Objective: To introduce and encourage the use of generalised linear models (GLMs) in analysing ca... more Objective: To introduce and encourage the use of generalised linear models (GLMs) in analysing caries data that do not require the response to be treated necessarily as a sample from a normal distribution. Basic research design: At the present time, it is most likely that the sampling distribution of dmf/DMF in industrialised countries will not approximate normality. Generalised linear modelling can be conducted assuming many underlying distributions which, in fact, includes the normal distribution. In this paper three GLMs are employed (normal, Poisson, negative binomial) for modelling an example caries data set. In addition, a binomial model is used to model the dichotomous outcome of caries-free/caries-present. Clinical setting: The data comprised 871 Old Trafford, Manchester primary school children aged between 4 years 0 months and 5 years 11 months. Results: The effect of one study covariate was prominent in a normal model applied to all available dmf data but not in two non-normal models which used dmf > 0 data only. Furthermore, the same covariate was significant at the 5% level in a binomial model indicating that it influenced whether or not caries was present and not the level of dmf. Conclusion: A suitable modelling approach for caries data is to employ a Poisson or a negative binomial model for the dmf/DMF response and a binomial model for the caries-free/caries-present outcome. This allows separate estimation of those factors which influence the magnitude of caries and those factors which influence whether caries is actually present or not.
Objective: To examine the socio-economic background of patients who underwent inpatient and day-c... more Objective: To examine the socio-economic background of patients who underwent inpatient and day-case oral operations from 1989-1994 in the West Midlands. Design: Retrospective. Setting: National Health Services Executive West Midlands; with a population of approximately 5.5 million. Subjects: A total of 4,926,438 hospital inpatient finished consultant episodes, within 56 specialties recorded in the hospital episode statistics database, of which 60,904 (1.24 per cent) were dental; oral surgery. Outcome measure: Standardised hospital inpatient activity ratios. Results: The overall levels of activity rose moderately over the five year study period, although the type of activity remained consistent. Surgical removal of teeth was the third most common activity of all surgical procedures. Patients who availed themselves of elective inpatient oral surgery were generally from a higher socio-economic group, in marked contrast to those patients admitted for emergency oral surgery. This observation was highlighted even further by the procedure 'removal of impacted wisdom tooth', which accounted for 41 per cent of all oral surgery activity. The most deprived communities (15 per cent of the regional population) utilised this service 50 per cent less than all other groups. Conclusions: The application of a deprivation index to hospital episode data enables more accurate assessment of service utilisation by differing socio-economic groups. The inequality of the oral surgery provision to the 15 per cent of the population which were most deprived adds to the overall debate on the appropriateness of this service. Further examination of the pattern of behaviour and referrals amongst primary dental care services is clearly needed.
Purpose of the study: This study set out to examine the prevalence of betel-quid chewing with or ... more Purpose of the study: This study set out to examine the prevalence of betel-quid chewing with or without the inclusion of tobacco and to provide baseline information on the experience, behaviour and perceptions of risk of first generation Bangladeshi adults. Population studied: A total of 127 households, which formed the sample base for this study, were selected by a systematic sampling procedure. Each household was visited by two interviewers and all adults resident in the home were asked to participate in the study. Method: A pretested questionnaire which explored the use, attitudes, knowledge of the health risk, and behaviour towards betel-quid chewing and the use of tobacco was used. Findings: A total of 92% of males and 96% of females chewed betel-quid on a daily basis with 39% and 82% respectively including tobacco within their quid. There was a general acceptance of the use of tobacco, that is, males on the whole, smoking and females chewing tobacco. The perception of health risk, with regard to tobacco chewing, was low. Conclusion: The general acceptance of tobacco use and low perceived health risk in those engaged in tobacco chewing is a major concern that health professionals involved in health education need to address. General dental practitioners should be aware there is a high level of use in this community.
