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Caries experience in Mediaeval Scots.

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AhfERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 83:69-76 (1990)
Caries Experience in Mediaeval Scots
N. W. m R R , M. F. BRUCE, AND J. F. CROSS
Department of Dental Surgery, Aberdeen Royal Infirmary, Aberdeen,
Scotland A B 9 2ZB (N.W.K.); Department of Anatomy, University of
Aberdeen, Aberdeen, Scotland AB9 1 A S (M.F.B., J.F.C.)
KEY WORDS
distribution.
Mediaeval Scots, Dental caries, Prevalence and
ABSTRACT
Dental caries prevalence, distribution, and site of attack was
investigated in a Scottish Mediaeval population. The findings supported
previous reports, which suggested that caries prevalence in Scotland was
lower than in contemporaneous English populations. Attrition of the occlusal
surface of the teeth with accompanying alteration of the anatomy of the
interproximal space is suggested as the principal reason for the differences in
the pattern of distribution of caries between this and modern populations.
In a recent study of a Late Mediaeval
population from Aberdeen on the northeast
coast of Scotland, Kerr et al. (1988) observed
that caries experience in that population
differed in a number of respects from that
reported in contemporaneous PO ulations in
England and Sweden (Tattersal ,1968; Olsson and Sa e, 1976) but was broadly comparable to t$e only previous studies on Scottish historic dentitions (Lunt, 1972, 1974,
1986). In particular, the caries revalence
in Scotland was less than in t ese other
studies.
Recently, the opportunity arose to investigate these differences further with the recovery of a substantial number of human skeletons from a rescue archaeological excavation
at Linlithgow, near Edinburgh. Like the Aberdeen series referred to above, these remains were associated with the site of a
Carmelite Friary. In both cases it appears
that the general population of the town is
represented, since individuals from all age
groups and from both sexes were identified.
This investivation was instituted to establish the prevalence and pattern of distribution by site and by age of carious lesions in
this Mediaeval Scottish population.
P
R
MATERIALS AND METHODS
The remains of more than 150 individuals
were recovered. However, some of the skeletons were incomplete and fragmentary with
no dentitions present. Individuals with extensively damaged dentitions (e.g., chipped
enamel or dentine that was disintegrating)
0 1990 WILEY-LISS, INC.
were excluded. There remained for inclusion
in the stud dentitions representing 101 individuals. he associated skeletal material
varied from almost complete skeletons with
sufficient pelvic or cranial material for reliable determination of sex to isolated jaws
with no accompanying skeletal remains.
Sex determination
Because of the number (27) of immature
individuals (where sex determination is unreliable) and because of the number of incomplete or fragmentar associated skeletons, no attempt was ma e to distinguish the
sexes for this study.
Age at death determination
This was based on a number of methods
(Cross and Bruce, 1989). In immature individuals, dental development phases and
eruption times were used (Ubelaker, 1978);
in adults, both skeletal age indicators
(Ubelaker, 1978) and molar occlusal wear
(Miles, 1962; Scott, 1979) were used. Four
broad age categories were used. These probably correspond to the age ranges given in
parentheses. The age categories were as follows: child (6-15) years, subadult (16-25)
years, adult (26-35)years, and mature adult
(36-45 + ) years.
Diagnostic criteria
The resence of a carious lesion was assessed y naked eye and the use of a dental
.3:
B
E
Received March 21,1989; accepted November 30,1989
70
N.W. KERR ET AL
diagnostic probe. A lesion was considered to
be present only if there was an obvious carious defect in the integrity of the enamel or of
the root surface. In the case of so-called
“sticky fissures,” the same criteria applied
and they were excluded unless there was a
necrotic carious lesion detectable by naked
eye inspection. All caries recording was carried out by one observer (NWK). To check
intraobserver reliability the material was
re-examined after an interval of several
weeks. Standard dental radiographs of the
mandibular molars and premolars were
taken to determine whether any carious lesions were missed using the above criteria.
