The impact of random natural variability on aspartic acid racemization ratios in enamel from different types of human teeth.

Previous research has indicated that the extent of amino acid racemization in enamel varies systematically between tooth types within the dentition. This phenomenon was suggested to be due to differences in temperature at various locations within the mouth. This paper presents an analysis of aspartic acid racemization in a fraction of the enamel proteins which should be particularly susceptible to deviations in temperature, in order to assess the impact of temperature on variability in racemization values. The acid soluble fraction of the enamel was analysed from 129 human teeth of different tooth types and from both living individuals and archaeological skeletal remains. Samples were collected by acid etching of the enamel to isolate proteins located a small distance below the enamel surface. For each population, the racemization values for different tooth types were compared to identify any possible systematic variation. Where multiple teeth were analysed from the one individual, the age estimates produced for the different teeth were compared to obtain an indication of the overall level of variability in racemization values. No systematic variation in the extent of racemization between different tooth types was observed in any of the populations analysed. There appeared instead to be a high level of random variability in the extent of racemization, with substantial differences observed between age estimates produced from multiple teeth from the one individual. The results of this study suggest that the differences in racemization values observed here are due to random variations and not the temperature at different locations within the mouth.

Age estimation of archaeological remains using amino acid racemization in dental enamel: a comparison of morphological, biochemical, and known ages-at-death.

The poor accuracy of most current methods for estimating age-at-death in adult human skeletal remains is among the key problems facing palaeodemography. In forensic science, this problem has been solved for unburnt remains by the development of a chemical method for age estimation, using amino acid racemization in collagen extracted from dentine. Previous application of racemization methods to archaeological material has proven problematic. This study presents the application to archaeological human remains of a new age estimation method utilizing amino acid racemization in a potentially closed system-the dental enamel. The amino acid composition and extent of racemization in enamel from two Medieval cemeteries (Newcastle Blackgate and Grantham, England) and from a documented age-at-death sample from a 19th century cemetery (Spitalfriedhof St Johann, Switzerland) were determined. Alterations in the amino acid composition were detected in all populations, indicating that diagenetic change had taken place. However, in the Medieval populations, these changes did not appear to have substantially affected the relationship between racemization and age-at-death, with a strong relationship being retained between aspartic acid racemization and the morphological age estimates. In contrast, there was a poor relationship between racemization and age in the post-medieval documented age-at-death population from Switzerland. This appears to be due to leaching of amino acids post-mortem, indicating that enamel is not functioning as a perfectly closed system. Isolation of amino acids from a fraction of enamel which is less susceptible to leaching may improve the success of amino acid racemization for archaeological age estimation.

Variability and patterning in permanent tooth size of four human ethnic groups.

AIMS: Dental dimensions vary between different ethnic groups, providing insights into the factors controlling human dental development. This paper compares permanent mesiodistal crown diameters between four ethnic groups highlighting patterns of tooth size between these groups and considers the findings in relation to genetic and environmental influences. METHODS AND RESULTS: Mesiodistal crown dimensions were recorded using standardised manual measurements on dental casts derived from four different human populations: Southern Chinese, North Americans of European ancestry, Modern British of European ancestry and Romano-British. Analyses based on double determinations showed that measurements in all study samples were reliable to an accuracy of 0.1mm. The Southern Chinese sample was found to have the largest teeth overall, whereas the Romano-British sample generally displayed the smallest mesiodistal crown dimensions (p<0.001). However, the Modern British sample had the largest maxillary central incisors, mandibular central and lateral incisors, and mandibular canines, while the North American sample had the largest maxillary first and second molars. Comparisons of coefficients of variation for teeth within each class showed that the later-forming teeth displayed greater variation in mesiodistal size than the earlier-forming teeth. CONCLUSION: The different patterns of tooth size observed between the study samples are thought to reflect differences in the relative contributions of genetic, and environmental influences to dental development between the four populations. For example, it is proposed that major environmental insults during the early life of Romano-Britons, including recurrent illnesses, poor nutrition and excessive lead ingestion, contributed to the reduction in size and greater variability of their later-forming teeth. Using a standardised methodology, significant differences in mesiodistal crown diameters have been demonstrated between four human ethnic groups. There were also distinct differences in the patterns of crown size between the groups, with the later-forming teeth in each type generally showing greater size variation.

