3 Dental Anthropology 2021 │ Volume 34│ Issue 02 Patterns of Antemortem Tooth Loss in Late Prehistoric West- central Tennessee Maria Ostendorf Smith 1* and Tracy K. Betsinger 2 1 Illinois State University 2 State University of New York, Oneonta Oral pathology has frequently been an effective barometer of community health and an attestable marker of subsistence strategy in archaeological contexts where material culture provides the inter- pretive context (e.g., Betsinger & Smith, 2018; Larsen, 1983; Larsen et al., 1991; Lukacs, 1992; Rus- sell et al., 2013; Turner, 1979; Watson, 2008). Maize is a cariogenic carbohydrate (e.g., Bibby et al., 1951; Horton et al., 1985; Newbrun, 1979). Caries has been a particularly interpretively useful oral patho- logical condition in North America, enabling the flagging of maize-intensive agriculture (e.g., Emer- son et al., 2005; Larsen, 1981; Powell, 1985; Watson, 2008). In the absence of adequate oral hygiene, crown or cervical carious lesions progress to pene- trate the pulp cavity resulting in dental necrosis and ultimately to exfoliation of the tooth from the alveolar anchor. In more extensive assessments of caries prevalence (i.e., caries correction factor), antemortem tooth loss (AMTL) has been included as a proxy for carious teeth (Duyar & Erdal, 2003; Erdal & Duyar, 1999; Lukacs, 1995; Marquez- Grant, 2009). Although AMTL is primarily attributed to the destructive pathogenesis of caries and periodontal disease (Baelum et al., 1986; Kida et al., 2006; Mül- ler & Hussein, 2017; Niessen & Weyant, 1989; Ong, 1998; Shaffer et al., 2013; van der Velden et al., 2015), there are other causes. These include rapid attrition, ablation, acidogenic response, and trau- matic injury (Costa, 1980; Duyar & Erdal, 2003; Han & Nakahashi, 1996; Humphrey & Bocaege, 2008; Lukacs, 2007; Nelson et al., 1999; Niessen & Weyant, 1989; Pollard et al., 1997). Although trau- matic injury may be a contributing factor in a few cases of AMTL in the late prehistoric samples from west-central Tennessee, the present study observed that attrition and ablation, as elsewhere in the Ten- nessee Valley (Smith, 1982), are absolutely not evi- dent. As such, oral pathology is the most apparent contributor to AMTL. Previous assessment of car- ies prevalence in Late Prehistoric human osteologi- ABSTRACT The later prehistoric subsistence-settlement pattern in the Kentucky Lake Reservoir (KLR) of northern west-central Tennessee is of interest as human occupation inexplicably terminates by AD 1450 as part of a larger regional depopulation. Antemortem tooth loss (AMTL) collectively and by tooth type was identified in four site samples from the KLR. These are a Late Woodland (AD 600-900) sample (Hobbs) and three Middle Mississippian period (AD 1100- 1400) hierarchically organized and presump- tively maize agriculturalist samples (Link/Slayden, Gray Farm, Thompson Village). AMTL prevalence in the Hobbs sample is consistent with a native crop and seasonal foraging economy. The AMTL in the Link/Slayden sample is more congruent with the pre-maize Late Woodland sample than the essentially contemporaneous Gray Farm site sample. Thompson Village, a later-dated satellite community of the Gray Farm polity, exhibits significantly fewer AMTL than Gray Farm. This may flag climate-influenced agricultural shortfall of dietary carbohydrates later in the occupation sequence. Additionally, males in the Gray Farm site sample have significantly more AMTL than males in the other two Mississippian samples. The patterns suggest regional, possibly shortfall mitigated, differences in maize intensification with a polity-specific male-focused maize consumption in the Gray Site. *Correspondence to: Maria Ostendorf Smith Department of Sociology and Anthropology Illinois State University Email: msmith@ilstu.edu Keywords: Mississippian, maize, Vacant Quarter, Tennessee 4 Dental Anthropology 2021 │ Volume 34│ Issue 02 cal samples from northern west-central Tennessee did not identify a clear temporal trend of caries increase with agriculturalization suggesting re- gional variability in the reliance of maize relative to domesticated native seed crops (Smith & Betsinger, 2019), a not uncommon phenomenon elsewhere in the Mississippian world (e.g., Hart & Lovis 2013; Hutchinson et al., 1998; Scarry, 1993). A renewed look at oral health using AMTL data and a larger sample of sites may help clarify the lack of comparative oral health congruence with maize- intensive samples. Given the inexplicable abandon- ment of the region by AD 1450 as part of the large scale depopulation of the lower Ohio River Valley (“The Vacant Quarter”) (Cobb & Butler, 2002; Wil- liams, 1990), the temporal and regional differences in AMTL may also provide some eco-political in- sight. The maize-intensive subsistence economy in the eastern United States temporally associates with the Mississippian period (~AD 1000 – 1500) and life way, the apex of which (AD 1200-1400) is socio- politically characterized as having centralized (possibly chiefdom level) authority, a complex iconographic-rich cosmology, a well-organized aggregated village settlement pattern, shell- tempered pottery, and wall trench architecture (Bense, 2016; Cobb, 2003; King, 2002; King et al., 2007; Lewis et al., 1998; Peregrine 2013; Wilson, 2017). Since the Mississippian period material cul- ture correlates are present in the late prehistory of upper west-central Tennessee, a maize-intensive agricultural subsistence economy has been pro- posed (Bass, 1985; Dye, 2004, 2007; Krus & Cobb, 2018; Lunn, 2013; Mainfort, 1996). The purpose of this assessment is to clarify why the Mississippian period Kentucky Lake collective site sample from Link [40HS6] and Slayden [40HS1] did not exhibit a caries frequency or pattern consistent with une- quivocal maize-intensive comparative samples from Tennessee (Smith & Betsinger, 2019). Materials and Methods Archaeological context In eastern North America, the time period span- ning the Late Woodland (~AD 600-900) to the apex of the subsequent Mississippian period (~AD1200- 1400) is one of marked regionally and temporally variable economic, settlement, and sociopolitical change (Bense, 2016; VanDerwarker et al., 2017; Fritz, 1990; Nassaney, 2001; Scarry, 1993; Wilson & Sullivan, 2017). The subsistence-settlement pattern of the Late Woodland is generally characterized by dispersed small villages within circumscribed terri- tories that economically engaged in cultivating native seed crops as well as foraging strategies (i.e., the Eastern Agricultural Complex) (Bense ,2016; Fritz, 1990; Nassaney, 2001; Scarry, 1993). This pat- tern is archaeologically evident in central Tennes- see (Shea, 1977). The geographic distribution and the ensuing time period of the Mississippian is de- fined by the transition to maize-reliant agriculture (Bense 2016; Fritz, 1992; Krus & Cobb, 2018; Lewis et al., 1998; VanDerwarker et al., 2017), palisaded aggregated villages with one or more variably functioning (e.g., domiciliary, mortuary, temple) platform mounds flanking a central plaza, and more complex, likely hierarchical, social organiza- tion (Bense, 2016; King & Freer, 1995; Schroedl, 1998). In the greater Southeast, the Mississippian period is also iconographically rich (i.e., “Southeastern Ceremonial Complex” or “Southeastern Ceremonial Exchange Network”) (Bense, 2016; King et al., 2007). The typical Mississippian large aggregated set- tlement was organized around a central plaza that was flanked by flat-topped mounds which varia- bly served as platforms for domiciles, temples, mortuary structures (e.g., charnel houses, mound burials), or community buildings (Bense, 2016; Lewis et al., 1998; Nash, 1968). Mound settlements were civic-ceremonial polity centers geographical- ly surrounded by satellite communities and sepa- rated from other mound-centered polities by buffer zones (Bense, 2016; Dye ,2004; Hally, 1993). The sites of Gray Farm (40SW1), Thompson Vil- lage (40HY5), Link Farm (40HS6)/Slayden (40HS1), and Hobbs (40HS44) are located in the Lower Tennessee River Valley of west-central Ten- nessee in the projected catchment area of what is now the Kentucky Lake Reservoir (KLR) (Figure 1). The sites were excavated between 1938 and 1944 as part of extensive salvage archaeological recovery operations conducted by TVA (Tennessee Valley Authority) and the Federal WPA (Works Progress Administration) program prior to the completion of the Kentucky Dam (Gilbertsville, Kentucky) (Dye, 2013). This section of the Tennessee River valley lies between the Western Tennessee Up- lands on the west, and the steep hills of the West- ern Highland Rim on the east. The archaeological recovery of the sites’ material culture and skeletal material was hampered by time constraints, many years of agricultural activity, highway construc- tion, and extensive looting (Bass, 1985). There are no monographic site reports for any of the five sites, but one or other of them has been the source of descriptive or synthetic archaeological assess- 5 Dental Anthropology 2021 │ Volume 34│ Issue 02 ment (Bass, 1985; Dye, 2002; Lunn, 2013). Given the absence of carbon samples, the sites are relatively dated (ceramic sequences, mortuary patterning) (Bass, 1985). The five site samples examined here consist of the Late Woodland period (~AD 500-900) site of Hobbs (Kuemin Drews, 2001) and four primarily Middle Mississippian period (~AD 1100-1350) sites that segregate into two geographically discrete pol- ities (Bass, 1985; Dye, 2004). Hobbs is a mound mortuary site on the main channel of the Tennes- see River downstream from the Link and Slayden sites (Figure 1). The Early-to-Middle Mississippian period sites of Slayden (~AD 1050-1250) and Link Farm (~AD 1250-1400) are located on opposite shores of the Duck River floodplain, geographical- ly close to the confluence with the Tennessee River (see Figure 1) (Dye, 2002, 2007; Kuemin Drews, 2000; Lunn, 2013). The multiple mound site of Link Farm is argued to have expanded from the Slayden village site with the former becoming the adminis- trative center for the Middle Mississippian period Link Farm polity (Dye, 2002, 2004; Lunn, 2013; Nash, 1968). Given the paucity of human remains recovered from Slayden, the site samples are com- bined for this study as Link/Slayden. The Gray Farm polity is located near the conflu- ence of the Big Sandy River and the Tennessee Riv- er (see Figure 1). The sites included here are the multiple mound Gray Farm site (~ AD 1150-1400) (Dye, 2004) and the Thompson Village site which fissioned from the former during the late Middle Mississippian period (~post AD 1250) and re- mained occupied through the early Late Mississip- pian period (Bass, 1985) (~AD1350-1450). All abo- riginal occupation of west-central Tennessee ap- parently ended before circa AD 1450 (Bass, 1985; Smith, 2010) as part of the phenomenon of Middle Mississippian period regional abandonment in the greater lower Ohio River Valley (the “Vacant Quarter”) (Cobb & Butler, 2002; Krus & Cobb, 2018; Williams, 1983). The specific reasons for the abandonment are unclear, but interpretations in- clude corollaries of climate change (i.e., the “Little Ice Age” [~ AD1400-1700]) (Grove, 2012; Mann et al., 2009, Meeks & Anderson, 2013) such as re- source depletion, and/or endemic warfare (Bass 1985; Krus, 2013; Worne, 2011). Although the Kentucky Lake Mississippian pe- riod site samples archaeologically exhibit the hall- marks of Mississippian settlement organization and iconography, they are not further sub-divisible into temporally and regionally defined cultural phases. This is partly an artifact of pre-excavation site disturbance which impeded stratigraphic con- trol. Geographically they are west of the arguably aboriginal interaction-impeding Western Highland Rim geophysical feature as well as outside of the Figure 1. Map of the Kentucky Lake Reservoir sites utilized in the study. The western boundary of the Mississippian Period (AD 1000-1450) Middle Cumberland Culture is indicated by the dashed line. 6 Dental Anthropology 2021 │ Volume 34│ Issue 02 Mississippian period (~AD 1050-1450) Middle