| Abstract|| |
Background: Oral mucous membrane is an integral part of the complex oral cavity which is associated with maintenance of oral as well as general body health. Oral mucosal lesion (OML) is one of the most prevalent diseases in India, which is caused by consumption of smokeless and smoked forms of tobacco. Aim: To assess the prevalence of OMLs and their association with pattern of tobacco use among patients visiting dental institution in Bhilai. Materials and Methods: This descriptive cross-sectional study included 872 participants who visited the Department of Oral Medicine and Radiology, Rungta College of Dental Science and Research, and fulfilled the inclusion criteria, and the study was carried out from July to September 2016. Self-designed proforma was used for recording demographic details, and WHO Assessment Form for Oral Mucosal Diseases was used to record the tobacco use status and findings of the clinical and laboratory investigation. Statistical analysis was performed using IBM SPSS version 23, and the mean, frequency, and percentage were calculated. Results: Among the 872 participants, 69.26% were male and 30.74% were female. The mean age of the study population was 46.19 ± 12.33 years. The prevalence of tobacco use among study participants was 51.26% and that of the OML was 36.36%. Aphthous ulcer was the most prevalent OML followed by oral submucous fibrosis and leukoplakia. Conclusion: The study emphasizes the harmful effects of tobacco use toward oral mucous membrane and also serves as a path for future tobacco cessation programs that would be helpful to prevent OML.
Keywords: Chhattisgarh, India, leukoplakia, premalignant lesions, prevalence, tobacco
|How to cite this article:|
Verma S, Sharma H. Prevalence of Oral mucosal lesions and their association with Pattern of tobacco use among patients visiting a dental institution. Indian J Dent Res 2019;30:652-5
|How to cite this URL:|
Verma S, Sharma H. Prevalence of Oral mucosal lesions and their association with Pattern of tobacco use among patients visiting a dental institution. Indian J Dent Res [serial online] 2019 [cited 2021 Sep 26];30:652-5. Available from: https://www.ijdr.in/text.asp?2019/30/5/652/273417
| Introduction|| |
Oral mucous membrane is considered as mirror to oral and general health as it acts as a gateway to our digestive system. Oral mucosal lesions (OMLs) act as predecessors to oral malignancy which is the sixth most common cancer globally. These OMLs may be a result of complex bacterial and viral interaction in localized environment, metabolic or immunologic alteration causing systemic diseases, drug reactions, or even due to deleterious lifestyle habits such as consumption of tobacco, betel quid, and alcohol.,
These OMLs not only cause pain and discomfort but also may interfere with speech and mastication. In addition to this, they may even hamper day-to-day activities of social life by producing symptoms such as xerostomia, halitosis, or oral dysesthesia. An oral premalignant lesion is similar to a smoldering volcano existing in a suppressed or concealed state which if not detected early ends in disastrous consequences.,,,
Tobacco usage in both smoked and smokeless forms are prevalent in India and extremely high in Chhattisgarh. The second Global Adult Tobacco Survey GATS-2 India (2016–17), conducted among 15 years and older estimates the decrease in prevalence of tobacco consumption by 6% as compared to that estimated by GATS-1 (2009–10) i.e. Decrease from 34.6% to 28.6%. The GATS-2 fact sheet India 2016-17 shows that 10.7% of all adults are currently involved in smoked tobacco use while smokeless tobacco is consumed by 21.4%.,
Several studies have reported the prevalence of OMLs in various parts of India, but very few in Central India particularly in states such as Madhya Pradesh and Chhattisgarh. Apart from the GATS survey, only one study conducted in Vidisha district of Madhya Pradesh reported the habit of smoked and smokeless tobacco in 21% and 42% of participants, respectively. The study also reported the use of both smoked and smokeless tobacco products by 11% of participants. The prevalence of clinically significant oral lesions was reported as 8.4%.
