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ORIGINAL ARTICLE
Year : 2021  |  Volume : 24  |  Issue : 9  |  Page : 1307-1312

Prevalence and Pattern of Self-medication with Alternative Medicine: Treatment-switch Analysis in Oral Submucous Fibrosis Patients


1 Department of Oral Medicine and Radiology, Government Dental College and Hospital, Nagpur, Maharashtra State, India
2 Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra State, India
3 Department of Dentistry, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra State, India
4 Independent Researcher Dental Surgeon, Aarti Regency, Mahalakshmi Nagar, Manewada Road, Nagpur, Maharashtra State, India
5 Department of Maxillofacial Surgery and Dia gnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
6 Department of Community Dentistry and Oral Epidemiology, College of Dentistry, Qassim University, Buraydah, Kingdom of Saudi Arabia
7 Department of Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha, University, Chennai, India

Date of Submission08-Sep-2020
Date of Acceptance14-Jan-2021
Date of Web Publication16-Sep-2021

Correspondence Address:
Dr. S C Sarode
Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune, Maharashtra - 411018
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_557_20

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   Abstract 


Aim: The aim of this study was to investigate prevalence and pattern of self-medication with alternative medicine (ALM) among oral submucous fibrosis (OSF) patients with emphasis on treatment-switch analysis. Methods: A total of 115 OSF patients were recruited and subjected to scientifically validated questionnaire. Two groups were identified: S-ALM: patients who have previously received modern medicinal treatment but switched to ALM; and DN-ALM: patients who started ALM from De Novo. Results: A total of 37 (32.18%) patients reported use of the ALM at some point of time. Twenty-five (67.56%) switched to ALM, whereas 12 (32.43%) patients used ALM from De Novo. The pattern of switching to ALM in short period was significantly prevalent in patients with advanced stages (stage III and IV) as compared to early stages (stage I and II) of OSF. Clarified butter, glycerin, and honey were the most commonly used ALM in both the groups. The most common reasons for switching to ALM were the cost of treatment (32.00%), longer duration of medicinal treatment (24.00%) and ineffectiveness of the medications (24.00%). Conclusions: ALM usage is common in OSMF patients with significant percentage of patient switched from modern medicine to ALM. Therapeutic efficacy of ALM in OSF needs exploration in future.

Keywords: Oral submucous fibrosis, premalignant disorder, self-medication


How to cite this article:
Gondivkar S M, Sarode S C, Gadbail A R, Gondivkar R S, Sarode G S, Patil S, Gaikwad R N, Yuwanati M. Prevalence and Pattern of Self-medication with Alternative Medicine: Treatment-switch Analysis in Oral Submucous Fibrosis Patients. Niger J Clin Pract 2021;24:1307-12

How to cite this URL:
Gondivkar S M, Sarode S C, Gadbail A R, Gondivkar R S, Sarode G S, Patil S, Gaikwad R N, Yuwanati M. Prevalence and Pattern of Self-medication with Alternative Medicine: Treatment-switch Analysis in Oral Submucous Fibrosis Patients. Niger J Clin Pract [serial online] 2021 [cited 2022 Nov 29];24:1307-12. Available from: https://www.njcponline.com/text.asp?2021/24/9/1307/325917




   Introduction Top


In a quest for recovery from diseases, self-medication is the most commonly seen phenomenon.[1] Main sources of self-medication are relatives, friends, social media, and pharmacists who not only provide medicines but also the information about drug's use.[2],[3] Especially in developing countries, factors such as lack of access to health care, physician fees, time constraint, lack of trust on physician, inadequate implementation of drug laws have been shown to influence self-medication behavior.[3],[4],[5] Self-medication is an important public health problem and is practiced globally with higher prevalence rate in India 79%[6] followed by Pakistan 84%[3], Saudi Arabia 78%[7] and Nigeria 67%[8]

Intriguingly, one of the practices for self-medication is consumption of non-conventional drugs or drugs associated with alternative medicine (ALM). Various reasons associated with it could be attributed to a need for self-empowerment regarding healthcare, a feeling of dissatisfaction with and distrust of conventional medicine, and individual values and beliefs.[9],[10]

