Reasons for Initiation of Areca Nut and Related Products in Patients with Oral Submucous Fibrosis within an Endemic Area in Gujarat, India

Abstract

Background: While the patterns of consumption of areca nut and its by-products (ANBP) vary across South Asia and the rest of the world, all users share the probable severe outcome of oral submucous fibrosis (OSMF), and this is well reported. The role of psychosocial drivers of habit initiation and addiction is reported less. Objective: To reveal the burden of ANBP abuse, exploring the psychosocial relationship between sex, age at first exposure (AFE), the reason for initiation (RFI) with the type of habit (TOH). Methodology: Data came from the prospective hospital-based study conducted at K.M. Shah Dental College and Hospital covering years 2017 and 2018. Patients with oral lesions were assessed with complete history recording demographics, TOH, AFE, RFI, duration of habit, and clinical diagnosis of any oral and systemic diseases. Patients with a history of scleroderma, facial burns, and oral malignancy were excluded. Results: Of the 13,874 patients, 9.89% reported ANBP. We included 1000 OSMF patients. The mean age of the study cohort was 38.97 ± 14.29 years, with a range of 17–75 years. Males constituted the majority (80.1%). The most common TOH reported was regular use of gutkha (60.1%) followed by mawa (31.4%) with tension and stress (30.3%) being the most common RFI among the cohort. TOH was notably different in relation to AFE. Interestingly, mawa chewing (38.69%) was observed more in females. Importance: This study reveals the burden of ANBP abuse and reports the complex psychosocial relationships between sex, AFE, and RFI with TOH in OSMF patients in this high incidence population.

Keywords:

• Areca nut and its byproduct abuse
• oral submucous fibrosis
• psychosocial effects

Disclosure statement

The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the article.

Author’s contributions

This manuscript arises from the study conducted by Dr Chandramani B. More, professor and chair, division of Oral Medicine and Maxillofacial Radiology at K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth University. The data description and the visual data representation was authored by Dr. Naman R. Rao and Dr. Sucheta More. The content and literature guidance were directed by E/Prof. Newell W. Johnson. The first draft was written by C. B. M. and N. R. R. The draft was revised with extensive input from N. W. J. All authors have approved the final version.

Disclosure

The photographs illustrated in this article are procured from department of Oral Medicine and Maxillofacial Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth University, Vadodara, Gujarat state, India.

Additional information

Funding

The study was self-funded.