J.o.P. 2 (2): 67-78 N.W. Kerr. * © 1988 Marino Sllanell Elitore Abstract. A method of assessing periodontal status in archaeologically derived skeletal material A method is deseribed for estimating periodontal health im archaeologically deri- ved human dentitions, The basis of the method is the classification of the architectural form and textural appearance of interndental alveolar bone. Fiive distinct categories of surface and texture were observed in a series of Late Mediaeval Scottish sleulls. Ma- eroscopic and microscopic examination demonsirated these categories were also reco gnisable in modern clinically diagnosed phases of periodontal disease. The method. is tm accord with present day concepts of the pathogenesis of periodontal disease, overco mes problems associated with post-mortem of root exposure. It provides a basis for epi Introduction. ‘The assessment of periodontal disea- se in archaeological material has in the past been based on estimates of the extent of alveolar bone loss. Brothwell (1965) sug- gested categories of none, mild, moderate and severe (or considerable) periodontitis, depending on the degree of root exposu: re, Tattersall (1968) employed this method in the assessment of periodontal disease in the Clopton series from Cambridge & Campbell-Wilson (1970) used it in a study of forteen skulls from a cairn cemetery in Fife. Such techniques rely heavily on sub- jective interpretation and make inter “observer and inter-study comparisons dif- ficult. To overcome this problem and to im- oth Loss and those of linear measurements riological studies of past populations. prove on the reliability of periodontal as- sessment in archaeological material Davied Gal. (1969) suggested a more objective me- thod where the enamel-cementum junction was used as a fixed level and the amount of bone loss on both the buccal/labial and mesial aspects of the teeth determined. This method greatly facilitated inter-study comparisons. Slight modifications of the Davies & al. method were suggested by Lavelle & Moo- re (1969) and Goldberg & al. (1976), but both retained the concept of linear measu- rements from a fixed point. The assumption, that alveolar bone crest to amelo-cemental junction distance accurately reflects the degree of inflamma- tory periodontal attachment loss, was put in doubt by the work of Darling & Levers * Department of Dental Surgery, Aberdeen Royal Infirmary, Aberdeen (U.K).(1975), Newman & Levers (1979) and Le- vers & Darling (1983) who showed that, in the human dentition, teeth with marked occlusal attrition underwent the phenome- non of supereruption or compensatory co- ronal migration. Such coronal movement of teeth past a vertically stable periodon- tium has the effect of increasing the alveo- lar bone crest to enamel-cementum junction distance. Hence, an increase in this dimension may be a reflection of oc- clusal attrition and continuous eruption, or of inflammatory periodontal attachment loss, or sorne degree of both. Such methods also require the presence of teeth in situ. In many collections this can reduce consi- derably the amount of material available for study. Costa (1982) described a method of as- sessing periodontal disease which avoided these problems. He studied the interden- tal septum and noted the changes in its form as well the presence or absence of what he termed “osteoporosis” of the sur- face bone. He devised a two digit scoring system to classify periodontal disease in stages of increasing severity. He also re- corded separately intra-bony defects and gave them a severity gradin according to the pocket depth and the number of root surfaces involved. His method was a ma- jor departure from previous approaches in that it focused attention on the site of the pathological lesion rather than estimating bone loss which might stem from one or more different factors. He recorded “tex- tural’’ changes only as the presence or ab- sence of osteoporosis, making no attempt to distinguish grades of change. Implicit in the method was the assumption that perio- dontal disease was a linearly progressive disease. This is not in accord with current coneepts of the pathogenesis of periodon- tal disease which is considered to be epi- sodic in nature (Lisgarten & Levin 1981). The present study was undertaken with the following objectives — (i) to exa- mine the condition of the interdental sep- tum