|Year : 2019 | Volume
| Issue : 2 | Page : 106-110
Prevalence of habit-related oral lesions in Kolkata and the surrounding districts
Tathagata Bhattacharjee1, Debarshi Jana2, Somnath Gangopadhyay3
1 Department of Oral Pathology and Microbiology, North Bengal Dental College and Hospital, Darjeeling, West Bengal, India
2 Department of Gynecology and Obstetrics, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
3 Department of Physiology, University of Calcutta, Kolkata, West Bengal, India
|Date of Submission||02-Jan-2020|
|Date of Acceptance||15-Jan-2020|
|Date of Web Publication||3-Feb-2020|
Dr. Somnath Gangopadhyay
Department of Physiology, Occupational Ergonomics Laboratory, University of Calcutta, Rashbehari Siksha Prangan, (Commonly Known as Rajabazar Science College Campus), 92, Acharya Prafulla Chandra Road, Kolkata - 700 009, West Bengal
Source of Support: None, Conflict of Interest: None
Background: India has the highest usage of smoked and smokeless tobacco around the globe. Various studies already showed that when smoking and chewing tobacco used together, it increases the risk for developing various cancerous and precancerous lesions in the oral cavity.
Context: The study was conducted among the population of Kolkata and the surrounding districts in West Bengal, India.
Aim: This study aimed to know the prevalence of cancer-causing habits and to find their pattern of use as well as to assess the prevalence of oral mucosal changes due to the use of these habit products(Tobacco in any form,arqqecanut and Alcohol).
Materials and Methods: Three hundred and seventy-four individuals aged 15 years and above were selected. Face-to-face interview was conducted using structured questionnaire. The data were summarized, and statistical analysis was done.
Statistical Analysis: Percentage calculation was done.
Results: About 42.24% of individuals (33.15% men and 9.09% women) above 15 years of age have any one or more than one cancer-causing habit. Among the study population, smoking was 26.20%, chewing was 20.32%, and drinking was 13.36%. The most prevalent oral lesion was leukoplakia (3.2%).
Conclusion: The study of this nature could help clinicians, researchers, and policy makers to identify their target population.
Keywords: Kolkata; leukoplakia; oral lesions; tobacco; West Bengal
|How to cite this article:|
Bhattacharjee T, Jana D, Gangopadhyay S. Prevalence of habit-related oral lesions in Kolkata and the surrounding districts. Indian J Multidiscip Dent 2019;9:106-10
|How to cite this URL:|
Bhattacharjee T, Jana D, Gangopadhyay S. Prevalence of habit-related oral lesions in Kolkata and the surrounding districts. Indian J Multidiscip Dent [serial online] 2019 [cited 2020 Jun 5];9:106-10. Available from: http://www.ijmdent.com/text.asp?2019/9/2/106/277446
| Introduction|| |
Tobacco can be considered as one of the consumer products which can harm everyone using it. Due to low price and inconsistent public policies against its use, its use is very common throughout the world. As per the data from the World Health Organization (WHO) at present, about 5 million people die prematurely every year around the globe due to tobacco use. By 2030, death toll will exceed 8 million a year.,,, India has the highest usage of smoked and smokeless tobacco around the globe. Among smoked products, cigarettes, beedis, chutta, chillam, and hookah are popular, whereas smokeless forms include gutkha, khaini, mawa, and gudaku.,
Various studies already showed that when smoking and chewing tobacco used together, it increases the risk for developing cancer in the oral cavity. Due to geographic as well as regional variations, risk factors differ from country to country as well as from state to state, even different parts of a state; as an example, use of smokeless tobacco or areca nut chewing is popular in developing countries, whereas cigarette smoking and high consumption of alcohol is popular in developed countries. Information obtained from various epidemiological studies reveals various patterns of oral habits at different places of India. With variation in the different habits, the prevalence of the diseases also varies.
