Central papillary atrophy of the tongue among bidi smokers in India: a 10-year study of 182 lesions

Oral Mucosal Lesions Associated with Smokers and Chewers - A Case-Control Study in Chennai Population

AIMS AND OBJECTIVES

To determine the association of oral mucosal lesions in a group of Chennai population aged 15 years and above with smoking and chewing habits. To also determine the dose-response relationship of these habits associated with the risk of oral mucosal lesions.

MATERIALA AND METHODS

The study was undertaken with 450 subjects with smoking and/or chewing habits aged 15 years and over gathered through random selection in Chennai, India. Subjects with alcohol intake were excluded from the study. Based on the habits the study group was categorized into smokers, chewers and mixed (smoking+chewing). One hundred and fifty subjects diagnosed with oral mucosal lesions designated as "cases" and 300 lesion-free "controls", frequency matched for age, sex, habit and family income were assessed during the study. The study protocol included a visual oral soft tissue examination and a questionnaire-based interview. In addition, those requiring further examination, scalpel biopsies were performed to establish a definitive diagnosis.

RESULTS

Irrespective of the type of habit, 78% of cases smoked and/or chewed for more than 10 years as compared to 37.4% of the control group. Similarly, 71.3% of cases smoked and/or chewed more than 5 times per day as compared to 25.6% of the control group. Eleven habits related mucosal lesions of the oral cavity were encountered. Smoker's melanosis was the most common oral mucosal lesion followed by Oral submucous fibrosis and Leukoplakia. Dose-response relationships were observed for both duration and frequency of habits on the risk of oral mucosal lesions.

CONCLUSION

The result of the present study provides information on the association of oral mucosal lesions in smokers, chewers and patients with mixed habits. The mucosal lesions encountered included a few potentially malignant conditions and oral squamous cell carcinoma. Habits were more prevalent in men thus more lesions were encountered in males than in females. Moreover, increase in the duration and frequency of habits was significant predictors of risk in the case population.

Challenges of the oral cancer burden in India

Oral cancer ranks in the top three of all cancers in India, which accounts for over thirty per cent of all cancers reported in the country and oral cancer control is quickly becoming a global health priority. This paper provides a synopsis of the incidence of oral cancer in India by focusing on its measurement in cancer registries across the country. Based on the International Classification of Disease case definition adopted by the World Health Organisation, and the International Agency for Research on Cancer, this review systematically examines primary and secondary data where the incidence or prevalence of oral cancer is known to be directly reported. Variability in age-adjusted incidence with crude incidence is projected to increase by 2030. Challenges focus on measurement of disease incidence and disease-specific risk behavior, predominantly, alcohol, and tobacco use. Future research should be aimed at improving quality of data for early detection and prevention of oral cancer.

Effect of cessation of tobacco use on the incidence of oral mucosal lesions in a 10-yr follow-up study of 12,212 users

OBJECTIVE

To study the effect of cessation of tobacco use on the incidence of lichen planus, leukoplakia and other oral mucosal lesions.

DESIGN

A 10-yr cohort study in a rural population of Ernakulam district, Kerala, India.

MATERIAL AND METHODS

Some 12,212 tobacco users were interviewed and examined in a baseline survey and re-examined annually for 10 years. At each examination they were exposed to health educational programs to encourage them to quit their tobacco use. The incidence rates were calculated using person-years method among those who stopped their tobacco use and all others.

RESULTS

A total of 77,681 person-years of observation accrued among men and 32,544 among women. Among men 6.5% of these and among women 14.4% were in the stopped category. The incidence of oral lichen planus did not show any consistent association with cessation of tobacco habits (incidence ratio 1.35) but for leukoplakia there was a substantial drop in the incidence after cessation (incidence ratio 0.31). Several other tobacco-associated oral mucosal lesions such as oral lichen planus-like lesion, smoker's palate, preleukoplakia, central papillary atrophy of the tongue and leukoedema showed either zero, or very small incidence, after cessation.

CONCLUSION

The reported association between tobacco use and lichen planus appears to be indirect but for all other lesions it is direct. The cessation of tobacco use led to a substantial fall in the incidence of leukoplakia and other lesions implying a reduced risk for oral cancer after cessation of tobacco use.

Cutaneous phaeohyphomycosis caused by Phialophora richardsiae and the effect of topical clotrimazole in its treatment

A 15-year-old girl and her 50-year-old mother from Jabalpur, India, were found to have phaeohyphomycotic skin lesions due to Phialophora richardsiae. Among the antimycotics tested in vitro, clotrimazole was found to be most active. Topical application of clotrimazole cream cured the lesions completely.