Infant dental enucleation in an East African population in Sweden: a cross-sectional study on dental records.

AIM: To examine the prevalence of infant dental enucleation (IDE) of primary canines, an East African traditional remedial procedure, in a multiethnic population of children in Sweden. DESIGN: A cross-sectional study was conducted of dental records of 1133 patients (mean age 4.6 years, SD ± 1.4) attending one public dental service clinic in Sweden. The clinic was located in an area with a large multiethnic community. All were born within the years 2002-2006 and had received a check-up in one of the years 2007-2009. A registry was made of missing primary canines where no reason could be found. In documented cases, information about ethnic origin was extracted. Statistical grouping was made according to known East African ethnicities. RESULTS: At least 36 ethnicities were recorded. Twenty-four (2.1%) patients were missing one or more canines according to the criteria for IDE. Significant difference was seen when comparison was made between patients of known East African ethnicities, of whom 20.8% (21/101) manifested findings consistent with the criteria, and the rest of the population (3/1032; P < 0.001). CONCLUSIONS: Prevalence of cases suggestive of IDE among patients of East African origin points to a need for increased awareness within dental and healthcare communities.

Cephalometric and electromyographic study of patients of East African ethnicity with and without anterior open bite.

INTRODUCTION: A review of the literature showed that there are disturbances of muscle activity and tongue function in patients with anterior open bite (AOB). However, most studies have had white subjects, even though open bite is more prevalent in black populations. In this pilot study, we examined jaw muscle activity and tongue pressure in East African black subjects. METHODS: Ten subjects (4 boys, 6 girls; ages, 10.1-13.2 years) were recruited. A cephalometric comparison of subjects with and without AOB was performed. Surface electrodes were placed on the bilateral anterior temporalis, superficial masseter, superior orbicularis oris, and anterior digastric muscles. Electromyograms were recorded at rest, maximal voluntary clenching, chewing, and swallowing. Tongue pressure during rest and swallowing, and maximal bite force were also measured. RESULTS: There was no statistically significant difference between the 2 groups in cephalometric measures (except in amount of open bite and overbite) and maximum bite force. During chewing, both groups showed similar coordinated activity patterns in the muscles, but the AOB subjects tended to show more electromyographic activity in the muscles of the balancing side. During clenching, the AOB subjects exhibited lower electromyographic activity compared with the controls. AOB subjects also had greater anterior tongue pressure during swallowing. Data from tongue pressure at rest were inconclusive. CONCLUSIONS: East African blacks appear to have neuromuscular and skeletal predispositions to AOB, but their vertical incisor relationships are variable. Factors in addition to those investigated might be involved.

Infant oral mutilation - a child protection issue?

Infant oral mutilation (IOM) is a primitive traditional practice involving the 'gouging out' of an infant's healthy primary tooth germs. This can lead to transmission of blood-borne diseases such as HIV/ AIDS, septicaemia and death. Other complications include eradication and/ or malformation of the child's permanent dentition. IOM is usually performed by village healers in low income countries as an accepted remedy for common childhood illness. The gingival swelling of the unerupted teeth is mistakenly thought to indicate the presence of 'tooth worms'. Crude methods to remove these are employed using unsterile tools. IOM has been reported in many African countries. More recently, some immigrants living in high income countries, such as the UK, have shown signs of IOM. Our aim is to raise awareness among clinicians about the existence of IOM practice being carried out among respective African immigrant groups. We encourage clinicians, particularly those working with paediatric patients to inform parents and carers of children with a history of IOM about the risks and consequences. As part of child safeguarding policies, dental practitioners and health care professionals should intervene if they are aware of any perceived plan that IOM is to be carried out in the future.

Driving under the influence of khat--alkaloid concentrations and observations in forensic cases.

The use of the herbal stimulant khat (Catha edulis FORSK) is maintained by immigrants from countries where it is part of their cultural life (Arabian Peninsula and eastern Africa). In western countries the drug and its effects are largely unknown and no experience in evaluating impairment symptoms due to the khat-alkaloids, e.g. cathinone, cathine and norephedrine exists. Blood and urine samples from khat users involved in 19 cases of suspected driving under the influence of drugs were analysed and correlated with the results of medical examination and police officer reports. In 3 cases impaired driving and in 10 cases marked impairment of psychophysical functions was observed such as effects on the nervous system (slow pupil reaction to light, dry mouth, increased heart-rate), trembling, restlessness/nervousness, daze/apathy/dullness, impairment of attention, walking and standing on one leg. However, the alkaloid concentrations assayed in blood did not correlate with the impairment symptoms. Apart from an acute phase of indirect sympathomimetic action the development of habituation and withdrawal symptoms must also be considered in explaining the diversity of effects observed. From these results it can be concluded that chewing khat may severely impair driving ability, but may also be without noticeable effects.