the prevalence of oral mucosal lesions in moradabad- uttar pradesh by- dr. anand pratap singh...
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Thesis Submitted To Mahatma Jyotiba Phule Rohilkhand University, Bareilly In Partial Fulfillment Of The Requirements For The Degree Of MASTER OF DENTAL SURGERY(M.D.S.) in Oral Medicine and Radiology, Kothiwal Dental College and Research Centre,Moradabad.by DR. ANAND PRATAP SINGH. [email protected]TRANSCRIPT
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MAHATMA JYOTIBA PHULE ROHILKHAND UNIVERSITY,
BAREILLY
“THE PREVALENCE OF ORAL MUCOSAL LESIONS IN PATIENTS
VISITING A DENTAL COLLEGE IN MORADABAD, INDIA”
BY
DR. ANAND PRATAP SINGH
Thesis Submitted To Mahatma Jyotiba Phule Rohilkhand University, Bareilly
In Partial Fulfillment Of The Requirements For The Degree Of
Master of Dental Surgery
in the subject of
ORAL MEDICINE AND RADIOLOGY
Year -2010
KOTHIWAL DENTAL COLLEGE AND RESEARCH CENTRE
MORADABAD, U.P. , INDIA
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DECLARATION BY THE CANDIDATE
I hereby declare that this thesis entitled “THE PREVALENCE OF ORAL MUCOSAL
LESIONS IN PATIENTS VISITING A DENTAL COLLEGE IN MORADABAD,
INDIA” is a bonafide and genuine research work carried out by me under the guidance of
Prof. Dr. G.N. Suma, Department of Oral Medicine and Radiology, Kothiwal Dental
College and Research Centre, Moradabad.
Date:
Place: Moradabad Dr. Anand Pratap Singh
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CERTIFICATE BY THE SUPERVISORS
This is to certify that the thesis entitled “THE PREVALENCE OF ORAL MUCOSAL
LESIONS IN PATIENTS VISITING A DENTAL COLLEGE IN MORADABAD,
INDIA.” is a bonafide research work done by DR. ANAND PRATAP SINGH in partial
fulfillment of the requirement for the degree of MASTER OF DENTAL SURGERY
(M.D.S.) in Oral Medicine and Radiology, Kothiwal Dental College and Research Centre,
Moradabad.
SUPERVISOR
DR. G. N. SUMA
Professor
Department of Oral Medicine and Radiology
DATE:
CO- SUPERVISOR
DR. RAVI PRAKASH S.M.
Associate Professor
Department of Oral Medicine and Radiology
DATE:
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ENDORSEMENT BY THE HOD, PRINICIPAL/HEAD OF THE
INSTITUTION
This is to certify that the thesis entitled “THE PREVALENCE OF ORAL MUCOSAL
LESIONS IN PATIENTS VISITING A DENTAL COLLEGE IN MORADABAD,
INDIA.” is a bonafide research work done by DR. ANAND PRATAP SINGH in partial
fulfillment of the requirement for the degree of MASTER OF DENTAL SURGERY
(M.D.S.) in Oral Medicine and Radiology, Kothiwal Dental College and Research Centre,
Moradabad.
Seal and Signature of the Seal and Signature of the
H.O.D. Principal
DR. OMPRAKASH D. TOSHINIWAL DR. SANJAY SINGH
DATE: DATE:
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ACKNOWLEDGEMENT
To begin with, I bow my head in reverence before God Almighty who has always
blessed me with His bountiful grace throughout my life and for being my strength and shield.
"Ideal teachers are those who use themselves as bridges over which they invite their
students to cross, then having facilitated their crossing, joyfully collapse, encouraging
them to create bridges of their own." These words are most suitable to express my deep
gratitude to my Professor and Guide Dr. G.N.SUMA, Department of Oral Medicine and
Radiology. The task of the excellent teacher is to stimulate "apparently ordinary" pupil to
unusual effort. The tough problem is not in identifying winners: it is in making winners
out of ordinary pupil. A renowned academician, her illuminative guidance, brilliant foresight
and expert evaluation has been a continuous source of inspiration. I consider it my privilege
to work under her supervision. Her incessant encouragement and constructive criticism
helped me to finish this project. Her involvement and originality has triggered and nourished
my intellectual maturity that I will benefit from, for a long time to come.
