The oral health consequences of chewing areca nut

Evaluation of the Smokeless Tobacco Awareness, Attitude, and Response Knowledge (STAARK) Scale With Integrated Risk Assessment for Tailored Intervention

Background Smokeless tobacco (SLT) use, particularly gutkha, is prevalent in India, with cultural acceptance contributing to widespread use, especially among tribal populations. Despite awareness programs, there is limited assessment of their effectiveness, leading to continued vulnerability, even among educated groups. This study aims to evaluate public health strategies by developing and validating the SLT Awareness, Attitude, and Response Knowledge (STAARK) scale, which assesses knowledge and attitudes post-awareness programs on SLT usage through questionnaires, identifying vulnerable individuals, and enabling targeted interventions to reduce SLT use and associated health risks, particularly through integrated risk assessment (IRA). Methods This study was performed during an SLT awareness program in Nagaland, utilizing a comprehensive survey to assess participants' demographics, knowledge, and attitudes. The STAARK score was calculated by combining normalized attitude and knowledge scores, ranging from 0 to 10, categorizing participants' comprehension and attitudes toward SLT usage awareness. The obtained scores were assessed twice for consistency evaluation of the scale, and vulnerable individuals were subjected to IRA for targeted intervention recommendations. Reliability and correlation analyses were performed, with Cronbach's alpha validating the scale's internal consistency. Results About 182 participants took up the assessment, with only 180 completing the survey among the population attending the awareness program. Demographic data revealed a diverse participant group, with ages ranging from 13 to 42 years. The survey assessed participants' knowledge and attitudes toward SLT, scoring them on a 0-10 scale for knowledge and a 10-60 scale for attitude. The STAARK scale was developed to combine these scores, providing a comprehensive measure of participants' understanding and attitudes toward SLT. The mean STAARK score was 5.27 with an observed lower limit of 2.40 and an upper limit of 6.50 in the responded population. Reliability testing using Cronbach's alpha showed acceptable internal consistency, though attitude had a weaker correlation with the overall STAARK score compared to knowledge. In a follow-up assessment with 88 participants, the STAARK score averaged 5.10, reinforcing the initial findings. The risk assessment of 17 participants with STAARK scores above six identified varying levels of risk, with most falling into the low- or moderate-risk categories. The study highlights the importance of targeted interventions to address SLT usage, particularly in populations with lenient attitudes toward its consumption. Conclusions The STAARK scale can serve as a key tool for evaluating SLT awareness programs by assessing participants' knowledge and attitudes and identifying high-risk individuals requiring personalized interventions for SLT usage cessation. It standardizes the assessment, enabling comparison across groups and times, and helps identify individuals with lenient attitudes toward SLT for targeted interventions. Its reliability ensures consistency, and by tracking changes in scores before and after programs, it assesses impact and guides future improvements. The STAARK scale is crucial for personalized, evidence-based public health efforts to reduce SLT use. However, eradicating SLT requires ongoing commitment, adaptability, and a focus on long-term outcomes to translate knowledge into lasting change.

Periodontitis presenting among betel quid users: A case series

BACKGROUND

Betel leaf chewing habit has been studied extensively, as it has been an ancient practice in many Asian countries. Although betel leaf has been reported to have potential beneficial properties, it has also been shown to have a strong association with oral diseases, including periodontitis. This case series addresses the presentation of periodontitis among betel quid users, to help clinicians identify and manage such patients when they are encountered in settings outside the countries and territories where betel quid use is common.

METHODS

Four patients of Asian ethnicity were referred to The Ohio State University College of Dentistry Graduate Periodontology clinic for periodontal treatment. Targeted questioning resulted in all four patients reporting a past and current betel leaf chewing habit, established at a young age, typically in a family setting, and long before their immigration from their native country.

RESULTS

All four patients exhibited similar reddish-brown staining on the teeth and generalized radiographic bone loss. Notably, the patients disclosed the betel chewing habit only after different vernacular names for betel quid were used during questioning, which complicated history taking. Severe periodontitis (stage III/IV, grade C) was diagnosed in all four patients, who were given appropriate periodontal treatment plans.

CONCLUSION

Betel leaf chewing, prevalent in many Asian countries, is associated with periodontitis and may present with extensive tooth staining. Oral healthcare providers should consider this cultural habit and pursue thorough assessment and history taking for their patients originating from countries where the habit is common practice.

KEY POINTS

Clinicians should be aware of the clinical presentation and oral findings in betel quid users. Given the increasing diversity of the patient pool that clinicians are encountering, knowledge of vernacular names for betel quid usage can prove valuable in history taking. A protocol for betel quid cessation should be incorporated into the management strategy for these patients in clinical practice.

PLAIN LANGUAGE SUMMARY

Betel quid (paan) chewing is a widespread cultural habit, especially in Asia. The chewing of betel quid, whether alone or with tobacco, has been strongly associated with periodontitis and other oral conditions, such as leukoplakia, oral cancer, and oral submucous fibrosis. This report illustrates the typical presentation of periodontitis patients who habitually chew betel quid, highlights the associated clinical features, such as reddish-brown tooth staining and severe bone loss, and underlines the challenge of obtaining a complete history because of the very many vernacular names used for betel quid in different countries and the fact that for many of the patients, this is considered a routine cultural tradition. It is unusual to encounter patients chewing betel quid in this country because the practice is not common. However, immigrants from countries where betel quid chewing is commonplace may continue the habit after they move to the United States. Oral healthcare providers should be aware of this possibility and elicit the relevant information from the patients. This will help practitioners to properly address this underlying factor and to provide appropriate care to these patients, including cessation advice and support, and establishment of routine oral screenings and regular periodontal maintenance.

Inhibitory effect of extracts from edible parts of nuts on α-amylase activity: a systematic review

Elevated blood glucose concentration is a risk factor for developing metabolic dysfunction and insulin resistance, leading to type 2 diabetes and cardiovascular diseases. Nuts have the potential to inhibit α-amylase activity, and so lower postprandial glucose, due to their content of polyphenols and other bioactive compounds. We conducted a systematic literature review to assess the ability of extracts from commonly consumed edible parts of nuts to inhibit α-amylase. Among the 31 included papers, only four utilised human α-amylases. These papers indicated that polyphenol-rich chestnut skin extracts exhibited strong inhibition of both human salivary and pancreatic α-amylases, and that a polyphenol-rich almond skin extract was a potent inhibitor of human salivary α-amylase. The majority of the reviewed studies utilised porcine pancreatic α-amylase, which has ∼86% sequence homology with the corresponding human enzyme but with some key amino acid variations located within the active site. Polyphenol-rich extracts from chestnut, almond, kola nut, pecan and walnut, and peptides isolated from cashew, inhibited porcine pancreatic α-amylase. Some studies used α-amylases sourced from fungi or bacteria, outcomes from which are entirely irrelevant to human health, as they have no sequence homology with the human enzyme. Given the limited research involving human α-amylases, and the differences in inhibition compared to porcine enzymes and especially enzymes from microorganisms, it is recommended that future in vitro experiments place greater emphasis on utilising enzymes sourced from humans to facilitate a reliable prediction of effects in intervention studies.

Oral Cavity Cancers: Ethnic Differences in Radiotherapy Outcomes in a Majority South Asian Leicester Community

AIMS

Squamous cell carcinoma oral cavity cancers (SCCOCCs) have a higher reported incidence in South Asian countries. We sought to compare presenting stage and outcome by ethnicity in patients with SCCOCC treated with radical radiotherapy in a single centre in the UK.

MATERIALS AND METHODS

All patients with SCCOCC treated with radical radiotherapy at an oncology department in Leicester (UK) between 2011 and 2017 were identified. Baseline demographic, clinical data and 2-year treatment outcomes were reported.

RESULTS

Of the 109 patients included, 40 were South Asian and 59 were non-South Asian. South Asians had significantly poorer 2-year disease-free survival compared with non-South Asians (54.6% versus 73%, P = 0.01).

CONCLUSION

Our analysis suggests that South Asians with SCCOCC have poorer outcomes despite a younger age and similar disease characteristics. Environmental, social factors and differing biology of disease may be responsible and further research is required to inform targeted interventions.

