Turner and Eder 2006.2

Most of human prehistory saw our ancestors
living in small groups as opportunistic hunters and
gatherers. Studies of pre-agricultural teeth have
repeatedly shown that diet and tooth use behaviors
were abrasive, tough, and destructive, producing much
tooth wear, periodontal disease, alveolar abscessing,
and tooth chipping and fracturing. On the other hand,
hunter-gatherers were largely free of both occlusal
and interproximal caries and other disorders linked
to cariogenic diets. Despite archaeologically-derived
pre- and early agricultural human teeth having been
described many times around the world, there are very
few accounts in the dental anthropological literature
that include ethnographic observations of actual diet
and tooth-use behaviors coupled with descriptions of
the related oral pathologies and wear. This is especially
so for remnant living groups whose consumption of
refined sugar and flour is limited. The best known
of such ethno-dentally described populations with
minimal modern contact and exchange are the
Australian Aborigines studied by T. D. Campbell (1925,
1939) and the East Greenland Eskimo researched by
P. O. Pedersen (1938) . Both workers were trained as
dentists, which explains their interest in diet, tooth-
use, and oral pathology. Ethnologists, on the other
hand, almost always describe diet and food preparation
techniques, but seldom comment on the resultant oral
conditions. Bioarchaeologists with paleo-ethnographic
and dental interests describe oral health but generally
lack the means to do more than infer diet based on
archaeologically-recovered foodstuffs and artifacts

Dental Pathology, Wear, and Diet in a Hunting and
Gathering Forest-Dwelling Group: The Batak People of
Palawan Island, The Philippines

Christy G. Turner II* and James F. Eder

School of Human Evolution and Social Change, Arizona State University, Tempe, AZ

ABSTRACT Described are observations on Batak foods,
tooth use, oral hygiene, and resulting wear and oral
pathology in dental casts of 29 Batak ranging from 15 to 49
years of age. Commonly consumed foods are roughly 80
percent plant, and 20 percent animal products. Cooking
is common. Eating includes one or two main daily meals
with occasional snacking. Cariogenic commercially-
manufactured flour and sugar are rarely available.

Oral hygiene involves “finger-brushing” of anterior
teeth with fine sand. The practice is more common in
females than in males. Caries are rare in both sexes as is
antemortem tooth loss. Tooth chipping is more common
in males. Periodontal disease is generally slight and
nearly equal in the sexes. Tooth wear is relatively slight
but strongly age-related as in many other populations.
Dental Anthropology 2006;19(1):15-22.

involved in food-preparation. Such artifacts include
grinding stones, cooking vessels, butchered bones, and
similar materials. Rarely, human coprolites are recovered
in archaeological excavations. These metabolic residues
are inherently rich in dietary information.

While the strength of bioarchaeological inference about
diet and tooth-use behavior can be quite substantial, it is
always desirable to have actual observations when dealing
with uniformitarian cause and effect relationships, which
in this case are diet, tooth use, and oral health. Hence,
this brief report identifies some of the foods and tooth-
use behaviors of the Batak observed by ethnologist and
co-author JFE, and the resultant effects on the dentition
identified by bioarchaeologist CGT. Information
concerning the origin and affinity of the Batak based
on the dental morphology of the sample described
herein can be found in Turner and Eder (2005). We hope
this note will stimulate further dental anthropological
study in the few remaining hunter-gatherer groups
around the world.

The Batak are one of approximately twenty
ethnolinguistically-distinct groups of so-called
“Negrito” peoples inhabiting various hinterland regions
of the Philippines. Like other Filipinos, they today
speak languages of the Austronesian language family,

*Correspondence to: Christy G. Turner II. School of
Human Evolution and Social Change, Arizona State
University, Tempe, AZ 85287-2404
E-mail: chrstygturner@aol.com

and they share many cultural beliefs and practices with
neighboring farming peoples. But Philippine Negritos
stand out by virtue of their mobile forest foraging
life way and the bundle of physical attributes—short
stature, dark skin, and curly hair—that earned these
distinctive-looking peoples their name (Eder, 1987).

