Article Type: Research
Received : September 22, 2018
Accepted : September 29, 2018
Published : October 10, 2018
*Correspondence to: Dr. Md. Asdullah, Assistant Professor, Department of Oral Pathology/Oral Medicine and Radiology,
Dr. Z. A Dental College & Hospital, A.M.U Aligarh (India),
Article Type: Research
Received : September 22, 2018
Accepted : September 29, 2018
Published : October 10, 2018
Tobacco is known to mankind since ages. Despite the widespread awareness about tobacco related health hazard and vigorous efforts to regulate its use in various form of strict tobacco control legislation; its use is increasing at an alarming rate. Tobacco use carries a high risk of major health-related illness and several forms of cancers. The epidemic of tobacco use in India is inflicting a huge damage on the human health and the associated health care costs are creating a huge financial burden on the government.
The objective of the study was to assess the prevalence of tobacco consumption and related oral mucosal lesions among patients reporting to dental outpatient department of a tertiary care Centre in Aligarh (U.P).
Out of the total patients reporting to the outpatient department of dentistry during the study period, 540 patients were considered for this study, 261 were found consuming tobacco in one or other form. The consent for participation in the study was given by244 tobacco users. They were interviewed through prepared questionnaires and clinically examined for tobacco associated oral lesions. The data were collected & subjected to statically analysis.
Most common form of tobacco intake was smokeless tobacco intake (62%), followed by smoking (26%), and both the forms of addiction (12%). OSMF is more commonly associated with smokeless forms of tobacco intake (61.5%), followed by combined intake of both forms of tobacco (29.8%) and smoking alone (8.7%)
Key words: Tobacco,form of tobacco,lesions
Tobacco in India was introduced some 400 years ago by Portuguese by establishing tobacco trade based in Goa. According to the World Health Organization (WHO) estimates, globally, there were 100 million premature deaths due to tobacco in the 20thcentury, and if the current trends of tobacco use continue, this number is expected to rise to 1 billion in the 21st century.Tobacco use in any form is one of the leading preventable causes of morbidity and mortality in the world.India is world’s third largest tobacco growing country and Bidi manufacturing is the largest tobacco industry in India. India had 275 million current tobacco users in the year 2009-2010,majority of them used smokeless tobacco (164 million) and 42 million used both forms of tobacco.India is one of the fewer countries in the world where prevalence of dual use of smoking and smokeless tobacco is high.In India, cigarette smoking comprises a small part of the tobacco smoking problem and a minor part of the overall tobacco problem, a major problem being beedi smoking and the oral use of smokeless tobacco products.The present study was conducted to evaluate the prevalence of tobacco use and associated oral lesions among the patients reporting to the Oral Medicine OPD at a tertiary care centre in Aligarh (U.P). The interpretations of the study will help in understanding the epidemiology of tobacco problem in this region and developing and implementing locally relevant tobacco intervention strategies.
A hospital-based cross-sectional study was conducted at the Department of Oral Medicine & Radiology, Dr.Z. A Dental College &Hospital,A.M.U Aligarh. The catchment areas of the hospital are Aligarh city, the rural areas and the surrounding districts (Hathrus, Kashganj, Mathura, Bulandshaher).Out of 550 patients from both urban and rural areas attending the outpatient department of Oral Medicine of Dr.Z. A Dental College & Hospital, 244 patients having habits of tobacco consumption in any forms have been randomly selected. The inclusion criteria included patients aged ≥20years who currently smoked, chewed tobacco. Informed consent was obtained from all patients prior to the interview and examination.The patients were clinically examined for any tobacco related oral lesions. The data were collected & subjected to statically analysis.
RESULT-In our study, 244 patients were addicted to different forms of tobacco intake. Most common form of tobacco intake was smokeless tobacco intake (62%), followed by smoking (26%), and both the forms of addiction (12%). (Figure 1)
Smoking was associated with a higher age (47.80±11.24 years) when compared to smokeless form of tobacco intake (33.44±11.35), as well as both the forms of intake (41.94±11.42). An analysis of variance (ANOVA) found the difference in age to be significant. Further post-hoc analysis also found significant difference among all the groups with age. (Table 1). As far as sex is concerned, all the females only took smokeless forms of tobacco and smoking alone or combined with smokeless tobacco intake was only found in men (Table 2).
The clinical evaluation of the patients revealed that OSMF (43%) is the most common oral lesion among the patients, followed by Leucoplakia (18%), Keratosis (13%) and Carcinoma (10%). About 16% of the patients were not found to have any oral lesions (Figure 2).
An analysis of the oral lesions with forms of smoking is shown in (Table 2). OSMF is more commonly associated with smokeless forms of tobacco intake (61.5%), followed by combined intake of both forms of tobacco (29.8%) and smoking alone (8.7%). A similar preponderance of Keratosis is found among smokeless forms of tobacco intake. Carcinoma is found only among smokers; whereas, leucoplakia only among those who took smokeless forms of tobacco. (Table 2).
