Australian Dental Journal 2005;50:4.267
Tooth follicle extirpation and uvulectomy
NL Johnston,* PJ Riordan†
Migration is not only the movement of people, but
also of their culture, customs and beliefs. As more
people from developing countries in Africa migrate
to industrialized countries, the more likely health
professionals will find themselves providing care for
people of whose customs and practices they have
little knowledge. This review of the literature
suggests that removal of deciduous canine follicles
and uvulectomy are frequently practised in some
African and neighbouring countries. Reasons given
for deciduous canine extirpation include the
prevention of vomiting, fever and diarrhoea. The
indications for uvulectomy appear widespread,
including treatment for persistent fever, coughing
and growth retardation. The practices are usually
performed by traditional healers. Risks for children
who undergo these procedures are extensive,
transmission, numerous dental complications and
death. With improved understanding between
Western health teams and local, traditional people,
an improved system may develop whereby the two
systems can work together in providing improved
health outcomes for the people.
potential for HIV
Key words: African traditional medicine, uvulectomy,
deciduous canines, tooth follicle extirpation.
(Accepted for publication 1 March 2005.)
deciduous canine tooth follicles. The removal of
deciduous canine follicles, either pre- or occasionally
post-eruptively, appears to be increasing in occurrence
and geography.1,2Both are practised mostly on children
for perceived health-related reasons.
The literature describes uvulectomy and canine
follicle removal in infants and children predominately
in Africa and neighbouring Arabian countries. These
practices occur within cultural environments where
knowledge and values are different from those in
industrialized countries. The purpose of this paper is to
describe these practices including their rationale, the
procedures employed, and the complications that may
arise so that health professionals who encounter these
conditions may understand their background.
Extirpation of deciduous canine follicles
The removal of deciduous canines is a procedure in
which the unerupted canine follicles are excised.
Typically, this is achieved without anaesthetic, using
some sort of sharp instrument like a hot needle, knife,
or even fingernail.1-3The children vary in age from a
few weeks old1up to 18 months.3The peak age is
reported to be between four and 18 months of age.3The
deciduous tooth follicles most likely to be removed are
reported to be the lower deciduous canines,2,4-7and the
removal is almost always bilateral (Fig 1).2,5,8
The procedure is usually carried out by a traditional
healer who makes a living from this practice,2,3
although in some cultures it may be performed by a
respected older woman, family member, priest or
teacher.1,9The instruments are usually not sterile,
risking infection.3The canine tooth is perceived to be a
cause of diarrhoea, vomiting and fever in infants7in
countries such as Ethiopia, Uganda, Tanzania, Somalia
and Sudan (Table 1). Kikwilu and Hiza, who
interviewed village health workers in Tanzania, state
that traditional healers associated infectious diseases,
fevers and diarrhoea in infants with the gingival
swellings overlying developing teeth.10
The historical origins of canine follicle extirpation
are not clear.3The practice is thought to be of relatively
recent origin.2,3The first reports of the procedure were
Health practices and health beliefs vary widely
between cultures. As people from developing countries
migrate to industrialized countries, health care workers
are liable to encounter persons of whose health customs
and practices they have little knowledge. Similarly,
health care workers from industrialized countries who
go to work in other cultures, particularly in Africa, may
encounter unusual practices. Frequently reported
examples include female and male circumcisions, body
piercing and filing of teeth. Less well known are intra-
oral mutilations such as uvulectomy and the removal of
*The Centre for Rural and Remote Oral Health, The University of
†Dental Health Services, Department of Health, Perth, Western
Australian Dental Journal 2005;50:(4):267-272
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Address for correspondence/reprints:
Ms Nicola Johnston
31 Malcolm Street
West Perth, Western Australia 6005
272 Australian Dental Journal 2005;50:4.