Discussion The present cross-sectional study explores the impact of different forms of sodiumcarbonate both in freshly mixed as well as premixed form which is added in snuff and oral condition among snuff users in Jammu City

Discussion
The present cross-sectional study explores the impact of different forms of sodiumcarbonate both in freshly mixed as well as premixed form which is added in snuff and oral condition among snuff users in Jammu City.
This study includes stratified samples of 284 constructing workers using snuff at various construction sites and slums in Jammu on the basis of prevalence of snuff use which is higher among them.
The present study indicates high prevalance of oral-mucosal lesions among snuff users with addition of sodium carbonate both in freshly mixed aswell as in pre-mixed form.
The results of the present study reveals highly significant relationship between snuff users using sodium carbonate(0.001**) in freshly mixed form than that of premixed (0.030*)form. It is due to reason that there is rise in pH and hence more absorption of nicotene due to addition of sodium carbonate in freshly mixed form than that of premixed form packed in pouches or sachets .
The degree of oral lesions is positively correlated with age, frequency, duration of snuff use in studies conducted by Hirsch et al 198211, Mornstad et 1989,12 Anderson et al 1991.13 Moist snuff use may be associated with adverse oral lesions. It has been
seen in our study that use of moist snuff is significantly responsible for causing mucosal changes. Numerous other studies have observed that snus use is associated with a characteristic reaction in the oral mucosa (e.g., Axéll 1976)14,Andersson and Axéll 1989,15 Larsson et al. 1991,16 Mornstad et al. 1989,12 Rolandsson et al. 200617).
This type of lesion has been referred to by various names, including snuff dipper’s
lesion, snuff-induced leukoplakia, or snus-induced lesions. The lesion generally
appears at the location in the mouth where the snus is held. The prevalence of this condition varies widely, and appears to be related to characteristics of the user

(such as age, salivary pH, patterns of tobacco use) and characteristics of the product (nicotine content, loose vs. portion bag, etc.).In addition the degree of lesions seems to increase with increasing pH as well as increasing nicotine concentration according to Mornstad et al 1989,12 Anderson et al .13
The present study also shows that a positive correlation between sodium carbonate both in freshly mix and premixed form and oral mucosal lesions or snuff lesions . It is added to raise the pH of the snuff to 8–9 in order to facilitate nicotine absorption through the oral mucous membranes. This causes local reactions in the gingival tissues and oral musosa exposing to snuff or nicotine resulting in mucosal changes and lesions.18
Mavropoulos et al. (2001) found an increased blood flow in the gingiva and oral mucosa of humans in response to local exposure to nicotine,19 and Petro et al.(2002) reported that smokeless tobacco extract increased IL-2 production and decreased IL-12 production from macrophages.20 In an experimental study, Alpar et al. (1998) showed that the growth of human oral fibroblasts decreased when exposed to nicotine.21
In summary, the observations of the present study indicate that there seems to be association between the use of sodium carbonate in moist snuff and and oral mucosal lesions.

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