Caries through the ages: a worm's eye view.

Abstract

Smog, acid rain, riddled teeth dental caries is often perceived as one of modern plagues . . . that we are paying for sweet life through teeth. In a quantitative sense this is true: The sugar-laden diets of many technologically advanced societies can be associated with an increased prevalence of dental decay. But caries is an ancient disease, and are hard data to support this view. The progressive demineralization and destruction of teeth characteristic of dental caries in life cease as an active process upon death, with depletion of locally fermentable carbohydrates, and skeletal remains provide a permanent record of dental caries through ages. Indeed, jaws and teeth have proved to be most durable of our remnants; examination of this inheritance contributes greatly to reconstruction of physical and social attributes of our forebears, and of their ills.1 Evidence of caries has been noted in skulls of Australopithecine hominids of South Africa a half million years old, in ancient Neanderthal skulls, and in teeth of prehistoric peoples around world. This skeletal record tells us that distribution of caries lesions in mouth was different than it is today and that prevalence in ancient peoples was very low probably no more than a few percent of teeth exhibited caries,2 but disease was present. As long as hunting and gathering were major means of eking out an existence, caries prevalence remained low. With discovery of agriculture, however, and an increased availability of fermentable carbohydrates, prevalence increased and reached 10% in some cultures3 -certainly a modest level when compared to most of world today, but in people with no means of intervening in a really therapeutic way, caries meant excruciating pain, tooth fracture, and infection. Toothache has figured prominently in art, literature, and folklore. A Scythian vase from Fourth Century B.C. depicts dental treatment in very realistic detail. The quotations on subject range from Galen's observation in 130 A.D. that the greatest pain that killeth not patient is a to Shakespeare's in Much Ado About Nothing that there has never been a philosopher that can endure toothache patiently. The Elizabethans, at least upper classes, were especially vulnerable to toothache, a consequence of caries resulting from their too great use of sugar.2 Dental ills plagued Queen Elizabeth through most of her life, and surviving medical data and descriptions suggest that she seems to have died from a septic condition arising from mouth.4 In her review of Elizabethan toothache, Lavine5 calls attention to a passage in John Webster's The Duchess of Malfi, written ten years after Elizabeth's death: