Analysis of various risk factors affecting potentially malignant disorders and oral cancer patients of Central India

Assessment of knowledge and awareness among North Indian populations about oral precancerous lesions (OPL): A cross-sectional survey study

Background

A precancerous lesion is a morphologically altered tissue in which oral cancer is more likely to occur than its apparently normal counterpart. They are quite common in the Indian population due to the habitual habit of chewing tobacco. The aim of this study was to evaluate the awareness of oral precancerous lesions by a questionnaire-based survey among the study subjects having been diagnosed with it.

Methods

In this descriptive study, a structured questionnaire having 11 survey questions has been used to record the response from study subjects who have been diagnosed and reported for treatment for oral premalignant lesions in the Department of Oral Medicine and Radiology. A total of 1013 study subjects were assessed for awareness about OPL and its consequences.

Results

44.3% of the study population was addicted to smoking tobacco (cigarettes) while 57.9% of study subjects were addicted to non-smoking tobacco (Pan masala). The reason behind their addiction was reported to be stress (54.9%) and workload (25.3%). Most of the study subjects were diagnosed with oral sub-mucous fibrosis (53.4%). 78.6% of study subjects diagnosed with OPL were not aware of it and 94% were willing to quit the addiction.

Conclusion

The awareness about OPL among patients was found to be low. Although many wanted to quit their addiction to smoking and chewing tobacco but were unable to do so. So it is a need for time to develop a national policy on tobacco use and related diseases. This policy will definitely reduce the burden of oral premalignant lesions and oral cancer in Indian population.

Modifiable risk factors for oral cavity cancer in non-smokers: A systematic review and meta-analysis

BACKGROUND

Oral cavity cancer (OCC) is traditionally associated with smoking, but there is an increasing prevalence of the disease among non-smokers. This review investigates possible modifiable risk factors in the development of OCC in non-smokers (OCCNS).

METHODS

PubMed, EMBASE, Web of Science, and Scopus were searched for publications prior to June 2021. Comparative studies investigating modifiable OCCNS risk factors were identified following PRISMA guidelines. Publication date, population size, and results were indexed. Study quality was assessed using MINORS (Methodological Index for Non-Randomized Studies). Factors examined by multiple studies were analyzed using random-effect meta-analysis framework.

RESULTS

Literature search resulted in 1,625 unique publications. 52 records met inclusion criterion, investigating alcohol (n = 22), chewing products (n = 18), diet (n = 7), dental health (n = 11), and medical comorbidities (n = 6).

CONCLUSION

This review demonstrates the paucity of large studies investigating OCCNS risk factors. Further investigation is warranted to help clinicians risk-stratify patients without traditional risk factors.

Death, Disability, and Premature Life Years Lost Due to Cigarettes, Bidis, and Smokeless Tobacco in India: A Comparative Assessment

BACKGROUND

Due to the staggering number of tobacco users in India, it is important to determine the exact mortality and morbidity rates due to tobacco use. This study aimed to estimate deaths, disability-adjusted life years (DALYs), and years of life lost (YLLs) attributable to cigarettes, bidis, and smokeless tobacco (SLT) in India.

METHODS

Data pooling and meta-analysis were done using case-control studies available on the three types of tobacco products. Health burden was estimated by applying the population attributable fraction (PAF) value to the total disease burden.

FINDINGS

A total of 33 studies were included. PAF was calculated for oral and lung cancer as well as ischemic heart disease (IHD) due to cigarettes, oral and lung cancer, IHD, and chronic obstructive pulmonary disease due to bidi, and oral and stomach cancer and IHD due to SLT. Cigarettes resulted in 8.4 million DALYs, 8.26 million YLLs, and 341 deaths; bidis led to 11.7 million DALYs, 10.7 million YLLs, and 478 thousand deaths, and SLTs accounted for 4.38 million DALYs, 4.3 million YLLs, and 171 thousand deaths annually.

CONCLUSION

Evidence of measurable health burden and methodology for calculation for individual states was provided in the study. The generated evidence could be utilized for policy recommendations and revision of the existing taxation norms.

Association Between Dietary Fatty Acid Pattern and Risk of Oral Cancer

Objective

To investigate the association between dietary fatty acid (FA) patterns and the risk of oral cancer.

Method

A case-control study which included 446 patients with oral cancer and 448 controls subjects was conducted in Southeast China. A structured food frequency questionnaire was used to assess the dietary FA consumption before cancer diagnosis. FA patterns were identified using the principal component analysis, and the relationship between the dietary FA patterns and oral cancer was analyzed by logistic regression.

