Public Health (1992), 106,465-471
© The Society of Public Health, 1992
Beliefs about Prematurely Erupted Teeth in Rural Yoruba Communities, Nigeria C. O. Oyejide, MB BS PhD 1 and G. A. Aderinokun, BDS MPH 2
1Department of Preventive and Social Medicine, College of Medicine, University College Hospital, Ibadan; and 2Department of Preventive Dentistry, College of Medicine, University College Hospital, Ibadan, Nigeria
A descriptive study was carried out in two villages: Badeku and Olodo, near the city of Ibadan, between May and November 1990. The objective of the study was to investigate the knowledge, beliefs and attitudes of respondents to premature eruption of deciduous teeth in babies. Of the 622 people interviewed, a large proportion (30.5%) believed that the first deciduous tooth should erupt between the age of 5-7 months; the next commonly mentioned time of tooth eruption was 7-9 months of age; and 50.3% of the respondents claimed to have seen a case of prematurely erupted primary teeth. There was a statistically significant association between age and also between educational status of respondents and having seen premature eruption of teeth (P < 0.01). The majority of the people (53.7%) felt that the condition was an indication of an evil child. Only 22.1% of those interviewed thought it could be just an individual variation. On the recommended remedy or management of the condition, as many as 26 (4.I%) said they would get rid of the child. A high percentage felt that sacrifices should be offered to appease the gods. It is suggested that a transcultural approach be adopted in managing cases in which the parents feel particularly anxious and uncomfortable about prematurely erupted teeth in order to cater for the social well-being of the child and family. It is also recommended that appropriate health education be directed at the society as a whole concerning this condition.
Introduction E m e r g e n c e o f t h e first d e c i d u o u s t e e t h in b a b i e s s h o w s as m u c h v a r i a t i o n b e t w e e n o n e i n d i v i d u a l a n d a n o t h e r as it d o e s a m o n g d i f f e r e n t r a c i a l g r o u p s . 1-9 S t u d i e s o n e r u p t i o n d a t e s of d e c i d u o u s t e e t h h a v e n o t e d e r u p t i o n of t h e first p r i m a r y t e e t h to b e at o r a b o u t six m o n t h s o f age. ~-9 O c c a s i o n a l l y , h o w e v e r , e r u p t i o n o f p r i m a r y t e e t h m a y o c c u r p r e m a t u r e l y . This p r e m a t u r e e r u p t i o n c o u l d b e o f two types. S o m e b a b i e s a r e b o r n w i t h t e e t h in t h e m o u t h - a c o n d i t i o n g e n e r a l l y r e f e r r e d to as n a t a l t e e t h . S o m e o t h e r s e r u p t t e e t h within the first 28 d a y s o f life, a n d t h e s e a r e r e f e r r e d to as n e o n a t a l t e e t h . ~0 N a t a l a n d n e o n a t a l t e e t h a r e o f t e n l o w e r c e n t r a l i n c i s o r t e e t h b e l o n g i n g to t h e n o r m a l d e c i d u o u s series. 11,12,13,14 T h e y c o u l d b e f u r t h e r q u a l i f i e d as m a t u r e o r i m m a t u r e t y p e s d e p e n d i n g o n t h e d e g r e e o f m a t u r i t y o f t h e e n a m e l at t h e t i m e o f eruption. These prematurely erupted teeth are usually mobile consequent on lack of r o o t f o r m a t i o n . F o r f e a r o f b e i n g a s p i r a t e d , t r a u m a t i s m to m o t h e r ' s n i p p l e s a n d d i s c o l o u r a t i o n o f t h e e n a m e l in t h e i m m a t u r e t y p e s , t h e s e t e e t h a r e u s u a l l y e x t r a c t e d . O c c u r r e n c e o f n a t a l t e e t h varies b e t w e e n 1 in 2,000 a n d 1 in 3,667 live births. 12,15 Correspondence to: Dr G. A. Aderinokun.
