dental caries in 19th century upper canada saunders et al 1997

8/10/2019 Dental Caries in 19th Century Upper Canada Saunders Et Al 1997

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Dental Caries in Nineteenth Century Upper CanadaS H E L L E Y R . S AU N D E R S , 1* CAROL D E VITO,1

AND M. ANNE KATZENBE RG 21Department of Ant hropology, McMaster Un iversity,Ha m i l t o n , O n t ar io , Ca n a d a L 8 S 4 L 9 2Department of Archaeology, University of Calgary,Calgary, Alberta, Canada T2N 1N4

K E Y W O R D S caries; 19th century; Ca nada ; diet

A B S T R A C T This study exam ines the presence of denta l caries in a largesample of adult skeletons from the 19th century cemetery of St . ThomasAnglican Church in Belleville, Ontario. The cemetery was used from 1821 to1874. Caries prevalence and frequencies of diseased and missing teeth werecalculated both by observing summary statistics of individual rates and by the

t ot a l s a m p le of t e et h . P o st m or t em t oot h l os s i s l ow i n t h is s a m pl e a n dan temortem tooth loss is highest in fi rst ma ndibular molars, all other molar san d then premolar s. Age at death, but not sex, wa s found to be significantlyre la t e d t o t h e o v era l l C a rie s R a t e wh ile bot h a g e a n d s e x w e re s ig n ifi c a n t lyassociated with the Diseased-Missing Index. The increase in diseased andmissing teeth in older individuals is expected while the sex difference is notexpla ined by simple dieta ry fa ctors. When compa red to reports on B ritish a ndA me ric a n s a mp le s , c a r ie s a n d a n t e mo rt e m t o o t h lo s s in t h e St . T h o ma s sa mple is most simila r to a pre-1850 B ritish gr oup a nd higher t ha n Americansamples. Although there is undoubtedly a complex of factors contributing tocaries prevalence in this sample, more da ta ar e required from la rge historics a mp les , p a rt icu la r ly f rom t h e Ame rica n n ort h e a s t a n d la t e 19t h ce n t u ryB rita in, to have a clearer understa nding of the influence of diet , cultura l, andenvironmental factors affect ing caries rates in historic populat ions. Am J

P hy s Ant hr opol 104:7187, 1997. 1997 Wiley-Liss, I nc.

The an thropological l iterature conta insma n y re port s of o ra l h e a l t h a n d dis ea s e inp a s t p op ula t ion s , p a rt icu la r ly t h e p rev a -l en ce of d en t a l ca r i es a s a r efl e ct i on ofdie t a ry c h a n g e s . T h e re a s o n s f o r t h is a reclear, since as densely calcified tissue, teethar e well preserved a nd ava ilable for observa-t ion in most archaeological circumstances.In addit ion, the observation and identifica-tion of carious lesions are relatively simple

t o dist in g u is h f rom ot h e r ca u s e s of t o ot hdestruction.H is t orica l s k elet a l s a mp les p rov ide re -

s ea r c h er s w i t h v a l u a b le i n for m a t i on b e-cause the preva lence of denta l pat hology canbe compared to complementary, documen-ta ry da ta about oral health, dietary composi-t ion, and dental hygiene. Much of the exist-

in g l i t e ra t u re in t h is a re a de a ls wit h 18t ha n d 19t h cen t u ry s a m pl es f rom B r i t a in(Colyer, 1922; Brothwell, 1959; Hardwick,1960; Rusht on, 1965; Wells, 1968; Mooreand Corbett, 1975; Corbett and Moore, 1976;Whittaker, 1993; OSullivan et al., 1993)andthe U nited S ta tes (Angel, 1976; Angel et a l. ,1987; Owsley et al. , 1987; Rathbun, 1987;Lanphear, 1988; Sciulli and Gramly, 1989;Sledzik an d Moore-J ansen, 1991; Sutt er,

1995). Compara t ive sa mples from similar

Contract gra nt sponsor: Cana da S ocial Sciences and Huma ni-ties Resea rch Council; Cont ra ct gra nt number: 410-91-1408.

* C or r e sp on d en ce t o : S h e ll ey R . S a u n d e r s , D e pa r t m e n t o fAnthropology, McMaster Universit y, 1280 Main S t. W., Ha mil-ton, Ontario, Canada L8S 4L9. E-mail: [email protected]

Received 8 February 1996; accepted 8 J uly 1997.

AME RI CAN J OURNA L OF P HY SICA L A NTH ROPOLOGY 104:7187 (1997)

1997 WIL EY-L I SS, INC.


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t imes in Upper Canada should prove inter-est ing since they are affected by the polit i-cal, economic, a nd close fa mily t ies to B rit-ain as well as the geographic placement in

North America a nd social a nd economic influ-ences from the U nited Sta tes.

A survey of the B rit ish studies indicat es an ot a ble a n d con s ist e n t s e cu la r t re n d f orin c re a s in g c a r ie s f ro m Sa x o n t ime s t o t h e20th century, including increases in totalf req u e n cies a n d ch a n g in g loca t io n s of le-sions from cemento-ena mel junctions to oc-clusal fissures and interst it ial contact areas(Corbett and Moore, 1976; Whittaker, 1993;Moore, 1993). Pa rticular ly ma rked increasesin the frequencies of caries occurred in thel a t t e r h a l f o f t h e 1 9 t h c e n t u r y a n d t h e s ehave been at tributed to dramatic increasesi n t h e con s um pt i on of s u ga r a n d r efi n e dca r b oh y d r a t e s b et w e en 1 830 a n d 18 80(Brothwell, 1959; Hardwick, 1960; Corbettand Moore, 1976; Moore, 1993). Neverthe-less, there are some significant differencesin reported frequ encies of caries for sa mplesfrom similar t ime periods and the explana-t ion s f or t h e s e di f fe ren ce s a re n ot clea r(Whit ta ker, 1993).As a result of meth odologi-cal variat ions in the report ing and analysesof ca ries, it is difficult t o identify the r easonsfor sample differences.

Su bs t a n t ia l in cre a s es in ca r ie s a ls o o c-

cu rred in Ame rica in t h e la t t e r h a l f of t h e19t h c e n t u ry , wh ic h a re a t t r ibu t e d t o t h econsumption of cariogenic foods. However,19t h c e n t u ry A me ric a n s a re s a id t o h a v ee a t en h a l f t h e a m o un t of s u ga r of t h ei rBritish counterparts (Deerr, 1950), and thisis be l ie v e d t o be re fl e c t e d in s o me c a rie sdifferences betw een sa mples (Sutt er, 1995).Difficult ies arise again with the interpreta-tions of inter-sample differences which areg ive n a v a r iet y of e xp la n a t ion s in clu din gsampling error, var ying age composit ion ofsa mples, sam ple biases, differences in infec-t ious disease rates, and dietary differences

(Sledzik and Moore-J ansen, 1991; Sutt er,1995). It is difficult to eva luat e these expla-nat ions because of variat ions in the report-ing of data (also noted by Whittaker, 1993,and Sutter, 1995). Reporting caries by indi-v idu a l a l lo ws e v a lu a t io n o f de t a i le d in t ra -sample varia bility, but both individual r at esa n d t o t a l p e rc e n t c a r io u s t e e t h ma y be a f -

fected by the age, sex composition, and sizeof the sa mple. Antemort em t ooth loss, whichis strongly affected by caries occurrence, isalso variably reported in the literature and

the effect of postm ortem t ooth loss on ca riesprevalence is often difficult to interpret frompublished data .

The present study reports on caries in ala rg e s a m p le o f a du lt in div idu a ls f ro m a19th century cemetery located in southeast-ern Onta rio. We a tt empt to provide a compre-h e n s iv e s u rv e y o f c a r ie s a n d a n t e mo rt e mtooth loss rates, examine the effects of ageand sex on dental pathology, and comparet h e se ob s er v a t i on s t o ot h e r B r i t i sh a n dAmerican historical samples. We also referto sta ble car bon isotope da ta on bone colla-g e n f ro m t h is s a mp le t h a t ma y p ro v ide ameasure of the consumption of cane sugar(Katzenberg et al. , submitted).