The aim of our study is to assess the prevalence of cancer-causing habits and find their pattern of use as well as to assess the prevalence of oral mucosal changes due to the use of these habit products.
| Materials and Methods|| |
This was a cross-sectional study, done among people of Kolkata and the surrounding districts to know the prevalence of different oral cancer-causing habits and related oral mucosal lesions among them.
The study was conducted in different private medical and dental clinics and oral health screening camps around different parts of Kolkata, Howrah, North 24 Parganas, and Nadia. People above 15 years of age who had no systemic disease and willing to participate in this study were included. Staffs who conducted the study chiefly consisted of the medical social workers, qualified dentists, and oral pathologists.
Medical social workers were trained to take data from the study sample.
First, the purpose of the study was explained to the study participants and informed consent was obtained from them. Face-to-face interview was conducted and oral cavity was clinically examined using a mouth mirror and explorer under daylight to rule out if any tobacco-related oral lesion was present. All the oral lesions were clinically diagnosed as per the WHO criteria and color atlas of oral pathology. Information regarding demographic characteristics was collected using a questionnaire formatted in both English and vernacular language Bengali. Along with these, information regarding their tobacco habits was assessed using the WHO.
The questionnaire and the study procedures were approved by the Institutional Human Ethics Committee, Department of Physiology of University of Calcutta. The validity and reliability of the questionnaire were pretested.
| Results|| |
A total of 374 individuals participated in the study. Among them, 201 (53.7%) were male and 173 (46.3%) were female.
We have taken samples from both the rural and urban areas. Among the study population, 193 (51.6%) were from rural areas and 181 (48.4%) were from urban areas.
In this study, the total of 158 (42.24%; 124 [33.15%] men and 34 [9.09%] women) individuals above 15 years of age have any one or more than one cancer-causing habit. Among individuals with any kind of habit, 78.5% were male and 21.5% were female. When considering individual habit among people using them, we found that 62.02% of individuals used smoked product, 48.10% used chewable product, and 31.64% used alcoholic beverages. Few of them had habits of taking more than one product. The number of habit products among the study population using it is described in [Figure 1].
The prevalence of different combinations of habit product is described in [Figure 2].
When we considered the prevalence among the study population, we found that smoking was 26.20%, chewing was 20.32%, and drinking was 13.36%. There was no female drinker in this study population.
The prevalence and gender distribution of different cancer-causing habits are depicted in [Table 1].
|Table 1: Prevalence and gender distribution of different cancer-causing habits|
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When considering the most common product among all habit products, we found that bidi (42.9%) and cigarette (42.9%) are the most common among smoking product and pan with areca nut/betel nut (30.3%) is the most common chewable cancer-causing habit. Among the study population, the most common smoking product bidi and cigarette user both were 11.22%. The most common chewing product pan with areca nut user was 6.14%.
The percentage of different cancer-causing habits in the study population is described in [Table 2].
|Table 2: Percentage of different cancer-causing habits in the study population|
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When considering the prevalence of different oral lesions, we found that 11.5% of the total study population had oral lesions. Among these lesions, leukoplakia was the most prevalent (3.2%). Among males, along with leukoplakia (4.5%), smoker's melanosis (4.5%) was more prevalent lesion. Among females, oral submucous fibrosis (2.31%) was the most common.
The prevalence of different oral lesions is described in [Table 3].
| Discussion|| |
Potentially malignant disorder of oral cavity may turn into oral squamous cell carcinoma, that is, the most common malignancy of oral epithelium. There are substantial evidences that tobacco (either in smoked form or smokeless), alcohol, and areca nut and their related products cause malignancy of oral epithelium in most of the cases. Hence, it is expected that potentially malignant disorder of oral cavity may also be caused by these factors.
Asper GATS-2 India,2016-2017,42.4% of all men and 14.2% of all women and 28.6% of all adults in India currently use any form of tobacco, which is the most predominant cancer-causing habit. For West Bengal, the percentage is 33.5%, little higher than the overall Indian percentage.