“A teacher is a compass that activates the magnets of curiosity, knowledge, and
wisdom in the pupils.” It is my immense pleasure to have the opportunity to convey my
humble regards and gratitude to my co-supervisor of this work Dr. Ravi Prakash S.M.,
Associate Professor for his invaluable guidance, constant support and sympathetic attitude
that enabled me to successfully complete this study.
“Guidance in the proper direction is a necessity for any form of success in life.” I
am highly thankful to Dr. Omprakash D. Toshiniwal, Professor and Head, Dept of Oral
Medicine and Radiology, Dr. M. Srinivasa Raju, Professor, Dr. Naveen Shankar, Reader,
Dr. Sumalatha M.N., Senior lecturer, Dept of Oral Medicine and Radiology, Dr. Ravi
Shankar T.L., Reader, Dept of Community Dentistry, Dr. U.P. Singh, Reader, Dr. Lalit
Chandra Boruah, Senior lecturer, Dept of Conservative Dentistry, Dr. Chaitra T.
R., Senior lecturer, Dept of Pedodontics and Preventive Dentistry, Dr. Monika and Dr.
Rajesh Bansal, Faculty of Dental Science, B.H.U., Varanasi for their encouragement and
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guidance at each step. Their unlimited patience, and affectionate moral boosting &
encouragement have led me to accomplish this task.
I am beholden to my parents Mr. R. N. Singh, Mrs. S. Singh, my brothers Mr.
Ravindra Pratap Singh, Er. Abhay Pratap Singh, and sister Swati for their support,
bearing with me when I was lost in the project and their all time encouragement without
which this project would not have been possible.
I would also like to thank my friends Dr. S.P.Singh, Dr. Mudit Mittal, Dr. Vipul,
Dr. Ishu, Dr. Faisal Azhar, Dr. Ravi Kant, Dr. Abhishek Rai, Dr. Amit Manjhi, Dr.
Javed Ahmad, Dr. Ankita, Dr. Kanika, Dr. Rohan Uppal and Dr. Abhay Gupta for their
constant support and the help they rendered during my thesis work.
I am thankful to my seniors Dr. Shirin, Dr. Upendra, Dr. Nitin Nigam, Dr. Manu
Dhillon and Dr. Sumit Goel, my batchmates- Dr. Sankalp, Dr. Navneet and my juniors-
Dr.Kaushik Dutta, Dr. Kuber, Dr. Sayan, Dr. Amit, Dr. Sumit, Dr. Vivek, Dr.
Amrendra, Dr. Sharib and Dr. Abhishek for their valuable assistance, without their help,
this work would not have been accomplished in time. I wish them all the success.
I am sincerely grateful to Mr. K. K. Mishra, Director, Dr. Sanjay Singh, Principal,
Mr. Sanjay Sinha, Adminsrtative Officer and Mr. Jeet Singh, Warden for their benevolence
in providing me a platform on which this study was made possible.
I gratefully acknowledge the help of Mr. Gurinder Singh for his statistical jobs.
There are many others whose names could not be included in this column. That does not
mean I am ignoring them. It simply means that they deserve more than my expressions in
writing.
Dr. ANAND PRATAP SINGH
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CONTENTS
S.NO CONTENTS PAGE NO.
