Traditional Milk Tooth Extraction Persists in Khartoum Children Despite Clear Clinical Risk
Milk tooth extraction remains embedded in family belief systems across parts of Sudan, even when the procedure targets healthy primary tooth buds in very young children. In a multicenter cross-sectional study from Khartoum State, mothers described a practice still linked to diarrhea, vomiting, cough, and fever, symptoms often interpreted through a traditional healing lens rather than a biomedical one. The findings place milk tooth extraction at the intersection of oral health, pediatric care, and community health education.
The study enrolled 385 mothers of children under five years of age across seven teaching hospitals. The mean maternal age was 34.96 years, and the children had a mean age of 2.14 years. Boys accounted for 54.8% of the pediatric sample, while girls made up 45.2%. Within this hospital-based group, 18.4% of children had undergone milk tooth extraction, a figure that signals ongoing exposure to a harmful practice during a developmental period when primary teeth and oral tissues are especially vulnerable.
One sentence in the dataset carries particular clinical weight: 40% of mothers endorsed the practice.
Belief, Tradition, and Misattributed Symptoms Drive the Practice
Mothers who accepted the procedure most often pointed to family tradition, cited by 69.4% of respondents who endorsed milk tooth extraction. Illness symptoms followed close behind. Diarrhea was named by 56.1%, vomiting by 46.5%, and fever by 37.7%. Those reasons are clinically important because they reveal how childhood illness can be reframed as a dental problem in communities where oral traditions shape first-line responses to symptoms.
The logic behind the practice is understandable from a social perspective, even when it is medically unsound. When infants and toddlers develop diarrhea, vomiting, or fever, families may search for a visible, immediate cause. Primary tooth buds can become the target because they are perceived as diseased structures that must be removed to restore health. In reality, these symptoms usually point to infectious, gastrointestinal, or systemic causes, not a need for tooth bud extraction. Once that false causal link becomes accepted inside a household or village network, the practice can be repeated across generations.
Maternal age, educational level, and rural origin were significantly associated with milk tooth extraction. These factors matter because they suggest that exposure is not random. It clusters in social environments where access to accurate oral health information may be limited, and where longstanding explanations for childhood illness can persist without challenge. Rural origin may also reflect differences in access to dental services, health promotion, and routine pediatric counseling.
Reported Complications Were Limited in the Sample, but the Procedure Still Carries Harm
Most mothers did not report complications after milk tooth extraction, but fever, bleeding, and other adverse events were described. A lack of major complications in this sample should not be interpreted as safety. A cross-sectional interview design can capture what parents remember and what they recognize as a complication, but it cannot reliably quantify the full burden of injury, infection, pain, poor feeding, or longer-term oral consequences.
The biologic concern is direct. Manual extraction of primary tooth buds in a child under five can traumatize oral tissues, introduce infection, and create distress in a patient who cannot easily describe pain or follow post-procedure care. In early childhood, even minor oral injury can affect feeding and hydration, especially when the child is already ill with vomiting or diarrhea. Bleeding during a procedure performed outside formal dental care is not a trivial side effect; it is a sign of avoidable procedural harm.
This is also a public health issue, not only an oral health one. The same children who are taken for milk tooth extraction may be delayed from receiving rehydration, evaluation for infection, or other basic pediatric interventions. When symptoms are attributed to a tooth bud, the delay can carry consequences that reach far beyond the mouth.
Hospital-Based Mothers Expose a Community Education Gap
Because the survey was conducted in pediatric units of teaching hospitals, it captured mothers already seeking medical care for their children. Even in that setting, endorsement of milk tooth extraction remained substantial. That suggests the practice is not confined to remote households untouched by formal healthcare; it survives alongside modern services and may still be viewed as compatible with them.
The finding has practical implications for counseling inside hospitals and primary care clinics. Mothers of childbearing age need clear, repeated messages that diarrhea, vomiting, cough, and fever in young children are not indications for tooth bud removal. Health workers also need consistent guidance so they can recognize the practice, ask about it without judgment, and explain why it should be avoided. When caregivers are met with hostility, they may hide the behavior rather than disclose it, making prevention harder.
A targeted approach makes sense because the determinants identified in the study point toward specific audiences rather than a diffuse population-wide problem. Women from rural settings, mothers with lower educational attainment, and families with strong traditional ties are likely to benefit from direct, culturally sensitive oral health education. Primary healthcare centers and pediatric hospitals are logical settings for that work because they already serve young children and their caregivers at moments of concern, illness, and decision-making.
Why the Findings Matter for Pediatric and Dental Care in Sudan
Milk tooth extraction is not a benign custom preserved only in memory; it is a live practice affecting real children in a contemporary hospital network. The 18.4% prevalence recorded in this study is enough to justify routine screening questions during pediatric visits, especially when children present with gastrointestinal or febrile symptoms. Oral health messages should not wait until a child reaches a dental clinic, because the procedure is often justified long before that point.
The study also reflects the broader challenge of reducing harmful traditional practices without dismissing the communities that sustain them. Effective prevention depends on explanation, not condemnation. Families are more likely to change when health professionals acknowledge the concern behind the behavior, then replace the false causal model with a clearer account of childhood illness and evidence-based care.
No specific funding supported the work, and the investigators reported no competing interests. The study was approved by the Ethics Review Committee of the Faculty of Dentistry at the University of Khartoum, with written informed consent obtained from all participating mothers. Those safeguards strengthen the credibility of the findings, even as the clinical picture remains sobering: a procedure tied to tradition is still being used on very young children, despite the availability of safer medical and dental care pathways.