Showing papers in "British Dental Journal in 2001"

Tooth discolouration and staining: a review of the literature.

Abstract: Objective To carry out an extensive review of the literature on tooth staining with particular regard to some of the more recent literature on the mechanisms of tooth staining involving mouthrinses. Design Comprehensive review of the literature over four decades. Conclusions A knowledge of the aetiology of tooth staining is of importance to dental surgeons in order to enable a correct diagnosis to be made when examining a discoloured dentition and allows the dental practitioner to explain to the patient the exact nature of the condition. In some instances, the mechanism of staining may have an effect on the outcome of treatment and influence the treatment options the dentist will be able to offer to patients.

A look at forensic dentistry – Part 1: The role of teeth in the determination of human identity

Abstract: Forensic dentistry can be defined in many ways. One of the more elegant definitions is simply that forensic dentistry represents the overlap between the dental and the legal professions. This two-part series presents the field of forensic dentistry by outlining two of the major aspects of the profession: human identification and bite marks. This first paper examines the use of the human dentition and surrounding structures to enable the identification of found human remains. Conventional and novel techniques are presented.

view from the chair: I go to a friend

Abstract: We all know that doctors make the worst patients because they always laughingly tell us so. But how do we rate at taking our own medicine?

Dental erosion in a group of British 14-year-old, school children. Part I: Prevalence and influence of differing socioeconomic backgrounds.

Abstract: Objectives To establish the prevalence of erosion in a cluster random sample of 14- year-olds in Birmingham UK. To determine whether socioeconomic group influences the prevalence of erosion. Methods The study group consisted of a cluster random sample of 14-year-old school children in Birmingham UK: 418 children were examined from 12 different schools; 209 were male and 209 female. The level of tooth wear was recorded using a modification of the (TWI) index of Smith and Knight (1984). The ACORN classification was used to assess the socioeconomic status of all children. Results Results showed that 48% of the children had low erosion, 51% had moderate erosion and only 1% had severe erosion. There were statistically significant differences between males and females; more males had buccal/ labial and lingual / palatal tooth surface erosion than females (Chi-square analysis P < 0.001). There was also significantly more erosion observed in teenagers in the lowest socioeconomic categories. Conclusion It was concluded that moderate levels of dental erosion are common in 14-year-old school children and this may lead to increasing clinical problems. There was significantly more erosion in children from low socioeconomic groups. Possible aetiological factors need to be investigated further.

Occlusal caries detection in primary teeth: a comparison of DIAGNOdent with conventional methods

Abstract: Objective To compare the accuracy and repeatability of three diagnostic systems (DIAGNOdent, visual and radiographic) for occlusal caries diagnosis in primary molars. Design Two examiner, in vitro, blinded study. Histological gold standard. Materials and methods 58 occlusal surfaces of primary molars examined in turn by two examiners using each of three diagnostic systems (DIAGNOdent, visual and radiographic). These results were compared with a histological gold standard. Sensitivity and specificity were calculated for each diagnostic system at a range of thresholds. Inter- and intra- examiner repeatability were calculated for each diagnostic system using the kappa statistic. Main outcome measures Sensitivity, specificity, inter and intra examiner repeatability for each diagnostic system. Results The highest sensitivity values were provided by DIAGNOdent (0.77 and 0.80, examiners 1 and 2 respectively) however this was offset by a lower specificity (0.82 and 0.85) than all other systems with the exception of examiner 1 at V1 visual threshold. The DIAGNOdent gave the highest values of kappa for intra- and inter- examiner repeatability with the exception of intra-examiner repeatability for examiner 2 where visual diagnosis had the highest value of kappa. Conclusion The DIAGNOdent was the most accurate system tested for the detection of occlusal dentine caries in primary molars. The performance of the DIAGNOdent systems was not statistically significantly better than that achieved using visual examination for non-cavitated teeth (V1 and V2 threshold). DIAGNOdent may prove useful as a predictive clinical tool, however with appropriate training visual examination may offer similar results without the need for additional equipment.

The oral cleanliness and periodontal health of UK adults in 1998.

Abstract: Periodontal disease continues to be a major concern for dentists and patients. This paper reports the findings of the 1998 UK Adult Dental Health survey in relation to plaque, calculus, periodontal pocketing and loss of attachment. It is apparent from this study that moderate periodontal disease remains commonplace amongst UK adults and that the associated risk factors of plaque and calculus are in abundance, even amongst those who profess to be motivated about their oral health and attend the dentist regularly. The continued high prevalence of disease needs to be seen in the context of the far larger number of people who are now potentially at some risk, particularly in the older age groups, because of improvements in tooth retention. However, the cumulative effect of disease means that control of the periodontal diseases, even mild and slowly progressing disease, will be a key issue if large numbers of teeth are to be retained into old age. If that level of control is to be achieved we need a widespread improvement in our management of the disease, particularly in our ability to improve the oral cleanliness of the UK population.

