Early Farming and Women: Subsistence and Sex-Differences in Dental Health Misty Fields Abstract Misty Fields examines

womens oral health as it relates to agricultural subsistence and associated dietary and physiological changes. The investigation focuses on the foraging-to-farming transition in the Desert Southwest (circa 1600 BC-AD 200) during a time of subsistence change and population increase. The study uses an osteological sample excavated from the archaeological site of La Playa in northwest Mexico. Analyses of dental data identify differential patterns in the occurrence of pathology in adult women and men. This bioarchaeological study provides insights into the development of health trends specific to reproductive-age women. By considering the interaction that occurs between biological and cultural phenomenon, study results provide a more dynamic picture of history and health in the ancient Southwest. Introduction In archaeological populations, skeletal and dental remains are one of the major ways that are used to investigate health and nutritional history (Stodder and Martin 1992). Osteological data are examined from numerous perspectives to mitigate what is recognized as the osteological paradox; is the sample representative of the population as a whole (Goodman 1993). Before attempting an interpretation, therefore, careful analysis requires drawing upon multiple lines of evidence, placing data in cultural context, and a search for patterns both within and between comparable populations. In early farming communities undergoing the subsistence shift from foraging to farming, profound implications have been recognized for a range of biological and cultural factors. Bioarchaeological investigations of skeletal materials have shown that some of these effects were positive (e.g., surplus food, growing populations) while others were negative (e.g., reduced dietary breadth, spread of infectious disease) (Cohen and Armelagos 1984; Steckel et al. 2002). The bio-cultural1 nature of the subsistence shift, however, is less well understood for women of reproductive age. Research Problem Research of many agricultural populations from around the world has shown that, on average, females have higher rates of dental disease when compared to male counterparts (Hillson 2002; Larsen 1995; Lukacs 1996, 2006, 2008). In general, this sex-differential pattern has been attributed to dietary changes and gender behaviors associated with the adoption of an agricultural lifeway, emphasizing the idea that women snack on carbohydrates throughout the day. This line of reasoning assumes a universal female behavior, but more problematic is the lack of empirical support. This study proposes an alternative explanation for the decline in the dental health of agricultural women, considering shifts in subsistence and associated cultural and biological changes. Wherever groups adopt agriculture, populations grow as a consequence of rising fertility rates believed to be associated with decreased birth intervals and a readily available food supply
1

Bio-cultural research examines the interaction between biological and cultural phenomena.

(Cohen and Armelagos 1984; Eshed et al. 2004; Larsen 1995). These changes can put substantial physiological demands on the bodies of reproductive-age women. Such factors are an important component in the assessment of sex-specific health patterns in populations. Bridges (1989) suggests that the health consequences associated with pregnancy, parturition, and lactation place increased nutritional demands on women. Martin (2000) argues that to assume women are biologically prepared for pregnancy and lactation is overly simplistic. Recurrent reproductive events, particularly with inadequate nutrition, can have harmful and long-term health effects for women. In a cross-cultural analysis of dental health in archaeological and ethnological populations, Lukacs (2008) identified two broad patterns related to differences between men and women. With agricultural subsistence, females were found to exhibit greater rates for dental caries (cavities) than males. Additionally the rise in caries occurrence intensified with age more in females than males. Lukacs (2008) meta-analysis highlights the need to consider subsistence shifts and associated effects to female health. This study examines the role of reproductive physiology in womens oral health and potential effects in the lives of farming females in the ancient Desert Southwest. An interdisciplinary approach draws from archaeological, ethnological, and clinical literature for insights into the development of health trends through time and across the female lifespan. The study uses a skeletal sample from an Early Agricultural group who lived at the archaeological site of La Playa in northern Mexico. The La Playa sample is used to provide greater understanding of the health consequences of the foraging-to-farming transition through a focus on male-female variation in dental disease. This study attempts to broaden understanding of changes that occur in association with subsistence behaviors and provide a more nuanced picture of differential health effects through time. Background Literature Dental Health and Farming Females From the early Holocene, groups undergoing the shift to agriculture experienced wideranging behavioral and health changes (Cohen and Armelagos 1984; Eshed et al. 2004; Larsen 1995; Steckel et al. 2002). Altered subsistence patterns in association with agriculture commonly result in changes to mobility and settlement with population increase and aggregation. The former can affect workload and social organization, while the latter facilitate the spread of disease and parasites (Goodman et al. 1984; Larson 1995, 2000). While research of archaeological populations has examined a range of pathologies, this study focuses on two measures of dental health known to be highly correlated to subsistence: dental caries and tooth loss during life (i.e., premortem) (Larsen 1995; Turner 1979). In many agricultural communities, the elevated rates in dental caries are associated with a dietary increase in processed carbohydrates (Hillson 2001; Larsen 1981, 1995). Premortem tooth loss provides a good indication of the progression of dental disease over the lifespan because it is highly agerelated, in addition to being linked to general health. Turner (1979) identified escalating rates of dental caries from foraging to farming, with foragers frequently averaging 2% for caries rates while farming populations have caries rates averaging 10%. Men and women within non-agricultural populations generally have equivalent rates of dental disease. With growing dependence on agricultural subsistence, however, womens dental health declines more than that of men, although this pattern is not universal

