Oral Mucosal Lesions Associated with Tobacco Use - A Retrospective Study
Vinaya Swetha T1, Archana Santhanam2*, Kiran Kumar Pandurangan3
1 Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
2 Assistant Professor, Department of Oral Pathology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, 600077, India.
3 Assistant Professor, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai,
600077, India.
*Corresponding Author
Dr. Archana Santhanam,
Assistant Professor, Department of Oral Pathology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai,
600077, India.
E-mail: drarch.s@gmail.com
Received: August 08, 2019; Accepted: August 28, 2019; Published: August 30, 2019
Citation: Vinaya Swetha T, Archana Santhanam, Kiran Kumar Pandurangan. Oral Mucosal Lesions Associated with Tobacco Use - A Retrospective Study. Int J Dentistry Oral Sci. 2019;S4:02:006:25-29. doi: dx.doi.org/10.19070/2377-8075-SI02-04006
Copyright: Archana Santhanam© 2019. 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
Introduction: Tobacco has become a global epidemic and the abuse of tobacco is a worldwide health problem. The oral mucosa
serves as a protective barrier against trauma, pathogens, and cariogenic agents. It can be affected by a wide variety of lesions and
conditions. Oral mucosal lesions are more prevalent in Indian subcontinent. The lesions are mainly due to smoke or smokeless
forms of tobacco. Common tobacco associated lesions are leukoplakia, oral submucous fibrosis, tobacco pouch keratosis, and
oral squamous cell carcinoma. Thus the aim of this study is to determine the oral mucosal lesions associated with tobacco use in
patients visiting a private Dental Institution.
Materials and Methods: A retrospective cross sectional study, We reviewed the case record of 86000 patients between June 2019
and March 2020 and then 312 data with the habit of tobacco usage were extracted. Demographic details like age, gender, and history
of habit and type of oral mucosal disease of all the patients were retrieved from patients records. All the data were transferred
to the excel sheet. Data was analysed by SPSS software. Chi square test was used to find out association between the study variables
with p value < 0.05 considered as statistically significant.
Results: Among the 312 study subjects 299 were males and 13 were females. The prevalence of oral mucosal lesion is more among
40-50 years of age (42.5%) with male predilection (95.7%). The most prevalent oral mucosal lesion is leukoplakia ( 34.2%), followed
by OSMF(30%). The most prevalent site is buccal mucosa (84%). The prevalence of gender and oral mucosal lesions shows
a positive correlation (P=0.001).
Conclusion: The results from the present study acknowledges the importance of screening and preventive protocols to increase
the community awareness regarding the adverse effects of smoking.
2.Introduction
3.Materials and Method
4.Results
5.Discussion
6.Conclusion
7.Acknowledgement
8.References
Keywords
Tobacco Lesion; Leukoplakia; Smoking; Smokeless.
Introduction
Smoking and smokeless forms of tobacco habits are highly prevalent
in India and is one of the most important risk factors for the
development of oral mucosal lesions including potentially malignant
disorder and oral squamous cell carcinoma [1]. Many studies
show that betel nut chewing and smoking are more prevalent in
asian regions than other regions across the world [2]. Consumption
of tobacco is alarmingly increasing in the past two decades.
Areca nuts are the most commonly used smokeless tobacco form.
The proven carcinogenic contents of areca nuts are the alkaloids
such as arecoline, arecaidine, guvacine, and guvacoline [3]. There
is a gradual reduction in the repair of the epithelium as it gets exposed
to tobacco products leading to constant mucosal irritation
and subsequent development of oral mucosal lesion [4]. Correction
of ankyloglossia would lead to improved oral hygiene and
enhanced phonetics [5].
The effect of tobacco on oral mucosa starts from initial mucosal
changes such as gingival recession to oral cancer and these changes
are in turn dependent on various forms of tobacco usage, frequency,
duration and immune response of the host [6]. Tobacco
use and alcohol drinking are clear risk factors for oral cancer in India [7, 8]. Oral mucosal lesions associated with tobacco are more
common among the elderly population. The most common oral
mucosal lesions are leukoplakia, oral submucous fibrosis (OSMF),
tobacco pouch keratosis, smokers palate and oral cancer.
Leukoplakia is the most commonly encountered oral lesion seen
in fourth decades of life in males [9, 10]. Elderly groups of patients
are at risk of developing many pathologies such as squamous
cell carcinoma, hepatocellular carcinoma due to habits such
as tobacco and alcohol [11]. Most oral mucosal lesions in children
were being related to either development or tissue reactions [12].
The current rate of prevalence of OSMF in India is about 6.3%
[13]. Biopsy being the best investigation measure for the diagnosis
of oral mucosal lesions [14]. Metabolomics as a diagnostic tool in
detecting Oral Squamous Cell Carcinoma is the study of metabolome
which describes the full repertoire of small molecules, and
the analysis of salivary metabolomics may help in identifying tumor‐
specific biomarkers for early diagnosis and prediction of tumor
progression for oral mucosal lesions associated with tobacco
[15-18]. Dental photography of the oral lesions can be preserved
as an evidence for future reference [19].
Understanding the distribution of the oral mucosal lesions, its
prevalence is essential to develop primary prevention, early diagnosis,
and treatment and also to reduce the risk of malignant
transformation of the potentially malignant disorders. Thus the
aim of this study is to determine the oral mucosal lesions associated
with tobacco use in patients visiting a private Dental Institution.
Materials and Methods
This study is a retrospective cross sectional study conducted
among patients with the history of tobacco habit visiting a private
Dental Institution, Chennai with approval from the Institutional
Review Board (SDC/SIHEC/2020/DIASDATA/0619-0320). It
included demographic data of all patients along with the clinical
history of the individual.
