Gutka Chewing Research Articles

Comparative Evaluation of Serum Levels of Vitamin B12, Folic Acid, and ESR in Chronic Periodontitis Among Smokers, Gutkha Chewers, and Type 2 Diabetic Patients: A Cross-Sectional Study.

The purpose of this research is to determine the relationship between periodontal disease severity, cigarette smoking, gutka chewing, and type 2 diabetes mellitus by estimating, correlating, and comparing blood levels of vitamin B12, folic acid, and erythrocyte sedimentation rate (ESR) in patients with chronic periodontitis. A cross-sectional research study conducted at Rama Dental College Hospital and Research Centre in Kanpur involved 240 patients with chronic periodontitis, who also exhibited additional risk factors including smoking, gutkha chewing, and type-2 diabetes mellitus. Divided into four groups of 60 individuals each, the study aimed to estimate and correlate blood levels of vitamin B12, folic acid, and ESR. Group I served as the control with chronic periodontitis patients, while Group II comprised chronic periodontitis patients who were smokers, Group III included those who chewed gutkha, and Group IV consisted of patients with type-2 diabetes mellitus. Clinical parameters were assessed, and patients were followed up to track any changes or correlations. This research confirmed that low levels of vitamin B12 and folic acid are linked to inflammatory diseases such chronic periodontitis. The study revealed that type-2 diabetic and gutka chewer groups exhibited statistically higher periodontal disease severity, vitamin B12, and folic acid deficiencies and elevated ESR compared to smokers and control groups.

Comparative evaluation of salivary, serum and urinary 8-OHdG in gutka-associated oral submucous fibrosis.

Gutka chewing is the most common deleterious oral habit prevalent in the geographical distribution of the Indian subcontinent. Gutka leads to the production of numerous free radicals, which causes oxidative stress in regional oral tissues. Oxidative stress brings about the oxidation of guanine bases of DNA that generates 8-OHdG as its main byproduct. The presence of 8-OHdG can be evaluated not only in tissue but also in saliva, blood and urine. The availability of 8-OHdG in these samples is quite documented. In addition, a comparative assay of 8-ohdg DNA damage marker in multiple samples is yet to be done. A sample size of 60 was divided into two groups, i.e., gutka consumers without any lesion and gutka consumers with OSMF. Ten samples each of saliva, serum and urine were collected from these two groups and healthy controls. Samples were centrifuged at 1000 RPM at 2-8°C for 15-20 minutes. A volume of 1.5 ml resultant supernatant was pipetted out in labelled Eppendorf tubes and stored at -80°C. The ELISA test was performed to measure the concentration of 8-OHdG protein in different samples at 450 nm after adding stop solution in 96-well microplate. 8-OHdG concentration was found to be highest in saliva followed by urine and serum. 8-OHdG concentration in serum was significantly less than that in saliva and urine (P-value <0.05). Intergroup difference in concentration of 8-OHdG of urine, saliva and serum was significant (P-value <0.05). Post hoc analysis revealed that concentration of 8-OHdG in saliva and urine was non-significantly different (P-value >0.05). Saliva appears to be the most appropriate sample type as compared to serum and urine for the evaluation of 8-OHdG in OSMF subjects.

A study for correlation of demographic data, chief complaints and risk factors with periodontitis

Background: Periodontal disease, ever since the days of hippocrates has crippled the survival of human dentition. As a quiescent disease most of the time, periodontal disease presents mainly a chronic or asymptomatic chief complaint. In its most common form, periodontal disease generally is considered to be a painless process unless it reaches severe stages. For this reason, it often is overlooked by patients and dentists in early stages, especially when inflammation is not obvious. The aim of this study was to determine the most common chief complaints of chronic periodontitis patients to assess public awareness about this disease symptom, distribution of these chief complaints among males &amp; females and their correlation with age and some of periodontal parameters. Methods: The data of patients include chief complaint of the patients, age-sex, patient’s education level, systemic and oral health status, smoking, tobacco and gutka chewing habits were collected. The examiner also collected information related to the toothbrushing frequency of each patient. Results: Total samples testing in the study were 100 (n=100). Out of which majority samples were female patients. Maximum samples were received from age group of 51-60 years. Major pre-disposing factor is Tobacco and Gutka Chewing. Majority of chief complaint was mobility of teeth. Conclusions: 51 years to 60 years of age group with higher number of females and tobacco chewer have higher incidence of periodontitis with major chief complaint of mobility of teeth. These patients are brushing once in a day.

