Prevalence of Oral Mucosal Lesions: A Prospective Study

Keywords

Mucosal Lesions; Oral; OSMF; Prevalence.

Introduction

Oral cavity is reflected as a mirror of general health.Throughout the world, oral mucosal lesions (OMLs) are commonlyseen in many populations. Mucosal lesions may be identigfied during regular dental examinations and they divergedepending on age, gender and/or race. There are very limited studies pertaining to oral mucosal lesions as compared to periodontal diseases and dental caries. Smoking and drinking are positively associated with oral lesions such as oral submucous fibrosis (OSMF), leukoplakia, and oral lichen planus, which have the potential for malignant transformation.[1] The World Health Organization considered as potentially malignant lesions or disorders with the following conditions: leukoplakia, erythroplakia, lichen planus, actinic cheilitis, and oral submucous fibrosis. Orawl leukoplakia is the most common premalignant oral lesion.[2]

Leukoplakia is the one of the most communal potentially malignant lesion occurred in the oral cavity. They are usually diagnosed at middle age and are commonly found in males due to smoking habit. Leukoplakia can be classified based on clinical presentation as homogeneous or non-homogenous. Homogenous lesions, which are usually thin, flat, asymptomatic, whereas nonhomogenous are usually symptomatic withnodular, verrucous.

Tobacco and areca nut use is the main risk factor for leukoplakia and OSMF. Leukoplakia can remain stable, or may progress to carcinoma. Oral leukoplakia needs to be differentiated from other white keratotic lesions including frictional keratosis and stomatitis nicotina, which do not have malignant potential.[3] Various oral premalignant lesion have risk for transferring into cancer. Conversely, all potentially malignant epithelial oral lesions should be diagnosed through microscopic examination because of apparent differences between clinical and histological diagnosis.[4] Hence there is a need of early identification of oral lesions and prompt treatment.

The aim of this study was to evaluate the prevalence of oral mucosal lesions, and location of lesion among participants aged 18 years and above, visiting to OPDdepartment of Oral medicine and Radiology.

Materials and Methods

This cross-sectional study was done to evaluate the prevalence of oral mucosal lesions and site preference for lesions. The study was carried out between March 2016 and August 2017. The study participants were consisting of patients visiting to the OPD department of Oral medicine and Radiology.Ethical clearance was obtained from institutional ethics committee and informed consent was attained from all the participants.

The World Health Organization (WHO) Oral Health Assessment Form was adopted for clinical evaluation and the findings were recoreded in the proforma. All subjects underwent a comprehensive type III clinical examination of the oral mucosa performed bytwo trained investigators. Demographic profile of all the participants was recorded including, gender, cigarette smoking, alcohol habits. The diagnosis of OML was performed in accordance with WHO criteria.[5]

The obtained data was tabulated and statistically evaluated using IBM SPSS statistical software version 18, Chicago, and frequency and distribution tables of oral mucosal lesions was obtained.

Results

Among total 826participants, 200 had various oral mucosal lesions. The prevalence of different oral mucosal lesions in the present study was 24.2 %. Tables 1 indicates prevalence and distribution of oral mucosal lesions among the participants. Among the reported oral mucosal lesions in the present study, Oral submucous fibrosis was more prevalent (21%) followed by coated tongue (16%), apthous ulcerations (12.5%), leukoedema (9%), candida lesions (8%), leukoplakia (6%), geographic/fissured tongue (5%), lichen lesions (4.5%), mucocele (4%), herpes lesions (3%), chewers mucosa (2.5%), radiation mucositis (2.5%), irritational fibroma (2%), malignancy(1.5%), linea alba (1.5%), and smoker’s palate (1%). The mean age for most of the lesion was above 40 years and 28.5 years for Linea alba and Geographic/ fissured tongue. There was higher prevalence of OSMF in males (15.5%) compared to females (5.5%). There is not statistically significant difference between males and females for other lesion in the present study.

Table 2 indicates the location of various oral mucosal lesions. Lesion location was more frequent at buccal mucosa (46%) followed labial mucosa (17.5%), vestibular region (15%), tongue (13%)m gingival (3.5%), palate (3%) and floor of mouth (2%).

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Table 1:

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Table 1. Prevalence and distribution of oral mucosal lesions among the participants.

