Studies of Relationships Between Nutritional Deficiencies and (A) Facial and Dental Arch Deformities and (B) Loss of Immunity to Dental Caries Among South Sea Islanders and Florida Indians

Previous studies among several remnants of primitive racial stocks have disclosed a marked uniformity of facial design and regularity of dental arch development and occlusion, so long as the individuals of the group were living exclusively on the native foods which were available for that district. A marked change, however, was found even in the first generation of the same racial stock when they were living on the foods of modern civilization, consisting largely of white flour and sweet foods.

The groups previously studied were living in the northern hemisphere and include the following: (1) the Swiss in the isolated valleys of the high Alps for comparison with modernized Swiss in easily accessible valleys and in the lower plains country of Switzerland. Here the efficient native foods consisted chiefly of rye and dairy products, with a little meat and vegetable foods, chiefly in the summer.

(2) The Gallics were studied in the Outer Hebrides, where their isolation still restricted them chiefly to the oat products, fish and other sea foods. These were compared with those living at and near the ports where imported foods were readily available and used liberally.

(3) The Eskimos in isolated districts in Alaska were studied for comparison with those of their stock living at the point of contact with the foods of modern civilization. These again were chiefly white flour and sugar products. The isolated Eskimos were living almost entirely on the large animal life of the sea.

(4) The Indians of the far north and central part of Canada were studied at points of nearly complete isolation for comparison with the modernized Indians living on the foods of modern civilization. The foods of the primitive Indians were limited almost entirely to wild game.

My reports^1,2 on the above groups have dealt with both the incidence of irregularities of the dental arches and facial form and the comparative incidence of dental caries in the two groups, namely, isolated and modernized.

The studies being reported herewith will deal with similar investigations made during the summer of 1934 of the inhabitants of the Islands of the Southern Pacific in the following archipelagos: Marquesas Islands, Society Islands, Cook Islands, Tongan Islands, New Caledonia, Fiji Islands, Samoan Islands and the Hawaiian Islands. There is also included a preliminary report of the facial and dental arch deformities and dental caries problems among the Indians of Florida as studied in February 1935.

The native inhabitants of the South Sea Island groups studied were composed of Melanesians in the New Caledonian and Fiji Islands and Polynesians in the remaining Island groups.

Two particular types of groups of individuals were searched for and studied, namely, those still sufficiently isolated because of their physical environment and hence unable to obtain modern foods or only in insignificant amounts; and groups consisting of individuals of the same racial stocks living at the point of contact with modern civilization and its foods. These individuals resided chiefly at or near the port-of-call of merchant ships or small trader ships. It is of interest to note that the isolation between these different archipelagos has been so complete that all spoke different languages and had different characteristics of physical development.

Individuals, however, of the same racial stock, whether on the same or different islands of that group, were found to have facial form and features so similar as to appear as though they belonged to the same finally. This was clearly not the result of inbreeding, which their local taboos rigidly controlled. In Fig. 1 will be seen a group of four Melanesian young men who are not related but so similar in appearance that they clearly look like brothers. Some of these lived on the isolated islands.

Fig. 1–Melanesians. Note the family resemblance, though not related.

 

In Fig. 2 will be seen a group of four Polynesian young women. It will similarly be noted that they have a very striking resemblance such as would suggest membership in the same family. In both these figures it will be seen that the dental arches are uniformly broad and have normal interdental relationships. The nostrils are broad and both the middle third of the face and the mandible are well developed. It is important that, among the individuals of the isolated groups living entirely on efficient native foods, in not a single instance was a dental arch found that was abnormal in contour or in which the teeth were disturbed either in their relation to other teeth of the arch or to the opposing teeth. Two individuals were found with supernumerary teeth in otherwise normal dental arches. These produced local crowding of one or two teeth, but without disturbance of the interdental relationship.

Fig. 2–Polynesians. Note the family resemblance, though not related.

 

In contrast with this uniformity of facial form and dental arch development among the isolated groups, those individuals of the same racial stocks who were living near the ports and using liberally imported foods, chiefly white flour and sugar products, showed marked irregularities of the dental arches and facial form. The divergencies from normal facial form were expressed quite constantly in certain patterns. One of these constituted in its simplest form a depression of the upper lateral incisors and narrowing of the upper arch. This was usually associated with a lack of development forward of the middle third of the face, as is seen in Fig. 3. To the left is a Polynesian of Samoa and to the right a Melanesian of Fiji. Less frequently a similar type of deformity occurred in the development of the lower arch. Frequently, however, the disturbance involved both the upper and lower arches, such as seen in Fig. 4.

