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.

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.

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.

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.

Demographic and socio-economic correlates of dental pain among adults in the United Kingdom, 1998.

OBJECTIVE: To report the demographic and socio-economic correlates for dental pain in UK adults, and characterise those with dental pain who did not access dental services and perceived treatment need. DESIGN: Secondary analysis of the 1998 UK Adult Dental Health Survey data. SETTING: Survey of random sample of UK households between September and December 1998. SUBJECTS AND METHODS: Face-to-face interviews with community-dwelling adults, aged 16 years and over. MAIN: outcome measures Self-reported dental pain in the past 12 months. Dental attendance and perceived treatment need of those reporting dental pain. RESULTS: Of the 4,942 valid responses, 46.1% were men, the proportion of subjects in each 10-year band age group up to 65 years ranged from 10 to 23%, and 42.6% were manual workers. Dental pain was reported by 28%. After controlling for gender and age, manual workers were more likely to report dental pain (OR = 1.21, 95% CI = 1.06-1.37), non-utilisation of dental services (OR = 1.43, 95% CI = 1.12-1.82), and perceived treatment need (OR = 1.28, 95% CI = 1.03-1.60). CONCLUSIONS: Inequality by social class, age and gender exists in the experience of dental pain, access to dental services and perceived treatment need in the UK adult population. Dental health services need to address the needs of this particular section of the population if the Government is to live up to its commitment to reducing oral health inequality and improving access.

Emotional intelligence and stress coping in dental undergraduates--a qualitative study.

OBJECTIVE: To explore how dental undergraduates with different levels of emotional intelligence (EI) cope with stress. DESIGN: Qualitative unstructured depth interviews. SETTING: A dental teaching hospital in the UK, 2002. SUBJECTS AND METHODS: Subjects selected from the undergraduate population of a 5-year dental degree course. A questionnaire survey was carried out to determine the EI scores of the subjects. In each year of study, subjects were divided into low and high EI groups at the median score. From each EI group in each year, one male and one female subject were recruited. DATA COLLECTION: Unstructured face-to-face interviews. DATA ANALYSIS: Transcribing, sifting, indexing and charting data according to key themes. RESULTS: 10 males and 10 females with low and high EI, representing all 5 years of study were interviewed. The experience of stress, expressed in emotional terms, ranged from anger and frustration to hatred. Four sets of coping strategies, adopted at varying degrees according to EI, were identified. High EI students were more likely to adopt reflection and appraisal, social and interpersonal, and organisation and time-management skills. Low EI students were more likely to engage in health-damaging behaviours. CONCLUSIONS: Future research needs to establish whether the enhancement of EI in dental students would lead to improved stress-coping, and better physical and psychological health.

The prevalence and causes of maxillofacial fractures in patients attending Accident and Emergency Departments in Recife-Brazil.

AIM: This study aimed to investigate the epidemiological characteristics of maxillofacial fractures among patients admitted to the Accident and Emergency Departments of three major hospitals in Recife, Brazil. MATERIAL AND METHODS: A prospective design. The data were collected from each hospital over 3 months. A timetable was developed which randomly allocated visits to the three hospitals, six times a week for 6 hours a day. Data on socio-demographic variables, presence of bone fractures and/or maxillofacial fractures, type of injuries, aetiological factors, and place of occurrence were recorded. RESULTS: The final sample size was 5,644 patients. The prevalence of any bone fractures was 32.1% and for maxillofacial fractures 4.1%. Multiple logistic regression analysis showed that maxillofacial fractures were related to age, sex and level of education but not to employment status. Violence was the main cause of maxillofacial fractures, and the most frequent place of occurrence was the street. CONCLUSIONS: Maxillofacial fractures represented 12.6% of all bone fractures, males and less educated subjects were more likely to be affected than their females and more educated counterparts, and violence was the most common cause.

The use of PBL to facilitate the development of professional attributes in second year dental students.

