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Year : 2019  |  Volume : 7  |  Issue : 4  |  Page : 92-95

Assessment of oral mucosal changes among tobacco users and nonusers in southern India

1 Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Guntur, India
2 Department of Public Health Dentistry, St. Joseph’s Dental College and General Hospital, Eluru, Andhra Pradesh, India
3 Department of Public Health Dentistry, Dr. Syamala Reddy Dental College Hospital and Research Center, Bengaluru, Karnataka, India

Date of Submission02-Dec-2019
Date of Acceptance10-Dec-2019
Date of Web Publication24-Dec-2019

Correspondence Address:
Dr. Parveen S Shaik
Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/INJO.INJO_40_19

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Introduction: Tobacco use and its association with oral diseases are a major contributor to the global oral disease burden and are responsible for various oral mucosal changes among adults. Objective: The objective of this study was to assess oral mucosal changes among male tobacco users and nonusers, aged 15 years and older. Materials and Methods: A comparative cross-sectional study was conducted among 300 tobacco users and 300 nonusers, who were matched for age. Male patients aged ≥15 years attending outpatient department were included. Data were collected using pretested structured questionnaire (Cronbach α = 0.88) and modified World Health Organization oral health assessment form 2013. Statistical analysis was carried out using the Statistical Package for the Social Sciences (SPSS) software, version 20.0; descriptive statistics, chi-square test, Pearson correlation, and linear regression were used; and P ≤ 0.05 was considered as statistically significant. Results: The prevalence of oral mucosal lesions in this study was 27.7%, whereas in tobacco users, it was 44.7%, and in tobacco nonusers, it was 10.7%. Smokeless tobacco users were associated with oral mucosal lesions such as oral cancer (33.3%) and leukoplakia (33.3%), whereas individuals who consume smoke form of tobacco were associated with smoker’s palate (29.1%) (P = 0.001). The chance of occurrence of oral mucosal changes was 0.373 units more among tobacco users than that among tobacco nonusers, which was statistically significant (P = 0.001). Conclusion: Oral mucosal changes were found to be high among tobacco users compared to those among tobacco nonusers. Smoking tobacco was associated with benign lesions such as leukoplakia and nicotine stomatitis, whereas smokeless tobacco was associated with potentially malignant lesions such as oral cancer, which reflect the lack of awareness or ignorance for the oral health issues.

Keywords: Buccal mucosa, oral cancer, oral health, smokeless tobacco, smoking

How to cite this article:
Shaik PS, Pachava S, Ravoori S, Palli CB, Lodagala A, Yaddanapalli SC. Assessment of oral mucosal changes among tobacco users and nonusers in southern India. Int J Oral Care Res 2019;7:92-5

How to cite this URL:
Shaik PS, Pachava S, Ravoori S, Palli CB, Lodagala A, Yaddanapalli SC. Assessment of oral mucosal changes among tobacco users and nonusers in southern India. Int J Oral Care Res [serial online] 2019 [cited 2021 Dec 9];7:92-5. Available from: https://www.ijocr.org/text.asp?2019/7/4/92/273974

  Introduction Top

Tobacco is the only legal drug that kills many of its users when used exactly as intended by manufacturers. World Health Organization (WHO) has estimated that tobacco use is currently responsible for the death of approximately six million people across the world each year.[1] Majority of the tobacco-related deaths are expected to occur in developing countries such as India, where tobacco use is on the rise.[2] According to the National Family Health Survey-4, conducted in 2015–2016, tobacco use was more prevalent among men, rural population, illiterates, poor, and vulnerable section of the society.[3] The Global Adult Tobacco Survey (2016–2017) conducted among persons aged 15 years and older indicated that 28.6% were current tobacco users of which 10.7% were smokers and 21.4% were smokeless tobacco users.[4] The Global Youth Tobacco Survey (2009) conducted among students aged 13–15 years stated that 14.6% were tobacco users.[5] There is a weighty evidence that tobacco has a considerable influence on oral health directly or indirectly, leading to oral mucosal lesions.[6] Its incidence and prevalence in south Asian countries is high owing to the increased production and consumption of tobacco. As there is no standard literature on oral mucosal changes among tobacco users in this region, collecting data from this population will help in building evidence that can be used to make the tobacco-cessation programs effective. Hence, this study was aimed to assess oral mucosal changes among tobacco users and nonusers, aged 15 years and older.

  Materials and Methods Top

Study design

A comparative cross-sectional study was carried out in a dental institution of southern India. A total of 600 sample size was obtained, of which 300 tobacco users and 300 nonusers visited the outpatient department (OPD) of the southern university of India. Everyday purposively 10 tobacco users attending OPD were selected and for every tobacco user, one non-tobacco user matching with the age was included in the comparison group. This method was repeated for 3 months.

