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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 1  |  Page : 9-12

Oral submucous fibrosis in North Gujarat: A demographic study


1 PhD Scholar, Gujarat University, Gujarat, India
2 Ex. Prof. and Head, Department of Oral Pathology, Government Dental College and Hospital, Ahmedabad, Gujarat, India
3 Senior Lecturer, Department of Orthodontia, Goenka Research Institute of Dental Science, Gandhinagar, Gujarat, India
4 Consultant, Oral Pathologist, Vadodara, Gujarat, India
5 Tutor, Department of Periodontia, Siddhpur Dental College and Hospital, Siddhpur, Gujarat, India
6 Associate Dentist, Spandan Oral Aesthetic Clinic, Ahmedabad, Gujarat, India

Date of Submission02-Feb-2021
Date of Acceptance15-Feb-2021
Date of Web Publication27-Mar-2021

Correspondence Address:
Dr. Ketan Prajapati
Department of Oral Pathology, Siddhpur Dental College and Hospital, Sidhhpur, Patan, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpcdr.ijpcdr_5_21

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  Abstract 


Background: Oral submucous fibrosis (OSMF) is a premalignant disorder, mainly caused by betel nut chewing in various forms. It is found in the Asian subcontinent, mostly India, Pakistan, Sri Lanka, and Bangladesh. The understanding of the exact role of alkaloids and other etiological agents with respect to pathogenesis will help in the management and treatment modalities.
Aim: The purpose of the study is to evaluate the epidemiologic profile of patients with OSMF in the North Gujarat population.
Materials and Methods: Patients of OSMF attending the OPD of Siddhpur Dental College were selected for the study. Total numbers of 100 cases of clinically diagnosed OSMF were included for this study. A detailed case history was taken and clinical examination was done in visible light. The patients having difficulty in opening the mouth along with associated blanched oral mucosa with palpable fibrous bands were diagnosed as OSMF patients were included in this study. This study was done on the basis of age group, habit duration, types of habit, and clinical grading of OSMF. After collecting data, they were analyzed statistically.
Results: From 100 OSMF patients majority had Grade III interincisal mouth opening. Among the groups divided based on age, Group II (15–30 years age) showed more prevalence than the others. Gutkha and masala (main content areca nut) were a powerful etiological factor (4%) among other etiological factors.
Conclusion: OSMF predominantly affects younger age group adults with male predilection and the majority of patients presented with a progressive and advanced form of disease. Thus, advancement in diagnostic aids is required to arrest the disease in its initial stages.

Keywords: Betel nut, North Gujarat, oral submucous fibrosis


How to cite this article:
Prajapati K, Chawda J, Thakkar M, Gajera N, Thakkar R, Thakkar J. Oral submucous fibrosis in North Gujarat: A demographic study. Int J Prev Clin Dent Res 2021;8:9-12

How to cite this URL:
Prajapati K, Chawda J, Thakkar M, Gajera N, Thakkar R, Thakkar J. Oral submucous fibrosis in North Gujarat: A demographic study. Int J Prev Clin Dent Res [serial online] 2021 [cited 2021 Apr 19];8:9-12. Available from: https://www.ijpcdr.org/text.asp?2021/8/1/9/312235




  Introduction Top


Oral submucous fibrosis (OSMF) is a premalignant disorder, mainly caused by betel nut chewing in various forms. It is found in the Asian subcontinent, mostly India, Pakistan, Sri Lanka, and Bangladesh.[1] OSMF is a chronic, progressive precancerous condition of the oral mucosa which was first termed as “atrophica idiopathica mucosae oris” by Schwartz in 1952.[2] According to J. J. Pindborg (1966) OSMF is defined “as an insidious chronic disease affecting any part of the oral cavity and sometimes the pharynx.”[3] Recent data suggest that the prevalence of OSMF in India has increased from 0.03% to 6.42%.[4] OSMF can lead to squamous cell carcinoma, a risk that is further increased by concomitant tobacco consumption. The diagnosis of OSMF is based on clinical symptoms and confirmation by histopathology.[5] The disease first presents with a burning sensation of the mouth due to spicy foods, often accompanied by the formation of vesicles or ulcerations and gradually stiffening of the mucosa occurs which leads to trismus. The mucosa appears blanched and opaque with the appearance of fibrotic bands that can easily be palpated. Histologically, it is always associated with a juxta-epithelial inflammatory reaction followed by fibroelastic change of the lamina propria.[5] Epidemiological data and intervention studies suggest that the areca nut is the main etiological factor for causing OSMF. Other etiological factors suggested are chillies, lime, tobacco, nutritional deficiencies such as iron and zinc.[6]


