Dental caries, periodontal disease and dental attrition : their role in determining the life span of the human dentition in Britain over the last three millennia : the medical, dental and social implications of the variable life span of the human dentition and the relevance of the findings of this study to both dental paleopathology and modern epidemiological research
It has been well recorded that, until fairly recent times in this country, dentitions disintegrated at a relatively young age. In way of explanation it has generally been assumed that the complete lack of oral hygiene that existed resulted in a rapidly advancing periodontitis. The almost universal finding of exposed root surfaces at a young age did much to confirm the hypothesis that the attachment loss observed was inflammatory in origin. Furthermore, from the 17th century onwards the prevalence of dental caries escalated rapidly as the carbohydrate level of diets in this country rose due the importation of sugars from abroad. The existence of these two dental diseases seemed to explain adequately the observed early loss of dentitions. However, in studying historic skeletal material close inspection often reveals that despite the severe attachment loss the alveolar bone appear to be reasonably healthy with only minimally damaged septal areas. A further observation in almost all historic skeletal material is that of severe occlusal attrition of dietary origin. Many of the earlier workers in the field of dental paleopathology believed that the root exposure they observed was not due to inflammatory alveolar bone loss but was secondary to occlusal attrition and was in fact explained by the teeth continuing to erupt to compensate for the lost tooth height. This thesis investigates the relationship between occlusal attrition, compensatory eruption and the prevalence of periodontitus. It attempts to determine the reasons for the early disintegration of dentitions and investigates material covering a period of some three thousand years. The findings suggest that the prevalence of periodontal disease has changed little over this period and was therefore unlikely to have been responsible for the early loss of dentitions. Evidence is provided to show that compensatory eruption of the human dentition does occur in response to occlusal wear of dietary origin and that this supereruption is past a static alveolar crest, thus exposing root surface. The conclusion is drawn that the early loss of dentitions in this country prior to the 17th century was more likely to be due to complications associated with compensatory tooth eruption secondary to severe attrition of dietary origin. But after this period the escalating prevalence of dental caries became the major factor in tooth loss. Softer diets reduced the incidence of supereruption of the teeth. From the results of this study recommendations are made regarding epidemiological studies on both clinical and skeletal material and the point is stressed of the importance of recording the presence or absence of occlusal attrition if linear measurements of attachment loss are used to record periodontal status.