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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 29  |  Issue : 4  |  Page : 282-287

Prevalence of Oral Mucosal Lesions in Western Maharashtra: A Prospective Study


1 Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India
2 Department of Periodontology, Shivtej Arogya Seva Sanstha's Yogita Dental College and Hospital, Ratnagiri, Maharashtra, India

Date of Submission24-Jan-2017
Date of Acceptance06-Jan-2018
Date of Web Publication15-Feb-2018

Correspondence Address:
Dr. Kamala A Kamble
Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Satara - 415 110, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.JIAOMR_14_17

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   Abstract 


Aim and Objectives: The purpose of this study was to determine the number, types, and locations of oral mucosal lesions in patients who attended our outpatient department. Materials and Methods: The patients were divided into four groups based on age: 17–24 years, 25–34 years, 35–44 years and >44 years old. Clinical oral examination was done with diagnostic instruments using the Color Atlas of Common Oral Diseases as a guide for diagnosis. When clinical features were not diagnostic, a biopsy was undertaken. The lesions were divided into 7 major groups – normal variants, tobacco related, tongue lesions, potentially malignant disorders and oral malignancies, reactive lesions, inflammatory and pigmented lesions. Results: Among 1500 outpatients, of the 587 (39.1%) patients diagnosed with oral mucosal lesions, males were 416 (70.8%) and females 171 (29.1%). The age range of the patients was between 17 and 80 years. The overall prevalence of oral mucosal changes or lesions was 39.1%. The most commonly affected age group was >44 years. Overall, tobacco-related lesions (35.9%) were the most frequently detected conditions, followed by tongue lesions (16.1%), premalignant and malignant lesions (13.9%), inflammatory lesions (12.6%), normal variants (9.5%), reactive lesions (7.6%), and pigmented lesions (4.0%). Conclusion: The results of the present study provide important information about the prevalence of oral mucosal lesions among patients seeking dental care. The study provides baseline data for future studies about the prevalence of oral lesions in the general population.

Keywords: Mucosal lesions, oral, potentially malignant disorders, prevalence


How to cite this article:
Kamble KA, Guddad SS, Nayak AG, Suragimath A, Sanade AR. Prevalence of Oral Mucosal Lesions in Western Maharashtra: A Prospective Study. J Indian Acad Oral Med Radiol 2017;29:282-7

How to cite this URL:
Kamble KA, Guddad SS, Nayak AG, Suragimath A, Sanade AR. Prevalence of Oral Mucosal Lesions in Western Maharashtra: A Prospective Study. J Indian Acad Oral Med Radiol [serial online] 2017 [cited 2019 Aug 21];29:282-7. Available from: http://www.jiaomr.in/text.asp?2017/29/4/282/225469




   Introduction Top


Oral health is important to the quality of life of all individuals. The oral mucosa serves as a protective barrier against trauma, pathogens, and carcinogenic agents.[1] Oral lesions can interfere with daily social activities in involved patients through impact on mastication, swallowing and speech, and symptoms such as xerostomia, halitosis, or dysesthesia.[2] Diagnosis of the wide variety of lesions that occur in the oral cavity is an essential part of dental practice. Proper clinical management of a patient with an oral lesion starts with an accurate diagnosis. Hence, oral soft tissue examination is crucial and should be done in a systematic manner to include all parts of the oral cavity.[3]

Epidemiologic studies provide information important to understanding the prevalence, incidence, and severity of oral disease in a specific population, but the results of such studies (including those on the established variety of changes that can occur in the oral mucosa) have rarely been published worldwide.[4] Basic information of prevalence studies of oral mucosal lesions (OMLs) can provide guidance in the administration of health services; it may be used to explain local disease occurrence and eventually contribute toward the understanding of the natural history of a disease. Hence, the present study was undertaken to assess the prevalence and types of OMLs in a general population in patients visiting School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University (KIMSDU), Karad, Maharasthra, India.


