Proceedings S.Z.M.C. Vol: 38(4): pp. 251-255, 2024.

PSZMC-951-38-4-2024

Oral Submucous Fibrosis Association with Sociodemo-

graphic and Personal Habits of Dental Patients Visiting
Tertiary Care Hospital in Hyderabad 
Hassan Shahid, Abubakar Abdullah, Naveed Irfan, Sadia Hassan, Zafar Abbas, Syed Muhammad
1 2 3 1 4 5

Ahmed Bukhari

ABSTRACT
Introduction: Sociodemographic and personal habits are variable among patients with oral submucous fibrosis and are
important to know to see the pattern of these factors in oral submucous fibrosis in local population.
Aims & Objectives: The present study aims to examine and associate the sociodemographic and personal habits of
patients with oral submucous fibrosis.
Place and Duration of Study: The Isra dental college, Isra University, Pakistan, from 1st July 2023 to 1st February 2024.
Materials & Methods: A cross-sectional study was conducted on 148 patients with clinically confirmed oral submucous
fibrosis (OSF) of any age or gender, after taking written informed consent using convenience sampling. Clinical
examination was done to palpate fibrous bands and a vernier caliper was used to measure the mouth opening. A
standardized questionnaire with information on socio-demographics and personal habits was utilized to gather the data.
SPSS version-22 was used to analyze the data.
Results: More than half of the patients with oral submucous fibrosis were males 60.1% followed by 39.9% females.
About 36.5 % of the patients had no formal education, while 32.4% had primary education, 22.3% were matric and 9%
were intermediate and above education. 55 patients (37.2%) had no work followed by 45 patients (30.4%) having private
job, 36 patients (24.3%) were laborers, and 12 patients (8%) were having government job and own businesses. OSF was
seen more in illiterate people which was associated with betal nut and gutka chewing habits (P –value was <0.001) and
11 patients were having more than one habits.
Conclusion: This study indicates that among various sociodemographic and personal habits of patients with oral
submucous fibrosis, illiteracy came to be significant factor associated with betal nut and gutka consumption.

Keywords: Betel nut, Educational level, Gutka, Oral Submucous Fibrosis


INTRODUCTION Only a small number of cases have been confirmed
in the United States and Europe, and those cases

The World Health Organization classifies oral have also been a result of Asian migration.2 The
disease is more common in South East Asia.
submucous fibrosis as a precancerous lesion with a Pakistan, Taiwan, Sri Lanka, and India have the
high probability of developing into oral squamous greatest rates of illness.3 Clear data from studies
cell carcinoma.1 The oral epithelium is accompanied conducted in Pakistan & India indicates that the rise
by tissue fibrosis that restricts the opening of the in OSF cases over the past 20 years has been linked
mouth and also becomes atrophic. The problem to an increase in the prevalence of oral cancer. The
becomes significantly worse when the restriction incidence of oral cancer increased by more than 30
reaches the point of being unable to chew or times between 1985 and 2010. Research has shown
swallow food because of soft palate fibrosis.2 that in both rural and urban populations, men are
most typically affected between the ages of 25 and
1
Isra University. Hyderabad. 35.3,4 Research carried out across Southeast Asia has
2
WATIM College of Dentistry, Rawalpindi
3
Bakhtawar Amin Medical and Dental College, Multan determined that the main risk factor for OSF is betel
4
Dow International Dental College, Karachi. nut, also known as areca nut. There have been
Bukhari Dental Clinic. Dera Ghazi Khan. reports of OSF caused by betel nut chewing, either
5

Correspondence: directly or in the form of pan, gutka, or mawa. 5

Prof. Dr. Hassan Shahid. Professor, Head of Department of Community
and Preventive Dentistry, Faculty of Dentistry & Allied Sciences,
Areca nut was assessed as a carcinogenic substance
Hyderabad, Pakistan by the WHO's International Agency for Research on
E-mail: [Link]@[Link] Cancer.6 OSF is correlated with how often it is used
Submission Date: 28thApril 2024
as well as how long it is held in the mouth. Despite
1st Revision Date:1st November 2024 being aware of the dangers of betel nut
Acceptance Date: 07th December 2024 consumption, people were unwilling to give up the


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 Oral Submucous Fibrosis Association with Sociodemographic and Personal Habits of Dental Patients……

habit, according to a survey done in various Statistical Analysis: The research data was analyzed
socioeconomic groups to gauge public awareness of by using SPSS version 22.0 (IBM, Corporation).
the nut's negative consequences.4 Young people are Data analysis included descriptive statistics like chi-
particularly vulnerable to the billion-dollar gutka square, frequency distribution, and percentage. A
industry, which is characterized by easy access, low significance level of less than 0.05% was set.
prices resulting in increased frequency of OSF.
These factors pose a serious threat to public health.3 RESULTS
Even though limited literature is available, there
haven’t been many research done to determine Patients with Oral Submucous Fibrosis who had
whether education level can lessen substance misuse been clinically diagnosed by a qualified clinician
habits and eventually lower oral submucous fibrosis. were the study participants of the current
This study will add more knowledge to this domain observational and cross-sectional hospital-based
regarding educational level of people consuming study. Table 1 displays the age distribution of the
gutka. The rationale of this research was to examine research participants by gender.
the sociodemographic and personal habits of
Table 1: Age Distribution in association with
patients with oral submucous fibrosis and ascertain
the frequency of the condition in patients visiting
gender(N=148)
the outpatient department of Isra dental college, Isra Age of p-
University. Male Female Total ૏2
Patient value
Below
MATERIALS AND METHODS 29
20 6 26

