Effects of educational interventions based on the theory of planned behavior on oral cancer-related knowledge and tobacco smoking in adults: a cluster randomized controlled trial.

BACKGROUND: The theory of planned behavior (TPB) is an effective model for facilitating behavioral change. The aim of the present study was to evaluate the impact of TPB-based educational interventions on oral cancer-related knowledge and tobacco smoking behavior in an Iranian adult population in 2022. METHODS: In this randomized controlled trial, a total of 400 healthy individuals were enrolled. The study was implemented in 20 urban health centers in the south of Tehran, Iran. The health centers were randomly allocated into two intervention groups. In group PowerPoint (PP), the participants received education through a 20-minute PowerPoint presentation complemented by a pamphlet. Group WhatsApp (WA) was educated via WhatsApp messages and images. Data was collected using a structured questionnaire at baseline, and at one- and three-month follow-ups. The outcomes were evaluated in terms of knowledge, tobacco smoking behavior, and the related model constructs i.e. intention, attitude, subjective norm, and perceived behavioral control. Generalized estimating equations (GEE) regression models were applied to assess the effect of interventions on repeated measurements of the outcomes. All analyses were conducted using STATA Software Version 17. RESULTS: Out of all the participants, 249 (62%) were women. The mean and standard deviation (SD) of age were 39.67 and 13.80 years. Overall, group PP had a significantly higher score of knowledge compared to group WA (ß = 0.43, p = 0.005). No significant differences were found between the groups with regard to tobacco smoking and the related TPB constructs, except for attitude with a higher score in group PP compared to group WA (ß = 0.50, p = 0.004). At the three-month follow-up, both interventions had significant effects on increasing knowledge (ß = 4.41), decreasing tobacco smoking (OR = 0.54), and increasing intention (ß = 1.11), attitude (ß = 1.22), subjective norm (ß = 1.37), and perceived behavioral control (ß = 1.08) (P < 0.001). CONCLUSIONS: Both interventions were effective in improving knowledge, tobacco smoking, and the TPB constructs after three months. Therefore, the application of both methods could be considered in the design and implementation of oral cancer prevention programs. TRIAL REGISTRATION: The trial protocol was registered in the Iranian Registry of Clinical Trials (IRCT) on 04/03/2022 (registration number: IRCT20220221054086N1).

Social cognitive predictors of regular dental visits and mouth self-examination behaviors among the elderly population: An application of the health action process approach model.

OBJECTIVE: The present study aimed to identify the social cognitive predictors of regular dental visits and mouth self-examination behaviors among the elderly population, based on the Health Action Process Approach (HAPA) model. BACKGROUND: Regular dental visits and mouth self-examination can prevent oral and dental problems among the elders. Little information is available regarding the social cognitive predictive factors of these two behaviors. MATERIALS AND METHODS: A cross-sectional study was conducted in 24 municipality centers in Tehran, Iran in 2021. The centers were selected randomly using a multi-stage cluster sampling method and 301 elderly attendants aged 60≥years participated in the study. Data collection was done using a researcher-made questionnaire including demographic characteristics and the HAPA model constructs for two target behaviors. Data were analyzed using the Smart-PLS version 3.3.9 via correlation and PLS-SEM analysis. RESULTS: The mean age of the participants was 65.3±5.33 years and 79.7% were female. The SEM analysis showed that Action Self-Efficacy [b (SD) = 0.595 (0.065), P< 0.001] and Risk Perception [b (SD) = 0.218 (0.070), P< 0.002] were predictors of Intention for mouth self-examination but only Action Self-Efficacy [b (SD) = 0.651 (0.043), P< 0.001] was predictor of Intention for regular dental visits. Recovery Self-Efficacy and Planning directly contributed to the prediction of Mouth Self-Examination. The relationship between Maintenance Self-Efficacy and both behaviors is mediated by Planning. Also, the mediating role of Planning between Intention and target behaviors was confirmed. CONCLUSION: Action self-efficacy predicted the intention for regular dental visits and mouth self-examination behaviors. The relationship between intention and both behaviors was mediated by Planning. Emphasis on improving Action Self-Efficacy and Intention formation will enhance the effectiveness of interventions aiming at promoting the oral health of the elderly population.

