Gutkha Chewers Research Articles

Assessment of periodontal status in smokeless tobacco chewers and nonchewers among industrial workers in North Bengaluru

Introduction: More than one-third of the tobacco consumed in India is of smokeless form. While the smokeless tobacco (ST) products have been strongly associated with oral cancer, the association between ST and periodontal disease is less clear. The present study was conducted on industrial workers because in premises, there is a ban on smoking tobacco and hence workers tend to consume more of ST products. Aim: The aim of this study is to assess periodontal status in ST chewers and nonchewers among industrial workers in North Bengaluru. Materials and Methods: A cross-sectional analytical study was conducted on 800 industrial workers (400 ST chewers and 400 nonchewers) of North Bengaluru. Information regarding ST habits was obtained using the Global Adult Tobacco Survey questionnaire, followed by clinical examination to assess periodontal status using the community periodontal index and attachment loss. The comparison between chewers and nonchewers was done using Pearson's Chi-square test. Logistic regression analysis was used to estimate the difference of periodontal status and loss of attachment (LOA) between chewers and nonchewers. Results: ST chewing habit was observed the maximum (46.5%) among age group 25–44 years. Most of male chewers had habit of chewing gutkha followed by khaini, and majority of the female chewers were using khaini followed by betel nut quid. A significantly higher prevalence of bleeding on probing and calculus was found among nonchewers. ST chewers had 2.06 (95% confidence interval [CI]: 1.55–2.75) times more risk of developing periodontal pockets and 2.23 (95% CI: 1.68–2.98) times more risk of having LOA when compared with nonchewers. Conclusions: ST has deleterious effects on the periodontium. Hence, it is one of the important risk factors for periodontal disease.

Exploratory Study to Evaluate Changes in Serum Lipid Levels as Early Diagnostic and/or Prognostic Indicators for Oral Submucous Fibrosis and Cancer among Gutkha Consumers in India.

In India smokeless tobacco users account for 25.9% of total tobacco use, Gutkha being the most common form. This study evaluated the association between serum lipid profile and Gutkha use as an early diagnostic and/or prognostic indicator for oral submucous fibrosis (OSMF) and oral cancer (Oral Ca) in non-smokers and non-alcohol consumers. A total of 163 participants were recruited from two sites in India. Participants were divided into four groups: individuals without any Gutkha chewing habit and without any oral lesions (control group), individuals with Gutkha chewing habit but without any oral lesions (GWL), patients with a confirmed clinical diagnosis of OSMF, and patients with a confirmed diagnosis of Oral Ca. Mixed linear modelling (MLM) was conducted to detect the change in mean serum lipid levels among four groups. The sample consisted of 69% males and 31% females. Results of MLM show an inverse relationship between serum lipid levels in OSMF, and Oral Ca groups when compared to the control group. The results of our study demonstrated that GWL, OSMF and Oral Ca patients had lower serum lipid levels. Low serum lipid levels could be an indicator of initial neoplastic changes in oral cancer.

Qualitative analysis of dermatoglyphics in oral submucous fibrosis

Aim: The study was conducted to analyze the significance of dermatoglyphics in predicting the development of oral submucous fibrosis (OSMF) among gutkha chewers. Objective: To evaluate the finger tip patterns in OSMF patients. Materials and Methods: The study was conducted on 75 subjects selected randomly from the OPD of Oral medicine and Radiology, out of which 25 subjects were gutkha chewers with OSMF, 25 were gutkha chewers without OSMF, and 25 were healthy subjects who were used as controls. The fingertip patterns were recorded using duplicating ink on A3 size paper and analyzed for their configurations using a magnifying lens. Results: Statistical analysis showed significant increase in the percentage of loops among gutkha chewers with OSMF and controls, and significant increase in the whorl patterns among the control group. The distribution of finger tip patterns of all the digits showed statistically significant increase in whorl pattern in right index (RI) and right ring (RR) finger. Conclusion: The present study showed a significant increase in the loop pattern among gutkha chewers with OSMF in comparison to controls. Thus, it can be concluded that people with more number of loop patterns are more prone to develop OSMF as compared to those with other patterns. Hence, dermatoglyphics can be used in this modern era to forecast the future of gutkha chewers, without much intervention.

