Well, before agriculture, they didn’t have the same kind of problem. With a diet of tougher food their jaw muscles were much stronger and consequently the structure of their entire jaw was wider and accommodated all of their teeth.
[https://www.smithsonianmag.com/smart-news/how-dawn-farming-changed-our-mouths-worst-180954167/](https://www.smithsonianmag.com/smart-news/how-dawn-farming-changed-our-mouths-worst-180954167/)
Yes, the tooth would get pulled, but this was a once or twice in a life event before ~1600 AD. Most people had most of their teeth their whole life.
Gingivitis and cavities are relatively modern problems because until ~1600 most people around the world did not have access to refined sugar. There is a colony of bacteria on our teeth and gums that love sugar, and they get to eat it whenever we eat (or drink) sugar. Then they poop acid onto your teeth and your teeth de-mineralize. The holes get bigger, and that’s a cavity.
After the 1600’s, also yes, they would just pull out all the teeth and give you dentures.
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