   Materials and Methods Top


The present study was conducted among 1500 new patients from suburban and rural areas of Karad taluka attending School of Dental Sciences, KIMSDU, Karad from October 2016 to December 2016. Permission was obtained from the institutional ethical committee of KIMSDU, Karad, and written informed consent was obtained from all patients participating in the study. Patients with written informed consent to participate in the study and those who consented to be clinically evaluated by oral examination were included in the study. Patients in whom an intraoral examination was not possible due to inadequate mouth opening, medically compromised patients, and patients without an informed consent were excluded from the study.

Patients were examined by single researchers from the department of oral medicine and radiology to avoid bias at School of Dental Sciences, KIMSDU, Karad. For our convenience, the patients were divided into four groups based on age: 17–24 years, 25–34 years, 35–44 years, and >44 years old. Along with patient's demographic details, patients were clinically examined using mouth mirrors under artificial light. Clinical oral examination was done using the Color Atlas of Common Oral Diseases (Langlais et al., 2009) as a guide for diagnosis.[5] Based on the history and clinical appearance, the oral mucosal lesions were grouped in 7 categories as normal variants, tobacco related, tongue lesions, potentially malignant disorders (PMD) and oral malignancies, reactive lesions, inflammatory and pigmented lesions. Cytologic smears were obtained when necessary and lesions which required histopathological examination were referred to the oral surgery clinic for biopsy. After histopathological confirmation, the lesion was added to one of the eight groups. The collected data was entered into the computer, and frequency and distribution tables of OMLs were generated using Statistical Package for Social Sciences (SPSS-16 version).


   Results Top


Among 1500 outpatients who reported to the department during the study period, 587 (39.1%) patients were diagnosed with OMLs. Males were 416 (70.8%) and females were 171 (29.1%). The age range of the patients was between 17 to 80 years. Of the total sample, the most commonly affected age group was >44 years (48.2%), followed by 35–44 years (26.6%), 25–34 years (17.7%) and 17–24 years (7.3%).

Among the 7 classified categories, tobacco-related lesions were observed in 35.9%, followed by tongue lesions (16.1%), PMD and oral malignancies (13.9%), inflammatory lesions (12.77%), normal variants (9.5%), reactive lesions (7.6%), and pigmented lesions in 4.0%. [Table 1] shows prevalence of OMLs according to clinical presentation, while [Table 2] shows distribution of OMLs according to gender and age. It was noticed that a large number of the lesions occurred on the cheek/buccal mucosa followed by vestibular region and tongue [Table 3].
Table 1: Prevalence of oral mucosal lesions according to clinical presentation

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Table 2: Distribution of oral mucosal lesions according to gender and age

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Table 3: Distribution of oral mucosal lesions according to site

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   Discussion Top


OMLs present a significant health problem with considerable morbidity. The prevalence of OMLs in our study was 39.1%, which was comparable to other Indian studies such as Sandeepa et al. (42.2%)[6] and Mathew et al. (41.2%).[7] Compared to our study, the prevalence of OMLs was found to be lower at 16.8% by Bhatnagar et al.,[8] 15.5% by Cebeci et al.,[4] 15.0% by Al-Mobeeriek et al.,[3] and 11.33% by Shivakumar et al.[9] Patil et al.[10] recorded highest prevalence of OMLs in their study (64%) followed by Patil et al. (61.8%)[11] and Ali et al. (58.1%).[1]

According to the gender distribution there was male predominance (416, 70.8%) in the present study compared to females (171, 29.1%). Majority of the studies have not demonstrated differences in prevalence of the lesions. The male predominance was in accordance with Patil et al.,[10] Castellanos et al.,[12] and Mehrotra et al.,[13] while Mujica et al.[14] and Al–Mobeeriek et al.[3] reported 67% and 57.7% female predominance, respectively. The high prevalence of lesions in males could be attributed to the higher number examined and the higher prevalence of tobacco use by males and the greater access they have to the outlets that sell tobacco and its products, whereas because of cultural constraints, women have to maintain a certain image and are less likely to practice the unhealthy habits.

