Cultural and socio-economic factors strongly influence the status of the teeth and their supporting structures in a given population. Many physiological and pathological conditions affecting the body and the skeleton during life also affect contents of the oral cavity. The condition of the teeth and contiguous tissues usually provides several indices of the individual's health status and that of his culture. In addition, the degree of dental attrition that accompanies biological aging, well known in archaeological skeletons, often provides a means of roughly estimating the age of a skelton at death (246-454).
Much has been written regarding modern dental disease, but until recently the paleopathological aspects have not been investigated and reported as thoroughly as other skeletal pathology (246-438). Problems affecting the teeth and surrounding structures often interdigitate and overlap, obfuscating what may have been the original cause of the obvious findings. In addition, more than a single pathologi- cal process may have been active. For this reason, assignment of dental abnormalities to arbitrary spe- cific categories can be misleading.
Abnormalities of the dentition fit into six groups (87-40). These include:
To systematize this presentation of dental osteopathology, abnormalities indicated above are combined and catagorized:
While comparing fatal disease of the lungs, respiratory system, and mind in man and lower animals, Catlin (72-3) discoursed concerning the teeth:
"Mankind everywhere are a departure from this sanitary condition, though the native races often times present a near approach to it, as I have witnessed amongst the Tribes of North and South America, amongst whom, in their primitive condition, the above-mentioned diseases are seldom heard of; and the almost unexceptional regularity, beauty, and soundness of their teeth last them to advanced life and old age."
During his travels Catlin visited the Mandans. In his report (72) he remarked about their use of scaffold burial, and the appearance of Mandans'teeth, as he saw portrayed in their skulls (Ch. 8, book page 174. Shut Your Mouth, pp.11-12).
Concerning Indian children in Southwestern U.S. over 80 years ago, Hrdlicka (167-84) stated: "Their first teeth begin to cut mostly during the sixth month, and the process is usually accomplished without noticeable difficulty. " In summary of his physiological and medical observations (167-190,191) he stated:
"Dental caries is not rare, though much less frequent than among the whites. It is usually a premolar or molar that is affected. Occasionally the gum or alveoli become involved, resulting in suppuration. Necrosis of importance was not seen in the living or in the bones examined."
Relating to effects of senility Hrdlicka (167-158) reported:
"The teeth, which in general are less subject to caries than among white Americans, become much worn down, and some are lost by becoming loose, while the gums and alveoli diminish through atrophy. Owing to the diminmution of the alveoli and the adipose tissue, the chin looks more prominent, prognathism disappears, and the face is shorter."
Ortner and Putschar discussed lesions of the jaws and teeth, and used photographs of skulls from this region now at the National Museum of Natural History, Washington, D.C., to illustrate enamel hypoplasia (Mobridge site, NMNH 325416), dental agenesis (Mobridge, NMNH 325417), fusion of mandibular incisors (Nebraska NMNH 243355), enamel pearls ("archaeological site in South Dakota," NMNH 325367), and dental attrition and secondary dentin formation ("an archaeological site in South Dakota," NMNH 325360). All of these except 325360 we had examined during Dry Bones research.
In his writing directed toward ancient osteopathology in Illinois Dahlberg (87-40) stated:
"It can be concluded from the conditions seen on the teeth of early Midwest Indians that their diet was basically good and that there was no severe debilitating disease during the period of development in childhood. This speaks well for their environment and the understanding they must have had of body nutritional needs."
The present.
Excellent facilitiesfor both prophylactic and curative dental care are available at U.S. Public Health Service Indian Hospitals and Clinics in the Aberdeen Indian Area, and through contract services. Comprehensive documentation of the dental health of people served and treatment rendered is kept in the Indian Health Service dental clinics. In public and other schools on and off reservations effective dental preventive health programs are conducted by teachers and public health nurses.
Although dental services are available, over a long interval they have been utilized somewhat less than the 55% optimum level (Figure 9.1). During the interval 1957-1973 in individuals aged about five to 19 years, the number of teeth missing per person remained low, the number of decayed teeth dropped from three to two, and the number of filled teeth rose from one to four (Fig. 9.2). This suggests that services rendered are proving effective.
