Panmasala chewing induces deterioration in oral health and its implications in carcinogenesis

Pan masala habits and risk of oral precancer: A cross-sectional survey in 0.45 million people of North India

OBJECTIVES

This cross-sectional community based study was conducted to estimate the prevalence of consumption habits for non tobacco pan masala (ASU) and the risk of developing oral precancer in North India.

METHODS

This study was conducted in the old town of Lucknow city in the state of Uttar Pradesh in India. Subjects residing for more than 6 months and aged 15 years or above, were enrolled in the study after their informed consent. A two page survey tool was used to collect the data. A three times more matched sample of non users was randomly obtained from this data to analyze and compare the final results.

RESULTS

0.45 million subjects were surveyed. Majority of tobacco users were in the age group of 20-35 years among males and 35-39 years among females. Consumption of non tobacco pan masala among males as well as females was most common in 15-19 years of age group. Prevalence of oral precancer (leukoplakia, submucous fibrosis, erythroplakia, lichen planus, smokers palate and verrucous hyperplasia) was 3.17% in non tobacco pan masala users and 12.22% in tobacco users. The odds of developing oral precancer in non tobacco pan masala users was 20.71 (18.79-22.82) and in tobacco users was 88.07 (84.02-92.31) at 95% confidence interval against non users of both.

CONCLUSION

The odds of developing oral precancer even with consumption of pan masala is high, even when it is consumed without tobacco. It is hence recommended to discourage this habit.

Developmental patterning and segregation of alkaloids in areca nut (seed of Areca catechu) revealed by magnetic resonance and mass spectrometry imaging

Areca nut (seed of Areca catechu) is consumed by people from different parts of Asia, including India. The four major alkaloids present in areca nut are arecoline, arecaidine, guvacoline and guvacine. Upon cutting, the nut reveals two kinds of regions; white and brown. In our present study, we have monitored the formation of these two regions within the nut during maturation, using the non-invasive techniques of magnetic resonance imaging (MRI) and volume localized magnetic resonance spectroscopy (MRS). Electrospray ionization mass spectrometry (ESI MS) and desorption electrospray ionization mass spectrometry (DESI MS) imaging have been used to study the associated change in the alkaloid contents of these two regions during the growth of the nut. Our study reveals that white and brown regions start forming within the nut when the liquid within starts solidifying. At the final stage of maturity, arecoline, arecaidine and guvacoline get segregated in the brown region whereas guvacine gets to the white region of the nut. The transport of molecules with maturity and corresponding pattern formation are expected to be associated with a multitude of physiochemical changes.

Comparative distribution of Lysyl Oxidase (G473A) and NQO1 (C609T) polymorphism among tea-garden workers (habitual chewers of betel quid) of Darjeeling district and Kolkata city of West Bengal

Context:

Chewing of processed arecanut products with tobacco and betel quid has been attributed to many oral pathological conditions. These products are very popular among the youngsters of lower economic groups. Genetic predisposition has been now identified as a major risk factor for increasing the susceptibility toward the disease among these chewers.

Aims:

Our study mainly aims to find out the predisposition of LOX (G473A) and NQO1 (C609T) polymorphisms and present a comparison between the population (habitually exposed to processed arecanut and smokeless tobacco products) of a metro-city Kolkata and the tea-garden workers of Darjeeling district of West Bengal.

Settings and Design:

Subjects for the study was recruited from various oral health check-up camps organized in the tea-gardens of Darjeeling district and Kolkata city.

Materials and Methods:

Genotyping analysis was done through a Polymerase Chain Reaction–Restriction Fragment Length Polymorphism (PCR-RFLP)-based approach.

Statistical Analysis Used:

A two-way contingency table analysis software (JAVASTAT: http://statpages.org/ctab2 × 2.html) using 95% confidence interval was used to study the distribution of genotypes among the populations. A P < 0.05 was considered to be significant.

Results:

The results indicates both the heterozygous and homozygous carriers of NQO1 C > T (609) was found to be significantly higher among the north Bengal tea-garden workers [OR 0.480 (0.280-0.82) P = 0.01; 0.218 (0.091–0.524) P = 0.0001], respectively. Interestingly CT (21% in both) and TT (8% and 7%, respectively) were found to be equally distributed in the two populations. For LOX G > A (473) a significantly higher number of Kolkata individuals were found to carry the heterozygous GA allele in individuals aged <30 years [OR 3.779 (1.684-6.547) P = 0.001]. However, none were carrier of heterozygous GA allele of Kolkata population as compared with 29% north Bengal tea-garden workers aged above 31 years.

