Blue Bridge Lane
&
Fishergate House
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Dental abscesses, also termed 'periapical inflammations', are recognised in skeletons when a sinus develops to release pus from the site of infection at the tooth root through the bone. Dental abscesses develop when the tooth pulp is exposed to bacteria, or bacteria is allowed to enter the root cavity through caries or severe wear or trauma (Dias and Tayles 1997, 548). Occasionally, new bone formation can be observed around the pus-releasing sinus, and is indicative of active infection.
The infection tends to be localised, and produces both pus and pain (Cawson 1991, 85, 142). Even without the pain, dental abscesses can be very debilitating, because the body's immune system is weakened as a result of the infection and may render the patient more susceptible to other illnesses. Furthermore, the abscess may drain via the maxillary sinus, causing sinusitis. Even today, with the availability of antibiotics, dental abscesses can be extremely persistent. In the past, however, they must have played a more significant role, both debilitating and causing extreme pain, and, if the infection entered the bloodstream, consequences could have been fatal.
At Fishergate House, a total of 134 dental abscesses were observed. The majority of these drained externally, towards the cheek, and none had drained into the maxillary sinuses. The majority of lesions were noted in the region of the molars, which may be related to the greater frequency of cavities in this part of the dentition. The prevalence of inflammations increased with advancing age, which was probably associated with age-related worsening dental health. A total of 19% of abscesses were related to calculus deposits and 22% of infections were associated with caries, while 17% of abscesses were linked to severe dental attrition. However, more than half the dental abscesses were associated with ante-mortem tooth loss, suggesting that either a tooth had been lost and bacteria had subsequently entered the root cavity, or alternatively, that the abscess had caused eventual tooth loss.
The frequency of abscesses per tooth socket (3.6%) was relatively high as compared with other medieval cemeteries (0.7% at Towton and Wharram Percy, 1.2% at St Helen's-in-the-Walls, 2.3% at Blackfriars), but lower than at St Andrew's (4.5%). The high frequency of abscesses at Fishergate House is indicative of general poor oral hygiene and high susceptibility to infection, which was also noted in the skeletal pathology.
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