Atrophic lesions of the tongue: a prevalence study among 175 diabetic patients

Median Rhomboid Glossitis: A Case Study

A smooth, red, oval, or rhomboid patch on the dorsal midline is the classic presentation of median rhomboid glossitis (MRG), a rare and benign lesion of the tongue. MRG is still not fully understood, which presents diagnostic hurdles and calls for additional clinical investigation. It is frequently associated with candidal infections. We describe a case of a 42-year-old man who initially appeared to have either mechanical irritation or thermal injury related to a painless patch on the dorsum surface of the tongue. We document a case of MRG that was consulted for a standard dental examination in this case report. This article also highlights a dentist's need to identify the lesion and provide appropriate education for the patient.

An Intelligent Tongue Diagnosis System via Deep Learning on the Android Platform

To quickly and accurately identify the pathological features of the tongue, we developed an intelligent tongue diagnosis system that uses deep learning on a mobile terminal. We also propose an efficient and accurate tongue image processing algorithm framework to infer the category of the tongue. First, a software system integrating registration, login, account management, tongue image recognition, and doctor-patient dialogue was developed based on the Android platform. Then, the deep learning models, based on the official benchmark models, were trained by using the tongue image datasets. The tongue diagnosis algorithm framework includes the YOLOv5s6, U-Net, and MobileNetV3 networks, which are employed for tongue recognition, tongue region segmentation, and tongue feature classification (tooth marks, spots, and fissures), respectively. The experimental results demonstrate that the performance of the tongue diagnosis model was satisfying, and the accuracy of the final classification of tooth marks, spots, and fissures was 93.33%, 89.60%, and 97.67%, respectively. The construction of this system has a certain reference value for the objectification and intelligence of tongue diagnosis.

Oral microbial diversity analysis among atrophic glossitis patients and healthy individuals

Atrophic glossitis is a common disease in oral mucosal diseases. The Current studies have found the human oral cavity contains numerous and diverse microorganisms, their composition and diversity can be changed by various oral diseases. To understand the composition and diversity of oral microbiome in atrophic glossitis is better to explore the cause and mechanism of atrophic glossitis. The salivary microbiome is comprised of indigenous oral microorganisms that are specific to each person, exhibits long-term stability. We used llumina MiSeq high-throughput sequencing based on the V3-V4 region of the bacterial 16S rRNA gene and the internal transcribed spacer (ITS) region of fungal rRNA genes from saliva in atrophic glossitis patients and healthy individuals to explore the composition and diversity of oral microbiome. In our reports, it showed a lower diversity of bacteria and fungi in atrophic glossitis patients than in healthy individuals. The data further suggests that Lactobacillus and Saccharomycetales were potential indicators for the initiation and development of atrophic glossitis. Moreover, we also discuss the relationship between the oral microbial ecology and atrophic glossitis.

Non-invasive intravital observation of lingual surface features using sliding oral mucoscopy techniques in clinically healthy subjects

To investigate intravital morphological features of the broader area of the lingual mucosa in clinically healthy subjects, and to attempt to evaluate subclinical conditions, we evaluated detailed intravital morphological features of the lingual mucosa using our newly developed oral contact mucoscopy techniques. Clinically healthy subjects (female: 19-22 years, average age: 20.27 years, and n = 28) were enrolled. A position indicator stain was placed on the lingual mucosal surface, and sliding images were captured and then reconstructed. In addition, the lingual mucosa was divided into six areas, and morphometry of the fungiform and filiform papillae was performed. The results were statistically analyzed. There were two morphological features among clinically healthy subjects involving the filiform papillae: the length of the papillae and the degree of biofilm (tongue coat) deposition. We defined a modified tongue coat index (mTCI) with scores ranging from 0 (tongue coating not visible) to 0.5, 1, 1.5, and 2 (thick tongue coating) for six sections of the tongue dorsum. No subjects received a score of 2. Significant differences were found in the mTCI between the six sections of the tongue dorsum, especially between the posterior areas and the lingual apex. The fungiform papillae of some subjects exhibited elongated morphological changes. Our findings suggest that magnified lingual dorsum examination of a broader area is especially important in accurate screening for subclinical or transient conditions of potential lingual mucosal diseases. For this purpose, our new oral mucoscopy and non-invasive intravital observational techniques were especially effective.

