This paper presents a preliminary orofacial analysis of a subadult population of
Hvar, a Croatian island in the Adriatic. Its population represents one of the last genetic
isolates in Europe and has therefore been the object of intensive crossdisciplinary research
over the last 30 years.We focussed on the coefficient of endogamy on the one hand
and malocclusal-related caries on the other hand, and expected differences in the latter
between subgroups of the population. We analyzed 224 dental casts from children all
over the island and found multiple caries in approximal surfaces in 55 percent of the
children, but no significant differences between the subpopulations. Instead, significantly
more caries affection was found in the boys than in the girls. The percentage of
general caries affection is fairly high, even when compared to other isolated populations;
it may be due to environmental influence. This would be consistent with the other
results, which have putatively been caused by complex environmental influences and
not solely by genetic components

H. Prossinger

K. Schäfer

M. Šlaj

T. Lauc

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Coll. Antropol. 24 Suppl. (2000) 1: 63–69UDC 616.314(497.5)Original scientific paperOrofacial Analysis on the AdriaticIslands: 1. The Island of Hvar as aModel for Odontogenetic ResearchesT. Lauc1, K. Schäfer2, H. Prossinger2 and M. [laj31 Institute for Anthropological Research, Zagreb, Croatia2 Institute of Anthropology, University of Vienna, Vienna, Austria3 Department of Orthodontics, School of Dental Medicine, University of Zagreb, Zagreb,CroatiaA B S T R A C TThis paper presents a preliminary orofacial analysis of a subadult population ofHvar, a Croatian island in the Adriatic. Its population represents one of the last geneticisolates in Europe and has therefore been the object of intensive crossdisciplinary re-search over the last 30 years. We focussed on the coefficient of endogamy on the one handand malocclusal-related caries on the other hand, and expected differences in the latterbetween subgroups of the population. We analyzed 224 dental casts from children allover the island and found multiple caries in approximal surfaces in 55 percent of thechildren, but no significant differences between the subpopulations. Instead, signifi-cantly more caries affection was found in the boys than in the girls. The percentage ofgeneral caries affection is fairly high, even when compared to other isolated popula-tions; it may be due to environmental influence. This would be consistent with the otherresults, which have putatively been caused by complex environmental influences andnot solely by genetic components.IntroductionIn this paper, we examine the dentalstatus of a subadult population of Hvar, aCroatian island, in order to augment theprevious research of the island’s demo-graphic parameters. As a part of the Mid-dle Dalmatian population, those living inHvar, or its neighboring islands of Bra~and Kor~ula and the peninsula of Pe-lje{ac, as well as the northern Adriatic is-lands of Krk, Lo{inj, Olib, Silba and Creshave been studied holistically for overthirty years. Heretofore, the character-ization and quantification of the dentalstatus has been lacking. Since the very is-63Received for publication June 19, 2000.sue of determining the dental status canbe considered a reliable indicator of boththe socio-economic situation and the ge-netic structure of a population, an analy-sis of the orofacial system should be ofsignificant interest.The population of Hvar, as well as ofthe other middle Dalmatian islands, rep-resents one of the last genetic isolates inEurope and can therefore be consideredan ideal model for the multidisciplinaryresearch of evolutionary processes. Mi-gration analyses showed that between1900 and 1981 only 8% of the presentsubadult population had parents bornoutside the island1. A coefficient of endog-amy of 0.76 indicates the very limitedgene pool. Studies showed that the coeffi-cient of inbreeding from isonymous mar-riages in some villages was as high as0.39 and the coefficient of kinship 0.10.The coefficient of kinship for the whole is-land was 0.041; the only higher coeffi-cient ever found was 0.092 in Amish, Ne-braska, USA2. Due to ethnohistorical andcultural differences, the proportion of iso-nymous marriages ranges from 5%–35%3.Brief ethnohistory of the islandA detailed description of the ethno-historical processes that had a major im-pact in shaping the island's populationstructure have been reported elsewhe-re3–15. The