Oral cancer is the third-most common form of cancer in India. The rate at which cancer will develop is dependent on the dose, frequency, and method of application of the carcinogen.  The development of oral cancer is a multistep process arising from pre-existing potentially malignant lesions. Leukoplakia is the most common precancer representing 85% of such lesions. It has been suggested that a vast majority of oral squamous cell carcinomas (SCCs) in India arise from pre-existing leukoplakia. Among all the risk factors, the disease is mainly associated with the use of tobacco, alcohol, viruses, radiation, and UV light. These factors can also cause disturbances in the levels of minerals in the body fluid. Often these factors may further contribute to metabolic abnormalities like coronary heart disease, liver disease, lung infection, kidney failure, and disorders of the endocrine system. Therefore, the primary focus has shifted to early detection of oral premalignant and malignant conditions rather than diagnosing it at an advanced stage.

Often such pre-malignant lesions are associated with the habit of tobacco in various forms. Dried tobacco leaves are mainly used for smoking in cigarettes, cigars, pipes, and shishas. They can also be consumed as snuff, chewing tobacco and dipping tobacco. Smokeless tobacco products can be used for chewing, sucking, gargling, sniffing, and as a dentifrice. Tobacco smoking poses a risk to health due to the inhalation of poisonous carcinogens in tobacco smoke. It has also been observed that many tobacco users often have a habit of alcohol. Alcohol also has a variety of adverse effects, like generalized impairment of neurocognitive function, dizziness, liver and brain damage. Alcohol’s effect on the oral cavity along with the habit of tobacco increases the risk of developing cancer by several times. The dehydrating effect of alcohol on the cell walls enhances the ability of tobacco carcinogens to permeate the mouth tissues, which shows a synergistic effect in the process of carcinogenesis.

Alterations in the levels of trace elements have been associated with patients with oral cancer, pre-cancer, and other disorders. Such trace elements are found in abundance in the human body and are involved in various physiological metabolic processes. They play a major role in the living body by maintaining the osmotic pressure and membrane potentials. Trace elements are chemical elements required in minute amounts, usually as part of a vital element.

Magnesium is one of the most abundant cations present in the living cells. It is an essential element that is required for a broad variety of physiological functions and it plays an important role as a regulator of cell functions. Serum Magnesium levels are remarkably constant in healthy participants and protect the body against various diseases. Aziz NZ et al (2018) has proposed that Magnesium deficiency can play an important role in precancerous cell transformation. Magnesium is a critical cation and cofactor in numerous intracellular processes. It is involved in a large variety of biological functions, ranging from structural roles by complexing negatively charged groups such as phosphates in nucleic acids, a control role in enzyme activation or inhibition and regulatory role by modulating cell proliferation, cell cycle progression, and differentiation. Any imbalances with Magnesium ion concentration have often been associated with the occurrence of a pathological condition. It has been suggested that Magnesium deficiency may trigger carcinogenesis by altering the fidelity of DNA replication and increasing membrane permeability.

Researchers have often observed a low Magnesium level in patients with tobacco habits due to increased demand for Magnesium by smokers owing to increased release of adrenaline and the thermogenic effect of nicotine, which is the main constituent of tobacco. Low levels could also result from a decreased supply in the diet and reduced absorption caused by disturbances in the digestive system function.

Not many studies have been done to evaluate Magnesium levels in serum and saliva of patients with tobacco and alcohol habits. Hence, the purpose of this study is to evaluate and compare the Magnesium levels in serum and saliva of patients with tobacco and alcohol habits to serve as a simple and reliable biomarker in the process of carcinogenesis.