emphasizing the need to consider local contexts (Fields et al. 2009; Hillson 2001; Larsen 1981, 1987, 1995; Lukacs 1996, 2008; Lukacs and Largaespada 2006; Watson et al. 2010). The development of caries involves a pathological process that results in the decay of dental hard tissues (i.e., enamel, dentin and cementum). With the consumption of sticky, processed carbohydrates, food particles adhere to tooth grooves and dental surfaces. As dental plaque develops, bacteria colonize and metabolize dietary starches and sugars. The metabolic action of oral bacteria produces acids that break down vulnerable dental surfaces, resulting in the formation of cavities (Hillson 2002). Larsen (1995) suggests that there is a corresponding pattern of increased tooth loss seen in association with the rise in caries rates in agricultural populations. During life, tooth loss can occur from dental decay due to advanced caries (Hillson 2001). Additional factors that contribute to premortem tooth loss include dental wear, periodontal disease, trauma, and certain cultural behaviors, such as using teeth to help process fibers (Hillson 2002; Turner 1979). Many researchers (Erdal and Duyar 1999; Hillson; 2001; Lukacs 1995) argue that understanding the pattern of tooth loss in a population is crucial when using data to build inferences about dental caries. If teeth are lost due to advanced carious decay, their absence for observation effectively obscures caries rates, so that the study of both of these pathologies provides a better understanding of oral health. Early Farming in the Desert Southwest The variable geographic environment known as the Desert Southwest has been loosely defined as ranging between Las Vegas, New Mexico to the east and Las Vegas, Nevada in the west, and from Durango, Colorado in the north to Durango, Mexico in the south. Around 8000 years ago, the Desert Archaic people, descendents of earlier Paleoindians, maintained sparse populations foraging across a diverse landscape formed from the buttes and mesas of the Colorado Plateau, the mountainous transition zone of the Mogollon Rim, and the basin-andrange topography of the southern deserts. In this marginal environment, regional and seasonal shifts in precipitation coupled with the heterogeneous topography produced discrete plant and animal biota (Wills and Huckell 1994). Over time, the arid climate and seasonal availability of resources helped to shape cultural behaviors and ideologies. Possibly as early as 2000 BC, maize entered the Desert Southwest from present-day Mexico (Merrill et al. 2009), and a long and culturally variable transition toward agricultural economies emerged with the traditions of the Anasazi (Ancestral Puebloans), Mogollon, and Hohokam. This cultural diversity has been attributed to regional differences, as well as density-dependent behavioral adaptations, and varying social strategies (Fish and Fish 1994). Researchers suggest that the decision to adopt cultigens required flexible systems that could accommodate socioeconomic changes (Diehl 2005; Gumerman et al. 2003; Wills 1988). Thus the adoption of agriculture across the Southwest may be best understood as a choice for enhancing predictability in the face of an often-unpredictable environment (Wills and Huckell 1994). Many groups remained casual horticulturalists for centuries even after maize was introduced (Kirchoff 1954), as they continued foraging locally available resources and farmed only as a supplemental food source. Farmers of the ancient Southwest developed resourceful cultural means to mitigate the difficulties of cultivation in a desert environment (e.g., dry farming). Across the Sonoran, the foraging-to-farming transition of the Late Archaic-Early Agricultural period (c. 1600 BC - AD 200) included a wide range of mobility strategies and agricultural reliance (Fish and Fish 1994). 3

