Congenital malformations
Several deviations from the norm were noted in the studied collection, for which palaeopathology cannot clearly state whether they were just a variety without clinical manifestation or an anomaly. Patella bipartita type III (graves No. 3865 and 3866) and spina bifida on the sacrum (graves No. 3851 and 3866) were among these.
Pathological changes on the skeleton of a 20- to 30-year-old female (grave No. 3889) can be considered a true developmental defect of the spine. A vertebral block from L3-L5 was created here (Fig. 2a). The vertebrae were fused in the area of the right articular processes, without osteophytes. The vertebral bodies had a normal shape, the slits at the place of the intervertebral discs were preserved. On the radiograph, the vertebrae had a normal structure, which is typical for congenital vertebral block (Vyhnánek et al. 1998). The main cause of congenital synostosis is considered to be a segmentation disorder of the mesenchymal blastema of the sclerotomes during the development of the axial skeleton. This type of congenital anomaly (type II) is one of the most common anomalies of the spine (Barnes 1994). Interarticular spondylolysis (Fig. 2b) could also be another manifestation of a congenital developmental defect of the spine, although a traumatic origin cannot be ruled out unequivocally on this skeleton. It was a bilateral interruption of the L5 vertebral arch between the upper and lower articular processes (known as interarticular spondylolysis). The margins of the central fragment of the arch were rounded by the repair process, the dorsal part was not preserved. Due to the changed biomechanics of the lumbar spine, a pronounced osteophytes (up to 6.8 mm in size) were formed around the margin of the facies terminalis inferior of the 5th lumbar vertebra. The 1st sacral vertebra also has visible osteophytes around the upper terminal surface. In addition, this vertebra did not grow with the sacrum and was displaced, relative to the lumbar section of the spine, about 7 mm dorsally. This formation of the lumbosacral segment was most probably the result of spondylolisthesis, when the body of the affected vertebra (and the entire column of vertebrae located above it) is displaced in the ventral direction and the lower section of the spine is therefore located dorsally (Fig. 2c). This condition is usually associated with neurological problems (Vyhnánek et al. 1998, Dungl et al. 2005). Vertebral arch defects can appear not only independently, but also as one of the symptoms of genetically determined syndromes, such as chondrodysplasia punctata, Gorlin-Goltz syndrome, Klippel-Feil syndrome, etc. (Žižka 1994; Aufdeheide and Rodríguez-Martín 1998).
Spondylolysis was also found in the examined osteological collection on the skeletal remains of a young male (grave No. 3865). The find had a completely identical character. The interruption of the vertebral arch was also found on the 5th lumbar vertebra and was located in the area between the articular processes. The edges of the defect were rounded by the repair process. In this case, no other pathological change that could be considered a developmental malformation was observed on the spine of the affected individual. For this reason, a traumatic origin was considered in the aetiology of the finding. In most cases, acquired spondylolysis is considered a fatigue fracture due to repeated overloading of the spine (pseudoarthrosis), which would logically correspond to its occurrence in a functionally heavily stressed part of the spine. More rarely, it may be a direct single trauma (Wiltse et al. 1975). However, the congenital predisposition to spondylolysis under the influence of external factors must also be taken into account. This is evidenced by the gradually increasing incidence of this defect during childhood until adolescence (Fredrickson et al. 1984; Tsirikos and Garrido 2010). Furthermore, an increase in this defect with increasing age was also recorded in adulthood, where the main cause is apparently osteoporosis and degenerative changes (Kalichman et al. 2009). In historical populations, the incidence of spondylolysis is estimated at 4–8% (Aufdeheide and Rodríguez-Martín 1998). In the Czech Lands, spondylolysis was studied in detail in Slavic burial grounds (9th-10th centuries), an overview of which is given, for example, by Vyhnánek (1976). In agreement with recent studies, its incidence in European populations varies between 5–6% (Vyhnánek and Stloukal 1977). Czech skeletal collections from the period of the Funnel-beaker Culture are currently few in number, and therefore the occurrence of spondylolysis could not be evaluated objectively. To date, spondylolysis has been recorded on the 5th lumbar vertebra of a 24- to 30-year-old male from Prostějov-Čechůvky (Drozdová 2011) and also on the 5th lumbar vertebra of an 18- to 25-year-old female from Dambořice (Šmíd et al. 2021b).
