Search

Objectives: The skeleton embodies an individual's environment and lived experiences. Studying childhood growth disruption can, therefore, aid in understanding the experiences of children in the past. This study evaluates growth disruption in a medieval Toulousian subadult sample to explore factors that may have influenced childhood growth and mortality at this site and to assess the utility of Harris line (HL) interpretations in bioarchaeology. Materials and Methods: Femoral growth disruption was assessed in n = 71 subadults (0.125–12.42 years) from the 10th–13th century St. Étienne cemetery of Toulouse, France, using femoral length, total area, cortical area, and relative cortical area. Femoral radiographs were assessed for HLs. To determine the prevalence of growth disruption, z‐scores were calculated using data from the Denver growth study. Results: The majority of subadults in this sample suffered from femoral growth disruption. Young children (1.0–3.99 years) were the most affected, with >65% experiencing reduced appositional growth and linear growth stunting at time‐of‐death. Additionally, while many individuals presented with observable HLs, linear and appositional growth did not significantly differ between individuals with and without HLs. Discussion: Maternal malnutrition and inadequate complementary feeding practices likely contributed to the high prevalence of growth disruption among the youngest individuals in the study. The older children and adolescents buried at St. Étienne experienced an amelioration in growth deficits, indicating an improvement in nutrition and/or disease load. The results of this study suggest that more consideration is required when interpreting the presence/absence of HLs, and that studies assessing HLs may benefit from using a more individualistic approach. [ABSTRACT FROM AUTHOR]

Adolescence is a key phase of the life course in modern western society, yet the study of adolescence in past populations has only recently developed. In this paper, we explore patterns of biological and social changes during adolescence, some of the challenges associated with this type of research, and how bioarchaeologists can explore this transitional period of life using macroscopic and biochemical approaches. We also examine why investigations of adolescence have been limited thus far, and how we may move forward to integrate studies of adolescence with the study of childhood, and life, in the past. [ABSTRACT FROM AUTHOR]

Objectives: The aims of the study are to investigate the effects of latitude, settlement type, age, and sex on the prevalence of vitamin D deficiency disease in the Roman Empire using human skeletal remains from cemetery sites (1st to 6th cent. AD). Materials and Methods: Data from 2,787 individuals (1,143 subadults, 1,644 adults) from 18 cemeteries associated with 15 different settlements in the Mediterranean and north‐western Europe were analyzed. Vitamin D deficiency disease (rickets, osteomalacia) was identified using standard paleopathological criteria. Multivariate statistical analysis was used analyze the effects of the variables of interest on the prevalence of vitamin D deficiency. Results: The overall prevalence of rickets in subadults (<20 years) was 5.7%, and 3.2% of adults showed osteomalacia and/or residual rickets. There was a positive association between rickets in subadults and latitude, with numerous cases of rickets among infants. There was no general association with sex or settlement type, although an elevated prevalence of rickets was observed at a cemetery associated with a settlement (Ostia, Italy), which had multi‐storey buildings. Discussion: The association of rickets with latitude may reflect care practices that, in more northerly locations where solar radiation is less intense, placed infants at increased risk of insufficient sunlight exposure to permit adequate vitamin D biosynthesis. The elevated level of vitamin D deficiency at Ostia may reflect, at least in part, the lack of sunlight due to dense occupation of multi‐storey blocks that prevented direct sunlight from reaching living quarters and the streets between these closely spaced buildings. [ABSTRACT FROM AUTHOR]

