Dentifrice Research Articles

Calcium phosphate bioceramics fabricated from extracted human teeth for tooth tissue engineering

Bioceramic tooth powders were prepared via heat treatment of extracted human teeth using sintering temperatures between 600°C and 1200°C, and their properties were investigated for potential tooth tissue engineering. The sintered human tooth powders were characterized using thermal analysis (thermogravimetric analysis (TG) and differential thermal analysis (DTA)), field emission scanning electron microscopy, X-ray diffraction, energy dispersive X-ray spectroscopy, and Fourier transformed infrared (FTIR) spectroscopy. Additionally, the phase constitutions and chemical homogeneities of the composite samples were examined using a quantitative chemical analysis with inductively coupled plasma spectroscopy. The results revealed that the annealing process produced useful hydroxyapatite-based bioceramic biomaterials when annealed above 1000°C. The FTIR spectra and the TG/DTA thermograms of the tooth powders indicated the presence of organic compounds, which were completely removed after annealing at temperatures above 1000°C. The tooth powders annealed between 1000°C and 1200°C had good characteristics as bioceramic biomaterials. Furthermore, the biocompatibility of each tooth powder was evaluated using in vitro and in vivo techniques; our results indicate that the prepared human tooth powders have great potential for tooth tissue engineering applications.

Assessment of secondary metabolites and bioefficacies ofPeltophorum pterocarpum(DC.) Baker ex K. Heyne cell cultures

Peltophorum pterocarpum (DC.) Baker ex. K. Heyne, is reputed for its medicinal importance. Its bark is used for dysentery, tooth powder, eye lotion, embrocating for pains and sores and bark also gives a dye of yellow color. In the present study, cell cultures of leaf explants were established on MS medium supplemented with benzene-6-aminopurine (BAP; 2 mg/L) and naphthalene acetic acid (NAA; 0.5 mg/L). Callus was harvested at the transfer age of 2, 4, 6, 8 and 10 weeks, dried, extracted in ethanol. Total levels of phenolics and flavonoids as also antimicrobial (agar well diffusion method) and antioxidant (DPPH and FRAP method) efficacies were evaluated. On phytochemical investigation, β-sitosterol and bergenin were isolated and identified. Higher levels of total phenolics and flavonoids were recorded in 8 weeks-old callus extract (12.40 ± 1.44 mg GAE/gdw and 22.5 ± 0.08 mg QE/gdw). In DPPH method 4, 6 and 8 weeks-old calli exhibited similar activity with IC50 value of 0.06 mg/mL. Likewise, 8 weeks-old callus exhibited higher FRAP activity (98.33 ± 10.40 mg AAE/g dw). On antibacterial screening, 10 weeks-old callus demonstrated appreciable results with inhibition zones of 24.33 ± 0.57, 21.00 ± 1.00, 11.00 ± 1.00 and 10.00 ± 0.00 mm against K. pneumoniae, B. subtilis, S. aureus and E. coli respectively.

Effect of Ayurvedic herbs on control of plaque and gingivitis: A randomized controlled trial.

Ayurveda had mentioned various procedures for maintaining oral hygiene. These include procedures like gandusha, kavala, dantadhavana, and jivha lekhana (cleaning tongue). Various plants have been mentioned in Ayurveda for dantakashta. Various Ayurvedic dental formulations are available in market in the form of powders, paste, etc. Present study was conducted for evaluating the effect of one of such Ayurvedic toothpowder named UDM, in controlling plaque and reducing gum inflammation in patients of moderate gingivitis. Scaling, root planning, and polishing were done for all the patients participating in the study. Oral hygiene instructions were given that included brushing twice/day with assigned tooth powder using BASS method for tooth brushing and also massage over gum tissue with finger. All the patients were recalled after 15 days. Scores of plaque index and gingival index was recorded on day 1 and day 15 of treatment. Total of 15 patients were recruited in each group. The mean reduction in gingival index was 1.15 (P<0.05) and 1.26 (P<0.05) in positive control and UDM treatment groups, respectively. However, the mean reduction in plaque indices were found to be 2.03 (P<0.05) and 2.16 (P<0.05) in positive control and UDM groups, respectively. No significant difference was seen in both the parameters between the two groups.

