International Journal of Osteoarchaeology Int. J. Osteoarchaeol. (2009) Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/oa.

1054

Dental Disease in the Nile Valley during the New Kingdom

M. R. BUZON a* AND A. BOMBAK b
a b

Department of Anthropology, Purdue University, West Lafayette, IN, USA Department of Anthropology, University of Manitoba, Winnipeg, Canada

ABSTRACT

This study examines evidence for dental disease (caries, abscesses, antemortem tooth loss and severity of dental wear) in Nubian and Egyptian groups living in the Nile Valley during the New Kingdom. Specic attention is given to individuals buried at the site of Tombos, a cemetery in Nubia used during the Egyptian colonial occupation. In addition, three Nubian and two Egyptian samples are included for comparative purposes. While some similarities in condition frequencies between Tombos and the comparative groups are apparent, especially in the rates of caries and abscesses, signicant differences in antemortem tooth loss and severity of tooth wear point to variation in these Nile Valley samples. These differences are especially evident for males. Higher rates of these conditions at Tombos may be attributed to the socio-political and cultural changes taking place during this time of colonial occupation. Changes in foodways and occupational environments may have resulted in stress, as demonstrated by these dental conditions experienced by the Tombos people throughout this transitional period. Copyright 2009 John Wiley & Sons, Ltd. Key words: Nubia; Egypt; caries; abscess; antemortem tooth loss; tooth wear; colonialism; culture contact

Introduction
Analysis of dental disease in archaeological remains is frequently and productively employed to gather information on the general health and diet of past populations (e.g. Buzon et al., 2005; Larsen, 1997). Combined with the examination of general stress indicators and information about the identity and composition of the population, the exploration of dental disease data provides an additional lens through which to view daily life experiences of people in the past. This study is designed to use the frequencies of carious lesions, abscesses, antemortem tooth loss (AMTL) and severity of tooth wear to reveal information about the state of dental and overall health in the Nile Valley around the time of the
* Correspondence to: Department of Anthropology, Purdue University, West Lafayette, IN, USA. e-mail: mbuzon@purdue.edu

New Kingdom (c. 15501069 BC). Specic attention is given to the New Kingdom site of Tombos, located in ancient Nubia. The examination of overall dental health at this site provides a means through which to view the cultural and biological changes experienced during a time of intense contact: the Egyptian New Kingdom colonisation of Nubia. Archaeological remains and textual information conrm that the food resources of the Nile Valley peoples during this time period were probably quite similar. Due to this probable homogeneity of available food, this study will also explore factors apart from subsistence that may have resulted in variation in dental disease.

Dental disease
The importance of dental health should not be underestimated, particularly in pre-historic
Received 20 August 2008 Revised 14 October 2008 Accepted 28 October 2008

Copyright # 2009 John Wiley & Sons, Ltd.

M. R. Buzon and A. Bombak

societies. Dental disease is an essential factor in overall health and serves as an important adaptive pressure in evolution. Wells (1975) contends that the inability to chew through tough, abrasive food stuffs or to use teeth in some instances as tools may have seriously affected an individuals longevity. Prior to antibiotics, dental infections could lead to life-threatening ailments (Calcagno & Gibson, 1991) including septic cavernous thrombosis and Ludwigs angina. For the examination of dental health in the past, it is essential to take into account the multifactorial nature of these conditions when deriving conclusions about diet or health from dental data. The diseases discussed in this study are carious lesions, abscesses and AMTL. We address the direct pathological causes that result in these diseases, as well as the factors that contribute to their frequencies within populations. Dental caries is a disease process in which tooth enamel is demineralised by organic acid (Larsen et al., 1991; Larsen, 1995, 1997). This acidity is the result of bacterial carbohydrate metabolism (Hillson, 1979). Therefore, the consumption of an agriculturalists diet high in carbohydrates (Wells, 1975; Larsen, 1995) will lead to a high frequency of carious lesions. However, it should be noted that not all agricultural crops are associated with similar, high rates of caries. For example, oral health studies in Asia of individuals with rice-based diets do not reveal an increase in caries rates as with other types of agricultural crops such as wheat (as reviewed in Oxenham et al., 2006). Another factor that may affect caries frequency is enamel composition, which is affected by the chemical and mineral composition of soil and water, such as high levels of Ni that may substitute for calcium during the formation of enamel (Schneider, 1986). Other factors that may affect caries frequency are food production, attrition and abrasion. The typical method of preparing an agriculturalists diet, boiling food into a soft, sticky gruel, encourages the accumulation of bacterial colonies in grooves and ssures of the posterior teeth (Larsen, 1995). Higher levels of tooth wear that eliminate ssures have been associated with lower levels of caries (Chazel et al., 2005). Tooth wear (Hall & German, 1975) may also serve as a form of tooth cleaning and encourage healthy gum-root
Copyright # 2009 John Wiley & Sons, Ltd.

relationships by eliminating crowding through mesial drift and the on-going deposition of cementum. Hillson (2001), however, discusses the possibility that a high level of tooth wear may be cariogenic because it may result in fracturing and dental pulp exposure. Agriculturalists, through the use of grinding stones, intensive grain collection and pottery in agricultural food preparation (Smith, 1984) usually display oblique wear patterns and can display high and rapid levels of wear (Scott and Turner II, 1988; Larsen, 1995). This oblique wear pattern is less evident in Nubian agricultural populations. Beckett and Lovells (1994) study on the Nubian A-Group and C-Group revealed that Nubian agriculturalists may have high levels of wear as a result of the unintentional or intentional addition of grit to food during food preparation or cooking. Wells (1975) has also detailed the high levels of tooth wear typical of Egyptian teeth. Oblique wear has also been noted in some hunter-gather groups, such as the Maori, who also show high rates of erosion (Kieser et al., 2001). Abscesses can result from a number of factors that form less obvious patterns of causation than carious lesions. Caries, attrition or trauma can expose dental pulp to infection which may result in chronic inammatory responses such as the formation of periapical granulomata, small smooth-walled cavities within the alveolus, which may develop into periapical cysts (larger cavities with the granulomata tissue replaced by uid). Subsequently, dental abscesses form. Pus gathers within these cavities and will track through preexisting channels within bone and soft tissue before the abscess bursts and discharges (Dias & Tayles, 1997; Hillson, 2001). Populations with high levels of caries, calculus or periodontal disease are likely to have similarly high levels of abscesses as these can all predispose the tooth to abscessing. Groups with subsistence strategies that do not result in extensive levels of caries, calculus or periodontal disease may still exhibit similar rates of abscesses, as a result of severe wear (Scott and Turner II, 1988). Before teeth are lost, an extensive accumulation of plaque stimulates a hypersensitive response from the bodys antigens. These antibodies affect metabolism and can destroy somatic cells. This
Int. J. Osteoarchaeol. (2009) DOI: 10.1002/oa