Social Story Based Toothbrushing Education Versus Video-Modeling Based Toothbrushing Training on Oral Hygiene Status Among Male Students Aged 7-15 Years Old with Autism Spectrum Disorders in Tehran, Iran: A Quasi-Randomized Controlled Trial.

Individuals with autism spectrum disorders (ASD) are at higher risks of developing chronic oral health conditions. This trial compared the efficacy of two tooth-brushing educational interventions on the oral hygiene status {Simplified Oral Hygiene Index (OHI-S)} among 7-15-year-old students with ASD in Tehran. Four schools were divided to intervention (video modeling) and comparison (social story) school groups. The OHI-S of 137 participants had been evaluated at baseline and 133 were analyzed finally after one month. Baseline characteristics were similar between both groups. OHI-S improvement was significantly higher in intervention group. We concluded that tooth-brushing educational intervention using video modeling based on modern technologies would improve oral hygiene status more than traditional social stories (standard education) in individuals with ASD. Trial registration number: IRCT20200208046413N1, Registration date: 2020-07-05.

Psychometric Properties of a New Questionnaire Assessing the Mothers' Knowledge and Perception about the Oral Health of Their School Children.

Objectives: The aim of the present study was to develop and evaluate the psychometric properties of an instrument in Persian to assess the mothers' knowledge, and perception about oral health of school children. Materials and Methods: A sequential exploratory mixed method design consisting of qualitative and quantitative phases was performed. We developed the questionnaire by inductive-deductive method, through a synthesis of literature review and a qualitative study with semi-structured interviews and focus group discussions. Face and content validity of the items were assessed by consulting a panel of 11 experts. In the quantitative phase, an exploratory factor analysis was performed using data from a cross-sectional study with a sample of 303 mothers. Reliability analysis with test-retest approach and Cronbach's alpha coefficient and intra-class correlation coefficient (ICC) was done. Results: Pre-final version of the scale consisted of 120 items extracted from the qualitative study and literature review. After content and face validity, 92 items were chosen with the greatest agreement between experts, with a content validity index (CVI) >0.8 and content validity ratio (CVR) of 0.59. The final questionnaire covered 62 items. The overall Cronbach's alpha was 0.94 and it ranged from 0.87 to 0.97 for the subscales. The ICC ranged from 0.91 to 0.98 (Cronbach's alpha ≥0.70). Conclusion: The present study introduced a valid and reliable questionnaire for assessment of the mothers' perception regarding school children's oral health. It can be used as a standardized measure for public health surveillance and evaluation of oral health promotion programs.

Oral Health Status and Related Factors in Children with Visual Impairment Aged 7-11 Years: A Cross-Sectional Study.

OBJECTIVES: We aimed to investigate oral health, oral hygiene, and associated factors in children with visual impairment aged 7-11 years. MATERIALS AND METHODS: This cross-sectional study was conducted on 47 children with visual impairment aged 7-11 years who were selected from all three schools available for visually impaired children in Tehran in December 2018. Questions regarding age, gender, status of visual impairment, level of education of the parents, self-reported dental and gingival health, oral health, and dietary habits were asked face-to-face using the World Health Organization oral health questionnaire for children. The decayed, missing, and filled teeth index for both primary (dmft) and permanent (DMFT) dentitions was determined by clinical examination. Simplified Oral Hygiene Index (OHI-S), and bleeding on probing (BOP) were also assessed. Linear and logistic regression tests were used for statistical analysis. RESULTS: Over 70% of the children were satisfied with their dental and gingival health. Daily brushing was reported by 70.2%. Over half of the children reported daily consumption of fruits and jam/honey. The mean dmft and DMFT scores were 2.85±3.21 and 0.81±1.15, respectively. The mean OHI-S was 2.09±0.58. Also, 57.4% and 34% of the children had unrestored caries in their primary and permanent teeth, respectively. BOP was seen in 78.7% of the children. A significant correlation was observed between toothache in the past 12 months and dmft score (P<0.003). Daily tooth brushing was inversely correlated with OHI-S index (P=0.02). CONCLUSION: The results highlight an urgent need for implementation of oral health programs for visually impaired children.

