Dental service use and the implications for oral cancer screening in a sample of Bangladeshi adult medical care users living in Tower Hamlets, UK

Abstract

517RESEARCH dental public health may arise de novo although in high prevalence areas such as Southern Asia it is usually preceded by a so-called precancerous lesion -a red (erythroplakia) or a white (leukoplakia) patch. 2 In India almost all oral cancers originate from leukoplakias. 3 Secondary prevention is aimed at the early recognition of oral cancer. Treatment of precancerous or small (less than 2 cm) lesions results in an improved prognosis and causes limited morbidity. 4 The UK Working Group on Screening for Oral Cancer and Precancer 5 recommended that screening for oral cancer should form part of a general oral examination by dentists and that all adults should be encouraged to attend for annual check ups. However, several studies have shown that among most minority ethnic groups there is a symptom oriented view in relation to use of dental services. [6][7][8] In India and other South Asian countries oral cancer is the most common cancer accounting for over 40% of all malignancies. 9 Relative frequency is high in Bangladesh, India and Sri Lanka. 10 Paan (betel quid) chewing with tobacco and smoking is associated with an increased risk of oral cancer 11,12 although a recent study 13 found that areca nut chewing by itself was carcinogenic. Paan chewing has a long history in South Asian communities and it is associated with many social and religious traditions. 14 The method and usage of the constituents of paan varies between countries, communities and individuals. Three principal ingredients, a leaf of the betel vine (Piper betle), areca nut and lime are necessary for the term paan to be used. Tobacco is frequently added to the paan quid. Within the UK, paan chewing is practised within Indian, Pakistani and Bangladeshi communities. 15 Recent investigations into paan chewing in the UK have found that the habit is very widespread among Bangladeshis. [15][16][17] These issues emphasize the need for more information on the use of dental services, barriers to the uptake of dental care, attitudes to regular dental examinations, and the paan and tobacco habits among Asians living in the UK.Research into the health of ethnic minority groups is often restricted by methodological difficulties. 18 The most practical and efficient means reported in the literature of identifying a sample has been the use of general medical practices, 8,[19][20][21][22][23][24][25] especially as it has been estimated 26 that only 2% of 'black' and 'Asian' groups were not registered with a general practice in inner London. This approach circumvents the lack of a sampling frame needed for a random sample and the expense of using the address or electoral register to identify ethnic minority members.Aim To assess the use of dental services, barriers to uptake of dental care and attitudes to regular dental examinations and the prevalence of tobacco and paan chewing habits in a group of Bangladeshi medical care users. Design Multi-centre cross-sectional study. Setting Four general medical practices' waiting areas in Tower Hamlets. Subjects Ba...

Prevalence, age of onset and demographic relationships of different areca nut habits amongst children in Tower Hamlets, London

“…Alarmingly, this study suggests that the highest period of risk for engaging in a betel-quid, areca nut alone or mistee pan habit is between the ages of 5 and 12. This is somewhat earlier than that reported in previous research 4 for which 11-15 was cited as the most frequent age range. This difference can be interpreted to suggest that the areca nut habit amongst children with a South Asian ethnic background, but are mainly first or second generation UK born, is being engaged in earlier than amongst previous cohorts born in the South Asian countries.…”

“…Although in far smaller proportions than reported in this study, an areca nut habit has been reported to begin amongst those aged up to 50, with daily frequency of use also increasing with age. 4 The current cohort of chewers in this study is therefore likely to under represent the size of the future population engaging in an areca nut habit, although the figures are likely to reflect a high percentage of this future population. The results from this study support the British Dental Association recommendations 20 which suggest that dentists pay special attention for signs of OSF and potentially malignant lesions amongst South Asian children during routine consultations.…”

“…This was significantly higher than the relative risk posed by betel-quid with or without tobacco (RR = 64 and RR = 32, respectively). 11 Another case controlled study from India reported Prevalence, age of onset and demographic relationships of different areca nut habits amongst children in Tower Hamlets, London P. Farrand, 1 R. M. Rowe, 2 A. Johnston, 3 and H. Murdoch, 4 Objective To examine prevalence and demographic relationships of different areca nut habits amongst children. Design Self-administered questionnaire.…”

Review of prevalence data in, and evaluation of methods for cross cultural adaptation of, UK surveys on tobacco and alcohol in ethnic minority groups

“…31 The health survey for England 1999 met three of the 12 guidelines and partially met one other. 2 Three studies met three guidelines.…”

Oral submucous fibrosis in a 12‐year‐old Bangladeshi boy: a case report and review of literature

“…Recent investigations into betel quid chewing in the UK have found the habit to be widespread among Bangladeshis [3,10]. The majority started this habit before the age of 15 years, women are more likely to use betel quid, and also more likely to add tobacco to the quid [20]. Previous studies showed that 95% of Bangladeshi women in West Yorkshire chewed betel quid, of whom 89% added tobacco [9].…”