Ritual tooth modification among the Baka pygmies in Cameroon.

INTRODUCTION: Ritual tooth mutilation is a relatively understudied human body mutilatory practices. The purpose of the study was to examine the effects of ritual tooth modification, teeth cleaning measures and herbal medications for their oral health problems among the Baka pygmies in Cameroon. MATERIALS AND METHODS: This cross-sectional study was conducted between January and March, 2012 using semi-structured questionnaire as the tool of data collection. Intra-oral examinations were carried out to determine the dental hard tissue loss using Smith and Knight Tooth Wear Index (TWI). RESULTS: Fifty-six pygmies with ritual tooth modification made of 34 males (60.7%) and 22 females (39.3%) with a mean age of 31 years were interviewed and had oral health examination. The reported age at which the tooth modification was done was between 10 and 15 years with mean age as 12 ± 1.66 years. More than half (58.9%) of the participants reported the tooth filing as painful and nearly two-thirds (64.3%) of the participants reported having persistent pain afterwards. The upper right central and lateral incisors were the most commonly modified teeth. A total of 42.9%, 12.5% and 7.1% of the participants had Smith and Knight TWI scores of 2, 3 and 4 respectively. All the participants reported cleaning their teeth at least once-daily with about two-thirds (66.1%) of them doing so with chewing stick. The majority (67.9%) of the participants reported cleaning their teeth for cosmetic reasons [to remove dirt' (60.7%) and 'to remove stains' (7.1%)]. The oral health problems among the participants in form of tooth sensitivity, toothache and dental abscess were treated with plant-based traditional medicines from Irvingia gabonensis, Ricinodendron heudoletti, Pterocarpus soyauxii, Alchornea cordifolia and Piptadeniastrum africanum. CONCLUSION: Ritual tooth modification is a painful mutilatory practice which is culturally significant for the Baka pygmies without health benefit. There is need for intervention to stop this harmful traditional practices among the pygmies. Further studies is recommended to elucidate the medicinal and pharmaceutical benefits of plants used for tooth sensitivity and other oral health problems by the pygmies.

Bilateral self-enucleation in acute transient psychotic disorder: the influence of sociocultural factors on psychopathology.

Self-inflicted eye injuries are rare but a devastating consequence of a serious mental disorder. Bilateral self-enucleation also known as oedipism has been documented in ancient texts and myths. Various biologic, psychologic, and social theories have been put forward to explain this rare phenomenon. In this report, we describe a case of oedipism, which highlights the influence of sociocultural factors on the psychopathology in acute transient psychotic disorder.

Self-mutilation and suicidal behaviour in Sami and Norwegian adolescents: prevalence and correlates.

OBJECTIVES: To study the prevalence and psychosocial and ethnocultural correlates of self-mutilation and/or suicidal behaviour in Indigenous Sami and majority Norwegian adolescents in north Norway. STUDY DESIGN: A cross-sectional questionnaire study. METHODS: A total of 487 students, aged 13-16 years in 21 junior high schools and 247 parents participated in this school based questionnaire study conducted in 1990 in Finnmark, the county in Norway with the highest suicide rates. Sociodemographics, substance use, thriving at school, ethnocultural factors such as ethnic context, ethnic identity, ethnic language competence and ethnic parentage, self-reported as well as parent-reported behavioural/emotional problems were assessed. RESULTS: Self-mutilation and/or suicidal attempts within the last 6 months were reported by 12.5% of the adolescents and 14.8% reported having suicidal thoughts. In univariate analyses, significant gender differences occurred for both ethnic groups, with more girls reporting self-mutilation and suicidal behaviour. However, in logistic regression analyses adjusting for all other significant variables, the gender difference disappeared. No significant ethnic differences occurred in prevalence. Although factors associated with self-mutilation and suicidal behaviour varied between Sami and Norwegian adolescents, self-reported anxiety/depression was a strong and significant correlate to both self-mutilation/suicide attempts and suicidal thoughts in both ethnic groups. Parents reported less emotional/behavioural problems associated with self-mutilation and/or suicidal behaviour than the adolescents did. Ethnic identification in Sami and ethnic context in Norwegian adolescents occurred in independent analyses as significantly related to self-mutilation and/or suicidal behaviour, but turned insignificant when adjusting for all other significant variables. CONCLUSIONS: In contrast to several other Indigenous groups the prevalence of self-mutilation and/or suicidal behaviour did not differ between Sami and Norwegian adolescents. In both ethnic groups, the effect of ethnocultural factors disappeared when controlled for other variables such as anxiety/depression. Across both ethnic groups, anxiety and depression problems occurred as a common and significant correlate for self-mutilation and suicidal behaviour.

Culturally competent assessment and care of self-mutilation in urological nursing.

Use of self-mutilating behaviors as ineffective coping techniques is increasing, and it cuts across cultural and ethnic populations. With increasing immigration, the chance of facing both issues with a single patient is also increasing. Therefore, the need for assessment and care that is culturally sensitive is a necessity.

Dental mutilations and associated alveolar bone pathology in African skulls of the anthropological skull collection, Charité, Berlin.

