Predictors of the severity of oral submucous fibrosis among gutka consumers: a regression analysis


      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.


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        • Rajendran R.
        Oral submucous fibrosis: etiology, pathogenesis, and future research.
        Bull World Health Organ. 1994; 72: 985-996
        • Javed F.
        • Altamash M.
        • Klinge B.
        • et al.
        Periodontal conditions and oral symptoms in gutka chewers with and without type 2 diabetes.
        Acta Odontol Scand. 2008; 66: 268-273
        • Javed F.
        • Bello Correa F.O.
        • Chotai M.
        • et al.
        Systemic conditions associated with areca nut usage: a literature review.
        Scand J Public Health. 2010; 38: 838-844
        • Abduljabbar T.
        • Hussain M.
        • Adnan T.
        • et al.
        Comparison of oral Candida species prevalence and carriage among gutka-chewers and betel-quid chewers.
        J Pak Med Assoc. 2017; 67: 350-354
        • Mehrotra D.
        • Pradhan R.
        • Gupta S.
        Retrospective comparison of surgical treatment modalities in 100 patients with oral submucous fibrosis.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 107: e1-e10
        • Shih Y.H.
        • Wang T.H.
        • Shieh T.M.
        • et al.
        Oral submucous fibrosis: a review on etiopathogenesis, diagnosis, and therapy.
        Int J Mol Sci. 2019; 20: 2940
        • Kiran Kumar K.
        • Saraswathi T.R.
        • Ranganathan K.
        • et al.
        Oral submucous fibrosis: a clinico-histopathological study in Chennai.
        Indian J Dent Res. 2007; 18: 106-111
        • Mehta F.S.
        • Hammer J.E.
        Tobacco-related oral mucosal lesions and conditions in India. Tata Institute of Fundamental Research Bombay.
        Jaypee Brothers Medical Publishers Ltd., 1993: 56-67
        • Satheeshkumar P.S.
        • Mohan M.P.
        • Jacob J.
        Restricted mouth opening and trismus in oral oncology.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2014; 117: 709-715
        • Banerjee S.C.
        • Ostroff J.S.
        • Bari S.
        • et al.
        Gutka and tambaku paan use among South Asian immigrants: a focus group study.
        J Immigr Minor Health. 2014; 16: 531-539
        • Rajendran R.
        Oral submucous fibrosis.
        J Oral Maxillofac Pathol. 2003; 7: 1-4
        • Li N.
        • Jian X.
        • Hu Y.
        • et al.
        Discovery of novel biomarkers in oral submucous fibrosis by microarray analysis.
        Cancer Epidemiol Biomarkers Prev. 2008; 17: 2249-2259
        • Shiau Y.Y.
        • Kwan H.W.
        Submucous fibrosis in Taiwan.
        Oral Surg Oral Med Oral Pathol. 1979; 47: 453-457
        • Lai D.R.
        • Chen H.R.
        • Lin L.M.
        • et al.
        Clinical evaluation of different treatment methods for oral submucous fibrosis. A 10-year experience with 150 cases.
        J Oral Pathol Med. 1995; 24: 402-406
        • Babu S.
        • Bhat R.V.
        • Kumar P.U.
        A comparative clinic-pathological study of oral submucous fibrosis in habitual chewers of pan masala and betel quid.
        J Toxicol Clin Toxicol. 1996; 34: 317-322
        • Ranganathan K.
        • Devi M.U.
        • Joshua E.
        • et al.
        Oral submucous fibrosis: a case-control study in Chennai, South India.
        J Oral Pathol Med. 2004; 33: 274-277
        • Ceena D.E.
        • Bastian T.S.
        • Ashok L.
        • Annigeri R.G.
        Comparative study of clinicofunctional staging of oral submucous fibrosis with qualitative analysis of collagen fibers under polarizing microscopy.
        Indian J Dent Res. 2009; 20: 271-276
        • Haider Syed Mahmood
        Oral submucous fibrosis: clinical and functional staging of oral submucous fibrosis.
        Br J Oral Maxillofac Surg. 2000; : 12-15
        • Pindborg J.J.
        • Mehta F.S.
        • Daftary D.K.
        Occurrence of epithelial atypia in 51 Indian villagers with oral submucous fibrosis.
        Br J Cancer. 1970; 24: 253-257
        • Harvey W.
        • Scutt A.
        • Meghji S.
        Stimulation of human buccal mucosa fibroblasts in vitro by betel-nut alkaloids.
        Arch Oral Biol. 1986; 31: 45-49
        • Trivedy C.R.
        • Warnakulasuriya K.A.
        • Peters T.J.
        • et al.
        Raised tissue copper levels in oral submucous fibrosis.
        J Oral Pathol Med. 2000; 29: 241-248
        • Bhonsle R.B.
        • Murti P.R.
        • Daftary D.K.
        • et al.
        Regional variations in oral submucous fibrosis in India.
        Community Dent Oral Epidemiol. 1987; 15: 225-229
        • Maher R.
        • Lee A.J.
        • Warnakulasuriya K.A.
        • et al.
        Role of areca nut in the causation of oral submucous fibrosis: a case-control study in Pakistan.
        J Oral Pathol Med. 1994; 23: 65-69
        • van Wyk C.W.
        • Grobler-Rabie A.F.
        • Martell R.W.
        • et al.
        HLA-antigens in oral submucous fibrosis.
        J Oral Pathol Med. 1994; 23: 23-27
        • Ara S.A.
        • Arora V.
        • Zakaullah S.
        • et al.
        Correlation of habits and clinical findings with histopathological diagnosis in oral submucosal fibrosis patients.
        Asian Pac J Cancer Prev. 2013; 14: 7075-7080
        • Rajendran R.
        • Rajeev R.
        • Anil S.
        • Alasqah M.
        • Rabi A.G.
        Helicobacter pylori coinfection is a confounder, modulating mucosal inflammation in oral submucous fibrosis.
        Indian J Dent Res. 2009; 20 (PMID: 19553724): 206-211
        • Nigam N.K.
        • Aravinda K.
        • Dhillon M.
        • et al.
        Prevalence of oral submucous fibrosis among habitual gutkha and areca nut chewers in Moradabad district.
        J Oral Biol Craniofac Res. 2014; 4: 8-13
        • Pindborg J.J.
        • Sirsat S.M.
        Oral submucous fibrosis.
        Oral Surg Oral Med Oral Pathol. 1966; 22: 764-779
        • Hosein M.
        • Mohiuddin S.
        • Fatima N.
        Association between grading of oral submucous fibrosis with frequency and consumption of areca nut and its derivatives in a wide age group: a multi-centric cross sectional study from Karachi, Pakistan.
        J Cancer Prev. 2015; 20: 216-222