ABSTRACT
Introduction:
Like general health, oral health also depends upon their occupational environment and occupational health policies. Workplace exposure to environmental tobacco smoke and its harmful effect is well known. The consumption of tobacco, arecanut, and alcohol is the leading preventable cause for development of oral potentially malignant disorders.
Aim:
To determine prevalence of habit-induced oral lesions in different occupations in different geographical places of West Bengal and compare among them.
Method:
A total of 841 people aged 15 years and above were selected from different parts of West Bengal. Face-to-face interview was conducted using a structured questionnaire, and oral cavity examination was done in daylight. Data were summarized, and statistical analysis was done.
Statistical Analysis Used:
Chi-square test and univariate logistic regression done.
Results:
The people in armed forces had cancer-causing habits most, and managers had cancer-causing habits least. People in armed forces had cancer-causing habits most, and people with Group-1 occupation/managers had cancer-causing habits least.
Keywords: Arecanut, occupation, oral precancer, tobacco, West Bengal
Introduction
People of West Bengal spend a long time of their life in their workplace. Hence, along with their general health, oral health also depends upon their occupational environment and occupational health policies as like other states of India and other countries. Various studies have described workplace exposure to environmental tobacco smoke in various places.[1,2]
The consumption of tobacco, arecanut, and alcohol is the leading preventable cause of death and disability around the globe. Most of these deaths are from middle- and low-income countries. India is the third largest tobacco-producing nation and the second largest tobacco consumer over the world. In India, about 1.3 million people dye due to tobacco consumption. Among them, 1 million are attributed to tobacco smoking and the rest are due to consumption of smokeless tobacco. Due to heavy tobacco use in India, the incidence of oral cancer is high in this place.[3,4,5]
At present, many people who used to take tobacco have switched over to other non-tobacco-containing products which contain arecanut. Betel quid contains arecanut. The habit of chewing this product is also a culturally accepted practice in India.[6,7]
In February, 2006, the State of California-Environmental Protection Agency, Office of Environmental Health Hazard Assessment-Safe Drinking Water, and the Toxic Enforcement Act of 1986 have considered arecanut as a carcinogenic agent.
Alcohol consumption is the third most modifiable risk factor for death and disability over the world. The International Agency for Research on Cancer has determined that alcohol consumption is related to cancer of oral cavity and its effects are multiplicative when used with tobacco.[6,7,8]
The prime causative factor associated with death due to oral cancer in India is its late presentation of patients to treatment givers. It has been reported that lack of awareness related to signs and symptoms of oral cancerous and precancerous lesions and their risk factors among the common people are the main reasons for delayed presentation of cases suffering from oral cancer. Along with it, barriers to access proper health care services, their social circumstances, and responsibilities also play important roles.
Both oral health and oral habits are affected by geographical changes as geographical changes are related to cultural changes, environmental changes, and nutritional changes.
In this study, prevalence of habit-induced oral lesions in different occupations in different geographical places of West Bengal was determined, and a comparison among them was done.
Subjects and Methods
The study was conducted in different private medical and dental clinics and oral health screening camps around different parts of West Bengal.
People above 15 years of age who had no systemic disease and willing to participate in this study were included. The study population was divided into six age groups. These age groups were 15–24, 25–34,35–44,45–54,55–64, and more than 64.
Distribution of occupation in the study population was categorized as per the International Standard Classification of Occupations (ISCO)-08 structures.[9] The ISCO-08 divides jobs into ten major groups: Group 1, managers; Group 2, professionals; Group 3, technicians and associate professionals; Group 4, clerical support workers; Group 5, service and sales workers; Group 6, skilled agricultural, forestry, and fishery workers; Group 7, craft and related trade workers; Group 8, plant and machine operators and assemblers; Group 9, elementary occupations; and Group 0, armed forces occupations. Each major group is further organized into submajor, minor, and unit groups. Housewives, students, retired persons and unemployed people were categorized separately due to the difference in nature of their working pattern.