  Materials and Methods Top


Patients of OSMF attending the OPD of Siddhpur Dental College were selected for the study. Total number of 100 cases of clinically diagnosed OSMF was considered for the study. Detailed case history and clinical examination were done in visible light. The diagnosis of OSMF was on examining difficulty in opening the mouth and associated blanched oral mucosa, with palpable fibrous bands [Figure 1]. The study was done on the basis of age group, type, duration and frequency of habit, and clinical grading of OSMF. After collecting data, they were analyzed statistically.
Figure 1: Clinical picture of oral submucous fibrosis

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For analyzing the prevalence of OSMF, the selected patients were divided into different groups as follows:

  1. According to their clinical mouth opening
  2. On the basis of age groups
  3. On the basis of duration of the habit
  4. On the basis of types of habit
  5. On the basis of frequency of the habit.


Four groups according to their clinical mouth opening

  • Grade I: Interincisal mouth opening up to or >35 mm
  • Grade II: Interincisal mouth opening between 25 and 35 mm
  • Grade III: Interincisal mouth opening between 15 and 25 mm
  • Grade IV: Interincisal mouth opening <15 mm.[7]


On the basis of age groups

  • Group 1: 15–30 years
  • Group 2: 31–45 years
  • Group 3: 46–60 years
  • Group 4: >60 years.


On the basis of habit duration

  • Group 1: 2–10 years
  • Group 2: 11–20 years
  • Group 3: More than 20 years.


On the basis of the type of habit

  • Group A: Betel nut with tobacco
  • Group B: Betal nut
  • Group C: Gutkha and masala
  • Group D: Tobacco and smoking.


On the basis of the frequency of habit (packets/day)

  • Group 1: 1–5
  • Group 2: 6–10
  • Group 3: >10.


Inclusion criteria

Clinically diagnosed cases of OSMF.

Exclusion criteria

Patients with any systemic diseases were excluded from the study.


  Results Top


In this study, a total 100 number of OSMF patients were considered. On analyzing results it was observed that, according to gender, the prevalence of OSMF was more in males (86%) in comparison to females (14%). In all grades, males were most commonly affected. According to mouth opening, more prevalence was recorded in Grade III (43%) than that in Grade II (37%); while the prevalence in Stage I (14%) and Stage IV (6%) were less. According to age groups, there was more prevalence of OSMF in Group I (43%) in comparison to Group II, Group III, and Group IV. In Group II (29%) and Group III (2%), there was almost equal prevalence. There was less prevalence in Group IV (03%) in comparison to other groups. This was statistically significant. Grade I, II, and III OSMF were more prevalent in Group 1 age group compared to other age groups. While Grade IV was more prevalent in Group 2 age group compared to other age groups. Which were also statistically significant (P = 0.003) [Table 1].
Table 1: Demographic detail of oral submucous fibrosis patients

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Based on the type of habits, the prevalence was more in patients having masala and gutkha chewing habit (4%) in comparison to patients having betel nut with tobacco (29%) and only betel nut habit (26%), which was statistically significant.(P = 0.02) [Table 2].
Table 2: Comparision of clinical grades of oral submucous fibrosis and types of habit

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According to duration of habit, it was observed that prevalence was higher in Group 1 (64%) in comparison to Group 2 (31%) and Group 3 (%), which was statistically significant (P = 0.02). In all grades maximum patients had duration of 2–10 years. And on the basis of frequency of habit, prevalence was more in Group 1 (60%) in comparison to group 2 (26%) and Group 3 (14%). Which was statistically significant (P = 0.02). In all grades, maximum patients had frequency of 1–5 packets/day.


  Discussion Top


The effects of tobacco on oral tissues have been an area of interest to researchers for a long time. Tobacco is addictive, and its use is harmful to health in many ways. Lack of awareness of the effects of tobacco use and the difficulty to discontinue the habit (psychology and nicotine dependence of an individual) has led to the increased incidence of tobacco use. Tobacco habit encountered around the world is mainly in the form of tobacco smoking, tobacco chewing, and tobacco snuff use.[8]

OSMF is the disease of Southeast Asia and the Indian subcontinent with few cases reported from South Africa, Greece, and the United Kingdom. OSMF has a malignant transformation rate of about 0.%–6%.[9]

Betel nut is the main etiological factor for the development of OSMF. Nearly three decades ago, a change occurred in the betel quid/areca nut use with the advent of “gutkha.” Gutkha consists of tobacco, areca nut, and catechu mixed together with several other ingredients believed to be highly addictive, flavored and sweetened, held in the mouth, and chewed.[10] In the present study Prevalence was more in patients having masala and gutkha chewing habit (4%) in comparison to patients having betel nut with tobacco (29%) and only betel nut habit (26%). This was in accordance with Sinor et al.[11] and Bakyalakshmi et al.[4] This indicated that tobacco acts as an addictive ingredient. The commercially available areca nut and tobacco (gutkha) byproducts have shown higher severity in terms of clinical staging. 100% of OSMF patients in the study were habitual chewers of betel nut in a variety of forms.

