (Fisher’s p: females = 0.4382; males = 0.3780). When frequencies
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Table 4 – Per individual frequency (2) of dento-alveolar pathology by sex and age. Age (years)
F (n/N, %) Ancaster
Winchester
18–34 35–49 50+ Unaged
Caries 8/13 (61.5) 2/2 (100.0) 0/0 (–) 1/1 (100.0)
Total
M (n/N, %) Total F
Ancaster
11/15 (73.3) 1/1 (100.0) 1/1 (100.0) 0/0 (–)
19/28 (67.9) 3/3 (100.0) 1/1 (100.0) 1/1 (100.0)
11/16 (68.8) 7/10 (70.0) 2/2 (100.0) 1/1 (100.0)
11/16 (68.8) 5/9 (55.6) 3/4 (75.0) 1/1 (100.0)
22/32 (68.8) 12/19 (63.2) 5/6 (83.3) 2/2 (100.0)
11/16 (68.8)
13/17 (76.5)
24/33 (72.7)
21/29 (72.4)
20/30 (67.7)
41/59 (69.5)
18–34 35–49 50+ Unaged
Calculus 9/13 (69.2) 0/2 (0.0) 0/0 (–) 1/1 (100.0)
9/15 (60.0) 0/1 (0.0) 0/1 (0.0) 0/0 (–)
18/28 (64.3) 0/3 (0.0) 0/1 (0.0) 1/1 (100.0)
13/16 (81.3) 10/10 (100.0) 2/2 (100.0) 1/1 (100.0)
8/16 (50.0) 7/9 (77.8) 2/4 (50.0) 1/1 (100.0)
21/32 (65.6) 17/19 (89.5) 4/6 (66.7) 2/2 (100.0)
Total
10/16 (62.5)
9/17 (52.9)
19/33 (57.6)
26/29 (89.7)
18/30 (60.0)
44/59 (74.6)
18–34 35–49 50+ Unaged
Periapical lesions 1/13 (7.7) 0/2 (0.0) 0/0 (–) 0/1 (0.0)
4/15 (26.7) 0/1 (0.0) 0/1 (0.0) 0/0 (–)
5/28 (17.9) 0/3 (0.0) 0/1 (0.0) 0/1 (0.0)
3/16 (18.8) 4/10 (40.0) 1/2 (50.0) 0/1 (0.0)
4/16 (25.0) 1/9 (11.1) 3/4 (75.0) 0/1 (0.0)
7/32 (21.9) 5/19 (26.3) 4/6 (66.7) 0/2 (0.0)
Total
1/16 (6.3)
4/17 (23.5)
5/33 (15.2)
8/29 (27.6)
8/30 (26.7)
16/59 (27.1)
18–34 35–49 50+ Unaged
Periodontal disease 2/13 (15.4) 5/15 (33.3) 1/2 (50.0) 0/1 (0.0) 0/0 (–) 1/1 (100.0) 1/1 (100.0) 0/0 (–)
7/28 (25.0) 1/3 (33.3) 1/1 (100.0) 1/1 (100.0)
7/16 (43.8) 5/10 (50.0) 1/2 (50.0) 1/1 (100.0)
3/16 (18.8) 5/9 (55.6) 3/4 (75.0) 0/1 (0.0)
10/32 (31.3) 10/19 (52.6) 4/6 (67.7) 1/2 (50.0)
Total
4/16 (25.0)
10/33 (30.3)
14/29 (48.3)
11/30 (36.7)
25/59 (42.4)
18–34 35–49 50+ Unaged
Antemortem tooth loss 3/13 (23.1) 6/15 (40.0) 2/2 (100.0) 1/1 (100.0) 0/0 (–) 1/1 (100.0) 1/1 (100.0) 0/0 (–)
9/28 (32.1) 3/3 (100.0) 1/1 (100.0) 1/1 (100.0)
8/16 (50.0) 8/10 (80.0) 2/2 (100.0) 1/1 (100.0)
7/16 (43.8) 4/9 (44.4) 4/4 (100.0) 1/1 (100.0)
15/32 (46.9) 12/19 (63.2) 6/6 (100.0) 2/2 (100.0)
Total
6/16 (37.5)
14/33 (42.4)
19/29 (65.5)
16/30 (53.3)
35/59 (59.3)
6/17 (35.3)
8/17 (47.1)
Winchester
Total M
F – females; M – males; n – number of individuals affected; N – total number of individuals with at least sixteen surviving teeth and sockets observed; % – per individual frequency (n/N).
were compared by dental arcade between the sexes, there were no significant differences (Fisher’s p: maxilla = 0.7103; mandible = 0.1964). Table 7 presents data on the distribution of caries lesions by tooth category and tooth aspect. Most lesions for which the initiation point could be determined (i.e. excluding gross caries) affected the crown (females: 58/99, 58.6%; males: 83/128, 64.8%). For the combined female and male samples, the relative proportions of coronal vs root/CEJ caries were not significantly different (Fisher’s p = 0.3387). In the case of coronal caries, the occlusal, smooth and interproximal surfaces were relatively similarly affected in the Ancaster sub-sample, and among Winchester females. In Winchester males, the interproximal surfaces were more frequently affected than other aspects of the crown. The CEJ was a more frequent site for caries development than the root surface proper. Overall, males exhibited relatively more gross caries (26.0% of all lesions, compared to 15.4% of female lesions), and when the proportions of coronal and root vs gross caries was compared between the sexes, the difference was significant (Fisher’s p = 0.0416).
3.2.
Calculus
Calculus was observed in 39.1% (34/87) of females and 64.3% (72/112) of males with at least one surviving tooth (Table 3). Males also exhibited higher rates of calculus within each subsample, with 68.2% and 58.7% of Ancaster and Winchester males affected, compared to 39.1% and 39.0% of Ancaster and Winchester females, respectively. In the Ancaster sub-sample, males had a significantly higher overall calculus rate. When the data for both sub-samples were combined, the male calculus rate was significantly higher than that for females (Table 11). Per individual calculus frequencies were greater when calculated for individuals with at least sixteen teeth and sockets preserved, with 57.6% (19/33) of females and 74.6% (44/ 59) of males affected (Table 4). Calculus was more common in males than females in almost all age and sub-sample comparisons, although the difference was only significant in the case of the combined female vs male 35–49 year age group (Table 11).
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Table 5 – Per tooth/socket frequency of dento-alveolar pathology by sex and age. Age (years)
F (n/N, %) Ancaster
Winchester
M (n/N, %) Total F
Ancaster
Winchester
Total M
18–34 35–49 50+ Unaged
Caries 30/408 (7.4) 19/111 (17.1) 7/50 (14.0) 5/37 (13.5)
39/470 (8.3) 6/62 (9.7) 7/53 (13.2) 4/52 (7.7)
69/878 (7.9) 25/173 (14.5) 14/103 (13.6) 9/89 (10.1)
47/532 (8.8) 28/392 (7.1) 13/119 (10.9) 6/33 (18.2)
36/451 (8.0) 25/272 (9.2) 17/161 (10.6) 1/24 (4.2)
83/983 (8.4) 53/664 (8.0) 30/280 (10.7) 7/57 (12.3)
Total
61/606 (10.1)
56/637 (8.8)
117/1243 (9.4)
94/1076 (8.7)
79/908 (8.7)
173/1984 (8.7)
18–34 35–49 50+ Unaged
Periapical lesions 3/534 (0.6) 2/217 (0.9) 5/183 (2.7) 0/86 (0.0)
5/546 (0.9) 0/81 (0.0) 3/228 (1.3) 1/75 (1.3)
8/1080 (0.7) 2/298 (0.7) 8/411 (1.9) 1/161 (0.6)
11/667 (1.6) 6/560 (1.1) 3/333 (0.9) 0/43 (0.0)
6/541 (1.1) 3/386 (0.8) 8/345 (2.3) 0/28 (0.0)
17/1208 (1.4) 9/946 (1.0) 11/678 (1.6) 0/71 (0.0)
Total
10/1020 (1.0)
9/930 (1.0)
19/1950 (1.0)
20/1603 (1.2)
17/1300 (1.3)
37/2903 (1.3)
18–34 35–49 50+ Unaged
Periodontal disease 46/390 (11.8) 34/106 (32.1) 20/45 (44.4) 30/37 (81.1)
56/436 (12.8) 27/47 (57.4) 25/49 (51.0) 11/39 (28.2)
102/826 (12.3) 61/153 (39.9) 45/94 (47.9) 41/76 (53.9)
124/530 (23.4) 151/381 (39.6) 61/114 (53.5) 23/29 (79.3)
28/440 (6.4) 112/260 (43.1) 101/154 (65.6) 0/24 (0.0)
152/970 (15.7) 263/641 (41.0) 162/268 (60.4) 23/53 (43.4)
Total
130/578 (22.5)
119/571 (20.8)
249/1149 (21.7)
359/1054 (34.1)
241/878 (27.4)
600/1932 (31.1)
18–34 35–49 50+ Unaged
Antemortem tooth loss 17/534 (3.2) 26/546 (4.8) 35/217 (16.1) 14/81 (17.3) 75/183 (41.0) 121/228 (53.1) 15/86 (17.4) 19/75 (25.3)
43/1080 (4.0) 49/298 (16.4) 196/411 (47.7) 34/161 (21.1)
32/667 (4.8) 61/560 (10.9) 106/333 (31.8) 9/43 (20.9)
27/541 (5.0) 33/386 (8.5) 128/345 (37.1) 1/28 (3.6)
59/1208 (4.9) 94/946 (9.9) 234/678 (34.5) 10/71 (14.1)
Total
142/1020 (13.9)
322/1950 (16.5)
208/1603 (13.0)
189/1300 (14.5)
397/2903 (13.7)
180/930 (19.4)
F – females; M – males; n – number of teeth/sockets affected; N – total number of teeth/sockets observed; % – per tooth/socket frequency (n/N).
3.3.
Periapical lesions
Per individual prevalences of periapical lesions were similar for females and males from both sites, and for the total sample combined. Among individuals with at least one surviving socket, the total per individual frequency of lesions was 19.5% (17/87) for females and 18.8% (21/112) for males (Table 3). Of those with at least sixteen intact teeth and sockets, prevalence rates were 15.2% (5/33) for females and 27.1% (16/59) for males (Table 4). None of the differences between the sexes was statistically significant (Table 11). At the per socket level, periapical lesions were less prevalent than other conditions, with only 1.0% (19/1950) of female sockets and 1.3% (37/2903) of male sockets affected (Table 5). There were no statistically significant differences between the sexes (Table 11). Among females, combined prevalence rates for the anterior sockets (0.9%, 7/775) and posterior sockets (1.0%, 12/1175) were similar (Fisher’s p = 1.0000). Males had a significantly higher rate of posterior socket involvement, with 1.8% (32/1770) of posterior sockets and 0.4% (5/1133) of anterior sockets affected (Fisher’s p < 0.0001) (Table 8). There were, however, no differences between the sexes when per socket frequencies were compared (Fisher’s p: anterior = 0.2450; posterior = 0.1195). Lesions occurred more commonly in the maxillary dentition than the mandibular dentition in both sexes, and the
difference between arcades was statistically significant for males (Table 8). The maxillary PL frequency was 1.2% (11/894) for females and 2.0% (27/1347) for males, and the mandibular PL frequency was 0.8% (8/1056) for females, and 0.6% (10/1556) in males (Fisher’s p: females = 0.3568; males = 0.0013). The difference in prevalence between the sexes when compared by arcade (maxilla versus mandible) was not statistically significant (Fisher’s p: maxilla = 0.2698; mandible = 0.8110).
