Tobacco use and oral mucosal changes in Baiga tribals of Madhya Pradesh

Background: Tobacco use leads to oral mucosal changes and submucous fibrosis. Use of tobacco products is common amongst primitive tribes for various purposes leading to high prevalence of oral lesions. Objectives: To estimate the prevalence of oral mucosal changes amongst tobacco users, to identify the factors contributing to increased tobacco use and suggest strategies for prevention. Materials and Methods: A cross-sectional study was conducted amongst primitive Baiga tribe at Mandla block in Mandla district of Madhya Pradesh. Multistage random sampling method used to select the study villages with predominantly Baiga families. Prevalence of mucosal changes estimated by pilot study 41% was used to calculate sample size of 540. Data was elicited by interview and clinical examination after consent. Diagnosis was according to various stages of Pindborg classification for oral mucosal fibrosis. Data is analysed in MExcel and prevalence values presented as percentages. Chi sq test and odds ratio calculated to express association and risk estimate. Results: All the 540 study subjects were of low socio economic status. A total of 256 (47.4%) developed oral mucosal changes as per the Pindborg classification for oral submucosal fibrosis. Amongst the 296 tobacco users 77% developed oral mucosal changes compared to 11.5% for non-users. (Odds ratio= 25.8. CI 16.03 to 41.71). Majority 59% had stage 1 changes in oral mucosa presenting as mucosal ulcers, erythema, melanotic pigmentation and petechiae ranging between 27 t0 18%, while 35% presented in stage 2 with fibrous bands in 19.3%. Leukoplakia observed in 5.8% The age group with maximum cases was 21-40 years but 53.6% amongst 10 to 19 years, had oral lesions. Extensive use of tobacco products (Nas&Gudhaku) as dental cleanser and other purposes caused addictions from young age. Lack of awareness, social norm and easy availability aggravated the condition. Conclusion: The current study highlights the problem of oral mucosal cha