A Comparative Study on the Dental Health Status of

Five Precolumbian Peruvian Cultures

RICHARD P. ELZAY 2. MAHVIN J. ALLISON AKD ALEJANDRO PEZZIA I
Department of Pathology, Medical College of Virginia, Health Science Dioision,
Virginia Comtnonwealth Cniuersity,Richmond, Virginia 23298, and
Museo Regional de Ica, Ica, Peru

KEY WORDS Dental Health

dibles.

Precolumbian

Peruvian

Man-

ABSTRACT
In a survey ofdental health status of ancient Southern Peru, 101
skeletal remains were studied from five cultures: Paracas, Nazca, Tiahuanaco, Ica,
and Inca. The Paracas and Ica cultures exhibited more missing antemortem teeth
per mandible than the other cultures. Frequency of missing one or more third
molars was less than expected and not as high as reported in peoples ofMongoloid
heritage. The Paracas, Ica and Nazca, coastal cultures had a higher caries incidence than the inland cultures. Whether this relates to some difference in diet or
water supply remains unresolved and warrants further investigation. Moderate attrition was noted in all the Precolumbian cultures but pulpal involvement was not
observed. Osteitis, noted in all the cultures, was more pronounced in the Nazca,
Paracas and Ica cultures. There appeared to be a direct relationship between
caries involvement and the number of missing mtemortem teeth to osteitis. Calculus was heavier in the Paracas and Ica cultures. In addition, the Paracas culture e x hibited a dark brown stain on the teeth which may imply some difference between
the cultures in either the food. water or social habits.
MATERIALS 4ND METHODS
Heports in English on dental characteristics of ancient and modern Peruvian culOne hundred and one dry, disarticulated
tures are scarce. Only Goaz and Miller mandibles of permanent dentition, sepa(661, Leigh (371, and Stewart (31) re- rated by cultural group but not b y age or
ported on dental morphology and pathol- sex, were included in the survey. The maxogy of the precolumbian Peruvian Indians. illae were not used because they were sepThe purpose of this study is to evaluate the arated from the mandibles, were fewer in
dental health status in ancient peoples of number and in generally poor condition.
different cultures to further our under- Since a dental radiographic unit was not
standing of the development of dental dis- available, all examinations were completed
eases in man and to provide baseline data by gross examination of materials with denfor comparisons.
tal probes and explorers under optimal
In a search for dental health status of an- light.
cient Southern Peru, we studied 101 skeleThe only teeth counted as missing were
tal remains from scientifically excavated those apparently lost prior to death (ancemeteries in the department of Ica. The temortem) as shown by osseous healing in
cultures studied were the Paracas (600 the edentulated area. Third molars were
B.C.-100 A.D.), Nazca (100 B.c.-800 A.D.), considered absent if the area posterior to
Tiahuanaco (900~.u.-1,200
A.D.), Ica (1,200
A.D.) and Inca (1,450~ . - ~ . - 1 , 5 3 2 Supported by a grant from the National Geographic
~.D.-1,450
A.D.).
AM. J. PHYS. ANTHROP., 46: 135-140.

Societs.

135

136

R P CLZAI, M J. ALLISON AYD A PEZZT4

the second molar showed no gross signs of

an erupting tooth and if the area exhibited
no evidence of previous tooth loss and subsequent repair. If the third molar crown
appeared within the bone but not completely erupted the tooth was classified as
partially erupted. The lack of a dental
radiographic unit prevented further clarification.
Severe attrition or abrasion with no gross
loss of crown enamel was scored as 0; 1 if
enamel loss on cusp tips did not involve the
grooves and fissures; 2 if the enamel loss involved the grooves and fissures; and 3 if
the process eliminated the grooves and
fissures on the occlusal surface. This system differs from the Attrition Index of
Lavelle ('73) only in omitting a fourth
category for teeth having pulp exposure
from attrition and in recording the highest
score, most severe, noted on the specimen
in lieu of individual scores for all teeth of
the specimen.
The incidence of dental caries was
recorded two ways. First, caries were
recorded according to the DMFS (decayed, missing, filled, surfaces) index. If a
tooth has a carious lesion involving only
one of its five surfaces, i.e., mesial, distal,
buccal, lingual and occlusal (incisall, it was
graded as 1. A missing tooth (antemortem)
or one with all five surfaces carious received a score of 5. This system denotes
severity of disease whereas reporting percent of teeth affected reports only the
caries rate. The second method was a
modification of the DMFS index. While
most teeth are lost today as a result of dental caries, teeth may have been lost in
earlier times via trauma, periodontal disease or pulpitis from severe attrition.
Hardwick ('60) developed a method attempting to correct this; however, it is
more meaningful to express caries incidence by omitting missing teeth. Hence
dental caries involvement is expressed as
DS (decayed tooth surfaces) per tooth and
jaw (specimen).
'The condition of osteitis was recorded as
present or absent only. Gross evidence of

either bone destruction and/or proliferation with or without a fistulous tract was
recorded as osteitis.
The degree of calculus formation was indicated as L (light) if less than 1mm ofcalculus was deposited on the lingual surfaces
of the anterior teeth; M (moderate) if concomitant deposition around posterior teeth
wa5 less than 1 mm; and H (heavy) if calculus deposition on anterior or posterior
teeth exceeded 1 mm.
Bone loss was recorded on a scale of 0
for no gross evidence: 1 for interdental
fcrestal)bone loss between adjacent teeth;
2 for bone loss down to the bifurcation area
of the roots; and 3 for bone loss beyond the
bifurcation area. In any one jaw specimen
only the most severe manifestation of bone
loss was recorded.
RESULTS