The skull of a 12- to 14-year-old child (grave No. 3871) was among the most interesting findings of congenital malformations on the skeletons of people of the Funnel-beaker Culture from Modřice. After the partial reconstruction of the fragments of the cranial vault, it was evident that the cranium is noticeably long and narrow (dolichocranial), although the metric assessment must be considered, due to the fragmentary state, only as an indicative value (cranial index = 66.5). However, during a detailed study of the cranial sutures, it became clear that there was a partial intracranial obliteration of the sutura sagittalis near the lambda point (Fig. 3), in sections S3 and S4 according to Olivier (1960). The other cranial sutures had a very ragged course, in places with ossa suturarum. The formation of cranial sutures and their obliteration have been addressed by a number of authors since the time of Hippocrates (e.g. Olivier 1960; Acsádi and Nemeskéri 1970; Linc 1971; Hajniš and Novák 1984; Meindl and Lovejoy 1985). The results of their research are evidence of quite considerable individual variability in this area. However, everyone agrees that, under normal circumstances, the sagittal suture does not fuse until adulthood. In the case of the child's skeleton (grave No. 3871) from Modřice, this is a partial premature obliteration of this suture (known as craniosynostosis). As early as the end of the 19th century, Virchow found that premature fusion of one of the cranial sutures halts the growth of the skull in the plane perpendicular to this suture (Delashaw et al. 1991). Deformities of the neurocranium are then created by compensatory growth in the place of free sutures. With premature obliteration of the sutura sagittalis, the cranial vault is long and narrow (dolichocephalic) and resembles a boat in shape – scaphocephaly. In more severe cases, the affected individual may have increased intracranial pressure (craniostenosis), accompanied by neurological dysfunctions due to oppression of the central nervous system (Kajdic et al. 2018). Currently, the incidence of craniosynostosis in Czechia is relatively low, up to 0.1% (in newborns), and approximately one-half of them are scaphocephaly. It occurs more often in boys than in girls. Changes on the skull may be an isolated finding, or craniosynostosis is part of congenital syndromes, such as Crouzon, Apert, Muenke or Pfeiffer syndrome (Kubátová et al. 2019). No other skeletal development disorders were found on the studied skeletal remains of the child from Modřice with partial obliteration of the sutura sagittalis. For this reason, it was probably only an isolated defect in this case, either hereditary or acquired during embryonic development. Since the fusion of the sutura sagittalis was only partial on the examined skull and clearly visible only on the intracranial surface of the cranial vault, the deformity of the neurocranium was not too large (more details in Williams et al. 2023).
The aetiology of craniosynostosis is currently unclear, as suture fusion is regulated at the cellular level from the dura mater in integration with the surrounding tissues. Growth regulators are affected by many factors, for example fibroblast factor, transforming factor beta, migration factors, mechanical factors, etc. This complex signalling cascade can be disrupted by a whole range of genetic mutations, several dozen of which are currently known (Johnson and Wilkie 2011; Kajdic et al. 2018 ).
In the palaeopathological literature, a rare finding of scaphocephaly on female skeletal remains from the cemetery in Náměšt na Hané has been documented to date at Czech archaeological sites from the period of the people of the Funnel-beaker Culture. Due to the pronounced foveolae granulares and pathological changes on the bones of the lower limbs, it cannot be ruled out that this was part of one of the genetically determined syndromes. The burial of the body was also unusual in this case, which differed from the usual burial rite (Pankowská et al. 2010). Other Czech finds are dated to the modern era and were recorded in larger osteological collections from the ossuary in Křtiny and Broumov. Four cases of craniosynostoses were found in the Křtiny ossuary (13th-18th centuries), which represents 0.6% of the total number of evaluable skulls (N = 583). From these finds, the sutura sagittalis was obliterated in two skulls (Vargová and Horáčková 1996). In the Broumov ossuary (13th-18th centuries), craniosynostosis was recorded in 4.8% of skulls (N = 743), which is an incidence many times higher than in the recent population (Pospíšilová et al. 2003; Pospíšilová and Procházková 2006). The stated values are higher than the prevalence of this malformation observed by Kubátová et al. (2019) in the current Czech population (around 0.1%). The main cause of these differences can be considered as the fact that partial premature obliteration of the sutures, which does not cause noticeable shape deformations of the head and does not cause any functional disorders, is considered in common clinical practice as a variation. However, osteological studies can capture these cases, especially on children's skulls.