Dental Disease in the Nile Valley during the New Kingdom

cellular destruction can lead to the loss of the collagen bres that tether the gingivae and teeth to the alveolus. The alveolus will resorb and assume a form that is incapable of retaining teeth, and teeth are subsequently lost (Hillson, 1979). Hillson has since (2001) discussed the likelihood that chronic periapical inammation, which typically manifests in the form of a periapical granuloma near the apex of the tooth, is unlikely to be a direct cause of AMTL. Acute inammation, however, usually as a result of a rapidly developing periapical abscess, may have resulted in enough pain that teeth were removed therapeutically. Periapical bone loss from jaws suffering from disease or remodelling from continuous eruption of teeth may have led to tooth loss. AMTL may also result from trauma to the jaw (Hillson, 2001). A number of factors contribute to AMTL including high levels of caries, periodontal disease, pulpal exposure, high and rapid levels of wear (Larsen, 1995), inadequate oral hygiene, sucrose-rich diets and old age (Roberts & Manchester, 2005). Excessive mechanical stress on the teeth and jaws can also contribute to tooth loss (Larsen, 1997). A study conducted by Sheridan et al. (1991) revealed that the loss of posterior teeth can contribute greatly to levels of temporomandibular joint degeneration. Factors contributing to AMTL may also result in an unclear representation of actual disease levels; painfully carious teeth may have been therapeutically extracted (Hillson, 2001) or caries and attrition may have resulted in pulp exposure that led to AMTL. This may lead to lower levels of caries being recorded than accurately reect the actual frequency (Lukacs, 1992, 1995). However, Irish (2001) found that his sample from Nabta Playa revealed conicting evidence between wear patterns and caries levels, suggesting that the relationship may be less than straightforward. disease in Tombos and other sites in the Nile Valley, particularly in a broader geographical and temporal context, the evolution and composition of the diet must be addressed. Although there is little direct information about dietary resources in Nubia during this time, the wealth of information regarding Egyptian diet, especially art and textual sources, provides additional data for this region. Excavations in the past often lacked systematic zooarchaeological and botanical analyses. However, more recent studies, including isotopic analyses (e.g. Iacumin et al., 1996, 1998; White et al., 1999; Dupras et al., 2001; Thompson et al., 2005), have provided valuable dietary data. Nubians and Egyptians made the transition from hunter-gathers to agriculturalists during the Neolithic Revolution (after 10000 BC; Wendorf & Close, 1992; Bianchi, 2004). The rst domesticates (c. 5500 BC) were sheep, goat and dog. Cattle were staple foods as well as markers of elite status. Millet, sorghum and barley were all eventually cultivated, and sh were also consumed regularly. Pottery vessels suggest that soupy and solid foods and beverages composed part of the Neolithic diet. Discoveries of pottery baking moulds and brewing vats conrm the importance of bread and beer as staple foods (Leek, 1972; Butzer, 1976; Bianchi, 2004). During the period of the A-Group culture (c. 32502800 BC) in Nubia and the pre- and early dynastic times in Egypt, trade between Egypt and Nubia increased. This led to Egyptian beer, wine, vegetable oils and cereals being incorporated into the Nubian diet (Bianchi, 2004). The crops grown diversied and came to include wheat, barley, peas, lentils and melons. Fishing, fowling and hunting continued, and antelopes may have been included in the diet. The C-Group diet is unlikely to have been altered substantially from the AGroup diet, but it was more greatly inuenced by Egypt. By the time of the Kerma period (2500 1500 BC), animal husbandry (goats, sheep and cattle) had greatly expanded. The diversication of Nubian pottery attests to the likely diversication of the Nubian diet (Bianchi, 2004). A study of isotopic ratios at Kerma in Nubia during three time periods conducted by Iacumin et al. (1998) determined that during the Ancient Period (c. 44504000 BP), cattle consumption was more important than in subsequent periods
Int. J. Osteoarchaeol. (2009) DOI: 10.1002/oa

Diet in the Nile Valley

Understanding a populations diet is an essential component of analysing dental health, as it is one of the main factors contributing to dental disease. In order to properly study the rates of dental
Copyright # 2009 John Wiley & Sons, Ltd.

M. R. Buzon and A. Bombak

and there was a high reliance on C4 plants, probably sorghum and millet. The Middle period and Classic Periods (40003700 BP and 3700 3450 BP, respectively) revealed a higher dependency on C3 plants such as wheat, barley, fruits and vegetables. The mean d13C and d15N values were identical to the values obtained from a sample of Egyptians ranging in age from approximately 7000 years BP to 1750 years BP (Iacumin et al., 1996). During the New Kingdom, Nubia was controlled by the Egyptian empire including the area where Tombos was located and further south to the Fourth Cataract (OConnor, 1993). The Egyptians built towns within Lower and Upper Nubia that served as centres of government and redistribution. Despite the colonisation, it is likely that Nubia maintained a considerable level of autonomy and was ruled by a pharaohappointed viceroy who resided in Egypt and viceroy-appointed deputies who lived in the large towns established by the Egyptians. Nubian elites may have maintained the majority of their power, while culturally homogenising with the Egyptian elite (Morkot, 1987, 2001; OConnor, 1993; Torok, 1995; Buzon, 2006a). The New Kingdom was a particularly pivotal time for Nubians as they were experiencing a socio-political transition and developing a power base that led to the establishment of the Napatan Kingdom, which would rule over Egypt during the 25th dynasty. At Tombos, the composition of the population appears to include Egyptian colonists and local native Nubians and their offspring (Buzon, 2006a). Preliminary isotopic research suggests that $25% were immigrant colonists (Buzon et al., 2007). This Egyptian occupation impacted the diet of New Kingdom Nubia. An increase in bread consumption, a staple of the Egyptian diet, probably occurred. Plants, from which the previously imported vegetable oils were derived including lettuce seeds, castor oil plant, ax, radish, saffron and sesame, were likely cultivated by the Nubians. Egyptians may also have introduced the cultivation of emmer. Pigs, ducks and geese may also have been incorporated into the Nubian diet from the Egyptian diet (Bianchi, 2004). The textual, archaeological and isotopic data on diet indicate the similarity in available foods consumed by peoples who lived in the Nile
Copyright # 2009 John Wiley & Sons, Ltd.

