dental disease in the nile valley during the new kingdom

International Journal of OsteoarchaeologyInt. J. Osteoarchaeol. (2009)Published online in Wiley InterScience

054
(www.interscience.wiley.com) DOI: 10.1002/oa.1
* Correspondence to: DepUniversity, West Lafayette, Ie-mail: [email protected]

Copyright # 2009 Joh

Dental Disease in the Nile Valleyduring the New Kingdom

M. R. BUZONa* AND A. BOMBAKb

a Department of Anthropology, Purdue University, West Lafayette, IN, USAb Department of Anthropology, University of Manitoba, Winnipeg, Canada

ABSTRACT This study examines evidence for dental disease (caries, abscesses, antemortem tooth lossand severity of dental wear) in Nubian and Egyptian groups living in the Nile Valley during theNew Kingdom. Specific attention is given to individuals buried at the site of Tombos, acemetery in Nubia used during the Egyptian colonial occupation. In addition, three Nubianand two Egyptian samples are included for comparative purposes. While some similarities incondition frequencies between Tombos and the comparative groups are apparent, especiallyin the rates of caries and abscesses, significant differences in antemortem tooth loss andseverity of tooth wear point to variation in these Nile Valley samples. These differences areespecially evident for males. Higher rates of these conditions at Tombos may be attributed tothe socio-political and cultural changes taking place during this time of colonial occupation.Changes in foodways and occupational environments may have resulted in stress, asdemonstrated by these dental conditions experienced by the Tombos people throughoutthis transitional period. Copyright � 2009 John Wiley & Sons, Ltd.

Key words: Nubia; Egypt; caries; abscess; antemortem tooth loss; tooth wear; colonialism;

culture contact

Introduction

Analysis of dental disease in archaeologicalremains is frequently and productively employedto gather information on the general health anddiet of past populations (e.g. Buzon et al., 2005;Larsen, 1997). Combined with the examinationof general stress indicators and information aboutthe identity and composition of the population,the exploration of dental disease data provides anadditional lens through which to view daily lifeexperiences of people in the past.

This study is designed to use the frequencies ofcarious lesions, abscesses, antemortem tooth loss(AMTL) and severity of tooth wear to revealinformation about the state of dental and overallhealth in the Nile Valley around the time of the

artment of Anthropology, PurdueN, USA.

n Wiley & Sons, Ltd.

New Kingdom (c. 1550–1069 BC). Specificattention is given to the New Kingdom site ofTombos, located in ancient Nubia. The examin-ation of overall dental health at this site providesa means through which to view the cultural andbiological changes experienced during a time ofintense contact: the Egyptian New Kingdomcolonisation of Nubia. Archaeological remainsand textual information confirm that the foodresources of the Nile Valley peoples during thistime period were probably quite similar. Due tothis probable homogeneity of available food, thisstudy will also explore factors apart fromsubsistence that may have resulted in variationin dental disease.

Dental disease

The importance of dental health should not beunderestimated, particularly in pre-historic

Received 20 August 2008Revised 14 October 2008Accepted 28 October 2008

M. R. Buzon and A. Bombak

societies. Dental disease is an essential factor inoverall health and serves as an important adaptivepressure in evolution. Wells (1975) contends thatthe inability to chew through tough, abrasivefood stuffs or to use teeth in some instances astools may have seriously affected an individual’slongevity. Prior to antibiotics, dental infectionscould lead to life-threatening ailments (Calcagno& Gibson, 1991) including septic cavernousthrombosis and Ludwig’s angina.

For the examination of dental health in thepast, it is essential to take into account the multi-factorial nature of these conditions when derivingconclusions about diet or health from dental data.The diseases discussed in this study are cariouslesions, abscesses and AMTL. We address thedirect pathological causes that result in thesediseases, as well as the factors that contribute totheir frequencies within populations.

Dental caries is a disease process in which toothenamel is demineralised by organic acid (Larsenet al., 1991; Larsen, 1995, 1997). This acidity isthe result of bacterial carbohydrate metabolism(Hillson, 1979). Therefore, the consumption ofan agriculturalist’s diet high in carbohydrates(Wells, 1975; Larsen, 1995) will lead to a highfrequency of carious lesions. However, it shouldbe noted that not all agricultural crops areassociated with similar, high rates of caries. Forexample, oral health studies in Asia of individualswith rice-based diets do not reveal an increase incaries rates as with other types of agriculturalcrops such as wheat (as reviewed in Oxenhamet al., 2006). Another factor that may affect cariesfrequency is enamel composition, which isaffected by the chemical and mineral compo-sition of soil and water, such as high levels of Nithat may substitute for calcium during theformation of enamel (Schneider, 1986). Otherfactors that may affect caries frequency are foodproduction, attrition and abrasion.

The typical method of preparing an agricul-turalist’s diet, boiling food into a soft, sticky gruel,encourages the accumulation of bacterial coloniesin grooves and fissures of the posterior teeth(Larsen, 1995). Higher levels of tooth wear thateliminate fissures have been associated with lowerlevels of caries (Chazel et al., 2005). Tooth wear(Hall & German, 1975) may also serve as a form oftooth cleaning and encourage healthy gum-root

Copyright # 2009 John Wiley & Sons, Ltd.

relationships by eliminating crowding throughmesial drift and the on-going deposition ofcementum. Hillson (2001), however, discussesthe possibility that a high level of tooth wear maybe cariogenic because it may result in fracturingand dental pulp exposure.

