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Urbanization, Economic Change, andDental Health in Roman and MedievalBritain

REBECCA C. GRIFFIN

Discipline of Anatomy and Histology, University of Sydney, Australia

In modern populations, inequalities in oral health have been observed between urban and rural commu-nities, but to date the impact of the place of residence on oral health in archaeological populations hasreceived only limited attention. This meta-study analyses dental palaeopathological data to examine therelationship between place of residence and oral health in Roman, early medieval, and late medievalBritain. Published data on ante-mortem tooth loss, calculus, caries, dental abscesses, and periodontaldisease were analysed from cemeteries in urban and rural locations from each period. The results indicatethat the place of residence influenced oral health in Roman and late medieval times, with urban popula-tions enjoying better oral health than rural populations in Roman Britain, but poorer oral health in thelate Middle Ages. These findings may reflect changes in the nature of urban settlements and in theirrelationship with their rural hinterlands over time.

Keywords: oral health, palaeopathology, urban, rural, economy, Britain

INTRODUCTION

In modern populations, place of residencehas been found to have a significantimpact on oral health. In some societiesthis is believed to be due to differences indiet, with urban communities havinggreater access to the refined sugars respon-sible for dental caries, and therefore higherrates of oral pathologies than rural popula-tions (Doherty et al., 2010; Ogunbobdedeet al., 2015). However, in other societiesdiet does not appear to play a significantrole in determining the relative oral healthof rural and urban populations. A numberof studies have found that rural popula-tions tend to have higher rates of dentalpathology than their urban counterparts(e.g. Skillman et al., 2010; Singh &Purohit, 2013; Shen et al., 2015); thisappears to be due to the relative isolation

and lower levels of income of rural popu-lations, the higher proportion of olderresidents in rural communities, and diffi-culties accessing dental practitioners inrural areas (Ettinger, 2007). The impact ofplace of residence on oral health thereforeappears to be strongly influenced by thesocial, cultural, and economic context ofthe populations examined.Recent work has shown that differences

in oral health between urban and ruralpopulations can also be observed in pastpopulations. Several studies of health inRoman Britain have identified such differ-ences between urban and rural sites (Pitts& Griffin, 2012; Redfern et al., 2015) orbetween different types of urban sites(Bonsall, 2013). Pitts and Griffin (2012)observed significantly lower rates of oraldisease in urban populations than in ruralcommunities at this time, while Bonsall

European Journal of Archaeology 20 (2) 2017, 346–367

© European Association of Archaeologists 2017 doi:10.1017/eaa.2016.23Manuscript received 4 April 2016,accepted 21 October 2016, revised 13 August 2016

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(2013) found lower rates of periodontaldisease, caries, and dental abscesses in themore highly urbanized ‘public towns’ thanin small towns in Roman Britain. Similarpatterns have been observed in RomanItaly, where the higher rates of dentaldisease in rural settlements have beenlinked to the greater availability of meat inurban contexts (Manzi et al., 1999). Thedifference in diet between urban andnon-urban settlements at this time is alsosupported by results from stable isotopeanalysis (Cheung et al., 2012; Killgrove &Tykot, 2013). Pitts and Griffin have sug-gested that the tendency towards betteroral health in urban settlements in RomanBritain may be due to the economiceffects of increasing urbanization and theincorporation of Britain into the RomanEmpire. The redistribution of agriculturalsurplus by the Roman government to theurban centres is likely to have affected thediets of both urban and rural populations,with higher quality food more readily avail-able in urban centres than in their ruralhinterland. Access to dental treatment isalso likely to have been greater in urbansettings. It has therefore been proposedthat a combination of a more diverse dietcontaining a higher proportion of meat andbetter access to dental care resulted inlower rates of dental disease in urban popu-lations at this time. However, the findingsof Redfern et al. (2015) of higher rates ofdental disease in urban settlements inRoman Dorset suggest that the impact ofplace of residence on oral health may havevaried within the province.While the evidence suggests that place

of residence influenced oral health inRoman Britain, it is unclear to whatextent this affected the oral health of laterpopulations, particularly given the substan-tial economic and social changes that tookplace in the centuries following the end ofRoman rule. Studies from continentalEurope have shown that there was a

significant deterioration in oral health inthe medieval period (Manzi et al., 1999;Slaus et al., 2011), and changes in diethave also been observed in analyses ofstable isotope data, both in Britain and onthe Continent (Müldner & Richards,2007b; Lightfoot et al., 2012). This trendis, however, not consistently observed,with some regions showing little change indental health (e.g. in the Molise region incentral Italy; Belcastro et al., 2007) orindeed indicating that there was animprovement in oral health in the latemedieval period (Watt et al., 1997;Gonçalves et al., 2015). This study there-fore seeks to better understand the impactof urbanization and economy on Britishoral health over the longer term by deter-mining the effect of place of residence onoral health in British populations fromRoman to medieval times.

MATERIALS AND METHODS

In order to gain an initial overview of oralhealth patterns across mainland Britain(Scotland, England, and Wales) fromRoman to medieval times, this studysought to include as many sites as possiblein a meta-study of oral health data, ratherthan focus on a smaller number of repre-sentative sites. Such an approach avoidshaving to select ‘typical’ sites for eachperiod and urban/rural location, whichmay turn out to be unrepresentative.However, the size of the study precludesthe analysis of conditions in the kind ofdetail that would be possible in a smallerstudy. Data on oral health from a sampleof 124 urban and rural cemeteries locatedin mainland Britain are included here:thirty-eight are Roman, fifty-two earlymedieval, and thirty-four late medieval(Table 1). The selection was based onsites which contained at least twenty indi-viduals, and for which data was available

Griffin – Urbanization, Economic Change, and Dental Health in Roman and Medieval Britain 347





Table 1. Cemeteries selected for inclusion in this study, with sample sizes in brackets.

Urban Intermediate Rural

Roman

Cirencester7 (407) Alchester33 (40) Barrow Hills, Radley34 (57)

Colchester17 (575) Ancaster46 (327) Bletsoe20 (50)

Dorchester, Little Keep40 (25) Baldock 134 (191) Boscombe Down35 (37)

Dorchester, Poundbury18 (1131) Baldock 334 (145) Cassington34 (71)

Gloucester, Gambier-Parry Lodge34

(94)Baldock 434 (63) Catterick34 (28)

Gloucester, Kingsholm34 (48) Caistor, Talbot Inn45 (22) Chignall29 (36)

Gloucester, London Road47 (27) Cambridge, Vicar’s Farm32 (21) Dorchester, Tolpuddle Hall34 (48)

Leicester, Newarke Street34 (34) Derby34 (46) Kempston36 (92)

London, Giltspur Street34 (124) Dorchester-on-Thames,Queenford Farm12 (92)

Owlesbury34 (49)

London, Trinity Street42 (44) Dorchester-on-Thames,Queensford Mill34 (81)

Radley34 (33)

London, West Tenter Street11 (112) Dunstable5 (116) Stanton Harcourt4 (36)

St Albans34 (27) Icklingham2 (50)

Winchester, Lankhills3,46 (369) Ilchester6 (49)

York, Trentholme Drive34 (329)

Early medieval

Chichester, Apple Down34 (125) Andover, Portway34 (68) Addingham34 (45)

Gloucester, Golden Minster31 (139) Bamburgh, Bowl Hole43 (92) Alton34 (40)

Ipswich, School St14 (95) Barton-on-Humber, Castledyke28

(200)Ashstead, Goblin Works15 (27)

Norwich, Farmer’s Avenue34 (91) Bedford, St Paul’s Square34 (31) Barrington, Edix Hill30 (148)

Norwich Castle34 (112) Great Chesterford34 (93) Beckford A27 (22)

Thetford, Red Castle1 (85) Kingsworthy, Worthy Park34 (101) Beckford B27 (108)

Thetford 219 (81) North Elmham Park34 (206) Berinsfield21 (122)

York, York Minster34 (60) St Andrews, Hallow Hill25 (93) Binchester34 (54)

Brandon, Staunch Meadow34 (158)

Burgh Castle16 (167)

Caister-on-Sea34 (139)

Cannington34 (542)

Charlton Plantation9 (45)

Collingbourne Ducis34 (29)

Deal, Mill Hill34 (75)

Eastbourne, Ocklynge Hill34 (23)

Eccles34 (166)

Empingham34 (153)

Eriswell34 (28)

Filton37 (51)

Jarrow38 (170)

Monkwearmouth38 (327)

Norton34 (125)

Oakington34 (23)

348 European Journal of Archaeology 20 (2) 2017





Table 1. (Cont.)

