Assessment of pH and Copper Content among Raw and Commercial Areca Nut Products, Contributing Factor towards Oral Submucous Fibrosis

@#Introduction: The increased prevalence of oral submucous fibrosis (OSMF) in the last few years relates to the increased consumption of areca nut(AN) products. OSMF is a premalignant condition and risk to progression to oral cancer is more when AN is chewed along with tobacco. Moreover, high copper content in AN is responsible for fibroblast dysfunction and fibrosis. This study was conducted with aim to assess and compare pH and copper content of raw AN and popular Indian commercial AN based (with and without tobacco) products. Method: Six samples each of twelve different brands of AN based commercial products i.e. six without tobacco (pan masala) and with tobacco were analyzed for pH and then the samples were dried, and powdered for estimation of the copper content. Results: For the six raw areca nuts (sample 1-6), the pH was found to range from 3.06±1.08 to 5.04±0.81, among the six non tobacco containing samples (sample 7-12), the pH was found to range from 6.03±1.08 to 9.09±0.81, and for six tobacco containing samples (sample 13-18), the pH was found to range from 9.18±0.90 to 11.07±0.09. The mean copper concentration among raw areca nut samples (sample 1-6) was 4.05±0.18 μg/g, among non-tobacco containing samples (sample 7-12) it was 10.17±1.08μg/g and among tobacco samples (sample 13-18),it was 18.09±1.08 μg/g (p<0.001). Conclusion: High copper content present in quid and commercial AN may be a causative factor for an increased fibrosis in OSMF, our findings need evaluation by further research and standardization.

Relationship among areca nut, intracellular reactive oxygen species, and autophagy / 华西口腔医学杂志

The relationship between areca nut as a primary carcinogen and oral cancer has been widely concerned. Areca can change the levels of reactive oxygen species (ROS) and autophagy in cells, and the levels of ROS and autophagy are closely related to the occurrence and development of tumors. This paper reviewed the relationships among areca nut, intracellular ROS, and autophagy.

Production Of Lignocelluloses From Aspergillus Niger Using Areca Nut Spade As Biomass

Areca palm (ChrysalidoCarpus lutescenes) a widely used plant having feathery arching brands with 100 leaflets. All these plants produce much of waste in additions to greeny and nuts. This waste of spade is used for the production of various molecules that are used in industry and pharma sector. Fermentation techniques are used to generate economically important enzymes for industrial and pharmaceutical purposes. Cellulase enzyme degrades the cellulose in between β-1, 4 glucosidic link found in lignocellulosic complex which under physical treatment is slower to degrade. The present study of Aspergillus niger for cellulose production was carried in solid state (SS) and submerged (SM) fermentations for production of cellulase enzyme. Cellulase production in SSF after 72 h of fermentation was 8.02 and in SMF activity was 2.98 per ml of cultured broth at H 6 and temperature at 30°C. Both SMF and SSF were supplemented with lactose and lactobionic acid, which acted as cellulase P production inducers. The aim of the present work was to study the effect of Areca palm spade as substrate for Aspergillus niger and its cellulase production under SMF and SSF.

Areca nut use disorder: A dynamic model map

Problem: Areca nut (AN) chewing is common among Southeast Asian population. Use of AN products (with or without tobacco) have a multifaceted effect on physical health, especially on cardiovascular, nervous, gastrointestinal, metabolic, respiratory, and reproductive systems. AN is a known group 1 carcinogen and carries addictive potential. Varying degrees of AN-related substance use disorder (SUD) have been reported among AN chewers. There is a lacuna in awareness of the health risk of AN use, prevention, and cessation programs among AN users, particularly in those who have developed SUD. Existing Lacunae: The dynamic interaction of factors that promote AN use and later the risk of developing SUD at individual and community level has not been studied in depth. Understanding of the bio-psycho-socio-economic-cultural factors is necessary to identify the factors that prelude, promote, and reinforce AN usage. For managing AN-related conditions, including the several systemic disorders, there is a knowledge lacunae, among health care providers with respect to the pathophysiology of AN-related health issues, SUD, and nonavailability of structured, evidence-based cessation protocols. Solutions/Recommendations: This manuscript presents a model-map to study the dynamics of AN use and the impact of AN on health and health care system at individual as well as community level. The model proposed can help the health policymakers to create evidence-based awareness and cessation protocols for AN.