Dynamic ventilatory functions in assessment of pulmonary system in gutkha users

Background There are diverse opinions about the degree of adaptability of the respiratory system in delivering the physiological needs in case of tobacco users. Role of the normal respiratory system in delivering oxygen to meet the demands of various degrees of exercise has been a topic of considerable debate. One view holds that the respiratory system is not normally the most limiting factor in the delivery of oxygen; others hold the absence of structural adaptability to physical training as the cause of limitation of the pulmonary system. The role of ventilatory functions in evaluating the respiratory functions in gutkha users has not been studied adequately in previous studies. Hence, there was a need for this study. Materials and methods Pulmonary function tests were performed before and after maximal exercise testing to assess dynamic lung functions in two groups: gutkha chewers and nongutkha chewers. Results On studying the differences in dynamic lung functions in two groups of nongutkha chewers and gutkha chewers, there was no difference in forced vital capacity and forced expiratory volume in 1 s, before or after exercise testing. The other flow rates maximum mid-expiratory flow, peak expiratory flow rate, and mid-expiratory flow 25-75% were on the higher side in nonchewer individuals, which were consistently maintained after exercise testing. A higher adaptability of the respiratory system to the training stimulus in the form of a higher elastic recoil pressure of the lungs and a lower resistance of medium to small airways is suggested as the mechanism of adaptability in this study.

Dynamic ventilatory functions in assessment of pulmonary system in gutkha users

BackgroundThere are diverse opinions about the degree of adaptability of the respiratory system in delivering the physiological needs in case of tobacco users. Role of the normal respiratory system in delivering oxygen to meet the demands of various degrees of exercise has been a topic of considerable debate. One view holds that the respiratory system is not normally the most limiting factor in the delivery of oxygen; others hold the absence of structural adaptability to physical training as the cause of limitation of the pulmonary system. The role of ventilatory functions in evaluating the respiratory functions in gutkha users has not been studied adequately in previous studies. Hence, there was a need for this study.Materials and methodsPulmonary function tests were performed before and after maximal exercise testing to assess dynamic lung functions in two groups: gutkha chewers and nongutkha chewers.ResultsOn studying the differences in dynamic lung functions in two groups of nongutkha chewers and gutkha chewers, there was no difference in forced vital capacity and forced expiratory volume in 1 s, before or after exercise testing. The other flow rates maximum mid-expiratory flow, peak expiratory flow rate, and mid-expiratory flow 25-75% were on the higher side in nonchewer individuals, which were consistently maintained after exercise testing. A higher adaptability of the respiratory system to the training stimulus in the form of a higher elastic recoil pressure of the lungs and a lower resistance of medium to small airways is suggested as the mechanism of adaptability in this study.

Investigation of the Possibility of Using Serum Ischemia Modified Albumin (IMA) as a Novel and Early Marker of the Extent of Oxidative Stress Induced by Various Tobacco Products.

Ischemia Modified Albumin (IMA) is an altered serum albumin that forms under the conditions of oxidative stress and is considered as a biomarker of cardiac ischemia. The objective of this study was to evaluate the ischemia modified albumin (IMA) in the serum of the individuals with different types of tobacco habits in order to investigate the possibility of using this as a biomarker for the oxidative stress induced by the tobacco products. The study included 90 subjects, who were Grouped as control (30), Group I (betel quid chewers), Group II (gutkha chewers), Group III (smokers) and Group IV (mixed). Serum was collected from subjects of all Groups and IMA estimation was done using Albumin Cobalt binding assay. The results were tabulated and analysed statistically. The mean serum IMA levels in control, Group I, Group II, Group III and Group IV were 0.52547 ABSU, 0.68767 ABSU, 0.47433 ABSU,0.36540 ABSU and 0.54593 ABSU respectively. The results show that serum IMA levels were increased in betel quid chewers and mixed Group compared to the controls. From the results noted in this study we suggest that IMA can be used as an early marker for tobacco related oxidative stress.