Roth and Freeman (2008) found evidence for subsistence adaptations dating to the Middle Archaic (c. 3500-1600 BC) that include seasonal use of alluvial floodplains, exploitation of seed plants, and development of grinding stone technology for processing plant foods. The evidence indicates a level of environmental knowledge and a suite of subsistence behaviors that allowed for a smooth transition of cultigens such as maize into diets. Watson (2008) suggests that the Early Agricultural period residents at the site of La Playa practiced a mixed-economy subsistence, exploiting local wild resources (i.e., cactus, mesquite, and agave) and growing domesticated maize (Zea mays). The Early Agricultural Period is divided into two archaeological phases, the San Pedro (1600-800 BC) and the Cienega (800 BC-AD 200). The San Pedro phase is defined from eleven alluvial sites in the San Pedro River Valley (Wills 1988). This phase is characterized by a shift from highly mobile, foraging subsistence to increasing sedentism. The Cienega phase is characterized by bigger settlements, growing populations, large roasting pits, and greater reliance on domesticated cultigens (Huckell 1995). At La Playa, the Cienega phase shows evidence for increased local investment and a growing population, with extensive site use, large numbers of burials, detritus from shell bracelet manufacture, and the ubiquitous presence of ground stone (i.e., manos and metates) (Watson 2005). Subsistence Behaviors and Female Fertility There have been numerous mechanisms implicated in the varying fertility rates seen between foraging and agricultural groups. Activity levels, breastfeeding practices, dietary factors, and settlement patterns are all believed to have an effect on female fecundity (Valeggia and Ellison 2001). Armelagos and colleagues (1991) argue that, as populations become more sedentary with agricultural subsistence, there is a reduction in birth spacing that results in population expansion. In foraging societies, longer intervals between births are considered a function of the physiological response that serves to maintain energy balance in women during childbearing years (Ellison 2008; Schultz and Lavenda 2004). Some researchers (E. Roth 1985) have argued for a causal link between sedentism and fertility, while others (Handwerker 1985) suggest that sedentism in itself does not affect fertility. Rather the combined effects of behavioral and dietary changes impact the energy expenditure of women and influence fertility indirectly. Eshed and colleagues (2004) cite ethnographic studies of foraging populations that experience a decline in fertility rates from seasonal weight fluctuations. In addition, lactation suppresses ovulation and in many foraging groups, children may be breastfed on demand into early childhood. However with agricultural subsistence, breastfeeding patterns change as women have readily available weaning foods (Pennington 1992; Ellison 2008; Sellen and Mace 1997; Valeggia and Ellison 2001). Other factors involve dietary shifts in the ratio of proteins to carbohydrates, as more carbohydrates are consumed. Ellison (2008) suggests that with a more consistent food supply, women can experience greater fat stores and increased energy availability, prompting a rise in fecundity. Thus, the interplay between biological and cultural factors present the potential for farming females to experience more reproductive events across their lifespan. Clinical Research The Academy of Periodontology (APA) has stated that women are at increased risk for oral health problems over men due to sex-specific physiological changes and hormonal fluctuations. Although the underlying processes still need to be fully understood, clinical research has shown that pregnancy-related changes to the oral environment can impact dental health. Additionally

