Abstract
Objective:This study aims to assess the correlation of exhaled CO and nicotine dependence with the occurrence of oral mucosal lesions while also taking into consideration socio-demographic, clinical and anthropometrical characteristics of participants. Methods:An observational cross-sectional study was carried out among smokers who visited the tobacco cessation center at Tertiary Care Dental Hospital in Goa, India. An intra-oral soft tissue examination for detecting presence of oral mucosal lesions followed by a questionnaire-based interview for the measurement of exposure, sociodemographic factors, body mass index, cooking habits and nicotine dependence was conducted. The exhaled CO levels were measured with a CO breath analyzer. Statistical analysis was performed using IBM SPSS version 20.0 Descriptive statistics were calculated and multivariable analysis was done to assess the association of different variables with oral mucosal lesions and carbon monoxide levels. p-value ≤ 0.05 was considered as statistically significant. Results:Of the 173 subjects enrolled in the study, 69.36% were without any lesions while 30.63% were diagnosed with some lesion. In the regression analysis, the variables of physical activity (present vs absent OR: 5.808), exhaled CO levels (OR: 1.098) and nicotine dependence (mild vs moderate OR: 6.518) were significant risk factors influencing the presence of oral mucosal lesions. Usage of both cigarettes and bidis by smokers exhibited highest mean exhaled CO values of 19.67±1.506 ppm. Exhaled CO levels were significantly higher in smokers who were overweight (14.96±9.14 ppm), physically inactive (13.98±8.26 ppm), highly nicotine dependent (20.67±8.30) and used coal for cooking (12.55±8.17). Conclusion:A robust correlation between exhaled CO levels, nicotine dependence and incidence of oral mucosal lesions was established. The multifactorial tenacity of exhaled CO which is affected by smoked tobacco as well as variables such as physical activity, BMI, cooking habits and type of smoking habit should be noted.
Highlights
The world is facing ‘The Tobacco Epidemic’ which is proving to be a grave global public health threat
This study aims to assess the correlation of exhaled carbon monoxide (CO) and nicotine dependence with the occurrence of oral mucosal lesions while taking into consideration socio-demographic, clinical and anthropometrical characteristics of participants
No subjects with lesions and 2 subjects without lesion had a familial history of cancer. 11.3% with lesions had existing co-morbidities (Diabetes and Hypertension)
Summary
The world is facing ‘The Tobacco Epidemic’ which is proving to be a grave global public health threat. Tobacco kills half of its users accounting to more than 8 million people every year across the globe of which more than 7 million are direct users of smoked or smokeless forms of tobacco while 1.2 million non-smokers lose their life to second hand smoke (World Health Organization, 2020). In the Indian subcontinent, oral cancer presents to be a major public health problem with it being among the top three types of cancers in the country prevalent in both urban and rural areas (Sharma et al, 2018). With a single puff of smoked tobacco more than 60 well-established carcinogens are inhaled. Critical constituents such as Polycyclic Aromatic Hydrocardons (PAHs), N-nitrosamines, aromatic amines, 1, 3-butadiene, benzene, aldehydes, and ethylene oxide possess high potency amounting to deleterious effects. The toxic effect of tobacco is demonstrated in the form of various oral mucosal lesions, periodontitis, hyperpigmentation, Asian Pacific Journal of Cancer Prevention, Vol 22 2781
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