Study design and study area
An institution-based descriptive cross-sectional study was conducted from January 2015-September 2016 at university of Gondar hospital. Gondar town is located 738 km Northwest of Addis Ababa, the capital of Ethiopia.
The study populations were children aged 2-12 years visited the dental clinic of the University of Gondar hospital in the study period. The children not included in the study were, under 2 and above 12 years, those who failed to provide the consent, acutely sick on the day of the examination
During data collection, all children (2-12 years) visited the University of Gondar hospital dental clinic were considered to participate in the study.
The sample size of the study was done using a single population
n=Z2P(1-P)
d2
Where
n=sample size
Z= Z statistic for a level of confidence (1.96)
P= expected prevalence or proportion ( a prevalence of 70% in the area according to the 1990 study (7)).
d= precision (5%)
n=1.962x0.7(1-0.7)= 322
(0.05)2
With 10% non-response rate (32) the total sample size was estimated to be 355.
Systematic sampling technique (every other child) was used in the data collection process.
Data collection
Data collection was done using both questionnaires and oral examination
A structured closed-ended questionnaire was prepared to collect the socio-demographic data and canine tooth bud removal practices. Socio-demographic information for the children and parents was taken by face-to-face interview of the parents/ legal guardians.
The study had two parts, a face-to-face interview with the parents or guardians using structured closed-ended questionnaires to collect data on age, gender, child position, maternal educational status, maternal occupation, predisposing factors to oral mutilation, and canine tooth bud removal practice.
The second part of the data collection tool was oral examination to assess the status of the participant’s teeth.
Face-to-face interview
A structured closed-ended questionnaire was used to collect data on age, gender, child position, maternal educational status, maternal occupation, predisposing factors to oral mutilation, and canine tooth bud removal practice. The questionnaire was initially piloted and tested by the two data collectors concerning the understandability of the questionnaire by the community before being used.
To assure the validity of the material a pilot study was done in 30 attendants before the actual data collection period to know the participants understand the questionnaire. The questionnaire was first written in English and translated to the local language (Amharic) and back to English again to check the validity of the language. A two days training was given for data collectors to briefe them about the data collection instruments and the overall aim of the study and they collected the data using the pre-designed questioners under the strict supervision of the principal investigator.
Oral examinations
Oral examination of the included children was done by the principal investigator at the dental OPD using a disposable glove, portable torch, wooden spatula, mouth mirror, dental probes, and dental x-ray. A record on the number of teeth present in the jaw was made using the individual form. The tooth was assessed for whether it had previously oral mutilated or not. In addition to this, the oral cavity was evaluated for the presence of missing, malformed, or normal dentition. Missed is recorded when a child had the previous history of oral mutilation and the tooth does not erupt within the expected time of the eruption and dental x-ray was used in some children. It was assumed malformed due to oral mutilation if there was a history of tooth bud removal and presence of enamel defect after the eruption.
Ethical clearance and Consent/assent
Ethical clearance was obtained from the institutional review board of the University of Gondar. The parents or guardians of the children were briefed for the aim of the study and asked for consent and Informed voluntary assent was obtained without pressure from parents. Before they are allowed to participate in the study, they are told the participation is voluntary and no risks. They are allowed to take part in the study after signing the consent form. The parents or guardians were given oral health education on the impact of oral mutilation practice in the general health of the child and tooth development.
Data analysis
After coding and editing, data were entered and analyzed using SPSS version 20.0. Descriptive data were given in frequency and percentages depending on the variable type. Prevalence estimations were made for different Sociodemographic characteristics.