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Dental health status changes during the Neolithisation in Syria: a diachronic perspective (9,820-6,000 cal. BC)

Bérénice Chamel
p. 83-96

Résumés

Résumé. La Néolithisation au Proche-Orient est une période phare de l’histoire de l’humanité : c’est en effet au cours de cette phase qu’interviennent de grands changements dans l’économie de subsistance, apportés par l’invention de l’agriculture et de l’élevage. D’autres changements dans le mode de vie sont également engendrés par la sédentarisation et, en dernier lieu, par l’invention de la céramique. L’objectif de cette étude est de voir si les bouleversements que connaissent les populations néolithiques s’observent dans l’état sanitaire bucco-dentaire, en se focalisant sur les marqueurs les plus pertinents. Les 312 individus, provenant de sept sites syriens (Tell Qaramel, Cheikh Hassan, Dja’de el-Mughara, Tell Aswad, Abu Hureyra, Tell Mureybet et Tell Ain el-Kerkh) ont donc été étudiés de façon systématique à la recherche de caries, d’abcès, de dents perdues ante-mortem et de maladie parodontale, et ces individus ont été regroupés par périodes afin de mesurer l’impact de la Néolithisation dans une étude diachronique. Ce travail a permis de mettre en évidence que les changements intervenus dans l’état de santé dentaire sont loin d’être linéaires ; il semblerait également que l’invention de l’agriculture et le mode de préparation des aliments aient joué un rôle important dans l’évolution de l’état de santé bucco-dentaire.

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The author would like to thank the directors of the osteological collections who made this study possible: Theya Molleson, from the Natural History Museum in London, Youssef Kanjou, from the Aleppo Museum, Akira Tsuneki, from the University of Tsukuba, Éric Coqueugniot from the UMR 5133 Archéorient, Henri de Lumley and Amélie Vialet from the Institut de Paléontologie Humaine, and Marie-Claire Cauvin, formerly of the UMR 5133 Archéorient. This thesis work was supported by a funding from the French Ministry of Research. The author would also like to thank Françoise Le Mort, director of the Maison de l’Orient et de la Méditerranée, for her advice and corrections, as well as Anne-Marie Tillier who invited me to contribute to this special issue.

Neolithisation in the Near-East: context and material

1The end of the Paleolithic in the Near-East was marked with climate and environmental changes, followed by a major shift in subsistence patterns. The term “Neolithisation” groups together several processes that led to a significant advance in the long evolution of human societies. In the Near East, four major stages followed one another, occurring in different locations: sedentarization, agriculture, animal husbandry and the use of ceramics as containers. In the South Levant, from the Natufian around 12,000 cal. BC, hunter-gatherers sedentarized and settled in villages of round houses, often on the banks of rivers and in coastal regions. They still hunted, fished, and gathered plants and cereals (Bocquentin 2003; Belfer-Cohen and Goring-Morris 2020). Traces of this type of occupation have also been found on the banks of the Euphrates on the sites of Abu Hureyra and Tell Mureybet. The PPNA (9,500-8,700 cal. BC; Cauvin 1994) was composed of several cultures, in the North as well as the South. The architecture alternated between round houses and rectangular buildings when the first community buildings appeared (Stordeur et al. 2001). It is during this period that the first pre-domestic crops, such as wheat and barley, and perhaps also pulses—lentils and peas—appeared (Willcox 2000; Fuller et al. 2012). Later on, the Early PPNB (EPPNB; 8,700-8,200 cal. BC) can be found in the Northern Levant, on the banks of the Euphrates, in Anatolia and Cyprus (Asouti 2006; Guilaine 2017). Agricultural experiments continued and seeds with domestic morphology appeared. It was also during this period that the first signs of animal husbandry occurred (Helmer et al. 1998). The culture of the Middle PPNB (8,200-7,500 cal. BC; Cauvin 1994; Chambrade 2012) spread southwards, with more and more sites presenting a rectangular architecture. Agriculture and animal husbandry were now proven on most sites, although some still practiced hunting and gathering (Stordeur et al. 2010). The number of sites was at its highest in the Late PPNB (LPPNB; 7,500-7,000 cal. BC), with some very large settlements found in new areas; agriculture and animal husbandry were by then widespread, as well as trade between communities (Willcox 2000; Vigne 2005; Asouti 2006). Finally, the last major innovation attributed to Neolithisation was the invention of ceramics in the Pottery Neolithic (early 7th millennium).

