Gloria C. Mejia

Epidemiology of Oral Cancer in Asia in the Past Decade- An Update (2000-2012)

The prevalence of oral cancers (OC) is high in Asian countries, especially in South and Southeast Asia. Asian distinct cultural practices such as betel-quid chewing, and varying patterns of tobacco and alcohol use are important risk factors that predispose to cancer of the oral cavity. The aim of this review is to provide an update on epidemiology of OC between 2000 and 2012. A literature search for this review was conducted on Medline for articles on OC from Asian countries. Some of the articles were also hand searched using Google. High incidence rates were reported from developing nations like India, Pakistan, Bangladesh, Taiwan and Sri Lanka. While an increasing trend has been observed in Pakistan, Taiwan and Thailand, a decreasing trend is seen in Philippines and Sri Lanka. The mean age of occurrence of cancer in different parts of oral cavity is usually between 51-55 years in most countries. The tongue is the leading site among oral cancers in India. The next most common sites in Asian countries include the buccal mucosa and gingiva. The 5 year survival rate has been low for OC, despite improvements in diagnosis and treatment. Tobacco chewing, smoking and alcohol are the main reasons for the increasing incidence rates. Low socioeconomic status and diet low in nutritional value lacking vegetables and fruits contribute towards the risk. In addition, viral infections, such as HPV and poor oral hygiene, are other important risk factors. Hence, it is important to control OC by screening for early diagnosis and controlling tobacco and alcohol use. It is also necessary to have cancer surveillance at the national-level to collect and utilise data for cancer prevention and control programs.

Construct Validity of Locker’s Global Oral Health Item

With clinical oral examinations not always possible in health surveys, researchers may instead be invited to add questions to a wider health survey. In such situations, an item is needed which adequately represents both clinical and self-reported oral health. This study investigated the clinical validity of Locker’s global self-reported oral health item among young middle-aged adults in populations in New Zealand and Australia. Clinical examination and self-report data (including the OHIP-14) were obtained from recent national dental surveys in NZ and Australia, and from age-38 assessments in the Dunedin Multidisciplinary Health and Development Study. National dataset analyses involved 35- to 44-year-olds. Caries and tooth-loss experience showed mostly consistent, statistically significant gradients across the Locker item responses; those responding ‘Excellent’ had the lowest scores, and those responding ‘Poor’ the highest. Periodontitis experience gradients in the NZ national sample were mainly as hypothesized; those rating their oral health as ‘Poor’ had the highest disease experience. OHIP-14 gradients across the Locker item responses were consistent and as hypothesized. The proportion of disease in the population borne by those ‘Fair’ or ‘Poor’ ranged from 26% to 72%. These findings provide preliminary support for the measure’s validity as a global self-reported oral health measure in young middle-aged adults.

Language and literacy relate to lack of children’s dental sealant use

OBJECTIVES This study aimed to determine the percent of Californias third grade public school children lacking sealants by child and family factors and to measure social disparities for lacking sealants. METHODS The study analyzed data from the California Oral Health Needs Assessment (COHNA) 2004-2005, a complex stratified cluster sample of children (n = 10,450) from 182 randomly selected public elementary schools in California. The dependent variable was absence of sealants in first permanent molars. The independent variables included child race/ethnicity; socio-economic position (SEP) measured as childs participation in the free or reduced-price lunch program at the individual and school level; acculturation measured as language spoken at home and school level percent of English language learners; and parent functional health literacy measured as correctly following questionnaire instructions. Absolute differences and health disparity indices (i.e. Slope Index of Inequality, Relative Index of Inequality-mean, Absolute Concentration Index) were used to measure absolute and relative disparities. RESULTS The percent of children lacking sealants was high in all racial/ethnic groups; no child or school level SEP differences in lacking sealants were seen, but significant differences existed by acculturation (child and school level) and parental functional health literacy. CONCLUSIONS NonEnglish language and poor parental functional health literacy are potential barriers that need to be addressed to overcome disparities in sealant utilization.

Comparison of adult oral health in Australia, the USA, Germany and the UK

BACKGROUND Australian adults reportedly have poor oral health when compared to 28 other OECD countries. The Australian ranking was based on edentulism and caries experience data from selected age groups that apparently were collected in 1987-88. The objective of this study was to compare the oral health of Australian adults with that of three other western countries that have comprehensive oral health survey data. METHODS Published data were obtained from the NHANES 2003-2004, the Fourth German Oral Health Study 2005 and the UK Adult Dental Health Survey 1998. Data from the Australian NSAOH 2004-06 were analysed to generate comparable age-specific estimates using nine dental clinical indicators, two measures of oral hygiene behaviour and two of dental attendance. RESULTS Australia had the best oral health based on two clinical indicators, was equal first on three indicators and ranked second in the remaining clinical indicators. Australia ranked first or second based on dental flossing, use of mouthwash and frequency of dental attendance. CONCLUSIONS The oral health of the Australian adult population was among the best of the four nations studied.

