Paan Chewing Research Articles

BETEL QUID (PAAN) CHEWING AND ORAL EPITHELIAL DYSPLASIA IN LAHORE: AN ANALYTICAL STUDY

<h3>Background</h3> Betel quid (locally–called "paan") is widely chewed habitually in Pakistan and South and Southeast Asia. It is hand-rolled at paan stalls by smearing a betel leaf (from Piper betel) with slaked lime, catech paste, chopped areca nut, and a variety of condiments and flavoring agents. Paan is considered a group 1 carcinogen for humans by the International Association for Research on Cancer. It is one of the major causes of oral cancer in these regions. The reactive oxygen species released during chewing can initiate carcinogenesis by inducing mutagenesis. <h3>Objective</h3> The present study was performed to determine the frequency of epithelial dysplasia among habitual paan chewers. It also calculated the association between the quantity and quality of paan chewing and the severity of oral epithelial dysplasia. <h3>Methods</h3> This was a cross-sectional analytical study. Cytological smears from 300 habitual paan chewers were collected. After fixation with alcohol, smears were then air dried and stained with hematoxylin, eosin, Giemsa, and Pap stains. The material was then examined under an optical microscope. Epithelial dysplasia was identified and graded using the method of Speight. <h3>Results</h3> Epithelial dysplasia was observed in 57.7% of the habitual paan chewers, which was significantly associated with the number of paans consumed per day as well as duration of paan consumption. These variables were positively correlated with grading of epithelial dysplasia. <h3>Conclusions</h3> The study concludes that epithelial dysplasia was present in the majority of habitual paan chewers in Lahore city. The correlation between the amount of betel quid chewing and the severity of epithelial dysplasia means the effect is dose-dependent.

Assessment of immunohistochemical expression of p16 in head and neck squamous cell carcinoma and their correlation with clinicopathological parameters.

Introduction:Oral squamous cell carcinoma is a major cause of death throughout the developed world. It is associated with tobacco chewing, paan chewing and alcohol consumption. Human papillomavirus (HPV) type 16 has also been suggested to play a role in the etiology of head-and-neck squamous cell carcinoma (HNSCC). p16 expression is now being used as a surrogate marker of HPV infection in squamous cell carcinoma.Materials and Methods:In this cross-sectional observational study, a total of 100 cases of HNSCC were taken. p16 expression was determined by immunohistochemical (IHC) staining and correlated with clinicopathological parameters. The obtained results were analyzed and evaluated using Chi-square test, value of P < 0.05 was taken significant.Results:P16 was positive in 60% of cases. A statistically significant direct association was observed between p16 with age, site of the tumor, abnormal sexual habits and lymph node involvement.Conclusion:IHC expression of p16 can be used as a surrogate marker of HPV. Study of p16 expression may provide clinicians with more exact information in order to evaluate tumor aggressiveness, treatment modalities and can provide support for vaccination program in a high-risk group.

A study on the effect of smokeless tobacco on oral cancer done in a Tertiary Care Hospital in Southern India

Background: Oral cancer is a major problem in India. The incidence is 10.1 cases per lac for males and 4.3 per lac in females. The risk factors for the development of oral cancers include smokeless tobacco. Objectives: The objectives of this study were to find the association between smokeless tobacco and oral cancer. Materials and Methods: A case–control study done at a tertiary care hospital, Bengaluru, India. Study subjects included new cases of oral cancer attending the hospital during the study period and equal number controls. Data collection was done by interview method. Results: Tobacco chewing with an odds ratio (OR) of 2.3 was significantly associated with the risk of oral cancer. Paan chewing with tobacco showed greater risk than paan chewing without tobacco. Chewers who started the habit before the age of 25 years showed an higher risk with OR of 4.5. An increasing trend in oral cancer risk with increase in the frequency and duration of paan chewing was found. The risk was 30 times higher for those with quid retention as compared to never chewers. Duration of quid retention for ≤5 h showed 29.6 times higher risk and for more than 5 h showed 33.3 times higher risk, as compared to those without quid retention. Conclusion: Smokeless tobacco shows higher risk for oral cancer. There is a great need to augment tobacco control measures and educate the public about harmful effects of smokeless tobacco.

