Rural-urban disparities in patient satisfaction with oral health care: a provincial survey.

BACKGROUND: Identifying spatial variation in patient satisfaction is essential to improve the quality of care. Thus, the objective of this study was to investigate rural-urban disparities in patient satisfaction and to determine the factors that could influence satisfaction with oral health care. METHODS: Data from 1788 parents/caregivers of children who participated in the Quebec Ministry of Health clinical study were subject to secondary analysis. The Perneger model of patient satisfaction was used as the conceptual framework for the study. Satisfaction with oral health care was measured using the WHO-sponsored International Collaborative Study of Oral Health Outcomes (ICS-II). Explanatory variables included predisposing factors and enabling resources. Statistical analyses included descriptive statistics, as well as bivariate and linear regression models. RESULTS: Individuals with higher income, dental insurance coverage, having a family dentist, reporting ease in finding a dentist, and having access to a private dental clinic were more satisfied with oral health care (p < 0.001). There were statistically significant differences between rural and urban Quebec residents in their ratings of patient satisfaction on four items, including dental office location (p = 0.013), dental equipment (p = 0.016), cost of dental treatment (p < 0.001), and cleanliness of dental office (p = 0.004), with greater satisfaction for urban dwellers. The multiple linear regression model showed that major determinants of patient satisfaction were being born in Canada, income ≥ 40,000$ CAD, having a family dentist, and having visited the dentist in the last year for regular checkups. However, ethnicity, having difficulty finding a dentist, and being in need of dental treatment negatively influenced patient satisfaction with oral health care. CONCLUSIONS: These findings suggest that Quebec rural-urban disparity exists in patient satisfaction with care and that determinants of health influence this outcome. Intensive and powerful knowledge dissemination activities are needed to mobilize policymakers in implementing public health strategies to reduce this disparity.

Improving effects of Echium amoenum aqueous extract on rat model of Alzheimer's disease.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder greatly accompanied by oxidative stress and acetylcholine reduction in synaptic cleft that leads to dementia. Previously approved there is correlation between nucleus basalis of Meynert (NBM) degeneration and loss of memory, learning ability and thought. The aim of this study was to investigate improving effects of Echium amoenum aqueous extract on memory deficient, pathophysiological and oxidative damages imposed by NBM lesion in rats as documented AD model. Results showed NBM destruction causes hash oxidative stress that possibly leads to neurodegeneration in hippocampus tissue. Orally administration of plant extract significantly reduced oxidative stress by reactive molecules scavenging that resulted to decrease lipid peroxidation also. Plant extract treatment inhibited acetylcholine esterase enzyme (more than 5 folds) in hippocampus tissue related to NBM lesioned rats. Histological studies approved NBM lesion causes harsh neurodegeneration in hippocampus tissue possibly by acetylcholine reduction that was compensated by plant extract protective effects. Interestingly improving effects of plant in molecular level causes improved spatial learning ability in Morris water maze test. By considering pathophysiological and molecular similarities between AD and NBM lesion model, E. amoenum could be used as a therapeutic adjuvant in patients suffering from Alzheimer or similar cognitive disorders.

Antioxidant effects of alfalfa can improve iron oxide nanoparticle damage: Invivo and invitro studies.

Medicago sativa Linn. or alfalfa (Leguminosae) has been used traditionally as an effective cure for CNS, heart and metabolic disorders and digestive aids. Alfalfa is a resistant plant against stress due to small antioxidant molecules and enzymes. Our previous work demonstrated that 100 µg/ml of 50 nm size Fe2O3-NP causes harsh oxidative stress in HepG2 cells and 100 mg/kg of same nanoparticle causes extreme damage in rat's liver. Therefore it can be used as a useful model for invivo and invitro studies of oxidative stress. This study assessed the effects of two concentration of alfalfa on the mentioned invivo and invitro damage. Our results showed alfalfa reduced reactive oxygen species (ROS) production and enhanced reduced glutathione (GSH) that cause reduction of DNA fragmentation and prevent apoptosis pathway so improve viability of the cells. Results also showed alfalfa decreased hepatic enzymes penetrating and lipid peroxidation in rat's liver. Note that Fe2O3-NP potentially has widespread biological application but its usage is limited due to bio incompatibility. A suitable antioxidant compound that reduce nanoparticle side effects can be used as an effective adjuvant with iron oxide nanoparticle (and may be other nanomaterials) in biological applications.

