Guide to epidemiology and diagnosis of oral mucosal diseases and conditions. World Health Organization

Prevalence and the relationship of oral mucosal lesions in tobacco users and denture wearers in the North Indian population

AIM

The aim of the present study was to determine the prevalence and the relationship of oral mucosal lesions in tobacco users and denture wearers in a North Indian population.

MATERIALS AND METHODS

The study comprised 3,749 patients attending the Department of Oral Medicine and Radiology, Jodhpur Dental College General Hospital between September 2008 and December 2012, for the treatment of dental problems other than oral mucosal lesions. The ages ranged from 28 years to 83 years, with a mean age of 49.7 years. The results were evaluated using the Pearson Chi-square test, with Yate's correction and ANOVA tests.

RESULTS

A total of 2,318 patients were diagnosed with lesions associated with the use tobacco and the wearing of dentures. The most frequently seen lesion was melanin pigmentation (29.9%) followed by linea alba (22.2%) and frictional keratosis (19.9%). Ulcers (6.1%) were the most common oral lesion seen in patients who wore dentures, followed by hyperplasia (4.8%). A statistically significant relation (P < 0.05) was established between tobacco and melanin pigmentation, frictional keratosis, traumatic ulcerations and leukoplakia. In those who wore dentures a statistically significant relation (P < 0.05) was found between candidiasis, traumatic ulceration and frictional keratosis.

CONCLUSION

The results of the present study indicate that the association of frictional keratosis with tobacco users and wearers of dentures can help in determining the diagnosis and treatment plan for oral cancer. Wearers of dentures should also be recalled for periodic checks at regular intervals and optimum preventive measures implemented.

Immunologic and psychologic parameters associated with geographic tongue

OBJECTIVE

Several conditions have been associated with geographic tongue (GT). However, there is no consensus on the etiology of GT. The purpose of this study was to investigate whether immunologic and psychologic parameters are associated with diagnosis of GT.

STUDY DESIGN

A case-control study was performed on 170 participants (85 with GT, 85 controls). Unstimulated whole saliva was collected, and tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) concentrations were measured. Anxiety level was measured using psychologic and physiologic testing instruments. An independent t test and a Pearson correlation analysis were performed with SPSS (α = .05).

RESULTS

There was a significant difference between the 2 groups regarding the salivary concentrations of TNF-α (P = .008) and IL-6 (P = .001). The concentration of salivary cortisol and state and trait anxiety levels in the GT group were significantly higher than those in the control group (P = .001).

CONCLUSIONS

Immunologic and psychologic parameters appear associated with GT and may constitute risk factors of this condition.

Prevalence of recurrent aphthous ulceration in the Indian Population

Objective: Patients with an oral ulcer may present initially to a general physician or a dental practitioner. Majority of the ulcers are benign and resolve spontaneously but small proportions are malignant. The aim of the present study was to determine the prevalence of recurrent aphthous ulcerations in the Indian population. Material and Methods: 3244 patients attending the Department of Oral Medicine and Radiology during the period from November, 2010 to December, 2012 with various complaints were examined. Of the patients examined 1669 were females and 1575 were males. Results: 705 patients presented with recurrent aphthous ulceration (21.7%). Females (56.3%) were more commonly affected than males (43.7%). Patients in the third and fourth decade were most commonly affected. Stress was the most common factor associated with recurrent aphthous stomatitis (386 patients). 54.5% patients did not take any medications and 72.9% patients opined that the condition needed no dental consultation. Conclusion: The results of the present study indicate that recurrent aphthous ulceration is a common mucosal disorder in the Indian population. The early and proper diagnosis of the ulcers will help the dental practitioner in providing information to the patient regarding awareness and management of the condition.

Key words:Recurrent aphthous ulcers, prevalence, Indian population.

Clinical and histological characterization of oral pemphigus lesions in patients with skin diseases: a cross sectional study from Sudan

Background

Pemphigus is a rare group of life-threatening mucocutaneous autoimmune blistering diseases. Frequently, oral lesions precede the cutaneous ones. This study aimed to describe clinical and histological features of oral pemphigus lesions in patients with skin disease has been canceled aged 18 years and above, attending outpatient’s facility of Khartoum Teaching Hospital - Dermatology Clinic, Sudan. In addition, the study aimed to assess the diagnostic significance of routine histolopathology along with immunohistochemical (IHC) examination of formalin-fixed, paraffin-embedded biopsy specimens in patients with oral pemphigus.

Methods

A cross-sectional hospital-based study was conducted from October 2008 to January 2009. A total of 588 patients with confirmed skin has been canceled disease diagnosis completed an oral examination and a personal interview. Clinical evaluations supported with histopathology were the methods of diagnosis. IHC was used to confirm the diagnosis. Location, size, and pain of oral lesions were used to measure the oral disease activity.

Results

Twenty-one patients were diagnosed with pemphigus vulgaris (PV), 19 of them (mean age: 43.0; range: 20–72 yrs) presented with oral manifestations. Pemphigus foliaceus was diagnosed in one patient. In PV, female: male ratio was 1.1:1.0. Buccal mucosa was the most commonly affected site. Exclusive oral lesions were detected in 14.2% (3/21). In patients who experienced both skin and oral lesion during their life time, 50.0% (9/18) had oral mucosa as the initial site of involvement, 33.3% (6/18) had skin as the primary site, and simultaneous involvement of both skin and oral mucosa was reported by 5.5% (1/18). Two patients did not provide information regarding the initial site of involvement. Oral lesion activity score was higher in those who reported to live outside Khartoum state, were outdoor workers, had lower education and belonged to Central and Western tribes compared with their counterparts. Histologically, all tissues except one had suprabasal cleft and acantholytic cells. IHC revealed IgG and C3 intercellularly in the epithelium.

Conclusions

PV was the predominating subtype of pemphigus in this study. The majority of patients with PV presented with oral lesions. Clinical and histological pictures of oral PV are in good agreement with the literature. IHC confirmed all diagnoses of PV.

Dental health status and treatment needs of transport workers of a northern Indian city: A cross-sectional study

AIM

To assess the dental health status and treatment needs of transport workers working in Chandigarh Transport Undertaking (C.T.U.) buses, Chandigarh.

MATERIALS AND METHODS

A cross-sectional study was conducted on all the available C.T.U. workers at all three bus depots. The data were recorded on a modified W.H.O. format (1997). A total of 1008 subjects constituted the final sample size.

RESULTS

The mean age of the subjects was 45.3 ± 7.8 years, and 97% (978) were males. Prevalence of dental caries was 63.4% and mean DMFT was 5.02. 47.6% of subjects needed some prosthesis in the maxillary arch while 53.3% needed some prosthesis in the mandibular arch. Regarding highest CPI (Community Periodontal Index) score, 8.13% of the subjects had healthy periodontium while maximum subjects (73.2%) had a score 2 (Calculus).

