Oral mucosal lesions and their association with sociodemographic, behavioral, and health status factors

Cheilitis: A cross-sectional study-multiple factors involved in the aetiology and clinical features

OBJECTIVE

Since the aetiologies of cheilitis are broad and overlapping, the purpose of this cross-sectional clinical study was to examine the multiple factors involved in aetiology and the disease's clinical features.

SUBJECTS AND METHODS

We analysed cheilitis prevalence, demography, clinical features, patients' habits, psychological stress, systemic diseases, vitamin B9, B12 and iron serum levels and allergy test results in a total of 130 subjects with cheilitis, plus 22 healthy subjects.

RESULTS

The most common cheilitis types were: cheilitis simplex and eczematous cheilitis (28.5%); herpetic cheilitis (16.9%); and exfoliative and angular cheilitis (7.7%). Concerning bad habits, there was a significant association/connection between self-reported saliva at the corners of the mouth and angular cheilitis, and between lip licking/biting and exfoliative cheilitis. Common associated conditions were skin diseases (56.5%) and atopy (84%). Vitamin B9 and B12 serum and iron values were mostly within the normal reference range. The patients suffering from herpetic cheilitis had significantly higher psychological/mental stress levels than the control group.

CONCLUSION

To our knowledge, this is the first study of cheilitis patients that has simultaneously analysed aetiological factors, characteristics of the disease and diagnostic parameters.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Factors Participating in the Occurrence of Inflammation of the Lips (Cheilitis) and Perioral Skin

Lip inflammation may manifest as mainly reversible cheilitis, mainly irreversible, or cheilitis connected to dermatoses or systemic diseases. Therefore, knowing a patient’s medical history is important, especially whether their lip lesions are temporary, recurrent, or persistent. Sometimes temporary contributing factors, such as climate and weather conditions, can be identified and avoided—exposure to extreme weather conditions (e.g., dry, hot, or windy climates) may cause or trigger lip inflammation. Emotional and psychological stress are also mentioned in the etiology of some lip inflammations (e.g., exfoliative cheilitis) and may be associated with nervous habits such as lip licking. To better manage cheilitis, it is also helpful to look for potential concomitant comorbidities and the presence of related diseases/conditions. Some forms of cheilitis accompany dermatologic or systemic diseases (lichen, pemphigus or pemphigoid, erythema multiforme, lupus, angioedema, xerostomia, etc.) that should be uncovered. Occasionally, lip lesions are persistent and involve histological changes: actinic cheilitis, granulomatous cheilitis, glandular cheilitis, and plasmacellular cheilitis. Perioral skin inflammation with simultaneous perioral dermatitis can have various causes: the use of corticosteroids and cosmetics, dysfunction of the skin’s epidermal barrier, a contact reaction to allergens or irritants (e.g., toothpaste, dental fillings), microorganisms (e.g., Demodex spp., Candida albicans, fusiform bacteria), hormonal changes, or an atopic predisposition. Epidermal barrier dysfunction can worsen perioral dermatitis lesions and can also be related to secondary vitamin or mineral deficiencies (e.g., zinc deficiency), occlusive emollient use, sunscreen use, or excessive exposure to environmental factors such as heat, wind, and ultraviolet light. Current trends in research are uncovering valuable information concerning the skin microbiome and disruption of the epidermal barrier of persons suffering from perioral dermatitis. Ultimately, an effective approach to patient management must take all these factors and new research into account.

Actinic cheilitis in rural workers: prevalence and associated factors

Objective

To evaluate the prevalence of actinic cheilitis in rural workers and factors associated with the development of this condition.

Methods

A cross-sectional study was conducted in a city in Northeastern Brazil. Data were collected by clinical examination and use of a questionnaire validated with 300 rural workers. The χ² test was employed to identify possible associations between the presence of actinic cheilitis and clinical and demographic variables. Multiple logistic regression analysis was performed using forward stepwise selection. A p value of 0.05 was considered significant.

