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Dental caries and antemortem tooth loss in the Northern Peten area Mexico A biocultural perspective on social status differences among the Classic Maya.

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AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 122:1–10 (2003)
Dental Caries and Antemortem Tooth Loss in the
Northern Peten Area, Mexico: A Biocultural Perspective
on Social Status Differences Among the Classic Maya
Andrea Cucina,1* and Vera Tiesler1
Facultad de Ciencias Antropológicas, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
KEY WORDS
dental anthropology; subsistence patterns; social strata; Classic Maya
ABSTRACT
Dental caries and antemortem tooth loss
(AMTL) are investigated in a Classic Maya sample obtained from the sites of Calakmul, Dzibanché, and Kohunlich (Mexico). This study aims at assessing the effect that
sex and social status had on the prevalence of oral pathologies. The lack of a direct relationship between caries,
AMTL, and age-at-death led us to interpret the results in
terms of the biological, socioeconomic, and behavioral conditions prevailing in these ancient Maya settlements. Benefits related to sex and social status are evident in the
frequency of carious lesions, which appear less frequently
in elite males than in low-status individuals of both sexes
and in elite females. Individuals from problematic mortuary contexts and isolated bone assemblages, who could not
be ascribed to any status group, showed the highest rates
of caries. Sex discrimination in dietary preferences appears in the elite sample, while the homogeneity encoun-
tered between sexes in the low-status segment suggests a
more uniform access to resources. Tooth loss clearly distinguishes elite individuals from commoners, regardless of
sex, with the former bearing a much higher rate of loss. In
individuals from the undefined mortuary assemblages and
sacrificial contexts, it was even more pronounced than in
the other groups, although its interpretation is problematic due to a lack of associated funerary data. The overall
evidence from oral pathologies is interpreted to be the
result of deficient oral hygiene coupled with a softer and
more refined diet in the high-status population, particularly males. Whereas elite males’ subsistence was apparently based more on animal proteins and relatively soft
and refined foods, a diet relying on carbohydrates may
account for the observed rate of oral pathologies in elite
females and commoners. Am J Phys Anthropol 122:1–10,
2003. © 2003 Wiley-Liss, Inc.
One of the features that characterized Lowland
Maya civilization during the Classic period (A.D.
250 –900) was its marked social stratification, with a
few related families ruling over a large population
living in the regional centers and their sustaining
hinterland (Chase and Chase, 1992; Sharer, 1994).
Power in the apical spheres of ancient Maya society
was accompanied by a set of privileges and a characteristic lifestyle enjoyed only by the elite. From
this point of view, the imposing palaces and monumental temple structures at Maya sites remain as
architectural witnesses not only of culture and
wealth, but also of the marked hegemonic social
structure and authority of Classic Maya rulers.
Likewise, the ever-growing corpus of inscriptions
and the iconographic record reinforce the image of
an elite exclusive social standing and way of life
(Coe, 1992).
We argue here that the distinctive lifestyles,
which developed within the social structure during
the Classic period, were accompanied by differential
distribution of resources and access to food supply
between and within social strata, similar to what
has been observed in other human archaeological
settings (Powell, 1988; Larsen, 1997; Goodman,
1998). We propose that the privileges enjoyed at the
upper end of Maya society, coupled with general
differences in lifestyle, are inevitably mirrored by
divergent patterns of manifestations of nutritional
and pathological conditions.
Like other precontact Mesoamerican areas, the
Lowland Maya population was characterized by its
strong dependence on maize and other tropical
crops, which made up a large portion of the diet
(Wright and White, 1996; Saul and Saul, 1997;
White, 1997, 1999; Wright, 1997; Whittington,
1999). Nonetheless, studies on caries and stable isotopes indicate a high level of heterogeneity in plant
consumption both between and within sites (Sanders and Price, 1968; Gerry and Krueger, 1997;
White, 1999; Whittington, 1999), when investigated
in terms of sex and social stratification. The available evidence provides divergent results on diet and
©
2003 WILEY-LISS, INC.
*Correspondence to: Andrea Cucina, Ph.D., Facultad de Ciencias
Antropológicas, Universidad Autónoma de Yucatán, Calle 76 #455 LL
41 y 43, 97000 Mérida, Yucatán, Mexico.
E-mail: acucina@yahoo.com or cucina@tunku.uady.mx
Received 6 February 2002; accepted 10 January 2003.
DOI 10.1002/ajpa.10267
2
A. CUCINA AND V. TIESLER
dynastic graves and commoners’ residential and
burial compounds, thus providing a sample likely to
reflect the social heterogeneity that characterized
Classic Maya society. The skeletal remains and the
archaeological information from these sites establish an interesting context for addressing research
questions about sex discrimination, social status,
and differential access to resources.
