Traditional tooth bud gouging in a Ugandan family: a report involving three sisters

Infant oral mutilation: data collection, clinical management and public health guidelines

Infant oral mutilation (IOM) is a traditional practice involving extraction of an infant's unerupted primary tooth buds. IOM has implications for oral and overall health due to blood loss, infection or transmission of bloodborne diseases, such as human immunodeficiency virus. IOM also leads to long-term dental complications, such as malformation of the child's permanent dentition. IOM is practised primarily in East Africa but can also be seen among immigrant populations in other countries. Currently, there are no tools for a comparative IOM diagnosis and reporting. The aim of this paper is to describe a data collection tool for healthcare practitioners, which was created based on the existing literature and a clinical consultation with senior clinical and public health physicians working in the field.The tool can be used to record IOM-related data for appropriate diagnosis, management and treatment, as well as for monitoring preventive interventions on a community level. Furthermore, this article also summarises clinical guidelines to support practitioners with the management of acute IOM cases. The article concludes by providing recommendations and examples of community education and engagement programmes that could guide the development of interventions to eradicate IOM globally.

Long-term dental implications of infant oral mutilation: a case series

Infant oral mutilation (IOM) is a ritual ceremony practised mostly in African cultures, in which the primary tooth bud of the deciduous canine is extracted. Complications and risks of IOM include pain, heavy bleeding and infection that may deteriorate to life-threating conditions. The main long-term consequence of IOM is future dental abnormalities. The scientific literature lacks in-depth analyses of the dental sequelae of this practice among adults who underwent it, and particularly of the aspect of dental treatment. Eight new cases of IOM are presented in this case series, with emphasis on dental diagnosis and treatment modalities. We describe different outcomes of this practice, such as enamel hypoplasia and crown deformations with later necrosis and infection of the root canal system, severe discolouration, immature root apex, impaction of a canine, failure of development and missing lower permanent incisors and canines, an odontoma-like structure, severe periodontal defect and root dilaceration. Familiarity with the practice of IOM is vital in order to identify its manifestations and arrive at the correct diagnosis and optimal course of treatment.

Infant oral mutilation (IOM) related to traditional practices among inner city pre-school children in Sudan

Background

The term Infant Oral Mutilation (IOM) refers to the aggressive cultural rituals where primary canine tooth germs of infants are enucleated for therapeutic reasons.

Objectives

To determine the prevalence and risk factors for IOM among inner city pre-school children in Khartoum.

Methods

In this cross-sectional study, 212 randomly selected children from twelve government pre-schools in Khartoum were examined for the presence of IOM. Socio-demographic, feeding and teething-related data were collected by self-administered questionnaires.

Results

The mean age of the sample was 4.7 years. The prevalence of clinical IOM was 10.8%. Multivariable regression analysis revealed that children who suffered from diarrhea during teething were 7.15 times more likely to have clinical IOM over their counterparts (p<0.0001). Mothers who were educated below elementary school level were 2.69 times more likely to have children showing clinical IOM (p= 0.0369).

Conclusion

The present study showed that the practice of IOM is common among inner city children. Certain teething-related symptoms especially diarrhea and maternal education could be strong determinants of the malpractice of IOM.

Infant Oral Mutilation

Ebinyo refers to the practice of removing primary canine tooth follicles in infants without anesthetic by African traditional healers or elders using unsterilized instruments. This report describes a case of ebinyo or infant oral mutilation (IOM) and associated sequelae in a child adopted from a remote African tribe. The intraoral examination revealed that the patient was missing his primary maxillary and mandibular canines. The maxillary anterior periapical radiograph displayed a dysmorphic ectopic unerupted maxillary right primary canine positioned mesial to the maxillary right primary first molar. Periapical films taken confirmed partial or complete absence of the patient's primary mandibular left (73) and mandibular right (83) canines, and a bitewing and periapical film confirmed the absence of the patient's primary maxillary left (63) canine. The permanent canines will be monitored for possible hypoplasia secondary to trauma to the tooth buds during extirpation of the primary canines. Research presented in this report reveals that there are serious health implications involved with the practice of ebinyo.

