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Dental mutilation and associated abnormalities in Uganda.

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Dental Mutilation and Associated
Abnormalities in Uganda
J. J. PINDBORG
Dental Department, U n i v e d t y Hospital a n d Department of Oral Pathology,
Royal Dental College, Copenhagen, D e n m a r k
ABSTRACT
In 1966 during a dental survey of four districts in Uganda-Acholi
in the north, Bugisu in the east, and Kigezi and Tor0 i n the southwest - 1169 Africans
were examined. In the sample from Kigezi District 11.9% of the Bakiga tribe showed
a form of dental mutilation consisting of the filing away of the mcsial angle of the
upper central incisors. In the sample Irom Acholi District 16.1% of the Acholi tribe
showed abnormal conditions related to the ritual extraction of the primary canines.
Extraction of the lower permanent incisors was seen occasionally in the Acholis ( 8 ) ,
Batoros (1) and Bugisus ( 3 ) .
Removal of the primary canines is attributed to a belief that infantile fever originates
from these teeth. Because the primary canines were removed i n a crude fashion, malformation, non-eruption or premature eruption of the underlying permanent canines
resulted.
I n 1966 the author made a dental survey
of four districts of Uganda by invitation
of the Ministry of Health of that country.'
Although the main purpose of the survey
was to determine the prevalence of periodontal conditions, dental caries and dental
fluorosis (Mgller, Pindborg, Gedalia and
Roed-Petcrsen, '69. Skougaard, Pindborg
and Roed-Petersen, '69) it offered an opportunity also to look for dental mutilations
due to local customs or superstitions. The
present paper deals not only with the observed mutilations, but with certain associated abnormalities which may not have
been recorded before. Since the native way
of Me is changing rapidly, it will not be
possible much longer to observe dental alterations of this sort, and therefore a
record of the present incidence and distribution is important.
PROCEDURES
The four districts selected for the survey -- in order of visit, Kigezi, Toro, Acholi
and Bugisu -- are shown in figure 1. The
population here consists of tribes which
are either Bantu- or Nilotic-speakers. In
each district the Government Hospital
served as the headquarters for the survey.
With the assistance of the local gombolola
chiefs, invitations were issued for all who
could to come to the headquarters for examination. They only exceptions were
those in need of dental treatment. I n order
to make the sample more representative,
AM. J. P H Y s . ANTHROP.,31: 383-390.
excursions were made to one or more rural
dispensaries and to at least two schools
(one rural and one urban). The resulting
total sample amounted to 1169, of which
70% were in the age range from 5 to 19
years.
The subjects were examined out of
doors, using a probe and two mirrors, the
sunlight being the only source of illumination. Unfortunately, facilities for taking
radiographs were not available.
RESULTS
Only three types of dental mutilation,
mostly independent of one another, were
observed: ( 1 ) Filing of the upper incisors,
usually the central ones alone; ( 2 ) extraction of the primary canines, usually the
lower ones; ( 3 ) extraction of the lower
permanent incisors. Filing was seen only
in the Kigezi District, in a Bantu-speaking
tribe. Canine extraction was seen only in
the Acholi District, in a Nilotic-speaking
tribe. Incisor extraction, the least common type of mutilation, was mostly associated with canine extraction in the Acholi
District.
1. Filing of the upper incisors. As
figure 2 shows, in a typical case, this type
of mutilation was produced by filing the
1The author's visit to Uganda was sponsored by the
Ministry of Health in Uganda and the Secretariat for
Technical Co-operation with Developing Countries
under the Danish Ministry of Foreign Affairs. The
author is grateful to the Chief Medical Officer, Mmistry of Health, Uganda, for permission to publish
this paper.
383
384
J. J. PINDBORG
SUDAN
/
CONGO
Fig. 1
Fig. 2
tribe.
Map of Uganda showing the four districts where the survey was performed.
Mutilation OP thc uppcr central incisors in a 15-year-old girl from the Bakiga
385
SURVEY O F TRIBAL DENTAL MUTILATIONS I N UGANDA
mesial incisal angle of each of the upper
central incisors, thus creating a n artificial
diastema between these teeth. In only two
cases, both females, the mutilation involved also the lateral incisors in the same
way.
