Doctors in UAE sound oral cancer alarm over use of qat, betel leaves

By: Jasmine Al Kuttab /Abu Dhabi | May 4, 2018 | Khaleej Times

Doctors in the UAE are warning against the illegal use of betel leaves (paan) and qat leaves, which they said are among the top causes of oral cancer.

“We have noticed people consuming these dangerous carcinogenic substances, mainly coming from South Asia and Yemen,” Dr Norbert W. Dreier, consultant – oncology at Burjeel Hospital, told Khaleej Times.

According to the UAE law, qat leaves are banned. The trafficking, possession or consumption of the substance is a criminal offence.

Betel leaves, which are widely chewed in Asia as a stimulant substance, are also banned in the UAE and those caught trafficking or consuming the product will face penalties. 

Dr Dreier pointed out although oral cancer is not the leading cancer in the UAE, expats from South Asia, who have been using these substances are mostly at risk. “What we have noticed is patients from these areas who have a habit of chewing the betel and qat leaves are more prone to the disease.

“In Western countries, we see more people with oral cancer, which has been caused mainly by tobacco and alcohol consumption. However, here we see more cases among people chewing betel and qat leaves.”

Dr Anoop Azad, specialist in prosthodontics at Universal Hospital, said betel nut (paan) chewing is popular among Asian people, and is a top risk factor for oral cancer.

However, oral cancer causes are not only related to the prohibited substances, but also to tobacco chewing or ‘reverse smoking,’ he warned.

“In India, many people smoke without filters,” he said, adding that he had noticed that oral cancer cases are more common among Indian expats in the UAE, particularly the workers in camp sites.

“The expats are the major part of the volume, and when we ask about their history, they refer to such substance use.”

He said the disease can be deadly because it can quickly spread to the neck and chest.

“The chances of oral cancer spreading to other areas is much faster, because of the extensive blood supply.”

He stressed that early intervention is crucial, and urged the public to undergo regular screenings, warning that the disease is difficult to detect and can thus turn fatal.

“If people ignore the signs, it will not only get worse, but it can turn fatal very quickly.”

“People tend to take this issue very light. They don’t understand how important it is to have their screening done.”

He said in the last two years, he has seen around 15 cases related to oral cancer, and the youngest patient was just 22 years old. He said he attends at least six cases of patients who have developed lesions and ulcers a month, which can develop into cancer.

Dr Per Rehnberg, CEO of Snö Dental, said the potential for death can significantly be reduced if the cancer is detected early, making treatment easier, less invasive and more than 90 per cent curable.

“The best way to manage and treat an oral cancer diagnosis is by combining early detection of the disease with timely treatment.”


He urged people to regularly examine their mouth, to look for non-healing ulcers, areas of bleeding, abnormal patches and swellings.


Dr Rehnberg added that professional screening should be conducted every six months.

He also advised people to protect themselves from sun exposure, as lip cancer is directly related to ultraviolet radiation from sunlight.


“People who work outdoors and have prolonged exposure to the sun are more likely to develop lip cancer.”


Top causes of oral cancer

>Chewing betel or qat leaves

>Around 50 per cent of the oral cancer cases are related to tobacco use

>Reverse smoking

>Human papilloma virus is another risk factor

>Those with a family history of cancer, and/or a weak immune system are at a greater risk



Jasmine Al Kuttab /Abu Dhabi

May 4, 2018

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Everything you need to know about finding a dentist

By: Camille Hogg | December 20, 2017 | Abu Dhabi World Online

From cavities to consultations, we find out about the main dental issues in Abu Dhabi and how to pick a good dentist.


Your smile says a lot about you, and that’s especially true when it comes to your teeth.

With cavities and gum disease on the rise, we consult the experts on maintaining good hygiene, dealing with dental emergencies and knowing what to look for in a clinician.

The root of the problem

“The two biggest diseases in dentistry are caries – or cavities – and periodontitis,” explains Dr Per Rehnberg, CEO at Snö Clinics.

Caused by factors including poor oral hygiene and diet, cavities are common in children and adults, and occur when your tooth enamel begins to erode due to acids caused by bacteria.

With a particularly high prevalence of decay in the region among children, Dr Per is keen to emphasise that more awareness is needed of the detrimental effects our sugary habits have on our teeth.

“In this region, the caries in kids are so much worse. Kids drink a lot of juice and soda, and the low pH means that the soda is acidic as well as sugary, so we see a lot of eroded teeth,” says Dr Per.

