| Abstract|| |
Introduction: Dental health and oral health are used almost synonymously when stating the goals of oral health; such statements are only valid for dental health. This may lead to severe underestimation of the need of total oral health care. When planning measures of oral health care, the lack of data may lead to a risk of overlooking diseases of the soft tissue in, and adjacent to, the oral cavity. Prevalence data of oral mucosal lesions are available from many countries, but the information is usually restricted to very few lesions in each survey.
Materials and Methods: The present study is an attempt to assess and compare the various deleterious habits and its associated oral mucosal lesions among patients visiting outpatient department of Jaipur Dental College, Jaipur, Rajasthan.
Results: It was found that the prevalence of habits was 51.4% including both the sexes and prevalence of oral mucosal lesions were 9.9%.
Discussion: The prevalence of habits and oral mucosal lesions is very high as compared with other studies. The habit of smoking was higher in males as compared to females.
Keywords: Bidi, gutka, Jaipur, oral mucosal lesions, prevalence
|How to cite this article:|
Pratik P, Desai VD. Prevalence of habits and oral mucosal lesions in Jaipur, Rajasthan. Indian J Dent Res 2015;26:196-9
Consumption of various tobacco products is becoming an upcoming trend for today's world. Epidemiologic studies have demonstrated a wide variety in prevalence rates in oral lesions in different population due to various habits. It has been reported that the oral mucosal disease may affect 25-50% of individuals having various habits, depending on the population studied (Andreasen et al., 1986). Chewing, smoking, and consumption of alcoholic beverages have become a common social habit in India. According to a study conducted by Neufeld et al., using National Sample Survey which is a representative sample of India, conducted in 1995-1996, constituting 471,143 people of age 10 years and older, the prevalence of regular use of alcohol was 4.5%, smoking tobacco is 16.2%, and chewing tobacco was 14%.  The prevalence of these habits was found to be more among men when compared to women. Furthermore, the prevalence was higher among the rural population and those with no formal education.  However, no study has been conducted in Jaipur, Rajasthan in this regard to our knowledge as Rajasthan is very well-known for practicing various deleterious habits since ancient times and hence to know the scenario of habits and its association with oral lesions in this part of Jaipur, Rajasthan present study was conducted.
|How to cite this URL:|
Pratik P, Desai VD. Prevalence of habits and oral mucosal lesions in Jaipur, Rajasthan. Indian J Dent Res [serial online] 2015 [cited 2019 Jun 24];26:196-9. Available from: http://www.ijdr.in/text.asp?2015/26/2/196/159166
| Materials and Methods|| |
A total of 10,456 patients visited the outpatient department of Jaipur Dental College, Jaipur; Rajasthan during the period of January 2012 to August 2012 among which 10,000 met the inclusion criteria and these constituted the study sample. Examination was carried out in each individual. A formal ethical clearance to conduct this study was obtained by the ethical committee of the institution. Patients selected for the study were explained in detail about the condition affecting their oral cavity. The diagnosis of the lesion was made based on history, clinical features, according to standard guidelines and color Atlas More Details. 
| Results|| |
Data collected were analyzed, and results showed following observation.
[Figure 1] shows the distribution of subjects by basic characteristics. There were more males 7364 (73.6%) than females 2636 (26.4%). Among 10,000 study population, 2553 (25.5%) were between 10 and 25 years age group, 2730 (27.3%) between 26 and 40 years of age, 2376 (23.8%) between 41 and 55 years whereas 1628 (16.3%) between 56 and 70 years of age group and rest 713 (7.1%) fell in 70+ age group which belong to both the sexes.
The overall prevalence of deleterious habit among the study population screened was 5137 (51.4%). Among these patients with habits, 4466 were males and 671 were females as shown in [Figure 2].
Prevalence of various habit-related lesions in different sexes is shown in [Figure 3] which shows that a total of 988 (9.9%) patients had lesions in which 863 (8.6%) were males and 125 (1.3%) were females of different age groups and in this, it was found that leukoplakia was most prevalent (2.04%) followed by smokers palate (1.96%) and smokers melanosis (1.85%). Among 51.4% patients who indulged in various deleterious habits, 19.2% of subjects had various oral mucosal lesions. It was also found that oral submucous fibrosis (OSMF) was relatively common in the younger age group which is due to the strong association with the use of areca nut, the chief component of gutka. Study subjects who smoked had a much higher prevalence of soft tissue lesions compared to those who did not. This was similarly the case among those who consumed alcoholic beverages and chewers.
|Figure 3: Prevalence of various mucosal lesions. SM: Smokers melanosis, SP: Smokers palate, OSMF: Oral submucous fibrosis, LEU: Leukoplakia, LR: Lichenoid reaction, CB: Chemical burn, TPK: Tobacco pouch keratosis, Others: Lesions due to deleterious habits, >1 LES: More than one lesion|
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| Discussion|| |
In India, there are 240 million tobacco users (195 million men and 45 million women), accounting for one-fifth of the world's tobacco consuming population. 
