The prevalence of oral mucosal lesions in adults from the Turin area

Clinical and histopathological correlation of oral malignancy and potentially malignant disorders based on a screening program at high-risk population in Tamil Nadu, India

Background

There is a high incidence of oral cancer and oral potential malignant disorder observed in southeast Asian countries such as India. Our study aimed to assess the correlation between screening and histopathological diagnosis and to predict the specificity and sensitivity of chair-side/field-based assessment of the oral lesion.

Materials and methods

A total of 40,852 subjects aged between 20 and 60 years were screened in the 1st phase of the study, suspected lesions were stained with toluidine blue (Manufactured by Otto Chemicals private limited, India) at two time points, those who stained positively during the two points were taken up for biopsy. Provisional diagnosis was later correlated with histopathological diagnosis.

Results

Subjects who underwent biopsy had a mean age of (49.01 ± 9.8 years), Leukoplakia (1.5%) was the most common lesion observed among tobacco users, interestingly it had the least correlation (39.6%) in diagnosis, Overall sensitivity (88%) and a positive predictive value (80%) was high for clinical diagnosis of OPMD in our study.

Conclusion

Correlation of clinical and histopathological diagnosis observed in our study confirms higher yield of true positives while screening in remote and vulnerable populations, which would assure a better quality of life for these subjects.

Prevalence and Distribution of Oral Mucosal Lesions and Normal Variants among Nepalese Population

Background

Oral mucosa is encountered by various lesions and normal variants. Some are not to be worried about, whereas others may be of significance. Knowing the prevalence of oral mucosal lesions in a particular region helps better evaluate, diagnose, and, thus, manage these lesions.

Objectives

To assess the prevalence and distribution of oral mucosal lesions and normal variants among various age groups, genders, and sites of the orofacial region.

Methods

This cross-sectional study was conducted in the Department of Oral Medicine and Radiology, KIST Medical College and Teaching Hospital from January 2021 to March 2021. Three different proformas were designed according to age, gender, and location of lesions for entry as per the WHO's guide. The obtained data were entered into a Microsoft Excel sheet for frequency analysis by SPSS, and the results were tabulated.

Results

Among the records of 16572 (9703 (58.55%) males and 6869 (41.44%) females) OPD patients, 3495 (21.08%) (1934 (55.33%) males and 1561 (44.66%) females) had OMLs and 2314 (13.96%) (1626 (70.26%) males and 688 (29.73%) females) had normal mucosal variants. The most commonly seen OML categories were tobacco-associated lesions, i.e., 2056 (34.07%), tongue lesions, i.e., 1598 (26.48%), oral potentially malignant disorders, i.e., 815 (13.50%), ulcers i.e., 728 (12.06%), and infectious lesions, i.e., 256 (4.24%).

Conclusion

The Nepalese population has a wide range of oral mucosal lesions and normal variants, and this study has attempted to have baseline data for the same. The most common OML was smoker's melanosis.

The global prevalence of oral leukoplakia: a systematic review and meta-analysis from 1996 to 2022

BACKGROUND

Oral leukoplakia(OLK) is a common oral potentially malignant disorder. The global prevalence of solely OLK was published in 2003, while the prevalence varied among different studies. In recent years, large-scale summary and definition-related analyses obtain insufficient attention. This study aimed to perform a systematic review of prevalence studies of oral leukoplakia and assess predisposing factors of its occurrence.

METHODS

The search terms ("Oral leukoplakia" OR OLK OR leukoplakia) AND (prevalence OR incidence OR epidemiology) were searched in databases (Pubmed, Embase, Scopus, and Web of Science) for OLK studies published from January 1996 until December 2022. The estimated prevalence calculation and risk of bias analysis used STATA 16.0.

RESULTS

We obtained 69 studies, including 1,263,028 participants, from 28 countries, and 6 continents. The prevalence was 1.39%, varying from 0.12 to 33.33%. The overall pooled estimated prevalence of OLK was 2.23% for population-based studies, 1.36% for clinic-based population studies, and 9.10% for specific populations. The pooled prevalence in different continents ranged from 0.33 to 11.74% with a statistical difference in the population-based calculation. The estimated prevalence of OLK was higher in males than in females. Those who smoked and consumed alcohol had a higher prevalence than those who did not.

CONCLUSION

Combining data from 69 published studies, the prevalence of OLK was determined as 1.39% and the pooling estimated global prevalence was 3.41%. The prevalence was relatively consistent and stable across different continents and different definitions. A higher pooled estimated prevalence was found among males, those aged over 60 years old, smokers, and alcohol consumers. The results from the included studies in this systematic review revealed that the prevalence was relatively consistent and stable across various definitions and continents, which may help in developing global treatment and prevention strategies for oral leukoplakia.

Acute Oral Lesions

A variety of acute oral lesions may be encountered in the scope of dermatology. Oral lesions may be single or multiple; may arise secondary to infectious, immune, congenital, medication use, or idiopathic causes; and may take a variety of forms. A thorough evaluation of the oral cavity is required to assess patients with oral lesions. Affected patients may be monitored, treated, or referred to an appropriate specialist for further management as needed. Many acute oral lesions are self-limiting in nature and patients may require only assessment and reassurance. Several common acute oral lesions are discussed in this article.

Continuing education activities improve dentists' self-efficacy to manage oral mucosal lesions and oral cancer

OBJECTIVES

This cross-sectional study aims to evaluate whether Continuing Education Activities (CEA) influence dentists' behaviour in relation to oral lesions. The secondary aim is to assess the association between dentists' perception of learning adequacy and self-efficacy for oral mucosal lesion management.

METHODS

A self-administered online questionnaire was conducted on dentists working at the public health system of Rio Grande do Sul State, Brazil. The questionnaire included questions pertaining to perception of adequacy for oral diagnosis classes upon graduation, participation in oral cancer CEA and self-efficacy in managing oral mucosal lesions.

RESULTS

221 dentists from 91 municipalities answered the questionnaire. Most participants were female (71.5%) with a mean age of 38.3 years. Perception of learning as adequate during undergraduate coursework was associated with self-efficacy to diagnose, biopsy, and treat oral mucosal lesions (P < .05, Chi-squared test). However, 83.3% of dentists considered the time devoted to these topics prior to graduation insufficient. The frequency of oral lesion detection was related to self-efficacy to treat oral lesions and detecting oral cancer (P < .05, Chi-squared test). Among dentists who detected oral lesions frequently, 88.9% had attended CEA, whereas 11.1% of them had never attended these activities.

CONCLUSIONS

CEA may improve awareness and efficacy of primary healthcare professional's detection of oral cancer.

Prevalence of oral mucosal normal variations and lesions in a middle-aged population: a Northern Finland Birth Cohort 1966 study

Background

In this cross-sectional study we investigated the oral mucosal changes in a middle-aged Finnish population. We analyzed the prevalence of potentially malignant disorders and the influence of smoking, snuff and alcohol use on the mucosal changes.