Association of periodontal pathogenesis and cardiovascular diseases: a literature review.

PURPOSE: To present a short review of recent literature available on the association of periodontal and cardiovascular diseases (CVD) and the role of peridontal disease as a risk factor to exacerbate CVD. MATERIALS AND METHODS: A thorough search of articles was carried out on the databases PUBMED and MEDLINE on the association of periodontal and cardiovascular diseases (CVD). The selected literature included review articles, observational and case-control studies as well as randomised control trials. While selecting articles, priority was placed on papers published within the last 12 years. A brief description of periodontal diseases, atherosclerosis, underlying pathophysiology and oral bacteria has been included. RESULTS AND CONCLUSION: There is growing evidence of the association of periodontal diseases and CVD, as reviewed by the epidemiological studies. The in vitro studies also highlight a potential link between oral bacteria and atherosclerosis. Thus, there is urgent need for proper case controls and efficient interventional trials to analyse how such interventions can produce a positive outcome on cardiovascular diseases. Some recent interventional trials have shown that periodontal treatment can decrease markers of systemic inflammation. The relationship between periodontal diseases and CVD deserves further research because of its consequences for public health.

Diagnosis and prescribing pattern of antibiotics and painkillers among dentists.

PURPOSE: To examine the pattern of antibiotic and painkiller prescriptions per diagnosis by dentists. MATERIALS AND METHODS: A cross-sectional study was conducted in Karachi, Pakistan. Dentists in the outpatient departments of the Dr. Isharat-ul-Ebad Khan Institute of Oral Health Sciences (DIKIOHS) filled out a form for each patient visiting during a two-week period. The form included: personal history of the patient, i.e. name, age, sex and education, patient's complaint(s), medical history, dental history, full examination of the teeth and oral cavity, treatment need as far as different specialties are concerned, investigations, provisional diagnosis and treatment given. The WHO ATC system for drug classification was used. The number of prescriptions and defined daily doses (DDD) were recorded. RESULTS: A total of 709 patient forms (355 for male patients and 354 for female patients) were collected and included in the analysis. Of these, 123 (17%) included antibiotics and 455 (64%) painkillers. Caries/pulpitis was the most common diagnosis (n = 222; 31% of cases), of which 48 (21%) were prescribed antibiotics. Amoxicillin and metronidazole were the most common antibiotics prescribed for this diagnosis (n = 25); for caries/pulpitis diagnosis, 44 DDD/100 patients were prescribed. This was also the diagnosis for which painkiller prescription was most common (n = 191; 86%), with 102 DDD/100 patients. CONCLUSION: Our study shows the prescription pattern of antibiotics and painkillers by dentists in Pakistan for the first time. There is a clear need to emphasise correct diagnostic methods and develop contextualised prescription guidelines and educational initiatives, so that the optimum effect of antibiotics and painkillers will be achieved without compromising patients' health.

Chlamydia trachomatis related knowledge and practices in medical practioners--a survey.

