Pattern of Occurrence and Severity of Oral Submucous Fibrosis Among Habitual Gutkha, Areca Nut and Pan Chewers

Oral submucous �brosis (OSF) is a complex, insidious and precancerous disease of the oral cavity. The high use of addictive substances in our local setting merits to be worked on �nding out the resultant prevalence of OSF. Objective: To determine the frequency of occurrence and severity of OSF among habitual gutkha, areca nut and pan chewers. Methods: A total of 183 patients with presenting complaints of burning in mouth, di�culty in chewing and cheek biting and who are habitual chewer of areca nut, gutkha or pan for over 6 months with minimum frequency of 1 pack per day were recruited in this study at Oral and Maxillofacial Surgery Department of

in ammation, which is followed by hypovascularity, brosis, and blanching of the oral mucosa, which has a marble-like effect.A brous band also develops, causing trismus, dysphagia, dysphonia, and abnormalities in hearing and gustatory perception [8][9][10].Multiple risk factors have been advocated to bear causative role in etiology of OSF, including chilies consumption, malnutrition, genetic predisposition, altered salivary composition, autoimmunity, collagen defects and areca nut chewing.Use of Areca nut, a habit in our region was believed to be the most signi cant risk factor contributing to OSF development [11].Additionally, it is also believed that the amount, frequency and duration of areca nut in betel quid chewing maybe related to the development of OSF [12].However, relying on a variety of circumstances including individual susceptibility, the kind of areca nut chewed, length of time and other variables.The time between the start of the chewing habit and the emergence of clinical signs of OSF may vary greatly, ranging from a few months to many decades [13].Betel quid is essentially made up of areca nut, catechu, slaked lime, and betel leaf wrapped in tobacco [14].Pan translates to "leaf" in a number of South Asian languages.The betel leaf is used to wrap a variety of items like Tobacco, spices, and areca nut wrapped in betel quid are the usual ingredients of pan.Gutkha is a tobacco and areca nut powder that is sold in premade pouches of 5 to 10 grams [15].The usage of gutkha has suddenly increased lately because of its affordability, ease of availability, eye-catching, colored packaging, and extended shelf life [16].Research has shown that areca nut reduces appetite, improves digestion, changes focus and relaxation, and sometimes even raises attentiveness.In a recent study patient with habit of chewing areca nut and gutkha were 58.58% [2].Others report the percent frequencies of chewing habits of OSF patients to comprise of guthka (30%) chaliya (6.5%), raw tobacco (21.2%), manpuri (20%), pan (12.9%) and naswar (9%) [17].Research on school going children has revealed that 40.8% children chewed areca nut regularly, 39% occasionally and 20.2% rarely [18].This study was conducted to determine frequency of occurrence and severity of oral sub mucous brosis among habitual gutkha, areca nut and pan chewers, which will be bene cial for our local population in order to change their behaviors regarding personal habits.This study will also help in generating baseline data and planning strategies to control disease burden.

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A cross sectional study was conducted from February 2021 to January 2022, in Oral Maxillofacial Surgery Department of Dentistry at Liaquat University of Medical Health Sciences Hospital, Jamshoro, Pakistan.The study was based on using non-probability consecutive sampling.Total sample size calculated was 183 with margin of error set as 2.5%.Sample was calculated using Open-Epi sample size calculator.Frequency of OSF was expected as 3.06% [19].Patients with either gender having age range of 18 to 50 years presenting with presenting complaints of burning in mouth, di culty in chewing and cheek biting and who were habitual chewer of areca nut, gutkha and pan for over 6 months with minimum frequency of 1 pack / 1 unit per day were included in the research.Patients with limited mouth opening due to causes other than OSF, history of tobacco smoking, mentally retarded and those who were having collagen defects and autoimmune disorders were excluded from study.This study was approved by Research Ethics Committee LUMHS (LUMHS/REC/22 Dated 25.1.2021).Every research individual had their OSF status checked.A medical history was taken from OSF patients, including the kind, frequency, and length of their chewing habit.A selfassessment descriptive rating scale (Absent, Mild, Moderate, and Severe) was used to evaluate the degree of burning sensation.Salivary change that was subjective was noted.The patient was questioned about if they need repeated sips of water to moisten their mouths, swallow meals, or deal with any accumulation of saliva in their mouths.According to the patient's reaction, a rise or fall in salivation was noted on the research proforma.Using a sweet and salt solution, changes in taste sensations were evaluated.Following mouth washing, the patient was given 2 ml of either a salty solution (1% sodium chloride), sucrose solution (0.25% saccharine solution), or water, which they were to swill for one minute before spitting it out.If both answers were accurately detected, the patient's gustation was deemed normal.If the participant could not identify any of them, then the gustatory experience was deemed to be reduced.The conductive hearing loss was evaluated using the tuning fork test.The soft palate, buccal mucosa, retromolar regions, and labial mucosa were palpated for the presence of brous bands during a clinical examination.To termed a brous band, a felt structure that was thick, vertical, and continuous was regarded to be a band.Using a Vernier calliper, the interincisal distance between the maxillary and mandibular right and left central incisors was determined.According to clinical staging (Stage 1: Faucial Bands Only, Stage 2: Faucial and Buccal Bands, Stage 3: Faucial and Labial Bands), the severity of OSF was evaluated.By coding the data, the privacy and con dentiality of each patient were protected.Data were analyzed using Microsoft Excel 2016 and SPSS version 21.0.Qualitative data (gender, presenting complaint, socioeconomic status, pattern of OSF, location of brous band, chewing habit and stage of OSF) was expressed as number and percentage.Frequency and severity of OSF was compared with the type of habit and duration of habit by applying Chi-Square test.Quantitative data (age, duration and frequency of chewing areca nut, gutkha or pan) was expressed as mean & standard deviation (X ± SD).Independent T Test was used to nd the signi cance of association among quantitative variables.

