{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T17:23:28Z","timestamp":1788024208202,"version":"build-2784847793"},"reference-count":60,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Oral Pathology Medicine"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Smokeless tobacco (SLT) use is a major global risk factor for oral potentially malignant disorders (OPMDs). However, the differential impact of SLT product composition, particularly tobacco\u2010only versus combined tobacco\u2010areca nut products, on OPMD prevalence remains inadequately characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the pooled prevalence of OPMDs between users of tobacco\u2010only SLT and users of SLT containing both tobacco and areca nut.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study was conducted following PRISMA guidelines. Electronic databases (PUBMED, Cochrane, Scopus, Embase, Web of Science) were searched until December 15, 2024. Included studies reported OPMD prevalence among current SLT users with a clear product description. Areca nut\u2010only products were excluded. Two reviewers independently screened studies, extracted data, and assessed quality (Newcastle\u2010Ottawa scale). Pooled prevalence estimates were calculated using random\u2010effects models in R software due to anticipated heterogeneity. Sensitivity analysis (leave\u2010one\u2010out) was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty\u2010three studies (62\u2009680 SLT users: 5058 tobacco\u2010only; 57\u2009622 tobacco\u2010areca nut) were included. Overall OPMD prevalence was significantly higher among SLT with areca nut users (16.3%, 95% CI) compared to tobacco\u2010only SLT users (10.4%, 95% CI). Tobacco\u2010areca nut use showed markedly high prevalence of oral submucous fibrosis (OSMF) (33%) and dysplasia (16%), especially in endemic regions like India (88.8% OPMD prevalence in this subgroup). Tobacco\u2010only SLT use was predominantly associated with leukoplakia (18%) and lichen planus\/lichenoid reactions (15%). A critical limitation was the high proportion of non\u2010specific OPMD diagnoses (27% overall, 38% in tobacco\u2010areca nut users), hindering precise estimates of specific conditions. Sensitivity analyses confirmed result robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This meta\u2010analysis demonstrates a substantial global burden of OPMDs among SLT users, with distinct risk profiles driven by product composition. Tobacco\u2013areca nut SLT poses the highest risk (especially for OSMF and dysplasia), while tobacco\u2010only SLT remains a significant independent risk factor (primarily for leukoplakia and lichenoid reaction). The high prevalence, particularly with combined products in regions like South Asia, underscores the urgent need for targeted public health interventions. Future research must prioritize precise product classification and standardized OPMD diagnosis to improve risk assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jop.70045","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T06:21:12Z","timestamp":1756794072000},"page":"921-933","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Prevalence of Oral Potentially Malignant Disorders in Smokeless Tobacco Users With or Without Areca Nut: A Meta\u2010Analysis"],"prefix":"10.1111","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5877-205X","authenticated-orcid":false,"given":"Gowri","family":"Sivaramakrishnan","sequence":"first","affiliation":[{"name":"Bahrain Defence Force Royal Medical Services  Riffa Bahrain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kannan","family":"Sridharan","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences Arabian Gulf University  Manama Bahrain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1843.2003.00507.x"},{"key":"e_1_2_11_3_1","volume-title":"Oral Potentially Malignant Disorders in High\u2010Risk Groups in South Asia: A Novel Approach to Screening and the Way Forward","author":"Kidwai Z.","year":"2023"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/biomed4040035"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.328.7435.323"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ntr\/nty074"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oooo.2023.02.019"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10903-013-9826-4"},{"key":"e_1_2_11_9_1","first-page":"1","article-title":"Analysis of Gul Component (Tobacco Product) by UV Spectrophotometer and Its Effects on Human Beings","volume":"3","author":"Deshmukh V. 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