Effect of fluoride therapy on remineralization and whiting of bleached enamel

Objective To evaluate the effect of fluorin dentifrice on the microhardness and whiting of dental enamel bleached with different concentration bleachers.Methods 6%carbamide peroxide(CP)and 30%CP were selected as bleachers.Twenty undefected molars were subjected to 3 groups.Groups A and B.which composed of 8 teeth each,were tested and group C was the control one.Group A(buccal surface)and group B(buccal surface)were treated with 6%CP.Group A (lingual surface)and group B(lingual surface)were treated with 30%CP.They were bleached 30 min every day for two weeks.The teeth in group B were brushed with fluorin dentifrice for 15 min after bleached every time and then all tested samples were kept in the artificial saliva at 37℃.Vickers microhardness of all teeth and color measurement of groups A and B were made before and at the end of bleaching procedure.Results The difference of microhardness values between the bleached and control samples were not statistically significant(P＞0.05).Brushed with fluorin agent significantly increased the hardness of enamelin group B(P＜0.05).The color change was not significant between bleached samples.Conclusion Using fluoride in the interphase of bleaching makes this therapy safer,and does not affect the whitening effect. Key words: Tooth bleaching; Fluoride; Microhardness; Color

Predictors and prevalence of nicotine use in females: A village-based community study

Background:Nicotine use and abuse is gaining increasing attention due to its negative and serious medical consequences. Multiple morbidities occur due to the intake of nicotine in various forms.Aims:To find the prevalence and type of nicotine use/abuse in females.Settings and Design:House to house survey in a village in Purvanchal, i.e. eastern part of Uttar Pradesh and bordering Bihar.Materials and Methods:Semi-structured performa was used to collect data; a house to house visit was made to collect data.Statistical Analysis:Simple percentages were calculated.Results:Tooth powder form of nicotine use is common and the need to address this problem is urgent.Conclusions:Widespread dissemination of knowledge and legislative measures have to be undertaken to stop the problem.

In vivo Evaluation of a Dentifrice Containing Eugenia uniflora L. Extract, on the Oral Health Indicators

Objetivo: Avaliar in vivo o efeito do uso de um dentifricio contendo o extrato hidroalcoolico do fruto maduro da Eugenia uniflora L. (Pitanga) sobre indicadores de saude bucal. Metodo: Foi realizado um ensaio clinico aleatorio, com uma amostra de 40 universitarios de 21 a 24 anos de idade, de ambos os generos. Os participantes foram divididos em dois grupos: G1- 20 universitarios que utilizaram o dentifricio a base do extrato hidroalcoolico do fruto maduro da Eugenia uniflora L. (Pitanga) a 3%; e G2 – 20 universitarios que utilizaram dentifricio da Colgate Total 12® (grupo controle). Os participantes usaram os dentifricios durante 22 dias consecutivos, tendo sido mensurados os indices de acumulo de biofilme (IHO-S), doenca gengival (ISG) e contagem de S. mutans salivar, nos tempos (t1) antes do uso, (t2) 15 dias de uso e (t3) 22 dias de uso dos produtos. Os dados foram analisados atraves do teste estatistico de t de Student. Resultados: As medias encontradas em t1, t2 e t3 para o G1 foram, respectivamente, IHO-S: 0,75/ 0,55/ 0,47; ISG: 2,96/ 1,86/1,35; UFC/mL: 1,69 x 104 / 1,45 x 104 / 1,33 x 104; para G2: IHO-S: 0,61/ 0,52/ 0,42; ISG: 1,94/ 1,62/ 1,20; UFC/mL: 1,84 x 104 / 1,47 x 104 / 1,36 x 104. Observou-se reducao estatisticamente significante entre os tempos t1 e t3 em ambos os grupo para os indices IHO-S, ISG e UFC/mL pelo teste t Student (p<0,01). Ao comparar os grupos G1 e G2, constatou-se diferenca estatistica apenas para o ISG (p<0,01). Conclusao: O dentifricio contendo o extrato hidroalcoolico do fruto maduro da Eugenia uniflora L. (Pitanga) possui eficacia semelhante ao dentifricio da Colgate Total 12® (grupo controle).

