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Year : 2010  |  Volume : 47  |  Issue : 4  |  Page : 470-

Gutka syndrome and oral submucous fibrosis: Few observations

LP Madathil, PS Rao 
 Department of Oral Pathology and Microbiology, ABSM Institute of Dental Sciences, Nitte University, Dearalakatte, Mangalore - 575 018, Karnataka, India

Correspondence Address:
L P Madathil
Department of Oral Pathology and Microbiology, ABSM Institute of Dental Sciences, Nitte University, Dearalakatte, Mangalore - 575 018, Karnataka

How to cite this article:
Madathil L P, Rao P S. Gutka syndrome and oral submucous fibrosis: Few observations.Indian J Cancer 2010;47:470-470

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Madathil L P, Rao P S. Gutka syndrome and oral submucous fibrosis: Few observations. Indian J Cancer [serial online] 2010 [cited 2020 Jul 3 ];47:470-470
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In response to the article by Chaturvedi in the Indian Journal of Cancer, [1] we wish to make a few observations.

The proposed new terminology of gutka or areca nut chewer's syndrome to the already existing well-known premalignant condition-oral submucous fibrosis (OSF)-is interesting as a synonym. It is understood by the scientific community that areca nut and its various commercial preparations could lead to OSF, [2],[3] presenting as a wide clinical spectrum as narrated by the author. Traditionally, pan chewing is a habit, which was prevalent as a cultural or social habit over hundreds of years in different parts of the Indian subcontinent and Asian countries. [4] However, the newer commercial preparations, which are widely used by the younger age group and among certain occupational sectors, are alarming.

In a recent epidemiologic survey conducted by us (unpublished data) in Karnataka among the truck drivers to assess the oral health status, the following observations were made, which could be of interest in the present context. Among a study group of 260 truck drivers who participated, 187 (72%) observed to be using gutka preparations, 132 (50.76%) gutka and pan chewing, and 79 (30.38%) only pan chewing as a recreational habit. Two hundred and thirty-six (90.76%) of them were exclusively smokers (beedies or cigarettes). Gutka chewing is preferred over the conventional pan as there is no need of spitting, unlike the latter. Further, a wide spectrum of pathological manifestations (burning mouth, mucosal pallor or mucosal stiffness) were observed much earlier than (less than three years) in the conventional pan eaters, suggesting advancement of the pathological events.

A buried wisdom tooth [1] may not necessarily be a sequel to OSF as the incidence of impacted wisdom tooth among the Indian population is a common finding. In an OSF patient with partially or fully impacted wisdom tooth, the dense fibrous bands may hinder the eruptive process. Abnormal alignment of teeth [1] because of pan or gutka chewing may not be a feature of the condition, as the disease process has not shown to be causing such hard tissue changes in the supporting tissues of periodontium.

With gutka practice on a rise, especially with the younger generation an aggravated symptoms and increased incidence of OSF is on a rise. In milieu of these observations and impending cataclysm is a possibility, it is imperative that predictive assays are taken up to identify the premalignant status in these abusers. This will also help the medical fraternity with information for the need of counseling and medical intervention so that the productive population is not affected.We would like to congratulate the author for an excellent documentation of the clinical spectrum of oral changes associated with areca nut chewing or gutka chewing. Introduction of a newer terminology may not effectively change the management of OSF but will emphasize the role of the etiologic agent, which is a sleeping carcinogen in our society over many centuries.


1Chaturvedi P. Gutka or areca nut chewer's syndrome. Indian J Cancer 2009;38:170-2.
2Murti PR, Bhonsle RB, Gupta PC, Daftary DK, Pindborg JJ, Mehta FS. Etiology of oral submucous fibrosis with special reference to the role of areca nut -chewing. J Oral Pathol Med 1995;24:142-52.
3Caniff JP, Harvey W. The etiology of oral submucous fibrosis. The stimulation of collagen synthesis by extracts of areca nut. Int J Oral Surg 1981;10:163-7.
4Gupta PC, Sinor PN, Bhonsle RB, Pawar VS, Mehta HC. Oral submucous fibrosis in India: A new epidemic? Natl Med J India 1998;11:113-6.