Oral health consequences of smokeless tobacco use

Epidemiological Trends and Clinicopathological Characteristics of Oral Leukoplakia: A Retrospective Analysis From a Single Institution in Chennai, Tamil Nadu, India

Background India has a high prevalence of oral potentially malignant disorders and malignant transformation. Cases of oral leukoplakia are not commonly encountered, and only a small cohort of patients undergo biopsies for the same. This study aims to assess the various etiological factors causing leukoplakia, the clinical features, histopathological findings, and treatment received by the patients who were histopathologically diagnosed with oral leukoplakia. Methodology Oral leukoplakia cases were included in this study from total biopsy samples received in the oral pathology department. Details were collected from the Dental Information Archival Software of our institution. The period analyzed was from January 1, 2021, to December 31, 2023. Relevant clinical and histopathological details were retrieved and tabulated. Statistical analysis (chi-square test) was used to assess the association between the clinicopathological parameters using SPSS software version 21.0 (IBM Corp., Armonk, NY, USA) with a significance level set at a p-value <0.05. Results A total of 76 oral leukoplakia cases were retrieved from 2,600 biopsy samples. The prevalence of oral leukoplakia was 3.1% to 3.4% for the three years. Leukoplakia was commonly observed in those aged 51 to 60 years (33%). Overall, 21% of the patients with leukoplakia showed severe epithelial dysplasia, 22% showed mild epithelial dysplasia, and 39% showed moderate epithelial dysplasia. Moreover, 30% of the patients presented with leukoplakia and oral submucous fibrosis and showed varying degrees of epithelial dysplasia. Finally, 45% of the patients were managed conservatively using pharmacotherapy. Conclusions Severe epithelial dysplasia was commonly associated with oral leukoplakia. Oral submucous fibrosis was also found to be associated with leukoplakia and showed epithelial dysplasia. None of our proliferative verrucous leukoplakia cases showed any association with oral submucous fibrosis. Surgical management was the preferred treatment.

Aberrant glycosylation of secretory mucin from the oral cavity in tobacco consumers: a pilot study

Mucins are a family of high-molecular-weight O-linked glycoproteins which are the primary structural components of mucus and maintain homeostasis in the oral cavity. The present study was conducted as the first step towards establishing a correlation of aberrant mucin glycosylation with tobacco-associated clinical conditions. Tobacco habituates for the study were identified on the basis of type, duration, amount, and frequency of using tobacco products. The secretory mucin and its saccharides were determined from the saliva collected from smokers, smokeless tobacco habituates, and healthy, nonsmoking individuals. On the one hand, the salivary mucin content was markedly reduced in smokeless tobacco habituates with respect to smokers. On the other hand, the amount of sialic acid and fucose moieties of salivary mucin was increased in both smokers and smokeless tobacco habituates compared to the healthy cohort. Furthermore, the duration of tobacco exposure have been identified as the main factor influencing the extent of damage to the oral mucosa in terms of mucin secretion. The reduced secretory mucin content with aberrant glycosylation in the oral cavity may have a significant role in the further development or progression of oral diseases.

Smokeless tobacco and periodontitis: A systematic review with meta-analysis

AIM

The present systematic review with meta-analysis aimed to investigate the global association between smokeless tobacco (SLT) use and periodontitis, considering significant effect size variation based on the income levels of countries.

METHODS

We searched seven databases to identify studies that assessed the prevalence of periodontitis in adult SLT users compared to non-users. The quality of studies was evaluated using the 10-item risk-of-bias tool, and publication bias was addressed through the trim-and-fill method. Sensitivity analysis utilized the leave-one-out approach. Meta-analysis and meta-regression, stratified by country income, SLT type, and smoking status, employed robust variance estimation.

RESULTS

From an initial pool of 484 studies, 29 studies met the selection criteria and were subjected to qualitative synthesis. Subsequently, data from 19 studies were included in the meta-analysis. SLT users exhibited a nearly threefold greater likelihood of periodontitis compared to non-users (OR = 2.99; 95% CI: 2.10, 4.27; p < .01). The pooled estimate did not vary significantly based on the type of SLT used or concurrent smoking. However, the odds of periodontitis varied according to the economic level of the country; the pooled estimate was higher in high-income countries (OR = 1.69; 95% CI: 1.20, 2.37; p < .01) and even higher in lower-middle-income and lower-income countries (OR = 3.91; 95% CI: 2.66, 5.77; p < .01).

CONCLUSIONS

Smokeless tobacco users have a higher likelihood of developing periodontitis. This study underscores global disparities in the SLT-periodontitis relationship, highlighting the need for targeted interventions, particularly in economically challenged areas where SLT use is largely unregulated.

Effects of Smokeless Tobacco on Oral Health: A Cross-Sectional Study

BACKGROUND

Smokeless tobacco (SLT) consumption poses a significant global public health challenge because of its adverse effects on oral health. Although the detrimental impact of SLT on oral tissues is well-documented, understanding its multifaceted effects is essential for effective prevention and intervention strategies.

OBJECTIVE

This study aimed to comprehensively assess the impact of SLT on oral health, focusing on various clinical parameters and their differences between placement and non-placement sites of SLT.

METHODS

A cross-sectional study involving 528 habitual users of SLT was conducted. Clinical parameters included the plaque index (PI), gingival index (GI), gingival bleeding index (GBI), gingival recession (GR), and probing depth (PD). Oral mucosal changes at SLT placement sites have also been reported. Statistical analysis was performed to compare parameters between the placement and non-placement sites.

RESULTS

 The study involved 528 subjects, mostly male (82%) and aged 21-40 years (mean±SD=31.14±9.10), habitual users of SLT. Prevalent SLT types included tobacco with betel nuts/masala/gutkha (59.9%) and tobacco with lime (54.5%). Significant differences were observed between SLT placement and non-placement sites: higher gingival inflammation (GI) at placement sites (1.54±0.61 vs. 1.45±0.54, p=0.01), lower GBI at placement sites (40.0% vs. 84.3%, p=0.001), and more prevalent GR (65.7% vs. 34.3%, p=0.03) at placement sites. Probing depths ≥ 3 mm were also less frequent at placement sites (2.67±0.72) than non-placement sites (3.37±1.03, p=0.001). These results highlight the detrimental impact of SLT on periodontal health, emphasizing the need for targeted interventions among SLT users.

CONCLUSION

SLT use is associated with adverse effects on oral health, including GI, plaque accumulation, gingival bleeding, GR, and changes in the oral mucosa. Targeted interventions and public health policies are needed to address these issues effectively.

Smokeless tobacco keratosis in oral mucosa with epithelial dysplasia: A case report

RATIONALE

Smokeless tobacco use is a risk factor for the development of various oral lesions, among which is smokeless tobacco keratosis (STK). This condition is caused by constant frictional irritation of smokeless tobacco products against the oral mucosa and appears as a White-to-gray plaque with wrinkling.

PATIENT CONCERNS

A 50-year-old man who had been using smokeless tobacco for 24 years visited our clinic complaining of changes in the lower right sulcus of the oral cavity for 10 days. Clinical examination revealed a unilateral, nonhomogeneous White lesion in the area of the complaint. Histopathological examination showed hyperkeratosis, areas of keratin plugging, and mild dysplastic epithelial changes.

DIAGNOSIS

The clinico-histopathological correlation suggested a diagnosis of STK with focal mild epithelial dysplasia.

INTERVENTION AND OUTCOME

A comprehensive management plan included maintaining oral hygiene, education on the detrimental effects of smokeless tobacco, advice to cease smoking, and regular follow-up to monitor the potential for malignant transformation. The patient was referred to a tobacco cessation society for tailored advice and counseling. On follow-up visits, there was an improvement in the lesion after habitual cessation.

LESSONS

The diagnosis of tobacco-related oral lesions is often delayed, which may result in malignant transformation. This illustrates the need to train healthcare professionals to identify tobacco-related conditions at an early stage and to educate patients regarding the harmful effects of tobacco use.

Repercussions of Smokeless Tobacco on Buccal Mucosa: A Community Based Observational Study at a Tertiary Care Centre in Western Rajasthan

Background

Tobacco is consumed mainly as smoking or smokeless tobacco [SLT]. "Smokeless tobacco" (SLT) term is used for the consumption of tobacco mixed with other constituents in form of chewing, spitting and dipping. Consumers of smokeless tobacco chew the products and spit out the juice that builds up in oral cavity which leads to various malignant and pre malignant lesions of oral cavity.

Methods

Descriptive observational study was conducted in the city of Jodhpur through department of ENT, Head & Neck Surgery, Dr. SN medical college, Jodhpur.