Valley. In addition, the vast temporal range examined suggests that this homogeneity persisted for a long time throughout the region. Regarding this information, the analyses below explore factors outside of available food sources that might have contributed to differences in dental disease found in various Nile Valley populations. In addition to the composition of the diet, this study considers aspects such as food preparation techniques, environmental differences such as occupational exposure to grit and other associated lifestyle changes that may have accompanied Egyptian colonialism in Nubia.

Materials and methods

Only adult remains were included in this study. In addition to the sample from Tombos, three Nubian samples were included for comparative purposes: Kerma, Shellal and samples excavated during the Scandinavian Joint Expedition (SJE). Two Egyptian sites are also included: Qurneh and Memphis (Figure 1, Table 1).

Tombos
The remains from the site of Tombos that are the focus of this study were obtained during excavations conducted by the University of California, Santa Barbara by ST Smith and M Buzon. Tombos is located at the Third Cataract of the Nile in Northern Sudan (Figure 1). The excavations revealed an elite Egyptian style pyramid, funerary chapel and middle-class cemetery. The pyramid was owned by a third-level Egyptian administrator Siamun, and provides dates from the late 18th Dynasty to the early 19th Dynasty, c. 14001250 BC (Smith, 2003). Burials in the alleyway around the pyramid were excavated in addition to the middle-class cemetery. Eighty-ve individuals were included in this study. Artefacts from the cemetery dated from the mid-18th dynasty to the 3rd Intermediate Period (14001050 BC). The individuals excavated were likely of both Nubian and Egyptian descent, based on their grave goods, burial style (Smith, 2003), craniometric analyses (Buzon, 2006a) and
Int. J. Osteoarchaeol. (2009) DOI: 10.1002/oa

Dental Disease in the Nile Valley during the New Kingdom

Figure 1. Map of sites examined.

strontium isotope analyses (Buzon et al., 2007). The grave goods and lack of inscriptions suggest that the cemetery contained middle-class individuals. The Tombos skeletal remains are currently housed at Purdue University.
Table 1. Sample information and composition (N 1084) Site Tombos Kerma Memphis Qurneh Shellal C-Group Pharaonic Date 14001050 BC 16801550 BC New Kingdom New Kingdom New Kingdom 20001600 BC 16501350 BC Female 44 179 43 77 71 118 38

Kerma and Shellal

Kerma is located close to Tombos at 20 km south of the 3rd cataract of the Nile. The 294 individuals examined were ethnically Nubian

Male 30 111 54 71 78 64 31

Indeterminate 11 4 2 13 1 35 9

Total 85 294 99 161 150 217 78

Copyright # 2009 John Wiley & Sons, Ltd.

Int. J. Osteoarchaeol. (2009) DOI: 10.1002/oa

M. R. Buzon and A. Bombak

including a chief, ofcials and possible sacrice victims (Buzon & Judd, 2008). The Kerma sample is dated to c. 16801550 BC. Shellal is located in Lower Nubia at the ancient Egyptian border. The 150 individuals from this study are dated to the New Kingdom. The individuals were buried in an ethnically Egyptian style, but looting was too extensive for social class to be determined. The remains from Kerma and Shellal are part of the Duckworth Collection in the Department of Biological Anthropology at the University of Cambridge. 2006b). Adults were divided into three age categories: 1829 years, 3045 years, 46 years and adults of indeterminate age for whom preservation and completeness precluded a more precise age estimate. Age distributions of the samples were compared using the Mann-Whitney U test. The adults of indeterminate age are not included in the comparison.

Dental disease
All samples were analysed for evidence of dental disease (Figure 2). The categories of dental disease examined were carious lesions, AMTL and abscesses. All these categories were recorded by tooth and location (Buikstra & Ubelaker, 1994). Following the descriptions for dental conditions in Buikstra & Ubelaker (1994), carious lesions were dened as dark eroded areas of tooth enamel. Abscesses were dened based on a drainage channel in the alveolar bone. AMTL was indicated by tooth absence and remodelling of the alveolar bone. In addition, tooth wear was scored on molars in order to evaluate its relationship with these dental conditions. Tooth wear was scored according to the Scott method (Buikstra & Ubelaker, 1994). Frequencies of overall dental decay and a measure of all the individuals affected by caries, abscesses and/or AMTL were also recorded. Rates of dental disease are presented by tooth and individual. All of the teeth included in this study have corresponding observable alveolar bone. Due primarily to postmortem loss, many of the samples lacked anterior teeth (enamel hypoplasia rates as detailed in Buzon, 2006b reveal the low sample sizes for incisors and canines). Thus, the majority of teeth examined were premolars and canines. Rates of AMTL were calculated by dividing the number of teeth lost antemortem by the total number of teeth observed plus the number lost antemortem (Lukacs, 1992). Signicant differences between the frequencies for Tombos and the other Nile Valley samples were determined through chisquared tests for independence (a 0.05) for carious lesions, abscesses, AMTL and overall dental decay. Signicant differences in tooth wear were determined by T-tests for independence
Int. J. Osteoarchaeol. (2009) DOI: 10.1002/oa

Scandinavian Joint Expedition to Nubia collection

The third Nubian sample originates from the excavations conducted by the SJE to Nubia. The locations of the excavated sites were from the modern Egyptian border to 60 km south. This sample was composed of material from the C-Group Nubian Culture (N 217, 20001600 BC) and Egyptian-style Pharaonic burials from the New Kingdom (N 78, 16501350 BC). It was not possible to derive social class data from the available information. The C-Group and Pharaonic material is curated at the Biological Anthropology Laboratory at the University of Copenhagen.

Qurneh and Memphis

Qurneh is located at the necropolis at Thebes. The material dates to the New Kingdom. The 161 individuals examined were suggested to be from the upper class, based on evidence of deluxe mummication methods. Memphis is located 19 km south of Cairo. The 99 crania are dated to the New Kingdom, possibly the 18th Dynasty (15391292 BC). Again, social class information was not available. The Memphis and Qurneh samples are also housed in the Duckworth Collection in the Department of Biological Anthropology at the University of Cambridge.

Demography
Age and sex were determined using standard protocols (Buikstra & Ubelaker, 1994; Buzon,
Copyright # 2009 John Wiley & Sons, Ltd.

Dental Disease in the Nile Valley during the New Kingdom

Figure 2. Antemortem tooth loss and tooth wear.

(a 0.05). Statistical program StataIC 10 was used for the analysis.