2The changes in diet that take place with new subsistence patterns are, in many parts of the world, linked to an increase in dental pathologies (Hillson 1979; Stock and Pinhasi 2011). It is indeed a fact that a raise in caries rates over time has been observed worldwide and that past and present hunter-gatherers have a lower caries rate (average < 4%) than agriculturists (average > 7%; Turner 1979), despite the intragroup variations (Marklein et al. 2019). The increased consumption of carbohydrate-rich plants, such as cereals, makes teeth more susceptible to caries, abscesses and in the end, ante-mortem tooth loss (AMTL). Similarly, the use of ceramics as container, by changing the way food is cooked—giving the food a stickier consistency and facilitating the proliferation of bacteria (Molleson 1995)—may also have had an impact on the increase in dental pathologies.

  • 1 Some researchers (Lukacs 2008: 909) linked this absence of changes in dental health with a gradual (...)

3The search for the impact that the adoption of agriculture and ceramics may have had on the state of health is in line with Smith’s early work (Smith 1970, 1991) and Cohen and Armelagos (1984). The first, on the Natufians, linked health status and food, and the second wondered about the links between infectious diseases and agriculture in different parts of the world. They both showed that the adoption of agriculture had an impact on the raise in the frequency of infectious pathologies and stress indicators. In contrast, the work of Eshed et al. (2006), based on Natufian populations of hunther-gatherers and agriculturists in the Southern Levant, have not shown any changes in the frequency of dental pathologies between the two periods.1 But a wider study (Bocquentin et al, in press), undertaken by crossing data from Southern and Northern Levant, with a chronological field from Natufian to Pottery Neolithic, showed on the contrary a constant increase of carious disease.

4The link between dental pathologies and diet must be tempered, however, because many other factors can be taken into consideration such as biological and physiological components specific to each individual (composition of saliva, dental morphology, dental hygiene...), age, sex, but also the presence of fluoride in the water, even the climatic factors (Reich et al. 1999; Lukacs 2008; Martinez-Mier and Zandona 2013; Marklein et al. 2019). Moreover, the consumption of carbohydrates does not date back to the adoption of agriculture, since cereals were already consumed in the form of harvested products (Tayles et al. 2000; Humphrey et al. 2014).

5Human remains from seven Syrian sites were studied for infectious diseases, both on bones and teeth, and biological stress indicators (Chamel 2014). This paper will only present the data from the dental health status. Archaeological sites were selected based on their availability and relevance, and with the aim of covering the entire Neolithic process, from 9,820 to 6,000 cal. BC. Four of them are in the Euphratic corridor (Dja’de el-Mughara, Cheikh Hassan, Tell Mureybet and Abu Hureyra), one in the Central Levant (Tell Aswad) and two in Northern Syria (Tell Qaramel and Tell Ain el-Kerkh, fig. 1). All the sites are in steppic environment, often near a watercourse, but each site is at the interface of at least two environments, creating a favourable terrain for hunting and gathering, but also for cultivation (table 1).

Table 1 Comparison of the environment, archaeobotanical and archaeozoological data of the sites selected for the study.

Table 1 – Comparison of the environment, archaeobotanical and archaeozoological data of the sites selected for the study.

Fig. 1 – Location of the studied sites in Syria (Chamel 2014).

Fig. 1 – Location of the studied sites in Syria (Chamel 2014).

6The site of Cheikh Hassan was discovered and excavated in the 1970s, then a second time before it was covered by the waters of Lake Tabqa in 1994 (Cauvin 1980; Stordeur 1999). Initially located on the left bank of the Middle Euphrates, this tell, more than 12 m high, has yielded, among other things, occupations from the end of the PPNA and the EPPNB (9,000-8,900 cal. BC; Stordeur and Ibañez 2008).

7Tell Mureybet was located, before its submersion, on the left bank of the Euphrates, not far from Abu Hureyra and Cheikh Hassan (fig. 1). Three environments intersected: the river and its banks, the river plain, and the steppic plateau, encouraging the Natufians to settle here, not far from a primary flint site (Cauvin 1977; Stordeur and Ibañez 2008). Mureybet was occupied in a seemingly continuous manner for 2,000 years, from the final Natufian to the Middle PPNB. Human remains were discovered in phase III (Mureybetian), from PPNA (IIIA) to the transition from PPNA to PPNB (IIIB, about 8,900 cal. BC). Then the tell was occupied at a different location than previously from EPPNB, around 8,300 cal. BC (phase IVA) to Middle PPNB (phase IVB, 8,200 cal. BC; Evin and Stordeur 2008).

  • 2 Coqueugniot E. 2010 – Dja’de el-Mughara. Rapport Scientifique 2010, unpublished.

