Various forms of tobacco usage and its associated oral mucosal lesions

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.

Occurrence of Oral Premalignant Lesions Among Tobacco Users in a Tribal Population: A Systematic Review and Meta-Analysis

This review aimed to comprehensively assess the association between tobacco use and oral health outcomes, specifically the presence of premalignant lesions (PMLs), through a synthesis of multiple assessments conducted in diverse populations. A systematic search of relevant literature was performed, and studies meeting the inclusion criteria were selected using appropriate Medical Subject Headings (MeSH) words and Boolean operators. Data from these studies was pooled and analysed using Review Manager 5.4 (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen). The Newcastle-Ottawa scale was used to assess the methodological quality of the studies included. The pooled analysis of the five selected papers revealed a significant correlation between tobacco use and an increased prevalence of PMLs among tobacco users. Tobacco users had an odds ratio of 15.22 (95% CI: 10.01-23.15) as compared to non-user cohorts, significant at p 0.0001. This comprehensive synthesis of assessments underscores the detrimental impact of tobacco use on oral health, particularly in terms of potentially malignant lesions. The findings emphasise the urgency of targeted public health interventions to address tobacco consumption and promote oral health awareness, especially in populations with high tobacco consumption rates. Standardisation of methodologies and representation of diverse populations in future research would strengthen the evidence base and facilitate more effective strategies to improve oral health outcomes globally.

Promotion of the resistance of human oral epithelial cells to herpes simplex virus type I infection via N6-methyladenosine modification

OBJECTIVE

This study aimed to explore the mechanism behind N6-methyladenosine (m6A) modification of the total ribonucleic acid (RNA) involved in the resistance to herpes simplex virus type I (HSV-1) infection in oral epithelial cells.

METHOD

The variation in m6A modification level on messenger RNA following HSV-1 infection was determined using the RNA dot blot method. The expression levels of alpha-ketoglutarate-dependent dioxygenase lab homolog 5 (ALKBH5) protein and fatty mass and obesity-associated genes (FTO) were determined using real-time fluorescence quantification polymerase chain reaction and the western blot technique, respectively. Next, after suppressing the expression of ALKBH5 or FTO via small interfering RNA, human immortalised oral epithelial cells (HIOECs) were infected with HSV-1, followed by measurement of the viral load or expression level of type I interferon (I-IFN) and interferon-stimulated genes (ISGs).

RESULTS

The m6A modification level was significantly increased following HSV-1 infection of the HIOECs (P < 0.05), while the expression of ALKBH5 and FTO genes was reduced (P < 0.01). Moreover, the suppression of ALKBH5 or FTO increased the production of I-IFN and ISGs during the HSV-1 infection of the HIOECs (P < 0.01), and the viral load was significantly reduced (P < 0.01).

CONCLUSION

During oral HSV-1 infection, the m6A level was increased through the down-regulation of ALBHK5 and FTO expression, increasing I-IFN production and the promotion of HSV-1 clearing in HIOECs.

Prevalence of precancerous lesions and conditions in India: A systematic review and meta-analysis

BACKGROUND

Smoking and chewing tobacco are associated with numerous oral mucosal lesions and conditions, often leading to cancer progression.

AIM

To investigate the prevalence of precancerous lesions and conditions among the Indian population.

METHODS

Systematic search was conducted for population or community-based observational epidemiological studies in PubMed, EMBASE, Web of Science, IndMED, Google Scholar, reports of the WHO South-East Asia Region, MOHFW India reports, Science Citation Index, WHO Index Medicus of the South-East Asian Region, Reference Citation Analysis (https://www.referencecitationanalysis.com/) and Open Grey from the earliest available up to 31^st January 2022. The effect size was calculated for the prevalence of precancerous lesions and conditions.