Factors predictive of difficulty of mandibular third molar surgery.

Abstract: Aim Historically the difficulty of third molar surgery has been judged using radiologically assessed dental factors specifically tooth morphology and position. This study investigated additional factors that have a bearing on the difficulty of extraction. Study design A prospective study undertaken by three clinical assistant grade surgeons who removed 354 single mandibular third molar teeth under day case anaesthesia over the 4-year period (1994–1998). Method Data relating to patient, dental and surgical variables were collected contemporaneously as the patients were treated. The difficulty of extraction was estimated by the surgeons pre-operatively using dental radiographic features and compared by the same surgeon within the actual surgical difficulty encountered at surgery. Operation time strongly related to both pre and post treatment assessments of difficulty and proved to be the best measure of surgical difficulty. Results Univariate analysis identified increased patient age, ethnic background, male gender, increased weight, bone impaction, horizontal angulation, depth of application, unfavourable root formation, proximity to inferior alveolar canal and surgeon as factors increasing operative time. Multivariate analysis showed that increasing age (P = 0.014), patient weight (P = 0.024), ethnicity (P = 0.019), application depth (P = 0.001), bone impaction (p=0.008) and unfavourable root formation (P = 0.009) were independent predictors for difficulty of extraction. Conclusions Half of the six independent factors that predicted surgical difficulty of third molar extraction were patient variables.

Dental erosion in a group of British 14-year-old school children. Part II: Influence of dietary intake.

Abstract: Objectives The aims of the present study were first to investigate the dietary intake pattern of UK teenagers and secondly to determine the relationship, if any, between dental erosion and dietary intake in these children. Methods The study group consisted of a cluster random sample of 14-year-old school children in Birmingham, UK: 418 children were examined from 12 different schools; 209 were male and 209 female. Data on the rate and frequency of consumption of drinks, foods, and fruits were obtained from a self-reported questionnaire supplemented by a structured interview. The data were analysed using SPSS with Chi-square, and Spearman correlation analysis. Results Over 80% of the teenagers regularly consumed soft drinks but approximately half of these children had a relatively low weekly consumption. However, 13% and 10% respectively had more than 22 intakes per week of cola and other carbonated drinks. Almost a quarter of these 14-year-olds had alcoholic drinks, with significantly more males than females involved (Chi-square P < 0.05). Girls had a greater intake of fruits. Statistically significant correlations were found between the prevalence of erosion and the consumption of soft drinks, carbonated beverages, alcohol drinks, fresh fruits, Vitamin-C tablets and foodstuffs (Spearman correlation analysis P < 0.05). Conclusion It was concluded that consumption particularly of soft drinks was high and common in teenage school children in Birmingham, UK. In addition there was a relationship between dental erosion and acidic dietary intake. Further investigation of the erosive potential of these drinks and foods is required.

Dental attendance in 1998 and implications for the future

Abstract: The 1998 survey of Adult Dental Health in the UK was carried out under the auspices of the Office of National Statistics together with the Universities of Birmingham, Dundee, Newcastle-upon-Tyne and Wales. A key behavioural indicator in these decennial surveys is whether people say they go to a dentist for a regular dental check-up, an occasional dental check-up or only when they have trouble with their teeth. The proportion of dentate adults in the UK who report attending for regular dental check-ups has risen from 43% in 1978 to 59% in 1998. Older adults (over 55 years old) in 1998 were the most likely to say they attend for regular dental check-ups. Many younger adults (16-24) in 1998 said they went to a dentist less often than 5 years previously, they were also the least likely to say they attend for regular dental check-ups. Dental anxiety remains a problem for many dental patients but another factor of importance to many is their want to be involved in the treatment process and especially to be given an estimate of treatment costs.