People with armed force occupation, who were born and bought up in a particular geographic location of West Bengal and currently working in the same geographic area without transfer, were only included in the study. Persons with transferrable job in different geographical locations of West Bengal were excluded from the study. Persons who had more than one occupation were excluded from the study. People who migrated from other geographical locations of West Bengal, India, or neighboring countries were excluded from the study.
Staffs who conducted the study chiefly consisted of the medical social workers, qualified dentists, and oral pathologists. Medical social workers were trained to take data from the study sample. First, the purpose of the study was explained to the study participants and informed consent was obtained from them. Face-to-face interview was conducted to know their habit details, and oral cavity was clinically examined using a mouth mirror and explorer under daylight to rule out if any tobacco-related oral lesion was present.
This study was conducted in different geographical locations of West Bengal; hence, the study population was a mixture of diverse ethnicities and religions. Information regarding demographic characteristics was collected using a questionnaire formatted in both English and vernacular language Bengali.
Along with these, information regarding their tobacco habits was assessed using the WHO questionnaire.[10] The questionnaire and the study procedures were approved by the Institutional Human Ethics Committee, Department of Physiology of University of Calcutta.
All the oral lesions were clinically diagnosed as per the WHO criteria and color atlas of oral pathology. All clinically diagnosed premalignant lesions (oral leukoplakia, oral lichen planus, oral submucous fibrosis, oral erythroplakia) and suspected oral malignancy cases were referred for biopsy and appropriate treatment. Oral malignancy suspected persons were recalled to ensure the appropriate diagnosis based on biopsy report and to ensure the start of treatment.
Data were compiled, tabulated in a MS excel spreadsheet, and subjected to descriptive statistical analysis using SPSS package software. Logistic regression was applied to find the association between the independent and dependent variables.
Results
A total of 841 people participated in this study. Among them, 467 were from North Bengal and and 374 were from South Bengal. Among the whole study population, 446 were male (245 from North Bengal and 201 from South Bengal) and 395 were female (222 from North Bengal and 173 from South Bengal).
Based on age, participants were divided into six groups in our study. The highest numbers of participants were from the age group of 35–44. The highest number of participants from North Bengal belongs to the age group of 25–34, and the highest number of participants from South Bengal belongs to the age group of 35–44.
The mean age of our study population was 40.2128.
Figure 1 classifies the study population based on occupation. The highest number of people who participated in this study were housewives (30.3%).
Figure 1.
Distribution of occupational groups in study population based on geographic location
In our study, 49% people had the habit of any cancer-causing product.
It was found that males had cancer-causing habits most in our study. Only 36.5% females had cancer-causing habits. It was found that people from North Bengal had more cancer-causing habits (61.7%) than people from South Bengal (38.3%).
Figure 2 describes cancer-causing habits in different occupations. We have found that Group 0, occupation/people in armed forces, had cancer-causing habits most and people in Group 1, occupation/managers, had cancer-causing habits least.
Figure 2.
Cancer-causing habits in different occupations
Table 1 Oral mucosal changes in different occupations.
Table 1.