Urban Intermediate Rural

Pontefract, Tanners’ Row34 (178)

Portchester Castle34 (22)

Raunds Furnells23 (361)

Ripon, Ailcy Hill24 (27)

Rivenhall34 (46)

South Acre34 (119)

Stretton-on-Fosse34 (41)

Ulwell13 (49)

West Heslerton34 (132)

Whitby Abbey41 (122)

Wicken Bonhunt34 (222)

Willoughby-on-the-Wolds,

Broughton Lodge34 (105)

Late medieval

Bristol, St Bartholomew’s Hospital34

(30)Aberdeen, Carmelite Friary34 (68) Abingdon Abbey34 (589)

Canterbury, St Gregory’s Priory34 (91) Bolsover, St Mary and StLawrence34 (28)

Barton Bendish, All Saints34 (79)

Chester, Greyfriars34 (49) Chichester, St James and St Mary Brough, St Giles’ Hospital22 (37)

Lincoln, Pennell St34 (79) Magdalene34 (351) Chevington Chapel34 (60)

Lincoln, St Mark’s RailwayStation34 (31)

Dundee26 (55) Denbigh, Ysgol Twm or Nant34 (170)

Grantham, London Road34 (53) Hatch Warren, Brighton HillSouth34 (52)

London, Carter Lane34 (58) Guildford, Dominican Friary34

(113)Hulton Abbey34 (24)

London, Holy Trinity Priory34 (68) Ipswich, Blackfriars Friary34 (25) Rivenhall34 (70)

London, St Mary Graces44 (100) Merton, Merton Priory34 (74) Stratford Langthorne Abbey10 (128)

London, St Mary Spital34 (126) Newark St Leonard’s Hospital34

(82)

London, Spitalfields Market39 (200) St Andrews, St Mary’s34 (330)

York, Jewbury34 (475) Taunton, Taunton Priory8 (162)

York, St Andrews Fishergate34 (402) Thetford19 (149)

York, St Helen on the Walls34 (1037)

Sources: 1Knocker, 1967; 2Wells, 1976; 3Clarke, 1979; 4McGavin, 1980; 5Matthews, 1981; 6Leach, 1982;7McWhirr et al., 1982; 8Rogers, 1984; 9Davies, 1985; 10Stuart-Macadam, 1986; 11Whytehead, 1986;12Chambers, 1987; 13Waldron, 1987; 14Mays, 1989; 15Poulton, 1989; 16Anderson & Birkett, 1993;17Crummy et al., 1993; 18Farwell & Molleson, 1993; 19Stroud, 1993; 20Denston and Duhig, 1994;21Boyle et al., 1995; 22Cardwell, 1995; 23Boddington, 1996; 24Hall & Whyman, 1996; 25Proudfoot, 1996;26Spalding et al., 1996; 27Wells, 1996; 28Boylston et al., 1998; 29Clarke, 1998; 30Malim & Hines, 1998;31Rogers, 1999; 32Lucas, 2001; 33Hawkes, 2003; 34Roberts & Cox, 2003; 35Wessex Archaeology, 2003;36Boylston & Roberts, 2004; 37Cullen et al., 2005; 38Cramp, 2006; 39Arce, 2007; 40McKinley, 2009;41Vincent & Mays, 2009; 42Langthorne, 2010; 43Groves, 2011; 44DeWitte, 2012; 45Keal, 2012; 46Bonsall,

2013; 47Jackson, 2013.






for at least one of the five oral health con-ditions under analysis: antemortem toothloss (AMTL), calculus, caries, dentalabscesses, and periodontal disease. Inorder to maximize the sample size, siteswere examined by the broad period towhich they belonged (Roman, early medi-eval, late medieval). It is, however, import-ant to note that not all sites were occupiedat the same time, and this could influencethe results obtained. Furthermore, it isalso possible that the populations exam-ined here are not representative of the ori-ginal living population, due to factors suchas differential burial practices, incompleteexcavation of some of the cemeteriesincluded in the study, and the effects ofthe Osteological Paradox, where lesionswill only appear in the skeleton of thosewho were able to survive a disease longenough for the skeleton to be affected(Wood et al., 1992). These aspects willneed to be taken into consideration wheninterpreting the results.The five oral health conditions chosen

for analysis were those that are most fre-quently recorded in osteoarchaeologicalreports. Dental caries is associated withhigh carbohydrate diets and poor oralhygiene, and can therefore provide infor-mation about diet and dental health(Larsen et al., 1991). Calculus is calcifieddental plaque, which can also provideinformation about the diet of the individ-ual (Hillson, 1996). It has been suggestedthat the relative proportions of caries andcalculus can be used to give an indicationof the relative proportions of proteins andcarbohydrates in the diet, although otherfactors such as oral hygiene and drinkingwater composition can also have aneffect on calculus rates (Lieverse, 1999).Periodontal disease is also associated withdental plaque, and is caused by guminflammation in areas of plaque accumula-tion, leading to the remodelling of the jawand the loss of alveolar bone (Hildebolt &

Molnar, 1991). Dental abscesses resultfrom the localized resorption of bone dueto infection of the tooth pulp, oftencaused by caries in the tooth crown orroot. In osteoarchaeological contexts, it isoften difficult to distinguish betweendental abscesses and less severe periodontallesions (Dias & Tayles, 1997). It is there-fore likely that the figures for abscessesshown here include more minor lesions inaddition to true abscesses. As this is likelyto affect all sites equally, this is unlikelyto significantly influence any patternsobserved between sites. AMTL is com-monly caused by oral pathologies such ascaries, periodontal disease, or tooth wear,and can therefore provide useful informa-tion about diet, particularly when exam-ined in conjunction with rates of cariesand periodontal disease (Hillson, 1996).The analysis of data on these five oralpathologies with diverse aetiologies istherefore likely to provide insights into thedietary and health factors influencing oralhealth in urban and rural sites in Romanand medieval Britain.Data were collected from published

reports giving details of the remains fromeach site or from published summaries ofpalaeopathological data (see sources listedin Table 1). The use of secondary data forthis study presents particular challenges.Because these data were recorded by dif-ferent osteoarchaeologists, the data avail-able varies between cemeteries anddepends on such factors as the time avail-able for analysis and the level of preserva-tion of the remains. The impact of suchvariations has been minimized for thisanalysis by using true prevalence rateswhere possible. The true prevalence rate isthe percentage of observable teeth orsockets affected by a specific pathology.This approach can be preferable whenstudying archaeological remains, as thelevel of preservation of the skeletons recov-ered varies and hence it is not always






possible to assess all conditions in allparts of the mouth for every individual(Brickley, 2004). This can have an impacton the prevalence of each conditionobserved per individual, known as thecrude prevalence rate. However, the use oftrue prevalence rates can also be problem-atic, as it is common for the same oralhealth condition to be present in multipleteeth from a single individual (Mays et al.,2004). If more teeth are preserved fromsome individuals than from others, thiscan bias the results. In this study, it wasdecided to use true prevalence rates wherepossible, as these are more commonly usedfor reporting dental diseases than crudeprevalence rates. For the majority of sitesunder examination it was possible to cal-culate true prevalence rates for caries,dental abscesses, and AMTL; hence theserates were used rather than crude preva-lence rates. However, for dental calculusand periodontal disease, it was not possibleto calculate true prevalence rates from thedata available. For these conditions, crudeprevalence rates were therefore used.Because of variations in the detail in