Clinico-Pathological Evaluation and Correlation of Stages of Oral Submucous Fibrosis with Different Habits

Objective: Oral Submucous Fibrosis (OSF) is a precancerous condition and is mainly associated with the chewing of areca nut. This study was undertaken to correlate the etiological factors (duration, frequency, style and chewing habit) associated with OSF with clinical grading and histological staging. Methodology: A total of 50 clinically and histopathologically diagnosed cases of OSF were included in the study. Detailed clinical examination of each patient was done; emphasizing on their habit. Clinical grading and histological staging of each case was done and the data was recorded in a prescribed format. Statistical analysis was done using chi-square test. Result and observation: A total of 50 subjects were studied, with a male to female ratio of 7.3:1 with age range of 20-30 year. Gutkha-chewing habit alone was identified in 46% of subjects and those associated with gutkha and tobacco were 33.3% with a mean ± S.D =32 ± 11.51. Conclusion: The widespread habit of chewing gutkha plays a major role in the development of Oral Submucous Fibrosis than any other habit. The duration and frequency of its use and type of areca nut product has effect on the incidence and severity of OSF.

Effect on micronucleus frequency and DNA damage in buccal epithelial cells of various factors among pan masala and gutkha chewers

ObjectiveGutkha and pan masala addiction among humans of different occupations is very common. The increase in the occurrence of oral cancer has raised a serious concern regarding the nature of these chewables. Study designIn the present study, the effect of pan masala and gutkha was studied on micronucleus frequency and comet tail length in the buccal epithelial cells taking into consideration the duration of keeping the chewables (gutkha and pan masala) in mouth, duration of addiction, and the number of pouches of the chewables (gutkha and pan masala) consumed per day. ResultsThe results of the present study reveal that the micronucleus frequency and comet tail length in buccal epithelial cells are higher in gutkha users as compared to pan masala users and also to controls. ConclusionThe micronucleus frequency and comet tail length also depend on the duration of chewables kept in mouth, duration of addiction and the number of pouches consumed per day.

Detection of aneugenicity and clastogenicity in buccal epithelial cells of pan masala and gutkha users by pan-centromeric FISH analysis.

Chewing of betel quid, smoking and alcohol consumption are all associated with higher incidences of oral cancer. Genetic damage can be detected by fluorescent in situ hybridization (FISH) using human centromeric probes. In the present study FISH was performed on buccal epithelial cells of pan masala and gutkha chewers alone with and without additional tobacco smoking and/or alcohol consumption. The study comprised of 1500 male individuals. The present study found the highest frequency of micronuclei without a centromeric region (MN(-)) among gutkha users who also smoked and drank (P < 0.05). A significant increase in cells having micronuclei with a centromeric region (MN(+)) was observed among pan masala users who also smoked (P < 0.05). The study reveals that the clastogenic effects of pan masala/gutkha increase with smoking and alcohol consumption, but aneugenic effects were also observed among the pan masala chewers who smoked.

Scalp hair and blood cadmium levels in association with chewing gutkha, mainpuri, and snuff, among patients with oral cancer in Pakistan.

It has been reported that smokeless tobacco (SLT) chewing can lead to caners of oral cavity. In this study, the relationship between cadmium exposure via consumption of different SLT products by patients with oral cancer with related to referents belongs to different cities of Pakistan are investigated. The cadmium in different types of SLT products (gutkha, mainpuri and snuff) consumed by studied population and biological samples (scalp hair and blood) of cancerous and healthy subjects were analyzed. Both referents and patients with cancer have same age group (ranged 30-60years), socioeconomic status, localities, and dietary habits. The concentrations of cadmium in SLT products and biological samples were measured by electrothermal atomic absorption spectrophotometer after microwave-assisted acid digestion. The validity and accuracy of the methodology were checked by certified reference materials. It was estimated that 10g intake of different types of gutkha, mainpuri, and snuff could contribute, 18-40%, 15.7-33.6%, and 14-68% of the provisional maximum tolerable daily intake of cadmium, respectively for adults (60kg). The results of present study showed that the mean value of cadmium was significantly higher in scalp hair and blood samples of patients with oral cancer as compared to those results obtained for referents (P<0.001). The high exposure of cadmium due to consuming different SLT products may have synergistic effects with other risk factors associated for oral cancer.