CONCLUSION

Mean DMFT (Decayed, Missing and Filled Teeth) was satisfactory. Prosthetic need of the subjects was high with only a few subjects possessing prosthesis. Advanced periodontal disease (CPI score, 4) affected small number of subjects with maximum subjects (73%) having a CPI score of 2.

A study to evaluate the frequency and association of various mucosal conditions among geriatric patients

Geriatric dentistry or gerodontics is the delivery of dental care to older adults involving the diagnosis, prevention and treatment of problems associated with normal aging and age-related diseases as part of an interdisciplinary team with other health care professionals.

AIM

To evaluate the oral mucosal status in the elderly population of different age group and fnd out the association of age, gender and denture with oral mucosal disorders.

MATERIALS AND METHODS

The study sample consisted of 570 geriatric persons concentrating mainly on the oral mucosal changes or lesions occurring in the geriatric population. Individuals those are aged above 60 years were selected, and all the examined geriatric persons were categorized into 3 age groups to fnd out the association of oral mucosal lesions in each group. Group I-60 to 65 years, Group II-66 to 70 years, Group III-71 and above years.

RESULTS

The sample of 570 elderly patients included 279 (48.95%) men and 291 (51.05%) women in three age groups: 61 to 65 years (40.35%), 66 to 70 years (31.05%), and 71 years and older (28.60%). The sample included 254 (44.56%) dentate patients, 205 (35.96%) denture wearers (partial and complete denture wearers) and 111 (19.47%) edentulous persons who lacked dentures in both the jaws. Almost half of the patients examined (48%) had one or more oral mucosal lesions. The 48% of the patients who presented with oral mucosal lesions, twenty fve different oral mucosal conditions were identifed and the three most common fndings were lingual varices (13.68%), denture induced infammatory fbrous hyperplasia (4.21%), squamous cell carcinoma (4.21%). There was some differences in the distribution of oral mucosal condition among the sexes. Leukoplakia and dysplasia were signifcantly associated with men (p < 0.001) whereas the association of fbroma and lichen planus with women were signifcant (p < 0.001).

CONCLUSION

In our study it was found that patients in groups II and III had more prevalence of oral mucosal disorders. Lingual varices, oral squamous cell carcinoma, fbroma and denture induced infammatory fbrous hyperplasia were more commonly associated with the geriatric patients. The oral lesions (fbroma and lichen planus) were strongly associated with women while leukoplakia was strongly associated with men. Ageing is an important factor that can infuence the occurrence of mucosal lesions and with age the oral mucosa becomes more permeable to noxious substances and more vulnerable to external carcinogens.

Prevalence of oral mucosal lesions in dental patients with tobacco smoking, chewing, and mixed habits: A cross-sectional study in South India

Background:

A variety of oral mucosal lesions and conditions are associated with the habit of smoking and chewing tobacco, and many of these carry a potential risk for the development of cancer. There have been no studies that report the prevalence of habits and associated oral changes in the population in Dharwad region, of Karnataka, south India.

Materials and Methods:

A hospital–based, cross-sectional study was carried out at SDM Dental College (Dharwad, Karnataka). A total of 2400 subjects (1200 subjects with and 1200 subjects without habits) attending the dental hospital were interviewed and examined by trained professionals to assess any oral mucosal changes.

Results:

Oral mucosal lesions were found in 322 (26.8%) subjects who had tobacco smoking and chewing habits as compared to 34 (2.8%) subjects without those habits. Oral leukoplakia (8.2%) and oral submucous fibrosis (OSF) (7.1%) were the prevalent oral mucosal lesions found in subjects who had those habits, while the other lesions (1.7%) namely; oral candidiasis, median rhomboid glossitis, recurrent apthous ulcer, frictional keratosis, and oral lichen planus (0.9%) were frequently reported among individuals without those habits. The odds of developing oral lesions in subjects with tobacco habits was nearly 11.92 times that of abstainers (odds ratio, OR = 11.92, 95% confidence intervals, CI = 10.61-14.59%).

Conclusion:

The study showed that the risk of the development of oral lesions associated with tobacco smoking, chewing, or both is quite high. Males who had one or more of these habits showed more frequent oral changes than females. The study reinforces the association of OSF with gutkha and areca nut chewing, and leukoplakia, erythroplakia, and oral cancer with tobacco smoking, chewing, or mixed habits.

Human papillomavirus in the lesions of the oral mucosa according to topography

Background

The association between human papillomavirus (HPV) types and oral lesions has been shown in many studies. Considering the significance that HPV has in the development of malignant and potentially malignant disorders of the oral mucosa, the purpose of this study was to investigate the prevalence of HPV DNA in different oral lesions. In addition, we wanted to elucidate whether the HPV infection is associated predominantly with either the lesion or a particular anatomic site of the oral cavity.

Methodology/Principal Findings

The study included 246 subjects with different oral lesions, and 73 subjects with apparently healthy oral mucosa (controls). The oral lesions were classified according to their surface morphology and clinical diagnosis. The epithelial cells were collected with a cytobrush from different topographic sites in the oral cavity of the oral lesions and controls. The presence of HPV DNA was evaluated by consensus and type-specific primer-directed polymerase chain reaction. The HPV positivity was detected in 17.7% of oral lesions, significantly more than in apparently healthy mucosa (6.8%), with a higher presence in benign proliferative mucosal lesions (18.6%). High-risk HPV types were predominantly found in potentially malignant oral disorders (HPV16 in 4.3% and HPV31 in 3.4%), while benign proliferative lesions as well as healthy oral mucosa contained mainly undetermined HPV type (13.6 and 6.8%, respectively).

Conclusions/Significance

The distribution of positive HPV findings on the oral mucosa seems to be more associated with a particular anatomical site than the diagnosis itself. Samples taken from the vermilion border, labial commissures, and hard palate were most often HPV positive. Thus, topography plays a role in HPV prevalence findings in oral lesions. Because of the higher prevalence of the high-risk HPV types in potentially malignant oral disorders, these lesions need to be continuously controlled and treated.

Prevalence of tongue lesions in the Indian population

Objective: Tongue lesions are a health concern for the dental practitioners and the patients as they constitute a significant proportion of oral mucosal lesions. The aim of the present study was to determine the prevalence of various tongue lesions in the Indian population. Material and methods: 4926 patients attending the Department of Oral Medicine and Radiology were examined for the presence of various tongue lesions during the period from October, 2010 to September, 2012. The age of the patients ranged from 12-80 years with a mean age of 36.51 years. Results: The prevalence of tongue lesions was 12.07%. The most common lesion diagnosed was coated tongue affecting 28.0% of the subjects, followed by geographic tongue (16.4%), fissured tongue (14.9%) and depapillated tongue (11.5%). Males were more frequently affected than females. The most common systemic condition observed in the patients with tongue lesions was anaemia (189), followed by hypertension (47) and diabetes mellitus (38). Conclusion: The high prevalence necessitates adequate awareness of the various tongue lesions in the general population. The dental clinicians should also be knowledgeable about the etiopathogenesis, clinical presentation, diagnosis, and treatment of these lesions.

