While leaving class last week, I was asked: why is this course being presented to graduate students in orthodontics? I might have been asked: why yet another course in their already crowded curriculum?

As I prepared to rewrite the articles this week, those questions came to mind, especially when I came to topics that some would call the occult and the weird: trephination and the mutilation of teeth.

The refreshing perspective of anthropology is this: it affords us an opportunity to see other life ways, beliefs, and attitudes. Comparative studies allow us to see beyond our narrow ideas and attitudes. Allow me an example. In this country, beautiful movie stars are thin. If you visit Italy and see the great art of the Renaissance, you'll see well fed 'Rubenesque' figures. In some aboriginal societies of Africa and Melanesia, a young woman is not attractive unless she is well more than 200 pounds.


My intent in dental anthropology is to expose you to ideas and connections not normally encountered in clinical dentistry. One is that when third molars are absent, there is an increased likelihood of partial anodontia elsewhere in the dentition. The clinical implications are self-evident.

In this article, I will challenge your cherished basic beliefs about what is attractive in teeth and what other societies consider as beauty. Anthropology treats the world as a giant natural experiment. It is fun to see what other people do. It makes us more open minded and aware of new possibilities.



You've learned the basics in dentistry and so have I: the essential functions of teeth are mastication, speech, and esthetics.

Anthropology extends this classification with an additional term, the paramasticatory functions of teeth. This new dimension offers learning and insight into cultural behavior. It is this: teeth are sometimes altered by intent or as an unconscious byproduct of their daily lives.

Teeth can be looking at the other way around. They are artifacts of human behavior. How they have been modified tells much about human behavior. The article by Milder and Larsen (1991) is strongly recommended for further reading.

In the next section, we focus on teeth at artifacts and how they tell of what people do as revealed by their teeth.



A. Habits

Teeth reveal a wide variety of activities unrelated to eating that result in unusual and often distinctive patterns that are task-specific. Some anthropology literature will refer to this as accidental or artificial dental modifications.

Clay-stemmed pipes leave a distinctive imprint on the teeth. When the teeth are in occlusion, a distinctive opening appears on one side, or both sides-depending upon the habits of the smoker.

Figure one. Opening due to clay pipe stem

Scott and Turner (1997) report such pipe wear in prehistoric up to an including modern populations from Melanesia and Siberia to the North Atlantic region.


Another distinctive mark on teeth is produced by the cultural practice of wearing labrets, the 'cheek plugs' worn using incisions cut into the cheek or lips.

The continuous movement of the labret against the teeth leaves distinctive polished facets of varying size on the facial surfaces of the teeth. Labret usage is known from many New World populations ranging from Eskimo in the north to Mesoamerican peoples in the south.

Figure two. Lower left quadrant of teeth with characteristic 'milled' surface due to labret use



Sixteenth century teeth from Europe occasionally show a notable loss of enamel accompanied by scratch marks as a result of metal toothpick usage-which was popular at that time.

Grooves on the approximal surfaces of molars in Paleolithic persons are attributed to the sustained use of bone needle tooth picks used to remove food from between teeth. The bone needles have been found in the same cave strata as the skeletal specimens.


B. Teeth as Tools (Paramasticatory Behavior)

We frequently use our teeth as tools, as in opening a cellophane package or nipping off a piece of thread. The most spectacular contemporary report of teeth-as-a-tool usage is the opening of a 55-gallon drum by an Eskimo with his teeth (see page 303 in Turner & Cadien, 1969). They used their teeth when their fingers couldn't do the job. Tools now available such as pliers, vises, and scissors have replaced many ancient tool uses of teeth.

When distinctive occupational wear of the teeth is reported, it is often described as task-related wear. Teeth have been used for working leather, softening boots, making grass baskets, the use of bow drills, and making cordage.


The classic example of 'extramasticatory wear' is the pattern of occlusal surface grooves seen on the surfaces of permanent mandibular incisors and canines of Great Basin Indians of Nevada.

The high polish and orientation of the grooves reveal the use of teeth in the processing of plant fibers for basketry (Larsen, 1999). Virtually all occlusal surface grooves in anterior teeth are found in New World foragers.

Figure three. Occlusal grooves from tooth use in preparation of cordage from plant stems


Occupational modifications are found in the teeth to dressmakers (thread), shoemakers & carpenters (nails), butchers (string), glass-blowers and musicians (mouthpieces), office workers (pens), jugglers, and trapeze artists. For an interesting review, see Alt and Pichler (1997).