The role of epithelial cells in fibrosis: Mechanisms and treatment

Fibrosis is a pathological process that affects multiple organs and is considered one of the major causes of morbidity and mortality in multiple diseases, resulting in an enormous disease burden. Current studies have focused on fibroblasts and myofibroblasts, which directly lead to imbalance in generation and degradation of extracellular matrix (ECM). In recent years, an increasing number of studies have focused on the role of epithelial cells in fibrosis. In some cases, epithelial cells are first exposed to external physicochemical stimuli that may directly drive collagen accumulation in the mesenchyme. In other cases, the source of stimulation is mainly immune cells and some cytokines, and epithelial cells are similarly altered in the process. In this review, we will focus on the multiple dynamic alterations involved in epithelial cells after injury and during fibrogenesis, discuss the association among them, and summarize some therapies targeting changed epithelial cells. Especially, epithelial mesenchymal transition (EMT) is the key central step, which is closely linked to other biological behaviors. Meanwhile, we think studies on disruption of epithelial barrier, epithelial cell death and altered basal stem cell populations and stemness in fibrosis are not appreciated. We believe that therapies targeted epithelial cells can prevent the progress of fibrosis, but not reverse it. The epithelial cell targeting therapies will provide a wonderful preventive and delaying action.

What Motivates Betel Quid Chewers to Quit? An Analysis of Several Cessation-Relevant Variables

Introduction: Betel quid (BQ) is globally the fourth most consumed psychoactive substance. It is consumed by an estimated 600 million people worldwide, accounting for nearly 8% of the world's population. There have been very few studies assessing chewers' motivation to quit. Objectives: In the current study, we sought to understand the relationship between several cessation-relevant variables and chewers' motivation to quit. Hypotheses: Based on analogous research on cigarette smoking, we hypothesized that the following cessation-relevant variables would be associated with motivation to quit: health risk perceptions, number of chews per day, cost, degree of BQ dependence, withdrawal symptoms, number of quit attempts, reasons for use, personal health improvement, and type of BQ chewed. Methods: A total of 351 adult BQ chewers from Guam participated in the survey and served as the sample for the analyses. Results: Majority of chewers want to quit and intend to quit. Chewers relatively high in motivation to quit evinced greater health risk perceptions of BQ chewing, greater perceived health benefits to quitting, and a greater number of past quit attempts, compared to those relatively low in motivation to quit. Conclusions: Understanding which factors are associated with chewers' motivation to quit can be helpful for designing BQ cessation programs. The results suggest that BQ cessation programs could be improved by an increased emphasis on information about the negative health effects of BQ chewing and relapse-prevention.

Duration and frequency of betel quid chewing affects periodontitis severity and life quality of people in Tanini Village, Kupang, Indonesia

BACKGROUND

Chewing betel nuts can increase the risk of periodontal disease severity and potentially become malignant in the oral cavity.

OBJECTIVE

This study aimed to investigate the effect of the duration and frequency of betel quid chewing behaviour on periodontitis severity and the life quality of people in Tanini Village, Kupang Regency, Indonesia.

METHODS

The type of this study was an analytic observational study with a cross-sectional design. We used a questionnaire to obtain sociodemographic data. Oral Health Survey Basic Methods were used to measure debris index, plaque index, bleeding on probing, loss of attachment, and pocket depth. Behaviour and quality of life were measured by questionnaire and WHOQOL-BREF method as well.

RESULTS

The largest number of respondents were male. Duration of chewing had a significant relationship with the frequency of chewing and periodontal status. Periodontitis was higher compared to all categories. The lifestyle of the community greatly influenced their behaviour in betel nut chewing and also affected the severity of their periodontitis and OHIs significantly.

CONCLUSION

The lifestyle of betel nut chewing of the people in Tanini Village, greatly influences their behaviour. Prolonged and excessive use of betel nut induced significant adverse effects on human health. The longer and more often chew betel or areca nut, the higher the incidence of periodontitis, which significantly affects the quality of life as there is a possibility of the development of carcinogenesis, particularly in the oral cavity.

Unveiling Mysteries of Quid-Induced Lichenoid Reactions: A Cross-Sectional Study

Lichenoid reactions occur exclusively in people who chew tobacco, areca nut, or both, in raw or any manufactured or processed form. The lesion is described as a lichen-planus-like lesion and is termed as quid-induced lichenoid reaction (QILR). In this cross-sectional study, amongst 935 quid consumers, 82 patients were diagnosed with QILR and it was seen that 65 patients used processed forms of tobacco and areca nut. Thereby, it could be concluded that QILR might occur because of flavors used in processing of tobacco and areca nut.

Low-dose arecoline regulates distinct core signaling pathways in oral submucous fibrosis and oral squamous cell carcinoma

BACKGROUND

Betel nut chewing plays a role in the pathogenesis of oral submucous fibrosis (OSF) and oral squamous cell carcinoma (OSCC). As the major active ingredient of the betel nut, the effect of arecoline and its underlying mechanism to OSF and OSCC pathogenesis remain unclear.

METHODS

Next-generation sequencing-based transcriptome and dRRBS analysis were performed on OSF and OSCC cells under low-dose arecoline exposure. Functional analyses were performed to compare the different roles of arecoline during OSF and OSCC pathogenesis, and key genes were identified.

RESULTS

In this study, we identified that low-dose arecoline promoted cell proliferation of both NFs and OSCC cells via the acceleration of cell cycle progression, while high-dose arecoline was cytotoxic to both NFs and OSCC cells. We performed for the first time the transcriptome and methylome landscapes of NFs and OSCC cells under low-dose arecoline exposure. We found distinct transcriptome and methylome profiles mediated by low-dose arecoline in OSF and OSCC cells, as well as specific genes and signaling pathways associated with metabolic disorders induced by low-dose arecoline exposure. Additionally, low-dose arecoline displayed different functions at different stages, participating in the modulation of the extracellular matrix via Wnt signaling in NFs and epigenetic regulation in OSCC cells. After exposure to low-dose arecoline, the node roles of FMOD in NFs and histone gene clusters in OSCC cells were found. Meanwhile, some key methylated genes induced by arecoline were also identified, like PTPRM and FOXD3 in NFs, SALL3 and IRF8 in OSCC cells, indicating early molecular events mediated by arecoline during OSF and OSCC pathogenesis.

CONCLUSIONS

This study elucidated the contribution of low-dose arecoline to OSF and OSCC pathogenesis and identified key molecular events that could be targeted for further functional studies and their potential as biomarkers.

Identifying oral microbiome alterations in adult betel quid chewing population of Delhi, India

The study targets to establish a factorial association of oral microbiome alterations (oral dysbiosis) with betel quid chewing habits through a comparison of the oral microbiome of Betel quid chewers and non-chewing individuals. Oral microbiome analysis of 22 adult individuals in the Delhi region of India through the 16S sequencing approach was carried out to observe the differences in taxonomic abundance and diversity. A significant difference in diversity and richness among Betel Quid Chewers (BQC) and Betel Quid Non-Chewers (BQNC) groups was observed. There were significant differences in alpha diversity among the BQC in comparison to BQNC. However, in the age group of 21-30 years old young BQC and BQNC there was no significant difference in alpha diversity. Similar result was obtained while comparing BQC and Smoker-alcoholic BQC. BQ smoker-chewers expressed significant variance in comparison to BQC, based on cluster pattern analysis. The OTU-based Venn Diagram Analysis revealed an altered microbiota, for BQ chewing group with 0-10 years exposure in comparison to those with 10 years and above. The change in the microbial niche in early chewers may be due to abrupt chemical component exposure affecting the oral cavity, and thereafter establishing a unique microenvironment in the long-term BQC. Linear discriminant analysis revealed, 55 significant features among BQC and Alcoholic-Smoker BQC; and 20 significant features among BQC and Smoker BQC respectively. The study shows the abundance of novel bacterial genera in the BQC oral cavity in addition to the commonly found ones. Since the oral microbiome plays a significant role in maintaining local homeostasis, investigating the link between its imbalance in such conditions that are known to have an association with oral diseases including cancers may lead to the identification of specific microbiome-based signatures for its early diagnosis.

