Teeth Mutilation: Review and Two Case Reports.

Teeth mutilation is referred to as intentional trauma and tooth modification. Since ancient past, they represent various social and cultural habits in different parts of the world, they could be symbol of beauty and youth, strength since the ancient past, clinically, it can be presented by notching, drilling, chipping, grinding, grooving, sharping, filling, staining, and covering the crown by precious metals or even tooth extraction. Teeth mutilation helps to identify the ethnicity of the individual by forensic experts and forensic odontologists; it can also associated with syndromes as Lesch-Nyhan syndrome; furthermore, teeth mutilation can result in reduction or even permanent impairment of the oral system. There is a need of educational and awareness programs regarding this phenomenon and its consequences in different regions of the world. Copyright:

INTRODUCTION

The face and teeth had an interest to express a wide range of traditions, believes, superstations, religious, social, and cultural factors as a symbol of beauty and youth, strength since the ancient past. This had been demonstrated by various mutilation and/or decorative rituals.[1] Dental mutilation is an intentional modification of the tooth shape that was done in many countries globally including African, Asia, the Pacific, China, India, South and Central American region, and even in the Viking communities.[23]

The teeth intentional trauma may be represented by modification of the tooth morphology or surface (e.g., by chipping, notching, grinding, drilling, grooving, sharping, filling, staining, and covering the crown by precious metals) or even tooth extraction; these practices were more notices in underdeveloped countries and some developed countries till nowadays.[3] On the other hand, teeth can give an impression about some behavioral practices as using the teeth to hold pipe sinew, pins, and pipe sinew that may guide the dental anthropologists and reported in archaeological specimens that helps in interpreting general and specific cultural behaviors of certain regions of the world that represents their own lifestyle in various civilizations.[4]

The teeth intentional mutilation may be done as a part of the preparation for certain social or ethnic groups, cultural event like to allow more efficient spitting, to improve the masticatory, as a part of marriage and puberty ceremonies.[1] In case of jaw luck as in tetanus it is done for feeding, or to look more beautiful, to appear just like an animal or just to avoid it. Furthermore, it could be done in order to be able to produce specific sounds. In addition, it can be done to express certain self-identity achievement or a transformation from one phase of life to another like from adolescence to adulthood, that is represented by endure the pain experience and withstanding physical pain of this intentional trauma.[1]

Various types of teeth mutilation were related to the origin of the population, and to the region, therefore, in western countries, it can be recognized in immigrant individuals.[5] Moreover, some of mutilation that carried out for young children is justified by their medical benefit, for example, in the presence of fevers and diarrhea, the extraction of deciduous canines tooth buds is performed as a remedy for this illness, which is far from the traditional or cultural base of teeth mutilation.[6]

CASE REPORT

Case number 1

A 23-year-old female from Douala–Cameroon attend dental clinic at Thumbay Dental Hospital, Ajman, United Arab Emirates, asking for teeth cleaning. During physical examination and in particular intraoral examination, we noticed the abnormality in the shape of the upper central incisors [Figure 1]; in addition to the presence of melanotic pigmentation of the gingiva which is racial and malalignment of the teeth, this is regardless of her chief complain.

Figure 1

Upper central incisors with filed mesio-incisal angle when she was 13 years old

When we ask her about the cause of this abnormal tooth shape, she hesitated and was embarrassed when asked, but with prolonged conversation, she then told us that this had been done intentionally by a priest who filed her teeth with a rock as a symbolic sign of her maturity when she was 13 years old. That procedure did not cause pain at that time in the teeth, and they are still vital as per our clinical examination. No radiograph had been taken as the patients complain, and the clinical intraoral examination was not indicated.

Case number 2

A 29-year-old male patient from Cameroon attend dental clinic at Thumbay Dental Hospital, Ajman, United Arab Emirates, complains from pain on his lower jaw. During physical examination and intraoral examination, his upper central incisors were abnormally shaped mesio-incisally [Figure 2], this is regardless of the findings of chief complaint area.

Figure 2

Upper central incisors with rubbed mesio-incisal angle when he was 14-year-old

When asked about the history of this teeth mutilation, he said that it has been done by his father intentionally when he was 14 years old. This filing was done with a sharp metal rod (iron cooler), the purpose of doing this he said that it is considered as a ritual in his tribe in community that is a symbolic sign for beauty and strength. He added that the procedure was not painful, and during examination, the two upper central incisors were vital, even the radiograph revealed no periapical changed. The tooth #37 showed a large carious lesion which is the cause of his chief complaint [Figure 3].

Figure 3

Orthopantomogram of the male patient

DISCUSSION

Dental mutilation or intentional dental modification is a common practice that related to ancient civilizations in various regions in the world. These intuitional modifications in the morphology were done for several purposes as a symbolic sign of beauty, identification of specific ethnicity or tribe; furthermore, it can refer to certain social status as marring or puberty[3] which can give an idea about migrated populations globally as its closely related to population of origin and to the region they migrate from.[7] In addition, it will help the forensic experts and forensic odontologists to identify the ethnicity or the provenance of the human being.[8]

Arora et al. reported that high frequency, low intensity form of self-injurious behavior is seen in mental retardation and personality disorder. While highly destructive, low-frequency form is seen in acute intoxications or psychosis.[9] Oral self-mutilation was reported by Lee, Jae-Ho; Berkowitz, Robert J., and Choi, Byung-Jai in two children, who are cousins with Lesch–Nyhan syndrome. This syndrome is clinically presented with mental retardation, self-mutilation, chorea, hyperuricemia, athetosis, and uricosuria. There was self-mutilation represented by severe lip(s) wounds.[10]

Agbor et al., in 2015, did a study in Cameroon on 56 pygmies with ritual tooth modification. He found that the mean age of at which the tooth modification was done was between 10 and 15 years which is in agreement with our two cases, they also found that the most commonly modified teeth were the upper right central and lateral incisors. Furthermore, two-third of the participants were complains from afterward persistent pain.[10]

The dental mutilation can be present in several patterns clinically, by teeth extraction of single or multiple teeth upper or lower or both. The extraction could be for primary or permanent teeth. It can be presented as modification in the teeth morphology by rubbing, notching or pitting of teeth, coloring of teeth, coving the teeth or part of it with, precious metal, and applying decorations.

“Teeth blackening” is referred to dying of whole or just the visible surfaces of the teeth is considered as ancient tradition done in puberty time.[11] The majority of these practices are performed by traditional healers, especially in African rural communities.[12]

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Nil.

Conflicts of interest

There are no conflicts of interest.