Location of lesions
Carious lesions were noted and recorded
as present in one of the categories listed
below, according to tooth surface and location, following Moore and Corbett (1971):
occlusal surface [(l)fissure, (2) cuspal, (3)
gross: too large for the initial site to be
decided with certainty]; approximal surface
“4) contact point, (5) at or near the cementoenamel junction, (6) gross: initial site uncertain]; buccal, lingual surfaces [(7)confined to
the enamel surface, ( 8 ) at or near the cemento-enamel junction, (9)gross: initial site
uncertain].
Where a gross cavity extended onto more
than one surface, a lesion was scored for each
surface. Two or more cavities on one surface
were scored as one affected surface; however,
the number of separate carious lesions per
tooth was also recorded. A carious tooth was
considered to be a tooth with one or more
carious cavities. Teeth missing ante- and
postmortem were also recorded. Where there
was doubt as to which type of loss had occurred, it was recorded as antemortem loss.
Caries prevalence
Caries prevalence was expressed as the
prevalence of caries in individual tooth types
and as the percentage of individuals with
carious lesions.
RESULTS
Age profile of the skeletal series
The age profile of the skeletal series is
shown in Table 1.
Intraobserver re1ia bil ity
There was no difference in the number of
carious lesions noted on the first and subsequent analysis. Radiographic examination
confirmed that no lesions had been missed
on visual examination.
Antemortem and postmortem tooth loss
Table 1 shows the number of teeth available for examination (n = 1,869) with the
numbers lost antemortem (153) and postmortem (212). Antemortem loss increased
from nil in the younger age group to 15.9%in
the oldest age group. Postmortem loss was
broad1 similar in all age groups (&lo%).
Overa 1, postmortem tooth loss (9.5%) was
slightly greater than overall antemortem
loss (6.8%). Single rooted incisors and canines made up almost two thirds (63%)of all
teeth lost postmortem.
Caries experience
Related to individuals. Almost 45% of all
individuals exhibited one or more carious
lesions (Table 2). While only 15% of the
youngest age group had caries, 41% of the
subadult and almost 60% of the adults and
mature adults were affected.
Related to teeth. The prevalence of carious teeth was expressed as a percentage of
all teeth available for examination; 2 4 of all
teeth in the youngest age group were affected compared with almost 11%of teeth in
the adult group (Table 3). Overall, 7.4% of
teeth were carious.
Related to individual tooth type. No carious lesions were found in the incisors or
f
TABLE 1. Teeth Present, Teeth Lost Anti- and Postmortem.’
Age
eroun
6-15
16-25
26-35
36-45+
Total
No. of
individuals
Teeth
orescn t
Teeth present
t AM t-PM loss
Antemortem
loss
Postmortem
loss
27
11
36
21
__
101
255
411
836
367
_____
1,869
279
453
1,008
497
__.2,237
Nil
3 (0.7%1)
74 (7.3%)
79 (15.9%)
lr;6 (7.0%)
24 (8.6%)
39 (8.6%)
98 (9.7%))
51
-(10.3‘XI)
212 (9.<5%)
’Twelve individuals in 6-15 age group with second molars erupted; 12 individuals in 16-25 age group with third molars erupted.