Oral submucous fibrosis (OSF) is an insidious chronic disease caused mainly due to chewing betel quid.[11] The major concern about OSF is the increasing prevalence of the disease and high malignant transformation rate.[12] OSF is mainly characterized by fibrosis of the oral mucosa and burning sensation and over the period of time, fibrosis causes progressive reduction in the mouth opening. Limited mouth opening and burning sensation are the two most important symptoms presented by the patients during therapeutic consultation.[11],[12]

OSF is associated with significant disturbance in the quality of life and mainly functional domain is affected quite frequently.[13],[14],[15] Due to chronic nature, OSF takes longer time to respond to the medicinal treatment prescribed by the oral healthcare professionals and needs frequent follow-ups. Hence, it is quite conceivable to expect patient's non-compliance to the prescribed treatment and switching over to ALM especially in patients residing in places with sparse oral/dental healthcare facilities. Moreover, OSF is most commonly reported in lower socioeconomic strata (SES)[15],[16] and hence it is also hypothesized that patients might prefer self-medications over costly dental healthcare professional's consultation.

With this view in mind, this study was designed to investigate the prevalence and pattern of self-medication with alternative medicine among OSF patients with special emphasis on treatment-switch analysis.


   Materials and Methods Top


Patient selection

A questionnaire based cross-sectional study was conducted at the Out Patient Department of Oral Medicine and Radiology, Government Dental College and Hospital, Nagpur, India. Ethics approval was obtained from institutional ethics committee of Government Dental College and Hospital, Nagpur, India. (Ref no. GDCHN/22/19, dated 01/01/2019). A total of 115 OSF patients participated in the study during a period of February 2019 to October 2019. Patients were diagnosed based on the following clinical criteria: intolerance to hot and spicy foods, pale oral mucosa, palpable fibrotic bands, and chronic, progressive trismus.[17] The patients giving history of any relevant systemic or local illness were excluded from the study. The grading of the OSF was performed according to classification suggested by Lai et al.[18] The SES of reported OSF patients was determined by the modified Kuppuswamy's SES scale.[19]

Questionnaire

To retrieve the history of usage of self-medications with ALM by OSF patients, a questionnaire was developed. The questionnaire was gone through the external and internal validity before its actual application in the study. (Supplementary file 1).

Statistical analysis

The obtained data were subjected to statistical analysis using Statistical Package for the Social Sciences, version 17.0. Descriptive statistics were carried out. The Chi-square test, Mann–Whitney U test, and Spearman rank correlation test, wherever appropriate, were used to calculate the P value. The level of statistical significance was at P < 0.05.


   Results Top


Demographic details

Of total 115 patients, 105 were males and 10 were females with male-to-female ratio of 10.5:1. The age of the patients ranged from 18 to 65 years with mean of 31.4 years. More than half of the patients (55.6%) belonged to lower SES followed by middle (40%) and upper SES (5%). Maximum patients were reported in stage III (34.7%), followed by stage IV (26.08%), II (21.7%) and I (17.3%). Of 115 patients, 78 (67.8%) were undergoing conventional medicinal treatment as prescribed by their oral healthcare physicians while 37 (32.1%) reported use of the ALM at some point of time [Table 1].
Table 1: Demographic details of included oral submucous fibrosis patients

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Groups

Based on results obtained from the questionnaire analysis of 37 OSF patients undertaking ALM, two groups were identified. A first group included patients who had previously received treatment from the oral healthcare professionals but switched to ALM (S-ALM). Second group comprised patients who started ALM from De Novo (DN-ALM).

Patients with switch to alternative medicine (S-ALM)

Out of 37 patients, 25 (67.5%) had switched to the ALM after receiving conventional treatment from oral healthcare professionals. The most commonly adopted ALM was clarified butter (n = 11, 44%) and glycerin (n = 11, 44%) [Table 2]. Cost of the treatment (32%), longer duration of the medicinal treatment (24%) and ineffectiveness of the medicines advised by oral healthcare professionals (24%) were reported to be the most common reasons for switching over to ALM [Table 3].
Table 2: Details of alternative medicines used by included oral submucous fibr osis patients

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Table 3: Reasons for switch over to self-medication with alternative medicine from conventional medication