Results
Age and sex distributions for Tombos and the comparative samples are listed in Tables 13. The age distribution of the Tombos sample does not differ signicantly from any of the other comparative samples. The frequency of dental

Table 2. Age distribution of skeletal samples Site 1829 yrs 3045 yrs 46 yrs Adults of indeterminate age 30 8 3 3 5 79 41 169

Tombos Kerma Memphis Qurneh Shellal C-Group Pharaonic Total

24 84 36 61 75 38 13 331

17 143 46 82 41 77 12 418

14 59 14 15 29 23 12 166

disease by tooth and by individual is listed in Tables 4a4c and Tables 5a5d, respectively. Tooth wear scores are listed in Table 6. It should be noted, however, that adults of indeterminate age, which account for a larger proportion of the Tombos, C-Group and Pharaonic samples, are not included in the age comparison. Preservation issues also resulted in varying numbers of observable teeth and sockets by individual and group. These sample differences present some challenges and limitations when interpreting these data. The adults of indeterminate age in some of these samples could play an unknowable role in this analysis. All populations had similar rates of caries by individual (below $42%) and by tooth (below $9%). The rate of abscesses was higher than the rate of caries in nearly all populations both by individual and tooth data. The rate of abscesses in the Tombos sample is moderate by tooth (10%, 82/821) and very similar by individual (48%, 31/ 65) in comparison with the other samples. AMTL is the most common dental afiction in all the populations studied by individual and by tooth. By tooth, the Tombos rate of AMTL is moderate
Int. J. Osteoarchaeol. (2009) DOI: 10.1002/oa

Copyright # 2009 John Wiley & Sons, Ltd.

M. R. Buzon and A. Bombak

Table 3. Sex distribution of adult skeletons by age (F, M, I: female, male, indeterminate sex) Site F Tombos Kerma Memphis Qurneh Shellal C-Group Pharaonic Total 17 57 16 28 42 24 7 191 1829 yrs M 5 26 20 33 33 9 4 130 I 2 1 0 0 0 5 2 10 F 8 81 21 33 19 46 6 214 3045 yrs M 8 61 25 37 22 28 5 186 I 1 1 0 12 0 3 1 18 F 7 34 5 15 8 11 6 86 46 yrs M 6 24 9 0 20 11 6 76 I 1 1 0 0 1 1 0 4 Adult of indeterminate age F 12 7 1 1 2 37 19 79 M 11 0 0 1 3 16 16 47 I 7 1 2 1 0 26 6 43

Table 4a. Frequency of abscesses by tooth (M, F: male, female) Number of observed teeth Total Tombos Kerma Memphis Qurneh Shellal C-group Pharaonic

Number of affected teeth F Total 82 230 54 129 84 192 80 M 21 95 28 77 47 65 40 F 54 134 26 52 34 102 32

Number of affected teeth (as % of observed) Total 10 12 6 6 18 9 17 M 10 13 5 7 21 11 28 F 11 13 9 6 16 10 13

M 216 710 552 1156 223 587 143

821 1891 862 2097 474 2156 472

495 1057 281 873 215 1067 239

Signicantly different from Tombos (a 0.05).

Table 4b. Frequency of AMTL by tooth (M, F: male, female) Number of observed teeth Number of affected teeth Number of affected teeth (as % of observed affected) Total 27 21 25 31 42 17 55 M 37 20 23 29 47 14 67 F 24 22 30 34 40 24 52

Total Tombos Kerma Memphis Qurneh Shellal C-group Pharaonic

M 216 710 552 1156 223 587 143

F 495 1057 281 873 215 1067 239

Total 296 496 284 930 340 450 572

M 126 175 163 474 195 92 291

F 154 303 121 456 215 331 258

821 1891 862 2097 474 2156 472

Signicantly different from Tombos (a 0.05).

(27%, 296/821); by individual, the Tombos rate (72%, 46/64) is signicantly higher than most of the comparative samples. Overall dental decay was found at high and similar levels in all populations (above $56%). The Tombos sample demonstrated high levels of tooth wear (Table 6).
Copyright # 2009 John Wiley & Sons, Ltd.

Tombos males were found to have signicantly higher levels of AMTL than Tombos females by tooth and individual. Possibly as a result of the high levels of AMTL in males, there were signicantly higher levels of decay in Tombos males than Tombos females. Tombos males had
Int. J. Osteoarchaeol. (2009) DOI: 10.1002/oa

Dental Disease in the Nile Valley during the New Kingdom

Table 4c. Frequency of caries by tooth (M, F: male, female) Number of observed teeth Total Tombos Kerma Memphis Qurneh Shellal C-group Pharaonic

Number of affected teeth Total 53 103 55 126 41 72 35 M 10 14 32 61 19 11 10 F 41 87 19 63 22 52 12

Number of affected teeth (as % of observed) Total 6 5 6 6 9 3 7 M 5 2 6 5 9 2 7 F 8 8 7 7 10 5 5

M 216 710 552 1156 223 587 143

F 495 1057 281 873 215 1067 239

821 1891 862 2097 474 2156 472

Signicantly different from Tombos (a 0.05).

Table 5a. Frequency of abscesses by individual (M, F: male, female) Number of observable individuals Total Tombos Kerma Memphis Qurneh Shellal C-Group Pharaonic 65 256 76 144 103 204 65 M 23 90 45 82 55 59 26 F 38 165 31 62 46 111 33 Number of affected individuals Total 31 119 35 70 51 83 40 M 11 47 21 42 30 25 17 F 19 72 14 28 19 49 21 Number of affected individuals (as % of observable) Total 48 47 46 49 50 41 62 M 48 52 47 51 55 42 65 F 50 44 45 45 41 44 64

Table 5b. Frequency of AMTL by individual (M, F: male, female) Number of observable individuals Total Tombos Kerma Memphis Qurneh Shellal C-Group Pharaonic

Number of affected individuals F Total 46 130 39 102 55 94 64 M 21 44 24 55 32 25 29 F 23 85 15 47 21 60 32

Number of affected individuals (as % of observable) Total 72 49 51 68 52 44 85 M 91 46 51 65 57 40 93 F 62 51 50 71 45 52 89

M 23 95 47 85 56 62 31

64 264 77 151 105 213 75

37 167 30 66 47 115 36

Signicantly different from Tombos (a 0.05).

signicantly higher levels of wear than Tombos females for all molars (Table 6). The age distributions of Tombos males and females may account for these differences (Table 3). Young individuals make up a larger proportion of the Tombos sample for females than males.
Copyright # 2009 John Wiley & Sons, Ltd.

