Infant oral mutilation also known as milk teeth extraction is a harmful practice, which has been inflicted upon children for centuries in Eastern and Central Africa and that is still being carried out today. Like many other harmful practices facing children, it poses serious health risks and in certain cases even leads to death. Since it is performed on minors, IOM has been labeled as a hidden public health issue by experts in the dental community and is also an issue pertaining to the violation of children’s rights.
Understanding infant oral mutilation
Infant oral mutilation (IOM) is an expression used by the international dental community to refer to traditional milk teeth extraction, a harmful practice against children. Experts in the field explain that IOM is typically done by “elders or community healers”, “religious leaders, traditional birth attendants [and sometimes] “family members” (Anjum et al., 2022; Kemoli et al., 2022). Without the use of anesthesia, IOM is carried out in non-sterile settings with common sharp objects like fingernails, hot nails, bicycle spokes, and regular knives (Girgis et al., 2016).
Simply put, traditional healers who practice IOM, often reuse the same tools without proper disinfection, putting children through unnecessary pain and at risk for serious short and long-term consequences. Though relatively unheard of, IOM continues to be carried out in appalling conditions and harms young children sometimes as early as 21 days after birth (International NGO Council on Violence Against Children, 2012).
Origins and root causes of IOM
Throughout history, different cultures have nurtured intriguing beliefs surrounding oral health and embraced what would now be considered unthinkable practices. From the belief that tooth decay was caused by tooth worms to extracting fallen soldiers’ teeth to produce dentures, various examples exist (Federación Dental Internacional, 2015).
As for IOM, it is alleged, that the practice emerged in the 18th century with a European surgeon who advocated for the incision of children’s gums to prevent or treat diseases. Traditional healers in East Africa are thought to have adopted the procedure after colonial dentists brought it there and sustained it until the present day (Girgis et al., 2016). IOM, therefore, has its roots in myths about oral health.
When a child experiences gum swelling or normal discomfort associated with teething, parents or caregivers from areas where IOM is practiced believe that tooth worms are to blame and should be extracted. Additionally, they assume that the swelling will result in illnesses like diarrhea or fever (Global Child Dental Fund, 2019). Driven by the belief that it serves their children’s best interests and that they are merely seeking treatment, parents continue to bring their children to healers to have this procedure done.
Where does IOM take place?
IOM is found in East and Central African countries, including Burkina Faso, Burundi, Chad, the Democratic Republic of the Congo, Ethiopia, Kenya, Rwanda Somalia, South Sudan, Sudan, Tanzania and Uganda (Girgis et al., 2016).
Yet, as with other harmful practices committed against children, IOM is not confined to Eastern and Central African States, and rather spans across communities (SRSGVAC and Plan International, 2012). With migration, cases of IOM have been encountered in many western countries among African immigrants.
This has been the case in Europe (France, Norway, United-Kingdom…) the Americas (United States) and Asia-Pacific (Australia, New Zealand) to only name a few (Girgis et al., 2016). This practice, which has been described by certain dentists as a “serious and hidden global public health problem” given that it affects minors, is also a relevant child rights issue (Kemoli et al., 2022).
IOM as a severe violation of children’s rights
Despite being framed almost exclusively as a public health issue, IOM or milk teeth extraction because it affects minors, defies both public health and children’s rights. Since at the international level, the Convention on the Rights of the Child (CRC) provides a framework for the protection of children’s rights, infant oral mutilation (IOM) contravenes several of these rights. Specifically, IOM violates article 24.3 of the CRC, which urges State Parties to implement measures against traditional practices that jeopardize children’s health.
IOM is not only a customary practice that places children’s health at risk but also obstructs the realization of additional rights outlined in the Convention. These encompass the right to freedom from all forms of violence (Art. 19), as well as the four guiding principles of the CRC: non-discrimination (Art. 2), best interests of the child (Art. 3), the right to life, survival, and development (Art. 6), and the views of the child (Art. 12).
At the regional level, the African Charter on the Rights and Welfare of the Child (ACRWC) offers similar provisions. While reconciling cultural sensitivity and protection, the Charter firmly discourages conflicting practices that threaten children’s health, welfare and development (Art. 21). The Charter also stresses that cultural practices cannot serve as a justification for infringing on children’s rights. And much like the CRC, calls on State parties to adopt measures to abolish such social and cultural practices detrimental to children.
The impact of IOM on children’s health and well-being
Considering the irreparable nature of IOM, the unhygienic conditions under which it is performed and most importantly who it affects, this practice raises serious short and long-term consequences detrimental to children’s overall health and well-being.
Dr. Arthur M. Kemoli, a leading pediatric dentist in the fight against IOM, has outlined that right after the procedure, IOM can cause children to experience trauma, pain, excessive bleeding, and inflammation among others. He further indicated that in worst-case scenarios, IOM is simply fatal (Kemoli et al., 2022). Since traditional milk teeth extraction is performed on various children and members of the community with the same unsterilized tools and instruments, the procedure also exposes children to various infections notably HIV, hepatitis and tetanus (Anjum et al., 2022; Kemoli et al., 2022).
Dentists have also raised flags about the long-term consequences of IOM. This ranges from improper teeth alignment resulting in the need for braces, benign tumors, “defective permanent teeth” or even the lack of permanent teeth due to premature extraction (Anjum et al., 2022; Musinguzi et al., 2019).
While milk teeth are only meant to be temporary, their presence is vital to children’s development. Essentially, milk teeth help children with indispensable functions such as eating, smiling and speech development but they also “hold space” for permanent teeth to erupt (Babich, 2023; Fox, 2022).
