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Who were the partners?
The main Cambodian partner was the Department of Preventive Medicine, Ministry of Health, with additional involvement of staff and students from the University of Health Sciences, the University of Puthisastra and International University.
What was the aim of the study?
The aim of the study was to determine the prevalence and types of oral mucosal lesions in the Cambodian population. The results could then help in the formulation of relevant oral health care policies for the country to address the high rate of oral cancer, and encourage early detection and treatment.
Where was the study carried out?
Data was collected from Phnom Penh and 4 provinces (Kampot, Kampong Cham, Pursat, and Stung Treng). Ethical approval for this research was obtained from the Cambodian National Ethics Committee for Health Research.
Who were the examiners and how were they trained?
Prior to data collection, local Cambodian senior dental students and dentists attended a standardization and calibration workshop where they were trained to accurately recognize and diagnose oral mucosal lesions. The training was conducted by Malaysian specialists and researchers from Universiti Malaya, Universiti Kebangsaan Malaysia and Universiti Sains Malaysia. Training was held for 27 local dental personnel. A score of 75% was set as an acceptable level to be identified as a clinical examiner for this project. Almost all reached this level, and eight people were chosen to be examiners for the project and went on to carry out data collection in the field. Data collection was held between April and October 2014. Data was collected at people’s homes and also at various Pagodas.
How many people were surveyed?
A total of 1,634 adults were recruited into this study (47% males and 53% females).
What risk factors were identified?
Alcohol consumption was the most common risk habit practiced in this population (22%), followed by smoking (20%) and betel quid chewing (8%). Cambodian men in this survey were much more likely to smoke and drink than women. 32% of males were both smokers and drinkers. 12% of females increased their risk of oral cancer by chewing betel/tobacco quid. Only 26% of the men in this population did not indulge in any of the risky behaviors, whereas among women it was 74%.
What oral mucosal lesions were found?
In the survey many oral mucosal lesions were found, but most of them were harmless. The prevalence of oral cancer and oral potentially malignant disorders (OPMDs) was 5.6%, which consisted of: 2 cases of oral cancer (2.2%), 59 cases of leukoplakia (64.8%); 1 case each of erythroplakia (1.1%) and oral submucous fibrosis (1.1%); and 28 cases of lichen planus (30.8%). There was a strong association between the presence of OPMDs and the practice of risk habits (such as smoking, alcohol using, and betel/tobacco chewing) ie those people who drank alcohol, smoked and chewed betel/tobacco quid were more likely to have OPMDs.
This study shows that the prevalence of oral mucosal lesions in the Cambodian population is relatively high, and that over 5% of people may have potentially malignant lesions in their mouths (ie lesions that could become oral cancer). It is very important that all oral lesions are checked by a dentist or doctor, when they are still very small. A biopsy (surgical removal) is sometimes needed to diagnose what the lesion is, and to help decide whether any other treatment is required. If the lesion is advanced, urgent referral to a hospital (such as the Khmer Soviet Friendship Hospital) is indicated, where the proper investigations can be carried out and the appropriate treatment provided. Oral cancer which is not detected early can result in death.
At the workshop today, more than 80 dentists and senior dental students are being trained how to recognize and classify oral mucosal lesions and oral cancer. This will help them to correctly manage these lesions when detected in their patients’ mouths.
The research group recommends that a public health awareness campaign is mounted in Cambodia to make the public more aware of oral mucosal lesions and oral cancer, the dangers of smoking and betel/tobacco chewing, and to encourage them to seek help if they detect a lesion in their own mouth. The research group also encourages the Ministry of Health to support the training of medical and dental personnel so that they become more skilled in examining patients’ mouths for lesions, and are able to make the correct diagnosis and management decisions when a lesion is detected.
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