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The rising burden of cancer in the developing world calls for a re-evaluation of the treatment strategies employed to improve patient management, early detection and understanding of the disease. There is thus an increasing demand for interdisciplinary research that integrates two or more disciplines of what may seemed to be highly unrelated and yet very much needed as strategies for success in research. This paper presents the processes and barriers faced in building partnerships in oral cancer research in a developing country.A case study was undertaken in a developing country (Malaysia) to assess the strengths and weaknesses of the situation leading to the formation of a multidisciplinary research partnership in oral cancer. Following the formalization of the partnership, further evaluation was undertaken to identify measures that can assist in sustaining the partnership.The group identifies its strength as the existence of academia, research-intensive NGOs and good networking of clinicians via the existence of the government's network of healthcare provider system who are the policy makers. The major weaknesses identified are the competing interest between academia and NGOs to justify their existence due to the lack of funding sources and well trained human resources.With the growing partnership, the collaborative group recognizes the need to develop standard operating procedures (SOPs) and guidelines for the sharing and usage of resources in order to safeguard the interest of the original partners while also attending to the needs of the new partners.

to investigate genetic polymorphisms in GSTM1, GSTT1 and CYP1A1 and the association with the risk of oral cancer in the Jakarta population.A total of 81 cases and 162 controls matched for age and sex were selected from 5 hospitals in Jakarta. Sociodemographic data using questionnaires were obtained and peripheral blood samples were collected with informed consent for PCR-RFLP assay. Conditional logistic regression analysis was performed to obtain the association between the risk of oral cancer and GSTM1, GSTT1 and CYP1A1 polymorphisms.GSTM1 and GSTT1 null were slightly overrepresented among cases (60.5% and 45.7% respectively) compared to controls (55.6% and 41.4% respectively), but no statistically significant differences were observed. In contrast, the distribution of CYP1A1 polymorphism was higher among controls compared to cases (52.5 % versus 42.4 %). The odds ratio of null GSTM1 and GSTT1 genotypes was slightly higher compared to wild type genotypes (OR 1.19, 95% CI 0.70-2.02 and OR 1.19, 95% CI 0.72-2.05 respectively). Furthermore, the presence of CYP1A1 polymorphism did not increase the risk of oral cancer (OR 0.70, 95% 0.39-1.25).Genetic polymorphisms of GSTM1, GSTT1 and CYP1A1 may not be risk factors for oral cancer in the Jakarta population.

The objective of this study is to share cost analysis methodology and to obtain cost estimates for posterior restorations in public sector dental clinics. Two urban and 2 rural dental clinics in Selangor state were selected. Only cases of 1 posterior restoration per visit by dental officers were included over 6 months. One capsulated amalgam type, 1 capsulated tooth-colored, and 1 non-capsulated tooth-colored material were selected. A clinical pathway form was formulated to collect data per patient. Annual capital and recurrent expenditures were collected per clinic. The mean cost of an amalgam restoration was RM 30.96 (sdRM 7.86); and tooth-colored restorations ranged from RM 33.00 (sdRM 8.43) to RM 41.10 (sdRM 10.61). Wherein 1 USD = RM 2.8. Restoration costs were 35% to 55% higher in clinics in rural areas than in urban areas. The findings demonstrate economy of scale for clinic operation and restoration costs with higher patient load. Costs per restoration were higher in rural than in urban dental clinics. More studies are recommended to address the dearth of dental costs data in Malaysia.

A survey was conducted to assess competencies of dental graduates of the Faculty of Dentistry, University of Malaya, as perceived by the graduates and their employers, based on the five-year undergraduate curriculum introduced in 1995. All senior dental officers in the Ministry of Health (MOH), representing employers, and all 164 dental graduates of the years 2000, 2001, and 2002 were sent a self-administered questionnaire covering eight areas of competency. The respondents had to rate these areas on a scale of 1 (very poor) to 4 (very good). The responses for each area were then dichotomized into poor (1 and 2) and good (3 and 4). If less than 60 percent of the respondents rated an area as good, then it was categorized as needing attention; 60-69 percent as satisfactory; and 70 percent and above as excellent. One hundred and six graduates (64.6 percent) and twenty-nine employers (96.7 percent) responded; of the graduates, 73.6 percent were working in the MOH and 22.6 percent in private practice. About 57.1 percent of employers reported that at least five graduates have worked under them. Graduates (85.7 percent) and employers (83.3 percent) agreed that graduates have excellent skills in communication. Although all graduates perceived their competency to be excellent in the four areas (treatment planning; community-based skills; management, administrative skills, and personal management; and professional development skills), employers felt that these are the areas that are of concern and needed attention. In conclusion, whilst generally the graduates' level of competency in almost all areas is acceptable or good, there are areas of concern that need to be addressed to further improve the five-year curriculum at the University of Malaya.

