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A RADIOGRAPHIC STUDY OF THE HEAD OF A CHILD
FROM GRECO-ROMAN EGYPT

Dr Pamela J.G. Craig
Unit of Oral Anatomy, Medicine & Surgery
School of Dental Science, The University of Melbourne

Abstract

In the area of forensic odontology, a routine request occasionally reveals some unexpected and interesting information. In the case described below a request to ascertain the age of the mummified head by dental radiographic means revealed evidence of possible interceptive orthodontic treatment having been carried out on the child prior to death, and also some evidence which may suggest a possible cause of death.

Introduction

The mummified head of the Greco-Roman child belonging to the Australian Institute of Archaeology was being prepared for exhibition purposes. The provenance of the specimen was unknown but it is thought to have been purchased in Alexandria at the turn of the 19th/20th century by London dealer who then sold it to an Australian representative of the Australian Institute of Archaeology.

An examination of the features of the head reveals the hairstyle to be that of a Greco-Roman with curly hair cut short. The features are in a remarkably well preserved state. There are traces of gold leaf remaining around the eyes suggesting that the face may well have been painted subsequent to the mummification process. The upper lip has been damaged as has an area on the left cheek. The vertebrae of the neck are angled forwards indicating that the odontoid peg had been fractured perimortem or postmortem prior to mummification.

The curators wanted a facial reconstruction made to show the visitors what the child may have looked like during life. This was to be done by the Forensic Odontology Unit at the University of Melbourne, Victoria, Australia, but before beginning, we needed to know the age of the child at death. The easiest way of determining age of death is to x-ray the skull and examine the developmental stages of the teeth.

Three plain skull films, an orthopantomogram (OPT) and a computerised tomograph (CT) scan were taken.

Findings

The orthopantomogram (OPT) was the best source of information as to the age of the child. The stages of development of the first permanent molars, the lower permanent canines and the lower second permanent molar teeth are at a stage consistent with that of a child of 8 to 9 years of age when compared with a contemporary population of children. Several teeth are missing from the dentition – the lower left lateral incisor tooth is missing, as are the first upper deciduous molars and their permanent counterparts, the first premolars. It would not be unreasonable to assume that the lower incisor tooth was knocked out perimortem or during the mummification process. Although this was not an uncommon occurrence, it is more difficult to explain the loss of the two upper first deciduous molars given the fact that the first permanent premolars are also missing. There did not appear to be any bone in the area, indicating that something had been removed at or close to the time of death.

A lateral cephalogram radiograph provides information about the degree of crowding of the dentition and enables predictions of growth patterns to be made. It revealed that the child had an extremely crowded dentition set back somewhat from the base of the skull. A growth analysis was done which indicated that had the child grown to adulthood, the facial complex could not have accommodated all the teeth and the child would not only have looked ugly but the teeth would not have functioned correctly.

The child suffered from dental decay in the 4 first permanent molars and several deciduous teeth. The condition of the upper second deciduous molars would indicate that the teeth were extremely decayed and only fragments remained. There does not appear to be any wear either on the first permanent molars or the deciduous teeth.

Discussion

Although the stages of dental development were such that one could assume that the child had been 8 to 9 years of age, data gleaned from a contemporary population does not necessarily reflect that of an individual growing up in a different climate and society some 2000 years ago. In fact the various stages of dental development of the individual teeth does not fit securely into any particular time frame. However for the purposes of our investigation, i.e. that of providing information prior to a facial reconstruction, it was sufficient to give a general age range.

The most unusual aspect of the child’s dentition is the lack of the upper first deciduous molars and their successors. Teeth may be congenitally missing from the dentition and it is not unusual to find missing incisors, premolars or molars in any given population. It is usual though, that the tooth missing will be the last member of that family of teeth, i.e. the second incisors, the second premolars and third molars. In addition one would expect bone to be present in the area indicating that no tooth buds had developed. The lack of bone indicates that something had been there prior to death and that no infill of bone had occurred subsequent to its presumed removal. The antero-posterior skull view revealed the position of the upper anterior teeth, i.e. the central and lateral incisors and the unerupted upper permanent canines. The position of the canines was well forward of their normal erupted position and the angulation suggests that when eruption occurred some 4 years later they would have been in an anterior position, giving the child a “vampire” appearance. All four upper incisor teeth were crooked and the erupting lateral incisors were rotated.

In life the unerupted upper permanent canines in their crypts would have been readily palpable beneath the tissues below the nostrils. It would therefore be obvious to an observer that their projected path of eruption would force them anteriorly from their ideal position. Early removal of the first deciduous molars and their permanent successors would allow sufficient space for the unerupted canines to drop back into the space and therefore provide enough room for the incisors to align themselves and for the canine to position itself in line with the rest of the arch. This procedure is commonly undertaken in modern times.

A study of the literature would indicate that tooth removal as a preventative measure against the development of malocclusion was not practiced in Greece or in Egypt at any time. This may be due to lack of affirmative evidence rather than negative, as there are various surgical instruments known to have existed for the extraction of teeth in the Grecian world during the Ptolemaic period in which the child lived.

The absence of evidence of bony healing on the radiographs would indicate that this procedure had taken place close to the time of death. Any surgical procedure in the absence of aseptic conditions would be likely to cause infection. As there was little knowledge of aseptic technique, blood poisoning and subsequent death would have to have been a common complication.

Although dental decay was somewhat of a rarity in ancient Egypt, it increased markedly during the time of the Greek Diaspora due to greater affluence and trade. Although the boy appears to have been Egyptian, most expatriate Greeks adopted Egyptian customs and practices, including mummification.

The diet changed among the upper classes to include large amounts of dried fruit, honey and sugar. Other dental diseases were also prevalent. Among these were dental abscesses that occurred subsequent to the rapid wear of the teeth down to the pulp chamber. This has been attributed to two factors: firstly the habit of grinding grain in stone quern thus incorporating particles of stone in the flour, and also to the general sandy environment which would have permeated the food eaten by the community.

The fact that this child exhibits no wear on the erupted permanent molars may not be an unusual occurrence given the fact that the teeth had been erupted for only two to three years. However, one would have expected a great deal more wear on the biting surfaces of the deciduous molars. Wear on the deciduous molars is not an uncommon occurrence among modern children, due to the relative thinness of the enamel coating and the habit of many children of grinding their teeth.

Therefore this child can be assumed to have consumed a diet that was somewhat out of the ordinary for the time. It was a diet that was low in abrasive qualities and high in fermentable carbohydrates. One explanation for this may have been the prolonged practice of breast-feeding, which occurred among the upper classes of the time. The period of weaning was, and still is in some communities, regarded as a period of great danger for the child due to the fact that many childhood ailments occur soon after weaning. It is known now that this is due to cessation of the maternal antibodies that protect the child during the breast-feeding period. In addition to breast milk the child would have needed another source of nutrient as it grew larger. It may have been consuming large quantities of soft fermentable carbohydrates in the form of fruit either fresh or possibly dried, dates, and honey.

Conclusion

The examination of the head of this eight-year-old child may have thrown some light on the oral health practices of the upper class Egyptian and Greek inhabitants of the Ptolemaic period. It also throws some light on the dietary habits of the upper classes, which were very different from those of the bulk of the population.
Due to the obvious failure of the surgical procedure in this case, it may be a one off experiment, which although fine in theory, failed to take into account the risks of infection. The answer to this question will be the discovery of more remains of the period, in particular adults, who have beautifully aligned teeth and two missing premolars!

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