Evaluation of the possible role of copper ions in drinking water in the pathogenesis of oral submucous fibrosis: a pilot study

We aimed to investigate the concentration of copper ions in drinking water and to assess whether copper has a role in the pathogenesis of oral submucous fibrosis (OSMF). We studied 50 patients with clinically and histologically diagnosed OSMF from the Yadgir district of Karnataka in India. Fifty healthy people matched for age and sex were used as controls. In both groups concentrations of copper ions in serum, saliva, and home drinking water were measured using atomic absorption spectroscopy and intelligent nephelometry technology. Serum ceruloplasmin concentrations were also estimated in both groups. The mean (SD) concentration of copper in the home drinking water of patients with OSMF was significantly higher (764.3 (445.9) μmol/L) than in the controls (305.7 (318.5) μmol/L) (p < 0.001). Patients with OSMF also had a significantly higher copper concentrations in serum and saliva, and serum ceruloplasmin than controls (p < 0.001). For the first time these data have shown a positive association between copper concentrations in home drinking water and OSMF. It raises the possibility that increased copper in drinking water contributes to the development of OSMF, and adds to that ingested when areca nut is chewed.