Methods

Of the 12,068 members of the NFBC 1966, a total of 1961 participants (16.2%) constituted the study population. Mucosal changes were diagnosed and photographed by seven general dentists, and two specialists re-analyzed all the diagnoses based on the documentation Cross-tabulation with Chi-square tests and logistic regression analysis were used to analyze the data.

Results

Of the participants, 10.5% had some mucosal changes, of which 81.8% were diagnosed as oral mucosal lesions (OML) and 18.2% as normal variations. Of the normal variations, the most common were Fordyce granules (1.2%), fissured tongue (1.1%) and geographic tongue (0.9%). The most common OMLs were white lesions (6.5%), of which oral lichen planus (OLP) and lichenoid reactions (OLR), grouped as oral lichenoid diseases, were present in 3.5%, males more often (3.8% vs. 3.1%). OLP was found in 1.5% of all participants, females more often (1.8% vs. 1.2%), while OLR was more common in males (2.7% vs. 1.3%). Leukoplakia was identified in 0.5% of the population; twice more often in males (0.6% vs. 0.3%). Erythroplakia was not found. Current smokers had higher risk for oral mucosal changes than former or non-smokers (OR 3.0, 95% CI 2.11–4.28), and snuff, used occasionally or regularly, also raised the risk (OR 2.6, 95% CI 1.48–4.70).

Conclusions

In the middle-aged northern Finland population, 4% of OMLs were potentially malignant disorders, including OLR (2%), OLP (1.5%) and leukoplakia (0.5%). In particular, smoking and snuff use increased the risk for having any oral mucosa changes.

Global Prevalence and Incidence Estimates of Oral Lichen Planus: A Systematic Review and Meta-analysis

Importance

Integrated information on the global prevalence and incidence of oral lichen planus (OLP) is lacking.

Objective

To examine the global prevalence and incidence of OLP in a systematic review and meta-analysis.

Data Sources

A systematic review of population-based studies and clinic-based studies reporting the prevalence and incidence of OLP was performed using 3 electronic medical databases (Cochrane Database of Systematic Reviews, Embase, and MEDLINE) from their inception to March 2019. The search terms included "(lichen planus or LP) and (prevalence or incidence or epidemiology)." No language restriction was applied.

Study Selection

Observational descriptive studies investigating the prevalence and incidence of OLP were included.

Data Extraction and Synthesis

Data were extracted by continent, sex, and other characteristics. The risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal Instrument for Studies Reporting Prevalence Data using random-effects models to synthesize available evidence.

Main Outcomes and Measures

The primary outcome was the prevalence (with 95% CIs) of OLP among the overall population and among subgroups. Between-study heterogeneity was assessed using the I2 statistic.

Results

Among 46 studies, the overall pooled estimated prevalence of OLP was 0.89% (95% CI, 0.38%-2.05%) among the general population (n = 462 993) and 0.98% (95% CI, 0.67%-1.43%) among clinical patients (n = 191 963). Among the 15 population-based studies, the prevalence of OLP was 0.57% (95% CI, 0.15%-2.18%) in Asia, 1.68% (95% CI, 1.09%-2.58%) in Europe, and 1.39% (95% CI, 0.58%-3.28%) in South America. Among the 31 clinic-based studies, the prevalence was 1.43% (95% CI, 1.12%-1.83%) in Africa, 0.87% (95% CI, 0.61%-1.25%) in Asia, 1.03% (95% CI, 0.51%-2.09%) in Europe, 0.11% (95% CI, 0.07%-0.16%) in North America, and 3.18% (95% CI, 0.97%-9.95%) in South America. The pooled prevalence of OLP by sex was 1.55% (95% CI, 0.83%-2.89%) for women and 1.11% (95% CI, 0.57%-2.14%) for men in the population-based studies and 1.69% (95% CI, 1.05%-2.70%) for women and 1.09% (95% CI, 0.67%-1.77%) for men in the clinic-based studies. In 5 clinic-based studies providing the age distribution of patients with OLP, the prevalence by age was 0.62% (95% CI, 0.33%-1.13%) among patients younger than 40 years and 1.90% (95% CI, 1.16%-3.10%) among patients 40 years and older.

Conclusions and Relevance

This study identified the global prevalence and incidence of OLP in terms of its spatial, temporal, and population distribution. The overall estimated pooled prevalence of OLP was 0.89% among the general population and 0.98% among clinical patients. A higher prevalence of OLP was found in non-Asian countries, among women, and among people 40 years and older. The findings should be considered with caution because of the high heterogeneity of the included studies.

The Analysis of the Frequency of Leukoplakia in Reference of Tobacco Smoking among Northern Polish Population

Objective: The aim of the study was an updated analysis of the frequency of leukoplakia in reference to tobacco smoking among the northern Polish population. Material and Methods: Medical records of 5720 patients who suffer from abnormalities and oral mucosa diseases between January 2015–December 2018 were analyzed. Among them, 416 medical charts of patients with leukoplakia were selected. The study group consisted of 196 women and 220 men aged between 21–86 years (average 45.6 years). The analysis was conducted in terms of age, gender, and smoking tobacco. The basic criterion for inclusion in the study was the presence of oral leukoplakia confirmed by histopathological examination, recorded in the chart. Information about the patient’s active smoking was obtained from documented medical interviews. An active smoker was defined as a patient who smoked 10 or more cigarettes a day for at least the previous six months. The study used parametric and non-parametric statistical methods. Results: The highest incidence of leukoplakia was found in the age group 41–60 (46.6%), where the vast majority were active smokers (85.1%), and mostly men (86.2%). However, among patients with leukoplakia, the highest prevalence of smoking was found in the age group 21–40 years (86.8%) in women, where out of 38 patients with leukoplakia, 33 were active smokers. More patients with leukoplakia were observed in groups of smokers and it was statistically significant. Homogeneous form was the most commonly diagnosed form of leukoplakia in our study; it was found in almost 95% of cases. Leukoplakia was mainly observed on the cheeks. Changes on the gums, the alveolar process or the bottom of the tongue and mouth were rarely found. Conclusion: Our studies revealed that there is a statistically significant correlation between tobacco smoking and the presence of oral leukoplakia among the northern Polish population. It should be noted that dentists, in particular, are capable of early diagnosis and implementation of appropriate treatment of leukoplakia and, most often, crucial elimination of the main risk factor, which is smoking, and the implementation of effective tobacco control interventions.

People would rather see a physician than a dentist when experiencing a long-standing oral ulceration. A population-based study in Spain

BACKGROUND

Primary care physicians have been reported to be the first choice for patients with oral ulcerations. This study investigates the health-seeking behaviour of lay public in Galicia (North-western Spain) if experiencing a long-standing oral ulceration.

MATERIAL AND METHODS

Cross-sectional population-based survey of randomly selected respondents conducted from March 1, 2015 to 30 June 2016.