Cumberland Region (MCR) (see Figure 1) of the central Cumberland River valley and its tributaries (Beahm, 2013; Dowd, 2008; Moore & Smith, 2001; Smith, 1992). There is also no archaeological evi- dence that the KLR samples had contact with Mis- sissippian period sites in the Mississippi River drainage of west Tennessee (Mainfort, 1996; Main- fort & Moore, 1998). However, some shared cultur- al elements with the MCR (Dowd, 2008; Ferguson, 1972; Smith, 1992) are evident (e.g., infants interred within house structures and at least some use of limestone slabs to line graves (i.e., stone box buri- als) (Bass, 1985; Wamsley, 2018). Sample and Diagnostic criteria The skeletal age at death and differentiation by sex were previously determined using standard non- metric osteological protocols (Buikstra and Ubelak- er, 1994) and the information is archived in a com- puter data base. The individuals regarded as adults in the AMTL assessment had least two of the third molars in occlusion in vivo. Mandibles and maxil- lae were the primary source of AMTL, but loose teeth were included if antimeres were present or if they were accounted for by alveolar bone (either as sockets or remodeled alveolar processes). Individ- uals assessed consisted of the numbered burials; unaffiliated or extraneous teeth were excluded. Adults were segregated into three age-at-death categories: young (~18 years to ~35 years), middle age (~35 years to ~50 years of age), and old age (50+) years of age (Table 1). Teeth were considered present when observed in situ, as loose teeth, and as un-remodeled alveo- lar sockets. Teeth were considered lost antemortem if the socket was porotic and failed to conform to the sharp alveolar contours of an in situ root, dis- played abscessing with no accompanying (loose) tooth, and ultimately, by the remodeling/ resorption of the alveolar corpus. Teeth were con- solidated by arch and antimere and evaluated for AMTL by categories of tooth type. Incisors and canines were collapsed into a single category (I/C), as were all premolars (PM). Molars were assessed by number (M1, M2, M3) and collectively. Preservation ranged from fair to poor for all sites limiting the primary assessment to post- mortem presence by tooth type rather than pat- tern(s) of AMTL by individual (see Table 1). The Gray Farm sample is particularly poorly preserved; seventy percent of the interments with dental data are not ascribable to an age-at-death category and 23 individuals (~38 %) are assignable to a sex. Table 1. Demographic overview of sample preservation and segregation by age-at-death and biological sex. LINK FARM/SLAYDEN (Total n = 252) young m aged old age males females sex-indet.1 males females sex-indet.1 males females sex-indet.1 1 3 2 4 3 1 0 3 0 GRAY FARM (Total n = 612,3) young m aged old age males females sex-indet.1 males females sex-indet.1 males females sex-indet.1 0 1 0 9 2 2 2 2 0 THOMPSON (Total n = 1032,4) young m aged old age males females sex-indet.1 males females sex-indet.1 males females sex-indet.1 8 14 1 16 19 3 5 8 0 HOBBS (Total n = 82) young m aged old age males females sex-indet.1 males females sex-indet.1 males females sex-indet.1 1 0 0 1 3 0 0 1 0 1 sex-indeterminate 2 sample Total includes individuals not assignable by either age or sex 3 43/61 not ageable, 7/43 sex assignable but not ageable 4 29/103 not ageable, 20/29 sex assignable but not ageable 7 Dental Anthropology 2021 │ Volume 34│ Issue 02 Therefore, the primary intersite assessments are based on the presence of teeth (loose and in situ), alveolar evidence (pre- and postmortem loss), and AMTL. Analytical methods Fisher’s exact test (https://www.graphpad.com) was used to test the prevalence differences for all teeth and by tooth category, and in the same cate- gories when segregated by sex and/or age-at- death. No tests were undertaken for samples of less than ten. Small sample sizes prevented several comparisons. For those tests meeting the minimum sample size, the results are considered tentative. Results The Late Woodland Hobbs mortuary sample has the lowest total tooth sample prevalence of AMTL (14/153, 9.1%) (Table 2), but it is not significantly less (p=0.4479) than the Middle Mississippian Link/Slayden sample (46/391, 11.8% ) (Table 3). However, the Hobbs sample has significantly few- er teeth lost antemortem than the Middle Missis- sippian site samples of Gray Farm (p = 0.0001) and Thompson Village (p=0.0160). The total tooth sam- ple AMTL between the Gray Farm (32.7 and Thompson Village (16.7%) site samples is also sig- nificantly different (p=0.0001). When AMTL is fur- ther evaluated by the five tooth type categories, the Hobbs and Link/Slayden samples remain congru- ent (see Table 3). Hobbs differs in almost all tooth categories from Gray Farm and from the Thomp- son site sample in the collective loss of molars. Link/Slayden lost significantly fewer teeth than Gray Farm in all tooth categories except the first molar, and in many tooth categories compared to Thompson Village. Thompson, with overall fewer AMTL than the Gray Farm, differs from it in fewer incisiform and premolar tooth loss (see Table 3). Age-at-death comparisons Despite the case deficit in the young age at death (see Table 2), it is apparent that overall, the young adult cohorts for all four west-central Tennessee sites experience the lowest AMTL prevalence in each of the respective site samples. Where statisti- cal tests are possible, there is a pattern of no inter- site differences except for the greater AMTL of all molars in Gray Farm relative to Thompson (see Table 2). In the Middle Age cohort, the vulnerabil- ity of complex-crowned teeth to factors contrib- uting to AMTL is evident. Hobbs and Link/ Slayden exhibit a significant difference in the loss of M1, the molar longest in occlusion, as well as molars overall and the dentition overall. Hobbs, however, has significantly fewer teeth lost in more categories than both Gray Farm and Thompson. The Link/Slayden site sample, in turn, has lost sig- nificantly fewer teeth than Gray Farm and molars compared