|Year : 2020 | Volume
| Issue : 2 | Page : 80-83
Assessment of Oral Mucosal Lesions Among Tobacco Users – A Cross-Sectional Survey
Geeta Sharma1, Sabitha Gokulraj2, Atul Bharadwaj3, Kyatsandra Narasimhaiah Jagadeesh4, Anuj Singh Parihar5, Shruthi S Hegde6
1 Professor, Department of Oral Pathology, Sarjug Dental College, Darbanga, Bihar, India
2 Associate Professor, Department of Oral Medicine and Radiology, Vinayaka Mission’s Sankarachariyar Dental College, Vinayaka Missions Research Foundation, Tamilnadu, India
3 Lecturer, Department of Prosthodontics Dental Sciences, College of Dentistry, Majmaah University, Al-Majmaah, Saudi Arabia
4 Professor, Department of Prosthodontics and Implantology, Sri Siddhartha Dental College, Sri Siddhartha Academy of Higher Education, Tumkur, Karnataka, India
5 Reader, Department of Periodontics, Peoples Dental Academy, Bhopal, MP, India
6 Department of Oral Medicine and Radiology, Srinivas Institute of Dental Sciences, Mukka Suratkal, Mangalore, Karnataka, India
|Date of Submission||19-Mar-2020|
|Date of Decision||21-May-2020|
|Date of Acceptance||18-Jul-2020|
|Date of Web Publication||16-Feb-2021|
Dr. Anuj Singh Parihar
Reader, Department of Periodontics Peoples Dental Academy, Bhopal, MP
Source of Support: None, Conflict of Interest: None
Introduction: Increased consumption of tobacco can lead to various oral mucosal lesions. The study was done to assess the oral mucosal lesions among tobacco users. Materials & Methods: This cross-sectional study was conducted on 5240 subjects who found to have a history of tobacco usage. Subjects with presence of oral mucosal lesions were subjected to vital tissue staining with toluidine blue dye (TB). Factors such as socio-economic status, occupation, type of tobacco usage, education status and type of lesions were recorded. Results: Hyperkeratosis was seen in 562 patients followed by smoker’s melanosis in 360, leukoplakia in 252 patients, squamous cell carcinoma in 190 patients, smoker’s palate in 130 patients, erythroplakia in 96, lichen planus in 80 and OSMF in 70 patients. Cases were due to Cigarette/bidi, were due to gutkha usage, 252 (14.4%) due to hookah, hukli and 214 (12.2%) due to zarda/pan masala. Oral mucosal lesions were significantly higher in patients with the habit of smoking cigarette/beedi 974 (55.9%) compared to those patients that were chewing gutkha 300(17.2%) or panmasala 214 (12.2%) (P < 0.05). There was significantly maximum lesions seen in buccal mucosa (812) followed by the retromolar pad area in 302, floor of mouth in 199, palate in 176, gingiva in 128, tongue in 90 and lip in 33 cases (P < 0.05). Conclusion: Authors found that most common oral mucosal lesion was hyperkeratosis followed by leukoplakia and smokers melanosis. Most common type of tobacco use was cigarette/bidi and gutkha.