RESULTS

A total of 5,727 pedestrians entered the study (response rate: 53%), mostly in the 45-64 age group (30.2%; n=1,728), 47.7% of them (n=2,729) were males. Most participants (42.1%; n=2,411) reported to visit their dentist once a year and had secondary or compulsory education as their highest educational achievement (28.18%, n=1,614; 28%, n=1,600 respectively). When questioned what they would do if they had a wound/ulceration lasting longer than 3 weeks, most participants answered they would go to see their primary care physician (62.8%; n=3,597) and less than one quarter of the sample (23.8%; n=1,371) would seek consultation with their dentist.

CONCLUSIONS

General Galician population would seek professional consultation about a long-standing oral ulceration, relying mostly on primary care physicians. Those neglecting these lesions are elderly, less-schooled people and unaware of oral cancer.

Applying dental implant therapy in patients with oral lichen planus: a review of literature

Lichen planus (LP) is a violent, paranormal inflammatory disease that can affect the skin or any lining of the mucous membrane. LPs are a branch of immune-mediated inflammatory disease (IMID) that collaborates with the function and structure of the immune system that are precipitated through various etiological infectious agents. Oral lichen planus (OLP) is one of the most common kinds of IMID. These traumas might limit the normal life of patients and, in some cases, can be treated spontaneously. In patients who are affected by OLP, the dental clinicians must be capable of the proper diagnosis of the disorder. Dental implants are progressively applied for the treatment of partial or complete edentulism. Implant rehabilitation in OLP patients is one of the main challenges for patients and dental clinicians. There is not enough knowledge about this condition, and also medical documents are limited. In this study, by conducting a comprehensive review of literature, we tried to collect related data around the safety and success rate of implant rehabilitation in patients who suffer from OLP disorder. There proved to be no relation between implant survival rate and OLP diseases, but it is proven that some factors such as bone quality and fracture resistance, parafunctional habits, and resection of the marginal mandible could powerfully affect it. For evaluation of the advantages and disadvantages of applying implants in patients with OLP disorders, implementation of controlled studies is required.

Oral Human Papillomavirus: a multisite infection

Background

The Human Papillomavirus (HPV) has different strategies for persist in the cells. This characteristic has led us to consider the presence of the virus in tissues of the oral cavity that had no clinical signs of infection. The aim of this study was to detect the presence of DNA-HPV at multiple sites of the oral cavity.

Material and Methods

A case-control study was designed: Oral Squamous Carcinoma Group (OSCG), healthy n=72 and Control Group (CG), n=72, healthy volunteers paired by sex and age with OSCG. Four samples were taken from OSCG: saliva, biopsy, brush scraping of lesion and contralateral healthy side. In CG a saliva sample and a scratch of the posterior border of tongue were collected. HPV was detected by PCR using Bioneer Accuprep genomic DNA Extraction kit, and consensus primers MY09 and MY11. Chi square test was applied.

Results

432 samples were obtained from 144 individuals. DNA-HPV was detected in 30 (42%) of OSCG subjects and 3(4%) of CG. Two or more positive samples were obtained in 67% of the OSCG, 67% in saliva and 60% in biopsy; in CG 100% of the individuals were positive in the two samples.

Conclusions

HPV is frequently present in oral cavity as a multifocal infection, even without the presence of clinical lesions.

Key words:HPV, Oral cavity, Saliva, Oral cancer.

Prevalence of and related risk factors in oral mucosa diseases among residents in the Baoshan District of Shanghai, China

BACKGROUND

Oral mucosal diseases (OMDs) encompass a variety of different types of diseases. Our aim was to evaluate the prevalence and related risk factors of OMDs among residents in the Baoshan District of Shanghai, China, and provide a scientific basis for prevention and control strategies.

METHODS

A sample of 653 residents aged 17 to 92 years from the Baoshan community was investigated in 2014. Each resident was surveyed by questionnaire to evaluate their oral mucosa and oral mucosa examinations were conducted. We followed up with 607 residents in 2018. All data were statistically analyzed using the SPSS 25.0 software package (Chicago, IL, USA) at the general population, gender and age levels. A X2 test was used to compare rates of risk factors and logistic regression analysis was used to detect the correlation between disease and risk factors.

RESULTS

The prevalence rate of OMDs was found to be 9.19%-9.56% (2014-2018). The most common OMDs were atrophic glossitis (1.84%), recurrent aphthous ulcer (RAU, 1.68%), burning mouth syndrome (BMS, 1.38%), oral lichen planus (OLP, 1.23%) and traumatic ulcers (1.23%). The prevalence of RAU and BMS in different age groups was significantly different. Tobacco and alcohol use and psychological factors in the OMDs group were higher than the no-OMDs group. Systemic diseases including diabetes mellitus (DM) was significantly relevant to OLP.

CONCLUSION

Age, tobacco and alcohol use, and psychological factor correlated strongly with the occurrence and development of OMDs, and they should be the focus of primary prevention. General epidemiological studies suggested that OLP was closely related to DM.

Comparison of the Efficacy of Sediment Cytology over Oral Brush Cytology in Oral Leukoplakia

INTRODUCTION

A method called sediment cytology includes the investigation of smears arranged from the sediment of the biopsy specimen fixatives. The sediment from this fixative is used to prepare smears and provides a potentially rich source for cytological material. Investigation of the fixative sediment and understanding of the cytological picture with pertinent clinical and radiological information permits diagnosis in a few hours.

AIM

To evaluate the diagnostic efficacy of sediment cytology and oral brush cytology compared with histopathological findings in oral leukoplakia (OL) cases.

METHODS

Cytological smears were obtained from 30 clinically diagnosed OL lesions using 2 techniques: oral cytobrush and 10% formalin fixative sedimentation. Both smears were stained with Papanicolaou. Cytological smear evaluation was conducted with respect to cellularity, cell distribution, cellular clumping, and the presence of blood, debris, inflammatory cells, and microbial colonies. The cytopathological scores for all cases were compared between sediment and brush cytology and correlated with the histopathological diagnosis. For statistical analysis, the κ test and the Wilcoxon matched-pair test were used.

RESULTS

The cytobrush technique had a sensitivity of 83.3% for OL cases histopathologically diagnosed as severe dysplasia, while the sediment cytology technique had a sensitivity of 16.6%. For moderate/mild dysplasia cases, the cytobrush technique had a sensitivity of 7.7%, whereas the sediment technique showed no diagnostic sensitivity.

CONCLUSION

Based on the results from the present study, sediment cytology, unlike oral brush cytology, is not a useful screening tool for the preliminary diagnosis of potentially malignant oral lesions.

Analysis of oral and maxillofacial pathology lesions over an 18-year period diagnosed at Kuwait University

AIMS

The aim of the present study was to determine the range, frequency, prevalence, and distribution of oral lesions submitted for histopathological diagnosis at the oral pathology laboratory at Kuwait University.

METHODS

A retrospective analysis was conducted of all cases submitted to the oral pathology laboratory over an 18-year period. Age, sex, histopathological diagnosis, and location of the lesions were recorded. Lesions were classified into 10 diagnostic categories.