8Further north, the site of Dja’de el-Mughara stands on a middle Quaternary terrace, above the left bank of the Euphrates river, and dominates the alluvial plain and the steppe hinterland of the Jezirah (Coqueugniot 1999; fig. 1). Dja’de was continuously occupied between the end of the PPNA to the end of the EPPNB, delivering three levels of the Pre-Pottery Neolithic (DJ1: 9,310-8,830 cal. BC; DJ2: 8,800-8,500 cal. BC; DJ3: 8,540-8,290 cal. BC),2 each of them with human remains, with the largest number of individuals at DJ3 (Chamel 2014; Chamel and Coqueugniot 2020).

  • 3 The data given in the monograph by Moore et al. 2000 have not been calibrated with the current refe (...)

9Abu Hureyra settled on one of the right lower terraces overhanging the Euphrates, at the interface of the alluvial plain and the arid steppe (fig. 1; Moore et al. 2000). The site was occupied in several phases, the first dating from the recent/final Natufian (AH 1: 11,500-9,650 cal. BC; Hillman 2000), after which the site was abandoned during the PPNA, then reoccupied at the Middle PPNB and the Pottery Neolithic after the tell was flattened by the new inhabitants (AH 2A: 8,650-7,350 cal. BC; 2B: 7,350-6,200 cal. BC; 2C: 6,200-6,000 cal. BC;3 Moore et al. 2000).

10The site of Tell Aswad, in the Central Levant, is in the Damascus basin (fig. 1), on the edge of a lake that has now disappeared, with forest-steppe type vegetation (Contenson 1995). The site, excavated by Contenson and then by Stordeur, was occupied from the end of the EPPNB to the beginning of the LPPNB. If lithic industries prove that the different phases belonged to the PPNB dating by 14C remains inconclusive (Stordeur et al. 2010).

11Tell Qaramel, excavated by a Syro-Polish team since 1999, is an 18.7 m high tell located in the valley of the Qoueiq River, in northern Syria (fig. 1; Mazurowski 2012). According to 14C and lithic industries, the site was occupied discontinuously between the Epipaleolithic and the end of the PPNA. Horizons H3 and H4, which represent the periods of the Middle and Late PPNA that yielded human remains are dated between 9,817-8,711 cal. BC for horizon H3, and 9,305-8,783 cal. BC for horizon H4 (Mazurowski et al. 2009).

12Lastly, Tell el-Kerkh is located in the Rouj basin (fig. 1, northern Syria), in a plain on the banks of a lake that has now disappeared. The site encompasses three artificial tells, Tell el-Kerkh 1, Tell el-Kerkh 2, and Tell Ain el-Kerkh (Tsuneki et al. 1997, 1998, 1999), and the human remains studied come from the latter. The occupation of Tell Ain el-Kerkh began in the LPPNB, between 8,500 and 8,300 cal. BC (Arimura 2007). After a hiatus, the site was reoccupied in the Late-Final PPNB, between 7,300 and 7,000 cal. BC. The main occupation took place during the Pottery Neolithic period (7,000-6,200 cal. BC; Iwasaki and Tsuneki 2003; Arimura 2007), and the human remains come from a “cemetery” of more than 200 individuals in a central area close to the dwellings (Hudson et al. 2003).

13The archaeobotanical and archaeozoological data from the sites are summarized in table 1 and in figure 2, which also presents the modalities of the subsistence economy: presumed agriculture, confirmed agriculture, animal domestication and ceramics (Zeist 1970; Leroi-Gourhan 1974; Zeist and Bakker-Heeres 1982; Moulins 2000; Colledge 2001; Tanno and Willcox 2006, 2012; Willcox 2008; Willcox et al. 2008; Colledge and Conolly 2010; Douché and Pichon 2018). Sharing fairly similar environments, almost all the sites harvested or cultivated cereals: barley, emmer and einkorn wheat, and rye. Legumes such as peas, lentils and vetches were also consumed, although it is not known whether this was the result of harvesting or cultivation. As far as animals are concerned, cynegetic activities targeted aurochs, horses, deer and gazelles, depending on the environment. The domestication of aurochs was in progress in Dja’de during the DJ3 phase (Helmer et al. 2005; Edwards et al. 2007). Domestication of pigs, cattle, sheep and goats was effective in Tell Aswad, Tell Ain el-Kerkh and Abu Hureyra (Legge and Rowley-Conwy 2000; Helmer and Gourichon 2008, 2017), and of goats and cattle during the last period of Tell Mureybet (IVB; Gourichon 2004; Helmer et al. 2005; Gourichon and Helmer 2008). Only the sites of Tell Qaramel and Cheikh Hassan show no evidence of plant cultivation nor animal domestication (Grezak 2012; Willcox and Herveux 2012).

