Betel nut chewing habits and risk of precancerous oral lesions among Paniya tribes of Wayanad, India: A cross sectional study

Abstract

Background: Oral cancer is a major public health problem among Paniya tribes, a marginalized tribal group in Kerala state, South India. Previous studies have documented a high prevalence of betel nut chewing habit among Paniya tribals in Wayanad. Precancerous lesions of oral mucosa, known as potentially malignant disor-ders are consists of a group of diseases, which should be diagnosed in the early stage. Oral leukoplakia, oral submucous fibrosis, and oral erythroplakia are the most common oral mucosal diseases that have a very high malignant transformation rate. The aim of this study was to evaluate the risks imposed by betel nut chewing in the development of oral cancer. Methods: A cross-sectional descriptive study was conducted to assess betel nut chewing and precancerous oral lesions prevalence among 600 Paniya tribes in the Wayanad District, Kerala, India. Information on betel nut chewing status, type, quantity and duration of chewing was collected from cases and controls using a questionnaire.Inhabitants of the villages aged 18 to 65 years who were residing for more than 10 years were included. All the examinations were per-formed by a single examiner. Data was collected using a survey proforma which comprised of a questionnaire and WHO Oral Health Surveys-Basic Methods Proforma (1997). The collected data was subjected to statistical analysis. Results: In this study precancerous lesions were found to be far more prevalent among chewing Paniya tribes than among the controls. (P< 0.0001). The prevalence of pre-cancerous oral lesions were higher among betal nut chewers (18.9%, 95%, CI 16.5-20.9). This was much higher than found among the non chewer (0.8%, 95 CI 0.6-1.3). Among the betel nut chewers a statistically significant relationship was observed between precancerous lesions and poor access to health care (P < 0.001). Conclusions: Prevalence of precancerous oral lesions in the study population was due to betel nut usage and lack of awareness regarding the deleterious effects of the products used. Regular oral examination by dental professionals, dental health education and motivation to maintain oral hygiene should be insisted to improve the oral health status of this community.