Agriculturalists, through the use of grindingstones, intensive grain collection and pottery inagricultural food preparation (Smith, 1984)usually display oblique wear patterns and candisplay high and rapid levels of wear (Scott andTurner II, 1988; Larsen, 1995). This oblique wearpattern is less evident in Nubian agriculturalpopulations. Beckett and Lovell’s (1994) study onthe Nubian A-Group and C-Group revealed thatNubian agriculturalists may have high levels ofwear as a result of the unintentional or intentionaladdition of grit to food during food preparationor cooking. Wells (1975) has also detailed thehigh levels of tooth wear typical of Egyptianteeth. Oblique wear has also been noted in somehunter-gather groups, such as the Maori, whoalso show high rates of erosion (Kieser et al.,2001).

Abscesses can result from a number of factorsthat form less obvious patterns of causation thancarious lesions. Caries, attrition or trauma canexpose dental pulp to infection which may resultin chronic inflammatory responses such as theformation of periapical granulomata, smallsmooth-walled cavities within the alveolus, whichmay develop into periapical cysts (larger cavitieswith the granulomata tissue replaced by fluid).Subsequently, dental abscesses form. Pus gatherswithin these cavities and will track through pre-existing channels within bone and soft tissuebefore the abscess bursts and discharges (Dias &Tayles, 1997; Hillson, 2001). Populations withhigh levels of caries, calculus or periodontaldisease are likely to have similarly high levels ofabscesses as these can all predispose the tooth toabscessing. Groups with subsistence strategiesthat do not result in extensive levels of caries,calculus or periodontal disease may still exhibitsimilar rates of abscesses, as a result of severe wear(Scott and Turner II, 1988).

Before teeth are lost, an extensive accumulationof plaque stimulates a hypersensitive responsefrom the body’s antigens. These antibodies affectmetabolism and can destroy somatic cells. This

Int. J. Osteoarchaeol. (2009)DOI: 10.1002/oa

Dental Disease in the Nile Valley during the New Kingdom

cellular destruction can lead to the loss of thecollagen fibres that tether the gingivae and teethto the alveolus. The alveolus will resorb andassume a form that is incapable of retaining teeth,and teeth are subsequently lost (Hillson, 1979).Hillson has since (2001) discussed the likelihoodthat chronic periapical inflammation, whichtypically manifests in the form of a periapicalgranuloma near the apex of the tooth, is unlikelyto be a direct cause of AMTL. Acute inflamma-tion, however, usually as a result of a rapidlydeveloping periapical abscess, may have resultedin enough pain that teeth were removedtherapeutically. Periapical bone loss from jawssuffering from disease or remodelling fromcontinuous eruption of teeth may have led totooth loss. AMTL may also result from trauma tothe jaw (Hillson, 2001).

A number of factors contribute to AMTLincluding high levels of caries, periodontaldisease, pulpal exposure, high and rapid levelsof wear (Larsen, 1995), inadequate oral hygiene,sucrose-rich diets and old age (Roberts &Manchester, 2005). Excessive mechanical stresson the teeth and jaws can also contribute to toothloss (Larsen, 1997). A study conducted bySheridan et al. (1991) revealed that the loss ofposterior teeth can contribute greatly to levels oftemporomandibular joint degeneration. Factorscontributing to AMTL may also result in anunclear representation of actual disease levels;painfully carious teeth may have been thera-peutically extracted (Hillson, 2001) or caries andattrition may have resulted in pulp exposure thatled to AMTL. This may lead to lower levels ofcaries being recorded than accurately reflect theactual frequency (Lukacs, 1992, 1995). However,Irish (2001) found that his sample from NabtaPlaya revealed conflicting evidence between wearpatterns and caries levels, suggesting that therelationship may be less than straightforward.

Diet in the Nile Valley

Understanding a population’s diet is an essentialcomponent of analysing dental health, as it is oneof the main factors contributing to dental disease.In order to properly study the rates of dental


disease in Tombos and other sites in the NileValley, particularly in a broader geographical andtemporal context, the evolution and compositionof the diet must be addressed. Although there islittle direct information about dietary resources inNubia during this time, the wealth of informationregarding Egyptian diet, especially art and textualsources, provides additional data for this region.Excavations in the past often lacked systematiczooarchaeological and botanical analyses. How-ever, more recent studies, including isotopicanalyses (e.g. Iacumin et al., 1996, 1998; Whiteet al., 1999; Dupras et al., 2001; Thompson et al.,2005), have provided valuable dietary data.

Nubians and Egyptians made the transitionfrom hunter-gathers to agriculturalists during theNeolithic Revolution (after 10000 BC; Wendorf &Close, 1992; Bianchi, 2004). The first domesti-cates (c. 5500 BC) were sheep, goat and dog.Cattle were staple foods as well as markers of elitestatus. Millet, sorghum and barley were alleventually cultivated, and fish were also con-sumed regularly. Pottery vessels suggest thatsoupy and solid foods and beverages composedpart of the Neolithic diet. Discoveries of potterybaking moulds and brewing vats confirm theimportance of bread and beer as staple foods(Leek, 1972; Butzer, 1976; Bianchi, 2004).