OBJECTIVES: To investigate dental students' perception as to whether PBL can facilitate the development of professional attributes. DESIGN: A cross-sectional survey of second year dental undergraduates in a UK dental school. METHOD: At the end of a PBL module, all students were asked to complete a fully structured questionnaire. Data were collected on socio-demographics, aspects of the PBL experience and the extent to which students perceived that PBL had facilitated the development of professional attributes. RESULTS: The response rate was 96%. The frequency distributions of the PBL experience and development of professional attributes were skewed to the positive. Non-white students, compared to white students, rated significantly more highly the extent to which they thought PBL had facilitated the development of professional attributes. Differences between male and female students, and mature and less mature students were not significant. Students who rated the PBL experience positively were significantly more likely to rate highly the extent to which they thought PBL had facilitated the development of professional attributes. CONCLUSIONS: The factors that affect the relationship between ethnicity and development of professional attributes need further research. To enhance the development of professional attributes, teachers of PBL need to ensure that students find the learning experience worthwhile and stimulating.

Tobacco cessation, oral pain, and psychological distress in Bangladeshi women.

This study reports the experience of oral pain and psychological distress following tobacco cessation in Bangladeshi women. A cross-sectional survey was carried out in which telephone interviews were conducted in the Sylheti language by two female Bangladeshi researchers using structured questionnaires. Study participants were 58 Bangladeshi women, aged 22-60 years, who had recently given up chewing paan-with-tobacco. The General Health Questionnaire (GHQ-12) was used to measure psychological distress. A questionnaire on pain description, location, duration, onset, and intensity also was administered. Logistic regression analysis was carried out to explore the relationships between psychological distress and age, chewing characteristics, and the oral pain experience. The response rate was 100%. Of the sample, 22% reported having pain for 2 days and 28% for at least 1 week, 65% reported that the pain started by itself, 69% reported the intensity as mild or discomforting, and 52% experienced psychological distress. Significant predictors for high psychological distress were number of daily paan (odds ratio, OR=1.13), current tooth problem (OR=4.60), pounding pain (OR=6.50), pain onset (OR=3.21), and pain intensity (OR=5.57). The prevalence of oral pain reported for Bangladeshi women following an attempt at chewing tobacco cessation is high. Characteristics of this outcome suggest the pain is of dental origin. These characteristics are correlated to psychological distress. The success of chewing tobacco cessation initiatives in the population may be influenced by oral pain and psychological distress. Further research is needed to explore the etiological factors associated with oral pain in this group of tobacco users.

Oral tobacco cessation with UK resident Bangladeshi women: a community pilot investigation.

Our objective was to establish the short-term outcomes for successful tobacco cessation of a programme offering UK resident Bangladeshi women chewing paan with tobacco nicotine replacement therapy (NRT) in addition to brief advice and encouragement alone. We used a short-term longitudinal, quasi-experimental study design, in the setting of two local authority housing estates in Tower Hamlets, London. Bangladeshi women volunteers were recruited following presentations to community groups. The volunteers were assigned, after matching for age, number of paan with tobacco chewed daily and medical screening, to receive one of two tobacco cessation interventions (NRT with brief encouragement and advice, and brief advice and encouragement alone). The main outcome measures were changes in tobacco use and nicotine dependence, assessed by questionnaire and intake measures, adverse effects, and withdrawal symptoms. In total, 130 volunteers were recruited. Their mean age was 42.5 years (SD = 11.3). Mean number of paan quid with tobacco chewed daily was 10.7 (SD = 9.3) and the average age of starting to add tobacco to paan was 24 years (SD = 12). Ninety-one percent completed the 4-week trial. We found that 19.5% had stopped tobacco use, of whom 22% had received NRT, and 17% brief advice and encouragement alone. The successful members of the NRT group made a significantly greater reduction in their salivary cotinine scores at final review compared to baseline. Oral pain was reported as a barrier to successful oral tobacco cessation by 62% of the volunteers at final review. We conclude that methods identified as helping tobacco smokers successfully stop smoking can be used with Bangladeshi women chewing paan with tobacco. More research is needed to investigate these short-term outcomes and to explore the particular barriers to successful cessation for this group such as oral pain.