3.4.
Periodontal disease
Periodontal disease affected 33.3% (29/87) of females and 42.0% (47/112) of males with at least one surviving socket (Table 3). Males were more affected than females in most age groups in both sub-samples, but no statistically significant differences were observed between the sexes. Among individuals with at least sixteen intact teeth and sockets, the per individual frequency was 30.3% (10/33) for females and 42.4% (25/59) for males (Table 4). Again, there were no significant differences between the sexes (Table 11). Males in both sub-samples exhibited a higher total per socket frequency of periodontal disease than females (Table 5). The male and female prevalence rates for the Ancaster sub-sample were 34.1% (359/1054) and 22.5% (130/ 578), and in the Winchester sub-sample 27.4% (241/878) of male, and 20.8% (119/571) of female sockets were affected, respectively. For both sub-samples combined, the difference
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Table 6 – Per tooth frequency of caries by sex and tooth position. Tooth/socket
F (n/N, %) Ancaster
M (n/N, %)
Winchester
Total F
Ancaster
Winchester
Total M
0/49 (0.0) 1/54 (1.9) 1/69 (1.4) 6/70 (8.6) 10/57 (17.5)
1/53 (1.9) 2/59 (3.4) 0/66 (0.0) 6/68 (8.8) 10/59 (16.9)
1/102 (1.0) 3/113 (2.7) 1/135 (0.7) 12/138 (8.7) 20/116 (17.2)
Maxilla I1 I2 C PM1 PM2
0/23 0/31 3/43 5/47 3/41
M1 M2 M3
7/44 (15.9) 5/37 (13.5) 5/23 (21.7)
4/42 (9.5) 7/36 (19.4) 5/33 (15.2)
11/86 (12.8) 12/73 (16.4) 10/56 (17.9)
3/38 (7.9) 9/48 (18.8) 5/40 (12.5)
12/54 (22.2) 7/47 (14.9) 8/33 (24.2)
15/92 (16.3) 16/95 (16.8) 13/73 (17.8)
Total
28/289 (9.7)
23/296 (7.8)
51/585 (8.7)
35/425 (8.2)
46/439 (10.5)
81/864 (9.4)
Mandible I1 I2 C PM1 PM2
1/32 2/44 1/51 5/48 2/36
0/32 2/49 0/47 1/48 5/48
1/64 4/93 1/98 6/96 7/84
0/65 4/79 0/86 1/88 5/91
0/44 2/58 0/71 3/71 6/65
0/109 (0.0) 6/137 (4.4) 0/157 (0.0) 4/159 (2.5) 11/156 (7.1)
M1 M2 M3
5/32 (15.6) 9/41 (22.0) 8/33 (24.2)
10/41 (24.4) 12/48 (25.0) 3/28 (10.7)
15/73 (20.5) 21/89 (23.6) 11/61 (18.0)
18/83 (21.7) 17/88 (19.3) 14/71 (19.7)
9/51 (17.6) 8/57 (14.0) 5/52 (9.6)
27/134 (20.1) 25/145 (17.2) 19/123 (15.4)
Total
33/317 (10.4)
33/341 (9.7)
66/658 (10.0)
59/651 (9.1)
33/469 (7.0)
92/1120 (8.2)
(0.0) (0.0) (7.0) (10.6) (7.3)
(3.1) (4.5) (2.0) (10.4) (5.6)
0/38 1/36 0/40 2/34 4/37
(0.0) (2.8) (0.0) (5.9) (10.8)
(0.0) (4.1) (0.0) (2.1) (10.4)
0/61 1/67 3/83 7/81 7/78
(0.0) (1.5) (3.6) (8.6) (9.0)
(1.6) (4.3) (1.0) (6.3) (8.3)
(0.0) (5.1) (0.0) (1.1) (5.5)
(0.0) (3.4) (0.0) (4.2) (9.2)
F – females; M – males; n – number of teeth affected; N – total number of teeth observed; % – per tooth frequency (n/N); I1 – central incisor; I2 – lateral incisor; C – canine; PM1 – first premolar; PM2 – second premolar; M1 – first molar; M2 – second molar; M3 – third molar.
in per socket frequency was statistically significant for the total samples, and young and mature adults (Table 11). Females and males exhibited a broadly similar pattern of socket involvement, with the anterior sockets being more affected than posterior sockets (Table 9). In females, the overall per socket prevalence rate was 24.1% (103/428) for the anterior sockets and 20.2% (146/721) for the posterior sockets (Fisher’s p = 0.1387). In males, 31.8% (228/718) of anterior sockets and 30.6% (372/1214) of posterior sockets (Fisher’s p = 0.6113) were affected. PD prevalence was significantly higher for males compared to females in both the anterior (Fisher’s p = 0.0057) and posterior (Fisher’s p < 0.0001) dentitions. The mandibular sockets were more affected than the maxillary dentition in both sexes (Table 9). Among females, 16.9% (91/539) of maxillary sockets and 25.9% (158/610) of mandibular sockets were affected (Fisher’s p = 0.0002). In males, 29.2% (244/835) of maxillary sockets and 32.5% (356/ 1097) of mandibular sockets had PD (Fisher’s p = 0.1366). When prevalences were compared between the sexes by arcade, the difference was statistically significant for both maxilla (Fisher’s p < 0.0001) and mandible (Fisher’s p = 0.0050).
3.5.
Antemortem tooth loss
A majority of individuals exhibited some degree of antemortem tooth loss. Of those with at least one surviving socket, 59.8% (52/87) of females and 66.1% (74/112) of males were affected (Table 3). There were no significant differences between the sexes. Per individual prevalence rates were lower for those with 16+ surviving teeth, with 42.4% (14/33) of females and 59.3% (35/59) of males affected (Table 4), which can probably be ascribed to the inclusion of fewer mature and
elderly individuals in this count, as AMTL usually increases with age. Once more, no statistically significant differences between the sexes were observed (Table 11). Antemortem tooth loss affected 16.5% (322/1950) of female sockets and 13.7% (397/2903) of male sockets (Table 5). There was no significant difference in total per socket prevalence between the sexes among the Ancaster sub-sample; however, Winchester females had a significantly higher rate of AMTL compared to Winchester males. When the samples were combined, the overall per socket frequency of female AMTL was significantly higher than that for males (Table 11). For both sexes, the molars and premolars were the most frequently lost teeth (Table 10). AMTL frequency for the anterior dentition was 7.4% (57/775) for females and 5.0% (57/ 1133) for males, and for the posterior dentition it was 22.6% (265/1175) for females and 19.2% (340/1770) for males. The difference in AMTL frequency between the anterior and posterior dentition was statistically significant for both sexes (Fisher’s p < 0.0001). When prevalence rates were compared between the sexes by tooth category, the differences were statistically significant (Fisher’s p: anterior = 0.0389; posterior = 0.0287). Among females, the mandibular dentition (19.1%, 202/1056) was more affected than the maxillary dentition (13.4%, 120/ 894) (Table 10), and the difference was statistically significant (Fisher’s p = 0.0008). In contrast, males had more maxillary toothloss – 15.1% (204/1347) compared to 12.4% (193/1556) for the mandibular sockets, and the difference was significant (Fisher’s p = 0.0346). When compared by dental arcade, the difference between the sexes was not significant for the maxilla (Fisher’s p = 0.2699), but women had significantly more mandibular AMTL (Fisher’s p < 0.0001).
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Table 7 – Per tooth frequency of caries by sex, tooth category and tooth aspect. Tooth aspect
Tooth category (n, %) N
Incisors
Females Ancaster Crown: occlusal Crown: smooth surface Crown: interproximal Root: CEJ Root: root surface Gross caries Total
10 7 10 23 1 10 61
– – 1 (10.0) 2 (8.7) – – 3 (4.9)
– – – 1 1 2 4
Winchester Crown: occlusal Crown: smooth surface Crown: interproximal Root: CEJ Root: root surface Gross caries Total
9 11 11 16 1 8 56
– – 1 (9.1) 2 (12.5) – – 3 (5.4)
– – – – – –
– – – 5 1 6 12
Males Ancaster Crown: occlusal Crown: smooth surface Crown: interproximal Root: CEJ Root: root surface Gross caries Total
15 15 13 30 3 18 94
– – – 2 (6.7) – 3 (16.7) 5 (5.3)
– – – – – 1 (5.6) 1 (1.1)
1 – 6 8 – 7 22
(6.7)
Winchester Crown: occlusal Crown: smooth surface Crown: interproximal Root: CEJ Root: root surface Gross caries Total
8 4 28 12 0 27 79
– 1 – 1 – 3 5
– – – – – – –
1 – 7 4 – 13 25
(12.5)
(25.0) (8.3) (11.1) (6.3)
Canines
(4.3) (100.0) (20.0) (6.6)
Premolars
– – 4 8 – 3 15
Molars
(100.0) (100.0) (50.0) (52.2)
(30.0) (24.6)
10 7 5 12 – 5 39
(31.3) (100.0) (75.0) (21.4)
9 11 10 9 – 2 41
(100.0) (100.0) (90.9) (56.3)
14 15 7 20 3 7 66
(93.3) (100.0) (53.8) (66.7) (100.0) (38.9) (70.2)
7 3 21 7 – 11 49
(87.5) (75.0) (75.0) (58.3)
(40.0) (34.8)
(46.2) (26.7) (38.9) (23.4)
(25.0) (33.3) (48.1) (31.6)
(50.0) (63.9)
(25.0) (73.2)
(40.7) (62.0)
n – number of lesions by tooth category; N – total number of lesions observed by tooth aspect; % percentage of lesions; CEJ – cemento-enamel junction.
4.
Discussion
4.1.