BACKGROUND: Dental mutilations (DM) were and are still common among people in Africa. The purpose of this study was to examine DM in 33 skulls from Cameroon, which have been collected around the turn of the 20th century (anthropological collection, Berlin Museum of Medical History). MATERIALS AND METHODS: From the files of the museum, locations and/or tribal origin were recorded. DM classification described by De Almeida was used (1957). RESULTS: DM of the inverted V-shaped type was most common (30.3%). Pulp exposure was seen in 10 cases (30.3%). Periapical ostitis/radicular cysts were seen in nine cases (27.3%). General loss of alveolar bone was seen in all cases with a marked loss of the maxillary anterior labial alveolar bone plate in six cases (18.2%). CONCLUSIONS: DM may result in alveolar bone pathology characterised by inflammatory changes such as periapical ostitis or formation of radicular cysts.

Tooth and lip mutilation practices and associated tooth loss and oral mucosal lesions in the Makonde People of southeast Tanzania.

OBJECTIVE: To determine the prevalence of tooth and lip mutilation (TLM) and the prevalence of tooth loss and the associated oral mucosal lesions among adults in south east Tanzania. DESIGN: A cross sectional, clinical study and questionnaire administration. SETTING: Rural population in southeast Tanzania. SUBJECTS: Randomly selected 217 adults aged 40 years and older. RESULTS: About 16% of all participants performed tooth mutilation. There were more females (20.6%) than males (11.3%) who performed tooth mutilation but the difference was not statistically significant. There was only about 17% of participants in the age group 40-54 years who performed tooth mutilation while there was 50% and 32% in the age groups 55-64 years and 65-95 years and the difference was statistically significant (P < 0.001). Tooth loss due to mutilation was significantly (P < 0.001) less than tooth loss due to other reasons in the anterior teeth and there was no tooth loss due to mutilation in the posterior teeth. Lip mutilation in form of piercing the upper lip and inserting a wooden stick called "ndonya" was found only in women. No oral mucosal lesions were found in this study group. CONCLUSION: Tooth mutilation does not lead to significant tooth loss and lip mutilation and the use of "ndonya" does not cause oral mucosal lesions in this society. Extraction of anterior teeth due to other reasons was significantly higher than extraction following mutilation while in the posterior teeth there was no tooth loss due to tooth mutilation.

Reported childhood trauma, attempted suicide and self-mutilative behavior among women in the general population.

This study attempted to determine the prevalence of childhood trauma among women in the general population as assessed in a representative sample from a city in central Turkey. The Dissociative Experiences Scale (DES) was administered to 628 women in 500 homes. They were also asked for childhood abuse and/or neglect. DES was administered to 251 probands. Mean age of the probands was 34.8+/- 11.5 years (range 18-65). Sixteen women (2.5%) reported sexual abuse, 56 women (8.9%) physical abuse, and 56 women (8.9%) emotional abuse in childhood. The most frequently reported childhood trauma was neglect (n= 213, 33.9%). The prevalence of suicide attempts was 4.5% (n= 28). Fourteen probands (2.2%) reported self-mutilative behavior.

The frequency of culturally derived dental modification practices on the Cape Flats in the Western Cape.

The people living on the Cape Flats (Western Cape) have been practicing dental modification by having their incisors removed for at least 60 years. A survey, by means of a questionnaire, of eight adjoining areas in the Northern Suburbs was done to investigate the current prevalence of this practice. Three groups of study subjects (scholars, working people and retired people) were included to gain a perspective of the community in general. The individual ages ranged between 15 and 83 years old. A total of 2 167 individuals participated in this study of which 41% had modified their teeth. More males (44.8%) than females (37.9%) were involved in this practice. The percentage incidence was overwhelmingly higher in lower income areas. 'Race' and social class are both important factors. Of people who called themselves 'coloured', 74.5% modified their teeth, but 39.8% of 'blacks' and 31.6% of 'whites' within the sample had also practiced tooth removal. The frequency of tooth removal for those who identified themselves as South African was much lower (22.9%). This suggests that dental modification is a phenomenon of ethnicity and community and those who perceive themselves to be part of a broader national fabric are less likely to practice it.

Sex, culture and the anthropologist.

The apocalyptic threat of AIDS, combined with recent ethnological developments, is promoting an anthropological "rediscovery of sex." If this rediscovery is to have important and lasting effects on the development of theory, a stock-taking is in order--one which examines anthropology's historical, methodological, and practical relationship to the study of sexual behavior. Parallel theoretical directions taken in both American and British anthropology, starting in the late 1920's, resulted in a disciplinary departure from the study of sexuality, as such; sexual behavior became shielded from analytic view by a more abstract, propositional approach to society and culture. In addition to reviewing these historical trends, the paper considers elements of personal privacy and intrasocietal variation in the anthropology of sex and, with illustrations taken from the Ilahita Arapesh of northeastern Papua New Guinea, proposes that the locus of sexual behavior and experience lies in the interaction of cultural ideas and psychobiological impulses.

Self-inflicted burns.