Patterns in dental enamel hypoplasia by sex and age at death in two archaeological populations.

AIMS: Levels of enamel hypoplasia in past populations are frequently used to study health. However, few studies have looked at patterning in the occurrence of different types of hypoplasia. In this pilot study, skeletal remains from an Iron Age tomb at Pella in Jordan were analysed for the presence of linear and pit enamel hypoplasia, to investigate enamel hypoplasia aetiology by comparison of the results obtained for adults and juveniles, and females and males. METHODS AND RESULTS: The proportion of individuals with enamel hypoplasia was determined for males and females and for adults and juveniles using the F.D.I. Developmental Defects of Enamel (DDE) Index. Although males and females had a similar percentage of individuals affected, females had a higher prevalence of enamel hypoplasia per tooth than males. Adults had a higher prevalence of enamel hypoplasia than juveniles. In particular, adults had a higher prevalence of linear enamel hypoplasias and pit enamel hypoplasia arrays, but a similar prevalence of single pit enamel hypoplasia when both the permanent and deciduous dentitions were considered. These differences were largely due to different patterns and frequencies of enamel hypoplasia in deciduous teeth compared to permanent teeth. CONCLUSIONS: The different patterns of occurrence of the various forms of hypoplasia observed in this study imply that single pits may have a different aetiology to linear enamel hypoplasias and pit arrays. By investigating similar patterns in other archaeological populations, we may develop a better understanding of the specific causes of particular types of enamel hypoplasia, and may be able to more meaningfully interpret enamel hypoplasia data from past populations.

Tooth size patterns in patients with hypodontia and supernumerary teeth.

AIMS: Anomalies of tooth number may not be isolated conditions but may have wider associations in the development of the dentition including tooth size. This study aimed to examine links between hypodontia, supernumerary teeth and crown size, considering the effect on the development of the whole dentition and so increase understanding of the aetiology of these conditions. METHODS AND RESULTS: The patients, who were all of European ancestry, were 60 young adults (30 males and 30 females) with hypodontia and 60 age and sex matched controls together with 60 young adults (39 males and 21 females) with supernumerary teeth and 60 age and sex matched controls. Hand measurements of mesiodistal and buccolingual dimensions were made of the teeth on dental study models using Mitutoyo electric callipers. The mean value of two measurements was used and intra-operator and inter-operator reliability determined. Patients with hypodontia had smaller teeth than the control group and this difference was statistically significant (p<0.05) for all teeth except the MD dimensions of 13, 23, 24 and 44. The difference in size was greatest for the BL dimensions in hypodontia patients. Further, the greater the number of missing teeth the smaller the tooth size. The hypodontia patients also showed higher variability in tooth dimensions than the control group. Patients with supernumerary teeth had larger teeth than the controls, with the greatest differences in the MD dimensions. In both hypodontia and supernumerary patients the differences in tooth size were generalised throughout the dentition. CONCLUSIONS: In anomalies of tooth number the size of teeth is also involved. In patients with hypodontia and supernumerary teeth the crown size of the whole dentition is affected. These findings are compatible with a multifactorial aetiology of these conditions.

The aetiology of hypodontia: the prevalence, severity and location of hypodontia within families.