RESULTS

One hundred sixty-two estimates from 130 studies yielded 52 high, 71 moderate, and seven low-quality studies from 823845. Point estimate based on cross-sectional studies for leukoplakia was 4.3% (95%CI: 4.0-4.6), oral submucous fibrosis was 2.7% (95%CI: 2.5-3.0), palatal lesions in reverse smokers and nicotine palatine were 5.8% (95%CI: 4.4-7.2), and Erythroplakia was 1.2% (95%CI: 0.7-1.7), and lichen planus was 1.1% (95%CI: 0.9-1.2). Amongst hospital-based studies, the pooled prevalence for Leukoplakia was 6.7% (95%CI: 6.0-7.3), oral submucous fibrosis was 4.5% (95%CI: 4.2-4.9), lichen planus was 7.5% (95%CI: 5.3-9.6), and erythroplakia was 2.5% (95%CI: 0.4-4.5), and palatal lesions in reverse smokers and nicotine palatini were 11.5% (95%CI: 8.0-15.0).

CONCLUSION

Precancerous lesions and conditions are prevailing problems among the Indian population. It is mainly due to tobacco use, the smokeless form of tobacco. The meta-analysis indicates that hospital-based studies have a higher effect size of 6.7% than community-based studies. Patients who have already developed this condition may be advised to reduce their exposure to the risk factor to prevent the condition from progressing further.

Identification & correlation of bacterial diversity in oral cancer and long-term tobacco chewers- A case-control pilot study

Introduction. Squamous cell carcinoma is a highly aggressive type of oral cancer (OC). It is the most common cancer among men, and accounts for almost 90 % of all oral cancers in India. Consumption of tobacco is a leading factor contributing to maximum oral cancer incidences as per the WHO.Hypothesis/Gap statement. Researchers reported a direct association of microorganisms with dysbiosis in various oral lesions including oral cancer. However, there is a dearth of information related to compositional changes in the oral microbiome in long-term tobacco chewers and the Indian oral cancer population.Aim. The aim of this study was to identify and correlate the bacterial diversity in the oral cavity of tobacco chewers, patients with oral cancer and healthy subjects in the Indian population.Methods. Oral rinse samples were collected for ten subjects in each group followed by DNA extraction. The variable regions of the bacterial 16S rRNA gene (V6-V8) were amplified, sequenced, processed, and analysed using QIIME2 platform to assess alpha and beta diversity between the study groups.Results. This pilot study showed genus Streptococcus dominated the control group (18.54 %), and the abundance decreased in tobacco and OC group (9.63 and 5.45% respectively); whereas genus Prevotella dominated the tobacco and OC group (21.01 and 26.03% respectively). A shift in abundance of microbiome was observed from control population to oral cancer via the tobacco chewing population. Maximum alpha diversity of oral microbiome was found in Indian tobacco chewers. Beta diversity of tobacco chewers was similar to both the healthy population as well as oral cancer patients suggesting transitioning of the oral microbiome from healthy to oral cancer microbiome via the tobacco chewers microbiome.Conclusion. The data provides evidence of oral bacterial dysbiosis due to tobacco chewing habits that can further lead to progression towards cancer.

Evaluation of DNA damage in tobacco associated human buccal cells using comet assay

Aim and objective

To assess the DNA damage in tobacco associated human buccal cells using comet assay.

Methods

The study included 75 study subjects, which were divided into 3 groups on the basis of tobacco usage. Group I - 25 individuals with no history of tobacco usage, Group II - 25 individuals with tobacco usage but without oral lesions and Group III - 25 individuals with tobacco associated oral lesions. Cytological smears collected from these individuals were used to assess the tobacco associated DNA damage by measuring the tail length in the comet assay method.

Results

The average tail length was found to be 1.46 μm in the normal mucosa, 2.86 μm in tobacco users without oral lesions, 3.86 μm in the lesional sites of tobacco users and 3.67 μm in the non-lesional sites of these individuals. Factors like age, gender, duration and different forms of tobacco habit had their own impact on the oral mucosa.

