Strong association between areca nut use and oral submucous fibrosis

Abstract

DesignA case–control study was carried out in Chennai, South India.Participant selectionAll subjects (cases and controls) were recruited from the outpatient department of Ragas Dental College and Hospital, Chennai. The cases were patients who had either reported for treatment of oral submucous fibrosis (OSF) or who had been diagnosed with OSF during routine oral examination. The clinical diagnosis was confirmed by biopsy in every case using established criteria. The control patients were chosen using a random selection method, in which every fifth patient of the outpatient department would be included. These individuals had no oral lesions other than periodontal disease associated with a chewing or smoking habit. One control was then selected for each case, matched by age (±2 years) and gender. All chewers in case and control groups used some form of areca nut at least once a day.Data analysisThe habits of cases and controls were classified into various categories without any overlap. Statistical tests were performed to find out if there was any significant difference in the duration, frequency and intensity of all habits between cases and controls. Univariate binary logistic regression was used to ascertain the significance of risk factors for the cases.ResultsA total of 185 consecutive patients with OSF were assigned corresponding age- and sex-matched controls. The male to female ratio of OSF cases was 9.9:1.0. All areca nut products were associated with OSF (Table 1), with the risk being greatest for pan masala (processed areca nut without betel leaf; odds ratio, 81.5). This was followed by areca nut plus alcohol use (odds ratio, 69.9). Smoking and alcohol, together or on their own, did not show any correlation with the occurrence of OSF but their concurrent use along with processed areca nut increased the risk of OSF (P<0.05). Both duration and intensity of habit showed a statistically significant difference between the cases and controls (P<0.002 and P<0.005, respectively). There was no significant difference in the frequency of chews per day between the cases and controls.Table 1 Areca nut habits and Odds ratiosFull size tableConclusionsThe present study confirms the strong association between areca nut use and OSF and between OSF and the increasing use of pan masala.