Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 19  |  Issue : 1  |  Page : 61-64

An 8-year retrospective analysis of oral submucous fibrosis in patients visiting dental College, Secunderabad


1 Department of Public Health Dentistry, Army College of Dental Sciences, Secunderabad, Telangana, India
2 Department of Oral Pathology, Army College of Dental Sciences, Secunderabad, Telangana, India

Date of Submission17-Mar-2020
Date of Acceptance10-Feb-2021
Date of Web Publication31-Mar-2021

Correspondence Address:
Vedati Prathima
B/14, Plot No 33, SBH, Krishnapuri Colony, West Marreddpally, Secunderabad, Telangana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_34_20

Rights and Permissions
  Abstract 


Background: Oral submucous fibrosis (OSMF) is a chronic, progressive, scarring precancerous condition of the oral cavity seen predominantly in the Indian subcontinent and South East Asia. In India, the prevalence of OSMF has been increased over the past four decades from 0.03% to 6.42%. Aim: The study aims to provide an 8-year retrospective analysis of OSMF in patients visiting dental college, Secunderabad. Materials and Methods: A retrospective analysis was conducted from 2008 to 2016 in dental college, Secunderabad. Data were collected from patient's outpatient records from the department of oral medicine and radiology, year wise in the perspective of demographic details, history of nutritional deficiency, adverse habits, symptoms, clinical features, site involved, and mouth opening. There were no inclusion or exclusion criteria. All the cases which were provisionally diagnosed to be OSMF were included. The data were analyzed with SPSS package version 24. Chi-square test has been applied to check the association of different parameters such as gender, nutritional deficiency, adverse habits, area, palpable fibrous bands, and mouth opening with age. P < 0.05 was considered statistically significant. Results: The total patients were found to be 107. The mean age of the patients was 38 ± 12. Among the total patients, 86% were males and 14% were females. Among them, 3.7% were unskilled workers. Almost all of them (99%) reported no nutritional deficiency. Majority (51.4%) were having betel nut chewing habit, followed by tobacco chewing, intake of spicy food, smoking, and alcohol. Nearly 43% had limited mouth opening, followed by burning sensation and other symptoms. Palpable fibrous bands were present in 4.1% of the patients. Nearly 83.2% have been affected with OSMF in the buccal mucosa site. Grade 1 (>20 mm) mouth opening was present in 12.1% of the patients, 7.5% were having Grade 2 (11–19 mm), and 3.7% had Grade 3 (<10 mm) mouth opening. A significant association was found between age and adverse habits (P = 0.023). There was no significant association between age and sex (P = 0.924), nutritional deficiency (P = 0.766), area (P = 0.567), palpable fibrous bands (P = 0.221), and mouth opening (P = 0.155). Conclusion: Majority of the patients with OSMF were males who were < 30 years, having betel nut chewing habit and Grade 1 mouth opening.

Keywords: Betel nut, oral submucous fibrosis, premalignant condition, retrospective statistical analysis


How to cite this article:
Prathima V, Koneru M, Sunil VV, Jois H, Reddy M. An 8-year retrospective analysis of oral submucous fibrosis in patients visiting dental College, Secunderabad. J Indian Assoc Public Health Dent 2021;19:61-4

How to cite this URL:
Prathima V, Koneru M, Sunil VV, Jois H, Reddy M. An 8-year retrospective analysis of oral submucous fibrosis in patients visiting dental College, Secunderabad. J Indian Assoc Public Health Dent [serial online] 2021 [cited 2021 Apr 17];19:61-4. Available from: https://www.jiaphd.org/text.asp?2021/19/1/61/312641