The history and global market of oral home-care products

This literature review reports the history and the current market of oral home-care products. It provides information extending from the products used by our ancestors to those currently available, as well as on the changes in the supply and consumption of these products. Although the scientific knowledge about oral diseases has improved greatly in recent years, our ancestors had already been concerned with cleaning their teeth. A variety of rudimentary products and devices were used since before recorded history, like chewing sticks, tree twigs, bird feathers, animal bones, tooth powder and home-made mouth rinses. Today, due to technological improvements of the cosmetic industry and market competition, home-use oral care products available in the marketplace offer a great variety of options. An increase in the consumption of oral care products has been observed in the last decades. Estimates show that Latin America observed a 12% increase in hygiene and beauty products sales between 2002 and 2003, whereas the observed global rate was approximately 2%. A significant increase in the per capita consumption of toothpaste, toothbrush, mouthrinse and dental floss has been estimated from 1992 to 2002, respectively at rates of 38.3%, 138.3%, 618.8% and 177.2%. Pertaining to this increased supply and consumption of oral care products, some related questions remain unanswered, like the occurrence of changes in disease behavior due to the use of new compounds, their actual efficacy and correct indications, and the extent of the benefits to oral health derived from consuming more products.

Evaluation of Some Biological Aspects of the Presence of Abrasive Silica and Thickening Silica in Basic Formulations of Dentifrices

El objetivo del estudio fue evaluar algunas caracteristicas biologicas y de toxicidad provenientes de las formulaciones basicas de dentifricos que contienen silice en su composicion y compararlos con dos dentifricos disponibles comercialmente que tambien presentan silice. El analisis hematologico no mostro diferencias entre los grupos evaluados. Los niveles de trombocitos presentados por los grupos fueron tambien normales. La transaminasa gluamico pirubica se mostro un aspecto normal en 5 de los grupos estudiados, asi como en el grupo control. La transaminasa glutamico oxaloacetica en uno de los grupos tuvo un pequeno incremento. En relacion a la orina, 4 grupos presentaron leucocitosis urinaria significativamente mayor que el grupo de control. La evaluacion histologica del higado, estomago, rinones y glandulas submandibulares se presento con aspecto normal, sin presencia de infiltrado inflamatorio.

Exalting the Weird

Exalting the Weird Joan Marcus (bio) We were in the back seat of our '73 Subaru, on our way to the community gardens with a trunk load of cow manure, when my little brother asked me to sock him in the arm. "Not hard," he insisted. "Like this. Three times on this side. One-two three. And four times over here." He took my wrist, made a fist of my left hand. "Come on—do it." I don't think my parents were listening. I don't think they knew that their eight-year-old had committed himself to living his life symmetrically, doing everything from chewing his food to caring for his hermit crab in two even sets, using each side of his body exactly four times. I'd just sucker-punched him in the upper arm. Now, despite the obvious risks, he wanted me to finish the job. I probably didn't hit him very hard. I remember thinking that I was showing remarkable restraint under the circumstances, that somebody ought to be praising me for my maturity. Mom was behind the wheel; Dad was trying to stretch out his lame leg on the cramped passenger side. The seats of the little stick shift were dingy, bone-colored vinyl. The trunk was loaded down with sacks of dried manure, rusty trowels, canvases on stretcher sticks, tubes of toxic oil paint in metal tackle boxes, and a big tin of turpentine, whose sharp, pitchy odor either neutralized the smell of cow manure or made it worse, I could never decide which. We were on our way to fertilize our garden plot, after which the four of us would sit down on foldout benches in the adjoining park and paint pond water and flowering trees. Then we'd go eat at a family restaurant in the affluent suburb where we rented our apartment cheaply for the sake of [End Page 43] the good schools. We'd walk in there with mud on our knees and under our nails, paint smears on the backs of our hands. I'd look around at the upscale families in their neat Sunday attire and feel a queer mix of embarrassment and defensive pride. It's the way I felt about my family most of the time. "Stop right there," my brother said as I finished pounding his left side. "Now get away from me or we'll have to start over." My parents were discussing the rattle in the Subaru's front end, or something uncouth my mother's mother had said 20 years earlier. I'm not sure what they would have done if they'd known what was going on. Probably nothing. I cannot imagine my parents—middle-aged bohemians who slept on an ancient horsehair mattress, brushed with tooth powder, and hung portraits of nude women on the walls of our apartment—being fazed by a quirky ritual or two. Anyway, this was 1976. Today, a boy like my brother, with numerous compulsions as well as social delays and difficulty in school, would be identified and tested. He'd be given a diagnosis, possibly treated with pharmaceuticals. Back then, for better or for worse, children were left to do their counting in peace. My daughter Anna is not a counter, but she does eat her kisses. She's been doing it religiously for two years, scooping the kiss from her cheek or the back of her head—wherever some adult has happened to plant it—tossing it in her mouth and chomping audibly. "The kisses go down to kiss world in your heart," she tells me. "They make you healthy." She tries to get me to eat mine as well. At night when I tuck her in, we'll go through the same routine each time. I'll kiss, she'll scoop and chomp, then blow me one herself. "Eat it," she'll say. "No thanks. I'm full." "Eat it, come on! Here . . ." She'll swipe at the air, grab the kiss, and try to feed it to me. "Just say 'gowp.' Please, just say it. Please!" This is serious business. According to Anna, who is nine, refusing to eat...

Properties of Hydroxyapatite from Bovine Teeth

The objective of this work was to study the production of hydroxyapatite (HA) from bovine teeth. Hydroxyapatite (HA) was produced from bovine teeth powder after calcination at 1150 °C. It was discovered that the sample preparation process influences its properties, so, crystal structure and thermal stability of HA were investigated. The X-Ray diffraction analysis (XRD) results confirmed that HA has been successfully produced. Fourier transform infrared spectroscopic (FT-IR) study confirmed the presence of hydroxyl (OH) and phosphate (PO4−3) functional groups. The scanning electronic microscope (SEM) was employed to identify the surface morphology of HA, and showed the nanoporous structure throughout the matrix. The sample constituents such as Ca, P, K … etc., and their values were determined by Energy dispersive X-Ray (EDX).

Phytochemical composition and in vitro antimicrobial activity of Anogeissus leiocarpus on some common oral pathogens

An assessment of phytochemical composition and antimicrobial activity of aqueous and ethanolic extract of root and stem of Anogeissus leiocarpus against clinical isolates of Candida albicans, Streptococcus mutans and Staphylococcus saprophyticus was carried out. Saponins, tannins and alkaloids were highly concentrated in the stem and root, with the later containing a significantly higher (P 0.05) on the inhibition of C. albicans while the length of incubation period had a significant effect (P<0.05) on its inhibition. The inhibitory effect produced by the ethanol extract of the root and stem on S. saprophyticus and S. mutans was significantly higher (P<0.05) than the effect produced by aqueous extract. On a general note, root extracts exhibited significant inhibition (P<0.05) compared to stem extracts. Results from this study strongly indicates that A. leiocarpus is a potential candidate plant whose extract could be incorporated into dentifrice. Key words: Anogeissus leiocarpus Candida albicans, chewing stick, dentifrice,oral pathogen, Staphylococcus saprophyticus, Streptococcus mutans.

A dentrifice assists breath odor improvement

A dentrifice assists breath odor improvement

In-depth, high-accuracy proteomics of sea urchin tooth organic matrix

BackgroundThe organic matrix contained in biominerals plays an important role in regulating mineralization and in determining biomineral properties. However, most components of biomineral matrices remain unknown at present. In sea urchin tooth, which is an important model for developmental biology and biomineralization, only few matrix components have been identified. The recent publication of the Strongylocentrotus purpuratus genome sequence rendered possible not only the identification of genes potentially coding for matrix proteins, but also the direct identification of proteins contained in matrices of skeletal elements by in-depth, high-accuracy proteomic analysis.ResultsWe identified 138 proteins in the matrix of tooth powder. Only 56 of these proteins were previously identified in the matrices of test (shell) and spine. Among the novel components was an interesting group of five proteins containing alanine- and proline-rich neutral or basic motifs separated by acidic glycine-rich motifs. In addition, four of the five proteins contained either one or two predicted Kazal protease inhibitor domains. The major components of tooth matrix were however largely identical to the set of spicule matrix proteins and MSP130-related proteins identified in test (shell) and spine matrix. Comparison of the matrices of crushed teeth to intact teeth revealed a marked dilution of known intracrystalline matrix proteins and a concomitant increase in some intracellular proteins.ConclusionThis report presents the most comprehensive list of sea urchin tooth matrix proteins available at present. The complex mixture of proteins identified may reflect many different aspects of the mineralization process. A comparison between intact tooth matrix, presumably containing odontoblast remnants, and crushed tooth matrix served to differentiate between matrix components and possible contributions of cellular remnants. Because LC-MS/MS-based methods directly measures peptides our results validate many predicted genes and confirm the existence of the corresponding proteins. Knowledge of the components of this model system may stimulate further experiments aiming at the elucidation of structure, function, and interaction of biomineral matrix components.

ORAL HEALTH STATUS

Oral health, although an important aspectof the general health, unfortunately is an ignored aspect, by almost all population strata. Poverty, lack of education andlack of public awareness programs add to the dilemma. Aims &amp; Objectives: Evaluation of the oral health, toothcleaning devices and at the top, awareness about such devices, among the most ignored and deprived group ofpopulation. The evaluation of oral hygiene of the poor railway coolies, was the objective of this study. Materials &amp;Methods: A very simple proforma in Urdu was designed. It included some questions about personal data, tooth cleaninghabits, the devices used for the purpose and the reasons for not using the tooth brush. DMFT and the periodontalconditions were then noted in the same proforma. About 120 coolies agreed to participate in the study. Examinationwas made in day light with a mirror and a blunt probe. Results: The age varied from 15-60 years. There was about100% periodontal involvements, while DMFT increased with age (0.75 to 12.5). About 49.5 % used brush, 41.5%miswak, 5.3% tooth powder, while 3.5 % did not use any of these. Tooth brush users had least DMFT while powderusers had the maximum. Of the non brush users 50.9% of people could not buy brush, 33.9% did not like it while15.09% were ignorant of it. Conclusion: Poverty, illiteracy and lack of dental awareness are the major causes of dental/ periodontal problems. The tooth brushing techniques must be taught to the public.

Effect of a whitening dentifrice on removing stains from tooth surfaces: a clinical study

目的 测试一种增白牙膏用于减少牙面外源性色素的效果. 方法 研究对象121例,年龄21～57岁.实验组60例,对照组61例,两组年龄和性别分布差异无显著性.采用双盲法两组平行设计,根据Lobene色斑指数(LSI)和性别均衡分为两组,随机分配使用实验牙膏或对照牙膏.实验组牙膏含3 %植酸钠和1.3 %焦磷酸钠,对照组牙膏不含相应成分.临床检查分别在基线、3周和6周后进行,由同一人测定LSI.问卷询问刷牙情况. 结果 基线检查、实验3周和6周后实验组LSI分别为3.00、2.16和1.47, 对照组分别为3.10、3.08和2.18.基线检查两组LSI差别无显著性意义, 实验3周和6周后两组LSI比较差异均有显著性意义. 实验组LSI在3周和6周后分别比基线时降低28 %和51 %. 结论含3 %植酸钠和1.3 %焦磷酸钠牙膏能有效减少牙面色素,效果随使用时间而增强。

Tobacco‐specific nitrosamines in smokeless tobacco products marketed in India

Smokeless tobacco products are a known cause of oral cancer in India. Carcinogenic tobacco-specific nitrosamines in these products are believed to be at least partially responsible for cancer induction, but there have been no recent analyses of their amounts. We quantified levels of 4 tobacco-specific nitrosamines, N'-nitrosonornicotine (NNN), N'-nitrosoanatabine (NAT), N'-nitrosoanabasine (NAB) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), in 32 products marketed currently in India. Levels of nitrate, nitrite and nicotine were also determined. The highest levels of tobacco-specific nitrosamines were found in certain brands of khaini, zarda and other smokeless tobacco products. Concentrations of NNN and NNK in these products ranged from 1.74-76.9 and 0.08-28.4 microg/g, respectively. Levels of tobacco-specific nitrosamines in gutka were generally somewhat lower than in these products, but still considerably higher than nitrosamine levels in food. Tobacco-specific nitrosamines were rarely detected in supari, which does not contain tobacco, or in tooth powders. The results of our study demonstrate that exposure to substantial amounts of carcinogenic tobacco-specific nitrosamines through use of smokeless tobacco products remains a major problem in India.

Parâmetros bioquímicos e microbiológicos e suas relações com a experiência de cárie em adolescentes sadios

OBJETIVOS: verificar a relação da experiência da doença cárie com o grau de ocorrência de Streptococcus mutans, o fluxo salivar e a capacidade tampão da saliva em 111 adolescentes sadios atendidos no Setor de Puericultura do Hospital das Clínicas de Pernambuco MÉTODOS: realizou-se o exame intraoral e o preenchimento de ficha clínica, para determinação do índice CPO-S (Número de superfícies dentárias cariadas, perdidas ou com extração indicada e restauradas). Em seguida coletou-se a saliva para determinação do fluxo salivar e da capacidade tampão. A raspagem dos dentes anteriores foi realizada para quantificação de Streptococcus mutans presente na placa bacteriana. RESULTADOS: a população avaliada foi predominantemente de baixa atividade de cárie, apresentando capacidade tampão da saliva normal e fluxo salivar deficiente. O número de S. mutans da placa bacteriana foi superior a 105 UFC/mg, na maioria da população estudada. CONCLUSÕES: a atividade de cárie foi inversamente proporcional à capacidade tampão e diretamente proporcional a presença de Streptococcus mutans presentes na placa bacteriana. A baixa atividade de cárie na população estudada pode ser atribuída à boa condição do meio bucal promovida pelo número de escovações diárias com dentufícios fluoretados.

Pulsed laser deposition of bioceramic thin films from human tooth

The possibility of pulsed laser deposition of thin films from human tooth targets was studied, since bioceramic thin film coatings on dental and orthopaedic implants may have their surface characteristics for biointegration improved. Pellets were pressed from tooth powder at different pressures and ablated with pulses of ArF (λ=193 nm) and KrF (λ=248 nm) excimer lasers with fluences up to 4.5 and 12 J/cm2, respectively. Layers were deposited onto heated (250 °C) titanium, glass, and KBr substrates. The increase of the pellet pressing pressure from 150 to 450 MPa enhanced the roughness of the deposited films. IR spectroscopic measurements showed that the chemical composition of the films were close to that of original tooth material under appropriate fluence. The adherence of the layers to the substrates could be significantly improved by post annealing at 550 °C.

Popularizing the toothbrush.

TOOTH DECAY IN EUROPE and America is believed to have increased dramatically during the 19th century as a result of the growing general availability of refined flour and sugar in industrially processed foods. By the end of the century, surveys showed that between 90% and 95% of all children had untreated decaying teeth.1 Most children saw a dentist—if at all—only for emergency extractions. In 1910, local dentists examined 447 schoolchildren in Elmira, NY, and reported that only 22 of the children had teeth “in perfect condition.”2 The other children collectively had 2063 cavities and 617 “teeth and roots needing extraction.” Similar results were being reported from other towns and cities. Between 1910 and 1916, philanthropists built and endowed the first free and reduced-fee clinics for children and established the first schools for dental hygienists in Rochester, NY, Bridgeport, Conn, and Boston, Mass. By the 1920s, almost all American cities had free or reduced-fee clinics, and by 1950, such clinics were providing almost half of all oral health services delivered to children. Members of local dental associations staffed some clinics on a volunteer basis together with young dental school graduates seeking clinical experience. During the Great Depression, federal funds helped local and state governments to hire unemployed dentists. The first dental hygienists entered the schools to clean children’s teeth and teach them how to use toothbrushes.3 Some cities provided each child with a free toothbrush and tooth powder, while others sold them at 2 or 3 cents each. As in England, where toothbrushes were provided to all servicemen during World War I, this helped establish and extend the use of the toothbrush in working-class families.4 American schools also adopted the “toothbrush clubs” and “toothbrush drills” begun in England.5 This image, from a New York school, shows children demonstrating their newly acquired skills of toothbrushing.

Smokeless tobacco and health in India and South Asia.

South Asia is a major producer and net exporter of tobacco. Over one-third of tobacco consumed regionally is smokeless. Traditional forms like betel quid, tobacco with lime and tobacco tooth powder are commonly used and the use of new products is increasing, not only among men but also among children, teenagers, women of reproductive age, medical and dental students and in the South Asian diaspora. Smokeless tobacco users studied prospectively in India had age-adjusted relative risks for premature mortality of 1.2-1.96 (men) and 1.3 (women). Current male chewers of betel quid with tobacco in case-control studies in India had relative risks of oral cancer varying between 1.8-5.8 and relative risks for oesophageal cancer of 2.1-3.2. Oral submucous fibrosis is increasing due to the use of processed areca nut products, many containing tobacco. Pregnant women in India who used smokeless tobacco have a threefold increased risk of stillbirth and a two- to threefold increased risk of having a low birthweight infant. In recent years, several states in India have banned the sale, manufacture and storage of gutka, a smokeless tobacco product containing areca nut. In May 2003 in India, the Tobacco Products Bill 2001 was enacted to regulate the promotion and sale of all tobacco products. In two large-scale educational interventions in India, sizable proportions of tobacco users quit during 5-10 years of follow-up and incidence rates of oral leukoplakia measured in one study fell in the intervention cohort. Tobacco education must be imparted through schools, existing government health programmes and hospital outreach programmes.