Prevalence, knowledge, and attitude of gutkha chewing among school children of Arsikere, India.

To assess the prevalence, knowledge, and attitude of gutkha chewing among school children of Arsikere, India. Two thousand school children aged between 10 and 15 years were examined with individual interviews along with a questionnaire to evaluate the presence of betel nut and paan chewing habit in various forms. Children of both sexes were included in the study. Responses of all study population and the association between dependent and explanatory variables were assessed using Chi-square test. Twenty-eight percent of children had the habit of gutkha chewing, more among boys than girls at the ratio of 4:1 which was statistically significant (P < 0.05). The habit was more common in government school children than private school children; over 70% of children believed that it is a bad habit, but half the study population was not aware of side effects; 30% of children believed that it is not a bad habit and has no side effects. There is a higher prevalence of gutkha chewing habit in school children who are not aware of the side effects. Children themselves purchase the gutkha and betel nut sachets, hence the Government should ban the sale and purchase by children.

Relationship between Parental Bonding and Tobacco Specific Practices as Predictors of Tobacco Usage in Adults.

Parents influence their child's conduct and adolescence hostility either directly or indirectly. Similarly children can acquire a particular behaviour by observing and intentionally imitating their parents in order to simply copy them without understanding the positive or negative outcome. To assess and compare the association between parental tobacco usage and parental bonding with participants tobacco usage habits. A descriptive cross-sectional study was conducted among 130 adults. Information pertaining to demographics, parental bonding (using parental bonding index) and behavioural habits (e.g., smoking, alcohol) of both participants and their parents was collected with the use of a questionnaire-based interview. Tobacco usage was measured as categorical variable as ever chewer and never chewer. Chi-square test, independent sample t-test, multinomial logistic regression and rotated factor loadings was used to analyse the data. Majority of the participants were males with a mean age of 30.4±8.5 years. Tobacco use was prevalent among less educated males. Parental smokeless tobacco use, paternal alcohol and maternal paan chewing was significantly associated with participants adverse habits. Multinomial logistic regression showed a significant association between parental and participant's tobacco usage. Perceived parental bonding were also significantly associated with participant's tobacco usage habit. Parental bonding measures and tobacco usage was significantly associated with the participant's tobacco use. Hence, interventional and educational efforts to weaken intergenerational influences should target parents. In addition to parents, the smoking behaviour of adults should also be targeted for prevention efforts.

Cervical Cancer – Bench to Bedside

AbstractCervical cancer is the second most common cancer in Indian women and 4th most common cancer in women world-wide. Over nearly two decades, we have carried out epidemiological and molecular studies in cervical cancer, with an intent to identify potential early diagnostic biomarkers, predictive and prognostic markers, develop newer therapies against cervical cancer and identify potential new targets for therapy.Our studies had identified 14 high risk and 10 low risk human papilloma virus (HPV) in our cervical cancer patients for the first time; had identified life style related cofactors in the development of cervical cancer (paan chewing, parity, early age at first sexual intercourse and first childbirth, husband with two or more sexual partners). We have developed a p16 ELISA kit for cervical cancer screening for use at point of care like PHC's; identified a 7 gene signature which help identify patients who can be treated with radiotherapy alone; identified potential prognostic markers for use in the clinic; developed the country's first Dendritic cell vaccine therapy for cervical cancer and completed the phase 1 study; have identified newer potential therapeutic targets for treatment of cervical cancer.

Oral Health Status and Treatment Needs of Paniya Tribes in Kerala.

The tribal communities of Kerala have been largely left out of the gains of the Kerala model of development. The study was aimed to obtain baseline data of oral health status and treatment needs of Paniyas, in Kerala, India. A descriptive population based survey of adult Paniya belonging to index age groups of 35-44 years and 65-74 years was conducted. The study population comprised of 420 subjects drawn from three talukas by stratified cluster sampling. Modified version of WHO Oral Health Assessment Form (1997) was used to assess the oral health status. Caries prevalence was 40%. The mean DMFT in the 35-44 years age group was 1.52±1.95 and in 65-74 age group it was 18.47 ± 13.10. Oral mucosal lesions were seen in 4.52% and 76.9% had periodontal disease. Tooth brushing was reported by 55.5% of the subjects. Paan chewing, with tobacco or without tobacco, habit was reported by 89.3%. Bi-variate analyses between the CPI scores and age groups showed high statistical significance. The maximum mean treatment requirement was for extraction (1.37 ± 4.01) and was observed in 65-74 age groups. The lack of basic oral health care access is important for high oral disease burden in these populations. Efforts are to be done for basic oral health care facility to these marginal populations.

