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 LITERATURE CITED Booton H (1985) New Light on Mediaeval Aberdeen. pp. 46-58. Aberdeen University Press. Brothwell D (1959) Teeth in earlier human populations. Proc. 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