During the period of the A-Group culture (c.3250–2800 BC) in Nubia and the pre- and earlydynastic times in Egypt, trade between Egypt andNubia increased. This led to Egyptian beer, wine,vegetable oils and cereals being incorporated intothe Nubian diet (Bianchi, 2004). The crops growndiversified and came to include wheat, barley,peas, lentils and melons. Fishing, fowling andhunting continued, and antelopes may have beenincluded in the diet. The C-Group diet is unlikelyto have been altered substantially from the A-Group diet, but it was more greatly influenced byEgypt. By the time of the Kerma period (2500–1500 BC), animal husbandry (goats, sheep andcattle) had greatly expanded. The diversificationof Nubian pottery attests to the likely diversifica-tion of the Nubian diet (Bianchi, 2004).

A study of isotopic ratios at Kerma in Nubiaduring three time periods conducted by Iacuminet al. (1998) determined that during the AncientPeriod (c. 4450–4000 BP), cattle consumptionwas more important than in subsequent periods



and there was a high reliance on C4 plants,probably sorghum and millet. The Middle periodand Classic Periods (4000–3700 BP and 3700–3450 BP, respectively) revealed a higher depen-dency on C3 plants such as wheat, barley, fruitsand vegetables. The mean d13C and d15N valueswere identical to the values obtained from asample of Egyptians ranging in age fromapproximately 7000 years BP to 1750 years BP(Iacumin et al., 1996).

During the New Kingdom, Nubia was con-trolled by the Egyptian empire including the areawhere Tombos was located and further south tothe Fourth Cataract (O’Connor, 1993). TheEgyptians built towns within Lower and UpperNubia that served as centres of government andredistribution. Despite the colonisation, it islikely that Nubia maintained a considerable levelof autonomy and was ruled by a pharaoh-appointed viceroy who resided in Egypt andviceroy-appointed deputies who lived in the largetowns established by the Egyptians. Nubian elitesmay have maintained the majority of their power,while culturally homogenising with the Egyptianelite (Morkot, 1987, 2001; O’Connor, 1993;Torok, 1995; Buzon, 2006a). The New Kingdomwas a particularly pivotal time for Nubians as theywere experiencing a socio-political transition anddeveloping a power base that led to the esta-blishment of the Napatan Kingdom, which wouldrule over Egypt during the 25th dynasty. AtTombos, the composition of the populationappears to include Egyptian colonists and localnative Nubians and their offspring (Buzon, 2006a).Preliminary isotopic research suggests that �25%were immigrant colonists (Buzon et al., 2007).

This Egyptian occupation impacted the diet ofNew Kingdom Nubia. An increase in bread con-sumption, a staple of the Egyptian diet, probablyoccurred. Plants, from which the previouslyimported vegetable oils were derived includinglettuce seeds, castor oil plant, flax, radish, saffronand sesame, were likely cultivated by theNubians. Egyptians may also have introducedthe cultivation of emmer. Pigs, ducks and geesemay also have been incorporated into the Nubiandiet from the Egyptian diet (Bianchi, 2004).

The textual, archaeological and isotopic dataon diet indicate the similarity in available foodsconsumed by peoples who lived in the Nile


Valley. In addition, the vast temporal rangeexamined suggests that this homogeneity per-sisted for a long time throughout the region.Regarding this information, the analyses belowexplore factors outside of available food sourcesthat might have contributed to differences indental disease found in various Nile Valleypopulations. In addition to the composition ofthe diet, this study considers aspects such as foodpreparation techniques, environmental differ-ences such as occupational exposure to grit andother associated lifestyle changes that may haveaccompanied Egyptian colonialism in Nubia.

Materials and methods

Only adult remains were included in this study. Inaddition to the sample from Tombos, threeNubian samples were included for comparativepurposes: Kerma, Shellal and samples excavatedduring the Scandinavian Joint Expedition (SJE).Two Egyptian sites are also included: Qurneh andMemphis (Figure 1, Table 1).

Tombos

The remains from the site of Tombos that are thefocus of this study were obtained duringexcavations conducted by the University ofCalifornia, Santa Barbara by ST Smith and MBuzon. Tombos is located at the Third Cataract ofthe Nile in Northern Sudan (Figure 1). Theexcavations revealed an elite Egyptian stylepyramid, funerary chapel and middle-class cem-etery. The pyramid was owned by a third-levelEgyptian administrator Siamun, and providesdates from the late 18th Dynasty to the early 19thDynasty, c. 1400–1250 BC (Smith, 2003). Burialsin the alleyway around the pyramid were excavatedin addition to the middle-class cemetery.

Eighty-five individuals were included in thisstudy. Artefacts from the cemetery dated from themid-18th dynasty to the 3rd Intermediate Period(1400–1050 BC). The individuals excavated werelikely of both Nubian and Egyptian descent,based on their grave goods, burial style (Smith,2003), craniometric analyses (Buzon, 2006a) and


Figure 1. Map of sites examined.


strontium isotope analyses (Buzon et al., 2007).The grave goods and lack of inscriptions suggestthat the cemetery contained middle-class indi-viduals. The Tombos skeletal remains arecurrently housed at Purdue University.

