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ABSTRACT: Background: Smokeless tobacco (SLT) use, particularly gutka and khaini, is a significant public health concern in India, mainly in rural areas. This prospective cohort study aimed to investigate the association between SLT use and oral cancer incidence among rural Indian men. Methods: A cohort of 300 rural Indian men without a history of oral cancer was recruited and followed for five years. Baseline data on SLT use (type, frequency, and duration) and other risk factors were collected. Annual oral examinations and medical record reviews were conducted to identify incident cases of oral cancer. Incidence rates, relative risks, and hazard ratios (HR) were calculated to assess the association between SLT use and oral cancer. Results: Among the 300 participants, 185 (61.7%) were SLT users at baseline. During follow-up, 25 incident cases of oral cancer were diagnosed. The incidence rate of oral cancer was significantly higher among SLT users (24.3 per 1,000 person-years) compared to non-users (5.4 per 1,000 person-years). After adjusting for confounders, the HR for oral cancer associated with SLT use was 4.51 (95% CI: 2.03–9.98), indicating a significantly increased risk. A dose–response relationship was observed, with higher frequency and longer duration of SLT use associated with increased risk. Conclusions: This study provides strong evidence for a significant association between SLT use and increased risk of oral cancer among rural Indian men. The findings underscore the urgent need for targeted interventions to reduce SLT use and promote oral cancer awareness in this high-risk population. [ABSTRACT FROM AUTHOR]

Background: Smokeless tobacco (SLT) use, particularly gutka and khaini, is a significant public health concern in India, mainly in rural areas. This prospective cohort study aimed to investigate the association between SLT use and oral cancer incidence among rural Indian men. Methods: A cohort of 300 rural Indian men without a history of oral cancer was recruited and followed for five years. Baseline data on SLT use (type, frequency, and duration) and other risk factors were collected. Annual oral examinations and medical record reviews were conducted to identify incident cases of oral cancer. Incidence rates, relative risks, and hazard ratios (HR) were calculated to assess the association between SLT use and oral cancer. Results: Among the 300 participants, 185 (61.7%) were SLT users at baseline. During follow-up, 25 incident cases of oral cancer were diagnosed. The incidence rate of oral cancer was significantly higher among SLT users (24.3 per 1,000 person-years) compared to non-users (5.4 per 1,000 person-years). After adjusting for confounders, the HR for oral cancer associated with SLT use was 4.51 (95% CI: 2.03–9.98), indicating a significantly increased risk. A dose–response relationship was observed, with higher frequency and longer duration of SLT use associated with increased risk. Conclusions: This study provides strong evidence for a significant association between SLT use and increased risk of oral cancer among rural Indian men. The findings underscore the urgent need for targeted interventions to reduce SLT use and promote oral cancer awareness in this high-risk population.

Introduction: Sociodemographic and personal habits are variable among patients with oral submucous fibrosis and are important to know to see the pattern of these factors in oral submucous fibrosis in local population. Aims & Objectives: The present study aims to examine and associate the sociodemographic and personal habits of patients with oral submucous fibrosis. Place and Duration of Study: The Isra dental college, Isra University, Pakistan, from 1st July 2023 to 1st February 2024. Materials & Methods: A cross-sectional study was conducted on 148 patients with clinically confirmed oral submucous fibrosis (OSF) of any age or gender, after taking written informed consent using convenience sampling. Clinical examination was done to palpate fibrous bands and a vernier caliper was used to measure the mouth opening. A standardized questionnaire with information on socio-demographics and personal habits was utilized to gather the data. SPSS version-22 was used to analyze the data. Results: More than half of the patients with oral submucous fibrosis were males 60.1% followed by 39.9% females. About 36.5 % of the patients had no formal education, while 32.4% had primary education, 22.3% were matric and 9% were intermediate and above education. 55 patients (37.2%) had no work followed by 45 patients (30.4%) having private job, 36 patients (24.3%) were laborers, and 12 patients (8%) were having government job and own businesses. OSF was seen more in illiterate people which was associated with betal nut and gutka chewing habits (P –value was

The article discusses research which explored the correlation of consumption of gutka, a smokeless tobacco, during pregnancy with healthcare risks on maternal and child health in Karachi, Pakistan. Study findings revealed higher rates of premature birth, still birth, low birth weight and birth defects linked to gutka consumption, as well as anemia in pregnant women addicted to gutka, and potential transfer of harmful chemicals in tobacco to the infant during breastfeeding.