Key words:Tongue lesions, prevalence, Indian population, coated tongue.

Prevalence study of oral mucosal lesions, mucosal variants, and treatment required for patients reporting to a dental school in North India: In accordance with WHO guidelines

The aim of the study was to evaluate the prevalence of oral mucosal lesions (OML) in adult patients reporting to the dental outpatient department at the Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India. The purpose was to determine the priorities in oral health education, preventive measures, and identify the group in urgent need of treatment.

EDNRB and DCC salivary rinse hypermethylation has a similar performance as expert clinical examination in discrimination of oral cancer/dysplasia versus benign lesions

PURPOSE

Promoter hypermethylation has been recently proposed as a means for head and neck squamous cell carcinoma (HNSCC) detection in salivary rinses. In a prospective study of a high-risk population, we showed that endothelin receptor type B (EDNRB) promoter methylation in salivary rinses is a useful biomarker for oral cancer and premalignancy.

EXPERIMENTAL DESIGN

Using that cohort, we evaluated EDNRB methylation status and 8 additional genes. Clinical risk assessment by expert clinicians was conducted and compared with biomarker performance in the prediction of premalignant and malignant disease. Methylation status of 9 genes was analyzed in salivary rinses of 191 patients by quantitative methylation-specific PCR.

RESULTS

HOXA9, EDNRB, and deleted in colorectal cancer (DCC) methylation were associated (P = 0.012; P < 0.0001; P = 0.0005) with premalignant or malignant disease. On multivariable modeling, histological diagnosis was only independently associated with EDNRB (P = 0.0003) or DCC (P = 0.004) methylation. A subset of patients received clinical risk classification (CRC) by expert clinicians based on lesion examination. CRC, DCC, and EDNRB were associated with diagnosis of dysplasia/cancer on univariate (P = 0.008; P = 0.026; P = 0.046) and multivariate analysis (P = 0.012; P = 0.037; P = 0.047). CRC identified dysplasia/cancer with 56% of sensitivity and 66% of specificity with a similar area under curve [AUC; 0.61, 95% confidence interval (CI) = 0.60-0.81] when compared to EDNRB and DCC combined AUC (0.60, 95% CI = 0.51-0.69), sensitivity of 46% and specificity of 72%. A combination of EDNRB, DCC, and CRC was optimal AUC (0.67, 95% CI = 0.58-0.76).

CONCLUSIONS

EDNRB and/or DCC methylation in salivary rinses compares well to examination by an expert clinician in CRC of oral lesions. These salivary biomarkers may be particularly useful in oral premalignancy and malignancy screening in clinical care settings in which expert clinicians are not available.

Prevalence of oral mucosal lesions in a group of Iranian dependent elderly complete denture wearers

AIM

Oral mucosal lesions are frequently observed in institutionalized elderly patients more than other age groups. The aim of this study was to determine the prevalence of epulis fissuratum and denture stomatitis and their associated causes in dependent elderly complete denture wearers.

MATERIALS AND METHODS

This study was conducted in dependent elderly complete denture's wearers living in four randomly selected nursing homes located in Tehran. Associated factors such as gender, age, use of medication, site of nursing home, denture quality and denture-wearing habit were studied.

RESULTS

Overall, 674 patients were examined; 201 had complete denture. The prevalence of denture stomatitis was 36%. There was significant relationship among the prevalence of denture stomatitis with gender and denture wearing period (p < 0.05). The prevalence of epulis fissuratum was 16.4%. There was significant relationship among the prevalence of epulis fissuratum with gender, denture quality and denture wearing habit (p < 0.05).

CONCLUSION

In this particular dependent age group, the prevalence of oral mucosal lesions is high and the mentioned associated factors should be noticed.

CLINICAL SIGNIFICANCE

Dependent elderly complete denture wearers need more support and motivation for reducing the prevalence of these particular denture-associated oral mucosal lesions.

Oral manifestation of HIV/AIDS infections in paediatric Nigerian patients

Background:

The aims of this study were to determine the pattern and frequency of oral lesions and to compare the prevalence of HIV-related oral lesions in paediatric Nigerian patients on HAART with those not on HAART.

Materials and Methods:

All patients aged 15 years and below attending the Infectious Disease Clinic of Aminu Kano Teaching Hospital with a diagnosis of HIV were consecutively examined in a cross-sectional study over a 2-year period. Information was obtained by history, physical examinations, HIV testing, and enumeration of CD+ T cells. The results are presented. A P-value of <0.05 was considered significant.

Results:

A total of 105 children comprising 63 males and 42 female who met the inclusion criteria participated in the study, mean age in months was 53.3±42.2, with a mean of 3.4±2.2 for male and 2.8±1.8 for female respectively. Oral lesions occurred in 61.9% of the children Overall, 22 (21.0%) had at least one oral lesion, 43 (41.0%) had multiple lesion. The most common lesion was oral candidiasis (79.1%). The angular cheilitis (43.8%) variant was most frequent. The mean CD4 counts were 1138 cells/mm³, 913 cells/mm³ and 629 cells/mm³ for those without oral lesion, with single lesion and multiple oral lesions respectively. These differences were not statistically significant (ANOVA: F=0.185, df=2, 80, 82, P=0.831. Patients on HAART comprised about 61.9% and these were found to have reduced risk for development of such oral lesions as angular cheilitis (OR=0.76; 95% CI=0.56-1.02; P=0.03), pseudomembranous candidiasis (OR=0.71; 95% CI=0.54-0.94; P=0.024) and HIV-gingivitis (OR=0.59; 95% CI=0.46-0.75; P=0.001). HAART had some beneficial but insignificant effect on development of HIV-periodonttitis (OR=0.60; 95% CI=0.51-0.70; P=0.09). The chances of occurrence of other oral lesions were not significantly reduced by HAART (Kaposi sarcoma, OR=1.24; 95% CI=0.31-5.01; P=0.47, erythematous candidiasis, OR=1.13; 95% CI=0.62-2.06).

Conclusion:

HIV-related Oral lesions are frequently seen in HIV-infected Nigerian children. Paediatric patients receiving HAART had significantly lower prevalence of oral lesions, particularly oral candidiasis and HIV-gingivitis.