settling of the island Hvar ismarked by two major waves of immigra-tion: the first one between the 6th and8th Century, when the Croats (Slavs) set-tled throughout the entire island (creat-ing the population substratum), and thesecond wave when the peoples from themainland Balkans (especially from theDinaric mountain chain) settled predomi-nantly in the eastern region of the islandmainly due the Turkish wars of the 16thand 18th Centuries, and especially theCandian war of the mid-17th Century16.These latter immigrants created a super-stratum of newly arrived inhabitants,who thereby could potentially become agenetic admixture to the then endemicpopulation. Instead, these two major wa-ves of immigration have resulted in twoisland subpopulations: one that settledmostly in the western part of the island,speaking the so-called »~akavian« dialectof the Croatian language and the otherone, speaking the »{tokavian« dialect,settled mostly in the eastern part12,17,18.Even today, these two subpopulationshave largely remained reproductively iso-lated due to various ethnohistorical, eco-nomic and geographic reasons; they in-deed represent two distinct stra-ta4,5,8,10,11,16,19.During these ongoing encompassinganthropological investigations of the ru-ral populations of the eastern Adriatic is-lands of Croatia, various measures of in-terpopulation distances are used toassess the population structure. Studieshave revealed significant differences in:the ethnohistorical and demographic cha-racteristics of the island subpopula-tions8,15, their migration trends13, theirquantitative and qualitative dermatogly-phic traits of the digito-palmar com-plex4–7, their morphological9,20 and physi-ological21 traits; their basic and culturalvocabulary12,17,18 the morphometric fea-tures of their metacarpal bones22, and,furthermore, their differences as shownby erythrocites antigen analyses23, sero-genetical polymorphism24 isolation by di-stance14, isonymy3 and VNTR DNA ana-lyses 25.A systematic analysis of the orofacialsystem has not yet been carried out. Werestrict our analysis to the incidence ofmalocclusial-related caries and the rela-tion with the coefficient of endogamy. Weexpect that a high proportion of endog-amy could correspond to a low rate ofheterozygosity, leading to developmentalinstability26,27, manifesting itself in –among other things – a high incidence ofmalocclusion. Therefore, we expect to64T. Lauc et al.: Orofacial Analysis in Hvar, Coll. Antropol. 24 Suppl. (2000) 1: 63–69find a fairly high proportion of maloc-clusal-related caries problems in the twosubpopulations, and we hypothesize thatthe subpopulation with the higher degreein endogamy suffers a significantly hi-gher incidence in malocclusion and ap-proximal surface caries. These prelimi-nary results will be a model for furtherdental, intermaxillar, anthropometrical,morphometric and other analyses consti-tuting the study of genetic epidemiologyof the orofacial system on Hvar and otherCroatian islands.Materials and MethodsIn 1999 a team from the Institute forAnthropological Research, Zagreb, con-ducted a survey of school children onHvar, Croatia. The sample consisted of224 dental casts of children from all overthe island, representing about 90% of thecohort of the Eastern population (N = 31)and about 20% of the cohort of the west-ern population (N = 193). The children,aged 7–14 years had a sex distribution of126 boys (56%) and 98 girls (44%). Theage distribution was almost uniform forboth groups.Upper and lower alginate impressionswere taken and poured in dental stone.The sample was divided into the threegroups of dental development: primarydentition only, mixed dentition, or sec-ondary dentition only. For this study, thechildren were divided into two groups, ac-cording to the incidence of untreatedcaries: a caries »affected« and a »non-affected« group. In order to incorporatecaries as an environmental factor in theetiology of malocclusion, only multiple ca-ries on approximal surfaces were consid-ered. Following Brin et al.28 caries-af-fected occlusion was defined as a multiplemesial or distal carious lesion or a prema-ture extraction with resultant tooth gaploss.The criterion for the regional classifi-cation of the children was the place ofbirth of their grandparents.After compiling descriptive statistics,significance testing between the groupswas done using the Chi-Square-test.ResultsIn the total sample, caries-affectedchildren predominated: 54.5% had multi-ple caries on the approximal surfaces.The sex distribution was asymmetric:60% of the boys had caries versus 48% forthe girls (P < 0.05).We found no significant difference inthe frequency of caries distributionamong the two subpopulations. In theeastern part, 68% of the children had car-ies afflictions, as statistically expected byPearson’s Chi-Square-test, and amongthe western population only 52.3% sho-wed caries affliction, also as expected (Ta-ble 1).65T. Lauc et al.: Orofacial Analysis in Hvar, Coll. Antropol. 