Oral health status and pattern of tobacco use among Tuberculosis patients

INTRODUCTION

Tuberculosis (TB) disease continues to represent a global threat. Several risk factors play a key role in the disadvantaged status. One of the most important risk factors is tobacco addiction, which may be smoked or smokeless tobacco (SLT).^[1,2] In India, over 2.8 million TB cases were reported,^[3] and about 267 million adults were using tobacco.^[4] Tobacco is one of the important drivers of TB epidemic.^[5,6]

The World Health Organization estimated 1.35 million deaths due to tobacco use in India.^[5] India is a developing country, and tobacco smoking is becoming the popular form of tobacco consumption in rural and urban populations.^[6]

There is strong evidence that tobacco use has numerous negative effects on the oral health of TB patients, for example, staining of teeth and dental restorations, reduction of the ability to smell and taste, development of oral diseases such as smokers’ palate, smokers’ melanosis, and coated tongue.^[7] Even though dental caries has a multifactorial etiology, there is a suggestive relationship between tobacco use and dental caries incidence.^[7]

With this above background, it was thought prudent to assess the oral health status and pattern of tobacco use among TB-tobacco patients visiting directly observed therapy shortcourse (DOTS) center of tertiary care hospital.

MATERIAL AND METHODS

The research plan, the materials (or subjects), and the methods used should be described. An explanation of how the disease was confirmed and the controls used must be included, as well as the details of the data obtained and how it was analyzed.

It was a descriptive cross-sectional study conducted in patients diagnosed with TB on anti-tubercular therapy.

RESULTS

One hundred patients diagnosed with TB on anti-tubercular therapy visited the DOTS center between January 2022 and June 2022 consuming tobacco. Seventy-four patients were male, and only 26 patients were female in the study.

Figure 1 shows that the most common age group of TB-tobacco patients in the study was in between 61-70 years (n=24), followed by 71-80 years (n=18).

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Figure 1:

Distribution of patients with respect to age group.

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Figure 2: The most common occupation amongst the TB-tobacco patients were unskilled workers (34)..

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Figure 2:

Distribution of patients with respect to occupation.

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Figure 3 shows that 39 TB-tobacco patients had only primary education and 37 had secondary education respectively.

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Figure 3:

Distribution of patients with respect to education.

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Figure 4 shows that red/white patch was seen in 70 patients out of which 50 was seen on buccal mucosa of the oral cavity which was the most common site for (SLT) Smokeless tobacco in tuberculosis patients

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Figure 4:

Distribution of patients with respect to type and presence of oral mucosal lesion.

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Figure 5 shows that 74 patients were consuming Smokeless Tobacco (SLT) amongst which 38 were chewing tobacco, 29 used tobacco mishri and 7 were consuming Gutka and 26 were consuming Smoked tobacco (ST) which included cigarettes (8) and Bidi (18).

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Figure 5:

Distribution of patients with respect to type of tobacco used.

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Figure 6 shows that the most common factor responsible for the start of consuming tobacco was Peer pressure (35) followed by stress (31) in TB-tobacco patients.

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Figure 6:

Distribution of patients with respect to factors responsible for start of addiction.

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Figure 7 The most common age at which tobacco use started amongst the TB-tobacco patients was 16-20 years (54)

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Figure 7:

Distribution of patients with respect to age of start of addiction.

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Figure 8 shows that 36 of TB-tobacco patients were consuming tobacco in one or the other form more than 4 times a day.

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Figure 8:

Distribution of patients with respect to frequency of tobacco consumed per day.

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DISCUSSION

One hundred patients diagnosed with TB on anti-tubercular therapy visiting the DOTS center between January 2022 and June 2022 consuming tobacco satisfying the inclusion and exclusion criteria were enrolled for the study.

Out of 100 TB-tobacco patients, the most common age group of TB-tobacco patients in the study was in between 61 and 70 years (n = 24) followed by 71 and 80 years (n = 18). This signifies that the elderly were the most common TB-tobacco patients [Figure 1]. The age findings are in contrast to the involvement of the younger population for tobacco use.^[4,9] This may be due to only inclusion of TB patients who were using tobacco. Involvement of elderly tobacco users may also point toward increasing risk of occurrence of TB with the increase in duration of its use.^[10]

In this study, we found out that 74 patients were male and only 26 patients were female in the study. Males were found to have a significantly higher percentage than females in the study may be due to the rural setup where males are more addicted to tobacco than females. Most common form of tobacco used by females was mishri. In India, adult males are expected to be more addicted than the females.^[6,7,9] This gender difference in addiction behavior is reflected in our study.

The most common occupation among the tobacco addicted TB patients were unskilled workers (34%) [Figure 2] which are in accordance with the studies by Vellappally et al.^[7] In our study, the unskilled laborers/workers were most commonly addicted to one or the other form of tobacco.

The results of our study show that 39% TB-tobacco patients had only primary education and 37% had secondary education, respectively, only 5% graduates were addicted [Figure 3] that this shows the trend that a higher percentage of people with higher education were less common among the study population. This is in accordance with the studies by Subramanian et al,^[11] Vellappally et al.,^[7] and Rani et al.^[6]

On oral examination at baseline, red/white patch was seen in 70% patient out of which 50% was seen on buccal mucosa of the oral cavity which was the most common site for SLT in TB patients [Figure 4]. Oral mucosal lesions in the form of patches are due to continuous and frequent use of tobacco resulting in local irritation or chronic stimulation of lymphoid tissue in the oral mucosal membrane.^[7]

In our study, we found that 74% patients were using SLT among which 38% were chewing tobacco, 29% used tobacco mishri, 7% were using gutka, and 26% were using smoked tobacco (ST), which included cigarettes (8%) and bidi (18%) [Figure 5]. Our results coincide with results of Vellappally et al.^[7] In rural India, SLT use is higher than ST, chewing tobacco was the most common form of tobacco use. Mishri use was mostly recorded in rural female patients. Chaly found prevalence of bidis more than cigarettes, which are in accordance with our study (26% ST).^[12]

On analysis of factors responsible for the use of tobacco among TB patient, we found that the most common factor responsible for the start of addiction was peer pressure (35%) followed by stress (31%) in TB-tobacco patients [Figure 6]. Our results are in accordance with studies of Nair et al.^[13] Peer pressure is most commonly considered as one of the most important factors. In our study, the educational status and the age at which the addiction began reveals that the young primary or secondary school children are more involved may be due to peer pressure. The most common age at which tobacco use started among the TB-tobacco patients was 16–20 years (54%) [Figure 7].

In our study, 24% patients addicted to mishri were mostly unaware of the ill effects of tobacco and even about the content of tobacco in mishri. These females used mishri for cleaning teeth as a tradition which was seen in rural females more than the males. The findings of our study reveal that 36% of TB-tobacco patients were consuming tobacco in one or the other form more than 4 times a day, this percentage was lower than other studies.^[14,15]

Overall, these studies highlight the high prevalence of tobacco use in India, with both smoking and SLT use being common among both males and females. The major reason would be occupational stress, as most of them were unskilled workers [Figure 8].

CONCLUSION

The present study contributed in assessing the oral health status and revealed that buccal mucosal patches were the most common patches seen in the oral cavity of tobacco addict’s TB patients. Among the patients using SLT, chewing tobacco, followed by use of mishri were most common forms of tobacco addiction. In tobacco addict’s TB, patients 16–20 years were the vulnerable age to start tobacco use, unskilled workers were the most common occupation among these patients.