Volume 62 December 1969

Section of OdontologyPresident L J Godden OBE FDS RCS

Meeting March 24 1969at the Royal College of Surgeons,Lincoln's Inn Fields, London

Papers

The Dentition of the Anglo-Saxons[Abridged]by Professor A E W Miles FDS RCS LRCP MRCS(Honorary Curator, Odontological Museum,Royal College ofSurgeons ofEngland, London)

The Anglo-Saxons inhabited at least the south-eastern part of these islands in the years that ledup to the Norman Conquest. They began toarrive from Germany and Holland in about thefifth century AD after the Romans had leftBritain and, at times peaceably but more oftenforcibly, gradually replaced the partially Roman-ized Celts or Britons. The Saxon newcomersgradually became Christianized after the arrivalof St Augustine in Kent in AD 596.The material on which my observations have

been made consists of two separate collections:First, the skeletal remains of about 180 indi-viduals from an Anglo-Saxon cemetery atBreedon-on-the-Hill in Leicestershire and,secondly, the remains of about 80 individualsfrom more recent excavations at Polhill ne%rSevenoaks in Kent (Philp 1967). The Breedonsite is dated by arch2eologists to about AD 800and the Polhill one to about AD 600. They areboth Christian burials, the Breedon very definitelyso and in association with a monastery, but thePolhill burials show evidence of the survival ofpagan customs; grave goods in the form of ironknives, spear heads and so on were found withthe burials.The Breedon material consists of skulls, jaws

and teeth with very few postcranial bones. ThePolhill material is more complete, and much ofthe postcranial skeleton is available. However,it is much more broken up than the Breedonmaterial principally because of the difficulty ofdislodging it from chalk which had becomeseverely impacted around the bones.

The first notable thing about the dentition omany of the Anglo-Saxons in comparison withthat of the present day is the size of the tootharches (Goose 1962). Typically the arches arebroad and the palatal vault low. However, evenwhere the arches are broad (Fig 1), minor irregu-larities in the position of teeth in the arches andminor crowding of the teeth are fairly commonand in a few instances the arches are narrow andthe palate high-vaulted (Fig 2).A second conspicuous feature is the great

amount of wear of the teeth. For example, by theage of 18 years the dentine of several cusps of thefirst permanent molars has been exposed bywear, and exposure of the dentine of the cusps ofthe second molars is commencing (Fig 1). Habitsof less inhibited mastication than those ofmodernman, as well as a diet of coarse character, pro-bably contribute to cause this high rate of toothwear (Miles 1962).The first aim of the study of collections of

skeletal material of this sort is to assess the sexand ages of the individuals. From the ages, if thesample is large enough, it is possible to derive anestimate of the life expectancy of the people andit is only when considered in relation to the agesof the affected individuals that such matters ascaries prevalence have any significance.The ages of the Breedon individuals were

assessed some years ago using tooth wear and themethod described (Miles 1962). The first stageis to assess the ages of the immature ones, up toabout 18 years of age, from the state of develop-ment of the dentitions; the next stage is to extendthe range of 'reliably aged' by a few years, toabout 24 years, by a careful study of the wear ofthe third molar which is assumed to have eruptedat about 18 years. In particular, account is taken(Fig 3) of wear facets at the approximal contactpoints between the second and third molars.It is then possible, if the number of jaws in the

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1312 Proc. roy. Soc. Med. Volume 62 December 1969

Fig 1 Upperjaw ofyoung Anglo-Saxon male (estimatedage, 18 years, from partially erupted third molar).Although the palate is broad, there is some crowding ofthe teeth. Wear has exposed the dentine of severalcusps of the first molars which bear unusually largecusps of Carabelli. (Breedon specimen No. 93)

