Nadia Sultan Ali1 , Mahjabeen Khan2
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J PakDentAssoc. 2011 (4) : 230-234
The study was conducted to determine the Frequency and determinants of oral substance abuse among patients seeking dental care at Department of Periodontology, Dr. Ishrat-ul- abad Khan, Institute of Oral health Sciences,DowUniversity ofHealth Sciences,Karachi.
Across session studywas conducted during January to June 2011.Atotal of 2259 patientwere interviewed from a structured questionnaire atDepartment of Periodontology,Dr. Ishrat-ul- abad Khan, Institute of Oral health Sciences, Dow University of Health Sciences,, Karachi. The questionnaire was based on demographic data along with risk factors resulting in use of substance abuse. The substance abuse included Pan and cigarettes, Niswar, betel nut, Pan, cigarettes, Niswar and Betel nut and gutka. The data was collected on the performa and analyzed using SPSS windows version 17. Frequencies and percentages were calculated for categorical variables including age, gender, education, type of substance used. Stratification was done with substance user and non-user to see the effect on their oral health. Chi-square was used to compare the categorical variables at 5% level of significance between substance user and non-user.
There were 2259 respondents consented for interview regarding use of substance abuse by them.Most of the patients 1362 (60.3%) belonged to younger age group 18-25 years. Female respondents were 1384(61.3%). Most of the dental care seekers were graduates 984 (43.6%) out of 2259, there were 884 (39.1%) substance abuser. The type of substance abusedmostlywere pan and cigarettes both 1375 (60.9%) and cigarettes, niswar, beetle nuts all together in 483 (21.4%). On examination the oral health statuswas good only in 582 (25.8%).Mostly substance abuse was started on self basis 433(49%) compared to others 45 (51%). It was also found that unemployment 300(33.9%)was themajor reason for substance abuse.
The frequency of oral substance abusewas found in 39.1% of the patients seekingmedical advice at the dental and oral institute.The commonest determinants of substance userwere younger age group between 18- 25 years, commoner in male than female, one third were graduates and unemployed were found more addicted to substance use. The study found that the type of substance abuse at the time of interview were multiple variety of substance. Pan along with cigaretteswas used by maximum number of participants. Pan and cigarettes along with Niswar and betel nutswere used by quarter of the sample.
Substance abuse, Frequency, risk factors, determinants, cigarettes, Pan,Niswar,Arica nut,Gutka
ubstance use disorders are primary, chronic, and often progressive diseases that affect overall health of person including oral health. According to the American Dental Association dental problems are common among oral substance abusers (OSA) .These OSAagents can jeopardize health and even affect the overall health. Similar survey was conducted and obligatory statement consumptions were evaluated by the patients. In developing countries underserved population are more prone to develop habit of substance abuse. These substance include pan,Arica nut, Niswar, cigarettes and gutka as single and multi-abusers.
Laslett reported sixty-eight percent dental problems that were commonly severe and caused dental pain.About half the patients had not visited the dentist in the 12 months prior to the survey. The substance abuser had bleeding and periodontal disease 42% and 95% respectively. Both social factors and characteristics of drug use were related to oral health. Drug abuser had low social status; low education and poor dental treatment were the factors causing dental 0 problems. Schultz reported that dental decay and periodontal disease, and dental caries were associated with oral drug abuse.
Areca nut is the fruit of the tree in southAsia . It is chewed in various preparations. The most commonly used form is betel quid which consist of betel leaf, from the Piper betel plant, areca nut, slaked lime (calcium hydroxide mixed in water) and various condiments, sweeteners along with tobacco.Areca nut and betel quid use is a social norm in Pakistan and being used by both men and women.
The use of these substances causes fibroblast proliferation and collagen production. Studies indicate that chewing betel quid and its ingredients produces cell mutagenicity and mitosis in oral mucosa.