in a substantial series of human skeletons, (ii) to describe the variations in architectural form and surface texture of the interdental alveolar bone, (iii) to rela- te these observed changes to phases of pe- riodontal disease seen in clinical practice; and (iv) from these observations, to devi- se a method for assessing the periodontal status of past populations which is objec tive and reliable. Materials and methods. A skeletal series, considered to be of Late Mediaeval origin, recovered from the site of a Carmelite Friary at Linlithgow, near Edinburgh, was available for study. It is believed the material was represen- tative of the general population of the town (Cross 1988); 69 virtually complete Mediae- val dentitions were available (Table 1). In addition, a limited amount of maxillae and mandibles from a 20th century dissecting room collection were available as well as clinical material exhibiting the spectrum of periodontal disease from early gingivitis to advanced periodontitis. Examination of the alveolar bone of each specimen was confined to the inter- dental area adjacent to fully erupted per- manent teeth. The interdental septal bone was chosen because of its particular vul- nerability to periodontal disease (Polson, 1985), and because buccal and labial alveo- lar surfaces are subject to developmental defects and to various mechanical impacts and forces which can result in loss of, or in some cases, deposition of alveolar bone (Mason, 1976). Septal areas were exami- ned and described in respect of (a) the con- tour of the septum judged in the bueco-lin- gual (palatal) direction and (b) the nature of the bone surface in respect of the type and degree of osseous disruption it di- splayed. Septa adjacent to teeth lost ante- mortem or those showing postmortem da- mage were designated unrecordable. ‘The examination was carried out with the aid of a zoom stereomicroscope using a magnification of ten times. Fibre optic 68 Journal of Paleopathology 2 (2)HISTORIC MATERIAL Age Number of | Number of groups: individuals sites: 615 8 149 16-25 13 269 26.35, 32 627 36-454 16 239 ‘Total 69 1283 MODERN MATERIAL Number of Number of individuals sites 10 274 illumination greatly facilitated the exami- nation of the interproximal areas. Histological preparations were made of historic material typical of each catego- ry and of modern interdental septa clini- cally diagnosed as gingivitis, acute or quiescent periodontitis. The specimens we- re examined both by direct and polarised light. Results. Historie sample. Variations in the ba- sic contour of the interdental septum we- re observed in the various segments of the arch. In the incisor region of the mandible the septum was crest like being narrow mesio-distally and sharply convex labio- lingually. In the molar region the septum was more plateau like, being broader mesio-distally and flatter bucco-lingually. Intermediate forms were characteristic of the premolar region (Fig. 1). The most di- stal septum, that mesial to the third mo- lar, often exhibited a slight concavity in the ‘Table 1. healthy situation. In the upper jaw, septal areas were of a similar form but modified to some extent by the palatal extension of bone and in the anterior region by the lar- ger diameter of the incisor roots. Minor variations in these characteri- sti regional septal contours were occasio- nally observed in situations such as imbrications in the incisor region, or crow- ding or rotation of teeth in the premolar or molar region. ‘The texture of the cortical hone in a healthy situation was assumed to be smooth with minimal interruption by fora- mina, depressions or grooves ‘All contour and textural variations ob- served in this series could be accommoda- ted within the following six categori 0. Unrecordable — tooth on either si- de of the septum lost ante-mortem or the septum damaged post-mortem. 1, Septal form characteristic of its re- gion (e.g. convex in the incisor region gra- ding to flat in the molar region). The cor- Journal of Palecpathology 2 (2) 699 gory 1). Marked increase ging present in the premolar/molar septum (category 2). Normal septal form retained throughout in all thre interspa Figure 2. Category 8 — Septum immediately distal to the molar tooth demonstra tion of the ar chitectural form with a sharp and ragged appearance to the bone surface (category 8). (Other septal area. category 2). Journal of Paleopathology 2 (2)tical surface smooth and virtually uninter- rupted by foramina, depressions or groo- ves (Fig. 1). This category was not commomly ob: served in adults and was most often recor- ded in juveniles. 