Conclusions:

A close observation of occurrence of oral diseases over time among such a population will be helpful to identify risk genotypes responsible for betel quid-induced oral diseases.

Protective effect of Eleteria cardamomum (L.) Maton against Pan masala induced damage in lung of male Swiss mice

OBJECTIVE

To study the potential ameliorating properties of cardamom Elettaria cardamomum (E. cardamomum) L. Maton against pan masala induced damage in lung of male Swiss mice.

METHODS

The experimental animals were divided into 3 groups (control, pan masala treated group and pan masala with cardamom treated group) to evaluate pan masala toxicity. The observations were substantiated with profound changes in the lung tissue as revealed in the histologic and transmission electron microscopic examinations.

RESULTS

Lung of pan masala treated group showed adenocarcinoma, edema, and inflammation with increased activity of acid phosphatase, alkaline phosphatase, and lactate dehydrogenase. The deleterious effects were seen to be less in cardamom treated group and the enzymatic activity also decreased significantly (P<0.05) in the ameliorating group.

CONCLUSIONS

Thus, the present experiment exciting results are observed when cardamom is supplemented with pan masala, or when given alone.

Tobacco and areca nut chewing--reproductive impairments: an overview

A large number of people are using smokeless tobacco and areca nut worldwide. Sufficient data on tobacco smoking have harmful effect on human health and reproduction is available. However, data on the smokeless tobacco and areca nut use on human reproduction is scanty. This overview is an attempt to compose on the consumption of smokeless tobacco and areca nut on human reproduction and some relevant experimental data were also included. The existing studies suggest that tobacco and areca nut chewing alone, together or with other ingredients had reproductive toxic potential. Pregnant women using smokeless tobacco during pregnancy also had adverse effect on pregnancy and its outcome. Thus pregnant women must avoid consumption of any mixture containing areca nut and tobacco in order to protect the pregnancy and outcome. The data suggest that smokeless tobacco use is also harmful as smoking for reproduction and use of areca nut might have further compounded the problem.

Micronucleus investigation in human buccal epithelial cells of gutkha users

BACKGROUND

Gutkha is a cheap and convenient betel quid substitute, which is popular among all age groups. Various studies reveal its carcinogenic nature that leads to oral submucosus fibrosis and increases the chances of oral cancer. The micronucleus (MN) assay in exfoliated mucosal cells is a useful method for observing genetic damage in humans.

AIM

To observe the genotoxic effect of gutkha on human buccal epithelial cells.

MATERIALS AND METHODS

The MN assay was performed to assess the frequency of MN in human buccal epithelial cells. The study comprises 60 individuals of which 30 individuals were gutkha chewers and another 30 were nonusers (control). The MN frequency was scored to estimate the genotoxic damage.

RESULTS

In gutkha users, the frequency of MN was highly significant (17.4 ± 0.944) as compared with nonusers (control) groups (4.53 ± 0.331) (P < 0.001).

CONCLUSIONS

The MN assay in human buccal epithelial cells is a useful and minimally invasive method for monitoring genetic damage in humans. Asignificantly higher frequency of micronucleated cells are found among gutkha users.

Effect of α-tocopherol on salivary reactive oxygen species and trace elements in oral submucous fibrosis

BACKGROUND

Oral submucous fibrosis (OSMF) is a chronic debilitating disease and a well-recognized, potentially malignant condition of the oral cavity associated with betel quid chewing. Betel quid chewing is a popular oral habit in India and shows strong association in the incidence of OSMF. The objective of the study was to determine the levels of trace elements, pro-oxidants and reactive oxygen species (ROS) in saliva of betel quid chewers and OSMF patients, which may help in the diagnosis of cancer progression in the oral cavity.

METHODS

A total of 35 cases of OSMF and 35 cases of healthy individuals were included in the present study. The salivary status of ROS, pro-oxidants and some trace elements was studied in OSMF patients and normal healthy individuals.