studies confirm that without proper care, oral conditions may decline, leading to lifelong health problems specific to females (AAP 2006; Bobetsis et al. 2006; Boggess and Edelstein 2006; Laine 2002; Lieff et al. 2004). For example, changing hormonal components and the presence of irritants in the saliva of pregnant women contribute to an inflammatory response of gingival tissues known as pregnancy gingivitis where gums become reddened and bleed easily (Burakoff 2003). The condition has been linked to rising progesterone levels in the second trimester that occur when the placenta takes over regulation of hormone production (Laine 2002). Progesterone plays an essential role in the vascular system and in maintaining the endometrium (lining of the womb). The increased vascularization of corporal tissues, however, can lead to gingival inflammation and edema (fluid retention). Edema-related smoothing and thickening of the gingival margin allows periodontal pockets to form where bacterial colonies thrive (Neville et al. 2008). According to Laine (2002), healthy gingivae have the same chemical composition in pregnant or non-pregnant states, but the response of gingival tissue to irritants becomes heightened during pregnancy. It is important to emphasize that pregnancy is not the cause of gingivitis, but changes to gingival blood vessels can aggravate the condition, as tissues are more permeable and sensitive to bacterial substances. Consequently the oral environment becomes more favorable to the development of gum disease (Neville et al. 2008; Silk et al. 2008). In addition, saliva contributes to the health of the oral environment. It provides a buffer against excess acid and contains antimicrobial elements that help to inhibit bacteria (Lukacs and Largaespada 2006). During late pregnancy, oral flora may be modified as salivary pH becomes less alkaline, diminishing the buffering and antimicrobial action (Laine 2002). Research by Laine (2002) found salivary levels of Streptococcus mutans increase during pregnancy. S. mutans is a highly cariogenic (cavity-inducing) bacteria that rapidly process sugars and produce acids (Hillson 2002). This microbe is infrequent in normal plaque or with a low sugar diet, but with increased dietary carbohydrates, the bacteria gain an adaptive advantage. The increased presence of cariogenic bacteria and the changing oral environment may facilitate caries formation (cariogenesis) during pregnancy. Materials and Methods The adult dentition from 142 crania from the archaeological site of La Playa (SON F:10:3) in Sonora, Mexico was analyzed for statistically significant sex-differences in caries and premortem tooth loss. The collection is housed at the Centro Instituto Nacional de Antropologa e Historia (INAH), Hermosillo, Mexico. This collection is highly suited for investigations into the health effects of the subsistence shift to agriculture in the Sonoran Desert, as radiocarbon dating of the inhumation burials have shown they span the Early Agricultural Period (3100 BC-AD 620 cal.). The skeletal and dental remains are well preserved and in general, show signs of adequate nutrition and low rates for infectious disease (Watson 2005). The site is located in the northeast region of the Sonoran Desert and is part of the southern Arizona archaeological sequence. Archaeological excavations have recovered and preserved large assemblages associated with the Early Agricultural period that include ceramics, faunal remains, ground stone, lithics, and shell (Glycymeris) (Carpenter and Villalpando 2002). Data was collected according to Standards for Data Collection from Human Skeletal Remains (Buikstra and Ubelaker 1994). Data collection involves macroscopic assessment for the presence or absence of dental caries and premortem tooth loss. Carious lesions were recorded wherever decay of the tooth surface(s) or root(s) was observed. If necessary to aid in identification of caries, a magnifying glass and dental probe were used. The following were 5

