Original Article

Prevalence of oral potentially malignant

disorders (OPMD) in adults of Western
Maharashtra, India: A cross‑sectional
K. M.
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Shivakumar,
Vaishali Raje1,
hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 04/26/2023

study Vidya Kadashetti

Departments of Public
Health Dentistry
ABSTRACT & Oral Pathology
and Microbiology,
Background: Oral cavity cancer is estimated to be the third most common malignancy after cancer of cervix and stomach in Faculty of Dental
developing countries. Sciences, Krishna
Institute of Medical
Objectives: The objective of this study is to investigate the relationship between smoking, alcoholic consumption, betel quid chewing, Sciences Deemed
and OPMD in a prospective manner. to be University,
Materials and Methods: A descriptive, cross‑sectional study was conducted among 35–55‑year‑old adults of Western Maharashtra,
1
Department of
Community Medicine,
India. Oral cavity examination as recommended by the American Dental Association specification was followed. Data recorded were
Krishna Institute of
transferred from precoded survey pro forma to the computer. The prevalence of OPMD was assessed by determining the percentage Medical Sciences,
of the study population affected. Analysis was done to find out the risk of oral premalignant disorders. The Chi‑square (x2) test and Krishna Institute of
adjusted odds ratio (ORs) with 95% confidence interval (CI) were calculated. The Statistical Package for the Social Sciences (SPSS) Medical Sciences
software version 21.0 was used for the statistical analysis and significance level was set at P < 0.05. Deemed to be
University, Malkapur,
Results: Odds of having OPMD are five times higher for those who smoke (OR = 5.78; 95% CI, [6.18, 7.82]) as compared to Karad, Maharashtra,
those who do not. The odds of suffering from OPMD are about five times higher among those who chew as compared to those who India
do not (OR = 4.98; 95%CI, [2.91, 7.28]). The mean frequency of tobacco chewing per day and duration in years in participants
For correspondence:
with OPMDs was significantly higher as compared with normal oral mucosa (P < 0.05 and P < 0.05), respectively, in the use of
Dr. Vaishali Raje,
different tobacco forms. Professor, Department
Conclusion: These findings can be used to design case control or cohort studies to further understand the relation between habits of Community
and OPMD. Medicine, Krishna
Institute of Medical
Sciences, Krishna
Institute of Medical
KEY WORDS: Oral cancer, oral premalignant disorders (OPMDs), smoking, tobacco chewing
Sciences Deemed to be
University, Malkapur,
Karad ‑ 415 110,
INTRODUCTION sinus – two‑thirds of these occur in developing Satara (Dist.),
Maharashtra, India.
countries.[2‑5] Oral cancer has also been one of the
E‑mail: vaishalinala
Oral cancer is an important component of the top ten causes of death from cancer since 1991 in wade@yahoo.com
worldwide burden of cancer and is eighth most Taiwan and the death toll for oral cancer in males
common cancer worldwide. It is a major global has been rising at a surprising rate.[6] It is often Submitted: 30-Sep-2020
health issue. Oral cavity cancer is estimated to be preceded by “potentially malignant lesions and Revised: 06-Jan-2021
the third most common malignancy after cancer conditions.”[2,7] A recent workshop conducted by Accepted: 12-Jan-2021
of the cervix and stomach in the developing the WHO Collaborating Center for Oral Cancer and Published: 25-Oct-2021
countries. It is the 12th most common cancer Precancer in London has recommended the term
in females and sixth most common cancer in oral potentially malignant disorders (OPMD).[2] In
males.[1] The oral and pharyngeal cancer is the Access this article online

6th most common cancer in the world, with an
annual global estimated incidence of 275,000
for oral and 130,300 for pharyngeal cancers in
2002, excluding salivary neoplasms, malignant
neoplasms of the nasopharynx, and of the pyriform
This is an open access journal, and articles are distributed under the terms of the Website: www.cancerjournal.net
Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which DOI: 10.4103/jcrt.JCRT_1444_20
allows others to remix, tweak, and build upon the work non‑commercially, as
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For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com

Cite this article as: Shivakumar KM, Raje V, Kadashetti V. Prevalence of oral potentially malignant disorders (OPMD) in
adults of Western Maharashtra, India: A cross-sectional study. J Can Res Ther 2022;18:S239-43.