Other findings of premature fusion of cranial sutures from Czechia are deposited in various museum collections of medical faculties, dating from the 19th century to the present. These are mostly narrowly selective pathological collections without a specific historical context. However, they can serve as important comparative material in palaeopathological differential diagnosis.
Metabolic diseases
In palaeopathology, porotic changes on the roof of the orbits called cribra orbitalia are classified as non-specific manifestations of metabolic diseases (e.g. Møller-Christensen et al. 1963; Hengen 1971; Steinbock 1976). Many authors consider anaemia to be the main cause of these lesions (e.g. Moseley 1963; Aufderheide and Rodríguez-Martín 1998). However, it may only be one of the symptoms of another disease, for example kidney disease, digestive tract disease, vitamin deficiency (C, K, B6, B12) or haematogenous diseases (Ploier 2015). For this reason, it is always necessary to search for other causes of these changes (Wapler et al. 2004; Brickley 2018; Brickley et al. 2020).
In the studied skeletal group, cribra orbitalia was found on the roof of the orbits in 4 children (graves no. 3854, 3869, 3871, 3896) out of a total of 13 evaluable individuals (i.e. 30.7%). In most cases, these were several small openings (cribra orbitalia - grade I); only in the case of a single skeleton (grave No. 3854) were the changes more pronounced (cribra orbitalia - grade II). The recorded occurrence of cribra orbitalia at the investigated burial site falls within the range of values found during similar Central European archaeological investigations dating to the Neolithic (Ash et al. 2016, Bickle and Whittle 2013; Smrčka and Tvrdý, 2009).
When searching for the aetiology of cribra orbitalia in individual cases, in only one child's skeleton (grave No. 3869) was it possible to suspect that scurvy could have been the cause of it. The other findings can only be classified as non-specific stress manifestations acting on the examined population sample. The reason for suspecting scurvy in the individual from grave No. 3869 was the significantly increased porosity at both ends of the bodies of the long bones of the limbs near the epiphyseal cartilages and the simultaneous occurrence of tooth enamel hypoplasia. However, other typical diagnostic criteria for scurvy on the skull, established for example in the work of Ortner and Ericksen (1997), or on the long bones of the limbs (Brickley and Ives 2006; Dewitte and Bekvalac 2011), were not present. For this reason, it was not possible to unequivocally confirm avitaminosis C in this case.
Several possible symptoms of scurvy were noted on the skeletal remains of a 3- to 4-year-old child (grave No. 3850). Due to the damage, it was not possible to evaluate the occurrence of cribra orbitalia and possible enamel hypoplasia on the damaged enamel in this individual, but there was newly formed bone tissue around the infraorbital foramen on the right upper jaw. A similar periostotic lodgement was also noted on the tuber maxillae, on almost the entire length of the arms on the inner side of the mandible (mostly in the area of the canalis mandibuale).
Periosteal new bone formation was also observed on the postcranial skeleton – on the inner and outer sides and in the sulcus costae of most of the preserved rib fragments, in the sternal end of the right clavicle, on the bodies of both humeri (Fig. 4), in the entire range of the bodies of both forearm bones (left, to a lesser extent). The skeleton of the lower limbs was equally affected. Newly formed bone tissue was noted on both hip bones, on the ventral surface of the distal third of the body of the right femur, on the bodies of both tibiae (mostly around the foramina nutricia) and fibulae (Fig. 5).
All the described changes on this child's skeleton (grave No. 3850) corresponded to the diagnostic criteria of scurvy (Ortner and Ericksen 1997; Pimentel 2003; Stark 2014; Snoddy et al. 2018). In the differential diagnosis, leprosy was considered, although it causes enlargement of the openings on the skull for the penetration of branches of the trigeminal nerve and pitting on the bones of the facial skeleton. However, the palatonasal destruction and resorption of the bones of the hands and feet, typical for this disease, were absent (Møller-Christensen 1961; Buikstra 2019).
Syphilis congenita was also excluded, because in addition to periostotic lodgements on the long bones of the limbs, there were no dental stigmata, palatonasal destruction or other deformities (e.g. Hackett 1976; Suzuki 1984; Ortner and Putschar 1985; Buikstra 2019).
