Sir, we read with interest the letter by Bibi, Dixon and Barry titled 'Cultural impact on dental care'.1

Infant oral mutilation (IOM) is a barbaric ritual practice in some parts of Africa that can result in fatality, systemic as well as dento-alveolar complications.2

Unexplained dental anomalies, particularly affecting the canines, as a result of IOM may vary in clinical presentation and hence awareness of this grossly under-reported practice is an integral part of clinical diagnosis and safeguarding children.

In the UK, IOM, unlike female genital mutilation (FGM) is not unlawful. Reported cases of IOM have been evidenced in UK-born children with immigrant Africa mothers who did not speak English and were living within rural and less educated communities.3

It is important to highlight, similar to FGM, IOM continues outside of the native settlement among isolated minority African refugee communities in the developed world as they knowingly encourage this deep-rooted superstitious belief. The lack of awareness of IOM among dental and medical professionals is high due to limited literature and publicity.

It is important to recognise contributing factors amongst these sociodemographic groups may include distrust in Western medicine, stress of migration which can cause depression and reduction in self-confidence, isolation, personal and family crises, language barrier and lack of access to the National Health Service (NHS).

A sensitive and informed approach to communication and education by trained and skilled counsellors with an in-depth understanding of African cultures is crucial in dealing with traditional beliefs and practices.

From a social and ethical perspective, legal ramifications similar to FGM, could be considered in the UK as a deterrent for those individuals who incite, allow, or, themselves take part in this mutilating superstitious practice.

It is now widely acknowledged that FGM is an illegal practice. The Prohibition of Female Circumcision Act was first imposed in 1985 with further legislations in 2003 and 2005 making it a criminal offence to arrange for such a practice outside the UK.

Most recently, the UK government pledged £50 million, the biggest single investment worldwide to date, to help eradicate FGM in Africa. With increased awareness and reporting of IOM among dental and medical professions, we hope that IOM will attract similar publicity and help from the government to end IOM in Africa.

In the meantime, when dental professionals suspect possible planned IOM to be carried out in parents native countries, it should be managed according to the child's safeguarding policies.