Fig 3 A, pointer indicates a facet of wear on the distalaspect ofM1 ofa 14-year-old; this represents two yearsofwearfrom contact with M2 (Polhill specimen No. 66).B, pointer indicates a facet of wear of similar size ondistal aspect of M2; assuming that this represents twoyears of contact with M3, which erupted at 18 years,an estimate of 20 years for the age of the subject isarrived at. (Polhill specimen No. 95)

series is large enough, to appraise the rate of wearof the permanent molars up to the age of about24 years. Finally, by an extrapolation of thisinformation, by comparing the wear of the teethof slightly older ones, one by one progressively,with the reliably aged group and comparingdegrees of third molar wear with those of firstand second molars, ages are assigned to the olderones.The ages of the Polhill specimens were assessed

using tooth wear systematically in this way.The result for the 78 subjects for which there wassufficient material available is depicted in Fig 4,and that for the Breedon population in Fig 5.The Breedon estimates are depicted in comparisonwith a typical distribution of deaths in a knownpopulation prepared from the Registrar General's

Fig 2 Upper jaw of Anglo-Saxon with narrower andhigh-vaulted palate. Female aged 30 years, estimatedfrom tooth wear. The left third molar shows cariesstarting in the enamel of an occlusal fissure, a type ofcaries which is very unusual in this material. (Breedonspecimen No. 55)

figures for 1960. The Breedon distribution, withits peak deaths at a much younger age, 35-40years, than in the modem population, comparesfairly well with the typical distribution, theabsence of an infant mortality peak being ac-countable for by the failure of infantile bones tosurvive prolonged burial. The mean of theestimated ages of the Breedon material, whichgives a rough estimate of the expectation of lifeat birth for a population, is 31 years. This agreesclosely with estimates of 30 years for the expecta-tion of life in Ancient Greece and 35 years inthirteenth-century England (Dublin et al. 1949).The distribution curve of the estimated ages ofthe Polhill material agrees much less well. Themean age is only 24 years, and there is an overallpreponderance of young subjects. For example,more than half are below the age of 25 years.The discordance of the Polhill age distributionmay be due simply to the smallness of the sample.Alternatively, there may have been a chanceinclusion of a group of young burials. The areaso far excavated is estimated to be only aboutone-half of the total burial area.

Fig 6 records the stature of the Polhill Anglo-Saxons calculated from the length of long bonesusing the anthropometric formula of Trotter &Gleser (1958) and, for the immature bones, dataprovided by Camps (1968). The majority of malesare not much more than 5 ft 6 in (1I68 m) talland there are none that reach 6 ft (1-83 m) so wemust regard them as a little short compared withthe contemporary Englishman. The women,naturally, are a bit shorter and show a similarspread. The 5+-year-old child, at 3 ft 11 in

22

Section ofOdontology

(1.19 m) is rather tall but the 7- and 12-year-oldare near the mean for present-day children.The material was examined carefully for evi-

dence of absence of third molars; radiographywas employed wherever necessary and the distalaspects of second molars were examined for facetsof wear that would indicate the presence of afunctional third molar. In the Polhill material,out of a possible 148 situations where it could bejudged whether a third molar was present or not,14-2% were absent. In the Breedon material,out of a possible 282 situations, the correspondingfigure was 11-2%. These figures agree fairly wellwith those for modem Europeans; for example,Grahnen (1956) found 12-1 % of third molarsabsent among 1,064 Swedes, and Keene (1965)found 15-4% absent among 257 young Americansof European ancestry. Similar figures are quotedby Greene (1967).