Traumas
When studying even the few skeletal collections from various historical stages, traces of trauma are common findings. They were also described on the skeletal remains of the Funnel-beaker Culture (Horn 2021). Pathological changes were also recorded on the studied skeletons, which could have been caused by injuries. This group usually includes separation of part of the articular cartilage (osteochondritis dissecans), which manifests itself on dry bones as a minor depression on the joint surfaces. The edges of these defects are rounded by the repair process, the bottom is usually smoothed (Aufheide and Rodríguez-Martín 1998; Ortner 2003, Waldron 2009). A round focus on the sternal joint surface of the left clavicle with the size of about 6x4.8 mm in one of the female skeletons from Modřice (grave No. 3862) had the same character. Current research shows that there may be more aetiological factors involved in local damage to articular cartilage. According to Bruns et al. (2018), not only repeated long-term microtrauma or direct injury, but also metabolic disease, avascular necrosis due to insufficient nutrition of the articular cartilage, genetic predisposition, infectious disease or local morphological deviations from the norm can contribute to the development. However, several factors can cause osteochondritis simultaneously. The high incidence of osteochondritis dissecans in osteological collections of historical populations can also be considered as one of the indicators of increased physical load on a given population group (Wells 1974; Vikatou et al. 2017).
Repeated microtraumatisation of muscles (e.g. during long-term excessive strain) may lead to their partial ossification (myositis ossificans posttraumatica). This manifests as a bony outgrowth at the site of the origin of the muscle or its attachment (Aufderheide and Rodríguez-Martín 1998). An example of this condition may be the growth on the lateral edge of the right scapula at the site of the origin of the teres minor on a male skeleton (grave No. 3866). However, it should be noted that the pathophysiology of the processes leading to the development of myositis ossificans has not yet been fully clarified (Walczak et al. 2015).
Changes on the left 5th metacarpal bone on the skeleton of a young male's hand (grave No. 3872) are probably of traumatic origin. This bone was shorter, thicker, and its base had a thick and deformed articular surface. On the radiograph, a periosteal reaction was evident in this site; it was most probably a soft tissue injury with a subperiosteal haematoma, which gradually ossified.
A soft tissue injury with subsequent damage to the bones of the cranial vault could not be ruled out even in the case of the skeleton of a 50- to 60-year-old male (grave No. 3866). Two shallow depressions were observed in the front section of the left parietal bone. One of them was located approximately 15.2 mm from the sutura coronalis; it had a round shape with a diameter of about 17.5 mm. A second, smaller depression (with a diameter of about 11.8 mm) was found more dorsally. The surface of both pits is smooth, the edges are rounded and they pass into the surroundings without a clear boundary. The depressions were probably caused by trauma or pressure, for example, by benign tumours (lipomas) or cysts (atheromas).
There are traces of healed fractures in almost every skeletal collection. Diagnosis in these cases is usually based on X-ray examination. A small healed fracture was also found on one of the proximal phalanges of a female's hand (grave No. 4809). In this case, it was most probably an accidental injury during a daily activity.
Among the most significant traumatic changes from the Modřice osteological collection was a find on the skeleton of a 3- to 4-year-old child (grave No. 3881). On the left parietal bone, in the lower part, there is an extensive fracture in the shape of an inverted letter U, with a convexity directed dorsally with a radius of about 5 cm (Fig. 6). The fracture lines have sharp edges, are slightly bevelled and show no signs of healing. The fragments correspond to each other. Five radial cracks spread around the defect. The first goes to the squamous part of the frontal bone, the second to the parietal bone towards the sutura sagittalis, the third runs to the lambda, the fourth goes to the squamous part of the occipital bone, the fifth then reaches almost to the mastoid process. In this case, the differential diagnosis between perimortem and postmortem injuries was the most challenging. However, the finding totally corresponded to the fact that the bone was still flexible at the time of the injury. This is evidenced by the sharp edges of the broken parts of the defect, evident cracks around the defect, the individual bone fragments matched in shape and size and enabled the reconstruction of the cranial vault (Aufderheide and Rodríguez-Martín 1985; Lovell 1997; Horáčková et al. 2004). It is therefore obvious that the described comminuted fracture of the left part of the cranial vault most probably occurred perimortally, apparently by a blow to the head with a blunt object. Such an extensive injury with no signs of repair most probably damaged the brain and was the cause of the child's death. Due to the considerable extent and localisation on the left side of the cranial vault, the anthropogenic origin of the trauma (wound inflicted by a right-handed person) cannot be ruled out. It is also necessary to speculate about the possible fall of a small child from a great height. The method of burial of this child is also interesting, which is different from the others. The child was one of two individuals buried in the settlement's pits.
