The disease process of dental caries results in demineralization of tooth enamel (see fig- ure 5.9b) and is caused by a variety of factors, including bacteria, saliva, and plaque in the mouth as well as dietary practices (Larsen, 1997). A total of 2,542 teeth from 143 individuals were examined for the presence of dental caries based on the guidelines in Standards (Buikstra
Casal Bertone Castellaccio Europarco
Arcade Tooth affected examined % affected affected examined % affected
Maxilla Incisors 33 171 19.3 25 55 45.5 Canine 28 90 31.1 15 36 41.7 Premolars 49 168 29.2 28 70 40 Molars 74 250 29.6 42 85 49.4 Mandible Incisors 125 184 67.9 54 60 90 Canine 49 96 46.9 23 35 65.7 Premolars 74 214 34.6 36 71 50.7 Molars 83 286 29.0 37 90 41.1 Total 515 1459 35.3 260 502 51.8
Table 5.10: Calculus Frequency (%) by Tooth
(a) Calculus - Casal Bertone F1C, 21-30-year-old female
(b) Caries - Castellaccio Europarco ET18, 21-30- year-old female
Figure 5.9: Dental Pathologies - Calculus and Caries
and Ubelaker, 1994). Lesions were recorded based on location: occlusal surface, interprox- imal surface, smooth surface, cervical lesion, root lesion, large lesion, and noncarious pulp exposure. In this analysis, root lesions are omitted because of their different etiology (Hillson, 1996), and noncarious pulp exposure is omitted because it is not a true lesion (Buikstra and Ubelaker, 1994).
Researchers have used a variety of techniques to report dental caries in skeletal samples. The method most often used in the past to report dental caries frequencies is calculated by di- viding the number of teeth with carious lesions by the number of teeth observed in the sample
(Larsen et al., 1991). This statistic, however, can over-represent dental caries within a popu- lation if a small number of individuals have numerous lesions. Frequencies of carious lesions were also calculated for individuals, and this statistic is not affected by the degree of caries in any one individual (Hutchinson, 2002). These calculations do not account for antemortem tooth loss (AMTL) that might have resulted from carious lesions. At least three different re- searchers have proposed methods to correct this. The diseased missing index (DMI), also called the decayed, missing, filled index (DMF), involves adding the carious teeth and the teeth lost antemortem and dividing that by the sum of observable teeth and teeth lost antemortem (Klein et al., 1938). This index, however, assumes that all teeth lost antemortem were the re- sult of dental caries, when in reality periodontal disease can also cause AMTL (Hillson, 1996). The caries correction factor created by Lukacs (1995) uses AMTL and carious pulp exposure. Because this study did not collect information on carious pulp exposure, the caries correction factor cannot be applied. Hillson (1996) notes that because carious lesions are more common in molars, which tend to be less affected by postmortem loss, a population with a large number of anterior teeth lost postmortem will have an inflated carious lesion frequency. Erdal and Duyar (1999) developed a proportional correction factor for samples that deviate from the expected ratio of incisors to canines to premolars to molars. In a normal quadrant of the mouth, there are 3 anterior and 5 posterior teeth, which produces a ratio of 0.6. At Casal Bertone and Castel- laccio Europarco, of the teeth examined for carious lesions, the ratios of anterior to posterior teeth were 62% and 61% respectively, so the proportional correction factor should not change the frequency of carious lesions in either population. Therefore, no caries correction factors were used in this study. Reported in this section are tooth frequency (number of teeth affected) in table 5.11 and individual frequency (individuals affected) in table 5.12. In both tables, the first line in an age category is the count and the second line is the frequency. For these tables, subadults are included for the purpose of generating a carious lesion frequency for the entire population. The deciduous dentition will be further broken down in a subsequent section.