Greater Inequalities in Dental Treatment than in Disease Experience

This study aimed to (1) describe social gradients in dental caries in a population-level survey and (2) examine whether inequalities are greater in disease experience or in its treatment. Using data from Australia’s National Survey of Adult Oral Health 2004-2006, we examined absolute and relative income inequalities for DMFT and its separate components (DT, MT, FT) using adjusted proportions, means, and health disparity indices [Slope Index of Inequality (SII) and Relative Index of Inequality (RII)]. Approximately 90% of Australian adults had experienced caries, with prevalence ranging from 89.7% in the highest to 96.6% in the lowest income group. Social gradients in caries were evident across all components of DMFT, but particularly notable in Missing (SII = −15.5, RII = −0.3) and untreated Decay (SII = −23.7, RII = −0.9). Analysis of age- and gender-adjusted data indicated less variation in levels of disease experienced (DMFT) than in the health outcomes of its management (missing teeth). The findings indicate that social gradients for dental caries have a greater effect on how the disease was treated than on lifetime disease experience.

Self-rated oral health and oral health-related factors: the role of social inequality.

BACKGROUND The reasons why social inequality is associated with oral health outcomes is poorly understood. This study investigated whether stratification by different measures of socio-economic status (SES) helped elucidate these associations. METHODS Cross-sectional survey data were used from Australias 2004-06 National Survey of Adult Oral Health. The outcome variable was poor self-rated oral health. Explanatory variables comprised five domains: demographic, economic, general health behaviour, oral health-related quality of life and perceived need for dental care. These explanatory variables were each stratified by three measures of SES: education, income and occupation. RESULTS The overall proportion of adults reporting fair or poor oral health was 17.0% (95% CI 16.1, 18.0). Of these, a higher proportion were older, Indigenous, non-Australian born, poorly educated, annual income <

Oral conditions and their social impact among HIV dental patients, 18 years on.

20 000, unemployed, eligible for public dental care, smoked tobacco, avoided food in the last 12 months, experienced discomfort with their dental appearance, experienced toothache or reported a need for dental care. In stratified analyses, a greater number of differences persisted in the oral health impairment and perceived need for dental care domains. CONCLUSIONS Irrespective of the SES measure used, more associations between self-rated oral health and dental-specific factors were observed than associations between self-rated oral health and general factors.

Risk factors for impaired oral health among 18- to 34-year-old Australians.

BACKGROUND A study undertaken in 1992-1993 identified that HIV-infected dental patients were substantially disadvantaged with regard to the social impact of their oral disease. The oral pain experienced by HIV-positive patients prior to the introduction of combination antiretroviral therapy (cART) was attributable to specific features of HIV-related periodontal disease and other oral manifestations of HIV such as candida infections and xerostomia. A repeat of this study in 2009-2010 provided additional information in the post-cART era. METHODS Data were collected from three sources: the 2009-2010 HIV-positive sample, the National Survey of Adult Oral Health (NSAOH) and the original 1992-1993 study. Collation of data was by clinical and radiographic oral examination. Information about the social impact of oral conditions was obtained from the Oral Health Impact Profile. RESULTS The caries experience of the 2009-2010 HIV-positive sample was improved with statistical significance for both mean DMFT and mean DT, while the presence of HIV-related periodontal disease still occurs. Statistically significant improvements were achieved for prevalence and severity of oral health related quality of life. CONCLUSIONS The need for timely access to oral health care with a focus on prevention is essential for HIV-positive individuals whose health is impacted by chronic disease, smoking and salivary hypofunction.

Inequalities in Indigenous Oral Health: Findings from Australia, New Zealand, and Canada:

OBJECTIVES The objective of this study was to determine risk factors for a summary measure of oral health impairment among 18- to 34-year-olds in Australia. METHODS Data were from Australias National Survey of Adult Oral Health, a representative survey that utilized a three-stage, stratified, clustered sampling design. Oral health impairment was defined as reported experience of toothache, poor dental appearance, or food avoidance in the last 12 months. Multivariate Poisson regression models were used to evaluate effects of sociodemographic characteristics, self-perceived oral health, dental service utilization, and clinical oral disease indicators on oral health impairments. Effects were quantified as prevalence ratios (PR). RESULTS The estimated percent of 18- to 34-year-olds with oral health impairment was 42.4 [95 percent confidence interval (CI) 37.7-47.2]. In the multivariate model, oral health impairment was associated with untreated dental decay (PR 1.38, 95 percent CI 1.13-1.68) and presence of periodontal pockets 4 mm+ (PR 1.29, 95 percent CI 1.03-1.61). In addition to those clinical indicators, greater prevalence of oral health impairment was associated with trouble paying a

Estimating the effect of childhood socioeconomic disadvantage on oral cancer in India using marginal structural models.

100 dental bill (PR 1.37, 95 percent CI 1.12-1.68), usually visiting a dentist because of a dental problem (PR 1.46, 95 percent CI 1.15-1.86), reported cost barriers to dental care (PR 1.46, 95 percent CI 1.16-1.85), and dental fear (PR 1.43, 95 percent CI 1.18-1.73). CONCLUSIONS Oral health impairment was highly prevalent in this population. The findings suggest that treatment of dental disease, reduction of financial barriers to dental care, and control of dental fear are needed to reduce oral health impairment among Australian young adults.