Oral Mucosal Lesions - A Study of 369 Cases.

Diagnosing and treating oral cavity lesions is a challenging task for most of the clinicians due to similar symptoms and clinical appearances. Frequently, histopathology and immunohistochemistry aid in making the diagnosis. The objectives were to describe the clinical features, and histopathological features and systemic association in patients with oral mucosal lesions (OML). A cross-sectional descriptive study was undertaken at a tertiary care centre in patients with OML. A total of 369 cases with OML were included in the study. Males constituted 61.78% of the cases. History of habits such as tobacco, gutka chewing, smoking, and alcohol was given by 32.25%, 29.81%, 26.56%, and 11.38% of cases, respectively. Common symptoms were soreness, burning sensation, oral pain and ulcers. Both oral and cutaneous involvement was seen in 17.89% of cases. Oral lichen planus (oral LP) constituted largest group of patients (21.96%) wherein reticulate type was the most frequent type and buccal mucosa was the commonest site. Oral carcinomas constituted 20.33% of cases followed by infective etiology (11.92%), vesiculobullous group of diseases (10.30%), aphthous stomatitis (8.94%), premalignant lesions (7.05%) such as leukoplakia (3.80%) and submucous fibrosis (2.44%). Histopathology was done in 209 cases. Clinico-histopathological correlation was seen in oral LP (90.27%), oral pemphigus (82.35%), and malignancies (98.66%). Oral LP formed the largest group of cases followed by Oral squamous cell carcinoma (SCC). Several rare conditions, such as Melkersson-Rosenthal syndrome and blue rubber bleb nevus syndrome were also a part of the study. Thorough clinical and histopathological examination in this diverse group of diseases clinches the diagnosis.

Exclusive use of different types of tobacco products, exposure to secondhand tobacco smoke and risk of subtypes of head and neck cancer among Indian males.

Tobacco products are used in vary many forms in India. Although the risk of tobacco uses in developing head and neck cancer (HNC) is known, risk by exclusive use of different tobacco products on HNC and its subtypes is poorly understood. A case-control study was conducted at a tertiary cancer hospital, which receives cases from different geographical regions of India with use of different types of tobacco products. The study included 824 oral cavity (OC), 149 oropharynx (OPX) 104 hypopharyngeal (HPX) and 81 larynx (LX) cancer cases and 1206 visitor controls. Information on 11 different types of tobacco products and exposure to secondhand smoke was collected through structured questionnaires. Odds ratios (OR) and 95% confidence intervals (CI), for the association of various HNC subtypes with exclusive use of each tobacco product compared to nonusers of tobacco were estimated using logistic regression models, after adjusting for potential confounders. Exclusive use of any type of smokeless tobacco product was strongly associated with all subtypes of HNC. Gutka chewing (only) had highest risk (OR=33.67; 95% CI=19.8-57.0) while exclusive users of betel quid with tobacco (BQ + T), tobacco quid, Khaini, Mawa and Mishri users had a OR of 14.77, 24.20, 5.33, 2.96 and 3.32, respectively, for development of OC. Bidi smoking and secondhand smoke was independently associated with increased risk of HNC. Our study indicates that tobacco control policies should focus on product specific awareness messaging that switching between tobacco product types is not a safe alternative to complete cessation.

Nerve Conduction Velocity in Smokers and Gutka Chewers: A Case-control Study

Introduction: Chemicals that are present in cigarette/bidi smoke and gutka have been known to cause subclinical changes in myelin sheaths of peripheral nerves. Despite the antiquity and popularity of smoking and gutka chewing, its effect has not been investigated systematically in young adults. Aim: To investigate the chronic effects of smoking and gutka chewing on Nerve Conduction Velocity (NCV). Materials and Methods: The case-control study was conducted in the Department of Physiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India, from November 2018 to December 2020. A 40 male smokers (age group 20-60 years), 40 gutka chewers (age group 20-60 years) along with 40 age matched healthy male controls. The nerve conduction study was performed by using fully computerised Electromyography (EMG) and NCV machine. Sensory Nerve Conduction Velocity (SNCV) and Motor Nerve Conduction Velocity (MNCV) test of median and ulnar nerves was performed on subjects. Data was analysed by using unpaired t-test. Results: In this study of comparative analysis of total 120 subjects, [40 controls and 80 cases (40 cases of smokers and tobacco chewers each)], statistically significant changes (p-value &lt;0.05) were found in the sensory NCV of both the nerves and motor NCV of median nerve in smokers whereas no such changes were found in motor NCV of both nerves in gutka chewers. Conclusion: It can be concluded that smoking causes more reduction in NCV than gutka chewing.