Neandertals had unusually robust anterior teeth that were worn down in a distinctive manner, suggestive of their use in the preparation of hides.

The chipping of posterior teeth has been documented in Aleuts, Eskimos and Indians. It seems associated with the biting of very hard objects. Eskimo and Australian Aborigines have been studied for many craft functions. The most unusual for me was in pressure flaking a stone projectile point. For an interesting article about teeth as tools, see Molnar, 1972.


C. Tooth Wear and Function

The process of tooth wear is well understood. Wear of teeth reflects their use in life, and the degree of wear is used by anthropology to estimate the age of an individual at death. The reader is referred to Hillson (1997) and Larsen (1999) for a review of this topic.

The severity of wear is highly influenced by the consistency and texture of food and by how it is processed. The introduction of grinding tones for making flour from cereal grains is a consistent finding around the world.

In some settings, the degree of wear reflects social status. In the Medieval Edo period of Japan, members of the elite Shogun class had virtually no occlusal wear suggestive of a soft diet, unlike lower class persons. The related dental and skeletal findings are intriguing: Those elite individuals who consumed a soft, processed diet in childhood had narrow faces, reduced size of the maxillae and mandibles, and more gracile muscle attachment sites (see Larsen, 1999 p 258). These findings corroborate the disuse theory which we'll encounter later in this course.

In contemporary society, excessive tooth wear is often found among individuals exposed to mineral, metal, or vegetable dust.

Dental chipping of the enamel and tooth fractures are frequently found in prehistoric populations, suggesting encounters with hard objects in chewing.

Scratch marks have been seen on the labial surfaces of anterior teeth of some adult Neandertal specimens. They seem to have been caused by incidental contact with stone blades used to cut meat held between the anterior upper and lower teeth (de Castro et al, 1988). The direction of the scratchmarks are evidence of right or left handedness.



This topic is also described in the literature as scarification or mutilation of teeth. For the sake of impartiality, we will treat these as cultural artifacts.

For the American trained dentist, this seems like the occult and the weird. We implicitly take for granted our culture's norms and ideals as absolutes. We don't see them that way until we encounter folks with different ideals. The central idea is this: our ideas about teeth are culturally determined.

Our clinical ideals of dental beauty as straight, white, vertically positioned teeth in perfect bilateral symmetry are shaped by Hollywood, advertising, and the media. Indirectly, we associate attractive teeth with health and vigor. To my knowledge, no culture idealizes broken-down, dirty teeth.

These ideas are NOT universal! People in other places and time modify their teeth intentionally in practices that range from extraction through to chipping, filing, staining, banding, and the setting of jewel encrustations (inlays in dental terminology).

Counter culture movements help to bring mainstream ideas into focus and often ridicule them. A example is the current practice of body piercing in the oral cavity-the implements of this practice are often called oral jewelry in dental literature. .

Body piercing involving oral structures is gaining popularity. According to body piercers, the tongue is the most popular site; however placement of 'oral jewelry' in the cheeks and lips are encountered frequently. Articles in dental literature are usually critical of the practice because of its dangers of infection and damage to the teeth

The most dramatic practice is extraction, called ablation (L = ablat, to remove), the intentional removal of teeth. This has been recorded for a number of contemporary societies, especially in Africa and Australia. How are teeth removed? Usually with a pointed stick, often the sharp hard end of a spear, struck with a rock.

Pindborg (1969) cites reports of preventing eruption of permanent teeth by destroying the germs of these teeth with a glowing-hot knife. Another technique was to removed the lower incisors with a fish hook.

The deliberate staining of teeth has been documented; a cultural ideal totally different from our own. In French colonial Annam (now Viet Nam), every Annamese of either sex was expected to have his/her teeth blackened by a process said to be very painful. "Any dog can have white teeth," they say. To them, white teeth are not only ugly but immoral!

The Iban peopole of Borneo both blacken and file their front teeth. Teeth are further beautified by drilling a hole in the middle of each tooth and therein placing a brass stud. The patient would bite one a piece of wood during the painful procedure.

The Moi of Vietnam would have their incisors chipped and ground down to the gum line. It was their idea of making themselves beautiful. A youth who had not done this was considerable neither marriageable nor of adult status. Some tribes gave their lower teeth a saw shape. Many years ago, traditional healers in Indochina had their incisors ground down to the gum line.

The filing of anterior teeth for cosmetic purposes has been documented in many cultures. This practice in many African cultures came to America and has been found in slave burials in the United States (Ortner, 1966).