© 2021 Journal of Cancer Research and Therapeutics | Published by Wolters Kluwer - Medknow S239
 Shivakumar, et al.: Prevalence of oral potentially malignant disorders (OPMD)
2005, the WHO recommended and proposed to use the term
“Oral Potentially Malignant Disorders” (OPMDs), which is
defined as “the risk of malignancy being present in a lesion or
condition either at the time of initial diagnosis or at a future
date.”[8] The most common OPMDs with malignant potential
include erythroplakia, oral leukoplakia, oral lichen planus, and
oral submucous fibrosis.[1,8‑10]
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The global prevalence of OPMD is reported to be between 1%
hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 04/26/2023
and 5%. A high prevalence of OPMD is reported from South
and East Asia with male preponderance and with malignant
transformation rates of over 2% per year.[2] The incidence of
cancer in the head‑and‑neck region accounts for 30%–40% of
all malignant tumors in India.[11,12] The prevalence of OPMDs
and their malignant transformation rates varies globally.
The main risk factors for OPMDs include tobacco use, alcohol
use, and human papillomavirus infection.[5] Chewing of
tobacco, smoking, and consumption of alcoholic beverages
have become common social habits in India. The prevalence
of regular use of alcohol is 4.5% and smoking tobacco is
16.2%. The risk factors which synergistically contribute to
potential for malignant transformation include smoking,
drinking alcohol, and chewing of tobacco which leads to
OPMD.[10,13] In India, 60%–80% of patients present with
advanced stages of the disease as compared to 40% in
developed countries.[7] Although OPMD can give rise to oral
cancer, the rate of malignant transformation varies with the
quantity and duration of tobacco and alcohol use. Therefore,
this study aimed to investigate the relationship between
smoking, alcoholic consumption, and betel quid chewing
on OPMD and its effects in the development of oral cancer.
MATERIALS AND METHODS
A descriptive, cross‑sectional study was conducted among
35–55‑year‑old adults of Western Maharashtra, India. This
study was conducted over a period of 1 year from March
2019 to February 2020. These participants were considered
as a target population for the study. An ethical approval
(Ref No. KIMSDU/IEC/01/2018, dated 01/02/2018) was obtained
from the Institutional Ethics Committee of Krishna Institute of
Medical Sciences Deemed to be University, Karad, Maharashtra,
India. A pilot study was carried out on 50 adults to determine
the feasibility of the study. The study participants were selected
by using simple random sampling procedures (lottery method),
which was followed by house‑to‑house survey.
Sample size determination
After the pilot study, the prevalence of OPMD was found to
be 5% and the sample size (n) was determined by using the
following formula:
Z 2 pq
n=
d2
Where, Z: Standard variate at 95% confidence level
S240
p: Prevalence
q: Proportion of the population not having this characteristics.
d: Allowable error = 5% of “p”
The sample size was found to be 300. Those participants
who are not willing to participate were excluded from the
study. A total of 300 adults in the age group of 35–55 years
were examined for the study. The purpose of the study was
explained in their local language (Marathi) to all the study
participants, and an informed consent was obtained. First
house was selected in the village by using simple random
sampling procedures (lottery method), which was followed
by house‑to‑house survey till we achieve estimated sample
size. The recruited study participants were given structured
questionnaire, which contains the general information and
questions regarding the use of tobacco and any other habits
along with details of diet pattern and examination for oral
premalignant disorders. Oral cavity examination was done
for the presence or absence of OPMD in the oral cavity.
A single examiner carried out the examination, and the
same was calibrated. Conventional oral examination using
normal light is used to check for the presence or absence of
oral premalignant disorders based on their clinical features.
The cases which required further investigation were referred
to the hospital for further diagnosis and treatment.
Examination procedure, examination area, and lighting
Type‑III clinical examination as recommended by American
Dental Association specification was followed. The clinical
examination was carried out under the adequate natural
light in school premises or corridors. Sufficient numbers of
instruments were carried to the examination place to avoid the
interruption during the study. After each day of examination,
the entire instruments were autoclaved.
The data recorded were transferred from the precoded survey
pro forma to a computer. The statistical average mean,
standard deviation was employed to represent the different
measurements. The prevalence of OPMD was assessed by
determining the percentage of study population affected.
The collected data were entered in Microsoft Excel sheet and
subjected to the statistical analysis.
The analysis was done to find out the risk of oral premalignant
disorders. The Chi‑square (x 2) test and adjusted odds
ratio (ORs) with 95% confidence interval (CI) was calculated.
The Statistical Package for the Social Sciences (SPSS) software
version 21.0 (version 21.0, Inc., and Chicago, IL, USA) was used
for the statistical analysis, and the significance level was set
at P < 0.05.
RESULTS
Table 1 shows the distribution of study participants by
Journal of Cancer Research and Therapeutics - Volume 18 - Supplement Issue 2 - 2022
 Shivakumar, et al.: Prevalence of oral potentially malignant disorders (OPMD)