Atrophic glossitis: Etiology, serum autoantibodies, anemia, hematinic deficiencies, hyperhomocysteinemia, and management

Atrophic glossitis (AG) is characterized by the partial or complete absence of filiform papillae on the dorsal surface of the tongue. AG may reflect the significant deficiencies of some major nutrients including riboflavin, niacin, pyridoxine, vitamin B12, folic acid, iron, zinc, and vitamin E. Moreover, protein-calorie malnutrition, candidiasis, Helicobacter pylori colonization, xerostomia, and diabetes mellitus are also the etiologies of AG. Our previous study found the serum gastric parietal cell antibody (GPCA), thyroglobulin antibody (TGA), and thyroid microsomal antibody (TMA) positivities in 26.7%, 28.4%, and 29.8% of 1064 AG patients, respectively. We also found anemia, serum iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia in 19.0%, 16.9%, 5.3%, 2.3%, and 11.9% of 1064 AG patients, respectively. Moreover, GPCA-positive AG patients tended to have relatively higher frequencies of hemoglobin, iron, and vitamin B12 deficiencies and hyperhomocysteinemia than GPCA-negative AG patients. Supplementations with vitamin BC capsules plus corresponding deficient hematinics for those AG patients with hematinic deficiencies can achieve complete remission of oral symptoms and AG in some AG patients. Therefore, it is very important to examine the complete blood count, serum hematinic, homocysteine, and autoantibody levels in AG patients before we start to offer treatments for AG patients.

The prevalence of median rhomboid glossitis in diabetic patients: a case-control study

BACKGROUND

Diabetes mellitus (DM) is one of the most common disorders of endocrine glands which has a worldwide distribution and is a risk factor for oral pathology so; the purpose of the present study was to investigate the association between median rhomboid glossitis (MRG) and DM.

METHODS

We examined 202 Iranian patients with DM aged 10-86 years and 261 healthy subjects aged 10-28 years and the diagnosis of MRG was made based on clinical features.

RESULTS

The examination indicated that 13 (6.43%) diabetic patients and 4 (1.53%) of control group had MRG.There was a significant difference in the prevalence of MRG, between patients and control group. MRG showed no association with other variables (age, sex, duration of DM, drugs, FBS, A1C).

CONCLUSION

In the present study the prevalence of MRG in diabetics was much higher than that of controls.

Diabetes mellitus and oral mucosa alterations: prevalence and risk factors

AIMS

To investigate the prevalence of oral mucosa alterations in patients with type 2 diabetes and to identify possible risk factors related to oral mucosa alterations.

METHODS

146 patients with type 2 diabetes and 111 age- and gender-matched healthy controls subjects were consecutively recruited from Araraquara School of Dentistry to answer a structured questionnaire designed to collect demographic data as well as current and former history of diabetes. Clinical examination of the oral mucosa was carried out by a stomatologist.

RESULTS

A higher prevalence of oral mucosa alterations was found in patients with diabetes than in patients without diabetes (p<0.001), with significant difference to development conditions (p<0.0001), potentially malignant disorders (p<0.0001) and fungal infections (p<0.05). In the multiple logistic regression, diabetes (odds ratio 9.9 IC 5.11-19.16) and smoking habit (odds ratio 3.17 IC 1.42-7.12) increased the odds of oral mucosa alterations significantly.

CONCLUSIONS

Patients with diabetes mellitus not only showed an increased prevalence of oral mucosa alterations but also a significant percentage of potentially malignant disorders. These findings elucidate the necessity of regular clinical examination to ensure early diagnosis and prompt management of oral mucosa lesions in patients with diabetes.

Morphological study of the connective tissue papillae and the capillary loops on the lingual dorsum in the type 2 diabetes mellitus model rats

We performed a morphological study in type 2 diabetes mellitus (DM) model rats by focusing on the connective tissue papillae (CTPe) and capillary loops (CLs) of filiform papillae in the lingual dorsum in the type 2 DM model rats (GK rats). The normal group comprised nine 8-week-old male Wistar rats. The DM group comprised nine 8-week-old male GK rats. Image analysis of light microscopic specimens in CTPe was performed (height and cross-sectional area). Image analysis of scanning electron microscopic specimens (acrylic plastic injection method) in CLs was performed (number, thickness, height, interval between the tops of the two CLs, and crossing ratio between ascending and descending crura (CRC)). We compared these values between both groups (Student's t test). The former analysis revealed that the height and cross-sectional area of CTPe were smaller in the DM group than in the normal group. The latter analysis revealed that the thickness, height, and CRC of the CLs were smaller in the DM group than in the normal group. However, no significant differences were detected in the number and interval of CLs between both groups. Therefore, we concluded that DM caused regressive change in CTPe and CLs.