Tobacco smoking currently kills five million people a year worldwide. It has been estimated that eight million people in 2030 and one billion over the course of the 21st century will die of cigarette smoking (WHO, Report 2010). Worldwide it is estimated that men smoke nearly five times as much as women. Several studies have shown varied rate of substance abuse Seventy-four per cent of the children used areca nut and 35% used betel quid daily. More boys 72% chewed areca nut than girls 30% . The duration of substance abuse has not been reported in underprivileged population with low resources to seek dental care. The substance abuse usually develop oral substance mucous fibrosis, pain in teeth , inability to eat and in later stage abl to open mouth properly even for oral hygiene purpose.
Sometimes ulceration also has been seen with bleeding gums. The prevalence and determinants of substance abuse has been studied in isolated communities and demographic health survey has not encompassed the need for the development of further policy in Pakistan for children and younger population especially for future strategies., There have been limited studies for substance abuse determinants, therefore the study was conducted to determine the frequency&determinants of substance abuse among general population. The study aimed to determine the age, gender, education, specific habituation, reasons for inclination of substance abusers from the perspective of interviewee responses. The study also aimed to highlight the association of substance abusers and status of oral hygiene and health compared to non-substance abuser.
A cross session study was conducted during January to June 2011. A total of 2259 patient were interviewed from a structured questionnaire at Department of Periodontology, Dr. Ishrat-ul- abad Khan, Institute of Oral health Sciences, DUHS, Karachi. The questionnaire consists of demographic data, information regarding oral hygiene, substance abuse in practice, health seeking behaviors and attitude towards the cigarette smoking, pan andArica nut use. The questionnaire was newly developed based on the determinants of substance abuse from the literature. The questionnaire was validated by a small base line study on 60 volunteers and changes were made according to the requirement and time consumed in out patients department.The questionnaire usewas inUrdu and sindhi.
All patients seeking dental care with or without having habit of substance abuse were interviewed. The study participates were recruited by non probability convenience sampling from outpatient Department of Periodontology, Dr. Ishrat-ul- abad Khan, Institute of Oral health Sciences, DUHS . All those consenting for participation in the study were interviewed after oral informed consent. Patients not in pain and refusing for interview for lack of time were not included in the study. The questionnaire was based on demographic data along with risk factors resulting in use of substance abused by the patients. The data was collected on the Performa and analyzed using SPSS windows version 17. Frequencies and percentages were calculated for categorical variables including age, gender, education, type of substance used. Stratification was done with respect to substance user and non-user to see the effect on their oral health. Chi-square was used to compare the categorical variables at 5% level of significance between substance user and non-user
There were 2259 respondents and 884(39.1%) were oral substance abusers. Most of the patients 1362 (60.3%) belonged to younger age group at 18- 25 years. Female respondents were 1384(61.3%). Most of the dental care seekers were graduates 984 (43.6%). The demographic data of substance abuser has been shown inTable I.
The type of substance abused mostly were pan and cigarettes both 1375 (60.9 %) and cigarettes,Niswar, beetle nuts all together in 483 (21.4%) as shown inTable II.
On examination the oral health status was good only in 582 (25.8%). Most patients did not prefer to seek dental care 1429(63.3%) by the dentist.Majority had no bleeding from gums 1151 (51.0%) and no tooth ache 1064 (47%) and perceived that it was sign of oral health.
The determinants found in substance abusers have been reported in Table III. The non-substance abuser were 1375 (60.5%) compared to user 884 (39.1%). The difference between gender was 449(50.8%) in female compared to 435(49.2%) in male among oral substance abuser. Among the graduates 335 (37.9%) were using oral substance abuse. Mostly substance abuse was started on self basis (n=433, 49%) compared to others (n=45, 51%). It was also found that family issues (n=454, 51.3%) were the main reason for start of OSA followed by unemployment (n=300, 33.9%) as shown in Table III.