We reviewed the case record of 86000 patients between June 2019
and March 2020 and then 312 data were extracted. A customized
examination form was used to collect the data and a special table for data collection was prepared. A total of 312 patients were
retrieved with the habit of smoking from 86000 data of the patients.
The data collected was classified according to age, gender,
site of the lesion, type of the lesion and tobacco use. Dependent
variables were oral mucosal lesion, tobacco-smoke and smokeless
forms and independent variables were age and gender.
Data collected was recorded in an excel sheet which was later
transformed to SPSS version 20.0 for statistical analysis. Descriptive
statistics and Chi square test was used to determine the correlation
between the variables where P value < 0.05 is considered
statistically significant. The pros were easy availability of data and
the Cons were small sample size and restricted geography.
Results
Out of 312 patients with the habit of tobacco 299 were males
(95.82%) and 13 females (4.18%) (figure 1). The mean age of
study participants with habits and oral mucosal lesions in the present
study was 45 years (29.90%) (figure 2). Among 312 patients
165 (53.05%) patients had the habit of smoking tobacco (figure
3). In this study the most prevalent oral mucosal lesion associated
with tobacco was leukoplakia (33.44%) followed by osmf
(30.55%) and smokers palate (12.86%) and tobacco pouch keratosis
(7.7%) (figure 4). The most commonly involved site in the present
study was left buccal mucosa (38.26%) followed by right buccal
mucosa(20.90%), palate (13.5%), left labial mucosa (1.29%),
right and left commissure of lip (0.32%), lower labial vestibule
(0.32%), right buccal vestibule (0.32%) (figure 5). In the present
study oral leukoplakia (99) is most commonly seen among males
(figure 6). In the present study, leukoplakia(102) had a strong association
with smoking type of tobacco use and OSMF(94) had
a strong association with smokeless type of tobacco (figure 7).
Figure 1. Bar chart depicting gender distribution of patients with tobacco habit.
Figure 2. Bar chart depicting age distribution of patients.
Figure 3. Bar chart depicting percentage distribution of various forms of tobacco among study participants.
Figure 4. Bar chart depicting percentage distribution of type of oral mucosal lesion.
Figure 5. Bar chart depicting site of oral mucosal lesion.
Figure 6. Bar chart represents the association between gender and oral mucosal lesion.
Figure 7. Bar chart represents association between oral mucosal lesion and the type of tobacco.
Discussion
Out of 312 patients with the habit of tobacco 299 were males and
13 females. It was interesting to observe that males had the habit
of tobacco, which is nearly double as compared to females.Result
of the present study is in agreement with previous published literature
where oral mucosal lesions are more prevalent in males
compared to females [20, 21]. The reason for this could be due to
stress, socioeconomic status and culture.
The mean age of study participants with habits and oral mucosal
lesions in the present study was 45 years. Similar results were seen
in a study, where the oral lesions are prevalent in 40 to 50 years of
age group [22]. The result of the present study was in contrast to
the study done by [23], with the mean of 35 years. The reason for
this could be different small size and age groups.
Among 312 patients 165 patients had the habit of smoking form
of tobacco, 129 with smokeless form of tobacco and 18 had the
habit of both forms of tobacco. In this study the most prevalent
oral mucosal lesion associated with tobacco was leukoplakia
(33%) followed by osmf (30%) and smokers palate (12.8%) and
tobacco pouch keratosis (7.7%). The study results are in consensus
with other studies done by Prashant patil et al, Krishna priya et
al, Axell et al. The reason for this could be due to chronic smoking
habits, more use of cigarettes than smokeless forms such as areca
nuts [24-26].
The most commonly involved site in the present study was buccal
mucosa (84%) followed by palate (13.5%), left labial mucosa
(1.29%), right and left commissure of lip (0.32%), lower labial
vestibule (0.32%), right buccal vestibule (0.32%). Similar results
were reported by Shaik P et al wherein oral lesions were more
prevalent in buccal mucosa(22%)[27]. According to Zain b et al., labial mucosa was the most commonly involved site(53.3%). The
reason for this could be due to the type of tobacco used and site
of placement [28].
Correlation between type of tobacco and oral mucosal lesion,
p=0.001 which shows a positive correlation. In the present study,
leukoplakia had a strong association with smoking type of tobacco
use and OSMF had a strong association with smokeless
type of tobacco. Squamous cell carcinoma was most commonly
associated with smokeless and smoking types of tobacco Tobacco
pouch keratosis had a strong association with smokeless types of
tobacco. This could be attributed to the constituents of different
types of tobacco and its placement in the oral cavity.
If tobacco were to be introduced today, it would not be approved
for human consumption anywhere in the world. Thousands of
compounds are found in both forms of tobacco, Many of these
compounds not only irritants and toxins they are also carcinogens.
The smoking form of tobacco contains over 4000 different
chemicals and at least 50 known carcinogens [29]. The limitation
of the present study could be Shorter sample size, single centered
study, and this study does not represent ethnic groups. Future
scope of the study is to identify the need for awareness in control
of tobacco use and the need for oral hygiene education.The
study reveals that oral mucosal lesion is still a major oral health
problem among the male population as it has the risk of malignant
transformation potential. Thus the health care professional
and government need to be focused on implementing preventive
measures such as cessation of the habit, the importance of having
regular screening preventive protocols to increase the community
awareness regarding the adverse effects of smoking.
Conclusion
Based on the findings of the present study it can be concluded
that oral mucosal lesions are common among 40-50 years with
male predilection. Leukoplakia is the most common oral mucosal
lesion associated with smoking form of tobacco and OSMF is
commonly seen in patients with smokeless form of tobacco.
Acknowledgement
The authors would like to thank the study participants for their
participation and kind cooperation throughout the study.
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