Background: Betel quid (BQ) consumption is prevalent globally, majorly consumed in South-Asia and South-East Asian countries. Among the other country studies done on BQ, the focus has been on its consumption prevalence, its physiological and psychological effects, and aids to discontinue this habit. Systematic literature research on suitability of different instruments (metric or scale) to measure BQ dependency is scarce, hence pointing to the need of more evidence-based studies in this domain. Aim: The aim of the article was to identify the instruments used in the published literature to measure BQ dependency among young and adult chewers and draw a comparison. Methodology: The electronic retrieval systems and databases PubMed (Medline), Cochrane Library, Scopus, Web of Science, and Google Scholar were searched independently by two authors from January 2011 to September 2022 for the collection of desired data. Results: Among 1271 articles, 337 were duplicates and removed, 866 did not meet selection criteria. Out of 68 articles, 57 were excluded due to the lack of relevant data. Finally, only 11 articles were included for the analysis in this systematic review. Conclusion: Due to a scarcity of researches in this direction, no scale can be assigned as the best Dependence Scale, thus necessitating more such systematic reviews and meta-analysis for better comprehension and usage of present dependence scales.

Background: Betel quid (BQ) consumption is prevalent globally, majorly consumed in South-Asia and South-East Asian countries. Among the other country studies done on BQ, the focus has been on its consumption prevalence, its physiological and psychological effects, and aids to discontinue this habit. Systematic literature research on suitability of different instruments (metric or scale) to measure BQ dependency is scarce, hence pointing to the need of more evidence-based studies in this domain. Aim: The aim of the article was to identify the instruments used in the published literature to measure BQ dependency among young and adult chewers and draw a comparison. Methodology: The electronic retrieval systems and databases PubMed (Medline), Cochrane Library, Scopus, Web of Science, and Google Scholar were searched independently by two authors from January 2011 to September 2022 for the collection of desired data. Results: Among 1271 articles, 337 were duplicates and removed, 866 did not meet selection criteria. Out of 68 articles, 57 were excluded due to the lack of relevant data. Finally, only 11 articles were included for the analysis in this systematic review. Conclusion: Due to a scarcity of researches in this direction, no scale can be assigned as the best Dependence Scale, thus necessitating more such systematic reviews and meta-analysis for better comprehension and usage of present dependence scales. [ABSTRACT FROM AUTHOR]

Introduction: Oral submucous fibrosis (OSMF) is a potentially malignant disorder which occurs due to dysregulation of collagen metabolism. It is also known as Atrophica idiopathica mucosae oris and is characterized by a burning sensation in the oral cavity, reduced mouth opening, burning sensation, and decreased tongue movement. Clinically there is blanching of oral mucosa due to the deposition of excessive collagen fibers. Aims: This study aims to estimate the prevalence of oral cancer in a cohort of patients suffering from OSMF and to understand the clinical pattern of oral cancer in these patients. Materials and Methods: It was a unicentric cross-sectional study conducted between January 2022 and January 2023. The study was conducted on 630 patients with clinical presentation of OSMF. Informed consent was obtained from the patient before the start of the study. Results: Data obtained were tabulated and Statistical Package for Social Sciences version 22 was used for analysis. Of 630 subjects, 176 subjects (27.83%) had oral cancer with OSMF. The most common site of the oral cancer was found to be buccal mucosa that was followed by lateral border of the tongue and retromolar trigone. Conclusion: OSMF is a potentially malignant disorder and use of areca nut with smokeless tobacco is the main cause. The use of areca nut and smokeless tobacco must be regularized. [ABSTRACT FROM AUTHOR]

Background: Tobacco use is a major risk factor for many chronic diseases, including cancer. India revised the pictorial warnings on all tobacco products in 2018, but its impact on tobacco consumers after the revision is less studied. Aim and Objective: To assess the awareness of the revised pictorial warnings on tobacco products and the impact of it on tobacco consumers in a coastal town. Methods: This cross-sectional study was conducted from 1st to 31st March 2021 among 185 adult tobacco consumers in a coastal town in Karnataka after obtaining ethical clearance and informed consent. The data was analysed using SPSS version 16.0 by descriptive statistics, Chi-square, Fisher's exact test and binary logistic regression analysis. Results: Majority (95.7%) were males and 96.2% had seen the pictorial warning on the tobacco products. The commonly consumed tobacco products were panmasala (44.9%), gutka (38.9%), cigarette (31.4%) and bidi (15.1%). The mean age of initiation of consuming tobacco products was 24.8 years and mean duration of the habit was 17 years. Conclusions: A majority (96.2%) have seen the pictorial warnings on the tobacco products and significant predictors for reducing tobacco consumption were those who inferred the pictorial warnings as tobacco is injurious to health and cancerous. [ABSTRACT FROM AUTHOR]