Comparative evaluation of periodontal inflammatory conditions among gutka-chewers with and without prediabetes.

The metabolic syndrome has become one of the major public-health challenges worldwide which include diabetes, prediabetes (raised blood glucose level), abdominal obesity, high cholesterol level, and high blood pressure. Periodontitis is described as a multi-factorial irreversible and cumulative condition and, is also the sixth complication of diabetes. Areca nut chewing has already been linked with the development of various cancers, and more recently with metabolic syndrome. Therefore, the purpose of the study is to investigate the association of periodontal inflammatory conditions among gutka chewing with and without prediabetes patients. There are about 50 pre-diabetic and 50 healthy patients, both males and females with the age range of 18 years to 45 years, were included in the study. They were then divided into 4 groups based upon gutka chewers and non-chewers i.e., pre-diabetic gutka chewers (PDC), pre-diabetic non-chewers (PDNC), healthy gutka chewers (HC), and healthy non-chewers (HNC). A complete demographic data was obtained along with clinical and radiographic parameters i.e. plaque index (PI), sulcus bleeding index (SBI), probing depth (PD), marginal bone loss (MBL) were recorded. A statistical analysis was performed and Bonferroni adjustment post hoc test was performed for multiple comparisons. The overall results suggested that the clinical periodontal parameters i.e., PD, PI, SBI and radiologic parameters i.e., MBL are significantly higher in prediabetes chewers compared with healthy chewers and healthy non chewers. The periodontal inflammatory conditions are worse in gutka chewers compared to non-chewers in healthy and pre-diabetic patients, concluding that the severity of periodontal inflammation is governed by hyperglycemia when compared to habitual gutka usage.

Text messaging and quality of life of diabetics in tertiary care hospital of Eastern Nepal

Background: Text messaging health service is used to improve quality of life of people living with diabetes in Eastern Nepal. It has been projected that the number of diabetic patients has increased to 170% from 1995 to 2025 in developing countries and to 41% in developed world. The objectives of the study were to assess the quality of life of people living with diabetes, to prepare and provide health education, and to evaluate the effectiveness of health education program and mobile/telephone health services provided to the diabetes patients. Materials and Methods: The study was conducted among consecutive stable ambulatory patients, >18 years old, and 396 patients diagnosed with diabetes for at least 3 months were included in the study. The education intervention was continued for 6 months by the principal investigator and a trained nurse. Results: Most of the respondents (53.3%) were of the age group 40–60 years; female (59.34%); Hindus (97%); and of the Janjati ethnic group (52.5%). The majority (96.5%) were married and self-employed (70.7%). About 30% of the respondents belonged to the poor economic status group. Most of the respondents had type II diabetes mellitus; about 34% of the respondents had a family history of (sibling) diabetes. Most of them were non-vegetarians (88.9%). About 16% of the respondents were obese. Regarding habits, 14% had tobacco chewing, 5% had gutka chewing, 8% had smoking, and around 8% had alcohol consumption habits. Regarding treatment, about 84% were on oral hypoglycemic agent, 22% on insulin therapy, 68% on diet control therapy, 58% on weight control, and 4.5% on herbal therapy. It was found that the mean knowledge score before education intervention was 22.53 and after education intervention was 35.32. It was found that the difference in the mean score calculated using t-test between knowledge before and after education intervention program was significant (P < 0.01). Conclusion: It can be concluded that the education intervention program and SMS mobile service provided to diabetes patients were found to be very effective.

