Barriers to early detection and management of oral cancer in the Asia Pacific region.

OBJECTIVE: Oral cancer is amenable to early detection but remains a prominent cause of mortality in the Asia Pacific region. This study aimed to identify barriers to early detection and management of oral cancer in the Asia Pacific region. METHODS: A mixed-methods approach was employed triangulating findings from a survey and focus groups. The survey was conducted among seven representative members of the Asia Pacific Oral Cancer Network (APOCNET) across six countries. Focus groups were conducted to gain deeper insights into the findings of the survey. RESULTS: The identified barriers were a lack of national cancer control strategies and cancer registries and the limited availability of trained health care professionals. Overcoming these challenges in the Asia Pacific region where resources are scarce will require collaborative partnerships in data collection and novel approaches for continuous professional training including eLearning. Further, to overcome the lack of trained health care professionals, innovative approaches to the management of oral potentially malignant lesions and oral cancer including telemedicine were suggested. CONCLUSION: The findings of this study should be taken into account when charting national cancer control plans for oral cancer and will form the basis for future collaborative studies in evaluating effective measures to improve oral cancer detection and management in low- and middle-income countries.

Effectiveness of "OralDETECT": a Repetitive Test-enhanced, Corrective Feedback Method Competency Assessment Tool for Early Detection of Oral Cancer.

Early diagnosis of oral cancer results in less aggressive treatment and improves the quality of life and overall 5-year survival rate. Well-trained dental professionals can play a crucial role in the early detection of oral cancers. The present study aims to determine the effectiveness of the training program "OralDETECT", a spaced repetitive, test-enhanced learning tool with a corrective feedback mechanism for early detection of oral cancer. Thirty-two dentists and 259 dental students from three Malaysian dental schools were involved in this study. All participants were trained and calibrated to recognize oral potentially malignant disorders (OPMD) and oral cancer using "OralDETECT", which is comprised of a series of pre-test, lecture, post-tests and review sessions. The percentage of correct answers (scores) for each test given by the participants was calculated and analysed using a paired t test. It was found that the overall percentage of diagnostic accuracy for both dental professionals and student groups increased to above 80% from the pre-tests to the final post-tests. There was a significant improvement in overall scores between the pre-tests and all three post-tests for the dental professional groups and the student groups. The diagnostic accuracy for individual OPMD and lesions suspicious of oral cancer also increased to above 80% for both groups. The results of our study demonstrate that the "OralDETECT" is an efficient and effective competency tool which can be used to train dental professionals and students for the early detection of OPMD and oral cancer.

Underweight and early childhood caries among young children in rural Cambodia: a pilot study.

OBJECTIVES: To investigate the association between underweight and early childhood caries (ECC) among children aged one to three years in rural Cambodia. MATERIALS AND METHODS: A total of 200 Cambodian children aged one to three years at several villages in Kampong Cham province participated in this study. The children whose Z scores were below two and three standard deviations were considered as moderately-underweight and severely-underweight. Children whose mid-upper arm circumstance (MUAC) was below 12.5 cm, were regarded as having malnutrition. ECC was recorded following the WHO guidelines. Associated factors were obtained through interviews with caregivers. RESULTS: 33.5% and 7.0% of the children were identified as being moderately-underweight and severely-underweight, respectively. The prevalence of ECC was 61.5%. ECC was significantly associated with children being moderately-underweight (P < 0.05). The prevalence of ECC was higher prevalence of those who with severely-underweight, although significant differences were not observed (P = 0.054). Logistic regressions showed that those with low birth weight (OR = 2.57; 95% CI = 1.03-6.40) and malnutrition (OR = 4.71; 95% CI = 1.08-20.62) were likely to be moderately-underweight and severely-underweight, whereas those who with ECC had more moderately-underweight, although it was not significant (OR = 2.21; 95% CI = 0.97-5.00). Those with low birth weight (OR = 10.68; 95% CI = 2.95-38.65) and ECC (OR = 6.67; 95% CI = 1.02-43.61) were likely to be severely-underweight. CONCLUSION: The findings of this study suggest that low birth weight, malnutrition and ECC were associated factors of underweight in this population.

Self-reported knowledge, attitudes, and practice of final-year dental students in relation to child abuse: A multi-centre study.