to Thompson. Thompson Village, with an overall tooth loss in the Middle Age category of 25% (n=179/715), is significantly lower than Gray Farm (89/165, 54%) in the loss of incisiform teeth (see Table 1) (7.8% versus 36.5%, 13.8% versus 49%), but congruent in the loss of individual molars. Meaning, the sam- ples are evidently significantly different in the ab- solute number of molars lost, but not different in the proportion by molar type (see Tables 2 and 3). Few meaningful statistical comparisons were pos- sible for many of the tooth categories in the Old Age cohort (i.e., samples < 10). All samples yielded few individuals in that age category (see Table 1) resulting in little available dental data. Intrasite and intersite differences by sex Site sample dissimilarities (see Tables 2 and 3) may be affected by sex-based differences in vulnerabil- ity to oral pathology (e.g., Lukacs & Largaespada, 2006). The samples were first compared for overall AMTL differences by sex (Table 4). In the collective adult sample, there are no sex differences in AMTL in the Hobbs and Link/Slayden samples. There are multiple categories of sex difference in the Gray Farm and Thompson samples. In the Gray Farm sample, males exhibit significantly more AMTL (p=0.0001) than females (43.5% versus 20.8%) and more AMTL in the anterior teeth; in the Thompson Village sample, females have more AMTL than males (~18% versus 12.6%) (p=0.0022). However, more tooth categories in the Thompson Village sample display the higher female AMTL preva- lence. Very few tooth class categories have a large enough Young Adult case sample to argue a pat- tern. However, the Gray Farm sample has more male AMTL for all molars and all dentition overall. Since most Young Adult site samples exhibit very few cases of AMTL (see Table 2) sex differences may be statistically undetectable. Sex differences do emerge in the Middle Age category (see Tables 4 and 5). At the Link/Slayden site, females lose significantly more molars overall (p=0.0088). Spe- cifically, the Link/Slayden females lost 46% (n=13/28) while males lost 13% (n=4/30). Antithet- ically, there is very little sex difference in AMTL in the Gray Farm sample. It is restricted to the incisi- form teeth (I/C) with males losing significantly more (males 50% [n=13/26], females 13.6% [n=3/22]). In the Thompson Village sample, first 8 Dental Anthropology 2021 │ Volume 34│ Issue 02 ANTEMORTEM TOOTH LOSS1 LINK FARM/SLAYDEN TOTAL males females young m aged old Tooth I/C 3/124 2.4 0/17 0.0 3/77 3.9 1/28 3.6 0/37 0.0 2/10 20.0 PM 8/106 7.5 0/17 0.0 8/63 12.7 4/16 25.0 3/36 8.3 0/13 0.0 M1 19/64 29.7 4/19 22.2 5/29 17.2 2/10 20.0 11/22 0.0 3/6 50.0 M2 8/56 14.3 2/18 11.0 4/19 21.0 0/11 0.0 6/20 0.0 0/4 0.0 M3 8/41 19.5 5/17 29.4 2/13 11.1 0/16 0.0 0/26 0.0 0/5 0.0 ALL M 35/161 21.7 11/54 20.4 11/61 18.0 2/37 5.4 17/58 29.3 3/15 33.0 ALL DENT 46/391 11.8 11/88 12.5 22/201 10.9 6/81 7.4 20/120 6.7 5/38 13.2 GRAY FARM TOTAL males females young m aged old I/C 46/140 33.0 29/64 45.3 8/59 13.5 0/23 0.0 19/52 36.5 18/33 54.5 PM 38/124 30.6 15/40 37.5 6/42 14.3 0/15 0.0 22/45 49.0 4/14 28.6 M1 26/61 42.6 11/21 52.4 7/20 35.0 0/8 0.0 16/23 9.5 3/6 50.0 M2 22/59 37.3 9/26 34.6 7/20 35.0 1/7 14.3 16/23 69.5 1/5 20.0 M3 23/50 46.0 10/19 52.6 5/18 27.8 0/6 0.0 16/22 72.7 2/7 28.6 ALL M 71/170 41.8 30/66 45.5 19/58 32.7 1/21 4.8 48/68 70.6 6/18 33.0 ALL DENT 155/434 35.7 74/170 43.5 33/159 20.8 1/59 1.7 89/165 4.0 28/65 43.0 THOMPSON TOTAL males females young m aged old I/C 44/743 6.0 6/300 2.0 24/348 6.9 0/70 0.0 21/266 7.8 5/38 79.0 PM 49/554 8.8 8/228 3.5 26/257 10.1 4/56 7.1 26/189 13.8 10/29 34.5 M1 81/253 32.0 26/106 24.5 42/114 36.8 6/28 21.4 49/97 24.9 0/8 0.0 M2 79/247 32.0 31/102 30.4 37/113 32.7 4/23 17.4 40/85 47.0 3/8 37.5 M3 82/215 38.1 32/83 38.5 37/97 38.1 5/24 20.8 43/78 55.1 1/7 14.3 ALL M 142/715 33.8 89/291 30.6 116/324 35.8 15/75 20.0 132/260 0.8 4/23 17.4 ALL DENT 235/2012 11.7 103/819 12.6 166/929 17.9 25/201 12.4 179/715 25.0 19/90 21.1 HOBBS TOTAL males females young m aged old I/C 1/55 1.8 0/23 0.0 1/32 3.1 0/8 0.0 0/21 0.0 1/10 10.0 PM 4/35 11.4 0/6 0.0 4/13 30.1 0/6 0.0 0/15 0.0 4/7 57.1 M1 4/20 20.0 0/2 0.0 4/6 66.0 0/2 0.0 1/13 7.7 3/3 100.0 M2 3/24 12.5 1/5 20.0 2/17 11.8 0/3 0.0 0/10 0.0 3/3 100.0 M3 2/19 10.5 0/1 --- 2/5 40.0 0/2 0.0 0/8 0.0 2/3 67.0 ALL M 9/63 14.3 1/8 12.5 8/28 28.6 0/7 0.0 0/31 0.0 9/9 100.0 ALL DENT 14/153 9.1 1/37 2.7 13/73 17.8 0/21 0.0 1/67 1.5 13/26 50.0 Table 2. Raw frequencies of antemortem tooth loss by tooth category segregated by sex and by three skeletal age-at- death categories. 1 Dentition was segregated by sex or age; sex-indeterminate dentition was included in the age-at-death samples. 9 Dental Anthropology 2021 │ Volume 34│ Issue 02 molars and molars collectively are more commonly lost by females. Females lost ~57% of M1 (n=29/51) compared to 34% (n=18/53) in the males. The disparity drives the significance for all molars (p=0.0272) and collectively for all dentition (males n=67/397 [16.9 %], females n=97/405 [24%]). Since the three sites with testable samples may have samples that may have a temporal bias (e.g., Link/Slayden biased by some temporally later Link cases), it is possible that the AMTL varies by sex between the sites (Table 6). Comparing the larger Middle Age category by sex and by site, fe- males apparently vary very little between samples. Thompson females significantly differ from Gray Farm females for only the premolars (PM) (p = 0.0382, Thompson 10.6% [n=12/113], Gray Farm 31.2% [n=5/16]). There are also no statistical differ- ences when all molars are pooled (p=0.0727) (Thompson 53% [n=77/145], Gray Farm 41% [n=25/61]). The scenario is different for the males. The Link/Slayden sample, with overall the fewest Link/Slayden x Gray Farm Link/Slayden x Thompson Gray Farm x Thompson Gray Farm x Hobbs Thompson x Hobbs Link/Slayden x Hobbs All I/C 0.0001 0.0093 0.0001 0.0001 0.3572 1.0000 PM 0.0001 0.5190 0.0001 0.0288 0.5440 0.3119 M1 0.1413 0.0592 0.1329 0.1083 0.3236 0.5672 M2 0.0196 0.0234 0.4444 0.0342 0.0611 0.7586 M3 0.0428 