In this investigation, we evaluate caries and antemortem tooth loss (AMTL) from the three abovementioned sites in relation to social factors. Unfortunately, abscesses and periodontoclasia could not
be taken into consideration due to the samples’ poor
state of preservation. The results of this investigation are intended to provide new regional, socioecological, and epidemiological insights into the
Classic Maya patterns of food access and preferences
in relation to social status as well as within the
domestic sphere.
CARIES AND ANTEMORTEM TOOTH LOSS
Fig. 1. Location of three sites. Northern Peten area corresponds to southern part of states of Campeche and Quintana Roo.
Southern Peten encompasses northern part of Belize and Guatemala.
health between the elite and commoners. For example, in the city of Copán, Honduras, adults from
privileged contexts were less affected by caries than
were low-status people (Hodges, 1985), indicating a
reliance on the less cariogenic animal proteins in the
wealthier group. Evidence from Belize site of Lamanai, where reliance on maize was inversely related to social status, supports this pattern (White,
1997). Interestingly, White (1997) found an opposite
pattern in the individuals from Pacbitun (Belize).
Besides the unquestionable reliance on maize, the
somewhat contradictory evidence has not provided
conclusive answers about the role played by sex and
social status in precontact Lowland Maya populations with regard to preferential access to resources,
as mirrored by oral pathologies and health.
The present study addresses the issue of social
and sex differences in dietary intake in northern
Peten. A multisite approach was required due to the
limited number of burials from each site, coupled
with their poor state of preservation. We investigated the human dental remains from Calakmul,
one of the largest regional capitals of the Classic
period, and Dzibanché and Kohunlich, two neighboring centers to its northeast (Fig. 1).This area has so
far only been marginally explored in terms of paleodiet, especially when compared to Belize, Honduras, and Guatemala, as can be inferred from Buikstra (1997) and Danforth et al. (1997). During the
last 20 years, the excavations of these settlements
brought to light ceremonial centers with noble and
The pathogenic process of caries results from an
acid demineralization of enamel and dentine caused
by fermentation of carbohydrates by bacteria from
the genus Streptococcus (White, 1975; James, 1975;
Kamp et al., 1983), a process initiated particularly
in the presence of sugars. Many intrinsic and extrinsic conditions such as mouth pH, dental hygiene,
and food preparation techniques are important causative factors in the etiology of caries (Silverstone et
al., 1981). Likewise, changes in dietary patterns,
with the shift to agriculture as a primary subsistence source in past societies, are associated with an
increase in the rate of dental caries. In his study on
the Jomon people, Turner (1979) ranked the rate of
cavities by tooth according to population subsistence
economy, and found low rates in foragers (1–2%),
medium rates in mixed economies (around 5%), and
high rates in agricultural economies (8 –9%). However, much variability occurs between populations
that share the same kind of subsistence pattern
(Larsen, 1997).
Once caries penetrates the pulpal chamber, bacteria enter the systemic circulation, causing inflammatory responses that may eventually result in the
loss of the tooth during the individual’s lifetime.
AMTL can also occur after a chronic, severe case of
gingival inflammation that extends to the alveolar
bone underneath the gum (periodontal disease),
causing its retraction and eventual loss of the tooth
(Hillson, 1996). In addition, tooth loss can be produced as a consequence of continuous eruption, a
natural physiological process related to the need for
the maintenance of biting capacity in heavily worn
teeth. Its differential etiology in archaeological samples has yet to be fully understood (Larsen, 1997).
In anthropological studies, tooth loss, caries, abscesses, and periodontoclasia have been recognized
as useful tools in the assessment of general oral
health (Costa, 1980; Keene, 1981; Lukacs et al.,
1985; Lukacs, 1989; Larsen et al., 1991; Hillson,
3
ORAL PATHOLOGIES IN NORTHERN PETEN CLASSIC MAYA
TABLE 1. Sample composition by site, age at death, sex, and social status
Low
High
Uncertain context
M
F
n.d.1
M
F
n.d.
M
F
Calakmul
18–20
25–30
35–45
40–50
40–50
45–55
18–20
35–45
50⫹
Adult
Adult
Adult
30–35
30–40
30–40
30–40
35–45
35–40
40–45
50–55
50–60
Adult
20–25
45–55
50–55
Adult
25–35
40–50
Adult
18–20
18–20
20–25
20–30
30–35
35–45
40–50
Adult
Dzibanché
35–45
50–60
Adult
30–40
50–60
35–45
35–45
Kohunlich
20–25
25–30
30–40
30–40
45–55
Adult
1
25–35
25–30
30–40
35–45
45–55
45–55
45–55
Adult
Adult
18–20
n.d.