Prevalence estimates and associated factors for dental pain: a review.

PURPOSE: To assess the methodological quality of epidemiological studies on dental pain and review the published literature for its prevalence, and association with age, gender and socio-economic status. MATERIALS AND METHODS: Medline and reference lists of relevant articles were searched for observational studies published in English from 1966 to 2001 carried out on humans aged 19 years and over. Articles for reading of the full text were selected by two reviewers independently. Selected articles were assessed independently by the two reviewers according to a set of 8 standardized criteria. Inter-rater agreement was measured using the kappa statistic. Disagreements were discussed and a final score for each study agreed. Data on prevalence estimates and their distribution by age, gender and socio-economic factors were extracted. RESULTS: 422 studies were identified, and 23 selected for review. Inter-rater agreement was high for all 8 criteria used (kappa > 0.6). Methodological quality was poor with the number of criteria fulfilled by each study ranging from 1 to 6, median score 3. The prevalence estimates for 5 case definitions identified were: 'toothache' 7-32%, 'pain in teeth with hot, cold or sweet things' 25-38%, 'pain and discomfort needing medication or treatment' 7-9%, 'pain or discomfort in the mouth, teeth or gums' 19-66%, and 'oral and facial pain'40-44%. Younger subjects and those from lower socio-economic groups were more likely to report pain. Gender was not associated with dental pain. CONCLUSION: Epidemiological data on dental pain are sparse and of poor quality. There is a need for well-designed surveys using randomly selected community samples and standardized measurement criteria to fill this knowledge gap.

Socio-economic aspects of areca nut use.

The socio-economic aspects of areca nut consumption have been overlooked. A narrative review was conducted to establish some of these features of areca nut consumption. Medline, Pubmed and the World Wide Web were searched using the terms: areca nut, betel nut, areca catechu and pan masala. Further analysis was conducted of datasets describing aspects of United Kingdom areca nut sales and consumption. South Asian economies at different stages of development have varying areca nut cultivation practices, employment opportunities and marketing strategies. Attempts at regulation of areca nut import and sales are described. Retail practice among the South Asian communities of the United Kingdom was found to reflect the diverse consumer practices current in their countries of origin. A study of areca nut consumption patterns and motivations among Bangladeshi women resident in East London identified differences between those chewing areca nut in paan with and without tobacco. Further research into the socio-economic aspects of areca nut consumption is needed which should be multidisciplinary in focus, of sound scientific quality and incorporating the opinions of consumers.

A dental practice placement scheme: benefits for practitioners and undergraduates.

OBJECTIVES: To report the feedback from general dental practitioners (GDPs) and dental undergraduates who participated in a general dental practice placement scheme. METHODS: Subjects All 61 students in a year made 2 to 3 full day visits, individually or in pairs, to 44 general dental practices allocated to them. Thirty four GDPs completed and returned the questionnaire, representing a response rate of 77%. Data collection Formal feedback from the students and GDPs were obtained through 6 structured seminar sessions and a postal questionnaire respectively. Analysis Sifting, indexing and charting the data according to key issues and themes. RESULTS: All 61 students attended the feedback sessions, 34 GDPs (response rate 77%) returned the questionnaire. The two most common themes that students reported having gained insight into were personal/professional development and practice management. The common positive aspects reported by the GDPs included exposure to the General Dental Service (GDS), motivation for undergraduate training and benefits for GDPs. These benefits included encouragement for the GDPs to reflect critically on their clinical practice, focus on their practice facilities and management, and stay in touch with developments in dental education. Through their visits and assignments, students gained skills in observation, interviewing, communication, relation-building and report writing. CONCLUSIONS: Placements of dental undergraduates in general dental practices enable students to gain insight into the GDS, develop key transferable skills and undergo professional socialisation. They are also beneficial and enjoyable for the GDPs who participated.

