Epidemiology and histology of oral leukoplakia and leukoedema among papuans and New Guineans

Pindborg, J. J.; Barmes, Odont D.; Roed‐Petersen, B.

doi:10.1002/1097-0142(196808)22:2<379::aid-cncr2820220215>3.0.co;2-a

Cited by 82 publications

(53 citation statements)

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“…However, it is of interest to note that when the superficial parts of the keratin layer is invaded by microorganisms, as in chronic hypertrophic candidosis, the state of keratinization seen is always parakeratosis (Cawson and Lehner, 1968). Pindborg et al (1964) and Meyer et al (1967) have shown that the oral epithelium in different sites of the oral cavity show a great variation in reaction to the different oral habits, and great variability exists even in the reactions of the epithelium of a single site to the same habit. Thus, Pindborg et al (1964) found that hyperorthokeratosis was the most common hypercornification in the cheek mucosa of Indians following betel-nut chewing with tobacco.…”

Section: Discussionmentioning

confidence: 99%

“…Pindborg et al (1964) and Meyer et al (1967) have shown that the oral epithelium in different sites of the oral cavity show a great variation in reaction to the different oral habits, and great variability exists even in the reactions of the epithelium of a single site to the same habit. Thus, Pindborg et al (1964) found that hyperorthokeratosis was the most common hypercornification in the cheek mucosa of Indians following betel-nut chewing with tobacco. Sirsat and Doctor (1967) stated that parakeratosis was a common finding while hyperkeratosis was less commonly observed, whilst Meyer et al (1967) found that no specimen was wholly ortho-or wholly parakeratinized, but that orthokeratotic, parakeratotic and unkeratinized regions were combined in various ways.…”

Section: Discussionmentioning

confidence: 99%

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The Effects of Betel-Nut Chewing on the Buccal Mucosa: A Histological Study

Lee¹,

Chin²

1970

Br J Cancer

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SUMMARY.-Sixty-two " leukoplakias " from the cheeks of betel-nut chewers in West Malaysia were studied histologically. Ten biopsies were from nontobacco betel-nut chewers. An amorphous von Kossa positive layer was seen on the keratin surface in 42 specimens. Tobacco did not appear essential for its formation, and it appeared to be significantly associated with parakeratosis. Its possible significance as a cuticle-like layer prolonging contact between carcinogens and the mucosa is discussed.Parakeratosis appeared to be the most common form of cornification seen, and the mitotic activity in parakeratinized leukoplakias appeared to be significantly greater than orthokeratinized leukoplakias.Comparison with studies on other population samples using different quids suggested that severe histological changes were more likely to be seen when tobacco-containing quids were chewed as compared to non-tobacco-containing quids.An attempt to correlate the histological changes seen with the clinical habit in leukoplakias from chewers using tobacco-containing quids suggested that epithelial atrophy appeared to be significantly related to the duration of the habit but not to the " intensity " of the habit.THE clinical effects of betel-nut chewing on the buccal mucosa of a sample of 296 Malaysians have been reported in a separate paper (Chin and Lee, 1970). The present paper deals with the histological changes seen in the buccal mucosa of chewers from this sample whose oral mucosa exhibited lesions conforming to the clinical appearance of " leukoplakia " as defined previously. Pindborg, Srivastava and Gupta (1964) described epithelial changes in tobacco-induced leukoplakias in India and referred to previous work on this aspect. They pointed out that previous workers have not correlated histological findings with different habits and have not analysed the type of keratinization in these lesions. They concluded from their pilot study of 39 biopsies from leukoplakias in 37 East Indians that various habits of tobacco consumption, although creating a similar clinical picture of leukoplakia cause microscopically different changes of the oral epithelium and that the oral epithelium may react differently in different locations.Sirsat and Doctor (1967) studied the effects of tobacco chewing on the buccal mucosa in Indians with and without oral carcinomas and concluded that hyperplasia of the epithelium was the commonest change observed among chewers, and that parakeratosis was also a common finding, whereas hyperkeratosis was less commonly observed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Effects of Betel-Nut Chewing on the Buccal Mucosa: A Histological Study

