Sir, the oral health charity, Dentaid, wishes to increase awareness amongst UK dental practitioners to the possibility of seeing the consequences of Infant Oral Mutilation (IOM) in patients born in Africa or with African parents.

This traditional practice of gouging out deciduous tooth buds (perceived to be 'tooth worms' causing diarrhoea and fevers and thought to be potentially fatal) is carried out in at least ten African countries. The unhygienic methods used can cause septicaemia, tetanus, transmission of blood-borne diseases such as HIV/AIDS, and can be fatal. Orthodontic and other sequelae have been reported in immigrant patients living in Israel, Sweden, the UK, USA, Australia, France and Norway.

Clinical presentation: When a child presents with missing primary canines it is most likely to be due to him/her having had treatment for 'tooth worms', as congenital absence of deciduous canines is very rare in African children. The most common presentation is absence of the primary canine, the majority being from the mandible, being three times more common than in the maxilla. Hypoplastic/dysplastic canines are also an indicator as, when the primary tooth is being enucleated, the permanent successor tooth can be damaged.

Other dental presentations are:

  • Missing mandibular primary lateral incisors

  • Peg shaped incisors or canines

  • Retention of primary lateral incisors, with distal eruption of permanent successors

  • Displacement and impaction of permanent canine

  • Missing lower permanent incisors

  • Failure of development of permanent canine

  • Compound odontoma

  • Orthodontic complications.

A detailed and regularly updated overview of IOM and photos of orthodontic consequences following the practice may be accessed at

In view of the worrying possibility that traditional healers who perform IOM may also be amongst those who have emigrated to the UK and may be still carrying out this practice (which is deeply entrenched in local beliefs), Dentaid would like to hear from any GDPs or orthodontists who would be willing to take part in a simple survey to investigate this, or who have identified IOM as a cause of malocclusion or missing/damaged permanent teeth. Please contact me on for further details.