Inflammations
Traces of inflammatory processes in the skeletal remains from Modřice were not frequent, with the exception of lesions in the oral cavity at the roots of the teeth and inflammation of the attachment apparatus of the teeth – periodontal disease, the description of which is found in dental diseases. In two cases, fine lodgements of newly formed bone tissue around the external auditory canal were observed on children's skeletons (graves No. 3850 and 3854). In these places, the surface was finely perforated, slightly bumpy, but rounded by the repair process. It can be assumed that these were signs of otitis media.
Several shallow depressions on the skull of a 50- to 60-year-old female (grave No. 4809) in the area of the linea nuchae inferior was a rare finding. The surface of these pits was bumpy, with a few very fine pits and signs of healing. Apparently, this was a chronic inflammation of the soft tissues in the occipital region, which partially spread to the bone. Near the depressions, on the left side of the squamous part of the occipital bone (about 18 mm from the crista occipitalis externa), there is an opening of approximately oval shape (transversely measuring 18x14.3 mm). From the outside, the edges of the defect are scalloped, but rounded by the repair process. From the inside, the opening in the ventral part is wider and its edge is bevelled (Fig. 7). It is possible that the perforation of the skull occurred as a result of an osteolytic inflammatory process. However, it could also have been skull trauma, complicated by chronic inflammation of the surrounding tissues. In this case, the indentation of the edges of the opening could also have been caused artificially, with a trepanation tool, when trying to clean the defect. However, the area around the lesion is partially damaged, so it cannot be examined in more detail.
Joint diseases
Among joint diseases, even in small osteological collections, mainly degenerative productive changes are always found. The skeletal remains from Modřice were no exception. These changes were noted mainly on the spine, where they affected the vertebral bodies (spondylosis) or the intervertebral joints (spondylarthrosis). It was possible to assess the condition of the spine in 12 adults (4 males and 8 females). In total, 234 vertebrae (64 cervical, 116 thoracic and 54 lumbar, i.e. an average of 19–20 vertebrae per individual) and 8 sacral bones or their parts were studied. Degeneratively productive changes were noted on one-half of them. They had the character of small erosions on the terminal surfaces of the vertebral bodies, osteophytes of varying size around their perimeter, or there were also variously deep depressions with rounded edges and bottoms on the terminal surfaces. These depressions are Schmorl nodes, which are caused by the protrusion of the nucleus of the intervertebral disc (nucleus pulposus) towards the vertebral body (Kahl et al. 2000; Mattei and Rehman 2014). The most affected part of the spine was the lumbar section, then the cervical, and the least changes were in the thoracic vertebrae. However, the interpretation of the findings is difficult. Degenerative changes of a smaller scale in individuals older than 40 years can be considered as a manifestation of the natural wear and tear of the locomotor system with age. For that reason, it is possible to consider degenerative changes in individuals younger than 40 years, or in older people with advanced stage manifestations, as a real disease (Dobisíková 1999). These include osteophytes bigger than 3 mm, eburnation and significant destruction of joint surfaces, geodes of large dimensions. In this context, then the actual diseases of spondylosis and spondyloarthrosis would only be in 3 individuals, namely in 1 male (grave No. 3866) and 2 females (graves No. 4805 and 4809). A special case is secondary spondylosis in the area of the lumbosacral segment in a young female (grave No. 3889), which originated as a complication of spondylolysis with subsequent spondylolisthesis. Schmorl's nodes on fragments of the bodies of four lumbar vertebrae of a 16-to 19-year-old subadult girl (grave No. 3860) are also an interesting find. In the differential diagnosis, in this case, the cause of Schmorl's nodes was considered not as spondylosis, but juvenile kyphosis, called Scheuermann's disease. This occurs in 0.5 -8% of the Czech population. This disease is typical for adolescent individuals in the period of growth acceleration. This is a structural defect of the vertebrae, which take on a wedge shape and cause, usually at the transition of the thoracic and lumbar sections, a kyphotic curvature of the spine. The aetiology is still unclear; factors such as osteopenia, hormonal imbalance, ischaemic necrosis, genetic influences, etc. are considered (Chaloupka et al. 2009; Mattei and Rehman 2014, Lewis 2018). The vertebrae of the affected girl were preserved only in fragments, so their shape could not be determined with absolute certainty. The diagnosis therefore remains only suspect in this case. In the palaeopathological literature, possible cases of juvenile kyphosis from the Late Iron Age were described by Anderson and Cartner (1994), from the Roman period by Lópéz-Lázaro et al. (2012) and from the 13th-14th centuries by Üstündağ and Deveci (2011).