71
CARIES IN MEDIAEVAL SCOTS
canines (n = 241) in either the maxilla or
mandible in the two youngest age ranges
(Table 4). Only three premolars (of 179 teeth)
were carious in these age groups, all three
being in the subadult group; 6% of first
premolars had caries in adults, rising to
almost 12% in mature adults. For second
remolars the prevalence of caries was simiPfirst
ar in both adult groups (12.8 and 14%). In
molars, while only some 3% were cari-
TABLE 2. Individual with Caries Exwerience
Age
group
No. and percentage
of individuals
No. and percentage of
individuals with caries
6-15
16-25
26-35
36-45-t
27 (27'%1)
17 (17%)
36 (36%)
21 (21%;)
101
4 (14.8%)
7 (41.2'81)
21 (58.3%;,
12 (57.0%)
(43.6'11)
Total
No. of carious
teeth and
percentage
Teeth
present
6-15
16-25
26-35
36-45f
255
411
836
367
No. of separate
carious lesions
5
31
66
42
5 (2.0%)
30 (7.3%1)
64 (7.6%)
40 (10.9%)
fp
if
44
TABLE 3. Caries Experience Expressed as a
Percentage of Available Teeth
Age
group
ous in children, nearly 20% (18.9, 19.4, and
18.9%) were carious in each of the three
oldest groups. The revalence of carious second molars ranged rom 9.4% in the youngest
group, to 16.3% in the oldest group, with no
apparent age dependent trend. In the third
molars, 22.2% of teeth were carious in the
subadults, compared to only 8.7% in adults
and 14.8% in mature adults. Overall the
tooth most commonly affected was the first
molar (15.2%)followed closely by the second
and third molars (12.0 and 12.9%, respectivel ). The second premolar was more common y affected than the first premolar in all
three age groups.
In the 6- to 15-year age group, 12 (out of 27
individuals) had erupted second molar teeth.
Three out of the five carious cavities occurred in these teeth. In the 16- to 25-year
age group 12 (out of 17 individuals) had
erupted third molar teeth. Ei ht out of thirty
carious cavities occurred in t ese teeth. Molar teeth appear to be more susceptible to
caries for the first few years after eruption.
Related to location of attack. Of all the
occlusal surfaces examined, some 6% (75 of
1173) showed evidence of caries (Table 5). In
the youngest age group, 2.5% of occlusal
surfaces were carious. This increased to
a
TABLE 4. Caries Experience Related to Tooth Type (maxilla and mandible combined)
Age 6-15
No. of teeth
No. carious
%I carious
Age 16-25
No. of teeth
No. carious
(81carious
Age 26-35
No. of teeth
No. carious
96 carious
I
I
29
37
Nil
-
45
Nil
-
89
2
2.2%
Nil
-
51
Nil
-
107
1
0.9%1
c
29
Nil
-
50
Nil
-
Nil
-
58
1
1.7%
31
Nil
-
57
2
3.5%
109
14
12.8%
10.2%
59
7
11.9%
57
8
14.0%
243
7
2.9'11
266
15
5.6%
254
24
9.4'81
2
1.7'11
47
1
2.1'81
48
49
1
5
Total
No. of teeth
No carious
'81carious
210
3
1.4%1
243
2
0.8%1
33
Pm________M1
1I6
M2
MJ
Total
64
2
3.1qJ
32
3
9.4%
-
255
5
2.0%
58
56
8
14.3%
36
8
22.2%
411
30
7.3%
92
8
8.7%
836
64
7.7%
27
4
14.8'81
367
40
..
.
.
...
7
6.0%
115
Age 36-45+
No. of teeth
No. carious
'81carious
2.1%
Pm
11
18.9%
98
19
19.4k8~
37
7
18.9%
257
39
15.2'81
110
11
10.0%
43
7
16.3%
241
29
12.0%
155
20
12.9'11
10.9%
1869
139
7.4'81
72
N. W. KERR ET AL
TABLE 5. Location o f the Carious Attack Occlusal surface
Occlusal surface
_____No. of
Age--_____.-.____
surfaces
Gross
Fissure
Cuspal
Nil
11 (4.2%)
26 (5.0%)
15 (6.7%)
__
52 (4.7%)
3 (1.9%)
16 (6.0%!)
3 (0.6%)
__ Nil
22 (1.9%)
1 (0.6%)
Nil
Nil
- Nil
1 (0.1%!)