466
C. O. Oyejide and G. A. Aderinokun
Records of the incidence in Nigeria to date are lacking. The condition is nevertheless occasionally encountered in clinical dental practice. Mothers of young babies present at times requesting the removal of such prematurely erupted teeth. A common feature which is striking is the anxiety of such mothers that the teeth be extracted at the earliest possible time. The explanation for this behaviour is the negative societal reaction to seeing teeth in the mouth of such young babies. Observation of this general unease among parents of these babies initiated a study to investigate the myths, beliefs and mode of management of prematurely erupted teeth in two rural Yoruba communities and thus to recommend appropriate clinical management in the context of the findings. Materials and Methods
A descriptive study was carried out in two rural communities: Badeku and Olodo, which are about 20 km from Ibadan City. These villages serve as sites for Primary Health Care activities of the Institute of Child Health, University College Hospital, Ibadan. The objective of the study was to document beliefs about prematurely erupted teeth and the usual remedy for the condition in the two villages. Meetings were held with the community leaders during which the objective of the study was explained and their consent sought. A standardized questionnaire was designed to elicit, among other things relating to tooth eruption, beliefs about the cause of premature eruption of teeth in babies and the recommended management of the case. The questionnaire was translated into Yoruba, the local language. It was then pre-tested in another village similar to the study sites. Field workers were recruited from the villages, hence they could conduct interviews in the evenings when residents returned from their farms and market-places. Training of the field workers consisted of sessions in which one of the investigators first discussed and practised interview techniques with them in the office, followed by further sessions in the field. The workers were evaluated after the training sessions. One of them had to be dropped because his results varied markedly from those of the others. Every household in the two villages was included in the study and selected respondents comprised every third adult on the list of inhabitants. Each completed questionnaire was checked by the investigators for missing information and immediately returned for correction. Data were entered onto an IBM PC AT microcomputer using the data entry software DATASTAR. Data analysis was done with SYSTAT, a comprehensive statistical package. Frequency distributions and relevant tables were generated. The chi-square test of association was used where appropriate. Results
A total of 622 questionnaires were completed from both villages; 40% of the respondents were males. The age distributions are as shown in Table I: 14% were under the age of 30 years. Their educational status is shown in Table II, with 51.1% of respondents having no formal education. A large proportion of respondents from this rural population (30.5%) believed that the first milk tooth should erupt between the ages of 5-7 months. The next commonly mentioned time of tooth eruption was
Beliefs about Prematurely Erupted Teeth Table I Age at eruption of first tooth
Perceived normal time of eruption of first tooth in babies
Below 30 years
(months) 3-5 5-7 7-9 9-11 >11 Missing Total
467
13 (14.9) 39 (44.8) 20 (23.0) 5 (5.7) 7 (8.0) 1 (1.1) 87 (100)
31-40 15 (11.6) 58 (44.9) 30 (23.2) 15 (11.6) 11 (8.5) 0 (0) 129 (100)
Age of respondents in years 41-50 Over 50 9 (5.8) 52 (33.7) 60 (38.9) 25 (16.2) 8 (5.1) 0 (0) 154 (100)
8 (3.2) 41 (16.3) 72 (28.6) 98 (38.9) 32 (12.7) 1 (0.3) 252 (100)
Total 45 (7.2) 190 (30.6) 184 (29.0) 143 (22.9) 58 (9.3) 2 (0.3) 622 (100)
Figures in parentheses are percentages. X2 = 112.1; df = 12; P < = 0.01. Table I1 Perceived normal eruption time by educational status of respondents Age at eruption of first tooth (months)
No formal schooling
Arabic education
Primary eduction
Postprimary education
Total
3-5 5-7 7-9 9-11 >ll Missing information Total
13 (4.1) 93 (29.3) 99 (31.1) 79 (24.8) 32 (10.1) 2 (0.6) 318 (100)
10 (9.1) 28 (25.5) 31 (28.2) 34 (30,9) 7 (6.4) 0 (0) 110 (100)
5 (5.1) 44 (44.4) 33 (33.3) 10 (10.1) 7 (7.1) 0 (0) 99 (100)
17 (17.9) 25 (26.3) 21 (22.1) 20 (21.1) 12 (12.6) 0 (0) 95 (100)
45 (7.2) 190 (30.6) 184 (29.6) 143 (23.0) 58 (9.3) 2 (0.3) 622 (100)
Figures in parentheses are percentages. 2"2 = 44.0; df = 12 P = < = 0.01. 7 - 9 months of age. There was a statistically significant association between age of respondent and reported time of tooth eruption ( P < 0.01) with a higher proportion of those over 40 years old believing in late times of eruption, i.e., 7 - 9 months and above (Table I). Similarly, there was a statistically significant association between educational status and perceived time of tooth eruption (Table II) with a greater proportion of those with secondary education believing in earlier times for eruption. There was no statistically significant association between sex of respondent and perceived time of tooth eruption. On the question of deviation from perceived normal time, 73% of the rural dwellers believed that such a situation sometimes occurs. About half (50,3%) of the respondents claimed to have seen a case of prematurely erupted primary teeth. There was a statistically significant association between age and also between educational status of respondents and having seen premature eruption of teeth ( P < 0.0i), meaning that the older people were more likely to have seen the condition (Table III). A higher proportion of those with lower level of education claimed to have seen teeth that erupted too early (Table IV). T h e r e was, however, no association between sex of respondent and having seen a case of premature eruption.