148 patients with clinically diagnosed oral 30-49 66 40 106

submucous fibrosis (OSF) who visited Isra dental 14.69 <0.001
college at Isra University between July 1, 2023 and Above
3 13 16
February 1, 2024, were recruited for our 50
observational cross-sectional study. Patients come Total 89 59 148
from both urban and rural areas because Hyderabad More than half of the patients with oral submucous
is a small city and the surrounding cities lack fibrosis were males (n=89) 60.1% followed by
tertiary care hospitals. Prior to the study, the ethical 39.9% females (Table 1). About 54 (36.5 %) of the
approval for this study was obtained from the ethical patients were having no education while 48 (32.4%)
review board of the institute had primary education and 33 (22.3%) were
(IU/DN(FD)/IDC/RD/2023/010) and written graduated till matric. Around 13 (9%) only were
informed consent was obtained from the patients. intermediate and above education as shown in Table
The consent forms were prepared in Sindhi, Urdu 2. 55 patients (37.2%) had no work. This is because
and English languages. The forms were filled on all of them were females and were housewives,
behalf of the patients, who were uneducated or followed by 45 patients (30.4%) having private job,
didn’t understand how to fill. This non-probability 36 patients (24,3%) were laborers and 12 patients
convenience sampling included all patients with (8%) were having government job and own business
clinically confirmed oral submucous fibrosis (OSF). respectively as shown in Table 3.
All patients who presented with OSF were included
in the research study, regardless of their age or Table 2: Educational Status in association with
gender. Clinical examination was done to palpate gender (N=148)
fibrous bands, and a vernier caliper was used to
Educational Femal Tota P-
measure the mouth opening. A standardized Male ૏2
Status e l value
questionnaire with information on Illiterate 38 16 54
sociodemographics, habit traits, and educational Under
level was utilized to gather the data. No pilot study Matric/Mat 41 40 81
was done prior to this research. Patients were only ric 6.95 .032
admitted if they agreed to give up these habits. Above 3
Participants in this study who had co-morbidities/ 10 13
matric
medical illnesses along with OSF were not included. Total 89 59 148
After compilation, each item of data was examined,
and the findings were collated. AI tools were not
used in this research writing.


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 Oral Submucous Fibrosis Association with Sociodemographic and Personal Habits of Dental Patients……

Table 3: Occupational Status across gender DISCUSSION

(N=148)
The current study, which is unique to the local
population, evaluated the sociodemographic and
KĐĐƵƉĂƚŝŽŶĂůƐƚĂƚƵƐ personal habits of patients with oral submucous
ŝƐƚƌŝďƵƚŝŽŶĂĐƌŽƐƐ'ĞŶĚĞƌ fibrosis and ascertained the frequency of the
condition in patients visiting the outpatient
EŽŽĨ/ŶĚŝǀŝĚƵĂůƐ

ϲϬ department of Isra dental college, Isra University.

ϱϬ
ϰϬ
ϯϬ In our study majority of the patients having Oral
ϮϬ
ϭϬ
Ϭ
submucous fibrosis were betel nut users, either
EŽ >ĂďŽƌĞ WƌŝǀĂƚ
'ŽǀĞƌ
ƵƐŝŶĞ
alone or with smoking. This is consistent with a
tŽƌŬ ƌ Ğ:Žď
ŶŵĞŶƚ
ƐƐ study done by Berniyanti T and Huang et al where
:Žď betel nut was consumed more.7,8 Gutka which is
&ĞŵĂůĞ ϱϱ ϰ Ϭ Ϭ Ϭ made up of slime and betel quid, was the second
DĂůĞ Ϭ ϯϮ ϰϱ ϴ ϰ most consumed item by the patients having oral
KĐĐƵƉĂƚŝŽŶĂů^ƚĂƚƵƐ submucous fibrosis.4,9 This is consistent with
various studies where Gutka was used by patients
DĂůĞ &ĞŵĂůĞ having oral submucous fibrosis. As per the statistics
of Pakistan Medical Association, Gutka and betel
nut are the main reason behind 1.5 million oral
The p –value was significant for the association of cancers in people.5 In our research study, betel nut
personal habits with educational status and gender, use was seen more in females than males, this is
shown in Table 4 and 5. inconsistent with different studies where males were
seen consuming more.4,7,8 However our results are
Table 4: Association of Personal Habits with consistent with various studies where females were
Educational Status (N=148) seen using more.10,11 Gutka was consumed in males
in our study which is consistent with various studies
Frequency of Personal where males were seen using more gutka as
Habits
compared to females.4,7 In an Indian study the
Educational