RESULTS

The levels of lipid peroxides (P < 0.001), conjugated dienes (P < 0.01), hydroxyl radicals (P < 0.01), superoxide dismutase (P < 0.05), copper (P < 0.05), calcium (P < 0.01), magnesium (NS), potassium (P < 0.05) and iron (P < 0.05) in OSMF patients were elevated when compared with normal healthy individuals. The levels of hydrogen peroxide (P < 0.05) and sodium (P < 0.01) in OSMF patients were found to be decreased when compared with control subjects. A significant alteration was noticed after supplementing with α-tocopherol in oral precancerous patients.

CONCLUSION

These parameters may help in the detection of the severity of oral diseases.

Assessment of genetic damage among chewers of mixture containing mainly areca nut and tobacco

Chewing mixture containing areca nut and tobacco is believed to be associated with oral cancer. Habit of chewing such mixture is prevalent among South Asian countries. This study aimed to evaluate the genotoxic effect of areca nut and tobacco on human lymphocytes. Peripheral blood from 107 subjects (nonchewers, 48; chewers, 59, including 20 subjects with oral submucous fibrosis [OSMF]) analyzed by cytokinesis-block micronucleus (CBMN) and alkaline comet assay. Nuclear anomalies, namely, binucleated cells with micronuclei (BN MN), total MN, nucleoplasmic bridge, and nuclear buds were higher in chewers whereas elevation in BN MN and total MN were significant among subjects with OSMF than nonchewers. DNA damage assessed by comet assay showed increased percentage of Tail DNA, Tail moment, and Olive tail moment among chewers as well as OSMF subjects. Significant positive correlation was observed between induction of CBMN and consumption of quids per day (r = .280, P = .033).

RESULTS

suggested cytotoxic and genotoxic potential of mixture containing areca nut and tobacco.

Reproductive toxic potential of panmasala in male Swiss albino mice

Some ingredients of panmasala have the ability to penetrate the blood-testis barrier but the reproductive toxic potential of panmasala has not been studied. This study is aimed to assess the possible damage caused by panmasala to male reproductive system in mice. Swiss albino male mice were randomly divided into 7 groups receiving either standard control diet or panmasala-containing diet. Three doses (0.5%, 1.5% and 3%) of panmasala plain (PMP) as well as panmasala with tobacco (PMT)—gutkha were given for a period of 6 months. Assessment of organ weight, sperm count and morphology, spermatid count, sperm production, testicular 17β-hydroxysteroid dehydrogenase (17β-HSD) activity and histology were conducted. A nonsignificant decrease in absolute and relative weight of testis and epididymis was observed. Spermatid count, sperm count and production were significantly decreased and 17β-HSD activity was found considerably declined at 3% of both PMP- and PMT-treated groups as compared to control. The histological observations revealed panmasala induced testicular damage. Abnormal morphology of sperm head shape was significantly elevated in higher doses of both types of panmasala-treated groups than control. The results suggests that panmasala has reproductive toxic potential and more alteration is seen with gutkha as compared to panmasala plain, indicating that similar effects might also be possible in humans.

Cytogenetic alterations in buccal mucosa cells of chewers of areca nut and tobacco

OBJECTIVE

the rationale of the study was to evaluate the cytological alterations especially micronucleus (MN) and other nuclear anomalies in buccal mucosa cells of chewers to understand the genotoxic and clastogenic potential of chewing mixture (containing areca nut and tobacco as main ingredients).

METHODS

the buccal cytome assay involves the examination of epithelial smear to determine micronucleated cell and other nuclear anomalies after the Feulgen plus light green staining. The assay was applied to exfoliated buccal mucosa cells of 262 subjects [non-chewers - 161 and chewers - 101 (includes 20 subjects with OSMF)] and 1000 cells per individual were examined microscopically. Nuclear anomalies were compared among chewers, non-chewers and OSMF subjects and correlated with consumption of quids per day and duration of chewing in years.

RESULTS

MN cells were found significantly (p<0.0001) higher among chewers and OSMF subjects as compared to non-chewers. Further analysis indicated that MN was significantly higher in OSMF subjects with respect to even chewers. Nuclear buds were significantly higher (p<0.0001) in OSMF subjects as compared to chewers as well as non-chewers. Nuclear anomalies viz. binucleated, karyorrhexis and karyolysis were also considerably higher in OSMF subjects as compared to non-chewers.

CONCLUSION

the MN and other nuclear anomalies reflected genetic damage and cytotoxicity, associated with tobacco and areca nut consumption. Further, these data reveal a risk for development of OSMF among chewers of mixture containing areca nut and/or tobacco, as all the OSMF subjects were chewers.