25–30
Adult
n.d., not determined.
2000). Thus, the combined analysis of caries rates
and AMTL provides insight about diet and dental
disease in past populations, and can provide evidence of the series of biological, socioeconomic, and
behavioral factors that are involved in oral pathology.
MATERIALS AND METHODS
The sample evaluated for this analysis comes from
the northern Peten urban sites of Calakmul, Dzibanché, and Kohunlich. The ancient city of Calakmul lies in the southern part of what is now the
Mexican state of Campeche, at the northern fringes
of the central Maya Lowlands (Folan et al., 1995).
The neighboring centers of Dzibanché and Kohunlich are located to the northeast, in the state of
Quintana Roo. All human remains analyzed for this
study are from the Classic period (A.D. 250 –900).
Samples were grouped based on cultural, archaeological, and ecological evidence. The three settlements developed in a seasonal tropical rain forest
with a moderately high canopy, bajos (seasonal wetlands), and interspersed open spaces, where areas of
fertile soil were cultivated. The richness in flora and
fauna provided an abundant source of food, clothing,
and medicine (Sharer, 1994). The similar ecological
conditions indicate that the three sites had access to
the same kinds of resources. Kohunlich was an active center, involved in trade activities that forged
close relationships with Dzibanché, a tie revealed by
architectural similarities (Nalda and Velázquez
Morlet, 1994). Martin and Grube (2000) reported
that Dzibanché was politically dependent on Calakmul. Notwithstanding all the similarities, the three
collections were combined only after a Mann-Whitney test on caries and AMTL between samples was
confirmed to be nonsignificant (P ⬎ 0.1 for both high
and low status). Individuals from isolated mortuary
assemblages had been previously excluded from the
test because of uncertain provenience and their low
sample size at Dzibanché and Kohunlich (one individual each).
Forty-nine adult individuals form the sample (Table 1). Nineteen individuals were ascribed to the
elite category, and the other 30 were identified as
low-status individuals. Social status was inferred
from funerary architecture, along with the placing,
quantity, and quality of grave goods, following the
status markers proposed for the lowland Maya burials by Krejci and Culbert (1994) and adapted by
Tiesler (1999). Final scores ranged from 0 (no status
markers, no grave goods) to 5 (more than six status
markers and likely to be dynastic burials), and were
broadly grouped into two main categories: one considered “nondistinctive” or “commoners” (0 and 1),
and the other being “privileged” (2–5). The ratio
between commoners and privileged individuals is
consistent with the data from other regional samples (Tiesler, 1999). Thirteen additional individuals
(for a total of 62 individuals) were retrieved from a
wide range of contexts (caches, problematic deposits,
or isolated assemblages) that were not assignable in
terms of status. Unfortunately, the geography of
origin and the social level of these often incomplete
skeletons are uncertain, which precludes their assignment to any specific category.
Sex was identified on macroscopic skeletal determination, which relied on gross morphological parameters of dimorphism from the pelvis, femur, cranium, and mandible (Buikstra and Ubelaker, 1994),
complemented by metric discrimination of single
and multiple variables adapted from a regional
Maya sample (Tiesler, 1999). The assessment of ageat-death in the adult segment of the population was
4
A. CUCINA AND V. TIESLER
TABLE 2A. Number of teeth affected by caries, number of caries-free teeth, and frequency of caries by dental arcade,
according to sex and social status
Maxilla
Total
Caries-free
%
N1
Caries
Caries-free
%
N
Caries
Caries-free
%
N
6
10
0
44
111
96
12.0
8.3
0.0
5
13
13
5
8
3
51
156
115
8.9
4.9
2.5
5
15
12
11
18
3
95
267
211
10.4
6.3
1.4
5
15
13
3
5
4
49
88
42
5.8
5.4
8.7
8
11
4
4
7
4
55
75
41
6.8
8.5
8.9
8
11
5
7
12
8
104
163
83
6.3
6.9
8.8
8
11
5
9
15
5
93
220
148
8.8
6.4
3.3
13
28
18
9
13
8
106
252
167
7.8
4.9
4.6
13
29
18
18
30
13
199
472
315
8.3
6.0
4.0
13
30
19
Males
Uncertain context
Low
High
Females
Uncertain context
Low
High
Sexes pooled
Uncertain context
Low
High
1
Mandible
Caries
N, number of individuals analyzed.
