Dental Pathology and Diet at Apollonia, a Greek Colony on the Black Sea.pdf

International Journal of Osteoarchaeology

Int. J. Osteoarchaeol. 18: 262–279 (2008)

Published online 31 August 2007 in Wiley InterScience

(www.interscience.wiley.com) DOI: 10.1002/oa.934

Dental Pathology and Diet at

Apollonia, a Greek Colony on

the Black Sea

A. KEENLEYSIDE*

Department of Anthropology, Trent University, Peterborough, Ontario, K9J 7B8, Canada

ABSTRACT Dental pathology has the potential to provide insight into the composition of the diet and to

reveal dietary differences based on age, sex and social status. Human skeletal remains from

the Greek colonial site of Apollonia (5 th to 2 nd centuries BC) on the Black Sea coast of Bulgaria

were analysed for various forms of dental pathology in order to: assess the prevalence of

dental disease in the population; compare the dental pathology data from Apollonia with

dietary data derived from ancient literary texts and from previous stable isotopic analysis of the

colonists’ remains; explore variations in dental disease with respect to age and sex; and

compare the prevalence of dental pathology in the Apollonians with that of other Greek

populations. The composition of the diet, as indicated by the dental pathology data, is

consistent with the stable isotopic evidence from Apollonia and with the ancient literary texts,

both of which indicate the consumption of a relatively soft, high carbohydrate diet. The higher

frequency of dental caries, abscesses, calculus, and antemortem tooth loss in older adults

compared with younger ones reﬂects the age-progressive nature of these conditions. The lack

of signiﬁcant sex differences in caries, abscesses, calculus and tooth loss corresponds with

the stable carbon and nitrogen isotopic data derived from bone collagen, which indicate no

signiﬁcant sex differences in the consumption of dietary protein. In contrast, these ﬁndings

conﬂict with the ancient literary texts, which refer to distinct dietary differences between males

and females, and with the stable carbon isotopic values derived from bone carbonate, which

indicate sex differences with respect to the overall diet. Despite the lack of marked sex

differences in dental pathology, overall trends point to subtle dietary differences between

males and females. A greater degree of tooth wear in males also hints at possible sex

Key words: dental pathology; diet; Greek colonial populations; Black Sea

Introduction

conditions and modes of subsistence (Littleton &

Frohlich, 1993; Tayles et al., 2000), investigated

dietary changes over time (Walker & Erlandson,

1986; Lillie, 1996), and examined age-, sex-, and

status-based differences in diet (Frayer, 1984;

Lukacs, 1996; Cucina & Tiesler, 2003). As an

indirect source of information on diet, dental

pathology has also been combined with direct

evidence of diet derived from stable isotopic

analysis of bone collagen and bone carbonate

(Sealy & van der Merwe, 1988; Lubell et al., 1994;

White, 1994; Lillie & Richards, 2000; Prowse,

2001).

Dental pathology is commonly recorded in archa-

eological samples, and its use in palaeodietary

reconstructions is based on the recognised link

between dental pathology and diet (Nelson et al.,

1999: 333). Studies of dental caries, antemortem

tooth loss, and other forms of dental disease

have explored the relationship between these

* Correspondence to: Department of Anthropology, Trent Univer-

sity, Peterborough, Ontario, K9J 7B8, Canada.

e-mail: akeenleyside@trentu.ca

Received 10 July 2006

Revised 30 April 2007

Accepted 11 May 2007

Dental Pathology in a Greek Colony

263

The earliest examination of dental pathology

in Greek skeletal samples was conducted by

Angel (1944), who compared dental pathology in

samples of early and modern Greek teeth with the

goal of assessing temporal changes in dental

health. Subsequent studies have examined dental

morphology and disease in approximately 1500

Middle Minoan (1750–1550 BC) teeth from

Knossos (Carr, 1960), explored the relationship

between dental caries and selenium and ﬂuoride

levels in archaeological and modern Greek teeth

(Hadjimarkos & Bonhorst, 1962), examined the

impact of changing subsistence patterns on dental

wear in Mesolithic and Neolithic remains from

Franchthi Cave (Smith & Cook, 1991), and

compared the skeletal and dental evidence for

social status in a Late Bronze Age skeletal sample

from the Athenian Agora (Smith, 2000).

