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Background: Oral cancer is one of the most common types of cancer worldwide, and India shows a high incidence of oral squamous cell carcinoma (OSCC) cases. Kerala accounts for a sizeable number of these cases, most of which can be attributed to the deleterious habits prevalent in a vast majority of the population. A comprehensive descriptive-prospective study was done in our institution over 18 months to identify the possible risk factors, to describe the clinical and sociodemographic variables of OSCC, and to understand the burden of this dreaded disease in the North Kerala population. Materials and Methods: Data collection was done using a structured pro forma. The data were tabulated and organized; uni- and bivariate analysis were performed along with cross-tabulations for various parameters and relevant variables. A total of 243 histopathologically confirmed cases of OSCC during 18 months comprised the sample in this study. Results: Among the 243 cases, 220 patients had deleterious habits. Betel chewing was the most predominant habit. Buccal mucosa was the commonly affected site. Twenty-three patients had no history of any habits. Majority of the patients presented in stage 3 and 4 of the disease. Moderately differentiated squamous cell carcinoma was the major histologic type. Conclusion: The majority of the patients had clinical lesions corresponding to the habit usage, showing a low awareness of tobacco cessation and intervention programs and a high burden of OSCC in the North Kerala population. [ABSTRACT FROM AUTHOR]

Background: Smoking, drinking and chewing tobacco product, common habits in India have been positively associated with oral lesions such as oral submucous fibrosis (OSMF), Leukoplakia, and oral lichen planus (OLP). Materials and methods: A total of 160 patients of both genders with age above 35-60 year were divided into four groups of Leukoplakia, OSMF, OLP and control group each. Detailed case history, habit history, habit score was recorded. Results: In this study it was found that OSMF patients with combined habit of smoking tobacco with quid usage patterns, Leukoplakia patients with smoking(beedi) and OLP patients with combined tobacco usage habits and quid usage habits showed presence of advance stages of disease. Conclusion: This study emphasised that deleterious habits as not only a predisposing factor in the occurrence but plays crucial role in progression to severe form of OSMF and Leukoplakia. [ABSTRACT FROM AUTHOR]

Background: Few traditions in South Asia have the antiquity and universal acceptance of betel quid and areca nut chewing. Its popularity dates back to ancient times in the South-Asian community with a foundation based on four factors, i.e. social acceptability, religious beliefs, perceived health benefits and addiction. We aim to provide an overview of its use in the South Asian region. Methods: We performed an electronic search on Medline, Embase and Google Scholar to identify the origins of the various betel quid and areca nut practices pertaining to the South Asian region along with their social and cultural influences. We also studied the prevalence across the region and the health effects, especially carcinogenic, along with the impact of diverse immigration today. Results: Other than the debate of where it originates, there is a diverse plethora of terms and methods of use of areca nut and betel quid in the region. Although established as a known carcinogen, the incidence is high, especially in the Indian subcontinent, with very few studies focusing on its use alone (without tobacco). The effect of globalization and increased movement of Asians across borders is resulting in changes in the patterns of diseases as well due to wider dissemination of areca nut and betel quid use. Conclusions: There is a huge loss of lives due to the addiction that areca nut causes. Governments need to tightly regulate the laws and set up tailored programs to tackle this specific issue in this region. [ABSTRACT FROM AUTHOR]

Background: Betel quid chewing is a deep-rooted practice in India and neighboring countries, which has migrated to other parts of the world. Betel leaf acts as a carrier for areca nut and most often, smokeless tobacco, both of which are carcinogenic, making betel quid a harmful product. Objectives: The first objective was to compare the prevalence of "use of betel quid with tobacco" from GATS-1 to GATS-2. The second was to study the association of "use of betel quid with and without tobacco" with different socio-economic groups (wealth quintiles) according to select background characteristics. Methods: This study used data from the Global Adult Tobacco Surveys (GATS), 2009–10 and 2016–17. Logistic regression with adjustment of co-variates (age, gender, residence and education) was used to study association of use of betel quid with different socio-economic groups. Results: Highest reduction (40 percent) was seen in "use of betel quid with tobacco" among male youth (15–24 years) over the two rounds of GATS. No change was seen in this form of use among females. The odds of "use of betel quid with tobacco" had a positive gradient with decreasing wealth quintiles. "Use of betel quid without tobacco" showed highest odds among participants with moderate levels of education. Conclusion: Health promotion interventions around harmful effects of "betel quid with and without tobacco" are needed for all genders from poorer populations with low education. Stress needs to be laid on universal population-level public health awareness campaigns about the carcinogenic properties of areca nut in betel quid. [ABSTRACT FROM AUTHOR]