Conclusion

Comet assay helps assess the subclinical genetic changes of oral mucosa even before the clinical manifestations of the precancerous lesions appeared due to tobacco usage. Thus, comet assay may bloom out as a novel adjuvant tool for the prevention of oral cancer in the near future.

Modern view on mechanisms of epithelium differentiation of the oral mucosa in normal and pathological processes

Background:In everyday clinical practice, patients who seek dental care in case of oral mucosa diseases are one of the most difficult categories of patients due to difficulties in diagnosis and treatment. Materials and methods: The review and analysis of scientific and medical literature based on the Scopus, Web of Science, MedLine, PubMed, NCBI databases, the study of which does not exceed 5 years, including literature reviews and the results of clinical trials. Results: Changes in the oral mucosa can be clearly specific. Clinicians can make the correct diagnosis and determine the tactics of treatment by appearance. However, in most cases the diagnosis of diseases with this anatomical location is complicated, because the clinical picture is nonspecific and often burdened with additional local and general adverse factors. A detailed clinical examination and additional research methods are required to establish the correct diagnosis. Diagnosis of oral mucosa diseases is based on a careful assessment of clinical and laboratory data. Conclusions: Taking into account the prevalence of diseases of the oral mucosa, of particular interest is the question of the course of the process of differentiation of the epithelium of various anatomical zones in the norm and the mechanisms of restructuring of the cellular composition in pathological processes, with the cops of objectifying the diagnosis, predicting the course of the disease and pathogenetically substantiated treatment.

Smokeless Tobacco Products (STPs) Harbour Bacterial Populations with Potential for Oral Carcinogenicity

INTRODUCTION

Smokeless Tobacco Products (STPs) vary significantly in their carcinogenicity, a feature accredited to the variation in the concentrations of carcinogenic chemicals. Tobacco associated bacteria are known to produce Tobacco-specific N-nitrosamines (TSNAs) and hence are determinants of TSNA levels in Tobacco. The primary objective of this study was to conduct a microbiological survey of STPs and to provide a baseline information of the bacterial communities present in the STPs.

MATERIALS AND METHODS

The present study analyzed the constituency of microbial communities in 7 different smokeless Tobacco products including four chewable (T1_CW to T4_CW), two snus (T5_Snus and T6_Snus) and one snuff sample (T7_Snuff) using high-throughput sequencing of the 16S rRNA based next generation sequencing. The Tobacco samples were also analyzed for pH and moisture content. Statistical analysis of the data obtained was done using SPSS software version 20. Pearson's Correlation was done to analyze the correlation between pH and moisture content of the Tobacco samples.

RESULTS

A total of 11 phyla were identified in all smokeless Tobacco products. A total of 36 classes were identified across all smokeless Tobacco products and bacilli was the predominant class in all the products followed by Actinobacteria and Bacteroidia. In species level, a total of 2369 species were identified across all smokeless Tobacco products. In T1 chewable Tobacco products, predominant species was staphylococcus whereas in T2 and T3, Bacillus subtilis and pumilus were predominant. In T4 chewable Tobacco product, Virgibacillus was predominant followed by halodentrificans, staphylococcus epidermidis. In snus 1 and 2, Bacillus pumilus and subtilis were predominant. In snuff, Bacillus cereus was predominant. Snus products had the highest moisture content (15.4% and 14.3%) compared to the chewable Tobacco and snuff products. The snus products analyzed had alkaline values (pH 8.50 and 8.15) and snuff and chewable Tobacco had acidic values ranging from 5.62 to 6.09.

CONCLUSION

The current study demonstrates that ST products differ qualitatively, quantitatively, and in their bacterial composition. There is a possibility that some of these species may contribute to oral carcinogenesis, either by influencing levels of TSNAs or directly inducing chronic inflammation.

Global Prevalence of Tobacco Use in Adolescents and Its Adverse Oral Health Consequences

BACKGROUND:

Smoking is associated with various systemic conditions and contributes to a huge financial burden to economies around the world.