The Oral Health Division, Ministry of Health in Malaysia piloted clinical pathways (cpath) in primary care in early 2003. This study investigated the knowledge, perception of cpaths and barriers faced by the clinicians involved in the pilot project. Self-administered questionnaires were sent to the clinicians (n=191). Dentists (67.9%) and dental nurses (70.6%) had good overall knowledge of cpaths. The majority of the clinicians (67.9% to 95.6%) perceived cpath positively in all areas. Only 9.2% of dentists encountered difficulties in using cpath forms compared to 28.4% of dental nurses. A higher proportion of dental nurses (73.5%) compared to dentists (64.8%) were willing to continue using cpath. The majority of dentists (76.7%) and dental nurses (73.1%) were willing to participate in future development of cpaths. Overall, there was evidence of managerial support for the pilot project. A follow-up of the pilot project was somewhat lacking as less than half (43.3%) of the clinicians reported that the state coordinator obtained feedback from them. The findings auger well for the future implementation of cpath should the Oral Health Division decide to adopt cpath routinely in the public oral health care service.

Patient satisfaction is critical for the growth and prosperity of any oral health service or practice. The success of any oral health service can be assessed by an evaluation of the degree of satisfaction/dissatisfaction of its patients.The aim of this study is to assess satisfaction/dissatisfaction with the oral health services among Non-Commissioned Officers (NCOs) in the Malaysian Armed Forces (MAF).A qualitative study using the Nominal Group Technique was undertaken. Eighty subjects from the Rasah Camp, Seremban were randomly selected from four lists, namely privates, male and female corporals and sergeants and were grouped into 10 discussion groups of eight participants each. Of the 10 groups, four groups comprised male corporals, three groups of privates, two groups of sergeants and one group of female corporals. Two separate discussion sessions were conducted to elicit factors/items causing dissatisfaction and satisfaction expressed by the participants. Every participant then scored all the factors perceived as important by members of the group. The score ranged from 0-9 i.e., the least to the most important. Scores were weighted, and the weighted score of every participant for each item was added. The ratings of the factors were determined by comparing the sum of the weighted scores.The six most important factors/items rated in the satisfaction discussion were modem equipment (9.07), friendly dentist (8.27), pleasant surgery (8.23), good quality treatment (7.93), friendly staff (7.18) and pain alleviation (6.07). These factors were further regrouped into three broad categories i.e. (1) Clinic set-up, (2) Patient-personnel interaction (PPI) and (3) Technical competency (TC). In the dissatisfaction discussion six factors/items were rated i.e. long waiting time (10.39), sequence of treatment not followed (7.18), non-availability of dentist (7.16), unfriendly staff (7.05), poor quality treatment (6.80) and restricted time for treatment (5.98). The three most important categories in the dissatisfaction discussion were (1) Administrative efficiency, (2) PPI and (3) TC.A conceptual model was developed to explain the factors affecting patients' satisfaction/dissatisfaction with the oral health services. It is recommended that a questionnaire survey be undertaken to validate and reflect the entire population of the MAF. Remedial measures highlighted in the areas of dissatisfaction should be addressed accordingly based on the quantitative study.

Introduction: Western researchers showed that oral squamous cell carcinoma (OSCC) patients exhibit lower survival rate and poorer prognosis compared to other type of cancer where several clinicopathological parameters have been implicated in the survival of patients. This study aims to assess the association between sociodemographic and clinicopathological parameters with survival of OSCC patients. Method: Data were collected from 253 histologically diagnosed OSCC patients attending selected clinics nationwide. Survival was analyzed for relation with habits, site, disease stage and nodal involvement. Results: Mean age was 58.9 ± 12.6 years with 8.3% aged less than 40. Majority is females (61.1%) and of Indian ethnic (48.0%). Most common habit was quid chewing (55.8%), followed by smoking (29.7%) and most came at stage IV (44.3%). Tongue was the most common site (38.9%), followed by buccal mucosa (35.0%). Factors associated with survival are smoking (p = 0.016), stage at presentation (p < 0.001) and nodal involvement (p < 0.001). Discussion: Majority of OSCC cases occurred among Indians where the patients were quid chewers and presents with advanced cancer. Survival of patients decreased steadily over the years. At 1 year after diagnosis, 67.2% was still alive but only 13.4% survived 5 years. Among the habits studied, only smoking was found to be associated with survival where among those smoking, only 38.7% is alive compared to 61.3% deceased. No association was found between site and survival. A highly significant association was seen for both cancer stage and nodal involvement with survival. More survivors were found among those who come at early stage (76.3%) compared to late stage (32.7%). Similarly, more than two thirds (69.1%) of those who present with negative nodal involvement were found to be alive. In conclusion, smoking, disease stage and nodal status are predictors of survival for OSCC patients in Malaysia. Acknowledgements: Grant-IRPA06-02-03-0174PR0054/05-05/, OPEX-UM 2008, 2009, 2010, Abraham, M.T., Anand, R., Tay, K.K., Mustafa, W.M.W., Yuen, K.M., Norlida, A., Rahman, Z.A.A.

