Aims and objectives: Oral submucous fibrosis (OSMF) is well known to be related to chronic areca nut chewing. There is considerable evidence for the role that copper contained in the nut has in the pathogenesis.The aim of our pilot study was to investigate the copper ion concentrations in drinking water and assess whether raised systemic Cu concentrations might have a possible role of in the pathogenesis of OSMF.

Methodology: The ethically approved study was conducted in India on fifty patients with OSMF diagnosed clinically and histologically. Fifty healthy individuals matched for age and gender were used as controls. In both groups copper ion concentrations in serum, saliva and home drinking water were measured using atomic absorption spectroscopy and intelligent nephelometry technology. Serum ceruloplasmin level was also estimated in both the groups.

Results: The mean home drinking water copper ion concentrations in OSMF patients was significantly higher (1.2 ± 0.7 μg/ml) when compared to controls (0.48 ± 0.5 μg/ml) ( P < 0.001). OSMF patients also had a subtle increase in both serum and saliva copper concentrations and serum ceruloplasmin compared to controls which was statistically significant ( P < 0.001)

Conclusion: The present data has found for the first time a positive association between home drinking water copper ion concentrations and OSMF. It raises the possibility of whether increased copper in drinking water is a contributing factor in the development of OSMF, and adds to the total copper ingested during areca nut chewing.

Key words: copper; drinking water; oral submucous fibrosis