Journal of Indian Association of Public Health Dentistry

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


Vedati Prathima1, Mrunalini Koneru1, V. V. N. Sunil1, Harshavardhan Jois2, Madhusudhan Reddy2,  
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

Correspondence Address:
Vedati Prathima
B/14, Plot No 33, SBH, Krishnapuri Colony, West Marreddpally, Secunderabad, Telangana
India

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.



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;19:61-64


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 Dec 4 ];19:61-64
Available from: https://www.jiaphd.org/text.asp?2021/19/1/61/312641


Full Text



 Introduction



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



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



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}{Figure 1}{Figure 2}{Figure 3}

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}

 Discussion



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 findingNutritional deficiency was assessed based on medical history.

 Conclusion



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.

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