Molecular Mechanisms of Malignant Transformation of Oral Submucous Fibrosis by Different Betel Quid Constituents-Does Fibroblast Senescence Play a Role?

Betel quid (BQ) is a package of mixed constituents that is chewed by more than 600 million people worldwide, particularly in Asia. The formulation of BQ depends on a variety of factors but typically includes areca nut, betel leaf, and slaked lime and may or may not contain tobacco. BQ chewing is strongly associated with the development of potentially malignant and malignant diseases of the mouth such as oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC), respectively. We have shown recently that the constituents of BQ vary geographically and that the capacity to induce disease reflects the distinct chemical composition of the BQ. In this review, we examined the diverse chemical constituents of BQ and their putative role in oral carcinogenesis. Four major areca alkaloids—arecoline, arecaidine, guvacoline and guvacine—together with the polyphenols, were identified as being potentially involved in oral carcinogenesis. Further, we propose that fibroblast senescence, which is induced by certain BQ components, may be a key driver of tumour progression in OSMF and OSCC. Our study emphasizes that the characterization of the detrimental or protective effects of specific BQ ingredients may facilitate the development of targeted BQ formulations to prevent and/or treat potentially malignant oral disorders and oral cancer in BQ users.

Rapid green analytical methodology for simultaneous biomonitoring of five toxic areca nut alkaloids using UHPLC-MS/MS for predicting health hazardous risks

Areca nut (AN) is a fundamental component of betel quid (BQ), an addictive and carcinogenic mixture chewed by hundreds of millions of people in India-Asia-Pacific. Chewing of BQ is associated with oral cancers due to specific carcinogenic alkaloids (arecaidine, guvacine, guvacoline, arecoline, N-Nitrosoguvacoline) in AN. To predict the hazardous health risks of short and long-term chewing of BQ, it is crucial to identify five toxic AN alkaloids in saliva and urine of BQ chewers. This study reports a green analytical methodology comprising in-syringe assisted vortex-induced salt-enhanced liquid-liquid microextraction coupled with ultra-HPLC-MS/MS for simultaneous biomonitoring of five AN alkaloids in saliva and urine. The analytical method validation results exhibited good linearities between 0.05 and 1000 ng mL^-1 with r² > 0.9930. The detection and quantification limits were between 0.01 and 1.5 and 0.05-5 ng mL^-1. Relative recoveries ranged between 87.9% and 110.1% with RSD < 9.1% for saliva samples, 81.5-115.1% with RSD < 9.7% for urine samples. The results indicated the successful identification and real-time monitoring of concentrations of five target AN alkaloids in saliva and urine of BQ chewers and demonstrated the utility of this technique as an efficient analytical protocol for routine biomonitoring of levels of toxic AN alkaloids from BQ chewers and to predict the exposure level and its harmful health risk.

Altered Spontaneous Brain Activity in Betel Quid Dependence Chewers: A Resting-State Functional MRI Study With Percent Amplitude of Fluctuation

OBJECTIVE

This study aimed to investigate brain spontaneous neural activity changes in betel quid dependence (BQD) chewers using the percent amplitude of fluctuation (PerAF) method.

METHODS

This study included 48 BQD chewers. The healthy control (HC) group comprised 35 volunteers who were matched with BQD chewers in age, gender, and educational status. All subjects underwent resting-state functional magnetic resonance imaging (rs-fMRI) and neuropsychological tests. The PerAF method was used to identify BQD-related regional brain activity changes. An independent samples t-test was used to evaluate the PerAF difference across two groups. The association between PerAF changes and clinical features such as BQD scores, duration of BQD, Hamilton Depression Rating Scale-24 item (HAMD-24), and Hamilton Anxiety Rating Scale-14 item (HAMA-14) was evaluated by using Spearman's correlation analysis. It assessed the ability of the PerAF method to distinguish between BQD chewers and HCs using a receiver operating characteristic (ROC) curve.

RESULTS

Compared to the control group, BQD chewers showed decreased PerAF in right anterior cingulate cortex (ACC), right middle frontal gyrus (MFG), right insula, right precuneus, left putamen, left supramarginal gyrus (SMG), and left cerebellum and increased PerAF in right orbitofrontal and left superior temporal gyrus (STG) [P < 0.05, Gaussian random field (GRF) corrected]. PerAF values of the right MFG and right ACC had a significant negative relationship with the duration of BQD (P < 0.05). The average values of PerAF in the left putamen, left cerebellum, and left STG showed significant discriminatory power in distinguishing BQD chewers from HCs, with relatively prime area under the curve (AUC) values.

CONCLUSION

Our findings suggested that betel quid chewing is associated with spontaneous neural activity alterations in the impulsivity areas (MFG and ACC), cognitive (MFG, ACC, precuneus, and the cerebellum), and reward (orbitofrontal, putamen, and insula) systems, which may be correlated with neuropathological mechanisms of BQD. Also, PerAF may be useful as a potential sensitive biomarker for identifying spontaneous brain activity changes in BQD chewers.

New Scenarios in Pharmacological Treatments of Head and Neck Squamous Cell Carcinomas

Head and neck squamous cell carcinoma (HNSCC) is one of the most frequent types of cancer with a lethal outcome in half of the diagnosed cases. Mostly, HNSCC develops in the oral cavity, and its development is associated with tobacco and areca nut/betel quid usage, alcohol consumption, and HPV infection. Oral squamous cell carcinoma, as other head and neck cancers, presents a high degree of intratumor heterogeneity, which makes their treatment difficult, and directly correlates with drug resistance. Since the classical treatments for HNSCC oftentimes do not resolve the clinical picture, there is great need for novel therapeutic approaches, models for drug testing, and new drug delivery systems.

Areca Nut Chewing: Initiation, Addiction, and Harmful Effects Emphasizing the Barriers and Importance of Cessation

Areca nut is a highly addictive substance with carcinogenic properties and causes many harmful effects to the human body. Alkaloids are the major chemicals found in areca nut, and their mechanism of action has been studied for several years. About 600 million people around the world use areca nut, and its usage is higher in Asian countries. Areca nut chewers get used to the habit mainly due to social influence, stress, or lack of awareness. Some studies have reported a dependence syndrome related to areca nut chewing. Even though there are many ongoing research studies regarding tobacco addiction, less concern has been given to the areca nut addiction. There are only few studies related to areca nut cessation, and even those few cessation programs are mainly designed using tobacco cessation methodology. Sociocultural influence, behavioral factors, and accessibility are the main barriers to cessation. Behavior changing interventions proved to be more effective in areca nut cessation, but recently studies on pharmacological therapies are also emerging.

Habit-associated salivary pH changes in oral submucous fibrosis: A cross-sectional study

Background:

Salivary pH plays a significant role in the pathogenesis of various oral diseases and conditions. Chewing of areca nut and various tobacco products changes salivary pH.

Aim:

The aim of the study was to measure the effect of habitual chewing of areca nut and various tobacco products on salivary pH.

Materials and Methods:

The present study included 360 individuals (chewers and nonchewers) of age group between 20 and 30 years who visited the Outpatient Department of Hi-Tech Dental College and Hospital. The patient's salivary pH was measured with the help of a digital pH meter before and after chewing areca nut and various tobacco products.

Results:

It was observed that, in all the groups of chewers, pH decreased after chewing except in the gutkha and lime chewing group, where pH increased (pH before chewing was 7.43 ± 0.41 and after chewing was 7.51 ± 0.399), the difference was strongly significant (P < 0.001). pH was found to be less in lime and tobacco chewers (6.83 ± 0.33) and more in tobacco, betel nut, and lime chewers (7.50 ± 0.41) in comparison to other groups before chewing; the difference was strongly significant (P < 0.001). In the mean ± standard deviation, increase in pH was found among chewers (7.32 ± 0.49) as compared to nonchewers (6.99 ± 0.14), which is the control group, and the data were statically significant (P < 0.001).

Conclusion:

pH is altered in areca nut and various tobacco chewers, rendering the oral mucosa vulnerable to the toxic effects of areca nut and various tobacco products.

