Oral mucosal disorders associated with habitual gutka usage: a review

Objective. The aim of this study was to investigate the oral mucosal disorders associated with habitual gutka consumption. Methods. 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 Unpublished data were not sought.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. Results. 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]). Conclusions. Habitual gutka usage is associated with severe oral mucosal disorders, and the consequences may extend beyond the oral cavity. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 857-864)