2. Septal form characteristic of the re- gion. Cortical surface showing a range from many small foramina and/or shallow grooves to a cortical surface showing lar- ger foramina and/or prominent grooves or ridges (Fig. 1). In a few instances, there was gross disruption of the cortical layer, but a normal contour for the region. 8. Septal form showing a breakdown of contour with bone loss in the form of a shallow depression extending across the in- terspace from the buccal to lingual aspect, or as one or two smaller diserete areas of bone destruction, the essential distingui- shing features being a sharp and ragged exture to bone defect (Fig. 2). 4. Septal form showing breakdown of contour with bone loss similar to that seen in category 8, the essential difference being the bone surface, instead of being ragged in appearance, showed a porous or smooth honeycomb effect with all defects rounded (Fig. 3). 5, Presence of a deep infra-bony defect with sides sloping at 45 degrees or more and with a depth of 3 mm. or more. The defect is more likely to be mesio-distally but may be buceo-lingually inclined. The surface may be sharp and ragged or smooth and honeycombed (Fig. 3). At microscopic levels, areas with evi- dence of periodontal disease showed fea- tures consistent with crestal bone resorption and deposition (Fig. 4). Modern sample. Material clinically dia- gnosed as being healthy or displaying gin- ivitis, or acute or quiescent periodontitis, iisplayed features corresponding to those of the five categories described above, At microscopic levels, bone histology similar to that of the historic material was obser- ved in each category. Septal areas clinical- ly diagnosed as gingivitis showed similar evidence of alveolar bone resorption and deposition as in historic material (Fig. 5). Crestal areas clinicaly diagnosed as under- going an acute burst of periodontitis de- monstrated ragged surface texture with loss of normal crest contour for the region (Fig. 6). Inter-examiner reliability. Inter- and intra-examiner reliability tests were carried out. To test intra- examiner reliability, a random selection of one hundred and thirty-five interspaces were scored on three separate occasions. ‘The second scoring recorded a difference of six scores, the third, a difference of se- ven. This represents and intra-examiner reliability of 95 percent. Inter-examiner reliability tests were undertaken with two other observers — one, a dentally qualified practitioner fami- liar with periodontal disease, the other, an experienced anatomist who was not den- tally qualified. Agreement between the Author and Observer 2 (dentally qualified) was noted in all but 16 of 185 septa (90% agreement) and between the Author and Observer 3 (anatomist) in all but 19 septa (86% agreement). When the scoring differences were analysed, it was found the majority rela- ted to categories 1 and 2. Most were re- solved by mutual discussion. The difficulty sipsered to be the level at which an indi- vidual interpreted the significance of small multiple or fewer enlarged foramina. The presence of grooving or ridging made the diagnosis much more certain, ‘On some occasions all three observers found difficulty in deciding whether an in- terdental area fell into category 2 or 4. When this was impossible to resolve the areas were systematically allocated to ca- Tournal of Paleopathology 2 (2) 7Figure 3. Category 4 & 5 — Inter premolar septum (category 4) shows loss of normal contour with concave form but smooth textural surface in contrast to category 3 (Fig. 2). Premolar/molar septum demonstrates steep angular bone destruction (category 5). tegory 4. The principal reason for doubt would be the presence of category 3 or 4 scores in adjacent areas, apparent equal loss of alveolar bone height, but yet the presence of anormal septal contour. It was felt such a septum was likely to have been an area of a previous periodontitis lesion that had reverted to a quiescent and later toa healed (or gingivitis phase) with refor- mation of a normal septal contour. Discussion. Ifa method is to provide a reliable esti- mate of the periodontal health of past