DISCUSSION-Tobacco consumption is growing at a rate of 2-3% per annum and it may account for 13% of all deaths caused due to non-communicable diseases by the year 2010. Tobacco smoking causes cancer of the lung, oral cavity, nasopharynx, oropharynx and hypo-pharynx, nasal cavity and paranasal sinuses, larynx, esophagus, stomach, pancreas, liver, kidney, ureter, urinary bladder, uterine cervix and myeloid leukemia of the bone marrow.
In present study prevalence of tobacco consumption in any form is 48.8% which was higher than that reported by Chaudhry et al. i.e. 29.6% in Karnataka and 34.6% in Uttar Pradesh.
Tobacco use in India has been higher among males than among females in India as this finding were consistent And most common form of tobacco intake was smokeless tobacco intake (62%), followed by smoking (26%), and both the forms of addiction (12%).
The prevalence of tobacco uses in females (20.90%) was similar to the findings of the Global Adult Tobacco Survey (GATS), conducted by the Union Ministry of Health and Family Welfare (2010),which reported that 20.3 percent of females - 15 years and above - consume tobacco in some form or the other.
Tobacco consumption among females was almost in the form of smokeless tobacco which was in accordance with many studies but contrary to the study by  which reported 21.7% females were smokeless tobacco users and 23.4% were smokers.
The prevalence of oral lesions in tobacco users in our study was 48.8% which was in accordance to 49.52% reported by  and more than 26.8% reported by  but less than 73.8% reported by .
The prevalence of oral submucous fibrosis in the present study was 43% which was not consistent with any study. This difference can be attributed to the variations in the study population surveyed, i.e., a hospital-based study with mixed population and differences in the pattern and duration of habits.
The overall prevalence of leukoplakia (18%) in the present study was more than that reported in a number of epidemiologic studies. [13,14,15].This difference can be explained by the difference in the study population and the tobacco habits of Indian and western populations.
The present study showed a much higher frequency of oral carcinoma (10%) compared to previous reports [15,16]. The lesion was more prevalent among males than among females. This difference may be due to the fact that a large number of men are reported to have the habit of smoking and chewing tobacco and with mixed habits.
However, prevalence of keratosis 13% in our study were not consistent with any other report.
1. Gupta VM, Sen P. (2001) Tobacco: the addictive slow poison. Indian Journal of Public Health.45:75-81.
2. The MPOWER package, warning about the dangers of tobacco. Geneva: WHO, 2011. WHO Report on The Global Tobacco
3. Gururaj G, Girish N. (2007) Tobacco use amongst children in Karnataka. Indian J Pediatr.74:1095-8.
4. International Institute for Population Sciences (IIPS), Mumbai. Global adult tobacco survey India (GATS India), 2009- 2010.
New Delhi; Ministry of Health and Family Welfare, Government of India; 2010.
5. Shimkhada R, Peabody JW. (2003) Tobacco control in India. Bull World Health Organ.81:48-52
6. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. IARC; 2002. Tobacco Smoke and Involuntary
Smoking; p. 83.
7. Chaudhry K, Prabhakar A, Prabhakaran P, Prasad A, Singh K, Singh A. (2001) Prevalence of tobacco use in Karnataka and
Uttar Pradesh in India. Final report of the study by the Indian Council of Medical Research and the WHO South East Asian
Regional Office, New Delhi.
8. International Institute for Population Sciences (IIPS), Mumbai. Global adult tobacco survey India (GATS India), 2009- 2010. New Delhi;
Ministry of Health and Family Welfare, Government of India; 2010.
9. Sinha DN, Gupta PC, Pednekar MS. (2003) Tobacco Use in A Rural Area of Bihar, India. Indian Journal of Community
10. Kasat V, Joshi M, Somasundaram KV, Viragi P, Dhore P, et.al(2012) Tobacco use, its influences, triggers, and associated oral lesions
among the patients attending a dental institution in rural Maharashtra, India. J Int Soc Prevent Communit Dent.2:25-30.
11. Patil PB, Bathi R, Chaudhari S. (2013) Prevalence of oral mucosal lesions in dental patients with tobacco smoking, chewing, and mixed
habits: A cross-sectional study in South India. J Family Community Med.20(2):130–5.
12. Chandra P, Govindraju P. (2012) Prevalence of oral mucosal lesions among tobacco users. Oral Health Prev Dent.10(2):149-53.
13. Lay KM, Sein K, Myint A, Ko SK, Pindborg JJ. (1982) Epidemiologic study of 6000 villagers of oral precancerous lesions in Bilugyum:
Preliminary report. Commun Dent Oral Epidemiol.10:152–5. [PubMed]
14. Axell T, Rundquist L. (1987) Oral lichen planus-A demographic study. Community Dent Oral Epidemiol.15:52–6. [PubMed]
15. Sinor PN, Gupta PC, Murti PR, Bhonsle RB, Daftary DK, et al. (1990) A case control study of oral submucous fibrosis with special
reference to the etiology role of areca nut. J Oral Pathol Med.19:94–8. [PubMed]
16. Ikeda N, Handa Y, Khim SP, Durward C, Axéll T, et al. (1995) Prevalence study of oral mucosal lesions in a selected Cambodian
population. Commun Dent Oral Epidemiol.23:49–54. [PubMed]
17. Campisi G, Margiotta V. (2001) Oral mucosal lesions and risk habits among men in an Italian study population. J Oral Pathol