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Table of Contents
ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 4  |  Page : 60-62

Prevalence of oral submucous fibrosis among habitual gutkha and areca nut chewers in Dhanbad district


1 Senior Resident, Department of Dentistry, Patliputra Medical College and Hospital, Dhnabad, Jharkhand, India
2 Professor and HOD, Department of Dentistry, Patliputra Medical College and Hospital, Dhnabad, Jharkhand, India
3 Assistant Professor, Department of Dentistry, GMC, Kathua, Jammu and Kashmir, India

Date of Web Publication29-May-2019

Correspondence Address:
Dr. Animesh Kumar Shivam
Department of Dentistry, Patliputra Medical College and Hospital, Dhanbad - 828 127, Jharkhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INPC.INPC_5_19

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  Abstract 


Objectives: To assess the incidence rate of oral submucous fibrosis (OSMF) and its etiology in patients attending outpatient department at Patliputra Medical College and Hospital (PMCH), Dhanbad.
Methodology: The diagnosis of OSMF was based on clinical examination and evaluating patient's signs and symptoms.
Results: The total number of patients affected by OSMF in this time duration was 270. Of these, 232 (86%) were male, while 38 were female (14%). The greatest proportion of OSMF patients (58.58%) had a habit of chewing areca nut alone or in the form of gutkha.
Conclusion: This study reveals that the incidence rate of OSMF in patients visiting PMCH, Dhanbad was 1%. Males were more affected than females. It was seen that the major etiological factors in the development of OSMF was areca nut and gutkha usage by the patients.

Keywords: Incidence rate, oral submucous fibrosis, outpatient department


How to cite this article:
Shivam AK, Azam F, Sadiq H. Prevalence of oral submucous fibrosis among habitual gutkha and areca nut chewers in Dhanbad district. Int J Prev Clin Dent Res 2018;5:60-2

How to cite this URL:
Shivam AK, Azam F, Sadiq H. Prevalence of oral submucous fibrosis among habitual gutkha and areca nut chewers in Dhanbad district. Int J Prev Clin Dent Res [serial online] 2018 [cited 2019 Aug 23];5:60-2. Available from: http://www.ijpcdr.org/text.asp?2018/5/4/60/259261




  Introduction Top


Oral submucous fibrosis (OSMF) is a chronic, progressive, scarring precancerous condition of the oral cavity mostly seen in the Indian subcontinent and South-East Asia.[1] In India, the prevalence increased over the past four decades from 0.03% to 6.42%.[2],[3] The WHO definition for an oral precancerous condition stated as “A generalized pathological state of the oral mucosa associated with a significant increased risk of oral cancer,” gives an appropriate description of OSMF.

It is a chronic, progressive, scarring disease, which predominantly affects people of South-East Asian origin. The condition was prevalent in the days of Sushruta (600 BC), a great practitioner of ancient medicine, where he described this condition as “Vidhari.” After a lapse of many years, Schwarz (1952) was the first person to bring this condition back into limelight. He described this condition as “atrophic idiopathic mucosae oris.” Later in 1953, Joshi from Bombay (Mumbai) redesignated this condition as OSMF, implying predominantly its histologic nature.[3],[4]


  Methodology Top


  • Type of study: Cross-sectional study
  • Duration of study: January 2016 to December 2016 (1 year)
  • Hospital-based study: All patients attending OPD at Patliputra Medical College and Hospital (PMCH), Dhanbad, Jharkhand, during a period of 1 year (January 2016 to December 2016)
  • Sample size: 26,823 patients attending OPD at Department of Dentistry, PMCH, were examined for OSMF. Among them, 270 patients displayed clinical features of OSMF.


A pretested, semistructured pro forma has been used for collecting information from the patients. Written consent of each patient was taken after explaining the purpose of the study. Pro forma consisted of two components: sociodemographic status and clinical features of the patients.

  • Inclusion criteria – (1) clinical features – burning sensation of the mouth on intake of hot beverages and spicy food, vesicle formation and ulceration, gradual reduction in mouth opening, limitation in tongue movement, and white fibrous bands are palpable and (2) patient's consent
  • Exclusion criteria – (1) the absence of clinical features, (2) patient' s unwillingness to give consent, and (3) unsupportive or medically compromised patient.


Patients having OSMF were categorized into five age groups – (1) 11–20 years; (2) 21–30 years; (3) 31–40 years; (4) 41–50 years; and (5) >50 years.

The armamentarium consisted of sterile mouth mirror, straight and curved explorers, kidney tray, disposable latex gloves, disposable mouth mask, and a Vernier caliper.

The questionnaire included the basic sociodemographic variables of all patients along with the presence of habit of areca nut or gutkha chewing, symptoms such as burning sensation in the mouth on intake of hot and spicy food, mouth opening, and altered salivation.

Clinical examination showed reduced mouth opening blanching and stiffness of oral mucosa and soft palate, palpable bands chiefly in buccal mucosa, and sometimes vesicle formation and ulceration.


  Results Top


Of the total OPD of 15,343 patients coming to PMCH Dhanbad, during January 2016–February 2016, the incidence rate of patients affected by OSMF was 270 (1%).

Gender distribution

[Table 1] shows that of 270 cases of OSMF, 232 (86%) were males and 38 (14%) were female.
Table 1: Age and gender distribution

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Age distribution

[Table 1] shows that the most affected age group was 21–30 years among both males (38.80%) and females (5.97%).

