Shape-coordinate analysis of skeletal changes induced by rapid maxillary expansion and facial mask therapy

The aim of this study was to evaluate maxillary and mandibular shape/size changes by means of Bookstein's shape-coordinate and tensor analysis in children with Class III malocclusions treated with rapid maxillary expansion and a facial mask in order to define optimum timing of intervention for this type of therapy. The treated group (46 subjects, 26 females and 20 males) was divided into two subgroups according to the stage of dentitional development. The early-treated group consisted of 23 subjects treated in the early mixed dentition (mean age at Time 1, 6 years 9 months +/- 7 months); the late-treated group included 23 subjects treated in the late mixed dentition (mean age at Time 1, 10 years 3 months +/- 1 year). The mean treatment period was about 11 months. The control group (32 subjects with untreated Class III malocclusion, 18 females and 14 males) also was divided into two subgroups (an early control group, 17 subjects in the early mixed dentition, and a late control group, 15 subjects in the late mixed dentition). Maxillary triangles (point T, the most superior point of the anterior wall of sella turcica, point FMN, the fronto-maxillary-nasal suture, and point A) and mandibular triangles (point Condylion, point Gonion, and point Pogonion) were digitized on cephalograms in both groups at Time 1 and Time 2. Combined facial mask and rapid maxillary expansion therapy produced a significant enhancement of the forward growth of the maxilla and significantly more upward and forward direction of growth of the mandibular condyle (leading to smaller increments in mandibular total length, Co-Pg) in the early-treated group when compared with controls and to the late-treated group. Both maxillary size and mandibular size were significantly affected by treatment in the early mixed dentition. The results of this study indicate that orthopedic treatment of Class III malocclusion induces favorable size and shape changes both in the maxilla and mandible, and that this combined treatment approach is more effective in the early mixed dentition than in the late mixed dentition.     

Caries prevalence in the deciduous dentition of a mediaeval population from the south-west of Scotland

The prevalence, distribution and location of dental caries were studied in the deciduous dentition of 185 skeletons aged between 6 months and 13 years from a large, mostly mediaeval, cemetery, where successive phases of use could be distinguished. The main phases dated from 1240 to 1440 AD. During this period, no consistent trend or pattern of caries was identified, but there was a significantly higher caries prevalence in the age band 6-12.9 years than in the age band 0.1-5.9 years. The caries prevalence in the juveniles from the earlier Northumbrian, or Anglo-Saxon, phase of the cemetery was higher than in any mediaeval phase group, with mostly approximal surfaces affected. In the mediaeval population, first deciduous molars generally showed lower caries prevalence than second deciduous molars, significantly lower for the older age band, and maxillary molars consistently showed lower levels than mandibular molars. The highest caries rate, shown by mandibular second molars in the older age band, was 7.9%. In deciduous molars, the occlusal surface was most frequently affected by caries, whereas in the permanent molars of the same population the approximal surfaces had shown the highest level of attack. The overall caries prevalence in deciduous teeth in the mediaeval population of Whithorn was 2.3% of the teeth present, lower than the levels found in previous Scottish and English population groups, including a small assemblage of children from the Scottish sites of Elcho, Southwick and Kirkhill.     

The impacted maxillary canine. Further observations on aetiology, radiographic localization, prevention/interception of impaction, and when to suspect impaction

Adjacent anomalous or missing maxillary lateral incisors have been implicated in the aetiology of palatally displaced canines by not providing proper guidance to the canine during its eruption. However, a recent review of the literature suggests that the aetiology of palatally displaced canines is genetic in origin. The aetiology of labially impacted canines differs, being due to inadequate arch space. Vertex occlusal radiographs have been recommended for localization but have limitations, and a case is illustrated where this radiograph is deceptive. The prevention/interception of a palatally displaced canine by the extraction of the deciduous canine is best carried out as early as the displacement is detected, mostly soon after 10 years of age. Usually, prevention/interception will avoid the surgical and orthodontic treatment needed to align a palatally impacted canine and may help prevent resorption of the adjacent incisor root. Suspicions that an impaction could occur or has occurred arise a) before the age of 10 years if there is a familial history and/or the maxillary lateral incisors are anomalous or missing; b) after the age of 10 years if there is asymmetry in palpation or a pronounced difference in eruption of canines between the left and right side; or the canines cannot be palpated and occlusal development is advanced; or, the lateral incisor is proclined and tipped distally; and, on a panoramic radiograph of the late mixed dentition if the incisal up of the canine overlaps the root of the lateral incisor.     