Oral health and dental caries experience among students aged 7-15 years old with autism spectrum disorders in Tehran, Iran.

BACKGROUND: Autism spectrum disorders (ASD) are a set of developmental, psychological, and neurological disorders that occur in early childhood. The most important characteristic of individuals with autism is difficulty in social interactions and communication. Researchers in the field of oral health have not paid enough attention to these individuals due to their specific behavioral characteristics. Therefore, due to the limitations of the studies in this field in Iran, increasing prevalence of autism, and importance of oral health in people with ASD, this study was conducted to evaluate the oral health status of primary school students with autism (7-15 years old) in autism schools in Tehran. METHODS: Students from seven governmental special primary schools in Tehran were selected for this study. Data about oral health behavior and the presence of each of the seven barriers of tooth brushing task was collected via questionnaires completed by parents. During the dental examination, the cooperation level according to the Frankle Index, oral hygiene status according to the Simplified Oral Hygiene Index, and caries experience (DMFT) of the students were recorded by a calibrated dentist. A psychologist assessed the level of ASD using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM5). Data analysis including descriptive and regression analysis was done using the SPSS software version 24. RESULTS: Two hundred and seventeen students aged 7-15 years participated in this study, of whom 65.4% brushed their teeth once or more every day, 85.7% had sugary snacks twice or less per day, 73.7% used fluoridated tooth paste, and 80% brushed their teeth with parents' help. The most common barrier to tooth brushing was difficulty in brushing (51.6%). The cooperation level was definitely positive in 46.1%. The mean Simplified Oral Hygiene Index (OHI-S) and caries experience (DMFT) scores were 1.92 ± 0.55 and 2.36 ± 2.38, respectively. CONCLUSION: The clinical indices of OHI-S and caries experience (DMFT) were used to evaluate the oral health status in the students with ASD in Tehran, Iran. A better oral hygiene status was related to higher brushing frequency and lower sweet snack consumption. The findings of the present study indicate that educational interventions regarding oral hygiene and healthy diet may improve oral self-care in individuals with ASD.

Perception of oral health and medical conditions as possible predictors of oral health status in visually impaired adolescents: a cross-sectional study.

BACKGROUND: We aimed to assess oral health and oral hygiene status among visually impaired adolescents and also to evaluate the factors related to their oral health. METHODS: This was a cross-sectional study among 130 visually impaired adolescents in Tehran, Iran, in December 2018. Of three schools for visually impaired children in Tehran, children in the sixth to the tenth grade (aged 12-17 years) were included after obtaining their parents' consent. WHO oral health questionnaire for children was filled out through face to face interviews. General characteristics were age, gender, status of visual impairment, place of residence, and parental education level. Oral health-related questions were perceived dental and gingival health, dental self-care, dental visits, medical conditions, and dietary habits. Oral examinations included Decayed, Missing, and Filled Teeth (DMFT) index, the Simplified Oral Hygiene Index (OHI­S), and Bleeding on Probing (BOP). Univariate and multiple logistic regression tests were applied using STATA. RESULTS: The mean age (SD) of the adolescents was 14.45 (1.61) years. The fully blind children were 33.8%, and those with low vision were 66.2%. Regarding the perception of dental and gingival health, nearly half of the adolescents were satisfied. The mean DMFT and decayed component (DT) were 2.43 ± 2.24 and 1.92 ± 2.12, respectively. The frequency of DMFT ≥ 3 was 45.4%. The mean OHI-S was 2.01 ± 0.70, and OHI-S > 1.8 was reported in 60% of children. The prevalence of BOP was 79.2%. DMFT was significantly associated with toothache (P = 0.003, OR = 3.70, 95% CI: 1.54-9.09), perceived dental health (P = 0.005, OR = 3.06, 95% CI: 1.40-6.67), and medical conditions (P = 0.03, OR = 3.13, 95% CI: 1.13-8.68). In addition, OHI-S was related to gender (P = 0.02, OR = 0.36, 95% CI: 0.15-0.83), perceived dental health (P = 0.006, OR = 2.87, 95% CI: 1.35-6.12) and medical conditions (P = 0.04, OR = 3.05, 95% CI: 1.04-8.97). BOP was associated with perceived gingival health (P = 0.02, OR = 2.94, 95% CI: 1.18-7.33). CONCLUSIONS: Medical conditions and perceived dental and gingival health are possible predictors for oral health status in these adolescents. Although these children could not visualize caries or gingival bleeding during the brushing time, they could perceive the status of their oral health correctly. Also, being involved in medical problems can make more ignorance of oral health.