24 Suppl. (2000) 1: 63–69TABLE 1CARIES OCCURENCE BY SUBPOPULATIONSSubpopulation N(Fraction of total)Caries statusAffected (fraction) Not affected (fraction)EasternStd. Residual31 (14%) 21 (68%)1.010 (32%)–1.0WesternStd. Residual193 (86%) 101 (52%)–0.492 (48%)0.4Total 224 (100%) 122 (55%) 102 (45%)Table 2 shows the distribution of car-ies and the distribution of dentition in thedifferent age groups which is graphed inFigures 1a and b.DiscussionInvestigative models based on oralhealth status are not unknown in inter-disciplinary and multidisciplinary stud-ies. One such study was established onthe Koster islands, where assessment ofhealth criteria could be followed by pre-ventive medical, odontological and psy-chosocial measures if the need should ari-se29. Populations (by necessity: small)having a specific ethnohistory – be it dueto migration, epidemic specificity, or so-cio-cultural barriers – are rare. The is-land of Hvar represents an exceptionallywell-characterized, genetically isolatedpopulation30.Most of the previous analyses of theHvar population were based on migra-tional8,13, socio-cultural12,17, anthropo-metric9,20, physiological21, dermatogly-phic6–8,31,32, radiogrammetric1 or geneticdistances1. All such analyses clearly dem-onstrated the division of the island vil-lages into two basic clusters: one from thewestern and the other from the easternpart. Juxtaposing these results with theincidence of caries in schoolchildren, nodifference between the eastern and thewestern part of the island could be de-tected. The environmental componentseems to have at least as much influenceon the dental status as any hypothesizedone. However, a tendency of less occlusalproblems and therefore less caries in thewestern part is suggested by the data,even if there is no identifiable parametersuch as the degree of preventive or pro-active measures. The dental status re-sults suggest the predominance of verycomplex and important interactions be-tween ethnohistorical, political, econo-mic, sociocultural, epidemiological, andaspects of the peculiar island demogra-phy.Another finding was the decrease incaries with age; a finding which could berelated to the change from deciduous topermanent dentition. The increase of car-ies-affected children is maximal with theeruption of the first molar. The propor-tion of incidences decreases with the on-set of mixed dentition. The decrease of66T. Lauc et al.: Orofacial Analysis in Hvar, Coll. Antropol. 24 Suppl. (2000) 1: 63–69TABLE 2CARIES OCCURENCE AND TYPE OF DENTITION BY AGE OF THE CHILDRENCaries DentitionAge(months)Affected Non-affected Deciduous Mixed Permanentn % n % n % n % n %81–90 10 77 3 23 13 100 0 0 0 091–100 18 95 1 5 14 74 5 26 0 0101–110 24 75 8 25 18 56 14 44 0 0111–120 18 82 4 18 5 23 17 77 0 0121–130 12 52 11 48 2 9 14 61 7 30131–140 6 29 15 71 2 10 3 14 16 76141–150 10 48 11 52 0 0 7 33 14 67151–160 7 32 15 68 0 0 3 14 19 86161–170 7 30 16 70 0 0 1 4 22 96171–180 10 36 18 64 0 0 0 0 28 100caries with age is not a real improvementin the dental status of the population,however, but just an artifact, a statisticalfluke, which is only related to the emer-gence of new teeth.An interesting result is the sex differ-ence in the occurrence of caries. Boysshowed significantly more approximal-surface caries than did girls. This can beinterpreted as an environmental influ-ence. Possibly, in mate choice, attracti-veness is a more important factor for wo-men than for men. Thus, women areencouraged to – and do – care more abouttheir appearance. Despite an apparentlydifferent motivation, this concern does fa-vorably affect their personal hygiene andmay, particularly in rural communities,result in these observed differences.As already noted, interproximal cariesis an important factor in connection withthe occlusal situation33. The population67T. Lauc et al.: Orofacial Analysis in Hvar, Coll. Antropol. 24 Suppl. (2000) 1: 63–69age (months)171-180161-170151-160141-150131-140121-130111-120101-11091-10081-90cariesaffection(%)10080604020Fig. 1a. Caries affection classified by the age of the children.age (months)171-180161-170151-160141-150131-140121-130111-120101-11091-10081-90dentition(%)100806040200teethpermanentmixeddeciduousFig. 