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      Donor site morbidity in oral mucosa graft urethroplasty: implications of tobacco consumption

      research-article
      1 , , 2 , 2 , 2
      BMC Urology
      BioMed Central

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          Abstract

          Background

          The purpose of this prospective study was to evaluate the donor site morbidity in patients who have undergone oral mucosa graft urethroplasty for stricture of the urethra. The impact of smoking and oral consumption of tobacco and/or paan masala on the donor site was also assessed. This study is probably the first of its kind where the affect of smoking, paan masala and tobacco chewing on the donor site morbidity has been documented.

          Methods

          Forty-eight patients suffering from stricture of the urethra underwent oral mucosa graft urethroplasty between July 2005 and December 2007. The patients were divided into two groups (users or non-users) based on tobacco consumption and oral hygiene. The donor site was evaluated at frequent intervals for pain, swelling, numbness, bleeding, salivation and tightness of mouth.

          Results

          Donor site morbidity was more in users with poor oral hygiene. Pain scores were higher amongst the users and the morbidity persisted longer in the users compared to non-users with good oral hygiene.

          Conclusion

          Patients who consume tobacco and have poor oral hygiene should be warned regarding poorer outcomes after oral mucosa graft urethroplasty.

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          Most cited references20

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          The prevalence of oral mucosal lesions in patients visiting a dental school in Southern India.

          The purpose of the present study was to evaluate the prevalence of oral mucosal lesions in Manipal, Karnataka State, India. A total of 1190 subjects who visited the department of oral medicine and radiology for diagnosis of various oral complaints over a period of 3 months were interviewed and clinically examined for oral mucosal lesions. The result showed the presence of one or more mucosal lesions in (41.2%) of the population. Fordyce's condition was observed most frequently (6.55%) followed by frictional keratosis (5.79%), fissured tongue (5.71%), leukoedema (3.78%), smoker's palate (2.77%), recurrent aphthae, oral submucous fibrosis (2.01%), oral malignancies (1.76%), leukoplakia (1.59%), median rhomboid glossitis (1.50%), candidiasis (1.3%), lichen planus (1.20%), varices (1.17%), traumatic ulcer and oral hairy leukoplakia (1.008%), denture stomatitis, geographic tongue, betel chewer's mucosa and irritational fibroma (0.84%), herpes labialis, angular cheilitis (0.58%), and mucocele (0.16%). Mucosal lesions like tobacco-related lesions (leukoplakia, smoker's palate, oral submucous fibrosis, and oral malignancies) were more prevalent among men than among women. Denture stomatitis, herpes labialis, and angular cheilitis occurred more frequently in the female population.
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            Oral cancer in southern India: the influence of smoking, drinking, paan-chewing and oral hygiene.

            Between 1996 and 1999 we carried out a case-control study in 3 areas in Southern India (Bangalore, Madras and Trivandrum) including 591 incident cases of cancer of the oral cavity (282 women) and 582 hospital controls (290 women), frequency-matched with cases by age and gender. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from unconditional multiple logistic regressions and adjusted for age, gender, center, education, chewing habit and (men only) smoking and drinking habits. Low educational attainment, occupation as a farmer or manual worker and various indicators of poor oral hygiene were associated with significantly increased risk. An OR of 2.5 (95% CI 1.4-4.4) was found in men for smoking > or = 20 bidi or equivalents versus 0/day. The OR for alcohol drinking was 2.2 (95% CI 1.4-3.3). The OR for paan chewing was more elevated among women (OR 42; 95% CI 24-76) than among men (OR 5.1; 95% CI 3.4-7.8). A similar OR was found among chewers of paan with (OR 6.1 in men and 46 in women) and without tobacco (OR 4.2 in men and 16.4 in women). Among men, 35% of oral cancer is attributable to the combination of smoking and alcohol drinking and 49% to pan-tobacco chewing. Among women, chewing and poor oral hygiene explained 95% of oral cancer. Copyright 2002 Wiley-Liss, Inc.
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              Smoking and smokeless tobacco-associated human buccal cell mutations and their association with oral cancer--a review.

              Reported herein are the results of a structured literature review that was undertaken to (a) determine if human buccal (mouth) cell changes are associated with smoking and smokeless ("chewing") tobacco, (b) tabulate different buccal cell alterations that have been reported, (c) delineate buccal cell assays that have been used successfully, (d) determine whether buccal cell changes correlate with oral cancer as defined in clinicopathologic investigations, and (e) assess the feasibility of developing a high-throughput buccal cell assay for screening smokers for the early detection of oral cancer. The results of the studies reported herein have established that diverse buccal cell changes are associated with smoking and smokeless tobacco. This review documents also that buccal cells have been collected in a noninvasive manner, and repetitively for serial studies, from different sites of the mouth (e.g., cheek, gum, and tongue) and from normal tissue, preneoplastic lesions (leukoplakia), and malignant tumors. Tobacco-associated genetic mutations and nongenetic changes have been reported; a partial listing includes (a) micronuclei, (b) bacterial adherence, (c) genetic mutations, (d) DNA polymorphisms, (d) carcinogen-DNA adducts, and (e) chromosomal abnormalities. Clinical studies have correlated buccal cell changes with malignant tumors, and some oral oncologists have reported that the buccal cell changes are practical biomarkers. Summarily, the literature has established that buccal cells are useful not only for characterizing the molecular mechanisms underlying tobacco-associated oral cancers but also as exfoliative cells that express diverse changes that offer promise as candidate biomarkers for the early detection of oral cancer.
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                Author and article information

                Journal
                BMC Urol
                BMC Urology
                BioMed Central
                1471-2490
                2009
                21 September 2009
                : 9
                : 15
                Affiliations
                [1 ]Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
                [2 ]Department of Urology, CSMMU (formerly KGMU), Lucknow, (U.P.), India
                Article
                1471-2490-9-15
                10.1186/1471-2490-9-15
                2754487
                19772567
                29d12119-461b-45ee-8650-76ec18f67ad5
                Copyright © 2009 Sinha et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 3 April 2009
                : 21 September 2009
                Categories
                Research Article

                Urology
                Urology

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