R E S U L T S
A total of 183 patients with presenting complaints of burning in mouth, di culty in chewing and cheek biting.who are habitual chewer of areca nut, gutkha or pan for over 6 months with minimum frequency of 1 pack / 1 unit per day were recruited in this study.The age of the patients was 34.57±9.98years.Median frequency of chewing and duration of addition was 1 (IQR=1) and 9 (IQR=6) as shown in (table 1)   Strati cation analysis was performed and observed that severity of OSF was associated with age groups, gender but n o t s t a t i s t i c a l l y s i g n i c a n t w i t h o c c u p a t i o n , socioeconomic status, frequency of chewing and duration of addition as shown in table 4.  Oral submucous brosis (OSF) is a chronic oral cavity disorder that has the potential to progress to malignancy and often results in mouth cancer [19,20].According to our analysis, the majority of OSMF patients, with an average age ranging from 34.57±9.98years.This is consistent with research done in Taiwan which found that the participants ages ranged from 20 to 39 years; however, research done on 1000 patients in Central India found that the participants' ages ranged from 30 to 39 years.Similarly, the age group most often a icted was found to be between 20 and 39 years old in research conducted in .
The primar y cause of the OSF conditions is the overindulgence in tobacco substances and areca nut based goods like gutkha, pan masala, khaini, mava, etc.These very addictive items, which have been around for a few decades, come in little, inexpensive, colorful sachets that serve as betel quid replacements.Intense marketing and advertising, which often portray them as safe items, cause high consumption across all age categories, especially in India and among the migrant populations who migrate there from other countries [24].The frequency of OSMF was much greater in males than in women [25].In India, Sinor et al. discovered a male preponderance in cases of OSF [26].The male preponderance in this research may be explained by the fact that men have easier access to areca nut and its products, which they employ more often than women.Patients who were male had a higher prevalence of OSF (73%

Table 2 :
Clinical Examination of the Patients

Table 3 :
Frequency Distribution of Different Variables

Table 4 :
Frequency of Severity of OSF Among Habitual Guthka, Areca Nut and Pan Chewers Strati ed by Effect Modi ers 7% habitually chewed gutkha.According to the research conducted bySrivastava et al [31].Out of the total participants, 55.81% were habitual gutkha consumers, 6.98% were betel quid and gutkha drinkers, 26.74% were tobacco and gutkha consumers, and 10.46%) were smokers and gutkha consumers.When areca nut and pan chewers were monitored, the severity of OSF was determined to be 31.15%stage 1, 51.91% stage 2, and 16.94% stage 3.In his analysis of 1,006 OSF patients, Kumar discovered that 422 (41.94%) of the cases were stage 2[32].In contrast to the current research, 226 individuals (22.29%) were in stage 4, 184 individuals (18.29%) were in stage 3, and 174 individuals (17.29%) were in stage 1.This may be due to the fact that in the early stages, notable changes speci cally, restricted mouth opening are not observed.Additionally, patients may not seek medical attention unless there is a severe impairment of their bodily functions.Lack of knowledge about the illness may also play a role in this.Babu et al.,   https://doi.org/10.54393/pjhs.v5i04.1422OralSubmucous Fibrosis among Habitual Pan Chewers DOI: