Prevalence and impact of infant oral mutilation on dental occlusion and oral health-related quality of life among Kenyan adolescents from Maasai Mara

Arthur Kemoli,Anders Johansson,Mark Lindholm,Hans Gjørup,Marie-Louise Milvang Nørregaard,Dorte Haubek,Tonnie Mulli

doi:10.1186/s12903-018-0631-2

Abstract

BackgroundInfant Oral Mutilation (IOM) includes germectomy and early extraction of primary and permanent incisors and canines, primarily in the lower jaw.The aim of the present study was to examine the prevalence and impact of IOM, involving the removal of mandibular permanent incisors and/or canines, on dental occlusion and Oral Health-Related Quality of Life (OHRQoL) among Kenyan adolescents from Maasai Mara.MethodsIn a cross-sectional study, 284 adolescents (14–18 yrs. of age) participated in an oral examination and an interview, using a structured questionnaire on age, gender, medical history, and IOM practice. For the analysis of the dental occlusion, participants with IOM, in terms of absence of two or more permanent teeth in the mandibular incisor and/or canine tooth segments (IOM group), were compared to participants who had all six incisors and canines present in the oral cavity (control group). OHRQoL was assessed using child perception questionnaire (CPQ11–14).ResultsThe majority of the participants (61%) had been exposed to IOM, among whom 164 (95%) had absence of two mandibular central incisors. More individuals in the IOM group had maxillary overjet exceeding 5 mm than in the control group (50.9% vs. 20%, p < 0.001). Nineteen (11%) subjects in the IOM group had mesial occlusion in contrast to none in the control group (p < 0.001). The mean and median total CPQ scores and the mean and median CPQ domain scores were low in both groups with no significant differences between the groups.ConclusionsApproximately two-thirds of the study population presented with IOM, with the majority of them missing two mandibular permanent central incisors. Although some participants with IOM had substantial maxillary overjet and mesial occlusion, only few of them showed substantial effect on their OHRQoL.

Highlights

Infant Oral Mutilation (IOM) includes germectomy and early extraction of primary and permanent incisors and canines, primarily in the lower jaw
Number of teeth present in the oral cavity Among 283 out of 284 teenagers entered into the study, the overall mean number of permanent teeth present in the oral cavity was 27.9 [standard deviation (SD): 2.0; range: 22–32; 95% confidence interval (CI): 27.7–28.1]
A total of 173 out of 284 (61%) teenagers belonged to the IOM group, with bilateral absence of the mandibular central incisors being the dominant finding in relation to the IOM practice (164 out of 173 subjects in the IOM group (94.8%) and 164 out of 284 in the total group (57.7%)) (Fig. 1c and d)

Summary

Introduction

Infant Oral Mutilation (IOM) includes germectomy and early extraction of primary and permanent incisors and canines, primarily in the lower jaw. Infant oral mutilation (IOM) is a traditional practice performed in young children, mostly as germectomy of developing primary or permanent mandibular incisors or canines, or early extraction of these tooth types [1,2,3,4,5]. Dental defects, dental deficiency (aplasia of succedaneous permanent teeth due to IOM on primary teeth), and eruptional disturbances may occur [1, 3, 8] In addition to these adverse defects and disturbances, unwanted side-effects on dental occlusion may occur due to imbalance of the space in the dental arches as, e.g., development of deep bite by overeruption of the upper incisors without antagonists [9, 10]. In Kenya, apart from the observations made by Hassanali and coworkers [20], no other studies on the assessment of the long-term effects of IOM on the dental occlusion of the affected children have been found

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