Getaneh et al. BMC Oral Health (2018) 18:159 https://doi.org/10.1186/s12903-018-0619-y RESEARCH ARTICLE Open Access Misconceptions and traditional practices towards infant teething symptoms among mothers in Southwest Ethiopia Addis Getaneh1*, Fikirte Derseh2, Michael Abreha2 and Tewodros Yirtaw3 Abstract Background: The assumption of a link between common symptoms such as febrile illness, diarrhea and the eruption of primary teeth has been established over many centuries. According to traditional beliefs in Ethiopia, diarrhea and fever at the time of milk teeth eruption may be due to a worm in the child’s gums. Current medical observations show little more than restlessness, drooling, and finger sucking resulting from teething. The purpose of this research was to assess mothers’ traditional beliefs and practices towards teething symptoms. Methods: A cross-sectional descriptive study design was used with the convenience sampling technique. Mothers were approached at the pediatric Out Patient Department (OPD) of Jimma University Specialized Hospital, southwest Ethiopia. A structured questionnaire was used for data collection. The data were analyzed by SPSS (version 20). Results: A total of 107 mothers were interviewed. Ninety-eight (91.6%) claimed that teething was associated with various symptoms. Ninety-seven (90.7%) attributed diarrhea to teething. Only one mother said she would give her child Paracetamol to relieve the teething symptoms. Five (4.7%) mothers said they would allow their children to bite on a pacifier. Ten mothers (9.3%) said that they would prefer the child’s milk tooth to be extracted. Some of the practices by mothers to relieve the symptoms include rubbing the gum of the child with garlic (12.1%) or rubbing the gum with herbs (6.5%). Conclusions: Most of the mothers had misconceptions about the symptoms that usually appear during teething. Health education should be provided by dentists and professionals concerned with child care in correcting these misconceptions and cultural beliefs about teething symptoms. Keywords: Teeth eruption, Symptoms, Infant, Culture, Ethiopia Background between the eruption of the primary teeth and the general The eruption of teeth (teething) is the movement of the health of infants has been held for over 5000 years [3]. A teeth from their pre-eruptive position in the alveolar bone cross-sectional study of five groups of child health profes- through the mucosa into the oral cavity as defined by sionals versus parents and medical personnel in Australia Carpenter J V in 1978 in a study that assessed the relation- and Israel, respectively, indicates that these assumptions are ship between teething and systemic disturbance [1].Teething not held by parents alone [4, 5]. The issue of symptoms usually begins around 6 months and lasts until approxi- associated with teething had been debatable with some mately 3 years of age [2]. Most parents regard the eruption authors asserting that different symptoms are associated of an infant’s first tooth as a significant developmental land- with teething while others claimed the contrary [3, 4, 6, 7]. mark, and an ‘old wives’ tale’ regards its precocious Traditional beliefs also strongly associate specific symptoms eruption as a sign of great intelligence. The relationship with times of teething. Some of the symptoms that had been associated with teething in children include fever, diar- rhea, general irritability, drooling of saliva, sleep disturbance * Correspondence: [email protected]; [email protected] 1Department of Dental and Maxillofacial, St.Paul Hospital’s Millennium and ear infection [5]. Others include pain, inflammation of Medical College, Addis Ababa, Ethiopia the mucosa overlying the tooth, facial flushing, circumoral Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Getaneh et al. BMC Oral Health (2018) 18:159 Page 2 of 6 rash, gum rubbing (biting), sucking, constipation, and loss data collection as the interview was conducted in a se- of appetite [4, 8] Traditional beliefs in Uganda assert that cluded area. primary canines are sources of illness and should be ex- tracted to prevent the illness [9]. According to traditional Study period beliefs in Ethiopia, diarrhea and fever at the time of milk The data were collected from August 10–14, 2015. teeth eruption may be due to a worm in the child’sgum [10]. The National Baseline Survey on Harmful Traditional Study design Practices (HTPs) of Ethiopia carried out in 1997 found that Cross-Sectional study design was