recorded for each carious lesion: location of the tooth in the dental arch (maxilla or mandible), specific tooth (incisor, canine, premolar or molar), and tooth surface(s) involved (occlusal, interproximal, buccal, lingual, cemento-enamel junction, or root). Premortem tooth loss was recorded when alveolar bone remodeling was observed. If the alveolar socket was open with no evidence of bone resorption2, tooth loss was recorded as postmortem. When the tooth was not present, it was recorded as absent to avoid inflated pathology rates. The sample included an equal number of males (n=71) and females (n=71) ranging in age between 15 and 55 years, making it suitable for examining changes over the course of the reproductive years. Sex and age at death were previously recorded based on an assessment of crania, dentition, and pelves conducted by Osteologists J. Watson and E. Barnes (after Buikstra and Ubelaker 1994). Groups were relatively evenly distributed between ages and sexes (except for young adults who would be expected to have the least degree of dental pathology). Age categories for the sample were assigned as follows: 15-24 as young adults early in their reproductive years (n=15), 25-34 as adults (n=35), 35-44 as mature adults (n=48) and 45-55 (n=44) as post-reproductive. By age category, sex ratios are as follows: young adults include 8 females and 7 males, adults had 15 females and 20 males, mature adults include 25 females and 23 males, and the post-reproductive group had 23 females and 21 males. Results In accordance with the research objectives for this study, descriptive statistics summarize raw data in frequency tables and statistical tests aid in a search for patterns relating to the dental health of La Playa inhabitants. Data on dental caries are presented in Table 1. Data on premortem tooth loss are shown in Table 2. Since a positive correlation exists between caries and tooth loss, Table 2 also presents a summary of these pathologies. Powell (1988) suggests that these pooled values demonstrate the magnitude of both dental pathologies on oral health. Results found that La Playa men and women suffered relatively equally from dental caries, although there were insignificantly more women with caries than men (45 women to 41 men). With slightly over 60% of individuals in the sample with caries, it is likely that many teeth were lost due to advanced carious decay. Furthermore, over the reproductive lifespan, sample women were found to have lost twice as many teeth as male counterparts, losing an average of 3.7 teeth per woman compared to 1.89 teeth per man (refer to Table 2). By the time women were 45-55 years of age, they had lost an average of 6.96 teeth, while men had lost 3.43. Combined values of caries and tooth loss for the sample indicate that females (33.6%) were impacted to a much greater degree by these pathologies than sample males (24.4%). A Chi-Square Goodness of Fit test examines the frequencies of cases from two groups to determine if observations differ significantly from previously determined expectations proposed by a null hypothesis (the null hypothesis assumes no difference between independent variables). This test was run on data for premortem tooth loss to evaluate whether the observed frequencies depart significantly from what might be expected, given an equal probability of tooth loss for both women and men. The expected distribution of half the tooth loss from women and half from men assumes that tooth loss is independent of physiological variables isolated by sex. A chi-square test identified statistically significant differences. Results found that the amount of tooth loss experienced by adult women at La Playa was significantly greater than what would be

The dynamic process that occurs when old bone is absorbed and new bone is deposited simultaneously, indicating bone remodeling.

expected (x2 = 41.92, d.f.=1, n=397, p<.0005)3. These findings support the argument that early farming women at La Playa had disproportionately greater tooth loss than male counterparts.

In statistical analyses, x2 represents the chi-square value and n equals the number of items in the sample. Chi-square tests analyze associations between two nominally scaled variables. Degrees of freedom (d.f.) are based on the number of values that are free to vary, based on sample size. The p-value is the significance level that sets the level of probability that differences observed are due to chance. For example, a probability value with a significance level of .05 means that a p-value of less than .05 could be expected to happen 5% of the time. The findings above lead us to reject the null hypothesis with a very low p-value indicating a less than .05% chance.

Table 1. Caries rates for La Playa sample

Variable: Caries Males Females Total Sample (n=) 71 71 142 Individual w/ Caries (n) 41 45 86 Carious Teeth (n) 134 116 250 Total # of Observed Teeth (n) 1099 1127 2226 Individual Caries Rate 57.7% 63.4% 60.6% Carious Teeth per Mouth (n) 1.89 1.64 1.76 Observed Caries Rate 12.2% 10.3% 11.2%

Table 2. Premortem tooth loss rates for La Playa sample

Variable: Sample Premortem (n=) Tooth Loss Males Females Total 71 71 142 Individuals # of w/premort Premort tooth loss Teeth lost (n=) (n) 33 35 68 134 263 397 # of Observed Teeth (n) 1099 1127 2226 Total # Premort Premort Caries tooth teeth and loss lost per Premort Intensity mouth teeth 12.2% 1.89 268 23.3% 3.70 379 17.8% 2.80 647 Combined Caries and Premort rate 24.4% 33.6% 29.1%