AIM:

The study aimed to evaluate global data about the prevalence of tobacco use among male and female adolescents and to discuss smoking-related oral complications.

METHODS:

The prevalence data of tobacco use among adolescents (13-15 years) was retrieved from the World Health Organization (Global Health Observatory). The World Bank’s statistics about gross national income (GNI) per capita were used to categorise low-income, lower-middle-income, upper-middle-income, and high-income countries. PubMed, Web of Science, Scopus, and Embase databases were searched to gather updated evidence about the adverse consequences of smoking on oral health among adolescents.

RESULTS:

The prevalence of tobacco use was 19.33%, and there were 23.29% of male and 15.35% female smoker adolescents in 133 countries (p < 0.001). The highest prevalence of tobacco use in male (24.76%) and female (19.4) adolescents was found in high-income countries. Significantly higher proportions of male adolescents were smokers than female counterparts in low-income, lower-middle-income, and upper-middle-income (p < 0.001). However, there were no statistically significant differences in tobacco use between male and female adolescents in high-income countries. Low-income countries had the lowest prevalence (14.95%) of tobacco use, while high-income countries had the highest prevalence estimates (22.08). Gingivitis (72.8%), gingival bleeding (51.2%), oral malodor or halitosis (39.6%) is common oral conditions among smoker adolescents. Smoking habit is significantly associated with dental caries, periodontal disease, hairy tongue, smoking-related melanosis, and hyperkeratosis among adolescents.

CONCLUSION:

There was a high prevalence of tobacco use among male and female adolescents around the globe. Available evidence suggests a strong association between smoking and compromised oral health among adolescents. Globally, measures should be taken to prevent and control the menace of tobacco use to reduce systemic and oral complications.

Prevalence of periodontal status among nicotine dependent individuals of 35-44 years attending community dental camps in Ghaziabad district, Uttar Pradesh

Background:

Tobacco is the second driving reasons for mortality worldwide and its broad utilization in the smoking and smokeless form have added to the expanding weight of non-communicable disease.

Aim:

To study the prevalence of periodontal status among nicotine dependent individuals of 35-44 years attending community dental camps in Ghaziabad District, Uttar Pradesh.

Methods:

A cross-sectional study was conducted on 800 individuals with the age range of 35-44 years. A pre-tested questionnaire was used to gather information about the sociodemographic profile and the pattern of substance use. Fagerstrom Test for Nicotine Dependence-Smokeless Tobacco (FTND-ST) and for smokers; Fagerstrom Test for Nicotine Dependence (FTND) for testing dependence. Periodontal status was assessed by Community Periodontal Index (Modified CPI WHO 2013) and loss of attachment (LOA). Statistical analysis was done by the Statistical Package for Social Sciences (SPSS) version 20.0.

Result:

The prevalence of periodontal disease was found to be 78.5% with maximum disease prevalence among males of 42-44 age. Majority of male consumed a smokeless form of tobacco (50.23%), followed by smoke (14.19%) form whereas females predominantly consumed smokeless form (37.36%). The mean number of teeth with pocket (3.37 ± 1.86) and mean of loss of attachment of more than 9 mm (0.67 ± 0.88) was higher among smokeless form of tobacco users as compared to other habit groups

Conclusion:

Higher prevalence of periodontal disease was seen among nicotine dependent individuals. A model for a comprehensive program in the dental office including the five A's and five R's for tobacco counseling must be applied at every institute.

Evaluation of the Prevalence of Oral Mucosal Lesions in a Population of Eastern Coast of South India

Objective/Aim

The aim of this study is to measure the association between oral mucosal lesions (OMLs) and habit of tobacco and alcohol in the population of Guntur city, Andhra Pradesh, South India.