Generally dental alignment and hygiene in Indian children we have seen at clinics is excellent. Occasionally at Craniofacial Anomalies Clinics (Ch. 7, Epilogue) we see badly decayed teeth in young children, attributable to propping the child in bed with a bottle of milk or other fluid. This is under treatment through education of Indian mothers.
In adult Indians examined at field clinics it has not been unusual to observe extremely bad tooth decay, many caries, and missing teeth. This is especially true in women. Badly worn teeth in some elderly individuals suggests the effect of some abrasive substance upon the occlusal surfaces. Despite extensive loss of teeth, it has been unusual to see dental appliances or artificial dentures in adult Indians. Otolaryngic outpatient clinic observations suggest that facilities for dental care are not being utilized as well by adults.
The past.
Abnormalities of the teeth and their supporting structures in pre-Columbian Crow Creek skeletons are listed in Table 9.1. Inflammatory and infectious changes were the most common alterations, followed in frequency by degenerative disease in the temporo-mandibular joint. Attrition of the occlusal surface, primarily the premolars and first and second molars, and alveolar bone alterations secondary to inflammatory disease were present in 66/129 (51%) maxillae. In 10/129 (7.8%) maxillae and 8/131 (6%) mandibles there were abscesses. Antral-oral fistulae were in 4/129 (3%) maxillae. Changes indicating temporo- mandibular joint derangement were imprinted upon the heads of 8/131 (6.1%) mandibles. The joint changes were the product of faulty mastication engendered by wasting of teeth and tooth loss. There was anomalous dentition in 9/129 (7%) maxillae and 2/131 (1.5%) mandibles.
Time constraints during the Dry Bones project did not allow optimum evaluation of dentition and dental alterations in miscellaneous post-Columbian skeletal groups, but these also showed tooth occlusal surface wear as the commonest abnormality, followed by tooth loss, dental abscesses, and caries and/or plaque (Table 9.2).
Table 9.1. Dental Abnormalities Crow Creek Maxillae (N=129) and Mandibles (N=131)*
Bone Number
Condition_________________________Involved__________affected_____________%___
Inflammation_and_Infection
Tooth wear, attrition, Maxilla 66 51.0
caries, alveolar resorption
Dental abscess Maxilla 9 7.0
Mandible 8 6.0
Antral-oral fistula Maxilla 4 3.0
Abscess, posterior surface Maxilla 1 0.8
Degenerative_change
Temporo-mandibular joint Mandible 8 6.1
Osteoporosis Mandible 1 0.7
Tumor
Dental pearl ? 8 instances, 4 multiple
Congenital/developmental
Anomalous dentition Maxilla 9 7.0
(absence, mal-positioned,
accessory, fused)
Hemi-mandibular hypoplasia Mandible 1 0.7
Hypoplasia, ascending ramus Mandible 1 0.7
_Bifid_head_________________________Mandible_____________3______________2.3_
Total dental abnormalities 113
* In the preliminary report relating to the Crow Creek Site (39BF11) massacre
(361-195=299) photographs of representative specimens with abnormalities in
the oral cavity-facial area were submitted and used in the discussion relat-
ing to general paleopathology. Data above are from the Dry Bones portion of
the Crow Creek massacre project.
In Appendix A, VI. Other Data Collected, it was indicated, "Dental survey:
procedures described, data sheets" (361-A-3).
To the best of our knowledge the dental survey has not as yet been published.
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Ubelaker performed an extensive evaluation of the dentition and dental abnormalities in 305 historic Arikara skulls from the Leavenworth site (33-184;330-184;333). In total 3,582 teeth were examined (2,798 permament and 784 deciduous) from 52 male and 56 female adults, 9 adults of undetermined sex, and 148 subadults. A discussion of his findings relating to dental morphology is not proposed here, but his findings relating to abnormalities is germaine to this discussion. Ubelaker emphasized the cultural relevance of this study, as follows:
"In addition, dental studies often provoke speculation about dietary and cultural practices of the respective populations, and may lead to conclusive statements about the incidence and degree of oral pathologies."
Caries were on 59 teeth from 15 males and 15 females (Table 9.3). Thirty eight caries were on 37 mandibular teeth, and 27 were on 22 maxillary teeth. Caries were evenly distributed on maxillary molar teeth, but mandibular caries occurred more often on the 3rd molars.