Casal Bertone Castellaccio Europarco
Age Male Female Unknown Total Male Female Unknown Total
0-10 7/219 7/219 0/95 0/95 3.2 3.2 0 0 11-20 7/182 2/68 7/304 16/554 2/95 - 0/26 2/121 3.9 2.9 2.3 2.9 2.1 - 0 1.7 21-30 4/151 1/59 - 5/210 2/87 3/26 - 5/113 2.7 1.7 - 2.4 2.3 11.5 - 4.4 31-40 15/341 0/34 1/21 16/396 29/116 - - 29/116 4.4 0 4.8 4.0 25 - - 25 41-50 10/180 17/112 - 27/292 4/46 7/79 - 11/125 5.6 15.2 - 9.3 8.7 8.9 - 8.8 51+ 6/55 5/82 - 11/137 - - - - 10.9 6.1 - 8.0 - - - - Adult 8/49 1/35 2/25 11/109 2/27 - 3/28 5/55 16.3 2.9 8.0 10.1 7.4 - 10.7 9.1 Overall # 50/958 26/390 17/569 93/1917 39/371 10/105 3/149 52/625 Overall % 5.2 6.7 3.0 4.9 10.5 9.5 2.0 8.3
Dashes indicate that no individuals were examined in that age and sex category.
Table 5.11: Dental Caries - Number and Frequency of Teeth Affected
The Casal Bertone population had an overall carious lesion frequency of 4.9%. This num- ber is relatively low for an agricultural population. Larsen (1997) calculated total carious lesion percentages based on data from Turner (1979) and found that foraging populations averaged a carious lesion frequency of 1.7%, mixed foraging and agricultural populations were 4.4%, and agricultural populations had a frequency of 8.6%.4 The high frequency of carious lesions
in agricultural populations in the Americas has been attributed to the rise in consumption of maize, a cariogenic food. In Europe, high carious lesion frequencies have been linked to eat- ing honey and sweet sticky fruits (Larsen, 1997, p. 71). The low Casal Bertone carious lesion frequency, however, needs a different explanation. The most likely causes include a diet low in cariogenic foods or good dental hygiene. Both of these explanations will be explored further below and in chapter 6. As expected, the majority of carious lesions were found in molars,
4Nevertheless, other studies have shown that populations do not necessarily conform to these expected carious lesion frequencies. Hutchinson (2002), for example, found high frequencies of teeth affected by caries, 17-19%, in non-agricultural Native American populations on the North Carolina coast.
Casal Bertone Castellaccio Europarco
Age Male Female Unknown Total Male Female Unknown Total
0-10 7/23 7/23 0/8 0/8 30.4 30.4 0 0 11-20 3/7 2/4 4/14 9/25 1/4 - 0/1 1/5 42.9 50 28.6 36 25 - 0 20 21-30 3/6 1/4 - 4/10 1/3 1/1 - 2/4 50 25 - 40 33.3 100 - 50 31-40 8/13 0/2 1/1 9/16 4/6 - - 4/6 61.5 0 100 56.3 66.7 - - 66.7 41-50 3/8 4/4 - 7/12 1/3 3/3 - 4/6 37.5 100 - 58.3 33.3 100 - 66.7 51+ 2/3 3/4 - 5/7 - - - - 66.7 75 - 71.4 - - - - Adult 3/9 1/2 2/5 6/16 1/2 - 1/3 2/5 33.3 50 40 37.5 50 - 33.3 40 Overall # 22/46 11/20 14/43 47/109 8/18 4/4 1/12 13/34 Overall % 47.8 55 32.6 43.1 44.4 100 8.3 38.2
Dashes indicate that no individuals were examined in that age and sex category.
Table 5.12: Dental Caries - Number and Frequency of Individuals Affected
with a decreasing prevalence towards the anterior teeth. The mandibular teeth were slightly more affected by carious lesions (5.3% of teeth) than the maxillary teeth (4.5%), but this result is not statistically significant. Carious lesions affected left-sided teeth (5.3% of teeth) more than right-sided (4.6%), but there is no statistical significance to this difference. Of the 93 lesions, the most common were interproximal lesions (61.1% of all lesions), followed by oc- clusal (16.7%), large (14.4%), cervical (4.4%), and root (3.3%). No instances of noncarious pulp exposure were noted in this population.
