Availability and use of Naswar: an exploratory study.

BACKGROUND: Naswar is a niche smokeless tobacco product from Pakistan. There is little information about its availability and user characteristics. METHODS: This cross-sectional survey identified outlets selling Naswar in two wards of one London borough and interviewed a purposively recruited sample of 73 Naswar purchasers. Data were analysed using descriptive and chi-square tests (significance, P ≤ 0.05). RESULTS: Of 65 outlets identified 15 sold Naswar. The purchasers' mean (SD) age was 32 (± 10) years and 63% had completed only secondary education. Naswar consumption was significantly associated with tobacco dependency, whilst starting Naswar use at a younger age, having lower education levels, using Naswar more frequently and being of Pakhtunkhwa origin was associated with high monthly consumption (P ≤ 0.05). CONCLUSIONS: Naswar was widely available. Naswar purchasers of Pakistani origin were employed and young, but with limited education and little knowledge of Naswar's health impacts. Naswar dependency and consumption was linked to behavioural and socio-demographic factors. Further evidence is needed to support policy development.

Campaign awareness and oral cancer knowledge in UK resident adult Bangladeshi: a cross-sectional study.

BACKGROUND: This study reports awareness of the 'Open up to Mouth Cancer' campaign materials and oral cancer knowledge among two UK adult Bangladeshi communities, both at high risk for oral cancer. METHODS: Differences in the outcomes of campaign awareness and knowledge of oral cancer risk factors and early signs were compared between campaign and comparison areas. Home-based interviews were conducted with representative samples from both areas by bilingual interviewers. Data collected included a modified 36-item Humphris Oral Cancer Knowledge Scale and socio-demographic information. The data were collected 4 weeks after the campaign completion and analysed using χ(2)-tests and binary logistic regressions. RESULTS: The response rate was 77%. Both awareness of the campaign materials (29.99% (95% confidence interval (CI) 15.82, 46.99) vs 8.12% (95% CI 6.16, 10.62)) and the mean Humphris Oral Cancer Knowledge Scale scores (13.32 (95% CI 11.06, 15.57) vs 8.27 (95% CI 6.59, 9.94)) were higher in the campaign area. The campaign area sample was significantly more likely to be aware of the materials (odds ratio (OR)=6.03, 95% CI 3.00, 12.1). CONCLUSION: Superior awareness and oral cancer knowledge was identified in the community with access to the campaign materials. Further evaluation to identify long-term campaign impact is required.

Accessibility of chewing tobacco products in England.

BACKGROUND: The carcinogenicity of chewing tobacco is well established. It is predominantly used by the South Asian community in England. Little is known about the accessibility of the products available for use in England. METHODS: Wards with high proportions or numbers of residents from the South Asian community were identified using 2001 Census data. Within each ward product purchasers identified retail outlets and purchased chewing tobacco products from them. RESULTS: Chewing tobacco products were found in a broad variety of premises in all but one ward, and were easily accessible. Ninety-eight products were identified and purchased with a mean price of pound1.82. Of the ninety four pre-packaged products purchased only 15% (95% CI: 8%, 22%) complied with legal health warning requirements. CONCLUSION: The study indicates the need to improve compliance with legal controls and enforcement to protect the South Asian community from health risks associated with chewing tobacco products.

Systematic reviews of topical fluorides for dental caries: a review of reporting practice.

This paper aims to assess systematic reviews on the caries-preventive effect of topical fluorides, identifying key content and reporting quality issues to be considered by researchers planning a review in this area. Published systematic reviews and meta-analyses of any topical fluoride intervention for caries control were included. Relevant databases were searched (December 2009), along with reference lists of included publications. Thirty-eight reports were identified and assessed. A majority of these focused on the child/adolescent population, fluoride toothpastes, no treatment/placebo comparisons, and had caries increment as the main outcome. Complete reporting of eligibility criteria (PICOS) was uncommon, except in Cochrane reviews. Less than half reported searching multiple sources and only one third reported a search strategy. Duplicate study selection and data extraction was reported in 27 (71%) and 16 (42%) reviews, respectively; quality assessment of included studies was not reported in one third of the reviews. Meta-analysis was reported in 20 (52%) reviews, with six not reporting the methods of synthesis used, 17 formally assessing heterogeneity, and 12 reporting analyses for its exploration. This study shows that some content features have been covered more often than others in existing fluoride reviews, while some relevant features are yet to be addressed. Also, reporting of several methodological aspects are below an acceptable level, except for Cochrane reviews. Current reporting guidelines for systematic reviews of interventions (e.g. PRISMA) and sources of high-quality existing reviews (e.g. The Cochrane Library) should be closely followed to enhance the validity and relevance of future topical fluoride reviews.

Oral cancer screening in the Bangladeshi community of Tower Hamlets: a social model.