Table 9.2. Dental abnormalities, Miscellaneous Skeletal Collections
39WW7 39WW1 39DW2 39RO2 39CL2 32BL18
Swan Four Double N.D.Hist. Over
Site________Creek___Mobridge___Bears___DeSpiegler___Ufford____Ditch____Society*__Coll.____Other___Total
Culture Arik Arik Arik Woodland Woodland Mandan? Several Several Several
Skeletons 82 55 41 est. 50 40 est. 24 151 228 241 912
Tooth wear 38 22 11 24 11 9 -- 123 29 267
mild 18 7 5 1 6 2 -- 25 10 74
severe 25 15 6 23 5 7 -- 98 19 198
Tooth loss 5 3 6 5 2 -- 4 33 4 62
1-4 -- -- 1 1 -- -- 1 2 -- 5
5+ 5 3 5 4 2 -- -- 26 3 48
edentulous -- -- -- -- -- -- 3 5 1 9
Abscess 4 4 1 6 1 -- 1 12 3 32
maxilla 3 3 1 3 1 -- 1 12 3 27
mandible 1 1 -- 3 -- -- -- -- -- 5
Ant.-oral 1 -- -- -- -- -- -- 4 -- 5
fistula
Caries 1 3 -- 7 -- 3 -- 5 6 25
TMJ change 1 1 2 1 1 1 -- 12 -- 19
Tooth
mal-align. -- -- 1 2 -- 1 -- 3 3 10
maxilla -- -- 1 -- -- -- -- 3 3 7
mandible -- -- -- 2 -- 1 -- -- -- 3
Asymmetry 1 1 -- -- -- -- -- 1 -- 3
mandible
Stafne def. -- -- -- -- -- -- -- 1 -- 1
Palate_torus___--_______--_______--__________--_________--_________--_____--_________1_______--______1
Total 103 63 40 82 29 24 10 366 84 801
* Analysis limited to skull primarily.
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Table 9.3. Leavenworth Skulls, Caries by Tooth
______________I____I____C____Pm1_____Pm2_____M1_____M2_____M3_______Total
Maxillary N= 1 1 6 7 7 22
Percent 4.5 4.5 27 32 32
Mandibular 1 1 6 13 13 37
_Percent________________3______3______16_____35_____43___________________
59
From: Ubelaker 1971, 184-193.
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Seven male and 8 female skulls had 76 abscessed teeth (Table 9.4). Of these, 62 teeth were lost ante-mortem and the remainder were actively infected at the time of death. Maxillary tooth disease accounted for 48/76 (63%) of the abscesses, and mandibular affectation was found in 28 (37%). The greatest number of abscesses were in maxillary and mandibular 1st molars. In order of frequency, Ubelaker attributed the abscesses to marked attrition, dental caries, and intravital tooth crown fractures. Inasmuch as the 1st molars are the first to erupt they had the greatest amount of attrition, and were abscessed most frequently.
Table 9.4. Leavenworth Skulls, Alveolar Abscesses by Tooth
________________I______I______C____Pm1_____Pm2_____M1_____M2_____M3_____Totals
Maxillary N= 6 6 1 4 2 11 9 9 48
Percent 12.5 12.5 2 8 4 23 19 19
Mandibular N= 3 2 1 1 4 7 4 6 28
_Percent_______11______7______4______4______14_____25_____14_____21__________
76
From: Ubelaker 1971, 184-193.
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Plaque was visible on the tooth surfaces of almost every skull from the Leavenworth cemetery. It was most noticeable in the molar region, on the buccal surface of maxillary molars and the lingual side of mandibular teeth. The finding of plaque upon teeth is significant in that it is an important factor in the production of caries. In addition, irritation from plaque at the tooth-gum margin is very important in peridontal disease and alveolar bone modification.
Shovel-shaped incisor teeth, especially the maxillary dentition were common throughout the region in the past and are so today. Ubelaker analyzed this trait in the Leavenworth Site Arikara skeltons and found 100% involvement of maxillary central incisor teeth in both sexes. Maxillary lateral incisors were involved in 100% of female and 91% of male skulls. Mandibular central incisor teeth had the lowest shovel-shape frequency (females- 74.4%, males 89.5%) (330-185).
