Histopathological Findings of Oral Mucosa in Smokeless Tobacco Users: Case Report

Abstract

Background New tobacco products, such as smokeless tobacco, are becoming more popular every year. In talking with our patients, we determined several reasons for that trend. The sale of these products is prohibited in many countries; hence, people obtain the product illegally. This is important, since when these products are stored under inappropriate conditions and temperatures, the quality and properties of the product change, including their carcinogenic properties. Sometimes people use a lot of this product or more than one tobacco product daily. It is challenging for dental practitioners to question their patients about tobacco consumption and more challenging to visually detect oral mucosal changes, because patients usually do not have concerns or they do not pay attention. Methods In the two cases presented here, the patients did not have any pain, nor did they notice when the lesions appeared. These patients used conventional cigarettes for some time and then switched to smokeless tobacco due to relocation to Latvia. Soft tissue excision was performed and sent for histopathological examination. Results The findings were proliferation of oral epithelial cells from buccal region, their overgrowth, an excessive amount of fibroblasts, cell destruction and necrosis, and a large amount of inflammatory cells, eosinophil leukocytes, and plasma cells. Conclusions We can conclude that these intraoral findings are important risk factors for possibly developing precancerous lesions. Such mucosal changes can occur with different forms of tobacco, including Swedish snus and betel leaves. Dental practitioners should always question patients about tobacco use and regularly check for mucosal changes for early detection.

Comparative analysis of trace elements in the saliva and serum of patients with oral submucous fibrosis and squamous cell carcinoma

“…Gutkha is a mixture of sun-dried, roasted and finely chopped tobacco, areca nut, slaked lime, catechu, spices, sweeteners and essences. This mixture is held in the mouth, chewed, or sucked with the generated saliva and is either spit out or swallowed (4,7,9). Epidemiological studies have indicated that chewing gutkha is one of the most significant risk factors for OSMF (6,(10)(11)(12) accounting for >3,50,000 oral cancer cases worldwide (7).…”

“…Comparatively, fewer cases have been reported in Europe and North America (5,6). OSMF cases are most commonly noted in younger generations owing to the intake of smokeless tobacco products (4,7,8). Smokeless tobacco is a tobacco product that is consumed in any manner or form other than smoking (8).…”

“…However, various carcinogens, such as nicotine, tobacco-specific N-nitrosamines, arsenic, beryllium, chromium, nitrite, nitrate, cadmium, nickel and polynuclear hydrocarbon benzo[a]pyrene, are present in smokeless tobacco (4,8). These carcinogens cause dysplastic changes in the oral mucosa and lead to various pathologic lesions, including smokeless tobacco keratosis, verrucous carcinoma, leucoplakia, erythroplakia, leukoedema, parakeratosis and OSCC (4,7). Gutkha is the most popular smokeless tobacco…”