The Michelet necropolis in Lisieux, France, dating to the late Roman and Merovingian period, comprises of a large number of well-preserved subadult remains offering a unique opportunity to better understand childhood trauma in the past. The focus of this study was to determine the amount, type and mechanisms of trauma evidenced in subadults from the 4th-8th century AD, and explore potential circumstances surrounding the trauma. The remains of 109 subadults from the Michelet necropolis were examined for the presence of cranial and post-cranial trauma. Three individuals exhibited perimortem trauma, one individual had an antemortem cranial injury, and no cases of post-cranial trauma were identified. Cranial trauma affected 4.1% of children with observable cranial remains ( N = 4/97). The children affected were young (2-7 years old), making it unlikely that they would have participated in militaristic activities. Based on the location, morphology and mechanism of injury identified, it is likely that the perimortem injuries sustained by three children were not accidental. The presence of a number of cranial injuries from this site may be related to increased stress in the community related to the decline of the Roman Empire in Gaul, possible raiding barbarian groups during the 4th-5th centuries, or stresses related to the Gallic aristocracy solidifying political powers in northern Gaul during the 5th-7th centuries AD. The consideration and inclusion of childhood trauma in bioarchaeological analyses allows for a more detailed and in-depth understanding of violence and childhood in the past. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Hip fractures have high incidence rates in many current groups and are associated with high morbidity, mortality, and considerable expenditure. Although hip fractures associated with significant traumatic events can occur at any age, many hip fractures occur in older adults. To date, few hip fractures have been reported from archaeological skeletal material, and a number of hypotheses have been suggested for this. This research presents a comprehensive assessment of hip fractures in archaeological bone; 1597 adult (18+ years) skeletons from eight urban post-medieval sites from England dating from the 18th and 19th centuries were recorded, and contemporary medical texts reviewed. This adult sample included 834 males and 652 females as well as 11 persons of undetermined sex. Ways of classifying and describing fractures in the clinical literature were reviewed and a methodology applicable to paleopathology determined. Of this sample, 15 (0.94%) had fractures in the femoral neck or intertrochanteric area: nine males, four females, and two individuals of undetermined sex. The numbers of fractures in males were interesting and most likely represent examples of accidental trauma as well as osteoporosis-related fractures, the latter receiving growing awareness in recent clinical literature. Overall there was an age-related trend with more individuals aged 50+ years with fractures than in other age categories. Underlying osteoporosis was potentially a complicating factor in five individuals and was likely associated with a vitamin D deficiency osteomalacia and a metastatic neoplastic condition in a further two cases. Fractures occurring close to the time of death and healed fractures were observed, indicating that the risk of mortality following this trauma was not consistent across this 18th and 19th century sample. Skeletal and historical evidence presented in this study indicate that the impact of hip fracture injuries varied, with survival likely linked to the fracture type. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Estimation of age-at-death is an important and challenging part of any investigation of human remains. Extensive research has been undertaken on this subject as demographic information contributes much to bioarchaeological and forensic work. Disarticulated, fragmentary and commingled human remains occur from a wide range of spatial and temporal contexts, and estimation of age-at-death can be particularly challenging in these collections. This study evaluated the impact of preservation on techniques that might be applied and their relative utility, using human remains from the site of the Smith's Knoll associated with the Battle of Stoney Creek, a War of 1812 collection from Ontario Canada with some supporting documentary evidence on age-at-death. Features assessed were the pubic symphysis, auricular surface and epiphyseal fusion in the innominate. An age-at-death estimate was produced for 16 out of 19 individuals considered; the highest minimum number of individuals (MNI) was 24 (right radius) from 2701 identifiable fragments. The pubic symphysis made no contribution to construction of a demographic profile, but as has been suggested previously epiphyseal fusion was useful in this respect. Results demonstrate that previous statements regarding preservation of the auricular surface and its utility in fragmented and poorly preserved collections need to be carefully evaluated. Although 129 fragments of innominate were recorded just one had an auricular surface and post auricular area that could be fully assessed. Transition Analysis was easier to apply than techniques developed previously, and findings from this study suggest that use of the forensic prior distribution could assist in assessment of battlefield assemblages. These results raise some valuable points that need to be considered in any future attempts to improve age-at-death estimates using the auricular surface, and important questions regarding expectations for estimation of age-at-death in disarticulated, fragmented and commingled collections of human bone. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: To examine and compare practitioners' judgements of risk of future pathology associated with pathology-free disease asymptomatic third molars.Subjects: 10 oral and maxillofacial surgeons and 18 family dentists (90% male) with experience ranging from 5-28 years.Method: Participants were presented with periapical radiographs of 36 asymptomatic, disease-free mandibular third molars and were informed of the age and sex of the patients and the degree of eruption of the third molars. Participants were asked to assess likelihood of future pathology in general, and more specifically, likelihood of root resorption, pericoronitis, periodontitis, cystic change and neoplasia if the third molar was left in situ.Results: There was significant variation between the 28 raters but not between the two groups. Excepting assessment of future cystic change, there was no evidence that oral and maxillofacial surgeons and family dentists rated the 36 cases in consistently different ways.Conclusions: Practitioners varied very considerably in their judgment of the risks of pathology associated with asymptomatic disease-free third molars. Specialisation, did not account for this variation. [ABSTRACT FROM AUTHOR]

The article investigates the living conditions for an urban working class group in the Industrial Revolution compared to thr rural population in the agrarian parish using English skeletal remains. The methodology involves the Industrial Revolution urban skeletal material from St. Martin's Churchyard, Birmingham (SMB) while the rural material is from Wharram Percy (WP). Bone lengths and dental age of the skeletal remains from the two groups were analyzed and no overall difference was found.