Discussion This study synthesizes clinical research of maternal oral health, ethnological literature on subsistence and fertility, and the archaeological evidence from La Playa to provide support for the scenario posited. The diet at La Playa included cariogenic carbohydrates during the Early Agricultural period. There is evidence for greater local investment and increased sedentism with extensive site use and substantial quantities of ground stone for intensified food processing, likely to feed a growing population. Thus socioeconomic conditions were in place that allowed changes to population density, conceivably impacting the health of La Playa women more than men. Greater understanding of the complex interaction between biology and culture is gained by considering the dietary shift to processed carbohydrates, population growth associated with subsistence changes, and the effects of physiologically related factors on womens dental health. By framing data in cultural context and examining the biological components of female reproductive events, a more nuanced picture of human health and history emerges. Findings from this bioarchaeological study provide insights into the development of health trends over the lifespan, with special significance for reproductive-age women. Results suggest that the adoption of an agricultural lifestyle led to enduring consequences in the lives of these women of the ancient Southwest.

References: American Academy of Periodontology (AAP) 2009 Protecting Oral Health throughout Your Life: Women and Gum Disease. http://www.perio.org/consumer/women.htm. Armelagos, George J., Alan H. Goodman and Kenneth H. Jacobs 1991 The Origins of Agriculture: Population Growth during a Period of Declining Health. Population and Environment 13(1): 922. Bobetsis, Yiorgos A., Silvana P. Barros and Steven Offenbacher 2006 Exploring the Relationship between Periodontal Disease and Pregnancy Complications. Journal of the American Dental Association 137 (suppl): 7S13S. Boggess, Kim A., and Burton L. Edelstein 2006 Oral Health in Women during Preconception and Pregnancy: Implications for Birth Outcomes and Infant Oral Health. Maternal and Child Health Journal 10(suppl): S169-S174. Bridges, Patricia S. 1989 Changes in Activities with the Shift to Agriculture in the Southeastern United States. Current Anthropology 30: 385-394. Buikstra, Jane E., and Douglas H. Ubelaker, eds. 1994 Standards for Data Collection from Human Skeletal Remains: Proceedings of a seminar at the Field Museum of Natural History organized by Jonathan Haas. Arkansas Archaeological Survey Research Series No. 44, Fayetteville, 272 pp. Burakoff, Ronald P. 2003 Preventive Dentistry: Current Concepts in Womens Oral Health. Primary Care Update OB/GYNs, Elsevier Science 10(3): f141-146. Carpenter, John P., and Elisa Villalpando 2002 Proyecto Arqueolgico La Playa (SON:F:10:3), Cuarto Informe, Temporada Verano 2001 y Propuesta para la temporada Verano 2002. Archivo Tchnico Centro INAH Sonora. Cohen, Mark N., and George J. Armelagos, eds. 1984 Paleopathology at the Origins of Agriculture. New York: Academic Press. Diehl, Michael W. 2005 Subsistence and Resource Use Strategies of Early Agricultural Communities in Southern Arizona. Anthropological Papers No. 34, Center for Desert Archaeology, Tucson, Arizona. Ellison, Peter T. 2008 Energetics, Reproductive Ecology, and Human Evolution. PaleoAnthropology 2008:172200. Erdal, Y.S. and I. Duyar 1999 A New Correction Procedure for Calibrating Dental Caries Frequency. American Journal of Physical Anthropology, 108(2):237-240. Eshed, Vered, Avi Gopher, Timothy B. Gage, and Israel Hershkovitz 2004 Has the Transition to Agriculture reshaped the Demographic Structure of Prehistoric Populations? New Evidence from the Levant. American Journal of Physical Anthropology 124:315-329. Fields, Misty, Edward Herschaft, Debra L. Martin, and James T. Watson 2009 Sex and the Agricultural Transition: Dental health of Early Agricultural Females at La Playa, Mexico. Journal of Dentistry and Oral Hygiene 1(4):042-051. http://www.academicjournals.org/JDOH/contents/2009cont/Oct.htm.