Plasticity of the different neuropeptide-containing nerve fibres in the tongue of the diabetic rat

Common oral complications of diabetes mellitus are xerostomia, impairment of taste, atrophic lesions of the tongue, leukoplakia, lichen oris planus, and tumours, which might be the consequence of chronic inflammation and changes in innervation. In this work, we examined the density of different neuropeptide-containing nerve fibres immunohisto- and immunocytochemically in the root of the control and diabetic rat's tongue. Quantitative analysis showed that the number of immunoreactive (IR) nerve fibres was decreased after 1 week of the streptozotocin treatment, which was prevented by immediate insulin treatment. However, after 4 weeks duration of diabetes, the number of all investigated IR nerve fibres increased significantly (p<0.05), which was further enhanced by the delayed insulin treatment. The numbers of substance P (SP) and vasoactive intestinal polypeptide IR perikarya were also increased by insulin treatment. The electron-microscopic investigations showed that some of the nerve terminals from diabetic animals were found in degeneration. After 4 weeks duration of diabetes, the number of inflammatory cells as well as the mast cell/nerve fibre contacts was also increased. The immunocells also showed IR for SP and neuropeptide Y in the diabetic rats. The insulin treatment decreased both the number and the immunoreactivity of these cells. The increased synthesis and/or regeneration of neuropeptide-containing nerves might indicate the plasticity of nerve fibres in diabetes mellitus, which might happen as a consequence of the changes in the level of neurotrophic factors released by increased number of inflammatory cells or as an effect of insulin.

Update on diabetes mellitus and related oral diseases

Diabetes mellitus (DM) is a group of complex multisystem metabolic disorders characterized by a relative or absolute insufficiency of insulin secretion and/or concomitant resistance to the metabolic action of insulin on target tissues. The chronic hyperglycaemia of diabetes is associated with long-term systemic dysfunction. The present article summarizes current knowledge of DM and details the oral and dental implications of this common endocrine disorder.

Diabetes and oral health promotion: a survey of disease prevention behaviors

BACKGROUND

Diabetes is a chronic metabolic disease known to affect oral disease progression. The authors surveyed health behaviors essential for preventing dental and periodontal diseases and maintaining oral health is a population of adult patients with type 1 (insulin-dependent) diabetes. The goals of this study were to assess these patients' oral health behaviors, access to dental care and need for improved health education.

METHODS

As part of a dental and periodontal examination, 406 subjects with type 1 diabetes completed a questionnaire regarding their oral health attitudes, behaviors and knowledge. The authors also evaluated 203 age-matched nondiabetic control subjects.

RESULTS

The authors found that diabetic subjects' tobacco use and oral hygiene behaviors were similar to those of the nondiabetic control subjects. Diabetic subjects, however, more frequently reported the cost of dental care as a reason for avoiding routine visits. Most of these subjects were unaware of the oral health complications of their disease and the need for proper preventive care.

CONCLUSIONS

Patients with diabetes appear to lack important knowledge about the oral health complications of their disease. The results of this survey did not indicate improved prevention behaviors among the subjects with diabetes compared with nondiabetic control subjects.

CLINICAL IMPLICATIONS

Dentists have an opportunity and the responsibility to promote good oral health behaviors such as regular dental examinations, proper oral hygiene and smoking cessation that may significantly affect the oral health of their diabetic patients.

Insulin-dependent diabetes mellitus and oral soft tissue pathologies. I. Prevalence and characteristics of non-candidal lesions

OBJECTIVE

A large epidemiologic study on oral health has found that several oral soft tissue lesions were more prevalent in subjects with insulin-dependent diabetes mellitus than in control subjects without diabetes. Our objective in part I of this article is to characterize those lesions not associated with Candida.

STUDY DESIGN

This cross-sectional study determined the prevalence and characteristics of oral soft tissue diseases identified during a comprehensive oral evaluation of 405 adult subjects with diabetes and 268 control subjects without diabetes.

