I was a dentist for 25 years, during which time I saw countless teeth, some were healthy, others weren’t, and acres of periodontal tissue, some healthy, some not. The one thing all of my patients had in common was that they were all alive!
When I retired from dentistry and was able to indulge one of my hobbies: I became a volunteer in the Finds Department at York Archaeological Trust in the UK. My main role is to process finds, that is, artefacts and bones that have been excavated from the sites on which the real archaeologists work. Many of the excavated bones are human; many of them display evidence of disease, and that includes the skulls and the teeth. (I will stress at this point that all of the skeletons I have been involved with were at least 500 years old.) York is such a wonderful place to work as an archaeologist because it has existed in some shape or form as a settlement since prehistoric times, through Roman and Viking occupations, the Middle Ages and up to the present day. York is rich with archaeology.
Nowadays we take a good set of teeth, as well as freedom from pain and sepsis, for granted. It soon struck me that for many of the individuals whose remains I was now handling, dental disease and all of its associated problems was the norm, and it also occurred to me that many of them lived with pain, sepsis, loose teeth and untreated broken teeth. There were no dentists to put things right. Unlike my living patient, I could not ask the skeletons for their medical and dental history.
The ancient Egyptians and the Romans practised a crude form of dentistry; the Romans even had their own dental goddess, Apollonia. These ancient civilisations had some forms of tooth cleaning implements and toothpastes. From the 14th century onwards Barber Surgeons and Toothdrawers very slowly evolved and developed into the modern dentist. The first modern toothbrush was not manufactured until the late 18th century, and amalgam was not available until the early 19th century. Tooth coloured filling materials did not appear until 140 years ago. People could not have tooth coloured crowns until just over one hundred years ago.
Leaving dental history aside, I became interested in what these ancient skulls and teeth could tell me about the individual. The most obvious thing I could work out from their teeth was their age. Archaeologists like to know the age of the skeletons they uncover, and although they tend not to rely on the teeth, they are a useful guide. Using the teeth to determine the sex of a skeleton is not however reliable: males tend to have bigger teeth than females, but as with the size of skeletons, there is considerable overlap. Once all of the adult teeth have fully erupted, the extent and degree of wear on the teeth can also provide some evidence of the age of an adult skeleton. However, ancient diets tended to be courser than ours and so the teeth probably wore down at a faster rate, which to the untrained eye would make them seem older than they actually were.
Archaeologists are also interested in where someone came from, and the teeth can help determine this. Isotopic oxygen ratios in teeth and bones can help pin point an individual’s geographic origin. You are no doubt familiar with dental fluorosis; this can help determine the area in which someone lived at the time their teeth were laying down calcium.
Something that seems to have been very common in the teeth of ancient populations is enamel hypoplasia, that is areas of the enamel in which there is a less than normal amount of calcium. The appearance of enamel hypoplasia varies enormously, ranging from a barely perceptible white mark to an entire malformed crown. Teeth with enamel hypoplasia can be unsightly, sensitive and more prone to caries. Someone with untreated severe enamel hypoplasia would perhaps not be able to eat comfortably. Their appearance would also be compromised. Non-chronological enamel hypoplasia of a permanent incisor as the result of an intrusion injury to the overlying deciduous tooth literally leaves its mark.
Childhood illnesses can affect enamel formation, causing defects in specific parts of those teeth that happened to be laying down enamel at the time. Matching defects to calcification dates helps to ascertain when someone might have been ill. It does not however tell you what caused the illness. A neo-natal and/or perinatal calcium deficient diet, hypocalcaemia or vitamin D deficiency can all compromise the quality of tooth enamel. As with all aspects of human growth, nutrition has a major effect of developing teeth. It is not just the nutrition of the child once it is born that is important in terms of the healthy development of the teeth, the mother’s health from conception to the end of weaning is also important.
The parents’ sexual habits can have an effect on the shape and quality of the child’s teeth. Tertiary (congenital) syphilis causes the incisors to have a ‘V’ shaped notch in the incisal edge, and the molars to have gnarled crowns.
The incidence of caries in ancient populations does vary a great deal. Sugar was not widely available until the New World was discovered, but the Romans, for example, used honey to sweeten their food, but it would not have been available to everyone. Similarly, when sugar was introduced into Europe, it would only be the wealthy who could afford it. However, where caries occurred it would go untreated, and as the teeth break down they could leave sharp edges that would cut the adjacent soft tissues. A carious tooth would first be sensitive to sweet things, then cold, then hot, then hot and cold, until it hurts all of the time. Death of the pulp produces pus, which as more and more of it is produced, produces more and more pain. Bone is destroyed until the pus escapes, which brings relief, but imagine standing next to someone who has a freely draining dental abscess in their mouth. While pus remains encased in bone the person will be in constant agony and will be unable to sleep. It was not uncommon for untreated dental abscesses to cause fever, septicaemia and sometimes even death.
Although the soft tissues do not survive in the archaeological record the underlying bone does, which is useful when trying to assess levels of periodontal disease in skulls. Bearing in mind that oral hygiene was not high on the list of priorities in ancient cultures, it will come as no surprise to learn that periodontal disease and the associate bone loss was very common. What would this have meant to the individual? The affected teeth would work loose and would probably be uncomfortable to eat with. Pus exuding from around affected teeth would make their breath fetid; swallowing pus would almost certainly cause digestive problems.
We take a healthy pain-free mouth for granted, but it is easy to see how many people throughout history weren’t so lucky. A poor diet, the inability to clean your teeth, or just sheer bad luck if you happened to injure a tooth, or a decayed tooth broke in your mouth, could condemn you to years of dental discomfort, if not pain. Dental problems affect your life on a day-to-day basis; imagine having them for most of your life.
Living patients are able to tell you about their pain and suffering, and about the psychological and emotional affect this is having on them. The physical remains of our long-deceased ancestors cannot speak to us in the same way, but it is still possible with a little bit of knowledge and a smattering of imagination to reconstruct what these people must have had to endure.
Written by By Dr. Michael Young
Biography of Dr. Mike Young
Dr. Mike Young is a former dentist. He lives in England. He had a very wide and varied career as a practice owner, a specialist in Paedodontics, a clinical teacher, and an expert witness. He is now an author, and in 2011 his book Managing a Dental Practice the Genghis Khan way won the Diagram Prize. He is also the author of the critically acclaimed How to be an effective Expert Witness. Outside dentistry, Mike has an interest in history, archaeology and the arts. As well as holding two dental degrees, he is also a Bachelor of Arts.
He can be contacted via email: