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Table 6 Prevalence of oral mucosal lesions in relation to ST use – evidence from the USA

From: Systematic review of the relation between smokeless tobacco and non-neoplastic oral diseases in Europe and the United States

   

% prevalence (n)a

 

Study

Endpointb

Exposurec

Exposed

Unexposed

Statistical tests and other results and commentsd

Experimental studies

Grasser 1977 [21]

Oral leukoplakia

ST ever

13.3 (4)

0.5 (1)

OR 28.2 (3.03–262)

     

Lesions in users resolved after 10 days quit

Payne 1988 [22]

Greer 1–3

Snuff current

100.0 (16)e

-

After switching site of snuff placement and to reference snuff, all 16 subjects had new lesions after 7 days of use, evident in 15 subjects by day 2. After 7 days, the original lesions at the habitual sites had resolved by 1 degree

Martin 1999 [23]

Oral leukoplakia

ST current

39.4 (119)

1.5 (42)f

OR 41.9 (28.6–61.4)

  

Snuff current

41.8 (118)

1.5 (42)f

OR 46.4 (31.5–68.2)

  

CT current

5.0 (1)

1.5 (42)f

OR 3.39 (0.44–25.9)

     

Lesion had completely resolved in 97.2% (106/109) of ST users 6 weeks after tobacco use was prohibited

Case-control studies

   

Cases

Controls

 

Fisher 2005 [26]

Oral leukoplakia

ST current

22.5

7.2

OR 9.21 (1.49–57.0)g

  

ST former

25.7

12.3

OR 2.73 (0.69–10.8)g

  

Snuff current

19.0

2.7

OR 30.1 (2.67–338)g

  

Snuff former

11.1

6.6

OR 0.98 (0.17–5.61)g

  

CT current

4.2

4.3

OR 0.97 (0.19–4.98)

  

CT former

20.0

12.0

OR 1.83 (0.76–4.40)

Cross-sectional studies of populations unselected by ST use

   

Exposed

Unexposed

 

Greer 1983 [27]

Greer 1–3

ST use

42.7 (50)

-

Only ST users examined

Poulson 1984 [28]

Greer 1–3

ST use

58.9 (33)

-

Only ST users examined

Offenbacher 1985 [29]

Oral mucosal pathology

ST use

22.7 (17)

4.7 (23)

OR 5.95 (3.00–11.8)

Wolfe 1987 [30]

Greer 1–3

ST currenth

25.5 (37)

3.7 (3)f

OR 8.91 (2.65–29.9)

Creath 1988 [32]

Oral leukoplakia

Snuff ever

5.2 (15)

0.1 (1)

OR 38.6 (5.07–294)

Cummings 1989 [31]

Soft tissue lesion

ST current

17.6 (3)

0.0 (0)

Only 6 never users of ST No differences significant

  

ST former

100.0 (2)

0.0 (0)

 
  

Snuff current

21.4 (3)

0.0 (0)

 
  

CT current

11.1 (1)

0.0 (0)

 

Stewart 1989 [33]

Greer 1–3

ST current

29.0 (9)

-

Prevalence only reported for male current users

Ernster 1990 [34]

Oral leukoplakia

ST current

46.3 (196)

1.4 (7)

OR 59.9 (27.8–129)

  

ST formerj

1.7 (3)

1.4 (7)

OR 1.19 (0.30–4.65)

  

Snuff currentk

58.3 (165)

1.4 (7)

OR 97.1 (44.4–212)

  

CT currentk

17.7 (14)

1.4 (7)

OR 15.0 (5.82–38.4)

Greene 1992 [35]

Oral leukoplakia

ST current

51.7 (167)

2.9

OR 35.8i

  

ST formerj

3.5

2.9

OR 1.21i

  

Snuff currentk

61.3 (157)

2.9

OR 53.0i

  

CT currentk

14.8 (8)

2.9

OR 5.82i

Sinusas 1992 [36]

Greer 1–3

ST current

37.1 (23)