Results

General differences in FA intake were observed between the patient and control groups. The intakes of saturated FAs (SFAs) C14:0, C16:0, C18:0, and monounsaturated FA C18:1 were higher in the patient group than the control group (p < 0.001). Four FA patterns were derived by principal component analysis. The "SFA" pattern, "Polyunsaturated FA" pattern, "Monounsaturated FA" pattern, and "Medium- and long-chain FA" pattern, which could explain 75.7% of the variance of the dietary FA intake, were submitted to logistic regression analysis. A positive association was observed between the "SFA" pattern and oral cancer risk. Compared with the lowest quartile score, the OR of the highest quartile score was 3.71 (95%CI: 2.31, 5.94, P _trend < 0.001) in the multivariate logistic regression model. No significant association was found among the other three patterns and oral cancer risk.

Conclusions

General differences in dietary FA intake were observed between patients with oral cancer and controls. A positive association between the "SFA" pattern and risk of oral cancer was observed after adjusting for potential confounders.

Burden of oral cancer in Asia from 1990 to 2019: Estimates from the Global Burden of Disease 2019 study

Background

Oral cancer (OC) poses a threat to human health and imposes a heavy burden on countries. We assessed the burden imposed by OC on Asian nations from 1990 to 2019 based on gender and age.

Methods

We collected oral cancer data from the 2019 Global Burden of Disease study from 1990 to 2019 in 45 Asian countries and territories. Annual case data and age-standardised rates (ASRs) were used to investigate the incidence, mortality, and disability-adjusted life-years (DALYs) of OC based on age and gender from 1990 to 2019 in 45 Asian countries and territories. Estimated annual percentage changes (EAPCs) were used to assess incidence rate, mortality, and trends in DALYs.

Results

The age-standardised incidence rate (ASIR) of OC increased from 1990 to 2019 with an EAPC of 0.32 (95% CI, 0.19–0.46), and the age-standardised death rate of OC remained stable at an EAPC of 0.08 (95%CI, from -0.06 to 0.21). The age-standardised DALYs of OC decreased at an EAPC of -0.16 (95%CI, from -0.30 to -0.02). The proportion of patients older than 70 years increased yearly in terms of incidence, mortality, and DALYs from 1990 to 2019. Of the DALYs, smoking was the main contributor in the Asian regions, and the largest contributor to DALYs in most Asian regions. Other contributors were alcohol use and chewing tobacco.

Conclusion

Although the burden of OC was declining in Asia, South Asia remained the region with the highest burden. OC caused the greatest burden in Pakistan, Taiwan China, and India. Therefore, measures should be taken to reduce the burden of oral cancer in high-risk regions and countries with attributable risk factors.

The health impact of smokeless tobacco products: a systematic review

INTRODUCTION

The objective was to systematically review studies on health outcomes from smokeless tobacco (SLT) products.

METHODS

We analysed published literature on the health outcomes from SLT use between 01/01/2015 to 01/02/2020, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol using PubMed, Embase, Scopus, and Google Scholar.

RESULTS

Of 53 studies included, six were global, 32 from Asia, Middle East and Africa (AMEA), nine from USA and six from Europe. 'Poor'-rated studies predominated (23;43%), in particular, for global (4;66%) and AMEA (16;50%). Health outcomes differed between SLT-products and regions; those in AMEA were associated with higher mortality (overall, cancer, Coronary heart disease (CHD), respiratory but not cardiovascular disease (CVD)), and morbidity (CVD, oral and head and neck cancers), with odds ratios up to 38.7. European studies showed no excess mortality (overall, CVD, from cancers) or morbidity (ischemic heart disease (IHD), stroke, oral, head and neck, pancreatic or colon cancers) from several meta-analyses; single studies reported elevated risk of rectal cancer and respiratory disorders. Pooled study data showed protection against developing Parkinson's disease. US studies showed mixed results for mortality (raised overall, CHD, cancer and smoking-related cancer mortality; no excess risk of respiratory or CVD mortality). Morbidity outcomes were also mixed, with some evidence of increased IHD, stroke and cancer risk (oral, head and neck). No studies reported on switching from cigarettes to SLT-products.

CONCLUSION

Our review demonstrates stark differences between different SLT-products in different regions, ranging from zero harm from European snus to greatly increased health risks in AMEA. The literature on the safety profile for SLT-products for harm reduction is incomplete and potentially misinforming policy and regulation.

