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Year : 2006  |  Volume : 17  |  Issue : 3  |  Page : 121-5
Prevalence of oral lesions in relation to habits : Cross-sectional study in South India.


Department of Oral and Maxillofacial Pathology, Ragas Dental College and Hospital, Chennai, India

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   Abstract 

BACKGROUND: Smoking, drinking and chewing tobacco product, common habits in India have been positively associated with oral lesions. No study has been conducted in this part of Tamilnadu regarding the prevalence of oral lesions in relation to habits. METHODS: A hospital based cross-sectional study was carried out at Ragas Dental College, Chennai. Already existing data of two thousand and seventeen consecutive patients from sub-urban areas of Chennai, who attended the outpatient department, at Ragas Dental College, for dental complaints during a period of three months in 2004, who underwent oral examination and interviewer based questionnaire was used. RESULTS: Oral soft tissue lesions were found in 4.1% of the study subjects. The prevalence of leukoplakia, OSF and oral lichen planus was 0.59%, 0.55%, and 0.15% respectively. The prevalence of smoking, drinking alcoholic beverages and chewing was 15.02%, 8.78% and 6.99% respectively. Smoking and chewing were significant predictors of leukoplakia in this population. DISCUSSION: The prevalence of leukoplakia, OSF and oral lichen planus in our study population is similar to those found in other populations. The prevalence of consumption of alcoholic beverages in our study population was higher when compared to the Indian National Sample Survey study. However the prevalence of smoking and chewing was found to be lower. Smokers were more likely to develop smoker's melanosis compared to other lesions. Among those who consumed alcoholic beverages alone, the prevalence of leukoplakia was higher compared to other lesions. OSF was the most prevalent lesion among those who chewed panmasala or gutkha or betel quid with or without tobacco.

Keywords: Betel quid, areaa nut, panmasala, unfiltered cigarette oral submucous fibrosis, lichen planus, leukoplakia, Tamilnadu India, chewer′s mucosa oral lesions

How to cite this article:
Saraswathi T R, 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 J Dent Res 2006;17:121

How to cite this URL:
Saraswathi T R, 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 J Dent Res [serial online] 2006 [cited 2017 Jun 22];17:121. Available from: http://www.ijdr.in/text.asp?2006/17/3/121/29877

   Introduction Top


Chewing, smoking and consumption of alcoholic beverages have become connnon social habits in India According to the study conducted by Neufeld and his coworkers, using National Sample Survey (NS S) which is a representative sample of India, conducted in 1995-96, constituting 4,71,143 people 10 years and older, the prevalence of regular use of alcohol is 4.5%, smoking tobacco is 16.2% and chewing tobacco is 14% [1]. The prevalence of these habits was found to be more among men when compared to women. Also, the prevalence was higher among the rural population and those with no formal education [1].

Smoking, drinking and chewing have been positively associated with oral lesions such as oral submucous fibrosis (OSF), leukoplakia and oral lichen planus, which has the potential for malignant transformation [2],[3],[4],[5],[6],[7],[8],[9]. The prevalence of OSF in India varies between 0.03% and 3.2% according to various studies conducted here [7],[10],[11],[12],[13],[14]. Also, higher occurrence of leukoplakia and cancer are observed in OSF patients and it is believed to be an important risk factor for oral cancer among youths [15],[16]. Prevalence of oral leukoplakia in India varies from 0.2%-5.2% [7],[10],[12],[13]. According to an Indian study at four urban centers, the prevalence of oral lichen planus varies between 0.02%-0.4% [10],[14],[17]. In yet another door-to-door survey of 7639 Indian villagers, the prevalence varies from 0.1%-1.5% [18]. However, no study has been conducted in Tamilnadu in this regard to our knowledge. We wanted to know the scenario of oral lesion's relation to habits in this part of the state. Therefore, a pilot hospital based cross-sectional study was carried out using already existing data collected during a period of three months at Ragas Dental College, Uthandi, Chennai, India


   Materials and methods Top


Two thousand and seventeen consecutive patients from sub-urban and rural areas near Chennai, who attended the outpatient department, at Ragas Dental College, for dental complaints during a period of three months from 16 fsub of August to December 2004 formed our study group. Trained dental surgeons collected the data using a combination of clinical oral examination and standardized questionnaire. Information on habits and other characteristics of the study participants were acquired using the standardized, interviewer based questionnaire.