St able carbon isotope rat ios differ in plan tsdepending on their mode of photosynthesis(see Ambrose, 1993; Ka tzenberg, 1992, orSchwarcz and Schoeninger, 1991, for back-ground information). These differences arepassed on to human consumers and may bedetermined by ana lysing preserved protein(largely collagen) and carbon in biologicalapa tite. Recent controlled feeding studiescarried out on rodents (Ambrose and Norr,1993; Tieszen an d Fa gre, 1993) demonstra te

that the carbon in bone collagen is mainlyderived from the protein component of theanima ls diet while t he carbon in biologicala p a t i t e is mo re re p re s e n t a t iv e o f t h e t o t a ldiet , including carbohydrates such a s suga r.

The diet of European migrants to UpperCa nad a during the 19th century wa s largelybas ed on C 3plants such as wheat an d barley.D o mes t ica t e d a n ima ls a t e p redomin a n t lylocally ava ilable C 3 p la n t s a n d C 3 feed fromwhea t , barley, and oat s. C4plants in t he dietof the people included maize, in the form ofcorn me a l u s e d in brea ds , a n d s u g a r ca n e ,used as a sweetener. Because maple trees,

a n d t h u s ma p le s u g a r , a re C 3, this form ofs u g a r wil l n o t be dis t in gu ish a ble f rom t h ema in ly C 3 diet . However, sugar from sugarcane may show up a s a slight increase in 13

C va lues in huma n bone. We assum e, for th iss t u dy, t h a t ma ize con s u mpt ion re ma in edf a i r l y c o n s t a n t . O u r d a t a a t t h i s t i m e a r ef ro m bo n e c o l la g e n . I f h u ma n s c a n be a s -

72 S .R. S A U N D ERS ET AL.


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sumed to be like rodents, then w e might onlyexpect to see a change in 13C du e t o s u g a r

consumption from the analysis of bone apatite.Such a nalyses a re planned but not completed.Here we report 13 C from collagen to see ifthere is a ny increase over t ime that mightreflect an increase in sugar consumption.

Fina lly, we exa mine documentar y informa -tion about socioeconomic factors, diet, den-ta l care, and environmental condit ions th atmight ha ve contributed to the observed rat esof dental pathology in this skeletal sample.

MATERIALS AND METHODS

St . Thoma sAnglican C hurch in B elleville,Onta rio, wa s founded in 1818 and it s ass oci-

at ed cemetery w as used from 1821 to 1874(Herring et al . , 1994). The total burials inthe cemetery numbered 1,564 of which 558or 36%were represented by completely in-ta ct , observable skeletons (Sa unders et al . ,1995a). Of th ese, 282 (50.5%) wer e a ged l essthan 15 years (Saunders et al . , 1995b). Oft h e re ma in in g 276 in div idu a ls , 229 c a s e shad observable dentit ions (Table 1). There ma in in g 47 c a s e s do n o t bia s t h e de n t a lstudy by their exclusion since only 16 oft h e m (6% of t h e t o t a l) we re f ra g me n t a ry.The rema ining 31 cases w ere edentulous forone or both jaw s.

Th e t ow n of B e ll ev il le w a s s et t l ed b yUnited Empire Loyalists (mainly Brit ish orAmerican born) after the American Revolu-tion as well as further waves of settlers fromt h e U n it ed St a t e s a f t er t h e Wa r of 1812,aga in of mainly B ritish origin. Further exten-sive wa ves of immigrants a rrived in the a reabeginning in th e 1830s an d these were mostly

from Britain (Herring et al. , 1994; Saunderset al., 1995b).

The personal identit ies of the skeletonsa r e u n kn ow n e xce pt f or a s u bs a m p le ofa p p ro x ima t e ly 80 in div idu a ls . D u e t o t wofi re s a t t h e c h u rch o v er t h e la s t t wo c en t u -ries , mos t t o mbs t on e s we re mov ed f romtheir gra ve sites. However, the subsa mple ofpersonally identified individuals wa s deter-mined by compa rison of legible coffin pla tesin the gra ves to list ings of interments in theparish registers. In a ddition, since the na mesof all individuals interred in the cemeteryare listed in the parish registers, i t is pos-sible to compare sampling distributions ofs ke le t a l a n a l y s es t o p a r is h r eg is t er d a t a

(Saunders et al., 1991; Rogers, 1991; Herring etal., 1994; Saunders et al., 1995a, 1995b).The sex of the documented individuals is

known from their names. Of the unidenti-fi e d s k e le t o n s , s e x wa s de t e rmin e d in t h emajority of cases from intact morphologicalfeatures of the bony pelvis (Rogers, 1991). Ac o mp a ris o n a n d s t a t is t ic a l t e s t o f t h e s e xr a t i o s o f t h e s k e l e t a l s a m p l e a n d o v e r a l lbu ria l s a mp le l ist e d in t h e p a ris h re g ist e rshowed no significant differences (Rogers,1991). Also, tests of accuracy of morphologi-cally determined sex from the pelvis usingthe documented sample were highly reliable

yielding an a ccura cy ra te of 99%(Rogers an dSaunders, 1994).E s t ima t ion of a g e -a t -de a t h of t h e a du lt s

was calculated using the following methods:pubic symphysis metamorphosis (followingthe smoothin g m ethod of J ackes, 1992) an dchanges to the auricular surface of the hipbone (Lovejoy et al . , 1985). A number of

TABLE 1. Summary of dental pathology sample

D escript ion C a ses Rema in in g % N %

C ase sAdult s in skelet a l st udy 276 276 100C a ses edent ulous 31 245 89C a ses fr a gmen t a r y 16 229 83

Maxilla only 6Mandible only 22Both jaws 201

TeethTota l teeth expected (276 32) 8,832Tota l teeth expected of a va ilable jaw s (207 ma xillae 16

teeth) 3,312 (223 man dibles 16 teeth) 3,568 267socket s or t eet h in fr a gment a r y ca ses 7,147

Act ua l socket s obser ved (due t o in det er min a t e ca ses) 6,635Tot a l t eet h obser ved 4,605 69.4

73D EN TAL C A RIES IN U PP ER C A NAD A


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other methods ha ve been employed for agee st i m a t ion b u t t h ey a r e n ot i ncl ud ed i nt h e s e e s t ima t e s beca u s e of p roblems wit hsa mpling (morphological changes t o the ster-

nal rib) or because of their apparent unreli-a b i li t y f or t h is s a m p le (d en t a l w e a r a n dcra n ia l s u t u re c los u re) ( Sa u n ders e t a l . ,1991). Average age-at-death of adults esti-ma ted from the skeletons is 42.5 year s, an dthe average age-at-death for the total adultbu ria l s a mp le in t h e c e me t e ry t a k e n f ro mthe par ish registers is 47.9 yea rs.

I n i t ia l ly, t e et h we re e xa min e d f or p res -ence, postmortem absence, antemortem ab-sence, congenital absence, partial eruption,or no eruption. Determination of the pres-ence or absence of carious lesions involvedvisual observation using a dental pick and ama gnifying glass. The study wa s conductedin daylight by windows receiving direct sun-l ig h t , u n de r o v e rh e a d l ig h t in g , a n d wit h ama nually an gled desk lamp. Ea ch tooth wa sexamined visua lly for evidence of a bla ck ornecrotic site. Scoring was both overall andfor specific surfaces, using a modification ofPa t tersons (1984) methods a nd ra nkings.These were used to indicate total number oflesions per tooth, size of destruction, andlocat ions of lesions. The visual method ofca rie s iden t ifi c a t io n h a s p rev iou s ly bee nshown to be reliable when compared to both

radiographic and histological studies (Whit-t a k e r e t a l . , 1981) a n d t o min imize in t e r-observer err or (Rud ney et a l., 1983).

