Abstract
Smokeless tobacco consumption, which is widespread throughout the world, leads to oral submucous fibrosis (OSMF), which is a long-lasting and devastating condition of the oral cavity with the potential for malignancy. In this review, we mainly focus on the consumption of smokeless tobacco, such as paan and gutkha, and the role of these substances in the induction of OSMF and ultimately oral cancer. The list of articles to be examined was established using citation discovery tools provided by PubMed, Scopus, and Google Scholar. The continuous chewing of paan and swallowing of gutkha trigger progressive fibrosis in submucosal tissue. Generally, OSMF occurs due to multiple risk factors, especially smokeless tobacco and its components, such as betel quid, areca nuts, and slaked lime, which are used in paan and gutkha. The incidence of oral cancer is higher in women than in men in South Asian countries. Human oral epithelium cells experience carcinogenic and genotoxic effects from the slaked lime present in the betel quid, with or without areca nut. Products such as 3-(methylnitrosamino)-proprionitrile, nitrosamines, and nicotine initiate the production of reactive oxygen species in smokeless tobacco, eventually leading to fibroblast, DNA, and RNA damage with carcinogenic effects in the mouth of tobacco consumers. The metabolic activation of nitrosamine in tobacco by cytochrome P450 enzymes may lead to the formation of N-nitrosonornicotine, a major carcinogen, and micronuclei, which are an indicator of genotoxicity. These effects lead to further DNA damage and, eventually, oral cancer.
Highlights
The term “smokeless tobacco” refers to the consumption of unburned tobacco, in the form of chewing, spitting, dipping, and snuff
Scopus was searched for terms including: “oral cancer due to paan and gutkha,” “genotoxic effect of paan,” “paan and gutkha che wers,” “betel quid compounds,” “risk factor of oral cancer,” “prevalence of oral cancer,” “paan associated with oral cancer,” “smokeless products lead to oral cancer,” and “gutkha usage.”
We have summarized the effects of cytochrome polymorphisms (CYPs), which are connected with the chewing of betel quid and lead to cancer of the oral cavity and pharynx, Table 3
Summary
The term “smokeless tobacco” refers to the consumption of unburned tobacco, in the form of chewing, spitting, dipping, and snuff. Received: Dec 16, 2016 / Accepted: Mar 9, 2017 / Published: Mar 9, 2017 This article is available from: http://e-epih.org/ People mostly use paan and gutkha due to a lack of awareness and education. They are not aware of the harmful effects associated with the use of these substances, and it has been reported that these products are consumed for perceived beneficial effects, such as mouth freshening, aid in digestion, germ-killing, astringency, mood enhancement, tension relief, and oral cleaning [1]. The consumption of smokeless tobacco and areca nut is high in South Asian countries in the form of paan. In various South Asian languages, paan means “leaf.” Various in-
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