0.0908 0.3373 0.0103 0.0222 0.2130 All M 0.0001 0.0005 0.0607 0.0001 0.0001 0.2632 All Dent 0.0001 0.0001 0.0001 0.0001 0.0160 0.4479 Young I/C 1.0000 0.3519 0.4017 ---- ---- ---- PM 0.3094 0.6704 0.6490 ---- ---- ---- M1 ---- 1.0000 ---- ---- ---- ---- M2 ---- 0.2741 ---- ---- ---- ---- M3 ---- 0.0712 ---- ---- ---- ---- All M 0.6495 0.1040 0.0156 ---- ---- ---- All Dent 0.2239 0.1681 0.0044 1.0000 0.1408 0.3410 Middle Age I/C 0.0001 0.0887 0.0001 0.0008 0.3810 1.0000 PM 0.0001 0.5865 0.0001 0.0004 0.2255 0.5462 M1 0.2307 1.0000 0.1100 0.0004 0.0056 0.0132 M2 0.0148 0.2136 0.0636 0.0003 0.0045 0.0741 M3 0.0001 0.0001 0.1515 ---- --- ---- All M 0.0001 0.0037 0.0039 0.0001 0.0001 0.0004 All Dent 0.0001 0.4091 0.0001 0.0001 0.0001 0.0012 Old Age I/C 0.0764 0.6251 0.0003 0.0261 1.0000 1.0000 PM 0.0978 0.0182 1.0000 ---- ---- ---- M1 ---- ---- ---- ---- ---- ---- M2 ---- ---- ---- ---- ---- ---- M3 ---- ---- ---- ---- ---- ---- All M 0.0135 0.0002 0.2889 ---- ---- ---- All Dent 0.6781 0.0780 0.0045 0.3643 0.5953 0.2073 Table 3. Pair-wise statistical comparisons of antemortem tooth loss based on the raw data from Table1. No tests were un- dertaken if a sample was less than ten cases. Statistical significance (p = ≤ 0.05) is indicated by bold font. 1 Fisher’s exact test, p = ≤ 0.05; sample n = ≥10 10 Dental Anthropology 2021 │ Volume 34│ Issue 02 teeth lost antemortem (7.7%), has fewer molar tooth loss than Thompson (p=0.0426) and exhibits significantly fewer tooth loss in all tooth categories from the Gray Farm sample (with a total tooth loss of 77.8%). Although both Gray Farm and Thomp- son village were occupied until regional abandon- ment, the Thompson site sample has a temporally later sample bias than Gray Farm. Thompson Vil- lage males have significantly fewer AMTL in all but third molar loss (see Table 5). Overall tooth loss for Thompson males is 16.9%. Discussion Although etiologically multifactorial, the primary clinical causes of AMTL are the progressive pathol- ogies of caries and periodontal disease (e.g., Baelum et al., 1986; Kida et al., 2006; Müller & Hus- sein, 2017; Niessen & Weyant, 1989; Ong, 1998; van der Velden et al., 2015). Both processes are associ- ated with the consumption of carbohydrates in combination with poor oral hygiene (e.g., Baum- gartner et al., 2009; Chapple et al., 2017; Hix & O’Leary, 1976). As a proxy for pre-Columbian car- bohydrate consumption, AMTL has the potential to augment archaeological information about diet and subsistence. In the context of the pre- Columbian skeletal samples from the Kentucky Lake Reservoir of northern west-central Tennessee, the insights are more than supplemental as archae- ological assessment is limited and will likely con- Link/Slayden Thompson Gray Farm Hobbs All Adults I/C 1.0000 0.0042 0.0002 1.0000 PM 1.0000 0.0043 0.0225 0.2554 M1 1.0000 0.0579 0.3499 ---- M2 0.7057 0.7697 1.0000 1.0000 M3 0.3892 1.0000 0.1837 ---- All M 0.3981 0.0827 0.1976 0.6478 All Dent 0.6908 0.0022 0.0001 0.0851 Young I/C ---- 0.5762 1.0000 ---- PM ---- 1.0000 0.2308 ---- M1 ---- 1.0000 ---- ---- M2 ---- 1.0000 ---- ---- M3 ---- 0.4423 ---- ---- All M 0.2881 1.0000 0.0420 ---- All Dent 0.5918 0.5810 0.0223 ---- Middle Age I/C 1.0000 0.7854 0.0131 ---- PM 0.3416 0.8239 0.5166 ---- M1 ---- 0.0297 1.0000 ---- M2 ---- 0.0656 1.0000 ---- M3 1.0000 0.5169 1.0000 ---- All M 1.0000 0.0272 1.0000 ---- All Dent 1.0000 0.0001 0.0646 ---- Old Age I/C ---- 0.1469 ---- ---- PM ---- 0.0061 ---- ---- M1 ---- 0.1939 ---- ---- M2 ---- 0.2364 ---- ---- M3 ---- 0.1939 ---- ---- All M 0.1923 0.0021 ---- ---- All Dent 0.6882 0.0008 ---- ---- 1 sample n ≥ 10 Table 4. Comparisons of antemortem tooth loss by sex for each site. No test was undertaken if either the male or female cohort consisted of less than ten cases. Statistical significance (p = ≤ 0.05) is indicated by bold font. 11 Dental Anthropology 2021 │ Volume 34│ Issue 02 tinue to be so for the foreseeable future. Absent from the KLR archaeological record are radiocar- bon dates, therefore, using attributes of the materi- al culture, the sites have been temporally se- quenced relative to each other (Bass, 1985; Dye 2002, 2003, 2004; Lunn, 2013). Pairing the occupa- tion sequence with the AMTL data in the Kentucky Lake Reservoir yielded several potentially inter- pretively valuable patterns. Unfortunately, poor sample sizes restrict assessments by skeletal age at death. Therefore, the interpretations of the rate and pattern of AMTL should be considered tentative. Temporal pattern Hobbs, the earliest site sample evaluated here, dates to the Late Woodland period (~AD 500-900). Overall ,there are fewer teeth lost antemortem by the Hobbs mortuary site relative to the Middle-to- Late Middle Mississippian Period Gray Farm and Thompson Village samples. The frequencies are consistent with the reconstruction of Late Wood- land subsistence in the Tennessee River Valley as pre-maize horticulturalists with (at least) seasonal foraging (e.g., mast, fleshy fruits) (Bense, 2016; Crites, 1978; Emerson et al., 2000; Kline et al., 1982; McMahan, 1983). Cultigens utilized were the grass- es native to the local environment. These were the oily (e.g., Iva [sumpweed], Helianthus [sunflower]) and starchy seeds (e.g, Chenopodium [goosefoot], Phalaris [maygrass], Polygonum [knotweed], Horde- um [little barley]), the latter of which are cariogenic and capable of initiation and progression of tooth decay (e.g., Lingström et al., 2000; Pollard, 1995). The AMTL results for Hobbs parallels the preva- lence of caries (Smith & Betsinger, 2019). That is, there were significantly fewer carious teeth com- pared to maize-intensive samples. The small Hobbs sample size did not permit age -at-death AMTL comparisons. Indeed, the sample was biased in favor of older individuals which, given the progressive nature of AMTL, might bias in favor of congruence with samples archaeologi- cally identified as agriculturalist. However, when segregated by age-at-death in the larger Middle Age category, Hobbs sustains the pattern of signifi- cantly fewer AMTL for all