Calculating caries occurrence

To an aly se car ies occurrence by sex, a ge,tooth type, location, a nd t otal sa mple, Mooreand Corbett (1971)have recommended calcu-l a t in g a C a r ies R a t e separ ately for eachi n d i v i d u a l by e xp res s in g t h e n u mbers ofeach tooth type carious as a percentage ofthe numbers of each tooth type present aswith the following:

e.g. Caries Rate for incisors

number of ca rious incisors

number of incisors present 100

3 car ious incisors

tota l of 8 possible incisors present

100 37.5

An overall mean Ca ries Rate for a sam pleof individua ls can be counted wh ich is repre-sented by the total number of car ious teetha s a percenta ge of the tota l number of observ-

able teeth per individual summed and thendivided by the total number of individuals.Observing car ies occurrence by individua l isseen to be the logical a pproa ch when t here isthe possibility of considerable variat ion incaries experience among individuals withina population an d beca use sample sizes mightha ve a considerable effect upon calculat ionsof the tota l proportion of carious teeth w ithinany one sample.

In addit ion, because t he ma jority of teethlost a ntemortem ar e often lost due to caries(Ha rr is, 1968; Mena ker, 1980), the D isea sed-

Missing In dex (DM I ndex) can be calculat edby a rch, tooth t ype, or tota l teeth. This indexis ca lcula ted as t he rat io of carious teeth andteeth lost antemortem, relat ive to the totalnumber of teeth and resorbed sockets ob-served for each individuals dentition usingthe following equation:

DM Index

total number of carious t eethand number of restored sockets

total n umber of teetha nd r esorbed sockets

100

Th e ma j ori t y of re se a rch e rs re port t h epresence of caries in skeletal sa mples as t hetota l number of carious teeth a s a proportionof the total observable teeth in the sample(referred to here a s Total P ercent Ca ries)rat her tha n by individual. These values a realso reported here.

Another way of dealing with the reportingof c a r ie s wh e n s a mp le s izes a re s ma ll , bu tstill confi ning observat ions to individua ls, isto report avera ge car ies rat es per m outh, orthe absolute numbers of carious lesions ob-served per intact teeth per individual (Rath-bu n , 1987) ra t h e r t h a n a s a p ro p o rt io n a s

Corbett a nd Moore have proposed. This va luedoes not control for differences in the num-bers of observable teeth from individual toindividual.

In order to determine whether there is astat ist ically significant difference in CariesR a t e s o r D M I n d i c e s b e t w e e n m a l e s a n df ema le s in t h e St . Th oma s s a mp le wh ile



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controlling for or removing the effect of are la t io n sh ip be t we en a g e a n d in cre a s in gcaries, a tw o-wa y a na lysis of covaria nce wa sc a lc u la t e d o n t h e in div idu a l Ca rie s R a t e su s in g s ex a s t h e in de pe n den t v a r ia ble a n dage a s the covaria te.

I n a r el a t ed s t u dy (K a t z e nb er g e t a l .,submitt ed) over 450 individua ls from the S t.Th oma s s a mp le w e re a n a ly s ed f or s t a bleis ot o pe s o f ca rbo n a n d n i t rog en . F o r t h epresent study, only 45 personally identifiedindividua ls are discussed since their dat es of

de a t h a re k n o wn . I n f a n t s a n d y o u n g c h i l-dren were not included in the analysis sincein fa n t s s h ow g re a t e r v a r ia t io n in 13C v a l -u es t h a n d o a d u l t s f r om t h e s a m e s a m p le(Ka tzenberg et a l. , 1993). If increa sed cariesp rev a len ce ov er t ime is du e t o in cre a s eds u g a r c o n s u mp t io n , t h e n t h is ma y be e v i-dent in the carbon isotope data.

RESULTS

Of the 6,635 observable sockets, 290 were

lost postm ortem (4.4%). P ostmortem tooth

loss proved to be much great er in t he ma x-

illa (N 204 t e e t h lo s t ) t h a n in t h e ma n -dible (N 86 teeth lost ). The teet h lost m ost

f re q u e n t ly we re ma x il la ry c e n t ra l a n d la t -e ra l in c is o rs , ma x il la ry t h ird mo la rs , a n dma ndibu la r centra l incisors (Ta ble 2). Never-theless, postmortem tooth loss is relativelylow in this sample. Antemortem tooth loss

ran ges from 5% to 53% for an y one toothtype with the highest values being observedf o r t h e fi r s t m a n d i b u l a r m o l a r s , a l l o t h e rmolar s, and t he premolars.

The numbers of carious teeth are variablebut relat ively common r anging from 5% to70%with highest values in the maxillary andmandibular molars. The percentages for caries

TA BL E 2. Teeth m issing or affected by cari es

Toot hSockets

(N)

P o st m or t em l os s An t em or t em l os s I ntac tteeth

(N)

C ari ousteeth

(N)

Observedteeth

(%)N % N %

18 142 17 12.0 22 15.5 88 51 58.017 207 12 5.8 65 31.4 120 69 57.516 207 6 2.9 82 39.6 110 67 60.915 207 11 5.3 65 31.4 122 42 34.414 207 14 6.8 64 30.9 123 38 30.913 206 7 3.4 29 14.1 166 33 19.912 207 16 7.7 37 17.9 149 38 25.511 207 19 9.2 28 13.5 156 34 21.821 207 30 14.5 22 10.6 149 36 24.222 207 23 11.1 34 16.4 142 44 31.023 207 11 5.3 27 13.0 164 33 20.124 207 9 4.3 64 30.9 130 46 35.425 207 10 4.8 67 32.4 126 48 38.126 207 5 2.4 74 35.7 123 78 63.427 207 7 3.4 64 30.9 126 81 64.328 141 7 5.0 29 20.6 89 49 55.148 168 3 1.8 56 33.3 102 55 53.947 223 3 1.3 99 44.4 119 82 68.946 223 3 1.3 117 52.5 98 60 61.2

45 223 1 0.4 43 19.3 177 53 29.944 223 7 3.1 28 12.6 185 31 16.843 223 4 1.8 10 4.5 2 09 23 11.042 223 6 2.7 21 9.4 194 14 7.241 223 12 5.4 35 1 5.7 174 9 5.231 223 18 8.1 27 12.1 176 11 6.332 223 11 4.9 15 6.7 1 94 17 8.833 223 4 1.8 9 4.0 210 17 8.134 223 3 1.3 19 8.5 2 00 38 19.035 222 2 0.9 43 19.4 173 39 22.536 223 2 0.9 111 49.8 106 63 59.437 223 2 0.9 100 44.8 114 80 70.238 166 5 3.0 59 35.5 91 55 60.4

Ma xilla S ubt ot a l 3180 204 6.4 773 24.3 2083 787 37.8Ma n dible S ubt ot a l 3455 86 2.5 792 22.9 2522 647 25.7Tot a l 6635 290 4.4 1565 23.6 4605 1434 31.1



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for each t ooth t ype are generally higher in th emaxilla than in the mandible. The percentagesfor caries listed in Ta ble 2 ar e proportions of thetotal number of observable intact teeth.

The percenta ges of ca ries out of all observ-a ble t e e t h f o r ma le s a n d f e ma le s a re p re -s en t ed i n Ta b l e 3 . H e r e a g a i n , c a r i es i shighest in the molar a nd premolar t eeth a ndhigher in the maxillar y ar ch. Ca ries appears

to be higher in females tha n in ma les. Thisobs erv a t ion is con fi rme d by re port in g t h eavera ge number of carious lesions by sex permou t h a s s ee n in Ta ble 4. F e ma le s h a v esignificantly higher numbers of carious lesionsper mouth than do males but the differencebetw een the sexes in a bsolute numbers of teethlost before death is not significant.