1. Acknowledgement v- vi
2. List of Figures viii-ix
3. List of Tables x
4. List of Graphs xi
5. List of Abbreviations xii
6. List of Appendices xiii
7. Abstract xiv- xv
8. Introduction 1-3
9. Aims and Objectives 4
10. Review of Literature 5-26
11. Materials and Method 27-34
12. Results 35-67
13. Discussion 68-86
14. Conclusion 87
15. Summary 88-89
16. Bibliography 90-94
17. Appendices 95-102
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LIST OF FIGURES
S. No Title of figures Page No.
Fig. 1 Armamentarium Used For Clinical Examination 32
Fig. 2 Armamentarium Used For Radiographical Examination 33
Fig. 3 Armamentarium Used For Biopsy Procedure 34
Fig.4 Aphthous stomatitis 60
Fig.5 Fordyce's condition 60
Fig.6 Traumatic Ulcer 60
Fig.7 Linea Alba Buccalis 60
Fig.8 Fissured tongue 60
Fig.9 Candidisais 60
Fig.10 Leukoedema 61
Fig.11 Herpes labialis 61
Fig.12 Primary Herpetic Gingivostomatitis 61
Fig.13 Pyogenic granuloma 61
Fig.14 Lichen planus 61
Fig.15 Coated tongue 61
Fig.16 Tongue pigmentation 62
Fig.17 Betel chewer’s mucosa 62
Fig.18 Median Rhomboid Glossitis 62
Fig.19 Squamous papilloma 62
Fig.20 Frictional Keratosis 62
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Fig.21 Smoker's palate 62
Fig.22 OSMF 63
Fig.23 Atrophic glossitis 63
Fig.24 Tobacco pouch keratosis 63
Fig.25 Peripheral giant cell granuloma 63
Fig.26 Mucocele 63
Fig.27 Sublingual varices 63
Fig.28 Thermal Burn 64
Fig.29 Geographic Tongue 64
Fig.30 Commissural Pit 64
Fig.31 Traumatic Fibroma 64
Fig.32 SCC 64
Fig.33 Lichenoid reaction 64
Fig.34 Vitiligo 65
Fig.35 Angular cheilitis 65
Fig.36 Myolipoma 65
Fig.37 Papillary Hyperplasia 65
Fig.38 Chemical Burn 65
Fig.39 Denture Stomatitis 65
Fig.40 Eruption Cyst 66
Fig.41 Leukoplakia 66
Fig.42 Parulis 66
Fig.43 Hairy Tongue 66
Fig.44 Hematoma 67
Fig.45 Herpes zoster 67
Fig.46 Ranula 67
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LIST OF TABLES
S. No. List Of Tables Page No.
Table I. Demographic Data And Dentate Status of 5203 Patients 40-41
Table II. Prevalence Of Habit In Different Demographic Locations
42
Table III. Prevalence Of Habit In Different Age Groups 43
Table IV. Prevalence Of Oral Mucosal Lesions With Gender 43
Table V. Prevalence Of Oral Mucosal Variants 44
Table VI. Prevalence Of Oral Mucosal Abnormalities 45-48
Table VII. Prevalence Of Lesions According To Age Groups 49
Table VIII. Prevalence Of Oral Mucosal Lesions In Different Demographic Locations
50
Table IX. Prevalence Of Oral Mucosal Lesions With Different Type Of Habits
51
Table X. Prevalence Of Tobacco Related Oral Lesions 52
Table XI. Prevalence Of Oral Mucosal Lesions According To Dentate Status
52
Table XII. Prevalence Of Oral Mucosal Lesions In Relation To The Prosthesis
53
Table XIII. Prevalence Of Oral Lesions According To Systemic Health Status
53
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LIST OF GRAPHS
S. NO. LIST OF GRAPHS PAGE NO.
Graph I. Prevalence Of Habit In Different Demographic Locations
54
Graph II. Prevalence Of Oral Mucosal Lesions With Gender 54
Graph III. Prevalence Of Oral Mucosal Lesions According To Age Groups
55
Graph IV. Prevalence Of Oral Mucosal Lesions In Different Demographic Locations
55
Graph V. Prevalence Of Oral Mucosal Lesions With Different Type Of Habits
56
Graph VI. Prevalence Of Tobacco Related Oral Lesions 57
Graph VII. Prevalence Of Oral Mucosal Lesions According To Dentate Status
58
Graph VIII. Prevalence Of Oral Mucosal Lesions According To Prosthesis
58
Graph IX. Prevalence Of Oral Mucosal Lesions According To Health Status
59
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LIST OF ABBREVIATIONS
SCC Squamous Cell Carcinoma
OSMF Oral Sub Mucous Fibrosis
M Male
F Female
ST Smoking Tobacco
SLT Smokeless Tobacco
Yrs Years
% Percentage
Fig. Figure
Pts Patients
± Plus or Minus
< Less than
> Greater than
i.e That is
RPD Removable Partial Denture
FPD Fixed Partial Denture
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LIST OF APPENDICES
S. NO. LIST OF APPENDICES PAGE NO.
1. CASE HISTORY PROPORMA 95-100
2. CONSENT FORM 101-102
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ABSTRACT
Background and Objectives:
The oral mucosa performs essential protective functions that significantly affect the general
health of the patient. Besides dental caries and periodontal diseases, oral mucosal lesions are
another significant problem of public health importance. This study aims to evaluate the
prevalence of oral mucosal lesions in patients attending outpatient department of Kothiwal
Dental College and Research Centre, Moradabad and correlation of the prevalence with the
tobacco habit among study population.