Assessment and clinicopathological correlation of p16 expression in head and neck squamous cell carcinoma

Oral squamous cell carcinoma is a major cause of death throughout the developed world. It is associated with smoking and alcohol consumption. Human papillomavirus (HPV) type 16 has also been suggested to play a role in etiology of head and neck squamous cell carcinoma (HNSCC). p16 expression is now being used as a surrogate marker of HPV infection in squamous cell carcinoma and provides important prognostic information and future therapy planning. In this prospective study, total of 75 cases of HNSCC were taken. Tumor grade was determined according to World Health Organization (WHO) criteria. p16 expression was determined by immunohistochemical staining. The obtained results were analyzed and evaluated using Chi-square test (Statistical Package for Social Sciences (SPSS) version 20), value of P <0.05 was taken significant. Out of 75 cases, 78.7% cases were positive for p16 (inclusive of all grades), while 21.3% cases were negative. Expression of p16 was higher in nonsmokers and nonalcohol consumers and significantly associated with paan chewing habit. No significant correlation was seen with history of abnormal sexual habits, but p16 expression was significantly correlated in cases with multiple sexual partners (P = 0.003), with increasing histological grade (P = 0.045) and in cases with lymph node metastasis (P = 0.03). As HPV integration with transcription of viral oncoprotein induces overexpression of p16, immunohistochemical expression of p16 can be used as a surrogate marker of HPV. This approach can be implemented in diagnostic laboratories and can provide support for vaccination program in high risk group.

No role for human papillomavirus infection in oral cancers in a region in southern India.

Oral cancer is a major public health issue in India with ∼ 77,000 new cases and 52,000 deaths yearly. Paan chewing, tobacco and alcohol use are strong risk factors for this cancer in India. Human papillomaviruses (HPVs) are also related to a subset of head and neck cancers (HNCs). We examined the association between oral HPV and oral cancer in a sample of Indian subjects participating in a hospital-based case-control study. We recruited incident oral cancer cases (N = 350) and controls frequency-matched by age and sex (N = 371) from two main referral hospitals in Kerala, South India. Sociodemographic and behavioral data were collected by interviews. Epithelial cells were sampled using Oral CDx® brushes from the oral cancer site and the normal mucosa. Detection and genotyping of 36 HPV genotypes were done using a polymerase chain reaction protocol. Data collection procedures were performed by qualified dentists via a detailed protocol with strict quality control, including independent HPV testing in India and Canada. HPV DNA was detected in none of the cases or controls. Associations between oral cancer and risk factors usually associated with HPV infection, such as oral sex and number of lifetime sexual partners, were examined by logistic regression and were not associated with oral cancer. Lack of a role for HPV infection in this study may reflect cultural or religious characteristics specific to this region in India that are not conducive to oral HPV transmission. A nationwide representative prevalence study is needed to investigate HPV prevalence variability among Indian regions.

Maternal and paternal contribution to intergenerational psychosocial transmission of paan chewing.

Paan chewing is a recognized risk factor for oral cancer in the Asian population. However, there is currently little evidence about the intergenerational psychosocial transmission of paan chewing in South Indian families. We investigated the association between parental and participant's paan chewing in a South Indian population. A subset of data was drawn from a hospital-based case-control study on oral cancer, the HeNCe Life study, conducted at Government Dental and Medical Colleges of Kozhikode, South India. Analyses were based on 371 noncancer control participants having diseases unrelated to known risk factors for oral cancer. Demographics, behavioral habits (e.g., paan chewing, smoking), and indicators of socioeconomic position (SEP) of both participants and their parents were collected with the use of a questionnaire-based interview and a life grid technique. Unconditional logistic regression assessed odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between parental and participant's paan chewing, adjusted for confounders. Over half of the participants were males (55.2%), and the mean age of participants was 59 (SD = 12) years. After adjusting for age, religion, parents' SEP, parents' education, smoking and alcohol consumption, and perceived parenting behavior, we observed that maternal paan chewing and paternal paan chewing were significantly associated with the participant's paan chewing ([OR = 2.40, 95% CI = 1.11-5.21] and [OR = 3.05, 95% CI = 1.48-6.27], respectively). Intergenerational psychosocial transmission of the habit of paan chewing could occur through shared sociocultural or environmental factors.

