Comparative Study on the Dental Health Status of Five Precolumbian Peruvian Cultures Elzay et al

8/10/2019 Comparative Study on the Dental Health Status of Five Precolumbian Peruvian Cultures Elzay et al

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Comparative Study on the Dental Health Status ofFive Precolumbian Peruvian Cultures

RICHARD P. ELZAY 2 MAHVIN J . ALLISON AKD ALEJANDRO PEZZIA IDepartment of Pathology, Medical Collegeof Virginia, Health Science Dioision,

Virginia Comtno nwea lth Cniuersity, Richm ond, Virginia 23298, andMuseo Regional de Ica Ica Peru

KEY WORDS Dental Heal th Precolumbian . Peruvian . Man-dibles.

ABSTRACT In a survey ofdental health statusof ancient So uthern Peru, 101skeletal remains were s tudied fromfive cultures: Paracas, Nazca, Tiahuanaco, Ica,

and Inca. T he Paracas and Ica cul tures exhibi ted m ore missing antemortem tee thper mandible than the other cul tures . Frequency of missing one or more thirdmolars was less than ex pec ted and not as high as reported in peoplesofMongoloidheritage. T he Paracas, Ica and Nazca, coastal cultures had a higher caries inci-dence than t he inland cultures . W hether this relatesto some difference in diet orwater supply remains unresolvedand warra nts further investigation. M oderate at -trition was noted in all th e Precolumbian cultures but pulpal involvement was notobserv ed. Osteitis, note d in all th e cultures, was more pro noun ced in th e Nazca,Paracas and Ica cul tures . There appeared tobe a direct re lat ionship betweencaries involvement and th e num ber of missing mte m orte m te eth to ostei tis . Calcu-lus was heavier in th e Paracas and Ica cultures. In addition, th e Paracas culturee x -

hibited a dark brow n stain on th e teet h which may imply some difference betwe enth e cultures in either t he food. water or social habits.

Heports in English on dental characteris-tics of ancient and modern Peruvian cul-tures are scarce. Only Goaz and Miller(661, Leigh 371, and Stewart (31) re-ported on dental morphology and pathol-ogy of th e precolumbian Peruvian Indians.The purpose of this study is to evaluate thedental health status in ancient peoples of

different cultures to further our under-standing of the development of dental dis-eases in man and to provide baseline datafor comparisons.

In a search for dental health status of ancient Southern Peru, we studied 101 skele-tal remains from scientifically excavatedcemeteries in the department of Ica. Thecultures studied were the Paracas (600B.C.-100 A . D . ) , Nazca (100 B.c.-800 A.D.),Tiahuanaco (900 ~.u.-1,200 .D . ) , Ica (1,200~.D.-1 ,450 .D . ) and Inca (1,450 ~ . - ~ . - 1 , 5 3 2A.D.).

A M . . PHYS. ANTHROP., 6: 135-140.

MATERIALS 4ND METHODS

One hundred and one dry, disarticulatedmandibles of permanent dentition, sepa-rated by cultural group but not b y age orsex, were included in the survey. The max-illae were not used because they were sep-ara ted from the mandibles, were fewer innumber and in generally poor condition.Since a dental radiographic unit was notavailable, all examinations were completedb y gross examination of materials with den-tal probes and explorers under optimallight.

The only teeth counted as missing werethose apparently lost prior to death (an-temortem) as shown b y osseous healing inthe edentulated area. Third molars wereconsidered absent if the area posterior to

Supported by a grant from the National GeographicSociets.

135


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136 R P CLZAI, M J. ALLISON AYD A PEZZT4

the second molar showed no gross signs ofan erupting tooth and if the area exhibitedno evidence of previous tooth loss and sub-sequent repair. If the third molar crownappeared within the bone but not com-pletely erupted the tooth was classified aspartially erupted. The lack of a dentalradiographic unit prevented further clari-fication.

Severe attrition or abrasion with no grossloss of crown enamel was scored as 0; 1 ifenamel loss on cusp tips did not involve thegrooves and fissures; 2 if the enamel loss in-volved the grooves and fissures; and 3 ifthe process eliminated the grooves andfissures on the occlusal surface. This sys-tem differs from the Attrition Index ofLavelle ('73) only in omitting a fourthcategory for teeth having pulp exposurefrom attrition and in recording the highestscore, most severe, noted on the specimenin lieu of individual scores for all teeth ofthe specimen.