Fish, Suzanne K. and Paul R. Fish 1994 Prehistoric Desert Farmers of the Southwest. Annual Review of Anthropology 23:83108. Goodman, Alan H. 1993 On the Interpretation of Health from Skeletal Remains. Current Anthropology 34(3):281288. Goodman, Alan H., Debra L. Martin and George J. Armelagos 1984 Indications of Stress from Bone and Teeth. In Paleopathology at the Origins of Agriculture. Mark N. Cohen and George J. Armelagos, eds. Pp. 13-49. Orlando: Academic Press. Gumerman, George J., Alan C. Swedlund, Jeffrey S. Dean, and Joshua M. Epstein 2003 The Evolution of Social Behavior in the Prehistoric American Southwest. Artificial Life 9(4): 435. Handwerker, W. Penn 1985 Scope of Perspective in Fertility Models. American Anthropologist 87(3):653-656. Hillson, Simon W. 2001 Recording Dental Caries in Archaeological Human Remains. International Journal of Osteoarchaeology 11(4): 249-289. Hillson, Simon W. 2002 Dental Anthropology. 3rd edition. Cambridge: Cambridge University Press. Huckell, Bruce B. 1995 Of Marshes and Maize: Preceramic Agricultural Settlements in the Cienega Valley, Southeastern Arizona. Tucson: University of Arizona Press. Kirchoff, Paul 1954 Gatherers and Farmers in the greater Southwest: A Problem in Classification. American Anthropologist 56(4):529-550. Laine, Merja A. 2002. Effect of Pregnancy on Periodontal and Dental Health. Odontology Scandinavia 60: 257-264. Oslo. ISSN 0001-6357. Larsen, Clark Spencer 1981 Skeletal and Dental Adaptations to the Shift to Agriculture on the Georgia coast. Current Anthropology 22: 422-423. Larsen, Clark Spencer 1987 Bioarchaeological Interpretations of Subsistence Economy and Behavior from Human Skeletal Remains. In Advances in Archaeological Method and Theory, Vol. 10. Michael B. Schiffer, ed. Pp. 339-445. San Diego: Academic Press. Larsen, Clark Spencer 1995 Biological Changes in Human Populations with Agriculture. Annual Review of Anthropology 24: 185-213. Larsen, Clark Spencer 2000 Skeletons in our Closet: Revealing our Past through Bioarchaeology. New Jersey: Princeton University Press. Lieff, Dr. Susan, Kim A. Boggess, Amy P. Murtha, Heather Jared, Phoebus N. Madianos, Kevin Moss, James Beck, and Steven Offenbacher 2004 The Oral Conditions and Pregnancy Study: Periodontal Status of a Cohort of Pregnant Women. Journal of Periodontology 75(1): 116-126. Lukacs, John R.