Hydroxychavicol, a polyphenol from Piper betle leaf extract, induces cell cycle arrest and apoptosis in TP53-resistant HT-29 colon cancer cells

This study aims to elucidate the antiproliferative mechanism of hydroxychavicol (HC). Its effects on cell cycle, apoptosis, and the expression of c-Jun N-terminal kinase (JNK) and P38 mitogen-activated protein kinase (MAPK) in HT-29 colon cancer cells were investigated. HC was isolated from Piper betle leaf (PBL) and verified by high-performance liquid chromatography (HPLC), nuclear magnetic resonance (NMR), and gas chromatography-mass spectrometry (GC-MS). The cytotoxic effects of the standard drug 5-fluorouracil (5-FU), PBL water extract, and HC on HT-29 cells were measured after 24, 48, and 72 h of treatment. Cell cycle and apoptosis modulation by 5-FU and HC treatments were investigated up to 30 h. Changes in phosphorylated JNK (pJNK) and P38 (pP38) MAPK expression were observed up to 18 h. The half maximal inhibitory concentration (IC₅₀) values of HC (30 μg/mL) and PBL water extract (380 μg/mL) were achieved at 24 h, whereas the IC₅₀ of 5-FU (50 μmol/L) was obtained at 72 h. Cell cycle arrest at the G₀/G₁ phase in HC-treated cells was observed from 12 h onwards. Higher apoptotic cell death in HC-treated cells compared to 5-FU-treated cells (P<0.05) was observed. High expression of pJNK and pP38 MAPK was observed at 12 h in HC-treated cells, but not in 5-FU-treated HT-29 cells (P<0.05). It is concluded that HC induces cell cycle arrest and apoptosis of HT-29 cells, with these actions possibly mediated by JNK and P38 MAPK.

Evaluation of cytotoxicity of areca nut and its commercial products on normal human gingival fibroblast and oral squamous cell carcinoma cell lines

Consumption of areca nut products is the most common cause of oral cancers, particularly in South Asian countries. This study evaluates the cytotoxic and necrotizing effects of areca nut and its formulations on normal human gingival fibroblasts (HGF-1) and oral squamous cell carcinoma (OSCC, CAL-27) cell lines. Identification of various carcinogens and adulterants using LC-HR-ESI-MS/MS analysis was performed in the extracts of areca nut and its products. Apart from alkaloids and flavonoids, a major adulterant, saccharin was found in all the samples of chalia (one of the most common chewing products of areca nut) in the ranges between 1.697-7.170 mg/g of the sample. Cytotoxic studies showed that most of the areca nut products were found cytotoxic to HGF-1 cells while being relatively non-cytotoxic against CAL-27 cells, rather they promote the growth of cancer cells. Our findings revealed that the components of areca nut and its products were injurious to HGF-1 cells and caused necrosis, which may attenuate HGF-1 protection toward oral epithelial cells. Moreover, the non-cytotoxic effect of these products on cancer cell lines suggests further predisposal of the habitual chewers for developing oral carcinomas. This study will give a better understanding of the hazardous effects of areca nut products.

Efficacy of Lycopene in the Treatment of Oral Submucous Fibrosis: A Meta-analysis of Randomized Controlled Trials

OBJECTIVES

The aim of this meta-analysis was to systematically evaluate the efficacy of lycopene in improving maximum mouth opening and other clinical symptoms in patients with oral submucous fibrosis (OSF).

METHODS

We searched 5 databases: PubMed, Web of Science, Embase, The Cochrane Library, and EBSCO. Randomized controlled trials were collected to evaluate the efficacy of lycopene in the treatment of OSF. Each database was searched from inception to April 30, 2019. The RevMan 5.3 software was used for this meta-analysis.

RESULTS

The included studies were 7 randomized controlled trials involving 758 patients with OSF. The results of this meta-analysis showed that lycopene was significantly more effective in improving maximum mouth opening in OSF patients than placebo treatment (mean difference [MD]: 3.15; 95% confidence interval [CI]: 2.19-4.10, P < .0001, I² = 0%). Compared with control groups, lycopene could significantly increase the maximum mouth opening in patients with OSF after 1 month of treatment (MD, 2.40; 95% CI, 2.22-2.58; P = .91; I² = 0%), 2 months of treatment (MD, 3.19; 95% CI, 2.87-3.51; P = .93; I² = 0%), and 3 months of treatment (MD, 4.89; 95% CI, 4.51-5.28; P = .86; I² = 0%). However, no significant difference was found in alleviation of burning sensation after 1 month (risk ratio [RR], 1.04; 95% CI, 0.89-1.23; P = .73; I² = 0%), 2 months (RR, 0.98; 95% CI, 0.73-1.31; P = .69; I² = 0%), and 3 months of treatment (RR, 0.84; 95% CI, 0.47-1.52; P = .81; I² = 0%); tongue protrusion (MD, -1.59; 95% CI, -4.15 to 0.97; P = .12; I² = 58%); and pain associated with the lesion after 1 month (RR, 1.05; 95% CI, 0.92-1.21; P = .77; I² = 0%), 2 months (RR, 0.95; 95% CI, 0.75-1.19; P = .35; I² = 0%), and 3 months (RR, 0.95; 95% CI, 0.68-1.33; P = .14; I² = 51%) in patients with OSF between lycopene and control groups.

CONCLUSIONS

The results of this meta-analysis showed that lycopene is more effective for improving symptoms of maximum mouth opening than placebo groups and control groups, but there were no significant differences in burning sensation, pain associated with lesion, and tongue protrusion in patients with OSF compared with control groups.

Association between interleukin-10 gene polymorphisms and risk of oral carcinoma: A meta-analysis

BACKGROUND

The single nucleotide polymorphisms (SNPs) of Interleukin-10 (IL-10) gene have been linked with the risk of oral carcinoma (OC) in a relatively small sample size. Our study aims to investigate the pooled associations by conducting a meta-analysis of published studies.

METHODS

PubMed, Web of Science and Google Scholar databases were searched to identify eligible studies published in English before October 2019. The odds ratio (OR) with a 95% confidence interval (CI) was used to assess association. The publication bias was detected by Begg's test. Sensitivity and cumulative analyses were performed to evaluate the stability of crude results.

RESULTS

The meta-analysis involved eight studies. Significant associations were certified between IL-10 gene -1082A/G polymorphism and susceptibility of OC for A vs. G (OR=1.817, 95% CI: 1.481-2.230), AA vs. GG (OR=3.436, 95% CI: 2.281-5.175), dominant genetic model (OR=2.913, 95% CI: 1.939-4.376), and recessive genetic model (OR=1.886, 95% CI: 1.372-2.594) in overall population, East Asians and South Asians. In addition, the significant association between -592A/C polymorphism of the gene and susceptibility of OC were detected in South Asians.

CONCLUSIONS

The meta-analysis results support that the IL-10 gene -1082G allele is a risk factor for OC in East Asians and South Asians, and IL-10 gene -592C allele is a protective factor for the disease.

Betel Quid Health Risks of Insulin Resistance Diseases in Poor Young South Asian Native and Immigrant Populations

Betel quid, traditionally prepared with areca nut, betel leaf, and slaked lime, has been consumed for thousands of years, mainly in the form of chewing. Originally used for cultural, medicinal, and ceremonial purposes mainly in South Asian countries, its use has recently spread across the globe due to its psychoactive, euphoric, and aphrodisiac properties. Now it is widely used as a social lubricant and source of financial profit. Unfortunately, the profit motive has led to high rates of habitual consumption with eventual conversion to addiction among young girls and boys. Moreover, the worrisome practice of including tobacco in quid preparations has grown, particularly among pregnant women. Major health concerns include increased rates of malignancy, oral pathology, and cardiovascular, hepatic, fertility, metabolic, and neuropsychiatric disorders. Metabolic disorders and insulin resistance disease states such as type 2 diabetes, obesity, and metabolic syndrome contribute to cognitive decline and neurodegeneration. Mechanistically, the constituents of areca nut/betel quid are metabolized to N-nitroso compounds, i.e., nitrosamines, which are carcinogenic at high doses and cause insulin resistance following chronic low-level exposures. From an epidemiological perspective, the rising tide of insulin resistance diseases including obesity, diabetes, and dementias that now disproportionately burden poor countries has been propagated by rapid commercialization and enhanced access to betel quid. Public health measures are needed to impose socially and ethically responsible barriers to yet another cause of global health disparity.