Oral changes in different occupations
| Oral changes | Group-0 | Group-1 | Group-2 | Group-3 | Group-4 | Group-5 | Group-6 | Group-7 | Group-8 | Group-9 | House wife | Retired | Student | Unemployed | Total |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Absent | 6 | 4 | 35 | 60 | 46 | 59 | 55 | 40 | 15 | 88 | 232 | 16 | 70 | 12 | 738 |
| Row% | 0.8 | 0.5 | 4.7 | 8.1 | 6.2 | 8.0 | 7.5 | 5.4 | 2.0 | 11.9 | 31.4 | 2.2 | 9.5 | 1.6 | 100.0 |
| Col % | 85.7 | 100.0 | 87.5 | 87.0 | 90.2 | 90.8 | 76.4 | 85.1 | 75.0 | 83.0 | 91.0 | 88.9 | 97.2 | 80.0 | 87.8 |
| Chewers-Mucositis | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 |
| Row% | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.9 | 0.0 | 0.0 | 0.0 | 0.0 | 0.1 |
| Smokers-lip | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
| Row% | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 1.5 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.1 |
| erythroplakia | 0 | 0 | 0 | 1 | 0 | 0 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 3 |
| Row% | 0.0 | 0.0 | 0.0 | 33.3 | 0.0 | 0.0 | 66.7 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 0.0 | 1.4 | 0.0 | 0.0 | 2.8 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.4 |
| leukoplakia | 0 | 0 | 0 | 1 | 2 | 1 | 4 | 1 | 1 | 3 | 2 | 0 | 1 | 1 | 17 |
| Row% | 0.0 | 0.0 | 0.0 | 5.9 | 11.8 | 5.9 | 23.5 | 5.9 | 5.9 | 17.6 | 11.8 | 0.0 | 5.9 | 5.9 | 100.0 |
| Col % | 0.0 | 0.0 | 0.0 | 1.4 | 3.9 | 1.5 | 5.6 | 2.1 | 5.0 | 2.8 | 0.8 | 0.0 | 1.4 | 6.7 | 2.0 |
| Lichen-planus | 0 | 0 | 0 | 2 | 0 | 1 | 1 | 2 | 1 | 1 | 6 | 0 | 1 | 0 | 15 |
| Row% | 0.0 | 0.0 | 0.0 | 13.3 | 0.0 | 6.7 | 6.7 | 13.3 | 6.7 | 6.7 | 40.0 | 0.0 | 6.7 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 0.0 | 2.9 | 0.0 | 1.5 | 1.4 | 4.3 | 5.0 | 0.9 | 2.4 | 0.0 | 1.4 | 0.0 | 1.8 |
| OSMF | 1 | 0 | 0 | 0 | 1 | 2 | 2 | 1 | 0 | 4 | 10 | 0 | 0 | 1 | 22 |
| Row% | 4.5 | 0.0 | 0.0 | 0.0 | 4.5 | 9.1 | 9.1 | 4.5 | 0.0 | 18.2 | 45.5 | 0.0 | 0.0 | 4.5 | 100.0 |
| Col % | 14.3 | 0.0 | 0.0 | 0.0 | 2.0 | 3.1 | 2.8 | 2.1 | 0.0 | 3.8 | 3.9 | 0.0 | 0.0 | 6.7 | 2.6 |
| scc | 0 | 0 | 1 | 0 | 0 | 0 | 3 | 0 | 1 | 0 | 2 | 0 | 0 | 0 | 7 |
| Row% | 0.0 | 0.0 | 14.3 | 0.0 | 0.0 | 0.0 | 42.9 | 0.0 | 14.3 | 0.0 | 28.6 | 0.0 | 0.0 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 2.5 | 0.0 | 0.0 | 0.0 | 4.2 | 0.0 | 5.0 | 0.0 | 0.8 | 0.0 | 0.0 | 0.0 | 0.8 |
| Smokers-melanosis | 0 | 0 | 2 | 2 | 0 | 1 | 4 | 1 | 0 | 2 | 0 | 1 | 0 | 1 | 14 |