Fig. 2 – Chronological timeline presenting the types of subsistence economy of the sites studied.

Fig. 2 – Chronological timeline presenting the types of subsistence economy of the sites studied.
  • 4 Minimal Number of Individuals.

14Our corpus comprises 4,307 observable teeth belonging to a minimum of 312 individuals from the seven sites described above, and attributed to hunther-gatherers and agriculturists, from 9,820 to 6,000 cal. BC. We have subdivided the corpus into 4 chrono-cultural phases, the PPNA (MNI4 = 25, 9,820-8,780 cal. BC), the EPPNB (MNI = 83, 8,800-8,200 cal. BC), the Middle-Late PPNB (MLPPNB; MNI = 128, 8,650-6,200 cal. BC) and the Pottery Neolithic (PN, MNI = 76, 7,350-6,000 cal. BC; table 2). As the sample size of the PPNA is smaller than in other periods, it is less representative, and the results should be taken with caution.

Table 2 – Number of individuals and tooth studied by phase and by site. QRM: Tell Qaramel; CH: Cheikh Hassan; DJ: Dja’de el-Mughara; Mb: Tell Mureybet; ASW: Tell Aswad; AH: Abu Hureyra; Kh: Tell Ain el-Kerkh.

Table 2 – Number of individuals and tooth studied by phase and by site. QRM: Tell Qaramel; CH: Cheikh Hassan; DJ: Dja’de el-Mughara; Mb: Tell Mureybet; ASW: Tell Aswad; AH: Abu Hureyra; Kh: Tell Ain el-Kerkh.

Methods

15We collected all data with the same methodology, to make inter-site and diachronic comparisons. The teeth were observed macroscopically, and the observations gathered in a database constructed with Filemaker (Chamel 2014). Repeatability in the assessment of lesions, due to the study circumstances (thesis work, and collections stored in an unstable country), was very difficult to evaluate. Only a small segment of the Dja’de el-Mughara sample was revisited, with an agreement of 92%. Isolated teeth were excluded from the study to analyse the results not only per tooth, but also per individual, which could lead to observations related to age at death and sex (Hillson 2001).

  • 5 The last bones to fuse in adults.

16In the populations observed, sex determination of individuals in the populations observed was very difficult, if not impossible, due to the poor conservation and representation of the remains. The methods used, when the coxal bones were sufficiently well preserved, are based on the visual method of Bruzek (2002) and the DSP of Murail et al. (2005). The estimation of age at death is based preferentially for immature individuals on dental remains, following the methods by Moorrees et al. (1963a, 1963b), and on degrees of bone maturation following the methods of Adalian (2002), Fazekas and Kosa (1978) and Scheuer and Black (2000). For adults, the method of Owing-Webb and Suchey (1985) on the degrees of fusion of the sternal end of the clavicle and the anterior crest of the ilium5 were preferred for the young adults, and the methods of Schmitt (2005, 2008) on the auricular surface of the ilium and the pubic symphysis for older individuals.

17For this study, attention has been focused on four infectious dental pathologies, including caries, abscesses, ante-mortem tooth loss and periodontal disease (fig. 3). The etiology of these diseases, as seen above, can be partially explained by the introduction of agriculture, with a diet richer in carbohydrates, and the invention of cooking in pottery. However, multi developmental factors should also be considered, and the raw and estimated caries rate must be interpreted in relation to diet only in large samples over a long period of time.

Fig. 3 – Illustration of the pathologies presented in the text. 1. Caries: A. Tell Ain el-Kerkh, ind. 712, stage 1; B. Tell Ain el-Kerkh, ind. 853 C-4, stage 2; C. Dja’de el-Mughara, ind. 283-A, stage 3; D. Tell Ain el-Kerkh, ind. 732 C-2, stage 4. 2. Abscesses: A. Tell Qaramel, ind. 10-09, periapical granuloma; B. Dja’de el-Mughara, ind. DJ00-32, sep. 180 inf, apical periodontal cyst; C. Dja’de el-Mughara, ind. 283-B, periapical abscess. 3. Ante-mortem tooth loss, Abu Hureyra, ind. 73-2952. 4. Periodontal disease, Dja’de el-Mughara, ind. 245, stage 1.