The response of heat shock proteins 25 and 72 to ischaemia in different kidney zones

Class III malocclusion with retrusive maxilla can be orthopedically corrected in the deciduous and mixed dentition, with reverse-pull headgear in combination with rapid palatal expansion. The literature recommends this procedure be carried out before the patient is 8 years old to obtain the optimal orthopedic result. This statement, however, has not been supported by scientific data. The current study examined the treatment effects of patients younger than 8 years old (5 to 8 years) and patients older than 8 years old (9 to 12 years). Thirty patients treated with maxillary protraction and expansion in the Department of Children's Dentistry and Orthodontics, University of Hong Kong were included in this study. Cephalometric radiographs were taken 6 months before the initiation of treatment (T(0)), at the initiation of treatment (T1), and after 6 months of treatment (T2). In this way, (T(2)-T1) represented cephalometric changes during the treatment period and (T1-T0) represented 6 months of growth changes without treatment. Experimental subjects served as their own control in this study. A grid system consisting of maxillary occlusal plane (OL) and a line perpendicular to OL through sella (OLp) was used for linear measurements. A total of 15 linear and 3 angular cephalometric measurements were made. A multivariate analysis of variance (MANOVA), which used age and treatment time as its factors, was used to determine effect of age and/or treatment on each cephalometric parameter. Results indicated strikingly similar therapeutic response between the younger and older age groups. These data suggest that similar skeletal response can be obtained when maxillary protraction was started either before age 8 (5 to 8 years) or after age 8 years (8 to 12 years).     

Improved treatment of cleft lip and palate is now available

When cleft lip and palate treatment was introduced at Gothenburg in 1957, the procedure used was early bone grafting (EBG). By 1965, EBG had been omitted from the regimen, bone grafting being postponed until the appearance of mixed dentition. Analysis of the results of both techniques showed maxillary retrusion of different degrees. Accordingly, this routine was abandoned in 1975, being replaced by a procedure which is characterised by delayed closure of the hard palate (DCHP). Thus, the surgical procedure comprised the following steps: 1, lip closure at 1-2 months of age; 2, soft palate repair at 6-8 months; 3, final lip-nose surgery at 12 months; and 4, closure of the left in the hard palate, and bone grafting to the alveolar process during mixed dentition at about 8-10 years of age. Follow-up has shown the majority of patients to manifest acceptable speech development during childhood, though problems may occur in some cases. Maxillary growth has been found to be improved after DCHP, and at present the need of maxillary advancement surgery has been reduced to approximately 5% of cases, as compared with the former rates of 50% of cases among those treated with EBG, and of 25% among those treated with the vomer flap procedure.     

Changes in maximal exercise ventilation and breathing pattern in boys during growth: a mixed cross-sectional longitudinal study

The aim of this mixed cross-sectional longitudinal study covering a total age range of 11-17 years, i.e. the entire pubertal growth period, was (1) to specify the changes in maximal breathing pattern during incremental exercise; (2) to determine what parts of the changes are due to anthropometric characteristics, physical fitness and inspiratory or expiratory muscle strength; and (3) to determine if the role of these variables is identical before, during and after pubertal growth spurt. This study was conducted in 44 untrained schoolboys separated into three groups, with an initial age of 11.2 +/- 0.2 years for group A, 12.9 +/- 0.25 years for group B, and 14.9 +/- 0.26 years for group C. These children were subsequently followed for 3 years, during the same time period each year. The maximal inspiratory and expiratory pressures (PI max and PE max) were used as an index of the respiratory muscle strength. During an incremental exercise test, maximal ventilation (VE max), tidal volume (VT max), breathing frequency (fmax), inspiratory and expiratory times (tI max and tE max) and mean inspiratory flow (VT/tI max) were measured at maximal oxygen uptake (VO2max). Our study showed that there was a marked increase with age in VE max, VT max, and VT/tI max, and no significant changes in fmax, tI max and tE max. PI max and PE max showed a general trend towards an increase between 11 and 17 years. The study of the linear correlations between maximal breathing pattern and the anthropometric characteristics, physical fitness and inspiratory or expiratory muscle strength showed that, in the three groups of children, (1) lean body mass was the major determinant of VE max, VT max and VT/tI max and the relationships were significantly different before, during and after the pubertal growth spurt; (2) physical fitness was the main determinant of tI max, tE max and fmax before and after the pubertal growth spurt; and (3) maximal respiratory strength did not play a significant role. In conclusion, this mixed cross-sectional longitudinal study showed, at maximal exercise, a significant increase in VE max during growth due only to a significant increase in VT max and VT/tI max, and that the relationships of anthropometric characteristics and physical fitness with maximal breathing pattern change during growth.     

