image/svg+xml33 VII/1/2016 INTERDISCIPLINARIA ARCHAEOLOGICA NATURAL SCIENCES IN ARCHAEOLOGY homepage: An Investigation of Dental Health in the Migration Period: A Case Study from Prague-Zličín, Czech Republic Ivana Jarošová a* a Labrys, o. p. s., Hloubětínská 16/11, 198 00 Praha 9, Czech Republic 1. Introduction The study of a population’s state of health and overall ftness are also items of interest to skeletal biologists. This paper is a study made of the main dental aspects of a population sample from the Migration period recovered from Prague-Zličín in Central Bohemia. The aim was to capture the changes inscribed in the dentition of this past population, by which a partial reconstruction of the living conditions of that time could be made, along with an assessment of the dental health of studied individuals. To achieve this aim, the study investigated three main signs of dental health or dental diseases, i.e. caries, dental wear and enamel hypoplasia (Aufderheide, Rodríguez-Martín 1998), through which it is possible to reconstruct not only some aspects of the food consumed, but also the state of health of the past population by comparing these data with other chronologically and geographically diferent series from the Czech Republic.Dental caries (caries dentis) is an irreversible microbial disease of the calcifed tissues of the teeth, characterized by demineralization of the inorganic portion and destruction of the organic substance of the tooth, which often leads to cavitation (Sivapathasundharam, Raghu 2012). An advanced caries can lead to loss in vitality of dental pulp and fnally to the loss of a tooth, or eventually to other pathological Volume VII ● Issue 1/2016 ● Pages 33–54 *Corresponding author. E-mail: ARTICLE INFO Article history: Received: 11 th December 2015Accepted: 1 st August 2016 Key words: Migration perioddental cariespre-mortem tooth lossdental enamel hypoplasiadental wear diet ABSTRACT In this study, 97 individuals from Prague-Zličín, in central Bohemia, Czech Republic, were scored for basic dental features, including dental caries, prevalence of dental enamel hypoplasia (DEH), and dental wear patterns, in order to discover basic characteristics of their diet, and the extent of non-specifc stressors ( i.e. indicators of metabolic and nutritional disruptions) during the Migration Period (5 th century AD). The sample is comprised of 18 subadults (0–14 year-old) and 79 adult individuals over 15 years, with a total number of 1129 permanent and 111 deciduous teeth.Values of caries intensity were 21.0 and its frequency 59.5. Higher values of caries intensity were found in males (24.0) than in the female population (21.3). The most frequent type of dental caries was found in the mesial and distal facets of the cemento-enamel junction and smooth surfaces of the crown (64.1%), which may be connected with deteriorated oral hygiene in this series. The 9.8% of dental caries located on the occlusal surface of the crown can be interpreted, together with the proven low dental wear, as the existence of a softer diet during this Migration period than in the former Neolithic period.DEH was present at a high frequency (32.2% of all examined individuals), but nearly all of these records of past stressors in childhood have only short-term acute forms in the way of lines or grooves. Only one single case provided evidence for a chronic form of DEH. The timing of linear enamel hypoplasia (LEH) studied in 13 individuals provides an assessment of the occurrence and frequency of age when LEH formed. Overall anthropological analysis suggests a relative high number of indicators of environmental stressors related to the prevalence of dental caries, pre-mortem tooth loss and the prevalence scores of DEH.