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Fig 4 Histogram ofestimated ages ofthe 78Polhill Anglo-Saxons in 5-year groups

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Aqe at Death

Fig 5 Histogram (unshaded columns) of estimated agesof the 157 Breedon Anglo-Saxons in 5-year groups. Ahistogram (shaded columns) representing the agedistribution of 157 hypothetical deaths for a 1960population is superimposed. (Reproduced from Miles1962)

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Fig 6 Stature of39 Polhill Anglo-Saxonsestimatedfrom the long bones

Caries of the kind we are familiar with today,starting in fissures and attacking the approximalenamel surfaces, is excessively rare in theseAnglo-Saxons but they did suffer from a ratherspecial kind of tooth decay - or rather two kinds -that arose as a complication of tooth wear. Wearat the occlusal surfaces is associated with veryconsiderable wear of the contact surfaces betweenthe teeth and, when the occlusal enamel was lostthe enamel between the cheek teeth, alreadythinned and weakened from approximal wear,was very apt to break away. This led to foodstagnation, and caries attacked the dentinesurfaces exposed by the fracture of enamel(Fig 7).A second type of caries attacked the exposed

surfaces of roots. Gingival recession, which, fromthe state of the alveolar crests, was probablyassociated with gingivitis, was common andseems to be related to wear and in particular toloss of the approximal architecture. It was thennot uncommon for the exposed cervical part ofthe root surface to be attacked by caries, especi-ally interdentally.

This is a type of caries that differs very sub-stantially from that of modem man and has adifferent etiology; for one thing it is not theenamel which is the site of primary attack but thedentine. From some experience of caries in othergroups of ancient skulls, I would say as a widegeneralization that primary caries of enamel isvery unusual and most of the caries that occurredin early times, and much of the periodontaldisease also, was secondary to tooth wear. Henceit is a great pity that so many writers haveignored these differences and we find in the

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1314 Proc. roy. Soc. Med. Volume 62 December 1969

A

Fig 7 Diagrammatic representation ofcaries associatedwith wear. A, the worn occlusal surfaces, the shadingbeing exposed dentine; wear has flattened the approxi-mal surfaces and thinned the approximal enamel which,now weakened, is liable to fracture leaving exposeddentine which is commonly attacked by caries. B, buccalview; the alveolar crests have receded and caries isdepicted on the exposed root surfaces starting eitherinterdentally or buccally

literature misleading comparisons between theprevalence of caries in early peoples and that inmodem man without any definition of the type ofcaries referred to. The value of such comparisonsis often diminished still further by the absence ofany reference to the ages of the subjects to whichthe statistics refer. It would, of course, beridiculous to quote figures for the prevalence ofcaries in present-day peoples without relating thefigures to the age of the subjects concerned.

There are many difficulties in producing usefulstatistics for caries prevalence in skeletal remains.First, it is necessary to do the best one can withincomplete jaws from which there has nearlyalways been some post-mortem loss of teeth.Then there is the problem of teeth that havebeen lost during life. Ante-mortem tooth loss,which was quite common after the presumptiveage of 30 years or so, was no doubt sometimesdue to tooth wear leading to exposure of thepulps, sometimes to caries attacking the exposeddentine, sometimes to periodontal disease, andparticularly to periodontal abscesses, but mostoften probably due to a combination of all theseprocesses.Where a major part of the dentition remains,

it is possible to hazard a guess regarding thecause of the ante-mortem loss of the remainder,based upon the condition of the teeth present.If they are affected by caries and bone loss fromperiodontal disease is not predominant, carieswould seem to be the more likely cause of ante-mortem loss. Periodontal disease would seemmore likely, on the other hand, if the teeth presenthad suffered much bone loss and there was little

caries. However, as in this material both cariesand periodontal disease appear to be secondaryto tooth wear, there seems little to gain in strivingafter such distinctions.

Fig 8 depicts in a very simplified way the cariesprevalence and ante-mortem tooth loss in thismaterial. The Breedon and Polhill material hasbeen pooled because there are no big differencesbetween them. Practically all the caries, includingthat in the deciduous teeth, is of the wear-fracturetype. The numbers of teeth available for examina-tion are small and not sufficient for full statisticaltreatment. For example, 3-6% of 193 deciduousteeth means that there are only about 7 instancesof caries. The data for anterior teeth have beenomitted. There is very little caries indeed amongthem, even of the wear-fracture kind. There arehardly any examples of caries of any sort before20 years but in those over 30 years it remainsin the 13-17% region with something of a fallafter the presumptive age of 50 years because bythen many of the cheek teeth have been lost.A surprising feature of the Breedon material,