AIMS: Previous studies have indicated that hypodontia has a significantly higher prevalence in the relatives of affected individuals than in the general population. This study aims to examine further the roles of genetic and environmental factors in the aetiology of hypodontia by investigating the relationship between the severity and distribution of hypodontia between family members, and any discernable effect of maternal health during pregnancy and birth weight. METHODS AND RESULTS: 117 first degree relatives of 41 index patients were examined clinically and radiographically to identify the presence, severity and location of hypodontia. Both siblings and parents of index patients had a higher prevalence of hypodontia than the general population. The number and location of missing teeth was not related to the number and location of missing teeth in parents or siblings. The expression of hypodontia within a family was not affected by maternal health during pregnancy. CONCLUSIONS: The variation found in the expression of hypodontia within families suggests that its occurrence is not solely determined by genetic factors, but epigenetic and environmental factors probably also are important. This finding is consistent with a multifactorial aetiology for this condition.

The application of amino acid racemization in the acid soluble fraction of enamel to the estimation of the age of human teeth.

Estimation of age-at-death for skeletonised forensic remains is one of the most significant problems in forensic anthropology. The majority of existing morphological and histological techniques are highly inaccurate, and show a bias towards underestimating the age of older individuals. One technique which has been successful in forensic age estimation is amino acid racemization in dentine. However, this method cannot be used on remains where the post-mortem interval is greater than 20 years. An alternative approach is to measure amino acid racemization in dental enamel, which is believed to be more resistant to change post-mortem. The extent of amino acid racemization in the acid soluble fraction of the enamel proteins was determined for modern known age teeth. A strong correlation was observed between the age of the tooth and the extent of racemization. No systematic bias in the direction of age estimation errors was detected. For the majority of teeth analyzed, the presence of dental caries did not affect the results obtained. In a minority of cases, carious teeth showed a higher level of racemization than would be expected given the age of the individual. These results indicate that amino acid racemization in enamel has the potential to be used in age estimation of skeletal remains.

Dental enamel hypoplasias and health changes in the Middle Bronze Age - Early Iron Age transition at Pella in Jordan.

Dental enamel hypoplasias are increasingly being used in epidemiological studies as indicators of health within both modern and prehistoric populations. This symptom of growth disruption is used here to examine possible changes in health occurring at the transition between the Bronze Age and Iron Age in Jordan, through examination of enamel hypoplasias in skeletal remains from two tombs at the archaeological site of Pella. A small but not statistically significant difference in the prevalence and frequency of hypoplastic defects was found between the two time periods. These results suggest that the political and economic changes occurring at this time were not sufficiently stressful to cause a dramatic deterioration in health at the onset of the Early Iron Age.

Emergency department use by nursing home residents.

STUDY OBJECTIVE: To describe a community's experience with the use of emergency department services by nursing home residents. METHODS: We performed a retrospective chart review of a population-based cohort of nursing home residents in an urban county in central Georgia with 10 nursing homes (1,300 beds) and 4 hospital-based EDs. All ED visits by nursing home residents during 1995 were analyzed. Demographic data, timing of the visit, chief complaint, tests and treatments, disposition, and financial charges were recorded. Further, we calculated the number of ED visits per 100 nursing home patient-years. RESULTS: A total of 873 nursing home residents made 1,488 ED visits. Mean age was 76.0 years; 66.4% were female, and 55.2% were white. Of the transfers, 42.9% occurred during regular working hours. The most common chief complaints were respiratory symptoms (14.4%), altered mental status (10.1%), gastrointestinal symptoms (9.9%), and falls (8.2%); 101 patients (6.8%) were transferred for malfunction of a gastrostomy tube. The most common laboratory tests were complete blood cell count (69.5%), chest radiograph (52.0%), electrocardiogram (45.0%), urinalysis (42.7%), and determination of electrolytes (42.7%). A total of 42.4% of the ED visits led to admission to the hospital. From the 10 nursing homes, there were 110 ED visits per 100 patient-years. A 3.5-fold difference in ED use among these nursing homes could not be explained by age, gender, or other factors. The average .charge per ED visit was $1,239. CONCLUSION: Elders living in nursing homes are frequently transferred to EDs for costly medical evaluations, and more than 40% of such visits lead to admission to the hospital.