Dental caries prevalence in early Hawaiian children.

The skeletal remains of 1338 dentate early Hawaiians (pre-Captain Cook -1778)from the Bishop Museum collection in Honolulu were examined. The proportion of children with primary or mixed dentition in the overall sample was 18.3%. All major islands were represented. Minor geographic variations in caries prevalence were observed. For the entire sample of 245 children and 2854 teeth, caries was detected in 25 children (10.2%) and teeth (2.2%). Carious lesions were restricted to thee primary teeth, with the most frequent lesion occurring on the occlusal surface of the first and second molars. Proximal, facial, and lingual lesions were observed less frequently; but in several specimens, multiple proximal or facial lesions were noted on the maxillary central and lateral incisors. In comparison with contemporary school children residing in the Hawaiian Islands, the early Hawaiian children had a significantly lower prevalence of dental caries. Late in the eighteenth century, when the first European sailing vessels arrived in eastern Polynesia, both French 1 and English 2 observers commented on the attractive, white, regular teeth of the island inhabitants. Approximately 100 years later, reports indicated that dental caries at the turn of the century was still practically unknown in that part of the world, thus apparently confirming the subjective impressions of the early voyagers. 3 The impact of these observations on the dental profession at that time was noted by Whitney:4 "We have been taught that primitive peoples, living in simple conditions, were in great measure free from dental caries as we see it in the mouths of our patients, and that many of the forms of dental disease with which we have to contend were with them wholly unknown." Whitney, a practicing Honolulu physician and dentist who had lived in the Hawaiian Islands for 24 years, made this remark in a paper presented in 1893 at the World’s Columbian Dental Congress in Chicago. His examination of an unspecified number of ancient Hawaiian skulls presented a somewhat different picture of Polynesian dental health: "I think I have discovered every form of dental disease known to our practice; dental caries in all its many types, necrosis of the teeth, erosion, alveolar abscess, pyorrhea alveolaris, disease of the antrum of Highmore, necrosis of the maxillae, ankylosis of the jaw, salivary calculus, etc." Although the romantic notion of primitive peoples living in pristine beauty and health still was being advanced at the time of Price’s excursions into the South Pacific 5,6 and as recently as 1972,7 scientific reports on the dental and skeletal pathology of precontact Hawaiians have tended to support Whitney’s early observations. 8-~1 The literature indicates that children and young adults in the ancient Hawaiian population were relatively free of dental caries compared to contemporary residents; but elderly individuals exhibited an extremely high caries attack rate of more than 40 carious teeth/100 teeth (primarily root surface caries) which approaches current rates based on age-specific DMFT scores. 12-14 Knowledge of the caries experience of early Hawaiian children is based primarily on recent studies of a limited number of specimens from the well-known Mokapu Peninsula sand dunes site on windward Oahu.~°-~,~4 Earlier, Chappel8 had examined a small sample of skulls from each of the major islands in the Hawaiian group and although his age classification (young, middle aged, elderly) permits little comparative analysis, he did note that for 36 young individuals, only 18 carious teeth were observed in a total of 411 teeth. In the present survey, which includes the entire Bernice P. Bishop Museum collection and represents PEDIATRIC DENTISTRY: December 1985/Vol. 7 No. 4 all of the major Hawaiian Islands, the focus is on 2 specific age groups of children: (1) those with only primary teeth present and having an estimated age at death of 6 months-5 years (N = 162); and (2) those in the mixed dentition stage having permanent as well as primary teeth present, with an estimated age of 6-11 years (N = 83). The inclusion of all islands the study results in an approximate doubling of the number of individuals in the specified age groups available for examination compared to the Mokapu site alone and permits inter-island comparisons of dental caries rates. Methods and Materials The results of a 3-year study of the skeletal remains of more than 2000 individuals located in the Bishop Museum in Honolu.lu are presented. Although all the major islands in the Hawaiian group are represented in the collection, the largest number of specimens are from the island of Oahu with the Mokapu site being the largest single source (Table 1). The absence artifacts such as rings, buttons, buckles, and other modern devices among the remains has been interpreted as evidence for a pre-European dating of the specimens and it has been estimated that their antiquity ranges from 200 to 500 years. 9,1° The possibility of some specimens falling within the European period cannot be excluded, is Estimation of age at death was made by a combination of dental developmental staging 16 for younger individuals and occlusal attrition and/or alveolar bone loss in adults. Predentate infants and edentulous adults were excluded. In some instances where unerupted teeth could not be removed easily from their developmental crypts for inspection, radiographs were taken to assist in age determination. For convenience the children were placed into a primary dentition group (approximate age 6 months-5 years) and a mixed dentition group (approximate age 6-11 years). Baume 3 has noted that contemporary Polynesian children tend to erupt their permanent molars approximately1-2 years earlier than their European counterparts. The actual number of individuals in the various groups (Table 1) probably is overstated to some degree because in some instances specimens are represented by single unmatched crania, mandibles, or isolated maxillary and mandibular fragments. The number of teeth available for examination was recorded for each individual and included only those teeth that were judged subjectively to be in a state of clinical eruption. This procedure excluded many teeth that were obviously present in the jaws, but that probably had not been exposed yet to the oral environment during the life of the child. The anatomic location of carious lesions was recorded by visual inspection under good lighting conditions with the assistance of a sickle-shaped probe to remove superficial debris from tooth surfaces. Except for a few instances of enamel hypoplasia, only obvious defects in the surface continuity of the enamel were considered to be carious lesions. Chalky-appearing areas on the proximal and buccolingual surfaces were not considered carious unless there was an associated break in the enamel surface. Buccal, lingual, and occlusal pits on the molar teeth were not considered carious unless the probe easily entered into a "cavity." Relative softness or hardness at the bottom of the pit was not considered in the evaluation. Population estimates of caries prevalence were made by calculating the percentage of individuals affected (number of individuals with caries/100 individuals) and the percentage of teeth affected (number of teeth with caries/100 teeth).