Age at natural menopause is a vital biological event in every woman's life because of the increase in diseases and other problems after middle age. The timing of the menopause can't be accurately predicted or determined and differs greatly from one woman to another and from one ethnic group to another. The cross-sectional study was conducted among the rural women of North Karnataka. The study includes 101 rural women who were farmers, labourers and housewives, have achieved menopause naturally (women with oophorectomy were excluded). The main objective of the present study is to find out the age at natural menopause, factors determining the event, examination of symptoms prevailing and to report the attitude of women towards menopause. The multiple regression analysis of the variables with the age at natural menopause showed the significant positive association of age of respondents, occupation, age at menarche, breastfeeding duration and significant inverse correlation with marital status and education with age at natural menopause. The study also found that the great number of women with the habit of consuming gutka, tobacco with betel leaf and nuts had bad oral health and reported much oral distress after menopause. 45.5% women had a positive attitude towards menopause. These women seek independence after menopause. Whereas 42.5% women didn't find any difference in living before and after menopause. [ABSTRACT FROM AUTHOR]

Introduction Tobacco consumption is a significant public health threat worldwide and a looming pandemic. World Health Organization data display that about five million people face premature death per year worldwide due to tobacco use. India is a leading nation among tobacco users in this regard. The aim of the present study was to determine the most prevalent tobacco consumption habit and the oral potentially malignant disorders (OPMDs) found in such users with an assessment of awareness and change in various habits. Material and methods A cross-sectional study over a duration of six months was carried out, in which every patient visiting the hospital OPD was assessed and evaluated for tobacco-related habits. A detailed history of the duration and frequency of the habit, the type of tobacco product consumed, and the predominant reason for its consumption among males and females were recorded and evaluated. An oral examination was performed to determine the evidence of OPMDs. Subjects under the age of 13 years and with systemic/metabolic disorders with oral manifestations were excluded from the study. Data obtained were subjected to statistical analysis using Stata Statistical Software, version 13.1 for Windows (released 2013 StataCorp LLC, College Station, TX). Results Data revealed a higher prevalence of tobacco consumption in males, with chewing tobacco followed by smoking and a mixed form of habit being predominant. Misri chewing was most common in females. Subjects in the 20-50 years age group were most commonly affected, with tobacco pouch keratosis being the most prevalent lesion followed by leukoplakia, with stress being a major causative factor for tobacco consumption. Conclusion The present study promulgated the prevalence of OPMDs in consumers of various kinds of tobacco products, which is highly valuable in the early detection of OPMDs. OPMDs remain unnoticed until advanced stages due to their asymptomatic or mildly symptomatic nature and due to a relative lack of awareness about the deleterious effects of tobacco usage despite an upsurge in tobacco cessation-related content on digital media. Thus, healthcare sector professionals can be appropriately guided to ensure efficient patient care at an early stage., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee, Guru Nanak Institute of Dental Sciences and Research issued approval GNIDSR/IEC/NOV-23/07. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Pandya et al.)

Introduction: Tobacco consumption is one of the most serious public health threats globally and is emerging as pandemic. Data from World Health Organisation proves that about 5 million people die prematurely per year around the globe due to tobacco use with India being a leading nation among tobacco users. Aim: To evaluate the most prevalent tobacco habit and the oral Potentially Malignant Disorders (PMDs) among the tobacco users and assessment of prevalence rate of awareness and change in various habits in relation to similar studies conducted in past in Eastern zone. Materials and Methods: A cross-sectional study was conducted over a period of six months, wherein all the patients visiting the OPD were assessed and questioned for Tobacco related habits. A detailed history about the duration and frequency of the habit and the type of tobacco and the predominant reason for its consumption among males and females were recorded and evaluated for the evidence of PMDs. Patients below the age of 13 years and with systemic/metabolic disorder with oral manifestations were excluded from the study. Results: The results of the study revealed that the tobacco consumption was more prevalent in males than in females. Most prevalent tobacco habit was chewing tobacco with slaked lime followed by smoking then mixed tobacco. Most common age group affected was 20-50 years and tobacco pouch keratosis were most prevalent lesion followed by leukoplakia. Conclusion: This study imparted us the particulars of association of Oral PMDs in different kinds of tobacco users thus reducing the chances of morbidity and mortality associated with them due to their asymptomatic or mildly symptomatic nature which remains unnoticed till advanced stages due to relative lack of awareness about the harmful effects of tobacco usage even in current times of social media, thus guiding physicians to provide better patient care at an early stage. [ABSTRACT FROM AUTHOR]

