Smokeless Tobacco Use and Oral Pre-malignant Lesions in the Indian Population

Background: Eighty percent of total smokeless tobacco users in the world are from India and Bangladesh. According to the Global Adult Tobacco Survey (2009), the percentage of adults who used smokeless tobacco in India was 25.9% with a 32.9% prevalence in males and 18.4% prevalence in females. Due to smokeless tobacco products being available and distributed in a variety of forms, independently or in different combinations; it’s use being addictive, lethal and carcinogenic; and the prevalence of varied beliefs, habits and misinformation influencing the use of smokeless tobacco products in India, it is necessary to understand the prevalence of smokeless tobacco use and prevalence of oral pre-malignant lesions in this population. Methodology: In this study, two datasets obtained from the Indian Dental Association under their ‘National Oral Health Programme’ initiative were analyzed. One dataset belonged to the truck driver population and the other dataset to the general population. Quantitative data analysis of these two cross-sectional studies for prevalence of smokeless tobacco use and oral pre-malignant lesions was conducted using STATA15 software. Results: The prevalence of smokeless tobacco use was 75.3% among truck drivers and 28.3% in the general population. The prevalence of oral pre-malignant lesions and conditions in the truck drivers was found to be 17.5% and 15.7% in the general population. The odds ratio for the presence of oral lesions and smokeless tobacco use was 2.84 (95% CI = 0.578 – 27.424) in the truck drivers, however the association was not found to be significant (p-value = 0.22). The association between smokeless tobacco use and presence of oral lesions showed a significant association (p-value \u3c 0.001) in the general population with an odds ratio of 11.7 (95% CI = 4.475 – 32.503). Conclusion: This study did provide a good insight of the prevalence of smokeless tobacco use in truck drivers. Since there are limited number of studies conducted in this population to assess their smokeless tobacco use and prevalence of oral lesions, the findings from this study are among the few early estimates that will help to provide basis for future studies. The relatively high use of smokeless tobacco in the truck drivers does point to existence of certain risk factors specific to the occupation which need further investigation. In the general male population, the high odds of prevalence of oral pre-malignant lesions in smokeless tobacco users indicate the susceptibility of this population in developing these lesions which can further advance into oral cancer