which these conditions were reported ineach publication, it was not possible tosplit the data from all sites by tooth type(permanent/deciduous or anterior/poster-ior). The data are therefore analysed as asingle overall figure for each condition ateach site. For the majority of sites, preva-lences were calculated directly from thepublished figures for that site. In caseswhere figures were not available for thenumbers of individuals/teeth affectedand/or the number of individuals/teethassessed, published prevalence rates wereused instead.Cemeteries were classified according to

the nature of the nearby settlement asurban, intermediate, or rural. Majortowns, as defined by Perring (2002) forRoman sites, and Palliser (2000) for medi-eval sites, were classified as urban; other

towns or major settlements were classifiedas intermediate, and all other sites wereclassified as rural. The classification ofsome sites was, however, not alwaysstraightforward, especially in the case ofRoman Britain, where the distinctionbetween intermediate ‘small towns’ andrural settlements has been subject todebate (Brown, 1995). It is hoped that theinclusion of a number of sites of each typewithin each period will help minimize theimpact of any potentially incorrectclassification.Differences in oral health between rural,

intermediate, and urban sites were assessedusing analysis of covariance (ANCOVA).As age and sex can also affect oral health,the age distribution and male:female ratioof each population were taken into accountin the analysis. Because of the varying agecategories used in the different reports, par-ticularly for individuals aged over twenty-five, it was decided to focus on a compari-son of the proportion of individuals agedover twenty-five as an indication of the agestructure of the population. The proportionof adults aged over twenty-five and themale:female ratio were therefore includedas covariates in each ANCOVA analysis.In addition, to gain an overall picture of

oral health per period, multidimensionalscaling was used to visualize patterns inhealth between sites from each period.Multidimensional scaling was selected forthis analysis because it plots the dataaccording to shared characteristics, doesnot rely on any assumptions regarding thegroups within the sample, and can beadapted for use with datasets containingmissing data (Pechenkina & Delgado,2006). To increase the reliability of theresults, only sites with data for at leastthree of the conditions considered in thisstudy were included in the analysis. Amatrix of similarities between sites wasproduced for each period, with the similar-ities calculated using Gower’s composite






similarity index (Gower, 1971), using theaverage similarity index for all healthindicators for which data were available ateach pair of sites. The resulting matrix wasanalysed using the PROXSCAL functionwithin SPSS (Statistical Package for theSocial Sciences), to produce a plot accord-ing to the similarities in oral healthbetween the sites under study, where theaxes are Dimensions 1 and 2. The plotswere then examined both visually and byusing regression analysis to determine thefactors underlying the distribution of thesites on the plot.

RESULTS

Differences in oral health were observedbetween urban, intermediate, and ruralsettlements in all three periods (Table 2),with the relationship between oral healthand place of residence appearing to changeover time. In Roman Britain, a signifi-cantly higher true prevalence rate ofabscesses occurred in rural settlementsthan in urban settings. Rural sites alsotended to have a higher prevalence of cal-culus, periodontal disease, and AMTL,although these differences were not statis-tically significant. While the particularlyhigh average rate of abscesses in rural set-tlements was influenced by the unusuallyhigh rate of abscesses at the Barrow Hillssite in Oxfordshire (26 per cent), all therural Romano-British sites included in thisstudy displayed high prevalences of dentalabscesses and the average prevalenceremained high even after the data fromBarrow Hills had been removed. In con-trast, in late medieval Britain, urban settle-ments tended to have a higher rate of oralpathologies, although this pattern was onlysignificant for periodontal disease aftertaking into account the sex and age com-positions of the sites analysed. The mainexception to this trend was dental caries,

which occurred at a higher rate in ruralpopulations in the late medieval period.The overall pattern of oral disease suggeststhat changes in the physical and socialenvironment over this time may haveaffected urban and rural settlements differ-ently, with urban environments beingmore beneficial to oral health in theRoman period. In contrast, rates of oraldisease were similar in urban and rural set-tlements in the early medieval period.No significant difference in age compos-

ition was observed between urban andrural sites in the Roman (p = 0.991) orearly medieval (p = 0.737) periods.However, the proportion of individualsaged twenty-five or over was significantlyhigher in urban and intermediate sites thanin rural sites in the late medieval period (p= 0.044). The greater proportion of olderindividuals in urban and intermediate sitesat this time is reflected in the higher preva-lences of AMTL, calculus, dentalabscesses, and periodontal disease there.However, the higher rate of periodontaldisease in urban populations appears tohave also been influenced by factors otherthan age composition; indeed, after havingtaken into account the age composition ata given site using ANCOVA, the higherprevalence of this condition in urban sitesremained significant.The impact of place of residence on oral

health observed here is supported by theresults of the multidimensional scalinganalysis. In Roman and late medievaltimes, the distribution of sites on themultidimensional scaling plot is stronglyinfluenced by site type. In the Romanperiod (Figure 1), urban and intermediatesites tend to be located towards thebottom of the graph, with rural siteslocated towards the top. This associationis significant after taking into account thesex and age composition at each site (p =0.044). Sites towards the bottom of thegraph (predominantly urban and






intermediate sites) are associated withlower rates of dental disease than those atthe top, particularly AMTL and dentalabscesses. No significant association wasobserved between either Dimension andthe age composition of the sites in thisperiod. In the late medieval period(Figure 2), urban sites appear to the rightof the graph relative to rural and inter-mediate sites. This association is, however,not statistically significant after taking intoaccount the age and sex composition ateach site (p = 0.072). In this plot, sites tothe right of the graph (predominantlyurban sites) are associated with higherrates of dental disease, particularly calculusand periodontal disease. No significantassociation was observed between eitherDimension and the age composition ofthe sites in this period. This suggests thatin Roman as well as late medieval timesthere is a relationship between overalllevels of oral health for each populationand the location of these communities,which is not primarily determined by theage composition of the site. No such asso-ciation between the position of sites on

the multidimensional scaling plot and sitetype could be observed for the early medi-eval group (Figure 3), a finding that isconsistent with the results of theANCOVA analyses.The prevalence of oral disease in both

rural and urban settlements also changessignificantly between the Roman and latemedieval periods (Figures 4 and 5). Forthe majority of conditions, urban popula-tions in the Roman period show a lowerrate of dental pathology than rural popula-tions, but these differences either becomemuch smaller or reverse in the early medi-eval period. Rates of caries and AMTLdecrease significantly in all three settle-ment types at this time after taking intoaccount the sex and age composition ofeach site, while dental abscesses increasein urban settings but decrease in inter-mediate and rural settlements. The gap inoral health between urban and rural sitesincreases in the late medieval period: ratesof caries increase significantly in all settle-ment types, after taking into account thesex and age composition of each popula-tion, and rates of periodontal disease

Table 2. Average prevalences of oral pathologies in urban, intermediate, and rural populations fromRoman, early medieval, and late medieval sites, with p values determined using ANCOVA taking intoaccount the male:female ratio and proportion of adults over 25 years old in each population.

Condition Period Urban(per cent)

Intermediate(per cent)

Rural(per cent)

p value

Antemortem tooth loss (true preva-lence rate)

Roman 12 13 20 0.246Early medieval 7 8 8 0.985Late medieval 17 14 13 0.157

Calculus (crude prevalence rate) Roman 39 34 44 0.444Early medieval 40 50 37 0.858Late medieval 68 59 39 0.870

Caries (true prevalence rate) Roman 12 7 11 0.455Early medieval 5 4 4 0.115Late medieval 7 9 12 0.671

Dental abscesses (true prevalencerate)

Roman 1.8 3.5 13 0.003Early medieval 2.9 3.8 2.3 0.568Late medieval 2.7 4.6 1.6 0.135

Periodontal disease (crude prevalencerate)

Roman 41 37 45 0.531Early medieval 15 30 24 0.045Late medieval 66 33 29 0.022






increase in urban sites but decrease in ruralsites. It therefore appears that both urbanand rural contexts saw changes whichaffected the susceptibility of these popula-tions to oral disease.

