Oral mucosal disorders associated with habitual gutka usage: a review

The aim of this study was to investigate the oral mucosal disorders associated with habitual gutka consumption.

Databases were searched from 1956 to June 2009 using the following terms: "gutka," "gutkha," "ghutka," "guttkha," "smokeless tobacco," "areca nut," "betel nut," "slaked lime," "dental," "oral," "periodontal," "inflammation," "submucous fibrosis," "carcinoma," and "cancer." The eligibility criteria included: human and experimental studies, use of control subjects, and articles published in English. Unpublished data were not sought. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed.

Twelve studies were included. Three studies associated gutka consumption with periodontal inflammation (ORs 1.64 [CI 1.2-2.1], 2.20 [CI 1.1-4.9], and 3.56 [CI 1.9-5.5]). Five studies showed a direct relationship between gutka usage and oral submucous fibrosis (ORs 1.65 [CI 1.2-2.3], 2.33 [CI 1.9-4.5], 2.98 [CI 1.5-3.9], 3.56 [CI 1.3-4.7], and 5.08 [CI 3.7-6.4]). An increased frequency of gutka usage was associated with malignant transformations in oral submucous fibrosis by 2 studies (ORs 4.59 [CI 2-5.6] and 18 [CI 5.8-61.6]). Two studies showed an extension of oral submucous fibrosis into the hypopharynx and esophagus in gutka users (ORs 4.59 [CI 2-5.6] and 33 [CI 2.2-46.6]).

Habitual gutka usage is associated with severe oral mucosal disorders, and the consequences may extend beyond the oral cavity.