Study Helps Sudanese Refugees By Offering Dental Implants

Study Helps Sudanese Refugees By Offering Dental Implants
Thursday, March 31, 2005
By: By EMILY FREDRIX
Associated Press Writer
Yankton Press & Dakotan: Story
OMAHA, Neb. -- As a 9-year-old in Sudan, Dhalbang Malua longed to have some of his teeth removed so girls would notice him.
"They would see you like you are nobody," Malua said of boys who had all their teeth.
For youngsters of some Sudanese tribes, removing teeth is a rite of passage and a symbol of attractiveness and maturity. But when Malua, 36, and many other Sudanese refugees resettle in the United States, they want their teeth back after finding that it has a different connotation.
"We know that people associate missing teeth with lower socio-economic status, lower education, lower health standards and being less attractive. That's impacted refugees," said Mary S. Willis, an assistant professor of anthropology at University of Nebraska-Lincoln who specializes in medicine, dentistry and Sudan.
Now, Willis is spearheading an effort to help Sudanese refugees receive dental implants so they can feel more confident in their new homeland. Having the teeth replaced also will help the refugees better pronounce English words and more easily eat certain foods, Willis said.
She and other researchers also will study how the implants help the Sudanese adjust to a new way of life.
Thirty Sudanese refugees living in Lincoln will participate in the study being conducted this week at the university. The refugees will meet with psychologists, linguists and nutritionists to assess their lives before and after they receive the dental implants, which cost about $6,000 per person.
Malua, who is a member of southern Sudan's Dinka tribe, plans to call Willis to sign up for implants, as suggested by a dentist. He agreed that his missing teeth have led to difficulty pronouncing words, not being able to eat corn and having to carefully cut up his meat. He also faces questions from his neighbors in the Omaha suburb of Bellevue, where he has lived since 2000.
"Nobody will ask me any more questions. And then also I will improve my pronunciation," said Malua, a student studying finance at Bellevue University.
Sudanese refugees sought shelter in the United States after a civil war broke out in the African nation two decades ago, displacing at least 4 million people and leaving several million dead. Several thousand relocated to Nebraska.
Steven H. Fox, a psychology professor at New Mexico Highlands University, said he hopes his involvement in the study will allow him to document how the dental implants may lessen the long-term trauma caused by the civil war.
"We place a lot of value on teeth," Fox said. "It could affect their ability to gain employment as well as being readily accepted by people within society."
The study is being paid for by a nearly $230,000 grant through the New York-based Langeloth Foundation. The grant will provide for between 25 and 30 implants, not nearly enough to treat everyone who wants them, said Willis, who plans to apply for more grants.
Within six months of moving to America, Sudanese refugees report that they want to get dental implants, undoing a tradition that dates back to at least the 1830s, Willis said.
The Dinka tribe removes six bottom front teeth, while the Nuer tribe, also of southern Sudan, removes those teeth, plus two upper teeth. The program's participants are evenly split between Dinka and Nuer, and only the bottom teeth will be implanted so that everyone receives the same services, Willis said.
She thinks the tradition may have been a way for people to cope with a byproduct of tetanus -- lock jaw. Willis said having those teeth removed allowed sufferers to consume liquids even when they could not open their mouths.
Not having those teeth works well for life in Sudan -- and the roughly 15 other African countries that have similar traditions, Willis said. She noted diets in those countries consists largely of soft foods, such as stews.
Participants in the study will be re-interviewed about seven months after their implant surgeries, which will be performed by volunteer dental students through the University of Nebraska Medical Center.
Researchers will analyze how refugees' stress levels and nutrition changed and how their pronunciation has improved. This study might also be able to isolate how important the front teeth are for pronunciation, she said.
Willis also hopes the study will benefit future refugees from other cultures.
"I'm really trying to focus on the fact that each refugee population that comes into the U.S. has very unique needs that allow them to succeed in each culture, things that wouldn't be an issue in other cultures," Willis said.