Dr Heba Aboushady, general dentist at the Boston Dental Center, agrees.

“Adults misunderstand the right diet for the teeth and switch from milk to fruit juices; these are actually very high in sugar and acids,” she emphasises. “We need more education on healthy diets and how to follow basic oral hygiene instructions.”

But with pain, sensitivity to cold and, in severe cases, visible holes as key symptoms of caries in children and adults, the solution isn’t always drilling.

“Small caries can be healed without drilling,” Dr Per clarifies. “If you do flossing and fluoride treatments, we can check in three to six months and you may not need a filling, so [the tooth] will have much better longevity.”

Even with larger cavities, there are still options before you need to undergo a root canal, where the infected pulp from inside the tooth is removed and the tooth sealed.

“The root has a function, so once you replace it with a root filling, it shortens the lifespan of the tooth,” Dr Per explains.

“When [the cavity] is middle-big and gets closer to the nerve, you can still do a filling in that case without a root canal treatment.

“If you have a cavity that is close to the pulp, one way of treating it is to have a special kind of dressing and calming filling on top of that in order to save the root,” he adds.

Periodontitis is another common disease in the region, but unlike cavities, pain is not a common symptom until more advanced stages.

“Many people in this region are under-diagnosed with periodontitis,” says Dr Per. “It’s not usually painful for the first ten to 15 years, but then it’s often too late to save the teeth.

“It generally starts with bleeding gums. Bad breath could also be a factor. When you eat, food gets stuck between your teeth and causes inflammation as it rots; this causes tooth loss. We also associate calculus (plaque that has hardened and cannot be removed by brushing) with the disease, which can be removed at the hygienist.”

One key way to slow the disease down is flossing, and Dr Per recommends a once-a-day regimen.

However, whatever your problem, acting early is key, as regular check-ups can prevent problems from escalating.

Things you should look out for include pain or sensation when you consume something cold, as well as bridges, crowns or problematic wisdom teeth – and any jaw joint issues should be dealt with by your dentist, too.

Dental emergencies

With many of us harbouring a deep fear of the dentist, we often ignore our problems before it becomes an emergency – and that’s not a good idea.

“There’s often a difference in opinion between the dentist and their patient as to what constitutes an emergency,” Dr Heba chuckles wryly.

“When there’s a cosmetic problem, like a tooth has fallen out or a filling has broken, I find that patients come in quite quickly, but with pain or infection, it’s not always the case.

“As a dentist, things like swelling on one side of your face, fever and difficulty swallowing can indicate a life-threatening infection,” Dr Heba states.

“Things like accidents involving knocked-out teeth also need quick intervention, and constant pain might be an abscess or deep cavity. One thing people don’t know too much about is that if you have red patches or ulcers in the mouth, you need to take instant action.”

Dr Per agrees, noting the location of the pain or problem: “Go quickly to the dentist, especially if the infection is in the lower jaw.”


Which dentist?

With so many options on the market, it can be hard to know what to look for when picking your dentist.

“That’s the hard thing about being the patient,” agrees Dr Per. “You just don’t know. We have a transitory community here and people don’t tend to get that long bond with their dentist that they might get in their home country.

“One way is to make sure you can audit what the clinic has done,” he adds. “You need to ask to see the documentation, diagnosis, x-rays, printouts and treatment plans so that if needed, you can get a second opinion.”

While many dentists may offer deals for free consultations, Dr Per recommends knowing what you’re getting from the experience.

“It’s very important to have a proper exam,” Dr Per advises. “If you don’t have all the data on the patient’s specific conditions, it’s very hard to suggest the right treatment – it’s like building a house without having a f

“Many dentists might offer a free exam, but these may not be full exams – a proper one would usually take at least 45 minutes and will detail the status today, risk calculation and a prevention plan.

“Patients also need to be informed about problems that might happen,” Dr Per adds. “Many dentists are reactive; they might only treat symptoms like tooth pain, but a good dentist would look at underlying causes.”

For Dr Heba, communication is a huge factor.

“A good dentist will explain everything to the patient, including treatment options, the procedures involved, the expected outcome and, of course, involve the patient in any decision making,” she says.

“Going to the dentist can be scary – I was that child and I had a bad experience,” she laughs. “These days, it’s very different: there are new techniques, technologies and types of anaesthetic.

“We don’t want you to have more pain; we want you to be rid of it, and a good dentist will explain what they’re doing.”