Table 1. Sample information and composition (N¼ 1084)

Site Date Female

Tombos 1400–1050 BC 44Kerma 1680–1550 BC 179Memphis New Kingdom 43Qurneh New Kingdom 77Shellal New Kingdom 71C-Group 2000–1600 BC 118Pharaonic 1650–1350 BC 38


Kerma and Shellal

Kerma is located close to Tombos at 20 km southof the 3rd cataract of the Nile. The 294individuals examined were ethnically Nubian

Male Indeterminate Total

30 11 85111 4 29454 2 9971 13 16178 1 15064 35 21731 9 78



including a chief, officials and possible sacrificevictims (Buzon & Judd, 2008). The Kerma sampleis dated to c. 1680–1550 BC. Shellal is located inLower Nubia at the ancient Egyptian border. The150 individuals from this study are dated to theNew Kingdom. The individuals were buried in anethnically Egyptian style, but looting was tooextensive for social class to be determined. Theremains from Kerma and Shellal are part of theDuckworth Collection in the Department ofBiological Anthropology at the University ofCambridge.

Scandinavian Joint Expedition to Nubiacollection

The third Nubian sample originates from theexcavations conducted by the SJE to Nubia. Thelocations of the excavated sites were fromthe modern Egyptian border to 60 km south.This sample was composed of material from theC-Group Nubian Culture (N¼ 217, 2000–1600BC) and Egyptian-style ‘Pharaonic’ burials fromthe New Kingdom (N¼ 78, 1650–1350 BC). Itwas not possible to derive social class data fromthe available information. The C-Group and Pharaonicmaterial is curated at the Biological AnthropologyLaboratory at the University of Copenhagen.

Qurneh and Memphis

Qurneh is located at the necropolis at Thebes.The material dates to the New Kingdom. The 161individuals examined were suggested to be fromthe upper class, based on evidence of deluxemummification methods. Memphis is located19 km south of Cairo. The 99 crania are dated tothe New Kingdom, possibly the 18th Dynasty(1539–1292 BC). Again, social class informationwas not available. The Memphis and Qurnehsamples are also housed in the DuckworthCollection in the Department of BiologicalAnthropology at the University of Cambridge.

Demography

Age and sex were determined using standardprotocols (Buikstra & Ubelaker, 1994; Buzon,


2006b). Adults were divided into three agecategories: 18–29 years, 30–45 years, 46þ yearsand adults of indeterminate age for whompreservation and completeness precluded a moreprecise age estimate. Age distributions of thesamples were compared using the Mann-WhitneyU test. The adults of indeterminate age are notincluded in the comparison.

Dental disease

All samples were analysed for evidence of dentaldisease (Figure 2). The categories of dentaldisease examined were carious lesions, AMTL andabscesses. All these categories were recorded bytooth and location (Buikstra & Ubelaker, 1994).Following the descriptions for dental conditionsin Buikstra & Ubelaker (1994), carious lesionswere defined as dark eroded areas of toothenamel. Abscesses were defined based on adrainage channel in the alveolar bone. AMTLwas indicated by tooth absence and remodellingof the alveolar bone. In addition, tooth wear wasscored on molars in order to evaluate itsrelationship with these dental conditions. Toothwear was scored according to the Scott method(Buikstra & Ubelaker, 1994). Frequencies ofoverall dental decay and a measure of all theindividuals affected by caries, abscesses and/orAMTL were also recorded.

Rates of dental disease are presented by toothand individual. All of the teeth included in thisstudy have corresponding observable alveolarbone. Due primarily to postmortem loss, many ofthe samples lacked anterior teeth (enamelhypoplasia rates as detailed in Buzon, 2006breveal the low sample sizes for incisors andcanines). Thus, the majority of teeth examinedwere premolars and canines. Rates of AMTL werecalculated by dividing the number of teeth lostantemortem by the total number of teethobserved plus the number lost antemortem(Lukacs, 1992). Significant differences betweenthe frequencies for Tombos and the other NileValley samples were determined through chi-squared tests for independence (a¼ 0.05) forcarious lesions, abscesses, AMTL and overalldental decay. Significant differences in toothwear were determined by T-tests for independence


Figure 2. Antemortem tooth loss and tooth wear.


(a¼ 0.05). Statistical program StataIC 10 wasused for the analysis.

Results

Age and sex distributions for Tombos and thecomparative samples are listed in Tables 1–3. Theage distribution of the Tombos sample does notdiffer significantly from any of the othercomparative samples. The frequency of dental

Table 2. Age distribution of skeletal samples

Site 18–29 yrs 30–45 yrs 46þ yrs Adults ofindeterminate

age

Tombos 24 17 14 30Kerma 84 143 59 8Memphis 36 46 14 3Qurneh 61 82 15 3Shellal 75 41 29 5C-Group 38 77 23 79Pharaonic 13 12 12 41Total 331 418 166 169


disease by tooth and by individual is listed inTables 4a–4c and Tables 5a–5d, respectively.Tooth wear scores are listed in Table 6. It shouldbe noted, however, that adults of indeterminateage, which account for a larger proportion of theTombos, C-Group and Pharaonic samples, arenot included in the age comparison. Preservationissues also resulted in varying numbers ofobservable teeth and sockets by individual andgroup. These sample differences present somechallenges and limitations when interpretingthese data. The adults of indeterminate age insome of these samples could play an unknowablerole in this analysis.