Dental pathology data have been recorded in a

small number of Greek colonial samples, most of

them from southern Italy (Becker & Donadio,

1992; Becker, 1995, 1996; Henneberg, 1998;

Henneberg & Henneberg, 1998, 2003). In

contrast, little is known about the dental health

of Greek colonists on the Black Sea. Few studies

of ancient Greek populations have explored sex

differences in dental health, and none have

compared data on dental pathology with that

derived from literary sources and stable isotopic

analyses to test the utility of each as sources

of information on diet (for an excellent example

of this approach applied to Roman remains see

Prowse, 2001). The ancient literary texts refer to

distinct sex differences in diet among the ancient

Greeks. At Apollonia, stable carbon isotope

values derived from bone carbonate indicate

sex differences with respect to the overall diet,

while stable carbon and nitrogen isotope values

measured in bone collagen revealed no sex

differences in the consumption of dietary protein

(Keenleyside et al., 2006).

The aim of this study is to assess the prevalence

of dental pathology in a skeletal sample from the

Greek colonial site of Apollonia on the Black Sea

coast of Bulgaria, explore variations in dental

disease with respect to age and sex, compare the

dental pathology data from Apollonia with

dietary data derived from ancient literary texts

and from previous stable isotopic analysis of the

colonists’ remains, and compare the prevalence of

dental pathology in the Apollonians with that of

other Greek populations.

Archaeological and biocultural context of the

sample

According to literary sources, the Greek colony

of Apollonia was founded in 610 BC by the city of

Miletus in Asia Minor, on the site of the

present-day town of Sozopol on the Black Sea

coast of Bulgaria (Figure 1). Thought to have been

occupied by Thracians at the time of the colony’s

foundation, the site had a number of desirable

characteristics, including an excellent harbour,

good ﬁshing, and an easily defensible location

(Nedev & Panayotova, 2003). Its strategic

location contributed to its establishment as a

major trading centre, and Apollonia became a

prosperous urban centre during the 5 th and 4 th

centuries BC, minting its own coins, producing its

own ceramics, erecting monumental public

buildings, and establishing secondary settlements

in the surrounding territory (Nedev & Panayo-

tova, 2003). Archaeological evidence indicates a

trading relationship between the colonists and

the local Thracian population, and close con-

nections between the two groups are further

indicated by the presence of Thracian names on

Figure 1. Map of Apollonia (Sozopol) showing the

location of the necropolis.

Int. J. Osteoarchaeol. 18: 262–279 (2008)

DOI: 10.1002/oa

264

A. Keenleyside

several Greek tombstones excavated from the

necropolis (Nedev & Panayotova, 2003). Like

other Greek colonies on the Black Sea coast, the

inhabitants of Apollonia attempted to recreate

the same way of life they had enjoyed in their

homeland (Tsetskhladze, 1997). While they

brought the religious and political institutions

of their mother city with them, and maintained

commercial links with Miletus and other cities in

Asia Minor, they remained independent and

self-sufﬁcient (Nedev & Panayotova, 2003).