Oral microbiota alteration associated with oral cancer and areca chewing

Oral cancer is among most common neoplasm of oral cavity; in many cases, it develops at the site of premalignant lesion. Areca nut has been identified as a carcinogen, which was proved to promote the inflammation level and contributes to oral malignancy. Chewing areca nut is the main cause of the premalignant disease oral submucous fibrosis (OSF). Bacterial alterations were suggested to be assonated with oral cancer progression. Therefore, the present study was carried out to determine the changes of microbiota in the mucosa along stage of development of oral cancer with areca nut chewing. 162 participants, reporting to department of oral medical center, were enrolled into the study which includes 45 patients each of OSF, 42 of oral cancer, 29 healthy controls (HC) with areca nut chewing, and 46 healthy controls (HC) never chewing areca nut. Oral swabbing of tongue dorsum, buccal mucosa, and gingiva was evaluated by MiSeq platform of the V3-V4 region of the 16S rRNA gene. These data revealed microbial changes that may mirror oral cancer progression and reflect clinical preconditions such as areca nut chewing. Consequently, revealing microbial changes in patients with oral squamous cell carcinomas and the premalignant disease oral submucous fibrosis (OSF) with areca nut chewing might improve our understanding of the pathobiology of the disease and help in the design of novel diagnostic and treatment strategies.

Evaluation of the Efficacy of Loricrin as a Diagnostic Marker in Patients with Oral Submucous Fibrosis

INTRODUCTION

Loricrin is usually observed in abundance in keratinizing epithelium in response to mechanical stress, which may be associated with development and malignant transformations in conditions such as oral submucous fibrosis (OSMF). Therefore, understanding of various molecular mechanisms associated with difference in gene expressions between OSMF and that of normal oral tissue is important.

AIM

The aim of this study was to evaluate of the efficacy of loricrin as a diagnostic marker in patients with OSMF.

MATERIALS AND METHODS

Fifty formalin-fixed paraffin-embedded tissue blocks were obtained from the archives of the department. The study sample was grouped into two groups of normal mucosa (group I; n = 20) and OSMF (group II; n = 30) specimens. The study tissues were immunohistochemically stained with loricrin antibody and were further graded on basis of staining intensity.

RESULTS

Loricrin immunostaining was observed significantly more in OSMF cases and even in stratum granulosum in comparison to normal mucosa.

CONCLUSION

Loricrin can act as an early indicator and a prognostic marker for detection of deleterious changes within epithelium in OSMF.

Estimation of Salivary 8-Hydroxydeoxyguanosine (8-OHdG) as a Potential Biomarker in Assessing Progression towards Malignancy: A Case-Control Study

Objective:

Squamous Cell Carcinoma is almost always preceded by potentially malignant disorders in the oral cavity before malignant transformation. Characterization of 8-OHdG from the saliva offers a relatively non-invasive, simple and efficient methodology for monitoring oxidative stress in subjects of Premalignant oral disorders (PMOD) and Oral Squamous Cell Carcinoma (OSCC). Hence the aim of the current study is to estimate the levels of salivary 8-hydroxydeoxyguanosine (8-OHdG) as a potential DNA Damage Biomarker in OSMF and OSCC patients in comparison to healthy individuals to assess disease progression from potentially malignant oral disorder to frank malignancy.

Materials and Methods:

The study was conducted among 90 patients [Oral Squamous cell carcinoma (n=30) and Oral Submucous Fibrosis (n=30) and healthy gender and age matched controls (n=30)]. 4ml of unstimulated saliva was collected from each of the subjects and was subjected to Sandwich ELISA for the quantification of salivary 8-OHdG. Statistical analysis was done using ANOVA, and p value was set at ≤0.05.

Results:

The mean age of OSCC patients were 56.8±11.8 years. Smoking was the most prevalent adverse habit among this group (66.6%) followed by Smokeless tobacco chewers (40%). The mean age of OSMF patients was 46.2± 9.8 years. Smokeless tobacco was the most predominant habit among the OSMF patients (83.33%) followed by smoking (33.33%). The mean OHdG levels among the controls was 6.59±1.47 (ng/dl) and almost doubled in patients of OSMF 13.89±1.96(ng/dL) and further raised in OSCC patients 19.96 ± 2.11 (ng/dL). These levels showed a highly significant difference (p <0.0001) in mean on comparison by using one-way ANOVA. Pearson correlation between the groups were also statistically significant (p=0.000).

Conclusion:

There were significant differences in the concentration of salivary 8-OHdG between healthy controls, OSMF, and OSCC patients. Hence, 8-OHdG can be used as a novel biomarker of DNA damage to assess disease progression.

Areca catechu-From farm to food and biomedical applications

The family Arecaceae includes 181 genera and 2,600 species with a high diversity in physical characteristics. Areca plants, commonly palms, which are able to grow in nearly every type of habitat, prefer tropical and subtropical climates. The most studied species Areca catechu L. contains phytochemicals as phenolics and alkaloids with biological properties. The phenolics are mainly distributed in roots followed by fresh unripe fruits, leaves, spikes, and veins, while the contents of alkaloids are in the order of roots, fresh unripe fruits, spikes, leaves, and veins. This species has been reputed to provide health effects on the cardiovascular, respiratory, nervous, metabolic, gastrointestinal, and reproductive systems. However, in many developing countries, quid from this species has been associated with side effects, which include the destruction of the teeth, impairment of oral hygiene, bronchial asthma, or oral cancer. Despite these side effects, which are also mentioned in this work, the present review collects the main results of biological properties of the phytochemicals in A. catechu. This study emphasizes the in vitro and in vivo antioxidant, antimicrobial, anticancer, and clinical effectiveness in humans. In this sense, A. catechu have demonstrated effectiveness in several reports through in vitro and in vivo experiments on disorders such as antimicrobial, antioxidant, or anticancer. Moreover, our findings demonstrate that this species presents clinical effectiveness on neurological disorders. Hence, A. catechu extracts could be used as a bioactive ingredient for functional food, nutraceuticals, or cosmeceuticals. However, further studies, especially extensive and comprehensive clinical trials, are recommended for the use of Areca in the treatment of diseases.

Temporomandibular joint osteoarthritis at Chelechol ra Orrak, Palau

OBJECTIVE

To explore the frequency and severity of temporomandibular joint osteoarthritis (TMJ-OA) and its causative factors in a skeletal assemblage from the prehistoric site of Chelechol ra Orrak, Palau, western Micronesia.

MATERIALS

50 temporomandibular joint surfaces (mandibular condyles and articular eminences), representing a minimum of 22 adult individuals, 17 of which retain teeth.

METHODS

Joint surfaces were macroscopically evaluated for characteristics associated with TMJ-OA and joint morphology. Dental remains were scored for tooth wear and staining.

RESULTS

Nine individuals (40.1 %) displayed lesions typical of TMJ-OA. The strongest associations were between tooth wear and TMJ-OA.

CONCLUSIONS

Indirect effects of parafunctional dental activity appear to be a factor in TMJ-OA frequency at Chelechol ra Orrak. While betel nut chewing may be one of those activities, it does not appear to be solely driving the presence of TMJ-OA.

SIGNIFICANCE

This study highlights the association between a specific parafunctional use of the temporomandibular joint and the potential pathological consequences. It also reinforces the need to carefully evaluate the archaeological context of skeletal remains in order to evaluate specific etiological factors in the presence of TMJ-OA in present and past populations.

LIMITATIONS

Sample sizes are limited in this study. This will increase as excavations continue.

SUGGESTIONS FOR FURTHER RESEARCH

Because dental occlusion appears to be associated with TMJ-OA, focus on dental conditions affecting occlusal patterns, such as third molar agenesis, antemortem tooth loss, and malocclusion, and their relationship to TMJ-OA frequency, are recommended.

