Prevalence of oral submucous fibrosis among habitual gutkha and areca nut chewer in Bihar population: A community-based research

Rashi Chauhan; Amit Kumar Singh; Kriti Singh; Khushboo Rani; Kumar Anand; Aparajita Tiwari

doi:10.4103/IJDS.IJDS_39_20

ORIGINAL ARTICLE

Year : 2021 | Volume : 13 | Issue : 1 | Page : 30-33

Prevalence of oral submucous fibrosis among habitual gutkha and areca nut chewer in Bihar population: A community-based research

Rashi Chauhan¹, Amit Kumar Singh², Kriti Singh², Khushboo Rani², Kumar Anand², Aparajita Tiwari²
¹ Department of Orthodontic, Buddha Institute of Dental Science, Patna, Bihar, India
² Department of Oral Medicine and Radiology, Buddha Institute of Dental Science, Patna, Bihar, India

Date of Submission	12-Mar-2020
Date of Decision	18-May-2020
Date of Acceptance	23-Sep-2020
Date of Web Publication	31-Dec-2020

Correspondence Address:
Kriti Singh
Department of Oral Medicine and Radiology, Buddha Institute of Dental Science, Patna, Bihar
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/IJDS.IJDS_39_20

Abstract

Background: The aim of the study was to determine the prevalence and severity of oral submucous fibrosis (OSMF) among habitual gutkha, areca nut, and pan chewers of Bihar population. Materials and Methods: The study was conducted of 3000 adult patients aged over 15 years who visited the Department of Oral Medicine and Radiology, Buddha Institute of Dental Sciences and Hospital. They were subjected to a thorough oral examination, and the bindings were recorded in the prescribed WHO Pro forma. Results: Our study revealed that the prevalence of OSMF was 1.6%. The prevalence among males was 2.60% and among females was 0.16%. All the 243 cases (100%) were associated with areca nut habits. Conclusion: Educating the population about the deleterious effects of the practice of tobacco and related habits on the body in general and the oral cavity. It is hoped that this study would serve as a reference for further epidemiological studies on the abovementioned lesion in this region.

Keywords: Areca nut, gutkha, oral submucous fibrosis

How to cite this article:
Chauhan R, Singh AK, Singh K, Rani K, Anand K, Tiwari A. Prevalence of oral submucous fibrosis among habitual gutkha and areca nut chewer in Bihar population: A community-based research. Indian J Dent Sci 2021;13:30-3

How to cite this URL:
Chauhan R, Singh AK, Singh K, Rani K, Anand K, Tiwari A. Prevalence of oral submucous fibrosis among habitual gutkha and areca nut chewer in Bihar population: A community-based research. Indian J Dent Sci [serial online] 2021 [cited 2021 Jan 16];13:30-3. Available from: http://www.ijds.in/text.asp?2021/13/1/30/305974

Introduction

In the era of the fast growth of industrialization and urbanization, the result of this growth and progress, human beings are subjected to more physical and mental stress. Humans react to this stress by adopting stress-relieving habits such as smoking, alcohol, betel nut chewing, and pan chewing etc.^[1]

These adverse habits do much harm than good to a human being. This habit has many detrimental effects on the human body, apart from being addictive^[2]. Due to these habits and cultural practices, human has been abusing the oral cavity. In day-to-day clinical practice, medical practitioners and dental surgeons often encounter a wide spectrum of oral mucosal lesions.

One such pathological condition is oral submucous fibrosis (OSMF). It is a peculiar, chronic progressive, insidious, irreversible, crippling disease of the oral cavity characterized by fibrotic change and severe burning sensation^[3],[4],[5] with restricted mouth opening.^[3]

The disease affects the most part of oral cavity as well as the upper third of the esophagus. The disease is characterized by blanching and stiffness of oral mucosa, followed by trismus and burning sensation in the mouth. It also produces hypomobility of the soft palate and tongue and loss of gustatory sensation. ^[4] There can be mild hearing impairment due to blockade of the Eustachian tube ^{More Details}.

Malignant transformation rate of OSMF was found to be in the range of 7%–13%.

The disease is predominantly seen in India, Bangladesh, Sri Lanka, Pakistan, Taiwan, and China, with a reported prevalence ranging up to 0.4% in the Indian rural population.^[5]

Materials and Methods

This prospective study has been conducted in the Department of Oral Medicine, Diagnosis and Radiology and Oral and Medicine and Radiology of a Buddha Institute of Dental Sciences and Hospital. The study was conducted in September 2019–December 2019. A total of 3000 patients were examined, in which 243 patients were diagnosed as OSMF.

Patients who reported with the limited mouth opening and associated blanched oral mucosa with palpable fibrous bands were screened and those patients who were diagnosed clinically having OSMF were included in the present study. Pro forma was provided to the patient to fill up the information regarding the type of habit, type of placement of areca nut, and its product.

Criteria for the diagnosis of OSMF were followed according to the workshop held in Kuala Lumpur, Malaysia, in 1996.

OSMF can be diagnosed on the basis of the presence of one or more of the following characteristics:

Presence of palpable fibrous bands
The mucosal texture feels tough and leathery
Blanching of the mucosa together with the histopathological features characteristic of OSMF.

Patients were divided into four groups according to severity, according to the criteria from a study done by Ranganathan et al.

The criteria taken were 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 < 20 mm
Grade IV: OSMF advanced with limited mouth opening. Precancerous or cancerous changes are seen throughout the mucosa.

Study design

After obtaining ethical clearance from the institutional review board, a cross-sectional study of stratified random technique 243 habitual chewers were selected. The study was conducted in the time period of 1 year from July 2018 to June 2019. The study population comprised rural and urban areas in close proximity.