Oral submucous fibrosis (OSMF) is an insidious chronic disease of the oral mucosa that is characterised by severely limited mouth opening, blanching of the oral mucosa, and a burning sensation in the oral cavity. Consumption of betel nut and/or gutka are the known risk factors. We undertook this study to correlate the frequency and duration of gutka intake with the severity of OSMF and to determine the predictors of severe OSMF (mouth opening <20mm). A cross sectional study was conducted on 300 participants (who were known gutka chewers) selected at the Baqai Dental College and Fatima Hospital, Karachi, Pakistan. Participants' medical and dental histories were recorded. Informed consent was obtained, and clinical oral examination was done. Information regarding the extent of mouth opening, chewing habits, frequency and duration of gutka intake, the site of placing gutka, duration of chewing, and whether they swallowed or spat out the gutka were collected. A standardised questionnaire was used to document the findings. Binary logistic regression was applied using the severity of OSMF (mouth opening <20mm) as an outcome variable. Out of 300 participants, 172 (57.3%) were males; mean (SD) age of the sample was 38.2 (12.3) years. A total of 156 (52%) participants had the habit of chewing gutka, of which 213 (71%) had clinical stage I OSMF, 75 (25%) had stage II, and 12 (4%) had stage III. As per functional staging, 18 (6%) subjects had mouth opening <20mm. Nearly 144 (48%) participants were consuming other forms of tobacco in addition to the gutka. Patients with palpable bands = 232 (77.3%), ulcerative lesions = 212 (70.7%), altered taste sensation = 210 (70%) and altered hunger = 252 (85.7%) were common findings. The duration of gutka intake was found to be positively correlated with the severity of OSMF; however; its frequency was not. Among intraoral findings, the presence of red and white lesions inside the mouth was the most significant predictor of the severity of OSMF. [ABSTRACT FROM AUTHOR]

Abstract Objective Immunohistochemical over expression of p53 is considered as a marker of poor prognosis in many cancers. Therefore, we aimed to evaluate immunohistochemical overexpression of p53 in 121 cases of head and neck Squamous cell carcinoma and its association with various clinicopathologic features and survival. Results Total 66.1% (80 cases) expressed positive p53 expression, 34% (29 cases) revealed no p53 expression, while focal positive p53 expression was noted in 9.9% (12 Cases). Moreover, high p53 expression (> 70%) was noted in 26.4% (32 cases), while 19% (23 cases) showed 51–70% p53 expression. On the basis of intensity of p53 staining; strong p53 expression was noted in 39.7% (48 cases), while 24.8% (30 cases) and 10.7% (13 cases) revealed intermediate and weak p53 expression respectively. Significant association of p53 intensity of expression with extranodal extension and higher tumor grade (grades II and III) was noted. p53 is useful prognostic biomarker in head and neck Squamous cell carcinoma and therefore we suggest that more large scale studies are needed to evaluate its prognostic significance in our population.

Abstract Background In this study, we intend to determine the immunohistochemical expression of EGFR in cases of head and neck squamous cell carcinoma and its association with prognostic clinico-pathologic features. Methods A total of 115 cases of head and neck squamous cell carcinoma treated at Liaquat National Hospital, Karachi, Pakistan, were included in the study. Clinico-pathologic features, risk factors, and recurrence status of cases were evaluated, and EGFR immunohistochemistry was performed. Results In our study, 52 cases (45.2%) of head and neck SCC were positive and 10 cases (8.7%) were focal positive for EGFR expression, while 53 cases (46.1%) were negative for EGFR expression. High EGFR expression (> 70%) was noted in 6.1% (7 cases), while 12.2% (14 cases) and 26.1% (30 cases) revealed 51–70% and 11–50% EGFR expression respectively. On the basis of intensity, strong EGFR expression was noted in 13.9% (16 cases) while 16.5% (19 cases) and 23.5% (27 cases) revealed intermediate and weak EGFR expression respectively. Significant association of EGFR expression was noted with tumor stage and disease-free survival. Conclusion We found a significant association of EGFR expression with tumor stage and disease-free survivals, which are the most important prognostic factors in head and neck squamous cell carcinoma; therefore, EGFR expression can help as a prognostic biomarker in head and neck squamous cell carcinoma. On the other hand, we suggest that molecular studies should be performed in squamous cell carcinoma of head and neck in our setup to identify patients that can avail response from anti-EGFR therapy.

In India and the South Asian part of the world use of tobacco is seen for a longtime. If we go back decades back tobacco is used as a gift to treat the guests and also it was encouraged to use in past times. Sooner when the malicious side effects of tobacco were noticed people tried to avoid the consumption of tobacco. The psychological mindset of the youth is quite impressionable, seeing the things that the adults do would easily encourage them to do the same. Thus, this article reviews various forms of tobacco used in our Indian society and how the government of India is taking action to curb the tobacco abuse. [ABSTRACT FROM AUTHOR]

