CULTURE, RELIGION

AND ORAL HEALTH

Dr. Zoha Abdullah
MDS II
Dept of public health dentistry

Contents

Introduction

Role of culture and religion on oral health

Tooth mutilations

Soft tissue mutilations

Conclusion

References

Introduction

The word culture means cultivation

It is a modern concept

First used by roman orator Cicero

cultura animi

Reappeared in europe in the 17th century

referring to.

During the 18th and 19th century.

In the 20th century it emerged as..

The concept of culture

Learned behavior.

Anthropologists have
provided many definitions

Most famous is E. B.
Tylors definition in 1871
that complex whole which
includes..

Edward Burnett
Tylor
1832-1917

Keesing stressed that culture comprises

of systems of shared ideas..

The American anthropologist Edward T.

Hall proposed that each human group
have three different levels of culture
namely primary, secondary and tertiary.

What is culture?

Product of the human society

Culture is like an iceberg.

Religion

Religion refers to a "belief in, or the worship

of, a God or Gods Chambers dictionary

"Service and worship of God or the

supernatural Merriam Webster Dictionary

Edward Burnett Tylor in 1871 defined religion

as "the belief in spiritual beings".

TERMINOLOGIES

Culture contact: Contact between people

with different cultures, usually leading to
change in one or both systems.

Acculturation

Volunta
ry

Amalgamation

Assimilation

Forced

Acculturation: Redfield et al in 1936 defined

acculturation as.

Enculturation: The transmission

of culture from one generation to
the next

Cultural competence, the ability to interact effectively

with people of different cultures and socio-economic
backgrounds, particularly in the context of human
resources, non profit organisations and government
agencies whose employees work with persons from
different cultural/ethnic backgrounds.
(a) Awareness
(b) Attitude
(c) Knowledge
(d) Cross-cultural skills.

Culture shock

Reverse culture shock

CULTURE AND
HEALTH???

Why should I study culture?

How does it affect my diagnosis or

treatment?

How does it matter to my patient

whether I know his/her culture or not?

ROLE OF CULTURE AND

RELIGION ON ORAL HEALTH

Family
Mother and child care
Food habits
Oral hygiene practices
Other habits
Caste
Sex and marriage
Social class

Family

Primary unit in all societies

Group of biologically related

individuals living together

As a cultural unit, the family

reflects the culture of wider
society of which it forms a
part and determines the
behavior and attitude of its
members.

Joint family system common in Asia, Africa, the Far East and

Middle East countries, more in the rural areas than urban

Nuclear family systems seen in most of the western countries

and urban areas of developing countries

The lack of parental attention leads to habits such as

smoking, alcoholism, drug addiction, etc at an early age

Adverse habits increase the incidence of oral cancers,

venereal diseases and mental illnesses (Western world)

Common blind belief

In rural areas of Bihar, U.P. and
Madhya pradesh
Number of children poor
mans wealth
Close birth intervals Maternal
malnutrition, anemia and low
birth weight
Oral
health

Mother and child care

Preference of a male child

Early pregnancy

The customs in the field of MCH have been

classified as:
Good
Bad
Unimportant
Uncertain

Forbidden eatables for pregnant

women. Rich sources of Vitamin
A, iron, calcium not available to
mother and developing foetus.

The child is not put to breast

feeding during the first 3 days,
this prevents the passive
transfer of immunity from
mother to child making the child
more susceptible to oral
infection.

Adverse cultural practices relating to

premature

termination

of

breast

feeding and feeding child with over

diluted cows milk

protein energy

malnutrition and affect oral health of

the child (Shah et al 1974).

Diarrhoea in children during teething

- normal

Food habits

Ariboflavinosis common in eastern and southern parts of the

country

[5]

Pellagra due to niacin deficiency is more in the population

(Telangana region of Andhra Pradesh) [6]

Severity of fluorosis among jowar eating population

Vegetarianism
glossitis

[8,9,10]

Moellers

Religion and food habits

Hindus and meat prevention of Taeniasis

oral manifestation oedematous oral mucosa, gingival
bleeding

Muslims and pork

prevention of taeniasis and

cysticercalis
oral

manifestation

oedematous

bleeding, lesions mimicking mucoceles

oral

mucosa,

gingival

Dietary habits

Tribal and primitive populations - diet is coarse

and fibrous in nature and free from refined
carbohydrates
refined foods

[11,12,13]

. Westerners eat more of

[14,15,16]

In certain communities of India, Men eat first and

women last and poorly.

