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An Ancient Egyptian mystery - What we can learn from dental anthropology what we can learn about oral disease in Ancient Egyptian populations
RUNNER UP - SANDS COX CHARITY ESSAY PRIZE 2019
Dental anthropology has been widely used to study ancient populations. The distinct anatomy of teeth, their resistance to decomposition and their strong interface with the environment, makes them an invaluable source for anthropological studies and have helped us gain an understanding of ancient communities.
The dry climate and the advanced burial customs of Ancient Egypt have uniquely preserved its specimens, more than any other civilisation, and thus they have been extensively studied within dental anthropology.
The level of attrition can help us infer dietary patterns and to differentiate between hunter-gatherer and agriculturist diets, which consists primarily of softer plant foods. Abrasion, as a result of foreign material being introduced into foods, results in rapid tooth wear. This is demonstrated in Ancient Egyptian populations .
Studies of Ancient Egyptian skulls showed widespread excessive tooth wear, with nearly 90% of teeth evidencing tooth wear in one study. Tooth wear increased with age and was often so extensive that it resulted in pulpal exposure, pulpal necrosis and apical infection. It is thought that apical infection, resulting in osteomyelitis, was responsible for many deaths during this time. Coarse, fibrous diets, combined with the introduction of abrasive inorganic particles into foods, resulted in such extensive wear. Contamination was primarily due to sand blown from the desert, and from harvesting and preparation tools. Tooth wear decreased later in Egyptian history due to improvements in diet and advances in food processing .
Figure 1 - Ancient Egyptian Neolithic skull demonstrating the characteristic flat wear plane seen in hunter-gatherers as a result of tough fibrous foods. During mastication of fibrous foods, teeth did not make contact often and molar wear is more evenly distributed resulting in a lower wear plane angle.
Figure 2 - Ancient Egyptian skull, Naqada period, demonstrating the characteristic oblique wear plane seen in agriculturists, resulting from diets based on ground grains and foods cooked in water, reducing the role of teeth in breaking down food. Molar teeth are in contact for longer periods of time during mastication, resulting in a pattern of wear which is more restricted and exhibits a steeper wear angle.
Evidence of caries can be traced back to the upper Palaeolithic period, although it appeared infrequently. This can be attributed to the lack of fermentable carbohydrates in the diet, as well as the ubiquity of tough fibrous foods which inhibited plaque retention on tooth surfaces. This is coupled with flattened occlusal surfaces, eliminating pits and fissures, and therefore thought to reduce caries incidence .
The arrival of Greeks in Egypt during the fourth century BC resulted in dietary changes and a suggested increase of caries from 5% to 30% during the Pharaonic period (3000-322 BC). This is attributed to foods such as white bread, honey and dates becoming more readily available, an increase in fermentable carbohydrates, and a decrease in fibrous, abrasive foods. Interestingly, caries was more prevalent in upper classes of society due to the nature of their diet, contrary to modern western society .
Many ancient Egyptian skulls show significant calculus deposits and there is little indication of oral hygiene regimes, with evidence of chronic periodontal disease. Although it is difficult to determine the cause of tooth loss, in ancient Egyptian populations, it is thought to be due to a combination of excessive tooth wear and periapical infection. It is important to consider the effect of environmental factors such as diet, smoking and stress on periodontitis. Periodontal disease is a chronic condition which progresses with age and therefore it is also important to note the average life expectancy in ancient Egypt was only 35 years .
Enamel hypoplasia has been used by anthropologists as a stress marker, giving an indication of malnutrition and systemic disease. It also demonstrates the age at which these stresses occurred. In populations in the Nile valley (13000-1500 BC), agricultural communities of ill health and unreliable food supplies, showed the highest incidence of hypoplasia. Over time, an improvement in agriculture and enhanced trade is thought to have improved health and thus reduced hypoplasia .
A fascinating wealth of information is revealed to us about ancient food practices and societal conditions of one of history’s greatest civilisations through the study of dentition. There is no doubt that dental anthropology is instrumental in allowing us to understand our ancestors and details of human societal development that would have otherwise been lost.
My interest in dental anthropology has allowed me to further appreciate the significant impact of behaviours and lifestyle on the dentition, a vital consideration if we are to treat our patients in a holistic manner.
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 Forshaw R. Dental indicators of ancient dietary patterns: dental analysis in archaeology. British Dental Journal. 2014;216(9):529-535.
 Forshaw R. Dental health and disease in ancient Egypt. British Dental Journal. 2009;206(8):421-424.