Introduction: Dietary intake has been hypothesized to be associated with various diseases including oral cancer. According to studies worldwide, imbalanced diet and nutrient deficiency have been attributed to promote oral malignancies. However, the function of specific nutrients in preventing oral cancer remains largely undefined. This study aims to investigate the association between intake of retinol and vitamin C with the risk of oral cancer. Materials and methods: Dietary intake data was collected from 8 participating hospitals throughout Malaysia using a validated foodfrequency questionnaire (FFQ). Intake of retinol and vitamin C were computed using the Nutriemart software. This case-control study included 150 cases and 150 controls matched for age, gender and ethnicity.The association between micronutrients, risk habits and oral cancer was analysed using Pearson Chi-Square test and multiple logistic regression. Results: Significantly more controls were found to consume retinol (27.3%) and vitamin C (83.3%) above the Recommended Daily Allowance (RDA) as compared to cases (10.7% and 72.0%, respectively). Among risk habits, only cigarette smoking was found to have an inverse association with vitamin C (p = 0.021) where as no risk habits were found to be associated with retinol intake. After adjusting for confounding factors, only retinol intake was found to be inversely related to the risk of oral cancer (aOR 0.272, 95%CI 0.135– 0.548). Discussion: This study suggests that vitamin C appears to reduce risk of oral cancer and this relationship is weakened after adjusting for risk habits. Meanwhile, retinol intake proves to provide protection against oral cancer up to 72.8% independent of risk habits practiced.

A total of 537 dentate adults from nine randomly selected government dental centers in three states in Malaysia were interviewed to assess their preference for either exodontia or preservation of teeth when they experience toothache, or have carious anterior or posterior teeth. The assumptions tested were i) patients prefer exodontia rather than preservation when they have toothache, and ii) patients are more willing to have posterior teeth extracted than anterior teeth for caries. Both these assumptions were rejected. Even though the majority of the subjects preferred preservation (59%) when having toothache, exodontia was the treatment of choice in a large proportion of subjects (41%). Significant differences in preference were found among the various ethnic, educational, income, and age groups. However, when ethnicity was held constant, binary regression indicated that the variations observed were determined by education, income, and age groups and not by ethnicity.

Introduction: Uncoordinated data collection by different research groups prompted the initiation of Malaysian oral cancer Research Initiative (MOCRI) group. Objectives: To coordinate and standardize data and tissue collection and storage, develop a minimum dataset on risk factors, intervention techniques and quality of life of oral cancer patients. Materials and Methods: A computer software programme is currently being developed to accommodate multi-centre data collection and research activities in eight hospitals. The complete dataset includes parameters on sociodemographic, clinical, pathological, quality of life measures, details of treatment methods, vital status and dietary intake. Tissues are being collected, stored and catalogued as fresh and formalin-fixed tissues for future use in satellite researches. The networking in tissue and data collection includes the establishment of oral cancer cell-lines. These tissues are being planned for studies on genetic profile, genetic polymorphism, diagnostic and prognostic markers. Results: Tissues and data on 115 oral cancers, 9 leukoplakia and 13 lichen planus has been collected since 2003. Preliminary data from 2004 were analysed for 58 cancer patients. Majority of them are more than 60 years old (65.5%) with a mean age of 63.3. Twenty-four (41.4%) were males, 34 (58.6%) females with the majority of them being Indians (56.9%) followed by Chinese and Malays (15.5% each), Indigenous people of Sabah and Sarawak (12.1%). Eighteen (31%) respondents were smokers, 17 (29.3%) alcohol drinkers and 31 (53.4%) betel quid chewers. Five patients have had histories of family cancers where 3 included immediate family members with head and neck cancers. For the quality of life measure, only 30.2% felt that their daily activities were disrupted despite having advanced cancers. Satellite researches are in progress on genetic polymorphism and tumour markers. One oral cancer cell-line has been established. Conclusion: The establishment of oral cancer database and tissue bank in encouraging and supports on-going satellite researches.

The dental needs, demands and patterns of service utilization were assessed in a randomly selected sample of 750 subjects attending the Dental Faculty, University of Malaya, Kuala Lumpur. Toothache accounted for the most frequent overall dental complaint. However, the most common motives for seeking dental care varied among children (2-12 yr), adolescents (13-18 yr) and adults (19 + yr). The attendance behavior of women is more preventively orientated and more inclined towards rehabilitation compared to that of men. The proportion of normative needs of the patients varies from 7.5% for dentures to 66% for dental caries. About 50% of service utilization for the first visit consisted primarily of extractions in the oral surgery department.