RESULTS

Twenty specific oral soft tissue lesions were identified. Nearly twice as many subjects with diabetes as subjects without diabetes were found to have one or more oral soft tissue lesions (44.7% vs 25.0%; P <.0001). Subjects with diabetes also had significantly higher prevalence rates for 7 lesions, 3 of which were non-candidal: fissured tongue, irritation fibroma, and traumatic ulcers. (Four lesions generally associated with Candida infection-median rhomboid glossitis, denture stomatitis, generalized atrophy of the tongue papillae, and angular cheilitis-will be described in part II of this article.) There were no differences found between the subjects with diabetes and the control subjects for lichen planus, gingival hyperplasia, or salivary gland disease.

CONCLUSIONS

Oral soft tissue lesions were seen more frequently in subjects with insulin-dependent diabetes than in the control subjects. Characterization of 3 non-candidal lesions suggests that they are associated with trauma, delayed healing, or both.

Insulin-dependent diabetes mellitus and oral soft tissue pathologies: II. Prevalence and characteristics of Candida and Candidal lesions

OBJECTIVE

To assess the prevalence of Candida albicans and oral infection with Candida in patients with insulin-dependent diabetes mellitus (IDDM).

STUDY DESIGN

This cross-sectional study compared the prevalence of candidiasis in 405 subjects with IDDM and 268 nondiabetic control subjects. Assessments included evidence of clinical manifestations of candidiasis and a quantitative measure of Candida pseudohyphae in a cytologic smear from the midline posterior dorsal tongue.

RESULTS

More subjects with IDDM than control subjects without IDDM (15.1% vs 3.0%) were found to have clinical manifestations of candidiasis, including median rhomboid glossitis, denture stomatitis, and angular cheilitis. IDDM subjects were also more likely to have any Candida pseudohyphae in their cytologic smears (23.0% vs 5.7%; P <.0001), as well as pseudohyphae counts of >10/cm(2) (7.1% vs 0.8%; P <.0001). Diabetic subjects with median rhomboid glossitis were more likely to have a longer duration of IDDM and complications of nephropathy and retinopathy. Denture stomatitis was associated with smoking, retinopathy, higher Candida counts, poor glycemic control, and longer duration of IDDM. A multivariate regression analysis found 3 factors to be significantly associated with the presence of Candida pseudohyphae in the subjects with IDDM: current use of cigarettes (odds ratio, 2:4), use of dentures (odds ratio, 2:3), and elevated levels of glycosylated hemoglobin (odds ratio, 1:9). The use of antimicrobials, immunosuppressants, or drugs with xerostomic side effects was not related to the presence of Candida.

CONCLUSIONS

Candida pseudohyphae and oral soft tissue manifestations of candidiasis were more prevalent in subjects with IDDM than in control subjects without diabetes. The presence of Candida pseudohyphae was significantly associated with cigarette smoking, use of dentures, and poor glycemic control.

Immunochemical characterization and distribution of laminin in the rat tongue

Anti-laminin serum was used to investigate the distribution and composition of laminin in the rat tongue. Immunohistochemical analysis showed that laminin is a useful marker to study the microscopic anatomy of the tongue. Laminin is expressed in most tissues that form this organ, such as smooth and striated muscle, epithelium, nerves, and endothelium, allowing the observation of fine details of neuromuscular junctions, taste papillae and microvasculature. Western blot analysis revealed that laminin extracted from the tongue differs from EHS tumor laminin. Tongue laminin contains B chains, while A chain seems to be present only in small amounts.

Long-term complications of diabetes mellitus, Part II: Gastrointestinal and infectious

Numerous gastrointestinal and infectious diseases are associated with long-standing and often poorly controlled DM in humans. Although not as well documented in veterinary patients, the veterinary practitioner must always have an index of suspicion for the possibility of these complications. Because the clinical signs of a number of these problems are identical, proper diagnostic procedures need to be used to differentiate among the gastrointestinal and even infectious problems. In all cases, stringent blood glucose control is the common denominator in effective treatment. Other agents can be used both to assist in short-term control and for long-term therapy.

