University of Health Sciences Lahore

Title: Oral cytopathological changes in habitual wet snuff (naswar) dippers in Pakistan


Dr. Mohyman Sarfraz is a postgraduate student of M.Phil in Oral Pathology at University of Health Sciences Lahore, Pakistan and is working on his MPhil Research thesis titled 'Oral Cytopathological changes in Snuff Dippers''. Earlier, he acquired his Bachelors in Dental Surgery in 2008. He also worked as a lecturer in Punjab Medical College, Faisalabad, Pakistan.


Dipping tobacco, traditionally known as moist/wet snuff, is a type of finely ground or shredded, moistened smokeless tobacco product. The easy availability, low cost and lack of awareness of its negative impact on health increases its consumption. Snuff induced oral lesions including leukoplakia, snuff dippers keratosis, epithelial dysplasia and even carcinoma etc. occur at the site where snuff is usually placed. This study was therefore designed to observe and record the cytopathological changes in the oral cavity in habitual wet snuff users. Oral smearswere prepared from n=100male patients takingwet snuff for at least 1 year and having clinically detectable oral lesions. Smears were examined microscopically using H&E,Giemsa, Papanicolaouand PAS stains. Cases were grouped according to age[<30 years (43%) and >30 years(57%)], dose of snuff taken [mild (16%), moderate (45%) and heavy (39%)] and duration of usage [<5 years (54%), 5-10 years (41%) and >10 years(5%)]. Mean age was 42.51± 13.8 years. Oral lesions were present in 73% cases with snuff dippers keratosis seen in all (100%) followed by erythroplakia (73%), gingivitis (62%), chronic periodontitis (35%), white plaque (31%), oral pigmentation andmucositis(12% each). On cytological examination, inflammationwas observed in42% (41% acute, 1% chronic) smears, nuclear atypia in 37%,micronuclei in 30%, Candidiasis in 14%and dysplastic changes in 4% (all grade 1) smears. With the increasing age(<30 years vs > 30 years), increased frequency of these cytological changes, particularly nuclear atypia (48.6% vs 51.4%) and dysplasia(25% vs 75%) was found. When clinic-cytological variables were compared, nuclear atypiawas significantly associated with the dose of snuff (p=0.000), duration of snuff usage (p=0.001), periodontitis (p=0.032) and micronuclei (p=0.012). Similarly, a significant association between dysplasia and dose of snuff (p=0.021), white plaque (p=0.008) and inflammation (p=0.026) was observed. Most of the habitual dipping tobacco users in our country are unaware of the implications of oral manifestations including the dysplastic ones occurring because of this addiction. Routine screening and early detection of such mucosal changes will improve the clinical outcome.Also there is a dire need to draft and enforce national policy and regulations for snuff usage and its manufacturing creating provisions of adequately tested material.

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