Objective: To explore the influence of photobiomodulation (PBMT) as an adjuvant to scaling and root planing (SRP) for treating periodontitis among gutka chewers. Materials and methods: Self-reported smokeless-tobacco (gutka) users were enrolled; and underwent SRP with (test group) and without (control group) PBMT. Full-mouth plaque index (P-I), bleeding upon probing (BUP), probing depth (P-D) clinical attachment loss (CAL), marginal bone loss (MBL) (on mesial and distal surfaces of the teeth), and number of missing teeth were recorded before treatment and at 3 and 6 months. Group comparisons were performed and p < 0.05 was referred significant. Results: In the control group, P-I (p < 0.013), BUP (p < 0.001), and P-D (p < 0.012) were high at baseline compared with 3 months follow-up. P-I, BUP, and P-D were higher in the test group, at baseline in comparison with the 3-month (p < 0.001) and 6-month (p < 0.01) follow-up. At 3 and 6 months, scores of P-I, BUP, and P-D were high in the control compared with the test group. No difference in CAL, and mesial and distal MBL was found among patients of both groups at 3 and 6 months. Conclusions: Among gutka chewers, SRP with PBMT is more efficient than SRP alone in the management of periodontitis. [ABSTRACT FROM AUTHOR]

Objectives: Gutka is industrially manufactured in India and some Indian states have instituted bans on the sale of manufactured gutka as a public health initiative. We explored whether gutka was still available for purchase after the ban and also sought to observe methods of ban circumvention. Methods: We visited 5 different markets at different locations separated by at least 15-20 km around the Mumbai Metropolitan Region (MMR) area, consisting of Mumbai and its satellite towns in Maharashtra, India during August- September, 2019. In each location, purveyors were queried as to the availability of gutka. Results: Tobacco purchases were made in 5 locations/sections of MMR. At all markets, banned gutka was not displayed, and could only be purchased after requesting from the shopkeeper. Three methods of ban circumvention were observed: (1) packages marked 'export only'; (2) use of twin packaging in which pan masala and tobacco are sold together for immediate mixing to create gutka; and, (3) non-descript packaging without mention of 'gutka'. Conclusions: Although not readily displayed in shops, gutka is readily available in MMR, despite a statewide ban in Maharashtra. Marketers have used multiple methods to circumvent the statewide gutka ban. [ABSTRACT FROM AUTHOR]

Objective: To learn about the use of various chewing substrates, such as areca nut and gutka, among subjects with oral submucosal fibrosis (OSMF) and controls with no oral mucosal lesions. Materials and Methods: In this hospital-based case-control study, 220 patients with OSMF were selected and compared to matched controls with regard to dietary habits, including spice use, smoking history, and preference for chewing substrates. Relative risk of various chewing habits was calculated using an odds ratio and logistic regression analysis to understand the influence of chewing habits, spices, and smoking on the development of OSMF. Discriminate analysis was employed to determine which risk factors were valid and reliable discriminators between individuals with or without OSMF. Results: The relative risk of developing oral submucosal fibrosis was highest with the gutka-chewing habit (relative risk, 1,142.4), which was significant (P < .01) at 95% confidence interval. The next highest relative risk for development of oral submucosal fibrosis was observed for the combination of gutka with other chewing habits. The relative risk of developing submucosal fibrosis increased with the frequency of chewing habit up to 15 times daily with a duration of habit up to 4 years. The relative risk decreased with chewing frequency beyond 15 times daily and 4 years in duration. Logistic regression and discriminative analysis show that chewing areca nut and gutka, especially daily, greatly influence the development of submucosal fibrosis. Conclusion: This study suggests that chewing commercially available areca-nut preparations such as gutka is strongly associated with the development of oral submucosal fibrosis. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of Smokeless Tobacco Consumption Among Patients Seen at Altamash Institute of Dental Medicine, Karachi. Study design: Descriptive cross-sectional study. Place and duration: Th is survey was conducted at Altamash Institute of Dental Medicine, Karachi. Th e survey was initiated on the March 2019 and was concluded on the May 2019. Method and Materials: A total of 230-participants have participated in the study. A sample of 230-patients was selected by random sampling technique. A questionnaire was used to evaluate the prevalence of smokeless tobacco among patients. Results: According to the results 87.82% were males, and 12.17% were females. Majority of the people were noted to be in their second decade of life and uneducated. Th e most common form of smokeless tobacco (SLT) being used was snuff 47.82%, with the least preference being given to paan with tobacco (13.04%). While the data showed that the main reason as to started the use of smokeless is pressure from friends and colleagues. Majority of the people had been using the product since more than 7-years, and they use the product 3-5 times in 1-day. Conclusions: Th e fi ndings of this study concluded that indulgence in smokeless tobacco habit usually starts as a pressure from friends and colleagues, youngsters and adults both can get addicted to this habit of consuming smokeless tobacco. [ABSTRACT FROM AUTHOR]