There were very few signicant differences found in levels of caries (Table 5c) and abscesses by individual between Tombos and the other samples examined when males and females were analysed separately. Tombos males, however, had signicantly higher levels of AMTL by individual
Int. J. Osteoarchaeol. (2009) DOI: 10.1002/oa

M. R. Buzon and A. Bombak

Table 5c. Frequency of caries by individual (M, F: male, female) Number of observable individuals Total Tombos Kerma Memphis Qurneh Shellal C-Group Pharaonic

Number of affected individuals F Total 18 60 26 63 29 44 19 M 6 12 16 33 15 8 6 F 10 47 9 29 14 27 9

Number of affected individuals (as % of observable) Total 24 25 38 42 34 19 27 M 29 14 39 42 34 15 32 F 27 33 36 48 37 25 29

M 21 88 41 79 44 55 19

76 243 69 151 86 227 70

37 141 25 61 38 107 31

Signicantly different from Tombos (a 0.05).

Table 5d. Frequency of decay by individual (M, F: male, female) Number of observable individuals Total Tombos Kerma Memphis Qurneh Shellal C-Group Pharaonic

Number of affected individuals Total 49 175 51 119 72 120 68 M 22 62 32 65 39 31 29 F 25 112 19 54 31 72 35

Number of affected individuals (as % of observable) Total 75 66 65 79 69 56 91 M 96 64 68 76 70 50 94 F 66 67 61 82 66 62 97

M 23 97 47 85 56 62 31

F 38 167 31 66 47 116 36

65 267 78 151 105 213 75

Signicantly different from Tombos (a 0.05).

Table 6. Average molar wear scores (M, F: male, female) M1 No. observable teeth Tot M F Tot Average score M F No. observable teeth Tot M F Tot M2 Average score M 26.8 19.5 16.5 18.6 17.3 25 25.7 F No. observable teeth Tot M F Tot M3 Average score M M

Tombos 40 10 23 27.3 34.9 Kerma 169 55 101 26.9 28.5 Memphis 50 28 18 24.0 25.1 Qurneh 104 52 42 23.7 27.7 Shellal 66 31 31 24.3 25.1 C-Group 137 42 69 27.3 32.6 Pharaonic 27 10 10 26.7 29

26.2 45 14 26 21.7 27.8 137 58 103 18.8 26.1 43 28 13 15.8 22.6 99 50 45 17.5 23.5 63 31 29 16.8 29.3 128 42 68 20.8 31.5 30 9 13 20.3

20.2 29 10 18 12.6 19.8 8.4 19.7 127 48 78 13.8 14.5 13 15.7 29 20 9 12.3 11.7 13.8 17.1 81 46 35 12.6 12.9 12.1 16.3 48 25 22 11.3 11.8 10.5 20.7 93 35 52 15.2 16.8 13.9 21.1 18 9 8 17.1 19.6 14.5

Signicantly different from Tombos (a 0.05).

Copyright # 2009 John Wiley & Sons, Ltd.

Int. J. Osteoarchaeol. (2009) DOI: 10.1002/oa

Dental Disease in the Nile Valley during the New Kingdom

(91%, 21/23) than most of the comparative samples. Probably as a result of these signicant differences, Tombos males (96%, 22/23) were shown to have signicantly higher levels of decay than many other samples as well. Tombos males had signicantly higher levels of rst and second molar wear than most of the other male comparative samples. However, there are higher numbers of younger males in the Qurneh and Shellal samples than in Tombos, which may account for their lower levels of AMTL and overall decay in those groups. By tooth, the Tombos males and females demonstrate an intermediate level of caries and abscesses. Tombos females experienced signicantly less AMTL than other populations. The groups that display signicantly lower frequencies contain similar or lower amounts of young females than the Tombos sample. In summary, the comparison with other samples reveals that Tombos individuals had an intermediate level of dental disease. The Pharaonic sample was the most highly affected group; this group also has the highest percentage of older adults when the adults of indeterminate age are removed. Shellal also suffered frequently from higher levels of dental afictions than other populations. The high levels of disease in Shellal are noteworthy because of its relatively young composition (Table 2), with more than half of the aged individuals in the young adult category. The C-Group population experienced signicantly lower rates of dental disease than Tombos. Kerma, Qurneh and Memphis were variable, and often had higher or lower rates of dental diseases than Tombos. among the groups included in this analysis. A more detailed examination, however, revealed that individuals (especially juveniles) at Tombos may have been experiencing a higher level of stress and lower recovery rate than other groups studied (Buzon, 2006b). The adults examined in the present study also reveal some differences between Tombos and the comparative samples, especially in the rates of AMTL and tooth wear. This discussion explores the similarities and differences between the samples examined in the context of overall health. We suggest that physiological and possibly mental stress associated with the socio-political and cultural transitions may have resulted in increased tooth wear leading to AMTL.

Caries
The low frequencies of carious lesions by tooth and individual suggest few differences between the samples studied, perhaps indicative of similarity of dietary resources. Caries have traditionally been found at low levels in Egyptian populations (Leek, 1972). The low level of caries in the populations studied may be correlated with the high levels of wear. Fissures of tooth crowns may have been worn down and resulted in less opportune locations for sticky food to become trapped and encourage bacterial action (Greene, 1972). The level of caries may also be affected by the high levels of AMTL. Carious teeth may have been lost or removed, thereby resulting in a rate that is lower than the true rate that was present in the population. This may be signicant in this study due to the high rate of teeth lost antemortem, as some of these teeth were likely lost due to carious lesions. The Tombos and Pharaonic samples, both of which have high rates of molar tooth wear, also display high rates of ATML and low rates of carious lesions.

Discussion
One goal of this study was to explore overall health and daily life experiences of the individuals and groups examined for evidence of dental disease. How do these results compare with other indicators of health? Previous research on nonspecic stress markers in these samples (Buzon, 2006b) indicates that frequencies of pathological conditions indicative of physiological stress are relatively low and similar in Tombos and comparative samples. As mentioned above, the rates of caries and abscesses are quite similar
Copyright # 2009 John Wiley & Sons, Ltd.