DISCUSSION

The findings of this study suggest that thesocial and economic relationship betweenurban and rural sites may have had animportant influence on oral health inRoman and medieval times. In compari-son to the overall rates of dental disease inthe Iron Age reported in Roberts and Cox(2003), there is an increase in the rate oforal diseases in the Roman period, andthis is more marked among Romano-British rural populations than in theirurban counterparts. One possible explan-ation is that the incorporation of rural set-tlements into the broader market economyat this time had a particularly detrimental

effect on oral health in rural areas. Theassimilation of rural communities into theimperial economy would be expected tohave led to increased extraction and redis-tribution of rural surplus to the towns,associated with a concentration of thehighest quality produce in the towns atthe expense of the rural population. Thisprocess is likely to have had an impact onoral health, with rural communitiesbecoming more reliant on a carbohydrate-rich diet with a high cereal content due tothe lower availability of meat, as has beenobserved in Roman sites on the Europeancontinent (Manzi et al., 1999; Bonfiglioliet al., 2003). However, while the existenceof dietary differences between urban andrural settlements is supported by isotopicevidence for urban and rural diets fromboth Britain (Cheung et al., 2012) andItaly (Killgrove & Tykot, 2013), the dif-ferences identified in these studies do notappear to result from variations in meatconsumption between rural and urban

Figure 1. Multidimensional scaling plot for oral health data from Roman Britain. Urban;Intermediate; Rural.






populations, but to more subtle differencesin dietary composition. The isotopic evi-dence instead indicates that both urbanand rural populations were consumingsignificant quantities of meat and dairyproducts (Cummings, 2009), though var-iations in diet also existed within popula-tions (Redfern et al., 2010). Furthermore,archaeobotanical evidence shows that bothurban and rural populations had access toa varied diet at this time, such variety notbeing limited to elite groups (van derVeen et al., 2008). Nevertheless, the pres-ence of high rates of AMTL, caries, andcalculus in both urban and rural settle-ments in Roman times suggests that urbanas well as rural populations were consum-ing a diet that was high in carbohydrates.This is consistent with evidence from iso-topic studies (Richards et al., 1998;Bonsall & Pickard, 2015) and with previ-ous osteoarchaeological findings (e.g.Moore & Corbett, 1973; O’Sullivan et al.,1993). It may therefore be that

comparatively subtle differences in therelative quantities of carbohydrates withinurban and rural diets are reflected in thepoorer oral health observed here.Differences in the types of carbohydrate

consumed may also have had an impact onthe caries levels observed. For example,foods rich in sugars are more cariogenicthan those containing starchy carbohy-drates such as potatoes and grains, withstarchy foods being more likely to causecaries when cooked than when consumedraw (Moynihan, 2005). It is possible thatrural communities may have been consum-ing greater amounts of sugary carbohy-drates such as fruit relative to urbanpopulations, or a higher proportion ofcooked starchy carbohydrates. In addition,there is evidence to suggest that theconsumption of dairy products may helpto protect against caries formation(Moynihan, 2005). If urban populationswere consuming higher amounts of dairyproduce than rural populations, this could

Figure 2. Multidimensional scaling plot for oral health data from late medieval Britain. Urban;Intermediate; Rural.






also potentially explain the lower rates ofcaries observed in urban sites. Further iso-topic and archaeobotanical studies areneeded to identify the nature of dietarydifferences between urban and ruralRomano-British populations. It is alsopossible that the lower crude prevalencerates of dental diseases in urban popula-tions reflect a higher level of mortality inurban settlements, with a greater propor-tion of individuals dying in childhood orearly adulthood before these conditionswould become visible in their dentition.The analysis of the age distribution ofthe urban and rural Romano-British sitesincluded in this study has, however, foundno evidence for a difference in childhood/young adult mortality between urban andrural sites. Furthermore, the poorer oralhealth observed at rural sites acrossnumerous dental pathologies with differentcauses suggests that varying levels of mor-tality are unlikely to be the sole cause ofthis pattern.

The influence of economic factors onoral health in urban and rural populationsis supported by the decreasing rates of oralpathologies in both urban and rural earlymedieval sites. The rates of caries andAMTL drop substantially in the earlymedieval period in both urban and ruralpopulations, but the rate of calculus onlychanges slightly. The presence of highrates of calculus but low rates of cariesmay be indicative of a diet higher inprotein, as calculus is associated with theconsumption of both proteins and carbo-hydrates, while caries is primarily asso-ciated with high levels of carbohydrateconsumption (Lieverse, 1999). This mayreflect a shift to more localized distribu-tion networks in the early Middle Ages,with trade on both urban and rural sites(Blair, 2000) and urban populationstending to consume produce from theirlocal area rather than further afield(Britnell, 2000). This would allow rural aswell as urban communities to consume a

Figure 3. Multidimensional scaling plot for oral health data from early medieval Britain. Urban;Intermediate; Rural.






more diverse diet with a higher proportionof meat. This is consistent with the simi-larity in the diets of urban and rural popu-lations observed in stable isotope datafrom this period (Mays & Beavan, 2012).However, the analysis of crude prevalencerates for calculus cannot capture potentialvariations in the severity of calculus, whichwould provide more nuanced informationon oral health and diet at this time.Further detailed analysis of patterns in cal-culus severity may therefore help elucidatepatterns in diet and oral health betweenurban and rural sites in the early medievalperiod.The evidence for oral health in early

medieval continental Europe is muchmore mixed, with some regions showingan increase in dental disease (Manzi et al.,

1999; Slaus et al., 2011), but othersshowing a decrease at this time (e.g.Belcastro et al., 2007). This variationappears to be due to the differing impactof the dissolution of the Roman Empire.In areas where oral health declines at thistime, it has been suggested that this is dueto the decreased availability of meat in set-tlements that had become economicallymore isolated, particularly in regionswhich had previously benefited fromincorporation into the wider Romaneconomy. However in regions like Britain,which were net producers of food duringthe Roman period, separation from theRoman economy is likely to have increasedthe availability of meat, which would beconsistent with the improvements in oralhealth observed here.

Figure 4. Prevalences of oral pathologies in urban settlements from the Iron Age to the late medievalperiod (per cent). Figures are true prevalence rates for ante-mortem tooth loss, caries, and dentalabscesses, and crude prevalence rates for calculus and periodontal disease.






By contrast, the rate of oral pathologiesin both urban and rural communities gen-erally increases in the late medieval period,with most conditions increasing moremarkedly in the urban population, withthe exception of caries where the increaseis greater in rural populations. While otherstudies have observed decreasing rates ofcaries (Watt et al., 1997) and periodontaldisease (Gonçalves et al., 2015) at specificsites at this time, the present study foundevidence for worsening oral health across awide range of sites and oral pathologies.This was particularly evident when datafrom urban and rural settlements wereconsidered separately, with different pat-terns in dental disease observed withinthese two settlement types across theperiod under consideration. The higher

rates of oral disease in urban populationsare likely to have been strongly influencedby the higher proportion of older indi-viduals in urban sites relative to rural set-tlements. In particular, this urban ageprofile may be contributing to the muchgreater increase in rates of periodontaldisease and AMTL relative to caries.Periodontal disease and AMTL are bothmore strongly associated with age thancaries, and are therefore likely to be morecommon in populations with a higher pro-portion of older individuals. In addition,the presence of rising levels of AMTL islikely to have had an impact on observablecaries levels, as teeth lost ante-mortem asa result of caries will no longer be visiblein the archaeological record, potentiallyreducing the apparent rate of caries in that

Figure 5. Prevalences of oral pathologies in rural settlements from the Iron Age to the late medievalperiod (per cent). Figures are true prevalence rates for ante-mortem tooth loss, caries, and dentalabscesses, and crude prevalence rates for calculus and periodontal disease.