po- pulations where only hard tissues are available for examination, then it must ma- ximise the information obtained from the limited evidence available. It must be con- sonant with clinical diagnostic criteria and with current concepts of the pathogenesis of periodontal disease. Finally, it must be as objective as possible if it is to facilitate comparisons between investigators and in- vestigations. Only if these criteria are esta- blished is a method based on paleo-epide- miological studies likely to make a mea- ningful contribution to the understanding of factors influencing periodontal health and disease. ‘Methods based on either gross subjec- 72 Journal of Paleopathology 2 (2)Figure 4. Section of crestal surface of Category 2 Mediaeval material viewed by polarised light. Arrows indleatearons of cant bone alteration atthe ereeal surface with darupton of mature amr bore formation tive assessment or on measurement of al- veolar bone loss from some predetermined base line can be criticised on a number of counts. Clarke & al. (1986), discussing this problem, pointed out that’ many develop- mental, anatomical and physiological de- fects had in the past erroneously been interpreted as indicative of periodontal di- sease and as a result of this, overasses- sment of the incidence of periodontal disease had been commonplace. Darling & Lever (1975), Newman & Lever (1979), Co- sta (1982) and Whittaker & al. (1985) fo- cussed attention on the phenomenon of supereruption of teeth with resultant root exposure subsequent to severe occlusal at- trition. Hence, it ean be said that neither subjective assessment nor bone height measurements are free from confounding influences, nor do they maximise the infor- mation available. Costa (1982) attempted to overcome these problems by focussing attention on, the condition of the crestal alveolar bone in the interdental areas. Although this was asignificant advance, his method failed to differentiate the many subtle variations in cortical bone texture that could be distin- guished, instead noting only the presence or absence of osteoporosis. In addition, Co- sta’s scoring system implied periodontal di- sease was progressive in nature and did Journal of Paleopathology 2 (2) 73not make allowance for its episodic natu- re of acute exacerbations intervening bet- ween longer oer shorter periods of quiescence and even healing (Lindhe & al. 1983; Socransky & al. 1984; Johnson & al. 1988). Thus, his method, although more di- scriminating than “bone height” measure- ments lacked the resolving power to identify separate phases of the disease process. Implicit in the method of assessment described is the assumption that clinical gingivitis may be recognised by alterations in the texture, but not the gross form, of the interdental crestal bone. This is a de- parture from earlier concepts of gingivitis where it was believed it was a disease con- fined to the tissues of the marginal gingi- vae (Orban 1942; Lyons & al. 1950; Lyons & al. 1959). However, much of the eviden- ce for this definition’ was based on gross clinical diagnostic criteria using periodon- tal probes or radiographic assessment. Mo- re sensitive histological, histochemical and istope studies have demonstrated that un- derlying bone is in fact intimately involved in any inflammatory process of the gingi- val tissues. Kennedy and Polson (1973) and Hijl & al, (1976), using animal models, de- monstrated active osteoclastic activity at the alveolar crest within two weeks of an induced gingivitis, Hausmann & al. (1979) using "I absorptiometry techniques de- monstrated a significant drop in alveolar mass within two weeks of an induced gin- givitis with considerable restoration when the gingivitis resolved. Greenstein & al. (1981) found little consistency between the presence or absence of an intact cortical surface in relation to overt signs of gingi- val inflammation. Such studies suggest a transient and labile situation occurs at the alveolar crestal surface with resorption and deposition of bone occurring in phase with fluctuations in gingival inflammation and host response. Suomi & al. (1981) and Page (1986) consider gingivitis lesions to be either transient or persistent with only a small proportion becoming progressive. It would seem the situations where osteo- porosity, ridging and grooving are obser- ved in an otherwise normal alveolar