Proliferative pool analysis in gutkha chewers

Gutkha chewing is a widely prevalent habit in South and Southast Asia [1]. Chronic exposure to gutkha constituents affects the pithelial proliferative pool [2]. This study investigates the proiferative pools and nuclear diameters in oral submucous fibrosis OSMF), oral epithelial hyperkeratosis and low-grade epithelial ysplasia to elucidate a hypothesis regarding their potentially alignant progression.

A dermatoglyphic study in oral submucous fibrosis patients

Aims and Objectives: (1) To determine the fingerprint patterns in gutkha chewers with oral submucous fibrosis (OSMF) and in healthy controls without gutkha chewing habit and OSMF. (2) To observe and compare the variations of fingerprints in both these groups. Materials and Methods: A prospective study was conducted in the Department of Oral Medicine and Radiology, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, with 50 subjects divided into two groups: group A consisted of 25 clinically and histologically proven OSMF cases and group B consisted of 25 controls without gutkha chewing habit and OSMF. Fingerprints were taken using the ink method described by Cummins and Midlo. Statistical analysis was done using Chi-square and Fisher's exact tests. Results: There was a marked decrease of tented arches, ulnar and radial loops, and an increase of simple whorls in OSMF subjects in comparison with normal individuals. Conclusion: Fingerprint pattern is genetically determined. Similarly, the tendency of development of OSMF in gutkha chewers is also genetically determined. An effort was made to compare the fingerprint patterns among gutkha chewers with OSMF in a small sample, which showed that there was a significant decrease of tented arches, ulnar and radial loops, and an increase of simple whorls in OSMF patients in comparison with normal individuals.

Evaluation of masseter muscle hypertrophy in oral submucous fibrosis patients -an ultrasonographic study.

Oral submucous fibrosis (OSMF) is a chronic insidious disease of the oral mucosa, commonly seen in South East Asia. It occurs mainly due to the habit of quid or gutkha chewing. There is a clear dose dependent relationship between gutkha chewing and development of OSMF, also due to continuous chewing for larger intervals of time unnecessary forces are exerted on the muscles mainly the masseter muscle. So, the present study was done to evaluate the thickness of masseter muscle in OSMF patients and to compare it with normal patients. The present study involved 50 subjects, 25 OSMF patients and 25 normal individuals. The thickness of masseter muscle was evaluated by ultrasonography (5-11mHz). There is a positive association between masseter muscle hypertrophy and OSMF (p-value 0.001). Thickness of masseter muscle was found to be more in OSMF patients as compared to control group and also thickness is more during contraction as compared to relaxation in both OSMF patients and normal individuals.

Clinical Evaluation of Gutkha chewing and Pattern of Bone Loss in Periodontitis

ABSTRACT Introduction Tobacco in the form of Gutkha is commonly used in India. The present study was done to analyze the extent and pattern of alveolar bone loss (ABL) among gutkha chewers who were having chronic periodontitis. Materials and methods A total of 55 habitual gutkha chewers within the age range of 18 to 35 years with chronic periodontitis, who were otherwise healthy were recruited for the study. Fourteen full mouth intraoral periapical (IOPA) radiographs were taken for each individual (a total of 770 radiographs) with the help of radiovisiography. Kodak dental software was used to analyze and measure the alveolar bone loss at each proximal site and data were computed as percentage alveolar bone loss. Results Almost all the subjects had poor oral hygiene status. Clinical parameters of periodontal examination represented by clinical attachment level, probing depth, gingival bleeding index had positive correlation with frequency and duration of gutkha chewing. The study population had a mean alveolar bone loss of 17%. Mean bone loss was more severe in mandible 18.3% ± 2.6, when compared with maxillary arch 15.7% ± 3.7. Conclusion Maximum bone loss was observed with molars and incisors. Alveolar bone loss was more frequently found in mandibular arch as compared to maxillary arch. How to cite this article Warad S, Chaudhari HL, Ashok N, Kalburgi V, Kalburgi NB, Jenifer HD. Clinical Evaluation of Gutkha chewing and Pattern of Bone Loss in Periodontitis. World J Dent 2014;5(4):199-203.

Determining the Effect of Gutkha on Serum Levels of Vitamin B12 and Folic Acid as Compared to Smoking among Chronic Periodontitis Subjects : A Cross-Sectional Study.

