13 THE ANTISEPTIC August 2016

A study of Lesions in oral cavity in smokeless Tobacco Consumers of Eastern U.P.NALINI MISHRA, TRIPATHI M.D., VIVEK GUPTA

Introduction

Use of tobacco products has emerged as the leading cause of premature disease and death in the world.

India is the second largest producer and third largest consumer of tobacco in the world, out of which U.P. is the largest consumer of smokeless tobacco. The various forms of smokeless tobacco available in Eastern U.P. are-1. Chewing tobacco leaf- Khaini,

Zarda, Betelquid with tobacco. 2. Areca nut mixtures for chewing

like- Pan masala & Gutkha3. Product for application- Gul

manjan, Lal Dunt manjan. Oral Carcinoma is 12th most

common cancer in the world and it is 8th most frequent cancer in males and 30% of all Head and Neck Cancer.

Oral cavity comprises of lips, buccal Mucosa, alvelolar ridges, (Upper & Lower jaw) Retro molar trigone, hard palate & floor of the mouth along with anterior 2/3rd of tongue. Typical Indian oral cancer mostly occurs in buccal mucosa and gingiva. Material and Method

Present study comprises of 500 oral cavity examinations of tobacco Dr. Nalini Mishra,MDS (Oral and maxillo facial surgery),Assoc. Prof. Deptt. of Dental, Dr. M.D. Tripathi, MS, FICS,Principal & Professor, Deptt. of SurgeryDr. Vivek Gupta, MD,Prof. & Head, deptt. of Pathology, Hind Institute of Medical Sciences, E-4, Vanasthali Apartment sector-1, Gomti Nagar, extension, Lucknow - 226 010.

Specially Contributed to "The Antiseptic" Vol. 113 No. 8 & P : 13 - 14

chewers of Barabanki district of U.P. and surrounding areas who attended the dental OPD of Hind Institute of Medical Sciences, Safedabad, Barabanki during last three years in this tobacco chewing belt of eastern U.P. All the patients were interrogated in detail for consuming tobacco. In Eastern U.P. area tobacco is consumed orally and placed between labial mucosa or in the area of buccal mucosa. Observations

Lesions detected were-Premalignant Lesions

1. Oral sub mucous fibrosis - Figure-1

2. Leucoplakia

3. Candidiasis

Malignant Lesions-

1. Ulcerative lesion - Figure-2

2. Indurated Patch

3. C e r v i c a l l y m p h n o d e enlargement

4. Carcinoma - Figure-3Discussion

All these brands of Smokeless Tobacco contain lots of Toxic and Carcinogenic compounds like Polycylicaromatic hydro carbons, Aldehydes, Nitrosamines and Radioactive substances. Thus in India tobacco use includes not only smoking but variety of Smokeless products are used and users are exposed to number of toxicants, carcinogen, co-carcinogens, and tumor promoters. Smokeless

Age Group distribution of tobacco consumer- (Table-1)

S.No. Age group No. of Cases Percentage 1. 10 to 20 year 25 5% 2. 20 to 30 year 100 20% 3. 30 to 40 year 150 30% 4. 40 to 50 year 175 35% 5. 50 onwards 50 10%

Maximum consumption was during age group 30 years to 50 years. Sex ratio- Male to Female ratio was 5:1

Type of consumption with duration - (Table-2)

S.No. Type of Tobacco No. of Cases Percentage Duration 1. Khaini 150 30% 10 years 2. Pan Masala 100 20% 5 years 3. Zarda 100 20% 10 years 4. Gutkha 125 25% 10 years 5. Lal duntmanjan 25 5% 5 years

Maximum Consumption in the form of Khaini & Gutkha with largest duration of 10 years.

August 201614 THE ANTISEPTIC

Tobacco use is associated with high incidence of oral cancer. Battery of Biomarkers with strong association with cancer risk need to be established in large population studies.

Commonest malignancy/Lesions associated with type of Tobacco consumed were as in observation- Table No. 3Conclusion

Use of smokeless tobacco in the eastern U.P. is very high specially among the males. Most of these users have multiple habits of tobacco chewing, smoking and drinking. Various smokeless tobacco products are easily available in this area and are freely used. Though various tobacco control Acts have been in introduced, their enforcement faces a huge challenge. Thus to achieve a high level success to control smokeless tobacco use great efforts are to be taken.

Strong will power is required to avoid tobacco consumption. REFERENCES

1. Banning smokeless tobacco in India: Policy analysis. Arora M, Madhu R. India Journal of cancer/October-December 2012/volume 49/issue4

2. Smokeless tobacco use in Nepal: Sinha DN, Bajracharya B, Khadka BB, Rinchen S, Bahttad VB, Singh PK. India Journal of cancer/October-December 2012/volume 49/issue4.

3. Subba SH, Binu VS, Menezes RG, Ninan J, Rana MS: Tobacco chewing and associated factors among youth of western Nepal: A cross-sectional study. Indian J, Community Medicine 2011; 36:128-32

4. Lee CH, Ko AM, Warnakulasuriya S, Ling TY, Sunarjo, Rajapakse PS, et al. Population burden of betel quid abuse and its relation to oral Premalignant disorders in south, southeast and east asia: An Asian Betel-quid Consortium study. Am J Public health 2012; 102:17-24.

Figure-1

Oral Submucos fibrosis

Figure-2

Leukoplakia with ulcerative Jeasion on tongue

Figure-3

Carcinoma alveolus

Type of Tobacco with lesions- (Table-3)

S.no. Type of Tobacco No. of Cases Percentage Type of Lesions Percentage

1 Panmasala 100 20% Sub mucous fibrosis with poor oral hygiene 80%

2 Slaked lime with khaini 150 30% Lucoplakia 60%

3 Tobacco leaf with slaked 100 20% Ulcerative lesions Lime (Zarda) in gingiva 40%

4. Gutkha 125 25% Sub mucous fibrosis/ Carcinoma 20%

5. Lal duntmanjan 25 5% Chronic periodontal diseases 10%

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