Abscesses
Abscesses are frequently caused by severe caries or dental attrition exposing the pulp tissue (Littleton and Frohich, 1993). Abscesses were found at a higher rate than caries in the
Int. J. Osteoarchaeol. (2009) DOI: 10.1002/oa

M. R. Buzon and A. Bombak

populations studied. While high levels of caries are often associated with high levels of abscesses, higher levels of abscesses may result from high levels of wear (Beckett & Lovell, 1994). Given the high levels of wear found within the samples, this seems to be a probable contributing agent to the rate of abscesses in the populations, although caries probably contributed to the level of abscesses, as well. Egyptian samples are known for high rates of wear (Wells, 1975) and this probably affected all of the populations studied. Pulp exposure caused by heavy wear has been implicated as the cause of Egyptian abscesses in the past (Leek, 1972). Similar to caries, AMTL may also have distorted the rate of abscesses. Abscesses serve as a predisposing factor of AMTL. Abscesses may have contributed to the high rate of AMTL, but they were found at a much lower rate than AMTL. The rate of teeth that were abscessed at some point in the community may have been substantially higher, but they may have been lost antemortem. In all communities apart from Tombos and Memphis, males experienced a higher level of abscesses than females. This may help explain the signicant differences between the rate of male AMTL and the rate of female AMTL in the populations. Tooth wear can predispose to tooth loss by resulting in enamel wearing more rapidly than dentin can replace the pulp chamber, leading to the exposure of pulp tissues to bacteria and subsequent infection, abscessing and loss (Hartnady & Rose, 1991). Tooth wear can also contribute to AMTL by leading to contact loss. Teeth are held in place within the alveolus by a periodontal ligament, bres of which are triggered by functional tooth movements to stimulate bone remodelling to compensate for tooth wear (Langsjoen, 1996). Space for interdental gingiva to secure and protect tooth protecting tissues are produced by the mesiodistal tooth diameters being smaller at the cervical area than the contact areas. By compromising functional tooth contact, severe wear may predispose a tooth to periodontal abscessing by exposing the interdental gingiva to infection that may spread to the connective tissues that tether teeth (Langsjoen, 1996). AMTL was found at extremely high rates in all populations. Males were signicantly more affected than females in Tombos. This is not unexpected given the higher proportion of older males than females. This is the opposite of most clinical and archaeological studies, although exceptions do exist (Lukacs, 2007). Both abscesses and wear are found at higher levels in males than females, and wear for all three molars was found at signicantly higher levels in Tombos males than Tombos females, which may help to explain the differences in AMTL between the sexes. Due to the multi-factorial nature of AMTL, there are any number of other possible reasons why males were more susceptible to AMTL, including a division of labour that precipitated a different diet (Lukacs, 1992; Larsen, 1997). For example, perhaps females consumed more cariogenic food and males ate more abrasive meat or sh, frequently associated with higher levels of attrition (Littleton & Frohlich, 1993). Using teeth as tools, traumatic injury or interpersonal violence (Lukacs, 2007) are also possible reasons.

AMTL
The multi-factorial nature of AMTL makes its etiology in a population particularly difcult to determine. AMTL can be the product of dietary texture, nutritional deciency diseases, oral health status, traumatic injury and cultural practices (Lukacs, 2007). AMTL is commonly thought to result from three main classes of dental disease: periodontal disease, attrition and caries (Langsjoen, 1996). The relatively low rate of caries in the populations studied and the high rate of wear is indicative of AMTL being mostly inuenced by tooth wear. This is unusual within an agricultural community in which high rates of caries typically lead to severe levels of AMTL. This coincides well, however, with the extremely high levels of wear that characterise Egyptian populations (Wells, 1975).
Copyright # 2009 John Wiley & Sons, Ltd.

Tooth wear
While agriculturalists are traditionally known for their less severe wear levels as compared to
Int. J. Osteoarchaeol. (2009) DOI: 10.1002/oa

Dental Disease in the Nile Valley during the New Kingdom

hunter-gatherers, Nubian agriculturalist teeth have as severe wear as hunter-gatherer groups such as Australian aborigines and Archaic American Indians (Smith, 1984). Egyptian teeth are known for their severe levels of wear caused by both rough, brous vegetable food (Wells, 1975) and environmental grit. Abrasive elements in food can range from the cellulose found in plants, the collagen of animal material and bone and gritty contaminants in stone-ground our. Dried sh have also been associated with high levels of wear (Macchiarelli, 1989; Littleton & Frohlich, 1993). Forces external to diet may also play a role in abrasion such as wind-blown sand (Smith, 1984; Macchiarelli, 1989; Littleton & Frohlich, 1993). This may be of particular consequence to the populations included in this study, as heavy wear is associated with all populations and regional dietary resources are unlikely to have any true explanatory power. A study by Leek (1972) conducted to determine the cause of extensive tooth wear in Egyptian samples detailed the importance of bread to the Egyptian diet and its abrasive components. The analysis of preserved ancient bread revealed whole grains of corn and the presence of inorganic particles. These inorganic particles principally arose from wind-blown sand, but other possible sources of contamination may include soil in which the grain was grown, sickles used while harvesting, wind-blown contamination during winnowing, contaminants from mud-brick silos or wooden granaries, unintentional contaminants added while grinding, intentional contaminants added while grinding including bricks, chalk and sand and contaminants inadvertently added during baking. For all molars, Tombos males were found to have signicantly higher levels of wear than Tombos females (Table 6). In addition to age differences in the male and female samples, this is possibly a result of consuming a more abrasive diet, or possibly males being exposed to windblown sand for more arduous or extended periods. For example, males at Tombos may have participated in activities such as the quarrying of granite for statues near the site (Figure 3). The high rates of tooth wear in this study are signicant because of the complex relationship between tooth wear, caries, AMTL and abscesses. Tooth wear likely predisposed the populations examined to AMTL and abscesses, but it may have prevented caries by wearing down occlusal ssures. The relatively high rate of wear

Figure 3. Granite quarry at Tombos.

Copyright # 2009 John Wiley & Sons, Ltd.

Int. J. Osteoarchaeol. (2009) DOI: 10.1002/oa

M. R. Buzon and A. Bombak

compared to caries may be indicative of a trend found in other populations (Larsen, 1997). Maat & van der Velde (1987) detail the possible cleansing effect achieved when the rate of attrition is more rapid than the rate of caries progression. Food may be too abrasive to stick to teeth or enter ssures. The two conditions, however, remain independent variables that correlate independently with diet (Meiklejohn et al., 1992); their relationship should not be overgeneralised (Larsen, 1997). on the teeth, it is not the only source. The clenching and grinding of teeth (bruxism) can expose the teeth to great pressure, forces more intense than those applied during chewing (Hillson, 1996). Clinical studies have suggested a relationship between tooth wear caused by bruxism and chronic stress (e.g. Johansson et al., 1991; Lurie et al., 2007). Accompanying the demonstrated health stress of the colonial interaction (Buzon, 2006a) may have been mental or psychological stress of dealing with the transition. The stressors may have resulted in clenching or bruxism that caused higher levels of tooth wear. This resulting tooth wear may also have led to higher levels of ATML. The interaction of Egyptians and Nubians at this site may have resulted in varied foodways and occupational environments. It is possible that activities associated with the Egyptian colonial centre at Tombos, including quarrying activities, resulted in a higher frequency of AMTL and tooth wear. While people in Egypt and Nubia had similar dietary staples, access may have varied from one place to another especially in terms of access to trade goods. In addition, cultural differences may have inuenced food preferences, preparation and cooking techniques, as well as exposure to environmental sources of grit. Two comparative groups that show similarly high rates of AMTL and tooth wear are the Pharaonic sample from the SJE to Nubia and the individuals buried at Shellal. These individuals, although located in Nubia, were all buried using Egyptian practices. In this sense, these sites are similar to Tombos. The sample may also represent both local Nubians and immigrant Egyptians as suggested by the craniometric data (Buzon, 2006a), and they may have experienced some of the same stressors resulting in higher rates of these conditions.