Third molar teeth displayed the greatest size variation both in the maxillae and in mandibles. Seventeen 3rd molar teeth were congenitally absent (maxilla=10, mandible= 7). Two mandibular third molars were impacted. One supernumerary tooth was located between the second and third maxillary molars. Similarly, when Leigh evaluated dental abnormalities in Arikara skulls at the U.S. National Museum, 85% of the abscesses he found were due to dental attrition, 31% were secondary to caries, and 5% followed tooth crown fracture (195).
Photographs of anatomic specimens used to illustrate other abnormalities many times also demonstrated oral cavity structures and dental osteopathology. By reference to these illustrations duplication is prevented and a more comprehensive assessment of the pathology seen during the Dry Bones study may be obtained. Figures suggested for perusal are:
Figure 1.12. Excellent dentition and tooth
alignment in a young adult.
Figure 1.23. Moderately severe tooth wear and occlusal
surface caries.
Figure 2.4a. Wear, ante-mortem tooth loss, alveolar
resorption.
2.4c,d. Wear, ante-mortem loss, alveolar resorption, abscess.
Figure 2.18. Wear, caries.
Figure 3.2. Osteomyelitis, mandible, apparently of dental
origin.
Figure 3.12. Wear, ante-mortem loss, alveolar resorption,
probable abscess.
Figure 4.1 Wear, ante-mortem loss, alveolar resorption.
Figure 4.2f. Wear, occlusal surface caries, ante-mortem loss,
antral-oral fistula, exostosis (arrow).
Figure 4.11. Stafne defect.
Figure 5.2. Mild wear.
Figure 6.9. Temporo-mandibular joint wear, severe,
edentulousness, secondary osteoporosis.
Figure 6.10. Wear, ante-mortem loss, temporomandibular joint
derangement (arrow), secondary osteoporosis.
Figure 6.17. Wear, ante-mortem loss, alveolar resorption,
secondary osteoporosis.
Figure 6.18. Wear, ante-mortem loss, alveolar resorption,
secondary osteoporosis.
Figure 7.4. Normal childhood dentition (two skulls).
Figure 7.9. Hemimandibular dysostosis, wear, ante-mortem
loss.
Figure 7.10. Asymmetry of mandibular heads, wear, caries,
ante-mortem loss, lethal fracture anteriorly.
Figure 7.12. Palatal lesion, wear, hypoplastic lateral
incisor, canine-1st premolar malalignment.
Figure 7.13. Non-odontogenic cyst (x2), antemortem loss,
alveolar resorption, local inflammation, abortive palate cleft.
Figure 7.14. Wear, occlusal surface caries, ante mortem
loss, antral-oral fistula, anomalous dentition, non-odontogenic cyst, torus palatinus.
Figure 7.15a. Wear, ante-mortem loss, caries,
non-odontogenic cyst.
Figure 7.15b. Wear ante-mortem loss, non-odontogenic cyst.
Figure 7.17a. Mild alveolar resorption, caries.
Tooth wear, caries, plaque, periodontal disease, abscess, antral-oral fistula, interproximal grooving, mandibular osteomyelitis.
Figure 9.3. 39SL4 Sully Site. Arikara male 35 yr.
Figure 9.3. Occlusal surface caries and wear of moderate degree, calcareous deposits (plaque,tartar), and alveolar ridge periodontal disease secondary to plaque, were present in the mandible of an adult male Arikara.
Figure 9.4A. Fort Clark, ND. Mandan-Arikara male 50+ yr.
Figure 9.4B. Over Museum Collection. No provenience. Arikara male 40+ yr.
Figure 9.4A. Occlusal surface wear, attrition, tooth crown fracture, a small maxillary tooth root abscess, maxillary and mandibular tooth loss, caries, and severe alveolar bone resorption and remodeling were all in an adult Mandan skull. Ante-mortem loss of the anterior dentition suggests the possibility of trauma as its cause.
Figure 9.4B. In an Arikara skull there was tooth wear of moderate degree, gumline caries, plaque, ante-mortem tooth loss, alveolar bone resorption and modification, and probably an old, evacuated abscess. The degree of maxillary and mandibular remodeling indicated tooth loss quite some time, before death.
Figure 9.5A. 39WW2 Larson Cemetery. Arikara female 35 yr.
9.5B. 39BF11 Crow Creek. Proto-Arikara female 35+ yr.
9.5C. 39SL4 Sully Site. Arikara male 50+ yr.