Analyses

Prevalence of oral lesions and habits were estimated using STATA statistical software version 7.0 (STATA Corporation 2001). Logistic regression was used to estimate the effects of different variables on oral lesions. Univariate analysis was done to find the effect of each variable on the prevalence of leukoplakia among the study subjects.


   Results Top


Profile of the study subjects

Table 1 shows the distribution of study subjects by basic characteristics. There were more males (63.75%) in the study population than females (36.25%). 17.15% of the study participants were in the age group of 13 to 20 years, 38.13% were in the age group of 21 to 30years, 21.47% were in the age group of 31 to 40 years and the remaining 23.25% were in the age group of 41 to 84 years. About 28.54% of the participants were either degree or diploma holders and remaining participants have had only school education or were illiterates. More than 85% of the study subjects come from families with monthly income between Rs 5,000 and Rs 10,000 per month, whereas less than 3% belonged to families with income less than Rs 5,000 per month.

Prevalence of habits

The overall prevalence of smoking, drinking alcoholic beverages and chewing were 15.02%, 8.78% and 6.99% respectively. Graph 1 shows the prevalence of habits by age. The prevalence of smoking was higher among men (23.25%) when compared to women (0.55%). Also, the prevalence of smoking is higher among the age group of 20 to 50, highest being in the age group of 20 to 31 (17.3%) and 40 to 51 (17.3%). More than 7 out of 10 smokers use lmfiltered cigarettes, as compared to the other types namely filtered cigarette, cigar and beedi. In this population, alcohol consumption was more common among men (13.37%) when compared to women (0.55%), with the prevalence being highest (11.44%) in the age group of 21 to 30. The use of beer, brandy and whisky was more prevalent compared to other alcoholic beverages consumed in this study group, namely arrack, wine, vodka andram.

The chewing habit was more prevalent in men (8.55%) as compared to women (4.25%), with highest being in the age group of 51-60. In women, the chewing habit was more prevalent when compared to the other two habits; wherein, in men it was the smoking habit that was more prevalent. The study participants were more likely to chew pan masala (commercially available processed areca nut product without tobacco) or gutkha (commercially available processed areca nut product without tobacco) (70%) as compared to other products namely betel quid, betel leaf with areca nut and lime, unprocessed and processed areca nut alone as can be seen in graph 2.

Prevalence of lesions

Oral soft tissue lesions were found in 4.1% of the study subj ects. In this study, smoker's melanosis was found to be the most common soft tissue lesion with the prevalence being 1.14%. Stomatitis nicotina palatini (0.89%) and leukoplakia (0.59%) were the second and third most common lesions. Table 2 shows that the prevalence of all lesions is more common in men when compared to women, but for chewer's mucosa. Among men, smoker's melanosis and stomatitis nicotina palatini were more prevalent compared to other soft tissue lesions, whereas among women leukoplakia and OSF were more prevalent. Majority of the oral soft tissue lesions were found among people aged from 41 to 60 years.

Prevalence of lesions in relation to habits

Study subjects who smoked had much higher prevalence of soft tissue lesions compared to those who did not. Same was the case among those who consumed alcoholic beverages and chewers. Smokers were more likely to develop smoker's melanosis compared to other lesions. Among those who consumed alcoholic beverages alone, the prevalence of leukoplakia was higher compared to other lesions. OSF was the most prevalent lesion among those who chewed panmasala or gutkha or betel quid with or without tobacco.

