Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer

Abstract

The term "smokeless tobacco" refers to the consumption of unburned tobacco, in the form of chewing, spitting, dipping, and snuff. Consumers chew the tobacco in the mouth and spit out the juice that builds up. Nicotine and other constituents are absorbed in the lining of oral cavity. People of many regions, including India, Pakistan, other Asian countries, and North America, have a long history of smokeless tobacco use. Approximately 28 chemical constituents present in smokeless tobacco are carcinogenic in nature, among which nitrosamine is the most prominent [1].People mostly use paan and gutkha due to a lack of awareness and education. They are not aware of the harmful effects associated with the use of these substances, and it has been reported that these products are consumed for perceived beneficial effects, such as mouth freshening, aid in digestion, germ-killing, astringency, mood enhancement, tension relief, and oral cleaning [1]. Gutkha is sweet in taste, and children consider it to be a form of candy. Many people believe that gutkha is a mouth freshener, but its pleasant taste and sweetness aggregate microbes, causing damage to teeth. The use of paan and gutkha is difficult to control in most countries where it is widespread, and their extensive use leads to oral cancer [2]. The consumption of smokeless tobacco and areca nut is high in South Asian countries in the form of paan. In various South Asian languages, paan simply means "leaf. " Various inSmokeless tobacco consumption, which is widespread throughout the world, leads to oral submucous fibrosis (OSMF), which is a long-lasting and devastating condition of the oral cavity with the potential for malignancy. In this review, we mainly focus on the consumption of smokeless tobacco, such as paan and gutkha, and the role of these substances in the induction of OSMF and ultimately oral cancer. The list of articles to be examined was established using citation discovery tools provided by PubMed, Scopus, and Google Scholar. The continuous chewing of paan and swallowing of gutkha trigger progressive fibrosis in submucosal tissue. Generally, OSMF occurs due to multiple risk factors, especially smokeless tobacco and its components, such as betel quid, areca nuts, and slaked lime, which are used in paan and gutkha. The incidence of oral cancer is higher in women than in men in South Asian countries. Human oral epithelium cells experience carcinogenic and genotoxic effects from the slaked lime present in the betel quid, with or without areca nut. Products such as 3-(methylnitrosamino)-proprionitrile, nitrosamines, and nicotine initiate the production of reactive oxygen species in smokeless tobacco, eventually leading to fibroblast, DNA, and RNA damage with carcinogenic effects in the mouth of tobacco consumers. The metabolic activation of nitrosamine in tobacco by cytochrome P450 enzymes may lead to the formation of N-nitrosonornicotine, a major carcinogen, and micronuclei, which are an indicator of genotoxicity. These effects lead to further DNA damage and, eve...

Perceived Benefits, Knowledge about Cancer and Attitude towards Promotion of Gutkha Amongst Gutkha users from Nepal

“…Reasons cited by young school-goers in Western Nepal were taste (22.94%), craving 12 (22.7%) and pleasure (19.13%) for areca nut chewing. 10 Similar beneficial effects were quoted in other study. In our study, 45% had seen possibility of qui ng it.…”

Differential DNA damaging effects of genotoxic agents from chewing tobacco and gutka

“…It is well established that chronic use of chewing tobacco and gutka can be one of potential agent in the prevalence of early onset of oral cancers in Indian sub-continent [1][2][3][4][5][6]. In this paper, we report the clear, reliable and efficient extraction of genotoxic agents in DMSO solvent from chewing tobacco and gutka in an appreciable amount.…”

“…In the developing countries of Indian sub-continent, an appreciable portion of populations are habituated to use chewing tobacco and gutka as a part of their lifestyles and to have stimulant and relaxation effects [1][2][3][4][5][6].…”

“…In recent, several clinical and basic scientists proposed views that these consumed chewing tobacco and gutka products contains several carcinogenic chemicals such as proprionitrile, nitrosamines, nicotine, sweeteners, flavoring agents [4][5][6]. However, there is a lack of clear evidence on the genotoxic abilities of these chewing tobacco and gutka.…”

Status and strategies for the management of head and neck cancer during COVID‐19 pandemic: Indian scenario

“…5 Oral cancer is the most common HNC in men in India, mainly due to the consumption of smoked and smokeless tobacco. 6 When patients with HNC present at a stage where resection is feasible, they can expect a reasonable outcome after the surgery and appropriate adjuvant treatment. 7 During the current pandemic, delaying surgery for even 1 or 2 months may lead to more extensive surgery or inoperability, when only supportive care can be provided.…”