Fig. 3 – Illustration of the pathologies presented in the text. 1. Caries: A. Tell Ain el-Kerkh, ind. 712, stage 1; B. Tell Ain el-Kerkh, ind. 853 C-4, stage 2; C. Dja’de el-Mughara, ind. 283-A, stage 3; D. Tell Ain el-Kerkh, ind. 732 C-2, stage 4. 2. Abscesses: A. Tell Qaramel, ind. 10-09, periapical granuloma; B. Dja’de el-Mughara, ind. DJ00-32, sep. 180 inf, apical periodontal cyst; C. Dja’de el-Mughara, ind. 283-B, periapical abscess. 3. Ante-mortem tooth loss, Abu Hureyra, ind. 73-2952. 4. Periodontal disease, Dja’de el-Mughara, ind. 245, stage 1.
  • 6 The first clinical sign is usually a white spot but is too difficult to identify in archaeological (...)
  • 7 Abscesses are caused by an inflammatory reaction around the apex of the tooth, which may be acute o (...)

18Caries is an infectious condition that manifests itself as a progressive demineralisation of enamel and dentin, resulting in the formation of a cavity in the tooth (Hillson 2005). For their study, the recording system is adapted from the methodology developed by Hillson (2001, 2005), modified to suit the archaeological context. We have therefore set up a rating into four stages: stage 1, brown spot on the tooth;6 stage 2, cavity in the enamel; stage 3, cavity in the enamel and the dentine; stage 4, very large cavity (Chamel 2014; fig. 3). As carious lesions sometimes develop into abscesses,7 the damage to the alveolar bone was recorded as periapical granuloma, apical periodontal cyst and periapical abscess (fig. 3), depending on the type and size of lesion (Dias and Tayles 1997). Ante-mortem tooth loss, defined as the absence of the tooth and the remodelling of the corresponding tooth socket, was also considered (fig. 3). The raw frequencies are presented in the results section for each condition, and a calibrated frequency for carious disease, including caries, abscesses and AMTL was performed, so as not to minimise the importance of this condition.

19Periodontal disease is caused by the progressive destruction of the periodontal ligament which gradually leads to the destruction of the alveolar bone, and the exposure of the tooth root. This disease has also been recorded (fig. 3), although the study of the regression of alveolar bone is difficult in an archaeological environment, given the fragility of this bone. We chose four recording stages for bone loss when measurable, with stage 0 indicating no regression, stage 1 regression on less than one third of the root, stage 2 regression exposing half or more of the root, and stage 3 regression exposing almost all the root (Alexandersen 1967).

20Comparing the frequencies of dental pathologies between the different periods required the use of statistical tests. Since our variables were qualitative in nature, we used contingency tables, for which we calculated theoretical numbers. When these are greater than 5, the Chi2 test is used; when at least one of the theoretical numbers is lower than 5, the exact Fisher test is used.

Results

21Table 3 presents the result of the MNI by age at death and by sex; as mentioned above, very little data on sex is provided, due to the poor preservation of bone remains. We will therefore not discuss this in the context of this study.

Table 3 MNI by age at death and sex for the sample. QRM: Tell Qaramel; CH: Cheikh Hassan; DJ: Dja’de el-Mughara; Mb: Tell Mureybet; ASW: Tell Aswad; AH: Abu Hureyra; Kh: Tell Ain el-Kerkh.

Table 3 – MNI by age at death and sex for the sample. QRM: Tell Qaramel; CH: Cheikh Hassan; DJ: Dja’de el-Mughara; Mb: Tell Mureybet; ASW: Tell Aswad; AH: Abu Hureyra; Kh: Tell Ain el-Kerkh.

22The results for the four selected pathologies are presented with charts for the raw frequencies per tooth/tooth sockets (fig. 4) and per individual (fig. 5).

Fig. 4 – Variation of the frequencies of the oral health markers during the four phases of Neolithic (count per teeth and tooth sockets).

Fig. 4 – Variation of the frequencies of the oral health markers during the four phases of Neolithic (count per teeth and tooth sockets).

Fig. 5 – Variation of the frequencies of the oral health markers during the four phases of Neolithic (count per individuals).

Fig. 5 – Variation of the frequencies of the oral health markers during the four phases of Neolithic (count per individuals).

23Concerning the dental caries, the raw frequency per tooth increases from 1.22% to 3.18% (fig. 4) between the PPNA and the EPPNB, and then decreases to 1.44% in the MLPPNB. There is afterwards a much greater raise between this period and the latter, the PN, where the caries frequency per tooth reaches 6.23%. Statistically speaking, while the increase in caries frequency between the first two periods is not significant (p = 0.0665), the decrease recorded in the MLPPNB (p = 0.0131) and the new increase in the last period (p = 0.0001) are. For each period, the most affected teeth are the molars (Chamel 2014).