Keywords: Bidi, buccal mucosa, cigarette, oral mucosal lesion
|How to cite this article:|
Sharma G, Gokulraj S, Bharadwaj A, Jagadeesh KN, Parihar AS, Hegde SS. Assessment of Oral Mucosal Lesions Among Tobacco Users – A Cross-Sectional Survey. J Orofac Sci 2020;12:80-3
|How to cite this URL:|
Sharma G, Gokulraj S, Bharadwaj A, Jagadeesh KN, Parihar AS, Hegde SS. Assessment of Oral Mucosal Lesions Among Tobacco Users – A Cross-Sectional Survey. J Orofac Sci [serial online] 2020 [cited 2021 May 8];12:80-3. Available from: https://www.jofs.in/text.asp?2020/12/2/80/309589
| Introduction|| |
There has been increased usage of tobacco and alcohol in the last few years. The reason for significant increase is modernization, availability of tobacco products, etc. Tobacco is consumed in 2 forms, smoking tobacco and chewing/smokeless form of tobacco. Under smoking tobacco, various forms available is cigarette, bidi, hookah, hukli, etc. whereas non-smoking tobacco comprised of gutkha, chaini khaini, pan, masala, zarda, etc.In India, only 20% of tobacco is consumed in the form of cigarette whereas tobacco is used in 40% in bidi, and rest in the form of smokeless tobacco. Stress, attitude, availability of tobacco products, advertising campaigns and work load are precipitating factors triggering use of tobacco.,
The most harmful effect of tobacco usage is the development of pre-malignant lesions and conditions. Pre-malignant conditions such as leukoplakia, erythroplakia and palatal changes are associated with reverse smoking are commonly occurring lesions. WHO has clubbed both pre-malignant lesions and pre-malignant conditions as potentially malignant disorders. Smokers melanosis and smoker’s palate also contributes to significant number.
The incidence of potentially malignant diseases in youngsters is on the rise owing to increase intake of the smokeless form of tobacco. Tobacco has been recognized as initiation and progression of oral cancer. As an oral physician, all patients giving a history of tobacco usage in any form should be screened to decrease the mortality and morbidity of oral diseases.
Vital tissue staining such as toluidine blue is a potent method of confirmation of bipsy site especially in potentially malignant disorders. Methylene blue (MB), Lugol’s iodine, and acetic acid have also been tried in the diagnosis of cancerous lesion. The present cross-sectional study was conducted on 5240 subjects with history of tobacco use and the occurrence of oral mucosal lesions recorded.
| Materials & Methods|| |
This cross-sectional study was conducted in the Department of Oral Medicine & Radiology which comprised of 5800 subjects who visited the department for dental treatment. Out of these, 5240 found to have history of tobacco usage. The inclusion criteria were subjects with history of tobacco usage since last 6 months, subjects age ranged 18–60 years of both genders and subjects giving consent. Exclusion criteria were pregnant women, subjects without history of tobacco consumption, subjects not giving consent. Selection of subjects was done based on simple random technique. The purpose of the study was explained to all included in the study and their written consent was obtained. Ethical approval for this study (protocol No. VMSDC/RES/2018-19/021) was provided by the Institutional ethics committee of Vinayaka Missions Sankarachariyar Dental college, Tamil Nadu, on 26th March 2018.
All subjects were provided with questionnaire data which comprised of name, age, gender, education status, socio-economic status, occupation, type of tobacco usage (smoking or non- smoking), frequency and duration of use.
A thorough oral examination was performed by the two trained investigators. Subjects with presence of oral mucosal lesions were subjected to vital tissue staining with toluidine blue dye (TB). All the participants were requested to wash the mouth two times with water for 20 seconds to eliminate the debris followed by application of 1% acetic acid for 20 seconds. All the participants were given 1% TB solution for 20 seconds as a rinse. Area which retained the dye appeared as dark blue. Later all the stained area was selected for punch biopsy. A punch of size 5 mm was used for the study. Tissue thus obtained were fixed in formalin and sent to oral pathology department for histopathology.
Data of the patient was tabulated and entered in MS Excel sheet. SPSS version 21.0 was applied for statistical evaluation. P-value less than 0.05 was considered significant.
| Results|| |
[Table 1] shows that out of 5240 subjects, males were 3820 and females were 1420. Age group 18–30 years comprised of 540 males and 225 females, 30–40 years had 810 males and 210 females, 40–50 years had 1320 males and 355 females and 50–60 years had 1150 males and 630 females.
[Table 2] shows that there was significantly higher cases of hyperkeratosis seen in 562 patients (males − 310, females − 252) followed by smokers melanosis in 360 (males − 240, females − 120), leukoplakia in 252 patients (males − 180, females − 72), squamous cell carcinoma in 190 patients (males − 110, females − 80), Smokers palate in 130 patients (males − 90, females − 40), erythroplakia in 96 (males − 75, females − 21), lichen planus in 80 (males − 45, females − 35) and OSMF in 70 patients (males − 60, females − 10) (P < 0.05).