~
6-15
16-25
26-35
16-451
Total
~
160
265
525
223
1,173
510
822
1,672
734
3,738
~
RuccalAinguaI surface
No. of
Aee
surfaces
6-15
16-25
26-35
36-45+
Total
27 (10.2%)
29 (5.5%!)
15 (6.7%)
75 (6.4%)
~
Amroxiinal surface
No. of
Age
surfaces
6-15
16-25
16-35
26-45+
Total
Total
___
4 (2.5%)
510
822
1,672
734
3,738
~
Gross
Nil
4 (0.5%)
22 (1.3%)
9 (1.2%)
% (0.9%)
Gross
Nil
5 (0.6%)
20 (1.2%)
__9 (1.2%))
34 (0.9%))
Contact
pt area
Enamel/root________ Root
Nil
Nil
3 (0.4%)
Nil
22 (I 3%)
14 (0.8%)
14 (1.9%)
13 (1.8%)
39 (1.0%)
(0.7%))
Nil
2 (0.2%)
2 (0.1%)
1 (0.1%)
5 (0.1%)
27
Total
Nil
9 (1.19%)
60 (3.6%,)
37 (5.0%
(2.8%
Enamel
EnameVroot
Root
Total
1 (0.2%)
Nil
Nil
3 (0.2W)
2- (0.3%)
5 (0.1%)
Nil
Nil
Nil
-1 (0.1%)
1 (4
1 (0.2%!)
7 (0.9%)
23 (1.4%)
12 (1.6%)
(1.2%)
2 (0.2'%)
Nil
- Nil
3 (0.1%)
10.2% in the 16- to 25-year age group but
reduced to around 5 4 %in the two older age
groups. Where the site of origin could be
identified, caries was more frequent in the
fissures than on the cusps (1.9%compared
with 0.1%).
Of 3,738 approximal surfaces, only some
3% (106) were carious. No caries was observed in the youngest age group, most was
seen in the oldest age group. Where the site
of origin could be identified, the cementoenamel junction (CEJ) was the most frequent site, followed by root caries althou h
caries at this site was not observed until tfle
26-35 year age group. There was a trend
towards increasing caries prevalence on the
ap roximal surface with age.
8aries was seen on the buccal or lingual
surfaces in only 43 cases of 3,738 surfaces
observed (1.2%).As with the approximal surfaces, there was a trend towards increasing
caries prevalence on the buccal and lingual
surfaces with age.
Carious lesions at or near the CEJ were
further examined to determine their precise
location in relationship to the enamel or the
cementum of the root (Table 6). Only one
E
carious lesion (in the youngest age group)
was entirely on the enamel surface and it
was associated with a buccal pit on a molar
tooth. On the approximal surfaces no carious
lesion occurred in the youngest age group,
while in the 16- to 25-year age group, caries
involved the enamel in two instances and the
cemento-enarneljunction in three instances.
Caries confined to the root was not observed
in either of the two younger age groups. In
the two older age groups, enamel caries on
the approximal surfaces fell t o some 3-5%
while CEJ caries accounted for 50-60% of
lesions. Root caries was seen only in the two
older age groups with more root lesions observed in the mature adult group, 46%compared with 37% in the adult group. On the
buccalllingual surfaces a similar trend was
observed with increasing age being associated with more apically sited carious lesions.
