Prevalence and risk factors of oral potentially malignant disorders in Indonesia: a cross-sectional study undertaken in 5 provinces.

Detection of subjects with oral potentially malignant disorders in a population is key to early detection of oral cancer (OC) with consequent reduction of cancer-related morbidity and mortality. Our aim was to investigate the prevalence and associated risk factors for OPMD in representative provinces of Indonesia. This cross-sectional study was undertaken in five Indonesian provinces: West Java (WJ), Jakarta (JKT), West Papua (WP), West Kalimantan (WK) and Banda Aceh (BA). Respondents answered a previously validated questionnaire including information on ethnicity, occupation, socioeconomic status (SES), oral health practices, and behaviours associated with oral cancer. An oral examination was undertaken using WHO standardized methodology. Data were analysed using ANOVA, Chi-Square, and logistic regression to assess association between risk factors and mucosal disease. A total of 973 respondents between the ages of 17 and 82 years was enrolled (WJ 35.5%,JKT 13.3% WP 18.3%, WK 9%, BA 23.9%). Tobacco smoking (14.8%), Betel quid (BQ) chewing (12.6%) and alcohol drinking (4%) varied geographically. A well-established OPMD was detected in 137 (14.1%) respondents and 2 (0.2%) presented with chronic ulceration later diagnosed as OC. Leukoplakia was the most common OPMD found (9.7%), while the prevalence of oral submucous fibrosis (OSMF), not previously described in the nation, was 2.3%. Poor knowledge of OC risk factors, poor oral hygiene behaviours, low-income SES and ethnicity were significantly associated with the presence of an OPMD. There is a previously under-reported high prevalence of OPMD in Indonesia. Overall, we found a strong correlation between the presence of an OPMD and individual habituation to known risk factors.

General dentists' knowledge, perceptions, and practices regarding oral potentially malignant disorders and oral cancer in Indonesia.

INTRODUCTION: The most effective means for reducing oral cancer (OC) mortality is by preventing late-stage disease. Early diagnosis can be improved by increasing awareness among healthcare providers, specifically general dental practitioners (GDP). Therefore, our study aimed to assess GDPs' knowledge of OC risk factors and perceived competence in performing conventional oral examination (COE) in routine dental practice. MATERIAL AND METHODS: This was a cross-sectional study conducted in five provinces of Indonesia, namely: Aceh, Banda Aceh (BA); Bandung, West Java (WJ); special district Jakarta (JKT), JKT; Pontianak, West Kalimantan (WK); and Sorong, West Papua (WP). The local Dental Association or Faculty of Dentistry invited the GDPs to attend an education program and complete the survey. RESULTS: One hundred seventy-seven GDPs completed the survey (WJ, n = 63; BA, n = 44, JKT, n = 27; WP, n = 23; and WP, n = 20). A large proportion (164 out of 177, 92.66%) of GDPs felt they had received insufficient training to equip them to diagnose OC and as many as 22.6% (n = 40) did not refer to specialists when they found suspicious mucosal lesions. Notwithstanding the significant regional variations, the majority of Indonesian GDPs self-reported inadequate knowledge and awareness of OC and scarce confidence in performing COE. CONCLUSION: GDP knowledge of OC risk factors and COE is key to improving early diagnosis of OC at a community level. Therefore, it is suggested that the lack of knowledge and confidence of GDPs reported here should be addressed through the national dental curriculum in Indonesia.

Distinct phenolic, alkaloid and antioxidant profile in betel quids from four regions of Indonesia.

Betel quid (BQ) is a chewing mixed package that mainly contains areca nut (AN), betel leaf (Leaf) or betel stem inflorescence (SI), and slaked lime, and is consumed with or without tobacco BQ chewing is common in South East Asia and has been strongly associated with malignant and potentially malignant diseases of the oral cavity. Alkaloids such as arecoline are often accounted for the carcinogenic potential of BQ, however the chemical composition of BQ has not been studied in detail. In the current study, we investigated the total phenolic content (TPC), antioxidant activity (by mean of ferric reducing antioxidant power, FRAP), radical scavenging activity (DPPH test), polyphenolic profile and arecoline content in different components of BQ, namely AN, Leaf or SI, Husk, and blended BQ (BQ mix, containing AN, Leaf or SI and slaked lime). Samples were imported from 4 major regions of Indonesia, namely: Banda Aceh (BA), North Sumatra (NS), West Kalimantan (WK) and West Papua (WP). The highest TPC, FRAP, and DPPH values were detected in AN samples compared to other BQ components, while samples from WP region were of higher values compared to the other regions. High performance liquid chromatography-Mass Spectrometry (LC-MS) analysis showed that Husk contains the widest range of polyphenols, including hydroxybenzoic acids, hydroxycinnamic acids, flavanols, flavonols and stilbenes. Catechin and epicatechin were the main polyphenols detected in BQ, and they were present at the highest concentrations in WP-AN sample. Arecoline was detected in all AN and BQ mix samples and was significantly correlated with catechin and epicatechin, and significantly negatively correlated with p-hydroxybenzoic acid. Notably, arecoline concentration changed significantly when AN was blended in BQ mixtures. The current study is the first to extensively characterise the chemical composition of BQ and provides insight for a better understanding of the interactions of BQ alkaloids and phenolics in the development of oral submucous fibrosis and oral cancer.