24Looking at the types of lesions, our observations have shown that for the PPNA, only stages 1 and 2 are represented, with stage 1 at 75% and stage 2 at 25%. In the EPPNB, all four stages are represented, with stage 1 still being the most present. While the frequency of caries decreases between the EPPNB and the MLPPNB (fig. 4), stage 3 is however better represented in the latter period. On the other hand, the PN shows, as in the PPNA, a higher rate of stage 1 caries than the others. The number of caries per tooth is also significant, because while teeth from PPNA have only one cavity, this is not the case from Early, Middle-Late PPNB and PN levels where there are teeth with two or three cavities.

25Concerning the caries frequencies per individual (fig. 5), there is a progressive decrease between the PPNA and the MLPPNB, from 12.5% to 8.69%. This decrease is not statistically significant (p = 0.5857), the following increase in the PN, with 36,62% of individuals with carious lesions, is very significant (p = 0.0001). Immature individuals are not very much affected by this pathology: only one individual who died between the ages of 6 and 7 years in the EPPNB and 3 individuals (7-9 years, 10.5-15.5 years, and 14-15 years) in the PN have carious lesions. The amount of caries per individual will also increases between PPNA and PN, from an average of 1.3 caries per individual to 2.5 caries per individual.

26Cysts, granulomas, and abscesses are relatively scarce for all periods combined: only 45 cases have been recorded in these populations. The frequencies per tooth sockets (fig. 4) decrease progressively from the PPNA (6.47%) to the PN (1.67%), and this decrease is very significant (p = 0.0256). The frequency of affected individuals (fig. 5) also decreases progressively from the first to the last period, with, however, a slight, not significant (p = 0.7870), increase between the Early and the MLPPNB. The curves per tooth socket and per individual for abscesses show the opposite of what happens with caries. Since abscesses are very often the consequence of caries, it is possible that the increase in caries over time is accompanied by a lower severity of lesions, as we have seen in the PN, where stage 1 caries are best represented. Thus, caries of lower severity generate fewer abscesses, which may explain the progressive decrease of the latter.

27For AMTL (fig. 4), there is a steady increase between the PPNA and the MLPPNB, before a decrease in the last period, the PN. In terms of frequency per individual, there is a difference with the counting by tooth sockets. In fact, the frequency decreases from the PPNA to the EPPNB, and then increases in the MLPPNB up to the PN (fig. 5). However, none of these fluctuations are significant according to the statistical tests. The most affected teeth are the posterior teeth, in 78.1% of cases, mainly the M1, lower and posterior, the P2 and M2. No immature individual has lost any teeth, as this pathology is strongly correlated with age at death.

28The calibrated frequency of carious disease (caries, abscesses and AMTL) is shown in table 4. A gradual decline in the estimated caries rate from the PPNA to the MLPPNB can be seen here, followed by a slight increase in the PN. The same trends for the raw frequencies per tooth are not found, except for this increase in the last period. As far as statistical tests are concerned, no increase nor decrease are significant.

Table 4 Estimated frequencies of carious disease for the four phases (count per teeth and tooth sockets).

Table 4 – Estimated frequencies of carious disease for the four phases (count per teeth and tooth sockets).

29The study of periodontal disease, which is not exempted of bias, could only be conducted on a small number of tooth sockets and individuals (figs. 4, 5). The frequencies per tooth sockets show a rate of more than 35% at the PPNA, which gradually decreases to the MLPPNB where it reaches 20.28%. It then rises to over 29% in the PN. According to statistical tests, these increases and decreases are highly significant. The frequency of periodontal disease per individual shows a slightly different pattern (fig. 5): the frequencies also decrease from the PPNA to the EPPNB, but then increase again in the MLPPNB. This then continues until the PN. The differences between periods, on the other hand, are not significant according to statistical tests. However, the high rate of periodontitis in the population does not really reflect the importance of this pathology; as very few individuals and tooth sockets are observable, the frequency may appear artificially high.

Discussion

30Before starting the discussion, it is worth mentioning the biases inherent in this type of study. Firstly, the small number of teeth and individuals studied for the PPNA minimises the significance of the increases and decreases in dental pathology between this period and the next, the EPPNB. Secondly, although environments are similar at many of the sites studied, as well as wildlife and archaeobotanical spectrum, the way in which food was prepared, about which we have little information, can play a very important role.

31For all the pathologies observed, the study showed on the one hand that they do not progress at the same rate, and on the other hand that their frequency does not increase in a linear way from the PPNA to the PN, as might be expected.