Sample size and technique

Two hundred and forty-three individuals of the age range of 16–60 years were selected using a stratified random sampling technique from the rural and urban population.

Inclusion criteria

Patients with habit of chewing areca nut, pan, and gutkha.
Patients who were diagnosed clinically having OSMF were included in the present study.

Exclusion criteria

Patients with limitation of mouth opening due to other causes such as odontogenic infections and joint disorders were excluded from the study.

Informed consent for each patient and biopsies were included in the study. The tissue samples were taken from the affected areas and then studied histopathologically. The data were analyzed statistically using t-test.

Results

A total of 243 adults over the age range of 11–60 years were examined. Among them, 213 were males and 30 were females. Among 243 adults, 90.32% had chewing habits and 9.68% had smoking habits.

All the cases of OSMF were associated with tobacco and related habits. It was observed that the prevalence of OSMF among males was 2.6% and among females was 1.16%. The combined prevalence for both males and females was 1.96%. The difference in the prevalence among males and females was statistically significant

Maximum number of patient were of Grade 2 OSMF and minimum number of patient were of Grade 4 OSMF. [Figure 1] showing prevalence of various grades of OSMF.

Figure 1: Prevalence of various grades of oral submucous fibrosis

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Maximum number of patient were seen in 20-30 year age range and minimum number of patient were seen in 50- 60 years of life. [Figure no 2] showing distribution of various Grades of OSMF according to the age of the patient.

Figure 2: Distribution of various grades according to the age of the patient

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[Table 1] shows the distribution of study participants according to the type of habit.A maximum number of patients were seen with an adverse habit of tobacco chewing 1–5 packets per day in duration of more than 10 min.[Table no 2] showingduration frequency number of subjects and Grades of OSMF.

Table 1: Duration Frequency Number of subjects and Grades of OSMF

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Table 2: Corelation of various grades of oral submucous fibrosis and areca nut chewing

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Among all the patients, a maximum number of male and female patients were seen in Grade 2 OSMF patients that 91 male and 15 female patients. [Figure 3] showing prevalence in male and female population in various grades of OSMF.

Figure 3: Prevalence in male and female population in various grades of oral submucous fibrosis

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Discussion

Chewing areca nut in a betel quid has a long history, which is deeply ingrained in many sociocultural and religious activities^{[7],[8],[9],[10],[11]}. In ancient Sanskrit literature, as early as the 1^st century BC references to betel nut appear. Areca nut with the ancient history of chewing in the Indian subcontinent, OSMF is commonly seen^{[11],[12],[13],[14],[15]}.

Areca nut incorporated in betel quid is the fourth most common psychoactive substance in the world. Its use is extending to several hundred million people. It has been reported that that betel quid is used by about 10%–20% of the world's population and that globally up to 600 million users chew areca nut.^[3]

In this present prospective study, there were 243 patients (213 males and 30 females) who were identified and diagnosed clinically for having OSMF. Although OSMF affects both genders, male predominance for this condition has been noted in many studies.

In our present study, 213 (87.6%) males were dominating. The male-to-female ratio was 7.1:1, which was quite high when compared to earlier studies. Thakur et al, in their studies, reported a male to female ratio of 2.7:1.[3^] However, a male predominance for this condition has been noted in several studies.^[7] The reason for male predominance is because of the availability of gutkha and other related products among young people. Males are the working gender and money earner among the Indian subcontinent. Areca nut/ betel quid, gutkha is chewed for various reasons as it act as stress reliever, mouth freshener.Females are more conscious about their esthetic values and it is considered socially unacceptable for a female. All the female patients in present study with OSMF were addicted to areca nut or betel quid, none of the showed addiction to gutkha.

In contrast to the present study, female predominance also has been noted in many studies. As these studies were done in the 70s and 80s, it was common a few decades earlier for females to chew areca nut for digestion after having food.^[10]

In the present study, the age of subjects was ranging from 20 years minimum to 61 years maximum with a mean of 38.6 years. It is similar to another hospital-based study by Ahmed where they reported the majority of the OSMF cases belonged to 21–40 years of age group. Sirsat reported OSMF cases from 20 to 40 years of age.^[11] According to a population-based relation studies in India conducted by Bhosle et al. (1987) the mean age of the 27 patients was 37 years which was significantly lower compared to the mean age of 64 patients in Ernakulum which was 52 years.^{[16],[17],[18],[19],[20],[21],[22],[23],[24],[25]}

In the present study, gutkha chewers showed more predominance of Grade II and Grade I stages of OSMF, and the mean duration was much less when compared to those having betel quid and mawa.

The abrasive nature of areca nut causes continuous local trauma and irritation to the oral mucosa, leading to morphological changes in the oral mucosa.^[25]

The reason for increased severity and risk of developing OSMF in gutkha chewers is due to more dry weight of areca nut releasing high amount of arecoline. The dry weight of areca nut in gutkha sachets is 3.26 g, whereas that in betel quid is 1.14 g; therefore, the betel quid chewers show less amount of severity, as the betel leaf contains beta-carotene, which has the capacity to neutralize the free radicals that are released from the areca nut.

Conclusion

OSMF is a commonly occurring premalignant condition increasingly affecting the youth. The occurrence of OSMF in gutkha chewers is more faster and more severe as compared in other forms of areca nut product chewers. The easy availability and promotions of these areca nut products, specially gutkha and pan masala outside the schools, colleges, and social places, have impacted young population in India, due to which has led to the increased occurrence of OSMF, a premalignant condition and malignancies such as squamous cell cancer. Control on the use of areca nut and its products in various forms, specially gutkha and pan masala, is essential.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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