The incidence of dental caries wasrecorded two ways. First, caries wererecorded according to the DMFS (de-cayed, missing, filled, surfaces) index. If atooth has a carious lesion involving onlyone of its five surfaces, i.e., mesial, distal,buccal, lingual and occlusal (incisall, it wasgraded as 1 . A missing tooth (antemortem)or one with all five surfaces carious re-ceived a score of 5 . This system denotesseverity of disease whereas reporting per-cent of teeth affected reports only thecaries rate. The second method was amodification of the DMFS index. Whilemost tee th are lost today as a result of den-tal caries, teeth may have been lost inearlier times via trauma, periodontal dis-ease or pulpitis from severe attrition.Hardwick ('60) developed a method at-tempting to correct this; however, it ismore meaningful to express caries inci-dence by omitting missing teeth. Hencedental caries involvement is expressed asDS (decayed tooth surfaces) per tooth andjaw (specimen).

'The condition of osteitis was recorded aspresent or absent only. Gross evidence of

either bone destruction and/or prolifera-tion with or without a fistulous tract wasrecorded as osteitis.

The degree of calculus formation was in-dicated as L (light) if less than 1 mm ofcal-culus was deposited on the lingual surfacesof the anterior teet h; M (moderate) if con-comitant deposition around posterior teethw a less than 1 mm; and H (heavy) if calcu-lus deposition on anterior or posteriorteeth exceeded 1 mm.

Bone loss was recorded on a scale of 0for no gross evidence: 1 for interdentalfcrestal) bone loss between adjacent teeth;2 for bone loss down to the bifurcation areaof the roots; and 3 for bone loss beyond thebifurcation area. In any one jaw specimenonly the most severe manifestation of boneloss was recorded.

RESULTS

The results are tabulated in tables 1 2,and 3. As noted in table 1, thc Paracas cul-ture exhibited the highest incidence ofmissing tee th , an average of 4.3 per mandi-ble followed b y Ica with 4 then Nazca with2.9, while Inca and Tiahuanaco had thehighest incidence of missing and partiallyerup ted third molars, and Ica, Paracas andNazca had the most missing first and sec-ond molars.

Eight jaw specimens were discarded forattrition and caries evaluation becausesome teeth were severely broken. Resultsare noted in table 2. All cultures exhibitedmoderate attrition with no appreciable dif-ference between them. Diagonal attritionand pulpal involvement was not observed.

A total of 656 tee th were examined fordental caries incidence. In table 2 resultsare indicated first as mean DMFS per toothand jaw. The Ica and Paracas cultures hadthe highest incidence of caries followed b ythe Nazca while the Inca and Tiahuanacohad the lowest. To compensate for errorsincumbent upon the supposition that teethmissing were not necessarily lost as a resultof caries, missing antemortem teeth werediscounted and caries was reported as


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DEUTAL IIEhLTH OF FIVE PERLI\IAiW LULIUHES

ThBLE 1

Frequency of mzssing or unerupted teeth

137

C u l t lire Teeth lost

ParacasNazcaTiahuanacoIcaInca.4vt:ragcs

N

4412199

1720.2

NTP

704192304144272323.2

No R

190 2735 1836 1236 2.530 1165.4 18.6

h13

X Teeihlost per

3.42.91.94.01.82.98

d U

missing1 or both

2050

113.6

Q with1 or 110th

cruptedplrtlcllly

201;261 15024.8

lacking1 o r tmttr

\ 1

605021552341.8

5 Isrking1 or both

XI2

5258105 52339.6

N . numlwr of j a w specimens; NTP. numbcr of teeth possible X, mean

TABLE 2

Frequency and seoerity of attrition and dental caries

X Caries based on DbFS Caries based on DSScore of

Culture attrition 2 DMFS: DMFSi . DS/ 2 DS/N 0,1,2.3 T N T tooth j aw TNT tooth jaw

Paracas 41 2.1 298 3.13 19.1 298 0.43 2.84Nazca 11 2.0 86 1.72 13.4 86 0.14 1.09Tiahhuanaco 18 2.1 156 1.01 8.3 156 0.06 0.45IL a 1.7 42 4.60 21.2 42 0.69 4.15Inca 16 1.9 74 1.70 6.8 74 0.12 0.56

Averages 18.6 1.96 131.2 2.43 13.76 131.2 0.288 1.82K, umher ofjaw specimens; INT, otal number of teeth. X, mcan: DMFS decay ed missing filled tooth surfaces

DS ecayed surfaces.