C. O. Oyejide and G. A. Aderinokun
468 Table III
Number of respondents who had seen prematurely erupted teeth by age
Responses 50
31-40 31 98 0 129
(24.0) (76.0) (0) (100)
89 65 0 154
(57.8) (42.2) (0) (100)
174 77 1 252
(69.0) (30.6) (0.4) (100)
Total 313 308 1 622
(50.3) (49.5) (0.2) (100)
Figures in parentheses are percentages. 22 = 103.5889; df = 3; P < = 0.01. Table IV
Respondents who had seen prematurely erupted teeth by educational status
Responses
No formal schooling
Arabic education
Primary education
Yes No Missing information Total
169 148 1 318
65 45 0 100
42 57 0 99
(53.1) (46.6) (0.3) (100)
(59.1) (40.9) (0) (100)
(42.4) (57.6) (0) (100)
Post-primary education 37 58 0 95
(38.9) (61.1) (0) (100)
Total 313 (50.3) 308 (49,5) 1 (0.2) 622 (100)
Figures in parentheses are percentages. 2.2 = 11.90288; df = 3; P = 0.01. W h e n asked to state the cause of the condition, 53.7% of the p e o p l e felt that the condition must be an indication of an evil child. Only 22.1% of those interviewed t h o u g h it could just be an individual variation (Table V). T h e r e was a statistically significant association b e t w e e n age and r e p o r t e d cause of p r e m a t u r e e r u p t i o n of teeth ( P < 0.01). T h e definition of an evil child included ' A b i k u ' , ' O g b a n j e ' , d e m o n - p o s s e s s e d child, or a vessel of the gods. A few ( 8 % ) , a t t r i b u t e d the condition to the m o t h e r ' s deeds in p r e g n a n c y which might have c o n t r a v e n e d traditional taboos. A statistically significantly higher p r o p o r t i o n of Table V
Perceived cause of premature tooth eruption by age of respondents
Perceived causes Individual variation Evil child Mother's exposure in pregnancy Mother's exposure leading to contact with evil child Missing information Total
50
Total
19 (21.9) 35 (40.2) 7 (8.0)
31 (24.1) 49 (37.9) 16 (12.4)
41 (26.6) 82 (53.2) 15 (9.8)
47 (18.6) 168 (66.7) 12 (4.8)
138 (22.2) 334 (53.7) 50 (8.0)
25 (28.7)
32 (24.8)
15 (9.8)
21 (8.3)
93 (15.0)
1 (1.2) 87 (100)
1 (0.8) 129 (100)
1 (0.6) 154 (100)
4 (1.6) 252 (100)
7 (1.1) 622 (100)
Figures in parentheses are percentages. 2.2 56.35179; df = 9; P = 1.490116. =
Beliefs about Prematurely Erupted Teeth
469
respondents with lower levels of education believed such a child to be an evil child (Table VI). When the people were asked the implication of premature eruption of teeth on the child and his family, 52.9% believed that it was a curse and also an embarrassment to the family; 35.2%, on the other hand, thought it did not bear any significance or stigma to the family. When asked the recommended management of such a child, quite incredibly, as many as 26 (4.1%) of the rural dwellers said they would get rid of the child. A high percentage felt that the teeth should be extracted after the appropriate sacrifices were offered to appease the gods and reverse the curse on the family. A large number responded that they would not institute any treatment. Similarly, the subject of childen who never erupt any teeth attracted some extreme reactions. Almost all respondents (81.9%) said it was an impossibility. Of the few who admitted that it could be a possibility, 25.1% attributed the condition to evil forces while 33.7% said it was merely a human variation. Not surprisingly, 41% of the people recommended that such a child should be managed by the traditional healers. Discussion
Parsons's sick role theory assumes that illness has not only a biological dimension but is also a social deviance in that it prevents the individual from fulfilling social roles.16 The sick role carries privileges of the individual being exempted from responsibilities. Friedson 17 expanded on Parsons's model by suggesting that the sick role encompasses three types of legitimacy depending on the nature of the condition: 1. conditionalized legitimacy with the rights and privileges corresponding to Parsons's sick role theory; 2, unconditional legitimacy which applies to chronic illnesses there is no cure; 3. some forms of illness are never legitimized although the assigned the sick role. The individual has no privileges in the and epilepsy. Table VI
of the sick r o l e - or conditions where individual has been case of mental illness
Perceived cause of premature eruption by educational status of respondents
Perceived causes
No formal schooling
Arabic education
Primary education
Post-primary education
Total
Individual variation Evil child Mother's exposure in pregnancy Mother's exposure leading to contact with evil child Missing information Total
68 (21.4) 165 (51.9) 23 (7.2)
20 (18.1) 78 (70.9) 6 (5.5)
20 (20.2) 55 (55.6) 12(12.1)
30 (31.6) 36 (37.9) 9 (9.5)
138 (22.2) 334 (53.7) 50 (8.0)
57 (17.9)
6 (5.5)
11 (11.1)
19 (20.0)
93 (15.0)
1 (1.0) 99 (100)
1 (1.0) 95 (100)
7 (1.1) 622 (100)
5 (1.6) 318 (100)
Figures in parentheses are percentages. X2 29.52867; d f - 9; P< = 0.01. =
0(0) 110 (100)
470
C. O. Oyejide and G. A. Aderinokun