In Kigezi District, the only place where
this type of mutilation was observed, 285
members of the Bakiga tribe, almost
equally divided as to sex, were examined
and of these 34 (11.9% ) were found to
have the condition present. Table 1 shows
the distribution by sex and age. According to this summary, almost twice as many
females as males bore the mutilation. Also,
there were more females than males with
the mutilation under the age of 20 and
therefore the affected females as a group
had a younger average age: 24.5 vs. 32.9
pears for the affected males. The fact that
this type of mutilation is not seen in the
juveniles and younger children probably
means that it is connected with a puberty
ceremony. Pulp necrosis was seen in one
central incisor in only two cases.
2. Extraction of the primary canines.
Since the primary canines appear in babyhood, extraction was done at a very early
age. And because it was done by witch doctors or other non-dental personnel, damage
to the underlying germ of the permanent
canine was a n ever-present possibility. Depending on the amount of damage, the permanent canine would not erupt or it would
erupt in a malformed state. Only rarely
were the upper primary canines extracted.
In the Acholi District, the only place
where canine extraction was observed, 322
members of the Acholi tribe were examined. Table 2 shows the distribution by
sex and age. Although males predominated
in the ratio of 179 to 143, the sexes appeared to he about equally affected: 15.6
vs. 16.8. Canine extraction jn thus more
common in this tribe than filing is in the
B akiga tribe.
The frequency of various types of canine abnormalities is seen in table 3 . In
33 individuals with lower primary canines,
the condition was bilateral in 29. In only
TABLE 1
Age and sex distribution of Bakigas w i t h tribal mzitilution of upper incisors.
Figures in parentheses give the total n u m b e r examined
Sex
Age 0-4
5-9
10-14
15-19
20-29
30-33
Total
Number
percent.
::\:
age
Males
(O)
(5)
(54)
(22)
3
(16)
8
(32)
(13)
12
(142)
8.5
Females
(3)
(I2)
1
(35)
4
(31)
11
(26)
5
(22)
1
(14)
22
(143)
15.4
(17)
(89)
14
(42)
13
(54)
1
(27)
34
(3)
(285)
11.9
Total
1
1
5
(53)
TABLE 2
Age and sex dlstrihution of Acholis affected by ritual extractions of primary canines or
romplications hereof. Figures in parentheses give t h e total n u m b e r examined
Sex
Males
Age 0-4
7
(13)
5-9
a
(30)
10-14
15-19
20-29
30-39
","b:t
5
(44)
(7)
Total
Number
Percentage
15.6
386
J. J. PINDBORG
one individual were the upper primary ca- in the lower permanent latcral incisors of'
nines missing. In 9 individuals with non- three individuals. In another individual a
erupted lower permanent canines, the transposition was observed involving the
condition was bilateral in iwo. For lack of left lower permanent lateral incisor and caradiographs it could not be determined nine (fig. 6). One individual had an unwhether the absence of the permanent ca- erupted lower left permanent canine, the
nines was due to severe damage to the malformation of which was visible a5 small
tooth germ, to removal of the germ itself, irregular enamel pearls piercing the ginor to a damaged tooth germ exfoliated as giva (fig. 7 ) .
The upper primary canines were found
a sequestrum.
to be malformed in only one individual.
The number of malIormed permanent
Early eruption of the permanent canines,
canines was 14, of which 12 were in the due to an early removal of the correspondmandible ( 3 bilateral cases). The slightest ing primary canine, was seen in nine indidegree of malformation appeared as a peg- viduals. Eruption was considered premaor shovel-shaped form (fig. 3 ) In other tiire only ii' i t occurred before nine years
individuals the malformation resembled a 01age.
partially split tooth (fig. 4 ) .
3. Extraction of the lower permanent
A malformation resenibling a severe i??cisors. This type of mutilation was so
type of invagination (fig. 5) was observed uncurnmon that little will be said about it.
TABLE 3
Various types of Lanine involvement cazised by riturrl extractions umong Acholis
Missing canincs
Lower
primary
upper
primary
Nmi-erupted
lower
permanent
canines
Lower
permanent
hlalformations of canines
Lriwer
permanent
Upper
permanent
canines
qpcr
primary
erupting
before
years
of ape
33
1
Fig. 3
9
12
2
1
Pegshaped lower right permanent canine in a 16-year-old Acholi boy.
9
S U R V E Y O F TRIBAL DENTAL MUTILATIONS I N UGANDA
Fig, 4 Partly split lower right pcrrnanent canine in a n 18-year-old Acholi boy. Note also
the non-erupted lower left canine.