DISCUSSION
The correspondence between the caries
scores on two separate examinations reinforces the findings of Kerr et al. (1988) and
Whittaker et al. (1981) that single-observer
73
CARIES IN MEDIAEVAL SCOTS
TABLE 6. Location of Carious Lcsiorts at or Ncar
the (CEJ) Where the Site o f Origin Could Be Identified
Approximal
________~
No: of
carious Sited on
Age
lesions
enamel
______6-15
16-25
26-35
36-45+
Total
Nil
5
38
28
71
Buccal /lingual
No. of
carious
Ape
lesions
Nil
2 (40.0'811)
2 (5.3%)
1 (3.6%1)
5 (7.0%)
Sited on
both enamel
and root
B
Sited on
-root
.~
14 (50.0'%)
39 (54.9%)
Nil
Nil
14 (36.8%)
13
___ (46.4'76)
27 (38%)
Sited on
both enamel
and root
Sited on
root
Nil
3 (60.0%)
22 (57.9%)
~ . . . . . _ _ _
G- - 1-5_
1
16-25
26-35
36-45+
Total
2
3
3
6
Sited on
enamel
1 il00.0'8lii)
Nil
Nil
2 (100.0~~1)
3 (100 0%)
Nil
2 (66 0%)
Nil
(33.3%))
5 (55.5%)
5
~
Any expression of caries prevalence must
take account of antemortem tooth loss.
Hardwick (1960) suggested a sliding ercentage of antemortem tooth loss shoul be
attributed to caries while Whittaker et al.
(1981) suggested a method of expressing
caries prevalence which assumed all antemortem loss was due to caries. Such adjustments can in fact mask important differences between populations. It was therefore
decided to follow the general practice of recording the number of carious teeth of a
particular type as a percentage of that type
present.
It is interesting to note that in this skeletal
series postmortem tooth loss was relatively
low, 9.5% compared with 16.3% in the Aberdeen study (Kerr et al., 1988). This owes
much to the skill and care of the excavators
and considerably increased the reliability of
the information obtained from the series.
Not surprisin ly, most of the teeth lost (63%)
were the sing e rooted incisors and canines
in which the incidence of caries in dentitions
of historic age (Lunt, 1974; Moore and Corbett, 1973) has been shown to be low.
The number of individuals with carious
teeth (44%) was considerably higher than
that (30%)reported in the study by the authors on a roughly contemporaneous sample
from Aberdeen in the Northeast of Scotland
(Kerr et al., 1988)but is still somewhat lower
than that reported by Olsson and Sagne
(19761, who found that almost 50% of individuals in a Swedish Mediaeval population
had one or more carious teeth.
Caries experience as expressed by the proportion of carious teeth was also hi her in
the present study (7.4%) than in t e Aberdeen sample (5.1%)but both were broadly
comparable with the 6-6.896 observed by
Lunt (1974; 1986) in the only two previous
Scottish studies. All four Scottish samples
have yielded values lower than that re orted
by Tattersall (1968)in an English MeJaeval
series (11%).James and Miller (1970) found
almost 6% of children (6-16 ears) in an
English Mediaeval sample ha caries compared to only 2% in the present study.
The number of carious cavities per individual showed a wide variation. While some
50%of all affected individuals had only one
or two cavities, more than 20% had between
five and nine cavities, suggesting that some
individuals were particularly susceptible to
caries attack. These figures were comparable to those for the Aberdeen population,
although no individual in that study had
Nil
Nil
Nil
1
_ (330%))
1 (1 1.1%)
f
scoring can provide a reliable assessment of
caries in dried specimens. A caveat that the
observer be experienced should be made
since it was noticed by Cross (1988) that an
inexperienced observer underestimated the
extent of caries present.
The reliability of the criteria appliedvisual assessment accompanied by the use of
a diagnostic probe-was also confirmed by
the complete correspondence between radiographic and visual diagnosis. Provided care
was taken in examination no great difficulty
was found in distinguishing carious lesions
from enamel hypoplasia or postmortem dama e in this study or in the previous study
err et al., 1988).
Caries prevalence in human archaeological material has been expressed in a variety
of ways. Whittaker et al. (1981) discussed
some of the resulting problems that make
interstudy comparisons difficult. In order to
facilitate comparisons with other investigations it was decided to follow the most common practice of recording the number of
carious teeth of a particular tooth type as a
proportion of all the available teeth of that
type. However, a more detailed assessment
of the pattern of distribution and age related
change in that pattern was also provided by
noting in addition, the number of individuals
with caries, the number of carious lesions
per individual and the distribution of lesions
according to site and age category.
