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      Prevalence of oral submucous fibrosis in patients visiting dental OPD of a dental college in Kanpur: A demographic study

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          Abstract

          Background:

          Oral submucous fibrosis (OSMF) is now globally accepted as an Indian disease. It has one of the highest rates of malignant transformation among potentially malignant oral lesions and conditions, therefore, a cause of concern for oral healthcare professionals. The present study aims to evaluate the prevalence of OSMF among betel nut chewers in different age groups in patients visiting Dental College and Hospital Kanpur city, India.

          Materials and Methods:

          A total of 860 patients of OSMF visiting the dental outpatient clinic of the Department of Oral Medicine and Radiology Rama Dental College Hospital and research center, Kanpur over a period of 24 months (1 January 2016 to 31 December 2018) were selected for the study. A detailed case history and clinical examination was carried out under visible light. The diagnosis of OSMF was based on difficulty in opening the mouth and associated blanched oral mucosa, with palpable fibrous bands. Other diagnostic features included burning sensation, salivation, tongue protrusion, habits, and associated malignant changes. Study was done on the basis of age group, habit duration, frequency of habit, and type of habit. Simple correlation analysis was performed.

          Results:

          Of the 860 cases of OSF studied, 390 (46.42%) cases were stage II, 290 (34.52%) were stage III, 90 (10.73%) stage I, and 70 (8.33%) stage IV. Based upon age group, group III (30--40 years) showed more prevalence than the others. Areca nut (gutkha) was a significant etiological factor (55.8%) as compared with other etiological factors.

          Conclusion:

          The high prevalence of OSMF requires significant awareness and management of these lesions among general population. Primary healthcare professionals and dentists should be knowledgeable and familiar with the etiopathogenesis, clinical presentation, diagnosis, and management of these lesions.

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          Most cited references21

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          The global burden for disease: A comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020

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            Smokeless tobacco and health in India and South Asia.

            South Asia is a major producer and net exporter of tobacco. Over one-third of tobacco consumed regionally is smokeless. Traditional forms like betel quid, tobacco with lime and tobacco tooth powder are commonly used and the use of new products is increasing, not only among men but also among children, teenagers, women of reproductive age, medical and dental students and in the South Asian diaspora. Smokeless tobacco users studied prospectively in India had age-adjusted relative risks for premature mortality of 1.2-1.96 (men) and 1.3 (women). Current male chewers of betel quid with tobacco in case-control studies in India had relative risks of oral cancer varying between 1.8-5.8 and relative risks for oesophageal cancer of 2.1-3.2. Oral submucous fibrosis is increasing due to the use of processed areca nut products, many containing tobacco. Pregnant women in India who used smokeless tobacco have a threefold increased risk of stillbirth and a two- to threefold increased risk of having a low birthweight infant. In recent years, several states in India have banned the sale, manufacture and storage of gutka, a smokeless tobacco product containing areca nut. In May 2003 in India, the Tobacco Products Bill 2001 was enacted to regulate the promotion and sale of all tobacco products. In two large-scale educational interventions in India, sizable proportions of tobacco users quit during 5-10 years of follow-up and incidence rates of oral leukoplakia measured in one study fell in the intervention cohort. Tobacco education must be imparted through schools, existing government health programmes and hospital outreach programmes.
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              Alert for an epidemic of oral cancer due to use of the betel quid substitutes gutkha and pan masala: a review of agents and causative mechanisms.

              In south-east Asia, Taiwan and Papua New Guinea, smoking, alcohol consumption and chewing of betel quid with or without tobacco or areca nut with or without tobacco are the predominant causes of oral cancer. In most areas, betel quid consists of a mixture of areca nut, slaked lime, catechu and several condiments according to taste, wrapped in a betel leaf. Almost all habitual chewers use tobacco with or without the betel quid. In the last few decades, small, attractive and inexpensive sachets of betel quid substitutes have become widely available. Aggressively advertised and marketed, often claimed to be safer products, they are consumed by the very young and old alike, particularly in India, but also among migrant populations from these areas world wide. The product is basically a flavoured and sweetened dry mixture of areca nut, catechu and slaked lime with tobacco (gutkha) or without tobacco (pan masala). These products have been strongly implicated in the recent increase in the incidence of oral submucous fibrosis, especially in the very young, even after a short period of use. This precancerous lesion, which has a high rate of malignant transformation, is extremely debilitating and has no known cure. The use of tobacco with lime, betel quid with tobacco, betel quid without tobacco and areca nut have been classified as carcinogenic to humans. As gutkha and pan masala are mixtures of several of these ingredients, their carcinogenic affect can be surmised. We review evidence that strongly supports causative mechanisms for genotoxicity and carcinogenicity of these substitute products. Although some recent curbs have been put on the manufacture and sale of these products, urgent action is needed to permanently ban gutkha and pan masala, together with the other established oral cancer-causing tobacco products. Further, education to reduce or eliminate home-made preparations needs to be accelerated.
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                Author and article information

                Journal
                J Family Med Prim Care
                J Family Med Prim Care
                JFMPC
                Journal of Family Medicine and Primary Care
                Wolters Kluwer - Medknow (India )
                2249-4863
                2278-7135
                August 2019
                28 August 2019
                : 8
                : 8
                : 2612-2617
                Affiliations
                [1 ] Department of Oral Medicine and Radiology, Rama Dental College, Hospital and Research Centre, Kanpur, Uttar Pradesh, India
                [2 ] Department of Dental Surgery, Ranchi Institute of Neuro-Psychiatry and Allied Sciences, Ranchi, Jharkhand, India
                [3 ] Department of Public Health Dentistry, Rama Dental College, Hospital and Research Centre, Kanpur, Uttar Pradesh, India
                [4 ] Department of Orthodontics, Rama Dental College, Hospital and Research Centre, Kanpur, Uttar Pradesh, India
                Author notes
                Address for correspondence: Dr. Rahul Srivastava, Department of Oral Medicine and Radiology, Rama Dental College Hospital and Research Centre, Kanpur, Uttar Pradesh - 208 024, India. E-mail: drrahul_osmf@ 123456yahoo.com
                Article
                JFMPC-8-2612
                10.4103/jfmpc.jfmpc_465_19
                6753822
                31548942
                620ec63e-5a4f-428d-ac60-5f38811b8882
                Copyright: © 2019 Journal of Family Medicine and Primary Care

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 14 June 2019
                : 19 June 2019
                : 12 July 2019
                Categories
                Original Article

                areca nut,clinical staging,oral submucous fibrosis,prevalence

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