Prevalence and Risk Factors for Oral Potentially Malignant Disorders in Indian Population.

BACKGROUND: The present study was conducted to assess risk factors and prevalence of potentially malignant disorders (PMDs) among Indian population.
MATERIALS AND METHODS: 1280 Indian population of both genders were enrolled. Habits such as smoking bidi, cigarette, consumption of tobacco such as in the form of zarda, chaini khaini, pan masala, arecanut, and alcohol were recorded. Risk factors and prevalence rate of disorders were recorded.
RESULTS: There were 750 (58.6%) males and 530 (41.4%) females. Speckled leukoplakia was seen among 470 (36.7%), oral lichen planus (OLP) in 246 (19.2%), oral submucous fibrosis (OSMF) in 274 (21.4%), erythroplakia in 120 (9.3%), and oral squamous cell carcinoma (OSCC) in 107 (8.3%) participants. Maximum cases of speckled leukoplakia (162) was seen in the age group of 31-40 years, OLP (99) in 41-50 years, OSMF (95) in 31-40 years, erythroplakia (48) in 21-30 years, OSCC (44) in 41-50 years.
CONCLUSION: Risks factors associated with PMDs were found to be tobacco and arecanut. There was higher prevalence of leukoplakia. Age group of 31-40 years had higher cases and most common site was buccal mucosa and vestibule. Copyright:

INTRODUCTION

Oral potentially malignant disorders (PMDs) are quite high in Indian population. According to studies a prevalence rate of 13.2%–13.9% has been observed. Premalignant lesions and conditions are considered to be PMDs.[1] Leukoplakia, erythroplakia, and palatal changes associated with reverse smoking are premalignant lesions whereas oral syphilis, oral submucous fibrosis (OSMF), sideropenic dysphagia, xeroderma pigmentosum, oral lichen planus (OLP), and systemic lupus erythromatosus are premalignant conditions.[2]

The consumption of tobacco in smoking and nonsmoking form is relatively high among Indian subcontinent.[3] Arecanut usage leads to OSMF. Other risk factors leading to oral cancer is body mass index, alcoholism, lack of vegetarian diet and diabetes. Because of cultural, ethnic, geographic factors and the popularity of addictive habits, a feasible path toward oral cancer is high.[4] Oral PMDs carry high risk of malignant transformation and OLP, OSMF and leukoplakia are among those who show rapid transformation. Oral cancer is main reason for high morbidity and mortality. It is thought to be third most commonly occurring cancer in India and sixth in world. Approximately, 300, 000 cases of oral cancer are reported every year universally.[5]

These lesions are also contributing to poor oral health-related quality of life. Early identification and management of these disorders may prevent their malignant transformation.[6] The present study was conducted to assess risk factors and prevalence of PMDs among Indian population.

MATERIALS AND METHODS

This prospective study was conducted among 1280 Indian population of both genders who reported to the department of oral medicine and radiology. The ethical approval for the study was obtained from institutional ethical committee. All participants were informed regarding the study and once they agreed to participate in the study, their enrollment was done.

Particulars such as name, age, and gender were recorded. Habits such as smoking bidi, cigarette, consumption of tobacco such as in form of zarda, chaini khaini, pan masala, arecanut, and alcohol were recorded. Results were clubbed for statistical analysis. P < 0.05 was considered statistically significant.

RESULTS

Table 1 shows that there were 750 (58.6%) males and 530 (41.4%) females in the present study.

Table 1

Distribution of participants

Gender	Number of patients
Total	1280
Gender (n)
Males	750
Females	530

Table 2 and Graph 1 shows that speckled leukoplakia was seen among 470 (36.7%), OLP in 246 (19.2%), OSMF in 274 (21.4%), erythroplakia in 120 (9.3%) and oral squamous cell carcinoma (OSCC) in 107 (8.3%) participants.

Table 2

Prevalence of potentially malignant disorders

PMDs	Number (%)
Speckled leukoplakia	470 (36.7)
Oral lichen planus	246 (19.2)
OSMF	274 (21.4)
Erythroplakia	120 (9.3)
OSCC	107 (8.3)

PMD: Potentially malignant disorder, OSMF: Oral submucous fibrosis, OSCC: Oral squamous cell carcinoma

Graph 1

Prevalence of potentially malignant disorders

Table 3 and Graph 2 shows that maximum disorders were seen in age group of 31–40 years (401), followed by 41–50 years (301), 21–30 years (216), 51–60 years (158), >60 years (109), 11–20 years (29), and 0–10 years (3).

Table 3

Age-wise distribution of potentially malignant disorders

Age group (years)	Speckled leukoplakia	OLP	OSMF	Erythroplakia	OSCC	Total
0-10	0	2	0	0	1	3
11-20	4	8	12	3	2	29
21-30	111	25	21	48	11	216
31-40	162	80	95	39	25	401
41-50	75	99	70	13	44	301
51-60	62	20	52	10	14	158
>60	56	12	24	7	10	109
Total	470	246	274	120	107	1217

OLP: Oral lichen planus, OSMF: Oral submucous fibrosis, OSCC: Oral squamous cell carcinoma

Graph 2

Age-wise distribution of potentially malignant disorders

Maximum cases of speckled leukoplakia (162) was seen in the age group of 31–40 years, OLP (99) in 41–50 years, OSMF (95) in 31–40 years, erythroplakia (48) in 21–30 years, OSCC (44) in 41–50 years.