Distribution of adverse oral habits in oral submucous fibrosis patients

[Table 2] indicates that the greatest proportion of OSMF patients (58.58%) had a habit of chewing areca nut alone or in the form of gutkha.
Table 2: Distribution of adverse oral habits in oral submucous fibrosis patients

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Mouth opening in oral submucous fibrosis patients

[Table 3] shows patients in whom mouth opening was reduced to less than 20 mm constituted the highest proportion (64%) of patients having OSMF who visited PMCH, Dhanbad.
Table 3: Mouth opening in oral submucous fibrosis patients

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Distribution of oral submucous fibrosis individuals according to their signs and symptoms in different grades

[Table 4] shows that 99.50% of the patients complained of restricted mouth opening. Fibrous bands were palpable in 98.13% of the patients on clinical examination. Restricted tongue movement was also seen in moderate-to-severe OSMF.
Table 4: Distribution of oral submucous fibrosis individuals according to their signs and symptoms in different grades

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  Discussion Top


There is compelling evidence to implicate the habitual chewing of areca nut with the development of OSMF. It occurs predominantly in the Indian subcontinent where the habit is more prevalent.[5] The common sites involved are buccal mucosa, labial mucosa, retromolar pads, soft palate, and floor of the mouth. Fibrotic changes in pharynx, esophagus, and paratubal muscles of  Eustachian tube More Detailss have also been observed. Early features of OSMF include burning sensation, hypersalivation/xerostomia, and mucosal blanching with marble-like appearance.[6] Later on, the mucosa becomes leathery and inelastic with palpable fibrous bands, resulting in restricted mouth opening. Eventually, OSMF leads to difficulty in swallowing, speech and hearing defects, and defective gustatory sensation.[6],[7],[8]

Our study showed that habitual gutka chewing was the main cause of OSMF along with areca nut chewing. A similar study done by Ahmad et al.[9] showed that 69% were consuming gutkha. Goel et al.[10] showed that commercial areca nut consumption was 40% among OSMF patients. Other studies have also reported an increased prevalence in the consumption of areca nut and areca nut-based products, which are addictive and psychoactive in nature. The findings of Babu et al.[11] among OSF patients in Hyderabad showed that people were more addicted to gutkha than any other related areca nut and tobacco products such as pan, pan masala, and raw areca nut. They found a strong association between gutkha chewing and OSF and pointed that gutkha consumption led to OSMF.

In our study, male patients were more affected than females due to easy accessibility for males to use areca nut and its products more frequently than females in our society along with the changing lifestyles of youngsters. A male predominance in OSMF was also seen in study reported by Sinor et al.[12] in India.


  Conclusion Top


The commercial availability of areca nut and tobacco (gutkha) by-products has shown to be the major cause of OSMF in Dhanbad. The current study found that although habit is variable in the form of duration, frequency, chewing for a longer duration and swallowing without spitting was found to correlate significantly with the severity of clinical staging.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ranganathan K, Devi MU, Joshua E, Kirankumar K, Saraswathi TR. Oral submucous fibrosis: A case-control study in Chennai, South India. J Oral Pathol Med 2004;33:274-7.  Back to cited text no. 1
    
2.
Pindborg JJ, Mehta FS, Gupta PC, Daftary DK. Prevalence of oral submucous fibrosis among 50,915 Indian villagers. Br J Cancer 1968;22:646-54.  Back to cited text no. 2
    
3.
Hazarey VK, Erlewad DM, Mundhe KA, Ughade SN. Oral submucous fibrosis: Study of 1000 cases from central India. J Oral Pathol Med 2007;36:12-7.  Back to cited text no. 3
    
4.
Jha RN, Kalyani PB, Savarkar SV. Incidence rate of oral submucous fibrosis (OSMF) and its etiology in patients visiting Government Dental College and Hospital, Jamnagar (GDCH, Jamnagar). JIHS 2014;1:11-5.  Back to cited text no. 4
    
5.
Shafer WG, Hine MK, Levy B. Benign and malignant tumors of the oral cavity. Shafer' s Textbook of Oral Pathology. 6th ed. Noida: Elsevier Publications; 2009: p. 96.  Back to cited text no. 5
    
6.
Rajendran R. Oral submucous fibrosis: Etiology, pathogenesis, and future research. Bull World Health Organ 1994;72:985-96.  Back to cited text no. 6
    
7.
Eipe N. The chewing of betel quid and oral submucous fibrosis and anesthesia. Anesth Analg 2005;100:1210-3.  Back to cited text no. 7
    
8.
Gupta SC, Singh M, Khanna S, Jain S. Oral submucous fibrosis with its possible effect on eustachian tube functions: A tympanometric study. Indian J Otolaryngol Head Neck Surg 2004;56:183-5.  Back to cited text no. 8
    
9.
Ahmad MS, Ali SA, Ali AS, Chaubey KK. Epidemiological and etiological study of oral submucous fibrosis among gutkha chewers of Patna, Bihar, India. J Indian Soc Pedod Prev Dent 2006;24:84-9.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Goel S, Ahmad J, Singh MP, Nahar P. Oral submucous fibrosis: A clinical-histopathological comparative study in population of south Rajasthan. J Carcinog Mutagen 2012:1:108.  Back to cited text no. 10
    
11.
Babu S, Bhat RV, Kumar PU, Sesikaran B, Rao KV, Aruna P, et al. A comparative clinico-pathological study of oral submucous fibrosis in habitual chewers of pan masala and betelquid. J Toxicol Clin Toxicol 1996;34:317-22.  Back to cited text no. 11
    
12.
Sinor PN, Gupta PC, Murti PR, Bhonsle RB, Daftary DK, Mehta FS, et al. A case-control study of oral submucous fibrosis with special reference to the etiologic role of areca nut. J Oral Pathol Med 1990;19:94-8.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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