This individual from the Kilkenny Union Workhouse has distinctive notches in their lateral incisors and canines, which are attributed to clay-pipe smoking. They also show signs of poor oral health including dental calculus, caries, and tooth loss. (PHOTO: Jonny Geber)

A new study analysing the teeth of adults who died in the Kilkenny Union Workhouse at the height of the Great Famine (1845-1852) has revealed some of the possible social reasons for their poor oral health, and how this may have affected their general wellbeing.

In total, Dr Jonny Geber from the University of Otago and Professor Eileen Murphy from Queen’s University Belfast examined the teeth of 192 men and 171 women, analysing them for health markers such as calculus (plaque build-up), caries (or cavities), tooth loss, and periodontitis (advanced gum disease). Their results showed a high level of poor oral health throughout the population: 97.3% of all individuals had calculus, 79.9% had at least one cavity, 64% displayed some tooth loss, and 57.6% showed signs of periodontitis.

The reasons behind this high prevalence of poor oral health are not immediately apparent, but diet could have played a role. Based on historical records, these individuals probably had a diet almost completely comprised of potatoes and milk, and although neither has been shown in modern studies to be very harmful to teeth, boiled potatoes and lactose do tend to lower oral pH levels, which can increase the risk of developing caries.

(IMAGE: Jonny Geber)

Given that early 20th-century populations with an identical diet have been recorded as having excellent dental health, though, this cannot be the whole picture. Another marker that was prevalent among the workhouse individuals may help explain this discrepancy, however. About 45.9% of the total population (60.7% of men and 28.6% of women) showed notches in their teeth that are attributed to smoking clay pipes (an example is pictured above). This figure varied by age: while only 24% of 18- to 25-year-olds displayed pipe-facets, the number jumped to 80% in individuals over 46 years of age. A few modern studies have suggested a connection between smoking and poor oral health, although a definitive causative link has never been fully established – but with no other immediate cause apparent, the researchers suggest, it does seem likely that the popular practice of smoking among the workhouse population could have significantly contributed to their tooth decay.

Today, it is well understood that dental health and hygiene are important to our overall wellness, but 170 years ago this link was not fully appreciated, and dentistry was a relatively new and emerging profession. Tragically, it could be that poor oral health made the inhabitants of the workhouse – who had entered the institution for help – more susceptible to contracting diseases such as typhus, typhoid fever, and cholera, some of the main causes of death during the famine.

The paper highlighting these results can be read for free at https://doi.org/10.1002/ajpa.23717.

This article appeared in CA 346.

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