Prevalence of oral mucosal lesions in psoriatic patients: A controlled study

Objectives: This study aimed to investigate and compare the prevalence of oral mucosal lesions in a group of psoriatic patients and healthy subjects, and its correlation to multiple clinical parameters. Study design: 100 psoriatic patients and 100 closely matched controls underwent clinical oral examination. Oral lesions were diagnosed according to the criteria proposed by the World Health Organization (WHO). The patients filled the Hospital Anxiety and Depression (HAD) questionnaire and the Dermatology Life Quality Index (DLQI). The severity of psoriasis was assessed by the Psoriasis Area and Severity Index (PASI). Categorical variables were evaluated using Chi-square test or Fisher’s exact test with overall significance set at p< 0.05. Results: Oral mucosal lesions were diagnosed in 43 (43%) psoriatic patients and 17 (17%) control subjects (p=0.000). Comparing psoriatic patients to control subjects the prevalence of fissured tongue (FT) was 35% vs. 13% (p=0.000); geographic tongue (GT) 17% vs. 9% (p=0.09); combination of FT and GT 5% vs. 5% (p=1.00); oral candidosis 3% vs. 0% (p=0.81); leukoedema 1% vs. 3% (p=0.62); physiologic melanin pigmentations 4% vs. 1% (p=0.37) respectively. The clinical type of psoriasis, duration of the disease, method of disease management (medicated vs. non-medicated for psoriasis), smoking habit, psychological status or the disease severity did not influence the prevalence of FT and GT. Psoriatic patients who experienced “very large” to “extremely large” adverse effect of psoriasis on their quality of life have significantly higher prevalence of GT (p=0.04). Conclusions: FT is significantly more common in psoriatic patients compared to controls; hence studies investigating the nature of this relationship are warranted. Oral health care providers should be aware of the predisposition of psoriatic patients to oral candidosis.

Key words:Oral lesions, fissured tongue, geographic tongue, leukoedema, oral Candida, candidosis, psoriasis.

Betel-quid dependence and oral potentially malignant disorders in six Asian countries

BACKGROUND

Despite gradual understanding of the multidimensional health consequences of betel-quid chewing, information on the effects of dependent use is scant.

AIMS

To investigate the 12-month prevalence patterns of betel-quid dependence in six Asian populations and the impact of this dependence on oral potentially malignant disorders (OPMD).

METHOD

A multistage random sample of 8922 participants was recruited from Taiwan, mainland China, Indonesia, Malaysia, Sri Lanka and Nepal. Participants were evaluated for betel-quid dependency using DSM-IV and ICD-10 criteria and assessed clinically for oral mucosal lesions.

RESULTS

The 12-month prevalence of dependence was 2.8-39.2% across the six Asian samples, and 20.9-99.6% of those who chewed betel-quid were betel-quid dependent. Men dominated the prevalence among the east Asian samples and women dominated the prevalence in south-east Asian samples. 'Time spent chewing' and 'craving' were the central dependence domains endorsed by the Chinese and southern/south-east Asian samples respectively, whereas the Nepalese samples endorsed 'tolerance' and 'withdrawal'. Dependency was linked to age, gender, schooling years, drinking, smoking, tobacco-added betel-quid use and environmental accessibility of betel-quid. Compared with non-users, those with betel-quid dependency had higher pre-neoplastic risks (adjusted odds ratios 8.0-51.3) than people with non-dependent betel-quid use (adjusted odds ratio 4.5-5.9) in the six Asian populations.

CONCLUSIONS

By elucidating differences in domain-level symptoms of betel-quid dependency and individual and environmental factors, this study draws attention to the population-level psychiatric problems of betel-quid chewing that undermine health consequences for OPMD in six Asian communities.

Oral submucous fibrosis: an overview of the aetiology, pathogenesis, classification, and principles of management

Oral submucous fibrosis (OSMF) is a complex, debilitating, and precancerous condition. Formerly confined to the Indian subcontinent, it is now often seen in the Asian populations of the United Kingdom, USA, and other developed countries, and is therefore a serious problem for global health. The well-known causative agent of the disease, areca-nut is now recognised as a group one carcinogen. We review and discuss all components of OSMF, including the terminology, presentation, aetiology, and pathogenesis, and provide a brief overview of its management.

Service evaluation of patients with orofacial granulomatosis and patients with oral Crohn's disease attending a paediatric oral medicine clinic

AIM

Presenting features associated with orofacial granulomatosis (OFG) and oral Crohn's disease (OCD) are varied, making successful diagnosis and management difficult. The aim of this service evaluation was to establish a profile of patients with these conditions attending a paediatric oral medicine clinic and to determine their overall satisfaction with the care received.

STUDY DESIGN

A retrospective case note analysis to establish the patient profile and a postal patient satisfaction questionnaire for service evaluation.

METHODS

All patients with OFG and OCD who had attended the joint paediatric dentistry/oral medicine clinic at Charles Clifford Dental Hospital, Sheffield in the previous 14 years were included in the study. Hospital case notes were retrospectively reviewed and patient demographics, clinical features, investigations, diagnosis, treatment and outcomes of treatment were recorded. An anonymous patient satisfaction questionnaire using the Healthcare Satisfaction Generic Module of the Paediatric Quality of Life Inventory (PedsQLTM) was distributed to all patients by mail.

RESULTS

A total of 24 patients (13 females and 11 males) were identified. Median age at presentation was 11 years (SD± 3.79, range 2-15). Fifteen patients (63%) were diagnosed with OCD, and 9 (37%) with OFG. Overall, the most common orofacial feature was oral ulceration (75%) followed by lip/facial swelling (71%), angular cheilitis (67%) and mucosal cobblestoning (67%). Differences in presentation were seen between the two conditions with oral ulceration (87%) and mucosal cobblestoning (80%) being the most frequently observed features of OCD and lip swelling (78%) and angular cheilitis (67%) being the most common features of OFG. 58% of patients reported relief of symptoms through treatment. Thirteen patient satisfaction questionnaires were completed (54%). 85% (n=11) felt the overall care received in the clinic was 'excellent'.

CONCLUSIONS

This service evaluation highlights the variety of presenting features of OFG and OCD. Despite only a moderate response to treatment, patient satisfaction with the service was high, emphasising the importance of good communication when managing children with chronic, debilitating conditions.

Oral Candida carriage and species prevalence amongst habitual gutka-chewers and non-chewers

Oral Candida colonisation is higher in tobacco smokers as compared to non-smokers; however, it remains unknown whether smokeless tobacco chewers are susceptible to increased oral Candida colonisation. The aim was to determine the oral Candida carriage and species prevalence amongst habitual gutka-chewers and non-chewers in a cohort from Karachi, Pakistan. Forty-five gutka-chewers and 45 non-chewers were included. Information regarding age, sex, duration of gutka-chewing habit, daily frequency of gutka consumption, duration of holding gutka in the mouth, daily frequency of tooth-brushing and tongue brushing was collected using a questionnaire. Oral yeast samples were collected by scraping the dorsum of the tongue and bilateral buccal mucosa with a sterile cotton swab. Identification of yeast species was performed using standard techniques. Tongue lesions were identified and recorded. Unstimulated whole salivary flow rate (UWSFR) was also measured. There was no significant difference in the mean age, UWSFR and oral Candida carriage among gutka-chewers and non-chewers. Individuals were chewing gutka since 4·4 years and were consuming five gutka sachets daily. Candida albicans (C. albicans) was the most common yeast species isolated from 57·8% gutka-chewers and 64.4% non-chewers. In 24.4% gutka-chewers and 22·2% non-chewers, two candidal strains (C. albicans and Candida tropicalis) were isolated. In conclusion, the present results indicated no significant difference in oral Candida carriage in habitual gutka-chewers and non-chewers.

Influence of oral mucosal lesions and oral symptoms on oral health related quality of life in dermatological patients: a cross sectional study in Sudan

BACKGROUND

There are only few studies considering the impact of oral mucosal lesions (OML) on the oral quality of life of patients with different dermatological conditions. This study aimed to assess the relationship between oral health-related quality of life (OHRQoL) and OML and reported oral symptoms, perceived general and oral health condition and caries experience in adult skin diseased patients attending an outpatient dermatologic clinic in Sudan.

METHODS

A cross-sectional survey was carried out with 544 diagnosed skin diseased patients (mean age 37.1 years, 50% females), during the period October 2008 to January 2009. The patients were orally examined and OML and caries experience was recorded. The patients were interviewed using the Sudanese Arabic version of the OIDP. OHRQoL was evaluated by socio-demographic and clinical correlates according to number of types of OML diagnosed (no OML, one type of OML, > one type of OML) and number and types of oral symptoms.

RESULTS

An oral impact (OIDP > 0) was reported by 190 patients (35.6%) (mean OIDP total score 11.6, sd=6.7). The prevalence of any oral impact was 30.5%, 36.7% and 44.1%, in patients with no OML, one type of OML and more than one type of OML, respectively. Number of types of OML and number and types of oral symptoms were consistently associated with the OIDP scores. Patients who reported bad oral health, patients with ≥ 1 dental attendance, patients with>1 type of OML, and patients with ≥ 1 type of oral symptoms were more likely than their counterparts in the opposite groups to report any OIDP. The odds ratios (OR) were respectively; 2.9 (95% CI 1.9-4.5), 2.3 (95% CI 1.5-3.5), 1.8 (95% CI 1.1-3.2) and 6.7 (95% CI 2.6-17.5). Vesiculobullous and ulcerative lesions of OML disease groups associated statistically significantly with OIDP.

CONCLUSION

OIDP was more frequently affected among skin diseased patients with than without OML. The frequency of the impacts differed according to the number of type of OML, oral symptoms, and OML disease groups. Dentists and dermatologists should pay special attention to skin diseased patients because they are likely to experience oral impacts on daily performances.

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.

Oral mucosal lesions in skin diseased patients attending a dermatologic clinic: a cross-sectional study in Sudan

Background

So far there have been no studies focusing on the prevalence of a wide spectrum of oral mucosal lesions (OML) in patients with dermatologic diseases. This is noteworthy as skin lesions are strongly associated with oral lesions and could easily be neglected by dentists. This study aimed to estimate the frequency and socio-behavioural correlates of OML in skin diseased patients attending outpatient's facility of Khartoum Teaching Hospital - Dermatology Clinic, Sudan.

Methods

A cross-sectional hospital-based study was conducted in Khartoum from October 2008 to January 2009. A total of 588 patients (mean age 37.2 ± 16 years, 50.3% females) completed an oral examination and a personal interview of which 544 patients (mean age 37.1 ± 15.9 years, 50% females) with confirmed skin disease diagnosis were included for further analyses. OML were recorded using the World Health Organization criteria (WHO). Biopsy and smear were used as adjuvant techniques for confirmation. Data were analysed using the Statistical Package for Social Science (Version 15.0.1). Cross tabulation and Chi-square with Fisher's exact test were used.

Results

A total of 438 OML were registered in 315 (57.9%, males: 54.6% versus females: 45.6%, p < 0.05) skin diseased patients. Thus, a certain number of patients had more than one type of OML. Tongue lesions were the most frequently diagnosed OML (23.3%), followed in descending order by white lesions (19.1%), red and blue lesions (11%) and vesiculobullous diseases (6%). OML in various skin diseases were; vesiculobullous reaction pattern (72.2%), lichenoid reaction pattern (60.5%), infectious lesions (56.5%), psoriasiform reaction pattern (56.7%), and spongiotic reaction pattern (46.8%). Presence of OML in skin diseased patients was most frequent in older age groups (62.4% older versus 52.7% younger, p < 0.05), in males (63.2% males versus 52.6% females, p < 0.05), patients with a systemic disease (65.2% with systemic versus 51.9% without systemic disease, p < 0.05) and among current users of smokeless tobacco (toombak) (77% current use versus 54.8% no use, p < 0.00).

Conclusions

OML were frequently diagnosed in skin diseased patients and varied systematically with age, gender, systemic condition and use of toombak. The high prevalence of OML emphasizes the importance of routine examination of oral mucosa in a dermatology clinic.

The use of toluidine blue in the detection of pre-malignant and malignant oral lesions

INTRODUCTION

The purpose of this study was to evaluate the efficacy of the toluidine blue (TB) test as a diagnostic tool in the detection of malignant and dysplastic lesions of the oral cavity. This study was carried out because of a lack of consensus among different authors on the utility of TB, as well as to determine useful adjuncts to detect oral pre-cancer and cancer.

MATERIALS AND METHODS

The study included 160 patients with oral mucosal disorders that included suspicious or malignant lesions detected at clinical visual examination, confirmed by histopathological evaluation. All lesions were submitted to TB staining.

RESULTS

The sensitivity and specificity for the detection of malignant or dysplastic lesions by this test were 65.5% and 73.3%, respectively. Overall, the detection rate with TB (sensitivity) was slightly lower compared with those reported by other authors but the specificity was comparable to several reports. Positive predictive value (35.2%) was also lower than previous studies, whereas negative predictive value (90.6%) was similar.

CONCLUSIONS

The simplicity of the test procedure and the validity of derived values suggest TB staining can be a valuable adjunct to the diagnostic process, as long as it is carefully correlated with the clinical characteristics of the mucosal disorder and histopathological diagnosis.

Mouth self-examination to improve oral cancer awareness and early detection in a high-risk population

Oral cancer is a potentially preventable disease due to its association with well-known risk factors and easy detectability. There is a significant deficiency in the awareness of oral cancer and its risk factors among the public. Raising public awareness could effectively contribute to achieving a significant reduction in the incidence of oral cancer. The objective of this study was to evaluate the effectiveness of mouth self-examination (MSE) in improving the awareness of oral cancer and its risk factors as well as test its feasibility as an oral cancer-screening tool. The study was carried out in a high-risk population of 57,704 from India, of which, 34,766 individuals who have met the eligibility criteria formed the study population. MSE brochures and trained health workers were employed for the purpose of health education and cancer screening. The present study compared their efficacy to detect oral lesions. Subjects with suspicious lesions were referred to the trained oral cancer specialist for confirmation. A questionnaire to assess the awareness of oral cancer and its risk factors was developed and validated. SPSS (v.11.0) was used for data analysis. The program identified 216 cases of potentially malignant lesions as well as three cases of oral cancer. The findings of MSE and health workers showed 72% concordance, while that of health workers and oral cancer specialist showed 100% concordance. MSE had a low sensitivity of 18%, while the specificity was 99.9%. Though the technique identified high-risk lesions such as red patches (66.7%) and non-healing ulcers (42.9%), the detection rate of white patches was low (12.7%). Overall awareness of oral cancer and its risk factors after introduction of MSE program was over 80%; but the compliance to seek treatment was poor (32%). Mouth self-examination may be used as an effective tool to improve the awareness of oral cancer and for the early detection of lesions.