Figure 9.5. Three skulls demonstrated progressively more severe inflammatory dental disease that ranged from extensive wear and attrition (9.5A,B), caries (9.5A,B), crown fracture (9.5A), multiple abscesses (9.5A, B), antral-oral fistula (9.5B, bilateral), to complete maxillary edentulousness (9.5C). The temporo-mandibular joint of the skull in 9.5-C had extensive wear upon both joint surfaces, secondary to faulty masticatory efforts over a long time.
Changes similar to but more severe than in this skull's mandible were illustrated in Figure 6.9. Resorptive and osteoporotic changes in the mandible following loss of teeth are depicted in Figures 6.17 and 6.18.
Figure 9.6. 39BF11 Crow Creek. Proto-Arikara adult.
Figure 9.6. Within an adult right maxilla, viewed from above with the inferior orbital plate removed, there was a large antral-oral fistula extending into the sinus from the oral cavity through the second molar tooth socket. A core of metaplastic bone 7 x 7 mm had formed around the fistula within the sinus. In addition, this maxilla had moderately severe tooth wear, ante-mortem loss, alveolar resorption, and caries. Obviously, this abnormality had existed for a long time before death. Changes of this magnitude are unique in our experience with clinical patients and ancient skeletons, and have not been common in the available paleopathology literature (223-47;329-many ref.)
Interproximal grooving.
Figure 9.7. 39WW2 Larson Site. Arikara male 25 yr.
Gum line caries were at the enamel root junction on the posterior surface of an upper second molar tooth (Figure 9.7). The cavity, precursor to anabscess and tooth loss, must have caused discomfort to the individual, because close inspection reveals that an attempt had been made to probe or file the diseased area. Repeated manipulative efforts to dislodge foreign material from between the teeth, or to relieve irritation, produced a groove in the tooth's posterior surface. Periodontal disease in the area had produced moderately severe alveolar bone resorption. The third molar tooth was missing, making it impossible to determine whether this tooth also had undergone auto-manipulation.
In 305 skulls from the Leavenworth Site Ubelaker encountered interproximal grooving of the second and third molar teeth in one adult male skull (33-184). Later he and co-workers found 42 similar grooves on 37 teeth in skulls from Kansas, that were probably of Hopewellian affiliation, and in skulls from other cultures elsewhere (330-184;331;351).
Berryman and co-workers found one or more pronounced interproximal grooves on the mesial and/or distal surfaces at the cemento-enamel junction in 49/161 skulls (30.4%) from the Larson site. Grooving was present on all teeth except the maxillary canines amd first premolars. Male skulls had more grooving, and the maxillary teeth and the posterior dentition were involved most frequently. Grooving was associated with cariesin 35.8%, and 66.2% were accompanied by alveolarbone resorption. Irritation from dietary gritcombined with the use of probes are hypothesizedas the cause for the large number of interproximal groovings at the the Larson Site (44). Similar changes have been found in other skeletal populations (288-13;340;351).
It is interesting to note that despite Ubelaker's finding of interproximal grooving in Hopewellian skeletons from Kansas (ca 200-1000 A.D.), and other skeletal groups from the Upper Missouri Basin and elsewhere, there was no evidence of this practice in either of the two regional pre-Columbian populations, Middle Plains Woodland Indians and the Crow Creek villagers.
Figure 9.8. 39CO9 Leavenworth Site. Arikara female 55-60 yr.
Osteomyelitis of the mandible.
Figure 3.2A. A circumscribed area of bone under going
destruction with only slight osteoanagensis at its periphery, was located in the midline
of an adult mandible, in the area of the central and lateral incisor teeth root tips. The
teeth involved were missing. The round central bone fragment appeared to be undergoing
sequestration. The mandibular pathology was accompanied by two inflammatory perforations
in the right mastoid cortex (Fig. 3.2B). Although the mandibular disease might be
suspected as of traumatic origin, the simultaneous contiguous infectious processes are
best explained on the basis of an infection that started in the oral cavity and pharynx.
Today, the first consideration for such a clinical picture would be a bacterial infection,
the best being by staphylococcus. Because both inflammatory processes appeared active at
death, it is likely they contributed to the fatal out come.
Other possible dental infection.
Dental treponematosis was suspected in a North Dakota child's skull with notched maxillary
central incisors (Ch. 3).
