The Association Between Periodontal Disease and Periosteal Lesions in the St. Mary Graces Cemetery, London, England A.D. 1350–1538 Sharon N. DeWitte 1,2* and Jelena Bekvalac 3 1 Department of Anthropology, University of South Carolina, SC 29208 2 Department of Biological Sciences, University of South Carolina, SC 29208 3 Museum of London Centre for Human Bioarchaeology, London, EC2Y 5HN, UK KEY WORDS paleoepidemiology; dental health; paleopathology; immune function; inflammation ABSTRACT Numerous studies have demonstrated significant associations between periodontal disease and many other diseases in living populations, and some studies have shown that individuals with periodontal disease are at elevated risks of mortality. Recent analy- sis of a medieval skeletal sample from London has also shown that periodontal disease was associated with increased risks of mortality in the past. This study examines whether periodontal disease is associated with periosteal lesions in a skeletal sample from the urban St. Mary Graces cemetery (n 5 265) from medieval Lon- don. The results reveal a significant association between periodontal disease and periosteal lesions in the St. Mary Graces sample (i.e., individuals with periodontal disease were also likely to have periosteal lesions), and the association between the two is independent of age. The association between the two pathological conditions might reflect underlying reduced immune competence and thus heightened susceptibility to pathogens that cause periodontal disease or periosteal lesions, exposure to an environmental factor, or underlying heightened inflammatory responses. Am J Phys Anthropol 146:609– 618, 2011. V V C 2011 Wiley Periodicals, Inc. Periodontal disease is an infection that causes inflam- mation and destruction of gum tissue (gingiva), the peri- odontal ligament, root cementum, and alveolar bone, and can be caused by a variety of pathogenic infectious agents that are found in oral biofilms (dental plaque), including the bacteria Actinobacillus actinomycetemcomi- tans, Porphyromonas gingivalis, and Treponema denti- cola and various herpes viruses (van Winkelhoff and Slots, 1999; Li et al., 2000; Slots, 2004). Periodontal dis- ease is one of the most common chronic diseases in liv- ing populations (Abdellatif and Burt, 1987), with severe forms affecting an estimated 10–15% of people world- wide and mild forms of the disease affecting as much as 90% of people in some populations (Beck et al., 1996; Pihlstrom et al., 2005). Numerous bioarchaeological investigations have also identified periodontal disease at varying frequencies in skeletal samples from past popu- lations (e.g., Clarke et al., 1986; Kerr, 1994; Chazel et al., 2005; Eshed et al., 2006; Oztunc et al., 2006; Palu- beckaite et al., 2006; Lieverse et al., 2007). Periodontal disease has repeatedly been found to be a risk factor for other diseases and is associated with increased risks of mortality. One study found that among adults in the United States, periodontal disease is associ- ated with a 46% increased risk of all-cause mortality (DeStefano et al., 1993), and Garcia et al. (1998) found that severe periodontal disease is associated with a 1.85- fold increase in mortality. Many studies within living populations have shown significant associations between periodontal disease and other diseases, such as cardio- vascular diseases, respiratory infections, cancer (e.g., lung, kidney, pancreatic, oral, esophageal, upper gastro- intestinal, gastric, and kidney cancers), Alzheimer’s dis- ease, obesity, diabetes, renal disease, osteoporosis, and rheumatoid arthritis (for example, see the following reviews: Hollister and Weintraub, 1993; Li et al., 2000; Kowolik et al., 2001; Slots, 2004; Pihlstrom et al., 2005; Johnson et al., 2006; Irwin et al., 2008; Williams et al., 2008). Periodontal disease is also associated with increased risks of spontaneous preterm birth, preeclamp- sia, low birth weight, and stillbirth (Holmstrup et al., 2003; Goepfert et al., 2004; Boggess, 2005; Boggess et al., 2006; Mobeen et al., 2008; Ruma et al., 2008; Polyzos et al., 2009). The consistent significant association between peri- odontal disease and general health and mortality in liv- ing populations raises questions about how the two were associated in past populations. We recently addressed this issue by examining the relationship between peri- odontal disease and the risk of mortality in a medieval skeletal sample from the cemetery of St. Mary Graces in London (DeWitte and Bekvalac, 2010). The results of that previous study suggest that periodontal disease was associated with an elevated risk of mortality in the medi- Grant sponsor: University at Albany Center for Social and Demo- graphic Analysis (CSDA). Grant sponsor: University at Albany Research Foundation. *Correspondence to: Sharon DeWitte, Department of Anthropol- ogy, 1512 Pendleton Street, Hamilton College, Room 317, University of South Carolina, SC 29208. E-mail: dewittes@mailbox.sc.edu Received 13 May 2011; accepted 18 August 2011 DOI 10.1002/ajpa.21622 Published online 14 October 2011 in Wiley Online Library (wileyonlinelibrary.com). V V C 2011 WILEY PERIODICALS, INC. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 146:609–618 (2011)