Various terminologies associated with areca nut and tobacco chewing: A review.

Globally, arecanut and tobacco are among the most common addictions. Tobacco and arecanut alone or in combination are practiced in different regions in various forms. Subsequently, oral mucosal lesions also show marked variations in their clinical as well as histopathological appearance. However, it has been found that there is no uniformity and awareness while reporting these habits. Various terminologies used by investigators like ‘betel chewing’,‘betel quid chewing’,‘betel nut chewing’,‘betel nut habit’,‘tobacco chewing’and ‘paan chewing’ clearly indicate that there is lack of knowledge and lots of confusion about the exact terminology and content of the habit. If the health promotion initiatives are to be considered, a thorough knowledge of composition and way of practicing the habit is essential. In this article we reviewed composition and various terminologies associated with areca nut and tobacco habits in an effort to clearly delineate various habits.

The expression of retinoblastoma tumor suppressor protein in oral cancers and precancers: A clinicopathological study.

Background:The role of retinoblastoma (Rb) protein in cell cycle regulation prompted us to take up this study with the aim of assessing its role in the progression of oral cancer and to correlate with various clinicopathological parameters, including habits such as smoking, Paan chewing, and alcoholism.Materials and Methods:This observational study included surgical specimens from 10 apparently normal oral mucosa, 14 oral reactive lesions (ORL), 29 precancerous lesions and 43 oral cancers. The expression of Rb protein in tissue samples were evaluated by immunohistochemistry and correlated with clinicopathological data. The percentage and mean expression of Rb protein were statistically analyzed using Student's t-test and P < 0.05 was considered as statistically significant difference.Results:The expression of Rb protein was found to increase from normal, ORL, precancerous lesions to cancers. A consistently high expression of Rb protein was seen in oral cancers, with an increase in well-differentiated and moderately differentiated tumors. Patients with combined habits of Paan chewing, smoking, and alcohol consumption had a higher expression compared with those without habits.Conclusion:Within the limitations of this study, it seems that overexpression of Rb protein noted in oral cancer, with an increase in well and moderately differentiated tumors suggest a possible role of Rb in differentiation. The high expression of Rb in patients with combined habits of Paan chewing, smoking and alcohol consumption indicates that Rb pathway may be altered in habit-related oral malignancies.

Comparison of various risk indicators among patients with chronic and aggressive periodontitis in davangere population.

Background:The aim of the present study was to compare various risk indicators of chronic periodontitis (CP) and aggressive periodontitis (AP) among patients of Davangere population.Materials and Methods:Totally, 89 CP and 90 AP patients were selected from outpatient Department of Periodontics, College of Dental Sciences, Davangere. Various clinical parameters proven to be risk indicators were determined for each patient such as age, gender, occupation, oral hygiene habits, personal habits, income, level of education, place of residence, frequency of dental visits, various oral hygiene indices, gingival status, wasting diseases, malocclusion, laboratory investigations, and the results were subjected to statistical analysis.Results:This study demonstrated that AP is manifested early in life in susceptible individuals. Proven risk indicators for AP and CP in the present study population included young age, place of residence, income and education levels, frequency of dental visits. Patients with AP had better oral hygiene habits and oral hygiene index results than patients with CP. Paan chewing and smoking could be considered as risk factors, both in CP and AP cases. The similar association of plaque scores but higher bleeding tendency in AP patients supported the fact of higher susceptibility of AP patients to periodontal breakdown. Malocclusion being present in the majority of cases could also be put forth as a risk factor for AP and CP.Conclusion:This study identifies the different risk indicators for CP and AP and demonstrates the need for constructing nationwide oral health promotion programs to improve the level of oral health awareness and standards in Indian population.