Caries
Caries frequencies in the Ancaster and Winchester populations, and the combined study sample, are similar to those reported for contemporaneous populations,121–123 and accord with archaeological, palaeoenvironmental and bone chemistry evidence for a predominantly cereal-based diet in this period.23,25,37,124 Consumption of sweet, sticky foods, such as honey, fruit syrups, dried fruits and imported dates and figs could have facilitated caries development,51 although such ‘exotic’ foods might not have contributed significantly to the average individual’s diet.23,26 Differences in caries prevalence between males and females have been documented in past populations from diverse geographic and temporal contexts, and such data have often been interpreted with reference to gendered variations in diet.48,51,64 In the case of the present study sample, the slightly higher rates of caries among women may hint at some
difference in the quantity or type of carbohydrates being consumed, with women perhaps eating relatively more carbohydrate-rich foods and/or softer, stickier foods that were more likely to promote plaque build-up.51,52,64 However, the lack of statistically significant differences between the sexes in caries frequency at the per individual level means the finding of higher female caries prevalence may not be meaningful. Men and women exhibited similar patterns of tooth involvement. The molars and premolars were more frequently affected by caries than the anterior teeth – a pattern widely observed in both ancient and modern populations, and largely explained by the morphology and posterior location of the molars and premolars.106 The general predominance of interproximal and/or CEJ caries in both sexes (Table 7) is consistent with archaeological evidence for frequent consumption of starchy cereals and other high carbohydrate foods, leading to frequent bacterial plaque accumulation along the gingival margin and between teeth.106,125 The relative rarity of root caries occurring below the CEJ is probably due to the fact that the root surfaces are usually
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Table 8 – Per socket frequency of periapical lesions by sex and tooth position. Tooth/socket
F (n/N, %) Ancaster
Winchester
Maxilla I1 I2 C PM1 PM2 M1 M2 M3
0/67 1/64 0/65 0/64 0/62 2/57 3/54 0/33
0/57 1/57 0/58 1/58 1/57 2/53 0/53 0/35
Total
6/466 (1.3)
Mandible I1 I2 C PM1 PM2 M1 M2 M3
0/69 2/70 0/73 1/73 0/73 1/73 0/72 0/51
Total
4/554 (0.7)
(0.0) (1.6) (0.0) (0.0) (0.0) (3.5) (5.6) (0.0)
(0.0) (2.9) (0.0) (1.4) (0.0) (1.4) (0.0) (0.0)
M (n/N, %) Ancaster
Winchester
0/124 (0.0) 2/121 (1.7) 0/123 (0.0) 1/122 (0.8) 1/119 (0.8) 4/110 (3.6) 3/107 (2.8) 0/68 (0.0)
0/92 3/94 0/97 1/97 2/96 6/90 3/89 1/59
0/82 0/84 1/85 1/86 2/86 2/83 3/76 2/51
5/428 (1.2)
11/894 (1.2)
16/714 (2.2)
11/633 (1.7)
27/1347 (2.0)
0/65 2/65 1/65 1/67 0/65 0/69 0/68 0/38
0/134 (0.0) 4/135 (3.0) 1/138 (0.7) 2/140 (1.4) 0/138 (0.0) 1/142 (0.7) 0/140 (0.0) 0/89 (0.0)
0/113 (0.0) 0/113 (0.0) 0/114 (0.0) 0/114 (0.0) 0/114 (0.0) 4/114 (3.5) 0/114 (0.0) 0/93 (0.0)
0/86 0/86 1/87 2/86 2/86 1/87 0/87 0/62
0/199 0/199 1/201 2/200 2/200 5/201 0/201 0/155
8/1056 (0.8)
4/889 (0.4)
6/667 (0.9)
(0.0) (1.8) (0.0) (1.7) (1.8) (3.8) (0.0) (0.0)
(0.0) (3.1) (1.5) (1.5) (0.0) (0.0) (0.0) (0.0)
4/502 (0.8)
Total F
(0.0) (3.2) (0.0) (1.0) (2.1) (6.7) (3.4) (1.7)
(0.0) (0.0) (1.2) (1.2) (2.3) (2.4) (3.9) (3.9)
(0.0) (0.0) (1.1) (2.3) (2.3) (1.1) (0.0) (0.0)
Total M 0/174 3/178 1/182 2/183 4/182 8/173 6/165 3/110
(0.0) (1.7) (0.5) (1.1) (2.2) (4.6) (3.6) (2.7)
(0.0) (0.0) (0.5) (1.0) (1.0) (2.5) (0.0) (0.0)
10/1556 (0.6)
F – females; M – males; n – number of sockets affected; N – total number of sockets observed; % – per socket frequency (n/N); I1 – central incisor; I2 – lateral incisor; C – canine; PM1 – first premolar; PM2 – second premolar; M1 – first molar; M2 – second molar; M3 – third molar.
only exposed to the oral environment in later life because of continuous eruption and/or periodontal disease, and root caries are thus more common among elderly individuals who tend to have fewer surviving teeth due to AMTL.106 While no statistically significant differences in total per individual or per tooth frequencies were observed (Tables 3–5), females did exhibit a significantly higher per tooth frequency of caries in mature adulthood. In particular, it appears that females experienced a greater increase between young and mature adulthood (7.9% to 14.5%), compared to males, among whom the per tooth frequency changed little between young and mature adulthood (8.4% to 8.0%). Additionally, females exhibited an increase in per individual frequency between young and mature adulthood, unlike males (Tables 3 and 4). An overall increase in per tooth frequency with age is to be expected, given that the condition is ‘age-progressive’103; however, the greater age-related increase in caries rate among females requires some explanation. The difference in caries prevalence between the sexes in mature adulthood could reflect changes in male and female diets over the life-course, e.g. an increase in the cariogenicity of the female diet relative to males. A stable isotope and dental pathology study of Roman individuals from Isola Sacra, near Rome, revealed agerelated differences in isotope values and oral health between the sexes, which were interpreted as evidence for variation in the relationship between gender and diet over the life-course. In particular, females in the Isola Sacra population were found to have lower average d15N values compared to males, and the difference was more pronounced among young and mature (
Available online at www.sciencedirect.com
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A comparison of female and male oral health in skeletal populations from late Roman Britain: Implications for diet L. Bonsall * University of Edinburgh, School of History, Classics and Archaeology, William Robertson Wing, Old Medical School, Teviot Place, Edinburgh, Mid Lothian EH8 9AG, United Kingdom
article info
abstract
Article history:
Objectives: Textual sources from the Roman period point to the existence of dietary differ-
Accepted 25 July 2014
ences between the sexes. The aim of this study was to assess the palaeopathological
Keywords:
the oral health of sexed individuals from two late Romano-British sites (Ancaster, Lincoln-
evidence for such gender differences in dietary habits in Roman Britain by comparing Dento-alveolar pathology
shire, and Winchester, Hampshire, England).
Diet
Materials and methods: Eighty-seven females (1243 teeth and 1950 sockets) and 112 males
Sex
(1984 teeth and 2903 sockets) were examined for the presence of five dento-alveolar condi-
Gender
tions, namely caries, calculus, periapical lesions, periodontal disease, and antemortem tooth
Roman Britain
loss. The frequency of each condition was calculated at the per individual and per tooth/socket level, and the results were compared between the sexes using Fisher’s exact tests. Results: Caries and antemortem tooth loss were slightly more common among women, but differences between the sexes were generally not significant. Males experienced higher rates of calculus and periodontal disease. There were no sex differences in the frequency of periapical lesions. Conclusions: Comparable rates of caries, periapical lesions and antemortem tooth loss in females and males indicate broad similarity in the diets of men and women. The greater levels of calculus and periodontal disease in males might point to some dietary differences, but could also be explained by non-dietary factors. Overall, the findings suggest that significant gender differences in diet, described in some contemporaneous textual sources, were not widely observed in Roman Britain. # 2014 Elsevier Ltd. All rights reserved.
1.
Introduction
Archaeologists have long been interested in studying ancient diets. At the broad scale, dietary habits are influenced by environmental and technological constraints, and palaeodietary studies provide insights into human–environment
interactions and socio-economic structures in the past.1–3 Many additional factors affect dietary choices at the withingroup level, including gender, class/status, ethnic affiliation and religious beliefs; thus, the study of ancient diets can also elucidate cultural dynamics.4,5 In relation to gender, many archaeological studies have examined dietary variations between the sexes as a means of
* Correspondence to: 10 Merchiston Gardens, Edinburgh EH10 5DD, Scotland, UK. Tel.: +44 131 346 2119. E-mail addresses: [email protected], [email protected]. http://dx.doi.org/10.1016/j.archoralbio.2014.07.019 0003–9969/# 2014 Elsevier Ltd. All rights reserved.
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exploring the roles and status of men and women in past societies. Studies of contemporary and recent historic populations have documented male-female dietary differences in both hunter-gatherer and agricultural societies, often reflecting gender divisions in labour and food procurement activities, and social status.6–8 Various archaeological and bioarchaeological studies have explored whether such differences existed in the past.9–12 In Roman society, biological sex, gender and status were closely intertwined. Literary, epigraphic and iconographic sources document the existence of pronounced differences in the socio-economic and legal status of men and women in the Roman world.13–16 Some texts from the period suggest the differing positions of men and women in Roman society could influence diet; in particular, it seems that men sometimes enjoyed greater access to ‘high status’ foodstuffs, particularly meat, fish and other marine sources. In addition, medical writers such as Galen advised men and women to consume different foods based on their views of variations between the sexes in energy and nutritional requirements, and erroneous beliefs about the impact of food on behaviour.17–18 In recent years, several palaeopathology and stable isotope studies of populations from Roman Italy have provided some corroborative evidence for dietary differences between the sexes such as those described in the aforementioned texts, and this could have had implications for health and nutrition.19–22 However, the Roman Empire was not necessarily homogenous in this respect, and gendered differences in diet might not have existed in all provinces. In the case of Roman Britain, relatively little is known about the existence or otherwise of gender-based dietary variations between the sexes. Very few relevant textual sources for the dietary habits of the general populace survive from this region of the Empire, and the extent to which the norms and ideals of medical writers regarding gender and diet were disseminated more widely is difficult to assess. Archaeological and palaeoenvironmental evidence document changes in subsistence practices and dietary habits in Britain following its incorporation into the Roman Empire, which included agricultural intensification, increased exploitation of fish and other marine resources, and greater consumption of ‘exotic’ imported foodstuffs.23–26 Research on Romano-British food-ways has increasingly emphasised the cultural, as well as economic and technological, significance of these changes,27–29 and it is possible that the ‘Romanisation’ of dietary habits included differences between the sexes, reflecting men and women’s changing roles and statuses.30,31 Most carbon (C) and nitrogen (N) isotope analyses of Romano-British populations have not observed statistically significant differences between the sexes.32–37 However, it should be noted that the majority of isotope studies considered bone collagen isotope ratios only, which reflect dietary protein rather than whole diet (as do bone apatite values).38 Additionally, C and N isotopes are only sensitive to quite significant differences in diet.35 This study explores whether gendered differences in dietary habits, such as those described in some Roman textual sources, existed in Roman Britain by comparing the oral health status of sexed individuals from late Romano-British cemeteries. While several studies of oral health in populations from this period exist,39–45 few have explicitly focused in detail on
male-female differences. The teeth and associated structures are directly exposed to foods consumed by an individual, and diet therefore influences oral health. The study of dentoalveolar pathology can provide important information on past dietary habits, especially since the teeth tend to survive relatively well in archaeological contexts.46,47 Numerous bioarchaeological studies have examined common dentoalveolar diseases as proxy indicators of past diets,48–67 and differences in oral health between the sexes have been interpreted with reference to diet.48,49,51,52,54,64,66,67
2.
