Oral submucous fibrosis: review on aetiology and pathogenesis.

Applied Discriminant Analysis

Introduction: India is undergoing rapid epidemiological transition as a consequence of economic and social change. The pattern of mortality is a key indicator of the consequent health effects but up-to-date, precise, and reliable statistics are few, particularly in rural areas. Methods: Deaths occurring in 45 villages (population 180 162) were documented during a 12-month period in 2003-04 by multipurpose primary healthcare workers trained in the use of a verbal autopsy tool. Algorithms were used to define causes of death according to a limited list derived from the international classification of disease version 10. Causes were assigned by two independent physicians with disagreements resolved by a third. Results: A total of 1354 deaths were recorded with verbal autopsies completed for 98%. A specific underlying cause of death was assigned for 82% of all verbal autopsies done. The crude death rate was 7.5/1000 (95% confidence interval, 7.1-7.9). Diseases of the circulatory system were the leading causes of mortality (32%), with similar proportions of deaths attributable to ischaemic heart disease and stroke. Second was injury and external causes of mortality (13%) with one-third of these deaths attributable to deliberate self harm. Third were infectious and parasitic diseases (12%). Tuberculosis and intestinal conditions each caused one-third of deaths within this category. HIV was assigned as the cause for 2% of all deaths. The fourth and fifth leading causes of death were neoplasms (7%) and diseases of the respiratory system (5%). Conclusion: Non-communicable and chronic diseases are the leading causes of death in this part of rural India. The observed pattern of death is unlikely to be unique to these villages and provides new insight into the rapid progression of epidemiological transition in rural India.

Chronic diseases now a leading cause of death in rural India—mortality data from the Andhra Pradesh Rural Health Initiative

OBJECTIVE: To examine all studies reporting prevalences of oral lichen planus (OLP) for epidemiological validity and to extract prevalence data from the valid papers. DESIGN: Computer based literature searches were carried out using the MeSH headings 'lichen planus, oral and (prevalence or incidence)' and were supplemented by manual searching. MAIN OUTCOME MEASURES: Each paper was examined for five criteria: clinic-based or population study, adequate demographic description (by sex and age group) of the population, adequate demographic description of the sample (if the population was sampled), adequate demographic description of the OLP cases identified, and histological confirmation of the clinical diagnosis. RESULTS: Forty-five relevant papers were identified, 21 clinic-based and 24 population studies. All but one of the population studies was deficient. One study, while having some defects, was probably sufficiently valid to permit the findings to be regarded as useful. An overall age-standardized prevalence of 1.27% (0.96% in men and 1.57% in women) can be calculated from this study. CONCLUSIONS: There appears to be only one usable prevalence study of OLP. Other large-scale studies are required in other populations. Such studies need to distinguish between OLP and lichenoid reactions.

The reported prevalence of oral lichen planus: a review and critique

Background: Very few reports have been published on the gender specificity of oral submucous fibrosis (OSF) in relation to habit patterns and the severity of disease in the world literature. The purpose of the study was to ascertain the gender specificity for different habits and severity of OSF.



Methods:  A hospital-based cross-sectional study on various habit patterns associated with OSF was performed in Nagpur over a 5-year period. A total of 1000 OSF cases from 266 418 out patients comprised the study sample.



Results:  The male-to-female ratio of OSF was 4.9:1. Occurrence of OSF was at a significant younger age group (<30 years) among men when compared with women (OR = 4.62, 3.22–6.63, P = 0.0001). Reduced mouth opening, altered salivation and altered taste sensation were found to be significantly more prevalent in women when compared with men. Exclusive areca nut chewing habit was significantly more prevalent in women (OR = 44.5, 25.4–79.8, P = 0.0001). Whereas significant increase for Gutkha (Areca quid with tobacco) (OR = 2.33, 1.56–3.54, P = 0.0001) and kharra/Mawa (crude combination of areca nut and tobacco) (OR = 6.8, 4.36–11.06, P = 0.0001) chewing was found in men when compared with women.



Conclusions:  There is a marked difference in literacy, socioeconomic status, areca nut chewing habits, symptoms and disease severity in women when compared with men in the central Indian population.

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Oral submucous fibrosis: study of 1000 cases from central India.

BACKGROUND: Smoking, drinking and chewing tobacco product, common habits in India have been positively associated with oral lesions. No study has been conducted in this part of Tamilnadu regarding the prevalence of oral lesions in relation to habits. METHODS: A hospital based cross-sectional study was carried out at Ragas Dental College, Chennai. Already existing data of two thousand and seventeen consecutive patients from sub-urban areas of Chennai, who attended the outpatient department, at Ragas Dental College, for dental complaints during a period of three months in 2004, who underwent oral examination and interviewer based questionnaire was used. RESULTS: Oral soft tissue lesions were found in 4.1% of the study subjects. The prevalence of leukoplakia, OSF and oral lichen planus was 0.59%, 0.55%, and 0.15% respectively. The prevalence of smoking, drinking alcoholic beverages and chewing was 15.02%, 8.78% and 6.99% respectively. Smoking and chewing were significant predictors of leukoplakia in this population. DISCUSSION: The prevalence of leukoplakia, OSF and oral lichen planus in our study population is similar to those found in other populations. The prevalence of consumption of alcoholic beverages in our study population was higher when compared to the Indian National Sample Survey study. However the prevalence of smoking and chewing was found to be lower. Smokers were more likely to develop smoker's melanosis compared to other lesions. Among those who consumed alcoholic beverages alone, the prevalence of leukoplakia was higher compared to other lesions. OSF was the most prevalent lesion among those who chewed panmasala or gutkha or betel quid with or without tobacco.