Subgingival microflora and treatment in prepubertal periodontitis associated with chronic idiopathic neutropenia

Prepubertal periodontitis affects both primary and permanent dentition. The purpose of this study was to examine the composition of subgingival microflora of the permanent dentition in an 11-year-old Caucasian female, who had premature exfoliation of her deciduous teeth on her 5th year of age, and the response of this condition to the antibiotic therapy and supportive periodontal care. Gingival tissues were highly inflamed and alveolar bone loss was detected radiographically. The girl had experienced frequent upper respiratory tract infections, tonsilitis and recurrent otitis media. Her mother had history of early onset periodontitis associated with chronic idiopathic neutropenia. Blood chemistry tests and immunological examinations were also performed. Subgingival plaque samples were collected from the proximal sites of permanent molars, incisors, canines and maxillary premolars. 27 different microbial species were isolated from the subgingival microflora. Among the predominant species were Porphyromonas gingivalis (17.6%-7.3%), Prevotella intermedia (12.4%-4.7%), Capnocytophaga sputigena (14.4%-10.4%), Capnocytophaga ochracea (13.2%-6.9%) and Actinobacillus actinomycetemcomitans (9.3%-5.5%). Periodontal treatment consisted of scaling, root planing in conjunction with antibiotic administration of Augmentin 312.5 mg and Flagyl 200 mg, each t.i.d. for 10 days. 3 weeks after the antibiotic therapy, bacterial samples were collected from the same sites. All the periodontal pathogens were recovered in lower levels and A.actinomycetemcomitans was almost eliminated in the 3-week period. The evaluation of clinical indices at 3, 6 and 12 months showed that periodontal treatment in conjunction with antibiotics was effective and rapidly followed by marked clinical improvement. The microbiological monitoring at 3, 6 and 12 months after antibiotic treatment and each time prior to supportive periodontal care, revealed that the periodontal pathogens fluctuated in low levels even 12 months after treatment and could be maintained at low level by supportive periodontal care at 3-month intervals.     

Correlation of occlusal factors and condyle position asymmetry with signs and symptoms of temporomandibular disorders in young adults

The role of the occlusion in the etiology and prevalence of temporomandibular disorders (TMD) has not been conclusively demonstrated. Occlusal factors and condyle position asymmetry as deduced from computed tomography (CT) axial scans were correlated with signs and symptoms of TMD in 49 young adults (mean age 24 years, range 15-33 years) with complete or almost complete dentition. A statistically significant correlation was noted between these signs and symptoms and occlusal variables describing asymmetry (the amount and lateral deviation of the slide from the retruded contact position (RCP) to the intercuspal position (IP), deviation of protrusion and asymmetry in bilateral cuspid occlusion). It seems that occlusal discrepancy can be a predisposing factor to TMD, especially when it is asymmetrically expressed.     

A comparative study of palatal height in a Saudi and Egyptian population

The present study constitutes an attempt to compare normal traits for palatal height and width at different stages of dentition development of two ethnic groups of the Middle East. The observations were obtained from 346 randomly selected normal subjects, 188 Saudis and 158 Egyptians. The stone models were divided into three categories in both groups--primary, mixed and permanent dentitions. Palatal index values were calculated at two levels. Vernier calipers were used to measure the palatal width. Palatal depth was measured by profile Gauge by Vitrex. The results of this study demonstrate no significant difference between ethnic groups at levels 1 and 2 in relation to the palatal height, width and index. For both groups, palatal index increased significantly from the primary to mixed and permanent dentition at level 1. At level 2, palatal index and height showed decreases in measurement in the mixed dentition compared with the primary and the permanent dentitions. Subjective assessment of the palatal height correlated with palatal index. The casts were then labelled so that the shallow group had the smallest palatal index followed by the normal and the deep group had the largest palatal index. The results contribute to the information available on the development of palatal shape within two Middle Eastern populations. Knowledge of the normal range in shape can act as a baseline for studies of certain oral developmental abnormalities.     

