On Oral Health, Inequality, and the Erie County Poorhouse: An analysis of oral health disparities in a 19<sup>th</sup>-century skeletal population using new methodologies
Knowles, Kevin Christopher
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The primary objective of this dissertation was to reevaluate how physical anthropologists address the issue of oral health and oral health disparities in past populations. By utilizing methodology from dentistry as well as theoretical frameworks from archaeology and public health, we are able to address oral health in a more comprehensive light, allowing for a more interdisciplinary approach to the understanding of oral health in past populations. The Erie County Poorhouse, established in Buffalo, New York in response to growing poverty, was located at what is now the University at Buffalo’s South Campus. In 2012, skeletal remains were recovered from the associated cemetery (1851-1913). In all, 482 burial locations were identified, with skeletal remains from 376 individuals being recovered for analysis. Archaeological analysis of artifacts and coffin alignment suggest a temporal boundary between an older (earlier) and more recent (later) sections of the cemetery. This time period marked a revolution for dental medicine in the United States. Changes in education, innovation, regulation, and public outreach all dramatically increased the accessibility, increased the quality, and decreased the costs of dentistry during the 19th century. Because of this, individuals occupying a lower socioeconomic class could have obtained dental services at higher rates than previous research suggests. This research analyzes dental pathologies, oral health, and oral health disparities within this sample in light of these advances in dentistry. Of the 376 individuals available for analysis, 253 had at least one tooth or portion of alveolar bone to be scored for dental pathologies (antemortem loss, carious lesions, abscesses, calculus, periodontal disease) and dental restorations (dentures, fillings, bridges). In general, high frequencies of dental pathologies are present within this sample while only 10 individuals had evidence of dental restorations. Differences in dental pathologies were analyzed using MANOVA/MANCOVA tests as well as Multinomial Logistic Regression between sex (males/females) and sections of the cemetery (earlier/more recent), as well as by age (<15, 15-19, 20-35, 36-50, 50+). To better address the concept of oral health, a new index, modified from an oral health index used in clinical dentistry, was utilized—The Oral Health Archaeological Index—which generates an ‘oral health score’ for each individual. The oral health scores generated were compared using ANOVA tests between sex and sections of the cemetery. Results indicate that females had on average higher oral health scores than males (Females= 0.871, Males=0.759). To assess the degree of oral health disparities, Lorenz curves and Gini coefficients were calculated using oral health scores and dental restorations. In order to test significance, 50 bootstrapped samples were generated for males, females, and for each section of the cemetery. For each bootstrapped sample, Gini coefficients were calculated. These Gini coefficients were than compared using student’s t-test between the sexes and sections of the cemetery. Results suggest that there is greater evidence of oral health disparities among males than females (Female Gini Coefficient=0.0658, Male Gini Coefficient=0.09185). This dissertation moved beyond traditional analysis of ‘oral health’ by utilizing the above Oral Health Archaeological Index, theory, and public health studies to allow for a more robust analysis of oral health in past populations. These methods and theories allow for new interpretations to be made beyond the biological and socioeconomic, focusing on the individual experience and agency of an individual, attempting to ascertain what factors encourage or discourage an individual from seeking out dental treatment.
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