image/svg+xmlIANSA 2016 ● VII/1 ● 33–54Ivana Jarošová: An Investigation of Dental Health in the Migration Period: A Case Study from Prague-Zličín, Czech Republic 34 processes (Kilian et al. 1999). The emergence of caries depends on the susceptibility of dental tissues (constitutional and genetic factors, sex, and age), the composition of oral microfora (dental plaque microorganisms are cariogenic), nutrition factors and time, i.e. the frequency and duration of interaction, which is also closely related with oral hygiene (Kilian et al. 1999; Wotke 2001). The dependence of dental cariosity on the food composition of historical populations has been a topic treated by many authors ( e.g. Lillie 1996; Saunders et al. 1997; Lingström, Borrman 1999). Palaeolithic and Mesolithic hunter-gatherers show the lowest caries rate; in Neolithic populations that began to settle down and switch to an agricultural way of life, caries rates gradually increased. This was connected with a transition to other types of food, which, over the course of centuries, and in contrast to preceding periods, contained more sugar; this food was also more elaborately prepared and relieved of undesirable ingredients such that the roughage content in food was gradually reduced (Caselitz 1998, 205). Dental wear is the loss of the dental surface due to external mechanical forces, above all in connection with food. The degree of dental wear depends not only on the coarseness of particles, but also on the condition of dental surfaces, because particles stick easier to a roughened surface than to a smooth one (Mair et al. 1996; Mair 1999). Further, there is also a peculiar form of wear that is concentrated to one single tooth or a group of teeth. This type of wear is mostly caused by objects coming in contact with teeth, and these processes are designated collectively as infuences due to an individual’s profession.The deterioration of environmental factors can result in a disturbed physiological balance – not only in individuals, but also in the population as a whole. Once a person exposed to a non-specifc stress exceeds their resistance threshold, then their physiological balance can be disturbed, sometimes resulting in a complete cascade of changes. This turnover leads to the emergence of non-specifc stress markers (Harris lines, dental enamel hypoplasia, cribra orbitalia, etc. ), which can be subsequently observed on skeletal remains. The impact of stress on a whole population is refected not only in the ftness and physical efciency (reduced work efort) of the decreased, but also in a diminished reproductive capacity (increased abortion rate and reduced viability of newborns). All these factors are refected in the disturbed socio-economic balance of the entire population (Goodman, Armelagos 1989; Larsen 1997). Dental enamel hypoplasia examined in individuals thus ofers valuable information on the state of health and overall ftness of a population, and helps towards the retrospective reconstruction of a population’s behaviour and adaptation to the environment it occupies. 2. Material Certain aspects of the archaeological burial ground from the Migration period (5 th century AD) have already been published (Vávra et al. 2008; Vávra et al. 2012; Jiřík et al. 2015), but a comprehensive anthropological evaluation is frst published in detail in this issue, even though some partial studies concerning the evaluation of demographic distribution and metrical characteristics were already published (Víšková et al. 2012; Horáková et al. 2014; Horáková, Jarošová 2015).Out of the total number of 180 detected individuals, 97 (53.9%) could be studied for their dentition or jaws. The state of dentition state could thus be evaluated in 18 subadults (0–14 years) and 79 adults (15+ years) (Table 9), who are further subdivided into sex and age categories. Of the individuals from the remaining 83 burials (46.1%) that had to be excluded from the dental health analysis: 9 individuals were excluded due to their jaws with teeth being found in poor condition or preserved only fragmentarily without the possibility to assess at least tooth type (grave no. 11, 21, 28, 58, 130, 139, 140, 166, 177); and the remaining 74 detected graves were excluded because of the absence of dental remains in the skeletal parts, which were either completely absent or preserved only fragmentarily without any tooth.As comparative samples the following were used: two Neolithic series from Moravia, consisting of 73 individuals belonging to the Linear Pottery Culture (LBK 5700–4900 BC), and 21 to the Lengyel culture, well known in Moravia as the Moravian Painted Pottery Culture (LgK 4700–4000 BC) (Jarošová, Dočkalová 2008); and an Early Middle Age population from Dolní Věstonice – Na Pískách that included 893 individuals, localized in South Moravia and dated back to the 9 th –11 th century AD (Jarošová 2007; Hrnčířová, Jarošová 2007; Jarošová et al. 2012). All three comparative series are localized in the Czech Republic about 250 kilometers from the Prague-Zličín sample and were examined by the same author using the unifed list of methods (see below). 