Excessive consumption of spicy food in the

form of green chillies is commonly seen in
some

Sex and Marriage

Orthodox Jews are forbidden to have intercourse

for seven days after menstruation cycle

The practices of polygamy and polyandry seen in

many tribal communities of the country (Todas of
Nilgiri

hills,

Nayars

of

Malabar

coast,

the

inhabitants of Jaunsar Bhawar in Uttar Pradesh)

venereal diseases affecting the oral health

In United States of America, excessive racial

mixing may be the cause for high rate of
malocclusion

when

compared

to

any

primitive population lacking racial mixing.

other

Oral hygiene practices

Brahmins and Hindu priests use cherry

wood

Muslims before "Namaaz" clean their

teeth five times a day using miswak

Orthodox Jains

In rural India, twigs from trees are used

Mango and cashew twigs in Karnataka and A.P

Neem and banyan twigs in Tamil Nadu

Coconut fibre in Kerala

Datoon (banyan or neem) in North Indian states

In

African

countries,

twigs

from

Salvaodora

Persicca are used for cleaning the teeth. Found to

be a good source of fluoride

Anticaries benefit.

Personal Habits

Purdah system

Pan chewing as a custom

Alum rinsing

Drug addiction

Ganja

Charas

Bhang

CANNABIS
PLANT OR
MARIJUANA

Tradition and Custom

Euphoria
Relaxation
Apatite

in short term Memory

Dry mouth
Reddening of eyes

Anxiety or paranoia

Alcohol

Tabooed by muslims and High caste

Hindus
Drinking culture in India
Tamil nadu, largest liquor market
In Kerala, Alcohol and Drugs Information
Centre India (NGO) found that the
average age of initiation had dropped
from 19 years to 13 years in the past
two decades.

Delayed healing following surgery

Tooth decay and erosion
Poor oral hygiene
Oral cancer
Upper Gastrointestinal cancer

Other habits

Cola nut chewing

West Africa
Tannin, caffeine, theobromine
Healing of oral mucosal lesions,
cariostatic

Fomentation

warm, moist medicinal compress

Spread of inflammation

Social factors

Caste system

In rural India caste is an important basis of

social differentiation.
Untouchability
Forbidden, ill treated, Discrimination

Mutilation
Is an act of physical injury that degrades
the appearance or function of any living
body, sometimes causing death

Source

From " The Northern Tribes of Central Australia

Knockin
g out a
girl's
tooth.
Kaitish
tribe in
Australi
a, 1912

Usage

Some ethnic groups practice ritual

mutilation,

e.g.

circumcision,

scarification, burning, flagellation,

tattooing or wheeling as part of a
rite of passage

The traditional Chinese practices

of lngch and foot binding are

The public flogging

of a slave in
Rio de Janeiro,
Brazil.

Act of tattooing is also

considered a form of
self-mutilation
according

to

cultural

traditions,

such

as

some

within

Christianity and Islam

Mutilations of teeth and oral soft tissues

Since antiquity the practice of decorating and mutilating

- an intrinsic fascination for mankind

Such practices have been carried out for a variety of

reasons ranging from motives related to aesthetics and
concepts

of

beautification

extremely complex

to

motives

which

are

Why know about this?

Important for diagnosis and , where necessary,

treatment of complications arising from these
acquired forms of pathology related to teeth
and oro-facial tissues

Important in the context of forensic odontology

Tooth mutilations

Known to have existed since prehistoric

times in an ethnically and geographically
diverse range of peoples

The

passage

of

time

and

the

impingement of Western culture has

led to a general decline in the prevalence
of these practices among many people

These practices include

..

Tooth evulsion (non-therapeutic tooth extraction )

Alteration in the shape of the tooth crown by

filling and chipping;

Lacquering and staining of teeth;

Decorative inlays and crowns; and

Tattooing , Facial scarring and Uvulectomy

Reasons for mutilations

Identification

Aesthetics

Sign of manhood or bravery

Sex differentiation

Signify a life event

Ensure life after death

Sign of mourning

Punishment

Entry of soul through the mouth

Tooth evulsion

Reasons for tooth evulsion

Number and type of teeth involved

Spiritual, life event, aesthetics, puberty.

Maxillary central incisors, lateral incisors,
canines
Mandibular central incisors, lateral incisors,
canines

Age and sex distribution

Methods of tooth evulsion

Knocked

out

rather

than

extracted

Using a piece of wood or metal

and striking the end

Teeth may be completely evulsed

by

this

method,

or

loosened

sufficiently to allow removal using

the fingers

The gingiva around the neck of the tooth is freed with.

The relative positions of operator and patient

during tooth evulsion vary

The patient may be seated, but more

commonly lies on the ground

Ways to Control postoperative hemorrhage may be

employed.

Fate of evulsed tooth

Embedding of evulsed teeth in the bark of a tree,

the burying of the teeth beside water pools,

throwing the extracted teeth into water, and

Throwing tooth as far as possible towards a legendary

camp-site

Another Aboriginal tribe pounded the evulsed teeth into

fragments which were then placed in a piece of meat.