The CLINICOPATHOLOGICAL SPECTRUM OF ORAL SQUAMOUS CELL CARCINOMA AMONG TOBACCO CONSUMERS: AN INSTITUTIONAL STUDY

Background: Oral squamous cell carcinoma (OSCC) constitutes 90% of all oral malignancies. Tobacco products, viral infections and additional risk factors are common etiological elements for this tumor.&#x0D; Objective: The aim of this study is to analyze the clinicopathological and sociodemographic features of patients diagnosed with oral squamous cell carcinoma.&#x0D; Material and Methods: Histologically confirmed 35 OSCC cases were selected for study. The clinicopathological data was obtained from patients and analyzed using SPSS software version 20.&#x0D; Results: Majority of cases was men and diagnosed with disease during fourth decade of life. Buccal mucosa was the common site while gutka chewing was observed as leading habit among our cases. Also, stage II and moderate histological differentiation was predominant among prognostic indicators of OSCC.&#x0D; Conclusion: Our data suggested that men, gutka consumers and early onset of disease are more prevalent characteristics in oral squamous cell carcinoma cases from our population. Most tumors classically affected buccal mucosa and late diagnosis seems to be common among our cases.&#x0D; Keywords: Malignancy, Squamous Cell Carcinoma, Oral Cavity, Tobacco

Abstract 5774: Indo-Canadian parternship for oral cancer screening in rural India

Abstract Aims: Oral cancer is ranked among the top three commonly occurring cancers in India with over 120,000 cases reported annually. Advanced stage diagnosis is common due to poor access to healthcare and low socioeconomic status, limiting the 5-year survival rate to a dismal 27%. In India, 60-80% of patients present with advanced disease as compared to 40% in developed countries. Oral cancer screening is a quick, painless, and non-invasive exam to detect suspicious lesions that can reduce mortality rates significantly. The aim of the project was to determine the feasibility of conducting oral cancer screening in rural areas around Hyderabad, India in collaboration with Two Worlds Cancer Collaboration, Canada; MNJ Cancer Hospital, India and two dental colleges in Hyderabad. Methods: Planning and communication between the Indian and Canadian partners were facilitated by Zoom videoconferencing. Ethics approval for the feasibility phase was obtained in both countries. A feasibility study was planned in a rural village. Prior to screening, the Urulla village community school required infrastructure changes such as furniture and electricity. Fluorescence Visualization (FV) units were shipped from Canada to India to assess if they improve the sensitivity and specificity of screening in this setting. The Canadian team trained the Indian clinicians on use of FV and study methodology. The feasibility study was conducted in March 2018 where participants received a detailed risk habit evaluation, intraoral and extraoral examination. Results: A total of 114 participants were screened, 62% males and 38% females with a median age of 55 years. Four percent had a family history of oral cancer, 33% had a smoking history of which the majority (65%) smoked beedis. Nineteen percent chewed pan, gutka or other chewing substances. Seventy-one percent drank alcohol, primarily beer/toddy (65%). Screening data was complete for 112 participants of which 16 (14.2%) had intraoral lesions. Lesion presence was not significantly associated with smoking, chewing habit or alcohol drinking (P=0.370, P=0.207, P=0.393). The majority of lesions were on the labial and buccal mucosa (79%). Forty-three percent of lesions showed a loss of fluorescence. Out of the 16 lesions, 7 lesions were clinically deemed as high-risk and recommended to undergo biopsy. Loss of fluorescence was noted in 6 out of 7 lesions, and was highly significant with high-risk lesion presence (p&amp;lt;0.05) A total of 5 biopsies were carried out on the field which came back later as 1 carcinoma in situ, 1 low-grade dysplasia and 3 hyperkeratosis. Conclusion: The high evidence of disease warrants the need for oral cancer screening in rural India. The feasibility study paved way for the pilot study which aims to screen over 1000 participantsin rural areas around Hyderabad using additional adjunct tools like FV and Quantitative Cytology to improve accuracy and semi-automate the screening process. Acknowledgements: This study was supported through fundraising efforts by Two Worlds Cancer Collaboration, an NPO based in Kelowna, Canada. Two Worlds aims to provide cancer palliative care in low resource countries. Citation Format: Madhurima Datta, Nallan CSK Chaitanya, Shyam Ndvn, Gayatri Palat, Jean Jacob, Priya Chandran, Vineela Rapelli, Jagannath Jn, Sandra Broughton, Simon Sutcliffe, Denise Marie Laronde. Indo-Canadian parternship for oral cancer screening in rural India [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5774.

Expression of Salivary S100A7 Levels in Stage I Oral Submucous Fibrosis: A Clinical and Laboratory Study.