At the end of the day, make sure you feel confident before you put your money where your mouth is, says Dr Per.

“Establishing trust with your dentist is very important, and if you don’t like the clinic or clinician, then close your mouth and get a second opinion.”

Word of mouth

Good oral hygiene takes some effort, so here are our experts’ top tips.

Have regular check-ups: Scheduling a check-up depends on your oral health, says Dr Per. If you have ongoing conditions such as periodontitis or you’re at increased risk of cavities, you’ll need them more frequently, but between six months and one year is common in the UAE.

Get a fresh brush: “You need to change your brush every three months – and use a soft one,” Dr Heba says.

Don’t forget to floss: “Use floss or interdental brushes if you have a brace, crowns or bridges. They have tighter contact than air flossers,” Dr Heba says.

Supplement with fluoride: “Water here has no fluoride,” says Dr Heba. “Fluoride application for children can help reverse early signs of decay.”

By Camille Hogg

December 20, 2017

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Most root canal treatments not needed, warn UAE dentists

By: Jasmine Al Kuttab/ Abu Dhabi | May 7, 2018 | Khaleej Times

Dental experts say root canal is the last treatment to be considered and 9 out of 10 patients do not need a root filling. Much less invasive and cheaper options can be carried out in most cases.

Dentists must inform their patients that only 10 per cent of the cases need a root canal.

Almost nine out of 10 patients never required root canal treatment but most were unnecessarily lured into the invasive treatment, an Abu Dhabi doctor has said.

As Root Canal Awareness Week gets under way across the globe, Dr Per Rehnberg, CEO of Snö Dental, is warning against the over-use of the treatment. He urged patients to obtain all the facts before proceeding with it. “Root canal is the absolute last thing you should consider for your teeth; everything should be done to ensure natural teeth are kept vital.”

He stressed that patients who often complain about tooth ache, which can be caused by a cavity, can usually have a much less invasive and cheaper option done than the root canal treatment.

“The problem is that around 10 per cent of the band aid cases (traditional filling) will need a root filling, that is why many dentists are often quick to suggest a root canal. But nine out of 10 patients do not actually need a root filling.”

He pointed out that dentists must inform their patients that only 10 per cent of the cases  need a root canal and share with them the other available options.

Moreover, Dr Rehnberg exp-lained that health insurance companies pay much more for a root canal treatment than the traditional filling, which could be why many dental clinics lure patients into getting the costly treatment.

He added that the band aid treatment costs around Dh500, whereas a root canal treatment is usually around Dh3,000, and will also require extra procedures, including placing a crown on top of the tooth, which costs another Dh2,000.

“What we have seen is that the root canal treatment has become a common option, or even a first-time option when the pat-ient only has slight tooth ache.”

In fact, Dr Rehnberg and his team conducted a mystery shopping survey around the UAE to identify the clinics that provide thorough information to the patients, and those that recommend invasive, costly and unnecessary treatments. “We wanted to look at the diagnoses and suggestions for treatment, and we found that it is very common to suggest the root canal treatment before they even knew what to do.

“We took 15 people from our company and sent them out for the mystery shopping in Abu Dhabi and Dubai and found that most dentists showed a lack of proper documentation. Many patients were also suggested the root can-als, which we later treated with simpler and more affordable treatments.”

He said that it is important for patients to trust their dentists; however, it is also important to receive transparent information about the alternatives.

Dr Rehnberg added that people are more prone to having dental cavities in the UAE, for various reasons that are often related to their lifestyle choices, including smoking and eating sugary and processed foods.

However, having cavities does not necessarily mean patients have to turn to the invasive treatment.  “I’ve seen people who had low risk and still had root canals. This is a sign of possible over-treatment.”

He also noted that official documentation is necessary for the pat-ient in order to be able to receive second opinions.

“If a dentist is reluctant to allow the patients to keep their documents, then this is a concern, because it’s a matter of trust.”

Dr Gun Norell of Snö Dental, who has worked in dentistry in various parts of the world for over 30 years, said raising awareness on the matter is key.

“We urge people to seek a second opinion before having invasive treatments carried out, and advise that they think about root canal as the last option rather than the first.”

Free second opinions for patients

To help support patients with their decision, Snö Dental is offering free second opinions on root canal treatments for all residents of Abu Dhabi, during Root Canal Awareness Week from May 6-12.

“We always evaluate the teeth and if we can avoid over treatment by providing a less invasive option for the tooth to recover, we will do that,” said Dr Per Rehnberg, CEO of Snö Dental.

