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2014; Vol.3,No.1 January -March
ISSN 2319 – 4154

Original Articles

Alterations in serum lipid profile patterns in patients with oral submucous fibrosis

Mayeesh Radhakrishna1, Jose Joy Idiculla and Aiswarya CJ2
1*Department of Oral Pathology & Microbiology, Mar Baselios Dental college Kothamangalam, Ernakulam , Kerala – 686691,
Department of Oral Pathology,
Dental wing, Melaka Manipal Medical College, Melaka, Malaysia
2Private dental practioner

Correspondence to: drmayeesh@gmail.com

  • Abstract

    Aim: Altered lipid profile patterns have been associated with pre-malignancies and malignancies because lipids play a vital role in the maintenance of cell integrity. The present study evaluated alterations in serum lipid profile in untreated patients with oral submucous fibrosis (OSF) and compared the changes in serum lipid profiles among various histological grades of OSF.

    Materials and methods: The study included 30 patients with oral submucous fibrosis and 19 healthy controls. Serum lipids, including (i) total cholesterol, (ii) LDL cholesterol (LDLC), (iii) HDL cholesterol (HDLC), (iv) VLDL cholesterol (VLDLC) and (v) triglycerides, were analyzed using spectrophotometry kits.

    Results: A significant decrease in serum total cholesterol (TC) levels, TC:HDLC ratios(p = 0.005, p = 0.001 respectively) were observed in oral submucous fibrosis patients as compared to the control group. The serum lipid profiles in different histologic gradings of OSF namely early and moderately advanced OSF showed no significance. Our data strengthens the evidence of an inverse relationship between serum lipid levels and oral submucous fibrosis.

    Conclusion: Our findings suggest that decrease in total cholesterol in patients with OSF could be due to the greater utilization of lipids including total cholesterol by the cells for new membrane biogenesis. Our findings strongly warrant an in depth study of alterations in serum lipid profile in patients with OSF. The lower serum lipid levels may have a diagnostic or prognostic role in the early diagnosis of Oral premalignant and malignant lesions.. Low levels of cholesterol could be due to the rapidly dividing cells in premalagnancies and malignancies


    Oral submucous fibrosis (OSF) is a chronic, progressive, scarring disease associated with the chewing of areca nut, an ingredient of betel quid and predominantly affects the people of South- East Asian origin. This condition was described first by Schwartz (1952) while examining five Indian women from Kenya, to which he ascribed the descriptive term ‘atrophia idiopathica (trpoica) mucosae oris,. Later in 1953, Joshi from Bombay (Mumbai) redesignated the condition as oral sub mucous fibrosis ,implying predominantly its histologic nature. The disease is characterised by burning sensation in the mouth while consuming spicy food, appearance of vesicles in the cheek and palate and fibrosis of the oral mucosa resulting in difficulty in mouth opening. The WHO definition of an oral precancerous condition –“a generalized pathological stage of the oral mucosa associated with a significantly increased risk of cancer,” describes well the characteristics of OSF.1

    Lipids are major cell membrane components essential for various biological functions, including cell growth and division of normal and malignant tissues. Usefulness of variations in tissue/blood cholesterol levels in diagnosis and treatment of various diseases has been studied by several workers.2,3,4 There is compelling evidence to implicate the habitual chewing of areca nut in the development of OSF.1 The major alkaloid in areca nut arecoline undergoes nitrosation and gives rise to N-Nitrosamine, which might have cytotoxic effect on the cells.5 This may induce the production of free radicals and reactive oxygen species which are responsible for high rate oxidation/ peroxidation of polyunsaturated fatty acids, this peroxidation further releases peroxide radicals which affect essential constituents of the cell membrane and might be involved in tumorigenesis. Because of the lipid peroxidation, there is a greater utilization of lipids, including total cholesterol, lipoproteins and triglycerides for new membrane biogenesis. Cells fulfil these requirements either from circulation by synthesis through the metabolism or from degradation of major lipoprotein fractions, like VLDL, LDL or HDL.6 Lower blood lipid levels have been associated with various cancers.7,8,9,10

  • However , only a few studies have been carried out on serum lipid profiles in precancerous conditions Considering this, the present study was aimed at evaluating the serum lipid profile, including total cholesterol, high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), very low-density lipoprotein cholesterol (VLDLC) and triglycerides in oral sub mucous fibrosis patients and comparing it with values among control groups and also among the various histological grades of OSF.

    Subjects and Methods

    The study was conducted at the Department of Oral Medicine and Radiology, Department of

    Oral and Maxillofacial pathology, Meenakshi Ammal Dental College and Hospital, Chennai

    The study subjects comprised 3 groups as follows:

    1. Group 1: Control Group.
    2. Group 2: OSF Group.
    3. Group 3: Subjects with different histologic grades of OSF.

    Selection of subjects

    Group 1( Control group) comprised of healthy individuals in the age group of 20-65 years, sex matched with those of the OSF group and with no deleterious oral habits and no associated oral lesions. Those with systemic diseases and disorders such as chronic heart disease, diabetes mellitus and AIDS, and bleeding dyscrasias were excluded. Patients on drugs that alter lipid profile were also excluded.

    Group 2 (OSF group) comprised of patients in the age group of 20-65 years and those who were clinically diagnosed to have oral submucous fibrosis lesions which were confirmed histopathologically. Those with systemic diseases and disorders such as chronic heart disease, diabetes mellitus and AIDS, and bleeding dyscrasias were excluded. Patients on drugs that alter lipid profile were also excluded.

    Method of examination and confirmation of clinical diagnosis

    The patients were explained in detail about the study and the procedure they were subjected to .A formal informed written consent was obtained. Examination of the patients was carried out using a mouth mirror and probe under artificial light. The clinical photographs were obtained to complete the clinical records. Routine hematological examinations (to ascertain bleeding time, clotting time, fasting blood sugar levels, hemoglobin count and erythrocyte sedimentation rate) and blood pressure estimation were done for all subjects to rule out any systemic diseases. A comprehensive history was obtained from the patients with reference to their habits and patients with burning sensation, difficulty in mouth opening and palpable fibrotic bands were clinically diagnosed as OSF and were finally confirmed by histopathology.

    Collection of Venous Blood

    Fasting blood samples were collected under all aseptic precautions by vein puncture. Two cc of venous blood was withdrawn with the help of a 2 ml disposable syringe and a 24 gauge disposable needle, into plain vacuettes. These samples were allowed to clot for 30 minutes and then centrifuged for 15 minutes to get a clear serum sample which is separated from the clot and transferred to a disposable vial for assay. The estimation was performed within 3 hours of receiving the samples by using an appropriate kit (Genuine Biosystem) and quantitated for total serum cholesterol, LDL, VLDL, HDL and triglycerides using a computerized semiautomated biochemistry analyzer.

    Serum cholesterol levels were estimated using cholesterol kits obtained from Genuine Biosystem, Chennai, India. Briefly, 10 µl of plasma sample was mixed with 500 µl of working reagent that contained cholesterol oxidase, cholesterol esterase, peroxidase, 4-aminophenazone, surfactant, phenol, buffer, preservatives and stabilizer. The mixture was incubated at 37°C for 10 minutes and absorbance was read at 505 nm. 

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