Oral submucous fibrosis: An enigmatic morpho-insight

Oral submucous fibrosis (OSMF) is a chronic progressive, scarring disease affecting oral, oropharyngeal, and sometimes the esophageal mucosa. It is characterized by the progressive fibrosis of the submucosal tissue. The pathogenesis of OSMF has been directly related to the habit of chewing areca nut and its commercial preparation, which is widespread in Indian subcontinent and Southeast Asia. The areca nut has been classified as a “group one human carcinogen.” Oral squamous cell carcinoma in the background of OSMF is one of the most common malignancies in South and Southeast Asian countries. Malignant transformation has been reported in 7%–12% cases of OSMF. Histopathological spectrum of OSMF includes the apparent alterations observed in the epithelium and connective tissue. Epithelial atrophy and sometimes epithelial hyperplasia with or without dysplasia are the peculiar alterations seen in the epithelium. In the connective tissue, there is extracellular matrix remodeling which results in excessive collagenization. Further cross-linking of collagen leads to hyalinization which makes the collagen resistant to proteolysis. Owing to fibrosis in the connective tissue, there is narrowing of blood vessels which further results in compromised blood supply to the local tissue milieu, that is, hypoxia. This tissue hypoxia elicits angiogenesis which may result in the malignant transformation of OSMF. Perpetual irritation of areca nut and its constituents to the oral mucosa leads to upregulation of pro-inflammatory cytokines and further juxtaepithelial inflammation. Thus, these coordinated reactions in epithelium and connective tissue leads the OSMF toward malignant transformation

Quantitative analysis of copper levels in areca nut plantation area – A role in increasing prevalence of oral submucous fibrosis: An in vitro study

Background: Oral submucous fibrosis (OSMF) commonly seen in the South Asian countries is mostly associated with the chewing of areca nut (AN). Copper content in the AN has been implicated to play a major role in the pathogenesis of OSMF. It was found that most of the AN plantations in South India commonly use a copper-based fungicide, Bordeaux mixture (BM). Objective: To evaluate the level of copper in the AN, root, and soil of the AN plantation with and without the application of BM and to correlate the role of copper in the pathogenesis of OSMF. Materials and Methods: ANs, roots, and soil were obtained from plantations located in Tanniadi, Kerala. Four areas were selected from the plantation with and without BM application. The samples were collected twice with the interval of 6 months during January 2015 and July 2015, respectively. Statistical Analysis: Arithmetic mean and standard deviation were calculated. The differences between means were calculated by paired sample t-test. Results: There was statistically significant difference in the copper content of ANs, soil, and roots from both groups (P < 0.05). Samples treated with BM showed significantly higher copper levels as compared to their counterparts in January and July 2015. Conclusions: External copper from BM and increased processing for the commercial products could collectively increase the total copper content of the commercial AN products, and this high copper concentration may be implicated to the pathogenesis and the increasing prevalence of OSMF.