Materials and methods
The materials used for the present study were examined during the author’s doctoral research, and derive from two RomanoBritish cemeteries in England – Ancaster, Lincolnshire, and Winchester, Hampshire (Fig. 1). Both assemblages predominantly date from the late Roman period (c. AD 270-410). The Roman settlement at Ancaster was a small, fortified site straddling Ermine Street, the main north-south road crossing the province. The associated cemetery was excavated between 1964 and 1973, during which the remains of over 250 individuals were recovered.68–70 Archaeological evidence suggests that the settlement’s economy was centred on a combination of small-scale trade and craft production, including potting and possibly stone masonry, as well as agriculture. There is little evidence for higher-order economic activities such as trade in luxury goods or mosaic production, which implies that the settlement at Ancaster served a primarily local, non-elite market.71–73 Evidence from the cemetery also points to a predominantly low-status population; while some individuals were interred in stone sarcophagi, signalling higher status, most graves were simple, unfurnished inhumations. The Ancaster population has not been subjected to stable isotope analyses to explore levels of mobility, but data from a site of comparable status (Catterick, North Yorkshire) suggest the populations of such sites were drawn almost entirely from the local area.74 Winchester (Venta Belgarum) was the fifth largest town of Roman Britain, and one of the main economic and administrative centres of the province’s south-central region.75 There is evidence for a wide range of commercial and craft activities at Winchester, typical of the major urban centres, including metal production, specialist butchering, bone working, and possibly weaving.76,77 Most of the inhabitants were probably traders and craftsmen72,78 although the discovery of large, well-appointed town houses points to the presence of higher status residents – perhaps members of the town’s ruling elite.79 Strontium and oxygen isotope analyses of individuals from Winchester and other major Romano-British urban centres suggest that a significant minority of people – up to c. 25% – residing in large towns were of non-local origin, and this almost certainly included individuals from the Mediterranean region and further afield.80–82 Extensive extramural inhumation cemeteries existed outside the town walls of Roman Winchester. Since the mid-twentieth century, rescue excavations carried out in advance of development have resulted in the discovery of around one thousand Roman burials (primarily unfurnished inhumations dating from the
archives of oral biology 59 (2014) 1279–1300
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Fig. 1 – Outline map of Britain (England and Wales), showing the locations of the study sites. Reproduced from Ordnance Survey map data by permission of Ordnance Survey# Crown copyright 2013.
third to early fifth century AD) at numerous sites in the modern city. Skeletal material included in this analysis derive from six sites (Andover Road, Hyde Street, Victoria Road, Chester Road, Carfax and New Road).83 For the present study, only individuals with intact or partially intact dentitions (at least one surviving tooth/socket) for whom sex could be determined with a relatively high degree of accuracy were considered. Thus, juveniles (defined as individuals aged less than c. 18 years) were excluded, since immature individuals cannot be sexed reliably using commonly applied morphological and metric methods.84 In accordance with recommended standards for British skeletal populations, sex was determined from pelvis and skull morphology, and postcranial metrics.85–89 Without the widespread application of ancient DNA analysis, an error margin exists when sexing skeletal remains from morphological and metric features. However, the pelvis is widely considered to
provide a relatively reliable indicator of sex (in excess of 90% accuracy).90,91 Consequently, only individuals with intact innominate bones that indicated female or male sex were included in this study. Age-at-death was estimated from pubic symphysis and auricular surface morphology, molar attrition, and skeletal maturation.92–96 Individuals were assigned to one of the following age categories: young adult (18–34 years), mature adult (35–49 years), elderly adult (50+ years) and unaged adult (18 years). The final sample comprised 87 females (46 from Ancaster and 41 from Winchester) and 112 males (66 from Ancaster and 46 from Winchester). The demographic composition of the study sample (individuals, teeth, and sockets) is summarised in Tables 1 and 2. For the combined Ancaster and Winchester sample, the age distribution of males and females across the young, mature and elderly adult age categories was not significantly different (x2 = 3.504, df = 2, p = 0.173).
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Table 1 – Composition of the study sample by sex and age. Age (years)
F (N, %) Ancaster
M (N, %)
Winchester
Number of individuals with at least one surviving tooth/socket 18–34 20 (43.5) 21 (51.2) 12 (26.1) 5 (12.2) 35–49 50+ 10 (21.7) 11 (26.8) 4 (8.7) 4 (9.8) Unaged 46 (100.0) 41 (100.0) Total
Total F
Ancaster
Winchester
Total M
a
41 17 21 8 87
(47.1) (19.5) (24.1) (9.2) (100.0)
26 22 15 3 66
(39.4) (33.3) (22.7) (4.5) (100.0)
18 14 13 1 46
(39.1) (30.4) (28.3) (2.2) (100.0)
44 36 28 4 112
(39.3) (32.1) (25.0) (3.6) (100.0)
Number of individuals with at least sixteen surviving teeth and socketsa 18–34 13 (81.3) 15 (88.2) 28 (84.8) 2 (12.5) 1 (5.9) 3 (9.1) 35–49 0 (0.0) 1 (5.9) 1 (3.0) 50+ 1 (6.3) 0 (0.0) 1 (3.0) Unaged 16 (100.0) 17 (100.0) 33 (100.0) Total
16 10 2 1 29
(55.2) (34.5) (6.9) (3.4) (100.0)
16 9 4 1 30
(53.3) (30.0) (13.3) (3.3) (100.0)
32 19 6 2 59
(54.2) (32.2) (10.2) (3.4) (100.0)
Number of teeth (in situ and loose)b 18–34 408 (67.3) 111 (18.3) 35–49 50 (8.3) 50+ 37 (6.1) Unaged Total 606 (100.0)
470 62 53 52 637
(73.8) (9.7) (8.3) (8.2) (100.0)
878 173 103 89 1243
(70.6) (13.9) (8.3) (7.2) (100.0)
532 392 119 33 1076
(49.4) (36.4) (11.1) (3.1) (100.0)
451 272 161 24 908
(49.7) (30.0) (17.7) (2.6) (100.0)
983 664 280 57 1984
(49.5) (33.5) (14.1) (2.9) (100.0)
Number of socketsc 18–34 35–49 50+ Unaged Total
546 81 228 75 930
(58.7) (8.7) (24.5) (8.1) (100.0)
1080 298 411 161 1950
(55.4) (15.3) (21.1) (8.3) (100.0)
667 560 333 43 1603
(41.6) (34.9) (20.8) (2.7) (100.0)
541 386 345 28 1300
(41.6) (29.7) (26.5) (2.2) (100.0)
1208 946 678 71 2903
(41.6) (32.6) (23.4) (2.4) (100.0)
826 153 94 76 1149
(71.9) (13.3) (8.2) (6.6) (100.0)
530 381 114 29 1054
(50.3) (36.1) (10.8) (2.8) (100.0)
440 260 154 24 878
(50.1) (29.6) (17.5) (2.7) (100.0)
970 641 268 53 1932
(50.2) (33.2) (13.9) (2.7) (100.0)
534 217 183 86 1020
(52.4) (21.3) (17.9) (8.4) (100.0)
Number of teeth and sockets (i.e. sockets with teeth in situ)d 18–34 390 (67.5) 436 (76.4) 106 (18.3) 47 (8.2) 35–49 45 (7.8) 49 (8.6) 50+ 37 (6.4) 39 (6.8) Unaged 578 (100.0) 571 (100.0) Total
F – females; M – males; N – number of individuals/teeth/sockets examined; % – percentage of individuals/teeth/sockets examined. Used to calculate per individual frequency. b Used to calculate per tooth frequency of caries. c Used to calculate per socket frequency of periapical lesions and antemortem tooth loss. d Used to calculate per socket frequency of periodontal disease. a
It is evident from Table 1 that the total male-to-female ratio (112:87 or 1.3) is higher than an expected sex ratio of 1.0, although not significantly so (x2 = 2.894, df = 1, p = 0.089). High sex ratios have been reported for other Romano-British sites, especially towns.97 The study sample’s high sex ratio could be the result of male-biased sexing error, due to the methods employed being inappropriate for the population.87,98 However, the morphological features from which sex was assessed in the present study are the same as those used by other researchers in sexing contemporaneous Romano-British populations, in which both balanced and high sex ratios have been observed.99,100 Furthermore, limiting the sample to individuals with pelvic features indicating male or female sex should have reduced the extent of sexing error. While some degree of sexing error cannot be ruled out, cultural factors (e.g. migration and differential burial treatment), as well as preservation bias, seem more likely to explain high sex ratios in the study sample and other Romano-British cemeteries.97,101,102 The intra-oral distribution of pathology by tooth category tends to follow certain trends.103 As a result, any difference between the sexes in the relative proportions of anterior and
