|Year : 2015 | Volume
| Issue : 3 | Page : 382-386
Prevalence of oral soft tissue lesions and medical assessment of geriatric outpatients in North India
Sameer Rastogi1, Pallak Arora1, Shalini Kapoor2, Sartaj Singh Wazir3, Shirin Vashishth1, Vandana Sharma4
1 Department of Oral Medicine and Radiology, Kalka Dental College, Hospital and Research Centre, Meerut, Uttar Pradesh, India
2 Department of Periodontics, SGT Dental College, Hospital and Research Centre, Gurgaon, Haryana, India
3 Department of Oral Medicine and Radiology, MB Kedia Dental College, Birganj, India
4 Department of Oral Pathology, Kalka Dental College, Hospital and Research Centre, Meerut, Uttar Pradesh, India
|Date of Submission||12-Jan-2015|
|Date of Acceptance||07-Nov-2015|
|Date of Web Publication||25-Nov-2015|
Sugandhit, 1 Pachenda Road, Devpuram, Muzaffarnagar - 251 001, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: Oral health reflects overall well-being for the elderly population. Compromised oral health may be a risk factor for systemic diseases commonly occurring in old age. Oral health evaluation should be an integral part of the physical examination, and dentistry is essential to qualify geriatric patient care. Aim: To determine the prevalence of oral soft tissue lesions and systemic diseases in institutionalized geriatric population in North India. Materials and Methods: Geriatric patients were clinically evaluated using a standard questionnaire and assessed for known medical illnesses and prevalence of oral soft tissue lesions. Four hundred patients (71% males and 29% females) with age ranging from 60 to 100 years were considered in the study group. Twenty-two (33.8%) patients were edentulous and seven patients (10.8%) were denture wearers. Forty-four (67.69%) patients reported with tobacco habits. Results: Most prevalent medical illness reported was diminished vision (15.5%), followed by hypertension (10%) and diabetes mellitus (6.25%). Several oral soft tissue lesions were reported among the study population. The most prevalent lesions were leukoplakia (12%), smoker's melanosis (10%), smoker's palate (9%), pigmentation on tongue (6%), frictional keratosis (5%), lichen planus (3%), denture stomatitis (2.5%), aphthous ulcers (2%), angular chelitis (1.5%), oral submucous fibrosis (1.5%), melanotic macule (1.5%), candidiasis (1.5%), irritation fibroma (1%), geographic tongue (1%), median rhomboid glossitis (1%), and traumatic ulcer (1%). Conclusion: The findings observed in this population are important and can have a determinant effect on the overall quality of life in this population. This information is a crucial prerequisite for health awareness programs involving the community health workers, oral physicians, and medical professionals.
Keywords: Geriatrics, medical illness, prevalence, soft tissue lesions
|How to cite this article:|
Rastogi S, Arora P, Kapoor S, Wazir SS, Vashishth S, Sharma V. Prevalence of oral soft tissue lesions and medical assessment of geriatric outpatients in North India. J Indian Acad Oral Med Radiol 2015;27:382-6
|How to cite this URL:|
Rastogi S, Arora P, Kapoor S, Wazir SS, Vashishth S, Sharma V. Prevalence of oral soft tissue lesions and medical assessment of geriatric outpatients in North India. J Indian Acad Oral Med Radiol [serial online] 2015 [cited 2019 Jun 20];27:382-6. Available from: http://www.jiaomr.in/text.asp?2015/27/3/382/170461
| Introduction|| |
Aging is an inevitable veracity of human existence on the planet earth. The world's population, including that of India, is aging,  and it has been projected that by the year 2050, the number of elderly people would rise to about 324 million. India has thus acquired the label of an aging nation with 7.7% of its population being more than 60 years old.  The UN Population Division estimates that by 2050, the geriatric population will double in Africa and treble in Asia.  It is predicted that seniors will outnumber children in every province, with a median national age of 44 years. , Certainly, with recent advancements in the medical field, the life expectancy of individuals has tremendously increased. , As life expectancy increases, giving more attention toward disease prevention is the need of hour, so that the quality of life in old age can be improved.  In spite of these demographic changes, research in gerodontology area has been scarce.