Dohra- a mixture of potent carcinogens

Background & objectives: Dohra is a areca nut preparation used with or without tobacco in a few of the areas of Uttar Pradesh (UP), India. There is evidence that it causes potentially malignant disorders and oral cancer. This study was undertaken to provide information on dohra by searching through literature and also through a survey in three areas of Uttar Pradesh (UP), India. Methods: The information on dohra was collected through literature search, study tour to different areas of UP, where group discussions with dohra vendors and with community members of different age group were done to obtain information. Results: Dohra was prepared by the users for their personal use or prepared by small-scale industry for sale. It was available mostly in betel shops or any other store/kiosks and was also available in special dohra shops. Dohra was available in both dry and wet form. Its common constituents were areca nut, catechu (Acacia catechu), edible lime, peppermint (Mentha piperita), cardamom (Elettaria cardamomum) and some flavoring agents. Dohra was consumed as such or with tobacco. Interpretation & conclusions: Different varieties of Dohra were available such as sukha dohra, sukha mulethi dohra and geela dohra. Different processing methods for producing dohra existed. As dohra increases the risk of cancer, it needs to be banned or it should be sold in packets with the details of its constituents and also statutory warning about its adverse health effects.

Prevalance Of Oral Submucous Fibrosis: A Clinicopathologic Study In A Population Of Jharkhand

Objectives: Oral submucous fibrosis (OSMF) is a common chronic debilitating oral health problem in India. The present study was conducted to correlate clinical staging with histopathological grading in patients of OSMF. Material and methods: The present study comprised of 50 patients of OSMF, which were evaluated for the age, sex, site, habit and clinical stage and were correlated with histological grading. Results: OSMF was reported as more in younger age group with a male predominance. Smokeless tobacco particularly arecanut and gutka showed a strong association in early development of OSMF. Conclusion:Though the present study showed no significant correlation between clinicalstaging and histopathological grading with p=0.635. This difference may be attributed toseverity and amount of fibrosis in various parts of the oral mucosa.

Areca Nut Chewing and the Risk of Re-hospitalization and Mortality Among Patients With Acute Coronary Syndrome in Pakistan / 예방의학회지

OBJECTIVES: Areca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. METHODS: A prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. RESULTS: Of the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p < 0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p < 0.001). CONCLUSIONS: The 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events.

Oral Squamous Cell Carcinoma in Background of Oral Submucous Fibrosis: A Case Report.

Oral submucous fibrosis (OSMF) is a well-recognized, potentially malignant disorder of the oral cavity that can affect any part of the oral mucosa, characterized by mucosal rigidity of varying intensity caused by fibro elastic transformation of the juxta epithelial layer of connective tissue. OSMF occurs in Indians and other population of the Indian subcontinent with certain oral habits. Betel quid chewing is a popular oral habit with potential links to the occurrence of oral cancer. In patients with submucous fibrosis, the oral epithelium becomes atrophic and thereby becomes more vulnerable to carcinogens. Since the ingredients of betel quid, tobacco are crucial for tumor initiation, promotion and progression, exposure to these toxicants simultaneously has been shown to markedly potentiate the oral cancer incidence in OSMF patients. The rate of malignant transformation of OSMF has been estimated to be 2-10%. Most cases with malignant transformation in OSMF have occurred gradually over a long period of time. This paper presents a case of oral submucous fibrosis turning into malignancy in a 34-year-old male patient.

Association Between Grading of Oral Submucous Fibrosis With Frequency and Consumption of Areca Nut and Its Derivatives in a Wide Age Group: A Multi-centric Cross Sectional Study From Karachi, Pakistan

BACKGROUND: Oral submucous fibrosis (OSMF) is a chronic, premalignant condition of the oral mucosa and one of the commonest potentially malignant disorders amongst the Asian population. The objective of this study was to investigate the association of etiologic factors with: age, frequency, duration of consumption of areca nut and its derivatives, and the severity of clinical manifestations. METHODS: A cross-sectional, multi centric study was conducted over 8 years on clinically diagnosed OSMF cases (n = 765) from both public and private tertiary care centers. Sample size was determined by World Health Organization sample size calculator. Consumption of areca nut in different forms, frequency of daily usage, years of chewing, degree of mouth opening and duration of the condition were recorded. Level of significance was kept at P < or = 0.05. RESULTS: A total of 765 patients of OSMF were examined, of whom 396 (51.8%) were male and 369 (48.2%) female with a mean age of 29.17 years. Mild OSMF was seen in 61 cases (8.0%), moderate OSMF in 353 (46.1%) and severe OSMF in 417 (54.5%) subjects. Areca nut and other derivatives were most frequently consumed and showed significant risk in the severity of OSMF (P < or = 0.0001). Age of the sample and duration of chewing years were also significant (P = 0.012). CONCLUSIONS: The relative risk of OSMF increased with duration and frequency of areca nut consumption especially from an early age of onset.