In some cases, the damage done by IOM blocks this process, leaving a lasting gap in children’s mouths which also play a role in their psychological state and self-esteem. Overall, all these consequences “can negatively impact a child’s well-being and overall quality of life” (Anjum et al., 2022).
Efforts and responses to eradicate IOM
In 2019, alarmed by this practice, Chief dentists from Eastern and Central Africa, gathered and agreed to elaborate strategies on how to eradicate IOM within 10 years (Wordley & Bedi, 2019). This meeting led to “The Addis Ababa Declaration to end infant oral mutilation” which called on all regional stakeholders inter alia to: launch public health campaigns addressing IOM “in every country in East and Central Africa” and requesting police forces to “treat IOM as child abuse” (Wordley & Bedi, 2019).
Since then, dentists from the region have focused on prevention and awareness raising in their places of work (Wordley & Bedi, 2019). Furthermore, NGOs, charities, and other local organizations have equally been at the forefront of the efforts to end this practice (Peiró, 2019). Nevertheless, the lack of data and tools to support IOM identification and reporting has made it difficult to track the progress and impact of these efforts (Elgamri et al., 2022).
Conversely, most of the efforts to eradicate IOM have been tackling the problem from a health standpoint, rather than also integrating awareness raising on children’s rights as a way to ensure children’s health and well-being. In that sense, more work is needed, not only with communities and healers who still practice IOM but also among dental professionals in the region and beyond.
At Humanium we advocate for the respect of children’s rights and categorically reject all forms of violence and harmful practices against children. Our team’s activities center on spreading awareness of the issues children face, and we invite everyone to do so. If you would like to support us, please consider sponsoring a child, making a donation, or becoming a volunteer.
Written by Sara Valdez
References:
African Union. (1990). The African Charter on the Rights and Welfare of the Child. Retrieved from African Union at https://au.int/sites/default/files/documents/30913-doc-acrwc-en.pdf, accessed in July 2023.
Anjum, Z., Bridge, G., & Bedi, R. (2022). Infant oral mutilation: data collection, clinical management and public health guidelines. British Dental Journal, 233(12), 1042–1046. Retrieved from Nature at https://doi.org/10.1038/s41415-022-5317-0, accessed on July 22, 2023.
Babich, S. (2023). Six Reasons Baby Teeth Are Important. NYC Pediatric Dentist. Retrieved from https://www.nycpediatricdentist.com/six-reasons-baby-teeth-are-important/, accessed on July 23, 2023.
Elgamri, A., Bridge, G., & Bedi, R. (2022). Empowering women: a public health strategy to end infant oral mutilation in Africa. British Dental Journal, 233(12), 988–989. Retrieved from Nature at https://doi.org/10.1038/s41415-022-5390-4, accessed on July 23, 2023.
Federación Dental Internacional (FDI). (2015). El desafío de las enfermedades bucodentales: una llamada a la acción global. Retrieved from FDI World Dental Federation at https://www.fdiworlddental.org/sites/default/files/2021-03/book_spreads_oh2_spanish.pdf, accessed on July 24, 2023.
Fox, D. (2022). Why do we have baby teeth? Sprout Pediatric Dentistry & Orthodontics. Retrieved from https://www.sproutpediatricdentistry.com/blog/pediatric-dentistry/are-baby-teeth-important/, accessed on July 23, 2023.
Girgis, S., Gollings, J., Longhurst, R., & Cheng, L. (2016). Infant oral mutilation – a child protection issue?. British Dental Journal, 220(7), 357–360. Retrieved from Nature at https://doi.org/10.1038/sj.bdj.2016.264, accessed on July 20, 2023.
Global Child Dental Fund. (2019). Endiom. Retrieved from Endiom at https://www.endiom.org/what-we-do, accessed on July 13, 2023.
International NGO Council on Violence Against Children. (2012). Violating children’s rights: Harmful practices based on tradition, culture, religion or superstition. Retrieved from Save the Children’s Resource Centre at https://resourcecentre.savethechildren.net/c3e94f0/, accessed on July 13, 2023.
Kemoli, A., Sidhu, S. K., & Cheng, L. (2022). The need for global safeguards for fundamental rights of children at risk of infant oral mutilation (IOM). BMJ Global Health, 7(3), e008010. Retrieved from BMJ Journals at https://doi.org/10.1136/bmjgh-2021-008010, accessed on July 21, 2023.
Musinguzi, N., Kemoli, A., & Okullo, I. (2019). Prevalence and dental effects of infant oral mutilation or Ebiino among 3–5 year–old children from a rural district in Uganda. BMC Oral Health, 19(1). Retrieved from BMC Oral Health at https://doi.org/10.1186/s12903-019-0890-6, accessed on July 24, 2023.
Peiró, P. (2019). Una mutilación para “sacar los gusanos de la boca.” El País. Retrieved from El País at https://elpais.com/elpais/2019/04/23/planeta_futuro/1556038167_251102.html, accessed on July 22, 2023.
SRSGVAC and Plan International. (2012). Protecting children from harmful practices in plural legal systems with a special emphasis on Africa. Retrieved from https://violenceagainstchildren.un.org/sites/violenceagainstchildren.un.org/files/documents/publications/5._protecting_children_from_harmful_practices_low_res.pdf, accessed on July 21, 2023.
United Nations. (1989). Convention on the Rights of the Child. Retrieved from United Nations at https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-child, accessed on July 2023.
Wordley, V., & Bedi, R. (2019). Infant oral mutilation in East Africa: eradication within ten years. British Dental Journal, 226(1), 14–15. Retrieved from Nature at https://doi.org/10.1038/sj.bdj.2019.1, accessed on July 20, 2023.