con- tour is likely to be associated with persi- stent or repeated gingivitis lesions and the requirement of an enhanced blood supply which is associated with such chronic or persistent situations (Greenstein & al. 1981), Ostoporosity is probably a reflection of this occurring in the path of the intra- septal artery, one of the three vascular supply routes to the gingivae (Lindhe, 1988), with the ridging and grooving a si- milar phenomenon along the paths of the periodontal ligament and supraperiosteal vessels. This suggestion accords with the histological observations of this study whe- re bone resorption and deposition was ob- served in crestal areas clinically diagnosed as gingivitis. Similar changes were obser- ved in historic material i.e. those with nor- mal septal contours but with a degree of textural change such as the presence of multiple foramina or ridging. Category 2 would therefore seem to represent gingivitis in its various forms or even on oceasions, a periodontitis lesion that has progressed through an acute to a chronic and finally, to a healed or quiescent phase. In some category 2 situations it was observed that the contour remained nor- mal for the region but the septal surface texture was similar to that observed in an acute situation i.e. a ragged appearance in- dicative of extensive osteoclastic resorp- tion. Although this has been classified as being a gingivitis lesion it is possible it in fact represents a more acute condition such as acute necrotising ulcerative gingi- vitis or even the oral manifestations of a systemic disease that was part of a termi- nal illness. Only with wider application and experience of using this method of asses- sment will the necessity to create any sub- divisions to categories become apparent. ‘This is not a dissimilar problem to the ones that beset the clinical diagnosis and clas- sification of periodontal disease wherein it 74 Journal of Paleopathology 2 (2)Figure 5. Modern gingivitis. Arrows indicate an area of new bone formation at the crestal surface, Area of inflammation adjacent. has been recognised that the definition and criteria for diagnosis of periodontal disea- se still lack precision and uniformity (Gree- ne, 1986). In this method of assessment, no ac- count has been taken of the alveolar bone on the buecal or lingual surfaces of the teeth, in the ease of molar teeth, this is so- metimes the surfaces whieh is most severly compromised, It may be that a more com- lete periodontal assessment will require ‘cation involvement to be included as an additional category. However, in the pre- sent method it was found that attempting to create further sub-divisions led to a lo- wering the levels of inter-examiner relia- bility. Periodontitis has been defined as an in- flammation associated with destruction of supporting bone and apical extension of the epithelial attachment Grant & al., 1972), According to Lisgarten & Levin (1981); Goodson & al. (1982) and Lindhe (1983), the active phase of destruction is transient and interspersed with longer or shorter periods of chronic inflammation, remission or even healing. Jonson & al. (1988) suggest there is movement with me through all these phases in both direc- tions. Marked osteoclastic activity has heen described as associated with the de- struetive phase (Garant 1976; Life & al., 1987) and the appearance of the septa in the Category 3 is suggestive of area under- Journal of Paleopathology 2 (2) aFigure 6. (Modern material). Alveolar crest of an interspace displaying an acute burst of periodontitis. Loss of normal contour and ragged surface texture. (b = buceal, going an acute bust of activity associated with osteoclastic resorption. Category 4 would seem to conform with that predic- ted for the controlled, quiescent, or non- progressive phase of periodontitis. ‘The Category 5 description is that of a site identified on architectural form alo- ne with no consideration given to the sur- lingual, ¢ = crest). face texture. Such an area diagnosed clinically, is considered to be or have been, an area of aggressive bone loss associated with conditions such as Rapidly Progres- sive Periodontitis (Page & al. 1983) or Ju- venile Periodontitis. This category was not subdivided into acute or quiescent phases, although this might be a possibility. 