Although dental ablation has been documented among groups around the world, it is most often associated with early Austronesian communities, which included people in Taiwan, Southeast Asia, and Polynesia. The first evidence of the procedure dates back to around 4,800 BCE, during the Neolithic period, and the tradition continued into the early 20th century.
The procedure involved removing healthy teeth, including incisors and canines, without the use of anesthesia. The cavities were then filled with ash to stop bleeding and inflammation, according to a study published in the December 2023 issue of the journal Archaeological Research in Asia.
Examples of tooth extraction on two skeletons. Arrows indicate teeth that were removed during the procedure. Tsang et al., 2011a, Cheng-hwa Tsang
After collecting data from more than 250 archaeological sites across Asia, the researchers found that 47 of them contained burials from the Neolithic (4,800 to 2,400 years ago) to the Iron Age (2,400 to 400 years ago) in which the deceased were missing teeth. The practice was equally common among men and women. However, by the 1900s, it had become more common among the latter group. And it wasn’t just adults who sought dental care; children did, too.
Tooth extraction arrived on the island of Taiwan between 6000 and 4800 BC. The first date is a Paleolithic burial of women in the fetal position, with their teeth still intact, from the Xiaoma-5 cave. The second, 4800 BC, is the Nanguangli East (Nanguanglidong) and Anhe sites, where there is evidence of rice cultivation, and people buried in an extended position already had their teeth extracted. Apparently, tooth extraction was not practiced by Paleolithic hunter-gatherers, and was only undertaken by farmers. To trace the custom, scientists collected data from more than 250 archaeological sites and studied more than 1,300 reports.
Photos from 1935 – Taiwanese with extracted teeth. Photo 4 shows a tooth extraction device used by the Bunun people. Anthropogenesis Magazine
Clear evidence of intentional extraction of healthy teeth was found on 47 sites – the oral cavity of the deceased was in good condition, pathologies were not observed at the extraction sites, and the teeth were always extracted symmetrically. If the skeleton was missing a fair number of teeth or there were pathologies on the jaws, it was not included in the sample.
Typically, either the second pair of upper incisors and canines (2I2C1) or only the second pair of incisors (2I2) were initially removed. Over time, in men, incisor-only removal became less common, while the 2I2C1 type became more common. Given that burial types also gradually changed, this may indicate a cultural transformation. By 1900 BCE, teeth were being removed primarily from women and only in southern Taiwan, although this region may simply have better bone preservation.
Nine of the 16 indigenous peoples of Taiwan preserved the tradition until at least the mid-20th century. Ethnographers have identified three types of extraction — in addition to the above-mentioned 2I2C1 and 2I2, there is also the extraction of fangs (2C1). As a rule, this occurred after the change of teeth in children aged 6-8 years, but it could also happen later, up to 20 years, in both women and men. The method of extraction varied depending on the tribe: the tooth could be knocked out — for example, by placing a special “mediator” on the tooth and hitting it with all your might with a hammer. In this case, the root of the tooth could break and part of it would remain in the alveolus. Or the tooth was pulled out using bamboo sticks and thread. As a rule, this happened in the winter — to reduce the risk of infection, or in the fall at the beginning of the new year. After the operation, the mouth was covered with sedge ash.
The teeth were not thrown away – they were kept under a barn, on a thatched roof or simply under a bed. It was believed that girls with removed teeth were more desirable brides, and also more harmless to men. In addition, without teeth, a child finally became a human and was more different from animals. For men, going through the ritual was a symbol of courage.
Modern Maasai woman, Tanzania. Anthropogenesis Magazine
“The first and most frequently cited motivation was adornment, arising from the desire to stand out from the facial features of animals and to enhance personal attractiveness, particularly to the opposite sex,” the authors wrote in the study. “Interesting evidence highlights the desire for the sight of a scarlet tongue peeking out from between brightly colored teeth.”
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Researchers also believe that tooth extraction was seen as a “test of courage” – as anyone who has undergone major dental surgery can attest – as well as a preventative measure.
Additionally, “locals believed that tooth extraction could reduce the pain of tattooing or ease pronunciation difficulties,” the authors write. “In many cases, the visible result was seen as proof of bravery or a measure of maturity.”
Another reason, taken from ethnological records from Borneo and historical descriptions from southwest China, may be that if a person had tetanus, an extracted tooth would allow food and medicine to be given to him.
“This most pragmatic rationale for life-saving dental ablation may explain its persistence despite the painful nature of the procedure,” the researchers wrote in the study. “Although cases of jaw lockjaw may have been rare, the preventive care of tooth extraction outweighed the deadly prospects.” In 2023, in Aswan, southern Egypt, researchers still encountered local Nubian residents with missing upper incisors
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