RESULTS

Of the 697 biopsies examined, the average age of the patients ranged from 1 to 93 years with a mean age of 37.83 ± 16.62 (mean ± SD). The most common diagnostic category was mucosal pathologies (N = 205, 29.4%), followed by odontogenic cysts (N = 158, 22.7%) and reactive lesions (N = 97, 13.9%). The three most common histopathological diagnoses were hyperkeratosis (N = 70), dentigerous cyst (N = 48), and mucocele (N = 44). Twenty-five malignant neoplasms were diagnosed, the majority of them in males. A significant association was observed between age and the group of lesions of the oral cavity (P ≤ 0.001).

CONCLUSIONS

The present study provides the first set of data from Kuwait that covers a wide range of oral lesions. Mucosal pathologies were the most frequently diagnosed lesions and the majority of diagnoses were benign.

Interobserver and intraobserver variability affecting the assessment of loss of autofluorescence of oral mucosal lesions

OBJECTIVES

The assessment of loss of tissue autofluorescence (LAF) has been proposed as an adjunct to comprehensive oral examination to enhance the detection of mucosal lesions harbouring dysplasia or carcinoma. The assessment of LAF is not based on completely objectified parameters therefore intraobserver and interobserver variability cannot be neglected alongside the issue of correct interpretation of LAF. The present study evaluated intraobserver and interobserver variability in the clinical assessment of LAF as performed by oral medicine practitioners (OMPs) or general dental practitioners (GDPs).

MATERIALS AND METHODS

Couples of clinical pictures, acquired under white incandescent dental operatory light and during the assessment of LAF performed by VELscope were retrieved. Four OMPs and eight GDPs were asked to assess the pictures and to score the LAF. Kappa statistics allowed the assessment of intra- and inter-observer related variability.

RESULTS

Pictures of 109 lesions representative of all oral mucosal sites and clinical appearances were selected. OMPs had a better intraobserver agreement than GDPs (substantial versus moderate). The moderate (k = 0.506) interobserver agreement observed among both OMPs and GDPs in a 2-score model (positive versus negative), lowered down to poor values only among GDPs when a 3-score or 4-score model (including uncertain judgements) was applied.

CONCLUSIONS

A good agreement (k>0.8) was never observed and the present results are similar to previously reported data about conventional oral examination. Irrespective of the diagnostic accuracy, the assessment of AF seems not to be able to improve observer-related variability in the clinical assessment of oral mucosal lesions.

Elevated serum insulin-like growth factor 1 in recurrent aphthous stomatitis

Over 100 million Americans experience recurrent aphthous stomatitis (RAS) at some point in life. To develop targeted drugs for RAS treatment, it is critical to identify its etiology. We determined if serum insulin‐like growth factor 1 (IGF‐1) and related factors are associated with RAS, because both RAS prevalence and IGF‐1 are highest during puberty. We analyzed data from 1,480 Third National Health and Nutrition Examination Survey participants aged 20–40 years. Participants with a history of diabetes or lupus, cotinine levels 6 ng/ml or higher or glycemia 110 mg/dl or higher were excluded. We compared levels of IGF‐1, IGFBP‐3, leptin, and insulin in participants with a positive vs. negative RAS history in the prior 12 months. We used logistic regression in SAS/SUDAAN to account for the complex sampling design. The odds of a positive RAS history were 1.31 times higher for every 100 ng/ml increase in serum IGF‐1. This association persisted after adjustment for age, race/ethnicity, medication intake, body mass index, insulin, leptin, glycemia, and income (adjusted OR = 1.30, 95% CI [1.06, 1.60]; p = 0.013). The odds of a positive RAS history were also higher among non‐Hispanic white compared with non‐Hispanic black participants (adjusted OR = 4.37, 95% CI [3.00, 6.38]). Leptin, IGFBP‐3, and insulin levels did not differ by RAS status. The significantly higher IGF‐1 levels in participants with a positive RAS history compared with controls suggest a possible role of the IGF‐1 pathway in RAS etiology.

Association between socioeconomic factors, behavioral, general health and oral mucosa status in elderly

This study aimed to investigate the association between socioeconomic and behavioral factors, general health, oral health, and plaque accumulation and oral mucosa condition outcomes in the elderly. This is a cross-sectional study conducted from 2004 to 2005 with 785 elderly dwellers of the city of Carlos Barbosa (RS), Brasil. We used questionnaires to collect socioeconomic, behavior and health status data. The physical examination of the oral structures comprised the Mucosal-Plaque Index proposed by Henriksen (MPS). A higher prevalence of moderate/severe plaque accumulation was observed in the elderly group, in less educated male elderly. The use of full upper dentures and income under one minimum wage were protective factors for moderate/severe plaque accumulation. Only the variables of the first block of the conceptual structure, male gender (OR = 2.13; 95% CI 1.26-3.61) and lower education (OR = 1.37; 95% CI 1.06-1.78) remained associated with an unacceptable MPS score. The findings suggest that, as per MPS, less educated male elderly are more likely to have poor oral health.

New Functions of Classical Compounds against Orofacial Inflammatory Lesions

Anti-inflammatory agents have been widely used to ameliorate severe inflammatory symptoms of a number of diseases, and such therapeutics are particularly useful for diseases with intolerable pain without significant mortality. A typical example of this is a disease known as stomatitis; although stomatitis itself is not a life-threatening disease, it severely impairs the individual’s quality of life, and thus a standard therapeutic strategy for it has already been established. The topical application of a bioactive agent is quite easy, and a strong anti-inflammatory agent can be used without significant adverse effects. In contrast, natural products with relatively mild bioactivity are used for systemic intervention. However, new aspects of classical drugs used in these established therapeutic methods have recently been discovered, which is expanding the utility of these compounds to other oral diseases such as osteoarthritis of temporomandibular joints (TMJ-OA). In this review article, after summarizing the general concept and pathobiology of stomatitis, its established therapeutics are explained. Thereafter, recent advances in the research into related compounds, which is uncovering new biological functions of the agents used therein, are introduced. Indeed, regenerative therapeutics for TMJ-OA may be developed with the classical compounds currently being used.

Recurrent aphthous stomatitis and gene variability in selected interleukins: a case-control study

Genetic factors, especially those related to immune system functioning, have been intensively studied to determine their role in the development of recurrent aphthous stomatitis (RAS). The aim of the present study was to analyze gene variability in interleukin (IL)2, IL4 (and its receptor α, IL4Rα), IL10, and IL13, which were selected based on literature review and/or their functional relevance, in Czech patients with RAS and in healthy controls. In total, 252 subjects (178 controls and 74 patients with RAS) were enrolled in this case-control study, and their detailed anamnestic, clinical, and laboratory data were obtained. Nine polymorphisms in the genes encoding interleukins were determined using PCR techniques. There were no significant differences in allele or genotype frequencies of the IL2, IL4, IL4Rα, IL10, and IL13 polymorphisms rs2069762/rs2069763, rs2243250/rs79071878, rs1801275, rs1800896, and rs1800925, respectively, between controls and patients with RAS. The minority alleles rs1800871 and rs1800872, which encode variants of IL10, were associated with a statistically significantly higher risk of RAS, as confirmed by the results of genotype and haplotype analyses. We suggest that variability in the IL10 gene may play an important role in the development of RAS in the Czech population.