BACKGROUND: The number of child abuse cases is increasing worldwide; therefore, it is important to educate individuals having contact with children about it. This includes dentists who play a pivotal role in detecting and reporting child abuse. AIM: To identify and compare the final- year dental student's knowledge, attitudes, and practice in relation to child abuse. DESIGN: A 38- item and four- part online questionnaire was distributed to students of 11 dental schools in 10 countries. SPSS and GraphPad Prism were used for data analysis. The levels of statistical significance were determined using a chi- square test. P ≤ .05 was considered to be statistically significant. RESULTS: A total of 660 students completed the survey. Fifty- six percent of the students received formal training on child abuse, and 86% wanted additional training. The knowledge of child abuse was significantly higher in Australia, the United States, and Jordan compared with other countries. Internet (60.3%) was commonly used as an information source for child abuse. CONCLUSIONS: The study showed that dental students lack knowledge and experience in recognizing and reporting child abuse. Most respondents indicated a desire for additional training; therefore, dental schools should review what they are currently teaching and make changes as appropriate.

Caries arrest and lesion appearance using two different silver fluoride therapies on primary teeth with and without potassium iodide: 12-month results.

BACKGROUND: Globally, has been an increase in the use of silver fluoride products to arrest carious lesions and a variety of products are available. OBJECTIVES: To examine differences in caries arrest and lesion colour of primary tooth carious lesions. MATERIAL AND METHODS: A four-armed, parallel-design cluster-randomised controlled trial which investigated four protocols for caries arrest at 6m and 12m. Children in Group 1 and Group 2 received Rivastar Silver Diammine Fluoride (SDF), and children in Group 3 and Group 4 received a stabilised aqueous silver fluoride solution (AgF). Children in Group 2 and Group 4 received an additional application of KI immediately after the fluoride. Differences in caries arrest and lesion appearance were examined at 6m and 12m using two level logistic regression modelling. RESULTS: The arrest rate varied by group membership; group 1 and group 3 had higher arrest rates (77.3% and 75.3% respectively) than group 2 and group 4 (65.4% and 51.2% respectively). The use of KI was also associated with lower odds of arrest (12m OR 0.25; CI 0.19, 0.34) and higher odds of avoiding black discolouration (12m OR 6.08; 2.36, 15.67). CONCLUSIONS: Globally, has been an increase in the use of silver fluoride products to arrest carious lesions and a variety of products are available. This study demonstrated that both AgF and SDF can effectively arrest carious lesions on primary teeth. The use of KI is associated with poorer caries control but better aesthetic outcomes.

School Based Tooth Brushing and Annual Silver Diammine Fluoride Application as a Highest Priority Package for Achieving Universal Oral Health Care for Cambodian Children.

Background: Achieving Universal Oral Health Care among Low-to Middle-Income settings is challenging and little literature exists around exploring what a "Highest Priority Package" of care might look like in the context of oral health. The Healthy Kids Cambodia (HKC) program differs from most conventional school dental services in that the initial package of care that is offered is daily toothbrushing with 1,500 ppm fluoride toothpaste (DTB) together with the topical application of Silver Diamine fluoride (SDF) for management of lesions in primary teeth. Aim: To examine tooth level outcomes for 8- to 10-year old children from two schools that performed DTB with application of SDF at differing time-points. Design: This was an observational cohort study that examined lesion progression among children in late mixed dentition at two schools. Data were collected using the dmft and pufa indices. Both schools received materials and training for DTB at baseline. School One received SDF at baseline while School Two received SDF after 9-months. Intraoral examinations were performed and the presentation of primary teeth with cavitated carious lesions were compared at baseline and 12 m. If a tooth was still caries-active or had become pulpally involved, this was considered to be an unacceptable outcome. Descriptive analysis was performed the chi-squared test was used to examine differences in the proportion of teeth with unacceptable outcomes by school membership. Results: Of the 521 children recruited, 470 (90.2%) were followed. Where there was a delay in SDF application (School 2) there was a three times greater chance of an unacceptable outcome. Ten percentage of primary teeth in School One and 33% of primary teeth in the School Two had unacceptable outcomes. Conclusion: The present study offers data on expected effect sizes that might inform future step-wedged clinical trials to validate an oral health Highest Priority Package of care for Cambodian children. The delivery of a package of care that includes both DTB and SDF can prevent adverse outcomes, such as dental infections, in primary teeth with carious lesions.