16 Journal of Paleopathology 2 (2)It is no longer valid to talk of periodon- tal disease as a single entity as it is likely there are many different forms of perio- dontal disease different clinical presenta- tions and rates of progression (Johnson & al., 1988). Hence, it must be accepted that a method of assessment of periodontal di- seases based on the examination of hard issues alone is in a similar situation to cur- rent clinical classification and open to re- vision as knowledge of the pathogenesis of periodontal disease improves. Neverthe- less, the results of this study indicate the assessment of periodontal disease situa- tions in historic material based on the exa- mination and recording of the surface contour and texture of individual septa at a magnification of 10x constitutes a prac- tical, reproducible and reliable method of assessment. The suggested categories are consistent with current concepts of the pa- thogenesis of the periodontal disease, and permit evaluation of historic material in terms similar to that of clinically observed periodontal situation. It is hoped this methos of assessing two aspects of septal change, namely form and texture, will be instrumental in allo- wing a wider range of material to be inve- stigated and facilitate more detailed and meaningful comparisons of periodontal sta- tus to be made between past and present populations. The value of such comparisons has been clearly established for the epide- miology of dental caries (Hardwick, 1960; Moore & Corbett, 1975; Corbett & Moore, 1976) and changing patterns in caries pre- valence and mode of attack over the years have been demonstrated. Periodontal di- sease, like caries, is a plaque related disea- se and it is possible it also may exhibit, differences in prevalence, mode and site of attack and individual predilection between early and modern populations as a result of changing oral environments and plaque ecology. It is hoped the assessment of the hard tissues alone will be able to reveal i formation in this respect. While appreci ting that the method has its limitations, nevertheless, it would also appear to have certain advantages, for instance, the gra- ding from a gingivitis to a periodontitis may be examined in more detail than is normally possible in clinical material. The results of inter- and intra- examiner tests suggest reasonable levels of objectivity can be attained by this me- thod, although all three observers did con- sider experience of clinical periodontal problems and their management as well as, knowledge of “normal” septal anatomical aberrations a useful pre-requisite. Acknowledgments. I should like to express my thank to Dr. Margaret Bruce of the Anatomy De- partment, Aberdeen University for her as- sistance, advice, criticism and encouragement, to Mr Keith Duguid, Head of the Department of Medical Illustration, for his skill and patient work in photogra- phing the septal areas; to Dr Stanely ‘wen, Pathology Department, Aberdeen Medical School, for the interpretation of the histological material, and to his Chief Technician Mr Alastair McKinnon for the difficult and time consuming preparation of the historie material and to Miss Fiona MeLean for her assistance with inter- examiner reliability tests. References. Brothyeel, D.R., 1965, Digging up Bones, First Edition. Bri tish Musotim (Natural History), Oxford University Press. P 155. ‘Campbell Wileon, M., 1970, Report on the occlusions and der titions of a group of skulls excavated at a eaimn cemetry in Fife, Dent, Practit, 21: 68.71 Carte, N.G., Carey, SE, Stikandi, W., Hirsch, B.S. & Lep- pard, B.1., 1886, Periodontal disease in ancient populations. Arm. J. Phys. Anthropol. 17: 171-183. Corbett, MLB, & Mooro, W.J., 1976, Distribution of dental cares in ancient British populations. Caries Res. 10: 401-404, Costa, R.L., Jr, 1982, Periodontal disease in the prehisto- ric Ipiutek and Tigara skeletal remains from Point Hope, Al ska, Am. J. Phye. Anthropol. 59: 97-110, Journal of Palecpathology 2 (2) 7Cross, JP, 1988, The Skeletal Biology of two Late Mediac- xual Zastern Scottish populations. Unpublished PhD Thesis, University of Aberdeen. Darling, A.1. & Levers, B.G-H., 1975, The pattem of erup- tion of some human teath. Arch oral Biol, 20: 89.98, Davies, D.M., Picton, D.C.A. & Alexander, A.G., 1969, An objective method of eesescing the periodontal condition in human skulls, J. Periolont, Res. 4: 74-17. Garant, P.R,, 1976, Light and electron microscopic obser vations of asteoelastie alveolar bone resorption in rats mo- noinfeoted with Actinomyces naeslundil J. Periodont. Res. at, 117-728, Goldberg, H.J.V., Weintraub, J.A., Roghmann, K.J. & Corn well, W.S., 1976, Measuring periodontal disease in ancient poptlations: Root and wear indices in study of Ameriean In- dian skulls. J. Periodontol. 