title: Estimation and Comparison of Copper Content in Raw Areca Nuts and Commercial Areca Nut Products: Implications in Increasing Prevalence of Oral Submucous Fibrosis (OSMF).
abstract: BACKGROUND
  Oral Squamous cell carcinoma (OSCC) is often preceded by potentially malignant disorders (PMDs) like oral submucous fibrosis (OSMF). The rate of transformation of OSMF to OSCC ranges from 3 to 19%. OSMF is etiologically related to chewing of areca nut (betel nut), a habit prevalent among the population groups in south-east Asia. Along with alkaloids, the high copper content in areca nut plays an important role in the pathogenesis of OSMF. The increased prevalence of OSMF in the last two decades or so corresponds with the increased processing and commercialization of areca nut products.
  
  
  OBJECTIVE
  The aim of the study was to estimate and compare the copper content of raw areca nuts in three different stages of maturity, and commercial areca nut products.
  
  
  METHODS
  Raw areca nut samples of three different maturities were obtained from four plantations in Sullia, Karnataka, India and commercial areca nut products were obtained from local shops in Chidambaram, Tamil Nadu, India. The samples were grounded and subjected to Atomic Absorption Spectrometry (AAS) for copper analysis.
  
  
  RESULTS
  There was statistically significant difference in copper content in raw areca nuts of all three maturities (p<0.05) and was highest in the exfoliated mature nuts. Importantly copper level was significantly higher in the commercial products compared to raw areca nuts of different degrees of maturity (p<0.05).
  
  
  CONCLUSIONS
  The copper levels in commercial products are significantly higher than that of raw areca nuts in all three stages of maturity. The increase in copper content on processing and post commercialization can be related to the increasing prevalence of OSMF.
authors.affiliation: Reader, Department of Oral Medicine and Radiology, Rajah Muthiah Dental College and Hospital , Annamalai University, Chidambaram, Tamil Nadu, India .
authors.forename: Philips
authors.initials: P
authors.lastname: Mathew
authors.affiliation: Professor and Head of the Department, Department of Oral Medicine and Radiology, Rajah Muthiah Dental College and Hospital , Annamalai University, Chidambaram, Tamil Nadu, India .
authors.forename: Ravi David
authors.initials: RD
authors.lastname: Austin
authors.affiliation: Senior Lecturer, Department of Oral Pathology and Microbiology, Mar Baselious Dental College and Hospital , Kothamangalam, Ernakulam, Kerala, India .
authors.forename: Soma Susan
authors.initials: SS
authors.lastname: Varghese
authors.affiliation: Reader, Department of Prosthodontics, KVG Dental College and Hospital , Sullia, Dakshina Kannada, Karnataka, India .
authors.lastname: Manojkumar
keywords: Absorption Spectrometry (AAS); Areca nut; Oral submucous fibrosis