The case of prematurely erupted teeth seems to fall into Friedson's third category in the context of the Yoruba community in which the present study has been carried out. Society's attitude towards certain conditions or phenomena plays an important role in the life of those who are so labelled. It may affect the pursuit of a job, a place to live, friends and future family life. From the results of the present study, it appears as if a child born with teeth or who erupts teeth within a few days of birth will be stigmatized and this is bound to affect his interaction especially within that particular community. This explains the anxiety demonstrated by mothers of such children presenting at the clinic. The results further show that these negative views are c o m m o n e r among the older age group such as grandmothers or grandfathers. It is well known that they are custodians of traditions and have a lot of influence in the decision-making process. Thus they would significantly contribute to mounting pressures on the young mothers of babies with natal and neonatal teeth. As previously mentioned, the prematurely erupted teeth may be extracted if they are too mobile, if they traumatize the mothers's nipples or if they are greatly discoloured. The current line of management tends to preserve the teeth utilizing various procedures. 13"15 This is because these teeth often belong to the normal deciduous series and their removal may lead to malocclusion at a later date. Based on this current trend, it was earlier suggested that mothers be educated, reassured and encouraged to comply with measures taken to preserve natal and neonatal teeth. TM However, in the light of the results of this study, which brings to view the strong societal implications of the condition on the family and child, it may be necessary to review the recommendation now viewing the problem in a transcultural perspective. The transcultural approach requires an ability to adopt a degree of perceptual distance from any two cultural traditions involved in specific health-related interactions. 19 Often, the significance of taking the 'total' patient welfare into consideration is frequently lost to the orthodox practitioner who perceives every sphere of treatment as being right only from his own angle and believing that he holds the answer to the complete welfare of the patient. In the case in question, the practitioner is apt to try and dissuade the parent from removing the deciduous teeth which have erupted too early especially if they are quite firm and when facilities exist to preserve them. However, sensitivity to the consequences of the condition on the patient's welfare may make the professional have second thoughts and comply with the parents' wish to extract the teeth. Thereafter, a space maintainer may be placed in the position of extracted teeth pending the eruption of permanent teeth. This approach should ensure patient satisfaction and foster trust in the dentist by patients who would otherwise be lost to follow-up or drop out completely. References
Sandier, H. C. (1944). The eruption of the deciduous teeth. Journal of Paediatrics, 25, 140. Falkner, F. (1957). Deciduous teeth eruption. Archives of Disease in Childhood, 32,386. Kitamura, S. (1942). Studies on time and order of eruption (II). Shikwa Gakuho, 47,352. Yun, Duk Jin (1957). Eruption of primary teeth in Korean rural children. American Journal of Physical Anthropology, 15,261. 5. McGregor, I. A., Thomson, A, M. & Billewicz, W. Z. (1968). The development of primary teeth in children from a group of Gambian villages, and critical examination of its use for estimating age. British Journal of Nutrition, 22,307. 1. 2. 3. 4.
Beliefs about Prematurely Erupted Teeth
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6. Billewicz, W. Z., Thomson, A. M., Barber, Flora M. & Field, C. E. (1973). The development of the primary teeth in Chinese (Hong Kong) children. Human Biology, 45, 229. 7. Barrett, M. J. & Brown, T. (1966). Eruption of deciduous teeth in Australian Aborigines. Australian Dental Journal, 11, 43. 8. Shourie, K. L. (1946). Eruption age of teeth in India. Indian Journal of Medical Research, 34, 105. 9. Reddy, V. R. (1981). Eruption of deciduous teeth among the children of Gulbaga, South India. Indian Journal of Medical Research, 772-781. 10. Massler, M. & Savara, B. N. S. (1960). Natal and neonatal teeth. Journal of Paediatrics, 39,349. 11. Spouge, J. D. & Feasby, W. H. (1966). Erupted teeth in the new-born. Oral Surgery, Oral Medicine, Oral Pathology, 22 (2), 198-208. 12. Kates, G. A., Needleman, H. L. & Holmes, L. B. (1984). Natal and neonatal teeth: a clinical study. Journal of the American Dental Association, 109 (3), 441-443. 13. Tomizawa, M., Yamada, Y., Tonouchi, K., Watanabe, H. & Noda, T. (1989). ShoniShikagaku Zasshi, 27 (1), 182-190. 14. Berendsen, W. J. & Wakkerman, K. L. (1988). Continued growth of the dentinal papillae after extraction of neonatal teeth: report of case. ASDC Journal of Dentistry for Children, 55 (2), 139-141. 15. Cohen, R. L. (1984). Clinical perspective on premature tooth eruption and cyst formation in neonates. Paediatric Dermatology, 1 (4), 301-306. 16. Parsons, T. (1975). The sick role and the role of the physician reconsidered. Milbank Memorial Fund Quarterly, 53,257. 17. Friedson, E. (1978). Professional Dominance. New York: Atherton Press. 18. Aderinokun, G. A. & Onadeko, M. O. Premature eruption of teeth in babies. Sociopsychological aspect in Yorubaland--Case Report (in press). 19. Weidman, H. T. (1979). The transcuhural view: prerequisite to interethnic (intercultural) communication in medicine. Social Science and Medicine, 13B, 85-87.
