To infer the diet and cultural behaviours of Islamic communities during the medieval period in Portugal, 43 adult skeletons (13 females, 27 males, and 3 individuals of undetermined sex) from the medieval Islamic necropolis of Santarém were analysed. A total of 779 teeth were macroscopically observed to score dental wear and dental alterations as enamel chipping, notching, transversal grooves observed on the mesiodistal occlusal surfaces (TGMOS), and lingual surface attrition of the maxillary anterior teeth (LSAMAT). Occlusal wear was moderate. Chipping was recorded in 13.08% (98/749) teeth from 28 individuals, and notching affected 3.87% (29/749) belonging to 17 individuals. Five subjects have transverse grooves, observed on the mesiodistal occlusal surfaces in 3% (23/750) of the teeth. LSAMAT was observed in 41.25% (66/160) of the anterior upper teeth belonging to 20 individuals. Combinations of different alterations were investigated: LSAMAT-chipping, LSAMAT-TGMOS, and LSAMAT-chipping-TGMOS. These could be related to hard food, extra-masticatory behaviours, chewing unknown substances, or trauma.