Epidemiology of oral mucosal lesions in Slovenia

Background

Among the diseases of oral mucosa, malignant tumors are the most dangerous, but not the most common lesions that might appear in the oral cavity. Since most of the studies are focused on the detection of cancer in the oral cavity, we were interested in detecting the frequency of benign changes of the oral mucosa in Slovene population. Oral mucosal lesions are important pointer of oral health and quality of life, especially in elderly. The prevalence of oral mucosal lesions, together with information on the risk habits associated with oral health, such as tobacco and alcohol use, can help in planning future oral health studies and screening programs.

Patients and methods

Survey upon oral mucosal lesions was conducted during the national project for oral cancer screening in spring 2017 in the Slovenia in which more than 50% of dentists participated and 2395 patients (904 men and 1491 women) were included.

Results

Clinical examination, which was conducted according to the WHO standards revealed that 645 patients (27%) had oral mucosal lesions. The ten most common oral lesions detected were fibroma, gingivitis, Fordyce spots, white coated tongue, cheek biting, linea alba, denture stomatitis, geographic tongue, recurrent aphthous ulcerations and lichen planus.

Conclusions

Overall, these epidemiological data suggest need for specific health policies for prevention, diagnosis and treatment of oral mucosal lesions.

Telediagnosis of oral lesions in primary care: The EstomatoNet Program

OBJECTIVE

The diagnosis of oral lesions is often challenging for primary healthcare providers, which explains the high number of referrals to specialist care. This favors increases in waiting lines and delays in diagnosis, contributing to high mortality rates from oral cancer. This study aimed to summarize the experience of the EstomatoNet, a telediagnosis program catering to primary care dentists and physicians from southern Brazil.

STUDY DESIGN

This exploratory study included all queries received by EstomatoNet from June 2015 to December 2016. Health providers (71 dentists and 18 physicians from primary care) submitted requests including clinical information and photographs of oral lesions by means of a cloud-based platform. Specialized oral medicine teleconsultants received the data, conveyed a diagnostic hypothesis, and conveyed management recommendations.

RESULTS

Actinic cheilitis (n = 41, 15.8%), squamous cell carcinoma (n = 22, 8.5%), and inflammatory hyperplasia (21, 8.1%) were the most frequent diagnoses. Teleconsultants recommended referral to specialists in 42.9% of the cases, total biopsy in 23.6%, and follow-up in 16.2%. After the EstomatoNet use, the intention to refer the patients to face-to-face consultation reduced from 96.9% to 35.1%.

CONCLUSION

Telediagnosis for oral lesions is feasible and has potential to improve the quality of primary health care by bridging the gap between primary and specialized health care.

Prevalence of oral potentially malignant disorders: A systematic review and meta-analysis

Oral potentially malignant disorders (OPMD) are chronic conditions, which have a higher risk of transformation to oral squamous cell carcinoma. The aim of this systematic review and meta-analysis was to answer the question: "What is the prevalence of oral potentially malignant disorders among adults?" Studies reporting the prevalence of these conditions (leukoplakia, erythroplakia, oral submucous fibrosis [OSMF], and actinic cheilitis) were selected, only studies in which a clinical assessment and histopathological confirmation were performed were included. Of the 5513 studies, 22 met the inclusion criteria for qualitative and quantitative analyses. The risk of bias (RoB) of the selected studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Seven studies were classified as high risk, 12 as moderate risk, and 3 as low RoB. The meta-analysis showed that the prevalence of OPMD was 4.47% (95% CI = 2.43-7.08). The most prevalent OPMDs were OSMF (4.96%; 95% CI = 2.28-8.62) and leukoplakia (4.11%; 95% CI = 1.98-6.97). OPMDs were identified more commonly in males (59.99%; 95% CI = 41.27-77.30). Asian and South American/Caribbean populations had the highest prevalence rates of 10.54% (95% CI = 4.60-18.55) and 3.93% (95% CI = 2.43-5.77), respectively. The overall prevalence of OPMD worldwide was 4.47%, and males were more frequently affected by these disorders. The prevalence of OPMD differs between populations; therefore, further population-based studies may contribute to the better understanding of these differences.

Prevalence of oral human papillomavirus (HPV) in the adult population of Córdoba, Argentina

Objective:

To determine the prevalence of oral human papillomavirus (HPV) in the population of Córdoba, Argentina and its association with other risk factors.

Methods:

A sample of 401 volunteers over 18 years, representative of Cordoba city population, was selected. Using a questionnaire, we collected sociodemographic data including the use of tobacco, alcohol, and mate consumption. Two biological samples were taken from each individual, whole mouth saliva and a scraping of the posterior border of the tongue. HPV was determined by polymerase chain reaction using MY09/11 primers. Statistical associations were analyzed using χ2 test.

Results:

Prevalence of HPV in the population was of 3% (13/401). The mean age of HPV-positive cases was 42 years with a range of 20–85; 54% were females. Among the 13 cases whose saliva was positive for HPV, only 7 (54%) had HPV-DNA in the tongue scraping. All identified genotypes were of low risk and HPV11 was the most frequent type in 62% of positive cases. None of the positive subjects exhibited oral lesions compatible with HPV infection. Ten (77%) of the HPV-positive subjects exhibited lesions in the oral mucosa, mostly related to chronic mechanical irritation (CMI) (odds ratio 3, 95% confidence interval: 1.01–8.97, p < 0.05). Fifty-four percent of HPV-positive individuals were light smokers and consumed alcohol moderately. The combination of both habits was observed in 31%. Sixty-two percent drank mate at high water temperatures. No differences were detected in the sexual behavior or in the reported number of sexual partners between HPV-positive and -negative subjects.

Conclusion:

The overall prevalence of oral HPV in adults was 3%; only the low-risk genotypes were detected and no association with other risk factors for oral cancer was found. However, an association with CMI of the oral mucosa was noted. The saliva sample proved to be a simple, efficient, and well-tolerated method suitable for screening for HPV, and more cases were detected in saliva compared with tissue scrapings.

A comparative analysis of oral and maxillofacial pathology over a 16-year period, in the north of Portugal

OBJECTIVES

To determine the frequency and spectrum of oral and maxillofacial lesions biopsied in a hospital population in the northern region of Portugal.

METHODS

We conducted descriptive analyses of pathology reports from biopsies of oral and maxillofacial lesions performed between 1990 and 2006, in Oporto Hospital Center. Information on gender and age of patient, location of the lesions and the histopathological diagnosis were analysed.