Prevalence study of tongue lesions in a Hungarian population

The aim of the study was to assess the prevalence of tongue lesions in a district population, in Budapest, called regularly for X-ray lung examinations. Oral examinations of 7820 individuals were performed, 42% were over 60 yr of age, 42.9% were men and 57.1% women. Tongue alterations were found in 18.52% of the examined individuals, more frequently in women than in men. Lingua fissurata has been diagnosed in 8.8%, geographic tongue in 3.0% of the examined subjects. Atrophic lesions of the tongue were found in 6.37%, among them 5.42% central papillary atrophy (median rhomboid glossitis): 0.35% of the total sample. Manifest clinical symptoms of oral Candidiasis were found in 2.15% of the total sample, and in 4.28% of patients with tongue lesions. The occurrence of oral leukoplakia and lichen in patients with tongue lesions was respectively 0.47 and 0.07%. The prevalence of tongue alterations was consistent with the literary data, the oral screening attached to the X-ray lung examinations proved to be useful in detecting changes of the oral mucosa.

Oral disorders associated with diabetes mellitus

The protean manifestations of diabetes include various associated oral disorders such as sialosis, xerostomia, impairment of taste, and localized infections of which oral candidosis is the most commonly observed. The association of specific oral diseases and diabetes is of importance both in the detection of undiagnosed diabetes and in the elucidation of the pathogenesis of various oro-facial diseases. The clinical features and possible causes of oral disorders recognized to be associated with diabetes are reviewed with emphasis on good oral hygiene in the diabetic patient.

Chronic atrophic oral candidiasis among patients with diabetes mellitus--role of secretor status

Non-diabetic individuals who are non-secretors of blood group antigens are prone to superficial infections by Candida albicans. In this study, 216 patients with diabetes mellitus who were denture wearers were examined for the presence or absence of denture stomatitis. There was an overall trend for non-secretors to be prone to denture stomatitis compared with secretors. Stepwise linear discriminant analysis was used to dissect the contribution of secretor status and other variables to the development of the disease. Secretor status was found to be a contributory factor among patients with non-insulin dependent diabetes but not among those with insulin-dependent diabetes. The possible reasons for this are discussed.

Central papillary atrophy of the tongue among bidi smokers in India: a 10-year study of 182 lesions

The occurrence of central papillary atrophy of the tongue among tobacco users, its clinical characteristics and the long term behavior in relation to changes in tobacco use was studied in 182 individuals in Ernakulam district, Kerala, India. Almost all (98%) lesions occurred among bidi smokers. Clinically, about 31% occurred in combination with bidi smoking associated lesions such as palatal erythema (14%), leukoplakia (8%) or both (3%). Histologic evaluation in 12 biopsies using single PAS stained sections showed candidal hyphae in 67%. A 10-yr follow-up (mean: 6.7 yr) of the 182 lesions showed that the regression was highest (87%) among those who stopped their smoking habit and persistence among those who did not reduce or stop their smoking habits. The findings from this study confirm a strong link between bidi smoking and central papillary atrophy of the tongue in rural Indian populations.

Painless, irregularly shaped erythematous area on the middorsum of the tongue

Regardless of what name is used to identify the lesion and its nature of origin, clinicians should be aware of the clinical features and biologic activity of this relatively common oral abnormality and be prepared to reassure patients of the innocuous nature of the lesion.

Tobacco smoking and denture wearing as local aetiological factors in median rhomboid glossitis

The importance of tobacco smoking and denture wearing in the aetiology of median rhomboid glossitis (MRG) has been evaluated in 39 patients. Significantly more of the MRG patients (85%) smoked tobacco compared with the corresponding proportion (41%) of the 39 healthy age-and sex-matched control subjects. Their tobacco consumption was also heavier. A significantly greater proportion of the MRG patients wore their dentures continuously compared with the controls. The number of MRG patients who were both tobacco smokers and denture wearers was significantly increased above that of the control group, as was the number who both smoked and wore dentures continuously. Only 1 patient neither smoked nor wore dentures and she was taking an antidepressant (imipramine hydrochloride) with a reported association with oral candidosis. It is suggested that these local factors may play a part in the development of MRG by favouring the local proliferation of Candida albicans on the dorsum of the tongue. Although conservative or surgical treatment may provide relief, management should also include attention to possible predisposing local factors.

Prevalence of different morphologic forms of the human tongue in young Finns

Morphologic variations on the surface of the human tongue were examined in 381 patients divided by age into three groups (Group I--3 to 8 years old; Group II--9 to 16 years old; and Group III--17 to 35 years old). In Group I there were 84 pre-school children; in Group II there were 146 schoolchildren; in Group III there were 151 dental students and dental nurse students. The prevalence of variations in the morphology of the tongue surface in the three groups combined was as follows: fissured tongue, 5.0 percent; filiform atrophy, 5.5 percent; geographic tongue, 2.1 percent, and hairy tongue, 8.3 percent. Prevalence of both fissured tongue (p less than 0.05) and filiform atrophy (p less than 0.01) increased with the age of the population. Geographic tongue and hairy tongue did not increase significantly with age. Fissured tongue was more common in males than in females (p less than 0.05). The amount of filiform atrophy and hairy tongue was not significantly different in males and females.

