A singular case of advanced caries sicca in a pre-Columbian skull from East Tennessee.

OBJECTIVE: Documentation of an advanced case of tertiary stage treponemal disease.

MATERIALS: The well-preserved cranium and mandible of an adult male (Burial G) from the Early Woodland period (900 BCE-200 CE) Wilhoite site (40GN10) from east Tennessee.

METHODS: Macroscopic examination of the cranio-facial periostosis on Burial G for pathognomonic indicators of treponemal disease.

RESULTS: There are extensive contiguous nodular lesions on the frontal, parietals, temporals, and occipital bones. The frontal squama additionally exhibits radial scaring and circumvallate cavitating lesions. Radial scars are also present on both zygomatic bones and the endocranial surface of the calotte. There is rounding of the nasal margins in addition to periostosis on the palate.

CONCLUSIONS: Burial G unequivocally exhibits the pathognomonic reactive changes of caries sicca, radial scarring, and cavitating lesions.

SIGNIFICANCE: The Early Woodland date in combination with the advanced degree of pathognomonic reactive change is exceptional, and to date, without parallel in the pre-Columbian archaeological record of North America. Any case approaching the severity displayed here is invariably late prehistoric.

LIMITATIONS: The absence of postcrania does not permit assessment of frailty or synergism of secondary conditions.

SUGGESTIONS FOR FURTHER RESEARCH: More comprehensive documentation of pre-Columbian treponemal cases is merited.