Rising incidence of oral cancer in Ahmedabad city.

CONTEXT: In 1999, an increase in mouth cancer incidence among young men (<50 years) in urban Ahmedabad was reported to be occurring along with decreasing mouth cancer incidence in older age groups and increasing oral submucous fibrosis incidence associated with areca nut consumption among young men in Gujarat. The aim was to investigate whether the increase in the incidence mouth cancer that had started among young men in the 1990s was continuing. SETTINGS AND DESIGN: Ahmedabad urban population, comparison of reported mouth cancer cases in the population across four time period. METHODS: Age‑specific incidence rates of mouth cancer (International Classification of Diseases [ICD]‑9:143–5; ICD‑10:C03–06) in five year age groups among men aged ≥15 years for the city of Ahmedabad for years 1985, 1995, 2007 and 2010 were extracted from published reports. For comparison, lung cancer (ICD‑9:169; ICD‑10:C33–C34) rates were also abstracted. STATISTICAL ANALYSIS USED: A cohort approach was used for further analysis of mouth cancer incidence. Age adjusted incidence rates of mouth and lung cancer for men aged ≥15 years were calculated and compared. RESULTS: The age specific incidence rates of mouth cancer among men increased over the 25‑year period while lung cancer rates showed a net decrease. Using a cohort approach for mouth cancer, a rapid increase in younger age cohorts was found. CONCLUSIONS: Mouth cancer incidence increased markedly among men in urban Ahmedabad between 1985 and 2010, apparently due to increasing consumption of areca nut products, mawa and gutka. Gutka has now been banned all over India, but a more vigorous implementation is necessary.

Tobacco and areca nut use among children of primary and secondary boarding schools of Gandhinagar district: a cross sectional study.

Tobacco and Areca nut use among school children is becoming a serious problem in developing countries. Objectives of current study were to determine the prevalence and pattern of smokeless tobacco and areca nut use among residential school children and to know the reason behind sending them in boarding school. Methods: The study was a cross sectional study. After taking the permission of principal of resident schools and consent of the parents of children, 867 children from 8 boarding schools were interviewed during February-March 2011. A self-administered questionnaire was used for data collection. Results: Age of the study children (total 867) ranged from 5-19 years. (Mean age = 13.80 ± 1.96 years). Out of 867, 434 (49.9%) were boys and 433 (50.1%) were girls. Out of 867 children 311 (35.9%) children [Females: 99 (22.8%); Males: 212 (48.8%)] had addiction. Prevalence of any type of addiction in girls and boys was 22.8% and 48.8% respectively. Tobacco prevalence was 18.6% and areca nut prevalence was 17.3%. Out of 212 male children who had addiction majority of children {149 (70.3%)} consume tobacco in the form of gutkha and out of 149, 127 (85.2%) male children consume tobacco since 1 to 3 years and 22 (14.8%) children since 4 to 9 years. Among the tobacco users, the mean age at the start of any tobacco use was 12.8 years with an SD of 1.1 years. Out of 99 female children who had addiction majority of children {87 (87.9%)} consume areca nut and out of 87, 74 (85.1%) female children consume areca nut since 1 to 3 years and 13 (14.9%) children since 4 to 9 years. The mean age group of children who consume tobacco and areca nut was 14.34 ± 1.83 years and 14.03 ± 1.41 years. 63.6% children were in residential school were due to economical reason. Conclusion: High prevalence of tobacco and betel nut in children indicate that more emphasis should be given to increase their awareness regarding hazards of these substances through health education campaign with active involvement of teachers and parents.

