From dust to disease: investigating the influence of dentoalveolar disease and dental wear on chronic maxillary sinusitis during environmental and sociocultural changes in Lower Nubia between 4th and 2nd millennium BCE

Variations in chronic maxillary sinusitis (CMS) worldwide have been linked to climatic conditions, cultural practices, and dental disease burdens. CMS rates in the Middle Nile Valley rank among the highest recorded globally, with increasing rates documented from the Neolithic through the Medieval period. These patterns have been linked to the hyper-arid Saharan climate of the region, as well as sociocultural changes toward agricultural intensification and urbanization, all of which may have heightened exposure to aeolian dust and respiratory irritants. This study examines 112 adults from 13 Lower Nubian sites spanning the A-group (3800–2900 BCE), C-group (2300–1200 BCE), and Pharaonic period (1550–1069 BCE) to assess diachronic changes in CMS and its relationship to dental wear and dentoalveolar disease. Maxillary teeth, alveoli, and sinuses were analyzed macroscopically for antemortem tooth loss, dental caries, periapical lesions, periodontitis, oroantral fistulae, and sinusitis-related bone changes. CMS (65.6%–85.7%) and oroantral fistulae (3.1%–22.9%) increased over time, alongside significant rises in AMTL (25.0%–62.9%), dental caries with pulpal exposure (0.0%–26.9%), and periapical lesions (40.6%–71.4%). Periodontitis (96.0%–96.9%) and heavy dental wear (78.1%–86.0%) remained consistently high. Age-related increases in CMS, AMTL, periapical lesions, and heavy wear likely reflect cumulative lifetime exposure. AMTL ( p = 0.015) and periapical lesions ( p = 0.014) showed significant correlations with CMS. This study offers insight into respiratory health in ancient Lower Nubia and the interplay between oral health and arid environments, suggesting that respiratory health in ancient Lower Nubia was shaped by a combination of environmental aridity, changing subsistence practices and living environments, and deterioration in oral health.