In 1938, the chance discovery of a grave in an

area known as Kalfata, located on the shore of the

Black Sea approximately 2.5 km south of Sozopol

(Figure 1), prompted scholars to direct their

attention to this area, and from 1946 to 1949,

large-scale excavations uncovered 801 graves

consisting of simple unlined pits, stone cists, tile

graves, wooden cofﬁns and urn burials (Venedi-

kov, 1963). Extending to a depth of ﬁve metres in

some places, most of the burials were typical

Greek inhumation burials containing single

individuals laid out on their backs in an extended

position, with their heads oriented primarily to

the east. The remains dated from the second half

of the 5 th century to the beginning of the 2 nd

century BC, based on associated grave goods

(Venedikov, 1963). A small number of cremation

and ﬂexed burials, dating from the mid to late 4 th

century BC, have been tentatively identiﬁed as

Thracian burials (Venedikov, 1963). Since 1992,

excavations led by Dr Kristina Panayotova of the

Institute of Archaeology in Soﬁa, of the Kalfata

necropolis and several adjacent sites have

uncovered an additional 400 burials (Panayotova,

1998; Nedev & Panayotova, 2003). Palaeopatho-

logical analysis of some of these remains has

revealed evidence of iron deﬁciency anaemia,

trauma and non-speciﬁc infections among the

colonists (Keenleyside & Panayotova, 2005,

2006). The sample utilised in this study is derived

from this most recent excavation.

the bacterial fermentation of dietary carbo-

hydrates, especially sugars’ (Larsen, 1997: 65).

Of the factors underlying the development of

caries, diet has been identiﬁed as the most

important (Powell, 1988). Diets containing

reﬁned sugars are more cariogenic than those

consisting of unreﬁned carbohydrates, while diets

high in protein and fat and low in carbohydrates

are known to impede caries formation (Powell,

1988). The texture of food also plays a role in the

development of caries, with soft, sticky foods

being more cariogenic than hard, abrasive foods

(Larsen, 1997). Other factors inﬂuencing tooth

decay include tooth crown morphology, attrition,

enamel hypoplasia, oral hygiene, ﬂuoride con-

sumption, oral bacteria and the composition of

saliva (Dawes, 1970; Lillie, 1996; Hillson, 2000).

Numerous studies of skeletal samples world-

wide have revealed higher rates of caries in

agricultural populations compared with hunter-

gatherers (Turner, 1979; Larsen, 1995; Hillson,

1996), reﬂecting their greater consumption of

carbohydrates. Agricultural diets have, in fact,

been inferred from high caries rates in the

absence of other types of dietary evidence

(Cohen, 1989: 107). In the western Mediterra-

nean region, for example, the transition to

agriculture was accompanied by an increase in

the rate of caries (Meiklejohn & Zvelebil, 1991).

Hunting and gathering populations, in contrast,

typically show an absence of caries, reﬂecting

their non-cariogenic, high protein diet; also,

populations heavily reliant on marine resources

typically show low rates of caries (Macchiarelli,

1989; Nelson et al., 1999).

One of the possible consequences of dental

caries is antemortem tooth loss, indicated by the

resorption of alveolar bone in the tooth socket.

Other causes of tooth loss include attrition,

trauma and periodontal disease, the latter being

one of the main causes of antemortem tooth loss

in modern populations (Hillson, 2005: 306).

Dental caries can also lead to periapical

abscessing, which occurs when bacteria invade

the exposed pulp cavity and proceed down the

root canal into the alveolar bone, causing an

infection of the surrounding tissue and the

formation of an abscess (Hillson, 2005). Pulp

exposure resulting from trauma or attrition can

also lead to abscesses.

Dental pathology and diet

Dental caries, the most common form of dental

pathology, is an age-progressive disease process

‘characterized by the focal demineralization of

dental hard tissues by organic acids produced by

Int. J. Osteoarchaeol. 18: 262–279 (2008)

DOI: 10.1002/oa

Dental Pathology in a Greek Colony

265

Dental calculus, or mineralised plaque, is

common in archaeological remains. Occurring

both above (i.e. supragingival) and below (i.e.

subgingival) the gums, it is most frequently found

on teeth closest to the salivary glands (Roberts &

Manchester, 1995). The relationship between

diet and the formation of dental calculus is not

straightforward (Hillson, 2001: 265), and high

calculus rates have been associated with both

high protein and high carbohydrate diets

(Meiklejohn & Zvelebil, 1991; Lieverse, 1999;