Males and females had slightly different frequencies of carious lesions, with 5.1% of male teeth and 6.7% of female teeth having a lesion. This difference was tested using the Mann- Whitney U statistic and found not to be significant. When carious lesions are examined by individual, 47.8% of males suffered from at least one lesion and 55% of females did. It appears that females had slightly more carious lesions than males did, both in terms of teeth affected (degree) and in terms of individuals affected. This is not unusual, as there is often a greater
caries prevalence in females in a population (Larsen, 1997, p. 72). There is a slight increase in carious lesion prevalence based on increasing age, particularly in the number of male teeth affected. Interestingly, females age 41-50 have a 15% carious lesion frequency by teeth. How- ever, these 112 teeth come from only 4 individuals. These females could have had a different diet or could have lacked the dental hygiene that other adults in the population had.
The population from Castellaccio Europarco had an overall carious lesion frequency of 8.3%, which is reasonable for a population that subsisted on a largely agricultural diet. This frequency could be influenced by diet, such as the consumption of sticky, carbohydrate-based foods, or by dental hygiene. The majority of the 52 lesions noted were discovered on molars, with 13.7% of all molars in the sample affected by caries. Surprisingly, there is a higher frequency of carious lesions on the incisors (n=7, 4.9% of all incisors) than on the canines (n=2, 2.7% of all canines). This could be related to the small sample size or to the degree of wear on the anterior teeth of this population. The maxillary teeth (10.9%) were more often affected by carious lesions than the mandibular teeth (7.4%), and left-sided teeth (9.8%) were more affected than right-sided teeth (8.3%). Neither of these results is statistically significant, however. Of the 52 lesions, the majority were interproximal lesions (53.9%), followed by large carious lesions (15.4%), cervical lesions (11.5%), occlusal lesions (9.6%), and root lesions (1.9%). There were four instances of noncarious pulp exposure noted, but these were not tabulated with the data for this analysis.
Within the Castellaccio Europarco population, male teeth were more often affected than female teeth (10.5% and 9.5% of teeth, respectively); however, 44% of males had at least one carious lesion whereas 100% of females did. The difference in individuals is most likely due to the very small sample, as only four female adults had teeth that could be examined. Three of these were in the 41-50 age category, which is an advanced age for a Roman woman. The paucity of adult individuals in general means that no statistically significant results can be obtained in terms of age and sex differences. No deciduous teeth from this population had carious lesions.
The two sites in this study are contemporaneous but were located about 12 km apart in antiquity: Casal Bertone was just outside the city walls of Rome, while Castellaccio Europarco was located in the suburbium. The archaeological context of Casal Bertone implies that this was an agricultural and industrial area as indicated by the presence of a villa and a fullery or tannery, whereas Castellaccio Europarco had only a villa and was likely a largely agricultural area in the suburbs. The overall carious lesion frequency for Casal Bertone (4.9%) is signifi- cantly lower than that of Castellaccio Europarco (8.3%). The two most likely explanations for this difference are diet and dental hygiene. The population at the more intensely agricultural Castellaccio Europarco might have been eating more cariogenic foods, while the population at Casal Bertone might have had more access to meat. In general, individuals who practiced a skilled trade in Rome, whether slave or free, were of a higher status and had more income than farmers (Bradley, 1994; Garnsey, 1988), which could explain more access to meat and the consumption of a different diet at Casal Bertone. Dental hygiene could also have con- tributed to the frequency of carious lesions. Some Romans did clean their teeth, with a variety of substances, and higher status individuals were more likely to do so (Cruse, 2004). Dietary differences between Casal Bertone and Castellaccio Europarco will be discussed in more detail in chapter 6.