32Beyond the frequencies per tooth/tooth socket and per individual, the study of the different stages of lesion severity allows us to propose hypotheses about the health changes brought about by agriculture and ceramics. Figure 6 relates the data for abscesses, caries, and periodontal disease for the four periods. This graph shows a peak in lesion severity for the period of MLPPNB, visible on caries and periodontal disease. It is the period with the highest rate of stage 2 and 3 caries and stage 2 periodontal disease, followed by a lower level of lesion severity in the following PN period, returning to what can be observed in the EPPNB.

Fig. 6 – Type of abcess, stage of caries and stage of periodontal disease for the four phases of the Neolithic.

Fig. 6 – Type of abcess, stage of caries and stage of periodontal disease for the four phases of the Neolithic.

33In our sample, we note that cultivated cereals are present from the EPPNB, even if the hypothesis of a proto agriculture from the PPNA has been proposed for some sites (fig. 2). The changes in all pathology frequencies (by teeth/tooth sockets) between the PPNA and the EPPNB are not significant. This may be due to the small sample size for the PPNA, but it is also possible that the switch to agriculture did not immediately have a strong impact on oral health status. Indeed, these were the early stages of plant domestication, and the harvesting of cereals, plants and pulses continued, so there were no significant changes in diet here. For the frequencies by individuals, the decrease in almost all pathologies can be explained in our opinion by the bias induced by the PPNA sample.

34In the following MLPPNB period, the increase in the frequencies of all pathologies, except abscesses, is to be related to the peak of lesion severity presented in figure 6. Agriculture is proven at each of the sites (fig. 2), and there is a real reduction in the variety of the diet, with a strong decrease in the spectrum of plants harvested in favour of cereals, with an increase in the carbohydrates present in the food. This is also the period in which animal husbandry begins, and it seems logical that there is a certain deterioration in sanitary conditions due to a new cohabitation between humans and animals (Mitchell 2003). A recent study offering a comparison between cultivated cereals (barley and emmer wheat) and their wild progenitors, suggests that there has been a shift towards larger seeds, with a higher glycemic load, while the relative contents of protein, fibers and minerals are lower (Hebelstrup 2017). This may explain the increase in caries frequency noted for the last period, the PN.

35In the PN, the general increase in frequency can be explained by the change in diet, since all the sites studied for this period show domestication of plants and animals, and also by the introduction of a new type of food preparation by boiling cereal flour in a ceramic pot, thus making a porridge. This gives a slightly sticky consistency which tends to promote the development of bacterial colonies in the fissures and grooves of the molars and premolars (Larsen 1995). Thus, the invention of ceramics and the introduction of a new method of cooking cereals during this period may have played a role in the increase in the number of caries, a phenomenon which was already noted by T. Molleson at Abu Hureyra (1995).

36The gradual decrease in the frequency of abscesses, both in terms of tooth sockets and individuals (figs. 4, 5) suggests, in our opinion, that the type of carious lesion has changed over time, and that caries which develop into abcesses have gradually been replaced by caries of lesser severity.

37Comparisons with South Levant are difficult, as little data is available. The paper by Eshed et al. (2006), dealing with the transition from the Natufian to the Neolithic, shows that there were no differences between the two periods in the frequencies of caries per tooth (6.4%/6.7%) and abscesses (less than 1.5%), and only a very slight increase in the frequency of ante-mortem tooth loss (3.7%/4.5%). For periodontal disease, the frequency is higher among the Natufians (36.4%) than in the Neolithic populations (19%).

Conclusion

38The study of dental pathologies for the four periods of Neolithisation gives us an idea of the influence of the shift in subsistence economy on the oral health status of populations. Despite the sample biases, it seems that the pattern here is less linear than it appears at first glance, and that all pathologies do not progress at the same rate. The peak in severity in most of the lesions in the MLPPNB, when agriculture was well established, can be explained by a drastic reduction of the variety of consumed plants. The increase in the frequency of pathologies during the last period, the Pottery Neolithic, is perhaps less due to a change in diet than to a new way of preparing food. In the future, the study of biological stress indicators such as porotic hyperostosis, Cribra orbitalia and linear hypoplasia of the dental enamel, still in progress, will undoubtedly provide new information to clarify our hypotheses.

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Notes

1 Some researchers (Lukacs 2008: 909) linked this absence of changes in dental health with a gradual adoption of agriculture in core areas, in contrast to a more abrupt transition in peripheric areas leading to a brutal increase.

2 Coqueugniot E. 2010 – Dja’de el-Mughara. Rapport Scientifique 2010, unpublished.

3 The data given in the monograph by Moore et al. 2000 have not been calibrated with the current reference curves. The dates given here have been calibrated using the CalPal application to facilitate comparison between sites.