BACKGROUND: UK oral cancer incidence has risen by 22% in the last 10 years. Oral cancer is often detected at a late stage when treatment is debilitating and the chances of survival are poor. Certain black and minority ethnic groups are at elevated risk of oral cancer due to the prevalence of risk factor behaviours. We describe the background to, the development of and outcomes of an oral cancer screening activity appropriate to the needs of members of a disadvantaged community at high risk of oral cancer, carried out between 2006 and 2008 in Tower Hamlets, East London. METHODS: In all, 1320 people participated during 34 days of screening, divided into two phases (Phase I (2006/2007): n=485, Phase II (2008): n=835). Modifications to the delivery process were implemented for Phase II in an attempt to recruit more high-risk individuals and to improve screening specificity. RESULTS: In total, 75 people were urgently referred for further investigation (Phase I: n=20, Phase II: n= 55). Nine were diagnosed with dysplastic lesions (Phase I: n=3, Phase II: n=6) and a further eight showed potentially malignant disorders without dysplasia (Phase I: n=1, Phase II: n=7). Screening participants with low levels of completed education (OR: 6.94, 95% CI: 1.66, 28.98) and who chewed paan with tobacco (OR: 8.01, 95% CI: 3.54, 18.08) were more likely to be referred for further investigation. CONCLUSION: The project offers insights for the further development of oral cancer screening interventions for disadvantaged communities.

Neuropsychologic effects of continuous oxygen therapy in the aged.

This study investigated the effects of continuous therapy with oxygen on the neuropsychologic functioning of aged subjects professing problems with their memory. Nineteen men (mean age, 71 years) were evaluated on eight neuropsychologic measures during three different periods of time. Subjects were tested before any treatment, after a month of continuous therapy with oxygen, and after a period of sham treatment. The results indicated statistically significant improvement in the Wechsler Memory Quotient and, with one exception, improvement in all other measurements in favor of the treatment with oxygen. Differences between the results of this investigation and those of other studies are discussed, along with the factors possibly accounting for these differences.

Social deprivation, income inequality, social cohesion and dental caries in Brazilian school children.

This ecological study investigated the associations between social deprivation, income inequality and social cohesion and dental caries levels in school children of the Distrito Federal, Brazil. Three sources of data were used: (1) area-based data from a 1997 social survey carried out on 13,000 families, (2) 1995 census data collected for the Government of the Distrito Federal (GDF), and (3) dental caries data from a 1997 oral health survey on 7296 6-12-year-old school children. Results of simple linear regression showed that percent with less than eight years of education (P = 0.03) and percent who did not have a maid (P = 0.009), were negatively statistically significantly associated with the percent of children free of caries. None of the deprivation measures were statistically significantly associated with mean DMF-T scores (P > 0.05). GINI coefficient, an indicator of social inequalities, was negatively statistically significantly associated with both measures of dental caries experience, percent of caries free (P = 0.003) and mean DMF-T scores (P = 0.01). Per thousand number of homicides or attempted homicides, an indicator of social cohesion was of marginal statistical significance associated with caries experience. Results of multiple linear regression analyses showed that only the Gini coefficient remained statistically significantly associated with both dental clinical measures used, after adjusting for potential confounding. In conclusion, relative rather than absolute levels of income were stronger determinants of the onset of caries in this study.

Satisfaction with care of patients attending a dedicated dental clinic: comparisons between 1989 and 1994.

This investigation aimed to audit patient satisfaction with care at a dedicated dental clinic, using previously developed standards and criteria. A self-complete questionnaire was administered to a group of 161 patients assessing the dimensions of care availability, affective behaviour and technical competence. Comparisons with baseline showed a high but slightly decreased level of satisfaction with technical competence, a significantly higher level of satisfaction with the affective behaviour of the clinic staff but a continuing level of dissatisfaction with the availability of care. Respondents with AIDS reported higher levels of satisfaction for all 3 dimensions. Women were less satisfied with the availability of care. The results indicate the inter-related nature of the dimensions of technical competence and care availability. Satisfaction with care availability will only improve if initiatives beyond the clinic are introduced to increase the overall supply of dental services available to this population.

Factors that influence dental visiting amongst young adults 16--20 years old.

Interviews investigating factors influencing dental visiting were held with a nationally drawn (England + Wales) random sample of 690 16--20-year-olds. The results presented relate specifically to the last reported dental visit, the balance of self and professional dental care, knowledge and acceptability of charges for dental treatment, factors in choosing a dentist, feelings about visiting the dentist and whether information relating to treatment or prevention is either asked of or given by the dentist. The results were found to vary by age, sex, social class and region. The implications of these findings for the training of dentists and dental health education messages are discussed.

Access to dental care--experiences of men with HIV infection in the United Kingdom.