Background:Oral submucous fibrosis (OSF) is a chronic debilitating condition characterized by juxta-epithelial fibrosis. The main etiological agent associated with the high-risk precancerous condition is areca nut use. S100A7 is a member of the largest calcium-binding proteins exclusively found in vertebrates and are associated with the regulation of numerous intracellular and extracellular functions. The aim of this study was to investigate the expression of protein S100A7 in salivary samples of individuals with stage I OSF and healthy controls. Methods:This study included 63 participants, 30 of whom had OSF stage I and 33 healthy controls. Nonprobability quota sampling technique was utilized for recruitment of the study participants. A structured baseline questionnaire was used to collect demographic data. Saliva samples were collected by passive droll technique in a sterile container. Salivary levels of S100A7 were quantified by enzyme-linked immunosorbent assay. For the normality of the data Shapiro Wilk test was performed. Student t-test was commuted to evaluate the expression of S100A7 protein expression between both the study groups. Results:The mean salivary S100A7 value for stage I OSF group was 0.334 ng/ml, compared to 0.172 ng/ml for healthy controls. Student t-test reported a statistically significant difference, indicating higher levels of S100A7 in stage I OSF group than in healthy controls (p < 0.001). In the individual group analysis, a significant negative correlation was found between salivary S100A7 and duration of areca nut use (r = –0.45, p = 0.009) and gutka chewing (r = –0.20, p = 0.03), while a significant positive correlation was found between salivary S100A7 and mouth opening (r = 0.03, p = 0.04). Conclusions:Higher levels of S100A7 protein level was seen in stage I OSF group in comparison to the healthy individuals. Results of our study suggest that S100A7 could be used as a surrogate assessment to identify patients at risk of OSF development.

Differential expression of salivary S100A7 in oral submucous fibrosis

AimTo investigate the expression of salivary S100A7 levels among patients with oral submucous fibrosis (OSF) and healthy controls. MethodA total number of 60 participants were included in the study (30 OSF cases and 30 healthy controls). Demographic data was collected using a structured baseline questionnaire. Salivary S100A7 levels were quantified using enzyme-linked immunosorbent assay. Data was analyzed using Student t-test. Pearson correlation test was used to evaluate correlation between S100A7 levels and independent variables such as frequency and duration of areca nut use, gutka use, and mouth opening. ResultsThe mean value of salivary S100A7 for OSF group was 0.275 ng/ml, whereas mean value of salivary S100A7 for healthy controls was 0.195 ng/ml. Student t-test indicated that there was statistically significantly higher levels of S100A7 in OSF group as compared to healthy controls (p < .001). When the clinical variables of individual groups were analysed, a significant negative correlation was found between salivary S100A7 and duration of areca nut (p = .009) and gutka chewing (p = .03), whereas a significant positive correlation was found for mouth opening (p = .04). ConclusionOSF presented higher levels of salivary S100A7 levels as compared with healthy individuals and may be used as surrogate measure to identify subjects at risk for OSF.

Prevalence of Deleterious Oral Habits and Oral Mucosal Lesions among Fishermen Population of Mahe, South India.

Fishing is an occupation associated with uneven diet, strain, drunkenness, tobacco use, and deleterious habits. The physical state of laborers on a large scale will also be influenced by conditions at their work site. Oral mucosal lesions can occur as a result of infections, local shock or infuriation, systemic diseases, and uncontrolled usage of tobacco, betel quid, and alcohol. The aim of the present study is to assess the prevalence of deleterious oral habits and oral mucosal lesions among fishermen population of Mahe, South India. The study population consists of 362 fishermen aged between 15 and 54. The questionnaire consisted of questions on personal data, and information related to the subjects' oral habits were collected by the interview. The World Health Organization (WHO) Oral Health Assessment Form was designed for the assessment of oral mucosal lesions. Among the 362 fishermen, 266 (73.48%) were males and 96 (26.52%) were females. The overall prevalence of smoking, alcohol consumption, and gutka chewing was found to be 24.3, 48.85, and 32.4% respectively. Smokeless tobacco (32.4%) was the most prevalent habit followed by smoking tobacco (24.3%). The prevalence of oral mucosal lesions was 14.9%. There is a statistically significant association between age groups and habits considered. Findings of the present study suggest that oral health condition of the fisherfolk community was relatively poor, with high habit prevalence and oral mucosal lesions. This epi-demiological study has provided baseline data to plan further research in this area. Low socioeconomic status, strenuous working hours, inadequate diet and nutrition intake, stress, and use of tobacco and alcohol act as contributing factors for ill health and oral diseases. It is a challenging population to the clinician to identify and treat them.