Oral Health Policies to Tackle the Burden of Early Childhood Caries: A Review of 14 Countries/Regions.

Aim: Early childhood caries (ECC) has significant public health implications but has received inadequate global attention. There is limited information regarding the success of oral health policies implemented to address the challenges of ECC. This review aimed to summarize such policies to tackle ECC from different countries/regions. Method: Independent collaborators from 14 countries/regions (Australia, Brazil, Cambodia, China, Hong Kong, Egypt, India, Indonesia, Japan, Nigeria, Thailand, UK, USA, and Venezuela) collected the data. The ECC status, dental workforce, oral health policies on ECC prevention in different countries/regions were summarized by each country. Results: The findings indicated that ECC prevalence varied in different countries/regions. The lowest prevalence of ECC among 5-year-old children was found in Nigeria (7%), and the highest was found in Indonesia (90%). The existing dental workforce and resources are limited in most countries. The smallest dentist to population ratio was reported by Nigeria at 1:48,400, whereas the highest ratio was in Brazil (1:600). Out of 14, three (21%) countries namely India, Venezuela and Cambodia had no national oral health policies addressing ECC and four (29%) countries (Cambodia, China, India, Venezuela) had no publicly funded dental care program for 0-5-year-old children. Water fluoridation is available in four countries/regions (Australia, Brazil, Hong Kong, USA). Conclusion: ECC remains a global health challenge and dental workforce is limited. National/regional programs to tackle ECC are not yet prioritized in many countries/regions. Evidence to support demonstration projects is limited. Further research on the cost-effectiveness of interventions strategies is required for policymakers.

Evaluation of a community-based early childhood caries (ECC) intervention in Cambodia.

OBJECTIVE: To critically evaluate an early childhood caries (ECC) intervention performed by non-dental primary healthcare providers. METHODS: This mixed-methods investigation includes data from three sources: (a) a pilot non-randomized controlled trial to examine clinical outcomes at four health centres; (b) stakeholder focus group interviews; and (c) a survey of parents whose children were exposed to the intervention. The pilot study involved four Community Health Centres in rural Cambodia whereby mother-child (6-24 months of age)dyads received oral health education (OHE), toothbrushes, fluoride toothpaste and fluoride varnish on up to six occasions as part of the routine vaccination schedule. Outcomes were as follows: presence of ECC; impacts on oral health-related quality of life (OHRQoL); stakeholder perceptions of intervention delivery; and parental perceptions of fluoride varnish. RESULTS: Participants in the intervention group had six times lower odds of developing ECC than those in the comparison group after controlling for socio-economic status (OR 0.13). Those in the intervention group also had a large reduction OHRQoL scale scores. Key knowledge and practice gaps were identified among stakeholders. Surveyed parents had favourable views of the fluoride varnish placement by medical professionals, and four out of five stated that they would recommend fluoride varnish for other children. Primary healthcare providers, commune council representatives and community health promoters supported oral health interventions being provided in CHCs. CONCLUSIONS: OHE and fluoride varnish interventions provided by non-dental primary health workers were feasible and acceptable for stakeholders in a Cambodian setting. The intervention group had lower ECC experience and better OHRQoL at 2 years of age.

Association between Early Childhood Caries and Maternal Factors among 18- to 36-month-old Children in a Rural Area of Cambodia.

PURPOSE: To investigate the associations between early childhood caries (ECC) and maternal factors among 18- to 36-month-old children in one rural province of Cambodia. MATERIALS AND METHODS: 121 mother-child pairs (male = 67, female = 54; mean age = 25.18 ± 6.24 months) were recruited at several villages in Stueng Trang district, Kampong Cham province. ECC and maternal caries experience were recorded following WHO guidelines. Maternal factors such as literacy and socioeconomic status, as well as child-rearing behaviours, were assessed through an interview questionnaire of the mothers. RESULTS: ECC and maternal caries prevalence were 54.5% and 84.3%, respectively. Statistically significant associations were found between ECC and: breast-feeding after 18 months; sugary food and beverage intake for the child (p < 0.05); maternal caries experience; illiteracy; night-time breastfeeding, bottle feeding, and late introduction of toothbrushing for the child (p < 0.01). A logistic regression revealed that ECC was more common in children whose mothers had DMFT > 0 (OR = 4.08; 95% CI =1.13-14.75; p = 0.032), children whose mothers were illiterate (OR = 8.21; 95% CI = 1.67-40.85; p = 0.009), children who had night-time breastfeeding after 18 months (OR = 2.76; 95% CI = 1.06-7.19; p = 0.037), and children for whom toothbrushing was introduced after 18 months (OR = 2.87; 95% CI = 1.03-7.97; p = 0.042). CONCLUSION: The findings of this study suggest that maternal caries experience and illiteracy, as well as a range of child-rearing behaviours including prolonged night-time breastfeeding and late introduction of toothbrushing were indicators for ECC in this population.