Gross and radiographic changes characteristic of inadequate bone mineralization due to rickets are described in 21 immature skeletons from a 19th century urban population from Birmingham, England. The aims of the study are as follows: to evaluate and if possible augment existing dry-bone criteria for the recognition of rickets in immature skeletal remains; to investigate the value of radiography for the paleopathological diagnosis of rickets; and to compare and contrast the expression of rickets in this group with that previously documented for a rural agrarian population from Wharram Percy, England. Some gross skeletal signs of rickets which were not previously well-documented in paleopathological studies are noted. The worth of radiography for evaluating structural changes to both cortical and trabecular bone in the disease is demonstrated, and features useful for the interpretation of vitamin D deficiency are discussed. The pattern of skeletal elements affected and the severity of changes differs in the Birmingham group from that seen in the comparative rural population. It is emphasized that a variety of factors may influence the expression of rickets in paleopathological material, including rate of skeletal growth, age cohort affected, and intensity of vitamin D deficiency. Nevertheless, careful analysis, not only of the frequency of rickets but also of the degree of severity of lesions and the patterning with respect to skeletal elements affected, may enable more nuanced understanding of the biocultural context of the disease in earlier populations. [ABSTRACT FROM AUTHOR]

Aim To elucidate and compare patients' outcome preferences for removal and retention of mandibular third molars in Sweden and Wales.Subjects and method The subjects comprised patients referred and scheduled for removal of one or both mandibular third molars in Sweden and Wales. The multi-attribute utility (MAU) methodology was applied to study patients' preferences for outcomes of removal and retention of the mandibular third molar.Results Relative weighting of domains was similar in the two countries. 'Home and social life' received the highest relative weighting in Sweden and 'general health and wellbeing' in Wales. 'Your appearance' received the lowest relative weighting in both countries. In both Sweden and Wales operative jaw fracture was considered to be the outcome with most impact and dentigerous cyst and imbricated incisors the least impact. Outcome ranking was similar in both countries and operative outcomes were considered by patients to be more detrimental to health than retention outcomes.Conclusions This comparison showed that patients' preferences in Sweden and Wales were similar and that the outcomes of surgery were considered worse after third molar removal than retention. Patient-orientated treatment decisions were less subject to variation than clinician-orientated decisions. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that Swedish dentists schedule more mandibular third molars for prophylactic removal compared with UK dentists and oral surgeons.Design: Clinical and radiographic information relating to a stratified sample of 36 disease-free mandibular third molars (equal distribution of males and females, patients' age, angular position and degree of impaction) was presented to 26 general dental practitioners (GDPs) and 10 oral surgeons in Sweden and 18 GDPs and 10 oral surgeons in Wales who were asked to decide whether or not the third molars should be removed.Results: There was no evidence of any difference in mean number of molars scheduled for removal by the GDPs, but the Swedish oral surgeons scheduled significantly more third molars for removal than oral surgeons in Wales.Conclusion: The less interventionist approach among oral surgeons in the UK may reflect the development and application of authoritative guidelines in the UK and an extensive debate concerning appropriateness of prophylactic removal there. [ABSTRACT FROM AUTHOR]

The aim was to study patients' preferences about outcomes of mandibular third molar removal and non-removal using multi-attribute utility (MAU) methodology. The study comprised three stages. Stage 1: Elicitation of domains, i.e. main areas of patients' lives which could be affected by third molar removal and non-removal. Stage 2a: Interdomain weighting was obtained by relative weighting of the domains elicited in Stage 1. Stage 2b: Intradomain weighting obtained by patients' designation of values for different health states of each domain. Stage 3: Rating of outcomes. The patients were asked to imagine experiencing a variety of outcomes of mandibular third molar removal and non-removal, described in 19 short vignettes. The numbers of patients interviewed for the three stages were 30, 78, and 55, respectively. Five domains were identified. The mean relative weightings were approximately equal for the domains "Home and social life" and "General health and well-being", followed in order of importance by 'Job and studies" and "Health and comfort of mouth, teeth and gums". "Your appearance" received the lowest mean relative weighting. The vignette, which described the presence of a fluid-filled sac and suggested that this tooth must be removed, received the highest mean preference (least effect on patients' lives). The lowest mean preference (most effect on patients' lives) was generated by the vignette, which stated that the jaw was broken and that the teeth must be wired together for 6 weeks. We conclude that, from the patient's perspective, outcomes of non-removal were preferable to outcomes of mandibular third molar removal. [ABSTRACT FROM AUTHOR]