| Row% | 0.0 | 0.0 | 14.3 | 14.3 | 0.0 | 7.1 | 28.6 | 7.1 | 0.0 | 14.3 | 0.0 | 7.1 | 0.0 | 7.1 | 100.0 |
| Col % | 0.0 | 0.0 | 5.0 | 2.9 | 0.0 | 1.5 | 5.6 | 2.1 | 0.0 | 1.9 | 0.0 | 5.6 | 0.0 | 6.7 | 1.7 |
| Smokers--palate | 0 | 0 | 1 | 1 | 2 | 0 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 6 |
| Row% | 0.0 | 0.0 | 16.7 | 16.7 | 33.3 | 0.0 | 0.0 | 16.7 | 0.0 | 16.7 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 2.5 | 1.4 | 3.9 | 0.0 | 0.0 | 2.1 | 0.0 | 0.9 | 0.0 | 0.0 | 0.0 | 0.0 | 0.7 |
| Tobacco induced keratosis | 0 | 0 | 1 | 2 | 0 | 0 | 1 | 1 | 2 | 6 | 3 | 1 | 0 | 0 | 17 |
| Row% | 0.0 | 0.0 | 5.9 | 11.8 | 0.0 | 0.0 | 5.9 | 5.9 | 11.8 | 35.3 | 17.6 | 5.9 | 0.0 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 2.5 | 2.9 | 0.0 | 0.0 | 1.4 | 2.1 | 10.0 | 5.7 | 1.2 | 5.6 | 0.0 | 0.0 | 2.0 |
| TOTAL | 7 | 4 | 40 | 69 | 46 | 59 | 55 | 40 | 15 | 88 | 232 | 16 | 72 | 15 | 841 |
| Row% | 0.8 | 0.5 | 4.8 | 8.2 | 6.2 | 8.0 | 7.5 | 5.4 | 2.0 | 11.9 | 31.4 | 2.2 | 8.6 | 1.8 | 100.0 |
| Col % | 100.0 | 100.0 | 100.0 | 100.0 | 90.2 | 90.8 | 76.4 | 85.1 | 75.0 | 83.0 | 91.0 | 88.9 | 100.0 | 100.0 | 100.0 |
Among oral mucosal alterations, it was found that in North Bengal oral lichen planus was more common among housewives. Oral submucous fibrosis (OSMF) was common among housewives, followed by people with Group 9 occupation. Oral squamous cell carcinoma (OSCC) and oral erythroplakia were more common in people with group 6 occupation. Table 2 describes oral mucosal changes in different occupations in North Bengal.
Table 2.
Association between oral lesion and occupation in North Bengal
| Occupational groups | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Oral changes | Group-0 | Group-2 | Group-3 | Group-4 | Group-5 | Group-6 | Group-7 | Group-8 | Group-9 | House wife | Retired | Student | Unemployed | Total |
| Absent | 4 | 13 | 33 | 17 | 33 | 25 | 17 | 12 | 60 | 119 | 11 | 56 | 6 | 406 |
| Row % | 1.0 | 3.2 | 8.1 | 4.2 | 8.1 | 6.2 | 4.2 | 3.0 | 14.8 | 29.3 | 2.7 | 13.8 | 1.5 | 100.0 |
| Col % | 80.0 | 86.7 | 84.6 | 89.5 | 91.7 | 71.4 | 81.0 | 80.0 | 85.7 | 88.1 | 91.7 | 96.6 | 85.7 | 86.9 |
| erythroplakia | 0 | 0 | 1 | 0 | 0 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 3 |
| Row % | 0.0 | 0.0 | 33.3 | 0.0 | 0.0 | 66.7 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 2.6 | 0.0 | 0.0 | 5.7 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.6 |
| leukoplakia | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 1 | 0 | 5 |