Fig. 5
Malformed lower right lateral permanent incisor, resembling a n invagination, in
a 16-year-old Acholi boy. Also note the non-erupted lower right canine.
387
388
J. J. PINDBORG
Fig. 6 Transposition of the lower left permanent canine between the two incisors i n a
16-year-old Acholi boy.
Fig. 7 Severe malFormation of lower left permanent canine and persistence of the primary canine in a n 11-year-old Acholi boy.
SURVEY O F T R I B A L D E N T A L M U T I L A T I O N S I N UGANDA
None of the Bakigas showed lower incisor
extraction either alone or in combination
with upper incisor filing. However, among
the Acholis three individuals showed extraction of the lower permanent incisors
m d the lower permanent canines. Five
other Acholis showed extraction of only
the lower permanent incisors. The only
other cases of lower permanent incisor extraction were observed in the Batoros (1)
and Bugisus ( 3 ).
DISCUSSION
Filing of the upper incisors, i n one form
or another, occurs, or has occurred, in
many parts of Africa (von Jhering, 1882;
Lignitz. ’19-’20; Moortgat, ’59). Yet in so
far as the author can discover, the reports
do not include references to the tribes of
Uganda. Nor do thcy include for tribes anywhere details about the prevalence of the
custom. For this reason it is not possible
to compare the figures obtained in the present survey. However, to judge from what
the author was told locally, the custom is
decreasing rapidly in the Kigezi District.
None of the Acholis who had been subjected to extraction of the primary canines
could give a reason for the custom. The
explanation that follows comes from one
of the auxiliaries on the survey team:
When an infant of the Acholi tribe has a
fever, the primary canines, especially the
lower ones, are believed to be the source.
To get rid of the fever the canines are removed, or a n attempt is made to remove
them. Since this procedure is carried out
by non-dental personnel, the underlying
germ of the permanent canine and sometimes also that of the adjacent lateral incisor may be subjected to a great force and
this may lead to damage of one or both
germs. It is impressive that, still in 1966,
16.1% of 322 Acholis examined were affected by this customary removal of the
primary canines.
The author has been able to locate only
two accounts of similar procedures. Von
389
Jhering (1882) mentions a report by
Fischer, dating from 1878, of deliberate
attempts by the Wapokomos of the Tana
River region in Kenya to prevent the eruption of permanent teeth. These people extracted the deciduous lower central incisors
and, in order to prevent the eruption of the
permanent central incisors, destroyed the
germs of these teeth by inserting the tip
of a glowing-hot knife.
The second report is by Seligman and
Seligman ( ’ 3 2 ) . In their monograph on
the pagan tribes of the Nilotic Sudan they
say in connection with the Nuer tribe:
“ W h m a n infant is from a few days to a
month old the canines are dug out of the
jaw with a piece of iron. The lower incisors. however, are removed with a fish
hook when the boys are about eight years
old.”
The procedures described in these two
accounts, like the findings here reported,
are unusual because tribal removal of teeth
most often involves permanent teeth only.
In most instances in African countries the
lower incisors are extracted. Thjs type of
tribal mutilation is markedly on the decline
and this is reflected in the present study
in which extractions of the lower permanent incisors were observed in only 0.9%
of the total sample of 1169.
LITERATURE CITED
Lignitz, H. 1919-1920 Die kiinstlichen Zahnverstiimelungen in Afrika im Lichte dcr kulturkreisforschung. Anthropos. 14-15: 891-943;
16-17: 247-264, 866-889.
Moortgat, P. 1959 Les mutilations dcntaires.
ActualitCs Odonto-Stomat., No. 4 5 : 87-110.
Mgller, I., Pindborg, J. J., Gedalia, I. and B.RoedPetersen 1969 The prevalence of dental fluorosis in Uganda. Arch. Oral Biol., in press.
Seligman, D. G. and B. Z. Seligman 1932 Pagan
Tribes of the Nilotic Sudan.
Skougaard, M., Pindborg, J. J. and B. Roed-Petersen
1969
Periodontal conditions in 1394
Ugandans. Arch. Oral Biol., 14: 707-719.
yon Jhering, H. 1882 Die kiinstliche Deformierung der Zahne. Z. Ethnol., 14: 213-262.
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