Consequences

Eradication and/or malformation of other

primary and permanent teeth in the area.

Blood loss and shock due to the crude

nature of the operation can lead to anemia.

The unhygienic methods can cause

septicemia, tetanus, transmission of blood
borne diseases, such as HIV/AIDS.

Alteration of the shape of

the tooth crown

For many centuries, people throughout the tropical

and nontropical worlds have had a tradition of altering
the shape and thus the appearance of the teeth

Confined to anterior teeth (canine to canine) of the

upper
and lower jaws

Reasons

Aesthetics

Tribal identity

Initiation rituals

Religious motives and

Identification with animals

For example, it has been reported that a particular tribe in

Sumatra sharpen their teeth so as to resemble the mouse

In North Borneo some people deliberately make their

teeth pointed so as to resemble the shark

However, throughout the world the teeth most affected by

these procedures are the central and lateral incisors of
each jaw and maxillary and mandibular canines

This practice related to the belief that at death all people enter
a purgatory and undergo a trial of chewing green bamboo

If

a person s teeth are sharp then the bamboo is likely to

splinter and pierce the mouth and intestines

If the teeth are smooth the bamboo can be chewed without ill
effects

Ring (1985) in describing the Montagnards of Vietnam

recorded that tooth crown mutilation among these people
was carried out at puberty

In earlier times, the custom was apparently associated

with initiation into manhood, but today it is performed for
aesthetic reasons

Patterns of chipping and tooth filing

1)The incisal edge;
(2)The mesial and or distal incisal angle;
(3)The mesial or distal surface;
(4)The labial face;
(5)The whole tooth crown

Incisal edge mutilation may involve: horizontal

flattening of the incisal surface such that the
length of the tooth crown is shortened; the
formation of actuate patterns extending across
the width of the tooth crown; or notching of the
incisal edge or grooving

Mesial and/or distal incisal angle patterns, involve

the formation of either sharply angled or actuate
defects which involve the mesial and distal

METHODS

IMMEDIATE COMPLICATIONS

Severe pain,

Unintended tooth fracture,

Pulp exposure, and

Laceration of oral soft tissues.

Peacock (1955) observed frequent pulp exposures among

the mutilated teeth of the Dusan people of north Borneo
when the mutilation was performed using a large chopping
knife

DELAYED COMPLICATIONS
1.

Pulp necrosis

2.

Inflammatory periapical pathology (granuloma, cyst,

abscess)

3.

Sequelae of periapical pathology (cellulitis, osteomyelitis)

4.

Caries

5.

Tooth loss.

Lacquering and dyeing of teeth

Poor oral hygiene,

Habits such as tobacco

smoking and chewing,

Betel usage, and

The deliberate application

of stains and dyes to the
tooth crown

In ancient Japan the deliberate

blackening of teeth using an
iron-containing mixture

In the mid 19th century the custom waned as a consequence

of Japan's developing contacts with the Western world

The custom of Ohaguro (tooth-blackening) among the

Japanese was primarily used to signify marriage and fidelity
in marriage

Young males

- Mru tribe of Bangladesh

deliberate blackening of teeth , along with

carefully

prepared

hair

styles,

earrings

plentiful use of flowers done to woo females.

and

Decorative dental inlays and crowns

Beautification,

To signify wealth,

To signify some event.

The inlay materials used include Haematite, Jade,

Pyrite, Turquoise, Obsidian and Gold

The practice of placing decorative inlays in front

teeth was also carried out in India in previous times

The teeth of important people such as Maharajahs

were reportedly laid with glass or pearls

The Dyaks of Borneo are reported to drill small holes into the
labial surface of maxillary teeth and place pieces of copper

In the Caribbean Islands and the Bahamas the placement of

gemstones and gold Crowns on natural teeth was described

People of Algeria in north-west Africa are known to insert a

small piece of gold between the proximal surfaces of the
anterior maxillary teeth for adornment purposes

In the modern world the use of gold crowns

on teeth is usually related to a therapeutic
need to replace lost or damaged dental
tissues

Muslims the presence of a gold crown on a

front tooth is used to signify that the
wearer has visited Mecca, the spiritual
centre of that religion

Mutilation of soft tissues

Tattooing

Oral and perioral piercing

Tattooing

Popular

in

many

non-tropical

and

tropical areas of the world

Tattooing of the lip and gingiva

The custom of tattooing the gingiva North Africa and the Middle East

The gingiva may be tattooed when

females
betrothed,
married

reach
or

puberty,
when

they

became
became

Painting the gingiva : a layer of pigmented material (usually

carbon) is impregnated into gingiva mucosa by means of sharp
thorns or needles which pierce the mucosa