(8
a
B
74
N. W. KERR ET AL.
more than five carious lesions. Multiple carious lesions on a single tooth were infrequent. In only 5 teeth was more than one
lesion found and in no case was more than
two lesions per tooth seen (see Table 3).
Caries prevalence was seen to increase
with increasing age, confirming the conclusions of Hardwick (1960), Kerr et al. (1988);
Lunt (1972, 1974, 1986), and Moore and
Corbett (19731, that caries in Mediaeval
times was essentially a disease affecting
adults.
The pattern of location of the caries differed somewhat in the Linlithgow series
from that reported in the Aberdeen series by
the present authors and that reported by
Lunt (1986) in a Scottish series from St
Andrews. Only in the Linlith ow series was
caries seen in the incisor anif canine teeth.
Most of the small number (seven) of canine
carious lesions were shallow root surface
lesions. By contrast, four of the five incisor
lesions were classified as gross, and it is
possible that they may have been subsequent to tooth fracture.
The susceptibility of the premolar and molar teeth was essentially similar to that seen
in the Aberdeen study, differing only in res ect of the first molar tooth. In Linlithgow,
t is tooth appeared to be more susceptible
(15 per cent of all first molars were carious),
whereas this figure was just under 7% in the
Aberdeen sample. Tattersall (1968) also
found the first molar to be the tooth most
susceptible to decay (23%).
The first premolar was the least susceptible of the premolars to caries attack. Interestingly, this pattern of first remolar being
the least susceptible and t e first molar
being the most susceptible was somewhat
modified in the different age groups. In the
youngest grou albeit a small sample, the
second molar s owed the higher incidence of
caries. In the subadult group, the third molar had the highest incidence. This probably
reflexts the fact that the molars are particularly susceptible soon after eruption when
the fissures act as foci for plaque retention
but later become less susceptible as they are
ground out by the severe occlusal attrition
seen in all dentitions in this series.
The general pattern of location of carious
lesions suggests the operation of an age related process. Occlusal surface caries was
most common in the subadult group (10%)
falling to about half that in the two older age
groups. Where it was possible to identify the
site of origin of the attack, the fissure was
K
E
IR'
the most common site. On the approximal
and buccaMingua1 surfaces, there was an
increased frequency of caries in the older age
groups. Where the origin of these carious
lesions could be identified, it was observed
that the site of origin tended to move in an
apical direction as age progressed. Similar
findings were reported by Moore and Corbett
(1973) in their study of a Mediaeval PO ulation in England. They also expresse the
opinion that caries prevalence and distribution had changed very little in Britain from
the Iron Age through to Late Mediaeval
times.
It has been observed that severe occlusal
attrition may be accompanied by the compensatory phenomenon of continued tooth
eruption in a coronal direction (Darling and
Lever, 1975; Costa, 1982), thought to be an
attempt to maintain face height lost by wear.
Severe occlusal attrition was a feature of
both the Linlithgow and Aberdeen series
(Kerr et al., 1988) and indeed seems to have
been a feature common to all populations
prior to the seventeenth century in Britain
(Miles, 1962; Brothwell, 1959).This rogressive coronal migration of teeth is ikely to
have been an important factor in the age
related progressive alteration in site susceptibility to caries attack. Initially, the fissures
of the occlusal surface of the premolar and
molar teeth were likely to have been the
most vulnerable sites for caries attack. However, once these stagnation areas had been
ground out by the process of attrition, the
vulnerability of that surface was reduced
and the approximal enamel (especially the
cement-name1 area) became the more vulnerable site. Constant abrasion is likely to
render the contact area less vulnerable to
plaque retention (Miles, 1969) and to caries
attack.
As teeth move coronally past a stable periodontium they will progressively present a
more apical aspect to the interdental space
and to any cariogenic factors present. It is
also likely that the interdental space itself
widens mesiodistally as the narrowing root
diameter provides the approximal walls.
