Relationship of Human Papilloma Virus with Trismus in Chewable Tobacco Users

Background: Human Papilloma Virus (HPV) is found in the oral tobacco chewers with precancerous lesions such as submucous fibrosis (SMF), leukoplakia and erythroplakia. Trismus is a common symptom seen in patients with SMF and oral cancers. In Pakistan the risk of oral cancers has been raised up to 8.5 to 10 times due to increase in tobacco chewers in the recent years. Objective: To determine the frequency of oral HPV infection in chewable tobacco users with trismus living in the lowincome areas of Karachi. Methods: Camps were set up in 5 different areas of Karachi. In each camp, 100 people were examined for oral lesions by experienced volunteers. Oral rinse (40ml) was taken after gentle brushing over the lesions. DNA was extracted and PCR was performed using Gp5+/Gp6+ consensus primers. The results were analyzed on SPSS version 17.0. Results: Out of 187 subjects with trismus, 157 (84%) were males and 30 (15.51%) were females with average age of 28.7 years (12 -70 years). Gutka, Naswar, Chalia and Paan users were 45.45%, 37.56%, 12.83% and 6.95% respectively. Mild trismus was found in 113 (60.43%) subjects followed by moderate trismus in 52 (27.81%) and severe trismus in 22(11.76%). Out of total 36 (19%) HPV positive subjects, 27(14.44%), 7(3.74%) and 2(1.07%) had mild, moderate and severe trismus respectively. 150 controls tested negative for HPV. 1 Zil-e-Rubab