3. Methods The analyzed occurrence of caries and hypoplasia included both individuals with deciduous teeth and those with permanent teeth. The analysis of dental wear only included adult individuals aged over 20 with permanent dentition. For individuals from the Prague-Zličín series to be selected, the presence of at least one intact tooth of whatever type was demanded both in the maxillas and the mandible, no matter if on the right or left side.The state of preservation of teeth and jaws was assessed using two indices – the comparative alveolar index (CAI) and the comparative dental index (CDI). CAI is characterized as a relation between the number of preserved alveoli and the number of all burials multiplied by 32 [CAI=A/(n×32)], and CDI is described as a relation between the number of preserved erupted teeth, the number of teeth lost intravitam ( i.e. ante-mortem) and the number of all burials multiplied by 32 [CDI=(Z+E)/(n×32)] (Hanáková, Stloukal 1966).The presence or absence of caries (C) was evaluated macroscopically. Upon the recommendation of Buikstra and Ubelaker (1994), the type of caries was evaluated macroscopically in both deciduous and permanent teeth,
image/svg+xmlIANSA 2016 ● VII/1 ● 33–54Ivana Jarošová: An Investigation of Dental Health in the Migration Period: A Case Study from Prague-Zličín, Czech Republic 35 according to the numerical codes adapted by Moore and Corbett (1971): 1 = occlusal surface caries; 2 = smooth surface caries – interproximal ( i.e. approximal) surfaces (mesial and distal); 3 = smooth surface caries (buccal/labial and lingual/vestibular surfaces); 4 = cervical caries – interproximal ( i.e. approximal) surfaces (mesial and distal); 5 = cervical caries (except interproximal surfaces); 6 = root caries (below CEJ).During the assessment of dental cariosity, consideration should be given to particular age categories, since cariosity increases with age. Thus subadults (0–14 yrs) with deciduous and mixed dentition were separated from juvenile (15–19 yrs) and adult individuals with permanent teeth, and in the fnal evaluation the group of subadults was treated separately. In the group of adults there were also juveniles included and this group was further divided into four subcategories: 15–19 yrs, 20–35 yrs, 35–50 yrs and over 50 yrs. Our understanding of the term “adult” is based on a consideration of an adult individual primarily in terms of social status, not biological status. This processing involved the data concerning healthy teeth (T), carious teeth (C), teeth lost intravitam ( i.e. pre-mortem) (E) and post-mortem (P). If a pre-mortem tooth loss occurred (E), such teeth were evaluated as carious (C), even in the case that this loss possibly occurred due to other, as yet indeterminable, reasons – loss caused by strong wear, abscess, periodontal disease or trauma (Andrik, Müncnerová 1961). The teeth lost post-mortem (P) were not included in the general evaluation of caries intensity and frequency. This general evaluation was performed following the method developed by Stloukal (Stloukal 1963). The abbreviations used (Z, A, E, C, %C, n, nC, %nC, nE, %nE, nCE, %nCE, I-CE, F-CE – for explanation see Table 1) were also adopted from this method elaborated by Stloukal (1963) (for a detailed description and relationships among the listed abbreviated terms, see Stloukal 1963 or Jarošová, Dočkalová 2008).The attrition rates for incisors, canines and premolars were recorded according to an eight-point scale based on the amount of exposed dentine (Smith 1984). Since the Smith system shows only a poor level of discrimination when attrition rates are moderate to low, Buikstra and Ubelaker (1994) prefer the standards developed by Scott (1979) for molars. In the Scott system, each molar occlusal surface is divided into quadrants, and the amount of observable enamel is scored on a scale from 4 to 40. If any of the quadrants was not observable, then such a tooth was not recorded.Dental enamel hypoplasia (DEH) can be defned, regarding its emergence, as an evolutionary defect of the hard dental tissues that are a refection of various non-specifc stress indicators in recent, historical and palaeoanthropological populations, and thus DEH ofers a unique record of the stress sufered in childhood, which can be also subsequently observed in the dentition of adult individuals. These enamel defects can be interpreted as displays of nutritional