Patterns of Tobacco Use and its Relation to Oral Precancers and Cancers among Individuals Visiting a Tertiary Hospital in South India

Abstract

Aim:The aim of this study was to evaluate the use of tobacco and its association with oral precancers and cancers. Materials and methods: Medical records of 1,007 individuals were assessed for the patterns of tobacco abuse and the presence of tobaccorelated oral mucosal alterations. Results: This study comprised 1,007 individuals (M:F: 95.4%:4.6%). In the cohort, 60.1% had smoking habit and 56.1% had smokeless habit. Of the bidi smokers, 18.2% developed carcinoma, 14.3% developed leukoplakia, which is statistically significant (p < 0.001). A logistic regression analysis of the development of oral submucous fibrosis (OSMF) shows that habit of smokeless forms of tobacco has an odds ratio (OR) of 18+ when compared with smoking. Combination of bidi and gutkha had 12.3 times higher risk of developing oral cancer and 4.4 times risk of developing leukoplakia. A total of 33.3% betel quid and gutkha chewers presented with tobacco pouch keratosis, which is statistically significant. Conclusion: Smoked and smokeless forms of tobacco were equally popular among the study population. The packeted form of smokeless tobacco (gutkha) was more prevalent. Oral submucous fibrosis was more common than leukoplakia, and oral cancer developed more frequently in elderly men smoking bidis. Clinical significance: This study throws light on the fact that the use of both smoke and smokeless forms of tobacco is still prevalent, and the use of gutkha was most prevalent. These findings will help tobacco cessation and counseling centers to focus their effort in motivating people to stop gutkha chewing habit. This also brings to the forefront the need to create better treatment strategies to manage OSMF.

Are There Betel Quid Mixtures Less Harmful than Others? A Scoping Review of the Association between Different Betel Quid Ingredients and the Risk of Oral Submucous Fibrosis

“…Khan et al reported that OSF associated with smokeless tobacco was most prevalent and that gutkha was the most commonly used smokeless product (26.3%). Khan et al reported an odds ratio of 17.704 (95% CI: 4.85-64.58) for developing OSF with a p-value < 0.001 [14]. These findings were confirmed by Mehrotra et al who showed that gutkha usage was associated with an OR of 10.77 (95% CI: 8.18-14.18) [15].…”

“…The three articles that described gutkha usage were from the Indian subcontinent. It appears that its practice is increasing and it is being used as a substitute for other BQ forms [14].…”

“…Although the mixtures were unspecified, it is important to note that most BQ mixtures from India contain tobacco whilst BQ mixtures from Taiwan mainly consist of AN, slaked lime, and piper BI with or without BL. Among the 13 datasets, 1 set reported a weak association between unspecified BQ and OSF [15], 4 sets reported a strong association [15,16,19], and 8 sets reported a very strong association [14,16,18,20,22].…”

Factors associated with the use of dental services in the previous 12 and 36 months by Brazilian older people residing in rural areas

“…Tobacco use was associated with the utilisation of dental services more than 3 years earlier, which suggests that older people who smoke spend longer periods of time without visiting a dentist. Khan et al 17 state that tobacco in all forms of consumption is a risk factor for oral cancer, which affects older men with greater frequency.…”

“…9,12,13,14,15 Other demographic variables, such as age group and skin colour were factors that influenced the use of dental services independently of the timeframe considered and place of residence, as described in the literature. 3,16,17 The use of Brazilian public dental services is greater among the economically underprivileged population. 18 The most vulnerable population is concentrated in this group, the majority of whom have less schooling and brown or black skin colour.…”