| Row % | 0.0 | 0.0 | 20.0 | 20.0 | 0.0 | 0.0 | 0.0 | 0.0 | 20.0 | 20.0 | 0.0 | 20.0 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 2.6 | 5.3 | 0.0 | 0.0 | 0.0 | 0.0 | 1.4 | 0.7 | 0.0 | 1.7 | 0.0 | 1.1 |
| lichen planus | 0 | 0 | 2 | 0 | 1 | 1 | 2 | 1 | 1 | 4 | 0 | 1 | 0 | 13 |
| Row % | 0.0 | 0.0 | 15.4 | 0.0 | 7.7 | 7.7 | 15.4 | 7.7 | 7.7 | 30.8 | 0.0 | 7.7 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 5.1 | 0.0 | 2.8 | 2.9 | 9.5 | 6.7 | 1.4 | 3.0 | 0.0 | 1.7 | 0.0 | 2.8 |
| OSMF | 1 | 0 | 0 | 1 | 2 | 2 | 1 | 0 | 4 | 6 | 0 | 0 | 1 | 18 |
| Row % | 5.6 | 0.0 | 0.0 | 5.6 | 11.1 | 11.1 | 5.6 | 0.0 | 22.2 | 33.3 | 0.0 | 0.0 | 5.6 | 100.0 |
| Col % | 20.0 | 0.0 | 0.0 | 5.3 | 5.6 | 5.7 | 4.8 | 0.0 | 5.7 | 4.4 | 0.0 | 0.0 | 14.3 | 3.9 |
| scc | 0 | 1 | 0 | 0 | 0 | 3 | 0 | 1 | 0 | 2 | 0 | 0 | 0 | 7 |
| Row % | 0.0 | 14.3 | 0.0 | 0.0 | 0.0 | 42.9 | 0.0 | 14.3 | 0.0 | 28.6 | 0.0 | 0.0 | 0.0 | 100.0 |
| Col % | 0.0 | 6.7 | 0.0 | 0.0 | 0.0 | 8.6 | 0.0 | 6.7 | 0.0 | 1.5 | 0.0 | 0.0 | 0.0 | 1.5 |
| Smokers melanosis | 0 | 1 | 1 | 0 | 0 | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 5 |
| Row % | 0.0 | 20.0 | 20.0 | 0.0 | 0.0 | 20.0 | 20.0 | 0.0 | 20.0 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 |
| Col % | 0.0 | 6.7 | 2.6 | 0.0 | 0.0 | 2.9 | 4.8 | 0.0 | 1.4 | 0.0 | 0.0 | 0.0 | 0.0 | 1.1 |
| Smokers palate | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 |
| Row % | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 1.4 | 0.0 | 0.0 | 0.0 | 0.0 | 0.2 |
| Tobacco-induced keratosis | 0 | 0 | 1 | 0 | 0 | 1 | 0 | 1 | 2 | 3 | 1 | 0 | 0 | 9 |
| Row % | 0.0 | 0.0 | 11.1 | 0.0 | 0.0 | 11.1 | 0.0 | 11.1 | 22.2 | 33.3 | 11.1 | 0.0 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 2.6 | 0.0 | 0.0 | 2.9 | 0.0 | 6.7 | 2.9 | 2.2 | 8.3 | 0.0 | 0.0 | 1.9 |
| TOTAL | 5 | 15 | 39 | 19 | 36 | 35 | 21 | 15 | 70 | 135 | 12 | 58 | 7 | 467 |
| Row % | 1.1 | 3.2 | 8.4 | 4.1 | 7.7 | 7.5 | 4.5 | 3.2 | 15.0 | 28.9 | 2.6 | 12.4 | 1.5 | 100.0 |
| Col % | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
Chi-square value: 93.0292; P: 0.5669
On the other hand, it was also found that in South Bengal, leukoplakia was more common among people with group 6 occupation. OSMF was common among housewives, and tobacco-induced keratosis was most common among people with group 9 occupation. Table 3 describes oral mucosal changes in different occupations in South Bengal.
Table 3.