Willey and Swegle reported and illustrated laterally notched maxillary incisor teeth in a 3.5-4.5 year old Sioux skull (ca 1880 A.D), opined as due to dental trauma. However, an addendum report noted Della Cook's interpretation of the finding as circular caries that form if pre-natal stress affects developing enamel (350).
Figure 9.8. 39CO9 Leavenworth Site. Arikara female 55-60 yr.
Nothing was found suggesting the effect of oral cavity or pharyngeal cancer during the Dry Bones survey.
Some benign exostoses in the form of oral tori have been located. These tumors characteristically appear in the midline on the oral surface of the hard palate (torus palatinus) and on the mandible's medial surface in the canine-premolar region (torus mandibularis). They are composed of laminated dense cortical bone, and vary considerably in size and configuration. Palatal tori are produced by slow overgrowth of the medial margins of both palatine processes. The force of excessive occlusal stress has been theorized as a causative factor (27-23).
Figure 9.9. 39WW1 Mobridge Site. Arikara female adult.
Oral tori.
Figure 9.8. A small torus palatinus presents on the oral surface of the hard palate
(arrow). Additional oral cavity abnormalities include tooth wear, ante-mortem loss,
alveolar remodeling, apparent anomalous right lateral incisor and both first premolar
teeth. Also there is inflammatory reaction on the anatomic left side of the hard palate's
oral surface.
Another small palatine torus was an incidental finding in a skull with other pathology (Fig.7.14). Despite the fact these tumors were reported to occur in about 20% of people today (27), in our ex- perience with both Native American and general populations of South Dakota, they are present in only 3-4% of individuals examined clinically. About 2-3% of skulls from this region have had torus palatinus deformities.
Mandibular tori have not been located while processing skeletons from this region. Palatine tori we have seen were all small and appeared as single, non-lobulated midline masses of bone.
Dental pearl (enameloma).
Eight skulls (4 multiple) from the fragmented Crow Creek skeletons had dental pearls.
Other enamelomas, single and multiple, were found occasionally in skeletons from the
region (Fig. 9.9). These tumors were small firmly adherent enamel globules, located most
often in or near the bifurcation or trifurcation of tooth roots, or on the root surface
near the cemento-enamel junction. They were incidental findings, but could be associated
with alveolar bone resorption (246-452).
Of 131 Crow Creek mandibles, 24 (18.3%) had altered configuration of the mandibular heads indicating the effect of disturbed joint dynamics. One mandible (0.7%) had changes attributable to severe osteoporosis (Table 9.1). Both the degenerative joint disease and osteoporosis were easily traceable to dental attrition and tooth loss.
It is well known among clinicians today that following tooth loss alveolar bone of the upper and lower jaws undergoes remodeling that includes structural alterations in the bones as well as change in tooth sockets. Structural changes after tooth loss include altered contours, loss of mass, and cortical and medullary changes usual typical for osteoporosis. When permanent dentition teeth are lost, structural alterations take place in the bone involved regardless of the age of the individual. Remodeling of the mandible can be to such an extent that only a thin rim of bone remains (132).
Degenerative joint changes on both the mandibular heads and the mandibular fossa of temporal bones have been quite frequent in skulls examined during this survey (Table 9.2, Fig. 6.9). Osteoporotic changes in mandibles, usually secondary to tooth loss, have also been frequent findings (Fig. 6.17, 6.18).
Non-odontogenic defects.
Cysts of non-odontogenic origin and palatal and facial clefting are discussed and
illustrated in Chapter 7.
One putative odontogenic cyst has been seen (Fig. 7.14), but no odontogenic tumors have been recognized.
Anomalous dentition.
Figure 9.11. 39BF11 Crow Creek. Proto-Arikara skull #154. Adult male ?
Figure 9.10. Different anomalies of maxillary dentition from the region are portrayed; all except 9.10-C are in adults. In 9.10-A&B, canine and central incisor teeth are rotated 180 degrees in the cephalad-caudad axis. Additionally, the tooth in 9.10-B, is rotated 180 degrees on its anterior-posterior axis, so the posterior surface presents anteriorly. In 9.10-C, a rudimentary permanant incisor tooth presents in the incisive foramen. In 9.10-D, a rudimentary tooth, rotated 180 degrees in its cephalad-caudad axis, is presenting in the midline of the hard palate about one half way back. In 9.10-E, two rudimentary teeth are erupting in the midline of the hard palate near its posterior border. Incidental findings are tooth wear in 9.10A,B, caries in 9.10B,E, plaque in 9.10A,B, and evidence of periodontal disease in 9.10A,B.