Progress in Drug and Formulation Development for the Chemoprevention of Oral Squamous Cell Carcinoma: A Review

BACKGROUND

Cancer is a life-threatening global problem with high incidence rates. Prioritizing the prevention of cancer, chemopreventive agents have drawn much attention from the researchers.

OBJECTIVE

This review focuses on the discussion of the progress in the development of chemopreventive agents and formulations related to the prevention of oral cancer.

METHODS

In this perspective, an extensive literature survey was carried out to understand the mechanism, control and chemoprevention of oral cancer. Different patented agents and formulations have also exhibited cancer preventive efficacy in experimental studies. This review summarizes the etiology of oral cancer and developments in prevention strategies.

RESULTS

The growth of oral cancer is a multistep activity necessitating the accumulation of genetic as well as epigenetic alterations in key regulatory genes. Many risk factors are associated with oral cancer. Genomic technique for sequencing all tumor specimens has been made available to help detect mutations. The recent development of molecular pathway and genetic tools has made the process of diagnosis easier, better forecast and efficient therapeutic management. Different chemical agents have been studied for their efficacy to prevent oral cancer and some of them have shown promising results.

CONCLUSION

Use of chemopreventive agents, either synthetic or natural origin, to prevent carcinogenesis is a worthy concept in the management of cancers. Preventive measures are helpful in controlling the occurrence or severity of the disease. The demonstrated results of preventive agents have opened an arena for the development of promising chemopreventive agents in the management of oral squamous cell carcinoma.

Chemical Markers for Short- and Long-Term Areca Nut Exposure

Background: Areca nut (AN) chewing causes oral cancer. AN cessation programs are the most effective approach to reduce AN chewing induced cancers but require biomarkers to determine program compliance and success. Objectives: To explore chemical markers for short- and long-term AN exposure using non-invasively collected saliva, buccal cells (BCs), and scalp hair of chewers. Methods: Saliva was collected from a male chewer before and up to 2 days after AN chewing. Saliva was separated into supernatant and pellet (BCs) then analyzed by spectrophotometry and liquid chromatography (LC) with UV/VIS detection. Scalp hair was collected from four chewers and analyzed for areca alkaloids using direct analysis in real time-tandem mass spectrometry (DART-MSMS). Results: The red pigmented saliva after chewing showed no valuable signals when either the saliva supernatant or pellet (BCs) were analyzed by spectrophotometry. Saliva analysis by LC-UV/VIS showed diagnostically valuable signals at 488 nm up to 5 and 24 h post chewing in the supernatant and pellet, respectively. DART-MSMS analysis detected two of the four AN specific alkaloids (arecoline and arecaidine) in male but none in female hair. Conclusions/Importance: LC-UV/VIS analysis of the red pigments extracted from saliva and BCs after AN chewing showed distinct signals up to 24 h post chewing while DART-MSMS analysis in BCs and scalp hair showed selective signals of AN alkaloids for several weeks or months after AN exposure. Chemical hair treatment might prevent detection of areca alkaloids in hair. AN cessation trials and other programs now have essential tools for bioverification.

Barriers to Quitting Areca Nut Consumption and Joining a Cessation Program as Perceived by Chewer and Nonchewer Populations in Guam

Background: Areca nut (AN) is a carcinogenic substance consumed by roughly 600 million individuals worldwide with increasing popularity in Guam. In response, a cessation program was developed and implemented in Guam and Saipan. However, to improve its delivery, it is necessary to understand the reasons influencing recruitment and participation, such as why a chewer may not want to quit or join a cessation program. Objective: To explore barriers inhibiting chewers from quitting AN chewing and from participating in a cessation program. Methods: Nine individual and group discussions were facilitated with a convenience sample of 17 chewers and nonchewers in Guam in 2017. The mean age of the participants was 36.4 years. Recurring themes relating to reasons for not quitting and not joining a cessation program were extracted. Results: Results produced three general categories-Sociocultural, Behavioral, and Accessible. Each category encompasses different attributes concerning reasons not to quit chewing (e.g. addiction, enabling community, or belief that AN is harmless), and reasons influencing lack of participation in a cessation program (e.g. time, transportation, or relatability). Conclusions: Current findings suggest chewers are unaware of the harmful effects of AN. Also, they may not comprehend the purpose of a cessation program. In addition, the likelihood of chewers participating in a cessation program is influenced by their level of comfort with the program and personnel, and whether a program addresses their time and transportation limitations.

Prevalence and Correlates of Betel Quid Chewing among Bhutanese Adults

Background: Chewing of betel quid, popularly known as doma khamdo, is prevalent in Bhutan and is associated with Bhutanese customs and traditions. The objective of this paper was to determine the prevalence and explore the correlates of current betel quid use in Bhutan. Materials and methods: This is a retrospective study of secondary data from the National Health Survey 2012 (NHS 2012) of Bhutan. The outcome variable of interest was current betel quid use. The self-reported demographic characteristics were obtained using a questionnaire developed following the WHO STEPwise approach to the surveillance of non-communicable diseases (STEP). Univariate and multivariate logistic regression were performed to identify correlates for betel quid use. Results: The prevalence of current betel quid use in this study was 45.0%. The correlates associated with current betel quid use were: being female; having a primary, high school or a monastic education; being professionals in the armed forces, managers, technicians, service and sales workers, and machine operators; being current smokers; alcohol consumption; and intake of drugs. Correlates associated with decreased betel quid use were: having a diploma/certificate-level and non-formal education, and living in urban areas. Conclusion: The findings indicate that betel quid was consumed by nearly half of the Bhutanese population. Bhutan should immediately initiate national prevention programs targeting these correlates of betel quid use.

Lichen planus: Oral manifestations, differential diagnosis and treatment

Introduction: Some of the typical skin diseases, such as Pemphigus vulgaris, Pemphigoid mucosae oris, Erythema exudativum multiforme, Sclerodremia, Dermatitis herpetiformis-Duhring and Lichen planus, can cause swelling and irritation in mucous membranes of the oral cavity. Aim: The aim of the study was to precise diagnosis and treatment of oral Lichen planus manifestations. Methods: Analyzing the literature data and the experience of clinicians, the most common oral lichen planus manifestations were investigated. Results: This disease most commonly occurs in middle-aged patients (30-60 years) and is more common in women than in men. Oral Lichen planus is rarely seen in children. The disease presents in 0.5% to 2% of the population. Clinical history established the relation between oral Lichen planus and oral carcinoma, and therefore this disease should be considered a precancerous lesion. Conclusion: Dermatoses in the mouth are localized most often in the oral mucosa, both at the height of the occlusal line and in the mucous membrane of the retromolar area, but they can also occur in the mucous membranes of the tongue, the floor of the mouth and lips.

Betel Nut (areca) and Smokeless Tobacco Use in Myanmar

Background: Betel nut (areca) is the world's fourth most commonly used addictive substance. Arecoline, a muscarinic agonist in areca, is also a partial agonist for the addiction-related high-affinity brain nicotine receptors. In many countries, smokeless tobacco is commonly mixed with areca. Objective: We sought to evaluate the knowledge of self-harm, and addiction associated betel quid use in an unban population. Methods: We conducted a survey study of 200 betel quid users in Yangon, Myanmar, and a survey of betel quid vendors to determine the relative amounts of areca and tobacco in the available quids. Results: The data determined that a large majority of the survey subjects (84%) used tobacco with their areca. Users had a general awareness that betel chewing was "a bad habit" (85%) and 80% were aware of the cancer risks. Understanding areca addiction remains a challenge since, aside from the strong muscarinic activity of arecoline stimulating salivation, overt neurologic effects are difficult for even the users to identify. Fifty eight percent of the respondents indicated that chewing betel quid had effects like drinking coffee, and 55.5% indicated that it had effects like drinking alcohol. Data obtained from the quid vendors indicated that 75% added tobacco in equal amounts to areca. Conclusion: The concomitant use of nicotine and areca indicates that betel quid addiction includes a significant component of nicotine dependence. However, the additional activities of areca, including the muscarinic effects of arecoline, indicate that potential cessation therapies should optimally address other factors as well.