tooth categories com- pared to Gray Farm and for the posterior teeth in Thompson. The AMTL of Link/Slayden relative to Hobbs Archaeologically, the Link/Slayden polity exhibits the material culture attributes of the Mississippian period (Bass, 1985; Dye, 2002, 2003, 2013; Lunn, 2013). The Link site (AD 1250-1400) is a civic- ceremonial mound center complex with a central plaza (Bass, 1985; Dye, 2007, 2012; Nash, 1968). Although Bass (1985) characterized Slayden as an expansion site from Link, recent ceramic analysis Link/Slayden Gray Farm Thompson MA Males I/C 0/12 0.0% 13/26 50.0% 6/146 4.6% PM 0/10 0.0% 10/23 43.5% 10/108 9.3% M1 3/10 30.0% 9/12 75.0% 18/53 34.0% M2 1/10 10.0% 8/12 67.0% 15/50 30.0% M3 0/10 0.0% 9/12 75.0% 18/40 45.0% All M 4/30 13.3% 26/36 72.2% 51/143 35.7% All Dent 4/52 7.7% 49/63 77.8% 67/397 16.9% MA Females I/C 0/25 0.0% 3/22 13.6% 8/147 54.4% PM 3/16 18.8% 5/16 31.3% 12/113 10.6% M1 8/12 67.0% 6/8 75.0% 29/51 56.9% M2 5/10 50.0% 6/8 75.0% 24/49 49.9% M3 0/6 0.0% 5/7 71.4% 24/45 53.3% All M 13/28 46.4% 17/23 73.9% 77/145 53.1% All Dent 16/68 23.5% 25/61 41.0% 97/405 24.0% 1 statistical tests not undertaken if sample size ≤ 10 Table 5. The Middle Age category generated the largest samples of antemortem tooth loss segregable by sex. However, several tooth clas- ses generated samples of less than ten teeth. These were not eligible for statistical comparisons. Table 6. For samples of at least ten individuals, statistical comparisons were undertaken between the site samples by sex. Statistical significance (p = ≤ 0.05) is indicated by bold font. Link/Slayden v Thompson Link Slayden v Gray Farm Thompson v Gray Farm Males I/C 1.0000 0.0026 0.0001 PM 1.0000 0.0303 0.0003 M1 1.0000 0.0237 0.0287 M2 0.2629 0.0115 0.0422 M3 0.0085 0.0016 0.2021 All M 0.0426 0.0001 0.0001 All Dent 0.1473 0.0001 0.0001 Females I/C 0.6048 0.0950 0.1577 PM 0.3986 0.6851 0.0382 M1 0.7462 ---- ---- M2 1.0000 ---- ---- M3 ---- ---- ---- All M 0.5421 0.0858 0.0727 All Dent 0.3063 0.3272 0.0601 1 Tests undertaken on samples ≥ 10 12 Dental Anthropology 2021 │ Volume 34│ Issue 02 suggests it is the earlier (circa AD 1050-1250) of the two (Dye, 2004; Lunn, 2013). The Link site was ar- guably abruptly abandoned circa AD 1400, based on the archaeological context of the Duck River Cache (Dye, 2007, 2012; Nash, 1968), a large assem- blage of ritual performance objects (e.g., crown- form clubs, monolithic axes, raptor talon claw effi- gies) recovered from the site. The cache was argua- bly deliberately buried as a last act prior to (possibly warfare-related) site abandonment (Dye, 2007; Dye & King, 2007). Although there is a gen- eral congruence of AMTL between the Link/ Slayden sample and the Late Woodland Hobbs sample (see Table 2), when the samples are segre- gated by age at death, the Mississippian Link/ Slayden sample does exhibit more molar loss, par- ticularly M1, the molar longest in occlusion. The M1 sample size drives the difference in all molars and all the dentition. Previous assessment of the caries pattern and prevalence in the Hobbs sample indicated an over- all higher prevalence of carious teeth compared to the Link/Slayden sample (although few tooth clas- ses are significantly higher) (Smith & Betsinger, 2019). Considering the temporal and archaeologi- cal context of Link/Slayden, maize was unequivo- cally available as a productive cultigen. It is possi- ble that as a shortfall-hedging strategy, food pro- duction within the Link polity included seasonal foraging and/or cultivation of native cultigens (e.g., Gremillion et al., 2008). It is also possible that the WPA era (Works Progress Administration, 1939-1943) (Dye, 2017) salvage recovery protocols at Link/Slayden biased in the direction of a tempo- rally earlier (i.e., incipient/early maize adoption) mortuary sample. More speculative, but an aspect to consider given the archaeologically-based con- clusion by Bass (1985) that the Link polity is ethni- cally different from Gray Farm, is regional variabil- ity in the symbolic or ritual role of maize or, in the routine maize processing and/or preparation (e.g., roasted, hominy, hoecake, and/or corn mush) which may have reduced the oral bioavailability of starch (e.g., Blitz, 1993; Briggs, 2016; Fritz & Lopincot, 2007; Katz et al., 1974; Peres, 2017; Ra- viele, 2011). The AMTL differences between the Mississippian samples In the large Middle Age cohort, the Link/Slayden site sample has significantly fewer AMTL than Gray Farm in all tooth categories except the first molars. This is unexpected given the apparently extensive temporal overlap of the sites, but may be explained by the scenarios presented above. The Gray Farm (AD 1150-1400) site sample might be considered exemplary of maize-intensive Missis- sippian agriculturalization. Based on the preva- lence of carious teeth by tooth type and age-at- death, the Gray Farm dental sample certainly allies with definitively maize-intensive Late Mississippi- an period sites from (at least) East Tennessee whereas Link/Slayden does not (Smith & Betsinger, 2019). However, in the Middle Age co- hort, compared to the maize-intensive samples, the Gray Farm dental sample exhibits small lesion size and virtually no cases of pulp exposure. If the pro- gression of tooth decay was comparatively rapid in the Gray Farm sample, the carious lesions achiev- ing pulp penetration may have precipitated the earlier exfoliation of affected teeth, generating the high AMTL results seen here. The co-occurrence of larger lesions with fewer teeth lost antemortem can potentially be tested in the Late Mississippian peri- od sites from East Tennessee. This faster rate could also explain the significant increase in the frequen- cy of AMTL in the anterior teeth (I/C, PM) of Gray Farm relative to both Link/Slayden and Thompson Village (see Table 2). Caries and AMTL initially progress in the complex-crowned teeth with great- er interstitial surface area (e.g., Broadbent et al., 2006; Carlos & Gittelsohn, 1965). The greater in- volvement of the anterior teeth in Gray Farm may signal an oral