Objective: This study was designed to determine the United Kingdom public's perception of how ora... more Objective: This study was designed to determine the United Kingdom public's perception of how oral health affects quality of life (QoL) and to determine socio-demographic variations in these perceptions. Research design: The vehicle for this study was the ONS Omnibus Survey in the UK. A random probability sample of 2,668 eligible addresses was selected from the British Postcode Address File. Setting The data were collected by qualitative, face-to-face interviews with respondents, nation-wide, in their homes, about how their oral health status affected their QoL. Participants: 1,778 adults aged 16 years or older across the UK took part in the study. Results: 75% (1,340) believed their oral health either enhanced or reduced their QoL. Most frequently, this was perceived as being the result of its effect on eating. comfort and appearance. Other ways in which QoL was affected are also presented. Sociodemographic variations were apparent. For example, people from higher socio-economic backgrounds believed that their oral health enhanced their QoL to a greater degree (OR=1.46, CI=1.20, 1.78) than the lower socio-economic groups. Women claimed that their oral health had a greater negative effect on QoL than did men (OR=1.36, CI=1.11, 1.64). Younger people (16-64 years old) reported that their oral health status reduced and enhanced QoL more than older adults (65 years and over) (OR=1.59, CI=1.23, 2.04). Conclusions: The study shows that the UK public perceives oral health as affecting their QoL in a variety of physical, social and psychological ways and that significant socio-demographic variations exist in these perceptions.
British Journal of Oral & Maxillofacial Surgery, Aug 1, 1999
The study retrospectively investigated variations in the use of secondary healthcare for head inj... more The study retrospectively investigated variations in the use of secondary healthcare for head injury, particularly assault. A total of 25,300 emergency head-related admission were examined over a two-year period, of which 3756 were for assault. More males were admitted during summer and holiday periods, while there were fewer female patients with head injuries and the incidence varied less. The largest number of admissions was among men aged 15-44 and most assaults occurred at weekends. Females were more likely than males to die from all head injuries (OR=1.31) and violent head injuries (OR=2.38). Women (15+) stayed longer in hospital than males. Injuries among males are primarily associated with social occasions. Females experience head injuries all the year round suggesting that these injuries are the result of domestic violence. There are important demographic differences in numbers of patients and duration of hospital care required to treat these avoidable injuries.
Silver diamine fluoride (SDF) was developed in Japan in the 1960s. It is a clear solution contain... more Silver diamine fluoride (SDF) was developed in Japan in the 1960s. It is a clear solution containing silver and fluoride ions. Because of its anti-bacterial and remineralizing effect, silver diamine fluoride has been used in managing dental caries for decades worldwide. This paper aims to summarize and discuss the global policies, guidelines, and relevant information on utilizing SDF for caries management. SDF can be used for treating dental caries in most countries. However, it is not permitted to be used in mainland China. Several manufacturers, mainly in Australia, Brazil, India, Japan, and the United States, produce SDF at different concentrations that are commercially available around the world. The prices differ between contents and brands. Different government organizations and dental associations have developed guidelines for clinical use of SDF. Dental professionals can refer to the specific guidelines in their own countries or territories. Training for using SDF is part of...
British Journal of Oral & Maxillofacial Surgery, Aug 1, 1999
This study retrospectively investigated variations in the use of secondary healthcare for head in... more This study retrospectively investigated variations in the use of secondary healthcare for head injury, particularly assault. A total of 25,300 emergency head-related admissions were examined over a two-year period, of which 3756 were assaults. There were seasonal differences according to ethnic group: far more injuries, particularly assault, occurred amongst the black and minority ethnic groups during the summer months and holidays. Black males had two to three times the rate of admission for assault than any other group. Among whites, females stayed longer in hospital after a head injury. White women stayed significantly longer than South Asian women following a head injury and South Asian men stayed significantly longer than white men after an assault. There are substantial seasonal variations and differences in the length of hospital stay after a head injury, particularly assault, depending on ethnic group. These differences require clarification and more detailed studies of head injuries ought to record the patient's ethnic background.