Job Satisfaction among Dentists according to Workplace in Tehran.

Objectives: The purpose of the present study was to assess the level of job satisfaction among dentists in Tehran, according to background determinants, working environment elements, and type of workplace in 2018. Materials and Methods: In this cross-sectional study, 350 dentists, selected by convenience sampling, completed a validated Persian job satisfaction questionnaire in a dental congress (with about 1100 participants) in Tehran, and in 59 dental clinics. The questionnaire included 39 structured questions (in 12 domains) on job satisfaction, reporting the satisfaction level according to a 5-point Likert scale. The level of satisfaction was measured by summing the weighted scores of each domain. The mean job satisfaction score (out of 100) was reported according to demographic factors (age, gender, level of income, years of experience, marital status, and number of children), working environment elements (number of assistants, number of colleagues, type of workplace), and stress score (8 questions). Linear regression was applied for statistical analysis. Results: The mean score of job satisfaction was 70±10. The analysis showed that women, dentists with a low income, those working in the public sector, and those with higher stress scores had lower job satisfaction scores (P<0.05). The number of dental assistants, number of colleagues, age, work experience, marital status, number of children, and monthly number of patients had no significant correlation with job satisfaction (P>0.05). Conclusion: The level of job satisfaction was mainly related to individual determinants. Improving job satisfaction can foster the whole dental care system and working environment elements.

A music- and game-based oral health education for visually impaired school children; multilevel analysis of a cluster randomized controlled trial.

BACKGROUND: Visually impaired children encounter some challenges for their oral health. We aimed to compare the effectiveness of oral health education using Audio Tactile Performance (ATP) technique alone, ATP combined with oral health education for mothers, and ATP along with art package on the oral health status of visually impaired children. MATERIALS AND METHODS: This cluster, randomized trial, included visually impaired children from preschool to 10th grade (32 classes, n = 200), in Tehran, Iran, in 2018-2019. A questionnaire was filled out through face to face interviews at baseline regarding age, gender, status of visual impairment, and place of residence. The Simplified Oral Hygiene Index (OHI-S) and Bleeding on Probing (BOP) were examined afterward. Classes were randomly assigned to three groups through simple randomization: 1. Art group (ATP, game-based, and music-based education (11 classes, n = 66); 2. Mothers group (children received ATP and their mothers received education by telephone (10 classes, n = 73); and 3. Control group (children received ATP (11 classes, n = 61). Children received reinforcement after 1 and 2 weeks. Follow-up oral examinations were performed after 1 and 2 months by a blind calibrated examiner. Descriptive statistics were performed using Chi-Square, and ANOVA tests by SPSS (version 22). In analytic statistics, two-level mixed-effects models for BOP and OHI-S were fitted using the Statistical Analysis Software (SAS) version 9.4. Both models fitted with the grouping variable and time (baseline, 1, and 2 months after interventions) as the fixed effects. RESULTS: The mean age (SD) of the children was 12.29 (3.45) years (range: 6-17). Male children (67%) more than female children (33%) participated in the study. Also, 35.5% were blind, and 12% resided at the dormitory. The art and mothers groups had no statistically significant difference compared with the control group, in terms of OHI-S (P = 0.92, and 0.39, respectively) and BOP (OR = 0.64, and 0.66, respectively). The time effect was statistically significant in both BOP and OHI-S models (P < 0.0001). CONCLUSIONS: ATP technique is an effective method to improve the oral health status of visually impaired school children. Oral health promotion programs can be done using this method to tackle oral hygiene problems in visually impaired children. TRIAL REGISTRATION: (https://www.irct.ir/trial/34676: Nov 29th, 2018).

