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Bioarchaeologists have long noted two unusual trends in the dentitions of prehistoric Native Californian populations: high rates of wear and low prevalence of caries. The Central California site of CA- CCO-548 offers a unique opportunity to examine the relationship between oral pathology and extreme den- tal wear in a large (n 5 480), ancient (4,300-3,100 BP), and temporally well-defined population sample. This study specifically examines three interrelated processes of the oral cavity in this population: dental wear, den- tal caries, and periodontal disease. The results show high levels of dental wear (average of 6.1, Smith sys- tem), low frequencies of carious lesions (2.5%), low fre- quencies of periodontal disease (17.8%), and high frequencies of periapical abscesses (10.7%). The patho- logical processes examined here have complicated mul- tifactorial etiologies. However, they all share the common primary etiological agents of facultative path- ogenic bacteria proliferation in the oral biofilm. Inte- gration of the current etiological explanations for infections of the oral cavity, information from the eth- nographic record pertaining to subsistence and activity patterns in Native Californian populations, and statis- tical analysis of specific disease and wear patterns leads to a novel explanation for the observed pattern of oral pathology in this population sample. Specifi- cally, the introduction of antibacterial compounds through dietary items and non-alimentary tooth use is suggested as the most likely explanation for the unusually low prevalence of dental caries and peri- odontal disease. Am J Phys Anthropol 154:171-188