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The mean duration for switching over to ALM after obtaining conventional treatment from oral healthcare professional was 3.3 ± 1.4 months. The shortest duration for such switch was shown by stage III patients (2.3 ± 0.9 months) followed by stage IV (3.1 ± 0.8 months),. Mainly, this switch to ALM was found to be prevalent in stage III (n = 11) and stage IV (n = 7) patients [Table 4].
Table 4: Details of duration for switching to alternative medicines after obtaining conventional treatment for oral submucous fibrosis from oral health professional

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The main sources of knowledge for use of ALM were noticed to be relatives (40%) and friends (28%) followed by social media (20%). Only 12% patients had history of true ALM [Table 5]. As per results of the questionnaire, about 15% patients of this group reported transient relief from oral ulcerations and burning sensation of oral mucosa to some extent.
Table 5: Oral submucous fibrosis patients' source of knowledge about use of alternative medicine

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Patients with De novo alternative medicine (DN-ALM)

Amongst 37 patients who were on ALM, 12 (32.4%) started ALM from de novo. DN-ALM group showed more patients with stage I OSF (n = 5) followed by stage II (n = 4) and III (n = 3). Similar to S-ALM group, clarified butter (50%) and glycerin (41.6%) were most commonly used DN-ALM [Table 2]. The results of the questionnaire revealed that the cause for self-medication with ALM was self-driven for almost 50% of the patients followed by relative (25%) [Table 5]. Interestingly, few patients of DN-ALM group experienced relief from oral ulcerations and burning sensation of oral mucosa after application of ALM.

Overall, the use of self-medication with ALM was more prevalent in stage III OSF patients [14 (37.8%)] and the most commonly reported ALM were clarified butter [17 (45%)] and glycerin [16 (43%)]. The relatives (43.2%) and friends (27.02%) were the main sources of information for use of ALM.

Relationship between and SES and use of ALM

It was noticed that majority of the patients who used ALM were in lower SES (n = 28; 75.6%) and none in upper SES used ALM during treatment. Statistically significant differences (P = 0.008) and correlation (P = 0.002) in SES was obtained between conventional and ALM group [Table 6].
Table 6: Relation between socioeconomic status and use of alternative medicines in oral submucous fibr osis patients

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   Discussion Top


For chronic disorders, self-medication with traditional drugs is very common practice in Indian population.[20] Old beliefs and customs are the major driving source for consumption of non-conventional medicines.[21] OSF is one of such chronic disorders where treatment response with modern allopathic medicines usually takes time to show results and hence, patients likely to show non-compliance and switching over to ALM. In this study, of 115 OSF patients, about one-third (32.1%) employed the ALM at some point of time. While 21.7% patients reported switch to the ALM after receiving conventional treatment from oral healthcare professionals, 10.4% patients reported to have used ALM from de novo.

In moderately advanced and advanced stages, OSF is characterized by dreadful signs and symptoms.[13] Patients especially reports for the consultation with manifestations such as limited mouth opening and burning sensation.[22] Limited mouth opening is caused due to the cross-linking and increased deposition of collagen in the stroma, which once occurred is very difficult to reverse by conventional medicinal treatment.[23] Burning sensation of the oral mucosa is attributed to the atrophic epithelium and vesiculations, which again is not completely relieved by conventional medicinal treatment.[24] Hence, especially in advanced stages, we observed more number of patients in S-ALM group as early stages symptoms are more tolerable. In tune with this, the main reason for such switch in advanced stages was cost of the treatment, longer duration of the treatment and ineffectiveness of the conventional treatment. However, chronic illness (20%) was the least common reason for the switch in overall grades of OSF. Moreover, in accordance, we observed significantly less duration for the switch over to ALM in advanced stages as compared to early stages of OSF.

In this study, it was observed that clarified butter, glycerin, and honey were used for the relief of OSF symptoms especially burning sensation of the oral mucosa. Clarified butter, glycerin, and honey are the integral part of traditional Indian folk medicine for use in various diseases.[25] Ancient scripts of Ayurveda have mentioned various uses of these ingredients such as anti-inflammatory, healing, antioxidant, anti-carcinogenic actions, etc., However, these agents lack any documented scientific evidences for their aforementioned actions. This information has passed from generation to generations in the Indian population. Hence, perhaps this could be the reason for their use in OSF treatment as ALM. Till date, there is no literature published on the use of clarified butter, glycerin, and honey in OSF treatment. Since OSF is fibrotic disorder associated with chronic inflammation and production of various cytokines, it is envisaged that the therapeutic effect seen in OSF after usage of these natural agents could be attributed to their anti-inflammatory nature.