Follow-up of two cases of Papillon-Lefèvre syndrome and presentation of two new cases

Periodontitis resulting from Papillon-Lefèvre Syndrome has been known to cause early loss of primary dentition with subsequent involvement of the permanent dentition. In this study, two Papillon-Lefèvre Syndrome patients were followed for 3 years after initial treatment and improvement of their periodontal condition. In addition, two new cases of Papillon-Lefèvre Syndrome are presented. The follow-up treatment of the first two patients included monitoring the oral hygiene and performing ultrasonic scaling. Their present clinical appearance is very satisfactory. The periodontal condition of the third (new) patient was brought under control by extracting the involved deciduous teeth under antibiotic coverage, and by scaling and root planing the already erupted permanent teeth as well as by maintaining a high standard of oral hygiene. In the fourth case, all permanent teeth had erupted and the periodontium had already been severely destroyed. Actinobacillus actinomycetemcomitans was not detected by microbiologic examination after the periodontal conditions improved, except in the fourth case. Western blot analysis showed that the three first three patients had positive antibody response to the same antigens of Actinobacillus actinomycetemcomitans. Phagocytosis by polymorphonuclear neutrophil leukocytes) had not decreased, but the expression of surface receptors of polymorphonuclear neutrophil leukocytes was within the normal limits.     

Traumatic dental injuries in a cohort of 16-year-olds in northern Sweden

The prevalence and yearly incidence of traumatic tooth injury between 1 and 16 years of age were studied in a cohort of 16-year-olds, born in 1975, and residing in the County of V?sterbotten, northern Sweden. The study comprised 3007 dental records from the public dental health service. The general distribution was 50.3% girls and 49.7% boys. The records showed that 35% of the children on one or more occasions had sustained injury to their primary or permanent dentition. The frequency was nearly twice as high for boys (64%) as for girls (36%). Twenty-five percent of the 16-year-olds had met with tooth injury more than once and this group consisted predominantly of boys. The incidence of injury episodes to primary and permanent teeth was 28 per 1000 per year. The boys had sustained trauma to their teeth most frequently when they were 4 years of age and between the ages of 8 and 11. This was also true for girls at 4 and at 9 years of age, although less evidently so. In the primary dentition, the majority of dental injuries had affected the supporting tissue of the maxillary incisors. In the permanent dentition, 75% of the traumatised teeth were upper incisors. Fractures of varying severity constituted 60% of all registered diagnoses in this dentition, followed by subluxation (19%) and concussion (11%).     

Human leucocyte antigens in pregnant women with pre-eclampsia associated with intrauterine growth retardation and in normal controls

Prenatal exposure to anticonvulsant medication has been shown to cause craniofacial dysmorphology, prenatal growth retardation, hypoplastic nails and phalanges, and visceral abnormalities. In this study we examined maxillary and mandibular stone dental casts (45) and panoramic radiographs (39) from 45 individuals with ages 4.5 to 22.0 years for changes in mesiodistal crown size of deciduous and permanent teeth, and the presence of dental anomalies. These individuals had been exposed prenatally to antiepileptic drugs (AEDs). Mesiodistal crown diameters were measured from the dental casts and converted into standard scores (Z), using published normative data from the University of Michigan Longitudinal Craniofacial Growth Series. A significant increase in mesiodistal crown dimensions of the posterior maxillary teeth was observed, specifically in primary molars and their permanent premolar successors, as well as permanent molars. Changes in tooth size were more common in females than in males. Dental maturity, assessed using the panoramic radiographs, was equal to chronologic age. An increased frequency of hypodontia was the only notable dental anomaly.     

Supraperiosteal flap technique versus mucoperiosteal flap technique in cleft palate surgery

Recent animal experiments have shown that palatal repair without denudation of bone leads to a superior dento-alveolar development. The aim of this clinical study was to evaluate the peri- and postoperative course and the dento-alveolar development of the deciduous dentition in Japanese ULCP, and CP patients up to 5 years after two different types of palatal repair. One of the methods, the Kohama (1991) supraperiosteal flap technique, is performed without denudation of the bony palate, while the other, the Wardill (1937) push-back technique, results in areas of denuded bone. It was concluded that the supraperiosteal technique can be performed successfully in approximately the same amount of time as the push-back technique. Re-epithelialization of the wound areas after supraperiosteal repair takes about 1 week, which is one third of the time associated with healing after the push-back technique. Arch depth of the deciduous dentition after the supraperiosteal technique is superior compared to the push-back technique. The question of whether or not the supraperiosteal technique produces more favorable dento-alveolar development than the mucoperiosteal technique in the permanent dentition in humans has to be elucidated in future research.     