All populations had similar rates of caries byindividual (below �42%) and by tooth (below�9%). The rate of abscesses was higher than therate of caries in nearly all populations both byindividual and tooth data. The rate of abscesses inthe Tombos sample is moderate by tooth (10%,82/821) and very similar by individual (48%, 31/65) in comparison with the other samples. AMTLis the most common dental affliction in all thepopulations studied by individual and by tooth.By tooth, the Tombos rate of AMTL is moderate


Table 3. Sex distribution of adult skeletons by age (F, M, I: female, male, indeterminate sex)

Site 18–29 yrs 30–45 yrs 46þ yrs Adult ofindeterminate age

F M I F M I F M I F M I

Tombos 17 5 2 8 8 1 7 6 1 12 11 7Kerma 57 26 1 81 61 1 34 24 1 7 0 1Memphis 16 20 0 21 25 0 5 9 0 1 0 2Qurneh 28 33 0 33 37 12 15 0 0 1 1 1Shellal 42 33 0 19 22 0 8 20 1 2 3 0C-Group 24 9 5 46 28 3 11 11 1 37 16 26Pharaonic 7 4 2 6 5 1 6 6 0 19 16 6Total 191 130 10 214 186 18 86 76 4 79 47 43

Table 4a. Frequency of abscesses by tooth (M, F: male, female)

Number of observed teeth Number of affected teeth Number of affected teeth(as % of observed)

Total M F Total M F Total M F

Tombos 821 216 495 82 21 54 10 10 11Kerma 1891 710 1057 230 95 134 12 13 13Memphis 862 552 281 54 28 26 6� 5� 9Qurneh 2097 1156 873 129 77 52 6� 7 6�

Shellal 474 223 215 84 47 34 18� 21� 16C-group 2156 587 1067 192 65 102 9 11 10Pharaonic 472 143 239 80 40 32 17� 28� 13

�Significantly different from Tombos (a¼ 0.05).

Table 4b. Frequency of AMTL by tooth (M, F: male, female)

Number of observed teeth Number of affected teeth Number of affectedteeth (as % of

observedþ affected)


Tombos 821 216 495 296 126 154 27 37 24Kerma 1891 710 1057 496 175 303 21� 20� 22Memphis 862 552 281 284 163 121 25 23� 30�

Qurneh 2097 1156 873 930 474 456 31� 29� 34�

Shellal 474 223 215 340 195 215 42� 47� 40�

C-group 2156 587 1067 450 92 331 17� 14� 24Pharaonic 472 143 239 572 291 258 55� 67� 52�



(27%, 296/821); by individual, the Tombos rate(72%, 46/64) is significantly higher than most ofthe comparative samples. Overall dental decaywas found at high and similar levels in allpopulations (above �56%). The Tombos sampledemonstrated high levels of tooth wear (Table 6).


Tombos males were found to have significantlyhigher levels of AMTL than Tombos females bytooth and individual. Possibly as a result of thehigh levels of AMTL in males, there weresignificantly higher levels of decay in Tombosmales than Tombos females. Tombos males had


Table 4c. Frequency of caries by tooth (M, F: male, female)

Number of observed teeth Number of affected teeth Number of affected teeth(as % of observed)


Tombos 821 216 495 53 10 41 6 5 8Kerma 1891 710 1057 103 14 87 5 2� 8Memphis 862 552 281 55 32 19 6 6 7Qurneh 2097 1156 873 126 61 63 6 5 7Shellal 474 223 215 41 19 22 9 9 10C-group 2156 587 1067 72 11 52 3� 2� 5�

Pharaonic 472 143 239 35 10 12 7 7 5


Table 5a. Frequency of abscesses by individual (M, F: male, female)

Number of observableindividuals

Number of affectedindividuals

Number of affectedindividuals (as % of

observable)


Tombos 65 23 38 31 11 19 48 48 50Kerma 256 90 165 119 47 72 47 52 44Memphis 76 45 31 35 21 14 46 47 45Qurneh 144 82 62 70 42 28 49 51 45Shellal 103 55 46 51 30 19 50 55 41C-Group 204 59 111 83 25 49 41 42 44Pharaonic 65 26 33 40 17 21 62 65 64

Table 5b. Frequency of AMTL by individual (M, F: male, female)




observable)


Tombos 64 23 37 46 21 23 72 91 62Kerma 264 95 167 130 44 85 49� 46� 51Memphis 77 47 30 39 24 15 51� 51� 50Qurneh 151 85 66 102 55 47 68 65� 71Shellal 105 56 47 55 32 21 52� 57� 45C-Group 213 62 115 94 25 60 44� 40� 52Pharaonic 75 31 36 64 29 32 85 93 89�



significantly higher levels of wear than Tombosfemales for all molars (Table 6). The agedistributions of Tombos males and females mayaccount for these differences (Table 3). Youngindividuals make up a larger proportion of theTombos sample for females than males.