Results

Male to female ratio of smokeless tobacco usage was almost same. Increasing age was associated with occurrence of oral lesions and 43% patients developed oral lesions in the group > 64 yrs of age. Duration was another associating factor and 66% developed symptoms within < 10 years of usage. Oral submucous fibrosis is the most common lesion. Malignant lesions were seen in 0.3% cases. Around 78% cases developed dependency. Diabetic patients were seen more prone to development of oral lesions.

Conclusions

Development of lesions in the oral cavity by smokeless tobacco depends on various factors such as quantity of tobacco usage per day, place of putting tobacco and duration. Awareness regarding its fatal effects and timely diagnosis and management can save many lives.

Prevalence of Keratosis in the Oral Cavity: A Clinical Retrospective Study

INTRODUCTION

A lesion in the oral cavity can appear clinically white due to an increase in keratin (hyperkeratosis), an increase in the thickness of the spongiotic cells (acanthosis), accumulation of fluid within the epithelium, and formation of the pseudomembrane. There are several innocuous white lesions, while only a few require aggressive management. The lesions of frictional keratosis, tobacco pouch keratosis, and morsicatio buccarum (MB) are innocuous white lesions that can be treated with simple treatments. This paper aimed to study the prevalence of the three white lesions among the patients visiting Saveetha Dental College. The objectives were to study the gender prevalence of the lesions and the average age distribution of these lesions.

METHODOLOGY

The study was a retrospective clinical study that collected data from DIAS (Digital Information and Archiving Software) over four years among the patients visiting Saveetha Dental College. The inclusion and exclusion criteria were based on the clinical diagnostic features, and the existence of any other oral potentially malignant disorder made the exclusion criteria. The collected data were entered into Statistical Package for the Social Sciences (SPSS) version 26.0 (IBM Corp., Armonk, NY). The data were analyzed for descriptive and inferential statistics.

RESULTS

The total number of patients with the lesions mentioned above was 5,613, with an average age of 37.28 years. The most common lesion was frictional keratosis with 4,026 patients, followed by tobacco pouch keratosis with 1,537 patients. The least common was MB, with 54 patients. Based on gender, all of the above lesions were most commonly seen in men. The age analysis revealed that frictional keratosis and MB were seen in middle age, while tobacco pouch keratosis was seen in middle to old age.

DISCUSSION

From the above study, it is noticed that frictional keratosis was the most common lesion, which had arisen most commonly in the third molar region and was seen in the younger age group due to the eruption of the third molars. Among the lesions, the only tobacco-induced lesion was tobacco pouch keratosis, which was seen predominantly in middle to old age, implying that prolonged habit usage was essential for the lesion to develop.

CONCLUSION

This study has helped us understand the prevalence of innocuous keratotic lesions in the South Indian population. The findings of this study will give a guideline for confirming the clinical diagnosis of similar lesions. This could potentially reduce the need for undertaking a biopsy and rather try treating with less invasive modalities, and when no response is seen, then it would be worthwhile to do a biopsy.

Comparative Analysis of Dentition and Periodontal Status in Patients With Unilateral Smokeless Tobacco Pouch Keratosis

INTRODUCTION

The consumption of smokeless tobacco (SLT) and related products has become an epidemic worldwide, especially among young people, as they come into direct contact with the tissues of the oral cavity. Therefore, the present cross-sectional study was conducted to compare the status of dentition and periodontal health of teeth associated with the unilateral SLT pouch keratosis with the unaffected contralateral side.

MATERIALS AND METHODS

In this study, 96 SLT users from north Maharashtra, India, with unilateral SLT pouch keratosis were studied. Demographic data, past and present SLT use history, features of SLT pouch keratosis, modified community periodontal index, dentition status index, and loss of tooth attachment were recorded. Data were collected and subjected to statistical analysis using the unpaired t-test and chi-square test.

RESULTS

The results of the present study showed a significant difference (p≤0.05) in gingival bleeding, pocket depth, and attachment loss in teeth associated with smokeless tobacco keratosis (STK) compared to teeth at the contralateral sides of the arch. The duration of tobacco use had a significant effect on the severity of loss of attachment at SLT pouch keratosis sides. There was a significant difference (p≤0.05) in the mean scores of the sound crown, carious crown, and coronal caries status between the SLT pouch keratosis side and the contralateral side.

CONCLUSION

The results of the study revealed that significant gingival bleeding, gingival recession, and attachment loss in the teeth are associated with SLT pouch keratosis compared with the teeth on the contralateral side without the lesion.

A model to explain smokeless tobacco consumption in adults: A grounded theory study

Introduction

Smokeless tobacco use remains a significant public health concern, necessitating the acquisition of comprehensive and extensive data to effectively address and control its consumption. Understanding the underlying patterns of consumption is crucial for this purpose.

Objective

This study aimed to develop a model that explains smokeless tobacco consumption among adults in the southeastern province of Iran, specifically in the city of Chabahar.

Methods

A qualitative study was conducted using a grounded theory approach with inductive processes. The participants consisted of 30 adults aged 18-64 years from Chabahar City in southeastern Iran. Purposive sampling was used to select participants, and data collection continued until theoretical saturation was achieved. Data analysis followed Strauss and Corbin's perspective, involving four stages: Analyzing Data for Concepts, Analyzing Data for Context, Bringing Process into the Analysis, and Integrating Categories.

Results

The analysis of data yielded three main categories: "starting to use," "continued use," and "cessation attempts," each with their respective subcategories. Additionally, two main categories related to the consequences of smokeless tobacco consumption were identified: "addiction and efforts to overcome addiction," also with their respective subcategories.

Conclusion

The Dependency Cycle Model in Consumption provides a comprehensive understanding of the contextual factors, processes, and consequences associated with smokeless tobacco consumption. This model serves as a valuable tool for researchers aiming to develop effective interventions in the field of smokeless tobacco consumption.

Assessment of oral health status amongst the Sevayats of Shree Jagannath Temple, Puri, Odisha: A cross sectional study

Aim

To assess the oral health status amongst the Sevayats of Shree Jagannath temple, Puri, Odisha.

Methodology

A cross-sectional study was conducted to evaluate the oral health status among 488 Sevayats of Shree Jagannath Temple, Puri, using a simple random sampling technique. Data were obtained by utilizing the WHO oral health assessment form for adults-2013. The documented data were assembled, entered into an MS Excel spreadsheet, and analyzed using SPSS version 26. The statistical tests applied for the analysis were one-way analysis of variance and the Chi-square test. The P value of < 0.05 was considered statistically significant.

Results

The majority of the participants, around 30.3%, had an educational qualification of higher secondary, followed by high school, 26.2%. A total of 84.4% of participants cleaned their teeth with a toothbrush. Around 48.0% of participants were consuming paan and 11.7% were gutkha. The majority, 77.8% of the participants had periodontal pockets, and 79.09% of them had 4-5 mm of periodontal loss of attachment. The mean DMFT of all the participants was 5.23 ± 4.71. In the 25-44 and 45-60 years of age groups, 34.2% and 31.4% of the participants had tobacco pouch keratosis. About 72% of the subjects had bleeding gums.

Conclusion

There was a higher prevalence of dental caries and periodontal disease among the subjects. The majority of the servitors who had a history of consuming paan were diagnosed with oral mucosal lesions.

Estimated projection of oral squamous cell carcinoma annual incidence from twenty years registry data: a retrospective cross-sectional study in Indonesia

Background

The incidence of oral squamous cell carcinoma (OSCC) has not been well documented in Indonesia. Thus, we aimed to analyze trends and clinicopathological profiles of OSCC cases in Indonesia, focusing on differences between age and sex groups.

Methods

A cross-sectional study was conducted in Indonesia's main referral hospital, analyzing 1,093 registered OSCC cases from 2001 to 2020. Trend analysis was performed using Joinpoint regression analysis to determine the annual percentage change (APC) for overall cases and each case group based on age, sex, and anatomical subsites. APC significance was assessed using a Monte Carlo permutation test. The projection of case numbers for the following 5 years (2021-2025) was estimated using linear/non-linear regression analysis and presented as a mathematical function. The significance of the trend slope was measured using an ANOVA test. Demographic and clinicopathological characteristics of OSCC were analyzed according to age and sex, and their comparative analysis was assessed using Chi-square and its alternatives.

Results

The incidence of OSCC in female patients and in the tongue and buccal mucosa showed a positive trend (APC 2.06%; 3.48%; 8.62%, respectively). Moreover, the incidence of OSCC overall, and in women with OSCC, is projected to increase significantly in the next 5 years following the quadratic model. The mean age of patients was 51.09 ± 14.36 years, with male patients being younger than female patients. The male-to-female ratio was 1.15, and 36.5% of these patients were categorized as young (≤45 years old). The tongue was the predominantly affected site. Prominent pathologic characteristics included well-differentiation, keratinization, and grade I of Bryne's (1992) cellular differentiation stage. Most patients presented with advanced staging, lymphovascular invasion, and uninvaded margins. Tumor sites and staging varied according to age, while age and tumor sites differed between sexes.