Degenerative changes in the form of arthrosis were noted in three adults (graves No. 3866; 4805 and 4809). Damage to the left temporomandibular joint was observed in the skeleton of a 50- to 60-year-old male (grave No. 3866), who had erosion of the joint surface on the left head of the mandible. No pathological changes were evident on the right side. Inflammatory lesions at the roots of the teeth could have been the cause of the asymmetric involvement of the temporomandibular joints. During chewing, both temporomandibular joints were therefore unevenly loaded due to pain. In a 40- to 50-year-old female (grave No. 4805), arthrotic changes were observed in the similarly fine bony rim on the ventral part of the facies lunata and around the facies symphysialis of both pelvic bones. It is therefore clear that this was a case of incipient arthrosis of both hip joints, which in this case can be considered as age-related wear and tear of the joints. Similarly, a sign of ossification of the ligamentum tibiofibulare anterius in the form of a light periostotic reaction in the distal part of the right tibia (proximal to the incisura fibularis) can be considered as a natural manifestation of the aging of the locomotor system. The same interpretation of the finding of degenerative changes in the sternoclavicular and shoulder joints was also found in the skeleton of a 50- to 60-year-old female (grave No. 4809).
The diagnosis of this type of joint changes is not difficult, but the comparability of findings between individual population samples is problematic. The reason is a different perspective on the assessment of degenerative changes of individual palaeopathologists (e.g. Crubézy et al. 2002; Nikita et al. 2013; Woo et al. 2013).
Dental diseases
The main indicator of dental health assessment in historical populations is primarily the study of dental caries. In the studied skeletal remains from Modřice, a total of 381 teeth were examined (224 teeth from 9 adults and 85 permanent and 72 milk teeth from children), as well as 287 dental alveoli.
To quantify the occurrence of dental caries, the total caries frequency index (F-CE) in the studied sample of the adult population was determined to be 77.7% and the caries intensity index (I-CE) to be 13.3%, while in males I-CE was slightly lower (10.0%) than in females (15.8%). Not a single tooth caries was recorded on the evaluable skeletons of juvenile individuals, therefore they are not included in the overall results.
It should be noted that the values found are only indicative, due to the small number of individuals examined (N = 9). Extreme findings in individuals could therefore significantly influence the result, e.g. a male (grave No. 3853) had 5 caries, a female (grave No. 4809) lost 14 teeth intravitally, while 2 young males (graves No. 3872 and 4811) had dentition without caries and intravital losses.
Comparing the results with other collections from the period of the people of the Funnel-beaker Culture is problematic, because mostly only isolated finds or only a few in number skeletal collections are available. Based on the study of Jarošová et al. (2022) of several similarly dated skeletal collections, including the presented skeletal collection from Modřice, the average I-CE in this period in the Czech Lands was 6.1%.
Caselitz (1998) attempted a worldwide diachronic capture of decay development, using the I-CE index. Based on his research, the I-CE is around 4.0-5.3% in the Paleolithic, Mesolithic and Early Neolithic (up to about 4500 BC). With the development of agriculture, in the Neolithic, there is a sudden rise to 7.0%, reflecting the increased amount of sugars in the diet. From the Middle Bronze Age (about 2350 BC), a gradual rise begins (e.g. around 500 BC it is 13.0%), and around 750 it reaches 17.0%. Throughout the Middle Ages, I-CE values are relatively stable (15.0–16.0%). Only at the beginning of the modern age does a very sharp rise begin, which is associated with the importation of new foods into Europe from America (mainly potatoes).
A similar study for Central Europe was compiled by Strouhal (2004). According to his results, tooth decay in Europeans was also very minimal in the oldest periods (2–5%), but its increase occurred only in the Early Bronze Age (8.0%). From the 1st century, however, significant differences were noted in individual population samples (from 3.5–14%), probably in connection with the stratification of society. Differences were also recorded during the Migration Period between Germanic tribes, with low I-CE values (2–5%) and Slavic tribes (10–30%).