Ta b l e 5 l i st s t h e s u m m a r y d a t a f or S t .Thomas ma les and females for C ar ies Rateand DM Indices by tooth type and arch. Themean a ge at dea th for the 102 adult femalesis 42.1 years and the mean age at death for

TAB L E 3. St. Th omas cari es and an termort em tooth loss by sex

Toot hTota l

sockets

Antemortemloss Observed

teeth

C ari ous

Toot hTota l

sockets

Antemortemloss Observed

teeth

C ari ous

N % N % (N) % N %

Adult Females

Ma xilla Ma n dible18 63 10 15.9 42 22 52.4 48 67 20 29.9 46 25 54.317 88 30 34.1 52 31 59.6 47 96 49 51.0 45 36 80.016 86 32 37.2 51 37 72.5 46 95 56 58.9 38 27 71.115 88 28 31.8 53 21 39.6 45 98 24 24.5 73 29 39.714 90 28 31.1 53 17 32.1 44 96 12 12.5 80 19 23.813 91 17 18.7 71 15 21.1 43 97 6 6.2 90 11 12.212 89 16 18.0 64 23 35.9 42 96 7 7.3 86 6 7.011 96 14 14.6 67 22 32.8 41 98 14 14.3 81 5 6.221 89 9 10.1 64 22 34.4 31 98 11 11.2 78 6 7.722 88 17 19.3 59 26 44.1 32 96 6 6.3 86 9 10.523 90 10 11.1 72 19 26.4 33 98 5 5.1 91 9 9.924 91 28 30.8 60 25 41.7 34 97 10 10.3 85 22 25.925 90 32 35.6 56 28 50.0 35 95 22 23.2 72 23 31.926 90 29 32.2 59 39 66.1 36 96 53 55.2 42 29 69.027 83 30 36.1 50 31 62.0 37 96 50 52.1 44 36 81.828 57 10 17.5 41 22 53.7 38 71 22 31.0 46 26 56.5

S ubt ot a l 1369 340 24.6 914 400 45.3 1490 367 24.9 1083 318 36.8Tot a l 2859 707 1997 718 41

Adult Males

Ma xilla Ma n dible18 84 12 14.3 60 29 48.3 48 101 36 35.6 62 30 48.417 109 35 32.1 68 38 55.9 47 125 50 40.0 74 46 62.216 112 50 44.6 59 30 50.8 46 123 61 49.6 60 33 55.015 110 37 3 3.6 69 21 30.4 45 124 19 1 5.3 105 24 22.914 113 36 3 1.9 70 21 30.0 44 124 16 1 2.9 105 12 11.413 111 12 10.8 95 18 18.9 43 125 4 3.2 118 12 10.212 113 21 18.6 85 15 17.6 42 124 14 11.3 107 8 7.511 113 14 12.4 89 12 13.5 41 123 21 17.1 93 4 4.321 112 13 11.6 85 14 16.5 31 123 16 13.0 98 5 5.122 111 17 15.3 83 18 21.7 32 124 9 7.3 108 8 7.423 114 17 14.9 94 14 14.9 33 125 4 3.2 119 8 6.724 112 36 32.1 70 21 30.0 34 125 9 7.2 115 16 13.925 113 35 3 1.0 70 20 28.6 35 123 21 1 7.1 101 16 15.826 112 45 40.2 64 39 60.9 36 122 58 47.5 63 33 52.4

27 113 33 29.2 76 50 65.8 37 120 50 41.7 70 44 62.928 87 19 21.8 61 27 44.3 38 96 37 38.5 55 29 52.7

S ubt ot a l 1739 432 24.6 1198 387 34.3 1927 425 22.6 1453 328 27.4Tot a l 3666 857 23.6 2651 715 30.9

TAB LE 4. Average absolute num ber of cari ous lesionsand antemortem teeth lost per mouth

Me an 1 S .E . S .D . N

FemalesC a rious lesion s 7.05 0.54 5.46 102Ant emort em loss 7.07 0.63 6.36 102

MalesC a rious lesion s 5.63 0.35 3.97 127Ant emort em loss 6.65 0.47 5.24 127

1 Mann-Whitney U test for sex differences for caries P .142.Man n-Whitney U test for sex differences for a ntemortem lossP

.997.



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the 127 St. Thomasmales is 45.6 years. Thistable also summarizes the total numbers of

observable teeth, numbers of carious teethand numbers of resorbed sockets as can befound in Ta bles 4 and 5. These illustra te t hehigh overa ll proport ions of car ies and ant e-mo rt e m t o o t h lo s s f o r bo t h ma le s a n d f e -males.

F o r a l l t e et h a n d s ock et s obs erv ed, f e-ma les ha ve a mean Ca ries Rate of 34.53 an da mean DM Index of 53.66, whereas malesh a v e a m ea n C a r i es R a t e o f 28. 26 a n d amean DM Index of 47.12. The discrepancybet we e n t h e t wo in dice s in dica t e s t h a t t h eCa rie s R a t e ma y u n dere s t ima t e t o t a l c a r iesa n d t h e D M I n de x ma y o v e re s t ima t e i t a s

noted by Luka cs (1995). However, previousa u t h o rs h a v e u t i l ize d t h e D M I n de x a s t h eindicator of caries (Kelley et al. , 1991; Sut-ter, 1995) based on clinical evidence that theloss of teeth a ntemortem is direct ly relatedto carious destruction. This assumption isprobably appropriate in those populat ionsnot experiencing heavy wea r, severe peri-odonta l disease, or extensive tooth tra uma,as is th e ca se for the S t. Thoma s sa mple.

B ased on the da ta presented in Table 5,females display a h igher overall Car ies Ratea n d a h ig h e r D M I n de x t h a n ma le s f o r a l ltooth t ypes a nd both a rches. In a ddit ion, as

mig h t be e xp ect e d, p os t e rior t e et h s h owh ig h er v a l ue s f or t h e D M I n d ex t h a n d oanterior teeth. The results of the analysis ofcov a ria n c e w h e re s e x is t h e in dep en de ntvaria ble and a ge is the covar iate w ere calcu-l a t ed a f t er t r a n s for m in g t h e C a r i es R a t ea n d D M I n de x v a lu e s f o r e a c h in div idu a lu s in g a s q u a re root t ra n s f orma t io n , s in ce

t h e v a lu es f or t h e s e s t a t is t ics a re n ot n or-ma lly distribut ed. The results a re presentedin Ta ble 6. Ag e a t de a t h wa s f ou n d t o be

significantly related to both caries rate andd is ea s e d t e et h a n d t e et h m i ss in g b ef or edeat h. When a ge is account ed for, there is nos ign ifi c a n t di ff ere n ce bet we e n t h e ov era l lCaries Rate of ma les a nd females (P 0.298).However, even when age is accounted for,there is still a significant difference betweent he D M I nd ex of m a les a n d fem a les(P 0. 023) wit h f ema le s s h owin g h ig h erDM Indices tha n ma les.