Today, our universe is in a state of tobacco epidemic with a larger population of tobacco users emerging day by day. In our country, various forms of smoking and chewing tobacco are practiced by the people. Most common form is bidi and cigarette followed by cherrut or chutta, chillum hukli and hukkah which is rare. 
Bidi smoking is predominant in many parts of Rural India. When compared to cigarettes, bidis produce only a smaller volume of smoke. But the smoke which is generated is rich in higher concentrations of several toxic agents such as hydrogen cyanide, carbon monoxide, ammonia, and carcinogenic hydrocarbons. Bidi smoking is also considered to cause about 2-3 times greater nicotine and tar inhalation than conventional cigarettes. 
The prevalence of deleterious habit in our study was 51.4% with male (44.7%) population being more prone than females (6.7%). This is in accordance with the other studies ,,, which may be due to social stigma as this part of Jaipur, Rajasthan is still very backward and women still follow the parda system where they are not allowed to go out of their house for work.
Among the subjects screened in the study, 29.5% gave the history of smoking and in them, 27.4% were males and 2.1% were females which supports study conducted by Colombo et al. 2002.  In our study, 17.6% of the study population had smokeless tobacco habit and among which 13.5% were males and 4.1% females gave the history of smokeless tobacco habit which is comparatively higher than smoking habit as women in many rural areas believe that tobacco has many magical and medicinal properties in keeping the mouth clean, getting rid of a foul smell, curing toothache, controlling morning sickness, during labor pains, etc., and among these (2.4%) females gave the history of eating supari (plain areca nut) followed by gutka which is almost similar with a study done by Summers et al. in 1994. 
Our study also confirmed the fact that there is increasing number of young individuals (9.5%) who are indulging in various deleterious habits due to easy availability of products, peer pressure, various advertisements etc., indicating that the trend of usage is deep rooted and not a recent one and this is also supported by a study done by Pednekar and Gupta in 2004. 
The consumption of alcohol in the present study was only 1% out of the total screened subjects and it is lowest when compared to other habits and all were males which may be due to occupations that require a substantial amount of physical energy as well as due to underreporting of the subjects about the habit. Our findings coincide with the study of Aruna et al.  but contrary to the study done by Saraswathi et al. 
Multiple habit reported by the patient in the present study was 3.98% and these had negligible lesions when compared with single habit subjects with all being males and the possible reason being reduced time of contact or exposure to each individual habit which is supported by a study done Sujatha et al., 2012.  But the exact reason behind this has not yet been confirmed.
This study also shows that the prevalence of oral mucosal lesions is 9.88% with male (8.6%) population being more affected than females (1.3%) which is very high because the study took place in a hospital campus where the patients generally visit for dental and oral problems and is contradictory with the report presented by WHO (2003)  which shows the prevalence of oral mucosal lesions in Rajasthan is 1%.
The present study showed bidi smoking was significant predictor of oral mucosal lesions such as leukoplakia (2.04%), smokers melanosis (1.85%), and smokers palate (1.96%) with duration and frequency of habits had a significant effect in the development of oral lesions which is supported by the study done by Yen et al.  and because of the easy availability and cost effectiveness and bidi contains a raw form of tobacco which is backed up by the study done by Mehta et al.  It was also observed that habitual areca nut chewers (chemically processed variety) had a higher prevalence of OSMF which is in accordance with a study done by Tang et al. 
| Conclusion|| |
Among the study population assessed for tobacco-related habit prevalence, bidi smoking was more common in study population compared to cigarette smoking and among the chewing habits, khaini chewing habit was more prevalent than any other type of smokeless tobacco habit. Prevalence of habits was more in males than females. Females had chewing habit more when compared to smoking. Lesions associated with smoking were homogenous leukoplakia, smokers melanosis, and smokers palate. Even though the present study gives an overall picture of prevailing tobacco related habits and their associated lesions in Jaipur, Rajasthan. In near future, more and more studies need to be conducted, so as to derive at an exact conclusion. 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.
I thank my guide and HOD Dr. Vela Desai; I would like to thank Dr. Rajeev Sharma and Dr. Isha Gaurav Senior Lecturers, Department of Oral Medicine and Radiology, Jaipur Dental College and Hospital.
Financial support and sponsorship
Conflict of interest
There are no conflict of interest.
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Dr. Prerna Pratik
Department of Oral Medicine and Radiology, Jaipur Dental College, Jaipur, Rajasthan
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3]