A Survey of Common Payment Methods and Their Determinants in Dental Clinics, in Tehran, 2018.

OBJECTIVE: It is believed that the payment method to dentists may affect their treatment decisions. Although payment systems may enhance job satisfaction, reduce the costs, and make better treatment decisions, there is little information about how to achieve these objectives. The aim of the present study was to survey the payment methods and the related factors in dental clinics of Tehran. MATERIALS AND METHODS: Using the latest list published by the Iranian Ministry of Health, we visited all dental clinics located in Tehran, and used a checklist to collect the data of the type of management, geographical location of the clinic in Tehran, payment method and its amount, history of payment method changes in the last decade, relationship between the amount of payment and the position of technical supervisor dentist, any difference in the amount of payment to male and female dentists and to young and experienced dentists. Then, the relationship between the amount of payment and the above-mentioned variables was investigated. RESULTS: The governmental sector tends to use fixed salary methods and the private sector usually uses the fee-for-service (FFS) method. Geographical location, type of management, date of establishment, and having the position of technical supervisor dentist had a significant relationship with the amount of payment. The dentist's gender and years of experience did not have any relationship with the amount of payment. CONCLUSION: According to the results of the present study, the method and amount of payment to dentists were related to the date of clinic establishment, having the position of technical supervisor dentist, and geographical location of the clinic. These factors could be considered as the main elements in balancing costs in clinics and improving job satisfaction among dentists.

Perception of Iranian Mothers About Oral Health of Their School-Children: A Qualitative Study.

OBJECTIVES: Oral health is an important aspect of general health and well-being for children. Understanding the viewpoint of mothers about children's oral health provides a basis for the development of interventions to improve oral care and disease prevention. The purpose of this study was to explore the perception of Iranian mothers regarding the oral health of their children. MATERIALS AND METHODS: This descriptive qualitative study was the first phase of an exploratory mixed method design and collected data from April to May 2015 in Tehran, Iran. The qualitative data were collected through seven focus group discussions and three semi-structured interviews. The participants were 58 Iranian women who had a first grader. Data were analyzed using conventional content analysis. RESULTS: The main themes identified from the data were: (I) the definition of oral health, (II) the importance of maintaining oral health and dental treatment, (III) the effect of nutrition on children's oral health, (IV) the role of oral health behaviors, (V) the causes of dental caries and malocclusion/crowding, (VI) the symptoms and causes of gum disease, (VII) the causes of halitosis. CONCLUSIONS: According to the mothers' perception, the main factors influencing children's oral health were: nutrition and oral health behaviors such as daily tooth brushing and flossing. The results of this study can be used to develop a model of oral health education and a prevention program for improving oral health among Iranian school-children.

Preventive Orientation of Iraqi Dentists in Baghdad in 2016.