In the Czech Lands, Stránská (2013) focused on monitoring caries from prehistoric times to modern times, noting its gradual rise from the Neolithic (7.8%) through the Middle Ages (9.6%) to the modern times (13.2%). Even in this work, however, large differences between individual social groups of the population were captured. In summary, it can therefore be stated that, in the past, tooth decay in the Czech Lands was generally higher than in the global and Central European comparisons. Taking into account the above-mentioned data, the frequency and intensity of decay in the collection from Modřice are very high even by Czech standards. The state of preservation of the dentition, necessary for comparing the results with similar locations, was assessed on the basis of commonly used comparative indices. The comparative alveolar index (CAI) had a value of 99.7%, which meant that the damage to the dental alveoli was minimal in the examined individuals. The comparative dental index (CDI) reached a value of 84.7% (males 81.3%; females 87.5%). Almost 100% preservation of alveoli and 85% preservation of teeth are unusually high, considering the age of the collection. A detailed comparison of the dental caries' results of residents from Modřice with similar studies from the Neolithic period is given in their work by Jarošová et al. (2022). Based on their research, along with dietary research, the inhabitants of Modřice consumed mainly plant food, such as wheat, which was rich in carbohydrates (Drtikolová Kaupová et al. 2023). A congenital predisposition to this disease cannot be ruled out, which may be supported by future studies of congeniality.
Of the genetically determined dental defects, an interesting finding on the upper jaws of a 30-to 40-year-old male (grave No. 4811) was a supernumerary tooth – mesiodens. The tooth was located between the incisors and protruded into the nasal cavity in close proximity to the spina nasalis anterior on the left side (Fig. 8a). On the radiograph, it was pin-shaped (Fig. 8b). As a result, there was asymmetry of the lower part of the apertura piriformis. An even more pronounced deformation of the nasal landscape due to the presence of a mesiodens was described, for example, by Wood and Mackenzie (1987). Mesiodens is the most common type of supernumerary tooth (hyperodontia); its prevalence in individual populations ranges from 0.09–2.05%. Its typical localisation is in the upper dental arch in the middle plane between the incisors (in 82%). Rarely, it can also occur in the lower jaw. There is usually only one mesiodens, but more can be found. It can be conical, pin-shaped, tube-shaped, or resemble a normal tooth. Its occurrence has been observed mainly in the permanent dentition, it is a rare finding in the deciduous dentition (Meighani and Pakdaman 2010).
Mesiodens may be a separate dental anomaly, or be part of the symptoms in several congenital syndromes, such as Gardner's syndrome, dysostosis cleidocranialis, palatognathoschisis, etc. (Subasioglu et al. 2015). No bone changes were observed on the studied male skeleton from Modřice, which would indicate a genetically determined syndrome. In this case, the mesiodens was probably only an isolated finding.
Congenital dental deviations can also include orthodontic anomalies, such as dental crowding. This condition was evident in the mandible of a 3- to 4-year-old child (grave No. 3850), where the unerupted incisors were so pressed together that the incisal margin of the right mesial incisor was almost in the sagittal plane. There was also a lack of space for the teeth in the left upper jaw of the female from grave No. 3851, where the canine was significantly rotated.
Of the inflammatory changes that can occur in the oral cavity, these are primarily periapical granulomas or cysts. They most often originate as a complication of deep caries extending into the medullary cavity. The infection can thus penetrate from the oral cavity through the root canal to the bone. In palaeopathology, only traces of a periapical granuloma or a radicular cyst can be observed in the form of cystic formations of various sizes near the tooth roots. They can open with a channel (fistula) or one of their sides to the surface of the bone. A periapical granuloma is usually small in size (up to 10 mm), while a radicular cyst is larger. Both formations can only be distinguished histologically (a granuloma is filled with granulation tissue with fibroblasts; a cyst is a bag formed by an epithelial lining and a fibrous capsule). Traces of periradicular inflammation were recorded on the studied skeletal remains of 2 males (graves No. 3866; 3853) and 3 females (graves No. 3851, 4805, 4809).
Other inflammatory changes in the oral cavity can be attributed to periodontal disease, which is inflammation of the attachment apparatus of the teeth and surrounding soft tissues. The causes of its occurrence are various. Most often, the disease is caused by bacteria from dental plaque, which is considered the main cause of marginal gingivitis. In chronic forms of periodontal disease, calculus, which is formed by ossification of dental plaque, is mainly involved in the development of aseptic inflammation. This then mechanically irritates the surrounding soft structures. Gingivitis is one of the typical symptoms of some general diseases, especially scurvy (Ortner and Eriksen 1997; Snoddy et al. 2018), diabetes mellitus, endocrine imbalance (puberty, pregnancy, menopause), when the body's defences are reduced by some serious disease (for example, in leukemia). However, the cause can also be a congenital, genetically conditioned disposition (Dřízhal 2003).