A blue-black colouration is the usual hue achieved with gingival

tattoos

The carbonized material used to tattoo the gingiva may be

obtained from calcified peanuts(pimpi), burned wood, or from
lamp black (the fine, black soot obtained from burning oil lamps)

Tattooing of the lower lip occasionally may be

encountered chiefly in the region of North Africa

A tattooed lower lip in a Sudanese woman

signifies that the woman is married

Other forms of soft tissue

mutilation
(1)Piercing of lips and peri-oral soft tissues and the
insertion of materials such as wood, ivory, or metal ;
(2)The temporary piercing of oro-facial soft tissues for
ceremonial purposes
(3) Uvulectomy
(4) Facial scarring

Oral and Perioral Piercing

1.

Aesthetics;

2.

A sign of
marriage;

3.

Tribal Identity;

4.

To prevent evil
spirits entering

Wearing

of

spectacular,

extremely

large lip plates by some people derives

from the time of the slave trade
between Africa and other countries

In this context it has been suggested

that large lip plates were used in a
deliberate attempt to make the wearer
unattractive to slave traders

This form of defect may be single

or multiple and can involve the
upper lip, the lower lip, both lips,
and the peri-oral facial tissue

The plugs (labrets if in the lips)

may be made of wood, ivory or
metals

Uvulectomy

The practice of Uvulectomy is encountered in

East Africa and north-east Africa (Wind 1984)

Uvulectomy is carried out mainly by Muslim

populations, but there does not appear to be a
direct link with particular religious beliefs

The reasons for Uvulectomy are reportedly prophylactic

in nature and are concerned with improving general
health and decreasing pulmonary diseases in children

STUDIES ON CULTURE AND

ORAL HEALTH

TRADITIONAL AND EMERGINGORAL

HEALTHPRACTICES IN PARTS OF
NIGERIA
Oke GA et al, Odontostomatol Trop, Dec
2011

The purpose of this study was to document the beliefs and

perceptions and emergingoral healthcare practices in
parts of Nigeria.

Focus group discussions and in-depth interviews

Chewing sticks and locally prepared toothpastes ranked

prominent among the tooth cleaning implements

Dental care remedies were employed ranging from warm

saline wash to herbal preparations, antibiotics and battery
water.

The belief in ill defined "worms" as causative agents of

alloral healthproblems was very firm.

THE TRADITIONAL PRACTICE OF CANINE

BUD REMOVAL IN THE OFFSPRING OF
ETHIOPIAN IMMIGRANTS
Esti Davidovich,Eli
Kooby,Joseph Shapira andDiana
Ram
BMC Oral Health, 2013

To assess whether the prevalence of missing primary

canines and dental defects in offspring of emigrants
from Ethiopia is greater than in offspring of native
Israeli parents of similar socioeconomic class.
Canines were present in more Israeli than Ethiopian
children
More dental defects were detected in Ethiopian than
in Israeli children
The prevalence was greater among offspring of
parents who had emigrated from Ethiopia 1520 years
earlier than among offspring of native Israeli parents
living in the same low socioeconomic neighborhoods.

PRENUPTIAL DENTAL EXTRACTIONS IN

ACADIAN WOMEN: FIRST REPORT OF A
CULTURAL TRADITION.
Gordon SC,Kaste LM,Barasch A,
Safford MM,Foong WC,ElGeneidy A.
Journal of Womens health, 2011

The purpose of this study was to confirm the

existence of this practice among Acadian
women.

Survey instrument was mailed to 182 dentists

from traditionally Acadian regions of Canada.

Prenuptial extractions in this population have

been confirmed by the current cohort of dentists.

A SURVEY OF TEETHING BELIEFS AND

RELATED PRACTICES AMONG CHILD
HEALTHCARE WORKERS IN ILE-IFE,
NIGERIA.
Oziegbe EO1,Esan TA,Adekoya-Sofowora CA,
Folayan MO.
Oral health Prev Dent. 2011;9(2):107-13.

To determine the perceptions/beliefs and related

practices of child healthcare workers regarding
teething problems in Ile-Ife, Nigeria.
Child healthcare workers comprising dentists,
paediatricians, communityhealthphysicians,
pharmacists and communityhealthnurses.
A majority of the dentists believed in teething
problems based on personal experience, books, local
myths and school/workshop.
Fever and diarrhoea were the most prevalent
symptoms and signs believed to be associated with
teething.

A REVIEW ON THE ORAL

HEALTH IMPACTS OF
ACCULTURATION
Xiaol-Li Gao Colman McGrath

Utilization of dental services positive

impact on Hispanics and Asians in the US
Highly accultured hispanics had lower
prevalence of caries
In Australia, Vietnamese immigrants with
medium level of acculturation had
significantly lower oral health knowledge

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