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Table 2:

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Table 2: Oral mucosal lesions distribution according to location.

Discussion

The prevalence of oral mucosal ranges from 10.8 to 61.6% in severalpeoples. [6] Oral health is significant to the quality of life of all individuals.Oral lesions can interfere with daily social activities in affected patients through impact on swallowing and speech, mastication, and symptoms such as halitosis, xerostomia, or dysesthesia. Suitable management of a patient with an oral lesion begins with ancorrect diagnosis. Oral soft tissue evaluation is critical and should be done in a systematic means.Epidemiologic studies provide important information to understand the prevalence, incidence, and severity oforal disease in a specific population.[4] Mehta and Pindborg conducted a survey on leukoplakia and oral cancer on 50,915 participants and found 0.2 to 4.9%. prevalence for Leukoplakia and 3.0% to 12.4% prevalence for epithelial atypia. They stated that hookli smoking and reverse smoking were related with leukoplakia.[7] Vlad et al, evaluated the prevalence of oral leukoplakia and correlated it with age, gender, age, alcohol and smoking habit. Prevalence of 3.32% for homogenous leukoplakia and it was commonly found on check, lip and tongue and commonly in males.[2] Feller and Lemmer from their review stated that, leukoplakia is considered as precancerous lesion and there is a link between human papillomavirus (HPV) with oral leukoplakia.[3]

Kumar et al evaluated the prevalence, distribution and associated risk factors of oral mucosal lesion on 1048 patients. They found 18.89% prevalence of oral mucosal lesions and 5.63%. premalignant lesions. They concluded that smoking, chewing habits, and alcohol use as amain factor for higher prevalence of premalignant lesions.[1] These findings are similar to our results. Bokor-Bratiæ evaluated the prevalence of precancerous oral lesions on 2385 participants. In this majority of cases was homogeneous type as compared to non- homogeneous type. They found leukoplakia above 40 years of age.[8] Ambika et al found oral mucosal lesions in more than half of the participating children.[9] Kamble et al found 39.1% of prevalence of Oral lesions.[4]

Mathew et al assessed the prevalence of oral mucosal lesions and they found most commonly Fordyces conditions (6.55%) followed by frictional keratosis (5.79%), fissured tongue (5.71%), and leukoedema.[10] Rooban et al evaluated the prevalence of various oral mucosal lesions. They concluded that subjects who misuse alcohol have poor oral hygiene and are at risk for the development of periodontal disease. It has been reported that, chronic alcohol exposure in rats causes oral mucosal atrophy, dysplastic changes, an increase in the size of the basal cell nuclei.[11] Oivio UM et al assessed the prevalence of oral mucosal lesions on 12,068 participants and they found various oral mucosal lesions in 81.8% of participants. Among that oral lichen planus was most common.6Pontes et al from their study found higher prevalence rates (21%) of OML. Nicotine stomatitis (33%) and leukoplakia (19%) were common oral lesions reported. Prevalence was more among males compared to females.[12] Sharma et al from their study found hyperkeratosis followed by leukoplakia and smoker’s melanosis as a common oral lesions and cigarette/bidi and gutkha could be common couse for the oral lesions. [13] Saraswathi et al found OSF as prevalent oral lesions amongstwhochewedpanmasala or gutkha or betel quid with or without tobacco. [14]

Toum et al from their study concluded that there is a need of adequate awareness about management of oral mucosal lesions. [15] Gambhir et al concluded from their study that there is need of community based awareness program for management of oral mucosal lesions.[16]

In the present study prevalence of different oral mucosal lesions was 24.2 %. Oral submucous fibrosis was more prevalent (21%) which is similar to previous studies.[1, 12] In the present study due to smoking and tobacco chewing habit among males. There was higher prevalence of SMF in males (15.5%) compared to females (5.5%). Epidemiological survey can help in early diagnosis and management of various oral mucosal and premalignant lesions. There is need to create awareness among the public about various OML.

The drawback of the present study was smaller sample size and study didn’t use microscopic examination for confirmation of premalignant lesions. Further long term studies are required on larger sample size with microscopic confirmation.

Conclusion

The results of this study convey significant information about the prevalence of oral mucosal lesions amongst patients pursuing dental care. The study offers baseline data for forthcoming studies about the prevalence of oral lesions in the general public.