To Örebro University

The dental status of Early Iron Age agricultural populations in Sweden has not been extensively documented. The aim of this study was to record caries status in human remains from an Early Iron Age burial ground, Smorkullen, at Alvastra, Ostergotland, Sweden. The study included 96 adults and 50 subadults and comprised 1794 permanent teeth in the adults and 468 permanent and 221 deciduous teeth in the subadults. The caries frequency was exceptionally high, afflicting most of the adults (92.6%): 46.2% of the teeth examined showed signs of caries disease. Most of the lesions were shallow. However, around 60% of the adult individuals had moderate and severe lesions, which probably had an immediate impact on health. Lesions were most common in the cervical region and this is probably related to dietary patterns where the starchy, sticky food tended to accumulate around the necks of the teeth. Children showed low caries frequency, whereas most juveniles (91.7%) were affected. Most of the teeth with alveolar bone loss showed no signs of cervical or root caries lesions. However, in cases of moderate and severe loss of alveolar bone, seen mostly in the older age group, the frequency of cervical and root lesions was higher. Few initial caries lesions were observed, indicating an aggressive pattern of disease in this population. The lack of gender-related differences suggests that the diet was similar for both sexes, across all age groups.

In the skeletal remains of earlier populations, the presence and severity of dental caries preserves evidence about general health and diet. The quality of the data collected on dental caries is highly dependent on the diagnostic skills of the examining osteologist. A major barrier to more detailed data is reliance on visual inspection only. The present study compared quantification of carious lesions by osteologists, using both visual and radiographic inspection. Four osteologists with varying experience of caries diagnosis registered the presence and extent of dental caries on the crown and root surfaces of 61 teeth sourced from three different samples: Archaeological, Anthropological and Modern. The teeth were subsequently sectioned to provide a control or standard reference. The interobserver differences were calculated as sensitivity (observer correctness in identifying teeth with caries disease). The two observers with more experience of dental paleopathology showed higher agreement with the standard reference than the other two observers, i.e. they correctly diagnosed more carious lesions. The most pronounced interobserver difference was for radiographic inspection of root surfaces. The recordings by the two experienced observers conformed much more closely with the standard reference than those of the less experienced observers. The results confirm that experience has a major influence on practical observations in dental paleopathology. The quality of collected data on dental caries could be enhanced by improving osteologists’ knowledge of the disease process and the application of uniform, unambiguous criteria for registration of carious lesions.

Cranial skeletal lesions as well as linear enamel hypoplasias were investigated in an Early Iron Age (0–260 A.D.) population from Sweden. The analyses included the study of maxillary- and frontal sinusitis, cribra orbitalia and enamel hypoplasias in order to investigate nutritional and environmental related stress as well as possible relation to oral health. A majority of both subadult and adult individuals exhibited maxillary sinusitis as well as cribra orbitalia. In contrast, linear enamel hypoplasias were not frequently noted, although, the highest frequencies were found among the subadult individuals. In seven cases (12.7%) there was a clear correlation between a periapical lesions and maxillary sinusitis. A significant correlation between maxillary sinusitis and frontal sinusitis was found among adult individuals. Sixty-eight percent of the adults showed lesions in both these regions. The least common combination in adults was cribra orbitalia and enamel hypoplasias where 7.7% only exhibited lesions in both these regions. The significantly higher incidence of this combination among subadults at Smörkullen suggests that this may have been related to life threatening conditions. Overall, the result showed that the individuals at Smörkullen foremost suffered from upper respiratory diseases as well as nutritional deficiency.

As in modern populations, dental caries in early populations is linked to diet and general health. In order to record not only advanced disease states with frank cavitation of teeth but also early lesions, indicating the presence of the disease in a population, it is important that the archaeologist can correctly detect and classify lesions of varying severity. The present study compares and contrasts quantification of dental caries by osteologists and odontologists. Four osteologists and four odontologists undertook visual and radiographic inspection of 61 teeth from three different sources: medieval, 19th century and modern. Separate sets of criteria were applied to disclose observer confidence in detecting a lesion and in estimating lesion extent. For validation of visual assessments, the teeth were sectioned. Radiographic assessments were validated by a specialist in dental radiography. The results disclosed that the odontologists in general showed greater sensitivity than the osteologists, correctly identifying carious lesions, but the osteologists had higher specificity, correctly identifying healthy teeth. Thus, the osteologists tend to overlook carious lesions (under-diagnosis), while the odontologists tend to incorrectly record lesions in healthy teeth (over-diagnosis). For both osteologists and odontologists, correct assessment was poorer for radiographs than for visual inspection.

Periapical lesions were recorded by both visual and radiographic examination in an Early Iron Age population from Alvastra, Östergötland, Sweden. Only those individuals with discernible bone destruction were included in the study. The study comprised 37 adult individuals from both sexes of a total of 90 adult individuals among the population, thus the prevalence of visual periapical lesions in the population was 41.1%. Out of 819 tooth sockets, 83 (10.1%) showed signs of periapical lesions, mainly caused by chronic inflammations. Cyst-like lesions were recorded in five cases of which four were in a possible acute phase. Around thirty-two percent of the periapical lesions were associated with severe carious. The corresponding rate for severe attrition was 14.4%. No significant difference in frequency of lesions was observed between sexes and age groups. The most affected tooth was the first maxillary molar followed by the first molar in the mandible. Radiographic examination proved useful in detecting additional pathological processes, other than those observed by visual examination.