TABLE 2B. Number of teeth affected by caries, number of caries-free teeth, and frequency of caries by tooth type,
according to sex and social status
High
Males
Incisors
Canines
Premolars
Molars
Females
Incisors
Canines
Premolars
Molars
Sexes pooled
Incisors
Canines
Premolars
Molars
Low
Uncertain context
Caries
Caries-free
%
Caries
Caries-free
%
Caries
Caries-free
%
0
0
0
3
54
32
53
72
0.0
0.0
0.0
4.0
1
1
7
9
59
38
76
94
1.7
2.6
8.4
8.7
2
1
4
4
23
10
27
35
18.0
9.1
12.9
10.3
2
2
2
2
17
14
26
26
10.5
12.5
7.1
7.1
5
1
2
4
48
21
47
47
9.4
4.5
4.1
7.8
0
2
0
5
30
17
34
23
0.0
10.5
0.0
17.9
2
4
2
5
78
48
85
104
2.5
7.7
2.3
4.6
6
2
9
13
123
66
135
148
4.7
2.9
6.3
8.1
2
3
4
9
53
27
61
58
3.6
10.0
6.2
13.4
based on the macroscopic modification of the pubic
symphysis, auricular, and rib sternal surfaces
(Meindl et al., 1985; Iscan and Loth, 1986; Katz and
Suchey, 1986; Brooks and Suchey, 1990), along with
the degree of dental wear and the general presence
of skeletal degenerative disease.
Dental wear was not a factor in evaluating the
presence of caries and, as discussed below, was not
considered a causative factor in the frequency of
AMTL. The overall rate of occlusal surface wear is
low, particularly in the high-status group (Tiesler,
1999, 2000), which is expected in populations relying on agriculture and processed food (Molnar, 1972;
Larsen, 1997; Rose and Ungar, 1998; Kaifu, 1999).
Carious lesions were scored on all permanent
teeth and were registered as present when the cavity had invaded the dentine, corresponding to category 2 by Schultz (1988). This level indicates lesions
that are at least 2 mm wide and reach the dentine.
This way, enamel pits that could possibly be confused with early stages of caries were automatically
excluded from the count. In all, 830 permanent teeth
were analyzed from the high- and low-status groups,
in addition to 217 teeth of unknown context (Table
2).
Data on AMTL were collected from alveolar bone.
A tooth was considered present when its corresponding tooth socket was present, while it was considered
absent (AMTL) when its alveolar bone was clearly
resorbed up to complete closure of the socket. Loose
teeth that were not represented by their corresponding sockets were not considered in the count of
AMTL. The available tooth sockets equaled 344,
plus 82 resorbed ones (Table 3a). The problematic
group comprised 68 sockets and 45 lost teeth (Table
3a).
RESULTS
Due to the state of preservation of the samples,
caries and AMTL were scored by tooth rather than
by individuals. Frequencies are listed correspondingly for both oral pathologies in Tables 2a and 3b.
The prevalence of caries by dental arcade, sex, and
social status appears in Table 2a, while frequencies
by tooth type, sex, and status are reported in Table
2b. Results on AMTL are organized similarly in
Table 3a,b. The overall prevalence of caries ranges
between 1.4% in high-status males to 8.8% in highstatus females. The prevalence in unknown status
individuals is consistently between 6.3–10.4%. The
5
ORAL PATHOLOGIES IN NORTHERN PETEN CLASSIC MAYA
TABLE 3A. Composition of sample represented as number of sockets, and frequency of AMTL, according to sex and social status
Males
Sexes pooled
Sockets
%
N1
AMTL
Sockets
%
N
AMTL
Sockets
%
N
21
37
22
41
156
70
33.9
19.2
23.9
4
14
7
24
10
13
27
93
25
47.1
9.7
34.2
3
8
4
45
47
35
68
249
95
39.5
15.9
26.9
7
23
11
Uncertain context
Low
High
1
Females
AMTL
N, number of individuals analyzed.