Caries arrest and lesion appearance using two different silver fluoride therapies with and without potassium iodide: 6-month results.

OBJECTIVES: to compare arrest rates and colour change in carious lesions in primary teeth using two different silver fluoride solutions with and without potassium iodide (KI). METHODS: The study was a four-armed, parallel-design randomised controlled trial and investigated four protocols for caries arrest at 6m. Children in Group 1 and Group 2 received Rivastar Silver Diammine Fluoride (SDF), and Children in Group 3 and Group 4 received an aqueous silver fluoride solution (AgF). Children in Group 2 and Group 4 received a two-step procedure where application of the AgF or SDF solution was followed by KI. RESULTS: At the six-month follow-up 446 (82.2%) children were re-examined. The arrest rate across the full sample was 51.4% and there were no significant differences in arrest rate by type of silver fluoride therapy. The lesion size, tooth type, surface type, presence of plaque on the carious lesion and caries increment all had an influence on caries arrest. Once clustering effects were accounted for, the use of KI was associated with a higher chance of arrest (OR 1.23; P-value 0.008) and a lower chance of the lesion darkening (OR 0.73; P-value <0.001). CONCLUSIONS: The combination of AgF & KI was associated with the most favourable clinical outcomes in terms of caries arrest and lesion colour. CLINICAL SIGNIFICANCE: The major draw-back of arrest of caries treatment with silver fluoride solutions is that it can create an appearance which may be aesthetically unacceptable. This study explores ways in which the base colour of lesions could be improved and as such provide the opportunity for better aesthetic outcomes for children afflicted with a severe burden of dental caries in their primary dentition, and in whom conventional treatment is not being provided.

A method of estimating age of undocumented children and young adults of different socioeconomic status in Cambodia.

A growing number of Cambodian children without legal documentary evidence of date of birth are vulnerable to exploitation. This study aimed to evaluate the applicability of southern Chinese reference dataset for dental age estimation on Cambodian children and young adults of different socioeconomic status. Dental panoramic tomographs (DPT) of 371 Cambodian children and young adults belonging to lower and higher socioeconomic status (SES) groups were analyzed. All the left maxillary and mandibular permanent teeth including the third molars were scored based on Demirjian's classification of tooth development stages. Chronological age (CA) was calculated from the date of birth and date of exposure of radiograph. The mean age of attainment for each stage of development was obtained from the southern Chinese reference dataset. Dental age (DA) was calculated by averaging the mean age scores for all the teeth. Paired t-test and correlation analysis were conducted to measure associations between the chronological age and the dental age for males and females in the lower and higher socio-economic status groups. Underestimation of age was observed in both SES groups using the southern Chinese reference dataset. For the higher SES group, the difference between the chronological and dental age (CA-DA) was 0.26 years for females and 0.11 years for males. The difference was statistically significant only in females (p < 0.05). In the low SES group, the results showed a difference of 0.07 years in females and 0.01 years in males; the differences were not statistically significant in both sexes (p > 0.05). A strong correlation was observed between the CA and DA in both sex and SES groups ranging from 0.969 to 0.988 (p < 0.05). The southern Chinese dental reference dataset can be used to estimate the age of undocumented Cambodian male and female children and young adults of both higher and lower SES.

Healthy Kids Cambodia - A novel approach to triage for dental care in a population with extreme caries experience.

