Introduction
Use of tobacco in smoking and smokeless forms is found to be associated with various potentially malignant disorders and oral cancer.1 According to WHO approximately 6 million death occur due to tobacco use per year and this might increase to 8 million by 2030.2 Deadly carcinogens are found in both smoking and smokeless forms of tobacco.3 Use of tobacco leads to thickening of epithelium and increased keratinization. These might later lead to dysplastic changes and development of potentially malignant disorders and oral cancer.2
Various oral mucosal lesions associated with tobacco use include leukoplakia, smokers palate, tobacco pouch keratosis and oral cancer.4 Oral cancer is one of the most common cancer in India. This could be due to high prevalence of usage of betel quid, pan masala and other tobacco products.5 In India smokeless form of tobacco is most commonly used, which include betel quid, khaini, gutka etc.6 This study aims at promoting early diagnosis of lesions associated with smoking and prevent the malignant transformation of such lesions. Study also aims at educating patients about ill effects of tobacco.
Materials and Methods
The present study was a cross‑sectional prevalence study conducted in a dental college in South India.
Participants for the study were selected from the outpatients of department oral medicine and radiology who were willing to participate in the study. Patients who had habit of tobacco usage for more than a year was included in the study. Patients who had quit the habit for more than a month time were excluded from the study. Ethical clearance for the study (MINDS/SSIX/15042024/UG-004) was obtained from the institutional ethical committee before the start of the study.
The study was carried out for a duration of six months from March 2024 to September 2024. Patients with habit of tobacco usage was enrolled in the study. A written informed consent was taken from the participant for the study. The aims and objectives of the study were explained to the patients. A detailed case history including habit history was taken for each participant. Each participant was asked about the type, duration and frequency of tobacco use. Clinical examination was done using mouth mirror and sufficient lighting. Oral mucosa was examined by specialist in oral medicine and radiology for any tobacco associated oral mucosal lesions. The site and extend of lesion were noted. Diagnosis of each lesion were noted down.
Results
A total of 342 tobacco users participated in the study. 256(74%) participants had habit of smoking and 58(17%) had habit of chewing betel quid and 28(8%) had habit of both. Oral mucosal lesions were detected 144 participants. Various lesions found to be associated with tobacco were oral submucous fibrosis, leukoplakia, smokers melanosis, tobacco pouch keratosis, chewers mucosa and oral cancer. Table 1 shows prevalence of each lesion. Multiple lesions were noted in some participants. Site of each lesion is given in Table 2.
Table 1
Types of oral mucosal lesions
|
S. No. |
Lesion |
n |
|
1 |
Smokers palate |
113 |
|
2 |
Tobacco pouch keratosis |
9 |
|
3 |
Chewers mucosa |
8 |
|
4 |
Homogeneous Leukoplakia |
23 |
|
5 |
Speckled Leukoplakia |
7 |
|
6 |
Verrucous Leukoplakia |
3 |
|
7 |
OSMF |
7 |
|
8 |
Oral cancer |
5 |
Table 2
Site involved
|
S.No. |
Sites involved |
n |
|
1 |
Buccal mucosa |
42 |
|
2 |
Labial mucosa |
5 |
|
3 |
Vestibule |
12 |
|
4 |
Palate |
113 |
|
5 |
Tongue |
6 |
|
7 |
Alveolus |
3 |
|
8 |
Floor of the mouth |
2 |
Discussion
According to data given by WHO India is the third largest producer and second largest consumer of tobacco in the world. Now a days there are many commercially available tobacco products available in India and arecanut and tobacco constitute majority of these products.7 Most common tobacco product used in India is beedi. Most common smokeless tobacco product used in India is gutka.8 Use of tobacco is associated with various harmful consequences. Spreading awareness regarding the same is of utmost importance.
342 participants with habit of tobacco usage were examined in this study. Out of these 319(93%) were males and 23(7%) were females. Smoking form of tobacco was used by majority of the participants which is in accordance with the study conducted by Gambhir et al. were 72% were smokers.9 In contrast to this, in a study conducted by Patil et al. 57% tobacco users were betel quid and gutka chewers.10
In this study oral mucosal lesions were found in 42% percent of tobacco users. In a study conducted by Koothati et al.,5 in Telangana oral mucosal lesions were found in 30% tobacco users. In contrast to this a study by Patel P et al., conducted in Gujarat only 16% subjects were identified with oral mucosal lesions.11 Oral mucosal lesions were most commonly seen participants above 40 years of age. This could be due to reduced cell repair due to aging.12
Smokers palate or nicotina stomatitis is due to basilar melanosis causes by nicotine. It is characterised by whitish or greyish lesion with pinpoint erythematous areas.13 Smokers palate was the most common oral mucosal lesion found followed by leukoplakia. This is in accordance with the study done by Saraswathi et al.,14 and Sujatha et al.,15 In study conducted by Krishna et al. OSMF was most common lesion found.16 In present study since there was more number of smokers compared to tobacco chewers the prevalence of OSMF is lesser compared to other lesions.
Oral leukoplakia is seen as white patch or plaque which is associated with smoking habit.17 In this study leukoplakia was seen in 6.7% participants which is similar to study conducted by Patil R et al., were prevalence of leukoplakia was noted to be 8.2%.10
Chewers mucosa was identified in 2.3% participants. This is very similar to a study conducted by Patil et al. where chewers mucosa was observed in 2.2.% participants.10
Tobacco pouch keratosis is caused by continuous placement of smokeless tobacco products in the mucobuccal fold. Tobacco pouch keratosis was found in 2.6% patients. This is very less compared to study done by Divyadarshini et al., where prevalence of tobacco pouch keratosis was 25.8%.18
Oral cancer was diagnosed in 5(1.4%) patients. This is similar to study conducted by Patil, et al. where 1.6% participants were diagnosed with oral cancer.10
In present study oral mucosal lesions were more prevalent in smokeless tobacco users compared to smokers. Studies conducted by Koothati et al.,5 and Vellappally S, et al.,19 also showed similar results. Most common lesion found in smokers were smokers palate and in smokeless tobacco users it was tobacco pouch keratosis. Buccal mucosa and palate were the most common sites found to be involved which is similar to other studies conducted in India.16
Conclusion
Tobacco usage is associated with various oral mucosal lesions. Most of the oral mucosal lesions may be asymptomatic and patients may be unaware of these lesions. Hence oral screening is important in tobacco users. Also, education of patients regarding consequences of tobacco usage is pivotal. In present study all the participants were made aware of repercussions associated with tobacco use.
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