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IN BRIEF
On traditional dental extraction: case reports from Dinka and Nuer en route to restoration
Chronicles memories of a traditional childhood extraction process in Dinka and Nuer refugees from Sudan.
Describes canine/incisor root retention in three males who experienced ritual extraction during childhood in Sudan.
Describes dental practice and care systems among Dinka and Nuer in Sudan.
Provides information about dental status among refugees that might be useful to dentists in western host countries.
PRACTICE
M. S. Willis,1 L. E. Harris2 and P. J. Hergenrader3
Ritual dental extraction among Sub-Saharan African populations has been practised for centuries, yet little is known about the removal process for any ethnic group. Dinka and Nuer refugees to the US requested replacements for missing anterior teeth removed during childhood. Among 36 Sudanese refugees, 238 individual extractions had been performed. Three retained canine/incisor root fragments; their cases are presented, including memories of the tooth-extraction ritual.
The ritual removal of anterior teeth among Sub-Saharan African populations is an ancient practice, at least1,500 years old,1 and may have originated when tetanus incidence rates were high and lockjaw prevented normal food intake.2-12 Located in the eastern region of the African continent and north of the equator, Sudan is divided by the Sahara desert. It is in the subSaharan region of Sudan, as in much of Sub-Saharan Africa, where anterior tooth extraction occurs just after permanent tooth eruption and has been associated with adulthood, beauty, tribal identity, sound production, and soft food consumption.13-20 Historically, as many as nine cultures of Southern Sudan removed anterior teeth during their recent history and specic extraction patterns have become inextricably linked to tribal identity.15,16,18 Nilotic
pastoralists traditionally extracted two
practices and traditions. Contrary to historical accounts, anterior dental extraction is not restricted to males; rather anterior tooth extraction was also performed on females and was essential for the transition to adulthood.24,25 Among
the Nuer, it was not just the mandibular incisors but also the mandibular canines that were extracted. Furthermore, although not previously described, the permanent maxillary canines were also removed among the Nuer.24,25 The following three case reports are of individuals who have retained incisor/canine root fragments. The description of these cases and the memories of extraction procedures provide insight into Dinka and Nuer dental practices....