© The Society of Public Health, 1992
Beliefs about Prematurely Erupted Teeth in Rural Yoruba Communities, Nigeria C. O. Oyejide, MB BS PhD 1 and G. A. Aderinokun, BDS MPH 2
1Department of Preventive and Social Medicine, College of Medicine, University College Hospital, Ibadan; and 2Department of Preventive Dentistry, College of Medicine, University College Hospital, Ibadan, Nigeria
A descriptive study was carried out in two villages: Badeku and Olodo, near the city of Ibadan, between May and November 1990. The objective of the study was to investigate the knowledge, beliefs and attitudes of respondents to premature eruption of deciduous teeth in babies. Of the 622 people interviewed, a large proportion (30.5%) believed that the first deciduous tooth should erupt between the age of 5-7 months; the next commonly mentioned time of tooth eruption was 7-9 months of age; and 50.3% of the respondents claimed to have seen a case of prematurely erupted primary teeth. There was a statistically significant association between age and also between educational status of respondents and having seen premature eruption of teeth (P < 0.01). The majority of the people (53.7%) felt that the condition was an indication of an evil child. Only 22.1% of those interviewed thought it could be just an individual variation. On the recommended remedy or management of the condition, as many as 26 (4.I%) said they would get rid of the child. A high percentage felt that sacrifices should be offered to appease the gods. It is suggested that a transcultural approach be adopted in managing cases in which the parents feel particularly anxious and uncomfortable about prematurely erupted teeth in order to cater for the social well-being of the child and family. It is also recommended that appropriate health education be directed at the society as a whole concerning this condition.
Introduction E m e r g e n c e o f t h e first d e c i d u o u s t e e t h in b a b i e s s h o w s as m u c h v a r i a t i o n b e t w e e n o n e i n d i v i d u a l a n d a n o t h e r as it d o e s a m o n g d i f f e r e n t r a c i a l g r o u p s . 1-9 S t u d i e s o n e r u p t i o n d a t e s of d e c i d u o u s t e e t h h a v e n o t e d e r u p t i o n of t h e first p r i m a r y t e e t h to b e at o r a b o u t six m o n t h s o f age. ~-9 O c c a s i o n a l l y , h o w e v e r , e r u p t i o n o f p r i m a r y t e e t h m a y o c c u r p r e m a t u r e l y . This p r e m a t u r e e r u p t i o n c o u l d b e o f two types. S o m e b a b i e s a r e b o r n w i t h t e e t h in t h e m o u t h - a c o n d i t i o n g e n e r a l l y r e f e r r e d to as n a t a l t e e t h . S o m e o t h e r s e r u p t t e e t h within the first 28 d a y s o f life, a n d t h e s e a r e r e f e r r e d to as n e o n a t a l t e e t h . ~0 N a t a l a n d n e o n a t a l t e e t h a r e o f t e n l o w e r c e n t r a l i n c i s o r t e e t h b e l o n g i n g to t h e n o r m a l d e c i d u o u s series. 11,12,13,14 T h e y c o u l d b e f u r t h e r q u a l i f i e d as m a t u r e o r i m m a t u r e t y p e s d e p e n d i n g o n t h e d e g r e e o f m a t u r i t y o f t h e e n a m e l at t h e t i m e o f eruption. These prematurely erupted teeth are usually mobile consequent on lack of r o o t f o r m a t i o n . F o r f e a r o f b e i n g a s p i r a t e d , t r a u m a t i s m to m o t h e r ' s n i p p l e s a n d d i s c o l o u r a t i o n o f t h e e n a m e l in t h e i m m a t u r e t y p e s , t h e s e t e e t h a r e u s u a l l y e x t r a c t e d . O c c u r r e n c e o f n a t a l t e e t h varies b e t w e e n 1 in 2,000 a n d 1 in 3,667 live births. 12,15 Correspondence to: Dr G. A. Aderinokun.