  Introduction Top


India is considered “an epitome of the world” due to its vast population comprising diverse creeds, customs, and colors. Oral cancer in India is a major health problem. Studies which have been done worldwide on oral cancer have shown the annual incidence of 3,000,000 cases. General predisposing factors for oral carcinoma include alcohol, tobacco use and smokeless tobacco, betel nut chewing, and human papillomavirus. Poor dental care and poor diet may also contribute to oral cancer.[1] Premalignant condition like oral submucous fibrosis (OSMF) which is commonly seen in India plays an important contribution in transformation to malignant conditions. OSMF is a chronic, progressive, scarring precancerous condition of the oral cavity seen predominantly in the Indian subcontinent and South East Asia.[2] In India, the prevalence of OSMF has been increased over the past four decades from 0.03% to 6.42%.[3],[4] Studies on OSMF report an estimate of 5 million OSMF patients in India.[5] OSMF is seen commonly in males between the ages of 20 and 40 years. The common sites involved are buccal mucosa, labial mucosa, retromolar pads, soft palate, and floor of the mouth. Early symptoms of OSMF include burning sensation, hypersalivation/xerostomia, and mucosal blanching.[6] Then later, submucosal fibrosis leads to stiffness of the oral mucosa and deeper tissues with progressive limitation in opening of the mouth and protrusion of the tongue, thus causing difficulty in eating, swallowing, and phonation. Clinically, the mucosa appears blanched and opaque and fibrous bands are palpable in the buccal mucosa.[7] The pathogenesis of OSMF is multifactorial and enigmatic. The etiological factors implicated are excessive chilly consumption, areca nut chewing, Vitamin B complex and iron deficiency, autoimmunity, and genetic and environmental factors. However, the most consistent factor identified through epidemiological studies is areca nut consumption in the form of quid.[6],[8],[9] With the advancement of disease, there is a high risk of malignant transformation leading to poor prognosis.[7] The present retrospective analysis was hence conducted to provide an 8-year retrospective statistical analysis of OSMF in patients visiting a dental college, Secunderabad.


  Materials and Methods Top


A retrospective analysis was conducted for 1 month in a dental college in Secunderabad. Data were collected by two investigators from patient's outpatient records from 2008 to 2016 from the department of oral medicine. The total patients were found to be 107. Data were collected year wise in the perspective of demographic details, history of nutritional deficiency, adverse habits, symptoms, clinical features, site involved, and mouth opening. All the cases which were provisionally diagnosed to be OSMF were included. Ethical clearance was obtained from the Institutional Review Board of Army College of Dental Sciences. The data were analyzed with SPSS package version 24. Chi-square test has been applied to check the association of different parameters such as gender, nutritional deficiency, adverse habits, area, palpable fibrous bands, and mouth opening with age.


  Results Top


The total patients were found to be 107. The mean age of the total patients was 38 ± 12. Among the total patients, 86% were males and 14% were females [Table 1]. Majority 87.9% of their occupation is not known. Among the known majority (3.7%) were unskilled workers [Table 1]. Nearly 28% belonged to rural area and 13.1% to urban area [Table 1]. Almost all of them (99.1%) reported no nutritional deficiency [Table 1]. Among the total patients, majority (51.4%) were having betel nut chewing habit, followed by tobacco chewing, intake of spicy food, smoking, and alcohol [Figure 1]. Greater than 40% had limited mouth opening, followed by burning sensation and other symptoms [Figure 2]. Majority that is 84.1% had fibrous band palpable [Table 1]. Greater than 80% has been affected with OSMF in the buccal mucosa site [Figure 3]. Nearly 12.1% had Grade 1 (>20 mm) mouth opening, 7.5% were having Grade 2 (11–19 mm), and 3.7% had Grade 3 (<10 mm) mouth opening [Table 1].
Table 1: Distribution of study participants based on gender, occupation, area, nutritional deficiency, palpable fibrous bands, and mouth opening in relation to oral submucous fibrosis

Click here to view
Figure 1: Distribution of the study participants based on adverse habits

Click here to view
Figure 2: Distribution of the study participants based on symptoms

Click here to view
Figure 3: Distribution of the study participants based on site of oral submucous fibrosis