To the authors' best knowledge and belief, no studies are conducted in Chhattisgarh to assess the prevalence of tobacco-associated OMLs, which ignited the minds to carry out a descriptive, cross-sectional, hospital-based study to assess the prevalence of OMLs and their association with pattern of tobacco use.
| Materials and Methods|| |
A descriptive, cross-sectional study was conducted among 872 participants who visited the Oral Medicine and Radiology Department of Rungta College of Dental Science and Research (RCDSR) from July 2016 to September 2016. The study was approved by the Institutional Ethics Committee of RCDSR (Ref. No: RCDSR/MDS/Syno. Reg./2016-29A).
All individuals aged 15 years and above, visited during the study duration, and consulted for wilful participation in the study were included. The reluctant, prolonged systemic or mental ailment individuals, and those undergoing radiotherapy were excluded from the study.
All the individuals who agreed to participate and were qualified to participate in the study were asked to give written informed consent. Participants were thoroughly explained about the purpose and the nature of the study and were requested to provide authentic information and assured of confidentiality.
Assessment criteria for categorizing participants according to tobacco use
Demographic details along with tobacco use status were recorded by personal interviewing using a self-designed proforma. The habit of tobacco consumption were broadly classified into four categories based on the following criteria: those individuals who reported of daily or less than daily use of smoked form of tobacco without use of smokeless tobacco were considered as smokers, whereas those who reported daily or less than daily use of smokeless tobacco without use of smoked form of tobacco were considered as smokeless tobacco users. Individuals consuming both forms during the study were considered as dual users, whereas who never used tobacco or gave a history of discontinuing either or both the forms were categorized as nontobacco users.
Clinical and laboratory investigation
Type III clinical examination of oral mucosa was carried out by a single trained and calibrated examiner with patients well seated on a dental chair to identify type, location, number, and size of OMLs. Brief description of the aim and objectives along with the study protocol was explained to all the participants before obtaining written informed consent.
Final diagnosis was affirmed on the basis of clinical criteria, review, and cross-examination by experts. Cytological and histopathological investigation was also performed to confirm the clinical findings. The WHO Assessment Form for Oral Mucosal Diseases was used to record the findings of clinical examination.,
Statistical analysis was done using Statistical Package for the Social Sciences Software SPSS version 23 (IBM, Chicago, IL, USA). Data were analyzed for frequencies, percentage, and mean. The association between frequency of tobacco use and prevalence of OMLs was estimated by Chi-square test. The statistically significant level was set at P ≤ 0.05, with a confidence interval of 95%.
| Results|| |
A total of 872 individuals comprising 604 (69.26%) males and 268 (30.74%) females, with the mean age of 46.29 ± 12.32 years, constituted the study population [Table 1].
|Table 1: Distribution of study participants according to gender and tobacco use habit|
Click here to view
Out of 872 individuals, 311 (35.66%) did not possess any kind of tobacco habit while 74 (8.49%) reported of past smoking habit and 40 (4.59%) reported of past smokeless tobacco consumption habit. On the other hand, 236 (27.06%) individuals reported use of smokeless form, 167 (19.15%) of smoked form, and 44 (5.05%) reported of consuming both the types, thus making tobacco usage prevalence of 51.26% [Table 2].
|Table 2: Prevalence of oral mucosal lesions based on the type of tobacco use|
Click here to view
It was interesting to observe that 299 (66.89%) males had the habit of tobacco, which is nearly double as compared to 148 (33.11%) females [Table 1].
A number of 317 (36.36%) individuals were diagnosed with at least one OML. The prevalence rate was higher in smokeless tobacco users than smoked form users (24.20% vs. 9.75%) whereas dual users had prevalence of 15 (1.72%). The prevalence of 0.34% of OMLs was also reported in ex-tobacco users (smoked and smokeless tobacco form). The most prevalent lesions were recurrent aphthous ulcer, i.e., 128 (14.68%), followed by oral submucous fibrosis, leukoplakia, and leukokeratosis nicotina palatini with the prevalence of 6.20%, 4.70%, and 4.01%, respectively. Erythroplakia was found to be less prevalent as compared to leukoplakia exhibiting itself in 2.30 % individuals, while lichen planus, a precancerous condition was found in 27 (3.7%) of participants. The prevalence of oral cancer was 0.11% in the entire study population [Table 2] and [Table 3].
