Reverse smoking and palatal changes in Filipino women

Abstract

The habit of reverse smoking is practiced in various parts of the world including the Philippines. In this preliminary cross-sectional study, 9L volunteer women smokers(61 reverse and 30 conventional) residing in nine barangays in Cabanatuan City, Philippines were interviewed and examined clinically fo¡ the presence or absence of palatal mucosal change. Seven demographic variables and twelve habit variables were investigated to characterize and compare the two study groups. The clinical examination was done to verify changes in color, texture and topography of the palatal mucosa. These changes were recorded photographically and specific features such as leukoplakic change, thickening, fissuring, pigmentation, erythema, nodularity and ulceration were observed and graded. Smears were also taken from three areas of the palate to determine cytologic features. The majority (96.77o) of reverse smokers exhibited palatal mucosal changes including leukoplakic change, mucosal thickening, fissuring, pigmentation, nodularity, erythema and ulceration. In comparison, only 26.7Vo of controls exhibited mucosal changes predominantly that of intramucosal brown-black pigmentation and some erythema. This difference was statistically significant at a X2 value of 47.28 (p<.001). Analysis of the other variables indicated that the two study groups differed significantly with regard to age(p<.05), educational attainment(p<.01), use of filtered versus non-filtered cigarettes(p<.001) and duration of smoking in years(p<.01). The palatal changes in reverse smokers were able to be grouped into three categories. Group 1 subjects included those with pigmentation and some erythema only; Group 2 subjects(comprising the majority of reverse smokers) exhibited various combinations of mild to moderate leukoplakia, fissuring, thickening and pigmentation of the mucosa. Additional features of nodularity, erythema, prominence and reddening of minor salivary gland duct openings were also observed. Group 3 subjects included those with variable ulceration, severe reddening and nondescript roughening. Cytologic features of smears from the two study groups did not differ as to the predominating type of epithelial cells, density and type of inflammatory cells and micronucleated cells. Only the epithelial cell type found in different areas of the palate within each group was found to be statistically significant.