Prevalence of oral lesions in relation to habits: Cross-sectional study in South India.

Background: Oral submucous fibrosis (OSF) is a pre-cancerous condition caused by the use of areca nut in various forms. There are very few published reports on areca nut use and OSF from Chennai, South India.

Methods:  A hospital-based case-control study on habits and OSF was performed in Chennai over a 3-year period. A total of 185 consecutive patients with OSF were matched with age- and sex-matched controls. History was recorded in a pre-determined format by qualified dental surgeons.

Results:  The male to female ratio of OSF cases was 9.9 : 1. All areca nut products were associated with OSF, with the risk being greatest for pan masala. The duration of the habit was more significant than the frequency of the chewing habit.

Conclusion:  The present study confirms the strong association between areca nut use and OSF and the increasing use of pan masala.

Oral submucous fibrosis: a case-control study in Chennai, South India.

The external surface of lips has many elevations and depressions forming a characteristic pattern called lip prints, examination of which is known as cheiloscopy. The lip prints are unique and distinguishable for every individual like fingerprints. The use of lip prints for human identification was first suggested in 1950 and researches were carried out in 1960s and early 1970s, resuming in the last few years. The present study was aimed to study the lip prints of different individuals in different parts of the lip and find out the incidence of any particular pattern in the given age group. Although lip prints identification has been utilized in the court in isolated cases, more researches need to be conducted in this field with regards to confirmation of uniqueness, and the collection and interpretation of evidence.

Study of lip prints

INTRODUCTION: Human immunodeficiency virus (HIV) infection is a major health problem in India. The importance of oral lesions as clinical features of HIV infection and their gender specificity have been reported worldwide. However, there are very few reports on this aspect from the Indian subcontinent. MATERIALS AND METHODS: The study population comprised 1000 consecutive HIV seropositive patients presenting to YRG CARE, a non-governmental organisation in Chennai, South India. The oral lesions were diagnosed based on clinical appearance using international criteria. Data were entered into a database and analysed using the SPSS package. RESULTS: The male-to-female ratio was 3.4:1, and 95% of the patients had acquired infection via heterosexual contact. Majority of the patients (84%) were in the 21- to 40-year-old age groups. Pulmonary tuberculosis (12%) was the most common systemic finding. Oral lesions were seen in 86.6% of the patients. Gingivitis (72.3%) and periodontitis (33.2%) were the most common lesions followed by oral pigmentation (26.3%), oral candidiasis (23.8%), angular cheilitis (7.9%), oral ulcers (3.3%), oral hairy leukoplakia (2.1%), oral submucous fibrosis (0.9%) and leukoplakia (1.5%). The prevalence of oral candidiasis, periodontitis and oral hairy leukoplakia was higher in males than in females. CONCLUSIONS: Oral lesions occur commonly in HIV infection. A comprehensive oral examination plays an important role not only in the management of the patients, but also in assessing the immune status and in their follow-up.

Oral lesions and conditions associated with human immunodeficiency virus infection in 1000 South Indian patients.

Background: Oral submucous fibrosis (OSF) is a precancerous condition associated with the use of areca nut in various forms. There are very few reports to correlate the clinical stage to histopathological grading in OSF. Materials and Methods: A hospital-based study was conducted on 75 OSF cases who visited our hospital in Chennai from 2000-2003. A detailed history of each patient was recorded along with a clinical examination. Biopsy was performed for histopathological correlation. Clinical stage of the disease in terms of the ability to open one's mouth was correlated with histopathological grading. Results: The male to female ratio of OSF cases was 6:1. All forms of areca nut products were associated with OSF. Chewing of paanmasala was associated with early presentation of OSF as compared to chewing of the betel nut. Out of 57 cases, which were in clinical stage II, 91.2% had histological grading of I and II in equal proportions and 8.8% had histological grade III. Out of 13 cases that showed a clinical stage of III, 52% showed a histological grade of II, 40% grade III and 8% grade I. Conclusion: In the present study, there was no direct correlation between clinical stages and histopathological grading. The possibility of difference in the severity and extent of fibrosis in different regions of the oral mucosa and involved muscles were considered as contributory factors for this variation.

TR Saraswathi

Papers

Prevalence of oral lesions in relation to habits: Cross-sectional study in South India.

Oral submucous fibrosis: a case-control study in Chennai, South India.

Study of lip prints

Oral lesions and conditions associated with human immunodeficiency virus infection in 1000 South Indian patients.

Oral submucous fibrosis: a clinico-histopathological study in Chennai