This might account for an increased accumulation of cariogenic material and increased
susceptibility to caries with age.
Modern dentitions do not display the severe attrition seen in archaeological material and because of this, compensatory eruption mechanisms are not triggered. Modern
root caries probably has a different aetiological basis from that seen in preseventeenth
cp
P
75
CARIES IN MEDIAEVAL. SCOTS
TABLE 7. Number of Individuals and Age Profiles
of Three. Scottish Populations
St. Andrews,
1986)
_ _ _ _Aberdeen
_ _ ~ _ _Liniithgow
_ _ _ ~ _ Kirkhill.
_ _ _ _(Lunt
_ - ~
-
century material and is more likely to be
secondary to root exposure following periodontal disease rather than root exposure following the changing relationships brought
about by compensatory eruption. The periodontal status of the Linlithgow material was
investigated by Kerr (1989). Little evidence
of inflammatory periodontal destruction
was observed. This is in keeping with the
reports by Costa (1982) and Clarke et al.
(1986)suggestin that much of the root exposure in archaeo ogical material had been
mistakenly attributed to periodontal disease.
The differences in the prevalence of caries
between Scottish and other contemporaneous populations and the apparent regional
differences between the present study and
the earlier investigation by the authors may
be due to one or a combination of factors. It
has been shown that the pattern of prevalence and incidence of caries attack is age
dependent. Thus differences in the age profiles of the different samples could account
for differences in prevalence. However, the
age profiles of the Aberdeen and Linlith ow
samplcs are broadly similar and the di ferences may therefore be environmental.
It is difficult to make comparisons with
other studies where age-at-death assessment may have been made using different
techniques and where the proportions of the
different age oups varies. For example,
Lunt’s (1986)
Andrews Mediaeval population, although based on similar age ranges,
consisted of relatively fewer subadults and
children than in the Aberdeen or Linlith ow
material (Table 7). Given the pattern o increased caries prevalence with age and the
relatively higher proportion of older individuals in her study, the caries prevalence figures might have been expected to exceed
those from Aberdeen and Linlithgow.
It is possible that dietary variations could
account for the differences in caries prevalence in the Aberdeen and Linlithgow populations. Linlithgow, in Mediaeval times, was
?
f
I;
described as a place of “considerable trade,
opulence and splendour” (Simpson and
Stephenson, 19811, situated as it was in the
central belt of Scotland between Edinburgh
and Glasgow and the site of the Summer
Palace of the Scottish Monarchs. Althou h
Booton (1985) described Mediaeval A%erdeen as semifeudal, insular, and remote
and only slowly changing to a more competitive and fluid society, it must be borne in
mind that Aberdeen was a port with a thriving trade with the Baltic, the Low Countries
and the rest of the British Isles. Nevertheless, it is likely that the diet of the more
affluent Linlithgow society included more
cariogenic material.
Interestingly, Kerr (1989) reported that
there was evidence that the Linlithgow sample had more frequent, and more severe,
enamel hypoplasia than the Aberdeen sample. Mellanby (1934) considered enamel hypoplasia to be a predisposing factor in dental
decay and it is possible the increased number
of defects was a factor in the higher caries
prevalence noted in Linlithgow compared
with Aberdeen.
CONCLUSION
The results of this study support the findings of previous studies that caries prevalence in Scottish Mediaeval populations
tended to be lower than that seen in other
European populations and that caries was a
disease of adulthood in historic times. However, the sites of the lesions, the age related
distribution and the individual tooth prevalence show reasonably close parallels with
other studies. An explanation, based on compensatory tooth eruption following severe
occlusal attrition, is offered as a reason for
the a e related change in the pattern in the
speci ic sites of caries attack. It is concluded
that detailed information on age profiles, on
tooth type and on specific sites of caries
attack, is required before the significance of
within and between population differences
can be adequately assessed.
B
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