The Batak themselves inhabit a series of eight river
valleys lying along the east coast of the north central
part of Palawan Island, in the southwestern corner of
the Philippine archipelago. Their subsistence economy
today combines hunting and gathering, collection
and sale of commercially valuable forest products,
shifting cultivation, and wage labor for outsiders.
Wild yams and wild honey once provided the bulk of
the carbohydrates in the Batak diet. Today, rice, corn,
sweet potato, cassava, and plantain are also important
starch sources. Some brown sugar is used, but in small
quantities and almost exclusively to sweeten coffee.
Protein sources include wild pig, gliding squirrels,
porcupines, wild chickens, and other forest animals,
and fish, eels, mollusks and crustaceans obtained
from rivers and streams. Bamboo shoots, rattan pith,
and a variety of wild nuts, fruits, and greens are also
consumed (Eder, 1987).

Most food is roasted in wood fires or cooked
(typically by boiling) in cast iron cooking vessels.
Typically there are two meals a day, one at noon and
one in the evening, but sometimes there is only one.
There is often considerable snacking in the course of
the day, as foods are encountered on the trail or brought
into camp. The contemporary diet is low in animal
protein, low in vegetables, and probably even low
in calories. Actual food consumption patterns can be
narrow and monotonous for extended periods of time.
Drinking water is obtained from springs and streams.
Teeth are cleaned with toothpicks and finger-brushed
with fine sand or (sometimes) with toothbrushes. Betel
nut chewing is common, and all adult teeth are stained
accordingly.

MATERIALS AND METHODS

Eder and helpers collected dental impressions of 29
Batak natives whose ages ranged from 15 to about 49
years. The sample size was limited by the amount of
impression powder (Jeltrate®) and plaster that could
be conveniently carried into the field along with other
more critical supplies. Positive plaster casts were
poured immediately after the impressions were made.

0.5 0.6 0.7 0.8 0.9 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 2.0 2.1 2.2 2.3 2.4
14
16 F F F
18 M F
20 F F
22 F F F
24 F
26 M M
28 M F M M
�0 F F M
�2
34
�6 M
�8
40
42
44
46 M M F M
48
50 F

Fig. 1. Distribution between the average wear (horizontal axis) and the person’s age (vertical axis) for maxillary
teeth. Average wear was based on the 5-grade ordinal scheme: 0 = no wear, 1 = dentine exposed, 2 = cusps worn
off, 3 = pulp exposed, 4 = root stump functional (Turner, Nichol and Scott, 1991). The correlation coefficient between
age and mean wear for Batak male maxillary teeth is r = 0.749; for Batak females, r = 0.894. Sex of the specimen is
coded as male (M) or females (F).

C.G. TURNER II AND J.F. EDER

1�

Descriptions of the dental conditions are based on
standards used in the Arizona State University Dental
Anthropology System (ASU DAS) (Turner, Nichol and
Scott, 1991).

RESULTS

Wear

Tooth wear was scored for all observable occlusal
surfaces. The mean scores for each of the studied Batak
males and females is given in Tables 1 and 2. As is
evident, tooth wear is strongly related to age, i.e. mean
wear, which was calculated by summing the wear
scores for each tooth in an individual and dividing by
the number of teeth that the individual possessed. For
example, male number 3 in Table 1, age 19, had a total
maxillary wear score of 9.0, which divided by his 16
teeth gives a mean wear score of 0.56. In contrast, the
47 year old male number 7 has a mean maxillary wear
score of 1.10. This is almost exactly twice that of Batak
number 3.