environment of advanced tooth de- cay (e.g., O’Sullivan & Tinanoff, 1993). Possible mitigating factors, as yet unknown, are dental is- sues such as LEH which might predispose the inci- siform teeth to pulp-penetrating demineralization. It can be assumed that maize was the primary cariogenic carbohydrate consumed by the commu- nity residing in the Gray Farm site. But evidently, the consumption was differential by, at least, sex (see Table 5), but not by the same sex. In the Mid- dle Age category, Gray Farm males exhibit more AMTL than females (77.8 percent versus 41.0 per- cent) while the females of Link/Slayden have the higher frequency (23.5 percent versus 7.7 percent). Pregnant and nursing females are arguably more vulnerable to tooth decay and in archaeological contexts may signal reproductive stress (Ferraro and Vieira, 2010; Lukacs, 2011; Lukacs and Lar- gaespada, 2006; Walter et al., 2016), but the statisti- cally significant higher AMTL among females in the Link/Slayden sample (p=0.0260) may also sug- gest differential consumption of decay-causing carbohydrates (e.g., Larsen, 1983; Somerville et al., 2015). Greater maize consumption by females has been documented elsewhere in the Mississippian 13 Dental Anthropology 2021 │ Volume 34│ Issue 02 world (Ambrose et al., 2003; Larsen, 1983). The higher rate of AMTL in the males of Gray Farm strongly suggests greater consumption. This is un- derscored by the between sample comparison by sex in the larger Middle Age category (see Tables 4 and 5). There are few differences in the prevalence of AMTL among the females for all tooth types and all teeth between Link/Slayden, Gray Farm, and Thompson Village. However, male AMTL is signif- icantly higher in Gray Farm than either Link/Slayden or Thompson Village in the vast ma- jority of statistical comparisons. The reason for this pattern might include the use of maize in male- predominated ritual feasting. Given the similarity of female AMTL across the site samples, it does not suggest a simple community pattern of differential maize dietary consumption. As stated earlier, Bass (1985) has argued that the Link and Gray Farm polities are ethnically different. This is based on the differences in mortuary protocols in addition to the considerable geographic distance between the two polities. This is certainly plausible given the large buffer zone between the polities in addition to an intervening polity with its own large mound center (Dye, 2004). However, the high frequency and male bias of AMTL is not repeated in the Thompson Village sample, a satellite community within the Gray Farm polity. Based on the ceramic sequence and temporal pattern of domestic structure construction, the Gray Farm site was occupied earlier than the Thompson site with the founding of the Williams site (40HY1) (no AMTL data), part of the Gray Farm polity, straddling the two (Bass, 1985). Gray Farm, therefore, would have had a mortuary com- ponent earlier in time than Thompson Village. Both the Gray Farm and Thompson Village sites generated Late Mississippian period (post AD 1300) ceramic types which suggests both sites, as well as Link, were occupied until regional aban- donment (“Vacant Quarter”) of the 14th and 15th centuries (Cobb & Butler, 2002). If maize adoption intensified with Mississippianization, as conven- tional wisdom suggests (Bense, 2016; Emerson et al., 2020), the Thompson AMTL frequencies for all tooth types should be greater than Gray Farm, even if not significantly so (see Tables 1 and 2). They are not. The results may be a by-product of sampling error (biased site recovery, differential preservation, and/or small sample sizes) or reflect local socioeconomic issues. Thompson Village was a satellite community within the Gray Farm polity and may not have engaged in, or had access to, the same civic-ceremonial activities of a mound center. That is, if indeed the male AMTL bias at Gray Farm is reflective of non-dietary maize consump- tion. But the circumstance preceding regional abandonment may have also been a factor in the apparent better oral health of the temporally later Thompson Village sample. Climate volatility Maize cultivation may have been affected by a se- ries of droughts that occurred in the Southeast be- ginning circa AD 1100 (Aharon et al., 2012; Benson et al., 2009) and in Tennessee in the Middle Cum- berland River culture area (Figure 1) circa AD 1288 -1388 (Meeks & Anderson, 2013). Agricultural shortfall may have episodically reduced overall carbohydrate consumption potentially causing nu- tritional stress or dietary shifts to foraged resources (e.g., Scopa Kelso, 2018). This may have been re- flective of, or exacerbated by, the onset after AD 1300 of the climate phenomenon of the Little Ice Age (Bird et al., 2017; Naftz et al., 1996; Stahle & Cleaveland, 1994; Wilson, 2017). Nutritional stress may not be documentable,1 but dietary shifts are certainly a plausible scenario based on (for exam- ple) the botanical evidence from the Illinois River Valley of the apparent juxtaposition of maize adop- tion and reduction in arboreal seed crop harvest (VanDerwarker et al., 2017). Mast and fleshy fruits may have been fall-back options in times of carbo- hydrate harvest insufficiency. This may be what was occurring in the Link polity and in the later occupation within the Gray Farm polity. Political instability Perhaps synergistically related to climate change, there is a wide-spread decline of polities in the late Mississippian period (after ~ AD 1300) (Anderson, 1994, 1996; Benson, et al., 2009; Bird et al., 2017; Wilson, 2017). Although particular mound centers as loci of civic and ceremonial functions did fluctu- ate over time and space (e.g., Anderson, 1996; Beck, 2003; Benson et al., 2009; Blitz, 1999; Wilson, 2017), in the Middle Cumberland River Valley to the East of the KLR samples, political destabiliza- tion occurs circa AD 1325 (Dye, 2004; Krus & Cobb, 2015; Vidoli, 2012) just prior to the regional aban- donment. This is archaeologically manifested by the reduction in centralized authority and