An unusual permanent canine abnormality in Uganda has been traced to the folk belief that infantile fever originates in the deciduous canine teeth. The deciduous teeth, usually the lower, are removed in a crude fashion with resulting damage to the developing tooth germ (Pindborg, 1969)


The most elegant alteration of teeth for cosmetic purposes was practiced in Mesoamerica



In Late Classic Maya sites, modifications of teeth occur most frequently amongst young adults. Although there is debate on the issue, many investigators believe that dental mutilation correlates with high social position.

Lest you think that this is an esoteric practice not documented locally, many specimens with dental mutilation come from the Cahokia site near Monks Mound in southern Illinois. The securely dated teeth belong to the Mississippian period (AD 1000-1400). Both males and females are represented.


The best documentation and the most highly refined examples of the art come from Mesoamerica. There is a remarkable collection of 1212 teeth at the Instituto Nacional de Anthropologia e Historia in Mexico City.

The simplest form of dental mutilation is the filing of the teeth. A fresco in Teotihuacan records an artisan at work filing a client's teeth. If you find our dental chairs uncomfortable, try the position shown in figure one. Filing could be done with about any kind of stone. Eye witness accounts of tooth filing in Angola, Africa, provides insight into how it was probably done in the Americas.

Figure four. Tooth filing


The oldest form of mutilation in the Americas is the alteration of the contours of the dental crown. Many geometric variations are possible. The drawings here have been sketched to reflect the cultural modification as accurately as possible.

Figure five. Filed or chipped teeth

Another form of tooth mutilation was to make a cross-hatch pattern on the labial surface of the tooth. Done carefully, this technique was probably the least likely of the techniques to involve the pulp of the tooth.

Figure six. Cross hatch design

Where eyewitnesses have seen this done in Africa, Panama, and Venezuela, they report that the operators prefer to have their client seated in order to work as comfortably as possible.

The most spectacular of the mutilations are the incrustations of the teeth. You would call them jewel inlays.

This technique required great skill, and probably began in the Pre-Classic (100 BC-300 AD). Pyrite, jadeite, turquois, or gold would be set into the labial surface of the teeth. Figure four shows both the jewel inlays and the typical Late Classic design performed by Mayan artisans. This elegant workmanship dates from 700-900 AD.

Figure seven. Jewel encrustations

How would this have been done? The tooth filing is rather straightforward. Likely a stone was used such as is illustrated in figure one. The beautiful jewel inlays are another matter.



Methods used for the perforation of jade and rock crystal were probably used in doing the inlays. Very likely, this form of dentistry was an expression of a jewelers's craftsmanship. A rotating fine tube of quartz or other very resistant stone was rotated against the surface of the enamel with the addition of water,and some abrasive powder or fine sand would drill out the receptacle in the enamel to receive the inlay.

The technique did require considerable skill. A bow drill is shown, a device used widely around the world for a variety of purposes besides esthetic dentistry.

Figure eight-a. The dental artisan


In general, the jewel incrustations are perfectly fitted to the respective cavities made for them. This would account for their survival intact up to the present day. A special cement may have been used, but the formulation is unknown. It may have been a paste of powdered pyrite.

The use of gold inlays placed into prepared cavities in the teeth was also practiced in Mesoamerica. The teeth were decorated by the insertion of inlays into small perforations cut into the enamel of upper incisors.

Figure eight-b. The bow drill, bit with stone inset, and tooth prepared to receive the jewel inlay

Another remarkable practice was the successful transplantation and implantation of teeth. In one specimen, not only was a tooth implanted, but there was every indication of root resection or amputation having been performed with approximately a quarter of an inch of the root being removed. The root surface was perfectly smooth and even.



An alien visitor to Earth might describe a tooth-related cult now common in many industrialized societies. The people believe in the tooth cult so unquestionable, they call the holy doers doctor.

The cult requires an initiation wherein the holy material objects are fastened to their teeth. They then go through to two difficult years of trial until they emerge purified and the holy material objects are taken off in a rite of passage.

These people live in a society that admires what it sees on billboards, in magazines and a mystical place they call Hollywood. Both believers and priests learn their ideals there.

The practitioners of the cult have an obsession with lines and angles. The novices sit for long hours in darkened rooms looking at images prepared by the priesthood elite to whom they listen intently and seek to imitate.

Believers assemble in scattered places, notable for their peculiar chairs where they lie down, face up. All manners of ancient practice are done, from wiring teeth to removing them. The mystery of what teeth to take out and where seems determined by some sort of ritual distinctive for the hall of learning attended by the priest.