basic characteristics. The mean age of the participants was
42.55 ± 10.28 years. There were more males (67.74%) in
the study population than females (32.26%). 48.39% of the
study participants were in the age group of 35–45 years,
51.61% were in the age group of 46–55 years, and there was
statistically significant difference has been observed among
these gender. About 12.54% of the participants were either
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smoking, drinking alcoholic beverages, and chewing tobacco
was 19.26%, 15.19%, and 20.86%, respectively. The prevalence
of smoking was higher among men (69.58%) when compared
to women (0.28%). Furthermore, the prevalence of smoking
is the highest among the age group of 35–45 (56.9%) years,
higher being in the age group of 46–55 years (43.1%). More
than 6 out of 10 smokers use unfiltered cigarettes, as compared

degree or diploma holders, and remaining participants have to the other types, namely filtered cigarette and beedi. In this
had only school education or were illiterates. Significant population, alcohol consumption was more common among
hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 04/26/2023

difference has been noticed among the education of the study
participants. More than 54.49% of the study participants came
from families with monthly income between Rs. 4556 and Rs.
7593 per month, whereas <9.68% belonged to families with
income <Rs. 4555 per month.
Table 2 shows the overall prevalence of oral premalignant
disorders. Oral submucous fibrosis (0.82%), lichen
planus (0.11%), leukoplakia (0.75%), erythroplakia (0.1%),
discoid lupus erythematosus (0%), epidermolysis bullosa (0.2%),
smokeless tobacco keratosis (0.9%), smoker’s melanosis (0.5%),
and chewer’s mucositis (0.75%) were found in our study.
Table 3 shows the comparison of frequency and duration
of tobacco, alcohol, and betel quid usage with respect to
the OPMD. The odds of having OPMD are five times higher
for those who smoke (OR = 5.78; 95% CI, [6.18, 7.82]) as
compared to those who do not. The odds of suffering from
OPMD are about five times higher among those who chew
as compared to those who do not (OR = 4.98; 95% CI, [2.91,
7.28]). The consumption of alcoholic beverages alone is not
significantly associated with the OPMD, i.e., prevalence of
OPMD did not differ between those who consumed alcoholic
beverages and those who did not. The overall prevalence of
men (19.3%) when compared to women (0.19%), with the
prevalence being the highest (15.4%) in the age group of 45–55.
The brandy, beer, desi daru, and whisky were more prevalent
when compared to alcoholic beverages consumed in the study
group, namely vodka, wine, and rum. The chewing habit was
more prevalent in men (31.6%) as compared to women (13.8%).
In women, the chewing habit was more prevalent when
compared to the other two habits; wherein, in men it was the
smoking habit that was more prevalent. The study participants
were more likely to chew pan masala (commercially available
product) or Gutkha, (71%) as compared to other products,
namely betel quid, betel leaf with areca nut and lime, and
unprocessed and processed areca nut alone.
Table 4 shows the effects of different predictor variables on
the prevalence of OPMD. The mean frequency of tobacco
consumption per day and duration in years in participants with
OPMDs was significantly higher as compared to with normal
oral mucosa (P < 0.05 and P < 0.05), respectively, in the use
of different tobacco forms. The mean number of years of betel
quid consumption was 7.29 ± 7.96 in participants with OPMDs
which was significantly higher as compared to 5.82 ± 3.83 in
participants with normal oral mucosa (P < 0.05). The mean
mL of alcohol consumption per day was in participants with

Table 1: Comparison of sociodemographic characteristics of the study population in relation to oral premalignant disorders
Sociodemographic characteristics Oral premalignant disorders P
Normal (n=279; 93%) OPMD (n=21; 7%)
Age (years)
35‑45 135 (48.39) 9 (42.85) 0.725
46‑55 144 (51.61) 12 (57.15)
Gender
Male 189 (67.74) 19 (90.48) <0.05
Female 90 (32.26) 2 (9.52)
Religion
Hindu 173 (62.00) 12 (57.14) <0.05
Muslim 73 (26.16) 6 (28.57)
Parsi 0 0
Christian 21 (7.54) 2 (9.52)
Others 12 (4.30) 1 (4.76)
Education
Illiterate 55 (19.71) 7 (33.33) <0.05
Primary 41 (14.70) 6 (28.58)
Middle school 87 (31.20) 5 (23.80)
≥High school 61 (21.86) 2 (9.52)
Graduate 35 (12.54) 1 (4.76)
Income (INR) (modified Kuppuswamys SES scale, 2012)
1521‑4555 27 (9.68) 9 (42.86) 0.648
4556‑7593 152 (54.49) 7 (33.33)
7597‑11,361 68 (24.37) 5 (23.81)
P<0.05 (S), P>0.05 (NS). OPMD=Oral premalignant disorders, INR=Indian rupees, S=Significant, NS=Not significant

