Gum disease is worse in modern Britain than Roman Britain

The Roman Empire and its people have much to teach us about health and disease in modern times. In this context I was interested to see a study published in the British Dental Journal indicating that an ancient British-Roman cohort from c. 200-400 AD appears to have had far less gum disease than we have today.

Periodontal disease is the result of a chronic inflammatory response to the build-up of dental plaque. While many of us live with mild gum disease, factors such as tobacco smoking, genetic factors or conditions such as diabetes mellitus can trigger more severe chronic periodontal disease, which can lead to the loss of teeth.

The study examined 303 skulls from a Romano-British burial ground in Poundbury, Dorset for evidence of dental disease. Just over 5 per cent of the skulls showed signs of moderate to severe gum disease, compared to today’s population of which around 15-30 per cent of adults have chronic progressive periodontitis. In this ancient population, the prevalence rate remained nearly constant between the ages of 20 and 60, after which it rose to 10 per cent.

However many of the Roman skulls, which form part of the collections in the Palaeontology department of the Natural History Museum, showed signs of infections and abscesses. The Poundbury population also showed extensive tooth wear from a young age, as would be expected from a diet rich in coarse grains and cereals at the time. Such a diet would have required long, slow chewing and would have been abrasive to the teeth. Even the youngsters showed excessive amounts of wear and exhibited exposed dentine.

More than half the population had dental caries, except in the 25-34 year old group. Boiling milled flour into porridge was one of form of cereal that was thought to be enjoyed by the population. While porridge would have been less abrasive to the teeth than bread, but may have caused an increase in caries incidence.

The Poundbury cemetery community, genetically similar to modern European populations, was made up of countryside dwellers as well as a Romanised urban population. This was a non-smoking population and likely to have had very low levels of diabetes mellitus, two factors that are known to greatly increase the risk of gum disease in modern populations. Among the people who survived infancy, childhood illnesses and malnutrition into adulthood, the peak age at death appears to have been in their 40s. Infectious diseases are thought to have been a common cause of death at that time.

This research, albeit associated with methodological issues, shows a deterioration in oral health from Roman times to modern Britain despite the fact that this ancient population would not have used toothbrushes or visited the dentist as we do today. Smoking is likely to be one factor increasing the susceptibility to periodontal disease, suggesting that as smoking declines, a decline in periodontal disease should follow.

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Citation
The Pharmaceutical Journal, PJ, 20/27 December 2014, Vol 293, No 7841/2;293(7841/2):DOI:10.1211/PJ.2014.20067288