Oral mucosa in children with Prader-Willi syndrome

Prader-Willi syndrome is a genetic disorder. Abnormal saliva secretion, emotional and behaviour problems, may affect the health status of the oral mucousa.

OBJECTIVES

To assess the impact of self-destructive behaviour and abnormal saliva secretion on the oral mucosa in children with Prader-Willi syndrome (PWS).

MATERIALS AND METHODS

Fifteen PWS's children (mean age 9.8 ± 4.4 years) and 15 healthy children (mean age 11.5 ± 3.5 years) were assessed for self-destructive behaviours, such as picking at the skin, physical and chemical saliva characteristics, mycology, and the clinical status of the oral mucosa.

RESULTS

Picking at the skin was only in children with PWS (n = 12). In contrast to the control group, the moistening rate of the lower lip mucosa was slower, and the mean pH of the resting saliva was reduced in the affected subjects. Sticky frothy or frothy saliva, decreased secretion rate of the stimulated saliva, and a reduced buffer capacity were more frequently in PWS's children; Candida spp. and oral candidiasis were also more common. Injurious lesions in the oral mucosa were found in one control child, and in eight PWS's subjects. In affected children, the lesions were concurrent with picking at the skin. A statistical correlation was noted between the presence of Candida spp. and oral candidiasis, and unfavourable saliva properties, and between injurious lesions and a slow moistening rate of the lower lip mucosa, and oral candidiasis.

CONCLUSIONS

Abnormal saliva secretion and self-destructive behaviours in children with Prader-Willi syndrome predispose them to injurious lesions in the oral mucosa, and possibly, to oral candidiosis.

Oral mucosal lesions during orthodontic treatment

BACKGROUND

Oral mucosal lesions can result from irritation caused by orthodontic appliances or malocclusion, but their frequency is not known.

AIM

To examine the frequency of oral mucosal lesions in wearers of orthodontic appliances in comparison to children with malocclusion.

DESIGN

This study comprised 111 subjects: 60 wearers of orthodontic appliances and 51 controls (aged between 6 and 18 years). Type and severity of mucosal lesions, their topography, gingival inflammation, and oral hygiene status were determined by using clinical indices.

RESULTS

Mucosal lesions were more present in wearers of orthodontic appliances than in children with malocclusion. Gingival inflammation, erosion, ulceration, and contusion were the most common findings in orthodontic patients. The severity of gingival inflammation was in correlation with oral hygiene status; the poorer oral hygiene, the more severe gingival inflammation was. Better oral hygiene status was found in children during orthodontic treatment than in children with malocclusion.

CONCLUSIONS

Orthodontic treatment carries a higher risk of mucosal lesions and implies greater awareness of better oral hygiene as shown by the results of this study. Oral hygiene instructions and early treatment of oral lesions are important considerations in better patient's motivation, treatment planning, and successful outcome.

Smoking affects diagnostic salivary periodontal disease biomarker levels in adolescents

BACKGROUND

The effects of smoking on periodontal biomarkers in adolescents are unknown. This study investigates matrix metalloproteinase (MMP)-8 and polymorphonuclear leukocyte elastase levels in saliva together with periodontal health indices accounting for body mass index and smoking in a birth cohort from Finland.

METHODS

The oral health of boys (n = 258) and girls (n = 243) aged 15 to 16 years was examined clinically. Health habits were assessed by questionnaire. Saliva samples were collected and analyzed by immunofluorometric and peptide assays for MMP-8 levels and polymorphonuclear leukocyte elastase activities, and investigated statistically with the background factors.

RESULTS

Median MMP-8 values of male smokers were 112.03 microg/l compared to 176.89 microg/l of non-smokers (P = 0.05). For female smokers corresponding values were 170.88 microg/l versus 177.92 microg/l in non-smokers (not statistically significant). Elastase values in male smokers were 5.88 x 10(-3) Delta OD(405)/h versus 11.0 x 10(-3) Delta OD(405)/h in non-smokers (P = 0.02), and in female smokers 9.16 x 10(-3) Delta OD(405)/h versus 10.88 x 10(-3) Delta OD(405)/h in non-smokers (P = 0.72). The effect was strengthened by high pack-years of smoking (MMP-8, P = 0.04; elastase, P = 0.01). Both biomarkers increased with gingival bleeding. However, statistically significant associations were observed with bleeding on probing and MMP-8 (P = 0.04); MMP-8 was suggestively associated with probing depth (P = 0.09) in non-smoking boys. In smokers with calculus, MMP-8 increased after adjusting with body mass index (P = 0.03). No corresponding differences were seen in girls.

CONCLUSIONS

Smoking significantly decreased both biomarkers studied. Compared to girls, boys seem to have enhanced susceptibility for periodontitis as reflected in salivary MMP-8 values.

Psychiatric morbidity among patients with oral sub-mucous fibrosis: a preliminary study

BACKGROUND

Oral submucous fibrosis (OSF) is a chronic oral mucosal condition with pre-malignant potential. The association between psychiatric morbidity and OSF has been sparsely studied.

METHODS

This cross-sectional study included 33 consecutive subjects clinically diagnosed with OSF who attended an academic tertiary care dental centre. General Health Questionnaire-28 was administered to assess the psychological morbidity. Dependence to areca products was assessed using the ICD-10 criteria. Patient group was compared with an age and gender matched control group (n=33) from the same hospital that comprised patients who had dental diseases other than OSF and had no areca/tobacco habit.

RESULTS

Total mean scores (SD) of GHQ-28 for study group and control group respectively were 48.2 (18.1) vs. 24.2 (6.5) (P<0.001). Among the patient group, the mean total GHQ scores were significantly higher in those with functional stage C (those with worst functional staging) of OSF 63.4 (15.2) when compared with those with stage B 54 (14.2) and stage A 38.7 (17) (d.f.=2; P=0.005). 22 (66.7%) of patients met ICD-10 criteria for dependence to areca products.

CONCLUSIONS

OSF may be associated with considerable psychological morbidity. This morbidity may be significantly more in patients with worst functional staging. It is difficult to determine whether this is the cause or effect of the disease. Further systematic studies are urgently needed to address this issue.