Suicide by self-inflicted burns is uncommon in Western cultures. The majority of patients who attempt suicide in this manner have preexisting psychiatric illness, including a history of prior suicide attempts. A history of previous self-inflicted burn is rare, however, as are further suicide attempts in survivors. In this series of 33 patients, a cultural trend can be identified, with an increased incidence among Latin women.

Tooth mutilation in Angola.

In common with many countries throughout sub-Saharan Africa, some of the many tribes which comprise the indigenous population of Angola practise various forms of tooth mutilation. Three examples associated with distinctive tribes are described and compared with similar practices in neighbouring countries and their references from the literature.

Suicide and parasuicide in Singapore (1986).

Suicide and parasuicide rates have increased in Singapore since 1980 and in 1986 were estimated to be 13.1 per 100,000 and 92 per 100,000 respectively. Those most prone to suicidal behaviour are the Indians and the aged above 70 years. Jumping from a height is still the commonest method of suicide and self-poisoning is the most popular method of parasuicide.

Self-mutilation: culture, contexts and nursing responses.

Few papers address the issue of deliberate self-mutilation other than from clinical perspectives. This paper advocates a user-perspective and discusses some of the issues which might attend such a change. The occurrence of self-mutilation is placed within a cultural framework so as to enlarge the debate beyond the confines of medical/nursing responses. It is suggested that nurses abrogate their attachment to such responses and embrace more collaborative approaches to care. In particular, nurses are asked to review their (moral) responses to self-mutilation, an activity which, too often, has been responded to with scorn and derision.

Biometric analysis of the dental casts of Maasai following traditional extraction of mandibular permanent central incisors and of Kikuyu children.

Dental plaster casts of 93 Maasai and 79 Kikuyu children age 12-15 years were analysed. Four biometric measurements were taken of the maxillary and mandibular casts: intercanine distance (C-C), inter-molar distance (M-M), canine arch circumference (C-C ACirc.), and molar arch circumference (M-M ACirc.). Incisor space (IS) was also measured in the mandibular casts. The mean values of all measurements except (M-M) in the mandibular casts were significantly reduced in the Maasai who had permanent central incisors extracted compared to the non-extracted Maasai and the Kikuyu. The mean incisor space in the Maasai with extractions was 6.3 mm compared to 11.7 mm in the non-extracted Maasai group. The extent of reduction of IS, C-C, C-C ACirc. and M-M ACirc. following extractions of the incisors may depend on the mesial drift of lateral incisors, jaw growth and soft tissue influence. The position of the tongue and occlusal relationship of the molars may prevent bucco-lingual movements maintaining a constant M-M. There was no significant difference in the mandibular cast dimensions of the non-extracted Maasai and the Kikuyu. Analysis of the maxillary cast dimensions of the Maasai with extraction, non-extracted Maasai and Kikuyu showed no significant differences suggesting that the extraction of mandibular incisors has no effect on maxillary arch dimensions. The variability in growth of the dento-alveolar complex itself may explain why the dental arch dimensions are similar in the Maasai and Kikuyu despite ethnic differences. There was no significant difference between the male and female dental arch dimensions.

Severe morbid onychophagia: the classification as self-mutilation and a proposed model of maintenance.

OBJECTIVES: The aim of this review is to make a distinction between a mild and a severe form of onychophagia (nailbiting) that has not been adequately recognised in clinical research. Furthermore, the aim is to emphasise the need for greater understanding of the motivation for such self-injury as occurs in the severe form. The purpose of making the distinction is to evaluate whether a label of self-mutilation can be applied to the severe form. If this is the case, the tension-reduction model of self-mutilation can be proposed as the mechanism which may maintain the behaviour in the face of serious social and physical consequences. METHOD: Examination was made of the literature relating to onychophagia and to self-mutilation. Treatment studies of onychophagia were examined to evaluate the mechanisms by which the behaviour may be maintained. RESULTS: Considering the self-mutilative nature of the severe form and the common theme of tension reduction in the literature on onychophagia, application of the tension-reduction model of self-mutilation is warranted. CONCLUSION: There is a need for empirical research as to the tension-reducing nature of severe onychophagia.

Repetitive self-mutilation among Japanese eating disorder patients with drug use disorder: comparison with patients with methamphetamine use disorder.

Repetitive self-mutilation and drug use disorder are less prevalent in Japan, although the prevalence of eating disorder is comparable with rates in Western countries. However, repetitive self-mutilation has not previously been described in relation to eating disorder and drug use disorder in Japan. Subjects consisted of 19 patients with eating disorders and drug use disorders (ED+DUD) and 12 patients with methamphetamine use disorders (MAP). Subjects were drawn from 180 patients who were referred because of eating disorders and 22 patients who were referred because of methamphetamine-related problems. All subjects underwent a semistructured interview. Repetitive self-mutilation tended to be more prevalent among ED+DUD patients than MAP patients. Conversely, history of oppositional defiant disorder and antisocial personality disorder tended to be more prevalent in MAP patients than in ED+DUD patients. The low prevalence of repetitive self-mutilation appears to be due to low risk factors in Japan, even though the pathogenesis of these behaviors seems to be universal.