OBJECTIVES: The aim of the present study was to assess the preventive orientation of Iraqi dentists in terms of their "knowledge" and "attitude" towards caries prevention and to explore their "preventive practice". MATERIALS AND METHODS: A cross-sectional study based on a self-administered questionnaire was conducted among 159 dentists who worked in Baghdad during the summer of 2016. The questionnaires obtained information on variables such as knowledge and attitude towards preventive dentistry, preventive practice and demographic variables and were distributed during the official working time. Logistic and multiple regressions served for statistical analyses. RESULTS: From all the respondents, 71% were females and the response rate was 94% (n=150). The mean age was 40.75±9.88 years (range 27-65 years). After checking for completeness, 90 questionnaires remained for data analysis. The most positive attitude towards preventive dental care was related to the question: "whether preventive dentistry is essential for the community" (n=75, 83%). The highest knowledge was reported in response to three questions: "frequency vs. amount of sugar consumption", "effect of sealant on caries prevention of newly erupted molars" and "effect of dental problems on general health" (n=83, 92.2%). The regression analysis showed a significant association between attendance in the continuing educational courses and preventive practice (P=0.03). CONCLUSIONS: To improve preventive dental orientation of Iraqi dentists, dental schools should put more emphasis on the topics about preventive dentistry. This will consequently improve their practice and oral health of the community.

Midwifery students training in oral care of pregnant patients: an interventional study.

OBJECTIVE: Midwives may play an important role in oral health promotion of pregnant women, whom they are in close contact with. Our aim was to evaluate an educational intervention on the oral health attitude and practices among the junior midwifery students of Tehran University of Medical Sciences in 2010. MATERIALS AND METHODS: The junior midwifery students were divided into intervention (n=29) and control (n=33) groups. The intervention group was first educated about general oral health, oral hygiene practices during pregnancy, and tooth brushing and flossing on models. Subsequently, the students performed role playing to ensure they understood the aforementioned lessons correctly. Before and three months after the training course the students filled out a validated self-administered questionnaire and a simplified plaque index was recorded. Statistical analysis was done by Mann-Whitney test and linear regression models. RESULTS: Before the intervention, the mean scores of attitude in general oral health for the intervention and control groups were 5.8 and 5.4, respectively, which improved to 8.9 and 5.4 after the intervention (P<0.001). The mean score of oral health attitude in pregnancy was 20.4 in the intervention group and increased to 30.9 (P<0.001). The intervention group demonstrated much better oral health practices in pregnancy and lower plaque index score after the intervention. CONCLUSION: The promising finding about attitude and practice improvement in midwifery students after participating in a short course on oral health promotion in pregnancy shows the necessity to enrich their training program by including this subject.

Delayed diagnosis of oral cancer in Iran: challenge for prevention.

PURPOSE: The aim of this study was to investigate the diagnostic delay and its determinants among oral cancer patients in Tehran, Iran. MATERIALS AND METHODS: This study was conducted between September 2004 and September 2006 in three university hospitals, and included 100 consecutive patients with primary oral squamous cell carcinoma (international classification of disease, ICD-10 sites C01 to C06). Data were obtained through questionnaire interviews and medical records of the patients were reviewed to obtain information on the date of diagnosis, primary tumour site and the stage of the tumour at the time of diagnosis. Statistical analysis was performed by t test, ANOVA and logistic regression. RESULTS: The mean diagnostic delay was 7.2 months (SD 7.5, range 1 to 36 and median 4). The most important determinants of longer diagnostic delay were being single (OR = 4.8; 95% CI = 1.5 to 14.8; P < 0.05) and being at advanced tumour stages (OR = 5.3; 95% CI = 1.8 to 15.6; P < 0.01). The mean patient and professional delays were 5.3 months (SD 6.1 and median 2) and 2.1 months (SD 2.1 and median 1), respectively. Patients at advanced tumour stages were more likely to have longer patient and professional delays than those at early stages (OR = 5.6; 95% CI = 1.8 to 17.3 and OR = 3.4; 95% CI = 1.2 to 9.4, respectively; P < 0.05). Living alone was also a determinant of longer patient and professional delays (OR = 7.1; 95% CI = 2.0 to 24.7, OR = 3.5; 95% CI = 1.2 to 10.3, respectively; P < 0.05). CONCLUSIONS: Developing preventive programmes that focus on the enhancement of public and professional awareness about oral cancer is essential to promote earlier diagnosis in Iran.