The most commonly affected age group in our study was >44 years (48.2%). Some studies have shown higher prevalence of OMLs in older patients than in younger individuals.[11] Association has been reported between oral mucosal disorders and aging.[4],[11] Various causes leading to changes in the oral mucosa due to aging are infections, nutritional factors, metabolic changes, medication, prosthetic use, habits of alcohol or tobacco, and longer the duration of habit practice more the time for lesions to develop.[11]

The most frequent OMLs in the present study were tobacco-related lesions (35.9%). In tobacco-related lesions, the most common was tobacco pouch keratosis (24%) followed by mishri-induced pigmentation (7.6%), smokers palate (2.7%), and lichenoid reactions to tobacco (1.5%). Smokeless tobacco use is very common in India. Tobacco or tobacco-containing products are chewed or sucked as a quid, or applied to gums, or inhaled. Tobacco pouch keratosis is a condition that results from spit tobacco being habitually placed in the mucobuccal fold in the mandibular anterior or buccal regions where the mucosa is in direct contact with snuff or chewing tobacco. The development of this lesion strongly depends on early onset, frequency, type and brand of tobacco use, amount of daily usage, and number of sites routinely used for tobacco placement.[15]

Mishri is a form of smokeless tobacco which contains burnt tobacco. It is a black powder obtained by roasting and grinding tobacco on a hot metal plate until it is uniformly black, and is most commonly used as a method of oral hygiene maintenance in rural Maharashtra, especially by women.[16] Mathew et al.,[7] in their study, reported 0.84% prevalence of tobacco pouch keratosis. It was only observed in men, probably because of the chronic and high usage of tobacco in men. Patil et al.[10] reported nicotinic stomatitis (43%) as most common lesion, whereas Mujica et al.[14] and Cebeci et al.[4] showed that the most common lesion was denture stomatitis (18%) and anatomical changes (7%), respectively. Mishri-induced pigmentation was the third most common OMLs in our study (7.49%). We observed it most commonly on buccal mucosa and on the gingiva. It occurred more frequently in this study among older patients and smokers, similar findings have been shown in previous studies.[17],[18] However some studies have shown prevalence of melanin pigmentation due to tobacco-related habits and others have reported higher prevalence in females taking contraceptives.[11]

Tongue lesions comprised a considerable proportion of OMLs with different prevalence rate in various parts of the world.[2],[4] The prevalence of tongue lesions in the present study was second most common (16.01%) and this was in accordance with Patil et al.[11] The prevalence of tongue lesions was noted to be higher among males than females. The most common type of tongue lesion noted was coated tongue (7.66%), followed by geographic tongue (4.25%), and fissured tongue (2.72%). Other tongue lesions (lingual varicosis, bifid tongue, tongue tie, glossitis) constituted 1%. Coated tongue ranked the second most common OML in our study. Cebeci et al.[4] reported 51.4% coated tongue whereas worldwide, fissured tongue remains a common tongue lesion but its occurrence varies. Al-Mobeeriek et al.[3] reported fissured tongue (35.65%) as the most common tongue lesion followed by hairy tongue (0.55%) in his study while Patil et al.[11] and Ali et al.[1] reported hairy tongue as most common tongue lesion followed by fissured tongue and geographic tongue.

The oral cavity is one of the most suitable locations for the development of PMD and oral malignancies. However, all potentially malignant epithelial oral lesions should be diagnosed via microscopic analysis because of evident discrepancies between clinical and histological diagnosis. Occurrence of PMD and oral malignancies were third most common OMLs in our study accounting for 13.96%, with OSMF (5.96%) being the highest followed by lichen planus (3.91%), squamous cell carcinoma (2.38%), and leukoplakia (1.70%). Patil et al.[10] reported 30% OSMF, 22% leukoplakia, 18% lichen planus, and 2% squamous cell carcinoma, which was very high compared to our study. In contrast, Cebeci et al.[4] and Mujica et al.[14] showed lower prevalence of these lesions compared to our study. In our study OSMF was seen in all male patients while female predominance was seen in lichen planus (3.2%). Associations between oral mucosal lesions, alcohol and tobacco smoking have been illustrated in several studies and it has been indicated that oral lesions would increase with age in association with tobacco consumption and denture use.[2]