A piloted self-complete questionnaire enquiring about dental experiences was administered to a consecutive sample of men with asymptomatic HIV infection attending a dedicated clinic in London. Forty-seven men completed questionnaires. Despite a high level of dental attendance before diagnosis of HIV infection, 60% of the men had not visited a general dental practitioner since diagnosis. Nineteen men had visited a dentist since diagnosis; 15 had been refused or deterred by members of the dental team and 5 had attended without disclosing their HIV status. These data indicate that despite professional guidance to dentists, the perceptions of dentists held by people with HIV and the behaviours of dentists acts as barriers to care. Dedicated dental clinics act as an important safety-net for people with HIV infection.

Preventive dental health in adolescents: short and long term pupil response to trials of an integrated curriculum package.

A controlled evaluation of a 3-week teacher mediated dental health education curriculum package was undertaken in 35 English secondary schools in three Area Health Authorities. 4500 13-14-year-old adolescents were involved. The package emphasized self-care potential and combined a scientifically accurate message with educational and behavioural science concepts. Evaluation was at the levels of process and outcome using changes in oral hygiene recorded on a random sample (n = 1491) by two trained examiners; self-complete pre/posttest questionnaires, pupil worksheets and home experiment diaries. Behavioural, cognitive and affective outcomes are reported. Significant improvements in oral hygiene status were recorded at the conclusion of the programme along with large gains in knowledge and positive changes in attitude. Long term follow-up oral hygiene examinations in six schools (n = 145) conducted in conjunction with a reinforcement programme, indicated a maintenance of the initial improvements in five schools. Further significant improvements were measured after the reinforcement programme.

Self-reported gingivitis and bleeding gums among adolescents in Helsinki.

The purpose of this descriptive cross-sectional community based investigation was to analyze the relationship between professionally measured and perceived gingival health in a sample of 1217 adolescents (age 14.0 +/- 0.7 yr). The responses to two questionnaire items relating to self-reporting of "gingivitis" ("inflammation of gums" in Finnish) and "bleeding from gums" are reported along with Community Periodontal Index of Treatment Needs (CPITN), percentage of bleeding sites (BOP%) and modified Papillary Bleeding Index (PBI) scores. It was found that current or past "gingivitis" was less often reported than "bleeding from gums" by this sample and that responses to both items exhibited low levels of agreement with the clinical measures. The results suggest that the self-reporting of gingival health may be useful in monitoring the gingival health of populations but does not have sufficient validity for screening individuals for gingivitis as defined by dental professionals. Furthermore, it is suggested that the term "bleeding from gums" rather than "gingivitis" should be used during clinical or group oral health promotion.

The "spread of effect' of a school based dental health education project.

A study was undertaken to evaluate the impact of a school based dental health education programme ("Natural Nashers') upon the families of adolescents receiving the programme. Interviews with 73 randomly selected parents were conducted. One group (n = 35) had a child who had recently received the programme, the other (n = 38) had not. During the interview they were asked if they or other family members (apart from the programme recipient) had changed their dental behaviour or received any new dental information in the previous 2 months. Changes in behaviour were reported from 12 parents in the study group compared with seven in the control. Twenty two parents from the study group reported receiving new dental information in the family compared with four in the control group. The information and reported changes in behaviour related primarily to aspects of disclosing. In 80% of these cases of change or new information in the study group the source was an adolescent who had recently been taught "Natural Nashers'.

Lay perspectives on oral hygiene performance: their use in hypothesis development.

This paper examines issues related to oral hygiene performance. Results from interviews with 113 adults who had received oral hygiene instruction in eight general dental practices are presented with an emphasis on three issues--the respondents' tooth cleaning pattern (the location within other routines of tooth cleaning), the respondents' tooth cleaning structure (the range of items used in tooth cleaning) and the reported content of the oral hygiene instruction given. Respondents reported that the oral hygiene instruction concentrated upon issues of tooth cleaning structure and did not consider issues of tooth cleaning pattern. The two variables (structure and pattern) were cross-tabulated to create an hypothesis to explain individual variation in tooth cleaning performance. The implications of this hypothesis for understanding patient compliance and developing further quantitative investigations are described.

An investigation into the role of post-natal health clinics in oral health education.

This project investigated the oral health information that was given to parents by health visitors at post-natal clinics. This issue was examined by conducting an investigation in one health district in the United Kingdom and, within that, three socially diverse locations. A questionnaire to evaluate parental oral health knowledge and awareness, as well as the personal characteristics of each respondent was developed, tested and administered to 92 respondents. This questionnaire was analysed and compared with previous studies in the same field. Few parents reported receiving oral health information from health visitors. In general, levels of knowledge reported by this sample were better than those reported for the national sample used for the 1983 child dental health survey (Todd and Dodd, 1985). However, fewer of this sample reported receiving oral health education compared to the national sample respondents. A major gap in their knowledge related to fluoride levels in water and fluoride supplements. As found in other studies this sample was also confused about the role of diet in dental caries. Recommendations are made for further improvement in the delivery and reception of oral health education in the post-natal period.