1b. Type of dentition classified by the age of the children.studied showed 54.5% affected cases,which seems to be a relatively high per-centage even for isolated populations,since Bassat et al.34, using the same defi-nition, found only 24.9% caries-affectedchildren in a group of Ashkenazi Jews.Inadequate prevention is probably themain reason for this result. Broad screen-ing studies on the prevalence of dentalcaries should be undertaken periodicallyall over the Adriatic islands, resulting, nodoubt, in a systematic planning and im-plementation of oral health services. Asgeneral health is largely dependent onwhat may be considered the »health« ofthe environment and oral health maymirror general health, dentistry has akey responsibility in the international ac-tion program for a sustainable develop-ment (Agenda 21, UNCED, 1992). Conse-quently, traditional curricula in, forexample, odontology should be supple-mented with interdisciplinary courseswith a focus on more multifactorial viewof the human condition35.The very similar environmental fac-tors (food, medical and oral health ser-vices, education, etc.) confirm that the is-land of Hvar is a good model for re-searching the genetic and environmentalfactors in ethiology and how differenthealth parameters progress.AcknowledgementsThis work was supported by grant01960101 of the Ministry of Science andTechnology of the Republic of Croatia, asa part of the project »Anthropological In-vestigations of the Population Structureof Croatia – Biomedical Approach«. Theauthors wish to acknowledge LovorkaBara}, M. Sc. for assistance in data col-lecting and to Sta{o Forenbaher, Ph.D.for assistance in manuscript preparatingof. A special acknowledgement goes toprofessor Pavao Rudan for his generoussupport.R E F E R E N C E S1. RUDAN, P., B. FINKA, B. JANI]IJEVI], V.JOVANOVI], V. KU[EC, J. MILI^I], M. MI[IGOJ,D. F. ROBERTS, Lj. SCHMUTZER, N. SMOLEJ-NA-RAN^I], A. SUJOLD@I], L. SIROVICZA, D. [IMI],P. [IMUNOVI], S. M. [POLJAR-VR@INA: Anthro-pological investigations of the Eastern Adriatic: Bio-logical and cultural microdifferentiation of rural pop-ulations of the island of Hvar. (HAD, Zagreb, 1990).— 2. RUDAN, I.: Cancer in the population with highkinship coefficiant. M.S. Thesis. In Croat. (Universityof Zagreb, Zagreb, 1997). — 3. ROGULJI], D., I. RU-DAN, P. RUDAN, Am. J. Hum. Biol., 9 (1997) 595. —4. RUDAN, P.: Etude sur les Dermatoglyphes Digi-to-Palmar des Habitants de l'Ille de Hvar. Ph.D. The-sis. (Univ. Paris VII, Paris, 1972). — 5. RUDAN, P., J.Hum. Evol., 4 (1975) 585. — 6. RUDAN, P., Am. J.Phys. Anthropol., 46 (1977) 161. —7. RUDAN, P., Lj.SCHMUTZER, Hum. Hered., 27 (1976) 425. — 8. RU-DAN, P., D. F. ROBERTS, A. SUJOLD@I], B. MA-CAROL, N. SMOLEJ, A. KA[TELAN, Coll. Antro-pol., 6 (1982) 39. — 9. RUDAN, P., D. F. 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Phys.Anthropol., 46 (1977) 161. — 33. PEDERSEN, J., K.STENSGAARD, B. MELSEN, Comm. Dent. Oral Epi-dem., 6 (1978) 204. — 34. BENBASSAT, Y. B., D. HA-RARI, I. BRIN, Brit. J. Orthod., 24 (1997) 229. — 35.HEYDEN, G., Internation. Dent. J., 48 (1998) 167.69T. Lauc et al.: Orofacial Analysis in Hvar, Coll. Antropol. 24 Suppl. (2000) 1: 63–69T. LaucInstitute for Anthropological Research, Ilica 1, 10000 Zagreb, CroatiaOROFACIJALNE ANALIZE NA JADRANSKIM OTOCIMA:1. OTOK HVAR KAO MODEL ZA ODONTOGENETI^KA ISTRA@IVANJAS A @ E T A KOvaj rad je uvodno orofacijalno istra`ivanje populacije {kolske dobi otoka Hvara,Hrvatska. Navedena populacija jedan je od posljednjih geneti~kih izolata u Europi, paje stoga ve} 30 godina predmet me|udisciplinarnih istra`ivanja. Uspore|ivali smo ka-rijes kao etiolo{ki ~imbenik malokluzija s koeficijentom endogamije i istra`ivali razlikeizme|u dviju subpopulacijskih skupina. Analizirali smo 224 sadrena modela djece scijelog otoka i prona{li vi{estruko kariozna zubala s aproksimalnim karijesima u 55%slu~ajeva, no nismo utvrdili zna~ajne razlike me|u navedenim populacijama. Me|u-tim, utvr|ena je statisti~ki zna~ajno ve}a u~estalost karijesa kod dje~aka nego kod dje-voj~ica. Ukupni udio karijesa je relativno visok, ~ak i u usporedbi sa sli~nim izoliranimpopulacijama, vjerojatno uslijed vanjskih ~imbenika. Dobiveni rezultati u skladu su spostavkama koje podupiru okoli{nu teoriju nastanka karijesa u odnosu na geneti~kukomponentu.

Orofacial Analysis on the Adriatic Islands: 1. The Island of Hvar as a Model for Odontogenetic Researches

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