Conclusion

The rising incidence trends of OSCC among Indonesian patients, both in the past and projected future, are concerning and warrant attention. Further research into risk factors should be conducted as preventive measures.

A Comparative Study of Morphometric Analysis of Nucleolar Organizer Regions in Oral Leukoplakia and Oral Squamous Cell Carcinoma and Significance of AgNOR as a Diagnostic Tool

Background Silver stainable nucleolar organizer regions (AgNORs) have proven to exhibit utmost importance due to their higher occurrence in the nucleus especially in malignant cells than in normal. Thus, they assist in the examination of nucleolar structures and variations in nucleolar activity. Aim Quantitative and qualitative analysis in relation to the number and area of AgNOR in tissue sections of the normal oral mucosa (NOM), oral leukoplakia (OL), and oral squamous cell carcinoma (OSCC) was the main aim of the study. Materials & method A total of 50 cases comprising 20 OL with dysplasia, 20 OSCC cases, and 10 samples of normal oral mucosa were taken. Silver nitrate (Sol A) & gelatin (Sol B) solutions were freshly prepared for staining the lesional slides. Results The mean value of nuclear profile area (A Nuc) was comparatively higher in oral leukoplakia i.e. 41.97 and in oral squamous cell carcinoma i.e. 62.36 in comparison to the control group where it was 36.19. The mean value of a single AgNOR profile area per nucleus (A NOR) was found to be comparatively lower in both study groups i.e. oral leukoplakia (2.76) and oral squamous cell carcinoma (1.61) in comparison to the control group (3.45) . The mean value of total AgNOR profile area per nucleus (TA NOR) and the number of profiles of AgNORs per nucleus (n NOR) were found higher in both study groups (oral leukoplakia and oral squamous cell carcinoma) as compared to normal oral mucosa of the control group. However, the findings of all four parameters of morphometric analysis were found to be significantly associated with disorder of oral mucosa i.e. cases of oral leukoplakia and oral squamous cell carcinoma (P value <0.01). Conclusion It can thus be suggested that the mean AgNOR count displayed a higher value in OSCC. Hence, the number of AgNORs in nuclei increases as epithelial cells undergo malignant transformation which is designated that mean AgNOR count may contribute to establishing the prognosis of a lesion.

Put Down the Tin: Chewing Tobacco Use Is Associated With Worse Outcomes After Primary Lumbar Fusion

STUDY DESIGN

Retrospective study.

OBJECTIVE

This study evaluated the impact of chewing tobacco on both medical and spine-related complication rates after spinal lumbar fusions in comparison to both a control cohort and a smoking cohort.

SUMMARY OF BACKGROUND DATA

Smoking is a prevalent modifiable risk factor that has been demonstrated to be associated with increased complications after lumbar fusion. Although smoking rates have decreased in the United States, chewing tobacco use has not similarly reduced. Despite chewing tobacco delivering up to 4 times the dose of smoking, the impact of chewing tobacco is incompletely understood.

METHODS

A retrospective cohort study was conducted using the PearlDiver database. Patients who underwent lumbar spine fusion and used chewing tobacco were matched with a control cohort and a smoking cohort. Medical complications within 90 days after primary lumbar fusion were evaluated, including deep venous thrombosis, acute kidney injury, pulmonary embolism, transfusion, acute myocardial infarction, and inpatient readmission. Spine-related complications were evaluated at 2 years postoperatively, including pseudoarthrosis, incision and drainage (I&D), instrument failure, revision, and infection.

RESULTS

After primary lumbar fusion, the chewing tobacco cohort demonstrated significantly higher rates of pseudoarthrosis [odds ratio (OR): 1.41], revision (OR: 1.57), and any spine-related complication (OR: 1.32) compared with controls. The smoking cohort demonstrated significantly higher rates of pseudoarthrosis (OR: 1.88), I&D (OR: 1.27), instrument failure (OR: 1.39), revision (OR: 1.54), infection (OR: 1.34), and any spine-related complication (OR: 1.77) compared with controls. The chewing tobacco cohort demonstrated significantly lower rates of pseudoarthrosis (OR: 0.84), I&D (OR: 0.49), infection (OR: 0.70), and any spine-related complication (OR: 0.81) compared with the smoking cohort.

CONCLUSIONS

This study demonstrated that chewing tobacco is associated with higher rates of both spine-related and medical complications after primary lumbar fusion. However, chewing tobacco use is associated with less risk of complications compared with smoking.

LEVEL OF EVIDENCE

Level III.

Patterns and predictors of periodontal disease and tooth loss among users of smokeless tobacco

BACKGROUND

Smokeless tobacco (SLT) products of several different types are widely used in several South Asian countries including Pakistan. These products are consumed in different forms and with different names. The study aims to determine adverse effects of the SLT consumption on periodontal tissues.

METHODS

This cross sectional study was conducted in Karachi, Pakistan. It recruited 377 users of (SLT) with 231 males (61.3%) and 146 females (38.7%) of age 15 to 45 years. After obtaining informed consent, quantitative data were collected via a questionnaire followed by intra oral clinical examination to determine presence of periodontal diseases using community periodontal index (CPI). To determine the association between periodontal diseases and smokeless tobacco consumption habits, Chi Square test was conducted.

RESULTS

Gingival recession (Class II-IV) (65.8%) was the most prevalent periodontal disease among SLT users. CPI score was high (CPI score 3 and 4) in 31.3% participants, whereas tooth loss was found in 21%. Among types of SLT products, gutka (28.6%) and betel quid (23.3%) were most commonly used. Using SLT for five or more years was found to be associated with a high CPI score, gingival recession (Class II-IV), moderate to severe tooth mobility, and presence of tooth loss.

CONCLUSIONS

The study found statistically significant association between duration in years of using SLT and periodontal disease including gingival recession, tooth mobility and tooth loss. However, no significant results were found between retention during single use and frequency of SLT use per day. However, the link of these factors with the periodontal disease cannot be eliminated.

The Protective Role of Cranberries and Blueberries in Oral Cancer

BACKGROUND

Oral cancer has a high prevalence worldwide, and this disease is caused by genetic, immunological, and environmental factors. The main risk factors associated with oral cancer are smoking and alcohol.

RESULTS

There are various strategies to reduce risk factors, including prevention programs as well as the consumption of an adequate diet that includes phytochemical compounds derived from cranberries (Vaccinium macrocarpon A.) and blueberries (Vaccinium corymbosum L.); these compounds exhibit antitumor properties.

RESULTS

The main outcome of this review is as follows: the properties of phytochemicals derived from cranberries were evaluated for protection against risk factors associated with oral cancer.

CONCLUSIONS

The secondary metabolites of cranberries promote biological effects that provide protection against smoking and alcoholism. An alternative for the prevention of oral cancer can be the consumption of these cranberries and blueberries.

Physical and chemical characterization of smokeless tobacco products in India

The rapid proliferation of smokeless tobacco (SLT) in India has occurred without adequate information on the possible dangers and toxicity of these products. Tobacco flavors as well as nicotine (both protonated and un-protonated) are responsible for health dangers and addiction. The study aimed to offer information on the physical characteristics of commonly used smokeless tobacco products (including microscopic analysis), along with nicotine content (both total and un-protonated), pH, moisture, and flavors. The Standard Operating Procedures (SOPs) validated by the World Health Organization (WHO) recognized Tobacco Testing Laboratory TobLabNet) were applied for the analysis of various constituents of the SLTs. The microscopic analysis indicated that some of the SLT products like khaini were finely processed and available in filter pouches for users' convenience and prolonged use leading to prolonged retention and addiction potential. Nicotine absorption and availability (both protonated and un-protonated) are affected by moisture and pH. Essences provide a pleasant aroma and flavor, with an increased risk of misuse and other health problems. Few chewing tobacco and Zarda had the lowest levels of un-protonated nicotine (0.10-0.52% and 0.15-0.21%, respectively), whereas Gul, Gudhaku, and Khaini had the highest levels, ranging from 95.33 to 99.12%. Moisture and pH ranged from 4.54 to 50.19% and 5.25-10.07 respectively. Menthol (630.74-9681.42 µg/g) was the most popular flavour, followed by Eucalyptol (118.16-247.77 µg/g) and camphor (148.67 and 219.317 µg/g). SLT's health concerns and addiction dangers are exacerbated by the high proportion of bioavailable nicotine coupled with flavors. The findings of this study have important implications for the regulation and use of SLT in countries where use of SLT is prevalent.