defciencies and infectious diseases (El-Najjar et al. 1978; Goodman 1998; Hodges, Wilkinson 1990; Lukacs 1992; Goodman 1993; Malville 1997; Wright 1997). DEH was examined on three tooth types (I1, I2, C). This selection followed procedural considerations of, above all, Goodman and Armelagos (1985), who have been quoted that, from the morphogenetic point of view, chiefy the upper central incisors and mandibular canines are the most sensitive to the formation of hypoplasia.Following types of hypoplasia were defned: 1. Teeth with a degree of wear higher than 1/3 of the overall crown Table 1. Caries intensity (I-CE) in adults (15+ yrs) of analysed sample from Prague-Zličín according to sex [C, number of carious teeth; %C, caries incidence (the percentage of decayed teeth from total number of preserved teeth); E, number of teeth lost pre-mortem; %E, the percentage of pre-mortem losses; A, number of preserved dental alveoli]. Caries frequency (F-CE) in adults (15+ yrs) of analysed sample from Prague-Zličín according to sex [nC, individuals with at least one caries; nE, individuals with at least one pre-mortem loss; nCE, individuals with both caries and pre-mortem losses]. Individuals (15+ yrs)MalesFemales ?All individuals Number of examined teeth (n) 295479153927 C 19541689%C 6.411.310.59.6E71600131 A 4045961531153%E17.610.1011.4I-CE24.021.310.521.0Number of examined individuals (N) 22302779nE5207%nE22.76.708.9 nC 58922%nC 22.726.733.327.8nCE612018%nCE27.340.0022.8intact 681832% intact 27.326.766.740.5F-CE72.773.333.359.5
image/svg+xmlIANSA 2016 ● VII/1 ● 33–54Ivana Jarošová: An Investigation of Dental Health in the Migration Period: A Case Study from Prague-Zličín, Czech Republic 36 height; teeth with the presence of tartar and teeth with post-mortal enamel defects were excluded from the analysis. 2. Afterwards, the presence or absence of dental enamel hypoplasia was macroscopically examined on the labial surface of each tooth. 3. In the case of dental enamel hypoplasia being detected, the type of hypoplastic defect was determined according to the DDE index: lines (FDI type 4: L-lines, G-grooves); pits (FDI type 3: Ps-pits, Pl-pit line); and chronic enamel hypoplasia ( i.e. „pit patches“ and „continuous chronic enamel hypoplasia“) (Santos, Coimbra 1999; Goodman et al. 1992; Goodman, Rose 1990; Ensor, Irish 1995; Sarnat, Schour 1941; Corruccini et al. 1985; Littleton 2005; Obertová 2005; Jarošová 2007; Jarošová et al. 2012, etc. ). Lines and pits are classifed in this paper as acute DEH (A DEH). Timing of linear hypoplasia on anterior teeth with regard to tooth growth was assessed after Reid, Dean (2000). 4. Results4.1 State of preservation of teeth and jaws The state of preservation of alveoli and teeth in individuals from the Prague-Zličín population was characterised by the comparative alveolar index CAI and comparative dental index CDI. In the studied series less than half the teeth (41.9%) and alveoli (45.61%) were available for analysis; unfortunately this only allows us to make approximations in the results presented below and reduces the confdence in data reliability (see Table 9). Despite this extremely low number, other studied samples have also shown similar results ( e.g. Early Medieval sample from Dolní Věstonice – Na Pískách had CDI 40.1% and CAI 59.7%), but some of the comparative samples showed even higher values – Neolithic samples from Moravia had CDI 60.4% and CAI 70.5% (Jarošová 2007; Jarošová, Dočkalová 2008; Jarošová et al. 2012). 4.2 Carious teeth The occurrence of caries was analysed in 18 subadult and 79 adult individuals, with a total of 1,240 teeth, from the Prague-Zličín series in Central Bohemia. The evaluation of cariosity could be thus performed on 97 individuals (Table 1), representing 53.8% of the available 180 human remains from 176 burials in 173 graves at the burial ground of Prague-Zličín.During this epidemiological study based on direct inspection, all teeth of deciduous and permanent dentition were examined, both maxillar and mandibular. The general evaluation of the occurrence of caries in the dentition of adults included the testing of two mutually-independent criteria, i.e. sex and age ( i.e. subadults versus adults), and it was carried out based on the following analytic scheme: caries intensity (I-CE), caries frequency (F-CE) and type of dental caries. Figure 1. Caries intensity in adults (20+ yrs) according to tooth types of the analysed groups from: Neolithic settlements (LBK, LgK); the Migration period (Prague-Zličín; PRG ZL); and an Early Medieval sample from Dolní Věstonice – Na Pískách (DV P). For data sources, see Jarošová 2007 and Jarošová, Dočkalová 2008. For the Prague Zličín sample: I1=10.0; I2=10.6; C=14.6; P1=14.3; P2=29.2; M1=44.3; M2=44.7; M3=37.7.