Association between oral lesion and occupation in South Bengal
| Oral changes | Group-0 | Group-1 | Group-2 | Group-3 | Group-4 | Group-5 | Group-6 | Group-7 | Group-8 | Group-9 | House wife | Retired | Student | Unemployed | Total |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Absent | 2 | 4 | 22 | 27 | 29 | 26 | 30 | 23 | 3 | 28 | 113 | 5 | 14 | 6 | 332 |
| Row % | 0.6 | 1.2 | 6.6 | 8.1 | 8.7 | 7.8 | 9.0 | 6.9 | 0.9 | 8.4 | 34.0 | 1.5 | 4.2 | 1.8 | 100.0 |
| Col % | 100.0 | 100.0 | 88.0 | 90.0 | 90.6 | 89.7 | 81.1 | 88.5 | 60.0 | 77.8 | 94.2 | 83.3 | 100.0 | 75.0 | 88.8 |
| Chewers Mucositis | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 |
| Row % | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 2.8 | 0.0 | 0.0 | 0.0 | 0.0 | 0.3 |
| Smokers lip | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
| Row % | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 3.4 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.3 |
| leukoplakia | 0 | 0 | 0 | 0 | 1 | 1 | 4 | 1 | 1 | 2 | 1 | 0 | 0 | 1 | 12 |
| Row % | 0.0 | 0.0 | 0.0 | 0.0 | 8.3 | 8.3 | 33.3 | 8.3 | 8.3 | 16.7 | 8.3 | 0.0 | 0.0 | 8.3 | 100.0 |
| Col % | 0.0 | 0.0 | 0.0 | 0.0 | 3.1 | 3.4 | 10.8 | 3.8 | 20.0 | 5.6 | 0.8 | 0.0 | 0.0 | 12.5 | 3.2 |
| lichen planus | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | 0 | 0 | 2 |
| Row % | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 | 0.0 | 0.0 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 1.7 | 0.0 | 0.0 | 0.0 | 0.5 |
| OSMF | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 4 | 0 | 0 | 0 | 4 |
| Row % | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 | 0.0 | 0.0 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 3.3 | 0.0 | 0.0 | 0.0 | 1.1 |
| smokers melanosis | 0 | 0 | 1 | 1 | 0 | 1 | 3 | 0 | 0 | 1 | 0 | 1 | 0 | 1 | 9 |
| Row % | 0.0 | 0.0 | 11.1 | 11.1 | 0.0 | 11.1 | 33.3 | 0.0 | 0.0 | 11.1 | 0.0 | 11.1 | 0.0 | 11.1 | 100.0 |
| Col % | 0.0 | 0.0 | 4.0 | 3.3 | 0.0 | 3.4 | 8.1 | 0.0 | 0.0 | 2.8 | 0.0 | 16.7 | 0.0 | 12.5 | 2.4 |
| smokers palate | 0 | 0 | 1 | 1 | 2 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 5 |
| Row % | 0.0 | 0.0 | 20.0 | 20.0 | 40.0 | 0.0 | 0.0 | 20.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 4.0 | 3.3 | 6.3 | 0.0 | 0.0 | 3.8 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 1.3 |
| Tobacco-induced keratosis | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 4 | 0 | 0 | 0 | 0 | 8 |
| Row % | 0.0 | 0.0 | 12.5 | 12.5 | 0.0 | 0.0 | 0.0 | 12.5 | 12.5 | 50.0 | 0.0 | 0.0 | 0.0 | 0.0 | 100.0 |
| Col % | 0.0 | 0.0 | 4.0 | 3.3 | 0.0 | 0.0 | 0.0 | 3.8 | 20.0 | 11.1 | 0.0 | 0.0 | 0.0 | 0.0 | 2.1 |
| TOTAL | 2 | 4 | 25 | 30 | 32 | 29 | 37 | 26 | 5 | 36 | 120 | 6 | 14 | 8 | 374 |
| Row % | 0.5 | 1.1 | 6.7 | 8.0 | 8.6 | 7.8 | 9.9 | 7.0 | 1.3 | 9.6 | 32.1 | 1.6 | 3.7 | 2.1 | 100.0 |
| Col % | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
Chi-square value: 113.5851; P: 0.2447
Figure 3 describes reactive and benign lesions of West Bengal based on geographical location, and Figure 4 describes malignant and premalignant lesions of West Bengal based on geographical location.
Figure 3.
Reactive and benign lesions of West Bengal
Figure 4.
Malignant and premalignant lesions of West Bengal
We observed that reactive and benign lesions were more in South Bengal and malignant and premalignant lesions were more among people of North Bengal, except leukoplakia. Leukoplakia was more among people of South Bengal.
Multiple logistic regression was done to know the risk factor associated with oral lesions of housewives, and it was found that any kind of oral habits, specially chewing habits, was associated with oral lesions of housewives.
Discussion
As per NFHS-5 (2019–2020)[11] in West Bengal, 48.1% men used any kind of tobacco products. In urban areas, use of tobacco among men was 44.7%, and in rural areas, it was 49.9%. In NFHS-5 (2019–2020), it was found that 10.8% women used any kind of tobacco products in West Bengal. In urban areas, tobacco use among women was 8.0%, and in rural areas, it was 12.3%.