There were very few significant differencesfound in levels of caries (Table 5c) and abscessesby individual between Tombos and the othersamples examined when males and females wereanalysed separately. Tombos males, however, hadsignificantly higher levels of AMTL by individual


Table 5c. Frequency of caries by individual (M, F: male, female)




observable)


Tombos 76 21 37 18 6 10 24 29 27Kerma 243 88 141 60 12 47 25 14 33Memphis 69 41 25 26 16 9 38 39 36Qurneh 151 79 61 63 33 29 42� 42 48�

Shellal 86 44 38 29 15 14 34 34 37C-Group 227 55 107 44 8 27 19 15 25Pharaonic 70 19 31 19 6 9 27 32 29


Table 5d. Frequency of decay by individual (M, F: male, female)




observable)


Tombos 65 23 38 49 22 25 75 96 66Kerma 267 97 167 175 62 112 66 64� 67Memphis 78 47 31 51 32 19 65 68� 61Qurneh 151 85 66 119 65 54 79 76� 82Shellal 105 56 47 72 39 31 69 70� 66C-Group 213 62 116 120 31 72 56� 50� 62Pharaonic 75 31 36 68 29 35 91� 94 97�


Table 6. Average molar wear scores (M, F: male, female)

M1 M2 M3

No.observable

teeth

Averagescore

No.observable

teeth

Averagescore

No.observable

teeth

Averagescore

Tot M F Tot M F Tot M F Tot M F Tot M F Tot M M

Tombos 40 10 23 27.3 34.9 26.2 45 14 26 21.7 26.8 20.2 29 10 18 12.6 19.8 8.4Kerma 169 55 101 26.9 28.5� 27.8 137 58 103 18.8 19.5� 19.7 127 48 78 13.8 14.5 13�

Memphis 50 28 18 24.0 25.1� 26.1 43 28 13 15.8� 16.5� 15.7 29 20 9 12.3 11.7 13.8Qurneh 104 52 42 23.7 27.7� 22.6 99 50 45 17.5� 18.6� 17.1 81 46 35 12.6 12.9 12.1Shellal 66 31 31 24.3 25.1� 23.5 63 31 29 16.8� 17.3� 16.3 48 25 22 11.3 11.8 10.5C-Group 137 42 69 27.3 32.6 29.3 128 42 68 20.8 25 20.7 93 35 52 15.2 16.8 13.9�

Pharaonic 27 10 10 26.7 29 31.5 30 9 13 20.3 25.7 21.1 18 9 8 17.1 19.6 14.5


Copyright # 2009 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. (2009)DOI: 10.1002/oa



(91%, 21/23) than most of the comparativesamples. Probably as a result of these significantdifferences, Tombos males (96%, 22/23) wereshown to have significantly higher levels of decaythan many other samples as well. Tombos maleshad significantly higher levels of first and secondmolar wear than most of the other male com-parative samples. However, there are higher numbersof younger males in the Qurneh and Shellal samplesthan in Tombos, which may account for theirlower levels of AMTL and overall decay in thosegroups. By tooth, the Tombos males and femalesdemonstrate an intermediate level of caries andabscesses. Tombos females experienced signifi-cantly less AMTL than other populations. Thegroups that display significantly lower frequen-cies contain similar or lower amounts of youngfemales than the Tombos sample.

In summary, the comparison with othersamples reveals that Tombos individuals had anintermediate level of dental disease. The Phar-aonic sample was the most highly affected group;this group also has the highest percentage ofolder adults when the adults of indeterminate ageare removed. Shellal also suffered frequently fromhigher levels of dental afflictions than otherpopulations. The high levels of disease in Shellalare noteworthy because of its relatively youngcomposition (Table 2), with more than half of theaged individuals in the young adult category. TheC-Group population experienced significantlylower rates of dental disease than Tombos.Kerma, Qurneh and Memphis were variable,and often had higher or lower rates of dentaldiseases than Tombos.

Discussion

One goal of this study was to explore overallhealth and daily life experiences of the individualsand groups examined for evidence of dentaldisease. How do these results compare with otherindicators of health? Previous research on non-specific stress markers in these samples (Buzon,2006b) indicates that frequencies of pathologicalconditions indicative of physiological stress arerelatively low and similar in Tombos andcomparative samples. As mentioned above, therates of caries and abscesses are quite similar


among the groups included in this analysis. Amore detailed examination, however, revealedthat individuals (especially juveniles) at Tombosmay have been experiencing a higher level ofstress and lower recovery rate than other groupsstudied (Buzon, 2006b). The adults examined inthe present study also reveal some differencesbetween Tombos and the comparative samples,especially in the rates of AMTL and tooth wear.This discussion explores the similarities anddifferences between the samples examined inthe context of overall health. We suggest thatphysiological and possibly mental stress associ-ated with the socio-political and cultural tran-sitions may have resulted in increased tooth wearleading to AMTL.

Caries

The low frequencies of carious lesions by toothand individual suggest few differences betweenthe samples studied, perhaps indicative of simi-larity of dietary resources. Caries have traditionallybeen found at low levels in Egyptian populations(Leek, 1972). The low level of caries in thepopulations studied may be correlated with thehigh levels of wear. Fissures of tooth crowns mayhave been worn down and resulted in lessopportune locations for sticky food to becometrapped and encourage bacterial action (Greene,1972). The level of caries may also be affected bythe high levels of AMTL. Carious teeth may havebeen lost or removed, thereby resulting in a ratethat is lower than the true rate that was present inthe population. This may be significant in thisstudy due to the high rate of teeth lostantemortem, as some of these teeth were likelylost due to carious lesions. The Tombos andPharaonic samples, both of which have high ratesof molar tooth wear, also display high rates ofATML and low rates of carious lesions.

