title: Oral mucosal disorders associated with habitual gutka usage: a review.
abstract: 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 Unpublished data were not sought.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.
authors.affiliation: Division of Research, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden. fawjav@gmail.com
authors.forename: Fawad
authors.initials: F
authors.lastname: Javed
authors.forename: Milisha
authors.initials: M
authors.lastname: Chotai
authors.forename: Abid
authors.initials: A
authors.lastname: Mehmood
authors.forename: Khalid
authors.initials: K
authors.lastname: Almas
mesh_terms: D000045:Acacia / Q000009:adverse effects; D001114:Areca / Q000009:adverse effects*; D002126:Calcium Hydroxide / Q000009:adverse effects; D045424:Complex Mixtures; D006801:Humans; D009059:Mouth Diseases / Q000139:chemically induced*; D009061:Mouth Mucosa / Q000187:drug effects* / Q000473:pathology; D009062:Mouth Neoplasms / Q000139:chemically induced / Q000473:pathology; D009914:Oral Submucous Fibrosis / Q000139:chemically induced / Q000473:pathology; D010518:Periodontitis / Q000139:chemically induced / Q000473:pathology; D019966:Substance-Related Disorders / Q000473:pathology*; D014030:Tobacco, Smokeless / Q000009:adverse effects*
chemical_list: D045424:Complex Mixtures; D002126:Calcium Hydroxide