Missing front teeth in exile Tamils—An unresolved phenomenon

In the period from 1986 to 1995, the Department of Public Health in Wuppertal conducted an examination of 263 patients who had come from Sri Lanka as refugees and applied for political asylum in the Federal Republic of Germany. Isolated front tooth gaps were observed in more than 60% of the patients, an incidence significantly higher than in a control group of asylum seekers from countries other than Sri Lanka, and much higher than the incidence of traumatic tooth loss reported in the literature. The aetiology of this tooth loss remains largely unresolved. The bulk of the medical histories given by the patients did not correspond with the clinical and X-ray evidence gathered. Since medical and dental causes for the loss of the teeth can be excluded, one must ask whether social, cultural or religious causes are responsible.