The study has shown that substance abusers in urban city ofKarachiwere 39.1%.Most studies have shown that OSAwas started earlier in life in some of the communities particularly in south Asia. SMA Shah et al has reported that seventy-four per cent of the children used areca nut and 35% used betel quid daily. Arndts reported that the proportion of older adults using substance abuse has beenincreasing compare to younger group. The study showed that younger ages 18-25 yearswere using substance abusemore 509(57.6%) compared to101 (11.45%) age group > 40Year.
Substance abuse have been found in females more common 1384(61.3%) compared to 875(38.7%) among males. Female substance abuser blame that this habit remained constant because of tensions, poor economics and frustration when women remain unsafe. Therapeutic effects of treatment programs for women with substance abuse problems have reported that the individualized care was more beneficial and treatment facilities required inductive positive environment. Farabee conducted a longitudinal study and reported an experience of tracking and locating participation for the study was difficult. In this study since the interviewwas taken at the time of seeking medical care, the responses for substance abuse were more commonly accepted by the patients. However studies have shown that the validity is compromised as the information is biased provided by the patients in other settings.
The pattern of substance abuse has been changing and females are more inclined towards connectional & domestic uses of substance abuse. Pan and cigarettes being usedmore 1375 (60.9%) and mostly the substance abuser were not using single substance. Themultiple use of substanceAbuse were in 483 (21.4%) of patients. Substance abusers were 884(39.1%) from general population and patients seeking dental care at department of Periodontology Dr.Israt uEbaad Institute of oralHealth Sciences.
Some of the studies have also shown that the early detection of substance abuse was correlated with better prognosis in the rehabilitation management. The risk factors resulting in substance abuse were gender, low educa tion and unemployment. Therefore considering the demographic, social, economic, constraints in present situation countrywide and increase level of anxiety and substance abuse among younger age group require early detection and rehabilitation. Hopwood reported substance use disorder (SUDS) where under lying risk factors for substance abuse were age at 18-45 years. This study showed that major risk factors for substance abuse were contact with a person in the habit of using substance widely available in the society. These contact people were usually family members or peer, school / college friends and peers at working place The study findings were similar to park study.
Collins reported that homelessness and unemployment were the determinants for substance abuse. In our study the patients seeking care were mostly from 1ow social group with quarter of them were educated for 5 and 10 years. Belanko reported high rates of substance abuse associated with social and health problems. Our study also showed that substance abuse was more among female 1384(61.3%) compared to male 875(38.7%) In our study based on the examination the oral health status was good in 582(25.8) compared to bad oral hygiene 799(35.4%) dental caries, 43(1.9%) gingivitis, 734 (32.5%) and periodontiti s 101 (4.5%). Fewstudies have shown interventions to impact substance abuse in underserved population. Our community with 39% substance abuse need priority interventions for rehabilitations based on gender and age and same should be considered when designing measures to prevent substance abuse related to occupation. Since the study has been conducted in tertiary care center of an urban area and reported 39 % OSA, the determinants observed were significant and important for the policy makers and future planning. The determinants found in the study included; young age 57.6% female 50.8% , 14 years of education 335 (37.9%) , family issues 454 (51.35) and half of the patients started substance abuse on their own.
Hwang showed 46% street oral abusers compared to 39% substance abusers from general society in urban area. . Oral Substance abuse have been documented from toddlers by maid servants, preschool and at adolescent from colleges reported by Leejh. The study had limitations for finding reasons and duration of substance abuse. It was noticed that the patients were not able to recall the time at which they started using oral substance abuse. The observation is from the single institute therefore generalization for inference cannot be optimum from this study.
The frequency of oral substance abuse was found in 39.1% of the patients seeking medical advice at the dental and oral institute. The commonest determinants of substance user were younger age group between 18-25 years, commoner in male than female, one third were graduates and unemployed were found more addicted to substance use. The study found that the type of substance abuse at the time of interview were variety of substance. Pan along with cigarettes was used by maximum number of participants. Pan and cigarettes along with Niswar and betel nuts were used by quarter of the sample.
Conflict of Interest:
The authors declared no conflict of interest for this study.
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