Results

The prevalence of actinic cheilitis was 12.0% in the sample. The highest prevalence of actinic cheilitis was observed in white males, with low educational level, and an approximately 40-year history of sun exposure. Chronic lesions were commonly found in the lower lip and were characterized by scaling, dryness, and mild edema. Skin color, sex, educational level of patients, and cumulative sun exposure (in years), were identified as predictors of development of actinic cheilitis.

Conclusion

Our results suggest the need to implement educational health strategies aimed to orient the population about risk factors and preventive measures of the disease. Appropriate clinical management of patients with actinic cheilitis is important for prevention of lip cancer.

The impacts of oral health-related quality of life of elderly people living at home: a cross-sectional study

The scope was to verify the impact of oral and sociodemographic conditions, the dental treatment needs and dental pain, on the quality of life of the elderly. This cross-sectional study was conducted in 15 primary health care areas. A backward multivariate linear regression model was used (p<0.05) with oral health related-quality of life as dependent variable. There were 335 elderly people with predominance of women (56.72%) and aged up to 74 years (59.40%). Those who had up to 8 years of education predominated (87.46%), and those who were still working were the minority (13.43%). Multivariate linear regression (p<0.05) showed association with missing teeth (β=0,12; IC 0,00:0,04; p<0,04) and dental prosthesis needs (β=0,14; IC 0,13:0,81; p<0,01), women (β=0,18; IC 0,23:0,85; p<0,01), less aged (β=-0,12; IC -0,05:0,00; p<0,02), not working (β=-0,15; IC -1,09:-0,20; p<0,01), with dental care need (β=0,24; IC 0,25:0,63; p<0,01) and dental pain (β=0,14; IC 0,10:0,64; p<0,01). Missing teeth, sociodemographic conditions, dental treatment needs and dental pain might impact oral health-related quality of life of elders.

Sun protection as a protective factor for actinic cheilitis: Cross-sectional population-based study

OBJECTIVE

To determine whether sun protection is associated with lower occurrence of actinic cheilitis in adults living in a city from southern Brazil.

MATERIALS AND METHODS

A multi-stage proportional sample of 404 individuals 18 years and older was obtained. Interviews and clinical examinations were conducted in participants' households. Four categories of self-reported use of sun protection were determined. Multivariable Poisson regression was used to assess the associations.

RESULTS

Prevalence of actinic cheilitis was 47.1%. In the first main-effects multivariable model, AC was significantly associated with sex, age, skin colour and duration of sun exposure, but not with sun protection. However, the association between sun protection and actinic cheilitis was modified by the time of sun exposure. Among those exposed ≥4 hr/day to sun, individuals using physical protection or physical + chemical protection were 33% (prevalence ratio = 0.67, 95% confidence interval [CI] 0.47-0.94, p = .02) and 36% (PR = 0.64, 95% CI 0.47-0.94, p = .02), respectively, less likely to have actinic cheilitis than those who did not use any sun protection, adjusting for sex, age and skin colour.

CONCLUSIONS

Physical and chemical sun protection were associated with lower occurrence of actinic cheilitis in individuals with greater exposure to sun.

A retrospective 11-year study on lip lesions attended at an oral diagnostic service

Background

The objective of this study was to describe the upper and lower lip lesion occurrence in an oral diagnostic service.

Material and Methods

Retrospective descriptive sectional study was performed. Clinical records were obtained from the archives of an Oral Diagnostic Service referral center between 2006 and 2016. Data such as gender, age, anatomical location, and diagnosis were collected and categorized. The collected data were submitted to a descriptive analysis and Pearson's chi-square test (p ≤ 0.05).