|Table 3: Prevalence of different oral mucosal lesions in the study population|
Click here to view
Distribution of various OMLs in relation to frequency of tobacco use shows that there was a significant increase in the occurrence of all the OMLs with the increase in frequency of tobacco use (P < 0.05). Surprisingly, a significant decrease in frequency of recurrent aphthous ulcers occurrence was seen in relation to increase in frequency of tobacco use (P = 0.001) [Table 3].
| Discussion|| |
Oral mucous membrane is most susceptible to many diseases, but surprisingly, very scarce information is available regarding abnormalities of oral mucosa, particularly among the rural or semiurban population of India where the use of tobacco products is most prevalent and major cause of havoc.,
The prevalence of OMLs was found to be 36.36% in this study. Tobacco usage pattern in India varies significantly by location and cultural beliefs of the community. Comparison of data from the present research with the data provided by GATS-India i.e. GATS 1 and 2 reveals that use of tobacco in Bhilai, Chhattisgarh is very high for homemade smoked and smokeless tobacco products when accounted together i.e., 51.26%. This shows that the prevalence of tobacco use in Bhilai, Chhattisgarh is still much higher as compared to estimates made by GATS 1 and 2 i.e. 34.6% and 28.6% respectively. This high use of homemade tobacco products with less awareness regarding the harmful effects of varying composition and mixture of tobacco might have resulted in such a high prevalence of OMLs encountered in our study. Further differences in the participants, conditions, methods of examination, and confirmation of diagnosis by laboratory investigation, which was the major strength of our study.,,
In our study, the most prevalent OML was found to be aphthous ulcer (14.68%), which is in accordance with the studies conducted in the Indian population where they found aphthous ulcers to be present in 47.4% and 44.5% of individuals, respectively., High occurrence of aphthous ulcers may be attributed to the fact that Indian cuisine utilizes various herbs and spices and majority of the Indian population consume spicy food which may damage oral mucosa or result in acidic regurgitation leading to aphthous ulcers. Aphthous ulcers may be the result of stress and dietary deficiency of vitamins. All these factors may have aggregately led to high prevalence of aphthous ulcers.,
High prevalence of tobacco use in this study may be attributed to ease of accessibility of homemade tobacco products which are available at cheaper price. Easy availability of these homemade products imparts deleterious health effects due to varying mixture and composition which is not regulated.,,
Majority of rural population using Gudhaku (a paste form of smokeless tobacco) as an oral hygiene aid to clean the teeth without being aware of its deleterious effects in oral cavity.
This study has inherent limitation that measure of tobacco use is based on self-reports which may be biased. However, the strength of study includes cross-confirmation of clinical diagnosis by laboratory investigation, which makes the diagnosis much more accurate.
The results of this study provide further evidence that there is a critical need for tobacco cessation clinical interventions with awareness programs regarding harmful effects of tobacco use, especially Gudhaku. Further, these findings coupled with the findings from GATS-1 (2009–2010) survey for Chhattisgarh can help identify several important targets for tobacco cessation interventions.,,
The development and formal testing of this intervention approach, based on the data accumulated from the target population, is needed in the hope of reducing the substantial public health problem of continued tobacco use by a rural population of Chhattisgarh.
| Conclusion|| |
This cross-sectional, hospital-based study highlights the improper use of variety of homemade tobacco-based products as well as the high prevalence of OMLs in the study population. The study also evokes the need for implementation of proper tobacco cessation programs and screening programs focusing on OMLs. Emphasis should be given for cessation of habit through counseling and proper referral and treatment procedures. Educational programs should be conducted by health professionals with implication of dentist, health workers, anganwadi workers, and allied medical science professional who can be trained for detecting OMLs and education regarding harmful effects of tobacco consumption. This study is concluded with the hope that the results from this study will act as a foundation for state-based tobacco research along with state-wise screening program for detection and treatment of several tobacco-associated OMLs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Goyal R, Jadia S, Jain L, Agarawal C. A clinical study of oral mucosal lesions in patients visiting a tertiary care centre in central India. Indian J Otolaryngol Head Neck Surg 2016;68:413-6.