used. milk tooth extraction is performed in more than 80.2% of the general population. In the Gambella region, there is a Sample population very high prevalence of this tradition that is valued as a All mothers who visited JUSH’s pediatric OPD, south- marker of ethnic identity in the region. In the Oromia re- west Ethiopia from August 10–14, 2015. gion, the prevalence of this practice is 89% [10]. Current medical studies show little more than restlessness, Sample size and sampling technique drooling, finger sucking and appetite loss arising from Convenience sampling technique was used. The working teething [7, 11, 12]. The timing of eruption of the days of the week from August 10–14, 2015 were ran- primary incisors (6–12 months) coincides with the domly selected. All mothers who presented at the decrease in the circulating maternal humoral immun- pediatric OPD and verbally consented were interviewed. ity conferred via the placenta and the development of the child’s own humoral immunity. Consequently, Table 1 Socio-Demographic profile of the study population children of this age are prone to myriad of relatively Demographic characteristics Number % minor infections [12]. In Ethiopia, there is a misconcep- Age < 20 4 3.7 tion that symptoms associated with teething are relieved 20–29 62 57.9 by having the teeth extracted or by having the gum drilled 30–39 35 32.7 and the primary teeth or the new permanent teeth ex- > 50 6 5.6 tracted or craved out [10]. The objective of this research was to assess mothers’ traditional beliefs and practices Total 107 100.0 towards teething symptoms. Education Illiterate 16 15.0 Red and write 4 3.7 Methods Primary 32 29.9 Study area Secondary 28 26.2 The study was conducted in Jimma University Post-secondary 3 2.8 Specialized Hospital (JUSH) located in southwest Ethiopia, Oromia region. Jimma is the largest city in University/college 24 22.4 southwest Ethiopia located 352 km away from Addis Total 107 100.0 Ababa. Jimma University Specialized Hospital is one Occupation Farmer 4 3.7 of the oldest public hospitals in the country. It was Civil servant 24 22.4 established in 1937 by Italian invaders for the service Professional 6 5.6 of their soldiers. It is the only teaching and referral Merchant 15 14.0 hospital in the southwestern part of the country. It provides services for approximately 15,000 inpatients, Housewife 53 49.5 160,000 outpatients, 11,000 emergency cases and Other 5 4.7 4500 deliveries a year from the catchment popula- Total 107 100.0 tion of about 15 million people. Income Class Poor class 30 28.0 Floating class 22 20.6 Ethical consideration Lower middle class 26 24.3 The Informed consent process was approved by the Jimma University’s Institute of health sciences communi- Upper middle class 20 18.7 ty-based education office (CBE). Permission was also ob- Rich class 9 8.4 tained from the JUSH Medical director’s office. Verbal Total 107 100.0 Informed consent of the participants was obtained. The Place of residence Urban 92 86.0 confidentiality of the information they provide was as- Rural 15 14.0 sured by removing unique identifiers from the question- Total 107 100.0 naire. The privacy of the mothers was maintained during Getaneh et al. BMC Oral Health (2018) 18:159 Page 3 of 6 Table 2 Mothers’ knowledge about teething Table 4 Symptoms ascribed to teething by mothers Questions Yes No Don’t Total Symptoms Frequency (%) Total know Yes No Babies’ teeth start 70(65.4%) 19(17.8%) 18(16.8%) 107(100%) Fever 52(48.6%) 55(51.4%) 107(100%) to erupt around 6–7 months of Age Diarrhea 97(90.7%) 10(9.3%) 107(100%) The first teeth to 80(74.8%) 21(19.6%) 6(5.6%) 107(100%) Vomiting 38(35.5%) 69(64.5%) 107(100%) appear in the mouth are lower central incisors Irritability 78(72.9%) 29(27.1%) 107(100%) The eruption of teeth 41(38.3%) 45(42.1%) 21(19.6%) 107(100%) Poor appetite 66(61.7%) 41(38.3%) 107(100%) gets completed at The numbers do not add up to 100 because of multiple symptoms by many of approximately 2 years the mothers of age Delayed eruption of 29(27.1%) 74(69.2%) 4(3.7%) 107(100%) Poor class: - those who earn less than 2$/day teeth may be an indication of the Floating class: - those who earn 2$-4$/day presence of systemic Lower middle class: - those who earn 4$-10$/day disease Upper middle class: - those who earn 10$-20$/day Rich class: - those who earn greater than 20$/day Data collection and analysis Data collected were analyzed by SPSS software (ver- Data were collected by the interviewer-administered ques- sion 20).