image/svg+xmlIANSA 2016 ● VII/1 ● 33–54Ivana Jarošová: An Investigation of Dental Health in the Migration Period: A Case Study from Prague-Zličín, Czech Republic 37 4.2.1 Caries intensity (I-CE) and Caries frequency (F-CE) In the studied Prague-Zličín sample examined, 131 of a total of 1153 preserved alveoli (A) were detected as intravital losses, and 89 of a total of 927 permanent teeth were carious in individuals above 15 years old. The fnal I-CE is herewith 21.0. The highest caries rate (%C) was detected in females, whereas the highest ratio of ante-mortem losses (%E) could be detected in males. It can be stated that the I-CE of males is 24.0 and of females 21.3 (Table 1). Despite the high caries intensity in males and females, for the ambiguous individuals in the Prague-Zličín sample it was impossible to score ante-mortem loss as no remains of their jaws were present for study. This is the main cause for such a low caries intensity value (I-CE=10.5), rather than an indication of the good state of their dentition. The comparative Neolithic sample (20+ years) showed a very low caries intensity of 10.2 (%C=3.1; %E=7.1), and the Early Medieval sample at Dolní Věstonice – Na Pískách (20+ years) also showed lower values of 15.3 (%C=6.9; %E=8.4) (Jarošová, Dočkalová 2008; Jarošová 2007; Jarošová et al. 2012) than the examined series from Prague-Zličín. With regard to tooth types, the highest I-CE values were found in all tooth types of individuals from the Migration period (Figure 1). The results from the comparative samples show that either the dental health status of individuals from Prague–Zličín was quite poor or the composition of their diet was rich in saccharides, i.e. the sugars that are the main cause of increased dental caries.In a complete evaluation of caries intensity with regard to age categories within the investigated period, we should undoubtedly prove an increase of values with increasing age. Unfortunately, we are lacking sufcient data to proportionally represent individuals by particular age category. The data quoted are only fragmentary and one should regard the resulting I-CE values in many cases to be unrepresentative, as, for example, in the case of males between 20 and 35 years. The population of Prague-Zličín males and females coincide with their zero I-CE values in the 15–20 year age category, which means completely healthy dentition for the individuals involved. The highest I-CE value of 33.0 was found in males over 50 years old (%C=8.0; %E=25.0). The second highest I-CE value was recorded in males between 35–50 years old (%C=9.3; %E=19.4), while the healthiest teeth were detected in males 15–35 years old where the sum of caries rate and the ratio of ante-mortem losses only reached 0.0% (Table 2). This unexpected result was caused more by the lack of available teeth for caries examination in the sample of males 20–35 years old, rather than the extremely healthy status of males in this age range and must be treated with reserve. The female sample provided more reliable data, although the sample of their age categories was also very low (see Table 2).The caries frequency, i.e. percentage of caries and intravital losses depending on the number of individuals, could be evaluated in 79 adults (15+ years). In the case of some males from Prague-Zličín (burial 18 and 164), only the alveoli stayed preserved, all of their teeth having been lost ante-mortem. Among the individuals of Prague-Zličín studied, more than half were afected by caries or ante-mortem loss (F-CE=59.5); in both males and females, caries or ante-mortem loss did not occur in only every fourth individual examined (males: F-CE=72.7; females 73.3) (Table 1). Despite of the high caries frequency in males and females, ambiguous individuals in the Prague-Zličín sample had no ante-mortem loss, which resulted in an unexpected F-CE of 33.3. On the other hand, no remains of their jaws were present for study of ante-mortem loss: this was the main cause of such a low caries frequency, rather than the good state of their dentition. In spite of this “gap”, we can conclude that in the Migration period more than two thirds of inhabitants were afected by a pathological change in teeth and jaws. For comparison, in the population from Moravian Neolithic