Study on prevalence and sociocultural aspects of tobacco use in India

Aim:

The present study focuses on the prevalence of tobacco use and aims to determine various sociocultural aspects of tobacco use in Indian population.

Materials and Methods:

The study sample comprised 384 participants. There were three study groups, and in each study group, there were 128 participants. Group A was tobacco users without oral precancer, Group B was tobacco users with oral precancer, and Group C was healthy individuals with no history of tobacco or areca nut use and oral precancer. Both male and female adults in the age group of 18 years and above visiting the Outpatient Department of Oral and Maxillofacial Surgery at King George's Medical University were recruited for the study. The study participants were explained in detail about the study, and informed consent was obtained through them. Data have been collected using a standard structured predesigned questionnaire. The questionnaire consisted of the details of the demographic profile of the study participants, details of tobacco use, and the major social and cultural reasons which motivated them to consume tobacco. Data were extracted from the case sheet, and the data were entered into a worksheet for the purpose of analysis. The analysis was performed using the commercially available Statistical Package SPSS.

Conclusion:

The rate of tobacco prevalence is very high among the Indian population, and a number of social and cultural factors are responsible for its use. To curb this problem, more studies could be done to find the causes responsible for its use.

Betel quid chewing and cessation in the sociocultural context of Paiwan people from Taiwan: a qualitative study

Although recent medical studies have found a significant correlation between betel quid chewing and oral cancer, some Taiwanese aboriginal people continue the traditional betel quid culture. Using the transtheoretical model framework, we conducted a qualitative study to examine the stages of behavioral change in betel quid chewing in the Paiwan sociocultural context. We conducted in-depth interviews with 20 aboriginal chewers of betel quid. Results of a content analysis showed significant patterns in the precontemplation, contemplation, action, and maintenance stages, but none in the preparation stage. Relapse was most likely to occur between the contemplation and action stages. In the precontemplation stage, interviewees showed no motivation to change their chewing behavior due to shared positive attitudes of psychosocial benefits and cultural identity. In the contemplation stage, dependent-type chewers were aware of oral damage and pain caused by chewing betel quid but could not resist their cravings; social-type chewers showed approach-avoidance conflicts between social needs and cessation. Chewers entered the action stage once they decided to quit; "to stop immediately" or "reduce quantity" were the most frequent strategies reported. In this stage, chewers endured withdrawal symptoms and refused betel quid from others but tended to relapse easily. Participants entering the maintenance stage were not affected by withdrawal symptoms and did not have ulcers or pain. Future research should identify ways to preserve traditional aboriginal culture while encouraging aboriginal people to quit betel quid chewing to promote the prevention and treatment of oral cancer.

Oral health-related quality of life among 11-12 year old indigenous children in Malaysia

BACKGROUND

Poor oral health among Malaysian indigenous Orang Asli (OA) children may impact on their daily performances.

AIM

To assess the oral health status, related behaviours, and oral health-related quality of life (OHRQoL) among OA children in Cameron Highlands (CH), Malaysia, and to identify the predictor(s) for poor OHRQoL.

DESIGN

This was a cross-sectional study involving 249, 11-12 year old OA children from 4 OA primary schools in CH. The children completed a self-administered questionnaire comprising information on socio-demographics, oral health-related behaviours, and the Malay Child Oral Impacts on Daily Performances (Malay Child-OIDP) index followed by an oral examination. Data were entered into the SPSS version 23.0 software. Non-parametric tests and multiple logistic regression were used for data analysis.

RESULTS

The response rate was 91.2% (n = 227/249). The prevalence of caries was 61.6% (mean DMFT = 1.36, mean dft = 1.01) and for gingivitis was 96.0%. Despite the majority reported brushing their teeth ≥ 2x/day (83.7%) with fluoride toothpaste (80.2%), more than two-thirds chewed betel nut ≥ 1/day (67.4%). Majority of the children (97.8%) had a dental check-up once a year. Nearly three-fifths (58.6%) reported experiencing oral impacts on their daily performances in the past 3 months (mean score = 5.45, SD = 8.5). Most of the impacts were of "very little" to "moderate" levels of impact intensity with 90.2% had up to 4 daily performances affected. Most of the impacts were on eating (35.2%), cleaning teeth (22.0%) and relaxing activities (15.9%). Caries in primary teeth is associated with oral impacts among the OA children.

CONCLUSIONS

The 11-12 year old OA children in Cameron Highland had high prevalence of caries and gingivitis with the majority chewed betel nut regularly. Caries in primary teeth is associated with poor OHRQoL. Future programmes should target younger age group children to promote positive oral hygiene practices, reduce caries, and improve quality of life.

Efficacy of Salvia miltiorrhiza injection combined with steroids in the treatment of oral submucous fibrosis: A meta-analysis of randomized controlled trials

BACKGROUND

This study was performed to systematically review the efficacy of Salvia miltiorrhiza injection combined with steroids in the treatment of oral submucous fibrosis.

METHODS

We searched 9 databases: Web of Science, PubMed, Medline, EBSCO, Embase, The Cochrane Library, WanFang Data, the China National Knowledge Infrastructure (CNKI), and Chinese Scientific Journals Full-text Database (VIP). Randomized controlled trials were collected to study the treatment of oral submucous fibrosis by S miltiorrhiza injection combined with steroids. Each database was searched from inception to November 2018. RevMan 5.3 software was used for the meta-analysis.

RESULTS

In total, 13 randomized controlled trials involving 1190 patients were included. The results of the meta-analysis showed that compared with conventional treatment, S miltiorrhiza injection combined with steroids could significantly increase the maximal mouth opening [mean difference (MD), 0.23; 95% confidence interval (CI), 0.16-0.30; P <.0001], decrease the oral mucosal lesion area (MD, -1.35; 95% CI, -2.46 to -0.25; P = .02), improve the subjective symptom burning sensation (MD, -0.77; 95% CI, -1.38 to -0.16; P = .01), and reduce adverse drug reactions (risk ratio, 0.27; 95% CI, 0.14-0.49; P <.0001).

CONCLUSIONS

The results of this meta-analysis from current evidence showed that compared with conventional treatment, S miltiorrhiza injection combined with steroid could significantly improve the maximal mouth opening and the subjective symptom burning sensation as well as decrease the oral mucosal lesion area without increasing adverse effects.

Loricrin expression and its implication in oral submucous fibrosis, hyperkeratosis and normal mucosa with association to habits - An immunohistochemical study

Objective

The coarse fibres of areca nut and the continuous friction from occluding teeth are major causes of mechanical stress to the oral mucosa in conditions like oral submucous fibrosis and frictional keratosis. The continuous micro trauma provided in areca nut chewers, creates an environment where the keratinocytes exhibit alteration. Loricrin, is expressed abundantly in keratinizing epithelium in response to mechanical stress. Their expression or absence could play a role in malignant transformation. This study attempts to assess the potential of Loricrin as an early diagnostic marker in patients with chewing habit.

Methods

73 archival samples of formalin fixed, paraffin embedded tissue specimens histopathologically confirmed, were segregated as normal mucosa 11, hyperkeratotic 32 and oral submucous fibrosis 30 and stained with antibodies to Loricrin and graded as negative, mild, moderate and intense based on the staining intensity. Pearson's chi square test was done for statistical analysis.

Results

Loricrin expression was observed in all groups with staining in the stratum granulosum showing a significant association to habits (P = 0.000).

Conclusion

This prominent staining indicates a compensatory cytoskeletal rearrangement of surface epithelium during cell division in early oral submucous fibrosis showing potential as an early marker of the condition.

