Noma as a complication of false teeth (Ebiino) extraction: a case report

Abstract

BackgroundEbiino, also known as false tooth extraction, is a traditional practice done mainly in the remote areas of African countries, including Uganda. It involves the extraction of tooth buds in babies with common childhood illnesses such as fever, cough, and diarrhea. It is thought that the tooth buds are responsible for the ailments seen in these infants. The practice is performed by traditional healers using unsterile instruments. The complications associated with this dangerous practice have been mentioned in the literature and include anemia and septicemia, among others. This case report describes a baby with noma, an orofacial gangrenous infection.Case presentationA 16-month-old girl from western Uganda belonging to the Banyankole ethnic group was admitted to Mbarara University Teaching Hospital with a 5-day history of a dark lesion on the left cheek. The lesion had started from the left upper gum at the site where a tooth bud had been extracted 1 week prior to admission. The child had experienced occasional cough and fever and also had erupting tooth buds. These tooth buds had been seen as the cause of the cough and fever by the traditional herbalist; hence, they were extracted. An unsterile instrument had been used for the procedure. At the hospital, a local examination showed necrotic tissue involving the left cheek and extending into the left upper gingival area of the girl’s mouth. A clinical diagnosis of orofacial gangrene (noma) was then made.ConclusionsEbiino, or false tooth extraction, is still practiced in some remote areas of Uganda. Noma has been mentioned as a possible complication of this traditional practice; however, case reports in the literature are scant. Public awareness of the dangers of this practice is therefore still required to prevent this dangerous complication.

Prevalence and dental effects of infant oral mutilation or Ebiino among 3–5 year–old children from a rural district in Uganda

“…The crude methods used accompanied by the associated trauma and pain for the infant qualifies it to be a form of child abuse. Case reports of the occurrence of a radicular cystic lesion [11] and noma [12] have been reported to occur in infants following this practice. Death also occurs, with a 21% fatality rate reported in a Ugandan study [2].…”

Effects of nutrition and hygiene education on oral health and growth among toddlers in rural Uganda: follow‐up of a cluster‐randomised controlled trial

“…A study in Northern Uganda reported that complications from removal of ‘false teeth’ were among the leading causes of death in the children's ward . A noma (cancrum oris) case has been reported following extraction of ‘false teeth’ in a hospital in South‐Western Uganda . The other complications include missing or malformed permanent teeth due to the operation trauma, osteomyelitis of the jaw, ablation of neighbouring teeth and dentofacial malocclusions .…”

The need for global safeguards for fundamental rights of children at risk of infant oral mutilation (IOM)

“…IOM has been associated with bloodborne diseases such as HIV and AIDS and up to 7%–87% of nutrition-related conditions12 17 such as Noma or cancrum oris 20. Other conditions associated with IOM include dental hypoplasia (up to 35%), trauma, malformation and dilaceration of both deciduous canines and succedaneous canines,14 15 17 missing permanent canines and ectopic eruption of primary and permanent canines,14 and unnecessary loss of the targeted primary tooth/teeth (figure 1).…”