Oral health reflects a history of the older persons' behavioral attitudes and expectations for their own oral health.  Compromised oral health may be a risk factor for systemic diseases commonly occurring in old age.  Conversely, elderly patients are more susceptible to oral conditions due to age-related systemic diseases and functional changes/decay.  Globally, poor oral health among older people has particularly been observed to result in a high level of tooth loss,  dental caries,  high prevalence rates of periodontal disease,  xerostomia,  and soft tissue lesions.  To provide quality care, it is important to understand the physical, mental, socioeconomic, and family background of the elderly, their chronic illnesses and drug treatment, and age-related disabilities such as poor vision, hearing, and locomotor control.  Today's dentist must be aware of the patients' medical conditions, medications, and the impact of oral health and dental care on the overall health of the patient.  In precise, hastily aging population and oral complications in geriatric patients will endure to upsurge. As an outcome, oral physicians will become more tangled in the management of geriatric patients and the oral conditions relevant to an aging population, and delivery of that care might become more intricate and vigorous. 
The oral lesions and treatment needs in the geriatric patients greatly vary according to each country, region, and even in hospitalized, institutionalized, and community patients.  India is a land of diversity with regard to race, region, caste, educational, cultural, and social customs. These aspects may affect the oral health status.  Epidemiological studies serve as an eminent tool for acknowledgment of the prevalence and magnitude of various oral diseases in the inhabitants.  During the last decade, several studies of prevalent oral lesions have been reported from South India, Maharashtra, and Gujarat, ,,, but they were not age specific. The present study was conducted as no extensive studies have been conducted in North India to obtain information on the oral status of geriatric patients.
| Aims and objectives|| |
- To know the prevalence of oral soft tissue lesions in the geriatric population of Meerut city, Uttar Pradesh, North India.
- Assessment of medical illness in the geriatric population.
- To evaluate the risk factors responsible for the oral soft tissue lesions.
| Materials and Methods|| |
In the present study, 400 geriatric individuals presenting to the outpatient department with age ranging from 60 to 100 years, during the period from November 2011 to December 2012, were examined to detect medical illness and oral mucosal lesions. Inclusion criteria were as follows: geriatric subjects aged 60 years or older and with complete medical records. All the subjects were administered a standardized questionnaire to obtain data on any history of relevant risk factors, general status of the patient, systemic diseases, medications used, age, gender, alcohol and tobacco consumption, habits (trauma), and use of prosthetic or other appliances, and written consent was taken for the procedures to be carried out on them subsequently. The intraoral examination was conducted by a single examiner throughout the study. The examination was performed using sterile plain mouth mirror, explorer, cotton swabs, and CPI probe under artificial illumination. Cotton swabs were used for removing debris and examining whether white lesions could be wiped off. Demographic data (age, gender, name, educational level, etc.) and medical records were collected using the subjects' files in the institute. The World Health Organization (WHO) guidelines were used in the methodological procedure of oral examination and in the description of oral lesions. The study was approved by the university's ethical clearance committee.
| Results|| |
A total of 400 subjects were screened; of these, 232 presented oral lesions. The age range of patients was 60-100 years with a mean age of 65.35 ± 7.38 years. Among the subjects, 71% were males and 29% were females. Out of 400 subjects, 272 were dentulous, 96 (24%) participants were completely edentulous, and 32 (8%) were denture wearers. Regarding the habit of tobacco use, 124 were smokers, 18 were tobacco chewers, 10 were smokers and chewers, while 96 neither smoked nor chewed tobacco. Tobacco chewing and smoking was more prevalent in males.
In the entire group, 58% (n = 232) of the participants had oral lesions. We reviewed 443 lesions corresponding to 232 patients. The most frequent soft tissue locations, where lesions were found, were tongue (194), followed by buccal mucosa (118), palate (50), lip (23), gingiva (22), labial mucosa (20), alveolar ridge (12), and floor of mouth (4). No mucosal abnormalities were detected in 42% of subjects. The most prevalent normal variant was fissured tongue (20.5%), followed by varices (13.5%), Fordyce's granules (11.5%), leukoedema (3%), and linea alba (2%) [Figure 1]. The most prevalent lesion was leukoplakia (12%), followed by smoker's melanosis (10%), smoker's palate (9%), pigmentation on tongue (6%), frictional keratosis (5%), lichen planus (3%), denture stomatitis (2.5%), aphthous ulcers (2%), angular cheilitis (1.5%), oral submucous fibrosis (1.5%), melanotic macule (1.5%), candidiasis (1.5%), irritation fibroma (1%), geographic tongue (1%), median rhomboid glossitis (1%), and traumatic ulcer (1%) [Figure 2]. Out of four cases of geographic tongue, one patient reported with history of psoriasis. Denture stomatitis (25%) and epulis fissuratum (12.5%) were the most frequent denture-related lesions (DRLs) [Figure 3]. Diminished vision (15.5%) was the most frequent medical illness, followed by hypertension (10%) and diabetes mellitus (6.5%). [Table 1] shows the frequency of systemic diseases in this study.