Materials and Method:
5203 patients, who visited the department of oral medicine for diagnosis of various
complaints over a period of three months, were examined for oral mucosal lesions. All the
patients were taken consent to participate in the study. Patients from 2-80 years were
included in the study and were divided in to four groups: group I (02-20 years), group II (21-
40 years), group III (41-60 years) and group IV (61-80 years). The examination consisted of
collecting the demographic data, general history and the clinical findings. All the subjects
were examined clinically and questioned regarding any habit like smoking, pan/gutkha
chewing and the frequency and duration of the habit. All the lesions were recorded by digital
camera and the identification of lesion was done according to guidelines as given in the text
books of Oral Medicine. The identification was also supported by the color atlas of oral
lesions (Bengel, Veltman, Loevy & Taschini. Differential Diagnosis of Diseases of the Oral
Mucosa.Quintessence Publishing Co., Chicago, George Laskaris. Color Atlus of Oral
Diseases. 3rd Edition. Thieme Stuttgart, Newyork, Bork, Hoede, Korting, Burgdorf &
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Young. Diseases of Oral Mucosa & Lip. 2nd Edition. W.B. Saunders Company.
Philadelphia) and the data were documented on the proforma. The gathered data was sorted,
tabulated and subjected to statistical analysis.
Results:
The overall prevalence of oral mucosal lesions was 17.16% (males = 11.34%, females =
5.82%). Males have higher prevalence (18.83%) compare to females (14.64%). The
difference between male and female was found to be statistically highly significant (p<
0.001). It has been found that patients habitual to smoking have higher oral lesions (43.00%)
than who used smokeless tobacco (24.89%) and who do not have any deleterious habits
(13.83%). The comparison of prevalence of oral mucosal lesions in smokers versus no habit,
smokeless tobacco users versus no habit and smoker versus smokeless tobacco users was
found to be statistically highly significant (p˂ 0.001).
Conclusion:
This study establishes the prevalence of Oral Mucosal Lesions (OML's) in patients attending
outpatient department of Kothiwal Dental College and demonstrates that smoking, tobacco
chewing and increasing age is associated with greater occurence of Oral Mucosal Lesions.
Key Words:
Oral mucosal lesions, Prevalence, Tobacco users, Abnormalities
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INTRODUCTION
There is no region in the body in which so many diseases manifest themselves as in the oral
cavity. Total Oral health care aims at dental as well as oral health, and is important to the
quality of life of all individuals. Oral lesions can cause discomfort or pain that interferes with
mastication, swallowing, and speech, and they can produce symptoms such as halitosis,
xerostomia, or oral dysesthesia, which interfere with daily social activities [1].
The oral mucosa performs essential protective functions that significantly affect the general
health of the patient. The oral mucosa separates and protects deeper tissues and organs from
the environment of the oral cavity like mechanical forces (biting, chewing etc), surface
abrasives and toxic effects of toxins released by the micro-organisms. The oral mucosa
performs essential protective functions that significantly affect the general health of the
patient2. Besides dental caries and periodontal diseases, oral mucosal lesions are another
significant problem of public health importance [2].
The oral mucosa is subjected to many changes that are due to its complex embryonic origin.
These changes can be modified in specific immunological situations as a consequence of
local factors, or as an expression of a superimposed dermatosis or a manifestation of a
systemic disease [3].
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Among the broad spectrum of causes leading to changes in the oral mucosa are infections
from bacteria, fungi, viruses, parasites, and other agents; physical and thermal influences,
changes in the immune system, systemic diseases, neoplasia, trauma and other factors, some
of which are issues of aging. These lesions could develop as a result of reduced immunologic
reactivity, impaired DNA repair capacity, impaired carcinogen metabolism and age specific
involution and atrophy of oral tissues, particularly of the oral epithelium and the salivary
glands [2, 4]. These lesions can be found in any site in the oral cavity.