Lee¹,

Chin²

1970

Br J Cancer

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“…However, it is of interest to note that Chang (1966) observed discernible clinical changes in the oral mucosa in 56 out of 174 betel-nut chewers (32X1 %) in Taiwan who do not use tobacco but use a shell-lime and betel-nut mixture. Pindborg, Barmes and Roed-Peterson (1968) studied the prevalence of leukoedema, preleukoplakia and leukoplakia among Papuans and New Guineans. In the North Coast Area where 95% of the study sample examined were betel-nut chewers (non-tobacco) 62 out of 283 Slight chewers Loss than 10 years' history of habit and "intensity of habit " less than one hour per day.…”

Section: Discussionmentioning

confidence: 99%

“…Differences in composition of the quid Pindborg, Kiaer, Gupta and Chawla (1967) reported 38 different habitual ways in which tobacco and/or betel-nut were used, and it is necessary therefore to categorize the method of usage, before comparative studies can be made. All subjects in the present series chewed betel-nut in the form of a quid or " pan ".…”

Section: Methodsmentioning

confidence: 99%

“…Clinically discernible mucosal changes which do not meet this qualification, however, appear more difficult to categorize. Pindborg, Barmes and Roed-Peterson (1968) use the term " preleukoplakia " to denote " a lesion of the oral mucosa too vague in colour to be called manifest leukoplakia. The affected area usually presented a whitish or greyish hue and occasionally was slightly raised and could not be scraped off.…”

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The Effect of Betel-nut Chewing on the Buccal Mucosa of 296 Indians and Malays in West Malaysia. A Clinical Study

Chin¹,

Lee²

1970

Br J Cancer

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SUMMARY.-Changes in the buccal mucosa of 296 Indian and Malay betelnut chewers in Perak, West Malaysia, were studied clinically. 167 out of 212 Indian subjects incorporated tobacco in their quids, while 45 out of 84 Malay subjects incorporated " Gambir ". The Indians appeared to show a higher proportion of mucosal changes, particularly when tobacco was used. " Gambir " did not appear to be potent in the production of mucosal changes.Comparison with studies in other parts of the world suggested comparable findings with respect to both tobacco and non-tobacco chewing samples, and there would appear to be some evidence that tobacco-containing quids are likely to produce a higher proportion of mucosal changes as compared to nontobacco-containing quids. An attempt to demonstrate a dose-effect relationship by dividing the subjects into " slight " and " heavy " chewers did not yield significant differences between these two categories in each of the groups.THE high incidence of oral cancer in South-East Asia has for long been linked with the habit of betel-nut chewing, particularly when tobacco has been incorporated into the quid. Hirayama (1966) in an extensive epidemiological study of oral and pharyngeal cancer in Central and South-East Asia showed (1) that there is a relationship between the site of cancer within the mouth and the site where the tobacco-containing quids are kept, (2) that there is a dose-response relationship and that the relative risk of developing a cancer of the mouth increases with the amount chewed, and (3) that within the mouth this relative risk for tobacco chewers is greater for the anterior parts of the mouth and not so great for the posterior parts. He concluded that the chewing of tobacco and lime mixtures play an important role in the aetiology of oral cancer in most parts of South-East Asia and Central Asia causing cancer at the place in which the quid is habitually put. He pointed out, however, that whether it was the tobacco or the lime which played the major role was a matter for future study, as it is also known that oral cancer is rare in territories where people chew tobacco without lime, and that it can be high in territories where betel-nut and lime are chewed without tobacco. The composition, chemistry and pharmacology of the quid have been reviewed by Muir and Kirk (1960).The changes that occur in the oral mucosa as a result of betel-nut chewing in * Present address: Dental Clinic, District Hospital, Kluang, Johore, West Malavsia.

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