INTRODUCTION: Chlamydia trachomatis is a frequently encountered condition by general physicians, urologists and infectious diseases specialists. It can affect both genders and causes significant morbidity if not treated properly and promptly. In addition, it can cause ophthalmia neonatorum, which manifests as neonatal conjunctivitis in the newborns. METHODOLOGY: The data was collected from fourteen tertiary care hospitals in two provinces of Pakistan during the time period of four months (September-December 2013). Inclusion criteria included all medical practitioners working at those hospitals and there were no limitations of age and gender to participate. The participants were approached through email which included a self administered questionnaire. Written consent was obtained from the participants and the study was approved by the ethical committee of all selected hospital. RESULTS: Overall 130 participants participated with a response rate of 65%. Females were 52.3% and males were 47.7%. In the study 17.7% of male and 29.4% of female participants proclaimed that they referred a patient to an infectious disease specialist in case the diagnosis of Chlamydia was dubious. 72.5% of the male and 55.8% of the female medical practitioners indicated that they yield detailed sexual history from the patients with Chlamydia. Regarding inquiring about the drugs history from the patient at risk of STDs, 22.6% male and 35.3% of female participants informed that they took a detailed drug history. Only 1.5% of the female medical practitioners notified Chlamydia to the partner of diseased patient themselves (provider referral). 24% male and 17.6% female participants had an understanding regarding the definite test of diagnosis for sexually transmitted Chlamydia. CONCLUSION: More sexual health skills development is required in medical practitioners working in Pakistan. The major deficient areas are sexual and drug history taking, management of sexually transmitted diseases and partner notification.

Effect of diabetes on periodontal status of a population with poor oral health.

OBJECTIVE: Diabetes is a global health problem and its prevalence is increasing worldwide. The objective of the study was to investigate the effect of diabetes on the periodontal status of a Pakistani population with poor oral hygiene. MATERIAL AND METHODS: Eighty-eight individuals with diabetes and 80 non-diabetic individuals were recruited from a disadvantaged district in Karachi, Pakistan. The group with diabetes comprised 50 males and 38 females, and the non-diabetic group 43 males and 37 females. All underwent clinical and radiographic examination. RESULTS: The average numbers of teeth in the diabetes and non-diabetes groups were 24 and 26, respectively. The odds ratio (OR) for missing or fewer teeth was 2.3 times higher for diabetics than for non-diabetics (CI 1.32-4.14; p<0.001). Diabetic patients had more sites with plaque than did non-diabetics (OR 1.96, CI 0.99-3.88; p<0.056). Moderate to severe periodontitis was significantly more prevalent among diabetic patients (p<0.01). CONCLUSION: In this disadvantaged population with poor oral hygiene, diabetes has had a strongly negative influence on oral health: diabetic patients have fewer teeth, more plaque, and a higher prevalence of moderate to severe periodontal disease than non-diabetics.

University-based initiatives towards better access to oral health care for rural and remote populations: A scoping review.

This scoping review maps a wide array of literature to identify academic programs that have been developed to enhance oral health care for rural and remote populations and to provide an overview of their outcomes. Arksey and O'Malley's 5-stage scoping review framework has steered this review. We conducted a literature search with defined eligibility criteria through electronic databases, websites of academic records, professional and rural oral health care organizations as well as grey literature spanning the time interval from the late 1960s to May 2017. The charted data was classified, analyzed and reported using a thematic approach. A total of 72 citations (67 publications and seven websites) were selected for the final review. The review identified 62 universities with program initiatives towards improving access to oral health care in rural and remote communities. These initiatives were classified into three categories: training and education of dental and allied health students and professionals, education and training of rural and remote community members and oral health care services. The programs were successful in terms of dental students' positive perception about rural practice and their enhanced competencies, students' increased adoption of rural practices, non-dental health care providers' improved oral health knowledge and self-efficacy, rural oral health and oral health services' improvement, as well as cost-effectiveness compared to other strategies. The results of our review suggest that these innovative programs were effective in improving access to oral health care in rural and remote regions and may serve as models for other academic institutions that have not yet implemented such programs.

Primed PMNs in healthy mouse and human circulation are first responders during acute inflammation.

Polymorphonuclear neutrophils (PMNs) are the most abundant circulating leukocytes, and the first cells recruited to sites of tissue inflammation. Using a fixation method to preserve native CD marker expression prior to immunophenotyping, we identified a distinct population of "primed for recruitment" PMNs in healthy mouse and human blood that has high expression of adhesion and activation markers compared with the bulk resting-state PMNs. In response to acute tissue inflammation, primed PMNs (pPMNs) were rapidly depleted from the circulation and recruited to the tissue. One hour after acute peritoneal insult, pPMNs became the dominant PMN population in bone marrow (BM) and blood, returning to baseline levels with resolution of inflammation. PMN priming was induced by the granulopoietic factors granulocyte-macrophage-colony-stimulating factor (GM-CSF) and granulocyte-colony-stimulating factor (G-CSF). High levels of pPMNs were observed in neutropenic mice and in pediatric neutropenic patients who were resistant to infection, highlighting an important role of this population in innate immune function.