RESULTS

The analyses revealed that 1,520 (47.7%) patients were male and 1,666 (52.3%) were female. They had a mean age ± standard deviation of 47.8 ± 18.6 years. The site most frequently biopsied was the labial mucosa (17.5%). A non-neoplastic diagnosis was established in 2,162 (63.3%) cases, potentially malignant disorders in 163 (5.1%) and neoplasms in 886 (27.6%) (403 benign and 483 malignant). The most commonly reported diagnosis was fibroepithelial polyp (n = 186; 15.9%), followed by squamous cell carcinoma (SCC) (n = 158; 13.6%). SCC was the lesion most commonly found in male patients (n = 279; 18.4%) whilst fibroepithelial polyp was the lesion most commonly found in female patients (n = 268; 16.1%). The most common lesion in patients 0-17 years of age was a follicular cyst (n = 25; 12.8%), whereas in patients 18-64 years of age it was a fibroepithelial polyp (n = 299; 13%). SCC was the most common type of lesion found in patients ≥ 65 years of age (n = 160; 24.6%).

CONCLUSION

This large sample provides useful information about the incidence and distribution of oral biopsies over a period of 16 years, allowing valuable comparison with other countries. Non-neoplastic lesions were the types of lesion most commonly reported, with fibroepithelial polyp being most frequent. SCC was the second most common diagnosis.

[Epidemiology of oral diseases in a university hospital specialized consultation]

INTRODUCTION

Oral diseases (OD) are common and affect, according to studies, 2.5 to 61.6% of general population. The main objective of our study was to determine the most common diagnoses of OD in a dedicated consultation in a University Hospital.

MATERIAL AND METHOD

We conducted a descriptive observational study over 12 months from weekly OD consultations provided within the oral and maxillofacial surgery department at the Timone university hospital, Marseille, France. We divided our patient population into 4 subgroups: subgroup A, in which each patient was considered as a new one for each consultation; subgroup B, in which each patient was only considered once; subgroup C, including patients seen three times at least and subgroup D, including the children. At each consultation, were identified: age, sex, alcohol and tobacco consumption, corresponding physician specialty, time between onset of symptoms and consultation, reason for consultation and final diagnosis.

RESULTS

Subgroups A, B, C and D respectively included 393, 208, 23 and 11 cases. Age and sex were similar in the subgroups A, B and C (mean age: 53.6, 54.3 and 51.4 years, respectively; female predominance: 62.9%, 66.8% and 65.2%, respectively). The most commonly encountered diagnoses were similar in the subgroups A and B: oral lichen planus (19.6% and 19.2%), aphthous stomatitis (11.5 and 7.2%), burning mouth syndrome (11.5 and 14.9%). In subgroup C, were found: oral lichen planus (34.8%), aphthous stomatitis (21.7%), cicatricial pemphigoid (13%) and pemphigus (13%). In the subgroup D, the most common diagnoses were aphthous stomatitis (45.5%) and traumatic injury (18.2%). The mean time before diagnosis was about 2 years.

DISCUSSION

The most common diagnoses in a specialized OD consultation are: lichen planus, aphthous stomatitis and burning mouth syndrome. The time before diagnosis could be improved by means of more information for practitioners and patients.

Thyroid Disease and Oral Lichen Planus as Comorbidity: A Prospective Case-Control Study

BACKGROUND

Thyroid disease has been mentioned to have a possible relation to the development of oral lichen planus (OLP).

OBJECTIVE

Because goiter is considered endemic in many countries, we proposed to determine whether thyroid disease constitutes a comorbidity of OLP.

METHODS

Two hundred and fifteen patients diagnosed as having OLP were evaluated concerning their serum thyroid-stimulating hormone and thyroxine (T4) levels. The results were contrasted with those obtained in control series of the same number of subjects matched for age and sex.

RESULTS

Diagnosis of thyroid disease was present in 15.3% of OLP patients (33/215) and in 5.2% (12/215) of the control group. In relation to OLP patients, the odds ratio of presence of thyroid disorders was 3.06 and that of using levothyroxine medication 3.21.

CONCLUSIONS

In the present study, OLP patients were associated with thyroid disease, specifically with hypothyroidism. Because most thyroid patients need T4 treatment, our findings confirmed that OLP and thyroid disease could be comorbidities.

Oral soft tissue biopsies in Oporto, Portugal: An eight year retrospective analysis

Background

The diseases that affect the oral cavity are wide and diverse, comprising a broad spectrum of either benign or malignant lesions. However, few histological-based studies were performed for the evaluation of oral cavity lesions, and very few directed to oral soft tissue pathology. The aim of this study was to carry out pioneering research, within a Portuguese population, to determine the frequency and characteristics of oral malignancies, potential malignant disorders, and soft benign tissues pathologies submitted for biopsy in a north Portugal (Oporto) hospital population.

Material and Methods

We performed a retrospective study of soft tissue, oral cavity biopsies, in a hospital north of Portugal (Oporto) between 1999 and 2006. We analysed information on gender, age, location of the lesion, and the histopathological diagnosis.

Results

A total of 1042 oral biopsies were observed, 557(53.5%) in females and 485 (46.5%) in males, with a mean age of 51.7 years (S.D. ±17.6). The topographic location most frequently affected was labial mucosa (n=306). Considering the nature of the lesions, 700 (67.2%) corresponded to non-neoplasic lesions, 45 (4.3%) to potentially malignant disorders, and 297 (28.5%) to neoplasms (93 benign and 204 malignant). Non-neoplasic lesions were more prevalent in female gender (59.9%) when compared with potentially malignant disorders (46.7%) and neoplasms (39.4%) (P< 0.001). Non-neoplasic lesions presented the lower mean age (49.2±17.6) and potentially malignant disorders the highest mean age (60.5±14.5) (P< 0.001). The most common lesion of entire sample was fibro-epithelial hyperplasia (n=186; 17.9%), followed by squamous cell carcinoma (n=158; 15.1%).

Conclusions

Fibro-epithelial hyperplasia, followed by squamous cell carcinoma, was the most common pathologies. This pioneering study provided, for the first time, data about the proportion of squamous cell carcinoma when compared with benign conditions in a Portuguese hospital population.

Key words:Oral biopsies, oral cavity, oral pathology, Portugal, soft tissue lesions.

Oral mucosal lesions in elderly dental patients in Sana'a, Yemen

OBJECTIVES

With aging, the oral mucosa becomes more susceptible to external stimuli. The aims of this study were to obtain baseline data on the prevalence of oral mucosal lesions (OMLs) in a population of elderly Yemeni patients and to investigate differences in the presentation of these findings in relation to age, gender, education level, and the wearing of dentures.

PATIENTS AND METHODS

The prevalence of OMLs was assessed by clinical examination of a sample of 310 elderly Yemeni patients aged 60 years and older. A single examiner performed detailed oral examinations of the oral cavity according to international criteria and the World Health Organization codes.