4 Minimal Number of Individuals.

5 The last bones to fuse in adults.

6 The first clinical sign is usually a white spot but is too difficult to identify in archaeological human remains. The brown spot can be differentiated from diagenetic effects by the presence of a roughened enamel surface (Hillson 2005).

7 Abscesses are caused by an inflammatory reaction around the apex of the tooth, which may be acute or chronic, and manifest as a cavity in the alveolar bone.

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Table des illustrations

Titre Table 1 Comparison of the environment, archaeobotanical and archaeozoological data of the sites selected for the study.
URL http://journals.openedition.org/paleorient/docannexe/image/921/img-1.jpg
Fichier image/jpeg, 155k
Titre Fig. 1 – Location of the studied sites in Syria (Chamel 2014).
URL http://journals.openedition.org/paleorient/docannexe/image/921/img-2.jpg
Fichier image/jpeg, 522k
Titre Fig. 2 – Chronological timeline presenting the types of subsistence economy of the sites studied.
URL http://journals.openedition.org/paleorient/docannexe/image/921/img-3.jpg
Fichier image/jpeg, 161k
Titre Table 2 – Number of individuals and tooth studied by phase and by site. QRM: Tell Qaramel; CH: Cheikh Hassan; DJ: Dja’de el-Mughara; Mb: Tell Mureybet; ASW: Tell Aswad; AH: Abu Hureyra; Kh: Tell Ain el-Kerkh.
URL http://journals.openedition.org/paleorient/docannexe/image/921/img-4.jpg
Fichier image/jpeg, 137k
Titre Fig. 3 – Illustration of the pathologies presented in the text. 1. Caries: A. Tell Ain el-Kerkh, ind. 712, stage 1; B. Tell Ain el-Kerkh, ind. 853 C-4, stage 2; C. Dja’de el-Mughara, ind. 283-A, stage 3; D. Tell Ain el-Kerkh, ind. 732 C-2, stage 4. 2. Abscesses: A. Tell Qaramel, ind. 10-09, periapical granuloma; B. Dja’de el-Mughara, ind. DJ00-32, sep. 180 inf, apical periodontal cyst; C. Dja’de el-Mughara, ind. 283-B, periapical abscess. 3. Ante-mortem tooth loss, Abu Hureyra, ind. 73-2952. 4. Periodontal disease, Dja’de el-Mughara, ind. 245, stage 1.
URL http://journals.openedition.org/paleorient/docannexe/image/921/img-5.jpg
Fichier image/jpeg, 553k
Titre Table 3 MNI by age at death and sex for the sample. QRM: Tell Qaramel; CH: Cheikh Hassan; DJ: Dja’de el-Mughara; Mb: Tell Mureybet; ASW: Tell Aswad; AH: Abu Hureyra; Kh: Tell Ain el-Kerkh.
URL http://journals.openedition.org/paleorient/docannexe/image/921/img-6.jpg
Fichier image/jpeg, 237k
Titre Fig. 4 – Variation of the frequencies of the oral health markers during the four phases of Neolithic (count per teeth and tooth sockets).
URL http://journals.openedition.org/paleorient/docannexe/image/921/img-7.jpg
Fichier image/jpeg, 75k
Titre Fig. 5 – Variation of the frequencies of the oral health markers during the four phases of Neolithic (count per individuals).
URL http://journals.openedition.org/paleorient/docannexe/image/921/img-8.jpg
Fichier image/jpeg, 103k
Titre Table 4 Estimated frequencies of carious disease for the four phases (count per teeth and tooth sockets).
URL http://journals.openedition.org/paleorient/docannexe/image/921/img-9.jpg
Fichier image/jpeg, 41k
Titre Fig. 6 – Type of abcess, stage of caries and stage of periodontal disease for the four phases of the Neolithic.
URL http://journals.openedition.org/paleorient/docannexe/image/921/img-10.jpg
Fichier image/jpeg, 215k
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Bérénice Chamel, « Dental health status changes during the Neolithisation in Syria: a diachronic perspective (9,820-6,000 cal. BC) »Paléorient, 47-1 | 2021, 83-96.

Référence électronique

Bérénice Chamel, « Dental health status changes during the Neolithisation in Syria: a diachronic perspective (9,820-6,000 cal. BC) »Paléorient [En ligne], 47-1 | 2021, mis en ligne le 01 décembre 2021, consulté le 19 juin 2025. URL : http://journals.openedition.org/paleorient/921 ; DOI : https://doi.org/10.4000/paleorient.921

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Auteur

Bérénice Chamel

Archéorient, UMR 5133, Maison de l’Orient et de la Méditerranée, Université Lyon 2, Lyon – France

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