Stable carbon isotope ratios in the peopleburied in St . Thomas C hurch cemetery showlit t le varia t ion. For the 45 individuals overt h e a g e o f 4 y e a rs a t de a t h , t h e me a n 13C

v a lu e is 19. 5 w i t h a r a n g e o f 21.8 to18.0. These numbers are characteristic ofa la rg e ly C 3 based diet with some C 4 basedplants. A compar ison of ma les an d femalesaged 4 years and older shows no significantdifference between the sexes. Eighteen fe-ma les have a m ean value of19.6 0. 8incompa rison to 26 ma les with a mea n va lue of

TAB LE 5. Summ ary of caries rates and d iseased-missing in dices

Fema les Ma les

Number of in dividua ls 102 127Mea n skelet a l a ge a t dea t h 42.1 45.6Number of t eet h 1997 2651Number of ca rious t eet h 718 715Number of resorbed socket s 707 857Overa ll C a ries ra t e 34.53 (S .E . 2.29) 28.26 (S .E . 1.74)Overa ll D isea sed missin g in dex 53.66 (S .E . 2.35) 47.12 (S .E . 1.93)Diseased missing index by tooth type

I n cisors 31.83 (S .E . 3.27) 26.40 (S .E . 2.68)C a n in es 25.65 (S .E . 3.13) 21.39 (S .E . 2.57)P remola r s 52.00 (S .E . 3.36) 41.77 (S .E . 2.70)Mola rs 80.47 (S .E . 2.39) 74.73 (S .E . 2.01)

Diseased missing index by arcadeMa xilla ry a rca de 53.61 (S .E . 3.26) 46.33 (S .E . 2.49)Ma ndibula r a rca de 46.71 (S .E . 2.37) 39.18 (S .E . 2.04)

TABLE 6. Analysis of covariancefor caries ratea n d DM 1 in dex for sex and age2

SourceSum ofs qu a res D F

Me ans q u a r e

Fr a t i o

P

val ue

C ari e s RateS ex 10.01 1 10.01 3.92 .049Age 3.80 1 3.80 1.49 .224E rr or 503.00 199 2.55

DM I nde xS ex 19.13 1 19.13 8.41 .004Age 63.24 1 63.24 27.79 . 000E rr or 480.15 213 2.28

1 D M Diseased-Missing.2 Sex is the independent varia ble and age is the covariate.



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19.4 0.8. The d ifferen ce is not st a ti st i-c a l ly s ig n ifi c a n t . I n div idu a ls a g e d o v e r 12y e a rs (t h o se w it h t h e ir p erma n e n t de n t i-t ion) were a nalysed t o compare 13C valuesa n d y ea r of d ea t h . R es u lt s of r eg r es s ionanalyses indicate a weak posit ive relat ion-ship with r 0.338 and P 0.067. Figure 1s h o ws t h is we a k t re n d t o wa rds in c re a s in g(less negative) 13C v a l ue s f r om 1850 t o1880.

DISCUSSION

The etiology of dental caries

Denta l caries is a pathological process oflocalized dissolution of the minera l pha se oftooth t issues by organic acids produced byba cteria l ferment a tion (New brun , 1982). Thedevelopment of dental caries involves threeimportant components: the presence of mi-

croorganisms in dental plaque, susceptibletooth structure, and a cariogenic diet . Re-sear ch into the epidemiology of denta l cariesh a s e st a b l is h ed t h a t t h e m o s t i m por t a n tdietary factor contributing to caries risk isfermenta ble carbohydrate, especially sugar(Winter, 1990). The presence of sugar aroundp la q u e -c ov e red t o ot h s u rf a c e s h a s be en

s h ow n t o b e e s s en t ia l f or e ve n t h e m os tminimal levels of caries formation (Rugg-Gunn and Edga r, 1984). New bruns 1982summa ry of the literat ure has shown tha t ofa l l t h e s u g a r s , s u c r o s e a p p e a r s t o b e t h emost cariogenic based on research showingt h e mo s t ra p id me t a bolis m of t h e s imp lesugars by bacteria, studies of experimentalcaries in anim a ls, and clinica l and epidemio-logical observat ions of the relat ionship be-tween sucrose intake and caries prevalence.

Dietary sugar is t he primary fa ctor a ssoci-ated with caries prevalence but recent stud-ies ha ve a lso observed substa ntia l declinesin car ies in areas w ith and w ithout fluorida-tion, despite the fact t ha t th ere are concomi-tant increases in the consumption of caloricsw eeteners (Winter, 1990). Appar ent chan gesin de n t a l h y g ie n e p ra c t ic e s a n d t h e t re a t -

ment of community water supplies in indus-tria lized countries a re considered by some tobe insufficient explanations for this trend(Winter, 1990). This phenomenon of a cariesde cre a s e w it h ou t diet a r y ch a n g e s e mph a -sizes tha t the mechan isms contr olling cariesprevalence in populat ion groups a re com-plex.

Fi g . 1 . Pl ot of 13C values a gainst year of death for sam ple of personally identifi ed individua ls.



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Diet and dental health in19th century Belleville

Canadian pioneering set t lers in the 19th

centur y ha d a n a bunda nce of food. Althoughoften cash poor, people were said to never bea t r is k o f s t a rv a t ion beca u s e o f t h e ch e a p -n e ss a n d p rof u sion of da i ly f a re . Abon y i(1993) ha s reconstr ucted t he B elleville dietof the mid-19th century based on historicsources. She notes th a t mea t (pork, beef, andmu t t o n), bre a d, a n d v eg et a ble s w e re t h ediet a ry s t a p les , w i t h s we et , ba k e d g o odsalso being popular. Three meals a day weregenerally served with lit t le variance in thecomposit ion of t he recipes or methods ofprepar at ion. Can adia n set t lers also took ad-vantage of North American foods, part icu-

larly maple sugar, maize, used primarily ascorn mea l flour, pumpkins, and w ild fruits.

Ab on y i a l s o a n a l y s ed i n g re d ie n t s a n dcook ed s t e ws , brea ds a n d v eg e t a bles f ortheir chemical composit ion. The highest(least negative) 13C v a lu e s we re f o u n d inbaked goods which include either or both oft h e m a i n C 4 food sources, maize and canesugar. Vegeta ble foods ar e exclusively C 3and meats indicated animals feeding on C 3plants.

It is difficult to obtain information on thecomp os it ion a n d q u a n t i t ie s of ba s ic f o odg r ou ps i n t h e d a i ly d ie t i n 19t h ce nt u r yBelleville but there are some excellent pri-ma ry sources from wh ich we can constr uct aclearer picture of the relative importance ofdifferent foods. The most valuable of these isthe collection of letters written by WilliamHut ton, settler in B elleville, to his mother inIrela nd from 1834 t o 1858 (B oyce, 1972).Hutt ons let ters conta in m any references tof ood , a n d s in ce h e w a s a f a r mer w i t h astrong interest in agricultural developmentsthey also contain details about the successand failure of various crops, the quality off ood p rodu ct ion a n d t h e f a milys e xp eri-

ments with novel North American agricul-tura l pra ctices (Boyce, 1972). These lettersprovide some indica tion of th e relat ive impor-t a n c e o f ca r b o hy d r a t e s a n d p a r t i cu l a r l ysuga r in th e diet of Belleville residents.

A lo t o f me a t wa s e a t e n bu t t h e la c k o frefrigerat ion meant that most meats couldonly remain fresh for a few days in the warm

months and often the lack of winter foddern e ce s si t a t e d e a rly bu t ch e rin g of f a rm a n i-mals and the eat ing of cured meats. Peopleat e these cured or par t ially fresh meats w ith

large a mounts of sw eetened fruit preservesor pickles. In the summer, wild and cult i-vated fruits were eaten as a main meal withs u g a r, cook ed s we et e n ed fl o u r, a n d milk ,eaten as a type of porridge (Boyce, 1972).

The high consumption of foods preparedwit h re fi n e d fl o u r wh ic h ma k e s f o r s o f t e r ,st ickier brea ds a nd cakes is a lso implicat edin t h e r is e in c a r ie s in B ri t a in in t h e 19t hcentur y (Moore, 1993). Most 19th centur ysources note t he grea t importa nce of brea din the diet, even for homesteaders. WilliamH u t t o n in f o rme d h is mo t h e r in 1836 t h a t

bread is our principal support(Boyce, 1972,pp. 50). The heavy reliance on bread by thesett lers, in addit ion to t he use of corn mealporridge, cooked, sweetened flour mixturesand stewed, sw eetened fruits probably con-t r ibut e d t o t h e ca r io ge n ici t y of t h e diet .While ceramic rollers for producing highlyrefined flour were not introduced to NorthAmerica unt il a fter 1875 (Leung, 1981) thequa lity of stone ground fl ours va ried great lyand Hutton noted that even the familys ownlocally ground flour produced bread nearlya s s o f t a n d fi n e a s t h a t f ro m t h e ba k e rs inB e lle vi lle. Th e bra n (a n d ot h e r lea v in g s

conta ining grit) that wa s produced from t hegrinding of the flour was fed to the livestock(Boyce, 1972).

