The Global History of Dental Caries and Links to Systemic Health

Dental caries and oral health generally are central to understanding systemic health, quality of life, and fundamental aspects of lifestyle (e.g., diet and nutrition).  Epidemiologists and others have tracked the record of oral health, especially in Western settings over the last half century.  Biological anthropologists provide the important perspective of the prehistory and history of dental caries and other oral conditions that go back thousands of years, giving essential context for understanding prevalence and pattern in people today.  This paper discusses the results of a research program focusing on the history of oral health, with special focus on dental caries, over the last 10,000 years in Europe.  Dental samples are from 400 localities, representing some 9500 individuals.  Statistical treatment reveals age-related increases in dental caries prevalence (r², p<0.001).  Temporal comparisons reveal dramatic increase in prevalence, especially between the Early and High Middle Ages (AD 500-1300; chi-square, p<0.02) and the High and Late Middle Ages (AD 100-1500; chi-square, p<0.007).  These temporal trends reflect increased consumption of plant carbohyrates and the later access to sugar brought about by trade relationships.  Women have significantly greater prevalence than men (chi-square, p<0.0007), a pattern reflecting differential access to animal sources of protein as well as amount of carbohydrates in diet.  Antemortem tooth loss and other oral conditions (e.g., infection and abscesses) mirror these trends.   Similar to the growing record of association between oral pathology and systemic disease and early death in living populations, this analysis suggests that elevated levels of poor oral health coincides with increased morbidity and increased mortality in past populations.  In this regard, analysis of oral health and skeletal health in the European samples show strong associations with regard to the increased prevalence of skeletal infection and other indicators of health.  We suggest that poor nutrition and deterioration of living circumstances in early life may have predisposed populations across Europe to susceptibility to the arrival of new epidemic diseases (e.g., leprosy, tuberculosis, plague).  The record of increased dental caries, both a dietary and health marker, in younger individuals and the burden of generally poorer health likely played an important role in understanding reduced living conditions for past Europeans, the European diaspora globally, and human populations today.