posterior teeth/sockets surviving for analysis, e.g. owing to differences in post-mortem tooth loss, could bias results when all tooth types are combined in calculating per tooth/socket frequencies. To assess whether this is an issue for the present study, the relative proportions of incisor, canine, premolar and molar teeth and sockets (Table 2) were compared between the sexes using chi squared tests. Among females, incisors, canines, premolars and molars comprised 22.9% (285), 14.6% (181), 27.3% (339) and 35.2% (438) of 1243 surviving teeth, respectively. The same figures for males (1984 teeth) were 23.2% (461), 14.7% (292), 28.7% (569) and 33.4% (662). The difference between the sexes in the proportions of incisors, canines, premolars and molars was not statistically significant (x2 = 1.366, df = 3, p = 0.714). Among 1950 female sockets, there were 514 (26.4%) incisor, 261 (13.4%) canine, 519 (26.6%) premolar and 656 (33.6%) molar sockets. The distribution of 2903 male sockets was similar, with incisor, canine, premolar and molar sockets comprising 25.8% (750), 13.2% (383), 26.4% (765) and 34.6% (1005) of all surviving sockets. Again, the difference between the sexes was non-significant (x2 = 0.512, df = 3, p = 0.916), meaning comparisons of total
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Table 2 – Numbers of teeth and sockets in the study sample by sex and tooth position. Tooth/socket
Ancaster (N, %) Teeth
Females Mx I1 Mx I2 Mx C Mx PM1 Mx PM2 Mx M1 Mx M2 Mx M3 Total Md Md Md Md Md Md Md Md
I1 I2 C PM1 PM2 M1 M2 M3
Total Males Mx I1 Mx I2 Mx C Mx PM1 Mx PM2 Mx M1 Mx M2 Mx M3 Total Md Md Md Md Md Md Md Md
I1 I2 C PM1 PM2 M1 M2 M3
Total
23 31 43 47 41 44 37 23
(8.0) (10.7) (14.9) (16.3) (14.2) (15.2) (12.8) (8.0)
289 (100.0) 32 44 51 48 36 32 41 33
(10.1) (13.9) (16.1) (15.1) (11.4) (10.1) (12.9) (10.4)
317 (100.0)
49 54 69 70 57 38 48 40
(11.5) (12.7) (16.2) (16.5) (13.4) (8.9) (11.3) (9.4)
425 (100.0) 65 79 86 88 91 83 88 71
(10.0) (12.1) (13.2) (13.5) (14.0) (12.7) (13.5) (10.9)
651 (100.0)
Sockets 67 64 65 64 62 57 54 33
(14.4) (13.7) (13.9) (13.7) (13.3) (12.2) (11.6) (7.1)
466 (100.0) 69 70 73 73 73 73 72 51
(12.5) (12.6) (13.2) (13.2) (13.2) (13.2) (13.0) (9.2)
554 (100.0)
92 94 97 97 96 90 89 59
(12.9) (13.2) (13.6) (13.6) (13.4) (12.6) (12.5) (8.3)
714 (100.0) 113 113 114 114 114 114 114 93
(12.7) (12.7) (12.8) (12.8) (12.8) (12.8) (12.8) (10.5)
889 (100.0)
Winchester (N, %)
Teeth and sockets 23 30 40 44 40 41 34 22
(8.4) (10.9) (14.6) (16.1) (14.6) (15.0) (12.4) (8.0)
274 (100.0) 29 40 48 46 36 32 40 33
(9.5) (13.2) (15.8) (15.1) (11.8) (10.5) (13.2) (10.9)
304 (100.0)
45 50 66 70 56 38 48 40
(10.9) (12.1) (16.0) (16.9) (13.6) (9.2) (11.6) (9.7)
413 (100.0) 62 76 84 87 91 82 88 71
(9.7) (11.9) (13.1) (13.6) (14.2) (12.8) (13.7) (11.1)
641 (100.0)
Teeth 38 36 40 34 37 42 36 33
(12.8) (12.2) (13.5) (11.5) (12.5) (14.2) (12.2) (11.1)
296 (100.0) 32 49 47 48 48 41 48 28
(9.4) (14.4) (13.8) (14.1) (14.1) (12.0) (14.1) (8.2)
341 (100.0)
53 59 66 68 59 54 47 33
(12.1) (13.4) (15.0) (15.5) (13.4) (12.3) (10.7) (7.5)
439 (100.0) 44 58 71 71 65 51 57 52
(9.4) (12.4) (15.1) (15.1) (13.9) (10.9) (12.2) (11.1)
469 (100.0)
Sockets 57 57 58 58 57 53 53 35
(13.3) (13.3) (13.6) (13.6) (13.3) (12.4) (12.4) (8.2)
428 (100.0) 65 65 65 67 65 69 68 38
(12.9) (12.9) (12.9) (13.3) (12.9) (13.7) (13.5) (7.6)
502 (100.0)
82 84 85 86 86 83 76 51
(13.0) (13.3) (13.4) (13.6) (13.6) (13.1) (12.0) (8.1)
633 (100.0) 86 86 87 86 86 87 87 62
(12.9) (12.9) (13.0) (12.9) (12.9) (13.0) (13.0) (9.3)
667 (100.0)
Teeth and sockets 35 32 37 30 34 37 33 27
(13.2) (12.1) (14.0) (11.3) (12.8) (14.0) (12.5) (10.2)
265 (100.0) 30 42 42 43 40 37 44 28
(9.8) (13.7) (13.7) (14.1) (13.1) (12.1) (14.4) (9.2)
306 (100.0)
48 57 63 66 59 52 45 32
(11.4) (13.5) (14.9) (15.6) (14.0) (12.3) (10.7) (7.6)
422 (100.0) 41 55 71 69 64 51 56 49
(9.0) (12.1) (15.6) (15.1) (14.0) (11.2) (12.3) (10.7)
456 (100.0)
N – number of teeth/sockets examined; % – percentage of teeth/sockets examined; mx – maxilla; md – mandible; I1 – central incisor; I2 – lateral incisor; C – canine; PM1 – first premolar; PM2 – second premolar; M1 – first molar; M2 – second molar; M3 – third molar.
per tooth/socket prevalences for all tooth-types combined should be valid. All dental remains were examined macroscopically, and with the aid of a hand-held magnifying glass when required. The following pathological conditions were examined: caries, calculus, periapical lesions, periodontal disease and antemortem tooth loss. Caries is defined as ‘focal demineralisation of the dental hard tissues’ owing to the presence of bacteria in the mouth that ferment dietary carbohydrates, especially sucrose, producing organic acids in the process.53,104 Caries frequencies in archaeological populations are generally considered to be related to levels of carbohydrate consumption, with higher caries rates usually observed in populations that consumed significant quantities of
carbohydrates, e.g. many agrarian communities.46,58–61,105 In the present study, caries was identified where focal demineralisation penetrated the enamel. Caries were divided into crown (coronal caries) and root caries. Coronal caries were further classified by tooth surface, i.e. occlusal, interproximal (mesial/distal approximal), or smooth surface (buccal/labial or lingual). Root caries were subdivided into those affecting the cemento-enamel junction (CEJ), or root proper. In some cases, the original initiation site could not be determined (‘gross caries’).106 Calculus is mineralised bacterial plaque.107 In palaeodietary studies, high calculus rates associated with low caries rates have been linked to high protein consumption, but high rates of calculus and caries are thought to indicate high
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Table 3 – Per individual frequency (1) of dento-alveolar pathology by sex and age. Age (years)
F (n/N, %) Ancaster
Winchester
18–34 35–49 50+ Unaged
Caries 12/20 (60.0) 8/12 (67.7) 4/10 (40.0) 3/4 (75.0)
Total
M (n/N, %) Total F
Ancaster
Winchester
16/21 (76.2) 5/5 (100.0) 4/11 (36.4) 1/4 (25.0)
28/41 (68.3) 13/17 (76.5) 8/21 (38.1) 4/8 (50.0)
16/26 (61.5) 12/22 (54.5) 7/15 (46.7) 2/3 (66.7)
12/18 (66.7) 8/14 (57.1) 6/13 (46.2) 1/1 (100.0)
28/44 (63.6) 20/36 (55.6) 13/28 (46.4) 3/4 (75.0)
27/46 (58.7)
26/41 (63.4)
53/87 (60.9)
37/66 (56.1)
27/46 (58.7)
64/112 (57.1)
18–34 35–49 50+ Unaged
Calculus 11/20 (55.0) 3/12 (25.0) 1/10 (10.0) 3/4 (75.0)
11/21 (52.4) 3/5 (60.0) 1/11 (9.1) 1/4 (25.0)
22/41 (53.7) 6/17 (35.3) 2/21 (9.5) 4/8 (50.0)
20/26 (76.9) 18/22 (81.8) 5/15 (33.3) 2/3 (66.7)
9/18 (50.0) 11/14 (78.6) 6/13 (46.2) 1/1 (100.0)
29/44 (65.9) 29/36 (80.6) 11/28 (39.3) 3/4 (75.0)
Total
18/46 (39.1)
16/41 (39.0)
34/87 (39.1)
45/66 (68.2)
27/46 (58.7)
72/112 (64.3)
18–34 35–49 50+ Unaged
Periapical lesions 5/20 (25.0) 1/12 (8.3) 4/10 (40.0) 0/4 (0.0)
4/21 (19.0) 0/5 (0.0) 2/11 (18.2) 1/4 (25.0)
9/41 (22.0) 1/17 (5.9) 6/21 (28.6) 1/8 (12.5)
5/26 (19.2) 4/22 (18.2) 2/15 (13.3) 0/3 (0.0)
3/18 (16.7) 3/14 (21.4) 4/13 (30.8) 0/1 (0.0)
8/44 (18.2) 7/36 (19.4) 6/28 (21.4) 0/4 (0.0)
Total
10/46 (21.7)
7/41 (17.1)
17/87 (19.5)
11/66 (16.7)
10/46 (21.7)
21/112 (18.8)
18–34 35–49 50+ Unaged
Periodontal disease 5/20 (25.0) 5/21 (23.8) 4/12 (33.3) 3/5 (60.0) 3/10 (30.0) 6/11 (54.5) 2/4 (50.0) 1/4 (25.0)
10/41 (24.4) 7/17 (41.2) 9/21 (42.9) 3/8 (37.5)
9/26 (34.6) 11/22 (50.0) 6/15 (40.0) 2/3 (67.7)
4/18 (22.2) 7/14 (50.0) 8/13 (61.5) 0/1 (0.0)
13/44 (29.5) 18/36 (50.0) 14/28 (50.0) 2/4 (50.0)
Total
14/46 (30.4)
29/87 (33.3)
28/66 (42.4)
19/46 (41.3)
47/112 (42.0)
18–34 35–49 50+ Unaged
Antemortem tooth loss 7/20 (35.0) 8/21 (38.1) 9/12 (75.0) 3/5 (60.0) 9/10 (90.0) 11/11 (100.0) 2/4 (50.0) 3/4 (75.0)
15/41 (36.6) 12/17 (70.6) 20/21 (95.2) 5/8 (62.5)
12/26 (46.2) 15/22 (68.2) 14/15 (93.3) 3/3 (100.0)
9/18 (50.0) 7/14 (50.0) 13/13 (100.0) 1/1 (100.0)
21/44 (47.7) 22/36 (61.1) 27/28 (96.4) 4/4 (100.0)
Total
27/46 (58.7)
52/87 (59.8)
44/66 (66.7)
30/46 (65.2)
74/112 (66.1)
15/41 (36.6)
25/41 (61.0)
Total M
F – females; M – males; n – number of individuals affected; N – total number of individuals with at least one surviving tooth/socket observed; % – per individual frequency (n/N).