Journal of Cancer Research and Therapeutics - Volume 18 - Supplement Issue 2 - 2022 S241
 Shivakumar, et al.: Prevalence of oral potentially malignant disorders (OPMD)

Table 2: Overall prevalence of oral premalignant disorders survey sample. However, the prevalence of chewing (20.86%)
Type Total prevalence (%) and smoking (19.26%) was found to be lower. Smoking and
Oral submucous fibrosis 0.82 chewing were the significant predictors of OPMD in our study
Lichen planus 0.11 population. However, the association between the presence
Leukoplakia 0.75 of OPMD and alcohol consumption was not statistically
Erythroplakia 0.1
Discoid lupus erythematosus 0 significant.
Epidermolysis bullosa 0.2
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Smokeless tobacco keratosis 0.9 In our study, it shows that smoking is more prevalent in men
Smoker’s melanosis 0.5 when compared to the other two habits of tobacco use. The
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Chewer’s mucositis 0.75

findings from the our study are in concordance to that of
Hashibe et al.,[17] with regard to chewing and smoking habit
Table 3: Comparison of frequency and duration of tobacco, being the significant predictors of OPMD. The consumption
alcohol, and betel quid usage with respect to the oral
premalignant disorders
of alcohol beverages (any amount) does not prove to be a
significant predictor as found in the studies by Hashibe et al.
Types of habit Oral mucosa, mean±SD P
and Gupta et al.[17,18]
Normal (n=279) OPMD (n=21)
Tobacco form The health‑care workers must be encouraged to perform oral
Mean number of years 1.75±1.29 7.31±6.94 <0.01 (S)
cancer examinations as part of their patient care program and
Frequency per day 1.56±1.51 4.92±4.02 <0.01 (S)
Betel quid to have knowledge about the early signs of oral cancer and
Mean number of years 5.82±4.97 7.29±7.96 <0.07 premalignant disorders. The need for continuing educational
Frequency per day 3.83±3.59 6.57±5.79 <0.128 campaigns at various levels to educate the public about the risk
Alcohol
mL/day 35.00±20.19 70.00±26.67 <0.001
factors and early signs/symptoms should be highlighted.[12,14]
Mean number of years 5.21±5.58 6.98±4.68 <0.001
P<0.05 (S), P>0.05 (NS). S=Significant, NS=Not significant, SD: Standard Workplace screening programs for the detection of oral
deviation, OPMD=Oral premalignant disorders malignant and premalignant disorders in these age groups are
suitable and cost‑effective alternative measure and effective
Table 4: Effects of different predictor variables on the utilization of existing infrastructure and workforce through
prevalence of oral premalignant disorders
the involvement of medical and dental hospital in the areas
Characteristics OR (95% CI) can also help in screening and early diagnosis.[7]
Chewing
Nonchewer 1.0
Chewer 4.98 (2.91‑7.28)
CONCLUSION
Smoking
Nonsmoker 1.0 The findings from this study can be used to design case control
Smoker 5.78 (6.18‑7.82) or cohort studies to further understand the relation between
Alcohol drinking
Nonalchohol drinker 1.0 habits and OPMD. Studies of this nature could population
Alcohol drinker 3.02 (0.87‑3.15) and which would be most beneficial for providing better oral
OR=Odds ratio, CI=Confidence interval hygiene programs. Programs to improve oral health should
be conducted regularly to promote oral health care in the
OPMDs was significantly higher as compared in participants population. Workplace should be promoted to ban the use and
with normal oral mucosa (P < 0.001 and P < 0.001), sale of tobacco‑related products which would decrease the
respectively. usage of the product and overall might reduce the prevalence
of disease and its severity of the oral premalignant disorders.
DISCUSSION
Financial support and sponsorship
In our study, we have analyzed the risk factors in estimating Nil.
the prevalence of an OPMD and in identifying the high‑risk
category population in the development of oral cancer. In Conflicts of interest
our sample, the prevalence of oral lesions was 7%, with There are no conflicts of interest.
the prevalence being greater for males than females. The
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