This article presents differences and similarities in dietary practices of fisher-gatherer groups excavated from two sambaquis (shell-mound archaeological sites) in Saquarema, Rio de Janeiro state, Brazil. We analyzed the buccal apparatus of 35 individuals excavated from Sambaqui da Beirada, dated from 5437 to 3440 years cal BP, and Sambaqui do Moa, dated from 4770 to 3199 years cal BP. Our oral health analysis of 852 alveoli and 704 teeth assessed the frequency and degree of teeth wear and the prevalence and frequency of caries, linear enamel hypoplasia, calculus, periapical cavities, and antemortem teeth loss. We applied the chi-square test and Fisher exact test to test statistical significance. Severe tooth wear, the absence of caries, a high frequency and prevalence of dental calculus, and a low prevalence of linear enamel hypoplasia were found in both sites, although periapical cavities and antemortem teeth loss indexes varied greatly. Despite a superficial homogeneity, the results point to variation in the physiopathological processes that occurred at both sites, including differences related to age and sex. These oral health-related results, together with other archaeological data from both sambaquis, showcase the expected cultural differences stemming from dietary practices.