Material and Method

A cross-sectional study was conducted on 300 participants in Guntur city with the habit of tobacco and alcohol consumption in various forms who were selected by stratified cluster random sampling technique. Guntur city was divided into four zones, that is, North, East, South, and West; and two administrative wards were randomly selected from each zone as clusters. Information was obtained by interviewing the participant regarding various tobacco-related habits followed by standardized clinical examination in the field. Clinical data were collected using a modified 1980 WHO Pro forma where the basis for diagnosis was established as per the criteria provided by the epidemiology guide for the diagnosis of oral mucosal diseases (WHO). Statistical tests such as Pearson Chi-square were exercised to test the significance, using SPSS version 19.0 with 0.05 as cutoff level of significance.

Results

Overall oral soft-tissue lesions were found in 42.4% of the study participants including nicotinic stomatitis, tobacco pouch keratosis, smokers melanosis, mild keratosis of the palate, and chewer's mucosa. In this study, nicotinic stomatitis was found to be the most common soft-tissue lesion among men, while leukoplakia was found to be the most common premalignant lesion with the prevalence being 5.7%. While oral submucous fibrosis was found to be the most common premalignant condition among women. It was found that 13.2% of illiterates (53) were having leukoplakia. In the present study, the lower labial mucosa and buccal mucosa were found to be the most common sites of occurrence of leukoplakia and oral submucous fibrosis.

Conclusion

This study gives information on the association of OML in smokers, chewers, alcoholics, and those with mixed habits. This study highlighted six habit-related OML which included potentially malignant disorders such as leukoplakia and oral submucous fibrosis. Future case-control or cohort studies for individual lesions and with larger sample size are necessary to evaluate the risk for OML including potentially malignant conditions and oral cancer resulting from smoking and chewing habits.

Prevalence of Oral Mucosal Lesions among Dental Patients with Mixed Habits in Salem District - A Study

BACKGROUND

The practice of betel nut chewing with or without tobacco is still practiced in south india, salem inspite of its harmful effects.

METHODOLOGY

200 Patients visiting the outpatient department, Oral medicine and radiology from Aug 2015 to Aug 2016.

RESULT AND CONCLUSION

In our study, 3 women were exclusively churut smokers. Thirty-eight percent of the dental patients were beedi smoker, 32% were tobacco chewers, 12% were both betel nut and tobacco chewers, 8% were exclusively betel nut chewers, 1% of the dental population were exclusively churut smokers. Mean age group of the study population is 50.2 (14.4). There are 28 females and 172 males in the study group. Chi-square test revealed a statistically significant difference (P = 0.001) between males and females based on soft-tissue findings and no statistically significant difference (P = 0.572) between males and females based on distribution of hard-tissue findings.

Effect of Frequency and Duration of Tobacco Use on Oral Mucosal Lesions – A Cross-Sectional Study among Tobacco Users in Hyderabad, India

Purpose: Tobacco use is one of the most important risk factors for the development of oral mucosal lesions including oral pre-cancer and cancer. The type and location of the lesion varies with the type of tobacco used, the way it is used, and the frequency and duration of use. Hence, the present study aimed to determine the effect of frequency and duration of tobacco use on oral mucosal lesions among tobacco users in Hyderabad city. Materials and Methods: A cross-sectional study was carried out among 280 tobacco users who were categorized into smokers, chewers and mixed groups according to the habit. One forty subjects diagnosed with Oral Mucosal Lesions, designated as cases and One forty lesion free controls, frequency matched for age, gender, habit and family income were assessed. The study protocol included a visual oral soft tissue examination and a questionnaire-based interview. Statistical analysis was done using Chi square test and t- test. Multiple logistic regression analysis was done to assess the association of the variables with lesions. Results: Oral submucous fibrosis (18%) was the most common oral mucosal lesion followed by Leukoplakia (14%) and Smoker’s palate (12%). Dose-response relationships were observed for both duration and frequency of habits on the risk of oral mucosal lesions. However, it was significant only for frequency of the habit. A significant positive correlation was observed between occurrence of lesion and those with no education (p=0.005). Conclusion: The study revealed that frequency and duration of tobacco use was associated with the risk of oral mucosal lesions.