The relationship between age and mean wear
is plotted in Figures 1 and 2. The age-mean wear

relationship is quite evident, that is, strongly positive.
The correlation coefficients for upper male age-mean
dental wear is r = 0.749; for female upper teeth r
= 0.894. For the lower jaws, male r = 0.860; female r
= 0.866. These values suggest that the tooth wear
scores provided here could serve as a useful guide for
estimating age in prehistoric hunter-gatherers who
lived in habitats similar to that of the Batak.

A relationship between tooth wear and caries in
these hunter-gatherers can also be seen. In Tables 1
and 2, some of the males and females with one or more
carious teeth have mean wear scores somewhat less
than non-carious individuals of comparable age. One
interpretation of this relationship is that individuals
with caries do not chew as much or as heavily as do
caries-free individuals. Obviously, the relationship
between caries and tooth wear would have some
effect on how much one can rely on wear to aid in
estimating age of prehistoric human remains. Although
interproximal caries could not be looked for in our
dental casts, we assume that there were some, and that
they also contributed to lowered use of the jaws due to
pain and discomfort.

0.5 0.6 0.7 0.8 0.9 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 2.0 2.1 2.2 2.3 2.4
14
16 F F F
18 F
20 M F
22 F F
24 F F F
26 M F
28 M F M
�0 M M
�2 F F M
34
�6 M
�8
40
42
44
46 F M
48 M M
50 F

Fig. 2. Distribution between the average wear (horizontal axis) and the person’s age (vertical axis) for mandibular
teeth. Average wear was based on the 5-grade ordinal scheme: 0 = no wear, 1 = dentine exposed, 2 = cusps worn
off, 3 = pulp exposed, 4 = root stump functional (Turner, Nichol and Scott, 1991). The correlation between age and
mean wear for Batak male maxillary teeth was r = 0.749; for Batak females, r = 0.894. Sex of the specimen is coded
as male (M) or female (F).

BATAK OF PALAWAN ISLAND

TABLE 1. Batak maxillary dental wear

Individual Total Number Mean
Number Age Wear of Teeth Wear Caries

Male Maxilla
3 19 9.0 16 0.56
27 26 12.0 16 0.75
1 28 13.0 16 0.81
21 28 14.0 16 0.87
20 29 12.0 16 0.75 RM1
23 29 17.0 16 1.06
11 31 22.0 16 1.37
10 36 21.5 15 1.43
5 45 26.5 13 2.04
22 >45 31.5 14 2.25
7 47 16.5 15 1.10 LP1
1�a Adult 15.5 12 1.29

Female Maxilla

2 15 8.0 16 0.50
9 15 10.5 14 0.75 RM1
26 15 8.0 14 0.57
28 18 7.0 14 0.50
8 20 10.0 16 0.62 RM1
4 21 11.0 16 0.69
25 22 9.0 16 0.56
24 22 11.5 15 0.77
14 23 13.0 14 0.93
17 23 12.0 16 0.75 LM3
18 24 12.5 16 0.78
12 26 15.0 16 0.94
16 ~ 28 13.0 16 0.81
29 30 19.5 16 1.22
19 30 12.5 16 0.78
6 46 23.0 16 1.44
15 ~ 49 36.0 15 2.40 LRM1

aMan had congenital absence of four upper teeth (LRI2, RC, LM3) and three lower teeth (RI1, LRM3). See Figs. 7
and 8.

Table 3 provides the frequencies of crown caries,
antemortem tooth loss, crown chipping, periodontal
disease, and oral hygiene. Inasmuch as these
observations were made from plaster casts, the values
probably err slightly on the side of under-reporting;
for example, caries and toothpick grooves could not be
looked for on interproximal crown surfaces including
those of the roots. The extent of general bone loss from
periodontal disease, which is easily studied in skeletal
remains, is largely hidden by gum tissue in the living.