Abscesses

Abscesses are frequently caused by severe cariesor dental attrition exposing the pulp tissue(Littleton and Frohich, 1993). Abscesses werefound at a higher rate than caries in the



populations studied. While high levels of cariesare often associated with high levels of abscesses,higher levels of abscesses may result from highlevels of wear (Beckett & Lovell, 1994). Given thehigh levels of wear found within the samples, thisseems to be a probable contributing agent to therate of abscesses in the populations, although cariesprobably contributed to the level of abscesses, aswell. Egyptian samples are known for high rates ofwear (Wells, 1975) and this probably affected all ofthe populations studied. Pulp exposure caused byheavy wear has been implicated as the cause ofEgyptian abscesses in the past (Leek, 1972).

Similar to caries, AMTL may also have dis-torted the rate of abscesses. Abscesses serve as apredisposing factor of AMTL. Abscesses mayhave contributed to the high rate of AMTL, butthey were found at a much lower rate than AMTL.The rate of teeth that were abscessed at somepoint in the community may have been sub-stantially higher, but they may have been lostantemortem. In all communities apart fromTombos and Memphis, males experienced ahigher level of abscesses than females. This mayhelp explain the significant differences betweenthe rate of male AMTL and the rate of femaleAMTL in the populations.

AMTL

The multi-factorial nature of AMTL makes itsetiology in a population particularly difficult todetermine. AMTL can be the product of dietarytexture, nutritional deficiency diseases, oral healthstatus, traumatic injury and cultural practices(Lukacs, 2007). AMTL is commonly thought toresult from three main classes of dental disease:periodontal disease, attrition and caries (Langs-joen, 1996).

The relatively low rate of caries in the popu-lations studied and the high rate of wear isindicative of AMTL being mostly influenced bytooth wear. This is unusual within an agriculturalcommunity in which high rates of caries typicallylead to severe levels of AMTL. This coincideswell, however, with the extremely high levels ofwear that characterise Egyptian populations(Wells, 1975).


Tooth wear can predispose to tooth loss byresulting in enamel wearing more rapidly thandentin can replace the pulp chamber, leading tothe exposure of pulp tissues to bacteria andsubsequent infection, abscessing and loss (Hart-nady & Rose, 1991). Tooth wear can alsocontribute to AMTL by leading to contact loss.Teeth are held in place within the alveolus by aperiodontal ligament, fibres of which are trig-gered by functional tooth movements to stimulatebone remodelling to compensate for tooth wear(Langsjoen, 1996). Space for interdental gingivato secure and protect tooth protecting tissues areproduced by the mesiodistal tooth diametersbeing smaller at the cervical area than the contactareas. By compromising functional tooth contact,severe wear may predispose a tooth to period-ontal abscessing by exposing the interdentalgingiva to infection that may spread to theconnective tissues that tether teeth (Langsjoen,1996).

AMTL was found at extremely high rates in allpopulations. Males were significantly more affectedthan females in Tombos. This is not unexpectedgiven the higher proportion of older males thanfemales. This is the opposite of most clinical andarchaeological studies, although exceptions doexist (Lukacs, 2007). Both abscesses and wear arefound at higher levels in males than females, andwear for all three molars was found at significantlyhigher levels in Tombos males than Tombosfemales, which may help to explain the differ-ences in AMTL between the sexes. Due to themulti-factorial nature of AMTL, there are anynumber of other possible reasons why males weremore susceptible to AMTL, including a divisionof labour that precipitated a different diet (Lukacs,1992; Larsen, 1997). For example, perhapsfemales consumed more cariogenic food andmales ate more abrasive meat or fish, frequentlyassociated with higher levels of attrition (Lit-tleton & Frohlich, 1993). Using teeth as tools,traumatic injury or interpersonal violence(Lukacs, 2007) are also possible reasons.

Tooth wear

While agriculturalists are traditionally known fortheir less severe wear levels as compared to



hunter-gatherers, Nubian agriculturalist teethhave as severe wear as hunter-gatherer groupssuch as Australian aborigines and ArchaicAmerican Indians (Smith, 1984). Egyptian teethare known for their severe levels of wear causedby both rough, fibrous vegetable food (Wells,1975) and environmental grit. Abrasive elementsin food can range from the cellulose found inplants, the collagen of animal material and boneand gritty contaminants in stone-ground flour.Dried fish have also been associated with highlevels of wear (Macchiarelli, 1989; Littleton &Frohlich, 1993). Forces external to diet may alsoplay a role in abrasion such as wind-blown sand(Smith, 1984; Macchiarelli, 1989; Littleton &Frohlich, 1993). This may be of particularconsequence to the populations included in thisstudy, as heavy wear is associated with allpopulations and regional dietary resources areunlikely to have any true explanatory power.

A study by Leek (1972) conducted todetermine the cause of extensive tooth wear inEgyptian samples detailed the importance ofbread to the Egyptian diet and its abrasivecomponents. The analysis of preserved ancientbread revealed whole grains of corn and thepresence of inorganic particles. These inorganic

Figure 3. Granite quarry at Tombos.


particles principally arose from wind-blown sand,but other possible sources of contamination mayinclude soil in which the grain was grown, sicklesused while harvesting, wind-blown contami-nation during winnowing, contaminants frommud-brick silos or wooden granaries, uninten-tional contaminants added while grinding, inten-tional contaminants added while grinding includ-ing bricks, chalk and sand and contaminantsinadvertently added during baking.