Fig. 3–The depression of the upper lateral incisors with a narrowing of the upper arch is one of the most frequent physical expressions of nutritional deficiency during the formative and early growth periods.

Fig. 4–A more severe injury is often expressed by a tendency for the upper teeth to go inside the lower teeth, associated with a lack of development of the middle third of the face. The lower teeth may also be involved.

 

Another type of divergence found was expressed as a marked narrowing of the width of the face. An illustration of this type is shown in Fig. 5, to the left, a modernized Polynesian and, for comparison, to the right, an American boy of about the same age who was also suffering from an early nutritional injury.

Fig. 5–There is often a marked disturbance in the relative bone growth of different parts of the head, with a narrowing and lengthening of the face. The boy at the left is a first generation Polynesian, the one on the right is an American.

 

It was of particular interest to note that the chief physical deformities did not develop until the time of eruption of the permanent teeth. The arches carrying the deciduous set were usually approximately normal. It was also quite frequently noted that in a family of several children, all raised entirely under the influence of trade foods, those grown members of the family who were born first had less deformity than those born later, apparently depending upon the number of children and their spacing.

In contrast with the typical comeliness of the facial form in both the native Melanesians, as shown in Fig. 1, and the Polynesians as illustrated in Fig. 2, the loss of typical native beauty as a result of injury in the formative and early growth periods is shown in Fig. 6. The two boys at the top shown from a side view have a marked irregularity of the facial form as a divergence from the racial pattern in a single generation. Two views of the same girl are shown below. The case for the protrusion shown in the lower left view is due in part to the abnormal development of the dental arches as shown in the view to the right.

Fig. 6–Irregularities of the dental arches with facial deformity developed in even the first generation on deficient diet.

 

I have made a study of the Indians of Florida both with regard to the incidence of dental caries and facial and dental arch deformities. The dental caries problem is being published in detail elsewhere. It is of interest, however, that the same striking divergence in the incidence of dental caries has been found among the Seminole Indians of Florida living today chiefly on the native foods as compared with those on the modern foods. In addition to these two groups, the skeletal material that has been taken from the mounds has been examined in three museums, namely, the Museum of Natural History in New York City, the Museum of the American Indian, Heye Foundation, in New York City, and the United States National Museum in Washington, D. C. It is of interest that not a single dental arch was found with irregularities of the teeth in this museum material. It is also of interest that practically 100 per cent immunity to dental caries was also found in the museum material. In the modernized group many cases of dental arch deformities were found. Two typical types are shown in Fig. 7. In the view to the left there is a depression of the lateral incisors and at the right a marked narrowing and crowding of the teeth of the upper arch.

Fig. 7–The Florida Indians are responding with the same deformity patterns as the other racial stocks. At the left, the upper lateral incisors are depressed and the upper arch narrowed; at the right, there is a marked crowding of the teeth with the left lateral incisor decayed to the gum line.

 

We are at this point primarily concerned with the characteristics of the native dietary in order that we may evaluate the factors which played the principal rôle in enabling these individuals to produce relatively perfect bodies built on the line of the racial patterns. The native foods in practically all the South Sea Islands consisted of a combination of two types; namely, plant foods and sea foods. The former included the roots and tops of several tubers and a variety of fruits. The sea foods consisted chiefly of small forms, both hard and soft shell, and invertebrates, together with fish of various types.

One of the purposes of this trip was to find, if possible, native dietaries consisting entirely of plant foods which were competent for providing all the factors needed for complete and normal physical development without the use of any animal tissues or product.