Objective: Assess trace elements in betel leaves and slaked lime from different regions of Karnataka, India using Laser Induced Breakdown Spectroscopy (LIBS). Materials and Method: Betel leaves from six different regions of Karnataka were obtained and named (for the purpose of the study) BL1, BL2, BL3, BL4, BL5, and BL6 and they were sun-dried. A single tube of slaked lime was obtained from the local ‘paan’ shop. Each dried leaf and a single blob of slaked lime was subjected to elemental analysis using Laser-induced breakdown spectroscopy. Results: A ten-trial experiment was carried out in all six leaves and a blob of the slaked lime. The National Institute of Standards and Technology (NIST) database was used to assess the emission lines. The elements that were predominantly present in all six betel leaves from different regions of Karnataka are calcium, copper, and iron. Slaked lime showed only the presence of calcium. Conclusion: It is widely accepted that the consumption of betel quid causes various changes in the oral mucosa including oral potentially malignant disorders (OPMDs) and oral cancer. It is important to analyze each component of betel quid to understand the disease progression. Copper is found to be relatively higher in betel leaves, and it is known that copper-induced fibrogenesis via the lysyl oxidase pathway in oral submucous fibrosis.

Objectives: To comparatively assess periodontal status in patients who chew different products and patients who do not have this habit and to assess how this practice interacts with predisposing factors and risk indicators of disease. Methods: Patients included in the dental care carried out in a rural community in India were considered for a cross‐sectional study. The simplified oral hygiene index and the community periodontal index (CPI) were assessed. Furthermore, a validated survey with items concerning chewing habits was administered. Statistical analysis of the effects of age range, gender, chewing products and hygiene status on CPI was performed. Results: In total, 1,023 patients met the inclusion criteria. The chewer patients (430) exhibited a significantly higher CPI than the non‐chewers (593). The chewing habit increased the likelihood of a higher CPI by 6.76‐fold, while excellent‐good oral hygiene status decreased the probability of a higher CPI by approximately 45%. CPI did not differ significantly among chewers of different products. Conclusion: In the population studied, a chewing habit was associated with a worse periodontal status, and this association was not modified by gender and age as predisposing factors. Oral hygiene could decrease the effect of chewing habit on periodontal health. [ABSTRACT FROM AUTHOR]

Objective: Betel quid chewing (BQC) is an important oral cancer risk factor widespread in the Indian subcontinent. This usage also is common among migrants from this region. As the number of immigrants from South‐East Asia is dramatically increasing in Italy, this survey was aimed at investigating BQC prevalence among immigrants from the Indian subcontinent. Subjects and Methods: First‐generation adult male immigrants coming from Pakistan, India, Sri Lanka, and Bangladesh, living in Rome, were consecutively selected. They were interviewed using a validated questionnaire. Descriptive statistics were performed, and factors associated to regular BQC were investigated through regression analysis. Results: A total of 211 subjects (mean age, 33.8 years) living in Rome for 11 years, on average, participated in the study. BQC prevalence was 37.9% with few differences between Pakistani, Sri Lankans, and Indians. Prevalence among Bangladeshi was 7.3%. 69% of the consumers chewed BQ at least twice daily, 90% chewed BQ with tobacco; 30.3% subjects were smokers and chewers. Chewing parents, smoking, health illiteracy were associated with BQC. Most chewers believed that BQ helps to relieve stress. Conclusions: The number of oral cancers in Italy is expected to increase because of BQC dissemination. Therefore, specific awareness campaigns directed to residents of South‐East Asian origin are needed. [ABSTRACT FROM AUTHOR]