The priesthood identifies itself by frequent hand washing or the wearing of special, smelly coverings. They attach great importance to this behavior. They use a large inventory of tools and decorative objects affixed to the teeth for a time. Strangely, the believers go to their ceremonial site only once a month-strange, considering the great size of their monthly offering in local currency

After a rite of passage with pictures and a gooey substance they stuff into the mouths of the supplicants, the gadgetry is removed from the teeth and the patient is given a pink object to keep in their mouth. Apparently it is a talismen of some sort; the believers tell me they have it for their benefit-but often don't obey what they are told.

The priest practitioners seem well paid. They often spend their leisure hitting a white puckered ball with implements unsuited to the task. Some priests are known the throw their game implements in anger.

..... CJ '99


Alt, K. and Pichler, S. "Artificial Modifications of Human Teeth" in Dental Anthropology Fundamentals, Limits and Prospects. Alt, K., Rosing, F., and Teschler-Nicola, M. eds. New York: SpringerWien, 1998.

de Castro, J., Bromage, Bromage, T., and Jalvo, Y. "Buccal striations on fossil human anterior teeth: evidence of handedness in the middle and early Upper Pleistocene" J. Human Evolution. 1988 (17) 403-412.

Larsen, C. "Dental Modifications and Tool Use in the Western Great Basin" Am. J. Phys. Anthrop. 1985 (67) pp 393-402.

Hillson, S. Dental Anthropology. New York: Cambridge University Press, 1996

Larsen, C. Bioarchaeology Interpreting Behavior from the Human Skeleton. New York: Cambridge University Press, 1997.

Milner, G. and Larsen, C. "Teeth as Artifacts of Human Behavior: Intentional Mutilation and Accidental Modification" in Advances in Dental Anthropology. New York: Wiley-Liss, 1991.

Molnar, S. "Tooth Wear and Culture: A Survey of Tooth Functions Among Some Prehistoric Populations" Current Anthropology 1972 (13) pp 511-516.

Ortner, D. "A Recent Occurrence of an African Type Tooth Mutilation in Florida" Am. J. Phys. Anthrop. 1966 (25) pp177-180.

Pindborg, J "Dental Mutilation and Associated Abnormalities in Uganda" Am. J. Phys. Anthrop. 1969 (31) pp 383-390

Schultz, P. "Task Activity and Anterior Teeth Grooving in Prehistoric California Indians" Am. J. Phys. Anthrop. 1977 (46) pp 87-92.

Scott, G., and Turner II, C. The Anthropology of Modern Human Teeth. New York: Cambridge University Press, 1997.

Turner, C. and Cadien, J. "Dental Chipping in Aleuts, Eskimo and Indians" Am. J. Phys. Anthrop. 1969 (31) pp 303-310.


BODY ALTERATION This is an addendum added for your interest.



Intentional, irreversible changes to the human body are a widespread practice. Scarification and mutilation are terms loaded with negative implications. We associate these words with damage and injury. In many cultures, however, intentional body alteration is a sign of status or beauty. In this article we seek to be as impartial as possible. Tattoos as body alteration have become increasingly common, and body piercing is enjoying a resurgence in popularity today. Female circumcision is the most provocative form of body alteration. This cultural practice which affects 100 million living women today strikes at the very heart of society versus the rights of the individual.




The practice of deforming the head was much more common in Mesoamerica than was mutilation of the teeth. The practice of head deformation has a very wide distribution and dates from antiquity. It is an enduring practice known from many parts of the world.

Plateau Indians in North America created a flattened forehead by pressing a board against the padded forehead of a infant swaddled in a cradleboard. Many Indian groups, particularly in the Northwest employed this procedure. Plateau Indians in Washington state and Idaho created a flattened forehead by pressing a board against the padded forehead of an infant swaddled in a cradleboard. The most famous were known as the 'Flatheads.' In Mesoamerica, deformation was also done by head binding. The Maya used head boards and head binding to produce a distinctive shape which denoted social status and rank in society. A person of high status would have mutilated teeth, a conical shaped cranium and crossed eyes (produced by dangling shiny objects close to the infant's eyes).



These can take many forms. One of the most extreme is the pokturu, a wooden shaft several inches long and about an inch in diameter worn by slipping it through a slit in the lower lip. It was worn by the adult men of the Pokturu of South America. Its use as an adornment is considered an honor.

Another variation was the lip labret worn by some Eskimo and Northwest Coast Indians. Made of soapstone, ivory, or other hard material, it was worn as decoration by women and placed in specially prepared slits cut into the lower lip. They considered it decorative Evidence for its use is deduced from the characteristic wear seen on the facial surfaces of teeth in surviving skulls.