which is not so common among the Polhill

22144142- .30. Ll'28

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PERMANENT CHEEK TEETH

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Fig 8 Percentage of teeth carious among 203 Anglo-Saxons (shaded columns). The data for the permanentteeth relate to cheek teeth only (there were only 5carious lesions in the incisors and canines of the wholematerial). The numbers of teeth examined are indicatedon each column. The open columns show the percentageof teeth missing. (The data for third molars are omittedfrom this because of the uncertainties involved indeciding whether such teeth are absent congenitallyor through disease.) The numbers oftooth sites availablefor examination are indicated. Absence ofteeth depictedcould be caused by caries, periodontal disease or otherprocesses

ffI -

24

384

5871

25 Section ofOdontology 1315

sample, is the presence of supragingival calculus.There are several examples where a great deal ispresent on the labial aspects of the incisors oras a festoon just above the gingival margins ofcheek teeth (Fig 9). This is surprising to find inassociation with the active function and probableconsumption of fibrous foods indicated by thepresence of so much tooth wear. It seems reason-able to suggest that this supragingival calculusmay have accumulated during a febrile terminalillness extending over weeks or a few monthsduring which a soft pappy diet was consumedand there was mouth breathing. Bronchialpneumonia and pulmonary tuberculosis come tomind as possibilities but this is, of course, purelyspeculation.

There are a number of examples of more grosspathology, especially among the better preservedBreedon material; for example, 4 instances ofgross arthritic changes in the temporomandibular

Fig 9 Right manzdibular teeth of a female of estimatedage 37 years. Although there is much occlusal wear, thecheek teeth are festooned with supragingival calculusand calculus almost covers the labial aspects of theincisors. (Breedon specimen No. 106)

>4

Fig 10 Gross arthritic changes in the right temporo-mandibular joint of a female, estimated age 60 years.The pointer indicates the glenoid cavity, seen frombelow, which has been converted into a flat, rough andlipped surface. The mandibular condyle, arrangedbelow is eroded and flattened with a characteristicshelf-like anterior projection. The contralateral jointwas similarly affected. (Breedon specimen No. 27)

S.::|...... :.. : :.:........: .::

Fig 11 Mandible ofa child aged about 14 years, showingchanges, with loss of substance, in the right molarregion probably due to infection. There is considerabledeformity at the angle and possibly the infection wasassociated with a now united fracture at that region.However, there is now a partially united fracturehigher up through the vertical ramus. The teeth bear agreat deal ofsupragingival calculus. (Breedoni specimenNo. 72)

joint, one bilateral (Fig 10), a fracture of themandible (Fig 11) and a unilateral hyperplasia ofthe mandibular condyle. The top of the craniumof one of the Breedon skulls has been cloven by asharp weapon, sword or battle-axe.

Acknowledgment: I am grateful to Mr D H Hainesfor his generous help in the examination of thePolhill material.

REFERENCESCamps F E ed(1968) Gradwohl's Legal Medicine. 2nd ed. Bristol; Chap. I1Dublin L I, Lotka A J & Spiegelman M(1949) Length of Life. A Study of the Life Table.2nd ed. New YorkGoose D H(1962) Arch. oral Biol. 7, 343Grahnen H(1956) Odont. Revy 7, Suppl. 3Greene D L(1967) Univ. Wyo. Publ. 33, 93Keene H J(1965) Angle Orthodont. 35, 289Miles A E W(1962) Proc. roy. Soc. Med. 55, 881Philp B(1967) Kent arch/ol. Rev. No. 9, p 2Trotter M & Gleser G C(1958) Amer. J. phys. Anthrop. 16, 79

The following paper was also read:

Studies in Experimental Oral PathologyProfessor B Cohen(Department of Dental Science,Royal College of Surgeons ofEngland, London)