OSF is commonly reported in the lower SES group of patients.[25] Due to lack of awareness of the disease and cost of the long-standing treatment, OSF patients usually prefer the self-medications suggested by the peers. In accordance, this study revealed a large number of patients of S-ALM and DN-ALM groups implemented ALM as per suggestions of their relatives and friends. Intriguingly, few patients using ALM experienced temporary relief of their symptoms including burning sensation of the oral mucosa. It is well-known fact that early intervention with conventional medicinal treatment along with discontinuation of habit in the initial stages of OSF can revert back the OSF state to normal condition.[26] In contrast, discontinuation of the conventional treatment at any stages of OSF not only worsens the signs and symptoms but more importantly also increases the possibility of OSF progression to malignant transformation. In this study, more than three-fourth of the 37 patients who employed ALM at any point of time belonged to lower SES. It might be possible that physician's fees, mistrust on the oral healthcare physician, frequent visits, and cost of the long-standing conventional treatment might have forced these lower SES patients to use other, relatively economic ALM.

In this study, we reported male preponderance with male-to-female ratio of 10.5:1. Moreover, age of the patients ranged from 18 to 65 years with mean of 31.4 years. This corresponds with the increased prevalence of Ghutka chewing habit among the young male population of India. These data are in accordance with the previously published literature.[27],[28]

Restricted study population (central India) is the major limitation of this study. Other regions might have practice of different ALM and hence nation-wide multi-centric study is warranted in this direction. Due to the cross-sectional observational nature of the study, it was not possible to confidently comment on the potency of ALM (clarified butter, glycerin, and honey). Future randomized controlled trials are needed in this direction to ensure its efficacy.


   Conclusions Top


Usage of scientifically unproven self-medications with ALM by OSF patients presents an alarming situation for oral healthcare providers and needs appropriate intervention. We recommend future studies with larger sample size to find out the usage of ALM, if any, in OSF management and reasons behind such practices. Moreover, outcome analysis of ALM practices could help in understanding the therapeutic efficacy of various drugs.

Financial support and sponsorship

The author received no specific funding for this work.

Conflicts of interest

All the authors associated with present manuscript declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplementary file 1: Questionnaire used in this study to elicit the response.

1. Are you aware of your mouth condition?

A. Yes B. No C. Don't know

2. Are you aware about the treatment options for your mouth condition?

A. Yes B. No C. Don't know

3. Did you visit dental healthcare professional for treatment of your mouth condition?

A. Yes B. No

4. Have you used medications advised by dental healthcare professional?

A. Yes B. No

5. For how long did you use medications advised by dental healthcare professional?

A. 1 month B. 2 months C. 3 months D. 4 months E. any other

6. Did you feel the treatment was adequate?

A. Yes B. No C. Don't know

7. Have you completed the treatment advised by dental healthcare professional?

A. Yes B. No

8. Were you satisfied with the treatment you underwent?

A. Yes B. No

9. Why have you not completed the treatment advised by dental healthcare professional?

A. Cost B. Long duration C. Chronic illness D. Ineffectiveness E. any other

10. Did you try medications for your mouth condition on your own?

A. Yes B. No

If yes,

11. Of the following, which ingredients you used on your own for treatment of your symptoms?

A. Glycerine B. Lime

C. Honey D. Clove oil

E. Clarified butter F. Any other

12. For how long did you used self-medication drug opted by you in question 11?

A. 1 months B. 2 months

C. 3 months D. 4 months e. any other

13. Have you received relief from the self-medication drug opted by you in question 11?

A. Yes B. No C. Don't know

If yes,

14. What type of relief you got from the self-medication drug opted by you in question 11?

A. Burning sensation B. Ulcerations

B. C. Pain D. Mouth opening E. Any other

15. Were you satisfied with the self-medication drug opted by you in question 11?

A. yes B. No C. Don't know

16. Have you noticed any side effects of self-medication drug opted by you in question 11?

A. Yes B. No

If Yes,

17. What were the side effects of self-medication drug opted by you in question 11?

A. Allergy B. GI irritation

C. Mucosal pigmentation D. Any other

18. Who suggested self-medication drug opted by you in question 11?

A. Friends B. Relatives C. On own D. Social media E. Any other



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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