This study investigates temporal changes in dietary practices in the Caribbean archipelago during the Ceramic Age (400 BC–AD 1500), through analyses of dental wear and pathology. Some previous studies in the region have suggested that diet and subsistence practices changed over time due to increasing sociopolitical complexity, climate change, or adaptation to island environments rich in marine resources. Both horticultural/agricultural intensification and increased marine focus of the diet over time have been posited, based among other things on faunal and botanical remains, and early ethnohistorical accounts. Local and micro‐regional stable isotope studies of temporal dietary variation have found few indications for change over time, and large regional isotope studies are still lacking. Dentitions from sites throughout the region dating to the Early Ceramic Age (400 BC–AD 600/800) and the Late Ceramic Age (AD 600/800–1500) were analysed in order to assess temporal differences. Intra‐individual rates of wear were calculated using the difference in degree of wear between the adjacent molars and the two groups were compared with principal axis analysis. Caries, antemortem tooth loss, abscesses and dental calculus were recorded per individual and per tooth/socket, and population caries and antemortem tooth loss rates were assessed and compared by age group, tooth class and sex. Comparisons between the two occupation periods revealed significant differences in the rate of dental wear and pathology, indicating a shift in dietary practices over time, coinciding with known social changes. The increase in pathology rates suggests a rise in the consumption of cariogenic foods or preparation techniques that increase cariogenicity. The decrease in rate of wear over time indicates a reduction in abrasivity of the diet. Together these data suggest that there was a growing focus on refined, cariogenic foods, likely horticultural/agricultural produce. Copyright © 2014 John Wiley & Sons, Ltd.