Letter to the editor: Harmful traditional practice – Infant Oral Mutilation

Author(s): Dr Shalini Ninan Cherian

Principal, Jonglei Health Sciences Institute.

[email protected]

Dear Editor,

While a lot of awareness is being raised about Female Genital Mutilation (FGM), not many people have heard or know about Infant Oral Mutilation (IOM). Before I say more about IOM itself, the word mutilation needs to be understood. By definition, mutilation is a surgical procedure performed in the absence of a medical indication. Body piercings, tattooing and scarification are examples. In most cases, these are cosmetic and done in adulthood. However, IOM is done on young infants and involves gouging out an unerupted embryonal tooth. It is called germectomy in dental jargon. IOM is the cause of acute complications such as septicaemia and tetanus, and even death. It can also lead to serious dental problems in adulthood and theoretically be the cause for the spread of blood-borne infections such as HIV and Hepatitis B and C.

The practice of IOM is common and unique to East African countries and is called by various names. For example, it is called Ebiino in Uganda and Lugbara in Sudan. In Bor Town of Jonglei state in South Sudan and surrounding areas, it is called ‘Hooth’. The reason caregivers of young children resort to IOM has been studied in Uganda and is considered to be because of the un-erupted deciduous tooth being mistaken for maggots eating the body.[1] A casual look at the number of children who undergo the procedure of ‘Hooth’ shows that it is very common in the town of Bor and is not specific to one tribe or ethnic group of the country. In a yet to be published study 86% of children under 6 months of age admitted to the hospital had undergone IOM/Hooth. Further study is required to find out the enormity of the problem in all states of South Sudan.

The Dental Associations of other East African countries have signed a ‘Call to Action’ to stop the practice.[2] While there are not many dentists in South Sudan, the Ministry of Health and the associations of medical and dental professionals should aim to eradicate IOM by collecting data about the practice,[3] signing the “Call to Action” and take steps to eradicate the practice. More studies on understanding why people resort to this practice would help to plan communication on behaviour change. Until then every educated person in South Sudan needs to warn friends and relatives about the harmful effects of IOM.


  1. Nuwaha F, Okware J, Hanningtone T, Charles M. False teeth “Ebiino” and Millet disease “Oburo” in Bushenyi district of Uganda. Afr Health Sci. 2007 Mar;7(1):25-32. DOI: https://doi.org/10.5555/afhs.2007.7.1.25  . PMID: 17604522; PMCID: PMC2366121.
  2. Wordley V, Bedi R. Infant oral mutilation in East Africa: eradication within ten years. Br Dent J. 2019 Jan 11;226(1):14-15. DOI: https://doi.org/10.1038/sj.bdj.2019.1.  PMID: 30631178. 
  3. Anjum Z, Bridge G, Bedi R. Infant oral mutilation: data collection, clinical management and public health guidelines. Br Dent J. 2022 Dec;233(12):1042-1046. DOI: https://doi.org/10.1038/s41415-022-5317-0  . Epub 2022 Dec 16. PMID: 36526778; PMCID: PMC9756706.