466
C. O. Oyejide and G. A. Aderinokun
Records of the incidence in Nigeria to date are lacking. The condition is nevertheless occasionally encountered in clinical dental practice. Mothers of young babies present at times requesting the removal of such prematurely erupted teeth. A common feature which is striking is the anxiety of such mothers that the teeth be extracted at the earliest possible time. The explanation for this behaviour is the negative societal reaction to seeing teeth in the mouth of such young babies. Observation of this general unease among parents of these babies initiated a study to investigate the myths, beliefs and mode of management of prematurely erupted teeth in two rural Yoruba communities and thus to recommend appropriate clinical management in the context of the findings. Materials and Methods
A descriptive study was carried out in two rural communities: Badeku and Olodo, which are about 20 km from Ibadan City. These villages serve as sites for Primary Health Care activities of the Institute of Child Health, University College Hospital, Ibadan. The objective of the study was to document beliefs about prematurely erupted teeth and the usual remedy for the condition in the two villages. Meetings were held with the community leaders during which the objective of the study was explained and their consent sought. A standardized questionnaire was designed to elicit, among other things relating to tooth eruption, beliefs about the cause of premature eruption of teeth in babies and the recommended management of the case. The questionnaire was translated into Yoruba, the local language. It was then pre-tested in another village similar to the study sites. Field workers were recruited from the villages, hence they could conduct interviews in the evenings when residents returned from their farms and market-places. Training of the field workers consisted of sessions in which one of the investigators first discussed and practised interview techniques with them in the office, followed by further sessions in the field. The workers were evaluated after the training sessions. One of them had to be dropped because his results varied markedly from those of the others. Every household in the two villages was included in the study and selected respondents comprised every third adult on the list of inhabitants. Each completed questionnaire was checked by the investigators for missing information and immediately returned for correction. Data were entered onto an IBM PC AT microcomputer using the data entry software DATASTAR. Data analysis was done with SYSTAT, a comprehensive statistical package. Frequency distributions and relevant tables were generated. The chi-square test of association was used where appropriate. Results
A total of 622 questionnaires were completed from both villages; 40% of the respondents were males. The age distributions are as shown in Table I: 14% were under the age of 30 years. Their educational status is shown in Table II, with 51.1% of respondents having no formal education. A large proportion of respondents from this rural population (30.5%) believed that the first milk tooth should erupt between the ages of 5-7 months. The next commonly mentioned time of tooth eruption was
Beliefs about Prematurely Erupted Teeth Table I Age at eruption of first tooth
Perceived normal time of eruption of first tooth in babies
Below 30 years
(months) 3-5 5-7 7-9 9-11 >11 Missing Total
467
13 (14.9) 39 (44.8) 20 (23.0) 5 (5.7) 7 (8.0) 1 (1.1) 87 (100)
31-40 15 (11.6) 58 (44.9) 30 (23.2) 15 (11.6) 11 (8.5) 0 (0) 129 (100)
Age of respondents in years 41-50 Over 50 9 (5.8) 52 (33.7) 60 (38.9) 25 (16.2) 8 (5.1) 0 (0) 154 (100)
8 (3.2) 41 (16.3) 72 (28.6) 98 (38.9) 32 (12.7) 1 (0.3) 252 (100)
Total 45 (7.2) 190 (30.6) 184 (29.0) 143 (22.9) 58 (9.3) 2 (0.3) 622 (100)
Figures in parentheses are percentages. X2 = 112.1; df = 12; P < = 0.01. Table I1 Perceived normal eruption time by educational status of respondents Age at eruption of first tooth (months)
No formal schooling
Arabic education
Primary eduction
Postprimary education
Total
3-5 5-7 7-9 9-11 >ll Missing information Total
13 (4.1) 93 (29.3) 99 (31.1) 79 (24.8) 32 (10.1) 2 (0.6) 318 (100)
10 (9.1) 28 (25.5) 31 (28.2) 34 (30,9) 7 (6.4) 0 (0) 110 (100)
5 (5.1) 44 (44.4) 33 (33.3) 10 (10.1) 7 (7.1) 0 (0) 99 (100)
17 (17.9) 25 (26.3) 21 (22.1) 20 (21.1) 12 (12.6) 0 (0) 95 (100)
45 (7.2) 190 (30.6) 184 (29.6) 143 (23.0) 58 (9.3) 2 (0.3) 622 (100)
Figures in parentheses are percentages. 2"2 = 44.0; df = 12 P = < = 0.01. 7 - 9 months of age. There was a statistically significant association between age of respondent and reported time of tooth eruption ( P < 0.01) with a higher proportion of those over 40 years old believing in late times of eruption, i.e., 7 - 9 months and above (Table I). Similarly, there was a statistically significant association between educational status and perceived time of tooth eruption (Table II) with a greater proportion of those with secondary education believing in earlier times for eruption. There was no statistically significant association between sex of respondent and perceived time of tooth eruption. On the question of deviation from perceived normal time, 73% of the rural dwellers believed that such a situation sometimes occurs. About half (50,3%) of the respondents claimed to have seen a case of prematurely erupted primary teeth. There was a statistically significant association between age and also between educational status of respondents and having seen premature eruption of teeth ( P < 0.0i), meaning that the older people were more likely to have seen the condition (Table III). A higher proportion of those with lower level of education claimed to have seen teeth that erupted too early (Table IV). T h e r e was, however, no association between sex of respondent and having seen a case of premature eruption.