A special effort was accordingly made to penetrate deeply into the interior of two of the largest islands where the inhabitants were living quite remote from the sea, with the hope that groups of individuals would be found living solely on a vegetarian diet. Not only were no individuals or groups found, even in the interior, who were not frequently receiving shell fish from the sea, but I was informed that they recognized that they could not live over three months in good health without getting something from the sea. A native interpreter informed me that this had been one of the principal causes of bitter warfare between the hill tribes and coast tribes of that and all of the Pacific Islands, since the hill people could not exist without some sea foods to supplement their abundant and rich vegetable diet of the mountain country. He informed me also that even during the periods of bitter warfare the people from the mountain district would come down to the sea during the night and place in caches delicious plants which grew only at the higher altitudes. They would return the following night to obtain the sea foods that were placed in the same caches by the people from the sea. He stated that even during warfare these messengers would not be captured or disturbed. This guide and many others explained to me that cannibalism had its origin in the recognition by the hill people that the livers and other organs of their enemies from the coast provided the much needed chemicals which were requisite to supplement the plant foods. Several highly informed sons of cannibals and a few who acknowledged that they had eaten “long pig” advised me that it was common knowledge that the people who had lived by the sea and who had been able to obtain lots of sea foods, particularly the fishermen, were especially sought for staying a famine. One native told me of having left an island where he was engaged in fishing because of a tip that came to him that his life was in danger because of his occupation. It was a very common experience for us to see the children following the tide out and picking up the sea forms, including scale fish and spiny forms, eating these raw after scraping the spines off with a piece of coral, which provided a handy grater.

While the plant foods varied somewhat for the different Islands according to the latitude, the sea foods played the same part in all the islands. We were advised in different groups that the community life included providing the expectant mothers with something fresh from the sea every day. Growing children hiving near the sea were taught to go at the time of low tide and feast upon the sea forms. One of the plant foods most generally eaten and in most liberal quantities was taro, prepared by baking in the ground. A variety of this is used in America for its decorativeness because of its very large leaves, and is commonly called “elephant ears.” The cooking was done with hot stones in underground ovens in which the foods were wrapped in various leaves, one of which was the ti, that has an especially high resistance to heat. In some island groups bananas were eaten both raw and cooked and in some archipelagos they were chiefly baked. In the eastern chain of archipelagos, particularly the Society and Cook Islands, oranges grow wild. Practically no native grains are used and milk is not available for the natives except for the infants and young children, from the mothers, whose supply is usually generously distributed without stinting the principal claimant. The chemical analysis of these foods will be discussed in another communication.

The problem of the relation of immunity to dental caries to the type of nutrition has also been discussed in detail in another communication. It is important to review here, however, that the incidence of dental caries among the primitive isolated South Sea Island groups was similar to that found in other primitive racial stocks, namely, nearly 100 per cent immunity to dental caries in the groups living entirely on the native foods, with tooth decay becoming rampant in those groups receiving modern trade foods. For the isolated Melanesians, only 0.38 per cent of the teeth examined had dental caries. For those Melanesians living largely on the imported trade foods, 29 per cent of the teeth examined had been attacked by dental caries. Among the isolated Polynesians only 0.32 per cent of the teeth had been attacked by dental caries, and for those living largely or in part on modern foods 21.9 per cent had been attacked by dental caries.

With regard to the Indians of Florida; while the skeletons that have been taken from the mounds have shown apparently 100 per cent immunity to dental caries, in the light of our newer knowledge we would assume that the then locally available dietary was highly efficient. The increased thickness of the skulls and the structures of their bones also strongly attested to this fact. It is essential that the native foods today available for the Indian residents of the Florida Everglades have been reduced in quantity, due to the ingress of civilization. The present incidence of dental caries among the individuals still living very largely on the native foods was 4 per cent of the teeth attacked by tooth decay. For those living very largely on the imported foods, however, the present incidence of dental caries was 40 per cent of all the teeth examined. Other degenerative processes were also frequently found in this highly modernized group.

Discussion

We are primarily concerned with the factors that are involved and the processes by which modifications of facial form are brought about. The clinical data obtained in these groups and those previously studied clearly indicate that an important phase of the disturbance occurred before birth. The most frequent expression involves the displacement inward of the lateral incisors so that they may erupt either slightly inside the line of the arch, as in Fig. 3, or, in more extreme cases, far inside the line of the cuspids, as seen in Fig. 4.

It is of particular interest and evident significance that the types of divergence from normal have been in general the same in the several racial groups studied, even though the native foods were different which had been displaced by the same modern foods. These latter were largely white flour and sweetened goods. This has occurred in spite of the fact that the groups were all of different racial stocks; namely, the Swiss in the high Alps, the Gallics in the Outer Hebrides, the Eskimos of Alaska, the Indians of northern and central Canada, the Melanesians of the Southwestern Pacific, the Polynesians of the South Central Pacific and the past and present Indians of Florida.

