BACKGROUND: The objective of the present study was to evaluate the prevalence of anterior and posterior tooth wear among dental patients visiting the Oral Medicine and Diagnosis outpatient department (OPD) of Bahria University Medical and Dental College, Karachi (BUMDC) and to assess the associated risk factors related to anterior and posterior tooth wear. METHODOLOGY: It was a cross sectional study conducted from January 2017 to June 2017. Total 526 participants with the chief complain of sensitivity and tooth wear were included in this study and were examined by trained dental surgeons. The examiners were trained on degree of attrition (Tooth Wear Index TWI; by Smith & Knight 1984) via using structured questionnaire. Descriptive analysis, Pearson Chi square test and ordinal regression analysis was performed on SPSS version 23for future predictions. RESULTS: In this study, tooth wear was found to be more prevalent among individuals aged 31-40 years (n=215) 40.9% and (n=145) 27.6% in those who were in social class IIIm (manual skilled workers like bus driver, carpenter etc). The prevalence of anterior tooth wear was (n=169) 32.1%, posterior (n=208)39.5% and both anterior and posterior location were (n=149) 28.3%. It was observed in this study that multiple risk factors had a significant impact on the location of the tooth wear. Majority of participants (n=409) 77.8% were practicing tooth brushing as a mode of oral hygiene with posterior tooth wear as most common finding (n=170,41.5%,P-value=0.0001). Regarding parafuctional habits, majority (n=419, 79.7%, P-value =0.0001) participants were in habit of clenching. There was a remarkable effect of gastro intestinal reflux disease (GERD) on tooth wear, (n=299) 56.8% participants had GERD, (n=147) 49.1% participants had posterior tooth wear (n=55) 18.3% had anterior tooth wear and (n=97) 32.4% had both anterior and posterior tooth wear (P-value=0.0001). There was a significant effect of oral habits (betel nuts chewing) on tooth surfaces (n=243) 46.2% participants were consuming betel quid in which (n=129) 53.08% participants were found with more posterior then anterior tooth wear (P-value=0.0001). A total of 184(75.5%) participants were consuming 5-10 packets/day of betel quid and of these 51.6% (n=95/184) participants reported with posterior tooth wear (P-value=0.0001).To assess the future predictions, ordinal regression analysis were carried out. It was observed that location of tooth wear would be effected by GERD, parafuctional habits (clenching), oral habits (betel nuts chewing) and frequency of oral habits. CONCLUSIONS: We conclude from this study that there were multiple risk factors associated with tooth wear. It was observed that posterior tooth wear, younger age group, social class IIIm, parafuctional habits (clenching), betel nut usage, history of GERD, abrasive oral hygiene practices and technique of brushing were most common findings.

Background: A wide variety of medication, from vitamins to analgesics and anti-inflammatory drugs, can be purchased by users without a medical prescription. These are referred to as Oral Non-Prescription Drugs (ONPD). While this may empower patients to treat themselves, when used irrationally these medications can have a negative health impact. Previous research on higher education students, particularly healthcare students, has demonstrated that they might be a high-risk population for irrationally use of ONPD. In 2004, the World Health Organisation issued specific guidelines to address research in this area. However, recent investigations still indicate that irrational use of medication occurs among this population. Therefore, the current thesis will be guided by the WHO framework in an attempt to develop a strategy to address this problem. Aim: The aim of this thesis is to determine the prevalence of irrational use of medication sold without a prescription in UAE to university students and to identify the reasons for this behaviour. A secondary aim of this investigation is to develop, implement and evaluate the effectiveness of an educational intervention to improve knowledge and awareness of, as well as attitudes and practice towards, rational use of ONPD medication by university students in UAE. To reach the aims of the study, a health behavioural model was used together with qualitative and quantitative methods. Methodology Study One: The aim of this study was to determine the prevalence and risk factors of four types of irrational use (incautious use, inappropriate use, use of antibiotics without prescription and polypharmacy) of ONPD among undergraduate students in UAE. This study used a cross-sectional design employing a randomised sampling technique (n=2875). Statistical analysis was used to analyse this data. Results obtained from this study indicated that 85.9% of students used ONPD, with 38.6% using antibiotics without a prescription. Based on WHO risk assessment criteria, this behaviour was found to the most severe form of irrational use. Additional findings indicated that female participants were 34% less likely to be incautious users (OR =0.344, 95% CI: 0. 