Objective: To introduce and encourage the use of generalised linear models (GLMs) in analysing ca... more Objective: To introduce and encourage the use of generalised linear models (GLMs) in analysing caries data that do not require the response to be treated necessarily as a sample from a normal distribution. Basic research design: At the present time, it is most likely that the sampling distribution of dmf/DMF in industrialised countries will not approximate normality. Generalised linear modelling can be conducted assuming many underlying distributions which, in fact, includes the normal distribution. In this paper three GLMs are employed (normal, Poisson, negative binomial) for modelling an example caries data set. In addition, a binomial model is used to model the dichotomous outcome of caries-free/caries-present. Clinical setting: The data comprised 871 Old Trafford, Manchester primary school children aged between 4 years 0 months and 5 years 11 months. Results: The effect of one study covariate was prominent in a normal model applied to all available dmf data but not in two non-normal models which used dmf > 0 data only. Furthermore, the same covariate was significant at the 5% level in a binomial model indicating that it influenced whether or not caries was present and not the level of dmf. Conclusion: A suitable modelling approach for caries data is to employ a Poisson or a negative binomial model for the dmf/DMF response and a binomial model for the caries-free/caries-present outcome. This allows separate estimation of those factors which influence the magnitude of caries and those factors which influence whether caries is actually present or not.
Objective: To examine the socio-economic background of patients who underwent inpatient and day-c... more Objective: To examine the socio-economic background of patients who underwent inpatient and day-case oral operations from 1989-1994 in the West Midlands. Design: Retrospective. Setting: National Health Services Executive West Midlands; with a population of approximately 5.5 million. Subjects: A total of 4,926,438 hospital inpatient finished consultant episodes, within 56 specialties recorded in the hospital episode statistics database, of which 60,904 (1.24 per cent) were dental; oral surgery. Outcome measure: Standardised hospital inpatient activity ratios. Results: The overall levels of activity rose moderately over the five year study period, although the type of activity remained consistent. Surgical removal of teeth was the third most common activity of all surgical procedures. Patients who availed themselves of elective inpatient oral surgery were generally from a higher socio-economic group, in marked contrast to those patients admitted for emergency oral surgery. This observation was highlighted even further by the procedure 'removal of impacted wisdom tooth', which accounted for 41 per cent of all oral surgery activity. The most deprived communities (15 per cent of the regional population) utilised this service 50 per cent less than all other groups. Conclusions: The application of a deprivation index to hospital episode data enables more accurate assessment of service utilisation by differing socio-economic groups. The inequality of the oral surgery provision to the 15 per cent of the population which were most deprived adds to the overall debate on the appropriateness of this service. Further examination of the pattern of behaviour and referrals amongst primary dental care services is clearly needed.
Purpose of the study: This study set out to examine the prevalence of betel-quid chewing with or ... more Purpose of the study: This study set out to examine the prevalence of betel-quid chewing with or without the inclusion of tobacco and to provide baseline information on the experience, behaviour and perceptions of risk of first generation Bangladeshi adults. Population studied: A total of 127 households, which formed the sample base for this study, were selected by a systematic sampling procedure. Each household was visited by two interviewers and all adults resident in the home were asked to participate in the study. Method: A pretested questionnaire which explored the use, attitudes, knowledge of the health risk, and behaviour towards betel-quid chewing and the use of tobacco was used. Findings: A total of 92% of males and 96% of females chewed betel-quid on a daily basis with 39% and 82% respectively including tobacco within their quid. There was a general acceptance of the use of tobacco, that is, males on the whole, smoking and females chewing tobacco. The perception of health risk, with regard to tobacco chewing, was low. Conclusion: The general acceptance of tobacco use and low perceived health risk in those engaged in tobacco chewing is a major concern that health professionals involved in health education need to address. General dental practitioners should be aware there is a high level of use in this community.
