Too much to swallow

Seventeen is the age to be carefree, healthy and happy. Not to have your mouth permanently clamped by trismus -- a painful symptom of oral ...

Seventeen is the age to be carefree, healthy and happy. Not to have your mouth permanently clamped by trismus — a painful symptom of oral submucous fibrosis (SMF), caused by chewing paan masala, gutkha or tobacco. But it took the trauma of trismus — or lockjaw — to cure young Pankaj Motla of his gutkha addiction. He started popping sachets of gutkha as a 13-year-old, and barely four years later found himself in St George’s Hospital with a mouth he could barely open, so ravaged was it by SMF.

Dr J Peter Rodrigues, who treated Pankaj, and is also honourary head of the hospital’s ENT

Department, is only too aware of the alarming rise in lockjaw over the past few years. "A decade ago, we used to treat a couple of cases every month. Now, however, we treat two to three cases everyday — nearly a 100 per cent increase, " says he. Luckily for Pankaj, Rodrigues and his colleagues have developed a single surgical technique to bring relief for devastated gutkha swallowers. Instead of opting for traditional, expensive and time-consuming surgery Dr Rodrigues’ method involves excising the fibrous bands on both sides, under general anaesthesia. The cost of the operation is a mere Rs 3 or 4, about the same as a three-month’s supply of paan masala.

But it takes more than the skill of dedicated surgeons to combat diseases caused by tobacco. Oral SMF cuts across all socio-economic barriers — gutkha sachets can cost as little as 50 paise, and the most expensive is priced at Rs 4. The low prices make school children an especially vulnerable segment. In fact, many parents themselves are unaware of the dangers of chewing tobacco.

Story continues below this ad

A pouch of paan masala does not contain tobacco, hence the small print on its foil says that chewing paan masala, "might be injurious to health." But the tobacco-free paan masala is just as guilty as gutkha which contains tobacco tempered with betelnut, catechu, lime and permitted flavourings.

Both work in an identical fashion in damaging the soft, supple lining (mucosa) of the oral cavity. Over a period of time, the gutkha chewer’s mouth starts sporting a denser tissue in the submucosal layer, causing disabling symptoms like trismus. What is the cause for concern on the eve of World No-Tobacco Day (today) is the increasing number of younger patients being treated for SMF. While cigarette smoking has been the chief whipping boy of the anti-tobacco lobby, the skyrocketing number of paan masala and gutkha addicts remain unnoticed.

It’s only hospital statistics and physicians that tell the tale. Says Dr Rodrigues, "Although far fewer women than men suffer from SMF, the majority of the patients are in the 20 to 30 age group. All the patients of oral SMF have had a history of chewing paan masala, gutkha or tobacco singly or in combination. About 50 per cent of the patients whom I have treated told me that they chewed paan masala along with tobacco, around 30 per cent used a combination of betel but with lime and tobacco."