There was more prevalence of OSMF in males (86%) in comparison to females (14%). This was in accordance with Bakyalakshmi et al.[4] and Das et al.[6] but according to the study of Sirsat and Khanolkar[12] the male-to-female ratio was 1:1. Male predominance in our study can be due to easy accessibility for males to use betel nut and its products more frequently than females in our society along with the changing lifestyles of youngsters.

There was more prevalence of OSMF in 15–30 years age group. Similar findings were also observed by Jha et al.[13] Choudhary and Kesarwani[2] Das et al.[6] Prevalence of OSMF in the younger age group which is strongly related to increase popularity and availability of betel nut containing products. The advertisement and marketing strategies of these products force the youth to accept it as sign of modernity and fashion. This habit was seen especially in young males as they got exposed to these products at an early age possibly because of increased social exposure, economic independence, and excessive freedom at an early age or resorted to it in a hope to overcome stress and tension.

In this study, high prevalence was noted in patients with 2–10 years habit duration and 1–5 packets/day frequency. These findings were in accordance with findings of Kumar[1] In the present study, prevalence based on duration and frequency of habit was variable, it was found that the severity was more in subjects who were chewing for a longer duration and swallowing.

The majority of patients present with an increased severity of disease with Grade III inter-incisal mouth opening which suggests a lack of awareness among patients and delayed diagnosis.


  Conclusion Top


OSMF is a chronic debilitating disease that predominantly affects younger age group adults with male predilection. The majority of patients present with a progressive and advanced form of the disease. An advancement in diagnostic aids is required to arrest the disease in initial stages. Moreover, awareness campaigns must be carried out to educate the youth about hazardous habits.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kumar S. Oral submucous fibrosis: A demographic study. J Indian Acad Oral Med Radiol 2016;28:2:124-8.  Back to cited text no. 1
    
2.
Choudhary A, Kesarwani P. Prevalance of oral submucous fibrosis: A clinicopathologic study in a population of Jharkhand. Int J Sci Res 2018;7:30-2.  Back to cited text no. 2
    
3.
Gupta DS, Gupta M, Oswal RH. Estimation of major immunoglobulin profile in oral submucous fibrosis by radial immunodiffusion. J Oral Surg 1985;14:533-7.  Back to cited text no. 3
    
4.
Bakyalakshmi K, Ramkumar K, Gomathi G, Karthikeyan D. A demographic study on oral submucous fibrosis in a tertiary care hospital in Chennai. IOSR J Dent Med Sci 2018;17:16-9.  Back to cited text no. 4
    
5.
Wollina U, Verma SB, Ali FM, Patil K. Oral submucous fibrosis: An update. Clin Cosmet Investig Dermatol 2015;8:193-204.  Back to cited text no. 5
    
6.
Das M, Manjunath C, Srivastava A, Malavika J, Ameena Musareth VM. Epidemiology of oral submucous fibrosis: A review. Int J Oral Health Med Res 2017;3:126-8.  Back to cited text no. 6
    
7.
More CB, Das S, Patel H, Adalja C, Kamatchi V, Venkatesh R. Proposed clinical classification of oral sub mucosa fibrosis. Oral Oncol 2012;48:200-48  Back to cited text no. 7
    
8.
Doni BR, Patil S, Peerapur BV, Kadaganchi H, Bhat KG. Estimation and comparison of salivary immunoglobulin a levels in tobacco chewers, tobacco smokers and normal subjects. Oral Health Dent Manag 2013;12:2.  Back to cited text no. 8
    
9.
George A, Sreenivasan BS, Sunil S, Varghese SS, Thomas J, Gopakumar D, et al. Potentially malignant disorders of oral cavity. Oral Maxillofac Pathol J 2011;2:1.  Back to cited text no. 9
    
10.
Arun Kumar MS, Mythri S, Hegde S, Rajesh KS. Effect of chewing gutkha on oral hygiene, gingival and periodontal status. J Oral Health Res 2012;3:3.  Back to cited text no. 10
    
11.
Sinor PN, Gupta PC, Murti PR. A case-control study of OSF with reference to the etiologic role of areca nut. J Oral Pathol Med 1990;19:94-8.  Back to cited text no. 11
    
12.
Sirsat SM, Khanolkar VR. The effect of arecoline on the palatal and buccal mucosa of the Wistar rat. An optical and electron microscope study. Indian J Med Sci 1962;16:198-202.  Back to cited text no. 12
    
13.
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;2:11-5.  Back to cited text no. 13
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]



 

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