In this study, we found that in Kolkata and the surrounding districts, 42.24% (33.15% men and 9.09% women) of total people more than 15 years of age use any kind of cancer-causing habit product. The percentage of the total number of people using cancer-causing habit product in our study is higher; however, considering gender distribution, we found that both male and female are lower in our study. Alcohol and areca nut were not included as habit product in GATS-2 which we included in our study. In our study, we considered both past and present habit product(tobacco in any form, arecanut and Alcohol) user as user but GATS-2 classified tobacco user as current user and past user. These could be the reason behind the increased prevalence of habit product users in our study.
As per GATS, West Bengal, India, 2009–2010, 21.3% of total adults used smoked tobacco and 21.9% of total adults used smokeless tobacco. In our study, we found that in Kolkata and the surrounding districts, smoking was 26.20%, chewing was 20.32%, and drinking was 13.36%. There was no female drinker in this study population. Increased percentage of smokers in Kolkata and the surrounding districts could be due to busy, stressful lifestyle.
As per the National Family Health Survey-4 (NFHS-4), in West Bengal, smoking tobacco product use is more common in urban areas except hookah, and chewing tobacco product is more common in rural areas.
Our study was done mainly in urban areas; we found that smoking is more common than chewing tobacco. NFHS-4, West Bengal, also shows that the prevalence of drinking alcohol is 28.7% in males and is 0.8% in females. In urban areas, the percentage of drinking alcohol among males is more, 35.7%. The results of this study contradict these data. We found 13.36% male drinkers and there was no female drinker.
In contrast to our study results, Saraswathi et al. in 2006 had done a hospital-based study in Chennai and found quite low prevalence of habit. As per their study, the prevalence of smoking was 15.02%, chewing was 6.99%, and drinking alcoholic beverages was 8.78%.
Mondal et al. in 2012 studied tobacco use pattern and awareness about tobacco hazards in a rural community of West Bengal and found that among habit product users, majority (81.7%) were only smokers, smokeless tobacco chewers 6.5%, and dual user 11.8%.
In this study, we found that 62.02% used smoked products, 48.10% used chewable products, and 31.64% people used alcoholic beverages. Among dual habit users the most prevalent dual habit was smoking along with chewing habit(82.05%). Increased chewing habit in our study could be due to the increased migrated population from different states in Kolkata and the surrounding districts whose predominant habit is chewing.
The finding of Koothati et al. differs from our result. They studied in 2017 at Mahaboobnagar District of Telangana among 3200 participants and found that 23.44% of people had tobacco-related oral habit. Among users, tobacco-chewing habit was the most prevalent (44.5%), followed by smoking (42.7%) and dual habit (12.8%). In our study, we found that;among any kind of cancer causing habit product user; around 46% use only one kind of habit product,49% people use two types of habit products, and 5% people use all 3 types of habit products.
Among all combination habit, the most prevalent is smoking with chewing. This finding was quite similar in a study done by Mutti et al. in 2016. They studied the pattern of use and perceptions of harm of smokeless tobacco in India and Bangladesh and found that one-fifth of the samples used both smoked and smokeless tobacco.
As per GATS 2016–2017 in India, 21.4% of people use any smokeless tobacco product. Among this population, considering individual smokeless tobacco product, we found that khaini is the highest (11.2%), followed by gutkha (6.8%), betel quid with tobacco (5.8%), and oral tobacco (3.8%). In West Bengal, 20.1% of people use any smokeless tobacco product. The highest number of people uses khaini (10.8%), followed by betel quid with tobacco (6.4%), oral tobacco (4.9%), and gutkha (2.9%). In Kolkata and the surrounding districts, we found that 20.32% of people have chewing habit. Among the study population, the most prevalent habit is pan with areca nut (6.14%), followed by khaini (5.35%), areca nut/packet areca nut (3.20%), and mixed habit (2.40%).