Oral health impairments can diminish one's social interactions, self-esteem, and self-image and have a dramatic effect on a person's quality of life. Aging is not a disease, but it does increase our susceptibility to disease. Oral, dental, and craniofacial diseases and conditions disproportionately affect the elderly, and frail elders are particularly vulnerable to increased morbidity due to oral infections. Dental professionals must comprehend the special prerequisites of the elderly and work meticulously with rest of their team. Information on the oral health of elderly population in a number of countries is available, but scarce data are available or have been published on the elderly population of North India.
In the present study, a total of 400 geriatric patients in the age group of 60-100 years with a mean age of 65.35 ± 7.38 years formed the study population. Prevalence ratio has been reported for specific oral lesions such as DRLs, normal variants, and mucosal lesions. In addition, associations have been described between oral mucosal lesions and deleterious habits. In the present study, more number of male subjects were suffering from oro-mucosal lesions as compared to females, which was similar to the finding of a study conducted by Gambhir et al.  It could be due to the increased prevalence of deleterious oral habits among males than females.
While comparing the present investigation results with similar epidemiological studies, the prevalence rate of 58% oral soft tissue lesions in geriatric patients in the present study coincides with the rates reported in the studies of Mujica et al.  (57%), Espinoza et al.  (53%), and Al-Aswad  (48%), respectively. On the other hand, Gonzalez et al. (1995) in Mexico demonstrated a prevalence rate of 23.2%. Other series reported in Spain documented a rate of 39% for aged patients presenting oral mucosa alterations.  Similar results have been shown in different studies; these variations could be explained as due to the different methodologies used. Cultural differences, oral habits, educational level, and even genetic difference can be responsible for this difference.
The most frequent sites of soft tissue lesions in our study were the tongue, followed by buccal mucosa. Previous studies have shown that tongue lesions constitute a significant proportion of oral lesions and their prevalence rate varies in different parts of world. The most prevalent normal variant in our population was fissured tongue (20.5%), followed by varices and Fordyce's granules. All subjects had fissures of at least 2 mm on the dorsal aspect of tongue. It can be due to a nutritional deficiency or allergy. Being 65 years of age or older was found to be a significant risk factor in fissured tongue. Similar finding was observed in Slovenian dental patients, with a prevalence of 21.1%. In this study, the prevalence of varices (13.5%) was observed to be lower than in Spanish population (21.1%; Vallejo et al. 2002).  Our finding is nearly comparable to that of Mathew et al.  (14.2%).
Tobacco-related lesions such as leukoplakia, smoker's melanosis, and smoker's palate were the most prevalent oral lesions with a prevalence of 12%, 10%, and 9%, respectively. All the subjects in our population were smokers and chewers. Since our study population constituted 71% males, this was attributable to the high tobacco consumption among males. Ikeda et al. in Japan found a prevalence of 25% for leukoplakia, while, in contrast, Reichart  and BánÓczy and RigÓ  reported prevalence rates of 1.1% and 1.3%, respectively. The prevalence of oral pigmentation (6%) was comparable to the study conducted by Mumcu et al.  (6.9%). In the present study, out of 24 patients with pigmentation, 5 patients were on medication. White lesions near rough dental restorations, sharp tooth, or due to biting because of unsuitable prosthesis were registered as frictional keratosis. The prevalence of 5% that we found was consistent with the findings of Corbet et al.  (6%) and Mathew et al.  (5%).
Most denture wearers (32 participants) had at least one DRL. Denture stomatitis (25%) and epulis fissuratum (12.5%) were the most frequent DRLs. Other investigators reported a frequency of 18-33% for DRLs.  A higher prevalence of DRLs (46.87%) in the present study can be due to old unstable dentures, poor oral health status, and lack of regular oral examinations. The result revealed that there was a direct correlation between the duration of denture wearing and the number of DRLs and oral mucosal lesions. In this study, some possible risk factors for oral lesions, such as smoking and tobacco habits, old unstable dentures, nutritional deficiency, and use of medication for systemic disorders, were assessed. Therefore, regular oral and dental check-up by dental professionals must be part of geriatric medical services.
| Conclusion|| |
There is a growing interest in the oral health status of elderly persons as the size of this population is increasing globally. In addition, older people's accessibility to dental services is very low than others due to physical and financial limitations. Consequently, the results of the present study give some information about the prevalence of oral lesions in the urban North Indian population. The results show that tobacco-associated lesions are more prevalent in our population. A high frequency of some lesions in this population commands national programs toward oral health awareness. Although some recent curbs have been put on the manufacture and sale of gutka and pan masala, further education is necessary to reduce or eliminate the use of these preparations.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]