Looking beyond tobacco and alcohol for oral squamous cell carcinoma

Squamous cell carcinoma is the most common malignant neoplasm of the oral cavity. Betel nut chewing, cigarette smoking and alcohol drinking are thought to be the major environment risk factors responsible for the development of oral squamous cell carcinoma (OSCC). Reports of OSCC in patients who never used tobacco and alcohol are infrequent. The aim of this article is to review the current data concerning the possible etiological factors causing OSCC other than tobacco like viral infections, diet, nutrition, chronic irritation, genetic mutations and other. Although it is well known that the incidence of OSCC increases with age, recent trends for a rising incidence particularly relates to cancer in young individuals. Investigations can be routine ranging from simple oral examination, blood test, bone marrow analysis, diet chart analysis as well as molecular analysis through techniques like PCR, ISH(in situ hybridization), DNA sequencing, southern blot and antibody test. This review critically examines numerous publications devoted to oral cancer in young individuals who never used tobacco and alcohol. Most studies suggest that 4-6% of oral cancer occur in such individuals. Awareness of this possibility is important since it can lead to potentially fatal consequences. Thus providing clinicians a broader vision for diagnosis which will lead to effective treatment and prevention in the future.