Are antibiotics being used appropriately for emergency dental treatment

Abstract: Aim To investigate the therapeutic prescribing of antibiotics to patients presenting for emergency dental treatment. Design A prospective clinical study. Method Information was collected via a questionnaire concerning the patient's reason for attendance and treatment undertaken at emergency dental clinics in North and South Cheshire. Results Over an 11-week period 1,069 patients attended the five clinics, 1,011 questionnaires were analyzed. The majority of the attendees had pain (879/1011). 35% (311/879) of these patient had pulpitis and 74% (230/311) had been issued a prescription for antibiotics, without any active surgical intervention. The principal antibiotic prescribed for both adult and child patients was amoxicillin. Conclusion The majority of patients attending the emergency dental clinics had pain, with a large proportion having localised infections either as pulpitis or localised dental abscess. Three quarters of these patients had no surgical intervention and were inappropriately prescribed antibiotics.

Evidence-based dentistry: an overview of the challenges in changing professional practice

Abstract: A great deal of effort and resources are currently being directed at developing an evidence-based approach to healthcare delivery. The success of the evidence-based movement will depend upon the provision of necessary support to help GDPs achieve change. This paper aims to give an overview of current knowledge on what types of interventions are most effective at changing health professionals' clinical practices. Barriers to change are highlighted and the implications for the development of evidence-based dentistry are considered. Further research on organisational, social and personal influences affecting the application of evidence-based practice is necessary.

The impact of oral health on people in the UK in 1998

Abstract: Knowledge of the extent of dental disease gives a clinical indication of the experience of dental problems but it does not necessarily reflect the problems that people experience as a result of their dentition. It is becoming increasingly appreciated that the way a disease affects people's lives is just as important as epidemiological measures of its prevalence or incidence. The 1998 Adult Dental Health survey is the first of the decennial series of UK adult dental health surveys to use and report a measure of the self-perceived impact on people of the dental and periodontal diseases and other oral conditions. Over half (51%) of dentate adults said they had been affected in some way by their oral health, and in 8% of cases the impact was sufficient to have reduced their quality of life.

Can dental attendance improve quality of life

Abstract: Objective The aim of this study was to determine the relationship between reported dental attendance patterns and the public's perception of how oral health impacts on quality of life (QoL). Method A national UK study involving a random probability sample of 2,668 adults. Respondents were interviewed in their homes about how oral health affects their QoL and about their dental attendance pattern. Responses were coded as oral health having a negative impact, positive impact or impact in general (either positive and/or negative) on QoL. Results The response rate was 70% with 1,865 adults participating in the study. 72% (1,340) reported that their oral health affected their QoL in general, 57% (1,065) reported that it had a positive effect, and 48% (902) that it had a negative effect. 61% (1,136) reported to have attended the dentist within the last year – 'regular attenders'. Bivaraite analysis identified association between perception of how oral health impacts on QoL and dental attendance pattern (P < 0.01). When socio-demographic factors (age, gender, and social class) were taken into account in the analysis, 'regular attenders' reported that oral health had greater impact in general on QoL (OR = 1.30, 95% CI = 1.04, 1.63) and, specifically, a greater positive impact (OR = 1.49, 95% CI=1.44, 1.77). Conclusion Dental attendance is associated with perceptions of how oral health impacts on QoL, specifically enhanced life quality. This may have implications for understanding the health gain of regular dental attendance.

The use of dental anxiety questionnaires: a survey of a group of UK dental practitioners

Abstract: Aim To determine the frequency of use of dental anxiety assessment questionnaires and factors associated with their use in a group of UK dental practitioners. Method A postal questionnaire to all 328 dentists whose names appear in the British Society for Behavioural Sciences in Dentistry Directory. Information collected for each practitioner included gender, year of qualification, type of practice in which anxious dental patients were treated, treatment used to manage anxious dental patients, type and frequency of use of dental anxiety assessment indices. Results Questionnaires were returned from 275 (84%) practitioners. 269 were analyzed. Only 54 practitioners (20%) used adult dental anxiety assessment questionnaires and only 46 (17%) used child dental anxiety assessment questionnaires. Male practitioners were more likely to report questionnaire use in comparison with females (P < 0.05), when treating dentally anxious adults (26% v 14%). In addition, practitioners providing intravenous sedation were more likely to use an adult dental anxiety questionnaire (P < 0.04) than those who did not use intravenous sedation (29% v 15%). The type of treatment provided had a significant association with the use of child dental anxiety. Those providing general anaesthesia (P = 0.03) and hypnosis (P = 0.01) for dentally anxious children were more inclined to use a questionnaire. Conclusion The use of pre-treatment dental anxiety assessment questionnaires was low in this group of dentists. Male practitioners and those providing intravenous sedation, general anaesthesia or hypnosis seem more likely to use dental anxiety assessment questionnaires.

