Prevalence of Oral Submucous Fibrosis (Osmf) Among Patients Visiting an Institutional Hospital Set Up
Geethika B1, Manjari Chaudhary2*
1 Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
2 Senior Lecturer, Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
*Corresponding Author
Manjari Chaudhary,
Senior Lecturer, Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University,
162, PH Road, Chennai 600077, Tamil Nadu, India.
Tel: 9969974889
E-mail:manjaric.sdc@saveetha.com
Received: July 30, 2021; Accepted: August 11, 2021; Published: August 18, 2021
Citation:Geethika B, Manjari Chaudhary. Prevalence of Oral Submucous Fibrosis (Osmf) Among Patients Visiting an Institutional Hospital Set Up. Int J Dentistry Oral Sci. 2021;8(8):3995-3999. doi: dx.doi.org/10.19070/2377-8075-210008160
Copyright: Manjari Chaudhary©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Oral Submucous fibrosis (OSMF) occurs in young adults, who are in the habit of chewing tobacco mixed with areca nut and its various commercially available preparations. The disease results in progressive inability to open the mouth due to the submucosal fibrosis initiated by chronic inflammation affecting mainly oral mucosa. Oral Submucous Fibrosis (OSMF) is a disease that frequently occurs among the Indian population. The present study aims to evaluate the prevalence of OSMF among the population visiting an institutional hospital set up. This retrospective study was conducted among the patients visiting the Oral Medicine and Radiology (OMR) department of a private dental college. The data was collected by reviewing the case sheets of the patients diagnosed with OSMF. The collected data was statistically analysed using IBM SPSS Software (20.0). Within the limits of the study, it can be concluded that OSMF was more prevalent among males. It can be seen that the Grade- I, III, IV of OSMF are the most prevalent among males and Grade II is more prevalent among females. The association between gender and OSMF is statistically significant (p-value: 0.016<0.05). It is the most prevalent among the age group of 20-29 years and 40-49 years; Grade I OSMF was the most prevalent among all the age groups. This association between age and the prevalence of different grades of OSMF shows a high statistical significance (p-value: 0.008<0.01).
2.Introduction
3.Conclusion
4.References
Keywords
Age; Chennai; Male; OSMF; Grading; Prevalence.
Introduction
Oral submucous fibrosis is a chronic insidious disease affecting
any part of the oral cavity and sometimes the pharynx [1]. It causes
trismus and difficulty to eat due to its association with juxta
epithelial inflammatory reaction. This is followed by fibroelastic
changes of lamina propria along with epithelial atrophy, leading to
stiffness of oral mucosa [2].
The first case of oral mucosa was seen occurring in Indian in
East Africa by Schwartz (1952) as “atropa idiopathica mucosae
oris” [3]. The four consecutive histological changes of OSMF was
reported by Pindborg and Sirsat (1966) [4]. The irreversible nature
of OSMF was described by Seedat and Van Wyle (1968)[5]. They
state that OSMF is induced by the habit of chewing betel nuts
and the reversal of the disease after the cessation of the habit
does not occur.
It has been suggested that consumption of chillies, nutritional
deficiency, genetic susceptibility, chewing of areca nut, autoimmunity,
altered salivary constituents and collagen disorders may
be involved in the pathogenesis of this condition [3]. OSMF is
a well-recognized, potentially premalignant condition. Malignant
transformation rates as high as 7.6% have been reported from the
Indian subcontinent over a 17 year period [6].
With 75,000-80,000 cases per year, India ranks the highest among
all the registries for the highest number of oral cancer cases in the
world. Initially these cases were reported in countries like India,
Bangladesh and Pakistan, but with the increasing amount of immigration,
it is now prevalent in the weatern countries as well [7-
11]. Since 1980, there has been vigorous advertising of products
like gutka and pan masala and sudden increase in the number of
factories involved. One of the main reasons why the government
has not been able to successfully curb this disease is due to the dependency
of the livelihood of farmers and others involved in the industry. About 65% of the total produce of the country’s supply
of areca nuts is produced from Karnataka. The only possible way
to change this would be to educate the farmers about it’s harmful
effects and encourage them to grow other plants which will also
benefit them [12-16].