Various studies showed that prevalence of tobacco use is different in different occupations.
Shoeeb Akram et al.[12] in 2015 performed a study among plywood industry workers on tobacco use and nicotine dependence and came to the conclusion that more than half of workers use tobacco in different forms, which were very high compared to the general population.
Sudhir Rewar et al.[13] in 2013 performed a cross-sectional survey on auto rickshaw drivers of Jaipur city, Rajasthan, and identified that prevalence of tobacco use was very high (87%) among them. As per responses from subjects, influence of friends (78%) played the most important role to develop the habit of tobacco use.
Mishra GA et al.[14] in 2010 studied call center employees and tobacco dependence and found the prevalence of tobacco dependence was 41% (mainly cigarette smoking).
Oral lesions related to cancer-causing habits are mainly oral squamous cell carcinoma, leukoplakia, erythroplakia, oral submucous fibrosis, oral lichen planus, lesion associated with reverse smoking, smokers melanosis, chewers mucositis, smokers lip, smokers palate, tobacco-induced keratosis, and so on.
Malaowalla et al.[15] in1976 examined 57,518 industrial workers aged more than 35 years old for oral lesions and found 29 oral cancers. Again, after a 2-year interval, they re-examined 43,654 workers and found 22 new oral cancers.
Over 90% of cancer cases were oral squamous cell carcinoma, and most lesions were in the oropharynx and tongue.
They found that patients who developed squamous carcinomas had tobacco habits in some or other form. They found that 85% of their entire study population had deleterious oral habits.
Padma K Bhat et al.[16] in 2018 assessed oral mucosal conditions among Beedi workers of Karnataka and found 26.9% had different oral mucosal lesions.
It is very easy to conduct awareness campaign for deleterious habit cessation, screening programs for oral malignant and potentially malignant disorder, and follow-up in work places. Hence, it is very important to know prevalence of different habit-induced oral lesions in different occupations and how it differs based on geographical locations and sociocultural changes.
In our study, it was found that in North Bengal, oral lichen planus was more common among housewives. OSMF was common among housewives, followed by people with Group 9 occupation. Oral squamous cell carcinoma and oral erythroplakia were more common in people with group 6 occupation.
On the other hand, it was also found that in South Bengal, leukoplakia was more common among people with group 6 occupation. OSMF was common among housewives, and tobacco-induced keratosis was most common among people with group 9 occupation.
In was found that all the cancerous and precancerous lesions (oral squamous cell carcinoma, erythroplakia, oral lichen planus, and OSMF) were more common in North Bengal except oral leukoplakia. Oral leukoplakia was more common in South Bengal.
On the other hand, except tobacco-induced keratosis, all other benign habit-induced oral lesions were common in South Bengal. Tobacco-induced keratosis was more common in North Bengal.
While comparing geographical area-wise distribution of oral lesions among males, all the cancerous and precancerous lesions (oral squamous cell carcinoma, erythroplakia, oral lichen planus, and OSMF) were more common among males of North Bengal except oral leukoplakia. Oral leukoplakia was common among males of South Bengal.
While comparing geographical area-wise distribution of oral lesions among females, it was found that all the cancerous and precancerous lesions (oral SCC, oral lichen planus, and OSMF) were more common among females of North Bengal except oral leukoplakia. Oral leukoplakia was equally prevalent among females of South Bengal.
This study will help policy makers and researchers to identify their target population to do campaigning against oral cancer and habits related to it based on specific geographic areas concentrating on specific occupations. It will also be easy to conduct periodic screening programs, pharmacotherapy, and follow-up. If comprehensive and sustainable tobacco control activities can be integrated along with appropriate backup referral facilities within the existing workplace, burden of tobacco-induced oral mucosal diseases could be minimized.
In this study, the sample size from each occupational group was less. A large number of samples and follow-up for long duration would be necessary to establish the relationship of different occupations, geographic locations, and habit-induced oral lesions.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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