On the skeletal remains, periodontal disease is most often manifested by porosity or indentation of the edges of the alveoli. There may be horizontal destruction of the tooth bed, resembling the physiological atrophy of the alveolus with age or, conversely, bone neoplasia. The dental alveoli are then lined with ridges that resemble an abnormally large torus maxillaris or mandibularis (Brothwell 1972; Strouhal 2004).
In the studied osteological collection, it was possible to assess the condition of the jaws in a total of 19 individuals (11 adults and 8 children), of which signs of periodontal disease were observed in 6 cases (i.e. 31.5%; see Table 1). Comparison with other localities is quite problematic, as a standardised evaluation system has not been universally adopted. Strohm and Alt (1998) tried to create criteria for the evaluation of periodontal disease in palaeopathology, according to the distance between the enamel and cementum border to the alveolar edge (up to 2 mm – standard; between 2–4 mm – 1st degree; between 4–6 mm – 2nd degree and above 6 mm – 3rd degree). However, the natural loss of bone tissue of the dental alveolus with age can significantly distort the result of this method. In addition, gingivitis often also results in bone neoplasia, which this classification does not account for. Nevertheless, it is known that this disease already occurred in the Paleolithic, and its frequency began to increase from the Neolithic (Brothwell 1972; Strohm and Alt 1998; Strouhal 2004).
Table 1
Summary of paleopathological findings on the skeletal remains of the Funnel-beaker Culture from Modřice (Brno-Country District)
| Grave No. | Sex | Age | Finding |
| 3850 | child | Infans II (3–4 yrs) | dental crowding otitis media scurvy |
| 3851 | F | A I (20–25 yrs) | dental caries dental crowding periapical inflammation periodotal disease dextroscoliosis |
| 3853 | M | M I (40–55 yrs) | dental caries periapical inflammation periodotal disease spondylosis periostosis on both fibulae |
| 3854 | child | Infans III (7 yrs) | cribra orbitalia (II) otitis media |
| 3857 | M | A | without pathological findings |
| 3858 | F | J (15–19 yrs) | without pathological findings |
| 3859 | child | Infans II (3–4 yrs) | without pathological findings |
| 3860 | F | J (16–19 yrs) | discopathy of lumbar spine |
| 3862 | F | A II (35–40 yrs) | dental caries osteochondritis dissecans |
| 3863 | child | Infans III (11–12 yrs) | without pathological findings |
| 3865 | M | A I (20–30 yrs) | intraarticular spondylolysis L5 patella bipartita (III) |
| 3866 | M | M II (50–60 yrs) | occipital bone depressions dental caries periapical inflammation periodotal disease spondylosis ad spondylarthrosis arthrosis myositis ossificans patella bipartita (III) |
| 3869 | child | Infans III (7–8 yrs) | cribra orbitalia enamel hypoplasia porosity on ends of long bones |
| 3871 | child | Infans III (12–14 yrs) | cribra orbitalia (I) craniosynostosis |
| 3872 | M | A I (20–30 yrs) | periodontal disease 5th metacarpal bone trauma |
| 3878 | child | Infans II (3 yrs) | asymmetry of cerebral fossae |
| 3881 | child | Infans II (3–4 yrs) | perimortal fracture of cranial vault |
| 3889 | F | A I (20–30 yrs) | dental caries enamel hypoplasia synostosis of L3-L5 intraarticular spondylolysis of L5 spondylosis of lumbar-sacral segment |
| 3896 | child | Infans II (2,5 − 3 yrs) | without pathological findings |
| 4805 | F | M II (40–50 yrs) | periodontal disease dental caries periapical inflammation spondylosis of L4, L5, S arthrosis of facies lunata, facies symphysialis periostosis on right tibia |
| 4809 | F | M II (40–50 yrs) | dental caries periapical inflammation traces after inflammation on occipital bone trauma – skull perforation spondylolysis spondylarthrosis phalanx fracture arthrosis of sternoclavicular joints omarthrosis |
| 4811 | M | A II (30–40 yrs) | mesiodens (polydontia) periodontal disease spondylolysis spondylarthrosis osteochondritis dissecans myositis ossificans |