Group pain education is as effective as individual education in patients with chronic temporomandibular disorders.

BACKGROUND: Temporomandibular disorders (TMD) are recognised as the most common chronic orofacial pain condition, with prevalence figures ranging from 3% to 12%. Patients referred to tertiary orofacial pain clinics for the management of TMD often experience delays in receiving treatment. The objective of the present study was to assess a group treatment programme to deliver effective earlier intervention for patients with chronic TMD. METHODS: Forty-two patients with TMD seen at the Oral Medicine Clinic, Royal Dental Hospital of Melbourne, were administered baseline validated pain questionnaires: the Graded Chronic Pain Scale and Pain Catastrophising Scale. Twenty patients subsequently received education about basic neurophysiology of pain, TMD and relaxation techniques in either a group setting or in a one-on-one session and were followed longitudinally. Administration of pain questionnaires was repeated at 4-6 weeks post-intervention. RESULTS: No evidence of difference in levels of anxiety, somatic symptoms or catastrophising was found between patients who received either group or individual intervention. Both were effective at reducing pain intensity and levels of disability. Individual intervention resulted in a greater reduction in rumination. CONCLUSION: Patients with TMD can receive effective reduction of TMD-related pain and catastrophising from either group or individual education regarding neurophysiology of pain, TMD and relaxation techniques. Group education should accelerate time to commencement of care in large referral-based settings.

A review and guide to drug-associated oral adverse effects-Dental, salivary and neurosensory reactions. Part 1.

Numerous adverse drug reactions (ADR) manifest in the oral cavity and orofacial region. Dentists and other health professionals commonly encounter and manage these adverse effects however, due to lack of awareness and training, they are not always recognised as being drug-induced nor reported to pharmacovigilance agencies. The broad diversity and increasing number of medications for which dental pharmacovigilance is needed can be overwhelming for all health professionals. Thus, the aim of this review and guide was to outline the common medications associated with orofacial side effects so as to improve recognition, management and reporting of ADR. Adverse effects discussed in Part 1 include drug-induced bruxism, tardive dyskinesia, hairy tongue, gingival enlargement, hypersalivation, xerostomia, tooth discolouration and taste disturbance.

Perceptions, attitudes and factors that influence prescribing by general dentists in Australia: A qualitative study.

BACKGROUND: Longitudinal studies of dental prescribing in Australia show that dentists make some inappropriate prescribing choices; literature has shown that dentists tend to overprescribe antibiotics and prescribe for incorrect indications. The unnecessary use of antibiotics is a contributing factor towards the development of antibiotic resistance. The aims of the study were to obtain a greater understanding of the perceptions, attitudes and factors that influence dental prescribing for all major relevant drug classes. METHOD: Semi-structured interviews of 15 purposively sampled dentists practising in Victoria, Australia were conducted from June-September 2018. Two dentists practised in rural areas and the remainder in urban locations. The range of clinical experience varied from 2.5 to 37 years, with a mean of 13 years. The transcripts were analysed thematically. RESULTS: Dentists generally preferred amoxicillin as first-line therapy for odontogenic infections, with some confusion about the spectrum and uses of antibiotics. Overprescribing was evident, mostly due to basing judgement for use of antibiotics on symptoms rather than clinical signs. Other factors, such as time pressure, patient expectations, pressure from assistant staff, concern about online criticism and medico-legal considerations, influenced prescribing. Of the dentists who prescribed anxiolytics, most did not have a care protocol for their sedated patients. CONCLUSION: A variety of prescribing practices were described, and future interventions should target misconceptions around the appropriate use and choice of antibiotics, resources to address the shortfall in knowledge of therapeutics, patient education and staff training, as well as appropriate care and monitoring of sedated patients.

Recurrent aphthous stomatitis revisited; clinical features, associations, and new association with infant feeding practices?

BACKGROUND: Recurrent aphthous stomatitis (RAS) is a common oral mucosal disease, characterized by painful oral ulcerations whose causes is poorly understood. The aim of the present study was to assess the characteristics of patients suffering from RAS. METHODS: Five hundred and twenty-eight consecutive patients attending an Oral Medicine Specialist Clinic in the UK were examined and 143 specific attributes recorded. RESULTS: Patients with a clinical diagnosis of RAS were significantly more often males (P = 0.001) younger (P < 0.001). Significant correlations were observed between a diagnosis of RAS and trauma (P = 0.044), stress (P = 0.006), non-smoking (P < 0.001), a family history (P < 0.001), breast feeding (P = 0.017) and the site in the mouth (buccal, labial, floor of mouth) (P < 0.007). CONCLUSION: This retrospective analysis of patients attending a tertiary referral center provides evidence to support some long held beliefs about RAS, such as young age of onset, sites affected, and associations with trauma, stress, familial history and hormonal changes, while raising a new and interesting decreased incidence with breast feeding.