The results are tabulated in tables 1, 2,

and 3. As noted in table 1, thc Paracas culture exhibited the highest incidence of
missing teeth, an average of 4.3 per mandible followed by Ica with 4 then Nazca with
2.9, while Inca and Tiahuanaco had the
highest incidence of missing and partially
erupted third molars, and Ica, Paracas and
Nazca had the most missing first and second molars.
Eight jaw specimens were discarded for
attrition and caries evaluation because
some teeth were severely broken. Results
are noted in table 2. All cultures exhibited
moderate attrition with no appreciable difference between them. Diagonal attrition
and pulpal involvement was not observed.
A total of 656 teeth were examined for
dental caries incidence. In table 2 results
are indicated first as mean DMFS per tooth
and jaw. The Ica and Paracas cultures had
the highest incidence of caries followed b y
the Nazca while the Inca and Tiahuanaco
had the lowest. To compensate for errors
incumbent upon the supposition that teeth
missing were not necessarily lost as a result
of caries, missing antemortem teeth were
discounted and caries was reported as

137

DEUTAL IIEhLTH OF FIVE PERLI\IAiW LULIUHES

ThBLE 1

Frequency of mzssing or unerupted teeth

h13
C u l t lire

X Teeih
lost per

Teeth lost

Paracas
Nazca
Tiahuanaco
Ica
Inca
.4vt:ragcs

NTP

No

JdU

B missing
1 or both

44
12
19
9
17
20.2

704
192
304
144
272
323.2

190
35
36
36
30
65.4

27
18
12
2.5
11
18.6

3.4
2.9
1.9
4.0
1.8
2.98

2
0
5
0
11
3.6

Q with
1 or 110th
plrtlcllly
crupted

% lacking
1 or tmttr

5% Isrking

\I 1

XI2

20
1;
26
11
50
24.8

60
50
21
55
23
41.8

52
58
10
55
23
39.6

1 or both

N. numlwr of jaw specimens; NTP. numbcr of teeth possible, X, mean

TABLE 2

Frequency and seoerity of attrition and dental caries

X
Culture

Paracas
Nazca
Tiahhuanaco
IL!a
Inca
Averages

41
11
18
7

16
18.6

Caries based on DS

Caries based on DbFS

Score of

2 DMFS: % DMFSi

attrition
0,1,2.3

tooth

jaw

TNT

DS/
tooth

2 DS/

TNT

2.1
2.0
2.1
1.7
1.9
1.96

298
86
156
42
74
131.2

3.13
1.72
1.01
4.60
1.70
2.43

19.1
13.4
8.3
21.2
6.8
13.76

298
86
156
42
74
131.2

0.43
0.14
0.06
0.69
0.12
0.288

2.84
1.09
0.45
4.15
0.56
1.82

%.

jaw

K,numher ofjaw specimens; INT,total number of teeth. X, mcan: DMFS, decayed, missing, filled tooth surfaces
DS,decayed surfaces.
TABLE 3

Frequenc!g and seuerity of osteitis, calcuEirs and bone loss

Bonr loss

(:alclllrls

Oxteitis
Culture

Paracaa
Nazca
Tiahuanaco
Ica
Inca
Averages

% affprtrd

Light

44
12
19
9
17
20.2

34
42
16
22
18
26.4

41
11
18
7
16
18.6

28
82
88
29
88
63.0

B affected
Moderate

54
18
6
42
12
26.4

X score
Heavy

18

44

6
29
0

10.6

12
18
7
17
19.6

0,1,2.3

1.7
1.5
1.0
1.3
1.3

1.36

N, number of jaw specimens: X, mean.