Current status of nylon teeth myth in Tanzania: a cross sectional study

BACKGROUND

Nylon teeth myth is a belief of associating infant illnesses with bulges on infants' alveolus that mark the positions of underlying developing teeth and that it is necessary to treat the condition mainly by traditional healers to prevent infant death. The traditional treatment often leads to serious complications that may lead to infant death. Although the government instituted educational campaigns against the myth in 1980s to 1990s, to date, repeated unpublished reports from different parts of the country indicate continued existence of the myth. Therefore, this study aimed to assess the current status of the nylon teeth myth in Tanzania.

METHODS

The study population was obtained using the WHO Oral Health pathfinder methodology. A structured questionnaire inquired about socio-demographics as well as experiences with "nylon teeth" myth and its related practices. Odds ratios relating to knowledge and experience of the nylon teeth myth were estimated.

RESULTS

A total of 1359 respondents aged 17 to 80 years participated in the study. 614 (45%) have heard of nylon teeth myth, of whom 46.1% believed that nylon teeth is a reality, and 42.7% reported existence of the myth at the time of study. Being residents in regions where nylon teeth myth was known before 1990 (OR = 8.39 (6.50-10.83), p < 0.001) and/or hospital worker (OR = 2.97 (1.99-4.42), p < 0.001) were associated with having have heard of nylon teeth myth. Proportionately more residents in regions where nylon teeth myth was not known before 1990 (p < 0.001), the educated (p < 0.001) and hospital workers (p < 0.001) believed modern medicine, whereas, proportionately more residents in regions where nylon teeth was known before 1990 (p < 0.001), less educated (p < 0.001) and non-hospital workers (p < 0.001) believed traditional medicine to be the best treatment for symptoms related to nylon teeth myth respectively.

CONCLUSION

The "nylon teeth" myth still exists in Tanzania; a substantial proportion strongly believe in the myth and consider traditional medicine the best treatment of the myth related conditions.

Infant oral mutilation in East Africa - therapeutic and ritual grounds

This paper reviews the practice and ritual traditions of infant oral mutilation, drawing on a literature search in PubMed and Google Scholar, historical reports, relevant textbooks, NGO materials and personal observations of the authors.

Canine Gouging: A Taboo Resurfacing in Migrant Urban Population

Cosmopolitan cities have become a pool of migrants from different parts of the world, who carry their cultural beliefs and superstitions with them around the globe. Canine gouging is a kind of infant oral mutilation (IOM) which is widely practiced among rural population of Africa where the primary tooth bud of the deciduous canine is enucleated. The belief is that the life threatening illnesses in children like vomiting, diarrhoea, and fevers are caused by worms which infest on tooth buds. This case report is of a 15-year-old Somalian born boy, who presented at the dental institute with intermittent pain in his lower right permanent canine which was associated with a discharging intra oral buccal sinus. The tooth was endodontically treated and then restored with composite. General dental practitioners need to be vigilant when encountered with tooth presenting unusual morphology, unilateral missing tooth, and shift in the midline due to early loss of deciduous/permanent canines. Identification of any such dental mutilation practice will need further counselling of the individual and family members. It is the duty of every dental professional to educate and safeguard the oral and dental health of general public.

Infant dental enucleation: A literature review on a traditional remedial practice in East Africa

OBJECTIVE

To summarize and review the literature on infant dental enucleation, a traditional remedial procedure prevalent mainly in East Africa.

MATERIALS AND METHODS

Literature searches were made electronically using general and specialized search engines. The main search was performed through a systematic strategy in PubMed, comprising tabulated keywords, search codes, and translated and transliterated terms. Criteria for the selection of studies were designed to provide a general understanding of the procedure. The findings were synthesized into two sections: a summary of the population prevalence studies, and a thematic literature review.