carbohydrate, low protein diets.52,107 Recording and interpreting data on calculus rates in curated osteological collections is problematic, since deposits can be dislodged from teeth during post-excavation cleaning and examination. This is especially likely when dealing with skeletal material from older excavations, as in the case of the present study.108 For this reason, it is probable that per tooth frequency rates for the study population would be inaccurate, and only per individual prevalence rates are presented here.109 A periapical lesion (PL) is a void extending around the apex of a tooth’s root(s). Lesions are usually categorised into three types: granulomas, apical cysts and chronic abscesses.110–112 All arise from infection and inflammation of the tooth pulp (‘pulpitis’) leading to necrosis. Caries is a common cause, but severe attrition and trauma resulting in pulp exposure can also lead to lesions.103 Granulomas represent the formation of a granulomatous tissue mass at the root apex in response to tooth pulp necrosis, which causes the surrounding alveolar bone to resorb. Apical cysts develop when existing granulomatous tissue is replaced by fluid build-up. Chronic abscesses
are caused by pyogenic infection; pus accumulates, the pressure of which eventually produces a fistula in the alveolar bone through which it is discharged. Granulomas and apical cysts are benign, subclinical features, while chronic abscesses are often painful and require treatment.111 Periodontal disease (PD) is an inflammatory condition of the supporting structures surrounding the teeth. PD can involve localised (vertical) and/or generalised (horizontal) alveolar bone loss.103,110 Bacterial plaque is the primary cause.113 In dry bone specimens, PD is sometimes diagnosed based on an increase in the distance between the alveolar crest (AC) and cementoenamel junction (CEJ) above c. 2 mm.114 Strictly speaking, ACCEJ distance alone is unreliable for diagnosing PD, since age and attrition-related continuous eruption also affect this parameter.110,115 For the present study, PD was identified when the following features were present: porosity and lipping of the alveolar crest, thinning of the interdental plates, and ‘trough’ formation around tooth roots.103,110 Pathologically-induced porosity was distinguished from post-mortem damage from evidence for fine pitting exhibiting remodelling, using a
archives of oral biology 59 (2014) 1279–1300
hand-held magnifying glass.116 Periodontal disease was only recorded for sockets with in situ teeth. Antemortem tooth loss (AMTL) refers to loss of the teeth during life. In skeletal remains, it can be recognised from alveolar remodelling (resorption). AMTL has several causes, including caries, PLs, periodontal disease, severe attrition, continuous eruption, scurvy, intentional extraction, and traumatic avulsion.108 When examining skeletal remains, it is sometimes not possible to identify the cause of AMTL with certainty. A positive correlation between caries prevalence and AMTL has been observed in some ancient populations,60,63 suggesting that caries was a significant contributor to premature tooth loss in the past. For the Roman period, there is both textual and archaeological evidence for intentional extraction of carious teeth.117,118 Periodontal disease is also likely to have been a major cause of tooth loss in ancient populations.103 Discerning AMTL, as opposed to congenital tooth absence (non-eruption or agenesis), is aided by the observation of contact-point facets on adjacent teeth and attrition on the occlusal partner.108 To assess and compare the oral health status of males and females in the study sample, two principal measures of disease frequency were used: (1) per individual frequency (number of individuals affected/total number of individuals observed 100); and (2) per tooth or socket frequency (number of teeth or sockets affected/total number of teeth or sockets observed 100). Per individual frequencies were calculated in the first instance using the total number of individuals with at least one surviving tooth/socket (i.e. the total number of individuals in the study sample) as the denominator (Table 3). However, per individual prevalences calculated in this way are potentially problematic, since differential preservation of skeletal remains from archaeological contexts means many individuals will not possess complete dentitions. Consequently, when individuals with relatively few surviving teeth/sockets are included in per individual frequencies, results may be less accurate. This can be militated against to a certain extent by including only individuals with a minimum level of dental preservation in calculations of per individual prevalence. Therefore, as well as calculating per individual frequencies for all individuals examined, a second measure of per individual frequency was used that gives prevalence rates as the proportion of affected individuals with at least sixteen surviving teeth and sockets, i.e. individuals with dentitions at least 50% intact (Table 4). This second measure of per individual prevalence should be less affected by inter-individual and inter-site preservation biases,116 but inevitably includes fewer individuals (especially elderly adults, owing to antemortem tooth loss). In terms of per tooth/socket frequencies, the denominator (N) differed according to the condition being assessed. For caries, per tooth prevalences were calculated as a percentage of all teeth present (in situ and loose). Periapical lesion and AMTL frequencies were calculated as percentages of all preserved sockets with or without teeth. Periodontal disease prevalence was calculated from the percentage of all sockets with in situ teeth. The numbers of teeth/sockets used to calculate these prevalences are provided in Tables 1 and 2. Per tooth/socket prevalences are not, strictly speaking, valid for use in statistical comparisons between groups. This is
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because dental disease often affects multiple tooth positions in a single individual and, ‘observations on several . . . teeth from a given individual cannot be considered independent for statistical purposes’.119 Nevertheless, per tooth/socket frequencies can be important in adjusting for differential skeletal preservation. Pathology frequencies were compared between the sexes using Fisher’s exact tests. The significance level was set at 5%, meaning a p-value less than 0.05 indicated a 95% probability that any difference between the sexes was not due to chance.119,120 Table 11 contains the results of significance tests comparing Ancaster females and males, Winchester females and males, and all females and males combined.
3.
Results
3.1.
Caries
Tables 3 and 4 present data for the per individual frequency of caries in the study sample. According to both measures of per individual prevalence, more females than males were affected. Among individuals with at least one surviving tooth, caries affected 60.9% (53/87) of females and 57.1% (64/112) of males (Table 3). When only individuals with at least sixteen teeth and sockets were considered, per individual frequencies were slightly higher, with 72.7% (24/33) of females and 69.5% (41/59) of males affected (Table 4). Ancaster females (11/16, 68.8%) were less affected than Ancaster males (21/29, 72.4%), while Winchester females (13/17, 76.5%) had a higher per individual frequency compared to Winchester males (20/30, 67.7%) (Table 4). However, there were no significant differences between the sexes in caries rates, either for the total sample or within sub-samples (Table 11). The per tooth caries frequency was higher for females (117/ 1243, 9.4%) compared to males (173/1984, 8.7%), and women were also more affected than males in both sub-samples (Table 5). In the case of mature adults, females had a significantly greater caries rate compared to males, but no other significant differences were observed (Table 11). The posterior teeth (premolars and molars) were significantly more affected than the anterior teeth (incisors and canines) among females and males, both overall and within each sub-sample (Table 6). For the total sample (Ancaster and Winchester combined), females had a prevalence of 2.1% (10/ 466) for the anterior teeth, compared to 13.8% (107/777) for the posterior teeth (Fisher’s p < 0.0001). Among males in the combined sample, prevalence rates for the anterior and posterior dentitions were 1.5% (11/753) and 13.2% (162/1231), respectively (Fisher’s p < 0.0001). When prevalences were compared between the sexes by tooth category (anterior vs posterior), there were no statistically significant differences (Fisher’s p: anterior = 0.3744; posterior = 0.7367) (Table 6). Among females, the mandibular teeth (10.0%, 66/658) were more frequently carious than the maxillary teeth (8.7%, 51/585), while males had a slightly higher rate of maxillary caries (9.4%, 81/864), compared to the mandibular dentition (8.2%, 92/1120) (Table 6); however, the difference between maxillary and mandibular caries rates was not significant for either sex (Fisher’s p: females = 0.4382; males = 0.3780). When frequencies
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Table 4 – Per individual frequency (2) of dento-alveolar pathology by sex and age. Age (years)
F (n/N, %) Ancaster
Winchester
18–34 35–49 50+ Unaged
Caries 8/13 (61.5) 2/2 (100.0) 0/0 (–) 1/1 (100.0)
Total
M (n/N, %) Total F
Ancaster
11/15 (73.3) 1/1 (100.0) 1/1 (100.0) 0/0 (–)
19/28 (67.9) 3/3 (100.0) 1/1 (100.0) 1/1 (100.0)
11/16 (68.8) 7/10 (70.0) 2/2 (100.0) 1/1 (100.0)
11/16 (68.8) 5/9 (55.6) 3/4 (75.0) 1/1 (100.0)
22/32 (68.8) 12/19 (63.2) 5/6 (83.3) 2/2 (100.0)
11/16 (68.8)
13/17 (76.5)
24/33 (72.7)
21/29 (72.4)
20/30 (67.7)
41/59 (69.5)
18–34 35–49 50+ Unaged
Calculus 9/13 (69.2) 0/2 (0.0) 0/0 (–) 1/1 (100.0)
9/15 (60.0) 0/1 (0.0) 0/1 (0.0) 0/0 (–)
18/28 (64.3) 0/3 (0.0) 0/1 (0.0) 1/1 (100.0)
13/16 (81.3) 10/10 (100.0) 2/2 (100.0) 1/1 (100.0)
8/16 (50.0) 7/9 (77.8) 2/4 (50.0) 1/1 (100.0)
21/32 (65.6) 17/19 (89.5) 4/6 (66.7) 2/2 (100.0)
Total
10/16 (62.5)
9/17 (52.9)
19/33 (57.6)
26/29 (89.7)
18/30 (60.0)
44/59 (74.6)
18–34 35–49 50+ Unaged
Periapical lesions 1/13 (7.7) 0/2 (0.0) 0/0 (–) 0/1 (0.0)
4/15 (26.7) 0/1 (0.0) 0/1 (0.0) 0/0 (–)
5/28 (17.9) 0/3 (0.0) 0/1 (0.0) 0/1 (0.0)
3/16 (18.8) 4/10 (40.0) 1/2 (50.0) 0/1 (0.0)
4/16 (25.0) 1/9 (11.1) 3/4 (75.0) 0/1 (0.0)
7/32 (21.9) 5/19 (26.3) 4/6 (66.7) 0/2 (0.0)
Total
1/16 (6.3)
4/17 (23.5)
5/33 (15.2)
8/29 (27.6)
8/30 (26.7)
16/59 (27.1)
18–34 35–49 50+ Unaged
Periodontal disease 2/13 (15.4) 5/15 (33.3) 1/2 (50.0) 0/1 (0.0) 0/0 (–) 1/1 (100.0) 1/1 (100.0) 0/0 (–)
7/28 (25.0) 1/3 (33.3) 1/1 (100.0) 1/1 (100.0)
7/16 (43.8) 5/10 (50.0) 1/2 (50.0) 1/1 (100.0)
3/16 (18.8) 5/9 (55.6) 3/4 (75.0) 0/1 (0.0)
10/32 (31.3) 10/19 (52.6) 4/6 (67.7) 1/2 (50.0)
Total
4/16 (25.0)
10/33 (30.3)
14/29 (48.3)
11/30 (36.7)
25/59 (42.4)
18–34 35–49 50+ Unaged
Antemortem tooth loss 3/13 (23.1) 6/15 (40.0) 2/2 (100.0) 1/1 (100.0) 0/0 (–) 1/1 (100.0) 1/1 (100.0) 0/0 (–)
9/28 (32.1) 3/3 (100.0) 1/1 (100.0) 1/1 (100.0)
8/16 (50.0) 8/10 (80.0) 2/2 (100.0) 1/1 (100.0)
7/16 (43.8) 4/9 (44.4) 4/4 (100.0) 1/1 (100.0)
15/32 (46.9) 12/19 (63.2) 6/6 (100.0) 2/2 (100.0)
Total
6/16 (37.5)
14/33 (42.4)
19/29 (65.5)
16/30 (53.3)
35/59 (59.3)
6/17 (35.3)
8/17 (47.1)
Winchester
Total M
F – females; M – males; n – number of individuals affected; N – total number of individuals with at least sixteen surviving teeth and sockets observed; % – per individual frequency (n/N).
were compared by dental arcade between the sexes, there were no significant differences (Fisher’s p: maxilla = 0.7103; mandible = 0.1964). Table 7 presents data on the distribution of caries lesions by tooth category and tooth aspect. Most lesions for which the initiation point could be determined (i.e. excluding gross caries) affected the crown (females: 58/99, 58.6%; males: 83/128, 64.8%). For the combined female and male samples, the relative proportions of coronal vs root/CEJ caries were not significantly different (Fisher’s p = 0.3387). In the case of coronal caries, the occlusal, smooth and interproximal surfaces were relatively similarly affected in the Ancaster sub-sample, and among Winchester females. In Winchester males, the interproximal surfaces were more frequently affected than other aspects of the crown. The CEJ was a more frequent site for caries development than the root surface proper. Overall, males exhibited relatively more gross caries (26.0% of all lesions, compared to 15.4% of female lesions), and when the proportions of coronal and root vs gross caries was compared between the sexes, the difference was significant (Fisher’s p = 0.0416).