[Table 3] shows the type of tobacco usage and oral mucosal lesions. There were significantly higher oral mucosal lesions seen in patients with the habit of smoking cigarette/beedi 974 (55.9%) compared to those patients that were chewing gutkha 300(17.2%) or panmasala 214 (12.2%) (P < 0.05).
[Table 4] shows demographic profile of patients. Maximum males (455) had education up to primary level while females (230) had up to secondary level, maximum males were laborer (490) and females were unemployed (230) by occupation. Maximum males (718) had lower SES and females (320) had middle SES. The difference was significant (P < 0.05).
[Table 5] shows that maximum lesions were seen in buccal mucosa (812) followed by retromolar pad area in 302, floor of mouth in 199, palate in 176, gingiva in 128, tongue in 90 and lip in 33 cases (P < 0.05). This depends on regular placement of tobacco in different areas of oral cavity.
| Discussion|| |
World Health Organization defined pre-malignant lesions as morphologically altered tissue in which cancer is most likely to occur than its apparently normal counterpart. Pre-malignant condition is defined as generalized state of body associated with significant increase risk of cancer. Various studies have established the relation between tobacco and oral mucosal lesions. The occurrence of tobacco induced lesions in oral cavity varies from area to area and there is gender discrimination. The occurrence of oral mucosal lesion is more frequently encountered in males as compared to females owing to high use of tobacco in males in various forms., Considering this, the present study assessed various oral mucosal lesions in study group.
In this study we screened 5240 subjects who gave history of tobacco usage in either smokeless tobacco or smoking tobacco. The prevalence of oral mucosal lesions found to be in 1740 (33.2%). Males contributed 63.7% (1110) and females 36.2% (630).
The screening of the patients was established through oral examination followed by biopsy after use of toluidine blue dye. This is a vital tissue stain which stains dysplastic area and thus provide suitable site for biopsy. It is an acidophilic dye that selectively stains acidic tissue components such as deoxyribonucleic acid (DNA) and ribonucleic acid (RNA). Compared to normal tissues, dysplastic and anaplastic cells contains additional nucleic acids. These tissues retain dye and enhance penetration of the dye.
We found that 562 patients (males- 310, females − 252) were of hyperkeratosis followed by smokers melanosis in 360, leukoplakia in 252 patients, squamous cell carcinoma in 190 patients, Smokers palate in 130 patients, erythroplakia in 96, lichen planus in 80 and OSMF in 70 patients. Hallikeri et al. in their study included 2280 subjects who had habit of tobacco usage. It was found that prevalence of oral mucosal lesions was 54.1% and higher frequency at the age of second and fourth decade. The prevalence of oral submucous fibrosis was 26.95%, leukoplakia was 10.35%, carcinoma in 9.94%, lichen planus in 5.5%, and erythroplakia in 0.66%. Smokeless tobacco habit was established amongst males (98.79%) in comparison to females (9.37%).
We found that 974 (55.9%) cases were due to Cigarette/bidi, 300(17.2%) were due to gutkha usage, 252 (14.4%) due to hookah, hukli and 214 (12.2%) due to zarda/ pan masala. Ray et al. observed that males having increased risk for developing SCC with the habit of taking smokeless tobacco or mixed habit poses. In female patients habituated to processed areca nut chewing had greater risk of developing SCC.We found that maximum males (455) had education upto primary level while females (230) had upto secondary level, maximum males were labourer (490) and females were unemployed (230) by occupation. Maximum males (718) had lower SES and females (320) had middle SES. We observed that maximum lesions were seen in buccal mucosa (812) followed by retromolar pad area in 302, floor of mouth in 199, palate in 176, gingiva in 128, tongue in 90 and lip in 33 cases.
Kumar et al. found that there were a total of 630 patients, with males representing 69.52% of cases and mean age of 42.64 years. Among 375 patients oral submucous fibrosis was more common followed by leukoplakia and lichen planus. Most commonly affected site was buccal mucosa.