OBJECTIVES: To describe the disease experiences and treatment provided according to a set of novel triage criteria among children in the Healthy Kids Cambodia project. METHODS: The present study describes the management of caries using the Healthy Kids Cambodia (HKC) strategy at one school in Phnom Penh, Cambodia. Treatment was provided across three levels of care based on a set of simple screening criteria. All children received Level 1 (L1) care, which included application of 30% silver diammine fluoride (SDF) to arrest dental caries. Level 2 (L2) care involved use of atraumatic restorative treatment (ART) and GIC fissure sealants for children between six and eight years of age, and for older children who had one or more cavitated lesions on permanent posterior teeth. Level 3 care involved conventional dental rehabilitation for those children with cavitated lesions in permanent anterior teeth, acute infections, pulpally involved permanent teeth or carious permanent posterior teeth that were not restorable using ART. Three activities were evaluated: (i) screening of all children at the school using the HKC triage criteria; (ii) a detailed re-examination of children in Grades 3 and 4; and (iii) a clinical audit of treatment provided at Level 3 (L3). RESULTS: 1194 children were screened using the HKC approach, and a sample of 304 8- to 12-year-old children was re-examined. Among those who were re-examined, 48 (15.7%) had been referred for L3 treatment and 88 (28.9%) referred for L2 (only). There was a significant difference in baseline caries experience by referral level, whereby those referred to higher levels of care had more severe caries experience. All children in the L3 category required advanced rehabilitative care. CONCLUSIONS: The application of a triage system by dental students was successful in identifying children in greatest need of complex care (L3). Further research may better validate the system for caries management.

Epidemiological survey of early childhood caries in Cambodia.

BACKGROUND: The Southeast Asian Forum for Early Childhood Caries identified the need for more epidemiological surveys involving preschool children. To date, the only data on Early Childhood Caries in Cambodia come from convenience samples and only using the basic dmft index without measurement of the early signs of disease. METHODS: A cross-sectional survey on an epidemiological sample of Cambodian preschool children was conducted in conjunction with the fourth follow-up of the Cambodian Health and Nutrition Monitoring Study. Children were examined in a field setting using both the South East Asian Index for Early Childhood Caries as well as the 'pulpally involved, ulcerated, fistula, abscess' (pufa) index. Caregivers also participated in a short questionnaire covering dietary habits, oral health knowledge and behaviors, as well as the Family Impact Scale (FIS) for Oral-Health-Related Quality-of-Life. RESULTS: The sample included 3985 participants between birth and 4-years of age, across three provinces. There was an even sex distribution (50.7% male). Overall 56.6% of participants had one or more carious lesions and 5.4% had one or more pulpally-involved teeth. There were some significant differences by age and location. Among those in the 3-year-old age group 84.9% had at least one decayed tooth, and 16.1% had one or more pulpally-involved teeth. There were differences in oral health knowledge and behaviors by province; those in Phnom Penh reported more favorable responses. Consumption of non-nutritious foods also differed between provinces with those in Phnom Penh consuming a higher mean number of sweet beverages per day. Those children with at least one pulpally involved tooth had a ten times greater chance of realizing an impact across the FIS. CONCLUSIONS: Cambodian preschool children have a severe burden of dental caries and a high proportion of families are impacted by this problem. There were differences in oral health knowledge and behaviors according to province and this translated into differences in caries experience. The data from this study support the need for urgent action to address the issue of ECC in Cambodia.

SEAL Cambodia-Evaluation of a modified protocol for placement of Fuji VII® Fissure Sealants at one and two years.

OBJECTIVES: In order to address the severe caries burden among Cambodian children and limited access to dental care this study had two objectives: (1) To evaluate the caries preventive effect of hand-mixed GIC Fissure Sealants (FS) placed on first permanent molars of 6-8 year-old Cambodian children using two protocols in the SEAL Cambodia Project and (2) validate the SEAL Cambodia population-based intervention. METHODS: The study had four groups, two cohorts, and investigated two clinical protocols (original and modified) for FS placement to compare caries preventive fraction. Three groups were followed up at 1y and two were followed up at 2y. The modified protocol involved control of the temperature of the material, the timing of mixing and placement, and adjustment of the occlusion. Data analysis examined differences in caries incidence by group. RESULTS: At 1 and 2 y, 62.8%, and 68.0% follow-up rates were achieved, respectively. The baseline mean dmft for the first and second cohorts was 8.0 (SD 3.9) and 9.9 (SD 4.3) respectively. The original protocol did not render a statistically significant preventive benefit. A preventive fraction of 89.1% at 1 y and 32.3% at 2 y was achieved using the modified protocol in the second cohort (P < 0.05). Children with baseline dmft> 8 realised half the preventive fraction at 2 y compared to those with dmft <8 (22.3% and 45.8% respectively). CONCLUSIONS: The modified FS protocol increased the caries preventive effect, although it was lower than that reported in other studies. CLINICAL SIGNIFICANCE: This study builds evidence for the use of glass ionomer cement Fissure Sealants (FS) for the prevention of caries at a population level. It showed that improving the field-based clinical protocol for application of FS had a large impact on clinical success.