Squamous Papilloma of the Buccal Mucosa with Oral Submucous Fibrosis

The squamous papilloma is a common benign oral epithelial neoplasm [11. Naik R, Nithin KP, Mujib BR, Rai KK (2014) An Unusual Presentation of Squamous Papilloma on the Buccal Mucosa. Indian Journal of Multidisciplinary Dentistry 4: 1015-18.]. Papilloma usually presents as an exophytic, painless papillary mass [22. Neville BW, Damm DD, Allen CM, Bouquot JE (2009) Oral and maxillofacial pathology. 3rd ed. Philadelphia. Elsevier p362-63.]. Oral Submucous Fibrosis is a premalignant condition [33. Auluck A, Rosin MP, Zhag L, Sumanth KN (2008) Oral Submucous Fibrosis, a Clinically Benign but Potentially Malignant Disease: Report of 3 Cases and Review of the Literature. J Can Dent Assoc 74: 735-40.]. A 45 year old female patient presented with growth in inner side of left cheek region. Patient had history of gutka chewing for past 6 years. On intra oral examination, the growth was pinkish, strawberry like in appearance with a papillary surface in the right buccal mucosa (Figure 1). Generalized blanching of oral mucosa was present (Figure 2). The growth was not tender on palpation and firm in consistency. The growth was pedunculated with no induration or bleeding on palpation. Palpable fibrotic bands were present in the buccal mucosa.

Comparison of salivary flow and candidal carriage in patients with oral submucous fibrosis.

Background:Oral submucous fibrosis (OSMF) is a high-risk precancerous condition that predominantly affects Indians due to prevalent gutka chewing. Changes in the salivary flow rate and its effect on candidal carriage in patients suffering from OSMF have not been extensively explored.Aim:The aim of this study is to compare the salivary flow rate and salivary candidal carriage in OSMF patients and healthy individuals.Materials and Methods:This pilot study included a total of 30 OSMF patients and 30 healthy individuals. Salivary flow was estimated using preweighed cotton rolls placed at the openings of major salivary duct for 5 min. The cotton rolls were then removed from the oral cavity and weighed again. The difference in weight was recorded. Salivary samples were collected by the oral rinse technique and cultured on Sabouraud agar medium. The cultured yeast colonies were identified based on Gram's staining, periodic acid-Schiff (PAS) and germ tube formation.Result:There was statistically significant (P < 0.001) decreased salivary flow rate in OSMF individuals as compared to the control. Salivary flow rates constantly reduced with different grades of OSMF patients, although candidal carriage was seen in grade II and grade III OSMF patients.Conclusion:A higher incidence of Candida was observed in OSMF patients when compared to the healthy individuals. The results of our study suggest that a higher candidal carriage in grade II and grade III OSMF patients could be related to decreased salivary flow rate.

Gutka Chewing (Spit Tobacco): A Common Cause for Teeth Discoloration in India

ABSTRACT Gutka has been in use for decades in many parts of the world particularly in the Asian region. The potential to persuade excitation and delight have made it very tempting among its users. The staining effect; however, both extrinsically and particularly intrinsically have not been thoroughly understood. This is a case report of a 40-year-old Indian male who presented to the department of periodontology, complaining of generalized discoloration. Subsequent examination and history revealed that the discoloration was due to chronic use of gutka. How to cite this article Saini R. Gutka Chewing (Spit Tobacco): A Common Cause for Teeth Discoloration in India. Int J Experiment Dent Sci 2014;3(1):57-58.

Evaluation of interleukin-1β and 8 in gutka chewers with periodontitis among a rural Indian population.

Smokeless tobacco-based oral-use products like gutka are popular in India. Gutka usage leads to increased periodontal destruction and inflammation; however, the relevant mechanism remains unknown. This study aimed to elucidate the role of gutka in periodontitis by examining its effect on the levels of interleukin (IL) 1β and IL-8 from the gingival crevicular fluid (GCF). A total of 45 patients were enrolled in this study. Thirty patients with periodontitis (15 gutka chewers [GCP] and 15 nongutka chewers [NGC]) and 15 periodontally healthy controls (HC) were selected. The full-mouth plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and recession (RC) were recorded. The IL-1β and IL-8 levels in the GCF of all subjects were assessed through an enzyme-linked immunosorbent assay (Quantikine). The IL-1β and IL-8 levels were not significantly higher in the GCP group (IL-1β, 369.01±273.44 µL; IL-8, 205.97±196.78 µL) as compared to those in the NGC group (IL-1β, 195.57±96.85 µL; IL-8, 178.61±149.35 µL). More gingival RC and loss of attachment was seen among the GCP group (RC: 2.02±0.31, P=0.013; CAL: 4.60±0.56, P<0.001) than among the NGC group (RC, 1.21±1.15; CAL, 3.70±0.32); however, PD was deeper among the NGC subjects (P=0.002). PI and GI were significantly higher for the periodontitis group (P<0.001) when compared to the HC, but there was no difference among gutka chewers and non-chewers (P=0.22 and P=0.89). A positive correlation was found between the IL-8 levels and the duration of gutka chewing (r=-0.64, P<0.01). Gutka chewing leads to increased gingival RC and clinical loss of attachment. There was no effect seen in the proinflammatory cytokine levels in the GCF of gutka users.