Dental treatment and hygienein 19th century Canada

The historical ba ckground for denta l prac-t ice in North America derives ma inly fromFra nce a nd Engla nd. The French were ahea dof most other countries in the field of den-t is t ry a n d ma n y F re n c h - t ra in e d p ra c t i t io -ners arrived in the United States at the endof the 18th centur y t o act a s preceptors for a

whole fi eld of American born dentists (Gul-lett, 1971).One of these individuals w as G .V.N. Re-

lyea, born in Alban y, New York, in the ea rly1800s, w ho a t tended lectures a t the AlbanyMedical College an d la ter st udied dentistryfor a year with a pract ising dentist (Gullet ,1971). R elyea settled in B elleville in 1843



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wh ere he practiced until 1874, comma nding

control over pat ients from a wide area. Re-

lyea, as would have most 19th century den-tists, offered to extract , restore, regularise

and replace teeth, to prepare dental plates

a n d t o t re a t p eriodon t a l dise a s e ( H il la m,

1991).

Nevertheless, there were limits imposedon these pract it ioners since there were no

a n a e s t h e t ic s , t h e y u s e d h a n d in s t ru me n t s

and relatively unsophisticated materials and

most important , there was a lack of knowl-

edge of the etiology and pathology of dental

disease. Consequently, preventive and com-mu n it y de nt is t ry p ra ct is es h a rdly e xis t ed

an d wha t services Relyea would ha ve offered

would be limited by their cost a nd the a bility

of the pat ients to pay. Of the 229 adults inthe S t . Thomas skeletal sa mple with inta ct

dentit ions, 18 were observed to have toothre st o ra t ion s , e it h e r of mixe d s i lv er a ma l-

gams or gold. These included 12 males and

e ig h t f ema le s of v a ry in g a g e s p os s es s in g

from one to six restora tions per mouth.

G enerally th ough, levels of denta l hygienewere not high in mid-19th century Belle-

ville. Ba sed on general a ccounts of the his-

t o ry o f ora l h y g ien e a n d t h e h is t ory of t h e

t oot h b ru s h i t a p pe a r s t h a t r eg u la r t oot h

cleaning was not a widespread practise (As-

bell, 1992). Although France and Englandw e r e t h e m a j or m a n u f a ct u r er s of t oot h -

brushes in t he 18th century, they remained

luxury items because of the cost of produc-

tion until the late 1860s (Mattick, 1992).

Other factors contributing to cariogenicity

The car iostat ic properties of fl uorine com-

pounds a re w ell known (Ha rris, 1968). Fluo-

ridat ion was not introduced until the 20th

c e n t u ry a n d n a t u ra l s o i l fl u o rin e le v e ls in

the North American northeast are some ofthe lowest on t he continent (Sha w, 1985).

Fluorine is virtua lly absent from the wa tersof L a k e O n t a rio a n d le ve ls in a re a s t re a msare negligible (Thomas, 1954). Belleville resi-dents in the 19th century took their waterf r om n a t u r a l l y fl o w i n g s pr i n gs (M ood i e,1853; B oyce, 1972) and consequent ly would

n o t h a v e in g e s t e d fl u o ride s in a n y s ig n ifi -cant amounts.

Sugar consumption

The dra ma tic increase in sugar consump-tion in Britain from the mid-19th through to

the 20th centuries is a well-described phe-nomenon (Drummond and Wilbraham, 1939;Hardwick, 1960; Burnett , 1966). Both theB ri t is h a n d t h e Ame rica n s a re s a id t o h a v edou bled t h e ir c on s u mp t ion o f p roc es s e dsugar during the mid-19th century (Deerr,1950; Kolodny, 1976 cited in Sledzik a ndM oore -J a n s e n , 1991) bu t t h e B ri t is h a rereported to ha ve eaten tw ice as much sugara s t heir American count erpar ts (Deerr, 1950).

Since the m ajority of 19th century Belle-ville residents were of British origin (particu-larly the Anglicans), we would expect thesepeople to ha ve followed t he dieta ry ha bits of

t h ei r r el a t i ve s i n E n g la n d , I r el a n d , a n dWa les. The ma jor source of sw eetenings for19t h c e n t u ry N o rt h A me ric a n a n d B ri t is hc o n s u me rs wa s c a n e s u g a r o r ig in a l ly p ro -duced in the West Indies. But almost equa lin importa nce in Ca nada wa s the productionof maple sugar. In the 1830s and 1840s thecost of ca ne suga r tended t o be a lit tle higherthan at home (Boyce, 1972), so maple sugarwas preferred. The predominance of canesugar over ma ple increased in Cana da in th e1860s and beyond (Gov t of Canada, 1864,1871, 1881).

It is possible to estimate the probable percapita consumption of sugar in the Huttonf a mily f rom Will ia m H u t t o n s let t e rs . I na d d i t ion , ce ns u s r e t u r ns a n d t h e a n n u a ls es s ion a l p a pe r s of t h e g ov er n m en t ofCa nad a r eport imports a nd exports of sugarfor 1861, 1871, and 1881 (Govt of Canada,1864, 1875, 1883). P ublished fi gures ar eava ilable for per capita consumption of sugari n B r i t a i n a n d t h e U n i t e d S t a t e s ( D e e r r ,1950; B u rn e t t , 1966; Cu mmin g s , 1970).These data are presented in graph form inFigure 2.

While there is some disagreement over

est imated consumption values for Britain,a l l s ou rce s a g re e t h a t con s u mpt ion ros edra ma t ic a l ly in t h e la t t e r h a l f o f t h e 19t hcentury as ta riffs on imports w ere removed.E s t ima t e s f o r t h e U n it e d St a t e s a ls o s h o win cre a s es t h rou g h ou t t h e la t t e r h a l f o f t h ece n t u ry bu t t h e a mou n t s in a n y de ca de a regenerally lower than those for Britain. The



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v a lu es es t im a t e d f or C a n a d a fl u ct u a t earound those for both B rita in and th e UnitedStates until the 1860s and then level off tovalues a lmost identical to those of the U nitedSta tes. Reported per capita sugar consump-

tion in the three countries in 1933 is 106 lbfor B rita in, 100 lb for the U nited Sta tes and93 lb for Ca na da (Deerr, 1950). However,caries prevalence in t he St . Thomas sam pleis clos es t t o p u blis h ed v a lu es f or B ri t is hh is t orica l s a mp les ra t h e r t h a n Ame rica nsamples.

Results of the regression a na lysis of 13Cvalues and year of death in t he small sampleof personally identifi ed individuals (Fig. 1)s h ow s a w e a k t r en d f or i n cr ea s i n g (l es snegative) values from 1850 to 1880. It is notpossible to tell if this tr end is due to increas-ing sugar consumption alone, or to increas-

ing maize consumption. However, there isno historical reference to increasing maizecon s u mpt ion wh ile t h e re su lt s f ol low t h ep re di ct i on t h a t ca n e s u ga r (a C 4 s u g a r)in cre a s ed du rin g t h a t p eriod. Sin ce s u g a rw a s u s ed a s a d ie t a r y s u pp le me nt (e .g .,sweetener a nd preservat ive) it w ould a ppearo n l y a s a s u b t l e c h a n g e i n 13C v a lu e s o f

collagen. As mentioned earlier, a furtherproblem w ith r elying on ca rbon isotope dat afrom colla gen is tha t because ca ne sugar is acarbohydra te, i ts isotope signa ture ma y notbe well reflected in collagen. I t is also pos-

s ible t h a t mu c h o f t h e s u g a r in g e s t e d wa sma ple sugar. However, historical sourcesde mon s t ra t e clea rly t h a t t h e import a t iona n d u s e of c a n e s u g a r in Ca n a da in cre a s edt h r ou g h ou t t h e 19t h ce nt u r y a s p r ice sdropped (B oyce, 1972; C a na da , 1864, 1875,1883).

