title: Association Between Grading of Oral Submucous Fibrosis With Frequency and Consumption of Areca Nut and Its Derivatives in a Wide Age Group: A Multi-centric Cross Sectional Study From Karachi, Pakistan.
abstract: BACKGROUND
  Oral submucous fibrosis (OSMF) is a chronic, premalignant condition of the oral mucosa and one of the commonest potentially malignant disorders amongst the Asian population. The objective of this study was to investigate the association of etiologic factors with: age, frequency, duration of consumption of areca nut and its derivatives, and the severity of clinical manifestations.
  
  
  METHODS
  A cross-sectional, multi centric study was conducted over 8 years on clinically diagnosed OSMF cases (n = 765) from both public and private tertiary care centers. Sample size was determined by World Health Organization sample size calculator. Consumption of areca nut in different forms, frequency of daily usage, years of chewing, degree of mouth opening and duration of the condition were recorded. Level of significance was kept at P ≤ 0.05.
  
  
  RESULTS
  A total of 765 patients of OSMF were examined, of whom 396 (51.8%) were male and 369 (48.2%) female with a mean age of 29.17 years. Mild OSMF was seen in 61 cases (8.0%), moderate OSMF in 353 (46.1%) and severe OSMF in 417 (54.5%) subjects. Areca nut and other derivatives were most frequently consumed and showed significant risk in the severity of OSMF (P ≤ 0.0001). Age of the sample and duration of chewing years were also significant (P = 0.012).
  
  
  CONCLUSIONS
  The relative risk of OSMF increased with duration and frequency of areca nut consumption especially from an early age of onset.
authors.affiliation: Department of Oral and Maxillo-Facial Surgery, Ziauddin College of Dentistry, Ziauddin University, Karachi, Pakistan.
authors.forename: Mervyn
authors.initials: M
authors.lastname: Hosein
authors.affiliation: Department of Oral and Maxillo-Facial Surgery, Ziauddin College of Dentistry, Ziauddin University, Karachi, Pakistan.
authors.forename: Sidra
authors.initials: S
authors.lastname: Mohiuddin
authors.affiliation: Department of Oral and Maxillo-Facial Surgery, Ziauddin College of Dentistry, Ziauddin University, Karachi, Pakistan.
authors.forename: Nazish
authors.initials: N
authors.lastname: Fatima
keywords: Areca nut; Betel quid; Clinical grading; Oral submucous fibrosis