Growing Burden of Stroke in Pakistan: A Review of Progress and Limitations

Stroke rates in middle-aged people are five to ten times higher in Pakistan, India, Russia, China, and Brazil, compared with the United Kingdom or United States. South Asia is home to 20% of the world's population and has one of the highest burdens of cardiovascular disease in the world. With an aging population, there is an expected increase in the number of stroke cases and a corresponding increase in the burden of stroke in developing countries including South Asian countries like Pakistan. Limited data from prior studies in developing countries indicate that stroke epidemiology differs between these and Western countries. These differences include a higher incidence of stroke at younger ages, a higher prevalence of hemorrhagic stroke, and higher age-specific prevalence rates of stroke in women. The reasons for these differences in stroke epidemiology in developing countries are not clear. This may be explained by higher prevalence of established stroke risk factors, or potential nontraditional risk factors such as water pipe smoking, use of daldaghee or naswaar, and paan chewing; hepatitis and rheumatic heart disease may also contribute to these differences. Acute and long-term stroke treatment has shown limited progress in Pakistan like other developing countries because of poor awareness of patients and general physician on stroke symptomatology, management of stroke risk factors, lack of specialized stroke units in the country, very low utilization of thrombolytic therapy because of financial constraints and, above all, poor knowledge of physicians on the role of rehabilitation and its different aspects in the management of post stroke disability.

Increased secretion of tissue inhibitors of metalloproteinases 1 and 2 (TIMPs ‐1 and ‐2) in fibroblasts are early indictors of oral sub‐mucous fibrosis and ageing

Oral submucous fibrosis (OSMF) is associated with paan chewing, altered collagen metabolism, inflammation and the upregulation of numerous cytokines. OSMF fibroblasts accumulate senescent cells at an increased rate because of increased reactive oxygen species production and DNA double-strand breaks (DDBs), generated intrinsically by damaged mitochondria. This results in a reduced replicative lifespan. However, it is still unclear which other changes are intrinsic to the fibroblasts and associated with OSMF rather than the paan chewing habit or the OSMF environment. Both the oral epithelium and the mesenchyme have elevated levels of TGF-β(1) in OSMF in vivo. However, in cultured fibroblasts, secreted levels of TGF-β(1,) other cytokines and the matrix metalloproteinases 1 and 2 showed no association with OSMF. In contrast, the tissue inhibitors of metalloproteinases, TIMP-1 and TIMP-2, were increased in 10/11 OSMF fibroblast cultures relative to normal and non-diseased paan user controls. OSMF fibroblast collagen levels were normal. TIMP levels correlated with replicative lifespan of the cultures but not with the presence of senescent cells, as senescent cell depletion in OSMF fibroblast cultures did not result in a reduction in either TIMP-1 or TIMP-2. However, the introduction of unrepairable DDBs into normal oral fibroblasts by ionizing radiation increased TIMP-1 and TIMP-2 secretion by two-fold and seven-fold, respectively, within 5 days, replicating early senescence and the elevation seen in OSMF cultures. Therefore, increased fibroblast TIMP-1/2 levels could be early disease-specific markers of OSMF onset, DDBs and ageing and may have clinical significance, as OSMF can be reversed in its early stages.

Areca nut (betel nut) chewing: a popular Indian cultural practice and its mucosal implications