Click here to view


A significant association was found between age and adverse habits (P = 0.023). There was no significant association between age and sex (P = 0.924), nutritional deficiency (P = 0.766), area (P = 0.567), palpable fibrous bands (P = 0.221), and mouth opening (P = 0.155) [Table 2].
Table 2: Association of gender, nutritional deficiency, adverse habits, area, palpable fibrous bands, and mouth opening with age

Click here to view



  Discussion Top


OSMF is a chronic, progressive, scarring precancerous condition of the oral cavity seen predominantly in the Indian subcontinent and South East Asia. The data reveal that the total patients with OSMF were found to be 107 during a period from 2008 to 2016, whereas in a study conducted by Nooni,[7] the total patients were found to be 70 during a period from January 2013 to December 2015. In a study conducted by Owais Gowhar et al.,[1] 32% were OSMF cases. In a study conducted in Nepal by Mantu and Mitra,[10] a total of 1200 patients reported in the OPD in the period between January 2017 to June 2017. Out of the total OPD, 589 patients were diagnosed with OSMF.

The mean age of the total patients was 38 ± 12. In a study conducted by Nooni,[7] the average age was found to be 18 years. Gupta and Ray[11] found in their study that consumption of gutka and tobacco was higher among the younger age group in Asian countries.

Among the total patients, 86% were males and 14% were females. In a study conducted by Nooni,[7] males were 60% and females were 40%; this suggests a higher incidence of disease in males.

In the present study, 3.7% were unskilled workers [Table 1], whereas in a study done by P. N. Wahi et al.,[12] the patients belonged to various occupational groups such as farmers, laborers, clerks, government officials, and technical personal and none of the occupations predominated to a significant extent.

In the present study, nearly 28% belonged to rural area and 13% to urban area [Table 1]. Almost all of them (99%) reported no nutritional deficiency [Table 1], whereas in a study done by P. N. Wahi et al.,[12] multiple vitamin deficiencies were noticed in cases of OSMF.

Among the total patients, majority (51.4%) were having betel nut chewing habit, followed by tobacco chewing, intake of spicy food, smoking, and alcohol [Figure 1]. Oakley et al.[13] in the region of the Mariana Islands also found a higher rate of disease in teenagers which was correlated to increase the consumption of areca nut preparation in their high school. In a study conducted by Kelusker and Kale,[14] among males, maximum were tobacco chewers, followed by bidi smokers and cigarette smokers.

Greater than 40% had limited mouth opening followed by burning sensation and other symptoms [Figure 2]. 84.1% had palpable fibrous bands [Table 1]. In a study conducted by Nooni,[7] 97% of the patients presented with burning sensation followed by 93% of the patients with a complaint of limited mouth opening and dryness of the mouth. In a study done by Misra et al.,[15] patients reported trismus, inability to open mouth, and protruding tongue in OSMF cases.

Majority 83.2% have been affected with OSMF in the buccal mucosa site [Figure 3]. In the study conducted by Nooni,[7] 73% of the patients were affected with OSMF in the palate region, followed by buccal mucosa and lips.

Nearly 12.1% had Grade 1 (>20 mm) mouth opening, 7.5% were having Grade 2 (11–19 mm), and 3.7% had Grade 3 (<10 mm) mouth opening [Table 1], whereas in a study conducted by DR. Karuna Nooni,[7] 57% had Grade 3 mouth opening and 36% Grade 2.

Limitations

  • OSMF was diagnosed only on provisional diagnosis but not on histopathological finding
  • Nutritional deficiency was assessed based on medical history.



  Conclusion Top


The total patients with OSMF were found to be 107 during a period from 2008 to 2016. Majority belonged to rural area. Almost all of them (99%) reported no nutritional deficiency. Greater than 50% were having betel nut chewing habit, followed by tobacco chewing, intake of spicy food, smoking, and alcohol. Lesser than 50% had limited mouth opening, followed by burning sensation and other symptoms. More individuals had palpable fibrous bands and have been affected with OSMF in the buccal mucosa site. Majority of them had Grade 1 mouth opening. A significant association is found between age and adverse habits.