increase in settlement fortification (palisades) (Krus & Cobb, 2015). Warfare is argued to escalate during this time period and, in the KLR, the apparent ab- rupt abandonment of the Link site (i.e., burial of the Duck River Cache) has been attributed to im- minent intergroup violence (Dye, 2004; Dye & 14 Dental Anthropology 2021 │ Volume 34│ Issue 02 King, 2007). Bass argued that it is only in the later occupation sequence of the Mississippian sites that palisades are firmly documented (1985:216). Cor- roboratively, based on a shift in mortuary pattern- ing, Bass argues the changes “indicate that the soci- opolitical structure of these polities in the late Mid- dle Mississippian Period… had altered to ones in which elite status or high rank was truncated and invested in and restricted to only one rank, an indi- vidual kin group or family which produced the chiefly line (1985:195).” Perhaps the absence of male-focused decay-inducing carbohydrate con- sumption in the Thompson Village sample com- pared to Gray Farm is reflective of this political decline with an overall reduction in AMTL in Thompson is suggestive of agricultural shortfall. Conclusions The trend towards maize intensification co- occurring with sociopolitical complexity is a gen- eral pattern within the Mississippian period (AD 1000-1550) in what is now the lower Midwest and much of the southeastern United States. However, the transition varies temporally and unevenly be- tween sociopolitical and/or ecological contexts. Mississippianization abruptly ended in northern west-central Tennessee by AD 1450. Occupation of the area was abandoned as part of a much broader inexplicable depopulation of the lower Ohio River Valley inclusive of the lower Tennessee River Val- ley. The dearth of archaeological context for the Kentucky Lake Reservoir region of northern west- central Tennessee contributes to the conundrum of the apparent abandonment. Much basic subsist- ence information is archaeologically unclear but can be remediated by certain lines of bioarchaeo- logical inquiry. Although AMTL has a complex etiology, it has been an effective proxy for oral decay which has been bioarchaeologically observed to vary by sub- sistence strategy and the dietary dependence on starchy cultigens. The AMTL observed in the Ken- tucky Lake Reservoir yielded three patterns which segregate the site samples of Hobbs, Link/Slayden, Gray Farm and Thompson Village by temporal period and geographic distribution. The first pat- tern is the retention of a general Late Woodland (AD 600-900) AMTL loss (Hobbs site sample) in the Mississippian period Link polity (Link/Slayden site sample). The pattern does not indicate a maize- intensive subsistence strategy. It may reflect a stra- tegically mitigated economic adjustment to include foraged resources consequential to demonstrable climate volatility (~AD 1400-1700). This subsist- ence strategy is similar to what has been archaeo- logically reconstructed for the pre-maize Late Woodland period. However, this pattern may also reflect possible salvage archaeology recovery bias inadvertently favoring temporally earlier Link/ Slayden burials, which may indeed have practiced a Late Woodland subsistence economy. Less likely, but culturally plausible given that Bass argued eth- nic differences between the Link and Gray Farm polities, there may have been polity-variable food preparation techniques which reduce the opportu- nities for dental decay in the oral environment. The second pattern is a regional difference in Mississippian period maize adoption. The caries data as well as AMTL of the Gray Farm site sample is consistent with maize-intensive agriculturaliza- tion and in contrast with the lower prevalence re- sults of the Link polity. Indeed, AMTL is higher than the Thompson Village site sample, a tempo- rally later-founded satellite community of the Gray Farm polity. It is possible that Gray Farm reflects a temporal window of successful maize overcrop which then declined just prior to regional aban- donment. Alternatively, maize may have been si- phoned from satellite communities to the Gray Farm site as it was the administrative capitol for the polity. The third pattern is the higher overall preva- lence of AMTL in the males of the Gray Farm sam- ple. This contrasts with the Link/Slayden and Thompson Village samples which indicated more AMTL among the females. Interpretively im- portant, the prevalence of AMTL is not significant- ly different between the females in the three Mis- sissippian period site samples. Therefore, the Gray Farm male pattern may reflect specific male- focused civic-ceremonial roles which involved maize consumption that may have declined in the later Thompson Village context paralleling docu- mented sociopolitical decline. Alternatively, the civic-ceremonial activity may not have been under- taken in satellite communities. The patterns apparent in this study may be a consequence of sampling error from possible exca- vation bias as well as small sample sizes available for assessment. However, the patterns may indeed reflect the political landscape as well as the climate, ecological, and sociopolitical challenges of the thir- teenth century prior to regional abandonment. Hopefully, more health status data can be mar- shaled to clarify the regional and temporal pat- terns. 1Access to the osteological collections has now been terminated pending reburial 15 Dental Anthropology 2021 │ Volume 34│ Issue 02 Acknowledgements The authors greatly appreciate the permissions to access and assess the collections curated by the Frank H. McClung Museum, Knoxville, Tennessee. We thank the staff for their forbearance to our presence, particularly Dr. Jefferson Chapman (Executive Director, retired), Dr. Lynne P. Sullivan (Curator of Archeology, retired), and Dr. Timothy Baumann (Curator of Archaeology). We also ap- preciate and commend the collecting assistance of Ms. Germaine Mosher and Ms. Amanda Bailey. REFERENCES Aharon, P., Aldridge, D., & Hellstrom, J. (2012). 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