Effects of Smokeless Tobacco on Color Stability and Surface Roughness of 3D-Printed, CAD/CAM-Milled, and Conventional Denture Base Materials: An In Vitro Study

Tobacco consumption in its different forms can affect the optical and surface properties of dental materials that are used in the oral cavity. Thus, the present study was conducted to evaluate the effects of two commercially available smokeless tobacco products on the color stability and surface roughness of denture base resins that were fabricated using three different techniques (CAD/CAM milling, 3D printing, and conventional heat polymerization). A total of 126 denture base resin specimens were fabricated using the three different manufacturing techniques (n = 42 each). Specimens from each group were further subdivided into three subgroups (n = 14 each) and immersed in three different immersion media (a khaini suspension, a tabbaq suspension, and artificial saliva). The differences in color and surface roughness were assessed according to data that were collected and statistically analyzed using SPSS version 24.0. The tabbaq smokeless tobacco was found to cause greatest changes in color and surface roughness; the effect was observed to be highest in the 3D-printed specimens followed by the conventional heat-polymerized and CAD/CAM milled specimens. The mean changes in color and surface roughness were the highest for the tabbaq smokeless tobacco followed by the khaini smokeless tobacco and the artificial saliva. Statistically significant (p-value < 0.05) differences were observed among all techniques and suspensions. We concluded that the mean changes in color and surface roughness were significantly higher for the 3D-printed dentures compared to the conventional heat-polymerized and CAD/CAM-milled dentures. Thus, the results of the present study strengthened the concept that tobacco in any form can lead to changes in the color and surface roughness of denture base materials.

Genetic and epigenetic instability induced by betel quid associated chemicals

Over the years, betel quid chewing and tobacco use have attracted considerable interest as they are implicated as the most likely causative risk factors of oral and esophageal cancers. Although areca nut use and betel quid chewing may lead to apoptosis, chronic exposure to areca nut and slaked lime may promote pre-malignant and malignant transformation of oral cells. The putative mutagenic and carcinogenic mechanisms may involve endogenous nitrosation of areca and tobacco alkaloids as well as the presence of direct alkylating agents in betel quid and smokeless tobacco. Metabolic activation of carcinogenic N-nitrosamines by phase-I enzymes is required not only to elicit the genotoxicity via the reactive intermediates but also to potentiate the mutagenicity with the sporadic alkylations of nucleotide bases, resulting in the formation of diverse DNA adducts. Persistent DNA adducts provides the impetus for genetic and epigenetic lesions. The genetic and epigenetic factors cumulatively influence the development and progression of disorders such as cancer. Accumulation of numerous genetic and epigenetic aberrations due to long-term betel quid (with or without tobacco) chewing and tobacco use culminates into the development of head and neck cancers. We review recent evidence that supports putative mechanisms for mutagenicity and carcinogenicity of betel quid chewing along with tobacco (smoking and smokeless) use. The detailed molecular mechanisms of the extent of accumulation and patterns of genetic alterations, indicative of the prior exposure to carcinogens and alkylating agents because of BQ chewing and tobacco use, have not yet been elucidated.

Assessment of Oral Lesions With Tobacco Usage: A Cross-Sectional Clinicopathological Study in Sri Ganganagar, Rajasthan, India

Background Tobacco usage in the form of smoking or chewing has increased the risk of oral potentially malignant disorders (OPMDs) and oral cancer. These deleterious habits are also related to changes in dentition and the oral mucosa. Aim The aim of our study was to evaluate the oral changes associated with tobacco usage among residents of Sri Ganganagar. Materials and methods This study was conducted among the residents of Sri Ganganagar, Rajasthan, India, using stratified cluster random sampling, prestructured questionnaires, and detailed oral examination. A total of 100 patients with a previous history of tobacco usage were enrolled in this study after obtaining informed consent. Age- and gender-matched controls were also evaluated to correlate the findings. Clinical details were documented, including the Oral Hygiene Index-Simplified (OHI-S), Decayed-Missing-Filled Teeth (DMFT) index, Community Periodontal Index (CPI), loss of attachment, dental findings, and oral mucosal changes. Suspicious lesions were stained with toluidine blue, and a biopsy was performed for histopathological evaluation. The tabulated results were statistically analyzed using the Statistical Package for the Social Sciences (SPSS) version 21.0 (IBM SPSS Statistics, Armonk, NY, USA) for significance. Results Attrition, abrasion, and erosion of teeth were more frequent in tobacco users than in controls. Smoker's palate, tobacco pouch keratosis, and leukoplakia were commonly noted mucosal lesions. The mean values of the parameters of the DMFT score (3.560), CPI score (2.190), and loss of attachment score (0.542) were higher among tobacco users, and it was statistically significant (P value < 0.05). Out of 100 patients, 17 had suspicious lesions. It included seven cases of oral submucous fibrosis (OSMF), two cases of tobacco pouch keratosis, and eight cases of leukoplakia. Toluidine blue staining and biopsy were performed. Histopathological examination of suspicious lesions revealed hyperkeratosis, various grades of epithelial dysplasia, and differing inflammatory responses. Out of 17 biopsied cases, there were two cases of hyperkeratosis with severe epithelial dysplasia, four cases of hyperkeratosis with moderate epithelial dysplasia, two cases of hyperkeratosis with mild dysplasia, two cases of superficially invasive squamous cell carcinoma, five cases of advanced OSMF, and two cases of moderately advanced OSMF. Conclusion Tobacco usage produces visible changes in dentition and latent alterations in the oral mucosa. Suspicious lesions should always be referred for histopathological examination to identify oral potentially malignant disorders and oral cancer so that prompt treatment could be initiated. Patient education is mandatory to avoid the usage of tobacco in any form.

Awareness of usage of Vicryl suture material in oral surgical procedures

Oral surgical procedures constitute a very important part in the broad scope of general dentistry. This necessitates a significant need for dental students to know about the suture materials. This study aims to assess the awareness of Vicryl suture material in dental surgical procedures. The descriptive survey was attended among 237 dental students. Results were analyzed using Microsoft Excel and using SPSS software version 23.0. The majority (96%) of the dental students were aware of Vicryl suture material. Approximately 75% and 66% knew that Vicryl suture was absorbable and braided, respectively. However, only 33% knew that Vicryl suture would get fall off in 2 weeks. According to the statistics, there is no significant difference between gender and awareness of Vicryl suture material (Chi-square; P = 0.14, not significant). Dental students have adequate knowledge about Vicryl suture material.

Awareness about Patterson syndrome among dental students

The aim is to create awareness about Patterson syndrome among dental students. Patterson-Stevenson-Fontaine syndrome is a very rare condition marked by irregular facial bone and tissue growth (mandibulofacial dysostosis) as well as limb abnormalities. A recessed jaw (retrognathism), cleft palate, and external ear defects are all possible symptoms of this disorder. A total of 112 undergraduate dental students participated in a longitudinal cross-sectional sample. To assess college students' awareness about Patterson syndrome, a self-administered, closed-ended questionnaire was developed and distributed. The only language allowed was English. The results were analyzed in SPSS software version 23. 10.71% of females and 14.29% of males were aware about Patterson syndrome. 32.14% of females and 38.39% of males were aware that Patterson syndrome was a rare adrenal disorder. We can conclude that very few of the population which was only 25% of the dental students were aware about Patterson syndrome and this survey helped in creating awareness about this syndrome.

Knowledge, awareness, and prevalence of various types of suturing techniques used for intraoral wound closure

Wound closing is critical to the completion of any surgical operation. An imperfect closure causes edge isolation, creating a possible route for bacterial contamination, which can lead to infection and scarring. While tissue adhesives and staples are now used as substitutes, surgical sutures remain the gold standard for a safe wound. The aim of this survey is to assess dental students' knowledge on the variety of suturing techniques. A comprehensive online survey of 100 dental students with simple questions about different types of sutures was performed. Each student was asked to complete a questionnaire of 20 questions. This study saw a total of 100 students take part in it. It was found that 58% of the participants opted for interrupted suturing technique and the rest 42% opted for simple continuous technique. It was found that 23% of the participants were not aware of the simple loop suturing technique and the rest 77% were aware of this suturing technique. Thus from the above results and discussion, we will conclude that almost all of the members are fairly privy to the distinctive suturing strategies; however; intensive expertise is required.

TikTok - Potential Impact on the Use of Smokeless Tobacco and Betel Quid by Young People

INTRODUCTION

TikTok has gained increasing popularity over the past year. The social media may affect awareness and perceptions of betel quid (BQ) and smokeless tobacco (SLT) by utilizing content generated by TikTok users. The purpose of this study is to examine how BQ and SLT are portrayed on TikTok.

METHODS

The 28 most viewed hashtag-based keywords were used to identify popular BQ and SLT-related videos on TikTok (n=513) from June 2018 to September 2021. Two researchers independently coded the number of likes, shares, views, user category and themes.

