Filling in the gap: dental disease in past populations | Human Anthropology

Roman adult dental decay
Roman adult, probable female from Cannon Street with heavy dental calculus on right premolars and molars

Today many people, both children and adults, dread going to the dentist. Whether it’s the odd smells, the gritty taste of the polishing paste, or the fear of being told you need a root canal, most people find it to be an unpleasant experience. For me, however, as an Anthropologist who has seen just how bad dental health can be, I look forward to my dentist visits! It only takes looking at the teeth of people from the past to make me brush my teeth and floss everyday.

Dental hygiene

The effects of dental disease have plagued most populations in the past, in fact the first mass produced tooth brush only became available in 1780. Early forms of tooth brush did exist; twigs with frayed ends called chew sticks were used in ancient Egypt and the Romans often carried hygiene kits that included metal tooth picks. Even in the early years of the mass produced tooth brush they were much too expensive for most people to afford, so instead old rags were used to scrub teeth using homemade tooth powders including chalk, salt, charcoal or even crushed bricks. These dental tools and tooth powders did not do much to combat the effects of dental disease and probably did more harm than good, wearing teeth down and making them more susceptible to infection. This leads us right into our first topic: dental attrition.

Dental attrition

Basic anatomy of a human tooth
Basic anatomy of a human tooth

Dental attrition is the wearing down of a tooth’s surfaces. The most common type of wear occurs on the occlusal (biting surface) of teeth and is characterised by a flattening of the cusps and exposure of the dentine. The major cause of dental attrition in the past was a coarse diet or one that contained high levels of fine grit. Even if people weren’t scrubbing their teeth with gritty powders they were often consuming it in the food they ate. Today the grain in our flour is ground by metal machines but in the past it was done by hand or with the use of a grinding stone, commonly called a quern stone. During the Roman and Medieval periods in Britain these stones were often quarried and imported from Germany and made from a type of lava stone that is soft and crumbly. These stones would slowly wear down during the grinding process, adding grit to the flour and the food that people ate.  The first adult teeth to erupt are the 1st molars, around 6 years old, this means that these teeth spend the longest amount of time in your mouth and with dietary attrition are typically the most worn down.

Prehistoric skull
Dental attrition of the left 2nd premolar and left and right 1st molars of a prehistoric, probable female, adult from Walthamstow

Unusual patterns of dental attrition

In addition to having a gritty diet, dental attrition can occur when teeth are used repeatedly for cultural activities such as chewing leather to soften it or holding twine during basket weaving, we can even tell that someone smoked a pipe by looking at the wear on their teeth.

Teeth of Roman, adult, probable female
Roman, adult, probable female from Cannon Street with advanced wear on 1st incisors and minimal wear on right 1st molar, possibly due to cultural use of anterior teeth.
Post medieval adult skull
Post medieval adult, male from St George’s in the East with two anterior pipe facets and associated dental attrition

Dental caries and abscesses

Dental caries are caused by bacteria that feed off the food debris and sugar that is lodged in our teeth and gums. Throughout time the people of Britain have suffered from caries; however, it’s examining the teeth of post medieval Brits that really makes me brush my teeth every day. The development of sugar cane plantations in South America and the Caribbean over the 16th and 17th centuries caused the production of sugar to skyrocket, making it affordable for all classes of society. With the increase in sugar consumption and a lack of dentistry we see a noticeable increase in dental caries.

Adult, probable female skull
Adult, probable female from St George’s in the Borough with extensive dental caries

Without dentists to drill out and fill caries the pulp at the centre of the tooth will die and the roots of the tooth will become infected. This can often lead to what is called a periapical abscess, or a collection of pus at the end of the root that creates a hole in the alveolar bone to enable the pus to drain. These abscesses cause bone loss which leads to periodontal disease and ultimately loss of the tooth.

Dental abscesses
Adult, probable male from the Green Ground Portugal Street and adult male from St George’s in the Borough, both with dental abscesses.

Dental calculus and periodontal disease

The removal of dental calculus is one of the main reasons we are told to brush our teeth every day and why we regularly get our teeth cleaned at the dentist. Calculus forms when minerals in our saliva cause the hardening or calcification of masses of bacteria (called plaque) that cover our teeth. By brushing our teeth we are removing the bacteria and reducing the amount of calculus that builds up. Even when dental hygiene was practiced in the past it wasn’t adequate enough to prevent build up, so looking at archaeological collections we are able to see how bad it can really get.

Roman adult, probable female skull
Roman adult, probable female from Cannon Street with heavy dental calculus on right premolars and molars


So if you don’t brush your teeth thick layers of calculus can form on them, but why is this so bad? These layers of calculus build up on your teeth right along the gum line causing inflammation and irritation of the gums, better known as gingivitis. This inflammation of the gums, in addition to causing bad breath, can spread to the ligaments that are holding your teeth in and to the alveolar bone itself.

Examples of alveolar recession
Examples of alveolar recession from the post medieval burial ground, The Green Ground on Portugal Street

This results in what is called periodontal disease or a gradual loss of the bone around the teeth. We see this loss of bone through alveolar recession. The bone starts to move away from the crown, exposing the roots of teeth and eventually causing the teeth to fall out, something we call ante mortem tooth loss.

Ante mortem tooth loss

Ante mortem tooth loss refers to adult teeth that were lost during a person’s lifetime. Today we have great dentists who can create dentures and implants to replace lost teeth; but even in the recent past the cost of visiting a dentist or buying dentures was too expensive for much of the population. When teeth fall out or are lost due to dental disease and implants are not put in their place the alveolar bone will heal and remodel, filling in the empty sockets and removing excess bone that is no longer needed.

Adult from the post medieval burial ground
Example of an adult from the post medieval burial ground, The Green Ground on Portugal Street who is edentulous (having lost all of their teeth during life).

We only get 32 permanent teeth in our lifetime and unfortunately, unlike our bones, teeth don’t have the ability heal themselves. If you are lucky some of the teeth in your mouth may have been working hard for you for up to 80 years! Studying the teeth of people who lived in the past makes me feel so fortunate that I live during a time with good dental hygiene methods; and ensures that I do everything I can to keep my teeth healthy and in my mouth for as long as possible.

by Dr Elissa Menzel

Read more


The Human Remains Digitisation Project was made possible thanks to the generous support of the Charles Wolfson Charitable Trust.