Results

A total of 587 patient records of lip lesions were analyzed. Most lesions were diagnosed in female (52.1%) and adults (56.9%) patients in the lower lip (76.2%). Among all lip lesions, the reactive/inflammatory lesions (n = 238; 40.5%) and oral potentially malignant disorders (n = 164; 28%) were the most frequent group lesions. Mucocele (n = 147; 25%), actinic cheilitis (n = 136; 23.1%) and vascular lesions (n = 51; 8.7%) were the most frequent lesion in the sample. Actinic cheilitis was significant in relation to gender (p < 0.001), all three most frequent lesions were significant in concerning to age group and anatomical site.

Conclusions

Mucocele was the most common lower lip lesion in all age groups, followed by actinic cheilitis and vascular lesions, which mainly affected adults and the elderly.

Key words:Lip, lip lesions, oral diseases, epidemiology.

Prevalence of Oral Mucosal Lesions and Relation to Serum Cotinine Levels-Findings from a Cross-Sectional Study in South Africa

Oral mucosal lesions (OML) can decrease oral health-related quality of life and some have the potential to become malignant. The aim of the present study was to report the prevalence of OML in relation to age, sex, and serum cotinine levels in a population with mixed ancestry from South Africa. This study is part of the Cape Town Vascular and Metabolic Health (VHM) study, conducted between 2014-2016. Trained dental examiners assessed the oral mucosa for the presence of OML according to WHO criteria. In total, 1976 individuals were included in the study, being 1496 females (75.7%) and 480 males (24.3%) with average age of 49.5 years (SD = 15.3). In total, 262 lesions were detected in 252 participants (overall prevalence of 13%). Males had higher prevalence than females (14% vs. 9%, p = 0.008). Participants aged 25-34 had the highest prevalence rates (21%). Participants who had cotinine ≥15 ng/mL had higher prevalence of OML as compared to those with <15 ng/mL (15% vs. 5%, p < 0.001). Most common lesions were nicotine stomatitis (33%) and leukoplakia (19%). Age, male sex, and higher cotinine levels were associated with increased prevalence of OML.

Oral potentially malignant disorders: clinical-pathological study of 684 cases diagnosed in a Brazilian population

BACKGROUND

The frequency and distribution of oral potentially malignant disorders (OPMD) may vary among different populations. The aim of the present study was to evaluate the clinical-pathological characteristics of OPMD diagnosed in a Brazilian oral pathology laboratory over a period of 11 years.

MATERIAL AND METHODS

All cases diagnosed as leukoplakia, speckled leukoplakia, erythroplakia, and actinic cheilitis from 2005 to 2015 were analyzed. Clinical information was obtained from laboratory forms and histological information was obtained from histological slides stained with hematoxylin and eosin.

RESULTS

the final sample was comprised of 684 cases, of which 292 were males and 392 were females. The mean age was 58 years. The anatomical site most often involved was the lateral border of the tongue (23%), followed by the lower lip (20%), and by the buccal mucosa/vestibule (18%). Leukoplakia accounted for 82% of the sample (564 cases). The mean size of the leukoplakia and speckled leukoplakia lesions was 13 mm (ranging from 1 to 100 mm) and 15 mm (ranging from 5 to 30 mm), respectively (p=0.460). Males reported smoking and drinking alcohol more frequently than females (p=0.001 and p<0.0001, respectively). In half of the cases, dysplasia was not histologically detected, while slight dysplasia was detected in 28% of the cases. The lesions from patients aged from 41 to 80 years presented moderate and severe dysplasia more often than lesions from patients in other age groups.

CONCLUSIONS

OPMD were more common in females in their sixties. Females were more frequently affected in all anatomical sites, except for the lips. Leukoplakia lesions were the most common OPMD, followed by actinic cheilitis. The lateral border of the tongue was the most affected anatomical site. OPMD located in the floor of the mouth/sublingual mucosa and lesions from older patients presented severe epithelial dysplasia with greater frequency.

Actinic cheilitis and lip squamous cell carcinoma: Literature review and new data from Brazil

Background

To investigate the prevalence of malignant and potentially malignant lesions of the lip in an oral pathology service and to compare these data with a literature review.