RESULTS

A final sample of 513 videos containing BQ and SLT that met the study criteria were included. Collectively, these videos were viewed over 725 million times, with a median 'view' count of 17,300 (range 152-155,000,000) and a median 'likes' count of 831 (range 4-2,400,000) and a median 'share' count of 21 (range 0-48,400). Majority of the videos showed BQ and SLT use positively i.e promoting the product (390/513; 76%) and these had more than 686 million times views. Neutral depictions of BQ and SLT use were viewed 15 million times (72/513; 14%) and negative portrayals of BQ and SLT have been viewed 193 million times (105/808; 13%). The video themes included 'life style' (349/513; 68.0%), 'marketing' (62/513; 12.09%), 'comedy' (44/513; 8.6%), 'warning' (25/513; 4.87%), 'awareness' (12/513; 2.3%), 'sports and other' (12/513; 2.3%) and social events or culture (9/513; 1.75%).

CONCLUSION

Our results demonstrated that video clips related to BQ and SLT on TikTok, a fast-growing, popular video-sharing platform among teens, which is available with no age restrictions has been viewed multiple times. Majority (76%) promoted these two products, that could be detrimental to oral health. Therefore, the age restrictions especially for the videos containing BQ and SLT is mandatory in order to reduce the potential exposure of adolescents/young adults.

Awareness and knowledge of oral manifestations in cardiovascular diseases among the general public

Cardiovascular diseases (CVDs) are disorders affecting the heart and blood vessels. Periodontal problems, bleeding gums, dry mouth, and gingival hyperplasia are common oral manifestations seen in cardiovascular-related problems. To assess the extent of awareness and knowledge, the general public has toward the oral manifestation related to that of CVDs. A questionnaire was distributed among the general public in relation to that of the extent of awareness and knowledge of oral manifestations with regard to CVD. A total of 161 responses were collected from the survey. The collected data were compiled and analyzed by the SPSS software; the Pearson Chi-square test was done where P < 0.05 was considered statistically significant. The study showed that 65.22% of the population is aware of the types of CVD. About 59.63% of the population do not know that periodontal problems lead to cardiovascular problems. About 39.75% have vague knowledge about the maintenance of poor oral health causing cardiovascular problems. The study concluded that the general public is not much aware of the oral manifestations related to that of CVDs.

Evaluation of difficulty index of impacted mandibular third molar extractions

When compared to other teeth, third molars have a greater rate of impaction. Third molars that have been impacted are commonly encountered in dental practice, and it is the reason for complications in third molar surgery. The most commonly performed surgical procedure by dental practitioners is the third molar extraction. Despite a well-planned surgical approach, there are complications in lower third molar extractions. This study analyzes the expected difficulty during surgical removal of lower third molars that are impacted. This study analyzes the expected difficulty during the removal of impacted lower third molars by surgery. With the data from our dental institution database, the difficulty index by Pederson was used to evaluate the difficulty level of the extraction. Using SPSS, data were analyzed and results were obtained. Among impacted left mandibular third molars (38), minimal difficulty in 20.60% of the extractions, moderate difficulty in 29.58% of the extractions, and most difficulty in 2.77% of extractions were present. Among impacted right mandibular third molars (48), minimal difficulty in 18.80% of the extractions, moderate difficulty in 25.78% of the extractions, and most difficulty in 2.47% of extractions were present. According to our study, there is moderate difficulty in impacted lower third molar surgery, and it depends on factors such as systemic status and patient's age, periodontal condition, and complexity of tooth position in the dental arch.

Knowledge and awareness of the Klinefelter Syndrome among the dental students

The presence of one or more extra X chromosomes in a male causes Klinefelter Syndrome (KS). KS affects 1 in 500-1 in 1000 men, while about half remain undiagnosed. KS is characterized by huge stature, increase in arm length, the feminine distribution of adipose tissues (including gynecomastia), less or pubic hair, infertility, hypotonia, reduced size of penis and less than average verbal IQ, struggle in learning and requirements for less specified speech therapy. KS is a primary testicular insufficiency with high levels of gonadotropin caused by a lack of pituitary gland feedback. The aim of the study is to assess the knowledge and awareness of the KS among the dental students. This cross-sectional survey was conducted among dental students of a private dental hospital. To evaluate the knowledge and awareness of the participants about KS, a self-administered questionnaire consisting of 10 questions was prepared. Percentage analysis and frequency analysis and percentage analysis were performed. A Chi-square test was done to assess the correlation using the SPSS software. In our study, most of the participants were aware of the KS. They also knew that the KS is caused due to the additional X chromosome. We would like to conclude that the dental students were much aware about the Klinefelter and they also had a thorough knowledge about it.

Knowledge and Awareness of Oral Mucosal Diseases Among Saudi Dentists

Background:

Oral mucocutaneous lesions have a significant impact on patient care. Late diagnosis of oral lesions may affect patients' quality of life and prognosis. Dentists are usually the first to encounter such lesions, and many studies have explored the knowledge and management related to oral cancer. However, not many studies have examined a more comprehensive understanding and management of oral lesions, including infectious and autoimmune/immune-mediated diseases.

Aims:

This study aimed at evaluating dentists’ knowledge and referral patterns regarding oral mucocutaneous diseases.

Methods:

A questionnaire-based cross-sectional study was conducted to evaluate dentists’ knowledge about oral mucocutaneous diseases and referral patterns among Saudi dentists. A total of 301 participants were included in the study. It was voluntary and written informed consent was obtained from the participants. A Chi-square test was used to compare the categorical variables. A p-value of less than 0.05 was considered statistically significant.

Results:

A total of 301 participants responded. Significant differences were observed between genders when asked about being comfortable with treating oral mucosal lesions in their practice (p-value: .019), and males were more convenient than females. A significant difference (p-value: .011) was observed between different educational levels when the participants were asked about the management of patients with oral mucosal lesions. Overall, the majority of participants rarely or never managed oral lesions. When comparing the different groups of participants, postgraduate residents responded more accurately (p-value: 007). Approximately 60% of all participants did not or rarely managed oral lesions in their practice.

Conclusion:

It was found that there was a lack of knowledge among dentists regarding the detection and treatment of oral mucosal lesions. This lack of knowledge can lead to unfavorable patient care and prognosis outcomes.

Smokeless tobacco consumption induces dysbiosis of oral mycobiome: a pilot study

Smokeless tobacco (SLT) alters the oral microbiome of smokeless tobacco users. Dysbiosis of oral bacteriome has been determined; however, the mycobiome of SLT users has not been characterized. The oral mycobiome was assayed by amplification and sequencing of the fungal internal transcribed spacer (ITS1) region from oral swab samples of non-SLT users, SLT users (with or without oral lesions), and SLT with alcohol users. We observed that the richness and diversity of oral mycobiome were significantly decreased in SLT with oral lesions users than in non-users. The β-diversity analysis showed significant dissimilarity of oral mycobiome between non-users and SLT with oral lesions users. Linear discriminant analysis effect size and random forest analysis of oral mycobiome affirm that the genus Pichia was typical for SLT with oral lesions users. Prevalence of the fungal genus Pichia correlates positively with Starmerella, Mortierella, Fusarium, Calonectria, and Madurella, but is negatively correlated with Pyrenochaeta, Botryosporium, and Alternaria. Further, the determination of oral mycobiome functionality showed a high abundance of pathotroph-saprotroph-symbiotroph and animal pathogen-endophyte-epiphyte-undefined saprotroph at trophic and guild levels, respectively, indicating possibly major changes in normal growth repression of types of fungi. The oral mycobiome in SLT users was identified and comprehensively analyzed for the first time. SLT intake is associated with oral mycobiome dysbiosis and such alterations of the oral mycobiome may contribute to oral carcinogenesis in SLT users. This study will provide a basis for further large-scale investigations on the potential role of the mycobiome in SLT-induced oral cancer. KEY POINTS: • SLT induces dysbiosis of the oral microbiome that can contribute to oral cancer. • Oral mycobiome diversity is noticeably reduced in SLT users having oral lesions. • Occurrence of Pichia can be used as a biomarker for SLT users having oral lesions.