Figure 9.11. In a fragmented Crow Creek maxilla a premolar tooth was lying in the antero-posterior axis (arrow). The root was poorly formed. In adition there was mild tooth wear and periodontal modification.
Figure 9.12. Lateral radiographs of skulls shown in Figure 9.10, 9.10A on the left and 9.10B on the right. Arrows indicate the anomalous teeth. Grossly both teeth appear well formed and normal other than their anomalous positions. Occlusal surface erosion and impending exposure of the pulp cavities can be seen in both radiographs.
Figure 9.13. Slight dental asymmetry anterior lyis seen in 9.13A and B, and crowding of the upper central and lateral incisors is apparent in 9.13D. Occlusal surface caries are in all four. Shovel shaped incisor teeth are clearly visible in 9.13 A,B. and E. All have moderate sized, open incisive foramina. The line of fusion between the premaxilla and the maxillary palatine processes is clearly visible in 9.13A,B, and C. Despite the fact that during embryogenesis the premaxilla is reported to form from a single midline globulomaxillary process, in 9.13 A,B, and C, a midline separation is still visible.
Anomalous or developmentally defective dentition were in 9/129 (7.0%) Crow Creek maxillae and 2/131 (1.5%) mandibles. Other anomalies in these skulls included hemi-mandibular hypoplasia (0.7%), mandibular ramus hypoplasia (0.7%), and bifid mandibular heads (2.3%) (Table 9.1).
Dental crowding involving the right maxillary canine and first premolar teeth is apparent in an adult skull suspected of abortive congenital palatal clefting (Fig. 7.12). Although for the most part dental alignment in aboriginal skulls from this region has been excellent, similar anomalies involving other teeth and both jaws have been found.
Abnormal dentition consisting of a right upper central incisor tooth socket that is unusual in size and shape, and a poorly formed secondary dentition tooth lodged in an abortive median alveolar cyst, are illustrated in Figure 7.14.
Developmental and incidental aberrations, especially in the maxilla, that affected teeth during formation and growth were in a number of skulls from different locations and cultures. Metabolic disturbance (nutrition, trace elements) (Ch. 5, 7), could easily have affected developing dentition in regional aborigines, but to date the subject has not been investigated seriously.
Generally, the types, locations, and severity of various dental diseases exhibited in Upper Missouri River Basin skulls are comparable to what has been found in evaluations of other similar skeletal populations (87-40;246-436;329-[many ref.]).
The status of teeth and their supporting structures have been of concern as a manifestation of the health and well being of the aborigines in the Upper Missouri Basin. Anatomic alterations reflecting problems that affected individuals during life have been more frequent in the teeth and adjacent tissues and structures than any other portion of the skeleton. Unfortunately, missing and broken teeth, and time constraints, precluded an in depth tooth by tooth assessment of each skull or its fragments during the Dry Bones survey, similar to Ubelaker's study of the Leavenworth skulls.
To date there has been no search for dental evidence of growth disturbance (Wilson lines) in the majority of skulls from the Upper Missouri Basin. In the Crow Creek skeletons especially, such investigation could have been quite fruitful. Unfortunately, these skeletons are now reburied and lost to scientific scrutiny forever.
The majority of this region's ancient inhabitants were agrarian and/or hunter-gatherers. Grains were ground between two rocks, contaminating the flour with gritty particles. Abrasive wear causing occlusal surface attrition, opening the way to pulp cavity infection, often followed by loss of the tooth, was the commonest abnormality.
In addition, many coarse foods were utilized, and much of the diet was carbohydrate, further promot ing tooth wear and caries. Serious dental disease was not a common finding in children's skulls from this region, but later in life dental wear and attrition were so frequent they often could be used as a rough criterion to judge the individual's age. In the average skull tooth wear was usually apparent in the mid to late twenties and became progressively more severe from that point in life until death.