Material and Methods

A total of 3173 biopsy reports and histopathological records were analyzed. Cases with a histological diagnosis of actinic cheilitis (AC) with or without epithelial dysplasia, in situ carcinoma, or lip squamous cell carcinoma (LSCC) were included. A comprehensive literature review was conducted to investigate the prevalence of AC and/or LSCC.

Results

124 cases (3.91%) were included, 75 (60.5%) had some degree of epithelial dysplasia and 31 (25.0%) were LSCC. Clinically, most of the lesions were diagnosed as AC (50.8%); however, eight cases clinically reported as AC were histologically diagnosed as LSCC. Regarding clinical characteristics, most individuals were fair-skinned male, with mean age of 54.3±12.3 years, and with a history of long-term solar exposure. Furthermore, 18 articles were selected from the literature, showing that the lower lip was predominantly affected and that most individuals were males, fair-skinned, and older than 40 years.

Conclusions

Since most of the cases diagnosed clinically as AC presented some degree of epithelial dysplasia, it is important to emphasize the value of biopsy and the histological evaluation of this lesion.

Key words:Actinic cheilitis, Precancerous conditions, In situ carcinoma, Oral diagnosis, Mouth neoplasms.

Mature dendritic cell density is affected by smoking habit, lesion size, and epithelial dysplasia in oral leukoplakia samples

OBJECTIVE

To compare the densities of CD1a + immature and CD83+ mature dendritic cells, and inflammatory infiltrate cells between smokers and non-smokers with oral leukoplakia. Parameters associated with malignant transformation were also evaluated.

DESIGN

21 smokers and 23 non-smokers diagnosed with oral leukoplakia were obtained. Densities of inflammatory infiltrate cells were calculated in H&E sections. Immunohistochemistry using anti-CD1a and anti-CD83 was performed and densities were calculated. Comparisons and statistical analyses were performed among the groups and parameters as gender, lesion size, site, and presence of cell dysplasia were analyzed.

RESULTS

A lower density of CD83+ cells was observed in smokers compared to non-smokers (P < 0.05). For samples of smokers, a lower density of CD1a + cells, CD83+ cells, and inflammatory infiltrate cells was observed in samples with <10 mm compared to samples ≥10 mm of diameter (P < 0.05), and a lower density of CD83+ cells was also observed between samples without dysplasia compared to samples with dysplasia (P < 0.05).

CONCLUSION

In oral leukoplakia samples, dendritic cell density decreases in the presence of smoking habit, and increases in larger lesions and with epithelial dysplasia. Smoking habit is an external factor that contribute to alteration of the anti-tumoral immune defense system in lesions of oral leucoplakia, reinforcing that smoking elimination is important to control the development of this disease.

Prevalence and Distribution of Oral Mucosal Lesions by Sex and Age Categories: A Retrospective Study of Patients Attending Lebanese School of Dentistry

Background

Prevalence and distribution of oral mucosal lesions in a sample of Lebanese population attending the School of Dentistry of Lebanese University is necessary to evaluate their oral health situation.

Objectives

The aim of the present study was to determine the prevalence and distribution of oral mucosal lesions of patients attending the School of Dentistry.

Methods

A descriptive study was carried out by retrospectively examining a total of 231 medical and clinical examination record files of patients, attending the School of Dentistry Lebanese University for multidisciplinary dental treatments. 178 medical records were retained. Each medical and clinical examination record was done by an undergraduate student and then evaluated by a doctor. The record file included a civil status, chief complaint, medical history, and extraoral and intraoral clinical examination during the period between October 2014 and May 2015. Exclusion criteria were lack of written information in their medical and clinical examination record and being nonevaluated by a doctor. Data regarding age, gender, socioeconomic status, chief complaint, systemic diseases, and drugs intake were collected by using a questionnaire while the type of extraoral and oral mucosal lesions by clinical examination.