Caries

The number of Batak with one or more crown caries
(31.0%) is unexceptional for a hunting and gathering
population, although it is at the upper end of the

range. Among the Middle to Late Period (ca. 1,000
B.C.) Jomonese of central Japan (a hunting, fishing,
gathering, and possibly small scale horticultural
population), the percentage of individuals with one or
more caries was 42.7% (Turner, 1979). The frequency
of Batak carious teeth (2.1%), mostly molars, is well in
line with prehistoric hunting and gathering economies
around the world. Within the Batak sample, there is no
statistically significant difference between males and
females for caries.

Antemortem loss

The low amount of antemortem tooth loss is
consistent with the low frequency of caries—caries
being viewed as the major cause of antemortem loss,

C.G. TURNER II AND J.F. EDER

Fig. 4. Labial surface smoothing of cast number 7
upper central incisors, an adult Batak male, age about 47
years. Periodontal disease was judged to be “medium”
(CGT neg. 3-22-02:24).

Fig. 3. Labial surface smoothing of upper left and
right central and lateral incisors. The cast (number 3)
was from a young Batak adult male, age 19 years (CGT
neg. 3-22-02:27).

Fig. 5. Arrows point to occlusal chipping of cast
number 21, an adult Batak male, age 28 years (CGT neg.
3-22-02:20).

Fig. 6. Periodontal disease of cast number 14, an
adult Batak female, age 23 years. Disease grade judged
to be “slight” (CGT neg. 3-22-02:22).

especially for molars, which is the situation in this
sample. Two lost incisors occurred in males. Trauma
likely was the cause of the loss. Combining antemortem
loss and carious teeth, only 3.0% of all teeth have
one or both of these conditions. This is far less than
what occurs in agricultural populations with their
highly processed, sticky, and cariogenic cereal-based
foodstuffs.

Chipping

Occlusal surfaces of an individual’s teeth may
exhibit one or more nicked or chipped edges. Chipped
areas are usually less than 0.5 mm in diameter (Figs.
5 and 8). Chipping is attributable to various activities
ranging from the heavy use of teeth as vice-like tools,
breaking up of hard materials like starvation-driven
scavenging of bone, gritty mineral food contaminants,
to accidental trauma arising from falls, and other

sources. Both individual and tooth counts show that
the Batak males have significantly more chipping than
do the females. Almost all males have one or more
chipped teeth (91.7%) in contrast to females (35.3%) who
have only about one third of their number exhibiting
chipping. Pooled, the number of chipped teeth occur
more often in the back of mouth (chipped incisors,
9; canines, 3; premolars, 21, molars, 26), suggesting
dietary and tooth use activities as the major contributor
to Batak chipping rather than trauma. Eder notes that
chipping was not likely caused by fighting since males
never fight among themselves. There is nothing in these
values to suggest excessive inter-sex conflict where
one would expect either comparable overall female
tooth chipping (females being abused and hit; male
chipping due to heavy tooth use), or excessive anterior
tooth chipping (falls by children, adolescent hitting,
being shoved, etc.). Eder feels that the observed pattern

BATAK OF PALAWAN ISLAND

TABLE 2. Batak mandibular dental wear

Individual Total Number Mean
Number Age Wear of Teeth Wear Caries

Male Maxilla
3 19 9.0 16 0.56
27 26 11.0 16 0.69
1 28 12.0 16 0.75
21 28 14.0 16 0.87
20 29 10.5 16 0.66
23 29 17.0 16 1.06
11 31 18.0 16 1.12
10 36 17.5 16 1.09 LRM2, M3
5 45 25.0 12 2.08
22 > 45 27.0 16 1.69 RM2
7 47 19.5 16 1.22
13 Adult 20.0 13 1.54