Sample comparisons

There a re only tw o other studies of histori-c a l s a mp le s wh ic h h a v e p u blis h e d Ca rie sR a t e s a n d D M I n dic e s c a lc u la t e d f o r in di-v idu a ls . Th e se a re by Co rbe t t a n d M oore(1976) (see also Moore, 1993) an d Sutt er

(1995). Unfortunately, it is not possible todire c t ly c o mp a re t h e re s u lt s f ro m t h e St .Thomassa mple to Corbett a nd Moores studyof 19th century E nglish because t heir sam-ple of skulls was divided into age groups onthe ba sis of denta l w ear. However, Figure 3p res en t s t h e p erce n t a g e s f or Ca rie s R a t ea n d D M I n de x ( D M I n de x is n o t a v a i la ble

F i g. 2 . P e r ca p i t a s u g a r co ns u m pt i on c a lcu l a t i on s f or 1 9t h -c en t u r y B r i t a i n , U n i t ed S t a t e s a n dC a n a d a .



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f rom C or b et t a n d M oor e) f or t h e t h r eesamples, the Highland Park Cemetery (HPC)(Su tt er, 1995), t he Asht on-und er-Lyne C em-etery in northwest E ngland, represented byburials before 1850 (Brit I) and after 1850(Brit II) (Corbett and Moore, 1976), and the

St . Thoma s Cemetery (St T). To a llow forcompa risons, Corbett a nd Moores va lues forthe last three dental wear stages were com-bin e d t o c a lc u la t e me a n Ca rie s R a t e s f o rall a dults. The fi gure also includes tw o sub-groups of the St. ThomasCemetery (St TM,ma les; and S t T F, fema les) from w hich someolder individuals were removed to reducet h e m e a n a g e s a t d e a t h f o r m a l e s a n d f e -m a l es t o m a k e t h e m com pa r a b le t o t h eH ig h la n d P a rk s a mp le.

Ca ries Rat es ar e low in the Highland Pa rks a mp le c o mp a re d t o t h e B ri t is h a n d Ca n a -d ia n s a m pl es . Th e D M I n d ex i n t h e S t .

Th oma s s a mp le is a ls o ma rk e dly h ig h ert h a n t h a t f o r t h e H i g h l a n d P a r k s a m p l e .When ma le and fema le subsamples of the St.Thomassa mple (St TM a nd St TF) with a gedist r ibu t ion s e q u iv a le nt t o t h e H ig h la n dPa rk sample are compar ed the Ca ries Rat esan d DM Indices are still noticeably higher inthe S t . Thomas subsample.

The Ca ries Rat es in th e St . Thomas sam -p le a p p ea r t o be clos er t o t h e p re-1850Brit ish sample than the post-1850 Brit ishsa mple. This is supported by a compa rison oft h e ra n g e s o f me a n Ca rie s R a t e s re p o rt e d

for each tooth type in the three adult at tri-tion age groups in the British samples to thereported percent ranges for tooth types int h e St . Th oma s s a mp le (Ta ble 7). Sin ceCorbett an d Moore only report mean Ca riesRat es for the four teeth in a qua dra nt of anypart icular tooth type (i .e. first molars) it isnecessary to look at the ra nge of means for

Fig. 3. Sa mple compar isons of Ca ries Rat es an d DM Indices for Highla nd Pa rk sample, Ashton-under-Lyne Br itish I (pre-1850) and I I (post-1850) sam ples, total S t. Thomas sam ple, and *S t. Thoma s sam pleselected for lower m ean age-at -death .

TABLE 7. Comparison of mean caries rates reported bytooth typein theAshton-under-Lyne19th century

B r i t i s h 1 and St. Thomas samples

Bri t i sh IRange of

me ans

Bri t i sh I IRange of

me ans

St. Thoma sRange ofme ans 2

I n cisors 721 2138 525C a n in es 1619 2530 819P r emola r s 2232 3848 1638Mola r s 3857 5674 4970

1 The Ashton-under-Lyne sample reported by Corbett an d Moore(1 97 6) wa s d i vi d ed i n t o a n 1 80 0 18 50 (B r i t i s h I ) a n d a n18501900 (British II) sa mple.2 Reported as a range of mean caries rates because the Bri t ishsamples are only reported graphical ly separated by tooth typeand attr i t ion stage.



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each tooth type from their sample. Whent h is is do n e , o n ly t h e ra t e s f o r t h e mo la rteeth of the St . Thomas sample show sub-stantial overlap with the post-1850, or Brit-ish II sample.

While report ing the prevalence of car iesan d/or an temortem t ooth loss by individua l(Caries Rate and Diseased Missing Index) isa useful method for investigat ing samples,Total P ercent C ar ies values (the t ota l num-ber of ca ries/tota l num ber of observa ble teethin a s a mp le) a re of t e n re la t iv ely clos e t oCa rie s R a t e s. F a ct o rs t h a t wo u ld a f fe ct t h edifferences betw een t hese two sta t ist ics arepoor preservation of observable tooth posi-t ions and a strong negative correlat ion be-tween the number of carious teeth and thenumber of total observable teeth present inany one individual. That is , i f individuals

who ha ve lost ma ny teeth tend t o have morec a rie s , t h e n t h e ir in div idu a l Ca rie s R a t e sw i ll b e m u ch h ig h er t h a n t h os e o f ot h erindividuals in the sample, creat ing greatervaria bility in t he frequency distr ibutions ofCa rie s R a t e s . A n e ga t iv e corre la t io n be-tween carious teeth and total teeth presentin the St . Thomassa mple wa s found but the

c oe ff ic ie n t is n o t s ig n ifi c a n t (r .025,P .712). When a series of random sampleswa s s e le c t e d f ro m t h e St . T h o ma s de n t i-t ions, ra nging from 5% to 90% of the totalsample, t he differences between calculated

mean C ar ies Ra tes and Total P ercent Ca riesfor each sa mple were found to be r elat ivelyclose (Fig. 4). Consequently, Total P ercentCa ries va lues a nd Antemortem Tooth Lossvalues were compared in a series of histori-ca l s a mp les re port e d f rom t h e l it e ra t u re(Fig. 5). The result shows tha t the cariesv a lu es f or t h e S t . Th oma s a n d t h e B ri t ishseries are th e highest of all reported sam ples.I t is unfortunat e that some of the studies donot report ant emortem t ooth loss va lues sothat a broader picture of sample differencesin denta l path ology could be exa mined. How-e ve r, s in ce t h e re is a s t ron g a s s ocia t ion

between the occurrence of caries and ante-mortem tooth loss, the above observationsprobably st ill hold.

The comparisons presented in Figures 3a nd 5 place the S t. Thomas sa mple closest t othe Br it ish series in terms of occurrence ofcaries, particularly to the pre-1850 (or Brit1) subgroup. Ca ries values reported for the

Fi g . 4. C ompari son of C ari e s Rate to Total Pe rc ent C ari e s c al cul ate d from random sampl e s, rang i ngfrom 5%to 90%of th e total s am ple of the S t. Thomas d entitions.



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British series by Wells (1968) are lower asa re t h o se f or t h e Sp it a lfi e lds s a mp le f romLondon (Whittaker, 1993). However, both oft h e s e s a mp le s da t e t o e a r l ie r t ime s in t h e17t h , 18t h a n d e a rly 19t h c e n t u rie s . I t islikely tha t these earlier groups representindividuals whose diets contained relativelylow a mounts of processed foods, par ticular lyrefined sugars.

