Cellular Morphological Changes on Oral Mucosa Among Patients Presenting in to the Dental Clinics in Two Narok County Referal Hospitals

Abstract

Cytological effects of chewing tobacco have been documented in India, Europe and North America. Use of cytology to investigate changes in cellular morphology associated with chewing tobacco has not been done in Kenya. This study utilized brush cytology for diagnosis of inflammatory, pre-malignant, malignant and other associated pathological conditions among the people who chew tobacco presenting at two Narok County level 4 hospitals. Objectives: To describe clinical and cytological changes in the oral mucosa of patients who chew tobacco in two Narok County level 4 hospitals namely Kilgoris and Narok. Setting: Recruitment was done in two level 4 hospitals Dental clinics with assistance from the county dentists and dental assistants. Half of the participants were recruited in Kilgoris and the other half in Narok. Subjects: One hundred patients with a history of chewing tobacco for more than six years were recruited in total after consenting. Design and Methodology: This study was a cross sectional descriptive study that in two level four hospitals in Narok county over a period of 6 months (March –September 2016) among Patients presenting to two Narok County level 4 hospitals who were oral tobacco users. Cytobrush procedure was used to collect cellular material from the oral cavity of patients presenting to the dental clinics. Once the sample was taken, it was gently rolled on three microscope slides to make an imprint. Two slides were immediately fixed by immersion in 95% ethanol and stained with Pap stain and H&E. The third slide was air-dried and stained with a Romanowsky stain. After staining in KNH/UON cytology laboratory slides were examined by the principle investigator and two pathologists who are the supervising pathologists to the principal investigator. Face to face interview was used to collect the demographic data as well as risk factors for oral mucosa diseases. Data management and statistical analysis Frequency and percentages were used to describe the patterns of oral mucosa cytology including the occurrence of neoplastic lesions that were reported. Statistical analysis was done using STATA VERSION12 RESULTS: Most of the participants were male (76%). Majority were negative (95%) for oral mucosa neoplasia and (5%) had atypical squamous cells of undetermined significance. 9% had bacterial infection and 20% had Candida probably due to poor oral hygiene and tobacco chewing x or sharing. The duration of chewing tobacco among the subjects ranged from 6-65 years. The longer duration of chewing did not have significant association with oral lesions. Conclusion: Candida and Bacterial infections were the most common cytological findings among the tobacco chewers in Narok County. Oral mucosal neoplasia was least observed even among the elderly who were oral tobacco users for more than 40 years. Analysis of association of risk factors was performed and found not to be significant. Recommendations. 1.0 Most of the findings could be attributed to poor oral hygiene of oral mucosa during the chewing processes. As a county health committee could educate the residents 2.0 The physical observation of Leukoplakia needs to be looked at to avoid development to full term neoplasia. 3.0 Candida and bacterial infections are the most common findings among the 100 subjects. This could be attributed to poor oral hygiene, mechanical biting during the chewing process as this could requires public education.