Introduction: High consumption of smokeless tobacco in adult Indian population increases the risk of developing oral cancers leading to high morbidity and mortality. Though the influence of abstinence from smoking on cognitive performance has been widely studied, the effect of smokeless tobacco on cognitive performance and its association with withdrawal symptoms is less understood. This study comparatively investigates the effect of short-term conscious abstinence and distraction during abstinence from smokeless tobacco consumption on the craving, withdrawal symptoms, sympathetic response, and cognitive performance in tobacco addicts. Methods: Age, sex, education and socioeconomic status matched control (N = 15) and smokeless tobacco addicts (N = 60) were recruited from residential areas in Bhubaneswar for the study. Following randomization of the addicts, conscious abstinence (N = 30) was induced by informed abstinence from tobacco consumption for 8 hours, while distracted cessation (N = 30) was induced by involving the participants in a cognitively engaging task for 8 hours during uninformed tobacco abstinence. Results: The results of the study show higher withdrawal symptoms and reduced cognitive performance in volunteers with conscious abstinence which was positively correlated. The decreased cognitive performance in conscious cessation was independent of tobacco-induced increase in the LF:HF ratio and cotinine concentration in saliva. Conclusion: While conscious abstinence results in higher withdrawal symptoms, distraction during abstinence lowers these symptoms. Inclusion of distraction sessions during cessation can, therefore, be a new element in tobacco control strategies. [ABSTRACT FROM AUTHOR]

Background: Gutka chewing is the most and popular form of smokeless tobacco use in India. Epidemiological studies showed a strong association between smokeless tobacco use and oral precancerous lesions, carcinoma and other oral mucosal lesions. Aim and objectives: To know the patterns of clinical and pathological manifestations of oral mucosal lesions in Gutka chewers (patients) attending out-patient department of oral Medicine and Radiology at Govt. Dental college/Hospital, Hyderabad, To assess the efficacy of the oral brush cytology in the detection of precancer and cancerous conditions of the buccal mucosa. Materials and methods: Oral mucosal lesions diagnosed in patients of both sexes with Gutka chewing habit were taken at Dept. of Oral Medicine and Radiology, Govt. Dental College, Hyderabad. Total 800 cases were studied from 2006 to 2017 (10 years study), Oral Brush cytology Procedure with papanicolaou staining procedure was used. Brush cytology results were divided into 3 groups: Negative brush cytology (normal or inflammatory smear), Positive brush cytology (Dysplasia positive smear), Atypical brush biopsy (Suspicious smear). Results: Out of 800 patients, males (80%) outnumbered females. Total no of controls 2246 with 51% were males. 75% were below 30 years of age. Higher percentage of cases (60%) belonged to the lower socio economic groups. Clinical diagnosis of sub mucosal fibrosis and carcinoma corresponding to histopathological confirmation is almost 100%. Conclusion: Oral brush cytology is useful in early detection of precancerous and cancerous conditions of the oral cavity lesions in Gutka chewers. [ABSTRACT FROM AUTHOR]

Introduction: Dental health and oral health are used almost synonymously when stating the goals of oral health; such statements are only valid for dental health. This may lead to severe underestimation of the need of total oral health care. When planning measures of oral health care, the lack of data may lead to a risk of overlooking diseases of the soft tissue in, and adjacent to, the oral cavity. Prevalence data of oral mucosal lesions are available from many countries, but the information is usually restricted to very few lesions in each survey. Materials and Methods: The present study is an attempt to assess and compare the various deleterious habits and its associated oral mucosal lesions among patients visiting outpatient department of Jaipur Dental College, Jaipur, Rajasthan. Results: It was found that the prevalence of habits was 51.4% including both the sexes and prevalence of oral mucosal lesions were 9.9%. Discussion: The prevalence of habits and oral mucosal lesions is very high as compared with other studies. The habit of smoking was higher in males as compared to females.

Purpose: To assess the knowledge, behavior and practices of oral cancer patients of low socioeconomic statusin our population. Method: This cross sectional study was conducted in Department of Otolaryngology Unit 1 and 2 of Civil Hospital, Karachi between August 2011 to August 2012. Only those cases were included in the studies whose diagnosis of oral cancer was confirmed by histopathological investigation. Questionnaire was designed and filled by investigators after validation and reliability assessment. Statistical Package for Social SciencesWindows version 17 was used for database assembly and analysis. Result: The mean age was found to be 48.3 ± 7.3 years with 119 males and 71 females (male to female ratio1.7:1). Most patients (82.1%) were of low socioeconomic status. From 190 cases, 88.9% admitted consumption of carcinogenic agents. Most patients (66.8%) used Gutka. Most patients (42.1%) presented with the lesion in the oral cavity. More than half (56.8%) first visited a doctor near their home, after appearance of symptom. Consultation to a doctor in any hospital, including the study center was reported by 35 (18.4%) of the cases. The mean disease appraisal time was 36.6±11.2 days. The mean illness time was 126.7±37.6 days. The mean behavioral time was 18.3±5.9 days. The mean scheduling time was 0.26±0.09 days. The mean treatment time was 6.3±1.9 days. The most common reason (81%) presented by patients for delayed presentation was lack of knowledge and education about the danger posed by their presenting complaints. Conclusion: In our population of low SES patients, we report poor knowledge status and dangerous practices of consumption of carcinogens. The patient health seeking behavior is related to their educational status. Most patients delay seeking help due to lack of awareness about the severity of symptoms. We propose organizationof multiple public health campaign to address the current problem at hand.