Previously our team has a rich experience in working on various
research projects across multipledisciplines [17-31]. Now the
growing trend in this area motivated us to pursue this project. The
aim of the present study was to evaluate the prevalence of OSMF
among the population visiting an institutional hospital set up.
Materials and Methods
Study Setting:
The present retrospective study was carried out in an institutional
setting study with an advantage of a wide range of data available
and disadvantage being the assessment of single location only. It
was conducted to correlate age and OSMF among the male population
visiting Saveetha Dental College from June 2019 to March
2020. Ethical clearance for this study was obtained from the Institutional
Ethical Committee with the ethical approval number
being SDC/SIHEC/2020/DIASDATA/0619-0320. The population
included in the study were 145 patients who were diagnosed
to have OSMF by the Oral Medicine and Radiology Department.
A signed consent was taken from the patients who were included
in the study. Two examiners were involved in the study.
Study design:
The study was designed based on the set inclusion criteria of patients
from the oral medicine department who were diagnosed
with OSMF. Patients were divided into four groups according to
severity, following the criteria from a study done by Ranganathan
et al[(32)]. The criteria taken was mouth opening as follows:
Grade I: Only symptoms, with no demonstrable restriction in
mouth opening
Grade II: Limited mouth opening. 20 mm and above
Grade III: Mouth opening less than 20 mm.
Grade IV: OSMF advanced with limited mouth opening. Precancerous or cancerous changes seen throughout the mucosa.
Cases which did not fall under this inclusion criteria were excluded
from the study.
Sampling:
The study was based on non-probability convenience sampling.
To minimize the sampling bias, all the case sheets of patients with
OSMF were reviewed and included.
Data Collection and Tabulation:
It is a retrospective study where the data was collected by reviewing
the case records of the patients visiting the Oral medicine
and Radiology department of a private dental college from June
to March. A total of 100 case sheets were reviewed. Cross verification
of the data was done by a reviewer. The collected data
was tabulated based on the following parameters: Patients details-
Name, Age, Gender, Patient identification number and if the patient
was diagnosed with OSMF or not. The age of the patients
was categorised for convenience purposes into the following: 20-
29 years, 30-39 years, 40-49 years, 50-59 years and 60-69 years.
Statistical Analysis:
The data were entered and analysed using Statistical Package for
the Social Sciences Software (SPSS) by IBM Version 20.0. Descriptive
Statistics (eg. frequencies and percentages) were calculated
to explore the general features of the data. Independent variables
were age and gender and the dependent variable was OSMF.
Results & Discussion
A total of 100 subjects participated in the study of which 93.4%
were males and 6.6% were females [Table 1]. Grade I OSMF was
the most (67.0%) prevalent among the population, followed by
grade II(22.0%), grade III (7.0%). The least prevalent was grade IV
OSMF [Figure 1]. Grade I OSMF was the most prevalent among
all the age groups (20-29 years,30-39 years- 21; 40-49 years-14; 50-
59 years-8; 60-69 years-4)[Figure 2]. The age groups which show a
high percentage of prevalence (25.5%) of OSMF are 20-29 years and 40-49 years. Chi-square analysis was performed and it can
be seen that there is a high statistical significance between the
age and the grade of OSMF (Pearson chi-square test, p-value:
0.008 <0.01) [Table 1]. It can be seen that the Grade- I,III,IV of
OSMF are the most prevalent (66.7%,10.1%,4.0% respectively)
among males and Grade II is more prevalent (71.4%) among females
and this association is statistically significant (Pearson chisquare
test, p-value:0.016 <0.05) [Table 1] [Figure 3].
There is compelling evidence that the habit of chewing areca nuts
is associated with OSMF and is predominantly seen in the Indian
subcontinent [33-36]. The alkaloid present in areca nut- arecoline,
is converted into arecadaine which stimulates fibroelastic activity
in oral mucosa resulting in excessive collagen which is seen in
OSMF [37-39].
From our results we can observe that Grade I OSMF is the most
prevalent among the population, across all the age groups. This
finding is similar to the observations by Nigam et al.,[40]. Studies
by Srivatsava et al.,[41]and Bajoria et al.,[42] shows that Grade
II OSMF was more predominant which is contradictory to our
study.
In this retrospective study there were 100 subjects who were diagnosed
clinically for having OSMF. Although OSMF affects both
sexes, a clear male predominance was seen in our study (93.4%).
This observation is similar to the findings of studies by Ali et
al [(43)], Ahmad et al.,[44], Wahi et al.,[45] and Tang et al.,[46].
Certain studies by Pindborg et al.,[47] and Gupta et al.,[48] have
shown that there is a female predilection. Certain other studies
by Hosein et al.,[49]and Bajoria et al.,[42] have shown that there
was no significant association between age, gender and the OSMF
grading.
It is observed in our study that the age groups which show a high
percentage of prevalence (25.5%) of OSMF are 20-29 years and
40-49 years. There is wide variation in age as reported by other
authors which include Pinborg et al[(50)], who stated that the average
age of a patients who are diagnosed with OSMF ranges
from 40-49 years, Babu et al.,[51]and Trivedy et al.,[52] reported
23% between 14-19 year olds. Other populations have reported
younger populations ranging from 20-30 years [32, 40, 52]. Another
study by Jha et al.,[53] shows similar results where a greater
fraction of patients were seen in the 21-30 and 31-40 years group.
The easy availability and promotions of the areca nut products
specially gutkha and pan masala outside the schools colleges and
social places has led to the occurrence of OSMF to a greater extent
among the younger population. Our institution is passionate about high quality evidence based research and has excelled in
various fields [54-64]. We hope this study adds to this rich legacy.
Limitations of the present study could be the sample size and geographical
isolation. Future studies with more number of participants
and studies involving different factors could be conducted.
Figure 1: This frequency distribution graph shows prevalence of different grades of OSMF. X axis is the grade of OSMF and Y axis represents the percentage of patients with OSMF. Grade I (Green); Grade II(Yellow); Grade III(Pink); Grade IV(Red). It can be seen that the highest percentage of prevalence is seen with Grade I OSMF (67.00%).
Figure 2: This bar graph shows the association between age and different grades of OSMF. X axis is the grade of Age and Y axis represents the number of patients with OSMF. Grade I(Green); Grade II(Yellow);Grade III(Pink); Grade IV(Red). Pearson chi-square test, pvalue: 0.008<0.01. It can be seen that Grade I OSMF is the most prevalent (20-29 years, 30-39 years- 21; 40-49 years-14; 50-59 years-8; 60-69 years-4) among all the age groups and this association shows a high statistical significance.
Figure 3: This bar graph shows the association between gender and different grades of OSMF. X axis is the grade of gender and Y axis represents the number of patients with OSMF. Grade I(Green); Grade II(Yellow);Grade III(Pink); Grade IV(Red). Pearson chi-square test, p-value:0.016<0.05. It can be seen that the Grade- I,III,IV of OSMF are the most prevalent (66.7%,10.1%,4.0% respectively) among males and Grade II is more prevalent (71.4%) among females and this association is statistically significant.
Table 1. This table shows the prevalence of different grades of OSMF with relation to age and gender.
Conclusion
Within the limits of the study, it can be concluded that OSMF was
more prevalent among males. It can be seen that the Grade- I, III,
IV of OSMF are the most prevalent among males and Grade II
is more prevalent among females. It is the most prevalent among
the age group of 20-29 years and 40-49 years; Grade I OSMF was
the most prevalent among all the age groups.
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