population. The age distribution of thesites, however, does not appear to be theonly factor influencing dental diseaseprevalence in these populations. Aftertaking into account the different age andsex distributions, urban and intermediatesites were found to have a significantlyhigher rate of periodontal disease thanrural sites. This suggests that the highernumber of older individuals at urban sitesis not the sole cause of the higher rates oforal disease in urban settlements.While sugar became increasingly avail-

able in the later Middle Ages, it is unlikelythat this is the primary cause of theincrease in oral pathologies, given that theobserved rate of caries is greater at ruralsites, and not at urban sites where sugar islikely to have been more plentiful. Duringthis period, towns grew in significance, ascentral places for the economic activityof both rural and urban populations,although substantial amounts of tradewere still conducted away from towns, toavoid the regulatory requirements and tollsassociated with many urban markets(Palliser, 2000). Meat and other producewas in high demand, and often had to beimported to the towns from further afield(Astill, 1983), which may have led to agreater reliance on cereals as the main-stay of the diet of the urban poor.Furthermore, this period is characterizedby a high level of inequality within urbansettlements. It is thus likely that urbanelites were able to consume a greater pro-portion of the available meat than theurban poor, although rates of meat con-sumption appear to increase generally inthe latter part of the Middle Ages (Dyer,1998). It is also possible that the con-sumption of dairy products was higheramong elite groups. As these would haveonly made up a small proportion of theoverall urban population, it is likely thatthe overall oral health status of each ceme-tery population reflects more closely the

health of the non-elite, except where thereis evidence for bias towards more affluentburials within a given cemetery. It there-fore seems likely that the generally pooreroral health observed in urban cemeterypopulations at this time reflects a tendencyfor greater longevity in urban sites as wellas a greater reliance on cereals in the dietof the urban poor.In addition to potential differences in

diet between urban and rural settlements,ease of access to dental treatment is likelyto have also affected oral health. Dentalpractitioners are likely to have been morecommon in urban settlements, and accessto such treatment outside urban centrespotentially more limited. In late medievaltowns, often only the most affluent citi-zens would have been able to afford dentaltreatment (Anderson, 2004b), limiting thebenefits of such greater access to dentalcare to a narrow group within each com-munity. This may have contributed to thehigh rates of most oral pathologies inurban sites in the later Middle Ages. Bycontrast, it has been suggested that inLate Roman towns in Britain a higherproportion of the population was made upof elite groups (Perring, 1991). It is pos-sible that the lower rates of dental path-ology in Roman urban populations are dueto the greater relative affluence of thoseliving in towns, with a larger proportion ofthe urban population able to afford dentaltreatment than in later periods. However,given the limited range of dental treat-ments available in Roman and medievalBritain (Anderson, 2004a, 2004b), it isunclear how significant the impact of suchtreatment would have been on overall ratesof oral health.The presence of monastic settlements

among the sites included in the study,both in urban and rural settings, constitu-tes an additional factor that needs to beconsidered for the early and late medievalperiods. Monastic settlements would have






contained concentrations of individuals ofhigher status, who may have consumedgreater amounts of meat than their lessaffluent contemporaries, and thereforewould exhibit lower levels of dentaldisease. A comparison of health indicatorsin cemeteries associated with monasticorders with data from non-monastic set-tlements showed no significant differencein oral health between the two groups ineither period (the p value range is 0.243–0.737 for the early medieval, 0.096–0.599for the late medieval after taking intoaccount the age and sex composition ofeach site). Although the number ofmonastic sites included in this study issmall, this suggests that the diet of themonastic communities and that of thegeneral populace were not substantiallydifferent, perhaps reflecting the fact thatmonastic settlements would also have con-tained significant numbers of servants andother lay people drawn from the non-aris-tocratic population. Such a finding is con-sistent with the evidence from isotopicstudies (Müldner & Richards, 2007a).However, DeWitte et al. (2013) havefound lower levels of mortality in monasticcommunities compared to non-monasticpopulations. It is therefore possible thatthe higher mortality of non-monasticpopulations is masking differences in oralhealth between these two groups, althoughno significant difference in age compos-ition was observed between the monasticand non-monastic sites included in thepresent study. However, the absence ofany observable difference in oral healthbetween monastic and non-monasticcemeteries suggests that treating monasticsettlements separately is unnecessary whenexamining the impact of place of residenceon oral health.The possibility that immigration, which

could have influenced the patterns in oralhealth observed, took place between urbanand rural areas constitutes a further

potential limitation to this study. Whilethere is considerable evidence for immi-gration from the countryside into thetowns from the late medieval period, with‘the majority of residents [being] … new-comers’ (Kermode, 2000: 458), it is diffi-cult to ascertain what impact this had onhealth, as immigrants often cannot bereadily identified from the archaeologicalrecord. In addition, many rural estateswere associated with houses located in anearby urban settlement (Hinton, 2000),suggesting regular movement betweenrural and urban contexts for the purposesof trade. Further isotopic studies of immi-gration patterns within medieval Britainmay help elucidate the impact of migra-tion on oral health at this time. Recentwork by Eckardt (2010) has also providedevidence for a significant presence ofmigrants within Romano-British urbansettlements. While this would have influ-enced the food consumed in Romantowns, with migrants potentially bringingdietary practices from their homeland toBritain, the isotopic evidence indicatesthat the majority of migrants adopted localfoodways (Eckardt et al., 2014). It there-fore seems unlikely that the presence ofmigrants would have significantly affectedthe overall oral health within urban settle-ments in Romano-British times.The results may also have been influ-

enced by the type of prevalence rateselected for each analysis. The crudeprevalence rates used may have beenaffected by the absence of teeth or jawsfrom some individuals at a given site,while the true prevalence rates may beunrepresentative of the prevalence withinthe whole population if the teeth and jawsof some individuals were better preservedthan those of other individuals at that site.Be that as it may, the trends observed donot appear to show any patterns withrespect to the type of prevalence rate used,with both crude and true prevalence rates






showing similar results. It therefore seemslikely that the trends observed are notstrongly affected by the prevalence rateselected for each condition. It is also pos-sible that the skeletal collections includedhere are not representative of the wholepopulation at each site. However, thetrends in oral health observed across mul-tiple sites from each site type in eachperiod suggest that any potential biaswithin individual sites is unlikely to be sig-nificantly influencing the overall results.The inclusion in the datasets of each

period of sites that were not occupied sim-ultaneously may also have influenced theresults obtained. If differences in oralhealth were present over time within agiven period, this would make it moredifficult to ascertain overall patterns inhealth within that period. Likewise, if thenumber of urban settlements varied withtime, it may also be difficult to separatethe impact of temporal changes in oralhealth from changes associated with settle-ment type. However, no such trend in sitetype was noted in any of the periods con-sidered here. It therefore seems unlikelythat this had a significant impact on theresults obtained. It is also possible that thefocus of this study on overall trends over awide geographical area masks regional dif-ferences in health; indeed there is evidencefrom Roman Dorset that rates of dentaldisease were higher in urban sites there(Redfern et al., 2015). Further work onthe influence of place of residence on oralhealth at the local level is needed to fullyunderstand the implications of the broaderpatterns observed here.

CONCLUSION

The findings of this study indicate thatplace of residence may have had a signifi-cant impact on oral health in Roman andmedieval Britain. While the same overall

trends in oral health are visible in bothurban and rural populations across thistime span, the extent to which these com-munities were affected differed: the ruralpopulations were more strongly affected bythe increase in oral disease in the Romanperiod, and the late medieval urban popu-lations were affected by increasing oralpathologies to a greater extent than theirrural counterparts. These patterns appearto reflect changes in diet associatedwith the changing economic relationshipbetween urban and rural settlements.However, it is likely that the effects ofsuch overall changes would have beenexperienced differently at the regional level,depending on the nature of the economicand social ties between a given town andits rural hinterland. It is hoped that thisstudy will provide a stimulus for furtherinvestigation into disparities in oral healthin town and country at a regional level andcontribute to a better understanding of thechanges that affected the population ofRoman and medieval Britain.

ACKNOWLEDGEMENTS

I am grateful to Dr Denise Donlon and tothe anonymous reviewers for their com-ments on the manuscript.

REFERENCES

Anderson, S. & Birkett, A. 1993. The HumanSkeletal Remains from Burgh Castle. In:M. Darling & D. Gurney, eds. Caister-on-Sea Excavations by Charles Green1951–1955 (East Anglian ArchaeologyReport 60). Gressenhall: NorfolkMuseums Service, pp. 256–60.

Anderson, T. 2004a. Dental Treatment inAnglo-Saxon England. British DentalJournal, 197: 273–74.

Anderson, T. 2004b. Dental Treatment inMedieval England. British Dental Journal,197: 419–25.






Arce, A. 2007. Health in Southern andEastern England (unpublished PhD dis-sertation, University of Durham).

Astill, G. 1983. Economic Change in LaterMedieval England: An ArchaeologicalReview. In: T. Aston, P. Coss, C. Dyer &J. Thirsk, eds. Social Relations and Ideas.Cambridge: Cambridge University Press,pp. 226–30.

Belcastro, G., Rastelli, E., Mariotti, V.,Consiglio, C., Facchini, F. & Bonfiglioli, B.2007. Continuity or Discontinuity of theLife-style in Central Italy during theRoman Imperial Age–Early Middle AgesTransition: Diet, Health and Behavior.American Journal of Physical Anthropology,132: 381–94.

Blair, J. 2000. Small Towns 600–1270. In:D.M. Palliser, ed. The Cambridge UrbanHistory of Britain. Cambridge: CambridgeUniversity Press, pp. 245–70.

Boddington, A. 1996. Raunds Furnells: TheAnglo-Saxon Church and Churchyard.London: English Heritage.

Bonfiglioli, B., Brasili, P. & Belcastro, M.2003. Dento-alveolar Lesions andNutritional Habits of a Roman ImperialAge Population (1st–4th c. AD): Quadrella(Molise, Italy). Homo, 54: 36–56.

Bonsall, L. 2013. Variations in the HealthStatus of Urban Populations in RomanBritain: A Comparison of SkeletalSamples from Major and Minor Towns(unpublished PhD dissertation, Universityof Edinburgh).

Bonsall, L. & Pickard, C. 2015. Stable Isotopeand Dental Pathology Evidence for Dietin Late Roman Winchester, England.Journal of Archaeological Science: Reports, 2:128–40.

Boyle, A, Dodd, A, Miles, D. & Mudd, A.1995. Two Oxfordshire Anglo-SaxonCemeteries: Berinsfield and Didcot. Oxford:Oxford Archaeological Unit.

Boylston, A. & Roberts, C. 2004. The RomanInhumations. In: M. Dawson, ed.Archaeology in the Bedford Region (BritishArchaeological Reports British Series 373,Bedfordshire Archaeological Monograph4). Oxford: Archaeopress, pp. 309–36.

Boylston, A., Wiggins, R. & Roberts, C.1998. Human Skeletal Remains. In: G.Drinkhall & M. Foreman, eds. The Anglo-Saxon Cemetery at Castledyke South,Barton-on-Humber (Sheffield Excavation

Reports 6). Sheffield: Sheffield AcademicPress, pp. 221–36.

Brickley, M. 2004. Compiling a SkeletalInventory. In: M. Brickley & J.L.McKinley, eds. Guidelines to the Standardsfor Recording Human Remains. Reading:Institute of Field Archaeologists, pp. 6–7.

Britnell, R. 2000. The Economy of BritishTowns 600–1300. In: D.M. Palliser, ed.The Cambridge Urban History of Britain.Cambridge: Cambridge University Press.pp. 105–26.

Brown, A. ed. 1995. Roman Small Towns inEastern England and Beyond. Oxford:Oxbow Books.

Cardwell, P. 1995. Excavation of the Hospitalof St Giles by Brompton Bridge, NorthYorkshire. Archaeological Journal, 152:109–245.

Chambers, R. 1987. The Late- and Sub-Roman Cemetery at Queenford Farm,Dorchester-on-Thames, Oxon. Oxoniensia,52: 35–69.

Cheung, C., Schroeder, H. & Hedges, R.2012. Diet, Social Differentiation andCultural Change in Roman Britain: NewIsotopic Evidence from Gloucestershire.Archaeological and Anthropological Science,4: 61–73.

Clarke, C. 1998. Excavations to the South ofChignall Roman Villa, Essex, 1977–81.Chelmsford: Archaeology Section, EssexCounty Council.

Clarke, G. 1979. The Roman Cemetery atLankhills. Oxford: Clarendon Press.

Cramp, R. 2006. Wearmouth and JarrowMonastic Sites, Volume 2. Swindon:English Heritage.

Crummy, N., Crummy, P. & Crossan, C.1993. Excavations of Roman and LaterCemeteries, Churches and Monastic Sites inColchester, 1971–88. Colchester:Colchester Archaeological Trust.

Cullen, K., Holbrook, N., Watts, M.,Caffell, A. & Holst, M. 2005. A Post-Roman Cemetery at Hewlett Packard,Filton, South Gloucestershire: Excavationsin 2005. Bristol and GloucestershireArchaeological Report, 4: 51–96.

Cummings, C. 2009. Meat Consumption inRoman Britain: The Evidence from StableIsotopes. In: M. Driessen, S. Heeren, J.Hendriks, F. Kemmers & R. Visser, eds.TRAC 2008: Proceedings of the ThirteenthAnnual Theoretical Roman Archaeology






Conference, Amsterdam 2008. Oxford:Oxbow Books, pp. 73–83.

Davies, S. 1985. The Excavation of an Anglo-Saxon Cemetery (and some PrehistoricPits) at Charlton Plantation, nearDownton. Wiltshire Archaeological andNatural History Magazine, 79: 109–54.

Denston, C. & Duhig, C. 1994. Discussion:The Human Remains. In: M. Dawson,ed. A Late Roman Cemetery at Bletsoe(Bedfordshire Archaeological Monograph1). Bedford: Bedfordshire County CouncilPlanning Department, pp. 30–33.

DeWitte, S. 2012. Sex Differences inPeriodontal Disease in Catastrophic andAttritional Assemblages from MedievalLondon. American Journal of PhysicalAnthropology, 149: 405–16.

DeWitte, S., Boulware, J. & Redfern, R.2013. Medieval Monastic Mortality:Hazard Analysis of Mortality Differencesbetween Monastic and NonmonasticCemeteries in England. American Journalof Physical Anthropology, 152: 322–32.

Dias, G. & Tayles, N. 1997. ‘Abscess Cavity’:A Misnomer. International Journal ofOsteoarchaeology, 7: 548–54.

Doherty, M.A., Blinkhorn, A.S. & Vane, E.S.2010. Oral Health in the Pacific Islands.International Dental Journal, 60: 122–28.

Dyer, C. 1998. Standards of Living in theLater Middle Ages: Social Change inEngland c. 1200–1520. Cambridge:Cambridge University Press.

Eckardt, H. ed. 2010. Roman Diasporas:Archaeological Approaches to Mobility andDiversity in the Roman Empire (Journal ofRoman Archaeology Supplement 78).Portsmouth (RI): Journal of RomanArchaeology.

Eckardt, H., Muldner, G. & Lewis, M. 2014.People on the Move in Roman Britain.World Archaeology, 46: 534–50.

Ettinger, R. 2007. Rural Dentistry: Lessonsfrom Other Countries. Special Care inDentistry, 27: 219–21.

Farwell, D. & Molleson, T. 1993. Poundbury,Vol. 2: The Cemeteries. Dorchester: FriaryPress.

Gonçalves, P., Griffiths, G. & Rawlinson, A.2015. A Study of the Periodontal State ofa Late Medieval United KingdomPopulation. Archives of Oral Biology, 60:1797–1801.

Gower, G.C. 1971. A General Coefficient ofSimilarity and some of its Properties.Biometrics, 27: 857–71.

Groves, S. 2011. Social and Biological Statusin the Bowl Hole Early Medieval BurialGround, Bamburgh, Northumberland.In: D. Petts & S. Turner, eds. EarlyMedieval Northumbria. Turnhout: Brepols,pp. 241–66.

Hall, R. & Whyman, M. 1996. Settlementand Monasticism at Ripon, NorthYorkshire, from the 7th to the 11thCenturies AD. Medieval Archaeology, 40:62–150.