For all molars, Tombos males were found tohave significantly higher levels of wear thanTombos females (Table 6). In addition to agedifferences in the male and female samples, this ispossibly a result of consuming a more abrasivediet, or possibly males being exposed to wind-blown sand for more arduous or extendedperiods. For example, males at Tombos mayhave participated in activities such as thequarrying of granite for statues near the site(Figure 3). The high rates of tooth wear in thisstudy are significant because of the complexrelationship between tooth wear, caries, AMTLand abscesses. Tooth wear likely predisposed thepopulations examined to AMTL and abscesses,but it may have prevented caries by wearing downocclusal fissures. The relatively high rate of wear



compared to caries may be indicative of a trendfound in other populations (Larsen, 1997). Maat& van der Velde (1987) detail the possiblecleansing effect achieved when the rate ofattrition is more rapid than the rate of cariesprogression. Food may be too abrasive to stick toteeth or enter fissures. The two conditions,however, remain independent variables thatcorrelate independently with diet (Meiklejohnet al., 1992); their relationship should not be over-generalised (Larsen, 1997).

Site and sample differences

Can population differences account for some ofthe higher rates of dental disease, such as AMTLand tooth wear (especially in males), seen atTombos? While the samples are relativelycontemporaneous and all are located in the NileValley with similar food resources, some socio-political and cultural differences are present.Based on craniometric data and burial ritual(Buzon, 2006a) as well as strontium isotope data(Buzon et al., 2007), the group of individualsburied at Tombos is likely composed of both localNubians and immigrant Egyptians. Despite manysimilarities, perhaps living in a different environ-ment from their native country for immigrantsand adapting to the new Egyptian colonialism forthe local Nubians proved to be a considerablephysiological stress to these individuals, asevidenced by the high rates of AMTL and toothwear (especially in males). The people living atTombos were likely adjusting to socio-politicaland cultural changes. This cemetery dates to theEgyptian colonial occupation of Tombos, a timewhen Egypt expanded its administration southinto Nubia. Nubians during this period showevidence of Egyptianisation, the adoption ofEgyptian cultural features (as demonstrated intheir burial ritual).

This cultural transition for the local Nubians aswell as the physiological effects of immigrationfor the colonial Egyptians may have resulted inhigher levels of stress and/or the need to adapt todifferent environments that may have impactedrates of dental disease. For example, whilemastication inflicts significant mechanical stress


on the teeth, it is not the only source. Theclenching and grinding of teeth (bruxism) canexpose the teeth to great pressure, forces moreintense than those applied during chewing(Hillson, 1996). Clinical studies have suggesteda relationship between tooth wear caused bybruxism and chronic stress (e.g. Johansson et al.,1991; Lurie et al., 2007). Accompanying thedemonstrated health stress of the colonialinteraction (Buzon, 2006a) may have been mentalor psychological stress of dealing with thetransition. The stressors may have resulted inclenching or bruxism that caused higher levels oftooth wear. This resulting tooth wear may alsohave led to higher levels of ATML.

The interaction of Egyptians and Nubians atthis site may have resulted in varied foodways andoccupational environments. It is possible thatactivities associated with the Egyptian colonialcentre at Tombos, including quarrying activities,resulted in a higher frequency of AMTL and toothwear. While people in Egypt and Nubia hadsimilar dietary staples, access may have variedfrom one place to another especially in terms ofaccess to trade goods. In addition, culturaldifferences may have influenced food prefer-ences, preparation and cooking techniques, aswell as exposure to environmental sources of grit.Two comparative groups that show similarly highrates of AMTL and tooth wear are the Pharaonicsample from the SJE to Nubia and the individualsburied at Shellal. These individuals, althoughlocated in Nubia, were all buried using Egyptianpractices. In this sense, these sites are similar toTombos. The sample may also represent bothlocal Nubians and immigrant Egyptians assuggested by the craniometric data (Buzon,2006a), and they may have experienced someof the same stressors resulting in higher rates ofthese conditions.

Conclusions

This study examined and discussed the rates ofdental disease (caries, abscesses, antemortemtooth loss and severity of tooth wear) in NewKingdom Nile Valley groups. Particular attentionwas paid to the site of Tombos, a cemetery used



during the Egyptian colonial occupation of Nubiathat was composed of both immigrant Egyptiansand local Nubians. Rates of caries and abscesseswere relatively similar between Tombos and thecomparative samples, reflective of the similardietary resources available to the people living atthese sites. The rates of AMTL and tooth wear,however, highlight some possible differencesbetween the samples examined. Individualsburied at Tombos, as well as the SJE Pharaonicsample, show very high rates of these conditions.These high frequencies may be related to theadditional stress put on individuals as theyexperienced the socio-political and culturalchanges associated with the Egyptian colonialoccupation. This study of dental disease in theNile Valley has provided a supplementary meansof illuminating details of daily life and the healthexperiences of past peoples.

Acknowledgements

Gratitude is extended to Stuart Tyson Smith,Director General Hassan Hussein Idris at theNational Corporation for Antiquities andMuseums and Ali Osman M. Salih at the Uni-versity of Khartoum for our collaboration on theTombos excavation. Pia Bennike at the Universityof Copenhagen and Marta Lahr at the Universityof Cambridge provided access to their collectionsfor this research. This work was sponsored in partby the National Science Foundation (Grant#0313247) and the Institute for Bioarchaeology.

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