settlements 38.8% of adult individuals (20+ years) were afected by dental caries or ante-mortem loss (Jarošová, Dočkalová 2008). The F-CE of the medieval population from Dolní Věstonice – Na Pískách (20+ years) was 59.6 (Jarošová 2007; Jarošová et al. 2012), which means that the Migration period population showed a higher cariosity than those in the previous periods; even when the youngest category of 15-20-year-old individuals was also included in the fnal calculation, still the caries occurred in individuals about 1.5 times more often than in the Neolithic populations.The caries incidence (%C) at the LBK, LgK, Neolithic settlements, the Neolithic graveyard of Vedrovice (LBK) and the Early Medieval sample from Dolní Věstonice (Jarošová, Table 2. Caries intensity (I-CE) in adults (15+ yrs) of analysed sample from Prague-Zličín according to age categories [C, number of carious teeth; %C, caries incidence (percentage of decayed teeth from total number of preserved teeth); E, number of teeth lost pre-mortem; %E, the percentage of pre-mortem losses; A, number of preserved dental alveoli]. Individuals (15+ yrs)MalesFemales15–1920–3535–5050+15–1920–3535–5050+ Number of examined teeth (n) 69912988446828681 C 0012715435%C A 6991861404482365105%E0.00.019.425. of examined individuals (N) 3 210725185
image/svg+xmlIANSA 2016 ● VII/1 ● 33–54Ivana Jarošová: An Investigation of Dental Health in the Migration Period: A Case Study from Prague-Zličín, Czech Republic 38 Dočkalová 2008; Jarošová 2007; Jarošová et al. 2012; Frayer 2004) showed lower values in all cases than the sample from Prague-Zličín. The values of settlement populations from the LBK and LgK periods approached rather the %C of Mesolithic European populations (Frayer 2004), whereas the graveyard of Vedrovice (LBK) has a similar caries incidence as the Early Medieval sample from Dolní Věstonice. The sample from the Migration period has twice a value of %C. From among the comparative data of selected dated series we display only the %nC, i.e. the number of afected individuals represented in a sample. Using the “total” (M+F+?) category, 45.3% at Vedrovice (%nC: males=38.1; females 55.3) possessed at least one caries. The ratio of adults with at least one caries in the Mesolithic is 19.1% (Frayer 2004), but the number of aficted individuals at the Vedrovice graveyard is more than twice as high. These data cannot be compared to the Czech Neolithic populations (LBK, LgK and Neolithic settlements), because the total number of afected individuals with at least one caries was counted in a diferent way ( i.e. %nC+%nCE). These values are thus: LBK 28.6 (males 37.5; females 33.3), LgK 30.8 (males 50.0; females 30.8), and for the entire Neolithic population from settlements 26.5. Compared to Frayer’s data, %nC+%nCE from Czech Neolithic settlements show slightly higher values than in the preceding period, but lower than those from the population of Vedrovice. The sample from Prague-Zličín shows a value of 55.71 for %nC+%nCE (males 57.9; females 75.0), which is even twice higher than the Vedrovice graveyard. The Early Medieval sample from Dolní Věstonice has a value of 36.7 (males 37.9; females 36.2), which is similar to the Vedrovice sample. To summarise, Prague-Zličín shows the highest caries incidence for the tooth level and also the Figure 2. Scatterplot of caries incidence in adults (20+ yrs): %C against %nC+%nCE in Mesolithic; Neolithic (LBK, LgK, and all individuals from Neolithic settlements); burial ground Vedrovice dated to Neolithic (LBK); Migration period (PRG ZL) and Early Medieval sample from Dolní Věstonice – Na Pískách (DV P) samples. For data sources, see Frayer 2004; Jarošová 2007 and Jarošová, Dočkalová 2008; for Prague-Zličín sample: %C=12.32; %nC+%nCE=55.71. Table 3. Dental caries in subadults (0–14 yrs) of analysed sample from Prague-Zličín. 0–6 yrs7–14 yrsAll individuals number of examined children (N) 11718children with caries (nC) 000% children with caries (%nC) 000number of deciduous teeth 9912111number of permanent teeth 11290202number of all teeth (Z) 211102313caries in deciduous teeth 000caries in permanent teeth 000number of all caries (C) 000% caries in deciduous teeth (%C) 000% caries in permanent teeth (%C) 000% number of all teeth with caries (%C) 000