A look at forensic dentistry – Part 2: Teeth as weapons of violence – identification of bitemark perpetrators

Abstract: Teeth are often used as weapons when one person attacks another or when a victim tries to ward off an assailant. It is relatively simple to record the evidence from the injury and the teeth for comparison of the shapes, sizes and pattern that are present. However, this comparative analysis is often very difficult, especially since human skin is curved, elastic, distortable and undergoing oedema. In many cases, though, conclusions can be reached about any role a suspect may have played in a crime. Additionally, traces of saliva deposited during biting can be recovered to acquire DNA evidence and this can be analyzed to determine who contributed this biological evidence. If dentists are aware of the various methods to collect and preserve bitemark evidence from victims and suspects it may be possible for them to assist the justice system to identify and prosecute violent offenders. This paper reviews the recognition and recovery of this evidence and provides insight into modern methods used to investigate bitemark evidence from heinous crimes.

The outcome of root canal treatment. A retrospective study within the armed forces (Royal Air Force).

Abstract: Objective The objective of this study was to investigate the outcome of conventional root canal treatment in a general practice setting within the Royal Air Force dental service. Design Retrospective review. Methods Teeth that had been root-filled for 12 months or more by Royal Air Force dental practitioners in patients attending a large Royal Air Force dental centre were included in the study. Following clinical and radiographic review the root fillings were classified as 'definitely successful', 'probably successful' or 'failed'. The effect on success of several variables on the outcome was investigated. Results Out of a total of 406 teeth, 59% were maxillary teeth and 41% were mandibular teeth. Sixty-nine per cent of the total sample had pre-existing periapical radiolucencies. Cold lateral condensation of gutta-percha was the most widely used filling technique (64% of all cases). Fifty per cent of the teeth had root fillings within 2 mm of the radiographic apex, 32% were greater than 2 mm from the radiographic apex and 18% were overfilled. Cold lateral condensation was the most successful (92% overall) filling technique. Maxillary anterior teeth had a better success rate (96%) than other tooth types. Teeth with pre-existing periapical radiolucencies had a higher success rate (87%) than those cases where there was no pre-existing periapical radiolucency (80%). Root fillings that were less than 2 mm from the radiographic apex of the tooth had a higher success rate (88% overall) than those that were greater than 2 mm from the radiographic apex (77% overall). Of the 406 cases, 57% (n=231) were classified as definitely successful, 28% (n=114) were classified as probably successful and 15% (n=62) were classified as failures. Thus, the overall success rate combining definitely successful and probably successful root fillings was 85% (n=344). Conclusions Root fillings placed using cold lateral condensation of gutta-percha to within 2 mm of the radiographic apex of the tooth were associated with the best outcome.

Tooth surface loss: Dental erosion in a group of British 14-year-old, school children. Part I: Prevalence and influence of differing socioeconomic backgrounds.

Abstract: Tooth surface loss: Dental erosion in a group of British 14-year-old, school children. Part I: Prevalence and influence of differing socioeconomic backgrounds.

The reasons for extraction of permanent teeth in Scotland: a 15-year follow-up study

Abstract: Aims Although Scotland has the highest proportion of edentulous adults in the UK, the frequency of edentulousness has fallen by 21% during the last 20 years. This study, carried out in 1999, was designed to establish whether the reasons for tooth loss have also changed since 1984 when they were last determined. Methods The Scottish Dental Practice Board provided the names of every fourth dentist on its list among which 425 general dental practitioners were identified. They were asked to record permanent tooth extractions for 1 week, specifying the age, sex and dental attendance of patients who underwent extractions and the reasons for these extractions. 352 dentists took part: a response rate of 82.8%. Results The study confirmed that there has been a reduction in the number of extractions between 1984 and 1999: there were 25% fewer teeth extracted per patient and 30% fewer per dentist per week. From 0–20 years of age, orthodontics has replaced caries as the commonest reason for extraction and in all age groups over 20 years, caries has become the commonest reason in contrast to 1984 when periodontal disease was the principal reason in patients over 40 years old. Conclusions Caries and its sequelae remain the most important cause of tooth loss throughout adult life in Scotland and, therefore, caries prevention and maintenance of restorations are of great importance at all ages.