Peri-implant clinicoradiographic status among betel-quid chewers and controls

The aim of the present case-control observational study was to evaluate the peri-implant clinicoradiographic status among betel-quid chewers and controls. Self-reported betel-quid chewers and controls were included. Participants were categorized into 3 groups: Group-1: Individuals chewing betel-quid with tobacco; Group-2: Individuals chewing betel-quid without tobacco; and Group-3: Controls (individuals not using tobacco in any form). Demographic data was collected using a questionnaire. Periodontal and peri-implant clinicoradiologic parameters (plaque and gingival indices [PI and GI], probing depth [PD] and crestal bone loss/marginal bone loss [CBL/MBL]) were assessed. Clinical attachment loss (AL) around teeth was also assessed. Group comparisons were done using the one-way analysis of variance and Bonferroni Post-hoc adjustment tests. Correlation of periodontal and peri-implant inflammatory parameters with the duration of betel-quid chewing habit and duration of placement in the mouth were assessed using logistic regression analysis. P<0.05 was considered statistically significant. Thirty, 30 and 30 patients were included in groups 1, 2 and 3, respectively. Full-mouth PI (P<0.01), GI (P<0.01), clinical AL (P<0.01), PD (P<0.01) and mesial and distal MBL (P<0.01) were higher in groups 1 and 2 than Group-3. Peri-implant mPI (P<0.01), mGI (P<0.01), PD (P<0.01) and MBL/CBL (P<0.01) were significantly higher in groups 1 and 2 than Group-3 with no significant difference in groups 1 and 2. Betel-quid chewing habit either with or without tobacco is a risk-factor of peri-implant soft-tissue inflammation and CBL.

Betel quid chewing and oral potential malignant disorders and the impact of smoking and drinking: A meta-analysis

BACKGROUND

Oral potential malignant disorders (OPMDs) are a precancerous condition of oral disease. Several studies have found that betel quid chewing, smoking and alcohol drinking might be the risk factors of OPMDs. But the relationships of them, especially their interaction are still inconclusive.

AIM

To evaluate the relationship between betel quid chewing and OPMDs and to explore the interaction of smoking and alcohol drinking on the relationship.

METHODS

We searched PubMed, Web of Science, Embase and the Cochrane Library databases with items complete until January 2021 for relevant studies. The research data were extracted according to the inclusion criteria. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to evaluate the effect size. Subgroup analysis was performed to assess interactions between exposures and OPMDs. Relative excess risk of interaction (RERI) was used to estimate the size of interaction.

RESULTS

Nine articles were selected in the final meta-analysis. The results showed that betel quid chewing (pooled OR: 8.70, 95%CI: 5.18-14.61), alcohol consumption (pooled OR: 1.95, 95%CI: 1.5-2.55), and smoking (pooled OR:4.35, 95%CI: 3.06-6.2) could significantly increase the risk of OPMDs compared to individuals without these behaviors. Smoking and alcohol drinking synergistically increased the association between betel quid chewing and OPMDs (pooled OR_(BQ+SM):14.38, 95%CI: 7.14-28.95; pooled OR_(BQ+DK): 11.12, 95%CI: 8.00-15.45, respectively). The RERI_(BQ+SM) and RERI_(BQ+DK) were 2.33 and 1.47, respectively.

CONCLUSION

The synergistic effects between smoking/drinking and betel quid highlights the importance of focusing on individuals with multiple exposures. Further study should be conducted to confirm these interactions.

Smokeless tobacco and cigarette smoking: chemical mechanisms and cancer prevention

Tobacco products present a deadly combination of nicotine addiction and carcinogen exposure resulting in millions of cancer deaths per year worldwide. A plethora of smokeless tobacco products lead to unacceptable exposure to multiple carcinogens, including the tobacco-specific nitrosamine N'-nitrosonornicotine, a likely cause of the commonly occurring oral cavity cancers observed particularly in South-East Asian countries. Cigarettes continue to deliver a large number of carcinogens, including tobacco-specific nitrosamines, polycyclic aromatic hydrocarbons and volatile organic compounds. The multiple carcinogens in cigarette smoke are responsible for the complex mutations observed in critical cancer genes. The exposure of smokeless tobacco users and smokers to carcinogens and toxicants can now be monitored by urinary and DNA adduct biomarkers that may be able to identify those individuals at highest risk of cancer so that effective cancer prevention interventions can be initiated. Regulation of the levels of carcinogens, toxicants and nicotine in tobacco products and evidence-based tobacco control efforts are now recognized as established pathways to preventing tobacco related cancer.

Assessing Long Non-coding RNAs in Tobacco-associated Oral Cancer

Cancer is one of the compelling and pegged diseases battled by clinicians and researchers worldwide. Among different types of cancer, oral cancer holds the sixth position globally. With an escalating prevalence in Asian countries, India, China, and Pakistan constitute a large proportion of total incidents of oral cancer patients in terms of new cases or deaths. This mounting prevalence is ascribed to poor oral hygiene and rampant use of substances earmarked as potential risk factors for the disease. Risk factors (dietary/lifestyle habits/occupational/environmental) trigger the activation of oncogenes, dysregulation of lncRNA and miRNA, and silence the tumor suppressor genes, which robustly contributes to the onset and progression of tumorigenesis in oral squamous cell carcinoma. Evidence suggests that specific carcinogens identified in tobacco and related products alter many cellular pathways predisposing to advanced stages of oral cancer. Long non-coding RNAs represent a broad group of heterogenous transcripts longer than 200 nucleotides which do not translate to form functional proteins. They regulate various cellular pathways by specifically interacting with other RNAs, DNA, and proteins. Their role in the pathogenesis of OSCC and other cancer is still being debated. In this review, we discuss the molecular insights of significant lncRNAs involved in some crucial deregulated pathways of tobacco-associated OSCC. The implications and challenges to harnessing the potential of lncRNAs as biomarkers in early diagnosis and targeted treatment have also been analyzed.

Declining trends in smokeless tobacco use among Indian women: findings from global adult tobacco survey I and II

BACKGROUND

Smokeless Tobacco (SLT) use is culturally rooted and more acceptable among women in India. SLT is a significant risk for oral cancers and has other adverse health outcomes on women's general as well as reproductive health. This study aimed to estimate and compare the prevalence and correlates of SLT among adult females in India using Global Adult Tobacco Survey (GATS), 2009-2010 (GATS 1) and 2016-2017 (GATS 2).

METHODS

Data from a nationally representative cross-sectional study GATS 1 (n = 35,529) and GATS 2 (n = 40,265) were analysed for adult female smokeless tobacco users. Correlates of SLT exposure were assessed separately using binary logistic regression. Multivariable logistic regression analysis was done for the variables which computed p < 0.1. The association was expressed as Adjusted Odds ratio with 95% confidence intervals.

RESULTS

There was a reduction in prevalence of SLT use among women in India between GATS 1 (18.4%) and GATS 2 (12.8%). SLT use was highest among the North-Eastern women in both rounds [AOR: 4.567 (3.942-5.292) during GATS-1 and 9.149 (7.722-10.839) during GATS-2]. Odisha had highest prevalence of 56.53% while Himachal Pradesh had lowest 0.14% during the recent GATS 2 survey. 33.3% vs. 34.80% of the participants were willing to quit tobacco in Central region across both rounds of survey.

CONCLUSIONS

Although, smokeless tobacco prevalence among females has reduced between 2009 and 2016 in India, yet tobacco control strategies need further pace. Hence, more focused gender-based tobacco control programs and policies are the need of time.

Analysis of Risk Factors Associated with Squamous Cell Carcinoma in the Indian Population

BACKGROUND

Squamous cell carcinoma (SCC) describes the carcinomatous growth in the oral cavity. Recently, various authors have described increased SCC incidence in the young population. The distribution of SCC shows varied geographic spread, with the highest distribution in Asian countries.

AIMS

The present trial was carried out to assess the associated factors that could lead to increased risk of developing oral cancer.

MATERIALS AND METHODS

Oral examination was carried out for 21 participants by a dentist and any significant oral lesion or deleterious habit if present, was recorded. The data collected were analyzed.

RESULTS

Areca nut was chewed by 47.61% participants (n = 10), smoking tobacco by 76.19% (n = 16), chewing tobacco by 38.09% (n = 8), and consuming alcohol in 9 participants (42.85%). No significant difference was seen concerning age for any factor except alcohol which showed higher intake in the older group where six participants depicted alcohol intake as compared to three participants in the younger group. In participants who chewed areca nuts, 6 participants also smoked tobacco and 1 consumed alcohol. For tobacco chewing, 5 consumed alcohol and 6 also took tobacco as smoke.

CONCLUSION

The present study showed that areca nut and tobacco chewing along with alcohol consumption and tobacco smoking increase the risk of developing SCC in the Indian population.

Association of Health Status and Nicotine Consumption with SARS-CoV-2 positivity rates

Background

Much of what is known about COVID-19 risk factors comes from patients with serious symptoms who test positive. While risk factors for hospitalization or death include chronic conditions and smoking; less is known about how health status or nicotine consumption is associated with risk of SARS-CoV-2 infection among individuals who do not present clinically.

Methods

Two community-based population samples (including individuals randomly and nonrandomly selected for statewide testing, n = 8214) underwent SARS-CoV-2 testing in nonclinical settings. Each participant was tested for current (viral PCR) and past (antibody) infection in either April or June of 2020. Before testing, participants provided demographic information and self-reported health status and nicotine and tobacco behaviors (smoking, chewing, vaping/e-cigarettes). Using descriptive statistics and a bivariate logistic regression model, we examined the association between health status and use of tobacco or nicotine with SARS-CoV-2 positivity on either PCR or antibody tests.