Effect (Univariate) of predictor variables on prevalence of leukoplakia

Table 3 shows the effect of different predictor variables on the prevalence of leukoplakia among the study subjects. The odds of having leukoplakia is 6 times higher for those who smoke [OR=6.82; 95% CI, (5.63, 8.01] as compared to those who do not. The odds of suffering from leukoplakia is about 5 times higher among those who chew as compared to those who do not [OR= 5.08; 95% CI, (3.75, 6.41]. The consumption of alcoholic beverages alone is not significantly associated with the prevalence of leukoplakia i.e, prevalence of leukoplakia did not differ between those who consumed alcoholic beverages and thosewho didnot.


   Discussion Top


Cross-sectional studies are important in estimating the prevalence of a disease in the population and identifying the higb-risksub population. In this sample the prevalence of oral lesions was 4.1%, with the prevalence being greater for males than females. The prevalence of leukoplakia (0.59%), OSF (0.55%) and oral lichen planus (0.15%) in our study population is similar to those found in other previous studies conducted in India [7],[10],[12],[15],[17],[18].

The prevalence of alcohol consumption (8.78%) in our study population was higher when compared to the results reported by Neufeld and his coworkers using the Indian National Sample Survey sample [1]. However the prevalence of smoking (15.02%) and chewing (6.99%) was found to be lower. Smoking and chewing were significant predictors of leukoplakia in this population. However the association between alcohol consumption and presence of leukoplakia was not statistically significant.

In the present study, females were more likely to chew when compared to the other two habits (this goes with the finding that chewer's mucosa is the most prevalent soft tissue lesion among them). Also, the study shows that smoking is more prevalent in men when compared to the other two habits. Findings from the present study are similar to that of Hashibe et al [19] with regard to chewing and smoking habit being significant predictors of leukoplakia. However consumption of alcoholic beverages (any amount and all types mentioned in Graph 3) did notprove to be a significant predictor as found in the studies by Hashibe et al and Gupta [19],[20].

Data was collected as a chair side procedure, which involved oral examination and questionnaire administration. Since the information on the habits was gathered through questionnaire, there could be information bias, but this could only bias our results towards the mill. In this study detailed information could not be gathered on other predictors of oral lesions such as nutritional status and BMI (Body Mass Index); a more detailed and case control study is required to better understand the oral lesions and habits association in this population.

The findings from this study can be used to design case control or cohort studies to further understand the relation between habits and oral lesions. Studies of this nature could potentially help clinicians in identifying high-risk population and which would be most beneficial for providing better oral hygiene programs. Programs to improve oral health should be conducted regularly to promote oral health care in the population.