Areca nut, a seed of the tropical palm, Areca catechu, is grown and chewed in many Asian countries, including India, Pakistan, Bangladesh, Myanmar, Cambodia, Indonesia, the Philippines, and Vietnam. India is documented as the biggest consumer of areca nut. In Hindi, the national language of India, this nut is called ‘‘supari’’. Areca nut (also, wrongly, called ‘‘betel’’ nut) is consumed in many forms. It is consumed in its raw form after being cut into small pieces with a special cutter, either at home or in shops and stalls that sell it (Fig. 1). However, the most popular method of consumption involves wrapping pieces of areca nut in a leaf (betel leaf or ‘‘paan’’) along with catechu (powdered bark of a tree), slaked lime, and other spices and condiments, including saffron, clove, cardamom, and aniseed, with or without tobacco, and then chewing it rather like a quid of tobacco (Fig. 2). The betel leaf is heart-shaped and comes from the vine, Piper betle. Areca nut with or without tobacco can also be chewed as ‘‘gutkha’’ (also known as ‘‘paan malsala’’ or ‘‘mawa’’), a form that has become very popular. It is commercially available as small pieces of areca nut treated with spices and condiments, with or without tobacco, and packed in small polythene sachets (Fig. 3). The cultural practice of paan chewing is documented in Indian mythology and dates back 5000 years to the scripture Shrimad Bhagvatam, one of the oldest of the Hindu scriptures, which describes Lord Krishna as chewing paan. It is believed that Queen Noorjahan of the Mughal dynasty popularized the habit of paan chewing by adding areca nut and smearing it with slaked lime and catechu liquid to impart a red look to the lips and tongue. Paan was also believed to be a mouth freshener and a digestive, a belief that is prevalent even today. The aroma of the ingredients of paan with areca nut can be so overpowering that it can mask the smell of alcohol and other noxious substances. Paan and its ingredients are recognized by Ayurvedic physicians as an antiseptic, an aphrodisiac, a cure for headaches, joint pains, constipation, and congestion, an antihelminthic, and even a lactation agent when used topically. In the past, paan had distinctly sexual associations, partly as a result of its breath freshening properties, and was frequently consumed by courting couples. The areca nut was perceived to represent the male and the betel leaf the female principle. Along with the areca nut, paan is considered auspicious 229 Figure 2 Prepared paan with paan leaves, catechu and lime Figure 1 Areca nut and cutter

Tobacco dependence in a UK Bangladeshi female population: a cross-sectional study.

The objective of this study was to establish the prevalence of paan chewing with tobacco by UK-resident Bangladeshi women and the extent to which they manifest nicotine dependence. The cross-sectional study was conducted at two local authority housing estates in Tower Hamlets, London. Participants were 242 Bangladeshi women, selected at random from the current electoral register, who supplied a saliva sample for cotinine and an expired air sample for carbon monoxide analysis. They also participated in a structured interview assessing knowledge, attitudes and behavior with respect to tobacco use. Main outcome measures were data on tobacco use and nicotine dependence, assessed by questionnaire and intake measures. The population prevalence of chewing paan quid with tobacco was 48.5% (95% confidence interval, CI 42.01-54.98%), while 4% (95% CI 2.05-7.41%) smoked cigarettes. Higher mean salivary cotinine scores were associated with greater consumption frequency and use of leaf tobacco in the quid. Above-average nicotine dependence was associated with chewing paan quid with tobacco within 1 h of waking (OR = 4.02, p = 0.03, 95% CI 1.08-14.94) and the use of leaf rather than processed tobacco (OR = 3.91, p = 0.025, 95% CI 1.19-12.81). Smoking prevalence is low, but the prevalence of paan quid with tobacco chewing is high in this sample of Bangladeshi women. Cotinine concentration appears to be a reliable indicator of levels of nicotine dependence among paan quid with tobacco chewers. Questionnaire-derived items can be used to identify those with above-average levels of nicotine dependence.

Oral cancer in southern India: the influence of smoking, drinking, paan-chewing and oral hygiene.

Between 1996 and 1999 we carried out a case-control study in 3 areas in Southern India (Bangalore, Madras and Trivandrum) including 591 incident cases of cancer of the oral cavity (282 women) and 582 hospital controls (290 women), frequency-matched with cases by age and gender. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from unconditional multiple logistic regressions and adjusted for age, gender, center, education, chewing habit and (men only) smoking and drinking habits. Low educational attainment, occupation as a farmer or manual worker and various indicators of poor oral hygiene were associated with significantly increased risk. An OR of 2.5 (95% CI 1.4-4.4) was found in men for smoking > or = 20 bidi or equivalents versus 0/day. The OR for alcohol drinking was 2.2 (95% CI 1.4-3.3). The OR for paan chewing was more elevated among women (OR 42; 95% CI 24-76) than among men (OR 5.1; 95% CI 3.4-7.8). A similar OR was found among chewers of paan with (OR 6.1 in men and 46 in women) and without tobacco (OR 4.2 in men and 16.4 in women). Among men, 35% of oral cancer is attributable to the combination of smoking and alcohol drinking and 49% to pan-tobacco chewing. Among women, chewing and poor oral hygiene explained 95% of oral cancer.

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

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

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

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