TABLE

Frequenc g and seuerity of osteitis, calcuEirs and bone loss

(:alclllrls Bonr lossOxteitis

Culture affected X scoreaffprtrd N Light Moderate Heavy N 0,1,2.3

Paracaa 44 34 41 28 54 18 44 1.7Nazca 12 42 11 82 18 12 1.5Tiahuanaco 19 16 18 88 6 6 18 1 0Ica 9 22 7 29 42 29 7 1.3Inca 17 18 16 88 12 17 1.3Averages 20.2 26.4 18.6 63.0 26.4 10.6 19.6 1.36

N, number of j a w specimens: X, mean.

mean decayed surfaces DS)per tooth andjaw. By this method the results were stillthe same but decreased in magnitude.

Of 101 mandibles examined grossly forosteitis, the Nazca culture exhibited thehighest incidence 42 as shown in table 3 .

The Paracas was second with 34 , whileinvolvement in the remaining three cul-tures was 22 and less. Of 93 mandiblesexamined for calculus accumulation theParacas and Ica cultures had thc highestdegree of moderate and heavy involve-


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138 R. P ELZAY. 11 ALLISON AND A PEZZIA

ment. The remaining three cultures hadlight to moderate accumulations while noheavy accumulation was noted in theNazca or Inca cultures. The cultures ex-hibited moderate hone loss but little dif-ference was noted between them.

DISCUSSION

Results indicate that t he Paracas and Icacultures had the highest incidence of miss-ing antemortem teeth and the leastaffected cultures were the Inca andTiahuanaco. These findings parallel find-ings on dental caries incidence. The dataon missing first and second molars also cor -relates to the caries experience. The inci-dence of antemortem tooth loss has beenreported to decline spectacularly with thetransition to an agricultural culture from41.6% loss in early hunting and gatheringeconomies to 6.2 n most recent phases(Sweeney, 65 .The Precolumbian ciilturesof this study were primarily agriculturalcultures. Average tooth loss for combinedcultures was 18.6%. Tabulated findings onantemortem tooth loss in ten prehistoricadult populations show 19.9% loss for CranCanaria (Brothwell, 63). The Inca andTiahuanaco cultures had the highest inci-dence of missing and partially eruptedthird molars. They also had low scores forcaries, bone loss and calculus suggestingthat although the two samples were adultsthey were of younger age than the otherculture samples.

Although two of the cultures may havebeen young adults, the average incidenceof third molar hypodontia was 3.6%. Car-bone11 (63) reported 2.6% incidence ofthird molar hypodontia (mandibles only) inthe Kish of Mesopotamia (3,000 B.w.) whileCrispim, et al. (72) reported 8% per quad-rant and 2 for all four third molars in atrihybrid Brazilian population. Niswander67) reported a 30.5% ncidence of one or

more missing third molars in the XavanteIndians of Brazil, and Dahlberg (63) indi-cated that Mongoloid people have a higherpercentage of agenesis of third molars thando other groups. The present data are sig-

nificantly less than expected for a people ofalleged Mongoloid background. An obviousdifficulty in comparison of available data isthe lack of uniformity in reporting results.

Our findings on attrition indicate thatthe five Precolumbian cultures had moder-ate attrition and no resulting pulp expo-sures. Occlusal wear pattern was not no-ticeably oblique as noted in cultures whereteeth are used to strip husk or bark from afood source. It would appear that the cul-tures shared a similar diet in terms of con-sistency and/or preparation. Previous re-ports on Precolumbian Peruvians similarlyfound no severe attrition or pulp involve-ment (Leigh, 37; Stewart, 31). SimilarlyCarbonell (66) ound no pulp involvementfrom attrition in ancient hlesopotamians.Although the data on partially eruptedthird molars suggest that the Inca andTiahuanaco specimens are of a youngerage, they still had attrition effects similarto the specimens of the other cultures.

Results on dental caries have meaningonly when comparisons are made amongthe cultures observed. Especially as onlymandibles were examined and most paleo-dontological studies report percent oftee th af fected rather than severity. Whilelower age may influence the low caries inthe Tiahuanaco and Inca cultures, causesfor different caries incidence in the re-maining groups are not as obvious. Thethree groups scoring high on caries alsoscored highest in osteitis involvement, alsoa sequelae of dental caries. The Ica, Nazcaand Paracas which had the highest cariesincidence were all coastal as opposed toinland cultures. Something in the diet orwater of the inland people such asfluoride could have protected them againstcaries. Further investigation on fluoridecontent of bones and teeth should shedsome light on this relationship.

