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It has been reported in the literature that some rural populations of Sub-Saharan and Eastern Africa and other isolated areas around the world, practise gouging or enucleation of primary tooth buds to cure childhood illnesses. The unerupted primary canine tooth bud is believed to be the cause of febrile illness, diarrhoea, and vomiting; prevalent in infants in these areas of the world. Tooth bud gouging has implications for the developing dentition, and is a potential risk to the health and life of the child. Reported prevalence ranges from 22%-90%. From the information in this case report, the practise of tooth bud gouging is no longer confined to rural areas and may well be performed by communities that have emigrated to the UK. The three sisters described, now resident in the UK, suffered tooth gouging in a city clinic in Uganda. The damage caused to the primary and permanent dentition is described and treatment planning and options are suggested for each case to restore structure and function. Appropriate provision of healthcare and education could avoid the potential long-term damage to the health of the child and their developing dentition by the practise of tooth bud gouging, whether it occurs in the developing or developed world.

Genetic factors have been implicated in the aetiology of infraocclusion, but only three published reports describe infraocclusion of primary molars in twins. This case report describes the occurrence of infraocclusion in two pairs of twins. The distribution of affected teeth and the severity of infraocclusion were strikingly similar in each pair. The report provides further evidence of a genetic contribution to the aetiology of the condition, and also highlights the need to examine siblings, and especially twins, of children who present with an infraoccluded primary tooth.