Traditional Chinese medicine for oral squamous cell carcinoma: A Bayesian network meta-analysis protocol

BACKGROUND

Traditional Chinese medicine is frequently used for malignant tumors in China, but in clinical practice, most practitioners choose appropriate Chinese medicines based on personal experience. In our study, Bayesian network meta-analysis will be used to identify differences in efficacy and safety between diverse traditional Chinese drugs for oral squamous cell carcinoma (OSCC).

METHODS

Relevant randomized controlled trials and prospective controlled clinical trials were searched from Medline, PubMed, Cochrane Library, Google Scholar, Excerpt Medica Database, Web of Science, China National Knowledge Infrastructure, China Scientific Journal Database, Chinese Biomedical Literature Database, and Wanfang Database from their establishment to September 2020. Study selection and data extraction will be performed independently by 2 researchers. Aggregate Data Drug Information System and R software were used for data synthesis. The evidentiary grade of the results will be also evaluated.

RESULTS

The results of this study will be published in a peer-reviewed journal, and provide reliable evidence for different traditional Chinese drugs on OSCC.

CONCLUSIONS

The findings will provide reference for evaluating the efficacy and safety of different traditional Chinese medicine for OSCC, and provide a helpful evidence for clinicians to formulate the best adjuvant treatment strategy for OSCC patients.

TRIAL REGISTRATION NUMBER

INPLASY202090082.

A retrospective pilot study of correlation of first maxillary premolar root trunk length with age and gender: a cone beam computed tomography study

BACKGROUND

Root trunk length (RTL) plays an important role in the diagnosis, prognosis and treatment of periodontitis. The aim of this retrospective pilot study was to evaluate the RTL of first maxillary premolar and to study the correlation with age and sex in this value.

METHODS

The sample included 110 cone beam computed tomography (CBCT) images comprising 220 maxillaries first premolars from systemically healthy patients aged between 18 and 70 years. The tooth length (TL), root length (RL) and RTL were measured (dependent variables). Age and sex were considered as independent variables.

RESULTS

No statistically significant correlation was found between the RTL and the TL. Longer RL and longer RTL were observed in younger patients than older subjects only in the left maxillary premolars. On the other hand, the sex of the patients had no effect on either of the dependent variables. The single rooted maxillary premolars were more frequent (relative to those with two roots) in woman and in elderly patients.

CONCLUSIONS

A correlation between the age and the RTL and RL has been found but only in left premolars. Sex seemed to have only a slight correlation on the frequency of single-rooted teeth of the right side of the mouth. Further studies should be addressed to clarify the significance of the asymmetries observed in the present study between the two sides of the mouth with the aim of deepening the knowledge and understanding of the different variables that could be correlated with the RTL.

Assessment of the oral health seeking behavior of patients with premalignant lesions

Background:

Before choosing/visiting any dental facility for their treatment, patients consider several factors. These factors may be related to the patient or service provider. The health-seeking behavior of a society defines how health services are used.

Aims:

To assess the health seeking behavior of patients with premalignant lesions.

Material and Method:

A cross sectional study using questionnaire was done among the patients who consulted in the Department of Oral Medicine and Radiology, of age 18 and above suffering from precancerous lesions. The questionnaire included 25 close-ended questions which collected information about the demographic details, oral hygiene habits, oral health issues, deleterious habits. The responses were either on dichotomous scale (yes and no) or on the frequency habits. A total of 218 subjects were included in the study. The data were analyzed using the Chi-square test. The acceptable level of significance was reduced to P < 0.05.

Result:

Slightly over 50% of study participants visited the dentist for their dental problems. Most of the participants visited dental clinic whenever needed. Maximum positive health seeking behavior is seen in fourth and fifth decade and minimum seen in second and third decade.

Conclusion:

The oral premalignant lesions have high chances of transformation into malignancies. The progression of these lesions can be prevented by stopping the progression at an early stage and thus instilling positive health seeking behavior serves as an important key to it.

Root and Root Canal Morphology Differences Between Genders: A Comprehensive in-vivo CBCT Study in a Saudi Population

OBJECTIVES

To comprehensively explore the differences of all maxillary and mandibular permanent teeth in relation to number of roots, number of root canals, and root canal configuration between both genders in a Saudi Arabian population.

METHODS

This retrospective radiographic study comprised 208 subjects (48% males and 52% females) with a mean age 28.74±9.56 years. The CBCT images of the recruited subjects were evaluated for all permanent teeth. A careful examination was obtained by optimal visualization using all the software features. The data were analyzed using SPSS software program. Cohen's Kappa test was used for reliability and the Chi-squared test of association was used for the differences between both genders in relation to the study variables. A P-value < 0.05 was considered significant.