Questionnaire design and oral examination

An interview-based questionnaire was used, which consisted of details regarding age, socioeconomic status of the participant (Kuppuswamy scale 2015), and their oral hygiene practices, and questions regarding tobacco habit such as form of tobacco used, its frequency, and duration of the habit were collected using modified WHO questionnaire (2013). Data on oral mucosal changes were recorded using modified WHO oral health assessment form (2013) and following the criteria of “WHO Guide to epidemiology and diagnosis of oral mucosal diseases and conditions 1980,” by examining in adequate light using mouth mirror for cheek retraction (American Dental Association specified type III intraoral examination).

Ethical approval

A detailed review of the multipronged aspect of the research and about the surrogate consent of the participants was elaborated for the acceptance and approval from the Institutional Ethics Committee (Pr. 36/IEC-SIBAR/CIR/15).


Before the study, an informed written consent was obtained from all the individuals willing to participate and ensured that participation was voluntary and anonymous. Surrogate consent was obtained from the participants below 18 years from their parents and guardians.

Statistical analysis

Data were entered into the Excel sheet, and were analyzed using IBM Statistical Package for the Social Sciences (SPSS) software for Windows, version 20.0 (IBM, Armonk, New York). The level of significance was set at <0.05. Descriptive and inferential analyses such as chi-square test, Pearson correlation coefficient, and linear regression were performed to ascertain the relation between different dependent and independent variables.

  Results Top

Smokeless tobacco users were highly associated with oral mucosal conditions such as oral cancer (33.3%) and leukoplakia (33.3%), whereas in individuals who consume smoke in the form of tobacco were associated with smoker’s palate (29.1%), and this comparison was statistically significant (P = 0.001). The most common site for the occurrence of oral mucosal conditions in smokeless tobacco users was lip commissures (40%), and in smoke form of tobacco users, it was hard palate (29.1%), which was statistically significant (P = 0.01) [Table 1] and [Table 2]. The occurrence of any oral mucosal changes was more likely associated with tobacco users, and the chance of occurrence was 0.37 units lesser among tobacco nonusers. Likewise, the site of oral mucosal conditions was more likely associated with both smoke and smokeless form of tobacco users compared to that of non-tobacco users, and the change of occurrence was 0.670 times more in tobacco users than that in non-tobacco users [Table 3].
Table 1: Distribution of study participants based on type of oral mucosal conditions observed in tobacco users and nonusers

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Table 2: Site-wise distribution of study participants with oral mucosal conditions based on the form of tobacco usage

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Table 3: Correlation and linear regression between tobacco users and oral mucosal conditions

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  Discussion Top

In this study, 44.7% of tobacco users and 10.7% of nonusers reported oral mucosal changes such as malignant lesions, leukoplakia, smoker’s palate, and abscess. When compared to other south Indian dental hospitals, studies carried out by Saraswathi et al.[7] (4.1%), Anzil et al.[8] (14.9%), and Mathew et al.[9] (28.2%) reported a low rate of Oral Mucosal Lesions in tobacco users where they are in accordance with the studies conducted by Sujatha et al.[10] (36.1% in males), Patil et al.[11] (54.1% in males), Aslesh et al.[12] (44.6%), Mishra et al.[13] (43.12%), and Kasat et al.[14] (49.52%).

Oral mucosal lesions highly depend on the tobacco form used, its dose, frequency of intake, and duration of habit. In this study, oral mucosal lesions were found to be more associated with smokeless tobacco users (80%) when compared to smoke form of tobacco users (57.3%) and tobacco nonusers (10.7%), and these findings were in agreement with the studies carried out by Aslesh et al.[12] (44.5%) and Vikneshan et al.[15] (55.7%). The most prevalent oral mucosal lesions encountered in this study were smoker’s palate (22%) followed by leukoplakia (20%), whereas the common sites affected by the oral mucosal condition were palate (22%) followed by buccal mucosa (12.7%). These findings are similar to the findings in the studies conducted by Bhatnagar et al.,[16] Saunders,[17] and Ramulu et al.,[18] which stated that smoking tobacco strikes the palate more directly resulting in smoker’s palate or nicotine stomatitis associated with definite atypical changes of the surface epithelium usually.

  Conclusion Top

In this study, the number of tobacco users under younger age-group ranging from 15 to 24 years was more. So, an urgent need of intervention to curb the use of tobacco and its products lies in the fact that many teenagers are embracing the addiction. The lesions were found in those who indulged in various deleterious habits such as smoking and chewing tobacco. Smoking tobacco was associated with a wide range of benign oral mucosal lesions such as leukoplakia and nicotine stomatitis, whereas smokeless tobacco was associated with potentially malignant lesions such as oral cancer.

