Association of oral pre-malignant lesions with the consumption of tobacco

Arpita Joshi, Chinmay Jani, Kushboo Jain, D. V. Bala, Divyesh Jetpariya, Harshal Jadav


Background: Tobacco consumption in the form of chewing and smoking is one of the biggest addictions. It causes various oral pre-malignant lesions which mainly include oral sub-mucous fibrosis (OSMF) caused by betel nut consumption and tobacco quid lesion, leukoplakia, erythroplakia and smoker's palate caused by chewing and smoking tobacco.

Methods: The data about the past and present consumption of tobacco was collected from 909 individuals. Based on the tobacco habits, the oral cavity findings were assessed and the statistical analysis was carried out to find the significance of associations observed between tobacco consumption and lesions.

Results: Out of 909 subjects, 537 were consuming tobacco, out of which 284 were chewers, 65 were smokers and 76 were consuming in both forms. Out of the 284 tobacco chewers, 43% had oral lesions (19.4% had OSMF and 21.5% had tobacco quid) as compared to just 1% of workers having oral lesions (OSMF) amongst those who had no addiction. There was a high prevalence of lesion in tobacco chewers (p<0.005). Out of total smokers, 15.8% had smoker's palate whereas no lesion was seen in the non-addicted workers. The odds of developing oral pre-malignant lesion are 43.62 times higher in exposed individuals.

Conclusions: The tobacco consumption in any form is hazardous. Betel nut exposure causes more harmful effect which goes unnoticed. Awareness should be created about various lesions caused by tobacco as well as betel nut and special steps should be taken for early diagnosis and its treatment.


Oral pre-malignant lesions, Tobacco smoking and chewing, Betel nut

Full Text:



WHO report on the global tobacco epidemic 2013. Geneva: World Health Organisation; 2013.

Rani M, Bonu S, Jha P, Nguyen SN, Jamjoum L. Tobacco use in India: prevalence and predictors of smoking and chewing in a national cross sectional household survey. Tobacco Control. 2003;12(4):e4.

Thankappan KR, Thresia CU. Tobacco use & social status in Kerala. Indian J Med Res. 2007;126(4):300-8.

Ali AA, Al-Sharabi AK, Aguirre JM, Nahas R. A study of 342 oral keratotic white lesions induced by qat chewing among 2500 Yemeni. J Oral Pathol Med. 2004;33(6):368-72.

Reichart PA, Philipsen HP. Oral erythroplakia--a review. Oral Oncol. 2005;41(6):551-61.

Rajendran R, Vidyarani. Familial occurrence of oral submucous fibrosis: report of eight families from northern Kerala, south India. Indian J Dent Res. 2004;15(4):139-44.

Rooban T, Saraswathi TR, Al Zainab FH, Devi U, Eligabeth J, Ranganathan K. A light microscopic study of fibrosis involving muscle in oral submucous fibrosis. Indian J Dent Res. 2005;16(4):131-4.

Vellappally S, Fiala Z, Smejkalova J, Jacob V, Somanathan R. Smoking related systemic and oral diseases. Acta Medica. 2007;50(3):161-6.

Country profile: India. J Indian Med Assoc. 1999;97(9):377-8, 83.

Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet. 1997;349(9063):1436-42.

Pentenero M, Broccoletti R, Carbone M, Conrotto D, Gandolfo S. The prevalence of oral mucosal lesions in adults from the Turin area. Oral Dis. 2008;14(4):356-66.

Taybos G. Oral changes associated with tobacco use. Am J Med Sci. 2003;326(4):179-82.

Bornstein MM, Klingler K, Saxer UP, Walter C, Ramseier CA. Tobacco-associated lesions of the oral mucosa. Schweiz Monatsschr Zahnmed. 2006;116(12):1261-74.

Schulz M, Reichart PA, Ramseier CA, Bornstein MM. Smokeless tobacco: a new risk factor for oral health? A review. Schweiz Monatsschr Zahnmed. 2009;119(11):1095-109.

Sujatha D, Hebbar PB, Pai A. Prevalence and correlation of oral lesions among tobacco smokers, tobacco chewers, areca nut and alcohol users. Asian Pacific J Cancer Prevent. 2012;13(4):1633-7.

Chandra P, Govindraju P. Prevalence of oral mucosal lesions among tobacco users. Oral Health Prevent Dent. 2012;10(2):149-53.

Morger R, Ramseier CA, Rees TD, Burgin WB, Bornstein MM. Oral mucosal findings related to tobacco use and alcohol consumption: a study on Swiss army recruits involving self-reported and clinical data. Oral Health Prevent Dent. 2010;8(2):143-51.

Ho PS, Yang YH, Shieh TY, Huang IY, Chen YK, Lin KN, et al. Consumption of areca quid, cigarettes, and alcohol related to the comorbidity of oral submucous fibrosis and oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104(5):647-52.

Angadi PV, Rekha KP. Oral submucous fibrosis: a clinicopathologic review of 205 cases in Indians. Oral Maxillofacial Surg. 2011;15(1):15-9.