Objectives: To know the serum ferritin and vitamin B12 levels in relation to C reactive protein in individuals using smokeless tobacco in Hyderabad, sindh, Pakistan. Study Design: Cross sectional study. Place of Study: Private clinics of consultants of Hyderabad, Sindh, Pakistan. Duration of Study: January 2016 to February 2017. Methodology: One hundred eighty three individuals were selected from different clinics of physicians, dental surgeons of sadder Hyderabad sindh Pakistan by judgmental sampling. Patients were young subjects, mean age was 21.4±7.4 years, mean BMI was 22.1±3.8 and mean duration of chewing tobacco was 2±1.5 years. All types and forms of gutaka, manpuri and flavored betel nut were included like bombart, zafri and panparag. The dose was 30-100grams once or two times. SPSS 16 was used as statical software and Chai square test was used to calculate p value. P value was taken <0.05 statically significant. Results: Frequency of use of gutka was 32%, Betel nut 38% and 29% had habit of chewing manpuri. Serum ferritin was low and c reactive protein was high, p value was <0.05 in gutaka and manpuri users. Vitamin B12 was reduced significantly in gutaka user p value was <0.05. In betel nut chewers significant finding was only high C reactive protein, p value <0.04. Conclusion: Smokeless tobacco has significant negative impact on serum ferritin and vitamin B12 levels. These chewing agents also increased inflammatory markers like c reactive protein. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: The finite details of tobacco consumption practices in north Indian population are hitherto not well described. This study depicts the modes of tobacco use, their relative frequency, demographic and psychosocial determinants. Materials and Methods: Random stratified sampling from the list of blocks, villages and urban localities was done. The study was community-based house-to-house survey using interview schedule. Results: There were 1607 tobacco users: 1399 male and 208 female; 1195 urban and 412 rural. Single mode of tobacco use was reported by 769 (47.85%). Chewing tobacco was prevalent in 511 (31.80%), smoking in 258 (16.55%) subjects and majority 838 (52.15%) had consistent multiple habit of smoking and chewing. Of the 10 preparations of tobacco use, the ‘top 5’ ranked as tobacco-betel, gutka, cigarette, bidi and khaini. Gutka consumption was significantly higher between age group of 25 years and 55 years (χ2 = 17.2; P

Nicotine dependence is a current indwelling and challenging health burden among smokeless tobacco users as it involves the compulsive use of a substance despite its known harmful effects. The evaluation of nicotine dependence is challenging as it involves physical and psychological dependence due to nicotine in smokeless tobacco., Aim and Objective: The primary aim is to assess the nicotine dependence in a group of smokeless tobacco by using a six-question Fagerstrom Test for Nicotine Dependence for Smokeless Tobacco (FTND-ST) and to assess the nicotine dependence among three groups, namely Group - 1, who were exclusively pan masala, gutka chewers, Group - 2, who were exclusively Hans users, and Group - 3, who were exclusively betel quid with smokeless tobacco chewers., Materials and Methods: Only those who use smokeless tobacco in the age groups between 21 to 70 years were randomly selected. The total sample size is 100 patients. The age groups were divided into 21-28, 29-35, 36-42, 43-49, 50-56, 57-63, and 64-70. Informed consent was obtained from the participants of the study., Results: The Hans chewers are predominantly females. Pan masala and gutka chewers are predominantly males., Conclusion: Smokeless tobacco chewers like pan masala were found to have high mean nicotine dependence Fagerstrom score than Hans and betel quid with smokeless tobacco chewers., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Shaashi uday et al.)

O0 bjective: The main objective of the study was to understand the perceptions of the residents of rural part of Sriperambudur Taluk, regarding areca nut use. This article discusses the findings of in-depth interviews and focus group discussions at rural part of Sriperambudur Taluk. Materials and Methods: A community-based survey was conducted using qualitative methods. Out of 168 villages, 11 were randomly chosen. Fifteen in-depth interviews and five focus group discussions were conducted. Only those above 10 years of age and who used areca nut either in processed or un-processed form were included in the study. Results: Among different forms of areca nut products, the use of Hans, which is a commercial flavored product containing areca nut, tobacco and other ingredients is believed to be the most prevalent habit in all the age groups. Chewing areca nut is the initiating habit, leading to other habits such as smoking and consuming alcoholic beverages. Residents less than 30 years of age chew areca nut products for fun or because of peer pressure whereas the 30 to 50 year olds get habituated due to reasons such as boredom and family problems. Although there is awareness regarding the ill-effects of tobacco use, there is not much awareness regarding areca nut. According to the residents, the community has not given enough thought regarding areca nut products and therefore no action has been taken to mitigate this high-risk behavior. Conclusion: It is the perception of the community that there is an increasing trend in the use of areca nut especially the commercial forms such as Hans , in rural Tamilnadu. Habit gets initiated at a very young age; therefore age specific intervention programs should be implemented. Periodic research should be conducted to better understand the changing trends of chewing areca nut products.