Arecanut (AN) usage is widespread in Asian countries, especially India and Taiwan. The incidence of oral cancer is increasing day by day, but there is no exponential increase with tobacco usage. Especially in the country like Taiwan where betel quid mostly do not contain tobacco, AN can be correlated with the increased incidence of cancer. There are different studies in the literature about AN and oral cancer but none of them have concluded with the definite pathway for carcinogenesis. The present paper includes reviews of the literature for AN and oral cancer and summarizes the possible mechanisms associated with AN-induced carcinogenesis; and we have also tried to propose pathway of carcinogenesis. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the prevalence of oral soft tissue lesions in patients who attended the outpatient department, at Bharati Vidyapeeth Deemed University Dental College during a period of 18 months in 2009-2010. About 24,422 subjects belonging to a semi-urban district of Sangli in Western Maharastra (India) were screened. Out of these about 623 cases showed soft tissue lesions. Statistical analysis was done using the SPSS software. 2.5% of the population studied had one or more oral lesions associated with prosthetic use, trauma and tobacco consumption etc. Six hundred and twenty-three patients were found to have significant mucosal lesions. 75 had leukoplakia, 152 had oral submucous fibrosis, 14 had both both leukoplakia and oral submucous fibrosis, 82 had oral squamous cell carcinoma, 35 had oral lichen planus, 195 had apthous ulcers, 23 had denture stomatitis, 28 had fibroma and 19 cases had pyogenic granuloma. The findings in the present study reveal a high prevalence of oral soft tissue lesions and a rampant misuse of variety of addictive substances in the community. Close follow up and systematic evaluation is required in this population. There is an urgent need for awareness programs involving the community health workers, dentists and allied medical professionals. [ABSTRACT FROM AUTHOR]

Conclusion: There is a high prevalence of human papilloma viruses (HPV) in oral submucous fibrosis (OSMF) and the etiologic implication of this finding warrants further studies. Objective: The prevalence of oral squamous cell carcinoma (OSCC) and OSMF is high in India, and the diseases are partly attributed to high consumption of betel quid containing areca nut and tobacco. This study investigated the prevalence of HPV, herpes simplex virus (HSV), and Epstein-Barr virus (EBV) DNA in two groups of patients using betel quid with tobacco, those with OSMF ( n = 12) and those with OSCC ( n = 62). Methods: DNA was extracted from all the samples and viral genome was examined by PCR/DNA sequencing. HPV-positive samples were analyzed separately for the high-risk types HPV 16 and 18. Results: HPV DNA, HSV DNA, and EBV DNA were detected in 11 (91%), 1 (8%), and 3 (25%) of the 12 samples from patients with OSMF compared with 15 (24%), 3 (5%), and 18 (29%), respectively, from 62 patients with OSCC. HPV 16 and 18 DNA was detected in 8/12 (67%) in the OSMF group and 10/62 (16%) in the OSCC group. The difference between presence of HPV DNA in OSMF and OSCC groups was statistically significant, while the difference between HSV and EBV DNA content in OSMF and OSCC groups was insignificant. [ABSTRACT FROM AUTHOR]

Summary: Oral squamous cell carcinoma (OSCC) is a world health problem and is associated with exposure to different risk factors. In the west, smoking and alcohol consumption are considered to be the main risk factors whilst in India and southeast Asia, betel quid (BQ) chewing is predominant. In this study, we compared the gene expression patterns of oral cancers associated with BQ chewing to those caused by smoking using Affymetrix microarrays. We found that 281 genes were differentially expressed between OSCC and normal oral mucosa regardless of aetiological factors including MMP1, PLAU, MAGE-D4, GNA12, IFITM3 and NMU. Further, we identified 168 genes that were differentially expressed between the BQ and smoking groups including CXCL-9, TMPRSS2, CA12 and RNF24. The expression of these genes was validated using qPCR using independent tissue samples. The results demonstrate that whilst common genes/pathways contribute to the development of oral cancer, there are also other gene expression changes that are specific to certain risk factors. The findings suggest that different carcinogens activate or inhibit specific pathways during cancer development and progression. These unique gene expression profiles should be taken into consideration when developing biomarkers for future use in prognostic or therapeutic applications. [Copyright &y& Elsevier]