Hawkes, S. 2003. The Anglo-Saxon Cemetery atWorthy Park, Kingsworthy, near Winchester,Hampshire. Oxford: Oxford UniversitySchool of Archaeology.

Hildebolt, C. & Molnar, S. 1991.Measurement and Description ofPeriodontal Disease in AnthropologicalStudies. In: M. Kelley & C. Larsen, eds.Advances in Dental Anthropology.New York: Wiley Liss. pp. 225–40.

Hillson, S. 1996. Dental Anthropology.Cambridge: Cambridge University Press.

Hinton, D. 2000. The Large Towns 600–1300. In: D.M. Palliser, ed. TheCambridge Urban History of Britain.Cambridge: Cambridge University Press.pp. 217–44.

Jackson, B. 2013. Nutritional Health Statusand Urban Food Economies: The Viewfrom Roman Britain (unpublished MAdissertation, UCLA).

Keal, L. 2012. Osteological and FuneraryAnalysis of the Human Remains. In:R. Savage & J. Sleap, eds. Former TalbotInn, 16, High Street, Caistor, Lincolnshire:Scheme of Archaeological Monitoring andRecording. Lincoln: Pre-ConstructArchaeological Services, Appendix 4.

Kermode, J. 2000. The Greater Towns 1300–1540. In: D.M. Palliser, ed. TheCambridge Urban History of Britain.Cambridge: Cambridge University Press.pp. 441–66.

Killgrove, K. & Tykot, R. 2013. Food forRome: A Stable Isotope Investigation ofDiet in the Imperial Period (1st–3rd

Centuries AD). Journal of AnthropologicalArchaeology, 31: 28–38.

Knocker, G. 1967. Excavations at Red Castle,Thetford. Norfolk Archaeology, 34: 155–86.






Langthorne, J. 2010. Human BoneAssessment. In: D. Killock, ed. AnAssessment of an Archaeological Excavationat 28–30 Trinity Street, London SE1,London Borough of Southwark. London:Pre-Construct Archaeology, pp. 194–201.

Larsen, C., Shavit, R. & Griffin, M. 1991.Dental Caries Evidence for DietaryChange: An Archaeological Context. In:M. Kelley & C. Larsen, eds. Advances inDental Anthropology. New York: Wiley-Liss, pp. 179–202.

Leach, P. 1982. Ilchester. Vol. 1, Excavations,1974–1975. Bristol: Western ArchaeologicalTrust.

Lieverse, A. 1999. Diet and the Aetiology ofDental Calculus. International Journal ofOsteoarchaeology, 9: 219–32.

Lightfoot, E., Slaus, M. & O’Connell, T.C.2012. Changing Cultures, ChangingCuisines: Cultural Transitions and DietaryChange in Iron Age, Roman and EarlyMedieval Croatia. American Journal ofPhysical Anthropology, 148: 543–56.

Lucas, G. 2001. Excavations at Vicar’s Farm,West Cambridge (Cambridge ArchaeologicalUnit, Report 425). Cambridge:Cambridge Archaeological Unit.

Malim, T. & Hines, J. 1998. The Anglo-SaxonCemetery at Edix Hill (Barrington A),Cambridgeshire (Research Report 112).York: Council for British Archaeology.

Manzi, G., Salvadei, L., Vienna, A. &Passarello, P. 1999. Discontinuity of LifeConditions at the Transition from theRoman Imperial Age to the Early MiddleAges: Example from Central ItalyEvaluated by Pathological Dento-alveolarLesions. American Journal of HumanBiology, 11: 327–41.

Matthews, C. 1981. A Romano-BritishInhumation Cemetery at Dunstable,Bedfordshire. Archaeological Journal, 15: 1–73.

Mays, S. 1989. The Anglo-Saxon HumanBone Report from School Street, Ipswich,Suffolk. English Heritage AncientMonuments Laboratory Report 115/89.

Mays, S. & Beavan, N. 2012. An Investigationof Diet in Early Anglo-Saxon EnglandUsing Carbon and Nitrogen StableIsotope Analysis of Human BoneCollagen. Journal of Archaeological Science,39: 867–74.

Mays, S., Brickley, M. & Dodwell, N. 2004.Human Bones from Archaeological Sites:

Guidelines for Producing AssessmentDocuments and Analytical Reports.Swindon: English Heritage.

McGavin, N. 1980. A Roman Cemetery andTrackway at Stanton Harcourt.Oxoniensia, 45: 112–23.

McKinley, J. 2009. Human Bone. In: K.E.Dinwiddy, ed. A Late Roman Cemetery atLittle Keep, Dorchester, Dorset. Salisbury:Wessex Archaeology, pp. 11–35.

McWhirr, A., Viner, A. & Wells, C. 1982.Romano-British Cemeteries at Cirencester.Cirencester: Cirencester ExcavationCommittee, Corinium Museum.

Moore, W. & Corbett, M. 1973. TheDistribution of Dental Caries in AncientBritish Populations: II. Iron Age,Romano-British and Medieval Periods.Caries Research, 7: 139–72.

Moynihan, P. 2005. The Role of Diet andNutrition in the Etiology and Preventionof Oral Diseases. Bulletin of the WorldHealth Organization, 83: 694–99.

Müldner, G. & Richards, M. 2007a. Diet andDiversity at Later Medieval Fishergate:The Isotopic Evidence. American Journal ofPhysical Anthropology, 134: 162–74.

Müldner, G. & Richards, M. 2007b. StableIsotope Evidence for 1500 Years ofHuman Diet at the City of York, UK.American Journal of Physical Anthropology,133: 682–97.

Ogunbobdede, E., Kida, I., Madjapa, H.,Amedari, M., Ehizele, A., Mutave, R.,Sodipo, B., Temilola, S. & Okoye, L.2015. Oral Health Inequalities betweenRural and Urban Populations of theAfrican and Middle East Region. Advancesin Dental Research, 27: 18–25.

O’Sullivan, E., Williams, S., Cape, J.,Wakefield, R. & Curzon, M. 1993.Prevalence and Site Characteristics ofDental Caries in Primary Molar Teethfrom Prehistoric Times to the 18th Centuryin England. Caries Research, 27: 146–53.

Palliser, D.M. 2000. The Cambridge UrbanHistory of Britain. Cambridge: CambridgeUniversity Press.

Pechenkina, E. & Delgado, M. 2006.Dimensions of Health and Social Structurein the Early Intermediate Period Cemeteryat Villa El Salvador, Peru. American Journalof Physical Anthropology, 131: 218–35.

Perring, D. 1991. Spatial Organisation andSocial Change in Roman Towns. In:






J. Rich & A. Wallace-Hadrill, eds. Cityand Country in the Ancient World. London& New York: Routledge, pp. 273–93.

Perring, D. 2002. Town and Country in England:Frameworks for Archaeological Research. York:Council for British Archaeology.

Pitts, M. & Griffin, R. 2012. Exploring Healthand Social Well-being in Late RomanBritain: An Intercemetery Approach.American Journal of Archaeology, 116: 253–76.

Poulton, R. 1989. Rescue Excavations on anEarly Saxon Cemetery Site and a Later(probably Late Saxon) Execution Site atthe Former Goblin Works, Ashstead, nearLeatherhead. Sussex ArchaeologicalCollections, 79: 67–97.

Proudfoot, E. 1996. Excavations at the LongCist on the Hallow Hill, St Andrews,Fife, 1975–7. Proceedings of the Society ofAntiquaries of Scotland, 126: 387–454.

Redfern, R., DeWitte, S., Pearce, J.,Hamlin, C. & Dinwiddy, K. 2015.Urban-Rural Differences in RomanDorset, England: A BioarchaeologicalPerspective on Roman Settlements.American Journal of Physical Anthropology,157: 107–20.

Redfern, R., Hamlin, C. & Athfield, N. 2010.Temporal Changes in Diet: A StableIsotope Analysis of Late Iron Age andRoman Dorset, Britain. Journal ofArchaeological Science, 37: 1149–60.

