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Erosive and Mechanical Tooth Wear in Viking Age Icelanders

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Erosive and Mechanical Tooth Wear in Viking Age Icelanders dentistry journal Article Erosive and Mechanical Tooth Wear in Viking Age Icelanders Svend Richter * ID and Sigfus Thor Eliasson Faculty of Odontology, University of Iceland, IS101 Reykjavik, Iceland; [email protected] * Correspondence: [email protected]; Tel.: +354-5254850 Received: 2 March 2017; Accepted: 30 May 2017; Published: 29 August 2017 Abstract: (1) Background: The importance of the Icelandic Sagas as a source of information about diet habits in medieval Iceland, and possibly other Nordic countries, is obvious. Extensive tooth wear in archaeological material worldwide has revealed that the main cause of this wear is believed to have been a coarse diet. Near the volcano Hekla, 66 skeletons dated from before 1104 were excavated, and 49 skulls could be evaluated for tooth wear. The purpose of this study was to determine the main causes of tooth wear in light of diet and beverage consumption described in the Sagas; (2) Materials and methods: Two methods were used to evaluate tooth wear and seven for age estimation; (3) Results: Extensive tooth wear was seen in all of the groups, increasing with age. The first molars had the highest score, with no difference between sexes. These had all the similarities seen in wear from a coarse diet, but also presented with characteristics that are seen in erosion in modern Icelanders, through consuming excessive amounts of soft drinks. According to the Sagas, acidic whey was a daily drink and was used for the preservation of food in Iceland, until fairly recently; (4) Conclusions: It is postulated that the consumption of acidic drinks and food, in addition to a coarse and rough diet, played a significant role in the dental wear seen in ancient Icelanders. Keywords: enamel erosion; mechanical tooth wear; Icelandic settlers 1. Introduction Wear is a generic term used in dentistry to describe phenomena of attrition (proximal and occlusal inter-dental friction), abrasion (friction with the intervention of particles) and erosion (chemical dissolution). This terminology suggests that these three phenomena act independently, whereas in fact it is more often the case that they interact simultaneously, which makes the diagnosis more difficult [1]. Dental erosion is tooth surface loss caused by extrinsic or intrinsic forms of acid. Extrinsic erosion is due to a highly acidic diet, while intrinsic erosion is caused by regurgitation of gastric acids [2]. Erosion softens the dental hard tissues, making them more susceptible to attrition and abrasion. Thus, if erosion and bruxism both exist, surface loss due to attrition is faster. The different physiological processes of tooth wear (abrasion, attrition and erosion) usually occur simultaneously and rarely work individually. Therefore, it is important to understand these tooth wear processes and their interactions to determine causes of tooth surface loss [1]. It is the norm to see extensive tooth wear in all ancient societies and is considered a major cause of tooth problems [1]. Tooth wear studies based on skull material from archaeological excavations have mainly been attributed to factors related to diet [3,4]. Acid erosion is hardly ever mentioned as a possible cause of this observed tooth wear [2]. From skeletal remains, evidence for dental health of ancient populations can be provided. The study of the ancient dentition can assist in reconstructing the lifestyle patterns and shed light on dental and general health. Among the conditions considered are ante mortem tooth loss, root abscesses, caries frequency, alveolar bone loss and occlusal tooth wear [5]. Hypo-mineralization of enamel, Dent. J. 2017, 5, 24; doi:10.3390/dj5030024 www.mdpi.com/journal/dentistry Dent. J. 2017, 5, 24 2 of 12 Dent. J. 2017, 5, 24 2 of 12 enamel,enamel enamel hypoplasia, hypoplasia, appearing appearing as lines as orlines pits, or particularlypits, particularly on incisors, on incisors, can can be anbe an indication indication of ofmalnutrition malnutrition or or infections infections during during tooth tooth formation formation [6]. [6]. Observation of of dental dental wear wear patterns patterns is is one of the most commonly util utilizedized methods of age estimation in in adult skeletal remains in archaeology. The The popularity of of this method arises from the high survival raterate ofof teeth teeth within within archaeological archaeological contexts contexts and and the the relative relative ease ease with with which which dental dental wear wearpatterns patterns can be can observed be observed and scored and scored [7]. [7]. Research by trained dental personnel on dental he healthalth in ancient Icelanders has been almost nonexistent. Archaeologists Archaeologists and and anthropologists anthropologists have, have, however, however, noticed, registered and commented on excessive tooth wear without classifying or categorizing the type of wear [[4,5].4,5]. InIn the years 1931–1939, archaeological and and