Genetic variation of innate immune genes in HIV-infected african patients with or without oropharyngeal candidiasis

BACKGROUND

The occurrence of oropharyngeal candidiasis (OPC) in combination with HIV disease progression is a very common phenomenon. However, not all HIV-infected patients develop OPC, even when they progress to low CD4 T-cell counts. Because T-cell immunity is defective in AIDS, the innate defence mechanisms are likely to have a central role in antifungal immunity in these patients. We investigated whether genetic variations in the innate immune genes DECTIN-1, TLR2, TLR4, TIRAP, and CASPASE-12 are associated with the presence of OPC in HIV-infected subjects from East Africa.

METHODS

A total of 225 HIV patients were genotyped for several single nucleotide polymorphisms (SNPs), and this was correlated with the occurrence of OPC in these patients. In addition, primary immune cells obtained from individuals with different genotypes were stimulated with Candida albicans, and cytokine production was measured.

RESULTS

The analysis revealed that no significant differences in the polymorphism frequencies could be observed, although a tendency toward a protective effect on OPC of the DECTIN-1 I223S SNP was apparent. Furthermore, interferon gamma production capacity was markedly lower in cells bearing the DECTIN-1 SNP I223S. It could also be demonstrated that the 223S mutated form of the DECTIN-1 gene exhibits a lower capacity to bind zymosan.

CONCLUSIONS

These data demonstrate that common polymorphisms of TLR2, TLR4, TIRAP, and CASPASE-12 do not influence susceptibility to OPC in HIV-infected patients in East Africa but suggest an immunomodulatory effect of the I223S SNP on dectin-1 function and possibly the susceptibility to OPC in HIV patients.

Oral mucosal lesions in non oral habit diabetic patients and association of diabetes mellitus with oral precancerous lesions

AIMS

This study was aimed to determine the prevalence of oral mucosal lesions (OML) in patients with diabetes mellitus (DM) and non-diabetic subjects without any oral habits and to investigate the association of DM with oral precancerous lesions.

METHODS

This cross-sectional study involved 420 diabetic and 420 non-diabetic control subjects without any oral habits. Detailed oral examination was performed based on international criteria.

RESULTS

A significantly greater proportion of subjects with DM (45%) had one or more OML in comparison to non-diabetics (38.3%). Patients with DM showed a significantly greater prevalence of geographic tongue, denture stomatitis and angular cheilitis than non-diabetics (p<0.05). The results also showed an association between occurrence of one or more OML and metabolic control of diabetic patients (p<0.05). For precancerous lesions, lichen planus was found in two diabetic patients while none of controls had any precancerous lesion (p>0.05).

CONCLUSIONS

Prevalence of OML was significantly higher in diabetic patients than non-diabetics and this prevalence was associated with the metabolic control of the patients. However, no association was observed between DM and oral precancerous lesions.

Endothelin receptor type B gene promoter hypermethylation in salivary rinses is independently associated with risk of oral cavity cancer and premalignancy

Endothelin receptor type B (EDNRB) and kinesin family member 1A (KIF1A) are candidate tumor suppressor genes that are inactivated in cancers. In this study, we evaluated the promoter hypermethylation of EDNRB and KIF1A and their potential use for risk classification in prospectively collected salivary rinses from patients with premalignant/malignant oral cavity lesions. Quantitative methylation-specific PCR was performed to analyze the methylation status of EDNRB and KIF1A in salivary rinses of 191 patients. We proceeded to determine the association of methylation status with histologic diagnosis and estimate classification accuracy. On univariate analysis, diagnosis of dysplasia/cancer was associated with age and KIF1A or EDNRB methylation. Methylation of EDNRB highly correlated with that of KIF1A (P < 0.0001). On multivariable modeling, histologic diagnosis was independently associated with EDNRB (P = 0.0003) or KIF1A (P = 0.027) methylation. A subset of patients analyzed (n = 161) without prior biopsy-proven malignancy received clinical risk classification based on examination. On univariate analysis, EDNRB and risk classification were associated with diagnosis of dysplasia/cancer and remained significant on multivariate analysis (EDNRB: P = 0.047, risk classification: P = 0.008). Clinical risk classification identified dysplasia/cancer with a sensitivity of 71% and a specificity of 58%. The sensitivity of clinical risk classification combined with EDNRB methylation improved to 75%. EDNRB methylation in salivary rinses was independently associated with histologic diagnosis of premalignancy and malignancy and may have potential in classifying patients at risk for oral premalignant and malignant lesions in settings without access to a skilled dental practitioner. This may also potentially identify patients with premalignant and malignant lesions that do not meet the criteria for high clinical risk based on skilled dental examination.

Oral mucosal lesions in denture wearers

OBJECTIVE

To determine the prevalence of oral mucosal lesions (OMLs) and denture-related mucosal lesions (DMLs) in denture wearers and to co-relate the prevalence with age, gender, type of denture and any systemic conditions.

MATERIALS AND METHODS

Dental records of 380 denture wearers were retrospectively reviewed for OMLs and DMLs.

RESULTS

We found 45% of the denture wearers had DMLs and 60.8% had OMLs not related to denture wearing. Although the prevalence of DMLs was higher in complete denture wearers than in partial denture wearers (49% vs. 42.2%), this difference was not significant. The most common DMLs were traumatic ulcer (19.5%) and denture-induced stomatitis (18.1%). When analysed by type, traumatic ulcer, denture hyperplasia, frictional keratosis and candidiasis were more common in complete denture wearers, whereas denture-induced stomatitis was more common in partial denture wearers. Frictional keratosis was more common in men than in women. The prevalence of OMLs not related to denture wearing was higher in complete denture wearers than in partial denture wearers, and the most common OML was fissured tongue (27.6%). No association between DMLs and systemic conditions or xerostomic drugs was noted.

CONCLUSION

No differences in the prevalence of DMLs in association with denture type were found. The prevalence of OMLs not related to denture wearing was higher in complete denture wearers than in partial denture wearers. This difference was affected by age, and the data were similar to the findings observed in the elderly.

Predisposition of allergy in patients with benign migratory glossitis

OBJECTIVE

The purpose of this study was to investigate the presence of allergy in patients with benign migratory glossitis (BMG) using patch and prick tests.

PATIENTS AND METHODS

Eighty patients (40 BMG and 40 healthy controls) received patch and prick tests. If at least one test result was positive, patients were considered to be allergic.

RESULTS

The prick test was positive in 10 patients (25.0%) of the study group and in 4 patients (10.0%) of the control group. The patch test was positive in 12 patients (30.0%) of the study group and in 6 patients (15.0%) of the control group. When results of both tests were evaluated together, the study group showed a positive rate of 47.5% (n = 19), whereas the control group showed a positive rate of 22.5% (n = 9) (P = .02).

CONCLUSION

Our results revealed that a combination of prick and patch tests can significantly enhance the diagnostic accuracy of predisposition of allergy in patients with BMG.