The maxillae are more frequently in-volved with caries than the mandible(Shafer, 74). In our study 70% of the man-dibles had one or more carious lesions.Leigh (37)reported a 35 incidence inspecimens having both jaws. The reason for


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DENT4L HEALTH OF FIVE PERIX'IAN CULTURES 139

the higher caries incidence in our study isunknown. The incidence in the combinedadult population in the United States as of1962 was 20.4 DMF teeth per person (U.S.Dept. Health, '62). The overall average ofDMFS per specimen in the Precolumbiancultures was 13.76. This figure is lowerthan the above rate and if maxillae wereincluded in our study the difference couldconceivably equalize. Caries data on pres-ent day Peruvians are not available forcomparison.

Osteitis was noted in all five cultures.The higher incidence in the Nazca, Paracasand Ica culture paralleled the findings onmean number of missing antemortem teethwhile calculus accumulation appeared torelate directly to t he caries incidence. Theabsence of heavy calculus in the Nazca andInca cultures may once again relate to theage of the sample. Whether the presenceof the dark brown coronal stain in theParacus relates to the type of water supply,diet or habit of chewing coca remainsunresolved.

The amount of alveolar bone loss wasmoderate among all the cultures and boneloss did not cor relate directly with calculusor caries scores. The slight association withattrition scores may imply that heavymastication forces were present. It isplausible that a less refined and abrasivediet caused b y moderate attrition andalveolar bone loss in the cultures irrespec-tive of age.

ACKNOWLEDGMENTS

The authors would like to express theirindebtedness to Mark S. Elzav for his

Mrs. Phyl Schureman for her patience dur -ing the preparation of the manuscript.

LITERATURE CITED

Brothwell, D. R. 1963 The Macroscopic DentalPathology of some ctarlier human populations. In .Dental Anthropology. Vol. 5 . D. R. Hrowthwell, ctd.Pergamon Press, Oxford, p. 278.

Brothwell, D. R., V. M. Carbonell and D. H. Goose1963 Congenital absence of tee th in humans. In:Dental Anthropology. Vol. 5. D. R. Brothwell, ed.Pergamon Press, Oxford, p. 184.

Carbonell, V. M 1966 The Paleodontal Pathologyof Ancient Mesopotarriianb. J. Dent. Res., 45: 413.

Crispim. J., K. G. Triqueiro, S. .4. . Beneuides Filhoand F. M. Salzano 1972 Third molar agenesis in atrihybrid Brazilian population. Am. J . Phys.Anthrop., 37: 189-292.

Dahlherg, A. A. 1963 Analysis of the American In-dian dentition. In: Dental Anthropology. Vol. 5. D.R. Brothwell, ed. Ptx-gamon Press, Oxford, p. 171.

1966 A prelimi-nary description of the dental morphology of thePeruvian Indian. J Dent. Res., 45: 106-1 19.

Hardwick, J. F. 1960 The incidence and distribu-tion of caries throughout thc ages in relation to theEnglishman's diet. Brit. Dent. J . 1 8: 9-17.

Lavelle, C. L. 1973 Alveolar hone loss and toothattrition in skulls from different population samples.J, Periodontal Hes., 8 : 395-399.

Leigh, R. W. 1937 Dental morphology arid pathol-ogy of Pre-Spanish Peru. Am. J. Phys. Anthrop., 22:267-296.

Niswander, J D. 1967 Further studies on XavanteIndians VII: The oral status of Xavante of SimoesLopes. Am. J Human Gonct., 19: 543-553.

Shafer, Q7 G., M . Hine and B. hl Levy 1974 ATextbook of Oral Pathology. Third ed. W. B. Saun-ders Co. hiladelphia, p. 395.

Stewart, T. D. 1931 Dental caries in Peruvianskulls. Am. J. Phys. Anthrop., 15: 315-326.

Sweeney, E. A. 1965 Dental caries in Tehuxanskeletons. Science. 149: 1118.

US. Department of Health Education and Welfare

1962 Selected dental findings in adults h y a p s ,race and scx, National Center for Health Statistics,Services 11. No. 7. Public Health Service, Rcthesda,

Goaz, P. W. and M. C. Miller, 3rd

efforts in collecting some of the data and to Maryland.

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Comparative Study on the Dental Health Status of Five Precolumbian Peruvian Cultures Elzay et al