Table 4 and Graph 3 show that common site for PMDs was buccal mucosa and vestibule in 54%, labial mucosa and vestibule in 8%, floor of mouth in 6%, tongue in 11%, alveolar ridge and gingiva in 7%, retromolar pad in 10% and palate in 4%. The difference was significant (P < 0.05).

Table 4

Site of potentially malignant disorders

Site	Percentage	P
Buccal mucosa and vestibule	54	0.001
Labial mucosa and vestibule	8
Floor of mouth	6
Tongue	11
Alveolar ridge and gingiva	7
Retromolar pad	10
Palate	4

Graph 3

Site of potentially malignant disorders

Table 5 shows that risk factors were tobacco usage in 45%, betel nut in 14%, arecanut in 25%, and alcoholism in 16%. The difference was significant (P < 0.05).

Table 5

Assessment of risk factors in potentially malignant disorders

Risk factors	Percentage	P
Tobacco	45	0.021
Betel nut	14
Arecanut	25
Alcohol	16

DISCUSSION

PMDs are commonly encountered entity in Indian population.[7] The high number of cases is due to tobacco usage, alcoholism, and dietary habits.[8] The occurrence of white patch/plaque or mixed red and white lesions is suspicious of PMDs.[9] There can be burning sensation in the oral cavity. Most of the PMDs are diagnosed accidently when patient get their routine examination performed. Most of the lesions are nonscrapable.[10] Leukoplakia is more prevalent in males and lichen planus in females. The present study was conducted to assess risk factors and prevalence of PMDs among Indian population.

In the present study, there were 750 (58.6%) males and 530 (41.4%) females. Speckled leukoplakia was seen among 470 (36.7%), OLP in 246 (19.2%), OSMF in 274 (21.4%), erythroplakia in 120 (9.3%), and OSCC in 107 (8.3%) participants. Ramya et al.[11] assessed 3223 oral biopsies in which 683 (21.16%) patients were segregated, out of which OPMDs were 205 (6.38%) and 478 (14.8%) were oral cancer. Oral leukoplakia was prevalent in 3.2% followed by OLP in 1.6% and OSMF in 1.36%. OSCC constituted 12.9%, verrucous carcinoma was seen in 1.86%. Oral leukoplakia and OSCC was highly prevalent in fifth decade in decades of life.

In the present study, maximum cases of speckled leukoplakia (162) were seen in age group 31–40 years, OLP (99) in 41–50 years, OSMF (95) in 31–40 years, erythroplakia (48) in 21–30 years, OSCC (44) in 41–50 years. We observed that maximum disorders were seen in age group 31–40 years (401), followed by 41–50 years (301), 21–30 years (216), 51–60 years (158), >60 years (109), 11–20 years (29) and 0–10 years (3). Sivakumar et al.[12] in their study evaluated 2368 patients, out of which 156 were identified with OPMD and 5 with OML. A male predominance was noted for both OPMD and OML. Strong association with smokeless tobacco and smoking tobacco habits was seen with patients having OPMD and OML.

We found that common site for PMDs was buccal mucosa and vestibule in 54%, labial mucosa and vestibule in 8%, floor of mouth in 6%, tongue in 11%, alveolar ridge and gingiva in 7%, retromolar pad in 10%, and palate in 4%. The risk factors were tobacco usage in 45%, betel nut in 14%, arecanut in 25% and alcoholism in 16%. Jain et al.[13] carried study on 1260 individuals and the overall prevalence of potential oral malignant disorders was 6.09% in OSMF and 0.15% in erythroplakia. 11.48% of population suffered from oral malignant lesions, with the prevalence rates of leukoplakia in 3.01%, lichen planus in 1.42% and lowest being erythroplakia in 0.15% of the subjects. Males prevalence was found to be higher (12.8%) as compared to females. Results showed no significant difference between socio-economic status, tooth brushing methods, brushing frequency with theprevalence of oral malignant disorders.

We found that risk factors were tobacco usage in 45%, betel nut in 14%, arecanut in 25% and alcoholism in 16%. Kumar et al.[14] conducted a study on 1048 patients of both genders. The overall prevalence of OML was found to be 18.89%. Results showed 5.63% prevalence of PMD. The prevalence of PMD was highest among the elementary occupation (15.63%). Age group 41–60 years showed a higher significant association of PMD. Male had higher association with leukoplakia than females. Smoking and chewing were significant risk factors associated with leukoplakia and OSMF.

There should be patient education regarding harmful effects of tobacco. Early diagnosis and prompt management of these disorders may be helpful in preventing conversion into oral cancer. Chair side investigations may be useful in diagnosis of lesions.

The limitation of the study is small sample size. Long follow-up was not performed.

CONCLUSION

There was higher prevalence of leukoplakia. The age group of 31–40 years had higher cases and most common site was buccal mucosa and vestibule. Risks factors found to be tobacco and arecanut.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.