Periodontal Inflammatory Conditions Among Gutka Chewers and Non‐chewers With and Without Prediabetes

It is known that gutka chewing jeopardizes periodontal health; however, severity of periodontal inflammation in gutka chewers with and without prediabetes remains unknown. The aim of this study is to investigate the association of periodontal inflammatory conditions with gutka chewing and prediabetes. In this cross-sectional study, the effect of gutka use on periodontal health is investigated among 44 individuals with prediabetes and 44 without prediabetes. Demographic information regarding age, sex, duration of prediabetes, and gutka-chewing habits was collected using a questionnaire. Periodontal inflammatory conditions (plaque index [PI], bleeding on probing [BOP], probing depth [PD], marginal bone loss [MBL]) and fasting blood glucose levels (FBGLs) were recorded. Group differences in periodontal inflammatory parameters were tested using univariate and multivariable analyses (α ≤5%). Periodontal inflammatory parameters (PI, BOP, and PD) were significantly higher in individuals with prediabetes irrespective of gutka-chewing habit (P <0.05). Odds of periodontal inflammation in individuals with prediabetes were nine times higher than in healthy controls (95% confidence interval [CI] = 3.4 to 23.6). Gutka chewing alone, chewing among individuals with prediabetes, and chewing among healthy controls did not significantly increase the odds of periodontal inflammatory conditions. Individuals with prediabetes were significantly more likely to have periodontal inflammation than individuals without prediabetes even after controlling for sex and gutka chewing (odds ratio = 13.2; 95% CI = 4.3 to 40.7). In medically healthy individuals, periodontal inflammatory conditions are worse in gutka chewers compared to non-chewers; in patients with prediabetes, the severity of periodontal inflammation is governed by hyperglycemia when compared to habitual gutka usage.

Coverage of Gingival Fenestration Using Modified Pouch and Tunnel Technique: A Novel Approach

Gingival fenestration defects are a rare phenomenon. Gingival fenestration means the exposure of the tooth due to loss of the overlying bone and gingiva. Though treatment of mucosal fenestration occurring in association with chronic periapical inflammation has been reported previously, the occurrence and treatment of gingival fenestration have not been documented in great detail. This report describes the occurrence of a gingival fenestration that developed secondarily to a gutka chewing habit. Treatment of the fenestration along with coverage of an adjacent recession defect in a single-step procedure using a pouch and tunnel technique is described.

Retrospective and prospective study of head and neck cancer.

A prospective clinico pathological study of Head and Neck Cancer cases presenting in E.N.T. OPD was done and its observations were compared with retrospective studies done earlier by Gupta et al (1986), It was seen that carcinoma laryngopharynx was the commonest (38.18%) malignancy seen in the present study followed by carcinoma of Larynx (16.36%) and Oesophagus (14.54%). Carcinoma of the nasopharynx was seen in 12.72% cases followed by carcinoma oropharynx (10.91%), Histopathologically; 98.18% cases were of squamous cell carcinomas and out of these only 31.48% were well differentiated carcinoma. There was only 1 case (1.81%) of occult primary. In the retrospective study, the incidence of cancer of Laryngopharynx was 33.33% followed by oropharynx 16.66% and Larynx and Lymphoma (11.11%) each. Occult primary was observed in 3 cases (5.33%) and carcinoma naspoharynx in 4 cases (4.44%). Poor socioeconomic status, bad orodental hygiene, Plummer-vinson syndrome in females were the commonest predisposing factors in addition to smoking, Pan Masala, Zarda and Gutka chewing in the causation of Head and Neck cancer both in prospective and retrospective studies.