Betel quid containing areca nut and chewing tobacco is used in many parts of India. In this study we evaluated the micronuclei (MN) in buccal mucosa of healthy individuals from southern India, who were regularly chewing a mixture of betel leaf, areca nut and tobacco. A total of 44 subjects were examined. The study population included 15 chewers, 14 chewers with smoking habit and 15 controls with the mean age of 38.57 ± 0.54, 34.50 ± 0.95, and 33.28 ± 0.89 years, respectively. The mean percentage of MN was 1.90 ± 1.03 in chewers, 2.00 ± 1.12 in chewers with smoking habits and 0.81 ± 0.66 in controls. There was no significant difference between the mean percentages of the two experimental groups. It can be concluded that a mixture of betel leaf, areca nut, and tobacco is unsafe for oral health. [ABSTRACT FROM AUTHOR]

Background: Areca nut (AN) and betel quid (BQ) chewing are ancient practices followed by an extensive proportion of the world's population. These practices are endemic in larger parts of South and Southeast Asia and selected Western Pacific countries. The prevalence of these habits varies across regions, age, gender, cultural practice, and socioeconomic status groups. Considerable variations exist between countries with respect to prevention/intervention programs, and policy guidelines of BQ usage. Objectives: (1) To provide an overview of the BQ chewing prevalence, practices, preventive interventions and policies in selected Asian and Western Pacific countries. (2) To explore the different terminologies associated with BQ use. Method: A narrative review of the current literature related to BQ, AN, and oral cancer was conducted by searching PUBMED, CINAHL, and GOOGLE databases. Results: The literature review revealed that the prevalence of BQ was found to be highest in Papua New Guinea, followed by Bangladesh, India, Pakistan, Myanmar and Sri Lanka. While, Cambodia, Malaysia, Indonesia and Taiwan had comparatively lower prevalence. Smokeless tobacco, BQ with tobacco, BQ without tobacco, AN were some of the terminologies used for BQ in various studies. Conclusions: The prevalence, and the interventional policies related to BQ and AN chewing habits varies widely among the selected countries. With the increasing awareness and association of BQ with oral cancer, there is a need to have better awareness, prevention and interventional strategies in place. We also found considerable variation in the use of terminologies associated with BQ.

We conducted a random-effects meta-analysis of 50 publications assessing the relationship between oral/oropharyngeal cancer and chewing betel quid, with (BQ+T) or without added tobacco (BQ-T), a common practice in many parts of Asia and globally among Asian immigrants. Exposure-response, by daily amount and years of BQ chewed, was assessed using spline models. Attributable fractions (PAF%) were calculated to estimate the public health impact if BQ were no longer chewed. The meta-relative risk (mRR) for oral/oropharyngeal cancer in the Indian subcontinent was 2.56 (95%CI, 2.00-3.28; 15 studies) for BQ-T and 7.74 (95%CI, 5.38-11.13; 31 studies) for BQ+T; in Taiwan, China, the mRR for BQ-T was 10.98 (95%CI, 4.86-24.84; 13 studies). Restricting to studies that adjusted for tobacco and alcohol use had only a small effect on the risk estimates. For BQ+T in the Indian subcontinent, the mRR was much higher in women (mRR, 14.56; 95%CI, 7.63-27.76) than in men. Exposure-response analyses showed that the risk of oral/oropharyngeal cancer increased with increasing daily amount and duration (years) of chewing BQ in India and Taiwan, China. Roughly half of oral cancers in these countries could be prevented if BQ were no longer chewed (PAF%=53.7% for BQ-T in Taiwan, China; PAF%=49.5% for BQ+T in India). We demonstrate that betel quid chewing, with or without added tobacco, increases the risk of oral/oropharyngeal cancer in an exposure-dependent manner, independently of tobacco and alcohol use. Further work is needed to explain the higher risks associated with chewing BQ-T in Taiwan, China., (© 2013 UICC.)