Influence of betel nut chewing, dental care habits and attitudes on perceived oral health among adult Pakistanis.

PURPOSE: To survey an adult population in a deprived district of Karachi, with reference to factors influencing perceived oral health. MATERIALS AND METHODS: Of 1000 questionnaires distributed to households, 994 were returned. The respondents were aged between 30 and 50 years old. Women comprised 49% of the sample. RESULTS: Pan and betel nut chewing had a strong influence on the perceived oral health of the respondents. Pan chewers, 32% of the respondents, had a greater risk of oral problems, odds ratio 3.63. In contrast to other oral problems, dental caries was significantly less frequent among pan chewers (odds ratio 0.63). Betel nut chewing (28%) was less deleterious to oral health: the only significant effects were a higher risk for dental caries, odds ratio 4.51, and more gingival bleeding. While most of the respondents used a toothbrush for oral hygiene, a substantial proportion (27%) used their fingers. The oral hygiene method had no influence on the perceived oral health, nor did consumption of sweets and tea with sugar. Over 80% of the participants seldom or never visited a dentist. Cleaning frequency was significantly associated with oral health: those who cleaned their teeth at least daily had fewer oral problems. Almost all participants considered that eating sweets, smoking, and chewing pan and betel nuts endangered oral health. CONCLUSIONS: In this population, typical of deprived urban areas of Pakistan, betel nut habits and frequency of oral hygiene have a strong influence on perceived oral health, while cleaning method and sugar intake do not.

Physiological and Biochemical Effects of Echium Amoenum Extract on Mn2+-Imposed Parkinson Like Disorder in Rats.

Purpose: Manganism is a cognitive disorder take places in peoples are exposed to environmental manganese pollution. Overexposure to manganese ion (Mn2+) mainly influences central nervous system and causes symptoms that increase possibility of hippocampal damages. Methods: In this study rats were administrated by two different doses of MnCl2 and behavioral and physiological consequences were evaluated. We also investigated effects of E. Amoenum on Mn2+-imposed toxicity by behavioral, biochemical, immunoblotting and histological studies on hippocampus tissue. Results: Results showed metal overexposure increases oxidative stress mainly by lipid peroxidation and reactive oxygen species overproduction. Histological studies and caspase 3 analyses by immunoblotting revealed Mn2+ induced apoptosis from mitochondrial-dependent pathway in the presence of low metal dose. This study provides evidence that oral administration of E. amoenum extract inhibited manganese neurotoxicity by oxidative stress attenuation and apoptosis reduction that lead to improved depression like behavior. Plant extract also increased catecholamine content in Mn2+ treated hippocampus. Conclusion: As molecular and pathophysiological effects of E. amoenum, it could be considered as a pre-treatment for Parkinson and Parkinson like disorders in high-risk people.

Perception of oral health among adults in Karachi.

PURPOSE: To survey an adult population in a deprived district of Karachi, with special reference to perceived oral health. MATERIALS AND METHODS: One thousand questionnaires, covering topics such as socioeconomic status, general health and oral health were distributed to the participants' homes by dental auxiliaries, and 994 were returned. The respondents were adults aged between 30 and 50 years. Women comprised 49% of the sample. RESULTS: Over half the participants (54%) perceived that they had oral problems: esthetic issues predominated (33%), but pain (17%), cavities (15%) and difficulty chewing (8%) were also reported. Most participants (94%) had dentitions of > or = 20 teeth. There was a weak but significant negative correlation between age and number of teeth (r2=0.03, p<0.001). Age and female gender were significantly associated with pain, bleeding gums and periodontitis. Pain was a more frequent complaint among poorly educated subjects than among the better educated. Diabetics comprised 17% of respondents and reported higher frequencies of dental problems, bleeding gums and calculus and fewer teeth. However, after compensation for age, gender, smoking, education and income, no significant associations were disclosed. Smoking was reported by 30% of all subjects and was significantly associated with pain, bleeding gums and periodontitis. CONCLUSION: The survey disclosed that over half the subjects in this sample of underprivileged Pakistani adults suffered from poor oral health, including pain.

