Abstract:
Rapidly growing world in terms of mechanization, industrialization and technology has
subjected mankind to emotional, mental, and physical tension. In reaction to such factors,
human beings fall prey to stress relieving habits because of their euphoric effect along with
hallucinogenic, psychotropic and mind relaxing properties to relieve stress and
anxiousness. However, they have deleterious effects on the body apart from only being
addictive. The most initial portal of entry of such habits is oral cavity and hence it is the
first and most at danger. In the subcontinent specifically Pakistan, such common ill habits
of areca nut products consumption include betel quid (Gutka), betel nut (Chalia), betel leaf
(pan) and other associated factors which eventually leads to develop oral submucous
fibrosis (OSMF).
The aim of this research was to evaluate and compare symptomatic and asymptomatic
subjects for alterations in normal anatomy of oral mucosa through tissue biopsy for OSMF
symptomatic cases and brush cytology (using soft bristle toothbrush) for all groups
involved in the study i.e., cases, asymptomatic chewers (control group 1) and healthy
controls (control group 2)
The study included 50 OSMF symptomatic cases along with control group 1 and control
group 2 of both sexes. H & E stained microscopic slides were prepared from oral mucosa.
Under a light microscope, clearly defined slides were evaluated to record histological and
cytological features and assessed for their morphology.
Collected data was manually entered into the Statistical Package for the Social Sciences
version 23.0 and analyzed using Binary logistic regression analysis, Chi Square test and
Fisher’s Exact test at 95% confidence interval with p value ≤ 0.05 as statistically
significant and 0.01 as highly significant.
Burning sensation (0.741), white fibrotic lines (0.351), ulcerations (0.357), hyalinization of
lamina propria (0.180), collagen presence around blood vessels (0.328) and muscles
(0.877), residual edema (0.747), Histo grade II (0.515), Histo grade III (0.537), Ulceration
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(0.357), epithelial type (0.193), gender (0.301), ethnicity (0.48), bacterial colonies with
gender (0.127), fungal colonies with type of habit (0.111) did not show statistically
significant association in cases of OSMF while Age (0.000), dysplasia (0.001), squamous
cell carcinoma (0.004), Histo grade I (0.011), Histo grade IV (0.000), nuclei (0.005),
bacterial colonies (0.046), dysplasia and inflammatory cells (0.029), histology of dysplasia
and appearance of nuclei (0.016), association of nuclei and nucleoli with OSMF (0.000),
bacterial colonies and inflammatory cells (0.000), fungal colonies and inflammatory cells
(0.000), epithelium with OSMF (0.004), dysplastic cells and hyalinization in lamina
propria (0.023) showed a reasonably higher value of significance.
The results demonstrate that oral brush cytology can be used as a potentially practical
noninvasive screening tool for predicting oral mucosal disease in a resource challenged
setting and non-compliant patients. However clinical judgement followed by tissue biopsy
is of prime importance and gold standard. Immediate biopsy is mandatory for assessment
of exact clinical and histological stage. Presence of hyperchromasia, dysplasia,
inflammatory cells, hyalinization, bacterial and fungal colonies are high risk features for
OSMF predictability. All ill habit chewers should be followed on a priority basis for early
detection and management of OSMF. Since diagnosis is mostly clinical and treatment of
oral submucous fibrosis is incredibly challenging, it was important to conduct a study to
bring awareness to the replete literature in terms of clinico-histological and cytological
presentation of OSMF