Mehrotra R, Thomas S, Nair P, Pandya S, Singh M, Nigam NS, et al.
Prevalence of oral soft tissue lesions in Vidisha. BMC Res Notes 2010;3:23.
Iype EM, Pandey M, Mathew A, Thomas G, Sebastian P, Nair MK, et al.
Oral cancer among patients under the age of 35 years. J Postgrad Med 2001;47:171-6.
] [Full text]
Parkin DM, Pisani P, Ferlay J. Estimates of the worldwide incidence of eighteen major cancers in 1985. Int J Cancer 1993;54:594-606.
Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol 2009;45:309-16.
Global Adult Tobacco Survey: India Report. Mumbai, India: International Institute for Population Sciences (IIPS), Ministry of Health and Family Welfare GoI; 2010. Available from: http://www.mohfw.nic.in
. [Last accessed on 2017 Nov 18].
Global Adult Tobacco Survey: India Report. Mumbai, India: International Institute for Population Sciences (IIPS), Ministry of Health and Family Welfare GoI; 2017. Available from: http:// mohfw.nic.in
. [Last accessed on 2017 Nov 18].
Kramer IR, Pindborg JJ, Bezroukov V, Infirri JS. Guide to epidemiology and diagnosis of oral mucosal diseases and conditions. World Health Organization. Community Dent Oral Epidemiol 1980;8:1-26.
World Health Organization. WHO assessment form for oral mucosal diseases. Guide to Epidemiology and Diagnosis of Oral Mucosal Diseases and Conditions. Munksgaard, Copenhagen: World Health Organization; 1980.
Babu RA, Chandrashekar P, Kumar KK, Reddy GS, Chandra KL, Rao V, et al.
Astudy on oral mucosal lesions in 3500 patients with dermatological diseases in South India. Ann Med Health Sci Res 2014;4:S84-93.
Niaz K, Maqbool F, Khan F, Bahadar H, Ismail Hassan F, Abdollahi M, et al.
Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer. Epidemiol Health 2017;39:e2017009.
Chadda RK, Sengupta SN. Tobacco use by Indian adolescents. Tob Induc Dis 2003;1:8.
Patil S, Doni B, Wadhawan R, Maheshwari S, Santosh B, Khandelwal S. Prevalence of benign oral ulcerations in the Indian population. J Cranio Max Dis. 2014;3:2631.
Hamedi S, Sadeghpour O, Shamsardekani MR, Amin G, Hajighasemali D, Feyzabadi Z, et al.
The most common herbs to cure the most common oral disease: Stomatitis recurrent aphthous ulcer (RAU). Iran Red Crescent Med J 2016;18:e21694.
Mehta FS, Gupta PC, Daftary DK, Pindborg JJ, Choksi SK. An epidemiologic study of oral cancer and precancerous conditions among 101,761 villagers in Maharashtra, India. Int J Cancer 1972;10:134-41.
Saraswathi TR, Ranganathan K, Shanmugam S, Sowmya R, Narasimhan PD, Gunaseelan R, et al.
Prevalence of oral lesions in relation to habits: Cross-sectional study in South India. Indian J Dent Res 2006;17:121-5.
] [Full text]
Vellappally S, Jacob V, Smejkalová J, Shriharsha P, Kumar V, Fiala Z, et al.
Tobacco habits and oral health status in selected Indian population. Cent Eur J Public Health 2008;16:77-84.
Dr. Swati Verma
W/o Mr. Ravi Baghel, 67 Arcadia Rd Apt B Hackensack, New Jersey - 07601
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]