In vitro toxicity of iron oxide nanoparticle: oxidative damages on Hep G2 cells.

During the past years many studies have been done highlighting the great need for a more thorough understanding of cell-iron oxide nanoparticle interactions. To improve our knowledge in this field, there is a great need for standardized protocols that would allow to comparing the cytotoxic potential of any Fe2O3-NP type with previously studied particles. Several approaches are reported that several parameters which are of great importance for Fe2O3 nanoparticle induced toxicity. Nanoparticles because of their very small size can pass through the cell membrane and can make oxidative damage in all parts of the cells such as mitochondria, membrane, DNA due to high surface area. This study focuses on acute cytotoxicity of reactive oxygen species and DNA damaging effects of mentioned nanoparticles. Results showed increase of the oxidative damage leads cells to the apoptosis, therefore reduced cell viability. It is interesting that all of the results are concentration and time dependent.

The Effects of Caffeine Supplements on Exercise-Induced Oxidative Damages.

BACKGROUND: There is an interaction between oxidative equilibrium and anti-oxidants in oxidative stress. Therefore, oxidative stress has an effect on intercellular oxidation and causes atrophy and is an underlying factor in many diseases. OBJECTIVES: The aim of this study was to investigate the effect of running downhill and the short-term effect of caffeine supplementation on oxidative stress in non-athletic men. PATIENTS AND METHODS: Twenty men, aged 25 - 28 years, from Tabriz, Iran were been selected and divided in two homogeneous groups of 10 men: the supplementation group and the placebo group. In the next stage, groups received caffeine supplementation (caffeine capsules at a dose of 5 mg/kg of body weight daily for 14 days) or placebo (5 mg/kg of dextrose during supplementation) and ran downhill (30 minutes of treadmill running with a slope of -10 degrees with 65% maximal oxygen consumption); blood sampling was also performed. RESULTS: Anti-oxidant capacity by the ferric reducing ability of plasma (FRAP) techniques and serum malondialdehyde (MDA) were measured by the thiobarbituric acid (TBA) method, while the total number of thiol molecules (TTM) with Hu and DNA damage was evaluated using ELISA. CONCLUSIONS: The results of this study indicated that running downhill caused significant changes in all measured parameters, but the short-term caffeine supplementation did not have a significant effect on the indices of oxidative stress or DNA damage measured.

Host modulation therapeutics in periodontics: role as an adjunctive periodontal therapy.

Host Modulation Therapy (HMT) is a treatment concept that reduces tissue destruction and stabilizes or even regenerates inflammatory tissue by modifying host response factors. It has been used for treating osteoporosis and arthritis for several decades. However, its use in dentistry has only been recently reported. The objective of this article is to present a review of the various literatures available on HMT and also its role as adjunct therapy in periodontics. For identifying studies for this review, a PUBMED search was carried out in 2013 for all articles published till December 2012. The search was restricted to English language publications only. Longitudinal prospective and retrospective studies were included in the search. The key words used were: Host Modulation Therapy; Sub antimicrobial dose doxycycline and Non-Surgical Periodontal Therapy. The main outcomes sought were host modulation therapeutics in periodontics. Exclusion criteria included cross sectional studies, short case series as well as studies with short follow-up periods. There is a paucity of literature on HMT in periodontics although the only drug approved by United States Food and Drug Administration (FDA) is a subantimicrobial dose of doxycycline (SDD) with highly predictable results as a host modulating agent in periodontal diseases and also an effective adjunctive therapy in various diseases of periodontium. However, more randomized controlled trials are needed to obtain clinical guidelines on the usage of other host modulating agents as adjunct as well as definite therapy for periodontal diseases. SDD is an effective adjunct therapy when used in dosage of 20mg twice daily for minimum 3 months duration in various periodontal diseases with predictable clinical outcomes. It is also recommended that future clinical research on anti cytokine drugs, chemically modified tetracycline and other HMT agents should be conducted so that new drugs are available with highly predictable results.