Female Maxilla

2 15 8.0 16 0.50
9 15 8.0 14 0.57 LM1
26 15 9.5 14 0.68
28 18 10.0 14 0.71
8 20 12.5 16 0.78
4 21 12.0 16 0.75
25 22 11.5 15 0.77
24 22 12.5 16 0.78
14 23 11.0 14 0.79
17 23 14.5 16 0.91
18 24 12.5 16 0.78
12 26 15.0 16 0.94
16 ~ 28 13.5 15 0.90 RM1,2; LRM3
29 30 15.5 16 0.97
19 30 12.0 16 0.75
6 46 24.0 16 1.50
15 ~ 49 14.0 13 1.08 LM2

almost certainly relates to a disproportionate tendency
for men more than women to put non-food items in
their mouths in the course of producing artifacts, or ad
hoc tools. Despite the sexes basically eating the same
foods, he has seen Batak men more often than women
biting on lengths of rattan, and using their teeth to
crack open nuts, break bones to obtain the marrow,
and even chewing on turtle carapaces. After such sorts
of tooth use to access nutrients, the man would share
with his wife or others.

Periodontal disease

While nearly all of the 29 Batak exhibit some degree
of gingival border recession, detachment, and swelling,
indicating bacterial infection and inflammation, we
characterize the amount as having been mostly slight
in both sexes (Fig. 6). There is, as expected, a small

degree of age-related expression of periodontal disease,
but the relationship is weak. Periodontal disease
among the Batak sample seems more idiosyncratic
than systematic. Thus, the Batak oral activities, while
culturally and environmentally channeled, have also a
degree of individual determination. This can include
regularity of oral hygiene practiced, immune strength,
amount of fibrous and other foods consumed that have
the inherent capability to remove plaque, and other
such variables, including choices of foods that might
possess antibacterial or anti-inflammatory qualities.

Oral hygiene

The type of oral hygiene that can be detected
from our Batak dental casts includes an interesting
flattening of the labial surface of one or more upper
incisors and canines (Figs. 3 and 4). As Eder observed,

C.G. TURNER II AND J.F. EDER

TABLE 3. Batak oral health

Male Female M & F Χ2 Total
Condition n Percent n Percent P-value n Percent

Individuals, 1 or more caries 4 33.3 5 29.4 n.s. (> 0.80) 9 31.0
Individuals, no caries 8 66.7 12 70.6 20 69.0

Carious incisors, n = 227 0 0 0
Carious canines, n = 115 0 0 0
Carious premolars n = 232 1 0 1
Carious molars n = 315 6 11 17
Carious teeth n = 889 7 11 n.s. (> 0.80) 18 2.1

Antemortem loss, incisors 2 0 2
Antemortem loss, canines 0 0 0
Antemortem loss, premolars 0 0 0
Antemortem loss, molars 3 4 7

Caries & antemortem loss, n = 898 12 3.3 15 2.9 27 3.0

Individuals, chipping, n = 29 11 91.7 6 35.3 sig. (< 0.01) 17 58.6
Teeth, chipping, n = 887 37 10.1 14 2.7 sig. (< 0.01) 51 5.7
(male = 366; female =521)

Periodontal disease, individuals
Absent 0 0.0 4 25.0 4 13.8
Slight 8 66.7 10 62.5 18 62.1
Medium 3 25.0 1 6.2 4 13.8
Severe 1 8.3 1 8.3 2 6.9
Total 28 96.5

Upper labial flattening, inds. 6 54.5 15 88.2 sig. (< 0.01) 21 75.0
Lower labial flattening, inds. 0 0.0 0 0.0 0 0.0

Central incisors, flattened 10 50.0 34 88.2 sig. (< 0.01) 54 81.5
Lateral incisors, flattened 6 30.0 20 58.8 sig. (< 0.05) 54 48.1
Canines, flattened 3 14.3 14 41.2 sig. (< 0.05) 55 30.9

developmental disturbance that might have had a link
to fixed or unfixed external environmental factors, even
possibly involving the degree of group inbreeding or
population genetic bottle-necking sometime in the
past. In any event, congenital absence is a category
of dental variation that often gets left out of both
morphological and pathological characterizations of
human populations.