RESULTS

A total of 5254 maxillary and mandibular permanent teeth were evaluated. In relation to number of roots, there were no significant differences between both genders for all maxillary and mandibular teeth together (P= 0.064) as well as for maxillary and mandibular teeth separately (P= 0.315 and P= 0.100, respectively). A significant difference was found between males and females in relation to the number of canals of maxillary teeth (P= 0.014). For mandibular teeth, the significant level of difference was at the cut-off point (P= 0.050). For all maxillary and mandibular teeth together, the distribution among both genders was not significant (P= 0.082). The difference between both genders with regard to canal configuration of maxillary roots was highly statistically significant (P< 0.001). For mandibular teeth, the difference between males and females in relation canal configuration of anterior and premolar teeth was significant (P= 0.016) while, the difference was not significant when related to mesial roots of 1st and 2nd molars (P= 0.205). However, the difference was highly significant when related to distal roots of 1st and 2nd molars (P< 0.001).

CONCLUSION

No significant differences between both genders in relation to number of roots were found. Regarding the number of canals, significant differences were found only in three groups out of 14 groups of teeth with females who had a smaller number of canals than males. For canal configuration, two groups of maxillary teeth and three groups of mandibular teeth showed statistically significant differences between both genders.

Is There Any Role of Arsenic Toxicity in HPV Related Oral Squamous Cell Carcinoma?

Arsenic is a potent human carcinogen affecting the rate of cancer deaths worldwide. In India, West Bengal is the worst affected state by arsenic. To our best knowledge, this is the first study relating arsenic toxicity with oral carcinoma, along with HPV infection, the latter being well established in western countries. To find out a possible correlation between arsenic toxicity and oral carcinoma in the population of West Bengal, in or without any association with human papilloma virus infection. Ethical clearance of this study was obtained from the institutional committee. One hundred and four malignant and 103 premalignant cases were selected for this study along with 200 healthy age and sex-matched individuals selected as control (100 each for malignant and premalignant) (2013-2017). On proper consent, their buccal swab and hair samples were assessed for the presence of HPV DNA by DNA extraction, followed by PCR and arsenic estimation by flow injection hydride generation atomic absorption spectrometry respectively. A very highly significant correlation has been observed between arsenic toxicity, HPV infection and the occurrence of oral carcinoma (p value = 2.18e-06; p value = 0.00100 respectively). A correlation has also been observed between these two factors simultaneously, contributing to this malignancy (phi coefficient = 0.2194839). A statistically significant correlation observed between this metal toxicity and viral infection in the occurrence of oral carcinoma in this population indicates a possible symbiotic role between these two factors in this malignancy.

Knowledge and awareness of oral cancer and impact of pictorial warnings on the willingness to quit tobacco in young tobacco consumers in India

BACKGROUND

Oral cancer is most common cancer globally and is one of the most life-threatening conditions worldwide.

AIM

To assess the knowledge and awareness of oral cancer and the impact of pictorial warnings on the willingness to quit tobacco in young tobacco consumers in India.

METHODS

This cross-sectional study included 250 young tobacco consumers from Ranchi, Jharkhand. A pretested validated questionnaire was used that collected information on knowledge and awareness of oral cancer from the respondents. The responses were estimated on a three-point scale (No/Don't know/Yes). p-Value <0.05 was considered statistically significant.

RESULTS

The majority of the respondents were aware of oral cancer (92.0%). Educational status was significantly associated with a good knowledge of awareness of oral cancer and its associated risk factors (p-Value <0.05). Media was identified as the main source for spreading oral cancer awareness (69.1%). The majority of the people were aware of the pictorial warnings on tobacco products (96.1%). However, the pictorial warnings seem to have a very low impact on willingness to quit tobacco by the respondents (20.0%).

CONCLUSION

Alternative strategies need to be employed by the government to motivate people to quit tobacco consumption. Dental health education should be provided and educational pamphlets should be distributed to create awareness about the harmful effects of tobacco consumption.

Relationship between type of smokeless tobacco & risk of cancer: A systematic review

Background & objectives:

Causative linkages of smokeless tobacco (SLT) use with oral potentially malignant disorders and cancers of oral cavity, oesophagus and pancreas have been reported. Published meta-analyses have provided pooled risk estimates for major cancers caused by SLT, both on global and regional levels. This systematic review was aimed at summarizing the available studies on occurrence and mortality risk of common cancers due to various SLT products.