Jasmine Al Kuttab/ Abu Dhabi

May 7, 2018

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Some UAE dentists caught out for grossly over-treating patients

By: Nick Webster | May 12, 2018 | The National

Dubai Health Authority handed out 25 fines for fraud, waste and abuse cases.

From left, Dr Per Rehnberg, chief executive of Snö Dental Clinics, and dentist Dr Nasser Fouda, say dentists can often view their practice as a business rather than as providing healthcare. Pawan Singh / The National

Expensive and pointless dental treatments offered to patients to boost profits have been exposed in a mystery shopping exercise at practices in Abu Dhabi and Dubai.

Fifteen clinics were checked by dentists posing as patients to assess how common over-treatment is in the industry.

One patient was offered unnecessary root canal treatment, crowns and fillings at a total cost of Dh26,200, when all that was required was two fillings and a visit to a hygienist.

The case was just one example highlighted by Scandinavian dentists in Abu Dhabi.

Regulators said they were stepping up inspections, and would only recommend providers based on a positive history of care.

Dr Per Rehnberg, chief executive of Snö Dental Clinics, who has been working in Sweden, Norway and Denmark before running a dentist practice in Abu Dhabi, was shocked at the high level of treatments being offered to patients, with insurers often picking up the costs.

“Root canal treatment is often suggested and is very common here.” he said.

“After my experience, I sent staff out to several other clinics and they found the same thing.

“There was a lack of documentation. Clinics take x-rays but it is very important for patients to get a proper status so they know what is being included in an exam.”

One clinic suggested a patient had a root canal, 3 crowns fitted and 4 fillings amongst other minor treatments costing Dh26,200.Caries – decaying teeth – were removed by another dentist to avoid the need for fillings, root canal work or crown fittings, at a cost of just Dh3,000.

“It is a competitive business, we know that, but none of the mystery shoppers were given any documents and the majority of clinics recommended over treatment,” Dr Rehnberg said.

“The science has gone so far forward. We know there are many alternatives that are cheaper and less invasive than a root canal.

“We earn less money as dentists, as insurance companies do not always pay for these kind of alternative treatments, but they are usually better for the patient.”

Dentists said nine out of ten patients in pain did not need a root canal treatment, yet the procedure was still offered.

“The Hollywood smile is big business; it looks good but many patients I see for follow up work it is clear it has been done in a hurry,” Dr Rehnberg said.

“Cosmetics are very popular, but many dentists are not describing the pros and cons to patients. “There is always risk.”

Veneers at a cost of between Dh2,000 to Dh4,000 per tooth were commonly prescribed, instead of a cheaper option of bleaching.

To achieve the perfect smile, patients can expect to pay anything from Dh12,000 to Dh40,000 for veneers, whereas bleaching can cost just Dh2,000.

Dentists have said proper record keeping is crucial to maintain a transparent industry.

Dr Nasser Fouda has been in the UAE since 1996 and said a common trend is dentists viewing their practice as more of a business than providing healthcare.

“Many dentists call people clients, rather than patients and want to make money – they are more like teeth mechanics, and are happy to drill, screw or carry out a root canal,” he said.

“Patients may go in for a simple filling, and end up with a crown – that’s not always the best option.

“Dentistry teams often want to do everything themselves, rather than call in specialists to maximise their profits. This is not always the best option.

“It’s preferable to preserve natural teeth for as long as possible, as the structure is much better and artificial products will never be as good as enamel and dentine.”

There are clear rules and regulations for dentistry to follow, and clinics must adhere to a strict operating policy imposed by regulators – either the Dubai Health Authority or Department of Health.

DHA has said its regulators inspected 59 clinics in Dubai in 2017, issuing seven warnings and handing out 25 fines for misdemeanors around fraud, waste and abuse.

“At the Health Funding Department we do not directly regulate provider service pricing at this time,” said Ali Lutfi, Head of Insurance Permit at Health Funding at the DHA.

“However, we do conduct inspections across all medical providers in the Emirate from a financial aspect – including hospitals, medical centers, dental clinics and pharmacies. Our inspections mainly look for fraud, waste and abuse (FWA).

“Part of our licensing requirements for insurance companies and third party administrators is for them to provide us with quarterly FWA reports, highlighting any providers with suspected FWA.

“We select providers to inspect based on these reports and feedback from members via our various complaints channels.”

The Department of Health did not respond to a comment request in time for publication.

By Nick Webster
May 12, 2018


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