Objective: This study was designed to determine the United Kingdom public's perception of how ora... more Objective: This study was designed to determine the United Kingdom public's perception of how oral health affects quality of life (QoL) and to determine socio-demographic variations in these perceptions. Research design: The vehicle for this study was the ONS Omnibus Survey in the UK. A random probability sample of 2,668 eligible addresses was selected from the British Postcode Address File. Setting The data were collected by qualitative, face-to-face interviews with respondents, nation-wide, in their homes, about how their oral health status affected their QoL. Participants: 1,778 adults aged 16 years or older across the UK took part in the study. Results: 75% (1,340) believed their oral health either enhanced or reduced their QoL. Most frequently, this was perceived as being the result of its effect on eating. comfort and appearance. Other ways in which QoL was affected are also presented. Sociodemographic variations were apparent. For example, people from higher socio-economic backgrounds believed that their oral health enhanced their QoL to a greater degree (OR=1.46, CI=1.20, 1.78) than the lower socio-economic groups. Women claimed that their oral health had a greater negative effect on QoL than did men (OR=1.36, CI=1.11, 1.64). Younger people (16-64 years old) reported that their oral health status reduced and enhanced QoL more than older adults (65 years and over) (OR=1.59, CI=1.23, 2.04). Conclusions: The study shows that the UK public perceives oral health as affecting their QoL in a variety of physical, social and psychological ways and that significant socio-demographic variations exist in these perceptions.
British Journal of Oral & Maxillofacial Surgery, Aug 1, 1999
The study retrospectively investigated variations in the use of secondary healthcare for head inj... more The study retrospectively investigated variations in the use of secondary healthcare for head injury, particularly assault. A total of 25,300 emergency head-related admission were examined over a two-year period, of which 3756 were for assault. More males were admitted during summer and holiday periods, while there were fewer female patients with head injuries and the incidence varied less. The largest number of admissions was among men aged 15-44 and most assaults occurred at weekends. Females were more likely than males to die from all head injuries (OR=1.31) and violent head injuries (OR=2.38). Women (15+) stayed longer in hospital than males. Injuries among males are primarily associated with social occasions. Females experience head injuries all the year round suggesting that these injuries are the result of domestic violence. There are important demographic differences in numbers of patients and duration of hospital care required to treat these avoidable injuries.
Silver diamine fluoride (SDF) was developed in Japan in the 1960s. It is a clear solution contain... more Silver diamine fluoride (SDF) was developed in Japan in the 1960s. It is a clear solution containing silver and fluoride ions. Because of its anti-bacterial and remineralizing effect, silver diamine fluoride has been used in managing dental caries for decades worldwide. This paper aims to summarize and discuss the global policies, guidelines, and relevant information on utilizing SDF for caries management. SDF can be used for treating dental caries in most countries. However, it is not permitted to be used in mainland China. Several manufacturers, mainly in Australia, Brazil, India, Japan, and the United States, produce SDF at different concentrations that are commercially available around the world. The prices differ between contents and brands. Different government organizations and dental associations have developed guidelines for clinical use of SDF. Dental professionals can refer to the specific guidelines in their own countries or territories. Training for using SDF is part of...
British Journal of Oral & Maxillofacial Surgery, Aug 1, 1999
This study retrospectively investigated variations in the use of secondary healthcare for head in... more This study retrospectively investigated variations in the use of secondary healthcare for head injury, particularly assault. A total of 25,300 emergency head-related admissions were examined over a two-year period, of which 3756 were assaults. There were seasonal differences according to ethnic group: far more injuries, particularly assault, occurred amongst the black and minority ethnic groups during the summer months and holidays. Black males had two to three times the rate of admission for assault than any other group. Among whites, females stayed longer in hospital after a head injury. White women stayed significantly longer than South Asian women following a head injury and South Asian men stayed significantly longer than white men after an assault. There are substantial seasonal variations and differences in the length of hospital stay after a head injury, particularly assault, depending on ethnic group. These differences require clarification and more detailed studies of head injuries ought to record the patient's ethnic background.
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