Adolescent betel nut use in Guam: beliefs, attitudes and social norms

Betel (areca) nut is an addictive substance chewed with or without tobacco widely in Asia and the Pacific, including the U.S.-affiliated Pacific Islands (USPI). Betel nut use has been found to cause oral cancer. Research suggests that most betel nut use initiation occurs in adolescence. However, very little is currently known about the etiology of adolescent betel nut use. The present study reports findings of a formative, qualitative research conducted to understand the attitudinal and social factors associated with adolescent betel nut use in USAPI. The objective was to develop a theoretical framework of adolescent betel nut etiology that would guide the development of a prevention program. Semi-structured interviews were conducted with 20 adolescent betel nut users (M age = 14.5; SD = 2.2) from Guam. Findings suggested a framework of adolescent betel nut etiology in which intrapersonal, social, and environmental factors influence betel nut use behavior. The framework is consistent with ecological frameworks of adolescent substance use in which proximal personal and social influences on adolescent substance use occur within the context of a wider socio-cultural context conducive to adolescent substance use. Specifically, we found that beliefs such as betel nut tastes good and induces relaxation represent some of the betel nut use motives; parental permissiveness and peer and sibling use encourage betel nut use; and cultural acceptance and easy accessibility to betel nuts provide an environmental context conducive to betel nut use. Findings are discussed in the context of developing an adolescent betel nut use prevention program.

Awareness about effects of tobacco and areca-nut use in school children of Ahmedabad, India: A cross-sectional questionnaire-based survey

INTRODUCTION

Tobacco use usually starts in the adolescent age group and continues in adulthood. This study’s aim was to identify knowledge regarding the adverse effects of tobacco and areca-nut use among high school children of Ahmedabad, India.

METHODS

An anonymous self-administered close-ended questionnaire was designed for the study. Principals of 9 schools, 3 municipal and 6 government-aided, were approached and written informed consent was obtained. A total of 3055 students studying in grades 7–12 were included. Data were analyzed using Microsoft Excel and SPSS 16.0. Chi-squared test was applied to investigate any differences between the responses of consumers and non-consumers, while Cramer’s V was applied to analyze the strength of association between the awareness of ill-effects and tobacco product consumption.

RESULTS

Of the 3055 children, 3% felt that tobacco use was definitely not harmful to health while 84% felt that it was. In all, 65% of respondents were aware that tobacco use caused cancer, 7% answered that it caused breathing problems, 5% said it caused heart problems, 0.3% answered that it caused paralysis, 4.3% felt it caused no health problems, whereas 18% thought that it caused multiple issues. With regards to the role of media, 78% had seen many anti-smoking warnings in the media, 15% had seen a few, 5% had seen none. There was a statistically significant difference between the tobacco users and and non-users with regards to exposure to media (p<0.001), discussions in class (p<0.001) and general awareness (p<0.001), but a weak association between awareness and tobacco consumption was identified (p<0.05).

CONCLUSIONS

Awareness about the harmful effects of tobacco is high among school children of Ahmedabad, though use may still be prevalent.

Effect of geraniol against arecoline induced toxicity in the third instar larvae of transgenic Drosophila melanogaster (hsp70-lacZ) Bg9

In the present study geraniol at the final concentration of 10, 20, 30, and 40 µM was mixed in the diet along with 80 µM of arecoline and the third instar larvae of transgenic Drosophila melanogaster (hsp70-lacZ) Bg⁹ were allowed to feed on it for 24 hrs. After the exposure of 24 hrs the larvae were subjected to ONPG, X-gal, trypan blue exclusion test, oxidative stress markers and apoptotic and comet assays. The exposure of larvae to geraniol showed a dose dependent decrease in the activity of β-galactosidase, tissue damage and oxidative stress markers. A dose dependent decrease in apoptosis and DNA damage was also observed. Molecular docking studies also support the protective role of geraniol against the arecoline induced toxicity. The results suggest that geraniol is potent in reducing the toxicity induced by arecoline in the third instar larvae of transgenic Drosophila melanogaster (hsp70-lacZ) Bg⁹.

A qualitative study of attitudes to and perceptions of betel quid consumption and its oral health implications in Taiwan

OBJECTIVES

Betel quid (BQ) chewing is extremely prominent in South and Southeast Asia because it considered by users to be of social, cultural and religious importance. BQ chewing has been recognized as a risk factor for oral premalignant lesions and oral cancer. Because BQ chewing has become a severe health risk in Taiwan, the development of prevention and cessation programmes is essential. The purpose of this study was to explore the attitudes and perceptions associated with BQ consumption and its oral health implications in an attempt to inform the development of health promotion initiatives and BQ cessation efforts in Taiwan, where the dental profession could have a pivotal role in preventing and controlling BQ use among persons at risk.

METHODS

This qualitative study used data gathered from focus groups and individual interviews. A convenience sample of 41 adults from Jhushan and Lugu Townships (Nantou County) and Taichung City, Taiwan, participated in this study (27 men, 14 women; 31 Han, 10 aboriginals from the Paiwan tribe; mean age 40.3, SD 9.2 years).

RESULTS

Among the seven themes that emerged from the original study, five (Initiation, Health Risk Perception, Health Consequences, Withdrawal Symptoms and Help from Healthcare Providers) had oral/dental implications.

CONCLUSIONS

Our study highlights research areas relevant to further investigation, such as incorporating brief BQ prevention and cessation counselling when early oral and dental signs associated with BQ consumption are detected. Undertaking behavioural interventions in dental settings might help to reduce the prevalence of BQ chewing in Taiwan.

Use of natural products for oral hygiene maintenance: revisiting traditional medicine

The use of traditional means of oral hygiene maintenance has a long-recorded history, with widespread usage in rural areas of Africa, South America and the Indian subcontinent till date. Though dental healthcare professionals and the general population, especially in the urban areas can have the temptation of out-rightly rejecting them as ineffective, the usage of these natural products is based on time-tested scientific principles.

The present article provides an overview of the major traditional practices of oral hygiene maintenance and how they compare against the modern-day armamentarium of oral hygiene maintenance.

Qualitative study for betel quid cessation among oral cancer patients

The psychoactive effects of using areca nut and its potential for dependence have been observed. However, the factors that create barriers to or promote chewing cessation are not well understood. This study aims to explore the behavioral changes of betel quid chewers who have been diagnosed with oral cancer within a transtheoretical model framework. Thirty oral cancer patients with betel quid chewing history were chosen for in-depth interviews. Qualitative content analysis was used to analyze the data and identify themes that described the behavioral changes of betel quid cessation. Our research showed that betel quid chewers with oral cancer typically experience four significant stages of behavior: pre-contemplation, contemplation, action, and maintenance. Each stage change was marked by specific characteristics. At first, chewers showed positive attitudes toward the psychoactive or social effects of betel quid. They then realized the negative effects of betel quid, such as dental or other physical problems. Some also realized that they were addicted to betel quid. When they decided to quit, most chewers reported going “cold turkey.” Some chewers successfully quit betel quid and attributed it to willpower. Those quitting because of the loss of oral functions were unable to chew anymore, though some chewers had experienced a relapse. In the maintenance stage, ex-chewers reported overcoming their addiction; however, relapse was possible. In this study, those who quit betel quid because of oral cancer usually quit tobacco and alcohol as well, with a lesser chance of recurrence. As the maintenance of chewing betel quid is multifactorial, this study provides information for betel quid cessation and oral cancer prevention.

Analysis of oral microorganism diversity in healthy individuals before and after chewing areca nuts using PCR-denatured gradient gel electrophoresis

To analyze oral microbial diversity in the saliva of 8 healthy individuals before and after chewing areca nuts. Saliva samples were collected before chewing areca nuts, after chewing areca nuts for 5 min and after chewing areca nuts for 30 min. DNA was extracted, and microbial diversity was examined using PCR-denaturing gradient gel electrophoresis (PCR-DGGE). When examining DGGE profiles collectively, the bands associated with Streptococcus and Veillonella were the most intense, making them the most prevalent bacteria. Furthermore, the band intensities did not decrease after chewing areca nuts for 5 or 30 min; thus, these bacteria were unaffected. However, when examining some individuals, the band intensities for Streptococcus and Veillonella became more intense after 5 min of chewing and then returned to the pre-chewing level. This difference may be attributed to the mechanical movements of the oral cavity or individual differences. Other bacteria, such as Neisseria, Actinomycetes, and Rothia dentocariosa, were also found to have an increased or decreased prevalence following areca nut-chewing. Since the predominant species that are present following areca nut-chewing include Streptococcus and Veillonella, it would seem likely that these bacteria play an important role in the periodontal diseases associated with areca chewing.