Prevalence of inflammatory lesions (12.77%) was the fourth most common OMLs in the present study constituting aphthous stomatitis (3.57%), followed by herpes labialis and angular cheilitis (2.89%), denture stomatitis (1.87%), candidiasis (1.02%), and burns (0.51%). Aphthous stomatitis was most prevalent in the younger (17-34 years) age-group and more frequent in females (2.38%) than males (1.19%). However Sandeepa et al.[6] in their study reported 16.6% with female predominance but Mathew et al.[7] reported prevalence of 2.1% with male predominance. The ratios of angular cheilitis (2.89%) and denture stomatis (1.87%) were much higher in our study compared to Mathew et al.,[7] whereas Mujica et al.[14] showed 18% prevalence of denture stomatitis in their study. Both lesions were frequently found in individuals above 35 years with almost equally affected males and females.

In many studies the most common OMLs were those considered to be anatomic variants.[1],[2],[4],[7] In the present study, normal variants were the fifth most common OMLs, such as fordyce granules (5.79%), leukoedema (2.55%), and linea alba (1.19%). Fordyce granules were more frequently observed on buccal and labial mucosa and prevalent more in men than in women. Reactive lesions accounted for 7.66%, of which traumatic ulcer (2.55%) were most common followed by irritation fibroma (1.53%), frictional keratosis (1.36%), and mucocele (1.19%). Few studies have shown the highest prevalence of OMLs to be traumatic ulcerations, irritation fibroma and frictional keratosis. It was found to be more frequent in males and smokers and occurred more often on the gingival/alveolar mucosa.[1],[6],[11],[12] Natarajan et al.[19] showed that it tends to occur on the alveolar ridge as a result of trauma from food being crushed on the gingiva/alveolar mucosa by unopposed teeth. Castellanos et al.,[12] Pentenero et al.,[18] and Byakodi et al.[20] reported fibroma as the most common exophytic lesion in their studies. The major cause of irritation fibromas is mechanical irritation from denture trauma, lip biting, calculus deposits, sharp margins of teeth and fillings, and long-term habits such as cheek biting and tongue thrusting. They can occur anywhere in the oral cavity; in our study, the buccal mucosa, and lip were the most frequent sites.

The prevalence of pigmented lesions was least in our study accounting for 4.08%, of which oral melanotic macules (1.73%), nevus (1.36%) and hemangioma (1.02%) were most common in our study group. Most of the pigmented lesions look very similar, so definitive diagnosis may be possible only after histopathological evaluation which was not done in the present study.

Regarding the distribution of mucosal lesions in the oral cavity, different sites in oral cavity show predilection for different types of lesions. Different interactions between genetic and environmental factors in the oral mucosa lead to the formation of different lesions. The site of the lesion is also an important etiological factor. Cheek/buccal mucosa (32.2%) was the most commonly affected site in the present study followed by vestibular region (25.6%), tongue (19.3%), labial mucosa (10.1%), and palate (7.8%) whereas gingiva (3.1%) and the floor of mouth (1.0%) were the least involved. In the present study tobacco related and premalignant and malignant disorders were the most prevalent OMLs which occurred on buccal mucosa. Ali et al.[1] in their study reported 49.1% of lesions on buccal mucosa whereas Ghanaei et al.[2] and Patil et al.[10] reported tongue and hard palate as most common site of occurrence of OMLs respectively.


   Conclusion Top


The results of the present study provide important information about the prevalence of oral mucosal lesions among patients seeking dental care in a South Maharashtrian cohort. This information can help determine the epidemiology, severity and also help identify risk factors for oral lesions. It will also serve as a baseline for future studies with the goal of finding ways to improve oral health in this country.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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