Results

Compared to people with self-identified “excellent” or very good health status, those reporting “good” or “fair” health status had a higher risk of past or current infections. Positive smoking status was inversely associated with SARS-CoV-2 infection. Chewing tobacco was associated with infection and the use of vaping/e-cigarettes was not associated with infection.

Conclusions

In a statewide, community-based population drawn for SARS-CoV-2 testing, we find that overall health status was associated with infection rates. Unlike in studies of COVID-19 patients, smoking status was inversely associated with SARS-CoV-2 positivity. More research is needed to further understand the nature of this relationship.

Compositional profile of mucosal bacteriome of smokers and smokeless tobacco users

INTRODUCTION

Smoked, and especially smokeless, tobacco are major causes of oral cancer globally. Here, we examine the oral bacteriome of smokers and of smokeless tobacco users, in comparison to healthy controls, using 16S rRNA gene sequencing.

METHODS

Oral swab samples were collected from smokers, smokeless tobacco users, and healthy controls (n = 44). Microbial DNA was extracted and the 16S rRNA gene profiled using the Illumina MiSeq platform. Sequencing reads were processed using DADA2, and taxonomical classification was performed using the phylogenetic placement method. Differentially abundant taxa were identified using DESeq2, while functional metagenomes based on KEGG orthology abundance were inferred using LIMMA.

RESULTS

A significantly higher microbial diversity was observed in smokeless tobacco users and smokers relative to controls (P < 0.05). Compositional differences in microbial communities were observed in all comparisons with healthy controls (PERMANOVA P < 0.05) but not between smokers and smokeless tobacco users. Levels of Fusobacterium spp., Saccharibacterium spp., and members of Shuttleworthia were elevated in smokers when compared to controls (BH adj P < 0.01). In addition, the relative abundance of three bacterial taxa belonging to genera Fusobacterium spp., Catonella, and Fretibacterium spp. was significantly increased in smokeless tobacco users relative to controls (BH adj P < 0.01). Major functional pathways significantly increased in smokeless tobacco users relative to both controls, and smokers were similar and involved amino acid metabolism including glutamate and aspartate biosynthesis and degradation (log FC > 1.5; BH adj P < 0.01).

CONCLUSIONS

A distinct taxonomic and functional profile of oral microbiome in smokers and smokeless tobacco users as compared to healthy controls implicates a significant role of microbes and their metabolites in diseases associated with tobacco use including oral cancer.

CLINICAL RELEVANCE

Future efforts in preventive, diagnostic, curative, and prognostic strategies for diseases associated with tobacco use in smokers and smokeless tobacco users could incorporate the oral microbiome.

The Association between E-Cigarette Price and TV Advertising and the Sales of Smokeless Tobacco Products in the USA

This study aims to examine how e-cigarette prices and advertising, key determinants of e-cigarette demand, are associated with the demand for smokeless tobacco (SLT) products in the US. Market-level sales and price data by year (2010-2017), quarter, and type of retail store were compiled from Nielsen retail store scanner database. E-cigarette TV advertising ratings data were compiled from Kantar Media. Four-way (market, year, quarter, store type) fixed-effect models were used to estimate the associations between e-cigarette price and TV advertising and sales of SLT products (chewing loose leaf, moist snuff, and snus). Our results showed that a 1% rise in own price was associated with a reduction in sales by 1.8% for chewing loose leaf, 1.6% for moist snuff, and 2.2% for snus, respectively. In addition, a 1% rise in disposable e-cigarette price was associated with 0.3% and 0.6% increased sales for moist snuff and snus, respectively. The association between e-cigarette TV advertising and SLT product sales was not significant. Our results suggest that disposable e-cigarettes and certain SLT products (moist snuff and snus) are potential substitutes. Policies aiming to regulate e-cigarette use and sales need to consider their potential link with the demand for SLT products.

Effect of tongue piercing on periodontal and peri-implant health: A cross-sectional case-control study in adults

OBJECTIVES

The authors hypothesize that periodontal and peri-implant inflammatory parameters are poorer in adult patients with tongue piercing compared with controls. The aim was to assess the influence of tongue piercing on periodontal and peri-implant health status in adults.

METHODS

Test and control groups comprised of individuals with and without tongue piercing, respectively. A questionnaire was used to collect information about gender, age, duration of tongue piercing and implants in function, jaw location of the implant, reasoning for wearing the tongue ornament, and oral hygiene and ornament cleaning habits. Full-mouth and peri-implant plaque index (PI), gingival index (GI), clinical attachment loss (CAL), probing depth (PD) and marginal/crestal bone loss (MBL and CBL, respectively) on mesial and distal surfaces of teeth/implants were recorded. The material (plastic or metal) from which, the bar and ball-ends of the ornament were fabricated was also recorded. A p < 0.01 was considered statistically significant.

RESULTS

Forty-eight and 49 individuals were included in the test and control groups, respectively. There was no difference in PI, GI, PD, CAL and MBL (mesial and distal) among individuals in the test and control groups. In the test group, peri-implant PI (p < 0.01), GI (p < 0.01), PD (p < 0.01) and mesial (p < 0.01) and distal (p < 0.01) CBL were significantly higher in the anterior mandible compared with implants in other jaw locations. In the control group, there was no difference in peri-implant PI, GI, PD and CBL around implants placed in both jaws.

CONCLUSION

Wearing tongue piercings could increase the risks of periodontal and peri-implant diseases particularly in the mandibular anterior segment.

Knowledge and Practice Regarding Oral Cancer: A Study Among Dentists in Jakarta, Indonesia

Objective

To assess Indonesian dentists' knowledge of risk factors and diagnostic procedures related to oral cancer (OC) and to determine the factors that influenced their level of knowledge.

Methods

A modified version of a questionnaire that had been used to assess dentists’ knowledge regarding OC in Canada was used. A total of 816 dentists were invited to participate in the study.

Results

The total response rate was 49.2%; however, the number of dentists from 5 regions in Jakarta were equally represented. Use of tobacco or alcohol and history of previous OC were the top 3 risk factors that were answered correctly by dentists, but there was a high proportion of dentists who considered some without any evidence as risk factors. Almost half of the dentists did not know the early signs of OC and that erythroplakia and leukoplakia were associated with increased risks of developing OC. Only about 27% of dentists had a high level of knowledge of risk factors and fewer dentists demonstrated a good knowledge of diagnostic procedures. Dentists’ age group, year of graduation, and experience of continuing education significantly influenced the level of knowledge of diagnostic procedures (P < .05).

Conclusion

Dentists in Jakarta had a considerable level of knowledge of major risk factors of OC, although some gaps in their knowledge, especially in diagnostic procedures, were present. Increasing these competencies may aid in the prevention and early detection of OC.

Knowledge, attitude, and implementation of nicotine replacement therapy by dental and medical interns in Davangere city: A cross-sectional survey

Background:

One of the prime causes of illness and premature death is smoking. Almost 50% of smokers attempt to quit the habit; however, at most, 2%–3% achieve success. The rationale is that innumerable withdrawal attempts are unplanned, and the most effective cessation aids are unacquainted. Nicotine replacement therapy (NRT) is the most common cessation aid. Furthermore, motivation from dental and medical professionals can be effective for patients to quit smoking. The study aimed to assess the knowledge, attitude, and practice regarding the implementation of NRT among dental and medical interns in Davangere city.

Materials and Methods:

A questionnaire-based survey was conducted, which included 442 dental and medical interns from two dental and two medical colleges in Davangere city, Karnataka. The questionnaire included multiple-choice questions regarding knowledge, attitude, and implementation of NRT. The response rate of interns was 93.67%.

Results:

Among dental and medical interns, there was no statistically significant difference in knowledge about NRT with P = 0.976 (P > 0.05). However, a statistically significant difference existed regarding attitude and implementation in the interns about NRT among dental and medical interns with P = 0.001 (P < 0.05). Among dental and medical interns, dental interns had a positive attitude and implementation toward NRT than medical interns.

Conclusion:

The overview implicated that the dental interns had better vision than medical interns; however, both the groups' comprehension concerning NRT is scanty and advocates education about the fundamentals of NRT either via workshop or by continuing dental education programs.