Site and sample differences

Can population differences account for some of the higher rates of dental disease, such as AMTL and tooth wear (especially in males), seen at Tombos? While the samples are relatively contemporaneous and all are located in the Nile Valley with similar food resources, some sociopolitical and cultural differences are present. Based on craniometric data and burial ritual (Buzon, 2006a) as well as strontium isotope data (Buzon et al., 2007), the group of individuals buried at Tombos is likely composed of both local Nubians and immigrant Egyptians. Despite many similarities, perhaps living in a different environment from their native country for immigrants and adapting to the new Egyptian colonialism for the local Nubians proved to be a considerable physiological stress to these individuals, as evidenced by the high rates of AMTL and tooth wear (especially in males). The people living at Tombos were likely adjusting to socio-political and cultural changes. This cemetery dates to the Egyptian colonial occupation of Tombos, a time when Egypt expanded its administration south into Nubia. Nubians during this period show evidence of Egyptianisation, the adoption of Egyptian cultural features (as demonstrated in their burial ritual). This cultural transition for the local Nubians as well as the physiological effects of immigration for the colonial Egyptians may have resulted in higher levels of stress and/or the need to adapt to different environments that may have impacted rates of dental disease. For example, while mastication inicts signicant mechanical stress
Copyright # 2009 John Wiley & Sons, Ltd.

Conclusions
This study examined and discussed the rates of dental disease (caries, abscesses, antemortem tooth loss and severity of tooth wear) in New Kingdom Nile Valley groups. Particular attention was paid to the site of Tombos, a cemetery used
Int. J. Osteoarchaeol. (2009) DOI: 10.1002/oa

Dental Disease in the Nile Valley during the New Kingdom

during the Egyptian colonial occupation of Nubia that was composed of both immigrant Egyptians and local Nubians. Rates of caries and abscesses were relatively similar between Tombos and the comparative samples, reective of the similar dietary resources available to the people living at these sites. The rates of AMTL and tooth wear, however, highlight some possible differences between the samples examined. Individuals buried at Tombos, as well as the SJE Pharaonic sample, show very high rates of these conditions. These high frequencies may be related to the additional stress put on individuals as they experienced the socio-political and cultural changes associated with the Egyptian colonial occupation. This study of dental disease in the Nile Valley has provided a supplementary means of illuminating details of daily life and the health experiences of past peoples.
Butzer KW. 1976. Early Hydraulic Civilization in Egypt: A Study in Cultural Ecology. University of Chicago Press: Chicago. Buzon MR. 2006a. Biological and ethnic identity in New Kingdom Nubia: a case study from Tombos. Current Anthropology 47: 683695. Buzon MR. 2006b. Health of the non-Elites at Tombos: nutritional and disease stress in New Kingdom Nubia. American Journal of Physical Anthropology 130: 2637. Buzon MR, Judd MA. 2008. Investigating health at Kerma: sacricial versus non-sacricial burials. American Journal of Physical Anthropology 136: 9399. Buzon MR, Eng JT, Lambert P, Walker PL. 2005. Bioarchaeological Methods. In Handbook of Archaeological Methods, Vol II Maschner H, Chippindale C (eds.) Altamira Press: Lanham MD; 871918. Buzon MR, Simonetti A, Creaser RA. 2007. Migration in the Nile Valley during the New Kingdom period: a preliminary strontium isotope study. Journal of Archaeological Science 34: 13911401. Calcagno JM, Gibson KR. 1991. Selective compromise: evolutionary trends and mechanisms in hominid tooth size. In Advances in Dental Anthropology, Kelley MA, Larsen CS (eds.) Wiley-Liss: New York; 5976. Chazel JC, Valcarel J, Tramini P, Pellisier B. 2005. Coronal and apical lesions, environmental factors: study in a modern and an archaeological population. Clinical Oral Investigations 9: 197202. Dias G, Tayles N. 1997. Abscess cavity - a misnomer. International Journal of Osteoarchaeology 7: 548554. Dupras TL, Schwarcz HP, Fairgrieve SI. 2001. Infant feeding and weaning practices in Roman Egypt. American Journal of Physical Anthropology 115: 204 212. Greene DL. 1972. Dental anthropology of early Egypt and Nubia. Journal of Human Evolution 1: 315324. Hall R, German T. 1975. Dental pathology, attrition, and occlusal surface form in a prehistoric sample from British Columbia. Syesis 8: 275289. Hartnady P, Rose JC. 1991. Abnormal tooth-loss patterns among Archaic-period inhabitants of the Lower Pecos region, Texas. In Advances in Dental Anthropology, Kelley MA, Larsen CS (eds.) WileyLiss: New York; 267278. Hillson SW. 1979. Diet and dental disease. World Archaeology 11: 147162. Hillson SW. 1996. Dental Anthropology. Cambridge University Press: Cambridge. Hillson SW. 2001. Recording dental caries in archaeological human remains. International Journal of Osteoarchaeology 11: 249289.

Acknowledgements
Gratitude is extended to Stuart Tyson Smith, Director General Hassan Hussein Idris at the National Corporation for Antiquities and Museums and Ali Osman M. Salih at the University of Khartoum for our collaboration on the Tombos excavation. Pia Bennike at the University of Copenhagen and Marta Lahr at the University of Cambridge provided access to their collections for this research. This work was sponsored in part by the National Science Foundation (Grant #0313247) and the Institute for Bioarchaeology.

References
Beckett S, Lovell NC. 1994. Dental disease evidence for agricultural intensication in the Nubian CGroup. International Journal of Osteoarchaeology 4: 223240. Bianchi RS. 2004. Daily Life of the Nubians. Greenwood Press: Westport. Buikstra J, Ubelaker D, (eds.) 1994. Standards for Data Collection from Human Skeletal Remains. Fayetteville: Research series no. 44. Arkansas Archaeological Survey: Fayetteville.