Methods:

PubMed and Google Scholar databases were systematically searched from 1985 till January 2018 for observational studies on SLT and cancer. The included studies were evaluated and data were extracted and reviewed.

Results:

The review included 80 studies providing 121 risk estimates for various cancers. Majority of the studies from South-East Asian Region (SEAR) and Eastern Mediterranean Region (EMR) showed a significant positive association of SLT use with oral [odds ratio (OR) ranging from 1.48 to 27.4] and oesophageal cancers (OR between 2.06 and 12.8), while studies from European Region (EUR) reported a positive association with pancreatic cancer (OR between 1.6 and 2.1). Cancer-related mortality was evaluated in a few reports with higher risk of mortality for lung (OR between 2.0 and 9.1), cervical (OR 2.0) and prostate (OR 2.1) cancers. A wide variation was noted in the association of various cancers and specific SLT products based on their nature, methods of use and inherent toxicity. The majority of chewing tobacco products displayed higher risk for oral and oesophageal cancers while the same was not observed for snus.

Interpretation & conclusions:

This review emphasizes on the significantly positive association of SLT use with oral and oesophageal cancers in SEAR and EMR and pancreatic cancer in EUR. Mortality estimates for SLT-associated cancers need further analysis. Risk analysis for cancers of other sites in SLT users also requires multicentric well-designed studies.

Betel Quid Chewing, Personality and Mood: Betel Quid Chewing Associated with Low Extraversion and Negative Mood

BACKGROUND

Betel quid (BQ), chewed by about 600 million people worldwide, is one of the most widely used addictive substances. Little is known about psychological factors in BQ chewers.

OBJECTIVES

The present study was the first attempt to explore the relationships between BQ chewing, personality, and mood.

METHODS

A survey was conducted with a purposive sample to assess BQ chewing habits in four subgroups: BQ-only users, BQ users who smoke and/or drink, smokers and/or drinkers only, and substance nonusers. A total of 494 participants were recruited from the civilian, non-institutionalized population in Taiwan. Habitual consumption of BQ, smoking and drinking; socio-demographic variables; extraversion; and mood (tension, depression, anger, vigor, fatigue, confusion, and self-esteem). All BQ chewers were evaluated on BQ dependence domains using DSM IV and ICD-10 criteria.

RESULTS

The 6-month BQ dependency rate among BQ chewers, defined by either DSM-IV or ICD-10 criteria, ranged from 42.9 to 45.6%. BQ-only users had significantly lower scores on extraversion than substance nonusers. BQ-only users had statistically significant higher scores on confusion and total mood than substance nonusers. BQ-only users had significantly higher scores on fatigue, anger, tension, and depression, than substance nonusers, BQ users who smoke and/or drink, and smokers and/or drinkers only. The number of BQ dependence domains correlated significantly negatively with total mood scores. Conclusions/Importance: The results supported the two hypotheses: (a) BQ chewing is associated with low extraversion; and (b) BQ chewing is related to negative mood.

Cytogenetic and micronuclei study of human papillomavirus-related oral squamous cell carcinoma

BACKGROUND

The association of human papilloma viral infection in oral squamous cell carcinoma is well studied in the Western countries, but its correlation with DNA damage in the form of micronuclei (MN) formation, ceased apoptosis or presence of chromosomal abnormalities has not yet been studied.

AIM

The aim of this study is to find any possible correlation between human papillomavirus (HPV) infection and cytogenetic damage in the oral malignant and premalignant population of West Bengal.

SETTINGS AND DESIGN

A total of 104 malignant and 103 premalignant cases were selected along with 200 controls.

METHODS

The buccal smear samples were Pap stained for the detection of MN, apoptosis frequency and koilocytes. The buccal swab samples were processed for DNA extraction followed by polymerase chain reaction for the detection of HPV DNA. The peripheral venous blood samples were processed for the detection of any chromosomal abnormality, by the method of human leukocyte culture followed by Giemsa staining.

STATISTICAL ANALYSIS USED

Correlation analysis using GraphPad Prism software was used in this study.

RESULTS

About 34.6%, 42.3% and 6.73% of malignant and 6.79%, 3.88% and 20.38% of premalignant cases showed the presence of HPV DNA, koilocytes and apoptosis, respectively. The difference between the MN frequencies of premalignant and malignant oral lesions with the control group is significant with respect to various risk factors (P < 0.05). One percentage of malignant cases showed the presence of chromosomal break.

CONCLUSION

A considerable percentage of malignant cases showing the presence of koilocytes and viral DNA may indicate the effect of HPV infection leading to the malignancy, which can be correlated with the MN and apoptosis frequency.