Infant Oral Mutilation and the Case for Eradication

KNOXVILLE, Tennessee — Infant oral mutilation is the practice of gouging out an infant’s unerupted cuspids, also known as canine teeth. Traditional healers refer to infant oral mutilation as “ebinyo,” Bantu for “false teeth.” Healers perform ebinyo in several East African countries including, Tanzania, Uganda, Ethiopia and Kenya.

To perform the procedure, traditional healers often use unsterile instruments, “bicycle spokes, hot needles, pointed knives, nails and other sharp objects,” without anesthesia. According to the Global Child Dental Fund, in Africa, approximately 25 million children endure infant oral mutilation annually, often as a customary tradition. Many believe that it is a treatment to ward off diarrhea, fevers and vomiting. The typical age bracket during which healers conduct the procedure is 4-8 months old, but this can extend to up to 18 months.

As the gums swell during the teething stage, the healers mistake the “white soft enucleated tooth buds” as “tooth worms.” Many healers believe that “tooth worms” are the source of common childhood illnesses. However, removing the canines often exacerbates illnesses because of blood loss and dehydration.

Many East African countries lack access to oral health care. Uganda has 310 dentists across the nation for a population of about 44 million, according to 2019 data, and Tanzania has 423 dentists for a country of about 56 million people, according to 2018 data.

In addition to the scarcity of dentists in East African countries, many people cannot afford oral health care services. In 2020, the U.S. spending on dental care stood at $142 billion while the average total health care spending per capita in East African countries stood at less than $100 in 2018.

Because many East Africans cannot afford or access oral health care services from a dentist, they rely on traditional healers who often lack the health literacy to keep their patients safe, which is why infant oral mutilation prevails. Yet, many East Africans continue to utilize healers because their services are affordable and they are often trusted members of the communities they serve.

Infant oral mutilation has both short and long-term risks. It is often painful and traumatizing and the invasive procedure could prove fatal due to the risks of the child going into immediate shock and the possibility of hemorrhaging. Additional dangers of infection, the transmission of diseases, blood loss and excessive clotting in the following weeks could occur. These conditions include “anemia, septicemia, meningitis, osteomyelitis, tetanus… hepatitis and HIV/AIDS.”

The most common causes of hospitalization related to the procedure are septicemia and anemia. The risks are common and the reported child mortality rate ranges from 10%-85%. Some of the long-term effects for children who do not die from infant oral mutilation include missing incisors, ill-formed enamel on adjacent teeth (hypoplastic teeth), fracture of primary canines (dilaceration), “failure of development of primary canine” and “early eruption” of permanent teeth. Lisps are another possible long-term effect of the procedure.

Global Child Dental Fund, which began in 2008, and Bridge2Aid, a nonprofit that has provided dental care training since 2004, are teaming up to develop a digital training cascade program in Tanzania. The pilot program will initially train around 150 clinicians and traditional healers on the hazards of infant oral mutilation and seek to replicate the model throughout Tanzania upon success. The model involves the key trainer holding two sessions to train dental therapists, district officers, community health workers and child workers. Those in the initial training sessions will hold subsequent sessions for clinical officers, nurses, health facility governing committee members and traditional healers. The cascade model enables more clinicians and healers to receive training at a quicker rate. The first stage of the program ran from March 2021 to October 2021.

In 2011, the organization Kinga Africa began its mission in Kenya to reach at-risk children with education on the importance of good oral hygiene. Since its inception, it has reached more than 5 million children while simultaneously running the campaign Action Against IOM to educate and train community health volunteers, primary school teachers, mothers and traditional healers.

In 2019, the Global Child Dental Fund, chief dental officers and ministries of health from several African countries met in Addis Ababa, the capital of Ethiopia, to discuss the prevalence and dangers of infant oral mutilation. They signed the “Addis Ababa Declaration 2019” as a commitment to “end the practice of infant oral mutilation within 10 years.”

Signatories will do this by advocating the importance of action against infant oral mutilation and educating people about the dangers of the practice. The declaration’s goal is “a public health campaign” in every East and Central African country with “educational posters” denouncing the practice. It will also create “school-based [programs]” to educate future generations on the matter.

Many people who realize the risks of the procedure in East Africa advocate ending the practice. Instead of villainizing traditional healers, it is imperative to involve them in eliminating infant oral mutilation because communities trust them. Educating and training healers on the dangers of the practice and offering an alternative treatment to common childhood illnesses is the key to eradicating infant oral mutilation.