Results

The sample consisted of 102 (57.3%) females and 76 (42.7%) males. The age ranged from 10 to 92 years with a mean age of 40.1 years. Among these subjects, 110 (61.8%) presented with one or more lesions. All patients were Lebanese. The most common lesion diagnosed was coated/hairy tongue affecting 17.4% of the subjects, followed by melanotic macule (11.2%), gingivitis (9.6), linea alba (6.2%), tongue depapillation (5.1), leukoplakia (5.1), traumatic fibroma (4.5), frictional keratosis (3.9%), fissured tongue (3.9%), hemangiomas (3.9%), Fordyce granules (3.9%), dry mucosa (3.4), angular cheilitis (2.2), gingival hyperplasia (2.2), and crenulated tongue (1.7%). Overall, the prevalence of oral mucosal lesions did not significantly differ between sex and age groups.

Conclusions

The high prevalence of oral mucosal lesions necessitates adequate awareness and management of these lesions in the general population. Dental clinicians should be knowledgeable and familiar with the etiopathogenesis, clinical presentation, diagnosis, and management of these lesions.

Prevalence of and Factors Associated with Actinic Cheilitis in Extractive Mining Workers

Abstract The objective of the present study was to determine the prevalence of actinic cheilitis among extractive mining workers and factors associated with the condition, especially the relationship between clinical appearance and the length of occupational exposure to sunlight. A cross-sectional study was performed in Dona Inês, Paraíba, Brazil between 2014 and 2015. A clinical examination, clinical photography and a questionnaire were applied to 201 extractive mining workers. The T-student’s, ANOVA one-way, Fisher’s exact and Pearson chi-squared tests were performed and the significance level was set at 5%. A high prevalence of actinic cheilitis was observed (38.8%). Length of occupational exposure to sunlight in months (169.63±112.68, p=0.002) was associated with actinic cheilitis. Most workers were Caucasian (p<0.001) and aged 37.41±12.15 years (p=0.004). The time of occupational exposure to sunlight was significant in relation to the following clinical features: atrophy (225.75±97.31; p=0.024); blurred demarcation between the vermilion border of the lip and the skin (186.68±113.15; p=0.032); vertical fissures (210.09±123.07; p=0.046); white and red spotting (199.51±91.80; p=0.004); hard consistency of the lip (225.81±122.34; p=0.012). A high prevalence of actinic cheilitis was found. Age and ethnicity were associated with the presence of AC. Severe clinical presentations of actinic cheilitis were found among participants who had worked for at least 185 months (approximately 15 years) exposed to the sun.

Oral mucosal lesions in teenagers: a cross-sectional study

Background

Adolescence is a period of transition to adulthood. Little is known about oral mucosal lesions (OMLs) in teenagers, in which the emergence of new habits, unfamiliar to children, could affect the type of lesions.

The aim of this study was to evaluate the distribution of oral mucosal lesions (OMLs) in a wide sample of adolescents.

Methods

A retrospective cross-sectional study was carried out examining all medical records of adolescents (aged 13–18 years) treated at the Dental Clinic of the University of Brescia (Italy) in the period from 2008 to 2014. Cases with OMLs were selected. Data regarding age, gender, type of OML, bad habits, systemic chronic diseases were collected.

Results

A total of 6.374 medical records (mean age 15.2 + −1.7 years) were examined. We found 1544 cases (31.7%) of oral mucosal lesions; 36 different types of mucosal alterations were detected and the most frequent were: aphthous ulcers (18%), traumatic ulcerations (14.3%), herpes simplex virus (11%), geographic tongue (9.6%), candidiasis (5.5%), and morsicatio buccarum (4.7%). Papilloma virus lesions (1.7%), piercing-related lesions (4%), multiform erythema (0.13%), oral lichen planus (0.13%) and granular cell tumour (0.06%) were also diagnosed.

Conclusions

The prevalence of OMLs in adolescents are different from those in children and, in some conditions, it could increase with age.