10

1995 The Caries Correction Factor: A New Method of Calibrating Dental Caries Rates to Compensate for Antemortem Loss of Teeth. International Journal of Osteoarchaeology, 5:151-156. Lukacs, John R. 1996 Sex differences in Dental Caries Rates with the Origin of Agriculture in South Asia. Current Anthropology 37(1): 147-153. Lukacs, John R. 2008 Fertility and Agriculture accentuate Sex Differences in Dental Caries Rates. Current Anthropology 49: 901-914. Lukacs, John R., and Leah L. Largaespada 2006 Explaining Sex Differences in Dental Caries Prevalence: Saliva, Hormones, and LifeHistory Etiologies. American Journal of Human Biology 18: 540-555. Martin, Debra L. 2000 Bodies and Lives: Biological Indicators of Health Differentials and Division of Labor by Sex. In Women and Men in the Prehispanic Southwest: Labor, Power and Prestige. Patricia L. Crown, ed. Pp. 267-300. New Mexico: School of American Research Press. Merrill, William L., Robert J. Hard, Jonathan B. Mabry, Gayle J. Fritz, Karen R. Adams, John R. Roney, and A. C. MacWilliams 2009 The Diffusion of Maize to the Southwestern United States and its Impact. In Proceedings of the National Academy of Sciences of the United States of America 106 (50) p. 21019-26. Neville, Brad W., Douglas D. Damm, Carl M. Allen, and Jerry E. Bouquot, eds. 2009 Oral and Maxillofacial Pathology. 3rd edition. Pp. 154-178. Philadelphia: Saunders/Elsevier. Pennington, Renee 1992 Did food increase Fertility? Evaluation of !Kung and Herero History. Human Biology 64(4): 497-521. Powell, Mary Lucas 1988 Status and Health in Prehistory. Washington: Smithsonian Institute Press. Roth, Barbara J., and Andrea Freeman 2008 The Middle Archaic Period and the Transition to Agriculture in the Sonoran Desert of Southern Arizona. Kiva 73:3. Roth, Eric A. 1985 A Note on the Demographic Concomitants of Sedentism. American Anthropologist 87(2): 380-382. Schultz, Emily A. and Robert H. Lavenda 2004 Anthropology: A Perspective on the Human Condition. 6th edition. USA: Oxford University Press. Sellen, Daniel W., and Ruth Mace 1997 Fertility and Mode of Subsistence: A Phylogenetic Analysis. Current Anthropology 38(5): 878-889. Silk, Hugh, Allen B. Douglass, Joanna M. Douglass, and Laura Silk 2008 Oral Health during Pregnancy. American Family Physician 77(8): 1139-1144. Steckel, Richard H., Jerome C. Rose, Clark Spencer Larsen, and Philip L. Walker 2002 Skeletal Health in the Western Hemisphere from 4000 B.C. to the Present. Evolutionary Anthropology 11:142-155.

11

Stodder, Ann L.W. and Debra L. Martin 1992 Health and Disease in the Southwest Before and After Spanish Contact. In Disease and Demography in the Americas. Douglas H. Ubelaker and John W. Verano, eds. Pp. 5573. Washington, D. C.: Smithsonian Institution Press. Turner, Christy G. 1979 Dental Anthropological Indications of Agriculture among the Jamon People of Central Japan. American Journal of Physical Anthropology 51: 619-635. Valeggia, Claudia R., and Peter T. Ellison 2001 Lactation, Energetics, and Postpartum Fecundity. In Reproductive Ecology and Human Evolution. Peter T. Ellison, ed. Pp. 85-105. New York: Aldine de Gruyter. Watson, James T. 2005 Cavities on the Cob: Dental Health and the Agricultural Transition in Sonora, Mexico. Ph.D. dissertation, Department of Anthropology, University of Nevada, Las Vegas. Watson, James T. 2008 Prehistoric Dental Disease and the Dietary Shift from Cactus to Cultigens in Northwest Mexico. International Journal of Osteoarchaeology 18(2): 202-212. Watson, James T., Misty Fields, and Debra L. Martin 2010 Introduction of Agriculture and its Effects on Womens Oral Health. American Journal of Human Biology 22(1):92-102. Wills, Wirt H. 1988 Early Prehistoric Agriculture in the American Southwest. Santa Fe: School of American Research Press. Wills, Wirt H. and Bruce B. Huckell 1994 Economic Implications of Changing Land-use Patterns in the Late Archaic. In Themes in Southwestern Prehistory. George J. Gumerman, ed. Pp. 33-52. Santa Fe: School of American Research Press. Misty Fields, M.A. Department of Anthropology University of Nevada, Las Vegas 4505 Maryland Parkway Las Vegas, Nevada 89154

12

Critical Thinking Questions: 1)What implications does this study have for women in developing nations? What implications are there for women in the developed world? 2)What role might gender play in the differences in dental disease identified between early agricultural women and men? 3)How does the use of a bioarchaeological approach develop better understanding of the subtleties of biological and cultural data? In other words, in what ways do culture and biology interact in the lives of people?

13