RESULTS

An overview of the known prevalence and clinical specifications was established. Insight was gained into the purpose of the procedure and the factors influencing its performance. Diverging suggestions were seen with regard to the rationale for use of infant dental enucleation between different populations. Moreover, reports of complications and consequences involving the general health and the dentoalveolar structures of patients were examined.

CONCLUSIONS

Prevalence, clinical features and risks of infant dental enucleation point to a need for greater awareness of the procedure. Further, there is a need for specific guidelines regarding management of suspected cases within dental and healthcare communities.

Longitudinal weight gain of immunized infants and toddlers in Moroto District, Uganda (Karamoja subregion)

This study examines longitudinal weight gain of a sample of 123 immunized children from Moroto District, northeast Uganda. The weight data were combined from two sources: (1) anthropometric examinations carried out between 1998 and 2004 by a research team from the University of Kansas, and (2) weights recorded on children's immunization records by local health care practitioners. Our findings conform generally to the pattern described in previous studies in this as well as other pastoralist populations in sub-Sahara. Relative to international standards, the weight-for-age status of Karimojong children was best during the first 3 months of infancy. Noticeable declines in weight velocity occurred in the fourth month and after the sixth month. Weight gain was static after the second year, when upward of 40% of children were clinically underweight. Factors influencing weight gain in this sample include immunization status and maternal height, weight, and parity, but these effects explain relatively little of the variance in weight gain. We conclude that immunization is not sufficient to buffer Karimojong children from multiple stressors during teething and weaning. Of these, the practice of canine follicle extraction (CFE) is of most interest, although its effects in this study are ambiguous. The data also are suggestive of variability in the pattern of weight gain between closely spaced birth cohorts. This finding may be of particular importance for the interpretation of growth patterns described for other pastoralist populations in sub-Saharan Africa.

Extirpation of the primary canine tooth follicles: a form of infant oral mutilation

BACKGROUND

Ebinyo is a form of infant oral mutilation (IOM), widely practiced in rural areas of eastern Africa, in which traditional healers and other village elders extirpate the primary canine tooth follicles of infants by using crude, often unsterilized, instruments or utensils. Traditional folklore suggests that the underlying tooth follicles, thought to resemble worms, are the cause of high temperature, vomiting, loss of appetite and diarrhea in infants. In addition to the serious and potentially fatal immediate postsurgical complications, many of those who undergo this practice exhibit characteristic long-term adverse dentoalveolar effects. Children in these families also may be at greater risk of undergoing other mutilation rituals because of their cultural background.

CASE DESCRIPTION

We report on the clinical and radiographic findings in five siblings who apparently were subjected to IOM as infants before immigrating to the United States.

CLINICAL IMPLICATIONS

Although the practice of IOM is believed to be exceedingly rare in developed countries, it is important that dentists and allied dental personnel who treat refugees from areas of the world in which IOM is endemic be aware of the social factors behind this practice as well as be able to recognize its dental and psychological sequelae.

The burden of traditional practices, ebino and tea-tea, on child health in Northern Uganda

Traditional medical practices persist today in Northern Uganda; for example, the operations of ebino and tea-tea are frequently performed in childhood. Ebino, or "false teeth", refers to gingival swellings during the eruption of the primary canine teeth in infants, and consists of the extraction of deciduous canine tooth buds. Tea-tea consists of systematic cuts made on the chest wall when the child has difficulty in breathing. The objectives of this study are to describe the morbidity and mortality related to complications arising from the ebino and tea-tea procedures among children admitted to the paediatric ward of St. Mary's Hospital Lacor in 1999, and to estimate the prevalence of ebino and tea-tea among children aged 0-4 years attending, for any cause, the child welfare department (CWD) of the hospital. The prevalence survey consisted of the examination of 1,995 children attending CWD during a four-week period in 1999 to look for missing primary canine teeth (ebino), and for "therapeutic" cuts on the chest wall (tea-tea). In the difficult context of war and social disruption prevailing in Northern Uganda, sustainable methods of data collection and analysis should be utilised to support evidence-based decision-making.