Most readers of National Geographic are acquainted with the large disc lip plugs worn by adult Kayapo men in Brazil. Their lips were progressively stretched in incremental stages by inserting larger and larger discs until a diameter as much as four inches was achieved. The lip disk amongst Kayapo adult men is a symbol of fatherhood and a strong, aggressive leader.



This is the intentional wounding and subsequent healing with scarring of the skin. The term describes any technique that produces scarring, whether it by cutting, tearing, or burning

of the skin with a hot implement--usually a heated needle.

Among the Nuba of the Sudan, a girl's body is decorated with its first scars when puberty begins, usually when she is nine or ten. The skin of the abdomen is repeatedly hooked with a sharp thorn, pulled away from the body, and sliced with a small metal knife. The Nuba see scarification as a beauty treatment. It is also a symbol of sexual status.

Scarification is undergoing a resurgence in this country as tatooing is becoming increasingly acceptable here. It is done with a hot needle heated in an open flame. The needle is drawn gently across the skin to produce the desired raised scar in a design pleasing to the client. The procedure is done without anaesthesia. One tattooist reported that a client brought a heating grate from her grandmother's old house. She wanted the design on her body. Her wish was accommodated.



This practice, seen in cave art, reaches back into the Stone Age. In cave art, hand prints in outline are a widespread occurrence. The hands are frequently missing one or all of the fingers; sometimes just a single digit. Was hand mutilation intentional? It indeed may be. The modern Dani of New Guinea offer crucial insight.

When the Dani avenge the death of one of their own, they kill one of the enemy. They also sever the tip of a finger of a young female relative of the victim. Some undergo this ritual for more than one dead relative. The mutilation is performed by a ritual specialist, who first ties a string tightly around the upper arm of the chosen girl. He numbs the finger by striking it hard against a rock. Then he severs one or two fingers at the first joint with a blow from a stone ax. The wound is quickly bound with leaves; she sits quietly for the rest of the day holding the hand upright so healing can begin. Many Dani women are so mutilated, but they go through life with little handicap, able to knit and weave with skill.



In tattooing, pigment is introduced by a rupture in the skin with the intent of leaving a permanent design in the skin. It has been done in most parts of the world. Egyptian mummies and the 5000 year old 'Iceman' have tattoos. In North America, Many Native American Indians customarily tattooed the body or the face. The usual technique was by simple pricking. Many Arctic and Subarctic peoples made needle punctures through which a thread moistened with urine and coated with soot from a lamp was drawn through underneath the skin. Often, the needle was not the slender steel implement we know today; earlier cultures used bone needles that were bulky and not very sharp.

Tattooing has undergone a major resurgence in this country as revealed on any warm summer day or trip to the beach.

There is a Biblical injunction against tattooing found in the Old Testament. Leviticus 19:20 is very specific: "You shall not make any cuttings in your flesh on account of the dead or tattoo marks upon you.'



Any reader of this article who has pierced earings has experienced this practice. The Yanomamo women seen frequently in college anthropology courses wear decorative sticks, piercing their lips for cosmetic purposes. Body piercing is an enduring practice that reaches deep into antiquity.

Maya glyphs vividly record a variety of body piercing practices. These include royal figures engaging in auto-sacrifice by drawing a cord through a hole in the tongue.

Another shows a person of royal rank penetrating his penis with a pointed instrument. Another displays a person piercing his own ear with an awl.

On the American Great Plains, Indian warriors would engage in the ritual Sun Dance, suspended above ground on a pole under the hot blazing sun with skewers through their breasts. They would hang until they would pass out or the skewers would tear through the flesh.

Body piercing has experienced a modern day resurgence along with tattooing and scarification. Studs in the tongue, pierced nipples, eyebrows, navels, and more private areas of the body are now increasingly popular. They are indeed the 'modern primitives.'

..... CJ '98


Vale, V. and Juno, A. eds Modern Primitives. San Francisco: RE/Search Publications, 1989.

Hicks, D. and Gwynne, M. Cultural Anthropology. New York: HarperCollins, 1994.

Maxwell, J. ed America's Fascinating Indian Heritage. Pleasantville: Readers Digest, 1992.

In the more traditional Sun Dance, the pectoral muscles are pierced and the supplicant is suspended off the ground exposed to the blazing sun, all the while blowing a bone flute awaiting a vision from the Creator. The Sun Dance is enjoying a modern-day resurgence, often among non-Indian wanabees.