3.2.
Calculus
Calculus was observed in 39.1% (34/87) of females and 64.3% (72/112) of males with at least one surviving tooth (Table 3). Males also exhibited higher rates of calculus within each subsample, with 68.2% and 58.7% of Ancaster and Winchester males affected, compared to 39.1% and 39.0% of Ancaster and Winchester females, respectively. In the Ancaster sub-sample, males had a significantly higher overall calculus rate. When the data for both sub-samples were combined, the male calculus rate was significantly higher than that for females (Table 11). Per individual calculus frequencies were greater when calculated for individuals with at least sixteen teeth and sockets preserved, with 57.6% (19/33) of females and 74.6% (44/ 59) of males affected (Table 4). Calculus was more common in males than females in almost all age and sub-sample comparisons, although the difference was only significant in the case of the combined female vs male 35–49 year age group (Table 11).
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Table 5 – Per tooth/socket frequency of dento-alveolar pathology by sex and age. Age (years)
F (n/N, %) Ancaster
Winchester
M (n/N, %) Total F
Ancaster
Winchester
Total M
18–34 35–49 50+ Unaged
Caries 30/408 (7.4) 19/111 (17.1) 7/50 (14.0) 5/37 (13.5)
39/470 (8.3) 6/62 (9.7) 7/53 (13.2) 4/52 (7.7)
69/878 (7.9) 25/173 (14.5) 14/103 (13.6) 9/89 (10.1)
47/532 (8.8) 28/392 (7.1) 13/119 (10.9) 6/33 (18.2)
36/451 (8.0) 25/272 (9.2) 17/161 (10.6) 1/24 (4.2)
83/983 (8.4) 53/664 (8.0) 30/280 (10.7) 7/57 (12.3)
Total
61/606 (10.1)
56/637 (8.8)
117/1243 (9.4)
94/1076 (8.7)
79/908 (8.7)
173/1984 (8.7)
18–34 35–49 50+ Unaged
Periapical lesions 3/534 (0.6) 2/217 (0.9) 5/183 (2.7) 0/86 (0.0)
5/546 (0.9) 0/81 (0.0) 3/228 (1.3) 1/75 (1.3)
8/1080 (0.7) 2/298 (0.7) 8/411 (1.9) 1/161 (0.6)
11/667 (1.6) 6/560 (1.1) 3/333 (0.9) 0/43 (0.0)
6/541 (1.1) 3/386 (0.8) 8/345 (2.3) 0/28 (0.0)
17/1208 (1.4) 9/946 (1.0) 11/678 (1.6) 0/71 (0.0)
Total
10/1020 (1.0)
9/930 (1.0)
19/1950 (1.0)
20/1603 (1.2)
17/1300 (1.3)
37/2903 (1.3)
18–34 35–49 50+ Unaged
Periodontal disease 46/390 (11.8) 34/106 (32.1) 20/45 (44.4) 30/37 (81.1)
56/436 (12.8) 27/47 (57.4) 25/49 (51.0) 11/39 (28.2)
102/826 (12.3) 61/153 (39.9) 45/94 (47.9) 41/76 (53.9)
124/530 (23.4) 151/381 (39.6) 61/114 (53.5) 23/29 (79.3)
28/440 (6.4) 112/260 (43.1) 101/154 (65.6) 0/24 (0.0)
152/970 (15.7) 263/641 (41.0) 162/268 (60.4) 23/53 (43.4)
Total
130/578 (22.5)
119/571 (20.8)
249/1149 (21.7)
359/1054 (34.1)
241/878 (27.4)
600/1932 (31.1)
18–34 35–49 50+ Unaged
Antemortem tooth loss 17/534 (3.2) 26/546 (4.8) 35/217 (16.1) 14/81 (17.3) 75/183 (41.0) 121/228 (53.1) 15/86 (17.4) 19/75 (25.3)
43/1080 (4.0) 49/298 (16.4) 196/411 (47.7) 34/161 (21.1)
32/667 (4.8) 61/560 (10.9) 106/333 (31.8) 9/43 (20.9)
27/541 (5.0) 33/386 (8.5) 128/345 (37.1) 1/28 (3.6)
59/1208 (4.9) 94/946 (9.9) 234/678 (34.5) 10/71 (14.1)
Total
142/1020 (13.9)
322/1950 (16.5)
208/1603 (13.0)
189/1300 (14.5)
397/2903 (13.7)
180/930 (19.4)
F – females; M – males; n – number of teeth/sockets affected; N – total number of teeth/sockets observed; % – per tooth/socket frequency (n/N).
3.3.
Periapical lesions
Per individual prevalences of periapical lesions were similar for females and males from both sites, and for the total sample combined. Among individuals with at least one surviving socket, the total per individual frequency of lesions was 19.5% (17/87) for females and 18.8% (21/112) for males (Table 3). Of those with at least sixteen intact teeth and sockets, prevalence rates were 15.2% (5/33) for females and 27.1% (16/59) for males (Table 4). None of the differences between the sexes was statistically significant (Table 11). At the per socket level, periapical lesions were less prevalent than other conditions, with only 1.0% (19/1950) of female sockets and 1.3% (37/2903) of male sockets affected (Table 5). There were no statistically significant differences between the sexes (Table 11). Among females, combined prevalence rates for the anterior sockets (0.9%, 7/775) and posterior sockets (1.0%, 12/1175) were similar (Fisher’s p = 1.0000). Males had a significantly higher rate of posterior socket involvement, with 1.8% (32/1770) of posterior sockets and 0.4% (5/1133) of anterior sockets affected (Fisher’s p < 0.0001) (Table 8). There were, however, no differences between the sexes when per socket frequencies were compared (Fisher’s p: anterior = 0.2450; posterior = 0.1195). Lesions occurred more commonly in the maxillary dentition than the mandibular dentition in both sexes, and the
difference between arcades was statistically significant for males (Table 8). The maxillary PL frequency was 1.2% (11/894) for females and 2.0% (27/1347) for males, and the mandibular PL frequency was 0.8% (8/1056) for females, and 0.6% (10/1556) in males (Fisher’s p: females = 0.3568; males = 0.0013). The difference in prevalence between the sexes when compared by arcade (maxilla versus mandible) was not statistically significant (Fisher’s p: maxilla = 0.2698; mandible = 0.8110).
3.4.
Periodontal disease
Periodontal disease affected 33.3% (29/87) of females and 42.0% (47/112) of males with at least one surviving socket (Table 3). Males were more affected than females in most age groups in both sub-samples, but no statistically significant differences were observed between the sexes. Among individuals with at least sixteen intact teeth and sockets, the per individual frequency was 30.3% (10/33) for females and 42.4% (25/59) for males (Table 4). Again, there were no significant differences between the sexes (Table 11). Males in both sub-samples exhibited a higher total per socket frequency of periodontal disease than females (Table 5). The male and female prevalence rates for the Ancaster sub-sample were 34.1% (359/1054) and 22.5% (130/ 578), and in the Winchester sub-sample 27.4% (241/878) of male, and 20.8% (119/571) of female sockets were affected, respectively. For both sub-samples combined, the difference
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Table 6 – Per tooth frequency of caries by sex and tooth position. Tooth/socket
F (n/N, %) Ancaster
M (n/N, %)
Winchester
Total F
Ancaster
Winchester
Total M
0/49 (0.0) 1/54 (1.9) 1/69 (1.4) 6/70 (8.6) 10/57 (17.5)
1/53 (1.9) 2/59 (3.4) 0/66 (0.0) 6/68 (8.8) 10/59 (16.9)
1/102 (1.0) 3/113 (2.7) 1/135 (0.7) 12/138 (8.7) 20/116 (17.2)
Maxilla I1 I2 C PM1 PM2
0/23 0/31 3/43 5/47 3/41
M1 M2 M3
7/44 (15.9) 5/37 (13.5) 5/23 (21.7)
4/42 (9.5) 7/36 (19.4) 5/33 (15.2)
11/86 (12.8) 12/73 (16.4) 10/56 (17.9)
3/38 (7.9) 9/48 (18.8) 5/40 (12.5)
12/54 (22.2) 7/47 (14.9) 8/33 (24.2)
15/92 (16.3) 16/95 (16.8) 13/73 (17.8)
Total
28/289 (9.7)
23/296 (7.8)
51/585 (8.7)
35/425 (8.2)
46/439 (10.5)
81/864 (9.4)
Mandible I1 I2 C PM1 PM2
1/32 2/44 1/51 5/48 2/36
0/32 2/49 0/47 1/48 5/48
1/64 4/93 1/98 6/96 7/84
0/65 4/79 0/86 1/88 5/91
0/44 2/58 0/71 3/71 6/65
0/109 (0.0) 6/137 (4.4) 0/157 (0.0) 4/159 (2.5) 11/156 (7.1)
M1 M2 M3
5/32 (15.6) 9/41 (22.0) 8/33 (24.2)
10/41 (24.4) 12/48 (25.0) 3/28 (10.7)
15/73 (20.5) 21/89 (23.6) 11/61 (18.0)
18/83 (21.7) 17/88 (19.3) 14/71 (19.7)
9/51 (17.6) 8/57 (14.0) 5/52 (9.6)
27/134 (20.1) 25/145 (17.2) 19/123 (15.4)
Total
33/317 (10.4)
33/341 (9.7)
66/658 (10.0)
59/651 (9.1)
33/469 (7.0)
92/1120 (8.2)
(0.0) (0.0) (7.0) (10.6) (7.3)
(3.1) (4.5) (2.0) (10.4) (5.6)
0/38 1/36 0/40 2/34 4/37
(0.0) (2.8) (0.0) (5.9) (10.8)
(0.0) (4.1) (0.0) (2.1) (10.4)
0/61 1/67 3/83 7/81 7/78
(0.0) (1.5) (3.6) (8.6) (9.0)
(1.6) (4.3) (1.0) (6.3) (8.3)
(0.0) (5.1) (0.0) (1.1) (5.5)
(0.0) (3.4) (0.0) (4.2) (9.2)
F – females; M – males; n – number of teeth affected; N – total number of teeth observed; % – per tooth frequency (n/N); I1 – central incisor; I2 – lateral incisor; C – canine; PM1 – first premolar; PM2 – second premolar; M1 – first molar; M2 – second molar; M3 – third molar.
in per socket frequency was statistically significant for the total samples, and young and mature adults (Table 11). Females and males exhibited a broadly similar pattern of socket involvement, with the anterior sockets being more affected than posterior sockets (Table 9). In females, the overall per socket prevalence rate was 24.1% (103/428) for the anterior sockets and 20.2% (146/721) for the posterior sockets (Fisher’s p = 0.1387). In males, 31.8% (228/718) of anterior sockets and 30.6% (372/1214) of posterior sockets (Fisher’s p = 0.6113) were affected. PD prevalence was significantly higher for males compared to females in both the anterior (Fisher’s p = 0.0057) and posterior (Fisher’s p < 0.0001) dentitions. The mandibular sockets were more affected than the maxillary dentition in both sexes (Table 9). Among females, 16.9% (91/539) of maxillary sockets and 25.9% (158/610) of mandibular sockets were affected (Fisher’s p = 0.0002). In males, 29.2% (244/835) of maxillary sockets and 32.5% (356/ 1097) of mandibular sockets had PD (Fisher’s p = 0.1366). When prevalences were compared between the sexes by arcade, the difference was statistically significant for both maxilla (Fisher’s p < 0.0001) and mandible (Fisher’s p = 0.0050).