Peer Tutoring for Anatomy Workshops in Cambodia.

Historical loss of staff and teaching resources in Cambodia has resulted in significant challenges to anatomy education. Small group anatomy teaching opportunities are limited. A visit to Cambodia by a teaching team from the University of Melbourne in 2010 demonstrated it was possible to implement well-resourced anatomy workshops for this purpose. However, continuation of the workshop program was inhibited by the limited number of local teaching staff. In 2015, another team from the University of Melbourne returned to Cambodia to implement anatomy workshops that incorporated peer tutoring. The objective was to improve teacher-to-student ratios and to demonstrate that interactive anatomy workshops could be delivered successfully despite low staff numbers. The anatomy workshops were attended by 404 students of Medicine, Dentistry, Nursing, and Midwifery at the University of Puthisastra. Medical students were invited to act as peer tutors for nursing students. A five-point Likert scale questionnaire was used to determine student satisfaction with both the workshops and peer tutoring. The overwhelming majority were positive about the workshops and keen for them to continue. Almost all medical students who acted as peer tutors agreed or strongly agreed that this role increased their anatomical knowledge (98%) and confidence (94%). Most nursing students agreed or strongly agreed with statements that they would like peer tutoring to continue (94%) and that they would like to be peer tutors themselves (88%). This report demonstrates that peer tutoring could be an effective tool in educational settings where poor staff-to-student ratios limit delivery of interactive workshops.

Perceptions of oral health among older Cambodians and their caregivers: A qualitative study.

OBJECTIVE: Older adults (those above the age of 60) are an emerging demographic in Cambodia, and very little is understood about their oral health experiences, needs, perceptions and behaviours. The aim of this study was to explore the oral health experiences, practices and perceptions of a convenience sample of a small but diverse group of older adults in Cambodia. METHOD: A cross-sectional qualitative study in which focus group interviews were conducted by 5 trained senior Cambodian dental students. A convenience sample of 56 older adults and caregivers was recruited across urban, semi-urban and rural locations. Focus group conversations were recorded, transcribed and analysed thematically. RESULTS: The themes that emerged were around low expectations for both general health and oral health. A communal responsibility for health was expressed, and both money and transport were identified as key barriers to accessing care. Participants recognised that they had oral health problems, and acknowledged the impact of poor oral function on health and nutrition. CONCLUSION: This study is an important first step in better understanding the oral health experiences and perceptions of older people in Cambodia. Participants described the impacts of poor oral health as being important, even when compared with other general health conditions.

Prevalence of oral cancer, oral potentially malignant disorders and other oral mucosal lesions in Cambodia.

OBJECTIVES: To obtain data on the prevalence of oral mucosal lesions (OMLs) among Cambodians, and to assess the relationship between known risk habits of oral diseases with prevalence of oral potentially malignant disorders (OPMDs). DESIGN: This was a population-based, cross-sectional study whereby subjects were adults aged 18 years old and above. A workshop on the identification of OML was held to train and calibrate dental officers prior to data collection in the field. Sociodemographic and risk habits data were collected via face-to-face interview, whilst presence of OML and clinical details of lesions such as type and site were collected following clinical oral examination by the examiners. Data analysis was carried out using the Statistical Package for Social Science (SPSS) version 12.0. The association between risk habits and risk of OPMD was explored using logistic regression analysis. RESULTS: A total of 1634 subjects were recruited. Prevalence of OML for this population was 54.1%. Linea alba was the most common lesion seen (28.7%). This study showed an overall OPMD prevalence of 5.6%. The most common type of OPMD was leukoplakia (64.8%), followed by lichen planus (30.8%). Subjects who only smoked were found to have an increased risk for OPMD of almost four-fold (RR 3.74, 95%CI 1.89-7.41). The highest risk was found for betel quid chewers, where the increased risk observed was more than six times (RR 6.75, 95%CI 3.32-13.72). Alcohol consumption on its own did not seem to confer an increased risk for OPMD, however when practiced concurrently with smoking, a significant risk of more than five times was noted (RR 5.69 95%CI 3.14-10.29). CONCLUSION: The prevalence of OML was 54.1%, with linea alba being the most commonly occurring lesion. Smoking, alcohol consumption and betel quid chewing were found to be associated with the prevalence of OPMD, which was 5.6%.

