Prevalence of oral potentially malignant disorders: A systematic review and meta-analysis.

Oral potentially malignant disorders (OPMD) are chronic conditions, which have a higher risk of transformation to oral squamous cell carcinoma. The aim of this systematic review and meta-analysis was to answer the question: "What is the prevalence of oral potentially malignant disorders among adults?" Studies reporting the prevalence of these conditions (leukoplakia, erythroplakia, oral submucous fibrosis [OSMF], and actinic cheilitis) were selected, only studies in which a clinical assessment and histopathological confirmation were performed were included. Of the 5513 studies, 22 met the inclusion criteria for qualitative and quantitative analyses. The risk of bias (RoB) of the selected studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Seven studies were classified as high risk, 12 as moderate risk, and 3 as low RoB. The meta-analysis showed that the prevalence of OPMD was 4.47% (95% CI = 2.43-7.08). The most prevalent OPMDs were OSMF (4.96%; 95% CI = 2.28-8.62) and leukoplakia (4.11%; 95% CI = 1.98-6.97). OPMDs were identified more commonly in males (59.99%; 95% CI = 41.27-77.30). Asian and South American/Caribbean populations had the highest prevalence rates of 10.54% (95% CI = 4.60-18.55) and 3.93% (95% CI = 2.43-5.77), respectively. The overall prevalence of OPMD worldwide was 4.47%, and males were more frequently affected by these disorders. The prevalence of OPMD differs between populations; therefore, further population-based studies may contribute to the better understanding of these differences.

Areca nut chewing in an expatriate population in Sydney: report of two cases.

Areca nut (betel nut) consumption occurs in a variety of forms, either on its own or with the addition of a number of products. This habit is prevalent in the Indian Subcontinent and South-East Asia. Recent immigration statistics indicate that 30% of new arrivals in Australia are from these geographical regions and are known to perpetuate this custom long after migration. The objective of this paper is to highlight the variety of oral presentations that may occur as a result of areca nut consumption in these particular demographic subgroups. Dental practitioners must be familiar with the wide spectrum of oral lesions that may present in this setting. More significantly, they must be aware that some of these lesions possess the potential for malignant transformation and hence require more specific management. Best practice mandates that dental practitioners in a multicultural society must: (1) be capable of recognizing the expatriate populations in which this custom is widely practised; (2) incorporate this particular line of questioning into the routine risk factor analysis that is undertaken for every patient from these particular sub-populations; and (3) institute appropriate referral and follow-up of these lesions if required.

Epidemiological survey of oral submucous fibrosis and leukoplakia in aborigines of Taiwan.

A population-based survey was designed to investigate the prevalence of areca/betel quid chewing, oral submucous fibrosis and leukoplakia in a typical aboriginal community of southern Taiwan. Three hundred and twelve people 20 years of age or older were collected in the study. The prevalence of chewing areca/betel quid was 69.5%, with an average of 17.3 portions a day for an average 24.4 years. More women (78.7%) than men (60.6%) chewed areca/betel quid. The prevalences of oral submucous fibrosis and leukoplakia were 17.6% and 24.4%, respectively. It was found that the odds ratio for chewing areca/betel quid and having at least one of the above oral mucosal lesions was 8.21. Any additional smoking or drinking habits were not significant for having oral mucosal lesions. Although the areca/betel quid in Taiwan does not contain any tobacco, a significant association was still identified between areca/betel quid chewing and oral mucosal lesions.

Oral submucous fibrosis. The South African experience.

A review of research related to oral submucous fibrosis (OSF) among South Africans of Indian descent shows a certain uniqueness compared to other countries. In South Africa the betel habit is more common among women, only 60% of chewers prefer the betel quid while the rest like the nut by itself, the majority of chewers prefer the baked (black) nut variety and a minority add tobacco to their chew. This pattern reflects in the distribution of OSF and the practice of the habit by OSF subjects. Compared to chewers without OSF, OSF subjects are younger and have shorter histories of chewing. Yet the profile of systemic diseases were similar among subjects with and without OSF. The habit as practised in South Africa also determines the pattern of oral squamous carcinomas. They are more common in women, with buccal mucosa cancers being the most frequent. The latter are commonly found in subjects not using any tobacco, indicating the carcinogenicity of the areca nut. It was also shown that oral cancer can develop in chewers without an intermediate precancerous OSF phase. A follow-up of OSF cases after cessation of the habit revealed that once present the disease is permanent. An analysis of cultured OSF fibroblasts demonstrated a permanent shift to larger cells theoretically capable of producing larger amounts of collagen. Thus the agents in the nut could be the initiators of the disease and its permanent character the result of a phenotypic alteration in cells from changes in gene expression.

Betel-nut chewing and submucous fibrosis in Durban.

A stratified random sample among South African Indians living in Durban revealed the occurrence of betel-nut chewing and the resultant submucous fibrosis (SF) to be relatively high. Women chewers predominated in a ratio of 13:1. The habit increased with age and 30.6% of women over 65 years practised the custom. Thirty-eight per cent of chewers revealed signs of impending and established SF; women predominated 70:1, and the majority of sufferers in this instance belonged to the age group 45-54 years (12.9%). Forty-six per cent of those with signs associated with SF had fibrous bands in the mouth and were regarded as having established SF. It was calculated that 5% of the total Indian population in South Africa could be chewers and that 2.3% may develop SF.

Regional variations in oral submucous fibrosis in India.

Regional variations in the characteristics of submucous fibrosis were studied in two districts in India. In Pune district this condition involved soft palate, uvula and retromolar areas significantly more often than in Ernakulam district. The tongue, floor of the mouth and the hard palate were not involved in Pune. The age of the patients in Pune district was lower than in Ernakulam district. Associated oral cancer, leukoplakia and petechiae were observed solely among patients in Ernakulam. The most important etiologic factor for submucous fibrosis is the chewing of areca nut, and in both areas studied all patients chewed areca nut. In Pune, cured areca nut without other ingredients was chewed by 66% and in Ernakulam, raw areca nut was chewed as an ingredient of pan with tobacco by 100%. Thus in Ernakulam, the juice and the quid were mostly spat out, whereas in Pune they were swallowed. The regional variations in the characteristics of submucous fibrosis could be related to the differences in the areca nut chewing habit between the two areas.