Copyright # 2009 John Wiley & Sons, Ltd.

Int. J. Osteoarchaeol. (2009) DOI: 10.1002/oa

M. R. Buzon and A. Bombak

Iacumin P, Bocherens H, Mariotti A, Longinelli A. 1996. An isotopic palaeoenvironmental study of human skeletal remains from the Nile Valley. Palaeogeography Palaeoclimatology Palaeoecology 126: 1530. Iacumin P, Bocherens H, Chaix L, Marioth A. 1998. Stable carbon and nitrogen isotopes as dietary indicators of Ancient Nubian populations (Northern Sudan). Journal of Archaeological Science 25: 293 301. Irish JD. 2001. Human skeletal remains from three Nabta Playa sites. In Holocene Settlements of the Egyptian Sahara 1: The Archaeology of Nabta Playa, Wendorf F, Schild R (eds). Kluwer Academic/Plenum Press: New York; 521528. Johansson A, Fareed K, Omar R. 1991. Analysis of possible factors inuencing the occlusal tooth wear in a young Saudi population. Acta Odontologica Scandinavica 49: 139145. Kieser JA, Dennison KJ, Kaidonis JA, Huang D, Herbison PGP, Tayles NG. 2001. Patterns of dental wear in early Maori dentition. International Journal of Osteoarchaeology 11: 206217. Langsjoen OM. 1996. Dental effects of diet and cocaleaf chewing on two prehistoric cultures of northern Chile. American Journal of Physical Anthropology 101: 475489. Larsen CS. 1995. Biological changes in human populations with agriculture. Annual Review of Anthropology 24: 185213. Larsen CS. 1997. Bioarchaeology: Interpreting Behavior from the Human Skeleton. Cambridge University Press: Cambridge. Larsen CS, Shavitt R, Grifn MC. 1991. Dental caries evidence for dietary change: an archaeological context. In Advances in Dental Anthropology, Kelley MA, Larsen CS (eds.) Wiley-Liss: New York; 179202. Leek F. 1972. Teeth and bread in ancient Egypt. Journal of Egyptian Archaeology 58: 126132. Littleton J, Frohlich B. 1993. Fish-eaters and farmers: dental pathology in the Arabian Gulf. American Journal of Physical Anthropology 92: 427447. Lukacs JR. 1992. Dental paleopathology and agricultural intensication in South Asia: new evidence from Bronze Age Harappa. American Journal of Physical Anthropology 87: 133150. Lukacs JR. 1995. The Caries correction factor: a new method of calibrating dental caries rates to compensate for antemortem loss of teeth. International Journal of Osteoarchaeology 5: 151156. Lukacs JR. 2007. Dental trauma and antemortem tooth loss in prehistoric Canary Islanders: prevalence and contributing factors. International Journal of Osteoarchaeology 17: 157173. Lurie O, Zadik Y, Einy S, Tarrasch R, Raviv G, Goldstein L. 2007. Bruxism in military pilots and non-pilots: tooth wear and psychological stress. Aviation, Space and Environmental Medicine 78: 137139. Maat G, van der Velde E. 1987. The caries attrition competition. International Journal of Anthropology 2: 281292. Macchiarelli R. 1989. Prehistoric sh-eaters along the eastern Arabian coasts: dental variation, morphology, and oral health in the Ras al-Hamra community (Qurum, Sultanate of Oman, 5th-4th millennia BC). American Journal of Physical Anthropology 78: 575594. Meiklejohn C, Wyman JM, Schentag CT. 1992. Caries and attrition: dependent or independent variables? International Journal of Anthropology 7: 1722. Morkot R. 1987. Studies in New Kingdom Nubia 1. Politics, economies and ideology: Egyptian imperialism in Nubia. Wepwawet 3: 2949. Morkot R. 2001. Egypt and Nubia. In Empires: Perspectives from Archaeology and History, Alcock SE, DAltroy TN, Morrison K, Sinopoli CM (eds.) Cambridge University Press: Cambridge; 227251. OConnor D. 1993. Ancient Nubia: Egypts rival in Africa. University Museum, University of Pennsylvania: Philadelphia. Oxenham MF, Nguyen LC, Nguyen KT. 2006. The oral health consequences of the adoption and intensication of agriculture in Southeast Asia. In Bioarchaeology of Southeast Asia, Oxenham M, Tayles N (eds.) Cambridge University Press: Cambridge; 263289. Roberts C, Manchester K. 2005. The Archaeology of Disease, 3rd edition. Cornell University Press: Ithaca, New York. Schneider KN. 1986. Dental caries, enamel composition, and subsistence among prehistoric Amerindians of Ohio. American Journal of Physical Anthropology 71: 95102. Scott RG, Turner II CG. 1988. Dental anthropology. Annual Review of Anthropology 17: 99126. Sheridan SG, Mittler DM, Van Gerven DP, Covert HH. 1991. Biomechanical association of dental and temporomandibular pathology in a medieval Nubian population. American Journal of Physical Anthropology 85: 201205. Smith HB. 1984. Patterns of molar wear in huntergatherers and agriculturalists. American Journal of Physical Anthropology 63: 3956. Smith ST. 2003. Wretched Kush: Ethnic identities and boundaries in Egypts Nubian Empire. Routledge: London. Thompson AH, Richards MP, Shortland A, Zakrzewski SR. 2005. Isotopic paleodiet studies of

Copyright # 2009 John Wiley & Sons, Ltd.

Int. J. Osteoarchaeol. (2009) DOI: 10.1002/oa

Dental Disease in the Nile Valley during the New Kingdom

ancient Egyptian fauna and humans. Journal of Archaeological Science 32: 451463. Torok L. 1995. The emergence of the kingdom of Kush and her myth of state in the rst millennium BC. Cahier de Recherches de l Institut de Papyrologie et d Egyptologie de Lille 17: 203228. Wells C. 1975. Prehistoric and historical changes in nutritional diseases and associated conditions. Progress in Food and Nutritional Sciences 1: 729779. Wendorf F, Close A. 1992. Early Neolithic foodeconomies in the Eastern Sahara. In Followers of Horus, Friedman R, Adams B (eds.) Oxbow Monograph: Oxford; 163172. White CD, Longstaffe FJ, Law KR. 1999. Seasonal stability and variation in diet as reected in human mummy tissues from the Kharga Oasis and the Nile Valley. Palaeogeography Palaeoclimatology Palaeoecology 147: 209222.

Copyright # 2009 John Wiley & Sons, Ltd.

Int. J. Osteoarchaeol. (2009) DOI: 10.1002/oa