Benign lip lesions. A 10-year retrospective study

OBJECTIVES

This paper aims to present a retrospective analysis of a cohort of patients with benign lip lesions managed over the last decade at the Department of Maxillofacial Surgical Oncology of Theagenio Cancer Hospital of Thessaloniki. It aims to highlight the substantial clinical and histological diversity of the lesions, as well as to present an epidemiological analysis for the specific cohort/population.

STUDY DESIGN

During the period 1995-2004 a total of 420 patients were managed for lip lesions. Of these, 280 were malignant and 116 benign. A total of 24 cases of actinic keratosis were added in the latter group.

RESULTS

Of the benign lesions, the commonest were haemangiomas (19.28%), actinic keratosis (17.14%), intradermal naevus (14.28%), fibroma (9.28%), papilloma (7.85%), mild and moderate dysplasia (7.85%) and mucocele (7.14%). The group included 17 different histological types of benign lesions. The most frequent site of presentation was the lower lip (56.42%). Post-operative follow-up ranged from 6 months to 2 years (average 15.5 months). There was a single case of recurrence during follow-up.

CONCLUSIONS

Benign lip lesions do not usually pose a problem for the clinician and their surgical management is straightforward. Accurate auditing and detailed statistical analysis aid in disease prevention and help avoid errors in diagnosis and management.

Comparing dose-response measurements of oral habits on oral leukoplakia and oral submucous fibrosis from a community screening program

BACKGROUND

Many studies have reported that the interaction and dose-response effects of betel quid chewing, tobacco smoking and alcohol drinking habits are important risk factors for oral cancer and precancerous lesions or conditions. These results are useful for comparing statistics, but may not be informative for personal disease-related information.

METHODS

This study used data from a community screening program to evaluate the dose-response effects of daily frequency and duration from oral habits in Taiwan. The receiver operating characteristic (ROC) curves were further used to compare exposure measurements on indicating the occurrence of lesions/conditions.

RESULTS

Our results showed that the highest prevalence was found in leukoplakia (11.1%) and followed by oral submucous fibrosis (OSF, 4.4%). Betel quid chewing habit was found to have dose-response effects on leukoplakia and OSF, cigarette smoking habit only has the dose-response effect on leukoplakia, and alcohol drinking was not associated with both oral precancers. The daily frequency of chewing habit is a better indicator than other dose-response measurements for the occurrence of precancers. In addition, the cut-off points of two to five counts per day have about 60-82% of sensitivities and 79-88% of specificities.

CONCLUSIONS

The cut-off points from ROC curves can provide an informative message to people with oral habits and their chances of developing diseases. High daily frequency of chewing can lead to excessive irritation to oral mucosa. Although the tobacco is never added to chewing quid in Taiwan, intensive irritation may play an important role in developing oral precancers in Taiwan.

Prevalence of oral soft tissue lesions in Vidisha

Background

The purpose of this study was to determine the prevalence of oral soft tissue lesions in patients and to assess their clinicopathological attributes. 3030 subjects belonging to a semi-urban district of Vidisha in Central India were screened. Patients were examined with an overhead examination light and those who were identified with a questionable lesion underwent further investigations. Statistical analysis was done using the SPSS software.

Findings

8.4 percent of the population studied had one or more oral lesions, associated with prosthetic use, trauma and tobacco consumption. With reference to the habit of tobacco use, 635(21%) were smokers, 1272(42%) tobacco chewers, 341(11%) smokers and chewers, while 1464(48%) neither smoked nor chewed. 256 patients were found to have significant mucosal lesions. Of these, 216 cases agreed to undergo scalpel biopsy confirmation. 88 had leukoplakia, 21 had oral submucous fibrosis, 9 showed smoker's melanosis, 6 patients had lichen planus, 17 had dysplasia, 2 patients had squamous cell carcinoma while there was 1 patient each with lichenoid reaction, angina bullosa hemorrhagica, allergic stomatitis and nutritional stomatitis.

Conclusions

The findings in this population reveal a high prevalence of oral soft tissue lesions and a rampant misuse of variety of addictive substances in the community. Close follow up and systematic evaluation is required in this population. There is an urgent need for awareness programs involving the community health workers, dentists and allied medical professionals.

Oral health in predialysis patients with emphasis on diabetic nephropathy

We investigated oral health of chronic kidney disease (CKD) patients at predialysis state. The hypothesis was that diabetic nephropathy affects oral health more detrimentally than other CKD patients due to the known risk diabetes presents in this regard. We expected worse oral health and particularly poor periodontal health among the diabetic patients. A cross-sectional study was conducted in the Helsinki University Central Hospital, Finland, on 148 patients with different kinds of kidney disease at predialysis state. Data from medical records, clinical oral examination, saliva, and mucosal yeast counts were analyzed and compared between the disease groups. Of the patients, 53 (36%) had diabetic nephropathy (29 patients with type 1, 24 patients with type 2 diabetes). Compared with other CKD patients, diabetic patients had poor glycemic control as expected (mean HbA(1C) 8.0% vs 5.9%, p < 0.01). Diabetic patients also had more dental caries (mean number of carious teeth 5.1 vs 3.1, p < 0.01) and lower salivary flow rates than other CKD patients (stimulated salivary flow 1.2 ml/min vs 1.6 ml/min, p < 0.05). No difference between groups was observed in periodontal health and yeast counts. In conclusion, diabetic nephropathy patients indeed had worse dental health in comparison to CKD group. However, contrary to our expectation, diabetic nephropathy did not seem to affect periodontal health more severely than the other kidney diseases.

Oral mucosal conditions in chronic hepatitis C Brazilian patients: a cross-sectional study

OBJECTIVE

Our purpose was to carry out an epidemiological study to assess the prevalence of oral mucosal conditions in Brazilian patients with chronic hepatitis C.

METHODS

A cross-sectional survey was carried out on 215 patients with chronic hepatitis C who were examined for oral mucosal conditions, including oral mucosal lesions and variations of normality.

RESULTS

The prevalence of patients with chronic hepatitis C presenting oral mucosal conditions was 96.3 percent (207 patients). Oral mucosal lesions were present in 147 patients (68.4 percent), whereas variations of normality were observed in 173 patients (80.5 percent). The most common lesions included cheek biting in 42 cases (19.5 percent), candidiasis in 39 cases (18.1 percent), and leukoplakia in 28 cases (13.0 percent). The association of oral lichen planus with hepatitis C virus (HCV) infection proved to be statistically significant (P = 0.002). The most frequent variations of normality included Fordyce's spots in 96 cases (44.7 percent), lingual varicosities in 67 cases (31.2 percent), and fissured tongue in 60 cases (27.9 percent).

CONCLUSION

The prevalence of patients with chronic hepatitis C presenting oral mucosal conditions was 96.3 percent. Despite this high prevalence, only the association between oral lichen planus and hepatitis C showed statistical significance. Considering that HCV infection may be associated with extrahepatic disorders, such as oral manifestations, efforts should be made to clarify the possible relation between oral conditions and HCV infection. This may be helpful in the earlier diagnosis of the infection mainly in asymptomatic patients.