Oral squamous cell carcinoma (OSCC) is the most commonly occurring malignant tumor in South East Asian region. It is a major cause of morbidity and mortality. This study was undertaken to assess the frequency of OSCC, gender, age distribution and anatomical site according to ICD-10 (International Statistical Classification of Disease and Related Health Problems. 10 Revision, ICD-10). The survey was undertaken at the Oral Surgery outpatient clinic of Hamdard University Dental Hospital, Karachi. Our sample size is comprised of 80 patients with histologically proven cases of OSCC of both genders were included in this study. In present study, most predominant site of occurrence of OSCC was buccal mucosa 34(50%) nevertheless least cases were found affected at floor of the mouth 1(1.5%). Of the total sample size maximum number of cases were reported between the age group of 31-60 years, 53(77.9%) and showed higher predilection towards male gender. However the OSCC of the hard palate and upper alveolar mucosa were specifically found more in female. Almost all of these patients gave a positive history of betal chewing. This has now become major public health problem, and awareness to the masses is necessary to control the rising rate of oral malignant disease in the country. [ABSTRACT FROM AUTHOR]

Oral submucous fibrosis (OSF) is a chronic, progressive, debilitating condition affecting oral mucosa with recognized high risk of transformation into malignancy. Areca nut, betel quid, and gutka consumption are the established primary culprits culminating in chronic irritation leading to inflammation and fibrosis of exposed mucosa. The aim of the study was to describe the pattern of presentation for oral submucous fibrosis (OSF) patients who were seen in dental OPD at Dow International Medical and Dental College, Ojha campus, Karachi during one year (January 2015 to January 2016). Data pertaining to patient demographics, oral habits, clinical history and presentation were gathered and analyzed using SPSS 16.0. OSF was seen mostly during third decade of life with a strong male predilection (male to female ratio 5:1). The predominant complaint at presentation was trismus followed by stomatitis. Majority of the patients indicated a positive history of certain oral habits. More than half of the patients presented in stage 3. A small percentage of patients also reported with unknown etiology suggesting a possible role of genetics in pathogenesis. Increasing incidence in younger adults, particularly men from low socio-economic status should alarm the healthcare providers to target their preventive programs at this population. An incurable, progressive disease like OSF needs more efforts to prevent than cure particularly when the causative agents are established and widely available in the market. [ABSTRACT FROM AUTHOR]

Background: People mostly use paan and gutkha due to a lack of awareness and education. Gutkha is a mixture of powdered areca nut and tobacco. Hence, we planned the present study to assess of prevalence of Gutka chewing among patients attending the periodontology department of Patna dental college & hospital. Materials & methods: A total of 252 patients attending the department of Periodontology for oral prophylaxis were included in the present study. Detailed information in relation to the type, quantity and frequency of Tobacco and Gutka intake was obtained. All the details were recorded Microsoft excel sheet. Results: The overall prevalence of Gutka chewers in the present study was found to be 59.52 percent. Prevalence of Gutka chewers was significantly higher in the present study among subjects of the age group of 30 to 50 years (32.54 percent). Prevalence of Gutka chewers was also significantly higher among males. Conclusion: In Patna, there is significantly higher prevalence of Gutka chewers. Therefore, various cancer awareness programs are recommended for increasing awareness about ill effects of Gutka chewing among general population. [ABSTRACT FROM AUTHOR]

White lesions of the oral mucosa are of concern to the dental surgeon in view of the fact that some of these may be potentially malignant. Oral lichen plane: (OLP) and oral lichenoid reactions (OLR) share similar clinical appearances but need to be carefully distinguished because of their different etiologies and clinical behaviour. This study screened 5.017 population, in a house-to-house field survey, for tobacco use and investigated the prevalence of oral lichenoid reactions in the 98 quid users. Six subjects with clinical/clinical and histopathological criteria compatible with the diagnosis of OLR were identified. All these subjects were users of ′Gutka′, a unique chewable variant of tobacco quid containing areca nut and catechu. Statistical analysis revealed a significant association between quid habit and lesion occurrence (p < 0.005).