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Betel quid, chewing habits and difficult intubation: A case report and critical appraisal of evidence for practice.

Narendra PL, Hegde HV, Vijaykumar TK, Nallamilli S - Anesth Essays Res (2015 Jan-Apr)

Bottom Line: OSF is now seen in Saudi Arabia and western countries with use of commercial betel quid substitutes.Although betel quid without tobacco is used in Taiwan, available evidence suggests rapid and early development of OSF where commercial chewing products like Pan Masala are used in India.Studies where personal habits are involved must be analyzed carefully for external validity.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Shri B. M. Patil Medical College Hospital and Research Centre, BLDE University, Bijapur, India.

ABSTRACT
Betel quid is used by 10-20% of world of population. Oral submucus fibrosis (OSF) is a chronic premalignant disease common in South Asian countries where betel quid is chewed. It is characterized by juxtaepithelial fibrosis of oral cavity and limited mouth opening, which can cause difficult intubation. A recent study in Taiwan has revealed long-term betel nut chewing is not predictor of difficult intubation. We describe two cases of OSF and critically analyze this study and its implications for clinical practice. OSF is now seen in Saudi Arabia and western countries with use of commercial betel quid substitutes. Although betel quid without tobacco is used in Taiwan, available evidence suggests rapid and early development of OSF where commercial chewing products like Pan Masala are used in India. Effects of betel quid may vary depending on the composition of quid and chewing habits. Studies where personal habits are involved must be analyzed carefully for external validity. Even though, Taiwan study is controlled, its validity outside Taiwan is highly questionable. Since OSF can cause unanticipated difficult intubation, thus during preanesthetic assessment, history of betel quid chewing, more importantly use of commercial chewing products is more likely to give clues to severity of OSF and possible difficult intubation. Further controlled trails in populations where commercial chewing products are used is necessary to detect association of chewing habits and difficult intubation.

No MeSH data available.


Related in: MedlinePlus

Chewing products involved in Oral submucus fibrosis (OSF). Conventional betel quid (a) and commercial chewing products with tobacco, (b) now banned, without tobacco, (c) Commercial products contain more areca nut per chew. Note, separately available tobacco products, (d) that can be combined with conventional quid or other tobacco less products inset, (e) shows tobacco less products containing betel nuts, catechu and lime involved in OSF
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Figure 1: Chewing products involved in Oral submucus fibrosis (OSF). Conventional betel quid (a) and commercial chewing products with tobacco, (b) now banned, without tobacco, (c) Commercial products contain more areca nut per chew. Note, separately available tobacco products, (d) that can be combined with conventional quid or other tobacco less products inset, (e) shows tobacco less products containing betel nuts, catechu and lime involved in OSF

Mentions: The three types of quid used in Taiwan are lao-hwa quid, betel quid and stem quid which do not contain tobacco.[1] In India, tobacco and commercial chewing products like Gutka and Pan Masala are commonly used and these are exported from India to over 50 countries around the world.[112] Products like Gutka and Pan Masala have high concentrates of areca nut per chew and cause OSF more rapidly than by conventional betel quid.[13] In a South Indian study, all patients who developed OSF within 1 year were Pan Masala/Gutka chewers.[14] While some studies identify tobacco as a risk factor for OSF, others do not.[115] However, chewing tobacco plays a modifying role on the malignant transformation of OSF.[10] Despite a ban on products like Gutka, ingredients of tobaccoless products like betel quid and Pan Masala contain constituents that can still cause OSF or oral cancer. Furthermore, a “Gutka like” quid can be made by combining separately available tobacco less and tobacco products [Figure 1].


Betel quid, chewing habits and difficult intubation: A case report and critical appraisal of evidence for practice.

Narendra PL, Hegde HV, Vijaykumar TK, Nallamilli S - Anesth Essays Res (2015 Jan-Apr)

Chewing products involved in Oral submucus fibrosis (OSF). Conventional betel quid (a) and commercial chewing products with tobacco, (b) now banned, without tobacco, (c) Commercial products contain more areca nut per chew. Note, separately available tobacco products, (d) that can be combined with conventional quid or other tobacco less products inset, (e) shows tobacco less products containing betel nuts, catechu and lime involved in OSF
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4383113&req=5

Figure 1: Chewing products involved in Oral submucus fibrosis (OSF). Conventional betel quid (a) and commercial chewing products with tobacco, (b) now banned, without tobacco, (c) Commercial products contain more areca nut per chew. Note, separately available tobacco products, (d) that can be combined with conventional quid or other tobacco less products inset, (e) shows tobacco less products containing betel nuts, catechu and lime involved in OSF
Mentions: The three types of quid used in Taiwan are lao-hwa quid, betel quid and stem quid which do not contain tobacco.[1] In India, tobacco and commercial chewing products like Gutka and Pan Masala are commonly used and these are exported from India to over 50 countries around the world.[112] Products like Gutka and Pan Masala have high concentrates of areca nut per chew and cause OSF more rapidly than by conventional betel quid.[13] In a South Indian study, all patients who developed OSF within 1 year were Pan Masala/Gutka chewers.[14] While some studies identify tobacco as a risk factor for OSF, others do not.[115] However, chewing tobacco plays a modifying role on the malignant transformation of OSF.[10] Despite a ban on products like Gutka, ingredients of tobaccoless products like betel quid and Pan Masala contain constituents that can still cause OSF or oral cancer. Furthermore, a “Gutka like” quid can be made by combining separately available tobacco less and tobacco products [Figure 1].

Bottom Line: OSF is now seen in Saudi Arabia and western countries with use of commercial betel quid substitutes.Although betel quid without tobacco is used in Taiwan, available evidence suggests rapid and early development of OSF where commercial chewing products like Pan Masala are used in India.Studies where personal habits are involved must be analyzed carefully for external validity.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Shri B. M. Patil Medical College Hospital and Research Centre, BLDE University, Bijapur, India.

ABSTRACT
Betel quid is used by 10-20% of world of population. Oral submucus fibrosis (OSF) is a chronic premalignant disease common in South Asian countries where betel quid is chewed. It is characterized by juxtaepithelial fibrosis of oral cavity and limited mouth opening, which can cause difficult intubation. A recent study in Taiwan has revealed long-term betel nut chewing is not predictor of difficult intubation. We describe two cases of OSF and critically analyze this study and its implications for clinical practice. OSF is now seen in Saudi Arabia and western countries with use of commercial betel quid substitutes. Although betel quid without tobacco is used in Taiwan, available evidence suggests rapid and early development of OSF where commercial chewing products like Pan Masala are used in India. Effects of betel quid may vary depending on the composition of quid and chewing habits. Studies where personal habits are involved must be analyzed carefully for external validity. Even though, Taiwan study is controlled, its validity outside Taiwan is highly questionable. Since OSF can cause unanticipated difficult intubation, thus during preanesthetic assessment, history of betel quid chewing, more importantly use of commercial chewing products is more likely to give clues to severity of OSF and possible difficult intubation. Further controlled trails in populations where commercial chewing products are used is necessary to detect association of chewing habits and difficult intubation.

No MeSH data available.


Related in: MedlinePlus