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Teeth from 19th century London indicate that most children were Vitamin D Deficient - Oct 2019

An investigation into the prevalence of vitamin D deficiency in a 19th century London population

Email: r.n.odonoghue at bradford.ac.uk
Ruth O’Donoghue, Marie C. Weale, Dr Jo Buckberry, Dr Hannah Koon

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This study investigates the prevalence of vitamin D deficiency in a 19th century London population, using radiographic assessment to identify adults with changes in pulp horn morphology associated with vitamin D deficiency during dental development.


The prevalence of rickets amongst urban children dramatically increased during the 19th century in England as a result of overcrowding, pollution, and poor diet.1’2’3 However, the identification of this condition in the archaeological record is limited due to the remodelling of bone over time, the poor preservation of non-adult remains, and because clinical symptoms can occur in the absence of skeletal change.4 Bioarchaeological identification of vitamin D deficiency (childhood rickets, residual rickets in adulthood, and osteomalacia) within post-medieval burial populations therefore likely does not represent the true prevalence of vitamin D deficiency during this period.

Materials and Methods

Individuals were acquired for analysis from New Bunhill Fields, Southwark (1821-53) (Naduit=157, Nnon-adult= 357).7 Age estimation and sex assessment was performed by Museum of London Archaeology using standard methods.8 A dental inventory of the adult population identified individuals with intact, non-friable, first permanent molars without significant dental wear or carious lesions. Palaeopathological analysis was performed on the adult population to assess for conditions associated with vitamin D deficiency (residual rickets, osteomalacia).9,10

Vitamin D deficiency impacts the absorption of minerals such as calcium and phosphate, which clinical studies have shown can lead to a range of dental abnormalities.5 Recent research has found significant differences in pulp chamber morphology in those with vitamin D deficiency, suggesting that radiographic analysis of teeth may be used as a screening tool to identify deficiency disease.6
30 adult individuals had suitable teeth and were selected for radiography (Nmale=17, Nfemale=13). All teeth were radiographed at the University of Bradford’s radiography laboratory using a Faxitron Cabinet X-ray System. The specimens were orientated as if a bitewing dental radiograph was being taken, from a lingual to buccal view in order to show the pulp chambers. All specimens were radiographed between 50-60kV for 90 seconds. The method established by D’Ortenzio et al. (2018) was followed to identify morphological changes in the pulp chamber (Fig.1).


Fig. 1: Diagram of different pulp chamber shapes in a generic permanent molar. Source: D’Ortenzio et al. 2018:4
The adult individuals included in this study represent 19.1% of the excavated adult burial population from New Bunhill Fields.
Only two of the 30 individuals had skeletal manifestations consistent with a diagnosis of residual rickets (abnormal bowing of the lower limbs) (1303, 1635).
However, 28 individuals exhibited evidence for constricted (N=16) or chair-shaped (N=12) pulp chambers associated with vitamin D deficiency during pulp chamber formation.
One adult male aged 18-25 years exhibited a normal pulp chamber.
One further adult male aged 26-35 years exhibited an enlarged pulp chamber. This molar has an abnormal, poorly mineralised occlusal surface consistent with cuspal enamel hypoplasia (CEH) (Fig. 11).
Table 1 : Summary of individuals included in this study.

Discussion and Conclusions

Of the 30 individuals analysed, 28 exhibit morphological changes to the pulp chamber consistent with vitamin D deficiency. Deficiency must occur during pulp chamber formation for morphological changes to arise (1.5-2 years in males, and 1.4-2 years in females), therefore these results suggest that the vast majority of adults in this sample group experienced prolonged vitamin D deficiency ~1.5 years of age.
Two individuals exhibit change in the first, second, and third molars, indicating chronic or recurring deficiency throughout childhood. Neither exhibited skeletal evidence for vitamin D deficiency.
SK1303 exhibited an enlarged pulp chamber. Clinically, this has been linked to both vitamin D- resistant hypophosphatemic rickets and odontogenesis imperfecta.6 This individual is currently the subject of further research, as they also exhibit skeletal change consistent with residual rickets (See Figs.10-13).
The results of this study indicate that childhood vitamin D deficiency was much more prevalent within this burial population than skeletal evidence has previously suggested. The timing of deficiency recorded in the first permanent molar is consistent with the age at which rickets is most common (6-24 months). The limited evidence for residual rickets in this population suggests that either the level of deficiency required to cause alteration to the pulp chamber is less than that required to cause skeletal change, or alternatively, that the re-modelling of bone throughout life has caused the loss of skeletal evidence for deficiency in all but two individuals.


  1. Newman, S. L. and Gowland, R. L. (2017) Dedicated Followers of Fashion? Bioarchaeological Perspectives on Socio-Economic Status, Inequality, and Health in Urban Children from the Industrial Revolution (18th-19th C), England. International Journal of Osteoarchaeology 27 (2), 217-229.
  2. Newman, Sophie L., Gowland, Rebecca L. & Caffell, Anwen C. (2019). North and south: A comprehensive analysis of non-adult growth and health in the industrial revolution (AD 18th-19th C), England. American Journal of Physical Anthropology 169(1): 104-121.
  3. Lewis, M. (2002) Impact of industrialization: comparative study of child health in four sites from medieval and postmedieval England (A.D. 8501859). American Journal of Physical Anthropology 119 (3), 211-213.
  4. Brickley, M.B. Moffat T. & Watamaniuk, L. (2014). Biocultural perspectives of vitamin D deficiency in the past. Journal of Anthropology Archaeology 36, 48-59.
  5. D'Ortenzio, L., Ribot, I., Raguin, E., Schattmann, A., Bertrand, B., Kahlon, B. and Brickley, M. (2016) The rachitic tooth: A histological examination. Journal of Archaeological Science 74, 152-163.
  6. D'Ortenzio, L., Ribot, I., Kahlon, B., Bertrand, B., Bocaege, E., Raguin, E., Schattmann, A. and Brickley, M. (2018) The rachitic tooth: #The use of radiographs as a screening technique. International Journal of Paleopathology 23, 32-42.
  7. Miles, A. and Connell, B. (2012) New Bunhill Fields burial ground, Southwark. Excavations at Globe Academy, 2008. London: Museum of London Archaeology.
  8. Connell, B. & Rauxloh, P. (2003). A rapid method for recording human skeletal data, unpub MOL rep.
  9. Brickley, M. Mays, S. & Ives, R. (2010). Evaluation and interpretation of residual rickets deformities in adults. International Journal of Osteoarchaeology 20, 54-66.
  10. Ives, R. & Brickley, M. (2014). New Findings in the Identification of Adult Vitamin D Deficiency Osteomalacia: Results from a Large-Scale Study. International Journal of Paleopathology 7, 45-56.

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