Periodontitis, being a common inflammatory disease has a multifactorial origin , with smoking and gutkha as few of the causative entities. The role of smoking as a risk factor for periodontitis is been well documented in literature. Cigarette smoke also affects vitamin B12 and folic acid mechanisms. Nutritionally derived vitamin B12 occurs mainly as either hydroxycobalamin or deoxyadenosycobalmin. Folic acid is also heat sensitive and water soluble, closely linked to vitamin B12 in its metabolism. However, effect of smokeless tobacco in form of gutkha on serum levels of vitamin B12 and folic acid is yet to be explored. To estimate and correlate serum vitamin B12 (VB12) and folic acid (FA) levels among periodontally healthy subjects and Chronic Periodontitis (CP) subjects with habit of smoking and gutkha chewing. The study included 111 subjects ranging in age from 18 to 60 y. Participants were divided into four groups: 30 healthy subjects (Group I), 29 subjects with CP (Group II), 25 smokers with CP (Group III) and 27 gutkha chewers with CP (Group IV). Clinical parameters included pocket probing depth (PPD), clinical attachment level (CAL) & gingival index (GI) following which VB12 and FA levels were estimated through UV-spectrophotometry method and data was analysed using Statistical Package for Social Scientists software, Mann-Whitney U-test and Pearson correlation coefficient. p-values less than 0.05 were considered as significant. Results : Pairwise comparison by Mann-Whitney U-test showed an increase in the serum VB12 in Group IV when compared to Group I (p=0.01) and Group II (p=0.01). Although serum FA levels were found to be low in Group III (7.61 ug/ml) & Group IV (8.64 ug/ml), Group III was found to be statistically significant (P=0.046). The clinical parameters GI, PPD and CAL among the four groups of patients were also statistically significant (p < 0.05). The study results suggested that among the patients with periodontal disease, serum VB12 levels are directly related while serum FA levels are inversely related to inflammation and tissue destruction in periodontium as occurred in Group IV.

Correlation of Habits and Clinical Findings with Histopathological Diagnosis in Oral Submucosal Fibrosis Patients

Oral submucosal fibrosis (OSMF) is one of the most prevalent premalignant conditions in India which is easy to diagnose but difficult to manage. At present it is considered as irreversible and incurable. It has also been referred to as an epidemic in India. To correlate the frequency and duration of habits with clinical staging, functional staging and histopathological grading and to correlate the clinical and functional staging with histopathological grading. The study included a total of 90 subjects, 80 with OSMF in the experimental group and 10 patients in the control group. Patient personal history was recorded with chewing habits, including frequency and duration of chewing. The site of keeping the quid, time duration and whether he/she swallows it or spits it were also noted. Clinical staging was done on the presence of palpable fibrous bands. Functional staging was accomplished by measuring mouth opening. Incisional biopsy was done for all the patients for histopathological examination. Histopathological grading was according to Pindborg and Sirsat. The experimental group comprised 71 males and 9 females, the majority of which were in the age group of 21-30 years. Correlation of habits with clinical staging, functional staging and histopathological grading were significant (p<0.05). Clinical and functional staging did not correlate with histopathological grading, but the correlation of clinical and functional staging was highly significant (p<0.01). The widespread habit of chewing gutkha is a major risk factor for OSMF, especially in the younger age group. In this study, it was found that with increase in the duration and frequency of the habit the severity of the disease increased.

Prevalence of oral submucous fibrosis among habitual gutkha and areca nut chewers in Moradabad district

BackgroundTo determine the prevalence and severity of oral submucous fibrosis (OSMF) among habitual gutkha, areca nut and pan chewers of Moradabad, India. MethodA survey was conducted for a period of one year in east, west, north and south zones of Moradabad district, Uttar Pradesh. One thousand habitual chewers were selected as study participants, using a stratified random sampling technique, between the ages of 11–40 yrs, with a habit of chewing gutkha, areca nut, pan for over a year. A detailed history was recorded and meticulous clinical examination was conducted. Evaluation of taste sensation, hearing, interincisal distance, clinical staging was done in the OSMF patients found amongst habitual chewers. The obtained data was statistically analyzed using an SPSS 16.5 version soft ware. ResultsThe prevalence of OSMF was 6.3% (63/1000) and gutkha chewing was the most common abusive habit (42/63) amongst OSMF patients. Stage 1, Stage 2, Stage 3 OSMF was seen in 28, 19 and 16 patients respectively. Restricted mouth opening, altered taste perception and defective hearing was observed in 37/63 (58.7%), 24/63 (38.09%) and 14/63 (22.22%) respectively. ConclusionOur study shows a prevalence of 6.3% OSMF among habitual chewers of Moradabad. Prevalence and severity were more in urban and rural patients respectively.