Lillie & Richards, 2000). When combined with

dental caries, however, it can be used to

determine the relative contribution of proteins

versus carbohydrates to the diet. High calculus

rates and low caries rates have been found to

characterise populations subsisting on a high

protein, low carbohydrate diet (Lillie, 1996: 140),

while heavy calculus deposits and high caries

rates have been observed in populations that

consumed a high carbohydrate diet (White,

1994: 283). The formation of calculus is also

inﬂuenced by a number of non-dietary factors,

including oral hygiene, the mineral content of

drinking water, the rate of salivary ﬂow, cultural

practices such as chewing betel nuts and coca

leaves, and the use of the teeth as tools (Lieverse,

1999).

Dental wear can provide valuable information

on the types of foods consumed, their consist-

ency and texture, and their methods of prep-

aration. Known to vary widely among popu-

lations, high levels of tooth wear recorded in

agricultural populations have been attributed to

the consumption of coarse cereal grains and the

use of grinding stones which can add a signiﬁcant

amount of grit to the diet (Larsen, 1997).

Differential wear between the anterior and

posterior dentition, seen in some archaeological

populations, has been interpreted as reﬂecting

different causes of tooth wear (e.g. diet vs. tool

use) (Littleton & Frohlich, 1993).

Enamel hypoplasia refers to a deﬁciency in

enamel thickness caused by a disruption in the

secretory phase of enamel matrix formation

(Goodman et al., 1984). Formed during tooth

crown development, hypoplastic defects are not

remodelled in later life, and therefore provide

permanent markers of stress episodes during

infancy and childhood (Goodman et al., 1984).

More than 100 different factors have been linked

to the development of enamel hypoplasia, with

particular attention being paid in the literature to

nutritional stress and childhood infections. Since

it is rarely possible to link enamel defects with

their underlying aetiology, they are considered to

be non-speciﬁc indicators of physiological stress

(Goodman & Rose, 1990). In some archaeological

samples, a higher prevalence of hypoplastic

defects in younger individuals compared with

older adults has been interpreted as reﬂecting an

increased likelihood of individuals who experi-

enced stress during childhood dying at a younger

age (Duray, 1996).

The Ancient Greek diet

Information on the ancient Greek diet derives

from a variety of sources, including literary texts,

most notably Athenaeus’ Deipnosophistae (Professors

of the Dinner-Table) and Galen’s On the Properties of

Foodstuffs, archaeological evidence in the form of

plant remains, animal bones, food preparation

utensils, storage vessels, ritual food offerings

associated with graves, and stable isotopic

analysis of human skeletal remains. These sources

indicate that the ancient Greeks relied on a staple

diet of cereals, legumes, olive oil and wine for

their subsistence. Olive oil was the main source of

dietary fat (Martin, 1996), and wine mixed with

water was the preferred beverage. Cereal crops,

most notably wheat and barley, comprised the

primary source of protein and carbohydrates

(Garnsey & Whittaker, 1983: 7; Rathbone, 1983:

46; Garnsey, 1999: 15). Dry legumes such as

lentils, broad beans, peas and chickpeas were also

an important source of protein. Several varieties

of millet were cultivated but were considered ‘an

emergency resource for small farmers’ (Garnsey,

1988: 52). Similarly, oats were grown mainly as a

fodder crop (Brothwell & Brothwell, 1969: 101). A

variety of fresh fruits, vegetables and nuts were

also consumed, and honey, dates and ﬁgs were

the main sweeteners (Brothwell & Brothwell,

1969; Grmek, 1989; Dalby, 1996).