an anthropologicalthropological research research was was undertaken undertaken at at the the Skeljastadir farm farm in Thjorsardalur in Iceland. Si Sixty-sixxty-six skeletons skeletons were were excavated excavated from from an ancient graveyard: 5 infants,infants, 22 children children and and 59 59 adults adults [8 ,9[8,9]. Volcanic]. Volcanic ash ash from from the mountainthe mountain Hekla, Hekla, dated dated from from1104, 1104, covered covered the skeletons the skeletons [10]. [10]. The skeletonsThe skeletons are preserved are preserved in the in Nationalthe National Museum Museum of Iceland. of Iceland. The purpose of this investigation was to undertakeundertake detailed and thorough odontological investigationinvestigation on on the the skulls skulls to tocast cast light light on ondental dental health health in Viking in Viking Age Icelan Age Icelanders,ders, especially especially in terms in ofterms the prevalence of the prevalence and type and of type tooth of wear. tooth wear. 2. Materials Materials and and Methods Methods The skeletonsskeletons werewere examined examined at theat the stores stores of The of NationalThe National Museum Museum of Iceland of Iceland and are inand relatively are in relativelygood condition. good condition. Of the 66skeletons, Of the 66 51skeletons, skulls could 51 skulls be used could for thebe used general for dentalthe general health dental investigation health investigationand 49 skulls and with 49 915 skulls teeth with could 915 be teeth evaluated could forbe evaluated tooth wear. for tooth wear. The examination of the skulls and teeth was performed blinded by the two authors. Agreement Agreement was on more than 90% of allall measurements.measurements. Wh Whenen there there was a disagreement, an agreement was reachedreached based on re-examination and discussion. Seven methods methods were were used used for for age age estimation, estimation, five five were were based based on tooth on tooth development development [11–15], [11– one15], onone tooth on tooth wear wear [16] [16and] and one one on onectodermal ectodermal suture suture closure closure [17]. [17 ].Gender Gender analysis analysis was was performed performed by by using morphological morphological characteristics characteristics from from the the skull, skull, ma mandiblendible and and in in a a few few instances, instances, pelvis pelvis [5,18–21]. [5,18–21]. Two methods were used to register tooth wear. The fir firstst method was simply to register the wear into fourfour categories:categories: (1)(1) nono wear, wear, (2) (2) wear wear in in enamel, enamel (3), (3) dentin dentin exposed exposed and (4)and exposure (4) exposure of the of pulp the cavity.pulp cavity.The second The second method method was that was developed that developed by Brothwell, by Brothwell, where where wear wear was registeredwas registered into 13into groups 13 groups [22] [22]as shown as shown in Figure in Figure1. The 1. The Brothwell Brothwell method method was was limited limited to to the the skeletons skeletons of of subjects subjects 18 18 yearsyears andand older: 22 22 males, males, 21 21 females females and and one one where where gender gender coul couldd not not be be determined. determined. For For statistical statistical calculations, calculations, thethe scale scale for for the the wear wear stages stages was was modified modified and and numbered numbered from from 0 0to to 12 12 as as shown shown in in Table Table 1.1 . Figure 1. BrothwellBrothwell classification classification of of molar molar wear. wear. White White denotes denotes enamel, black is exposed exposed dentine [22]. [22]. Dent. J. 2017, 5, 24 3 of 12 Table 1. Modification of Brothwell tooth wear. Scales for Wear Stages Brothwell Wear Stages (1981) 1 2 2+ 3− 3 3+ 4 4+ 4 5+ 5++ 6 7 Brothwell Wear Stages (authors modification) 0 1 2 3 4 5 6 7 8 9 10 11 12 Tooth wear examination was performed with a dental explorer under good lighting and loupes with 2.8× magnification (Exam Vision ApS, Samsø, Denmark) and photographs with high resolution (Lester A. Dine Inc., Olympus Digital Camera Model No C-5060, Palm Beach Gardens, FL, USA). Conventional dental and radiographic examinations were performed for analyzing abscesses. A portable X-ray unit for X-ray analysis was used (Sirona, Helio Dent, Bensheim, Germany), as well as digital X-ray technology (Trophy RVG Digital X-ray Systems, Eastman Kodak Company, Rochester, NY, USA). Statistical analyses were made in the Stat View statistical software package (Stat View Software, SAS, Cary, NC, USA). R (The R Foundation for Statistical Computing, Vienna, Austria), RStudio (Rstudio, Boston, MA, USA) and Microsoft Excel (Microsoft Corporation, Redmont, WA, USA) were used for analyzing tooth wear in quartiles and the percentage of the scores, while other statistics were analyzed in Stat View. 3. Results Gender distribution was equal: 24 females, 24 males and 1 of unknown sex. Tooth wear for each tooth number is shown in Table2, where 0 means no detectable wear, 1 is wear in enamel, 2 is wear exposing dentin and 3 is wear exposing the pulp cavity.
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