Abrasive attrition was followed in frequency by plaque (calculus), caries (and tooth loss secondary thereto), abscesses and antral-oral fistulae, and alveolar bone resorption. Residua of temporo-mandibular joint disfunction, the sequel attrition of teeth and faulty mastication engendered by tooth loss was common.
Tooth wear and associated problems were in both sexes, but were somewhat more frequent and more severe in females. Two additional factors instrumental in the early deterioration of young women's teeth were the effects of pregnancy and lactation, especially when calcium intake might have been marginal, and use of the teeth and jaws as tools in processing animal hides and other substances (87-40).
Dental diseases had affected pre and post-Columbian cultures represented by the skeletons evaluated (Arikara, Assiniboin, Chippewa, Crow, Hidatsa, Mandan, Middle Plains Woodland, Ponca, Siouan), demonstrating that serious dental disease was universal in this region during the past millennium.
The Dry Bones research included evaluation of 45 Mandan and 34 Arikara-Mandan skulls. The condition of the teeth in Mandan skulls showed no obvious difference from those of any other culture (Fig. 9.4).
These findings do not corroborate Catlin's assessment of the dental health status of "the Tribes of North and South America" (72-3) (Figure 8.1), or of the Mandans living this region in the early 19th century (72-11) (Figure 8.1).
Richard Blair (Secretary of Health, South Dakota State Health Dept. Personal communication) postulated a plausable explanation for the difference between Catlin's observations and these findings. He opined that Catlin may have observed the skulls of very young individuals who perished before their teeth had had the opportunity to deteriorate. Demographic information from this region relating to people who lived before, contemporaneous with, and after Catlin, indicates very high death rates before 20 years, the time in the lives of these people at which the changes of dental attrition started becomming apparent. Furthermore, smallpox and other epidemic diseases had affected the Mandans prior to Catlin's arrival, and warfare had taken its toll. Catlin could easily have witnessed the aftermath of some catastrophe, without recognizing its significance.
The fact of many dental infectious diseases corroborates the contention (Ch. 3) that previous inhabitants of the Upper Missouri River Basin throughout the past millennium were exposed to many pathogenic micro-organisms that behaved in a fashion similar to those prevalent today.
Misconceptions exist today that dental caries is a problem associated with increasing acculturation and were not prevalent in primitive societies (196,236). This is not corroborated by personal experiences with primitives in this region and elsewhere, and research in Missouri Basin skeletons. Inflammatory and infectious dental disease, including caries, were demonstrable throughout the region and in all time periods.
Findings relating to the completeness of tooth representation in skulls from this region agree with Stewart when he observed that in many ancient skulls, the teeth are gone or damaged, precluding assess ment for the totality of dental pathology (306,307).
Congenital and developmental abnormalities involving teeth and adjacent structures were seen in regional skulls occasionally. However, findings in Missouri Basin skeletons differ from some current concepts relating to anomalous human dentition. Held (157) stated:
"Inverted teeth seldom occur but are occasionally recorded in the dental literature. Inversion is probably due to an abnormal position of the tooth germ. The angle of inversion may vary considerably, but it is extremely rare to find the root apex pointing toward the alveolar crest."
Two identifiable Crow Creek skulls had inverted maxillary teeth, and a third had a maxillary premolar tooth oriented horizontally with the crown anterior, making the frequency of such anomalies 3/392 (0.76%). In another group of 2,500 skulls inverted maxillary teeth were found in two skulls.
It must be admitted that dry bone researchers who have access to sizeable cemetery populations have a singular advantage over clinicians and traditional pathologists in that the facial structures can be studied sans soft tissue, which obfuscates underlying abnormalities. In addition, it is entirely possible that temporal, racial, or genetic factors influence the difference between Held's and the findings from this region.
The anatomic pathology from this region relating to the teeth and their supporting structures reflect people living in a stone age culture, and as such, are similar to what others have seen in similar skeletal groups. However, four findings here, the mandible with putative hemifacial microsomia (Fig. 7.9), the adult mandible with asymmetrical ascending ramus development (Fig. 7.10), the maxilla with a metaplastic bone core extending into the maxillary sinus surrounding an antral-oral fistula, (Fig. 9.6), and the unusual number of inverted and transverse molar teeth (Fig. 9.10, 9.11) are singular to this region and unusual to the available literature of paleopathology.
Markup by Larry Zimmerman, 4/27/98