Quality assurance practices in the community dental services within the North and South Thames Regions.

The aim of this study was to describe the progress of implementing Quality Assurance (QA) programmes within the Community Dental Services (CDS) in the North and South Thames Regions. Nearly 70 per cent of CDS managers responded to the survey questionnaire. The results indicate that although definite progress has been achieved in most services, further progress is being limited by a lack of co-operation between different departments and the minimal support and guidance being given to those responsible for the management and development of the QA programmes.

Burnout and issues of the work environment reported by general dental practitioners in the United Kingdom.

OBJECTIVE: To investigate causes of burnout among general dental practitioners. DESIGN: A cross-sectional investigation. SETTING: General dental practices in two areas of the UK and a group of continuing education sessions. SUBJECTS: 325 general dental practitioners, composed of two random samples recruited from two areas of the United Kingdom and an opportunistic sample, recruited from continuing education sessions. OUTCOME MEASURES: Levels of burnout, as measured by scores on one of the three burnout sub-scales--emotional exhaustion, depersonalisation and personal accomplishment. RESULTS: Respondents were more likely to report high levels of emotional exhaustion and low levels of personal accomplishment if they worked in practices with few other dentists. Those respondents reporting high levels of depersonalisation were more likely to provide a greater proportion of care through the National Health Service. CONCLUSIONS: Burnout in this sample of general dental practitioners was related to features of their work organisation structure rather than necessarily due to an involvement with patients or the respondents' personal characteristics. Levels of social support in the workplace, measured here by the number of dentists in a practice, appear to have a protective effect against some aspects of burnout.

How do routines of daily activities and flexibility of daily activities affect tooth-cleaning behavior?

OBJECTIVES: The aims of this study were: (1) to investigate the level of routines and flexibility of people's daily activity and to identify how tooth cleaning fits into these activities; and (2) to evaluate the impact of different levels of routines and flexibility in daily living on pattern (frequency of tooth cleaning), structure (range of items used in tooth cleaning), performance (relative effectiveness of tooth cleaning) and the outcome of performance (gingival bleeding on probing) in tooth cleaning. METHODS: A convenience sample of 471 Brazilians aged 24 to 44 years was selected from factories, offices, banks, shops, and hospitals. Behavioral, socioeconomic, and clinical data were collected through structured interviews. Dental plaque and gingival bleeding were assessed by clinical examination. Data were analyzed by means of logistic regression. RESULTS: A highly significant relationship was observed between routines of daily activities and tooth-cleaning pattern (OR = 2.3; 95% CI = 1.34, 3.92) after adjusting for age, sex, marital status, and socioeconomic status. No significant associations were observed between routines of daily activities and gingival bleeding. A significant association was observed between tooth-cleaning frequency (OR = 1.6; 95% CI = 1.07, 2.49), performance (OR = 2.7; 95% CI = 1.77, 4.14), outcome (OR = 2.3; 95% CI = 1.31, 3.18), and flexibility of daily activities. Those who had more flexibility of daily activities had lower gingival bleeding scores. CONCLUSION: People who have a less routinized and more flexible day have higher tooth-cleaning frequency than those who have a less flexible and more routinized day. In this study, those with a more flexible day also cleaned their teeth more effectively than those who had a less flexible day, and had reduced gingival bleeding.

Current perspectives on improving chairside dental health education for adults.

This paper reviews current knowledge about improving chairside dental health education for adults. It places this knowledge within a general context of change in clinical ideas about appropriate treatment and of evidence about the current practice of oral health education for adults. The acronym SPERMAID is proposed as a summary of the principles to be followed in the motivation of the adult patient.

Criteria of good dental practice generated by general dental practitioners and patients.

A survey was carried out asking patients to evaluate the criteria of good dental practice proposed by patients and dentists. A total of 344 patients from 4 different general dental practices in South East England evaluated 16 criteria of good dental practice. Eight criteria were generated by 30 general dental practitioners and the other eight by 30 patients. Questionnaires containing the 8 pairs of criteria randomly assigned by a computer were drawn up, with each pair containing one patient and one general dental practitioner criterion. Patients were asked to indicate their preference. The number of times each criterion was preferred was scored and ranked. The three highest ranked criteria were explanation of procedures, sterilisation/hygiene and dentist's skills (all criteria proposed from patients), whilst the three lowest ranked criteria were up-to-date equipment, pleasant decor and surroundings and good practice image (all criteria proposed from dentists). Overall the criteria proposed by patients as a group scored significantly more highly than those proposed by dentists as a group. There was variation in rankings relating to the sex, age, pattern of attendance and social class of the respondents.