P -value

prevalence of betel nut, gutka, pan, and smoking

Status

Total
More than
one Habit
Betel Nut

Smoking

૏2
Gutka

behaviors was higher among those without formal

Pan

education than among secondary and college

students.12 However, various researches show that,
Illiterate 15 6 13 8 12 54 when compared to educated people, the usage of
13.2051

gutka and betel nut is more common among laborers

0.01

literate 7 12 37 10 28 94
Total 22 18 50 18 40 148 which include masonry workers, plumbers,
carpenters, tea sellers etc.3,4 In our study almost
38% people using substances were having private
Table 5: Association of Personal Habits with and govt jobs or their own business; they also used
gender (N=148) this habit as a way to replace diet and to remain
focused owing to tough schedules. The main cause
Frequency of of using gutka and betel nut is the demand for
Personal Habits
(Pan, Gutka, alertness and decreased appetite, which these
Betal nut, products are known to give along with their calming
Gender smoking) Total ૏2 P -value benefits. In low-income countries, this is a huge
More
Any
than compromise as it replaces healthy diet with low-cost
one
habit
one substance addiction.13 However, as prior research
Habit has shown; the high betel nut usage among women
Male 55 34 89
is closely tied to the family history of
Female 53 6 59 14.1368 <0.001 consumption.10-12
Total 108 40 148 There is a lack of evidence linking habits with
education, but it is evident that school and college
awareness efforts are necessary to lessen the threat
among the educated class. Additionally, we advise
providing affordable, wholesome food to skilled

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 Oral Submucous Fibrosis Association with Sociodemographic and Personal Habits of Dental Patients……

workers and daily wage earners so they won't have Pathogenic Mechanisms, and Treatments. Int J
to satisfy their hunger and turn to abusing narcotics. Mol Sci. 2020;21(19):7231. Epub 20200930.
Furthermore, the government must take strong 7. Berniyanti T, Jamaludin MB, Eky YE,
action to prohibit the substance from being sold, Bramantoro T, Palupi R. Duration and
along with ongoing oversight and investigation. frequency of betel quid chewing affects
Because of our constraints and the fact that this periodontitis severity and life quality of people
study was done in one hospital, it is not possible to in Tanini Village, Kupang, Indonesia. Int J Dent
apply the findings to the total Hyderabad Hyg. 2024;22(1):229-235. Epub 20230918.
population. Another limitation is rehabilitation 8. Huang C-H, Geng J-H, Wu D-W, Chen S-C,
centers; patients who tend to drop these habits need Hung C-H, Kuo C-H. Betel nut chewing was
proper counseling which is not present in the city. associated with obstructive lung disease in a
Government should focus on this issue as substance large Taiwanese population study. J Pers Med
abuse is on the raise. 2021;11(10):973.
9. Siddiqi K, Husain S, Vidyasagaran A,
CONCLUSION Readshaw A, Mishu MP, Sheikh A. Global
burden of disease due to smokeless tobacco
In conclusion, the study indicates that majority of consumption in adults: an updated analysis of
the patients consuming betel nut and gutka were data from 127 countries. BMC medicine.
having no education or minimal education. There 2020;18:1-22.
are concerns regarding the high frequency of betel 10. Kader M. Association between betel nut
nut consumption among housewives and gutka consumption and folate deficiency among
among workers. Even those with higher education pregnant women in rural Bangladesh. Int J Med
are not as prone to substance misuse as others, Public Health. 2013;3:81-88.
despite the fact that our literacy rate is extremely 11. Ngadilah C, Obi AL, Nubatons MO. The
low. relationship of pregnant woman who consume
betel nut to periodontal disease which will affect
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The Authors:
submucous fibrosis: comparison of efficacy
between clobetasol and triamcinolone Prof. Hassan Shahid
application in oral submucous fibrosis patients Professor and Head of Department of Community,
with burning sensation. Professional Med J. and Preventive Dentistry,
2018;25(07):1005-1012. Faculty of Dentistry & Allied Sciences,
5. Afridi SK, Afzal MS, Naqvi S, Rehan F, Wali Isra University, Hyderabad.
A. Prevalence of gutka; a form of smokeless
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Submucous Fibrosis: A Review on Biomarkers,


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 Oral Submucous Fibrosis Association with Sociodemographic and Personal Habits of Dental Patients……

Dr. Naveed Irfan

Associate Professor,
Department of Community and Preventive
Dentistry,
Bakhtawar Amin Medical and Dental College,
Multan.

Dr. Sadia Hassan

Associate Professor,
Department of Oral Biology Department,
Faculty of Dentistry & Allied Sciences,
Isra University, Hyderabad.

Dr. Zafar Abbas

Assistant Professor,
Department of Oral Medicine Department,
Dow International Dental College, Karachi.

Dr. Syed Muhammad Ahmed Bukhari

Consultant Dental Surgeon,
Bukhari Dental Clinic, Dera Ghazi Khan.

Authorship:

HS: Conception and design of work, results

compiling, write-up
AA: Literature research, Proof Reading
NI: Data entry, Write up
SH: Collection and interpretation of the data
ZA: Literature research/review
SMAB: Literature research


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