Oral sub-mucous fibrosis: realities of etiology / Fibrose de submucosa oral: a realidade da etiologia

Oral sub-mucous fibrosis (OSMF) is a well known potentially malignant condition resulting commonly due tothe use of areca nut. Areca nut chewing is a primordial tradition in Asian countries. It is also a psychoactiveessence. With the emergence of commercial pan masala and gutkha, witness of massive growth in the salesof these products, with huge worldwide export market developed. Various components in this quid have itsown mechanism of action resulting in OSMF. Other causes proposed were chillies, misi, nutritional deficiency,genetic predisposition, immunologic aspects, infection and saliva. This review attempts to give an overviewabout the postulated etiologies and its role in causation of OSMF.

Fibrose de submucosa oral (FSMO) é uma condição potencialmente maligna muito conhecida resultante geralmentedo uso da noz de areca ou betel. Mastigar a noz de betel é uma tradição primordial nos países asiáticos.É também uma essência psicoativa. O surgimento comercial da pan masala e da gutkha, aliado ao enorme crescimento nas vendas desses produtos, possibilitou um grande mercado de exportação em todo o mundodesenvolvido. Vários componentes neste material tem seu próprio mecanismo de ação, resultando em FSMO.Outras causas propostas foram pimentões, misi, deficiência nutricional, predisposição genética, aspectos imunológicos,infecção e saliva. Esta revisão procura dar uma visão geral sobre as etiologias postuladas e seu papelna causa da FSMO.

A clinical profile of oral submucous fibrosis.

Background: Oral submucous fibrosis (OSF) is a precancerous condition associated with the use of areca nut in various forms. There are very few reports to correlate the clinical stage to histopathological grading in OSF. Materials and Methods: A hospital-based study was conducted on 80 oral Submucous Fibrosis cases who visited our hospital in Jamnagar.. A detailed history of each patient was recorded along with a clinical examination. Biopsy was performed for histopathological correlation. Clinical stage of the disease in terms of the ability to open one's mouth was correlated with histopathological grading. Results: The male to female ratio of OSF cases was 3:1. All forms of areca nut products were associated with OSF. Chewing of paanmasala was associated with early presentation of OSF as compared to chewing of the betel nut The the result of all conservative therapy fails to reverse the disease. Conclusion: result of study recommend primary prevention for prevention of OSF.

Betel quid chewing and its risk factors in Bangladeshi adults.

Background: Despite its ill effects, betel quid chewing is a common practice in the South-East Asia Region. However, so far no large-scale study had been conducted, hence, this study was aimed at estimating the extent of betel quid chewing and its association with socio-demographic factors in Bangladeshi adults. Methods: The data of a cross-sectional sample survey, involving 15 155 and 15 719 adults from rural and urban areas of Bangladesh respectively, were analyzed. Data were collected on betel quid chewing and socio-demographic characteristics by interview method using a pre-tested structured questionnaire. Anthropometric measurements were done following standard protocols. Results: Overall 31% of the study samples chewed betel quid regularly. Prevalence was two times higher in rural (43.2%) compared to the urban areas (19.1%). Betel quid use was more common among Hindus (41.4%), farmers (55.3%), and people in the 40-year or more (63.9%) age group; and the habit was less common in unmarried (1.6%) and educated persons (19.6%). Ex-smokers (73.8%) and current smokers (37.3%) were more likely to use betel quid than never smokers (25.6%). The frequency of betel quid chewing was 5.15 times a day which varied significantly with age, locality, religion and occupation. Three-fourths of the betel quid users chewed tobacco with it which was not influenced by socio-economic variables. On average, 2.29 Takas (USD 0.03) was spent a day on betel quid chewing. Conclusions: Betel quid chewing was found to be a common habit in Bangladesh. Mature adults (40+years) of low socio-economic status, i.e., rural residents, farmers and the illiterate are more likely to chew betel quid.