Assessment of oral mucosal lesion among tobacco users may be helpful in preventing serious complications. Evaluation of lesions in early stage can be useful in inhibiting conversion to oral cancer.
The limitation of the study is undersized test sample. The occurrence of specific lesions in particular age group was not discussed. Further long-term studies required to evaluate the prevalence of oral mucosal lesions with tobacco consumption.
| Conclusion|| |
Authors found that most common oral mucosal lesion was hyperkeratosis followed by leukoplakia and smokers melanosis. Most common type of tobacco use was cigarette/bidi and gutkha.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Varshitha A. Prevalence of oral cancer in India. J Pharm Sci Res 2015;7:845-8.
Sadiq H, Gupta P, Singh N, Thakar SS, Prabhakar I, Thakral J. Various grading systems of the oral epithelial dysplasia: A review. Int J Adv Health Sci 2015;1:20-6.
Mortazavi H, Baharvand M, Mehdipour M. Oral potentially malignant disorders: an overview of more than 20 entities. J Dent Res Dent Clin Dent Prospects 2014;8:6-14.
Gowhar O, Ain TS, Singh NN, Sultan S. Prevalence of oral premalignant and malignant lesions in Moradabad, India − a retrospective study. Int J Contemp Med Res 2016;3:2079-81.
Hosagadde S, Dabholkar J, Virmani N. A clinicopathological study of oral potentially malignant disorders. J Head Neck Physicians Surg 2016;4:29-34. [Full text]
Maia HC, Pinto NA, Jdos SP, de Medeiros AM, da Silveira ÉJ, Miguel MC et al.
Potentially malignant oral lesions: clinicopathological correlations. Einstein (Sao Paulo) 2016;14:35-40. 20.
Hallikeri K, Naikmasur V, Guttal K, Shodan M, Niranjan KC. Prevalence of oral mucosal lesions among smokeless tobacco usage: a cross‑sectional study. Indian J Cancer 2018;55:404-9.
] [Full text]
Naga SD, Gundamaraju KK, Bujunuru SR, Navakoti P, Kantheti LC, Poosarla C. Prevalence of oral potentially malignant and malignant lesions at a tertiary level hospital in Hyderabad, India. J NTR Univ Health Sci 2014;3:S13-6.
Messadi DV. Diagnostic aids for detection of oral precancerous conditions. Int J Oral Sci 2013;5:59-65.
Sridharan G. Epidemiology, control and control and prevention of tobacco induced oral mucosal lesions in India. Indian J Cancer 2014;51:130-5.
Saraswathi TR, Ranganathan K, Shanmugam S, Sowmya R, Narasimhan PD, Gunaseelan R. Prevalence of oral lesions in relation to habits: cross-sectional study in South India. Indian Journal of Dental Research 2006;17:121.
Sujatha D, Hebbar PB, Pai A. Prevalence and correlation of oral lesions among tobacco smokers, tobacco chewers, areca nut and alcohol users. Asian Pacific J Cancer 2012;13:1633-7
Sudheendra US, Sreeshyla HS, Shashidara R. Vital tissue staining in the diagnosis of oral precancer and cancer: Stains, technique, utility, and reliability. Clin Cancer Investig J 2014;3:141-5. [Full text]
Ray JG, Ganguly M, Rao BS, Mukherjee S, Mahato B, Chaudhuri K. Clinico-epidemiological profile of oral potentially malignant and malignant conditions among areca nut, tobacco and alcohol users in Eastern India: a hospital based study. J Oral Maxillofac Pathol 2013;17:45-50.
] [Full text]
Kumar GK, Abidullah M, Elbadawi L, Dakhil S, Mawardi H. Epidemiological profile and clinical characteristics of oral potentially malignant disorders and oral squamous cell carcinoma: a pilot study in Bidar and Gulbarga Districts, Karnataka, India. J Oral Maxillofac Pathol 2019;23:90-6.
] [Full text]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]