Betel Quid Addiction: A Review of Its Addiction Mechanisms and Pharmacological Management as an Emerging Modality for Habit Cessation

Areca-nut (AN) and added smokeless-tobacco (SLT) are considered agents that may cause addiction to betel-quid (BQ). However, the primary addictive substance in AN is not clearly understood. Objective: The present review evaluates possible addictive chemicals in AN with their mechanisms of action for progression to BQ dependence, as it is essential to overcome barriers in BQ cessation. It also identifies innovative treatment modalities in BQ cessation including the scope for research on pharmacotherapy using Monoamine-oxidase Inhibitors, Selective Serotonin Re-uptake Inhibitors and Norepinephrine Dopamine Reuptake Inhibitors. Methods: This is a narrative review on addictive properties of BQ and trials undertaken to promote cessation of SLT or AN use. Results: Twenty interventional studies, three by behavioral therapy and seventeen using pharmacotherapy were reviewed. There was heterogeneity in reported follow up times, most studies reporting data at 12 weeks with abstinence rates of 45-55% for SLT cessation and at 8 weeks with abstinence rates around 35% for AN cessation. Conclusion: Even though literature reveals a few cessation programs through behavioral support for BQ addiction, its success has been limited in certain instances mainly due to addictive properties of AN, resulting in withdrawal and relapse. Hence, in line with pharmacotherapy in tobacco smoking cessation, potential pharmacological agents to assist in cessation of SLT and AN require more attention. Several clinical trials for SLT cessation have been carried out with varying levels of success using Nicotine Replacement Therapy and Varenicline while trials on antidepressants for SLT and AN cessation are also emerging.

Management of recurrent apthous ulcer using Corticosteroids, Local anesthetics and nutritional supplements

Recurrent Aphthous ulcers are the most common oral lesions among dental patients. The ulcers, which usually occur on the nonkeratinized oral mucosa, can cause considerable pain and may interfere with eating, speaking, and swallowing. Therefore, it is of interest to report data on the management of recurrent aphthous ulcer using corticosteroids, local anesthetics and nutritional supplements. Case sheets of 76 patients who underwent treatment for recurrent aphthous ulcer between June 2019 and March 2020 at the Saveetha Dental College, India were used in this analysis. Data was analyzed using Chi square test at a P value < 0.05 that is statistically significant. Results show that topical anaesthetics in population (49%) were more effective that corticosteroids. Thus, topical anaesthetics are recommended for recurrent aphthous ulcer.

Head and neck squamous cell carcinoma

Most head and neck cancers are derived from the mucosal epithelium in the oral cavity, pharynx and larynx and are known collectively as head and neck squamous cell carcinoma (HNSCC). Oral cavity and larynx cancers are generally associated with tobacco consumption, alcohol abuse or both, whereas pharynx cancers are increasingly attributed to infection with human papillomavirus (HPV), primarily HPV-16. Thus, HNSCC can be separated into HPV-negative and HPV-positive HNSCC. Despite evidence of histological progression from cellular atypia through various degrees of dysplasia, ultimately leading to invasive HNSCC, most patients are diagnosed with late-stage HNSCC without a clinically evident antecedent pre-malignant lesion. Traditional staging of HNSCC using the tumour-node-metastasis system has been supplemented by the 2017 AJCC/UICC staging system, which incorporates additional information relevant to HPV-positive disease. Treatment is generally multimodal, consisting of surgery followed by chemoradiotherapy (CRT) for oral cavity cancers and primary CRT for pharynx and larynx cancers. The EGFR monoclonal antibody cetuximab is generally used in combination with radiation in HPV-negative HNSCC where comorbidities prevent the use of cytotoxic chemotherapy. The FDA approved the immune checkpoint inhibitors pembrolizumab and nivolumab for treatment of recurrent or metastatic HNSCC and pembrolizumab as primary treatment for unresectable disease. Elucidation of the molecular genetic landscape of HNSCC over the past decade has revealed new opportunities for therapeutic intervention. Ongoing efforts aim to integrate our understanding of HNSCC biology and immunobiology to identify predictive biomarkers that will enable delivery of the most effective, least-toxic therapies.

Alternative Tobacco Product Use in Critically Ill Patients

Background: Alternative tobacco product (ATP) use has bee linked to critical illness, however, few studies have examined the use of these substances in critically ill populations. We sought to examine ATP use within critically ill patients and to define barriers in accurately assessing use within this population. Methods: We prospectively studied 533 consecutive patients from the Early Assessment of Renal and Lung Injury study, enrolled between 2013 and 2016 at a tertiary referral center and a safety-net hospital. ATP use information (electronic cigarettes, cigars, pipes, hookahs/waterpipes, and snus/chewing tobacco) was obtained from the patient or surrogate using a detailed survey. Reasons for non-completion of the survey were recorded, and differences between survey responders vs. non-responders, self- vs. surrogate responders, and ATP users vs. non-users were explored. Results: Overall, 80% (n = 425) of subjects (56% male) completed a tobacco product use survey. Of these, 12.2% (n = 52) reported current ATP use, while 5.6% reported using multiple ATP products. When restricted to subjects who were self-responders, 17% reported ATP use, while 10% reported current cigarette smoking alone. The mean age of ATP users was 57 ± 17 years. Those who did not complete a survey were sicker and more likely to have died during admission. Subjects who completed the survey as self-responders reported higher levels of ATP use than ones with surrogate responders (p < 0.0001). Conclusion: ATP use is common among critically ill patients despite them being generally older than traditional users. Survey self-responders were more likely than surrogate responders to report use. These findings highlight the importance of improving our current methods of surveillance of ATP use in older adults in the outpatient setting.

Interventions to prevent periodontal disease in tobacco-, alcohol-, and drug-dependent individuals

Substance abuse affects more than one sixth of the world's population. More importantly, the nature of the abuse and the type of addictive substances available to individuals is increasing exponentially. All substances with abusive potential impact both the human immuno-inflammatory system and oral microbial communities, and therefore play a critical role in the etiopathogenesis of periodontal diseases. Evidence strongly supports the efficacy of professionally delivered cessation counseling. Dentists, dental therapists, and hygienists are ideally placed to deliver this therapy, and to spearhead efforts to provide behavioral and pharmacologic support for cessation. The purpose of this review is to examine the biologic mechanisms underlying their role in disease causation, to understand the pharmacologic and behavioral basis for their habituation, and to investigate the efficacy of population-based and personalized interventions in prevention of periodontal disease.

Effect of tobacco in human oral leukoplakia: a cytomorphometric analysis

Objectives

Tobacco use is one of the most critical risk factors for different oral diseases. The aim of this study is to demonstrate the effect of tobacco on oral mucosa by cytomorphometric analysis of cells with the help of exfoliative cytology and to find out the improvement in diagnostic sensitivity of exfoliative cytology in the detection of dysplastic changes and early oral malignancy.

Methods

The nuclear area (NA) and cytoplasmic area (CA) of cells were measured within cytological smear obtained from leukoplakia lesions of buccal mucosa of 90 tobacco users, 30 smokers (TS), 30 chewers (TC) and 30 with combined habit of smoking and chewing (TSC) and from normal buccal mucosa of 30 non users (NU) of tobacco. Each habit group consisted of 30 tobacco users with oral leukoplakia lesion with mild epithelial dysplasia only. The 30 non-users of tobacco served as controls. The mean values of the CA and NA were obtained for each case, and the nuclear/cytoplasmic area (NA/CA) ratio was calculated.

Results

The results showed a statistically significant increase (P<0.001) in mean NA and a statistically significant decrease (P<0.001) in mean CA values of tobacco users with leukoplakia as compared to non-users, hence NA/CA ratio value was significantly higher in tobacco users with the lesion.

Conclusion

The changes in cellular morphology caused by tobacco use can be visualized by use of exfoliative cytology with the help of cytomorphometric analysis. The evaluation of parameters (NA, CA and NA/CA ratio) may increase the sensitivity of exfoliative cytology for the early diagnosis of oral premalignant and malignant lesions.

Smokeless tobacco use and related oral mucosal changes in Bengali Women

BACKGROUND

Tobacco use is called the single most cause of preventable cause of death all over the world. The various study confirmed that smokeless tobacco use is directly related to oral cancer and pre-cancer. The prevalence of smokeless tobacco use varies widely in different countries and states based on age group, gender, with varied socioeconomic, cultural and educational backgrounds.

CONTEXT

Bengali female population.

AIM

Explore the pattern of smokeless tobacco use and oral mucosal changes caused by it.

METHODS

155 women aged 15 years and above were selected. Face-to-face interview was conducted using a structured questionnaire. Data were summarized and statistically, analysis was done.

STATISTICAL ANALYSIS USED

Chi-square test and univariate logistic regression done.

RESULTS

The prevalence of current smokeless tobacco use was found to be 18.7%. On univariate logistic regression, it was found that there was a significant association between smokeless tobacco use and less educated females, odds ratio 0.4209 (0.1855-0.9550) family income less than 10,000, odds ratio 3.9773 (1.3047-12.1242), and oral changes odds ratio 0.2693 (0.1027-0.7061).

CONCLUSIONS

Health care providers, as well as social workers, should give all efforts to bring the women from behind the curtain and educate them about the hazards of smokeless tobacco use.