Objective: To investigate relationships between pathology, eruption status, age, anaesthetic modality and nerve damage during lower third molar surgery.Design: Single centre prospective study.Setting: Oral surgery out-patient clinics.Subjects: 367 patients unselected for age, gender or social class, scheduled for lower third molar removal. At 1 week, any evidence of iatrogenic nerve damage was recorded. Patients with altered lingual and/or labial sensation were followed up for 6 months.Results: 718 lower third molars were removed from 250 males and 117 females. 96 removals (13.4%) were associated with altered lingual, labial or buccal sensation. There were no significant associations between nerve damage and eruption status, age and pre-operative pathology. There was a highly significant difference in the incidence of nerve damage between LA removal (3%) and GA removal (18%) (chi-squared = 17.18; f = 2; P < 0.01) but no significant associations between surgical difficulty and nerve damage within each of the two groups.Conclusions: Lingual and inferior alveolar nerve damage was five times more frequent when lower third molars were removed under general anaesthesia rather than local anaesthesia. This could not be explained in terms of surgical difficulty, pre-operative pathology, age or anatomical position. [ABSTRACT FROM AUTHOR]

Purpose Of Investigation: The study was undertaken to identify the least costly, most effective and most cost-effective management strategy for asymptomatic, disease free mandibular third molars.Methods and Patients: A decision tree model of the outcomes of mandibular third molar retention and removal was constructed. Probability data for possible outcomes were obtained from a comprehensive literature review and entered into the decision tree. The cost to the NHS in treating each outcome was calculated. 100 patients attending the oral surgery clinics, University of Wales Dental Hospital rated the effect of each outcome on their own life. The cost and effectiveness data for each outcome were entered into the decision tree and the analyses were conducted by 'folding back' the decision tree based on the probabilities.Main Findings: Mandibular third molar retention was less costly (170 Pounds), more effective (69.5 effectiveness units on a 100 point scale) and more cost-effective (2.43 Pounds per unit of effectiveness) than removal (226 Pounds, 63.3 and 3.57 Pounds respectively). These findings were sensitive to changes in the probability of pericoronitis, periodontal disease and caries.Principal Conclusions: Mandibular third molar retention is less costly to the NHS, more effective for the patient and more cost-effective to both parties than removal. However, should the likelihood of developing pericoronitis, periodontal disease and caries increase substantially then removal becomes the more cost-effective strategy. [ABSTRACT FROM AUTHOR]

The accurate detection of malignant neoplasms whilst they are still small is recognised as one of the main factors increasing chances of survival. Neural networks have many biomedical applications and they have been applied to neoplasia but their use in oral pathology has only recently been documented. The objectives of this study were to train networks to discriminate between normal and dysplastic mucosa. Each network was trained by back propagation, internal cross validation and tested on additional data. The data were derived by analysing 348 intra-oral smears and included mean nuclear and mean cytoplasmic areas of the smears measured by image analysis. A neural network differentiated between normal/non-dysplastic mucosa and dysplastic/malignant mucosa (specificity 0.82, sensitivity 0.76). These early results suggest that integrating neural networks and image analysis, as well as investigating additional criteria, could enhance automation and accuracy of smear techniques in diagnosing oral malignancy. [ABSTRACT FROM AUTHOR]

Objective To investigate GDP opinions of the current referral system and to investigate the need and demand for telemedicine in oral surgery referrals. Design Postal questionnaire. Setting 400 GDPs in Greater Manchester. Results 84% participation rate. 48% were not satisfied overall with the service of their current specialist oral surgery referral site. The principal reason was the length of the waiting time for consultation and treatment. Distance for patients to travel to the specialist unit was also of concern, even though most patients (89%) travelled short distances (return journey of twelve miles or less). 23% of respondents wished to improve their ability to communicate with the oral surgeon and 70% wanted involvement in the patient consultation. Both of these requirements were more likely in younger practitioners. Conclusion There is a need and demand for change in the referral system for oral surgery specialist care. Telemedicine could conceivably be one way to improve access to specialist oral surgery care. [ABSTRACT FROM AUTHOR]

Objective To investigate current GDP oral surgery referral patterns given the anticipated change since the introduction by the General Dental Council of the specialty of surgical dentistry. Design Postal questionnaire. Setting 400 GDPs in Greater Manchester. Results 84% participation rate. 69% of dentists made a referral because of anticipated difficulty of surgery and 49% because of the complex nature of the patients' medical history. Practitioners who had undergone some oral surgery postgraduate training were more likely to undertake more surgery in their practices (P < 0.01) and to refer more patients for specialist care (P < 0.05). While female practitioners rated their own surgical confidence less highly than male practitioners (P < 0.001), and younger practitioners less than their older colleagues (P < 0.05), there was no significant difference in the number of referrals made. Conclusion The most common reasons for referral were the anticipated difficulty of surgery and patient medical compromise. There was a wide variation between practitioners in the number of patients referred for specialist care. Postgraduate oral surgery training was identified as a factor contributing to this variation. Other practitioner variables, such as sex, experience and type of practice were not found to contribute. [ABSTRACT FROM AUTHOR]