RESULTS

The overall prevalence of OMLs was 77.1%, with a significant difference (P < 0.05) between men (80.3%) and women (69.6%). The prevalence rate of OMLs indicated a significant decrease with advancing age. The most frequently observed lesions were fissured tongue (34.2%), benign tumors (17.1%), hairy tongue (16.5%), and qat-induced white lesions (12.6%). Hairy tongue, qat-induced white lesions, and shammah keratosis were associated with men (P < 0.01, P < 0.05, and P < 0.05, respectively), whereas geographic tongue was associated with women (P < 0.05). The presence of one or more lesions was significantly associated with low education level (P < 0.05). Certain OMLs showed a significant association with smoking and qat chewing (P < 0.05). No association was found between the occurrence of OMLs and denture wearing (P > 0.05).

CONCLUSIONS

The present study has shown a high prevalence of oral lesions among Yemeni elders.

Oral and maxillofacial pathologies in young- and middle-aged adults

OBJECTIVE

To evaluate the distribution of oral and maxillofacial pathologies (OMFPs) and its association with patient age in young- and middle-aged adults.

METHODS

Distribution of histopathologically diagnosed OMFPs (n = 385) treated during 2007-2010 was recorded and the association with patient age was retrospectively analyzed.

RESULTS

The main diagnostic categories included benign exophytic lesions (45.3%), white benign lesions (13.5%), potentially malignant lesions/disorders (10.1%), intrabony lesions (9.8%), mucosal discoloration (7.8%), benign pigmented lesions (7.3%), chronic trauma/inflammation (3.9%), and oral malignancy (2.1%). Potentially malignant lesions/disorders as a diagnostic category were positively associated with age (OR = 1.07 for 1 year; P < 0.001) and specifically the diagnoses of oral lichen planus (OR = 1.04 for 1 year; P = 0.037) and dysplastic changes (OR = 1.08 for 1 year; P = 0.013) that comprised this category. Pigmented melanocytic lesions were negatively associated with age (OR = 0.94 for 1 year; P = 0.039) as well as benign/reactive exophytic lesions (OR = 0.98 for 1 year; P = 0.038), the latter included the histopathological diagnosis of benign salivary gland pathologies (OR = 0.90 for 1 year; P < 0.001).

CONCLUSION

This study provided baseline information regarding the distribution OMFPs among young- and middle-aged adults. It is important to highlight the high frequency of potentially malignant lesions/disorders and oral malignancy in young- and middle-aged adults, as these lesions require lifelong follow-up.

Oral mucosal lesions and their association with tobacco use and qat chewing among Yemeni dental patients

Objectives: This study aimed to assess the prevalence of oral mucosal lesions (OMLs) in patients attending outpatient dental clinics in Sana`a university, Yemen, and to evaluate the association of such lesions with age, gender, and oral habits. Materials and Methods: This cross-sectional study included 409 subjects (272 males, 137 females, age: 15-86 years). Detailed clinical examination was performed in accordance with international criteria. Patient history included age, gender, education, denture wearing and risk habits (tobacco use and qat chewing). Data were analyzed using SPSS 19.00. Results: The prevalence of OMLs was 58.4% with a significant difference between men (63.6%) and women (48.2%; P < 0.05). The most common lesions were fissured tongue (37.2%), hairy tongue (15.9%), tumors and tumor-like lesions (9.8%), qat-induced white lesions (9.3%) and racial pigmentation (5.9%). Overall OMLs prevalence was linked to risk habits and age; qat chewing was statistically significant risk factor for having fissured tongue (OR: 1.77), hairy tongue (OR: 2.74), and white lesions (OR: 2.39) (P < 0.05). Cigarette smoking was statistically significant risk factor for having hairy tongue (OR: 2.82), white lesions (OR: 3.60) and tumors and tumor-like lesions (OR: 2.91) (P < 0.01). The increase in age was statistically significant risk factor for having tumors and tumor-like lesions (OR: 1.04; P < 0.001). Conclusions: The current results indicate that the occurrence of OMLs among Yemeni adults is high and emphasize that risk habits and age have some relationship with the presence of OMLs.

Key words:Oral mucosa, oral lesions, prevalence, smoking, qat chewing.

Political priority of oral health in Italy: an analysis of reasons for national neglect

PURPOSE

Oral health remains a neglected area and its political priority on most national agendas is low. This analysis aimed to identify the political priority of oral health in Italy.

BACKGROUND

Italian public health services are decentralised at the regional level and are financed by both central and local authorities. Despite certain legally guaranteed public oral health services, access to oral health care seems to be inhomogeneous.

METHODS

Appraisal of the political priority of oral health in Italy uses the Political Power Framework as proposed by Shiffman and Smith.

RESULTS AND DISCUSSION

There is no clear mandate for leadership or coordination within the oral health sector, resulting in fragmentation and in dominance of the private sector. As a consequence, oral diseases are mainly addressed through a curative rather than a preventive public health approach. Current, systematic and representative data are lacking. Therefore, the real burden of oral diseases is unknown and thus cannot be addressed adequately. Evidence-based, cost-effective and sustainable population-wide public dental health interventions are not implemented on a large scale, and growing inequities in terms of access to care are not seen as a concern.

CONCLUSION

Lack of relevant policies with a public health focus, absence of systematic oral health surveillance and limited access to care for large population groups are strong indicators that oral health is not a political priority. However, opportunities in the wider political environment could be used to facilitate analysis, discussion and change in order to improve political priority of oral health in Italy.

Nitric oxide synthase 2 (NOS2) expression in histologically normal margins of oral squamous cell carcinoma

The activity of Nitric Oxide Synthase 2 (NOS2) was found in oral squamous cell carcinomas (OSCC) but not in normal mucosa. Molecular changes associated to early carcinogenesis have been found in mucosa near carcinomas, which is considered a model to study field cancerization. The aim of the present study is to analyze NOS2 expression at the histologically normal margins of OSCC.

STUDY DESIGN

Eleven biopsy specimens of OSCC containing histologically normal margins (HNM) were analyzed. Ten biopsies of normal oral mucosa were used as controls. The activity of NOS2 was determined by immunohistochemistry. Salivary nitrate and nitrite as well as tobacco and alcohol consumption were also analyzed. The Chi-squared test was applied.

RESULTS

Six out of the eleven HNM from carcinoma samples showed positive NOS2 activity whereas all the control group samples yielded negative (p=0.005). No statistically significant association between enzyme expression and tobacco and/or alcohol consumption and salivary nitrate and nitrite was found.

CONCLUSION

NOS2 expression would be an additional evidence of alterations that may occur in a state of field cancerization before the appearance of potentially malignant morphological changes.