TABLE 3B. Number of sockets by tooth type and frequency of AMTL, according to sex and social status
High
Males
Incisors
Canines
Premolars
Molars
Females
Incisors
Canines
Premolars
Molars
Sexes pooled
Incisors
Canines
Premolars
Molars
Low
Sockets
% AMTL
AMTL
Sockets
% AMTL
AMTL
Sockets
% AMTL
9
1
4
8
15
9
23
23
37.5
10.0
14.8
25.8
11
2
8
16
42
21
41
52
20.8
8.7
16.3
23.5
8
1
3
9
8
4
13
16
50.0
20.0
18.8
36.0
1
0
2
10
10
5
6
4
9.1
0.0
25.0
71.4
0
0
2
8
26
11
23
33
0.0
0.0
8.0
19.5
7
1
6
10
6
4
8
9
53.8
20.0
42.9
52.6
10
1
6
18
25
14
29
27
28.6
6.7
17.1
40.0
11
2
10
24
69
32
64
85
13.8
5.9
13.5
22.0
15
2
9
19
14
8
21
25
51.7
20.0
30.0
43.2
TABLE 4. Correlation values between age at death and
respectively caries and AMTL for each social group, and t-test P
values for distribution of individual age at death
between social groups*
Social Status
Caries age
AMTL age
0.289
0.312
0.196
0.513
0.210
0.537
Correlation
Low
High
Unknown
t-test
High-Low
Low-Unknown
High-Unknown
*
Unknown
AMTL
0.497
0.198
0.094
Level of significance: P ⱕ 0.05.
percent values of caries in the female samples indicate the highest prevalence in high-status individuals. The opposite tendency is noted among males,
whose prevalence of caries rises from high- to lowstatus individuals, and even more to the unknown
sample. When sexes are pooled, the low-status group
reveals more caries than the high-status group, with
individuals from nonassigned contexts constantly
surpassing the two others. None of the pairwise
Mann-Whitney U tests between males, females, and
sex-pooled samples was significant in terms of toothtype composition, indicating that frequencies of caries and AMTL are not biased by sampling problems
related to differential preservation or recovery of
teeth and alveolar bone.
Because age-at-death is an indirect factor in oral
pathologies, correlation values between age-atdeath and caries and AMTL, respectively, are listed
in Table 4, as well as the t-test P-values between
groups for age distribution. Neither the correlation
nor the t-test indicate significant differences.
TABLE 5. Level of significance (P values) obtained from chisquare intragroup comparison of caries prevalence according to
sex1
Maxilla
Mandible
Whole dentition
Low,
males vs. females
High,
males vs. females
0.582
0.397
0.973
0.017
0.089
0.002
1
Statistically significant differences are in bold. Level of significance: P ⱕ 0.05.
TABLE 6. Level of significance (P values) obtained from chisquare intergroup comparison of caries according to and
regardless of sex1
Maxilla
Mandible
Whole dentition
Males,
low vs. high
Females,
low vs. high
Sexes pooled,
low vs. high
0.011
0.277
0.005
0.702
0.793
0.747
0.262
0.842
0.188
1
Statistically significant differences are in bold. Level of significance: P ⱕ 0.05.
Comparison between sexes within each group indicates no substantial differences in the low-status
sample; chi-square probability values are never significant (Table 5). On the contrary, the higher rate of
caries in high-status females is highly significant in
the maxilla as well as in the whole dentition when
compared to their male counterparts (Table 5). The
low prevalence in high-status males also holds up in
comparison with low-status males. Differences are
highly significant in the maxilla and in the whole
dentition in men, whereas women from the two subsamples do not show significant differences (Table
6
A. CUCINA AND V. TIESLER
TABLE 7. Level of significance (P values) obtained from chisquare intergroup and intragroup comparison of AMTL1
Intergroup AMTL
Whole dentition
Males,
low vs. high
Females,
low vs. high
Sexes pooled,
low vs. high
0.443
0.001
0.011
Intragroup AMTL
Males vs. Females
Low
High
0.054
0.324
1
Statistically significant differences are in bold. Level of significance: P ⱕ 0.05.
6). When social-status samples are compared regardless of sex, no significant differences are noted.
Results differ when AMTL is examined, however
(Table 3a,b). Ignoring the group of nonassigned provenienced individuals, which consistently surpasses
the two other groups, high-status individuals suffered from a higher rate of dental loss than commoners. The rates of 9.7% and 34.2% in females, respectively, from the lower- and higher-status groups
discriminate them at P ⫽ 0.001 (Table 7). Males do
not show a significant difference. However, a sexpooled comparison between social-status segments
is still significant (Table 7). Intragroup comparison
between sexes does not discriminate either sample,
although the reduced loss in the low-status females
differs from their male counterparts at an almost
significant level (P ⫽ 0.054, Table 7).