Caries incidence following restoration of shortened lower dental arches in a randomized controlled trial

Abstract: Context Removable partial dentures used to restore the shortened lower dental arch may adversely affect the remaining natural teeth and are associated with a low prevalence of use. Objective To report the findings for caries incidence 2 years after restoration of lower shortened arches with bilateral cantilever resin-bonded bridges (RBBs) and conventional partial dentures (RPDs). Design Randomised controlled trial. Setting Secondary care Patients 25 male and 35 female subjects of median age 67 years. were randomly allocated to 'bridge' and 'denture' treatment groups of 30 patients each matched for age and sex. Caries incidence was recorded during dental examinations 3 months, 1 and 2 years after insertion of new lower prostheses. Interventions Cantilever RBBs and conventional RPDs with cast metal frameworks. Results There was a highly significant difference in the frequency of new caries lesions, 11 and 51 in the bridge and denture groups respectively (P < 0.01). 20 out of 27 bridge patients and 9 of 23 denture patients had no caries experience. Multivariate modeling identified treatment group as the only significant predictor of caries occurrence. Conclusions Two years after restoration of lower shortened arches for an elderly sample of patients, there was a significantly greater incidence of new and recurrent caries lesions in subjects restored with RPDs compared with cantilever RBBs.

Radiographic diagnosis of root resorption in relation to orthodontics

Abstract: The literature regarding external root resorption in relation to orthodontics and its radiographic diagnosis is reviewed, including a summary of the more common radiographic techniques available. Sample cases are presented which demonstrate the need for good radiographic technique and an awareness of the limitations of certain radiographs. A provisional diagnosis of external root resorption may need to be confirmed by further radiographic views where appropriate.

The role of acupuncture in controlling the gagging reflex using a review of ten cases.

Abstract: The gagging reflex is a physiological reaction which safeguards the airway from foreign bodies. In some people this response is exaggerated to the extent that the acceptance/provision of dental treatment is not possible. The aim of this paper is to review the role of acupuncture in controlling gagging as a safe, cheap, quick and relatively non-invasive technique. Method: Ten people agreed to try ear acupuncture to control gagging during dental treatment. Prior to treatment the severity of gagging was assessed. Acupuncture needles were inserted into a specific anti-gagging point on each ear, manipulated briefly and left in situ. Dental treatment was then carried out and the effectiveness of the acupuncture in preventing gagging was assessed. After treatment, the needles were removed and the patient discharged. All acupuncture was carried out by a dentist trained in its use. Results: Four people had a severe gag reflex which made treatment impossible and six had a very severe reflex which made treatment impossible and affected their dental attendance. Ear acupuncture completely controlled the gag reflex in eight cases (23 treatment episodes) and partially controlled the reflex in two cases (two treatment episodes). Dental treatment could be carried out in all cases and at all visits. The cost of materials was £0.2 per person per visit. Additional clinical time was in the order of 2–3 minutes. There were no adverse reactions to the technique and, on all occasions, patients were fit to leave the surgery and travel home unaccompanied. Conclusions: Ear acupuncture was successful in controlling the gag reflex. It is a safe, quick, inexpensive and relatively non-invasive technique. A controlled clinical trial is required to investigate any placebo effect.

The laser welding technique applied to the non precious dental alloys procedure and results.

Abstract: Aim The laser welding technique was chosen for its versatility in the repair of dental metal prosthesis. The aim of this research is to assess the accuracy, quality and reproducibility of this technique as applied to Ni-Cr-Mo and Cr-Co-Mo alloys often used to make prosthesis Method The alloy's ability to weld was evaluated with a pulsed Nd-Yag Laser equipment. In order to evaluate the joining, various cast wires with different diameters were used. The efficiency of the joining was measured with tensile tests. In order to understand this difference, metallographic examinations and X-Ray microprobe analysis were performed through the welded area and compared with the cast part. Results It was found that a very slight change in the chemistry of the Ni-Cr alloys had a strong influence on the quality of the joining. The Co-Cr alloy presented an excellent weldability. A very important change in the microstructure due to the effect of the laser was pointed out in the welding zone, increasing its micro-hardness. Conclusion The higher level of carbon and boron in one of the two Ni-Cr was found to be responsible for its poor welding ability. However for the others, the maximum depth of welding was found to be around 2mm which is one of the usual thicknesses of the components which have to be repaired.

Management of the deep carious lesion and the vital pulp dentine complex.

Abstract: This article describes the relationship between the carious process and pulp-dentine complex reactions. Where the balance between the two is in favour of the carious process and where conventional cavity preparation leads to a direct pulp exposure, the direct pulp cap technique is described. The success of the technique is addressed and more importantly an alternative technique for caries removal, namely stepwise excavation, is described which may lead to a reduced risk of carious exposure and the need for the direct pulp cap technique.

