Dental Health and Disease in the Past


Dental diseases are among the most commonly seen pathological conditions in archaeological remains and can potentially provide a great deal of information. The dental diseases we see today have always been present, but their prevalence varied dramatically with the staple diet of the population and with the wealth and lifestyle of each individual.


Wear


Surprisingly, one of the biggest problems in Europe, before the Middle Ages was dental wear. Many foods were tough and abrasive and required so much chewing that by the time people were in their thirties they had lost much of the enamel from the chewing surfaces of their molars, exposing and infecting the dental pulps and leading to jaw infections. By the time people were sixty many of their back teeth had worn away or come out anyway. It was not until the seventeenth century that milling techniques dramatically improved and reduced the amount of grit in the everyday diet. Now we have reached a state where many would argue that we do not work our teeth hard enough to keep our jaws healthy.


Gum disease (Periodontitis)


We take relatively clean teeth for granted, but before the invention and manufacture of toothbrushes most people had thick layers of dental plaque (a layer of bacteria and food debris) covering the side surfaces of many teeth. The constant presence of thick dental plaque with its multitude of organisms generating harmful toxins led to swelling and destruction of the gums and to shrinkage of the jaw bone away from the teeth which then became mobile. The older one became, the more likely it would be that your teeth would become loose and painful. The 10% of the population who are always especially prone to gum disease would have lost all their teeth even earlier than the main population.


Dental Decay (Dental Caries)


Dental caries, in which acid produced by bacteria in the mouth acting on food debris eats cavities into the tooth enamel, and was largely a problem of the wealthy. However it was to become a problem on a huge scale during the eighteenth and nineteenth centuries. Sugar became cheap and available to all. This led to dental decay becoming a universal problem. Toothache, jaw abscesses and dental extractions became a normal part of life.


Toothbrushes and toothpastes developed in the Nineteenth century did little to prevent tooth decay, and it was not until the late Twentieth Century that the addition of fluoride to toothpastes and a greater variation in diet made a dramatic reduction in dental decay suffered by the general population.


Living with dental disease


Age inevitably brought with it an increasing lack of chewing power, frequent discomfort, very limited food choices, shame about appearance, bad breath, and periodic bouts of acute pain and swelling. It must be remembered too that in the pre-antibiotic era these bouts often lead to systemic infection and even death. In the early 1600s the London Bills of Mortality listed the causes of death and “Teeth” were continually listed as the 5th or 6th commonest cause of death. (This does not even include the category of “teething” which was wrongly blamed for the death of many children, since weaning coincides with loss of inherited immunity through breast milk to many diseases.).


Any form of dentistry, other than extractions, was not widely available until the Eighteenth Century and even then it was pretty ineffective. Any anaesthetics other than strong drink were not available until the late Nineteenth Century and so any attempt at dental treatment would have been acutely painful. Dentures were available to those relatively well off, but were mainly cosmetic and were probably a hindrance to talking and of limited effectiveness in aiding eating.





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