 
   References Top

1.Neufeld KJ, Peters DH, Rain M, Bono S, Bronner RK: Regular use of alcohol and tobacco in India and its association with age, gender and poverty, Drug Alcohol Depend, 77[3]:283-91,2005.  Back to cited text no. 1    
2.Gangadhran P, Paymaster JC: Leukoplakia-An epidemologic study of 1504 cases observed at the Tata Memorial Hospital, Bombay, India, Brit J Cancer, 25: 657-68,1971.  Back to cited text no. 2    
3.Gupta PC, Mehta FS, Daftary DK, Pindborg ff. Bhonsle RB, Jalnawalla PN, et al : Incidence rates of oral cancer and natural history in a 10-year follow up study of Indian villages, Common Dent Oral Epidemio1,8:287-333,1980.  Back to cited text no. 3    
4.Gupta PC, Bhonsle RB, Morn PR, Daftary DK, Mehta FS, Pindborg JJ: An epidemologic assessment of cancer risk in oral precancerous lesions in India with special reference to nodular leukoplakia, Cancer, 63: 2247-52,1989.  Back to cited text no. 4    
5.Kramer IRH, Lucas RB, Pindborg ff, Sobin LH: WHO collaborating centre of oral precancerous lesions, definition of leukoplakia and related lesions: An aid to studies on oral precancer oral Surg Oral Med Oral Pathol, 46: 568-9,1978.  Back to cited text no. 5    
6.MalaowallaAM, Silverman S Jr, Mani NJ, Bilimorai KF, Smith LW: Oral cancer in 57,518 industrial workers of Guj arat, India: Aprevalence and follow up study, Cancer, 7: 1882-6,1976.  Back to cited text no. 6    
7.Mehta FS, Gupta PC, Daftary DK, Pindborg JJ; Choksi SK: An epidemiological study of oral cancer and precancerous conditions among 101, 761 villagers in Maharashtra, India, Intermit J Cancer, 10: 134-41,1972.  Back to cited text no. 7    
8.Murti PR, Bhonsle RB, Pindborg ff, Daftary DK, Gupta PC, Mehta FS: Malignant transformation in oral submucous fibrosis over a 17-year period Common Dent Oral Epidemio1,13: 340-1,1984.  Back to cited text no. 8    
9.Pindborg ff, Morti PR, Bhonsle RB, Gupta PC, Daftary DK, Mehta FS: Oral submucous fibrosis as precancerous condition, Scand J Dent Res, 92: 224-9, 1984.  Back to cited text no. 9    
10.Pindborg JJ; Chavla TN, Mishra RK, Nagpaul RK, Gupta VK: Frequency of oral carcinoma, leukokeratosis, leukoedema, submucous fibrosis and lichen planus in 10,000 Indians in Lucknow, Uttar Pradesh, India Report, JDent Res, 44: 625,1965.   Back to cited text no. 10    
11.Pindborg JJ, Bhat M, Devnath KR, Narayan HR, Ramchandra S: Frequency of oral white lesions in 10,000 individuals in Bangalore, South India, Preliminary report, Ind J Med Sci, 2: 349-52,1966.   Back to cited text no. 11    
12.Pindborg ff, Mehta FS, Gupta PC, Daftary DK: Prevalence of oral submucous fibrosis among 50,915 Indian villagers, Brit J Cancer, 22:646-54,1968.  Back to cited text no. 12    
13.Wahi PN, Mittal VP, Lahiri B, LutheraUK, Seth RK, Arma GD: Epidemiological study of precancerous lesions of the oral cavity: A preliminary report, Ind J Med Res, 50:1361-91,1970.  Back to cited text no. 13    
14.Zachariah J, Mathew B, Varma NAR, Iqbal AM, Pindborg ff: Frequency of oral mucosal lesions among 5000 individuals in Trivandrum, South India, JhidDentAssoc,38:290-4,1966.  Back to cited text no. 14    
15.Gupta PC, Sinor PN, Bhonsle RB, Pawar VS. Mehta HC: Oral submucous fibrosis in India: A new epidemic? National Med J Ind,11:113-16,1998.  Back to cited text no. 15    
16.Gupta PC, Ray CS: Tobacco and youth in the South EastAsianregion, IndICancer, 39:5-34,2002.  Back to cited text no. 16    
17.Pindborg ff, Kalapesi ILK, Kale SA, Singh B, Taleyarkhan BN: Frequency of oral leukoplakia and related conditions among 10,000 Bombayites. Preliminary report, J Ind Dent Assoc, 37: 228-9, 1965.  Back to cited text no. 17    
18.Pindborg ff, Mehta FS, Daftary DK, Gupta PC, Bhonsle RB: Prevalence of oral lichen planus among 7639 Indian Villagers in Kerala, South India, Acta Dermato Venereologica, 52: 246-20,1972.  Back to cited text no. 18    
19.Hashibe M, Sankaranarayanan R, Thomas G, KuravillaB,MathewB. SomanathanT, ParkinDM, Zhang ZF: Alcohol drinking, body mass index and the risk of oral leukoplakia in an Indian population, hit J Cancer, 88[1]:129-34,2000.  Back to cited text no. 19    
20.Gupta PC: Epidemiologic study of the association between alcohol habits and oral leukoplakia, Common Dent Oral Epidemio1,12(l):47-50, 1984.  Back to cited text no. 20    

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Correspondence Address:
T R Saraswathi
Department of Oral and Maxillofacial Pathology, Ragas Dental College and Hospital, Chennai, India

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.29877

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    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

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