Except for the St. Peters sample (Owsleyet al., 1987), caries values are much lower inthe America n sa mples. Tempora l or groups elect ion f a c t ors ma y be imp ort a n t in e x-plaining a ny differences. Sledzik an d Moore-J an sen (1991) interpret the fi gures for theAme rica n mili t a ry s a mp les a s in dica t in glow car bohydra te diets in the earliest S nakeHill group, higher carbohydrate diets, andaddit ional denta l stresses affect ing the CivilWar group along w ith recruit select ion toe limin a t e me n wit h ca r io us les ion s .1 Thelowe r v a lu e o f c a r ies in t h e I n dia n Wa rsgroup is explained by the age structure ofthe sample and possible dietary differences.

The 18th century St . P eters sam ple comes

from New Orleans where the highly cario-

genic diet of cane suga r, corn mea l, fin e flour,

a n d m ol a s se s con t r ib u t ed t o h i gh d en t a l

pathology sta t ist ics by worldwide standa rds

(O ws ley e t a l . , 1987). Ye t , ca r ie s in t h isg rou p is s t i ll n o t a s h ig h a s t h a t f or t h e St .

Thomasor British samples.

Th e H i gh l a n d P a r k s a m pl e r ep re se nt s

residents of the ea rly 19th century Monroe

County Poorhouse in Rochester, New York.

The specific diets of these individuals are

not known but the impact of a developing

19th centur y car iogenic diet is thought to be

present (Sutter, 1995). While it is not pos-

sible to calculate percent antemortem tooth

l os s f or a l l t eet h i n t h e H i g hl a nd P a r k

sample, Sutters published values for DM

I n dice s s h o w t h a t a n t e mort e m t o ot h los s

w h e n a d d e d t o C a r i e s R a t e s s t i l l d o n o t

exceed those for either the overall or even

the age-adjusted St . Thomas sample (see

Fig. 3). Consequently, there were probably

differences in the cariogenicity of the diets

between the St . Thomas and H ighland Pa rk

people.

1In 186364, loss of teeth was the fourth highest cause forrejection for mil i tary draft into the Union Army (Lewis ci ted inGra ves and St amm, 1985).

Fig. 5. Int er-sam ple comparisons of Total P ercent Ca ries and Antemortem Tooth Loss for a n umber of18th a nd 19th centur y skeleta l samples.



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Th e e st ima t e s of p er ca p it a s u g a r con -sumption for the United St at es, B rita in, andCanada in the 19th century do not resolvethese comparisons. Suga r consumption is

n o t a s h i g h i n 1 9 t h c e n t u r y C a n a d a a s i nBritain and yet the St. Thomascaries occur-rence is considerably higher than that of theUnited S ta tes samples, even w hen ant emor-t e m t o o t h lo s s c a n be t a k e n in t o a c c o u n t .The weak relationship between 13C valuesan d yea r of deat h provides inconclusive sup-port for increasing cane sugar consumptionin B e l le v i l le t h ro u g h t h e la t t e r h a l f o f t h e19th centur y. It is possible tha t other dieta ryfactors such as food consistency, prepar a-tion, frequency of ea ting, etc. might contr ib-u t e t o t h e h ig h le v e ls o f c a r ie s in t h e St .Thomassample. Certainly, it has been dem-o n s t ra t e d t h a t a g e h a s a s ig n ifi c a n t imp a c ton the occurrence of ca ries in th e sam ple andthis was also shown by Sutter (1995) for theHighland Park sample. Consequently, cau-tion is necessary to prevent over interpreta-t ion of the sample comparisons. While ana t t e mpt wa s ma de t o c omp a re t h e S t . Th o-ma s a n d H ig h la n d P a rk s a mp les wit h s imi-lar a ge structures (Fig. 3) this is not possiblefor most published studies. Skeletal collec-t ions are often very sma ll, as is t he case fortw o recently published 19th century skeletalsa mples from Texa s a nd I llinois (Winchell et

a l., 1995; Lar sen et a l., 1995).From a broader perspective it should benoted that caries prevalence in the UnitedSta tes ha s long been reported as highest int h e n o rt h e a s t ( M a n de l , 1993) . P a rt o f t h eexplanation comes from the fact that molas-ses, which w a s produced in t he West In dies,w a s s en t t o t h e N e w E n g la n d s t a t e s t o b econverted to rum (Mintz, 1985). This prac-tise continued throughout the 18th centuryand thereby contributed to regional dietaryv a ria t io n s in t h e U n it e d St a t e s . B u t , h ig hcaries rates in t he American Northeast ha vep rev a i led u n t i l t h e p res en t da y , a n d t h e re

appears to be no clear explanation for thispersistence unless perhaps it is due to thecontinued effect of a regional cuisine or tothe very low levels of nat ura l fluorides in thea r e a (G r a v e s a n d S t a m m , 1985; M a n d el ,1993). It may be that the high levels of cariesin the St . Thomas sample are par t ly a t tr ib-uta ble to geography.

The observation that females have signifi-cantly higher Ca ries Rates and D M Indices,even when controlling for age, is in contrastto t he observations of S utter (1995), w ho

found age to be a sufficient explan at ion forany va riat ion in DM Indices in the HighlandPark sample. Since the sex difference is notsimply due to a higher proport ion of olderfemales other explan at ions should be sought.The analysis of carbon stable isotope ratiosdoes not provide support for a dieta ry d iffer-ence between the sexes. Whether womensu s ua l r ol e i n f ood p re pa r a t i on a n d t h ei rcontinuous a ccess t o food throughout theday is sufficient explanation is not clear atthis t ime.

CONCLUSIONS

This study demonstrates that the occur-rence of caries and antemortem tooth lossare high in the 19th century skeletal samplefrom St. Thoma s Chu rch, Belleville, in east -e rn C a n a d a . Wh i le f em a l es d o n ot h a v esignificantly higher Ca ries Rat es tha n malesw h e n t h e ef fe ct of a g e i s con t r ol le d t h ea ddit ion of a n t e mo rt em t o ot h los s v a lu esresults in significantly higher DM Indices inf ema le s in t h e s a mp le in s p i t e of t h e a ddi-t ional effect from a ge. What is required ar ef u rt h er in v es t ig a t ion s of la rg e h is t orica lsamples wh ere it is possible to sta t ist icallycompare consistently reported data. Particu-larly interest ing w ould be further la te 19thcentury data from the American northeastand late 19th century samples from B rita in.We a re a lso pursuing st udies of carbon iso-topes in biological apatites, which may pro-vide a stronger signal for C 4 carbohydratesin t h e die t . U n t i l s u c h re s e a rc h is c a rr ie dout, it w ill be extremely d ifficult to interpretinter-sam ple caries experience or the rela-t ive importa nce of var ious dietar y a nd n on-dietary factors in the production of cariesover the short t ime period represented bythe existing historical samples.

ACKNOWLEDGMENTS

We tha nk Tra cy Rogers, G erry B oyce, andSylvia Abonyi for their a ssistance with vari-ous pha ses of this study. We a lso thank St .Thoma s Anglican C hurch, B elleville for ini-t i a l p e r m i s s i o n t o s t u d y t h e r e m a i n s a n dHeat her McKillop for init ia t ing t he skeleta l



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project . S ta ble isotope a nalysis w as carriedout in the Sta ble Isotope La borat ory, Depart -ment of Physics, University of Calgary un-der the direction of H.R. Kr ouse. St a ff of the

Ontario Agricultural Museum, the CanadaWest In dies Molass es Company, the Onta rioM inis t ry of N a t u ra l R e sou rce s, a n d B e l le -ville P ublic Wat erworks w ere instrumenta lin offering helpful reference informa tion.Th a n k s a l s o g o t o An n H e r ri n g f or h erdiscussions on historical background and toJ erry Cybulski for reading and commentingon the manuscript.

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