mean decayed surfaces (DS) per tooth and

The Paracas was second with 34%, while

involvement in the remaining three culthe same but decreased in magnitude.
tures was 22% and less. Of 93 mandibles
Of 101 mandibles examined grossly for examined for calculus accumulation the
osteitis, the Nazca culture exhibited the Paracas and Ica cultures had thc highest
highest incidence 42% as shown in table 3. degree of moderate and heavy involve-

jaw. By this method the results were still

138

R. P ELZAY. 11.J ALLISON AND .A. PEZZIA

nificantly less than expected for a people of

alleged Mongoloid background. An obvious
difficulty in comparison of available data is
the lack of uniformity in reporting results.
Our findings on attrition indicate that
the five Precolumbian cultures had moderate attrition and no resulting pulp expoDISCUSSION
sures. Occlusal wear pattern was not noResults indicate that the Paracas and Ica ticeably oblique as noted in cultures where
cultures had the highest incidence of miss- teeth are used to strip husk or bark from a
ing antemortem teeth and the least food source. It would appear that the culaffected cultures were the Inca and tures shared a similar diet in terms of conTiahuanaco. These findings parallel find- sistency and/or preparation. Previous reings on dental caries incidence. The data ports on Precolumbian Peruvians similarly
on missing first and second molars also cor- found no severe attrition or pulp involverelates to the caries experience. The inci- ment (Leigh, 37; Stewart, 31). Similarly
dence of antemortem tooth loss has been Carbonell (66)found no pulp involvement
reported to decline spectacularly with the from attrition in ancient hlesopotamians.
transition to an agricultural culture from Although the data on partially erupted
41.6% loss in early hunting and gathering third molars suggest that the Inca and
economies to 6.2%in most recent phases Tiahuanaco specimens are of a younger
(Sweeney, 65).The Precolumbian ciiltures age, they still had attrition effects similar
of this study were primarily agricultural to the specimens of the other cultures.
cultures. Average tooth loss for combined
Results on dental caries have meaning
cultures was 18.6%.Tabulated findings on only when comparisons are made among
antemortem tooth loss in ten prehistoric the cultures observed. Especially as only
adult populations show 19.9% loss for Cran mandibles were examined and most paleoCanaria (Brothwell, 63). The Inca and dontological studies report percent of
Tiahuanaco cultures had the highest inci- teeth affected rather than severity. While
dence of missing and partially erupted lower age may influence the low caries in
third molars. They also had low scores for the Tiahuanaco and Inca cultures, causes
caries, bone loss and calculus suggesting for different caries incidence in the rethat although the two samples were adults maining groups are not as obvious. The
they were of younger age than the other three groups scoring high on caries also
scored highest in osteitis involvement, also
culture samples.
Although two of the cultures may have a sequelae of dental caries. The Ica, Nazca
been young adults, the average incidence and Paracas which had the highest caries
of third molar hypodontia was 3.6%. Car- incidence were all coastal as opposed to
bone11 (63) reported 2.6% incidence of inland cultures. Something in the diet or
third molar hypodontia (mandibles only) in water of the inland people such as
the Kish of Mesopotamia (3,000B.w.) while fluoride could have protected them against
Crispim, et al. (72)reported 8%per quad- caries. Further investigation on fluoride
rant and 2% for all four third molars in a content of bones and teeth should shed
trihybrid Brazilian population. Niswander some light on this relationship.
The maxillae are more frequently in(67) reported a 30.5%incidence of one or
more missing third molars in the Xavante volved with caries than the mandible
Indians of Brazil, and Dahlberg (63) indi- (Shafer, 74). In our study 70% of the mancated that Mongoloid people have a higher dibles had one or more carious lesions.
percentage of agenesis of third molars than Leigh (37)reported a 35% incidence in
do other groups. The present data are sig- specimens having both jaws. The reason for

ment. The remaining three cultures had

light to moderate accumulations while no
heavy accumulation was noted in the
Nazca or Inca cultures. The cultures exhibited moderate hone loss but little difference was noted between them.

DENT4L HEALTH OF FIVE PERIX'IAN CULTURES

the higher caries incidence in our study is

unknown. The incidence in the combined
adult population in the United States as of
1962 was 20.4 DMF teeth per person (U.S.
Dept. Health, '62). The overall average of
DMFS per specimen in the Precolumbian
cultures was 13.76. This figure is lower
than the above rate and if maxillae were
included in our study the difference could
conceivably equalize. Caries data on present day Peruvians are not available for
comparison.
Osteitis was noted in all five cultures.
The higher incidence in the Nazca, Paracas
and Ica culture paralleled the findings on
mean number of missing antemortem teeth
while calculus accumulation appeared to
relate directly to the caries incidence. The
absence of heavy calculus in the Nazca and
Inca cultures may once again relate to the
age of the sample. Whether the presence
of the dark brown coronal stain in the
Paracus relates to the type of water supply,
diet or habit of chewing coca remains
unresolved.
The amount of alveolar bone loss was
moderate among all the cultures and bone
loss did not correlate directly with calculus
or caries scores. The slight association with
attrition scores may imply that heavy
mastication forces were present. It is
plausible that a less refined and abrasive
diet caused by moderate attrition and
alveolar bone loss in the cultures irrespective of age.
ACKNOWLEDGMENTS

The authors would like to express their

indebtedness to Mark S. Elzav for his
efforts in collecting some of the data and to

139

Mrs. Phyl Schureman for her patience during the preparation of the manuscript.
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