C. O. Oyejide and G. A. Aderinokun
468 Table III
Number of respondents who had seen prematurely erupted teeth by age
Responses 50
31-40 31 98 0 129
(24.0) (76.0) (0) (100)
89 65 0 154
(57.8) (42.2) (0) (100)
174 77 1 252
(69.0) (30.6) (0.4) (100)
Total 313 308 1 622
(50.3) (49.5) (0.2) (100)
Figures in parentheses are percentages. 22 = 103.5889; df = 3; P < = 0.01. Table IV
Respondents who had seen prematurely erupted teeth by educational status
Responses
No formal schooling
Arabic education
Primary education
Yes No Missing information Total
169 148 1 318
65 45 0 100
42 57 0 99
(53.1) (46.6) (0.3) (100)
(59.1) (40.9) (0) (100)
(42.4) (57.6) (0) (100)
Post-primary education 37 58 0 95
(38.9) (61.1) (0) (100)
Total 313 (50.3) 308 (49,5) 1 (0.2) 622 (100)
Figures in parentheses are percentages. 2.2 = 11.90288; df = 3; P = 0.01. W h e n asked to state the cause of the condition, 53.7% of the p e o p l e felt that the condition must be an indication of an evil child. Only 22.1% of those interviewed t h o u g h it could just be an individual variation (Table V). T h e r e was a statistically significant association b e t w e e n age and r e p o r t e d cause of p r e m a t u r e e r u p t i o n of teeth ( P < 0.01). T h e definition of an evil child included ' A b i k u ' , ' O g b a n j e ' , d e m o n - p o s s e s s e d child, or a vessel of the gods. A few ( 8 % ) , a t t r i b u t e d the condition to the m o t h e r ' s deeds in p r e g n a n c y which might have c o n t r a v e n e d traditional taboos. A statistically significantly higher p r o p o r t i o n of Table V
Perceived cause of premature tooth eruption by age of respondents
Perceived causes Individual variation Evil child Mother's exposure in pregnancy Mother's exposure leading to contact with evil child Missing information Total
50
Total
19 (21.9) 35 (40.2) 7 (8.0)
31 (24.1) 49 (37.9) 16 (12.4)
41 (26.6) 82 (53.2) 15 (9.8)
47 (18.6) 168 (66.7) 12 (4.8)
138 (22.2) 334 (53.7) 50 (8.0)
25 (28.7)
32 (24.8)
15 (9.8)
21 (8.3)
93 (15.0)
1 (1.2) 87 (100)
1 (0.8) 129 (100)
1 (0.6) 154 (100)
4 (1.6) 252 (100)
7 (1.1) 622 (100)
Figures in parentheses are percentages. 2.2 56.35179; df = 9; P = 1.490116. =
Beliefs about Prematurely Erupted Teeth
469
respondents with lower levels of education believed such a child to be an evil child (Table VI). When the people were asked the implication of premature eruption of teeth on the child and his family, 52.9% believed that it was a curse and also an embarrassment to the family; 35.2%, on the other hand, thought it did not bear any significance or stigma to the family. When asked the recommended management of such a child, quite incredibly, as many as 26 (4.1%) of the rural dwellers said they would get rid of the child. A high percentage felt that the teeth should be extracted after the appropriate sacrifices were offered to appease the gods and reverse the curse on the family. A large number responded that they would not institute any treatment. Similarly, the subject of childen who never erupt any teeth attracted some extreme reactions. Almost all respondents (81.9%) said it was an impossibility. Of the few who admitted that it could be a possibility, 25.1% attributed the condition to evil forces while 33.7% said it was merely a human variation. Not surprisingly, 41% of the people recommended that such a child should be managed by the traditional healers. Discussion
Parsons's sick role theory assumes that illness has not only a biological dimension but is also a social deviance in that it prevents the individual from fulfilling social roles.16 The sick role carries privileges of the individual being exempted from responsibilities. Friedson 17 expanded on Parsons's model by suggesting that the sick role encompasses three types of legitimacy depending on the nature of the condition: 1. conditionalized legitimacy with the rights and privileges corresponding to Parsons's sick role theory; 2, unconditional legitimacy which applies to chronic illnesses there is no cure; 3. some forms of illness are never legitimized although the assigned the sick role. The individual has no privileges in the and epilepsy. Table VI
of the sick r o l e - or conditions where individual has been case of mental illness
Perceived cause of premature eruption by educational status of respondents
Perceived causes
No formal schooling
Arabic education
Primary education
Post-primary education
Total
Individual variation Evil child Mother's exposure in pregnancy Mother's exposure leading to contact with evil child Missing information Total
68 (21.4) 165 (51.9) 23 (7.2)
20 (18.1) 78 (70.9) 6 (5.5)
20 (20.2) 55 (55.6) 12(12.1)
30 (31.6) 36 (37.9) 9 (9.5)
138 (22.2) 334 (53.7) 50 (8.0)
57 (17.9)
6 (5.5)
11 (11.1)
19 (20.0)
93 (15.0)
1 (1.0) 99 (100)
1 (1.0) 95 (100)
7 (1.1) 622 (100)
5 (1.6) 318 (100)
Figures in parentheses are percentages. X2 29.52867; d f - 9; P< = 0.01. =
0(0) 110 (100)
470
C. O. Oyejide and G. A. Aderinokun