The efficacy of an elevated concentration of lidocaine HCl in impacted lower third molar surgery.

BACKGROUND: There have been few studies on the effect of an elevated concentration of lidocaine hydrochloride in the surgical removal of an impacted lower third molar. This study aimed to examine the efficacy of 4% lidocaine along with 1:100,000 epinephrine compared to 2% lidocaine along with 1:100,000 epinephrine as inferior alveolar nerve block for the removal of an impacted lower third molar. METHODS: This single-blind study involved 31 healthy patients (mean age: 23 y; range: 19-33 y) with symmetrically impacted lower third molars as observed on panoramic radiographs. Volunteers required 2 surgical interventions by the same surgeon with a 3-week washout period. The volunteers were assigned either 4% lidocaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine as local anesthetic during each operation. RESULTS: We recorded the time of administration, need for additional anesthetic administration, total volume of anesthetic used. We found that the patient's preference for either of the 2 types of local anesthetic were significantly different (P < 0.05). However, the extent of pulpal anesthesia, surgical duration, and duration of soft tissue anesthesia were not significantly different. CONCLUSIONS: Our study suggested that inferior alveolar nerve block using 4% lidocaine HCl with 1:100,000 epinephrine as a local anesthetic was clinically more effective than that using 2% lidocaine HCl with 1:100,000 epinephrine; the surgical duration was not affected, and no clinically adverse effects were encountered.

Hemodynamic changes associated with a novel concentration of lidocaine HCl for impacted lower third molar surgery.

BACKGROUND: The authors studied the hemodynamic effect influent by using the novel high concentration of lidocaine HCl for surgical removal impacted lower third molar. The objective of this study was to evaluate the hemodynamic change when using different concentrations of lidocaine in impacted lower third molar surgery. METHODS: Split mouth single blind study comprising 31 healthy patients with a mean age of 23 years (range 19-33 years). Subjects had symmetrically impacted lower third molars as observed on panoramic radiograph. Each participant required 2 surgical interventions by the same surgeon with a 3-week washout period washout period. The participants were alternately assigned one of two types of local anesthetic (left or right) for the first surgery, then the other type of anesthetic for the second surgery. One solution was 4% lidocaine with 1:100,000 epinephrine and the other was 2% lidocaine with 1:100,000 epinephrine. A standard IANB with 1.8 ml volume was used. Any requirement for additional anesthetic and patient pain intra-operation was recorded. Post-operatively, patient was instructed to fill in the patient report form for any adverse effect and local anesthetic preference in terms of intra-operative pain. This form was collected at the seven day follow up appointment. RESULTS: In the 4% lidocaine group, the heart rate increased during the first minute post-injection (P < 0.05). However, there was no significant change in arterial blood pressure during the operation. In the 2% lidocaine group, there was a significant increase in arterial blood pressure and heart rate in the first minute following injection for every procedure. When the hemodynamic changes in each group were compared, the 4% lidocaine group had significantly lower arterial blood pressure compared to the 2% lidocaine group following injection. Post-operatively, no adverse effects were observed by the operator and patient in either local anesthetic group. Patients reported less pain intra-operation in the 4% lidocaine group compared with the 2% lidocaine group (P < .05). CONCLUSIONS: Our results suggest that a 4% concentration of lidocaine HCl with 1:100,000 epinephrine has better clinical efficacy than 2% lidocaine HCl with 1:100,000 epinephrine when used for surgical extraction of lower third molars. Neither drug had any clinical adverse effects.