Patterns of Periodontal Destruction among Smokeless Tobacco Users in a Central Indian Population

Periodontitis presenting among betel quid users: A case series

BACKGROUND

Betel leaf chewing habit has been studied extensively, as it has been an ancient practice in many Asian countries. Although betel leaf has been reported to have potential beneficial properties, it has also been shown to have a strong association with oral diseases, including periodontitis. This case series addresses the presentation of periodontitis among betel quid users, to help clinicians identify and manage such patients when they are encountered in settings outside the countries and territories where betel quid use is common.

METHODS

Four patients of Asian ethnicity were referred to The Ohio State University College of Dentistry Graduate Periodontology clinic for periodontal treatment. Targeted questioning resulted in all four patients reporting a past and current betel leaf chewing habit, established at a young age, typically in a family setting, and long before their immigration from their native country.

RESULTS

All four patients exhibited similar reddish-brown staining on the teeth and generalized radiographic bone loss. Notably, the patients disclosed the betel chewing habit only after different vernacular names for betel quid were used during questioning, which complicated history taking. Severe periodontitis (stage III/IV, grade C) was diagnosed in all four patients, who were given appropriate periodontal treatment plans.

CONCLUSION

Betel leaf chewing, prevalent in many Asian countries, is associated with periodontitis and may present with extensive tooth staining. Oral healthcare providers should consider this cultural habit and pursue thorough assessment and history taking for their patients originating from countries where the habit is common practice.

KEY POINTS

Clinicians should be aware of the clinical presentation and oral findings in betel quid users. Given the increasing diversity of the patient pool that clinicians are encountering, knowledge of vernacular names for betel quid usage can prove valuable in history taking. A protocol for betel quid cessation should be incorporated into the management strategy for these patients in clinical practice.

PLAIN LANGUAGE SUMMARY

Betel quid (paan) chewing is a widespread cultural habit, especially in Asia. The chewing of betel quid, whether alone or with tobacco, has been strongly associated with periodontitis and other oral conditions, such as leukoplakia, oral cancer, and oral submucous fibrosis. This report illustrates the typical presentation of periodontitis patients who habitually chew betel quid, highlights the associated clinical features, such as reddish-brown tooth staining and severe bone loss, and underlines the challenge of obtaining a complete history because of the very many vernacular names used for betel quid in different countries and the fact that for many of the patients, this is considered a routine cultural tradition. It is unusual to encounter patients chewing betel quid in this country because the practice is not common. However, immigrants from countries where betel quid chewing is commonplace may continue the habit after they move to the United States. Oral healthcare providers should be aware of this possibility and elicit the relevant information from the patients. This will help practitioners to properly address this underlying factor and to provide appropriate care to these patients, including cessation advice and support, and establishment of routine oral screenings and regular periodontal maintenance.

Effects of Smokeless Tobacco on Oral Health: A Cross-Sectional Study

BACKGROUND

Smokeless tobacco (SLT) consumption poses a significant global public health challenge because of its adverse effects on oral health. Although the detrimental impact of SLT on oral tissues is well-documented, understanding its multifaceted effects is essential for effective prevention and intervention strategies.

OBJECTIVE

This study aimed to comprehensively assess the impact of SLT on oral health, focusing on various clinical parameters and their differences between placement and non-placement sites of SLT.

METHODS

A cross-sectional study involving 528 habitual users of SLT was conducted. Clinical parameters included the plaque index (PI), gingival index (GI), gingival bleeding index (GBI), gingival recession (GR), and probing depth (PD). Oral mucosal changes at SLT placement sites have also been reported. Statistical analysis was performed to compare parameters between the placement and non-placement sites.

RESULTS

 The study involved 528 subjects, mostly male (82%) and aged 21-40 years (mean±SD=31.14±9.10), habitual users of SLT. Prevalent SLT types included tobacco with betel nuts/masala/gutkha (59.9%) and tobacco with lime (54.5%). Significant differences were observed between SLT placement and non-placement sites: higher gingival inflammation (GI) at placement sites (1.54±0.61 vs. 1.45±0.54, p=0.01), lower GBI at placement sites (40.0% vs. 84.3%, p=0.001), and more prevalent GR (65.7% vs. 34.3%, p=0.03) at placement sites. Probing depths ≥ 3 mm were also less frequent at placement sites (2.67±0.72) than non-placement sites (3.37±1.03, p=0.001). These results highlight the detrimental impact of SLT on periodontal health, emphasizing the need for targeted interventions among SLT users.

CONCLUSION

SLT use is associated with adverse effects on oral health, including GI, plaque accumulation, gingival bleeding, GR, and changes in the oral mucosa. Targeted interventions and public health policies are needed to address these issues effectively.

Prevalence of periodontitis and its association with smokeless tobacco (SLT) Use amongst the adult population of Greater Noida, India - A cross-sectional study

Context

Smokeless tobacco (SLT) has been consumed in India since times immemorial. It is the need of an hour to emphasise about awareness and harmful effects of SLT in relation to periodontium.

Aim

The aim of the study was to access the prevalence of periodontitis and its association with SLT amongst the adult population of Greater Noida, India. Settings and Design: Hospital-based study and cross-sectional design.

Methods and Material

This cross-sectional study included 512 SLT subjects between the ages of 18 and 79 years. The study was carried out from December 2019 to January 2022. A self-designed questionnaire was used for recording demographic details, forms of SLT, frequency, duration of use, and sites of retention of SLT products. The clinical periodontal parameters such as periodontal pocket depth (PPD) and clinical attachment level (CAL) were recorded in a given point of time.

Statistical Analysis Used

Chi-square test and logistic regression analysis.

Results

The prevalence of periodontitis among SLT was 81.6% with the highest occurrence of Stage III Periodontitis (35.4%). The use of SLT for ≥10 years [odds ratio (OR) = 3.05, 95% confidence interval (CI) 1.86-6.27] showed threefold the risk for periodontitis compared to others who consumed SLT for 4-5 years. Gutkha consumers [OR = 2.56 (95% CI = 0.75-3.48)] were 2.56 times more prone to have periodontitis as compared to other forms of SLT.

Conclusions

Periodontitis is positively associated with SLT use. Awareness, timely intervention, and periodic screening in the SLT users will help to prevent the progression of periodontitis.

Serum Vitamin D level and its association with red blood cell indices in patients with periodontitis

Background:

Research of late has brought to light a connect between Vitamin D and anemia. The level of 25hydroxyvitamin D (25(OH) D) is decreased in periodontitis subjects as against subjects without periodontitis and this reduced level could be related to more risk for anemia in periodontitis patients.

Objective:

This study aimed to evaluate the serum 25(OH) D levels and red blood cell indices in patients affected by generalized Stage III Grade B periodontitis and healthy controls and to assess the association between level of Vitamin D and red cell indices in periodontitis patients.

Materials and Methods:

The subjects were categorized into (i) case and (ii) control group of 30 each. Clinical parameters including oral hygiene index simplified, mean ratio of sites that bled on probing, gingival index, probing pocket depth, and the clinical attachment loss were assessed in both the groups. Subjects' blood samples (venous) were taken for the biochemical analysis.

Results:

In contradiction to healthy subjects, periodontitis subjects had significantly diminished 25(OH) D levels, hemoglobin (Hb), hematocrit, and mean corpuscular hemoglobin concentration (MCHC). 25(OH) D was moderately correlated with MCHC (r = 0.53) and it was statistically significant (P = 0.002).

Conclusion:

Periodontitis impacts Vitamin D status which further causes anemia. It suggests that effective management of periodontitis can help maintain sufficient Vitamin D status and may be vital in preventing anemia.