The case of prematurely erupted teeth seems to fall into Friedson's third category in the context of the Yoruba community in which the present study has been carried out. Society's attitude towards certain conditions or phenomena plays an important role in the life of those who are so labelled. It may affect the pursuit of a job, a place to live, friends and future family life. From the results of the present study, it appears as if a child born with teeth or who erupts teeth within a few days of birth will be stigmatized and this is bound to affect his interaction especially within that particular community. This explains the anxiety demonstrated by mothers of such children presenting at the clinic. The results further show that these negative views are c o m m o n e r among the older age group such as grandmothers or grandfathers. It is well known that they are custodians of traditions and have a lot of influence in the decision-making process. Thus they would significantly contribute to mounting pressures on the young mothers of babies with natal and neonatal teeth. As previously mentioned, the prematurely erupted teeth may be extracted if they are too mobile, if they traumatize the mothers's nipples or if they are greatly discoloured. The current line of management tends to preserve the teeth utilizing various procedures. 13"15 This is because these teeth often belong to the normal deciduous series and their removal may lead to malocclusion at a later date. Based on this current trend, it was earlier suggested that mothers be educated, reassured and encouraged to comply with measures taken to preserve natal and neonatal teeth. TM However, in the light of the results of this study, which brings to view the strong societal implications of the condition on the family and child, it may be necessary to review the recommendation now viewing the problem in a transcultural perspective. The transcultural approach requires an ability to adopt a degree of perceptual distance from any two cultural traditions involved in specific health-related interactions. 19 Often, the significance of taking the 'total' patient welfare into consideration is frequently lost to the orthodox practitioner who perceives every sphere of treatment as being right only from his own angle and believing that he holds the answer to the complete welfare of the patient. In the case in question, the practitioner is apt to try and dissuade the parent from removing the deciduous teeth which have erupted too early especially if they are quite firm and when facilities exist to preserve them. However, sensitivity to the consequences of the condition on the patient's welfare may make the professional have second thoughts and comply with the parents' wish to extract the teeth. Thereafter, a space maintainer may be placed in the position of extracted teeth pending the eruption of permanent teeth. This approach should ensure patient satisfaction and foster trust in the dentist by patients who would otherwise be lost to follow-up or drop out completely. References
Sandier, H. C. (1944). The eruption of the deciduous teeth. Journal of Paediatrics, 25, 140. Falkner, F. (1957). Deciduous teeth eruption. Archives of Disease in Childhood, 32,386. Kitamura, S. (1942). Studies on time and order of eruption (II). Shikwa Gakuho, 47,352. Yun, Duk Jin (1957). Eruption of primary teeth in Korean rural children. American Journal of Physical Anthropology, 15,261. 5. McGregor, I. A., Thomson, A, M. & Billewicz, W. Z. (1968). The development of primary teeth in children from a group of Gambian villages, and critical examination of its use for estimating age. British Journal of Nutrition, 22,307. 1. 2. 3. 4.
Beliefs about Prematurely Erupted Teeth
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6. Billewicz, W. Z., Thomson, A. M., Barber, Flora M. & Field, C. E. (1973). The development of the primary teeth in Chinese (Hong Kong) children. Human Biology, 45, 229. 7. Barrett, M. J. & Brown, T. (1966). Eruption of deciduous teeth in Australian Aborigines. Australian Dental Journal, 11, 43. 8. Shourie, K. L. (1946). Eruption age of teeth in India. Indian Journal of Medical Research, 34, 105. 9. Reddy, V. R. (1981). Eruption of deciduous teeth among the children of Gulbaga, South India. Indian Journal of Medical Research, 772-781. 10. Massler, M. & Savara, B. N. S. (1960). Natal and neonatal teeth. Journal of Paediatrics, 39,349. 11. Spouge, J. D. & Feasby, W. H. (1966). Erupted teeth in the new-born. Oral Surgery, Oral Medicine, Oral Pathology, 22 (2), 198-208. 12. Kates, G. A., Needleman, H. L. & Holmes, L. B. (1984). Natal and neonatal teeth: a clinical study. Journal of the American Dental Association, 109 (3), 441-443. 13. Tomizawa, M., Yamada, Y., Tonouchi, K., Watanabe, H. & Noda, T. (1989). ShoniShikagaku Zasshi, 27 (1), 182-190. 14. Berendsen, W. J. & Wakkerman, K. L. (1988). Continued growth of the dentinal papillae after extraction of neonatal teeth: report of case. ASDC Journal of Dentistry for Children, 55 (2), 139-141. 15. Cohen, R. L. (1984). Clinical perspective on premature tooth eruption and cyst formation in neonates. Paediatric Dermatology, 1 (4), 301-306. 16. Parsons, T. (1975). The sick role and the role of the physician reconsidered. Milbank Memorial Fund Quarterly, 53,257. 17. Friedson, E. (1978). Professional Dominance. New York: Atherton Press. 18. Aderinokun, G. A. & Onadeko, M. O. Premature eruption of teeth in babies. Sociopsychological aspect in Yorubaland--Case Report (in press). 19. Weidman, H. T. (1979). The transcuhural view: prerequisite to interethnic (intercultural) communication in medicine. Social Science and Medicine, 13B, 85-87.