Knowledge and reported practice of antibiotic prescription by dentists for common oral problems.

OBJECTIVE: To assess the knowledge and reported practice in relation to antibiotic prescribing regarding common oral problems by dentists in Karachi, Pakistan. STUDY DESIGN: Cross-sectional survey. PLACE AND DURATION OF STUDY: Three Dental Colleges of Karachi, from July to December 2010. METHODOLOGY: The cross-sectional study was conducted in Karachi, Pakistan in the Outpatient Departments (OPD) of three dental colleges. Inclusion criteria were full time employed dentists working in their respective OPDs (n = 100). The dentists were asked to fill a questionnaire. The questionnaire included (i) general information, (ii) perception and knowledge of antibiotic resistance, (iii) reported management of oral problems, (iv) perceptions about oral infections and (v) perceptions of how people perceive oral problems. To assess dentists´ ability to relate knowledge to practice regarding the management of the most common oral problems, written simulated case scenarios with related questions were also included. Scores were given for each correct answer. RESULTS: The response rate was 85%. Of the total respondents, 65 (76%) were under the age of 30 years, 53 (62%) were males and 32 (38%) females. Out of 85 respondents 53% (n = 45) reported prescribing of antibiotics 4-5 times a week, 87% (n = 74) prescribe antibiotics based upon symptoms and 64% (n = 54) prescribed antibiotics in abscess condition. The total score for all four scenarios showed that nearly two thirds (61%) of all respondents scored sub-optimally. CONCLUSION: A substantial number of dentists had suboptimal knowledge regarding antibiotic use. This might lead to the provision of suboptimal care of patients with dental infections. Therefore, continuing education, training and supervision are recommended to improve the quality of dental management.

Efficacy of miswak on oral pathogens.

The oral cavity harbors a diverse and abundant number of complex oral pathogens causing different oral diseases. The development of dental caries and periodontal diseases has been found to be closely associated with various gram positive and gram negative microrganisms. Miswak, a natural toothbrush, has been documented as a potent antibacterial aid and its use is encouraged in different countries because of its good taste, texture, availability, cost and beneficial effect on teeth and supporting tissues. Different researches have been carried out to evaluate the antimicrobial effects of Miswak. This review encompasses the efficacy of Miswak on suppression of oral pathogens with respect to conducted on fungi as well as cariogenic, periodontal and endodontic bacteria.

Effect of glycemic conrol on periodontal status.

OBJECTIVE: To assess the association between glycemic control and the periodontal status of an urban population with poor oral hygiene. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Memon Dental Care Centre and Memon Diabetic and Diagnostic Centre, Karachi, from July to December 2010. METHODOLOGY: One hundred and forty-one individuals with controlled diabetes and 143 with uncontrolled diabetes were recruited from the dental clinic. All underwent clinical examination and grades on plaque index, gingival index, periodontal index and calculus index were recorded and compared. RESULTS: The group with uncontrolled diabetes included 56 males (38.9%) and 88 females (61.1%), and the controlled diabetic group included 49 males (34.8%) and 92 females (65.2%). Periodontal index, gingival index and plaque index showed significant differences in both the groups (p-value < 0.016, < 0.001, < 0.002, respectively) while the difference of calculus was not significant i.e. 0.056. The mean number of teeth present in both the groups was 22. Most of the subjects cleaned their teeth once daily with the help of tooth brush, while the patients brushing twice daily were 16%. CONCLUSION: Uncontrolled diabetes had significantly severe impact on periodontal status in the studied groups with poor oral hygiene; diabetic patients have more number of missing teeth, and more plaque.