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Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organization. WHO global report on trends in prevalence of tobacco smoking 2015.Geneva, Switzerland: World Health Organization;2015.  Back to cited text no. 1
Warren CW, Jones NR, Peruga A, Chauvin J, Baptiste JP, Costa de Silva V, et al. Global youth tobacco surveillance, 2000–2007. MMWR Surveill Summ 2008;57:1-21.  Back to cited text no. 2
Haryana Fact Sheet. National Family Health Survey-4: Mumbai: International Institute for Population Sciences; 2016. Available from: http://rchiips.org/NFHS/pdf/NFHS4/HR_FactSheet.pdf [Accessed 2018 Nov 16].  Back to cited text no. 3
International Institute for Population Sciences. Global Adult Tobacco Survey (GATS) India 2009–2010. New Delhi, India: Ministry of Health and Family Welfare, Government of India; 2010.  Back to cited text no. 4
Gajalakshmi V, Kanimozhi CV. A survey of 24,000 students aged 13–15 years in India: Global Youth Tobacco Survey 2006 and 2009. Tob Use Insights 2010;3:23-3.  Back to cited text no. 5
Chandra P, Govindraju P. Prevalence of oral mucosal lesions among tobacco users. Oral Health Prev Dent 2012;10:149-53.  Back to cited text no. 6
Saraswathi TR, Ranganathan K, Shanmugam S, Sowmya R, Narasimhan PD, Gunaseelan R. Prevalence of oral lesions in relation to habits: Cross-sectional study in south India. Indian J Dent Res 2006;17:121-5.  Back to cited text no. 7
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Anzil K, Mathews J, Sai AG, Kiran M, Kevin S, Sunith S. Prevalence of deleterious oral habits and oral mucosal lesions among fishermen population of Mahe, south India. J Contemp Dent Pract 2016;17:745-9.  Back to cited text no. 8
Mathew AL, Pai KM, Sholapurkar AA, Vengal M. The prevalence of oral mucosal lesions in patients visiting a dental school in southern India. Indian J Dent Res 2008;19:99-103.  Back to cited text no. 9
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Sujatha D, Hebbar PB, Pai A. Prevalence and correlation of oral lesions among tobacco smokers, tobacco chewers, areca nut and alcohol users. Asian Pac J Cancer Prev 2012;13:1633-7.  Back to cited text no. 10
Patil S, Yadav N, Patil P, Kaswan S. Prevalence and the relationship of oral mucosal lesions in tobacco users and denture wearers in the north Indian population. J Family Community Med 2013;20: 187-91.  Back to cited text no. 11
Aslesh OP, Paul S, Paul L, Jayasree AK. High prevalence of tobacco use and associated oral mucosal lesion among interstate male migrant workers in urban Kerala, India. Iran J Cancer Prev 2015;8:e3876.  Back to cited text no. 12
Mishra A, Sharma D, Mishra TG, Adhikari P, Kabirpanthi V, Kumar M. Pattern and prevalence of tobacco use and associated oral mucosal lesions: A hospital based cross-sectional study at a tertiary care hospital in central India. Int J Res Med Sci 2015;3:2169-73.  Back to cited text no. 13
Kasat V, Joshi M, Somasundaram KV, Viragi P, Dhore P, Sahuji S. Tobacco use, its influences, triggers, and associated oral lesions among the patients attending a dental institution in rural Maharashtra, India. J Int Soc Prev Community Dent 2012;2: 25-30.  Back to cited text no. 14
Vikneshan M, Ankola AV, Hebbal M, Sharma R, Suganya M. Patterns of tobacco usage and oral mucosal lesions of industrial workers: A cross-sectional study. Austin J Public Health Epidemiol 2016;3:1029.  Back to cited text no. 15
Bhatnagar P, Rai S, Bhatnagar G, Kaur M, Goel S, Prabhat M. Prevalence study of oral mucosal lesions, mucosal variants, and treatment required for patients reporting to a dental school in north India: In accordance with WHO guidelines. J Family Community Med 2013;20:41-8.  Back to cited text no. 16
Saunders WH. Nicotine stomatitis of the palate. Ann Otol Rhinol Laryngol 1958;67:618-27.  Back to cited text no. 17
Ramulu C, Raju MV, Venkatarathnam G, Reddy CR. Nicotine stomatitis and its relation to carcinoma of the hard palate in reverse smokers of chuttas. J Dent Res 1973;52:711-8.  Back to cited text no. 18


  [Table 1], [Table 2], [Table 3]


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