Oral submucous fibrosis as a precursor of malignancy - a case report

Oral submucous fibrosis (OSF) is a high risk precancerous condition predominantly occurs in Indians and other population of the Indian subcontinent with certain oral habits. Betel quid (BQ) chewing is a popular oral habit with potential links to the occurrence of oral cancer. In patients with submucous fibrosis, the oral epithelium becomes atrophic and thereby becomes more vulnerable to carcinogens. Since the ingredients of BQ, tobacco are crucial for tumour initiation, promotion and progression, exposure to these toxicants simultaneously has been shown to markedly potentiate the oral cancer incidence in OSF patients. The rate of malignant transformation of OSF has been estimated to be 4.5%. Most cases with malignant transformation in OSF had occurred gradually over a long period of time.

Proliferative and morphologic characterization of buccal mucosal fibroblasts in areca nut chewers: A cell culture study.

Objective: To isolate, culture and characterize fibroblasts from the buccal mucosa of areca nut chewers with and without oral submucous fibrosis (OSF). Materials and Methods: Primary fibroblast cultures were established by the collagenase disaggregation technique and the phenotypic and growth characteristics were studied. Results: Cells cultured from OSF showed a statistically significant increase in both the post-mitotic fibroblast subpopulation and the population doubling time when compared with controls. Conclusion: There was a significant increase in the pro-fibrotic, post-mitotic subpopulation of fibroblasts in areca nut chewers with OSF.

Sociodemographic correlates of male chewable smokeless tobacco users in India: A preliminary report of analysis of national family health survey, 2005-2006.

Objective : To estimate the prevalence, the socioeconomic and demographic correlates of chewable smokeless tobacco consumption among males in India. Design : A cross-sectional, nationally representative population-based household survey. Subjects : 74,369 males aged 15-54 years who were sampled in the National Family Health Survey-3 (2005-2006). Data on tobacco consumption were elicited from male members in households selected for the study. Materials and Methods : The prevalence of various smokeless tobacco use currently was used as outcome measures. Simple and two-way cross tabulations and univariate logistic regression analysis were the main analytical methods. Results : Thirty-four percent of the study population (15 years or older) used chewable smokeless tobacco. Smokeless tobacco consumption was significantly higher in poor, less educated, scheduled castes, and scheduled tribe populations. The prevalence of tobacco consumption showed variation with types. The prevalence of chewing also varied widely between different states and had a strong association with an individual's sociocultural characteristics. Conclusion : The findings of the study highlight that an agenda to improve the health outcomes among the poor in India must include effective interventions to control tobacco use. Failure to do so would most probably result in doubling the burden of diseases-both communicable and noncommunicable-among India's teeming poor. There is a need for periodical surveys using more consistent definitions of tobacco use and eliciting information on different types of tobacco consumed.

Mixture of betel leaf, areca nut and tobacco chewing is a risk factor for cytogenetic damage in construction workers from south India

Aim: To determine the cytogenetic effect of betel leaf, areca nut and tobacco mixture usage among female construction workers in Tamilnadu, Southern India. Methods: Totally 236 buccal cells and blood samples were collected from 80 betel quid users and 76 users with tobacco snuffing habit which were compared with 80 healthy subjects. Peripheral blood leukocyte cultures were analyzed for chromosomal aberrations (CA) and exfoliated cells from the buccal mucosa were examined for micronucleus (MN). Results: Statistically significant (p<0.01) increase in CA and MN were observed in users with snuffing habit when compared to users without snuffing habit and controls as confirmed by chi-square test. Therefore, specific biomarkers on cytogenetic endpoints might help in planning precautionary measures to reduce oral cancer risks. Conclusions: The present study can be concluded that a mixture of betel quid, areca nut and tobacco chewing/snuffing is unsafe for oral health. The genotoxic effect of smokeless tobacco should be considered in addition to other known hazards for assessing health risks.