As per GATS 2016–2017 in India, 10.7% of people use smoked tobacco in any form. Among Indian smokers, the most popular is bidi (7.7%), followed by cigarette (4.0%) and hukkah (0.7%). In West Bengal, 16.7% of people use smoked tobacco in any form. The highest number of smokers prefers bidi (14.4%), followed by cigarette (5.2%) and cigar-like product (0.6%). As per our study, 26.20% of people have smoking habit in Kolkata and the surrounding districts. Among them, the percentage of bidi smoker and cigarette smoker was same (11.22%). 3.20% of people smoked cigarette and bidi; as well as 0.53% use other smoking product.
In 2006, Saraswathi et al. studied the prevalence of oral lesion in relation to habits in Chennai and found that 4.1% of the study population had soft-tissue lesions. Among these lesions, the prevalence of leukoplakia, oral submucous fibrosis, and oral lichen planus was 0.59%, 0.55%, and 0.15%, respectively.
Our study showed that the prevalence in Kolkata and the surrounding districts was higher. In our study population, 11.5% of people had at least anyone habit-related oral lesion. The most prevalent lesion was leukoplakia (3.2%), followed by smoker's melanosis (2.4%), tobacco-induced keratosis (2.1%), smoker's palate (1.3%), and oral submucous fibrosis (1.3%). The most prevalent oral lesion among males was leukoplakia (4.5%) and smoker's melanosis (4.5%), and the most prevalent oral lesion among females was leukoplakia (3.2%).
| Conclusion|| |
This study shows us the prevalence and pattern of use of different cancer causing habit product(Tobacco in any form, arecanut and alcohol) in Kolkata and surrounding districts. It also points out the percentage of different oral lesions occurring in people of this area due the use of cancer causing habit products In this study, information was collected using questionnaire and oral examination; hence, there could be information bias. Here, we could not consider other predictors for oral lesion in this study, such as nutritional status. A more detailed study is required for better understanding. The study of this nature could help clinicians, researchers, and policy makers to identify their target population for campaigning against cancer-causing agent in Kolkata and the surrounding districts.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Koothati RK, Reddy GV, Ramlal G, Prasad LK, Kumar VJ, Pokala A. An epidemiological study of tobacco-related oral habits in Mahabubnagar district of Telangana, India. J Indian Acad Oral Med Radiol 2017;29:205-8. [Full text]
Tekade AP, Srijampana VV, Silpa G, Babu SL, Sarathi YV. A study on tobacco consumption in various forms among the tobacco field workers. Int J Biol Med Res 2012;3:1509-11.
Yunus GY, Sahni H, Naveen N, Tiwari R, Vasant B, Suman S. “Tobacco” – The silent slayer for oral premalignant lesions conditions among beedi rolling workers of Durg City, Chhattisgarh, India: A cross-sectional study. J Indian Assoc Public Health Dent 2019;17:119-24. [Full text]
Nair PP, Chatterjee R, Bhambhal A, Agarwal K, Khare P, Neelkantan S. Insight to a tobacco user's mouth: An epidemiological study in Bhopal. J Oral Biol Craniofac Res 2014;4:14-8.
Ray JG, Ganguly M, Rao BS, Mukherjee S, Mahato B, Chaudhuri K. Clinico-epidemiological profile of oral potentially malignant and malignant conditions among areca nut, tobacco and alcohol users in Eastern India: A hospital based study. J Oral Maxillofac Pathol 2013;17:45-50.
] [Full text]
Porter S, Gueiros LA, Leão JC, Fedele S. Risk factors and etiopathogenesis of potentially premalignant oral epithelial lesions. Oral Surg Oral Med Oral Pathol Oral Radiol 2018;125:603-11.
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.
] [Full text]
Mondal TK, Karmakar PR, Sarkar GN, Saha I, Dash I, Chatterjee S. Tobacco use pattern and awareness about tobacco hazards in a rural community of West Bengal. Indian J Prev Soc Med 2012;43:361-4.
Mutti S, Reid JL, Gupta PC, Pednekar MS, Dhumal G, Nargis N, et al
. Patterns of use and perceptions of harm of smokeless tobacco in Navi Mumbai, India and Dhaka, Bangladesh. Indian J Community Med 2016;41:280-7.
] [Full text]
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]