47: 348-951 Goodson, JM, Tanner, A.C.R., Haffajee, A.D, Somberger, G.C. & Socranshy, §.8,, 1982, Patterns of progression and regression of advanced destructive periodontal disease. J. Clin, Periedontel. $: 472-481, Grant, D.A., Stern, LB. & Everet, F.G., 1972, Orban's Pe- riedontics. ith Ed. CN. Mosby, 8t Louis. 290. Groene, J.C., 1988, Natural history of per in man. J. Gin, Periodontol, 18: 441-444, iontal disease Greenstein, G., Polson, A.M., Iker, H. & Meitner, S., 1981, Associations between erestal lamina dura and periodontal status. J. Periodontol. 52: 362-306, Hartwick, J.L., 1960, The incidence and distribution of ca- ‘ies throughout the ages in elation to the Englishman's det. Brit, Dont, J. 108: 917. Hausmann, E., Ortman, L.B. & Sedransk, N., 1979, Expepic rental alveolar bone loss in the Moakey evaluated by absorptiometry. Calif Tissue Ini, 29: 185-189. Heij, L., Rifkin, B.R. & Zander, H.A., 1976, Conversion of chronie gingivitis to periodontitis in Squirrel Monkeys... Pe- ‘viodontal. 4: T10-716. Johnson, N.W., Griffith, G.S., Wilton, J.MLA. Maiden, MPJ., Curtis, LA., Gillet, LR., Wildon, D-T. & Steme, 4J.A.C., 1988, Detection of high-risk groups and individuals {for petiodonial disease. J. Clin, Periodentel. 15: 276-289. Kennedy, J.B, & Polson, A.M., 1973, Experimental margi- nal periodentitis in Squierel Monkeys. J. Periodontal. 40-144. Lavelle, C.L.B, & Moore, W.5., 1969, Alveolar bone resorp- tion in Anglo-Saxon and severiveenth century mandibles, J. Periodont. Res. 4: 10-73. Levers, B.G.H. & Dating, A.1., 1983, Continuous eruption ‘of some adult haman teeth of ancient populations. Arcks oral Biol. 28: 401-408. Lifo, .S., Beighton, D. & Johnson, N.W., 1987, Osteoela- sti activity is Seen distant from the inflammatory focus in experimental periodontitis in the Macaque monkey. Paper presented to the Autumn Meeting of the British Society of Periodontology. Lindhe, J., Haffajee, A.D. & Socransky, S.S., 1983, Progres ‘Son of periodontal disease in adult subjects in the absence ‘of periodontal therapy. J. Clin. Periodontol. 10: 438-442. Lid J 288, etl of lnc! Poridoilo. Mas act, Copehiagen. Be Eisgarten A. ELerin, $1981, Positive correlation bet- ‘woot the properticns of subgingival apirechsctes and mot letaetera and suscepti of nuran subjects to perioral Aoteriration. J. Clin. Periodontol. 8: 122-138 Lyons H., Bernier, H. & Goldman, H.M., 1958, Report of the Nomenclature and Classifieation Committee, J. Periodontol 80: 74:7. Lyon, H., Kerr, D.M. & Hine, M.K., 1950, Report from the 1949 Nomenclature Commitiee. J. Periodontol. 21: 40-48 ‘Manson, J.D., 1976, Bone morphology and bone loss in pe Fiodontal disease. J. Clin. Periodontol. 3: 14-22, Moore, Wot. & Corbett, MLE,, 1975, Distribution of dental ‘ares in ancient British populations. Caries Res. 9: 165-175 ‘Newman, H.N. & Levers, B.G.HL, 1979, Tooth eruption an funetion in an early Anglo-Saxon population, Pros. B. Sie Med. 72: 41-350. Orban B., 1942, Classification and nomenclature of Perio: dontal Disease. J. Periodontol. 18: 16: Page, B.C. 345-355. Page, R.C., Altman, L.C., Ebersole, J.L., Vandesteen, G.E., Dahlberg, W.H., Willams, B.L. & Osterberg, S.K,, 1983, Re idly progressive periodontitis. A distinet clinieal eonditior I. Pervodantel, 54 + 197-209, 1086, Gingivitis. J. Clin. Periodontol. 13: Polson. AM. & Caton, 1G., 1985, Current status of blee- ding in the diagnosis of periodontal disease. J. Periniontol 5B: 13, Socransky, 8.8, Hafajee, A.D., Goodson, J.M. & Lindhe, J. 1984 Ne Concerts of destractive percdostal disease. Clin. Periodontol: MA! Saoni, J.D., Smith, L.W. & McClendon, BJ, 1981, Mang nal gingivitis during a sixteen-week period. J. Periodontvi. 42: 268-270. Tattersall 1, 1968, Dental aleopattoiogy of Metizeval Br iain) Hit of Medicine. 45: 380°385.© Whittaker, DAK. Molleson,T., Daniel, AP, Willams, J.T Rose, P-aRestaghini, R, 1085, Quanitative assessment of tooth wear, alvdlar crest heigit ad continuing eruption in Romano British popunsion, Ave Oral Biol 30; 493-901 78 Journal of Paleopathology 2 (2)