Acknowledgment

I acknowledge Dr. N. Bala Krishna, Head, Department of Biostatistics, Apollo Hospital Education Research Foundation, Hyderabad, for statistical inputs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gowhar O, Ain ST, Singh NN, Sultan S. Prevalence of oral premalignant and malignant lesions in Moradabad, India – A retrospective study. Int J Contemp Med Res 2016;3:2079-81.  Back to cited text no. 1
    
2.
Ranganathan K, Devi MU, Joshua E, Kirankumar K, Saraswati TR. Oral submucous fibrosis: A case control study in Chennai, South India. J Oral Pathol Med 2004;33:274-7.  Back to cited text no. 2
    
3.
Pindborg JJ, Mehta FS, Gupta PC, Daftary DK. Prevalence of oral submucous fibrosis among 50,915 Indian villagers. Br J Cancer 1968;22:646-54.  Back to cited text no. 3
    
4.
Hazarey VK, Erlewad DM, Mundhe KA, Ughade SN. Oral submucous fibrosis: A study of 1000 cases from central India. J Oral Pathol Med 2007;36:12-7.  Back to cited text no. 4
    
5.
Shahid RA. Coming to America: Betel nut and oral sub mucous fibrosis. JADA 2010;141:423-8.  Back to cited text no. 5
    
6.
Rajendran R. Oral submucous fibrosis: Etiology, pathogenesis, and future research. Bull World Health Organ 1994;72:985-96.  Back to cited text no. 6
    
7.
Nooni K. Frequency and clinical presentation of oral submucous fibrosis. IOSR J Dent Med Sci 2016;15:23-7.  Back to cited text no. 7
    
8.
Murti PR, Bhonsle RB, Gupta PC, Daftary DK, Pindborg JJ, Mehta FS. Etiology of oral submucous fibrosis with special reference to the role of areca nut chewing. J Oral Pathol Med 1995;24:145-52.  Back to cited text no. 8
    
9.
Babu S, Bhat RV, Kumar PU. A comparative clinico-pathological study of oral submucous fibrosis in habitual chewers of pan masala and betel quid. Clin Toxicol 1996;34:317-22.  Back to cited text no. 9
    
10.
Mantu VK, Mitra R. To study the prevalence of oral submucous fibrosis in Biratnagar, Nepal. Int J Curr Res 2017;9:63271-4.  Back to cited text no. 10
    
11.
Gupta PC, Ray CS. Epidemiology of betel quid usage. Ann Acad Med Singap 2004;33:31-6.  Back to cited text no. 11
    
12.
Wahi PN, Kapur VL, Luthraand UK, Srivastava MC. Submucous fibrosis of the oral cavity: 2. Studies on epidemiology. Bull World Health Organ 1966;35:793-9.  Back to cited text no. 12
    
13.
Oakley E, Demaine L, Warnakulasuriya S. Areca (betel) nut chewing habit among high-school children in the common wealth of the Northern Mariana Islands (Micronesia). Bull World Health Organ 2005;83:656-60.  Back to cited text no. 13
    
14.
Kelusker V, Kale A. An epidemiological study for evaluation of oral precancerous lesions, conditions and oral cancer among Belgaum population with tobacco habits. Biosci Biotech Res Comm 2010;3:50-4.  Back to cited text no. 14
    
15.
Misra V, Singh PA, Lal N, Agarwal P, Singh M. Changing pattern of oral cavity lesions and personal habits over a decade: Hospital based record analysis from Allahabad. Indian J Community Med 2009;34:321-5.  Back to cited text no. 15
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed64    
    Printed0    
    Emailed0    
    PDF Downloaded19    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]