Of the domesticated animals, sheep, pigs and

goats were the primary sources of meat (Dalby,

1996), although meat was relatively scarce and

generally made up only a small component of the

Int. J. Osteoarchaeol. 18: 262–279 (2008)

DOI: 10.1002/oa

266

A. Keenleyside

diet (Jameson, 1983: 10; Garnsey, 1999: 16, 123).

Goat and sheep milk was consumed in diluted

form (Brothwell & Brothwell, 1969: 50), and

cheese made from the milk of both animals was

also eaten (Brothwell & Brothwell, 1969: 52). Fish,

including shellﬁsh, were a highly valued part of

the diet of many Greeks (Dalby, 1996) and

garum, or ﬁsh sauce, was a popular ingredient in

many dishes.

According to literary sources, sex differences in

diet existed among the ancient Greeks. Males

were given preferential access to foods, while

women were denied meat and other nourishing

food items (Garnsey, 1999). Consequently,

women were at higher risk of nutritional

deﬁciency and disease, and may have experienced

a higher incidence of malnutrition than men

(Garnsey, 1999). Given this evidence for sex-

based variation in diet, one should therefore

expect to ﬁnd sex differences in dental pathology

in ancient Greek skeletal samples. Such differ-

ences might, for example, take the form of lower

caries rates in males resulting from a greater

consumption of meat and ﬁsh. Fluoride and

strontium, elements present in high quantities in

marine foods (Siebert & Trautner, 1985; Malde

et al., 1997), are known to impede the formation

of carious lesions.

with some of the graves contained food remains

interpreted as evidence of funerary feasts

(Panayotova, 1998). These included animal

bones, grape seeds, acorns, almonds and hazel-

nuts, and ceramic ﬁsh plates and grills (Panayo-

tova, 1998: 105; Nedev & Panayotova, 2003:

138–9). Astragali from sheep/goats, found in the

graves of both children and adults (Panayotova,

1998), suggest the consumption of one or both

species.

Stable isotopic analysis of bone collagen and

carbonate samples taken from the remains of 54

of the adults examined for dental pathology in

this study revealed that the colonists relied on a

mixed diet of terrestrial and marine resources

(Keenleyside et al., 2006). Statistical comparisons

by age and sex revealed no signiﬁcant differences

in d 13 Cord 15 N values for bone collagen,

suggesting similarities in the consumption of

dietary protein. In contrast, males had signiﬁ-

cantly higher d 13 C values for bone carbonate,

suggesting sex differences with respect to the

overall diet (Keenleyside et al., 2006). As such, it

is hypothesised that sex differences should be

seen in the prevalence of certain forms of dental

pathology at Apollonia.

Materials and methods

Archaeological and stable isotopic evidence of

diet at Apollonia

The dentitions of 162 adult skeletons were

examined in this study (Table 1). Sex determi-

nation of the skeletons was done using standard

morphological and metric criteria of the crania

and pelvic bones (Bass, 1987; Ubelaker, 1989).

Age estimation was based on pubic symphysis

morphology (Brooks & Suchey, 1990), auricular

surface morphology (Lovejoy et al., 1985) and

ectocranial suture closure (Meindl & Lovejoy,

The archaeological evidence recovered from

Apollonia suggests that during the 5 th to 2 nd

centuries BC, the population subsisted on a varied

diet of grains, nuts, ﬁsh, meat and shellﬁsh

(Panayotova, 1998). Ritual ﬁreplaces associated

Table 1. Age and sex distribution of the sample

Age (years)

Number of individuals

Number of teeth

Males

Females

Indeterminate

Males

Females

Indeterminate

18–35

418/511

851/1031

65/72

36–50

762/908

424/594

73/73

50þ

171/388

175/436

0/0

Total

1351/1807

1450/2061

138/145

Number of observable teeth/number of observable teeth plus teeth lost antemortem plus teeth lost post-mortem.

Int. J. Osteoarchaeol. 18: 262–279 (2008)

DOI: 10.1002/oa

Statistically signiﬁcant differences between males and females, P < 0.05.

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