Longitudinal analysis of flexibility and reorganization in early adolescence: A dynamic systems study of family interactions.

A dynamic systems (DS) approach was used to study changes in the structure of family interactions during the early adolescent transition period. Longitudinal observational data were collected in 5 waves prior to, during, and after the transition. Boys (n = 149 families) were videotaped problem solving with their parents at 9-10 years old and every 2 years thereafter until they were 18 years old. State space grids (a new DS method) were constructed for all families across all waves. Two variables indexing the variability of the family interactions were derived from the grids. As hypothesized, the DS variables revealed a significant quadratic effect related to a peak in variability at 13-14 years of age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Replacements of restorations in the primary and young permanent dentition

The present study focused on the type of restorative material used and the reasons for replacements of restorations in the primary and the young permanent dentition. All patients with restorations and who were 8 and 19 years of age in 1995 and were regularly treated at 11 Public Dental Health clinics in J?nk?ping County, Sweden, participated in the study. Data were extracted from the records for all types of restorations in canines and molars for the preceeding of 5 years for the 8-year-olds (i.e. from 3 to 8 years of age; n = 546) and for approximal restorations in premolars and molars for the preceeding 13 years for the 19-year-olds (i.e. from 6 to 19 years of age; n = 606). In all, 6012 restorations were evaluated. The two most common restorative materials used in the primary dentition were compomer and glass ionomer cement and in the young permanent dentition composite and amalgam. In the primary dentition, 29% of the restorations had been replaced and 4% of the teeth with restorations had been extracted. Thus, 33% of the restorations in the primary dentition failed. The corresponding figure for the young permanent dentition was 13%. The most common reason for replacements in the permanent dentition was secondary caries. That restorations often fail because of caries and that the development of secondary caries is not prevented by replacement of an old restoration indicate that more attention should be paid to preventive dental care for patients with restorations in the primary as well as in the young permanent dentition.     

Endoscopic sympathectomy treatment for craniofacial hyperhidrosis

OBJECTIVE: To present endoscopic T-2 sympathectomy as a minimally invasive therapy for craniofacial hyperhidrosis (CH). DESIGN: Follow-up study of 30 patients with CH treated by the new method in a 4-year period. The duration of follow-up was from 8 to 44 months (mean, 15 months). SETTING: University hospital. PATIENTS: Thirty consecutive patients with CH (18 men, 12 women) treated by the new method. All patients were essentially in good health except that they suffered from distressing CH to the extent that their daily activities were often disturbed. Their ages ranged from 7 to 63 years (mean age, 42.8 years). INTERVENTION: Endoscopic sympathectomy on both sides was carried out in a 1-stage operation for all patients. MAIN OUTCOME MEASURES: The patients were interviewed 1 week and then 3 months after surgery and then followed up by telephone interview about the alleviation or recurrence of CH and complications. RESULTS: All of the treated patients obtained a satisfactory alleviation of CH. One case was complicated by a mild and transient ptosis of the left eye. No recurrence of CH was noticed during the follow-up period. CONCLUSIONS: This therapeutic procedure is minimally invasive and effective. It causes minimal discomfort and was associated with no major complications in this series. The patients require only an overnight hospital stay and the operation scars are small. Endoscopic sympathectomy has proven to be an effective method in treating patients with distressing CH.     

Complications of pediatric craniofacial surgery in the Orient: analysis of a 10-year experience

