Discussion
This cross-sectional study has been done to narrate the association between diferent forms of sodiumcarbonate ie freshly mixed and premixed form used in snuff and oral mucosal lesions among the snuff users in Jammu region. This study includes stratified samples of 284 constructing workers using snuff at various construction sites and slums in Jammu.
The present study indicates high prevalance of oral-mucosal lesions among snuff users with addition of sodium carbonate both in freshly mixed aswell as in pre-mixed form.
The results of the present study reveals highly significant relationship between snuff users using sodium carbonate(0.001**) in freshly mixed form than that of premixed (0.030*)form. It is due to reason that there is rise in pH and hence more absorption of nicotene due to addition of sodium carbonate in freshly mixed form than that of premixed form packed in pouches or sachets .
The degree of oral lesions is positively correlated with age, frequency, duration of snuff use in studies conducted by Hirsch et al 198211, Mornstad et 1989,12 Anderson et al 1991.13 Moist snuff use may be associated with adverse oral lesions. It has been
seen in our study that use of moist snuff is significantly responsible for causing mucosal changes. Numerous other studies have observed that snus use is associated with a characteristic reaction in the oral mucosa (e.g., Axéll 1976)14,Andersson and Axéll 1989,15 Larsson et al. 1991,16 Mornstad et al. 1989,12 Rolandsson et al. 200617). This type of lesion has been referred to by various names, including snuff dipper’s lesion, snuff-induced leukoplakia, or snus-induced lesions. The lesion generally appears at the location in the mouth where the snus is held. The prevalence of this condition varies widely, and appears to be related to characteristics of the user (such as age, salivary pH, patterns of tobacco use) and characteristics of the product (nicotine content, loose vs. portion bag, etc.). In addition the degree of lesions seems to increase
with increasing pH as well as increasing nicotine concentration according to Mornstad et al 1989,12 Anderson et al .13 The snuff leads to rise in pH to about 8-9 thereby facilitating nicotine absorption by oral mucosa causing local reactions in gingival tissues on exposing to snuff leading to mucosal changes and oral lesions.18 Study conducted by by Mavropoulos has shown that there is rise in blood flow in the gingiva and oral mucosa after nicotine absorption.19 Alpar et al 1998 has demonstrated in his study that there is decrease in oralfibroblasts on exposure to nicotine.20
The conclusion that can be made from results of the present study dipicts a positive correlation between sodium carbonate in snuff and oral mucosal lesions .
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