Prevalence of Oral Submucous Fibrosis in Individuals with history of Tobacco Chewing : Current vs Former users

Abstract

 Oral Submucous Fibrosis (OSMF) is a chronic, progressive, and potentially malignant disorder that predominantly affects the oral cavity, especially among individuals who consume smokeless tobacco. First described by Schwartz in 1952, OSMF has become a major public health concern, particularly in South Asia where the use of areca nut, often combined with tobacco, is prevalent (1). OSMF is characterized by the progressive fibrosis of the oral mucosa, which can lead to restricted mouth opening (trismus), difficulty in swallowing, and in some cases, malignant transformation into oral squamous cell carcinoma (2, 3).

The pathogenesis of OSMF is multifactorial, with tobacco use being the primary risk factor. Areca nut, a component of many smokeless tobacco products like gutka and pan masala, is recognized as a Group 1 carcinogen by the International Agency for Research on Cancer (4). It contains alkaloids such as arecoline, which stimulates fibroblast proliferation and collagen synthesis, leading to the fibrotic changes seen in OSMF (5). Additionally, the consumption of tobacco and other co-carcinogens present in smokeless tobacco products exacerbates the condition, accelerating the progression of fibrosis (6).

Studies indicate that OSMF predominantly affects younger individuals, with the highest prevalence seen in men aged 30-45 years (7). Gupta et al. (2018) reported a strong correlation between the duration of tobacco use and the severity of OSMF, with individuals who have been using tobacco for more than 10 years showing advanced stages of the disease (8). The development of OSMF is dose-dependent, with both the frequency and duration of tobacco consumption playing significant roles in disease severity (9).

Epidemiological studies have shown that the prevalence of OSMF varies by region, with the highest rates observed in India, Pakistan, and other Southeast Asian countries (10). A study by Mehrotra et al. (2019) highlighted the widespread use of smokeless tobacco products in rural and semi-urban areas, where limited awareness and poor healthcare access contribute to delayed diagnosis and management of OSMF (11). The cultural and social acceptability of areca nut and smokeless tobacco use in these regions further complicates public health efforts aimed at reducing their consumption (12).

Cessation of tobacco use has been shown to have a significant impact on the course of OSMF. Individuals who quit tobacco have a lower risk of progressing to advanced stages of the disease, and in some cases, partial regression of fibrosis has been observed (13). Tadakamadla et al. (2018) found that tobacco cessation led to a reduction in symptoms such as burning sensation and trismus, though complete reversal of the condition remains rare (14). This underscores the importance of early intervention and cessation programs as a means of controlling the progression of OSMF and improving quality of life for affected individuals (15).

Given the rising burden of OSMF and its association with smokeless tobacco, there is a critical need for targeted public health interventions. Increasing awareness of the risks associated with smokeless tobacco use, coupled with comprehensive cessation programs, can play a pivotal role in reducing the incidence and severity of OSMF. Moreover, further research is required to develop effective biomarkers for early detection and to explore novel therapeutic approaches for managing this debilitating condition.