DISCUSSION
The observed prevalence of caries and AMTL at
Calakmul, Dzibanché, and Kohunlich reveals valuable insights about the population that inhabited
the northern Peten area during the Classic Maya
period. In particular, this information sheds light on
the difference between sexes and social classes in
relation to nutritional and behavioral patterns. The
present results suggest that higher status does not
necessarily mean better oral health, as AMTL indicates a higher prevalence of dental decay in the elite
segment when compared to the nonelite for each sex
and for pooled sexes. On the other hand, lowerstatus individuals suffered from a higher prevalence
of caries when sexes are grouped. These results
should not contradict each other, for dental loss is
very often the natural consequence of caries. Complete tooth loss follows the erosion of the dental
structure by caries or the removal of an affected
tooth. For this reason, the relationship between caries and tooth loss must be taken into consideration
in the analysis of the present results. Moreover, the
lack of correlation between oral pathologies and ageat-death suggests that the underlying causes are to
be sought in the different nutritional and behavioral
patterns that characterized each segment of the society.
Evidence from other Classic Maya sites indicates
that animal protein consumption was likely not
equivalent between elite and nonelite individuals
(Hamblin, 1984; White, 1999; Shawn, 1999). A more
diversified and qualitatively better nutritional intake in the upper social segment was noted by Lentz
(1991) and Storey (1999) for Late Classic Copán. The
settlement’s high-status individuals are thought to
have benefited from a more diversified diet that
relied less on carbohydrates and more on meat, a
condition that supposedly led to a lower prevalence
of caries, similar to the tendencies reported in the
literature on caries related to consumption of meat
in the shift from hunting to farming (for a review,
see Larsen, 1997).
Along with daily eating habits, food consumption
during ritual events must have influenced the overall nutritional intake of commoners and so much the
more of the male elite in ancient Maya society. Ritual feasting was practiced on many different occasions, celebrating family and community affairs,
commemorating religious and war events, and providing scenes for political transactions and power
displays (McAnany, 1995; LeCount, 2001). Although
not confined to the elite, it was in the upper end of
the society where feasts took the form of exclusive,
lavish banquets, hosted and attended mostly by
male rulers, nobles, and heads of lineages. On these
occasions, prestige goods were exchanged with local
and foreign guests, and exquisite meals were offered, including tamales, cacao drinks, and meat
(Houston et al., 1989; LeCount, 2001; for references
on colonial Yucatan, see de Landa, 1982).
Evidence of caries in our samples seems to be
consistent with the data reported in the literature,
particularly for high-status males. Within the upper
class, the lower frequency of caries encountered in
males in comparison with females indicates that the
former had access to less cariogenic food. This is
indicative of the fact that preferential access to food
and resources was a factor, not just between classes,
but also between sexes within the elite itself. Highstatus males seem to be the ones who enjoyed better
attention and care in terms of food and resources, in
particular in the Maya society based on warfare
against surrounding states and on the expression of
political power and strength (Roys, 1972; Schele and
Miller, 1986). As in other highly ranked societies
with clearly defined gender roles, the males’ position
was predominant, while the females’ role was publicly less important and more restricted within
household boundaries (Harris, 1993; Crown and
Fish, 1996; McAnany and Plank, 2001). In terms of
food, sex discrimination in animal protein consumption within the high-status group may have resulted
in the tendency toward oral pathologies we encountered.
Interestingly, the difference between elite males
and females is highly significant, while, on the contrary, no significant discrimination between sexes in
terms of caries and AMTL is evident in the lowstatus segment. Moreover, females from high and
low classes do not reveal significant differences in
ORAL PATHOLOGIES IN NORTHERN PETEN CLASSIC MAYA
terms of caries frequency, which could be interpreted as the result of a more similar exposure to
cariogenic foods. The higher frequency of caries in
the high-class females from the northern Peten
sites, compared to high-status males, could reflect
their higher consumption of carbohydrates. On the
contrary, low-status females do not differ significantly from their male counterparts, which would
indicate that the extent of carbohydrate consumption in the low class was not particularly different
between sexes. Similarly to our findings, sex, as well
as status differences, was associated with different
food intake also at Copán, where elite males were
significantly taller than their low-status counterparts, and were likely better nourished than elite
females (Storey, 1999). Whittington (1999) encountered a more carbohydrate-dependent diet in lowstatus females than in low-status males at Copán,
which explained the significantly higher rate of caries in the former, although his studies did not consider high-status individuals or compare social
strata (Whittington and Reed, 1997; Whittington,
1999).
A potential explanation for our observations can
be drawn from Larsen et al. (1991), who discussed
the high frequency of caries in females as due to
behavioral and cultural patterns not directly related
to the kinds of food consumed. According to those
authors, women who are restricted to household activities tend to eat more frequently during the day,
while preparing the food for the family or performing their daily household activities. In turn, males,
who leave the house to engage in field labor, eat the
same kind of food in more restricted schedules than
their spouses, thus reducing the possibility for food
residuals to remain in the mouth, and consequently
shortening the time of exposure to bacterial reactions (Larsen et al., 1991; Hillson, 1996).