6.0 (5)

OR 9.32 (3.29–26.4)

  

ST formerl

6.7 (4)

6.0 (5)

OR 1.13 (0.29–4.39)

  

Snuff currentk

34.2 (13)

6.0 (5)

OR 8.22 (2.67–25.3)

  

CT currentk

16.7 (4)

6.0 (5)

OR 3.16 (0.78–12.9)

Daughety 1994 [37]

Oral lesions at placement site

ST current

33.0 (45)

-

Only ST users asked about oral lesions

  

Snuff current

43.9 (25)

-

 

Robertson 1997 [38]

Oral leukoplakia

ST current

≈50

< 2

Approximate estimates based on 1846 baseball players in various studies

  

ST former

< 2

< 2

 

Tomar 1997 [39]

ST lesions

Snuff current

34.9 (107)m

1.9 (102)m

OR 18.4 (8.5–39.8)n

  

Snuff former

5.6 (18)m

1.9 (102)m

OR 2.4 (1.0–6.1)n

  

CT current

19.6 (54)m

3.0 (156)m

OR 2.5 (1.3–5.0)o

  

CT former

6.0 (32)m

3.0 (156)m

OR 1.3 (0.7–2.2)o

Shulman 2004 [42]

Oral mucosal lesions

ST currentp

60.3 (224)

23.8 (1939)

OR 3.90 (2.75–5.55)q

  

ST formerp

12.8 (23)

23.8 (1939)

OR 0.53 (0.25–1.13)q

Sinusas 2006 [44]

Greer 1–3

ST current

27.9–46.3r

4.0

p < 0.001

  

ST former

9.5

4.0

p < 0.001

Cross-sectional studies of populations selected by ST use and/or presence of oral lesions

Smith 1970 [45]

Oral mucous membrane change

Snuff current

11.7 (1751)

-

Only snuff users examined

Christen 1979 [46]

Clinical leukoplakia

ST current

64.3 (9)

-

Only ST users examined

  

Snuff current

69.2 (9)

-

 
  

CT current

57.1 (4)

-

 

Kaugars 1992 [47]

Oral lesions

ST currents

13.0 (45)

-

Only ST users examined

  

Snuff currents

14.4 (34)

-

 
  

CT currents

8.4 (18)

-

 

Little 1992 [48]

Greer 1–3

ST current

78.8 (193)

6.3 (14)t

OR 55.4 (29.8–103)

Roberts 1997 [49]

Oral lesion

Snuff current

31.8 (7)

-

Only snuff users examined

  1. a n = number of subjects with endpoint
  2. b See Table 5 for further definition of endpoint
  3. c Where possible exposure is classified as "current" or "former" with exposure given as "use" only where the source paper did not clearly distinguish how former users were considered. The corresponding non-exposure is "never" or "non-use" to the same type of ST, except where indicated
  4. d ORs are unadjusted for potential confounding variables, except where stated. Where necessary ORs and 95% CIs are calculated from the data provided in the source paper
  5. e Subjects selected to have a lesion at site of snuff placement
  6. f Unexposed group is non-current ST
  7. g Adjusted for age, sex, smoking, alcohol, dental prostheses
  8. h Within the last 7 months
  9. i Numbers of never and former users not available so CI cannot be calculated
  10. j Former includes current in last month but not in last week
  11. k Product usually used
  12. l Former includes those who only used ST in baseball season (study conducted out of season)
  13. m Percentages are based on weighted data; numbers of cases are approximate, calculated by multiplying sample size by weighted percentage
  14. n Adjusted for age, cigarettes, alcohol and CT
  15. o Adjusted for age, cigarettes, alcohol and snuff
  16. p Analyses compare ST users who do not smoke with never users of any tobacco
  17. q Adjusted for age, sex, race and denture use
  18. r Prevalence in current users given only as range over the course of the 10 year study
  19. s Within the past 12 months
  20. t Comparison is with non ST users
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BMC Oral Health

ISSN: 1472-6831

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