3.5.
Antemortem tooth loss
A majority of individuals exhibited some degree of antemortem tooth loss. Of those with at least one surviving socket, 59.8% (52/87) of females and 66.1% (74/112) of males were affected (Table 3). There were no significant differences between the sexes. Per individual prevalence rates were lower for those with 16+ surviving teeth, with 42.4% (14/33) of females and 59.3% (35/59) of males affected (Table 4), which can probably be ascribed to the inclusion of fewer mature and
elderly individuals in this count, as AMTL usually increases with age. Once more, no statistically significant differences between the sexes were observed (Table 11). Antemortem tooth loss affected 16.5% (322/1950) of female sockets and 13.7% (397/2903) of male sockets (Table 5). There was no significant difference in total per socket prevalence between the sexes among the Ancaster sub-sample; however, Winchester females had a significantly higher rate of AMTL compared to Winchester males. When the samples were combined, the overall per socket frequency of female AMTL was significantly higher than that for males (Table 11). For both sexes, the molars and premolars were the most frequently lost teeth (Table 10). AMTL frequency for the anterior dentition was 7.4% (57/775) for females and 5.0% (57/ 1133) for males, and for the posterior dentition it was 22.6% (265/1175) for females and 19.2% (340/1770) for males. The difference in AMTL frequency between the anterior and posterior dentition was statistically significant for both sexes (Fisher’s p < 0.0001). When prevalence rates were compared between the sexes by tooth category, the differences were statistically significant (Fisher’s p: anterior = 0.0389; posterior = 0.0287). Among females, the mandibular dentition (19.1%, 202/1056) was more affected than the maxillary dentition (13.4%, 120/ 894) (Table 10), and the difference was statistically significant (Fisher’s p = 0.0008). In contrast, males had more maxillary toothloss – 15.1% (204/1347) compared to 12.4% (193/1556) for the mandibular sockets, and the difference was significant (Fisher’s p = 0.0346). When compared by dental arcade, the difference between the sexes was not significant for the maxilla (Fisher’s p = 0.2699), but women had significantly more mandibular AMTL (Fisher’s p < 0.0001).
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Table 7 – Per tooth frequency of caries by sex, tooth category and tooth aspect. Tooth aspect
Tooth category (n, %) N
Incisors
Females Ancaster Crown: occlusal Crown: smooth surface Crown: interproximal Root: CEJ Root: root surface Gross caries Total
10 7 10 23 1 10 61
– – 1 (10.0) 2 (8.7) – – 3 (4.9)
– – – 1 1 2 4
Winchester Crown: occlusal Crown: smooth surface Crown: interproximal Root: CEJ Root: root surface Gross caries Total
9 11 11 16 1 8 56
– – 1 (9.1) 2 (12.5) – – 3 (5.4)
– – – – – –
– – – 5 1 6 12
Males Ancaster Crown: occlusal Crown: smooth surface Crown: interproximal Root: CEJ Root: root surface Gross caries Total
15 15 13 30 3 18 94
– – – 2 (6.7) – 3 (16.7) 5 (5.3)
– – – – – 1 (5.6) 1 (1.1)
1 – 6 8 – 7 22
(6.7)
Winchester Crown: occlusal Crown: smooth surface Crown: interproximal Root: CEJ Root: root surface Gross caries Total
8 4 28 12 0 27 79
– 1 – 1 – 3 5
– – – – – – –
1 – 7 4 – 13 25
(12.5)
(25.0) (8.3) (11.1) (6.3)
Canines
(4.3) (100.0) (20.0) (6.6)
Premolars
– – 4 8 – 3 15
Molars
(100.0) (100.0) (50.0) (52.2)
(30.0) (24.6)
10 7 5 12 – 5 39
(31.3) (100.0) (75.0) (21.4)
9 11 10 9 – 2 41
(100.0) (100.0) (90.9) (56.3)
14 15 7 20 3 7 66
(93.3) (100.0) (53.8) (66.7) (100.0) (38.9) (70.2)
7 3 21 7 – 11 49
(87.5) (75.0) (75.0) (58.3)
(40.0) (34.8)
(46.2) (26.7) (38.9) (23.4)
(25.0) (33.3) (48.1) (31.6)
(50.0) (63.9)
(25.0) (73.2)
(40.7) (62.0)
n – number of lesions by tooth category; N – total number of lesions observed by tooth aspect; % percentage of lesions; CEJ – cemento-enamel junction.
4.
Discussion
4.1.
Caries
Caries frequencies in the Ancaster and Winchester populations, and the combined study sample, are similar to those reported for contemporaneous populations,121–123 and accord with archaeological, palaeoenvironmental and bone chemistry evidence for a predominantly cereal-based diet in this period.23,25,37,124 Consumption of sweet, sticky foods, such as honey, fruit syrups, dried fruits and imported dates and figs could have facilitated caries development,51 although such ‘exotic’ foods might not have contributed significantly to the average individual’s diet.23,26 Differences in caries prevalence between males and females have been documented in past populations from diverse geographic and temporal contexts, and such data have often been interpreted with reference to gendered variations in diet.48,51,64 In the case of the present study sample, the slightly higher rates of caries among women may hint at some
difference in the quantity or type of carbohydrates being consumed, with women perhaps eating relatively more carbohydrate-rich foods and/or softer, stickier foods that were more likely to promote plaque build-up.51,52,64 However, the lack of statistically significant differences between the sexes in caries frequency at the per individual level means the finding of higher female caries prevalence may not be meaningful. Men and women exhibited similar patterns of tooth involvement. The molars and premolars were more frequently affected by caries than the anterior teeth – a pattern widely observed in both ancient and modern populations, and largely explained by the morphology and posterior location of the molars and premolars.106 The general predominance of interproximal and/or CEJ caries in both sexes (Table 7) is consistent with archaeological evidence for frequent consumption of starchy cereals and other high carbohydrate foods, leading to frequent bacterial plaque accumulation along the gingival margin and between teeth.106,125 The relative rarity of root caries occurring below the CEJ is probably due to the fact that the root surfaces are usually
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Table 8 – Per socket frequency of periapical lesions by sex and tooth position. Tooth/socket
F (n/N, %) Ancaster
Winchester
Maxilla I1 I2 C PM1 PM2 M1 M2 M3
0/67 1/64 0/65 0/64 0/62 2/57 3/54 0/33
0/57 1/57 0/58 1/58 1/57 2/53 0/53 0/35
Total
6/466 (1.3)
Mandible I1 I2 C PM1 PM2 M1 M2 M3
0/69 2/70 0/73 1/73 0/73 1/73 0/72 0/51
Total
4/554 (0.7)
(0.0) (1.6) (0.0) (0.0) (0.0) (3.5) (5.6) (0.0)
(0.0) (2.9) (0.0) (1.4) (0.0) (1.4) (0.0) (0.0)
M (n/N, %) Ancaster
Winchester
0/124 (0.0) 2/121 (1.7) 0/123 (0.0) 1/122 (0.8) 1/119 (0.8) 4/110 (3.6) 3/107 (2.8) 0/68 (0.0)
0/92 3/94 0/97 1/97 2/96 6/90 3/89 1/59
0/82 0/84 1/85 1/86 2/86 2/83 3/76 2/51
5/428 (1.2)
11/894 (1.2)
16/714 (2.2)
11/633 (1.7)
27/1347 (2.0)
0/65 2/65 1/65 1/67 0/65 0/69 0/68 0/38
0/134 (0.0) 4/135 (3.0) 1/138 (0.7) 2/140 (1.4) 0/138 (0.0) 1/142 (0.7) 0/140 (0.0) 0/89 (0.0)
0/113 (0.0) 0/113 (0.0) 0/114 (0.0) 0/114 (0.0) 0/114 (0.0) 4/114 (3.5) 0/114 (0.0) 0/93 (0.0)
0/86 0/86 1/87 2/86 2/86 1/87 0/87 0/62
0/199 0/199 1/201 2/200 2/200 5/201 0/201 0/155
8/1056 (0.8)
4/889 (0.4)
6/667 (0.9)
(0.0) (1.8) (0.0) (1.7) (1.8) (3.8) (0.0) (0.0)
(0.0) (3.1) (1.5) (1.5) (0.0) (0.0) (0.0) (0.0)
4/502 (0.8)
Total F
(0.0) (3.2) (0.0) (1.0) (2.1) (6.7) (3.4) (1.7)
(0.0) (0.0) (1.2) (1.2) (2.3) (2.4) (3.9) (3.9)
(0.0) (0.0) (1.1) (2.3) (2.3) (1.1) (0.0) (0.0)
Total M 0/174 3/178 1/182 2/183 4/182 8/173 6/165 3/110
(0.0) (1.7) (0.5) (1.1) (2.2) (4.6) (3.6) (2.7)
(0.0) (0.0) (0.5) (1.0) (1.0) (2.5) (0.0) (0.0)
10/1556 (0.6)
F – females; M – males; n – number of sockets affected; N – total number of sockets observed; % – per socket frequency (n/N); I1 – central incisor; I2 – lateral incisor; C – canine; PM1 – first premolar; PM2 – second premolar; M1 – first molar; M2 – second molar; M3 – third molar.
only exposed to the oral environment in later life because of continuous eruption and/or periodontal disease, and root caries are thus more common among elderly individuals who tend to have fewer surviving teeth due to AMTL.106 While no statistically significant differences in total per individual or per tooth frequencies were observed (Tables 3–5), females did exhibit a significantly higher per tooth frequency of caries in mature adulthood. In particular, it appears that females experienced a greater increase between young and mature adulthood (7.9% to 14.5%), compared to males, among whom the per tooth frequency changed little between young and mature adulthood (8.4% to 8.0%). Additionally, females exhibited an increase in per individual frequency between young and mature adulthood, unlike males (Tables 3 and 4). An overall increase in per tooth frequency with age is to be expected, given that the condition is ‘age-progressive’103; however, the greater age-related increase in caries rate among females requires some explanation. The difference in caries prevalence between the sexes in mature adulthood could reflect changes in male and female diets over the life-course, e.g. an increase in the cariogenicity of the female diet relative to males. A stable isotope and dental pathology study of Roman individuals from Isola Sacra, near Rome, revealed agerelated differences in isotope values and oral health between the sexes, which were interpreted as evidence for variation in the relationship between gender and diet over the life-course. In particular, females in the Isola Sacra population were found to have lower average d15N values compared to males, and the difference was more pronounced among young and mature (