Following the above tendencies, the frequency of
caries scored in the sample from the northern Peten
reveals two different scenarios. One involves highstatus females, who were likely discriminated in
access to food or food choice and were probably restricted to more sedentary activities. The scheme
seemingly fits the discussion by Larsen et al. (1991)
and conforms to nutritional models already introduced by previous studies on ancient Maya populations (White, 1997, 1999; Whittington, 1999). The
second scenario concerns low-status individuals.
The homogeneity in oral pathologies seen between
sexes is suggestive of the limited ranking within this
segment of the society. It is possible that in the
sample of commoners from northern Peten, the intake of carbohydrates was high enough to take over
different daily habits between sexes and produce a
rate of oral pathologies that is statistically equivalent between the sexes.
Maya society was ranked, and two diverging
schools of thought debate the internal stratification
of elite and nonelite. One states that both classes
were internally ranked, and the second contends
7
that ranking occurred in the elite only (Sharer,
1994). The evidence encountered from the analysis
of oral pathologies would suggest that ranking occurred in the elite group in the form of sexual discrimination, while the commoners’ group was not
structured in a ranked system, thereby supporting
the second argument. Notwithstanding other possible explanations, several factors contribute to these
results, among which is the relatively small sample
size that induces us to interpret the results with
caution.
The subsistence economy of the low-status group
that is seemingly higher in carbohydrates, as likely
reflected by the higher rate of caries, should also be
supported by subsequent tooth loss. Instead, AMTL
does not seem to be consistent with what was expected. Male and female members of the elite segment show a greater prevalence of tooth loss when
compared to nonelites. If intake of cariogenic food
can be claimed to be a plausible direct causative
factor in the prevalence of tooth loss, at least in some
groups, a simple linear association between caries
and tooth loss cannot be equally applied to all
groups. Given that the interaction among all factors
involved in the expression of oral disease is very
complex (Hillson, 2000), and that inter- and intragroup variability cannot be assessed in detail on the
basis of oral pathologies only, the similarities and
differences encountered between and within status
groups in the rate of cavities and tooth loss in northern Peten seem to be due to a wide array of synergistic pathological, behavioral, nutritional, socioeconomic, and cultural factors. Age, calculus, gingival
inflammation, and periodontitis play important
roles in dental decay (Hillson, 1996; Larsen, 1997).
The analysis of demographic profiles of whole populations or subgroups can shed light on the extent of
caries and AMTL affliction in a population. Whittington (1999) noted that tooth loss in low-status
individuals in Copán was not equivalent to caries,
and argued that dental loss was related to dental
decay in younger individuals and to age in older
ones. When the age factor is correlated with tooth
loss in Calakmul, Dzibanché, and Kohunlich, it does
not seem to significantly discriminate between social
segments and account for the differences encountered between them. Caries and AMTL never show
significant correlations with age-at-death, as Table
4 indicates. The fragmentary state of the remains
should not bias the evidence of caries and AMTL, for
every subsample underwent the same extent of taphonomic alteration. But when a between-groups
t-test was performed on the demographic profile of
each subsample, no significant difference was encountered (Table 4), further indicating that age-atdeath in this sample was not a major causative
factor in the rate of dental disease.
Dental wear does not seem to provide a possible
explanation for the rate of AMTL encountered in the
sample, particularly in the elite group. Tiesler
(1999, 2000) noted that nobles from the three sites
8
A. CUCINA AND V. TIESLER
from northern Peten, as from other Classic sites,
averaged an even lower attritional rate than the
already low rate observed in the commoners’ group.
In particular, she noted that the four high-status
individuals unearthed from Structure II at Calakmul, all falling into the 35–50-year age class, were
characterized by a wear barely reaching the dentine.
This is indeed consistent with a very soft, refined
diet where animal proteins represented a major constituent along with soft tamale maize cakes, chocolate beverages, and atole soups (Houston et al.,
1989). The overall low rate of occlusal wear also
indicates that the commoners’ diet was not highly
abrasive, despite the grinding and consumption of
maize. A soft diet could have reduced the effects that
bite forces and grinding have on the alveolar bone,
possibly leading to periodontal disease and eventual
tooth loss (Corruccini and Whitley, 1981; Corruccini,
1991; Strohm and Alt, 1998). In turn, other factors
such as malocclusion do not produce periodontitis,
but rather accelerate a process already in progress
(Strohm and Alt, 1998). The fragmentary state of
the remains in this study does not allow us to assess
to what extent malocclusion and bite forces can be
related to AMTL. Even though we cannot rule out
masticatory forces as possible causative factors determining the rate of AMTL in high-status individuals, it seems plausible that they were not the main
factor involved.