Numerous reports on the complications of craniofacial surgery have been published in the western world. However, relatively little such information concerning Oriental populations has been documented. We therefore set out to provide a retrospective analysis of all the complications of craniofacial surgery encountered during the 10-year period of 1986 to 1995 at Seoul National University Children's Hospital, the only children's hospital in Korea. Forty-nine children underwent 57 consecutive craniofacial procedures at our institution during 1986 to 1995. A retrospective chart analysis of the frequency and types of complications was performed. Mantel-Haenszel chi-square tests were then calculated for several factors, including age at surgery, duration of surgery, intraoperative losses of hemoglobin and hematocrit, total amount of blood transfusion, and the number of complications according to year, diagnosis, and operative procedure to find any significant correlation with the incidence of complications. Mortality was 1.8%. The major complication rate was 7.0% and included cases of visual loss and persistent cerebrospinal fluid leak. Analysis revealed the presence of several trends, including an increased incidence of complications with increased patient age at surgery, duration of surgery, and intraoperative loss of hematocrit. The number of complications was also noted to increase in cases with complex craniofacial synostosis syndromes (Crouzon's, Apert's Antley-Bixler, etc.) and tumors of the orbit and cranium. Finally, complications were noted to decrease in recent years, most likely due to the increased experience of our craniofacial team. Nevertheless, statistical analysis revealed that the incidence of complications correlated significantly only with increased duration of surgery (p < 0.05). The results of our study indicate that although craniofacial surgery in the Orient carries an inherent risk for significant complications, the risk can be minimized and the rate of mortality and major complications kept to an acceptable level by a careful and experienced craniofacial team. Groups at most risk for complications are those with a long duration of surgery.     

Skeletal effects of early treatment of Class III malocclusion with maxillary expansion and face-mask therapy

The effectiveness of maxillary expansion and face-mask therapy in children with Class III malocclusion was studied in a sample of 46 subjects in mixed dentition and compared with a control sample of 32 subjects with untreated Class III malocclusion. Treated and untreated samples were divided into early and late mixed-dentition groups to aid identification of the optimum timing of the orthopedic treatment of the underlying skeletal disharmony. Cephalometric analysis was based on a stable basicranial reference system, appropriate for longitudinal studies started in the early developmental ages. The level of significance for intergroup comparisons was set at a p value of 0.01. Significant forward displacement of the maxillary complex was found in the early-treatment group. The region of the pterygomaxillary suture, in particular, showed significant changes in the subjects treated during early mixed dentition. No significant maxillary modifications were recorded in the late-treatment group. Both early and late groups exhibited smaller increments in mandibular protrusion and larger increments in the intermaxillary vertical relationship compared with their respective Class III control groups. Only children treated at an early age, however, showed a significant upward and forward direction of condylar growth, leading to smaller increments in total mandibular length. These results indicate that the combination of a bonded maxillary expander and face-mask therapy is more effective in early mixed dentition than in late mixed dentition, especially with regard to the magnitude of the protraction effects on maxillary structures.     

Intentions to Work During Terminal Illness: An Exploratory Study of Antecedent Conditions.

Facing a terminal illness is an unimaginably difficult experience, yet many individuals intend to work despite their prognosis. However, research has not systematically examined the potential antecedents underlying such intentions. Using behavioral intention theory as an underlying framework, this study hypothesized that reasons for working (intrinsic and extrinsic), the will to live, disability severity, accessibility of travel, and age would predict intentions to work during terminal illness. A representative sample of medically diagnosed amyotrophic lateral sclerosis (a.k.a. Lou Gehrig's disease) patients with a mean life expectancy of approximately 3 years participated (mean age=57.8 years). Controlling for length of diagnosis, employment status, and demographic variables, results indicated that intrinsic reasons were particularly strong predictors of intentions, followed by age, disability severity, and accessibility of travel. Exploratory findings also indicated that behavioral intentions were positively related to future employment status, consistent with past theory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Removal of deciduous canine tooth buds in Kenyan rural Maasai

The removal of deciduous canine tooth buds in early childhood is a practice that has been documented in Kenya and in neighboring countries. This paper describes the occurrence, rationale and method of this practice amongst rural Kenyan Maasai. In a group of 95 children aged between six months and two years, who were examined in 1991/92, 87% were found to have undergone the removal of one or more deciduous canine tooth buds. In an older age group (3-7 years of age), 72% of the 111 children examined exhibited missing mandibular or maxillary deciduous canines. It was found that the actual removal of a deciduous tooth bud is often performed by middle-aged Maasai women who enucleate the developing tooth using a pointed pen-knife. There exists a strong belief among the Maasai that diarrhoea, vomiting and other febrile illnesses of early childhood are caused by the gingival swelling over the canine region, and which is thought to contain 'worms' or 'nylon' teeth. The immediate and long-term hazards of this practice include profuse bleeding, infection and damage to the developing permanent canines. A multi-disciplinary approach involving social anthropologists in addition to dental and medical personnel, is recommend in order to discourage this harmful operation that appears to be on the increase.