These characteristic types of facial and dental arch deformities have included (1) a lack of development forward of the middle third of the face, (2) a lack of development forward of the lower third of the face, (3) a lack of development of both zones with narrowing and crowding of the teeth and (4) a narrowing and lengthening of the face, as seen in Fig. 5. It is of interest that these are the typical groups that have been constantly found in America, some of which have provided the basis for the Angle system. In that system Class I represents a relatively normal interlocking of the first permanent molars, but with a crowding of the teeth in both anterior arches corresponding with the third group that I have outlined. Class II, Angle’s system, includes those cases where the lower first permanent molars occlude distally to the upper first permanent molars, which corresponds with the second group I have mentioned. Class III in the Angle system includes cases where the lower first permanent molars occlude mesially to the upper first permanent molars. This corresponds to the first group I have mentioned. That system includes subdivisions within the Class II and Class III groups.

Prior to the development of the data I have gathered in these studies of primitive racial stocks which deal with the causes of dental arch deformities, the dental literature has given as the principal causes thumb and finger sucking, faulty breathing habits and wrong sleeping postures, etc. It is of particular interest that in all these racial groups thumb and finger-sucking were found to be universal habits and studiously encouraged by the mothers. Notwithstanding that, each primitive group had practically complete immunity to irregularities of dental arches while on their native diets.

The role of heredity in controlling facial form by the production of a constant racial pattern is apparently very great, as is illustrated in Figs. 1 and 2. The fact that first-generation individuals whose mothers had used considerable white flour and sweetened food products instead of the native foods of the district during the gestation and lactation periods, together with the fact that the child used these modernized foods during the growth period, suggests that a very powerful force is at work that is competent to overcome the inheritance factors always present for maintaining the standard type. That inheritance does play a part in contributing to the development of facial and dental arch deformities is strongly suggested by many clinical cases. If the contributing factors were entirely interference with the nutrition of the mother during gestation and lactation and the growth period of the child, we could not readily account for the fact that the type of irregularities in the child often follows the type of irregularities that is carried by the father. In one American family of three children all have reproduced the type of deformity of the father, and that the mother contributed to the disturbance is suggested by the fact that she suffered severely from malnutrition during and following each of her pregnancies. In early life she was operated upon for tubercular glands of the neck.

That a hereditary tendency to facial deformity from the father’s side may be quite completely overcome, however, by an adequate nutrition seems indicated in the following case. In Fig. 8, to the left, will be seen a child of about six years of age living on Rarotonga Island. Her mother is a native Polynesian and her father a New Zealander. He was a mouth breather, had very irregular teeth and had suffered from rampant tooth decay. He adopted the native diet, which his wife supervised. They have seven children, the oldest nineteen. None of them have developed facial deformities and not one of them has had a single carious tooth. It will be noted that there is the normal development of spaces between the deciduous teeth prior to the eruption of the permanent incisors. To the right in Fig. 8 will be seen a Polynesian child who has erupted both the central and lateral incisor teeth and whose lateral incisors are entirely inside the dental arch. This child lived at the port of Rarotonga, Avarua, and both the mother’s nutrition during the gestation and lactation period and the child’s during the growth period have consisted largely of imported trade foods. It is apparent that the influence of inheritance was overcome in each case by the more controlling factor of deficient nutrition.

Fig. 8–At the left note the normal spacing between the deciduous upper incisors in anticipation of the eruption of the permanent teeth, the result of an adequate nutrition. At the right note that the permanent lateral incisors are erupting entirely inside the arch. This child was on a trade-food diet. Both are Raratongans.

 

Another important development from these investigations has been the accumulation of evidence in all these racial groups that it is the individuals who were injured in the developmental and growth periods who most readily fall prey to diseases such as tuberculosis and arthritis. All of the twenty boys and girls in the Juneau (Alaska) hospital suffering from pulmonary tuberculosis had gross deformity of the dental arches. Similarly, all of the eighteen individuals between twelve and forty in the Hilo sanitarium (Hawaiian Islands) suffering from pulmonary tuberculosis had facial and dental arch deformities; and similarly all of the boys and girls in the Honolulu tuberculosis hospital suffering from pulmonary tuberculosis between ten and thirty years of age, nineteen in all, had dental arch deformities.

These data seem to indicate that the defensive mechanisms of the body did not adequately develop in those individuals who had suffered from a deficient nutrition which had disturbed the growth of the bones of the face. It would be strange indeed, if only the hard structures of the face suffered from these deficiencies. The evidence is rapidly accumulating in connection with these studies that the size and shape of the pelvic arches are similarly affected.