Richards, M., Hedges, R.E.M., Molleson, T.& Vogel, J. 1998. Stable IsotopeAnalysis Reveals Variations in HumanDiet at the Poundbury Camp CemeterySite. Journal of Archaeological Science, 25:1247–52.

Roberts, C. & Cox, M. 2003. Health andDisease in Britain: From Prehistory to thePresent Day. Stroud: Sutton Publishing.

Rogers, J. 1984. Skeletons from the LayCemetery at Taunton Priory. In: P. Leach,ed. The Archaeology of Taunton (WesternArchaeological Trust Excavation Mono-graph 8). Bristol: Western ArchaeologicalTrust, pp. 194–200.

Rogers, J. 1999. Burials: The HumanSkeletons. In: C. Heighway & R. Bryant,eds. The Golden Minster: The Anglo-SaxonMinster and Later Medieval Priory of StOswald, Gloucester (CBA Research Report117). York: Council for BritishArchaeology, pp. 229–46.

Shen, A., Zeng, X., Cheng, M., Tai, B.,Huang, R. & Bernabe, E. 2015.Inequalities in Dental Caries among 12-year-old Chinese Children. Journal ofPublic Health Dentistry, 75: 210–17.

Singh, A. & Purohit, B. 2013. AddressingOral Health Disparities: Inequity inAccess and Workforce Issues in aDeveloping Country. International DentalJournal, 63: 25–29.

Skillman, S., Doescher, M., Mouradian, W. &Brunson, D. 2010. The Challenge toDelivering Oral Health Services in RuralAmerica. Journal of Public HealthDentistry, 70: S49–S57.

Slaus, M., Bedic, Z., Sikanjic, P., Vodanovic, M.& Kunic, A. 2011. Dental Health at theTransition from the Late Antique to theEarly Medieval Period on Croatia’s EasternAdriatic Coast. International Journal ofOsteoarchaeology, 21: 577–90.

Spalding, R., Sinclair, D. & Cox, A. 1996.Dry Bones: A Palaeopathological Study ofSkeletal Remains from a MedievalGraveyard in Dundee. Scottish MedicalJournal, 41: 56–59.

Stroud, G. 1993. Human Skeletal Material. In:C. Dallas, ed. Excavations in Thetfordby B.K. Davison between 1964–1970.Norwich: Museums Service, FieldArchaeology Division, NorfolkArchaeological Unit, pp. 168–76.

Stuart-Macadam, P. 1986. Health and Diseasesin the Monks of Stratford LangthorneAbbey. Essex Journal, 21: 67–71.

van der Veen, M., Livarda, A. & Hill, A.2008. New Plant Foods in RomanBritain: Dispersal and Social Access.Environmental Archaeology, 13: 11–36.

Vincent, S. & Mays, S. 2009. Whitby AbbeyHeadland. Osteological Analysis of HumanRemains from Whitby, Whitby AbbeyHeadland Project: Southern AnglianEnclosure 1999–2000. Portsmouth: EnglishHeritage.

Waldron, H. 1987. The Human Bonesfrom Ulwell: English Heritage AncientMonuments Laboratory Report 87/87,unpublished report.

Watt, M., Lunt, D. & Gilmour, W. 1997.Caries Prevalence in the DeciduousDentition of a Mediaeval Population fromthe South-West of Scotland. Archives ofOral Biology, 42: 811–20.






Wells, C. 1976. The Human Burials. In:S. West & J. Plouviez, eds. The Romano-British Site at Icklingham (East AnglianArchaeology Report 3). Ipswich: SuffolkCounty Planning Department, pp. 103–19.

Wells, C. 1996. Human Burials. In: V. Evison& P. Hill, eds. Two Anglo-Saxon Cemeteriesat Beckford, Hereford and Worcester (CBAResearch Report 103). York: Council forBritish Archaeology, pp. 41–66.

Wessex Archaeology. 2003. New School Site,Boscombe Down, Wiltshire: ArchaeologicalExcavation Assessment Report. Salisbury:Trust for Wessex Archaeology.

Whytehead, R. 1986. The Excavation of anArea within a Roman Cemetery at WestTenter Street, London E1. Transactions ofthe London and Middlesex ArchaeologicalSociety, 37: 123–24.

Wood, J.W., Milner, G.R., Harpending, H.C. & Weiss, K.M. 1992. TheOsteological Paradox: Problems ofInferring Prehistoric Health from Skeletal

Samples. Current Anthropology, 33: 343–70.

BIOGRAPHICAL NOTES

Rebecca Griffin is a bioarchaeologist cur-rently based at the University of Sydney.Her research interests lie in understandingpatterns of health in past societies,through the study of oral health data fromarchaeological populations and the investi-gation of age-at-death using amino acidracemization in tooth enamel.

Address: Level 6, Jane Foss RussellBuilding (G02), University of Sydney,NSW 2006, Australia. [Email: [email protected]]

Urbanisation, évolution de l’économie et santé bucco-dentaire en Grande-Bretagneà l’époque romaine et médiévale

L’étude de la santé bucco-dentaire des populations d’époque moderne a révélé des inégalités entre lespopulations urbaines et rurales mais jusqu’à présent l’influence du milieu sur la santé dentaire de popu-lations provenant de contextes archéologiques n’a reçu que peu d’attention. L’étude méta-analytiqueprésentée ici se base sur des données paléo-pathologiques et a pour but de déterminer les rapports entre lelieu de résidence et la santé bucco-dentaire en Grande-Bretagne au cours de l’époque romaine et pendentle haut et le bas Moyen âge. Cette étude consiste en un examen diachronique des données publiées con-cernant la perte des dents avant décès, le tartre, les caries, les abcès dentaires et les maladies parodontalesrelevés dans les nécropoles et cimetières en milieux urbains et ruraux. Il en ressort que le lieu derésidence a eu un effet sur la santé bucco-dentaire à l’époque romaine ainsi que pendant le Moyen âge :la santé dentaire des populations urbaines romaines était meilleure que celle des communautés ruralescontemporaines ; par contre ces populations urbaines souffraient plus au bas Moyen âge. Ces résultatsreflètent probablement des transformations plus profondes dans la nature de l’habitat urbain et dans lesrelations que les villes entretenaient avec leur arrière-pays rural au cours des âges. Translation byMadeleine Hummler

Mots-clés: santé bucco-dentaire, paléo-pathologie, milieu urbain, milieu rural, économie,Grande-Bretagne

Urbanisierung, Wirtschaftswandel und Zahngesundheit im römischen undmittelalterlichen Großbritannien

Studien von modernen Bevölkerungen haben gezeigt, dass es Ungleichheiten in der Zahngesundheit vonstädtischen und ländlichen Gesellschaften gibt, aber der Einfluss des Wohnortes auf die Zahngesundheitvon archäologisch dokumentierten Gemeinschaften hat bisher wenig Aufmerksamkeit erregt. In der



mailto:[email protected]

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vorgelegten Meta-Analyse werden paläopathologische Angaben ausgewertet, um die Beziehungenzwischen Wohnort und Zahngesundheit im römischen, früh- und spätmittelalterlichen Großbritannienzu untersuchen. Die veröffentlichten Daten, die prämortaler Zahnausfall, Zahnstein, Karies, Abszesseund parodontale Krankheiten dokumentieren, wurden von Gräberfeldern und Friedhöfen in städtischenund ländlichen Bereichen in den verschiedenen Zeitabschnitten ausgewertet. Es ergibt sich, dass derWohnort die Zahngesundheit in der Römerzeit und im Spätmittelalter tatsächlich beeinflusste: Dierömischen Stadtbewohner hatten bessere Zähne als ihre ländlichen Zeitgenossen, aber im Spätmittelalterwar die Zahngesundheit in den Städten schlechter als auf dem Lande. Diese Ergebnisse weisenwahrscheinlich auf zeitliche Entwicklungen im Städtewesen und in dessen Beziehungen zu seinemländlichen Hinterland hin. Translation by Madeleine Hummler

Stichworte: Zahngesundheit, Paläopathologie, Stadtbereich, Landumgebung, Wirtschaft,Großbritannien