Candidal infections and populations of Candida albicans in mouths of diabetics

The prevalence of oral candidosis and the frequency of isolation of Candida albicans and its density and distribution have been determined in the mouths of 50 patients with diabetes mellitus and 50 healthy volunteers matched for age, sex, dental status and smoking habits. Three of the diabetic patients were found to have a chronic oral candidosis. According to an imprint culture technique, the oral carrier rate and density of C albicans were both higher in the diabetic group as a whole than in the control subjects. Smoking was associated with an increased prevalence of the yeast in diabetes mellitus. Diabetics wearing dentures had higher candidal density than those without a prosthesis. No differences in candidal status could be detected according to the degree of control of diabetes, mode of treatment, duration of diabetes or the patient's age. Local factors such as smoking and the presence of dentures, particularly when worn continuously, interact with diabetes mellitus in promoting candidal colonisation of the mouth. Attention to these predisposing factors could reduce the incidence of thrush in diabetics.

Candidiasis and atrophic tongue lesions

In an attempt to shed more light on the role of Candida albicans in the genesis of median rhomboid glossitis, a three-part study of normal, atrophic, and cadaver tongues was undertaken. Occasional fungal hyphae were found in 36 percent of the clinically normal tongues. Hyphae were far more numerous in cytologic smears from atrophic tongue lesions than in those from normal tongues. More than 40 percent of the cadaver tongues showed fungal hyphae. The possible role of C. albicans as a cause of median rhomboid glossitis is discussed in the light of these findings.

Median rhomboid glossitis: not a misnomer. Review of the literature and histologic study of twenty-eight cases

A series of twenty-eight cases of median rhomboid glossitis were studied histologically. Of these twenty-eight cases, 85 percent showed fungal hyphae in the parakeratin layer. The literature is reviewed, and additional evidence is presented to support the theory the median rhomboid glossitis is not a developmental condition but the clinical expression of a localized chronic fungal infection.

Central papillary atrophy of the tongue and denture stomatitis

A retrospective study of the epidemiologic data of 4,417 subjects has been undertaken to study the possibility of a link existing between glossal central papillary atrophy (median rhomboid glossitis) and denture stomatitis. Neither the association between glossal central papillary atrophy and denture stomatitis nor the association between glossal central papillary atrophy and denture use was statistically significant. However, the correlation between wearing removable dental prostheses and finding candidal mycelia in smears from these tongue lesions was statistically highly significant. Debilitation caused by general age changes would not appear to predispose to atrophy of the pappillae of the middle portion of the tongue-dorsum.

Glossal double fissures in pre- and post-natal human specimens

Glossal double fissures were found in a similar proportion of both pre- and post-natal tongue specimens. The condition was found in both sexes and in subjects of Negro, Caucasian and mixed ethnic origins. In cross-section, the area bounded by the fissures varied from raised to flat or depressed. Histologic analysis suggested that the double fissure appearance was a reflection of the topography of the subjacent muscle bundles and that true fissuring, when present, was probably a secondary phenomenon akin to acquired plication.

Oral health status of institutionalized elderly Cape Coloreds from the Cape Peninsula of South Africa

A study has been conducted to assess the oral health status and need for dental treatment among elderly Cape Coloreds resident in homes for the aged in the Cape Peninsula of South Africa. This paper describes the prevalence of diseases of the mouth with special reference to denture-induced lesions and white lesions of the oral mucosa. Dental caries was the most prevalent oral lesion (27.2%). The most common conditions of the soft tissues were leukoedema (24.4%) and leukoplakia (4.4% for the tongue; 20.4% for the remainder of the oral mucosa). Leukoedema and leukoplakia showed statistically highly significant correlations with tobacco habits. Men more commonly had a tobacco habit than women (P less than 0.002) and leukoplakia, leukoedema and depigmented lesions of the lips were significantly more common in men than in women. No significant difference could be proven statistically when the frequency of irritative fibrous hyperplasia in females was compared with that in males.