Genomic DNA copy number alterations from precursor oral lesions to oral squamous cell carcinoma

Oral cancer is a multifactorial disease in which both environmental and genetic factors contribute to the aetiopathogenesis. Oral cancer is the sixth most common cancer worldwide with a higher incidence among Melanesian and South Asian countries. More than 90% of oral cancers are oral squamous cell carcinoma (OSCC). The present study aimed to determine common genomic copy number alterations (CNAs) and their frequency by including 12 studies that have been conducted on OSCCs using array comparative genomic hybridization (aCGH). In addition, we reviewed the literature dealing with CNAs that drive oral precursor lesions to the invasive tumors. Results showed a sequential accumulation of genetic changes from oral precursor lesions to invasive tumors. With the disease progression, accumulation of genetic changes increases in terms of frequency, type and size of the abnormalities, even on different regions of the same chromosome. Gains in 3q (36.5%), 5p (23%), 7p (21%), 8q (47%), 11q (45%), 20q (31%) and losses in 3p (37%), 8p (18%), 9p (10%) and 18q (11%) were the most common observations among those studies. However, losses are less frequent than gains but it appears that they might be the primary clonal events in causing oral cancer.

Prevalence of oral mucosal lesions in an adult Iranian population

Background

Nowadays the importance of oral health to life quality is not obvious to anyone in our world. Oral lesions can interfere with daily social activities in involved patients through impacts on mastication, swallowing and speech and symptoms like xerostomia, halitosis or dysesthesia.

Objectives

To assess the prevalence and types of oral lesions in a general population in Rasht, Northern Province of Iran.

Patients and Methods

1581 people aged > 30 years old who were inhabitant of Rasht, Iran, enrolled in a cross-sectional study. For each individual a detailed questionnaire based on the world health organization (WHO) guidelines in order to diagnosis of the lesions was filled and it contained all the required data. Participants were divided into two groups with and without oral mucosal lesions and oral mucosal lesions were divided into two groups with and without. Demographic characteristics and clinical information including age, sex, smoking (cigarette and tobacco), opium consumption, medication and oral and dental hygiene were collected and compared between these two groups.

Results

The prevalence of mucosal lesions in our study was 19.4%. Our data demonstrated higher prevalence of oral mucosal lesions in males and young adults (30-40 years). The most common mucosal lesion among our participants was Fissured tongue(4%), followed by Fordyce granules(2.8%), geographic tongue(2.6%) , Pigmentation(2.5%), Candida(1.8%), Smoker Plate(1.6%), lingual Varices(1.5%), Petechiae(1.4%) and lingual labial(1.4%) . Leukoplakia was observed only in two people (0.1%).No case of malignant lesions was detected. No statistically significant difference was confirmed between the two groups regarding smoking, opium consumption, medication and oral and dental hygiene.

Conclusions

Our data has provided baseline information about epidemiologic aspects of oral mucosal lesions which can be valuable in organized national program targeting on oral health and hygiene in the society.

Prevalence of oral mucosal lesions in patients of the Kuwait University Dental Center

OBJECTIVES

The purpose of this study was to determine the number, types, and locations of oral mucosal lesions in patients who attended the Admission Clinic at the Kuwait University Dental Center to determine prevalence and risk factors for oral lesions.

SUBJECTS AND METHODS

Intraoral soft tissue examination was performed on new patients seen between January 2009 and February 2011. The lesions were divided into six major groups: white, red, pigmented, ulcerative, exophytic, and miscellaneous.

RESULTS

Five hundred thirty patients were screened, out of which 308 (58.1%) had one or more lesions. A total of 570 oral lesions and conditions were identified in this study, of which 272 (47.7%) were white, 25 (4.4%) were red, 114 (20.0%) were pigmented, 21 (3.7%) were ulcerative, 108 (18.9%) were exophytic, and 30 (5.3%) were in the miscellaneous group. Overall, Fordyce granules (n = 116; 20.4%) were the most frequently detected condition. A significantly higher (p < 0.001) percentage of older patients (21-40 years and ⩾41 years) had oral mucosal lesions than those in the ⩽20 years age group. A significantly higher (p < 0.01) percentage of smokers had oral mucosal lesions than did nonsmokers. Most of the lesions and conditions were found on the buccal mucosa and gingiva.

CONCLUSIONS

White, pigmented, and exophytic lesions were the most common types of oral mucosal lesions found in this study. Although most of these lesions are innocuous, the dentist should be able to recognize and differentiate them from the worrisome lesions, and decide on the appropriate treatment.

Urban legends series: oral leukoplakia

To date, the term oral leukoplakia (OL) should be used to recognize 'predominantly white plaques of questionable risk, having excluded (other) known diseases or disorders that carry no increased risk of cancer'. In this review, we addressed four controversial topics regarding oral leukoplakias (OLs): (i) Do tobacco and alcohol cause OLs?, (ii) What percentage of OLs transform into oral squamous cell carcinoma (OSCC)?, (iii) Can we distinguish between premalignant and innocent OLs?, and (iv) Is proliferative verrucous leukoplakia (PVL) a specific entity or just a form of multifocal leukoplakia? Results of extensive literature search suggest that (i) no definitive evidence for direct causal relationship between smoked tobacco and alcohol as causative factors of OLs, (ii and iii) the vast majority of OLs follow a benign course and do not progress into a cancer, and no widely accepted and/or validated clinical and/or biological factors can predict malignant transformation, and (iv) the distinction between multifocal/multiple leukoplakias and PVL in their early presentation is impossible; the temporal clinical progression and the high rate of recurrences and development of cancer of PVL are the most reliable features for diagnosis.

Demographic and behavioural profiles of patients with common oral mucosal lesions by a homogeneity analysis

OBJECTIVE

The aim of this study is to assess the main oral mucosal lesions (OMLs) within a hospital base and to provide an anamnestic, diagnostic model based on homogeneity analysis of some variables.

METHODS

The demographic and behavioural data (i.e. gender, age, smoking status, alcohol consumption and therapeutic drug usage) of 1753 patients with at least one OML were considered. Multiple correspondence analysis (MCA) and multivariate tests of the simultaneous marginal homogeneity hypothesis (SMH) were used to analyse the evidence of any differences between the demographic and behavioural profiles relating to OMLs diagnoses. Statistical significance of P < 0.05 was chosen.

RESULTS

With respect to the model used, patients affected by oral squamous cell carcinoma (n = 65; 3.5%) and oral leukoplakia (n = 73; 4.0%) differed significantly for demographic and behavioural characteristics analyzed, in particular with respect to gender (63.9%vs 50.1% males) and alcohol consumption (29.1%vs 12.1%). Patients affected by burning mouth syndrome (n = 134; 7.3%) and bisphosphonate-related osteonecrosis of the jaw (n = 40; 2.2%) differed significantly for chronic use of drugs (45.7%vs 71.6%). Finally, patients with halitosis (n = 60; 3.3%) and recurrent aphthous stomatitis (n = 103; 5.6%) showed similar profile, mainly in terms of men (47.6%), drinker (4.8%), drug user (34.9%), ≥60 years old (20.8%) and smoker (6.4%).

CONCLUSION

Knowledge of some similarities in patients' profile could help in positing the likely presence of OML when making diagnosis process by either general physicians or dentists, especially those without extensive experience in the field of oral medicine.