Anwar Merchant*, Syed Mehmood Haider+, Fariyal F. Fikree*

*Department of Community Health Sciences, Aga Khan University +Karachi Medical and Dental College, Karachi

Oral submucous fibrosis, a precancerous condition of the mouth, is more common in females than in males, and is associated with areca nut use. It starts with burning and intolerance to spicy food. This is followed by mucosal ulceration and blanching, and the formation of characteristic bilateral fibrous bands, restricting mouth opening. Its severity is staged histologically. In this study its severity was measured clinically as maximal mouth opening. Associations of clinical staging of oral submucous fibrosis and with gender, age and smoking habits are presented.

We examined 325 cases of oral submucous fibrosis coming to tree health facilities in Karachi between January 1992 and October 1994. Severity of the disease was assessed by the magnitude mouth opening. Mouth opening of less than or equal to 20 mm was classified as severe, otherwise as mild. The association of gender, age group, smoking status and severity of the disease was studied by the chi square.

There were 155 men and 178 women in the sample. Women were significantly older than men (mean ages 37 and 26 years respectively, p-value <0.001). The proportion of women with severe disease increased across the three age groups (<19, 20-39, and ³ 40 years). There was a sharp decrease in the proportion of men from the 20-39 to ³ 40 years age groups. Overall there were proportionately more men in the severe disease category than women (Mantael-Hanszel odds ratio 1.8, 95% CI 1.2-2.8). Smoking habit did not present a significant association with the severity of disease.

In this study men had more severe disease than woman. There are three explanations for these findings. It is possible that men with submucous fibrosis develop oral cancer and die prematurely. This is a likely explanation because in one study from India about 40% of all oral cancer cases had oral submucous fibrosis, and oral cancer is more common in men. If severe disease is associated with oral cancer it needs further evaluation, as it could be an important, and under appreciated, risk factor of oral cancer. It is also possible that severity of oral submucous fibrosis may be affected by dosage and frequency of use of areca nut, and these may have varied between men and women. Lastly, it may be that areca nut may biologically affect men differently than women. This is theoretically possible, but there are no data to support it.

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