A striking illustration of this is the case shown in Fig. 9, to the left, in which will be seen a girl whose lower third of the face had not developed forward normally. She could place her three fingers between the lower and upper teeth. She now has her first child and it is significant that a Cæsarian operation was required. In this case a marked improvement was made in the facial form, as will be seen in Fig. 9 to the right, by a combined surgical and orthodontic operation. This consisted of reducing the prominence of the middle third of the face to correspond with the lower third. It was accomplished by the extraction of the first bicuspid on each side above and the removal of a thin v-shaped piece of bone through the open sockets at the time of the operation. Immediate application of mild force in the form of an orthodontic appliance specially constructed was used, which drew the bone carrying the six upper anterior teeth backward sufficiently that the cuspids came in contact with the second bicuspids. This, as you will note, greatly improved her appearance.

 

Fig. 9–Note the extreme lack of development forward of the mandible, with narrowing of the upper arch. At the right the upper protrusion has been reduced by the extraction of the first bicuspids and the movement of the upper six incisors and their supporting bone backward en masse.

 

The problem as to whether this growth process is latent and how long it may remain so is a very important one. My clinical studies have accordingly been directed to ascertain to what extent changes may be made by reinforcing the dietaries of the individuals with suitable fat-soluble activators and natural foods rich in minerals, particularly phosphorus. The results have been most gratifying and encouraging. A typical case is shown in Fig. 10. In the view to the left, the girl was ten years and nine months of age and in the view to the right she was eleven years and eight months. The lack of development of the middle third of the face was such that the upper lateral incisors were occluding inside the lower cuspids at the time the first picture was taken. Under a reinforced dietary the middle third of the face has grown forward to the position shown to the right, in which the lateral incisors are one-eighth of an inch outside the lower incisors.

 

Fig. 10–Marked improvement in the growth of the bones of the face has been produced by a reinforced nutrition. At the left the upper incisors are inside the arch. At the right they are one-eighth inch forward of the lower incisors. Age ten years, nine months, and eleven years, eight months.

 

I have previously published another and more striking example, in which the girl was sixteen years of age.

SUMMARY

1. Remnants of several primitive racial stocks have previously been studied through a series of years with regard to the incidence of deformities and irregularities in the dental arches and in facial form.
2. The groups here presented studied in 1934 were Melanesians and Polynesians of the South Sea Islands and the Indians of Florida studied in February 1935. Among those living on the efficient native foods, not a single case of irregularity of the dental arches or facial form was found. Among modernized members of these groups where they were in contact with modern civilization and used its foods, particularly white flour and sugar products, many cases of gross irregularity were found.
3. The types of change in facial and dental arch pattern were the same in these groups as those discussed for the previous groups studied and reported, and the same as found among the members of modern civilization in America.
4. An example of typical pelvic arch deformity in an individual with marked facial deformity is herewith reported.
5. Evidence is presented which indicates that the dietary of the mother during gestation and lactation and of the child during the growth period determines the degree to which the ancestral physical pattern will be гергоduced.
6. The influence of nutritional deficiency is shown to change the racial pattern even in a single generation.
7. Even a marked deformity in the development of the father’s face is shown not to modify the form of the child where the mother had adequate nutrition.
8. The injury to the physical development as indicated by the change in pattern is shown to be accompanied by a reduction in the defense of the individual against such involvements as tuberculosis and arthritis.
9. Evidence that the disturbance in growth may be a latent factor is presented.

 

Editor’s note: Since the era in which this article was written, society’s understanding of respectful terminology when referring to ethnic and cultural groups has evolved, and some readers may be offended by references to “primitive” people and other out-of-date terminology. However, this article has been archived as a historical document, and so we have chosen to use Price’s exact words in the interest of authenticity.  No disrespect to any cultural or ethnic group is intended.

 

References Cited:

1. Price, Weston A.: “Why Dental Caries with Modern Civilizations?” Dental Digest, 39: March to August 1933; 40:52, 81, 130, 210, 240, February, March, April, June, July 1934.
2. Idem: “Eskimo and Indian Field Studies in Alaska and Canada on (a) Dental Caries; (b) Facial and Dental Deformities; (e) Lowered Defense for Disease; (d) the Nature and Route of the Defensive Factors through Nutrition; and (e) Practical Applications.” Journ. A. D. A., 1935. (In press.)