Factors associated with oral health: a multivariate analysis of results from the 1998 Adult Dental Health survey.

Abstract: This paper presents results from the 1998 Adult Dental Health Survey using multivariate analysis. This enables analysis of several variables at one time to see which are having an effect on people's oral health. The paper compares these variables to a variety of outcome measures and makes recommendations for dental practice.

Incomplete tooth fracture--proposal for a new definition.

Abstract: Many terms have been used to describe incomplete tooth fractures. This paper reviews them, discusses the clinical features of incomplete tooth fractures and proposes a clinically representative definition.

Occlusal considerations in periodontics

Abstract: In this part, we will discuss: Periodontal disease does not directly affect the occluding surfaces of teeth, consequently some may find a section on periodontics a surprising inclusion. Trauma from the occlusion, however, has been linked with periodontal disease for many years. Karolyi published his pioneering paper, in 1901 'Beobachtungen uber Pyorrhoea alveolaris' (occlusal stress and 'alveolar pyorrhoea').1 However, despite extensive research over many decades, the role of occlusion in the aetiology and pathogenesis of inflammatory periodontitis is still not completely understood.

Scope of the OSCE in the assessment of clinical skills in dentistry.

Abstract: Introduction The objective structured clinical examination (OSCE) is now an accepted tool in the assessment of clinical skills in dentistry. There are however no strict or limiting guidelines on the types of scenario that are used in the OSCE examinations and experience and experimentation will inevitably result in the refinement of the OSCE as a tool for assessment. Aim The aim of this study was to compare and contrast different types of clinical operative skills scenarios in multi-station OSCE examinations. Methodology Student feedback was obtained immediately after the sitting of an OSCE examination on two different occasions (and two different cohorts of students). The same questionnaire was used to elicit the responses. Results The questionnaire feedback was analysed qualitatively with particular regard to student perception of the usefulness and validity of the two different kinds of OSCE scenarios. Conclusions OSCE scenarios which involve phantom heads are perceived to lack clinical authenticity, and are inappropriate for the assessment of certain clinical operative skills. While the OSCE is useful in the examination of diagnostic, interpretation and treatment planning skills, it has apparent limitations in the examination of invasive operative procedures.

Prevalence, age of onset and demographic relationships of different areca nut habits amongst children in Tower Hamlets, London.

Abstract: Objective To examine prevalence and demographic relationships of different areca nut habits amongst children. Design Self-administered questionnaire. Subjects Children aged between 11 and 15. Of 800 questionnaires distributed, 704 were fully completed (88%). Setting Two secondary schools in the London district of Tower Hamlets. Measures Demographic, areca nut habits used, age first used, still using, frequency of use. Results Users of any areca nut habit were exclusively from the South Asian population. Of this population, 77% had engaged in a habit, and dependent upon habit between 54 and 92% of these still remained current users. The highest prevalence of current use for boys and girls respectively was for areca nut alone (36%, 43%), followed by mistee pan (35%, 29%), betel-quid (27%, 26%) and pan masala (14%, 16%). Of the current users, 44% engaged in one habit only, 24% two, 20% three and 13% all four. The highest period of risk for starting to use areca nut alone, betel-quid and mistee pan was between ages 5 and 12, whilst for pan masala it was after 10. Boys had a significantly higher risk of beginning use before 10 (P < .001) and a higher frequency of use for pan masala (P < .01), areca nut alone (P < .05) and betel-quid (P = .06) than girls. The frequency of using each habit was between 3 and 5 episodes per week, however boys use pan masala approximately 10 times per week. Conclusion South Asian children may already be experienced users of areca nut. Greater attention should be directed towards identifying signs of oral submucous fibrosis, oral cancer and other potentially malignant lesions within the South Asian population.

Primary care clinicians' knowledge of oral cancer: a study of dentists and doctors in the North East of England

Abstract: Objective To compare the knowledge of oral cancer and related issues of general dental and general medical practitioners (GDPs and GMPs) Design A questionnaire was sent to 420 primary care clinicians, half to dentists and half to doctors Responses to the questionnaire were analysed using odds ratios (OR) and 95% confidence intervals (CI) Results The response rate was 681% for GDPs and 719% for GMPs Dental practitioners were significantly more likely to have diagnosed cases of oral cancer than medical practitioners (OR = 268, 95% CI 16, 44) Important differences arose between the groups in terms of risk factor knowledge and clinical examination Conclusion This study demonstrates that whilst the knowledge level of both groups is generally good, there are some discrepancies These relate mainly to risk factor knowledge and clinical examination techniques