DISCUSSION

As hunting and gathering disappears as an
economic way of human life, the opportunity to
observe the ethnography of dentally related activities
and diet, and to match these observations with the
resultant effects on teeth, is drawing to a close. In fact,
very few ethnographic observations on tooth use and

this labial flattening results from the abrasive action
of finger-brushing using fine sand or silt in water.
There are significantly more females (88.2%) with
labial-abrasion than males (54.5%). This holds also
for the actual number of abraded teeth (Table 3). The
absence of abraded lower anterior teeth is interesting
from a cosmetic standpoint, as it is primarily the upper
anterior teeth that are apparent during smiling or other
teeth-displaying behavior.

Congenital absence

Figures 7 and 8 show upper and lower dental casts
of a Batak male who likely had seven congenitally
missing teeth. While congenital absence is not normally
considered as an oral pathology, we nevertheless
include the illustrations to indicate some manner of

BATAK OF PALAWAN ISLAND

Fig. 8. Absence of three mandibular teeth of cast
number 13 (Fig. 7). Missing are the right central incisor,
and both third molars. Cusp 2 of the right second molar
is chipped (CGT neg. 3-22-02:17).

Fig. 7. Absence of four maxillary teeth of cast number
13, a Batak male, age about 34 years. Presumably
congenitally missing are the right lateral incisor and
canine, the left lateral incisor, and the left third molar.
The right third molar is peg-shaped with a lingual-
buccal diameter of 6.5 mm. There is a cone-shaped
supernumerary tooth between the central incisors (CGT
neg. 3-22-02:15).

diet, coupled with oral pathology examinations, can be
found in the dental anthropological literature. Those
that are best known were made by dentists, seldom
anthropologists. Hence, this brief report represents a
contribution to an uncommon line of investigation of
human tooth use and its results. Our sample comes
from a remnant forest-dwelling hunting and gathering
group living in the Philippines, the Batak. The results of
our pathology examination (wear, caries, antemortem
loss, chipping, periodontal disease, oral hygiene) of
living Batak people are nicely in line with other dental
studies of prehistoric hunting and gathering people
throughout the world. The dentally destructive diet
associated with cariogenic agricultural foodstuffs and
processing is not evident in the Batak sample. What
stands out as markedly different is the effect of oral
hygiene on the Batak upper anterior teeth, the observed
actual activities demonstrably producing the labial
flattening of the upper anterior teeth. This flattening
would normally have been considered as intentional
modification had the acts of teeth cleansing not been
observed by the ethnographer (JFE). Also, the probable
cause of tooth chipping has been identified as a result
of ethnographic observation.

ACKNOWLEDGMENTS

The dental impressions were collected with the
assistance of Rafaelita Fernandez and Raul Fernandez,

from the Batak inhabiting the Langogan River valley of
central Palawan Island.

LITERATURE CITED

Campbell TD. 1925. Dentition and palate of the
Australian Aboriginal. Adelaide: University of
Adelaide Publications, Keith Sheridan Foundation
No. 1.

Campbell TD. 1939. Food, food values and food habits
of the Australian Aboriginals in relation to their
dental conditions. Aust J Dent 43:1-15.

Eder JF. 1987. On the road to tribal extinction:
depopulation, deculturation, and adaptive well-
being among the Batak of the Philippines. Berkeley:
University of California Press.

Pedersen PO. 1938. Investigations into dental conditions
of about 3,000 ancient and modern Greenlanders.
Dental Record 58:191-198.

Turner CG II, Eder JF. 2005. Dentition of the Batak people
of Palawan Island, the Philippines: Southeast Asian
Negrito origins. In: Oxenham M, Tayles N, editors.
Bioarchaeology of Southeast Asia. Cambridge:
University of Cambridge Press, p 172-187.

Turner CG II, Nichol CR, Scott GR. 1991. Scoring
procedures for key morphological traits of the
permanent dentition. In: Kelley MA, Larsen CS,
editors. Advances in dental anthropology. New
York: Wiley Liss, p 13-31.

C.G. TURNER II AND J.F. EDER