Since the high rate of AMTL in the elites does not
seem to be explained in terms of economy (food diversification) and culture (food preparing) alone, it
might relate to behavioral and hygiene conditions,
the more so since high-status individuals in northern Peten did show very extensive calculus (Cucina
and Tiesler, 2003). This indicates that oral hygiene
was not likely a major concern within the elite segment. Hillson (1996) reported that gingival inflammation, when observed in more advanced and acute
stages (periodontal disease), leads to bone resorption and eventually to tooth loss. Inflammation results from bacterial plaque that proliferates in exposed areas on the crown and root. When bacterial
plaque mineralizes, it leads to the formation of dental calculus (Scheie, 1989). The etiology of periodontal disease is very problematic and multifactorial,
but insufficient oral hygiene that removes dental
plaque is the basis of future dental loss (Hillson,
1996). Extensive calculus might have caused gingival inflammation and periodontal disease of the underlying bone tissues, causing a progressive deterioration of the alveolar region and subsequent loss of
the tooth (Hillson, 1996; Larsen, 1997). It is probably the lack of basic oral hygiene habits, along with
a softer, less abrasive diet, that accounted for the
high rate of AMTL among the elites.
CONCLUSIONS
In light of the many direct and indirect factors
contributing to the formation of caries and AMTL,
we infer lifestyle and life conditions according to sex
and status in the northern Peten area during the
Maya Classic period. Social status is closely associated with differential access to food and other resources. A more refined diet likely characterized the
elite individuals, as well as sexual discrimination in
the choices and access to food. Males were the ones
who mostly benefited from their social position. In
contrast, high-status females were seemingly more
restricted in access to food, and tended to closely
resemble low-status individuals, at least in terms of
caries frequencies. The reduced amount of caries in
elite males, as a consequence of a finer, more sophisticated, and diversified diet, is consistent with what
was reported by Lentz (1991) and Storey (1999).
Regarding the female elite segment, the small sample and the lack of chemical evidence imply a need
for further investigations.
On the contrary, the nonelite group is very homogeneous in the frequency of oral pathologies. Interestingly, no significant sex differences are noted.
This, along with the very high frequency of caries,
may be suggestive of a diet in which maize strongly
predominated to such an extent that possible differences between sexes due to normal daily activities
are not noted (Larsen et al., 1991). It may also indicate a more even distribution of resources and less
ranking within this group.
The higher frequency of AMTL in the elite segment could be attributed to periodontal inflammation and gingivitis, as witnessed by the extensive
tartar observed. Dental calculus could be interpreted as the combined consequence of behavioral
habits, such as lack of oral hygiene, and a less abrasive diet.
Finally, the group of individuals recovered from
uncertain funerary or extrafunerary contexts warrants a separate discussion. Their identity and provenance are still unknown, which makes it impossible
to place them in either of the two groups. Moreover,
they were recovered in public areas not related to
any residential compound, thus limiting any inference on their living spaces. Their mean age at death
is significantly younger than that of the two other
segments, but their rate of caries and tooth loss
always exceeds the others. Such high levels of oral
pathologies, along with their younger age, may trigger the question of whether they represented less
healthy, foreign, or fringe society members who did
not deserve to receive common funerary treatments.
Until a clear archaeological and anthropological definition of their status is available, any assessment of
their identity, more than suggesting that they did
not seem to belong to the local elite group, is impossible.
Our general conclusions on nutrition and food
choice, as evidenced by oral pathologies, confirm the
recent statement of White (1999). As that author
contends, diet furnishes an important source of complementary information, helping us to understand
the complexity of ancient populations. More than
the differences in food intake, it is the large and
ORAL PATHOLOGIES IN NORTHERN PETEN CLASSIC MAYA
entangled array of features and pathological manifestations that denotes differential access to food
and divergent lifestyles and privileges.
ACKNOWLEDGMENTS
The skeletal materials were studied originally by
V.T. as part of a doctoral dissertation in anthropology. We thank William Folan (Proyecto Calakmul,
UAC), Enrique Nalda, Luz Evelia Campaña, Adriana Velázquez (Proyecto Sureste de Quintana Roo,
INAH), and Ramón Carrasco (Proyecto Arqueológico
Calakmul, INAH) for their kind collaboration during
the evaluation of skeletal collections from their respective field sites. We thank D.L. Cunningham
(University of Missouri) for her comments on and
editing of the manuscript. Special thanks go to the
editor of the Journal and the two anonymous reviewers, whose useful comments helped us improve the
manuscript.
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