Survival after lip cancer diagnosis.

The purpose of this study was to analyze the 5-year survival rates of 82 patients with lip cancer attending 5 university hospitals during 1999-2003 in Tehran, Iran. We used information from patient records, telephone calls, and death register files of the Iran Ministry of Health to ascertain the patients' vital status. Associations between survival and the variables of sex, age, stage of the tumor at the time of diagnosis, treatment modality, and tumor histopathologic type were analyzed with Kaplan-Meier, log-rank, and Cox regression methods. Of all patients, 70 (85%) were men, with a median age of 62 years (mean, 58.6 years [SD, 15 years]; range, 27-85 years) at the time of diagnosis. The median follow-up time of the patients was 57 months (mean, 56.4 months [SD, 28 months]; range, 0-112 months). The 1- to 5-year overall survival rate was 91% to 62%. The tumor stage at the time of diagnosis and the treatment modality were associated with survival (P < 0.05) in both univariate and multivariable analyses. Patients who underwent surgery and had lower stage tumors at the time of diagnosis showed higher survival rates. No differences in patient survival were found regarding sex, age, and histopathologic type of tumors. These findings indicate that although lip tumors are curable, early detection, diagnosis, and treatment lead to even higher rates of survival. Importance of the early detection of lip cancer should be emphasized in all health care and cancer prevention campaigns directed to the public and professionals.

Survival after diagnosis of cancer of the oral cavity.

In this retrospective study we analysed the survival in 470 patients with oral cancer. Patients who attended five university hospitals in Tehran, Iran, during the period 1996-2002 were included. Data were obtained from a combination of sources including patients' records, telephone calls, and deaths registered by the Ministry of Health. Survival curves were generated using Kaplan-Maier curves. Univariate and multivariate analyses of the relations between survival and age, sex, site of primary tumour, stage, and histopathological type were made using the log-rank test and Cox's regression analysis. Sex and age were not associated with survival. Treatment and stage of tumour at the time of diagnosis were related to survival. The overall survival rates were higher in patients with stages I or II cancer than those in stages III (OR=2.8, 95% CI=1.8 to 4.4) or IV (OR=4.6, 95% CI=3.1 to 6.8) at the time of diagnosis. Patients treated with radiotherapy had lower survival than those who had been operated on and had radiotherapy or operation alone (OR=2.8, 95% CI=1.7 to 4.5). There was no difference in survival depending on the histological type of tumour. To achieve higher survival, early detection and diagnosis of oral cancers should be emphasised in oral health programmes to improve public awareness and preventive activities among dentists in Iran.

Malignant oral tumors in iran: ten-year analysis on patient and tumor characteristics of 1042 patients in Tehran.

This study analyzed characteristics of oral cancer patients from Tehran, Iran, and their tumors. Data came from the patient records of 30 major hospitals in Tehran. Patients (n = 1042), diagnosed with invasive oral cancer in 1993-2003, were classified by primary tumor site according to ICD-10 (C00-C10). Data were analyzed separately for lip, oral cavity and salivary gland tumors. Statistical evaluation included chi and t-test. Of all cases, 59% were male. Age for all cases ranged from 6-103 years, mean age was 58.8 years (SD 16; median 62); 89% were older than 40. Tumor site breakdown was 65% oral cavity, 21% major salivary glands and 14% lip. A clear gender difference (P < 0.001) appeared regarding the primary tumor sites: women dominated in oral cavity cancers and men in lip cancers. The most common cancer site was the tongue (32%), accounting for 50% of the oral cavity cancers. Histologically, 88% of all oral cavity and lip cancers were squamous cell carcinomas, 10% of those were in age /= age 65. At the time of diagnosis, 59% of oral cavity cancers and 29% of lip cancers were at stage III or IV (P < 0.001). The results emphasize an urgent need for a national program focusing on early detection of oral cancers, including educational information addressed to oral health professionals.