PALLIATIVE CARE FOR GUM DISEASE, OR EVIDENCE FOR A TASK ACTIVITY? Irish case studies from the prehistoric cave at Killuragh, County Limerick and passage tomb at Fourknocks, County Meath to Medieval Wood Quay, Dublin, and Tintern Minor Abbey, County Wexford by Catryn Power.

Posted on August 3, 2020


see also TRASNA NA TIRE LECTURE NUMBER 73. 10,000 teeth later: what have I learned ? by Catryn Power

During the analysis of the human skeletal remains from the cave at Killuragh, County Limerick (excavated by J. O’Shaughnessy and P.C. Woodman in the 1990’s), one interproximal abrasion groove on the neck of a tooth was recorded. This was a maxillary second permanent molar from an adult aged in their twenties. This groove may have been caused by a tooth pick to alleviate some pain or discomfort between the first and second upper molars. Occlusal attrition was evident on the crown of this tooth, though it was probably not severe enough to probe it with a tooth pick, though the individual may have suffered from exceptional sensitivity.

A small number of interproximal abrasion grooves on the necks of teeth have been recorded by the author from a number of human skeletal remains from four archaeological sites in Ireland. These grooves date from the prehistoric to the historic periods.

Tooth picks are known from historical records to have been used by the ancient Greeks in the first and second centuries AD. In Medieval times aloes or pine strips in particular were used to remove food particles and minimize the risk of dental caries, as well as stop bleeding. However, it was those in the higher echelons of society who would have had tooth picks or ‘tuthpikis’ (according to those writing about James IV of Scotland). In the 16th century AD an import duty of one penny per dozen had to be paid on tooth picks as well as ear picks! In the sixteenth century AD the quills of porcupine were preferred for scraping the teeth. Advice at the time that after picking with a toothpick then the teeth should also be rinsed with wine, and rubbed with alum or corals. In the eighteenth century there were advocates for and against the use of tooth picks. Tooth picks at the time had become available for sale in Bath.

The person with the interproximal abrasion groove at Killuragh cave may have suffered from gum disease or periodontitis, which could not be determined with certainty as the tooth had no associated surviving alveolar bone. In life periodontitis would have resulted in inflammation or degeneration, or both, of the dental periosteum, alveolar bone, cementum and adjacent gingiva. The person may have poked the gums with a tooth pick, as well as the side of the tooth to alleviate discomfort associated with the condition. Periodontal disease was also evident in a fragment of alveolar bone at Killuragh, though it could not be determined if it belonged to the individual with the abrasion groove or to another person.

The date of the tooth from Killuragh cave with the abrasion groove has not been accurately ascertained. It is derived from some time from the Mesolithic to the Bronze Age. Poor stratigraphy with disarticulated human bone was apparent at Killuragh where the archaeological deposits were extensively disturbed.

One possible abrasion groove is present on the interproximal surface of a first permanent mandibular molar from a young adult dating to the Early Bronze Age at the passage tomb at Fourknocks, County Meath (excavated in the 1950’s by PJ. Hartnett). The periodontal status of this person could not be determined. However, periodontitis was evident in some individuals whose alveolar bone survived postmortem.

Calcified plaque or calculus irritates and exascerbates periodontitis. Deposits of calculus were evident around the necks of ten teeth at Killuragh Cave. These teeth were from a minimum of three individuals, at least two adults and one adolescent. Calculus deposits result from the deposition of soft pap-like foods around the necks of the teeth. Oral hygiene was very poor in past populations including in Ireland, and calculus deposition as well as other dental conditions are a common occurrence. Soft foods which resulted in calculus formation probably included the consumption of soft gruels, as well as white foods such as curds, whey and other milk products. The introduction of the cow into Ireland from the Neolithic period meant that ‘white foods’ became a large part of the Irish diet until the introduction of the potato. Cattle became very important to the economy of the island of Ireland. Deposits of calculus and periodontal disease also continued to exist in dentitions throughout Ireland from the Neolithic period to modern times. Periodontitis is probably due to a combination of factors: micro-organisms in the mouth, poor oral hygiene, a diet high in carbohydrates and poor resistance to infection.

Subsequently the author has recorded interproximal abrasion grooves on some of the teeth from two medieval (12th/13th century) individuals from a shallow grave on the south bank of the River Liffey at Wood Quay in Dublin (excavated by Dr. PF. Wallace in 1972-1981) and in four sixteenth century individuals excavated at the Cistercian Abbey at Tintern Minor, County Wexford (excavated by Dr. A. Lynch in 1982-1983). All tooth types had abrasion grooves, incisors, a canine, premolars, and molars. The grooves are located on the mesial or distal surfaces of the teeth. They are below and clearly separate from the areas of contact between the crowns of adjacent teeth in the jaws. Some of the grooves are shallow and confined to the enamel, but the larger grooves involve part of the root as well. They were examined and photographed using a scanning electron microscope. In all cases the presence of a characteristic pattern of parallel scratch marks scored in the floor of the grooves was confirmed. The grooves in the Wood Quay and Tintern people were of similar morphology to those seen in the individuals from the passage tomb Newgrange. In the Wood Quay and Tintern Minor Abbey individuals some of these abrasion grooves were associated with severe attrition or periodontal disease. Recession of the alveolar bone was seen at Tintern. The periodontal status of the alveolar bone from the individuals at Wood Quay could not be assessed.

Another possible causative factor in the formation of the interproximal abrasion groove is a task activity. An action such as pulling vegetable fibres between the teeth could also be responsible for these grooves. Perhaps weaving of plant fibres required some softening prior to their use and so resulted in the interproximal abrasion groove. Baskets, decorative wrist bands, containers, or matting could be made with vegetable fibres.

The number of teeth with interproximal abrasion grooves which I have recorded is small, in spite of examining at least fifteen thousand teeth. As oral hygiene in the past was poor and if tooth picks were used for cleansing in between the teeth, or for poking at inflamed gums one would expect to find few, and this is in fact the case. Alternatively the small number of abrasion grooves could be the result of a task activity carried out by a small number of people.

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