244-0.486, p≤0.001), which set males at a higher risk of engaging in this behaviour. Not verifying the expiration date also increased the likelihood of being an incautious user by as much as 51%. Seeking drug information from health care professionals was found to be a protective factor against incautious ONPD use (OR =0. 798, 95% CI: 0.540-0.967, p967, p≤0.05). At the same time, not seeking information on cautious use of ONPD either from medical books or the internet was associated with a higher risk of incautious use (OR = 1.914, 95% CI: 1.353-2.708, p≤0.001). Being a healthcare student significantly increased the odds of being an incautious user of ONPD (OR = 1.561, 95% CI: 1.103-2.208, p≤0.05). Using antibiotics without a prescription was reported among 35.9% of the sample, with no statistically significant difference being observed between healthcare and non-healthcare students. Study Two: Based on the WHO Severity Rating Matrix, the use of antibiotics without prescription was found to be the most significant risk for personal and population health. Therefore, the aim of this study was to further explore the reasons for use of antibiotics without prescription among healthcare university students. This study used a qualitative design employing an interview method and a purposive sample selection technique (n=15) which included only the population of students who used antibiotics without a prescription. Thematic analysis was used to analyse the data. Five main themes emerged from this study: knowledge, awareness, attitude, views, and perceptions, as well as possible strategies to decrease their misuse of antibiotics. Study Three: The aim of this study was to develop and test an intervention for reducing the use of antibiotics without prescription based on the findings of study 1 and 2. The intervention was carried out for 14 weeks. Each session was delivered on a weekly basis and comprised of a 15 minutes PowerPoint presentation followed by 10 minutes of discussion. A quasi-experimental design with purposive sampling was used in which participants (n=140) were assessed at baseline for knowledge, awareness, attitude, and practice of using antibiotics without prescription. Results obtained through comparing baseline measures with post-intervention measures demonstrated a statistically significant (p<0.05) improvement in reducing the use of antibiotic without prescription among the sample. Moderate improvements were also noted in knowledge, attitude, and awareness of antibiotic use. Conclusion: This thesis has demonstrated that the prevalence of ONPD is high among university students in the UAE. This is particularly significant as this increased prevalence occurs concomitantly with irrational use. The most significant risk was related to using antibiotics without prescription. Although the intervention to change this behaviour was successful, other issues such as access to health care and lack of time to see medical practitioners may still promote the use of antibiotics without prescription. Recommendations underlined in this investigation include educating pharmacists to provide information to ONPD buyers.

Background: Antibiotic resistance affects generations. It is a major health issue. Resistance to antibiotics is on the rise globally. The absence of proper regulatory mechanism and free access to pharmaceutical agents have led to self-medication and inappropriate therapeutic and prophylactic prescription. Methods: Qualitative in-depth research was conducted using focus group discussions (FGDs) for data collection. The study was conducted in an underprivileged colony in Karachi, Pakistan. Community members and Dentist were part of the focus group discussion. Results: There were two major themes that emerged from the analysis. ‘Knowledge associated with common oral diseases and their consequences’ and ‘Home remedies and treatment seeking behavior’. The focus group discussions showed that the perceptions of community members and dentists was based on bad oral hygiene, lack of awareness of oral disease outcome and barriers in pursuing treatment by dentist There was a lack of Government healthcare facilities and poor professional attitudes and futile law enforcement regarding medicine dispensing and disposal. Conclusion: The value of this study is to understand the perceptions and determinants of health seeking behavior and recognize the reasons for use and misuse of antibiotics. There is a great need for Government intervention and inexpensive treatment for the masses.