The ancient Romans were certainly not known for their impeccable dental hygiene. In an era before germ theory and before the invention of the toothbrush, Romans chewed on twigs and used toothpicks to clean their teeth of food particles, and in some parts of the Empire, people used crushed shells or pumice to smooth teeth and urine to whiten them. Even without modern water picks and fluoride toothpaste, the average Roman had good gums, and their diet was not nearly as high in sugar as ours is today. One Roman toddler tells a different story, with widespread dental decay never before seen in a child from this time period.
Dental cavities are actually caused by a chronic infectious disease called caries. The disease is triggered when normal bacteria in the mouth, usually Streptococcus mutans, find a large source of sugar. S. mutans bacteria feast on the sugar and break it down, creating an acidic environment in the mouth. The acid attacks tooth enamel and causes the holes we know as cavities. Caries is technically an infectious disease because the bacteria involved can be passed from person to person, such as through kissing or through sharing of eating utensils.
Cavities are generally something we get as we age and our teeth, gums, and overall dental health deteriorate, but children are not immune to caries. A particularly common occurrence is “baby bottle caries” or “bottle tooth decay” to the top front teeth caused by allowing a baby prolonged access to a bottle with a sugary drink inside. Recent efforts to curb early childhood caries (ECC) are underway in countries where ECC is a major public health problem among socioeconomically underprivileged children. Little is known about ECC in ancient populations, but a growing interest in the diet and health of children in the past is bringing ECC to light in bioarchaeological literature.
A cemetery in Ancaster, England, dating to 270-410 AD has revealed the remains of at least 280 Romano-British people, including men, women, and children who worked as farmers, traders, and artisans. One skeleton in particular stood out for researchers Laura Bonsall, Alan Ogden, and Simon Mays: a child of 3 or 4 years of age who had massive amounts of missing and eroded enamel of the baby teeth.
To solve the mystery of this child’s poor dental health, Bonsall and colleagues performed a differential diagnosis, in an attempt to rule out similar diseases and settle on the most likely cause of the cavities. Possible diseases they considered included dental fluorosis from excess fluoride exposure, perimolysis caused by excessive vomiting, and xerostomia caused by reduced saliva production, but none of these was a good match for the Ancaster child’s particular dental lesions. Early childhood caries is the best-fit diagnosis, they write in a new article in the International Journal of Osteoarchaeology, because “distribution of ECC tends to follow a typical pattern” in which upper incisors and canines, as well as both upper and lower molars, are most commonly affected. Bonsall told Forbes that “it seems possible that the lesions began developing shortly after this child’s teeth had erupted,” but since ECC can progress rapidly “it’s difficult to be sure.”
The specific cause of ECC in the case of the Ancaster child may have been excessive consumption of honey and porridge, given historical information about foods the Romans chose to give infants and children. The second century AD Greek physician Soranus recommended substituting honey-sweetened goat’s milk for breastmilk when needed, suggested bread softened with honey as a weaning food, and advocated using plain honey to help with the pain of teething. Bonsall and colleagues note that, because this is an isolated case of ECC, it means very few people in Roman Britain were giving excess honey to their children. In surveying this child’s entire health, the researchers suggest that “the presence of active cribra orbitalia,” a pathological lesion that is the result of anemia, may mean that this child “suffered prolonged ill-health and/or poor nutrition with failure to thrive, and may have been fed for long periods with warm, sugary liquids as a compensation and comfort, or simply because normal chewing was painful.”