Assessment of DNA damage by panmasala, gutkha chewing and smoking in buccal epithelial cells using alkaline single cell gel electrophoresis (SCGE)

In the present study the comet assay was performed in buccal epithelial cells to evaluate DNA damage among pan masala or gutkha chewers and smokers. The assay is a rapid, suitable and sensitive method for detecting various forms of DNA damage at individual cell level. The study comprises 300 individuals of which 50 individuals were gutkha chewers along with smoking, 50 individuals were pan masala chewers along with smoking, 50 individuals were gutkha chewers, 50 individuals were pan masala chewers, 50 individuals were smokers and 50 individuals were non-users (control) or not having any addiction. Comet tail length was observed to measure the extent of DNA damage. In all groups a significant increase in the tail length was observed as compared to the non-users (control). The highest tail length was observed among gutkha chewers along with smoking (36.9±3.60). The results of the present study suggest that the panmasala and gutkha are genotoxic agents and induce DNA damage.

Cytomorphometric analysis of the keratinocytes obtained from clinically normal buccal mucosa in chronic gutkha chewers

Objective: The objective of this study was to examine the cellular changes induced by chronic gutkha chewing in buccal mucosa as revealed by cytomorphometry. Study design: Nuclear area (NA), cellular area (CA), nuclear diameter (ND), cellular diameter (CD), ratio of NA to CA (NA:CA), ratio of ND to CD (ND:CD) of exfoliated buccal squames obtained from clinically normal appearing buccal mucosa of chronic gutkha chewers ( n = 30), were stained by Papanicolou method and observed under light microscope. 100 cells in each case were measured using image analyser. Non-gutkha users (healthy) served as negative controls ( n = 20) and oral squamous cell carcinomas (OSCCs) in gutkha users served as positive controls ( n = 20). All the variables except for ND:CD (using Shapero-Wilk test) were normally distributed and hence their mean difference was tested using ANOVA followed by Tukey test. In case of ND:CD non-parametric Kruskal-Wallis test followed by Mann-Whitney test was applied. Results: A highly significant decrease in CD, CA, increase in ND, NA, ND:CD and NA:CA were observed in smears obtained from chronic gutkha chewers when compared with the healthy controls ( P < 0.05). The mean value of ND and NA in gutkha chewers was greater than those of healthy controls, but lesser than that of OSCC cases. Conversely, the CD and CA gradually decreased from healthy controls to gutkha chewers to OSCC cases. Conclusions: The findings indicate that gutkha chewing influences the cellular alterations. The study confirms cytomorphometric changes in the buccal keratinocytes of chronic gutkha chewers.

Quantitative dermatoglyphic analysis in patients of oral sub mucous fibrosis

Background - Dermatoglyphics is the collective name for all those integumentary features within the limits to be defined and it applies to the division of anatomy which includes their study. Diagnosis of many diseases which are genetically or non genetically determined like Diabetes mellitus, Schizophrenia, Hypertension, etc can now be aided by dermatoglyphic analysis. Oral submucous fibrosis is a chronic precancerous oral disease, specially seen in guthka chewers, but not all the gutkha chewers develops the disease or non gutkha chewers may also develop the disease. Genetic predisposition explains such individual variability. Such genetic predisposition can be explored with the help of dermatoglyphic studies. Objective- The study was aimed at finding the dermatoglyphic markers for the patients of Oral submucous Fibrosis by assessing the quantitative dermatoglyphic parameters. Method- 100 gutkha chewers without Oral Submucous fibrosis and 100 Gutkha chewers with Oral submucous fibrosis were selected for the study and their quantitative dermatoglypphic analysis with specific reference to total finger ridge count (TFRC) and atd angle was carried out and was statistically analyzed. Result- There was significant decrease in mean TFRC and atd angle for the patients of Oral sub Mucous Fibrosis.