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.

Dental health and treatment needs among a sample of Bangladeshi medical users aged 40 years and over living in Tower Hamlets, UK.

AIM: To assess the dental health status and treatment needs of Bangladeshi medical care users aged 40 years and over and to explore the relationship of oral disease status, tobacco usage and paan (betel quid) chewing. DESIGN: Multi-centre cross-sectional study. SETTING: General medical practitioners' waiting areas in Tower Hamlets, UK. SUBJECTS: 185 Bangladeshi adults aged 40 years and over. INTERVENTION: A clinical examination and an interview schedule. MEASURES: Dental status, periodontal status, dental plaque, calculus and denture status. Tobacco smoking and paan chewing behaviour. RESULTS: The response rate was 74%. 85% of participants were dentate with an average number of 24 (SD +/- 5.4) standing teeth. The mean DMFT score was 5.38, with missing teeth (3.81) being the major component. The decayed component was 0.43 and the filled was 1.14. 46% of participants were assessed as being free from gingivitis. Significant relationships between chewing paan and aspects of dental and periodontal status were found. Impacts of oral health were reported by 45% of the respondents. The normative need for dental treatment was 96% with a perceived need of 48%. CONCLUSION: There was considerable normative dental need. Whilst caries experience was low, there were high levels of periodontal treatment needs. Paan chewing was related to aspects of dental and periodontal status.

Prevalence of oral lesions among a sample of Bangladeshi medical users aged 40 years and over living in Tower Hamlets, UK.

AIM: To collect data on the prevalence of oral mucosal lesions among Bangladeshi medical care users aged 40 years and over and to explore the relationship of oral disease status and tobacco smoking and paan (betel quid) chewing. DESIGN: Multi-centre cross-sectional study. SETTING: General medical practitioners' waiting areas in Tower Hamlets, UK. SUBJECTS: 185 Bangladeshi adults aged 40 years old and over. METHOD: An oral mucosal examination, based on WHO criteria and an interview. Information on tobacco smoking and paan chewing behaviour was collected during the interview. RESULTS: Out of 185 adults there was a response rate of 74%. Oral mucosal lesions were observed in 40% of participants. The most common lesion was found to be leukoplakia with a prevalence of 25%. Significant relationships were found between smoking and the presence of oral pathology and between paan chewing with tobacco and the presence of leukoplakia. CONCLUSION: In this study of older Bangladeshi medical care users there was a high prevalence of oral mucosal lesions. Sensitively tailored health promotion interventions, which aim to reduce tobacco use, should be developed for this population.

Perceived inability to cope and care-seeking in patients with toothache: a qualitative study.

AIMS: To explore the subjective experience of a sample of patients attending a dental teaching hospital emergency clinic with toothache. MATERIALS AND METHODS: Subjects 21 female and 14 male dental patients, of different ages, marital status, employment status and levels of education, presenting with toothache at a dental teaching hospital emergency clinic. Data collection Unstructured in-depth interviews, following a topic guide. Analysis Transcribing, sifting, indexing and charting data according to key issues and themes. FINDINGS: A dimension of toothache pain that emerged was the perceived inability to cope. Patients reported a dependency on a dentist or other person to alleviate their pain, suggesting connotations of helplessness, disempowerment and incapacitation. The perceived inability to cope was also expressed in terms of loss of control, despair and isolation. A number of care-seeking patterns for toothache was identified: repeated visits to the same dentist for emergency care, repeated visits to different dentists, attendance at the dental hospital emergency clinic and consulting non-dental health workers such as doctors and pharmacists. CONCLUSIONS: The perceived inability to cope and care-seeking patterns are two unexplored dimensions of the toothache pain experience. Both dimensions may be associated with pain intensity, the clinical conditions that manifest as toothache, quality of treatment provided and management of demand for emergency dental care. A conceptual framework is proposed for future research to investigate these relationships.

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.