Many oral lesions which are habit related or not are found to have potential to undergo
malignant changes. A series of diseases may be unique to the oral cavity and its components,
others may involve other parts of the body. However, they localize preferentially and
frequently in the mouth. Others having symptomatic significance when localized in the oral
cavity appear as a partial manifestation of an acute or chronic general disease and elicit such
characteristic oral changes that they are of great importance for diagnosis.
Diagnosis of the wide variety of lesions that occur in the oral cavity is also an essential part
of the dental practice. A dental school setting may differ from the situation found in the
general population, because it is not open or randomized. This may be a model indicative of
general and daily dental practice, particularly compared with other settings that deal with
rather selected populations such as those seen in specialty centres, nursing homes and
veterans facilities, or oral mucosal disease prevalence established in biopsy services [5].
In spite of the diagnostic importance of the lesions, the lack of data may lead to a risk of
overlooking diseases of the soft tissues in, and adjacent to, the oral cavity [6].
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The prevalence of oral mucosal lesions is an important parameter in evaluating the oral health
of any population and the prevalence data of all the oral mucosal lesions becomes a
requirement for planning oral health care services.
The prevalence of oral mucosal lesions is somewhat limited, particularly those studies
documenting the entire range of oral lesions in a population group. The majority of
investigations of this nature have been limited to the study of a single condition, or a few
selected conditions with similar clinical appearances or presumed etiology. Except for oral
cancer and potentially malignant oral conditions, the epidemiological literatures on oral
mucosal diseases are scarce.
Hence, the need arises for more such prevalence studies. This study is undertaken to evaluate
the prevalence of oral mucosal lesions in patients who visit the department of oral medicine
and radiology, Kothiwal Dental College, Moradabad, UP, India, to obtain a data useful for
further planning of oral health care in this region.
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AIMS AND OBJECTIVES
1. To obtain a data base of the prevalence of oral mucosal lesions in patients attending the
OPD, Kothiwal Dental College and Research Centre, Moradabad, UP, India, in a span of
3 consecutive months.
2. To correlate the prevalence of oral mucosal lesions with the habits among the study
population.
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REVIEW OF LITERATURE
Redman R.[7], in a study to determine the prevalence of geographic tongue, fissured
tongue, hairy tongue, and median rhomboid glossitis among students of public
schools from the Robbinsdale, Minnesota. He included total 3611 Subjects (1819
male & 1792 female) between the age of 5-13 years. Students were examined for the
presence of one or more of the tongue anomalies.
He found, 51geographic tongue, 39Fissured tongue, 5 Hairy tongue and 5 median
rhomboid glossitis. They also found that, Geographic tongue affected 1.41 per cent of
the children, Fissured tongue affected 1.08 percent of the children, Median rhomboid
glossitis and hairy tongue were rare, affecting 0.14 and 0.06 per cent of the children,
respectively.
He concluded that the prevalence of these conditions differs in no important respect
according to age or sex, although the possibility that it may be significantly greater
among the very young (2 to 3 years of age) needs exploration. The occurrence of
median rhomboid glossitis in young children is compatible with its supposed
developmental aetiology. Conversely, the extreme rarity of hairy tongue in ostensibly
healthy children is compatible with the concept that it is frequently associated with
adverse oral conditions resulting from systemic or oral disease.
B. Roed-Petersen and J. J. Pindborg [8], an epidemiological survey on the
prevalence of oral leukoedema was undertaken in four districts of Uganda (Kigezi in
the South-West, Toro in the West, Acholi in the North and Bugisu in the East). A total
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of 1399 persons comprising Ugandans of both African and Asian descent were
examined. Among the 1399 persons, Leukoedema was found in 199 subjects (14.2
%).
They found that, decreasing order of importance, age, race and tribe, and sex were
significantly related to the prevalence of leukoedema, but there was no association
could be shown for the variable district.
Tony Axell [9], an epidemiologic study was done to assess the prevalence of oral soft
tissue lesions in Swedish population. A total 8,696 subjects, older than 14 years of
age in two communities, Habo aud Enkoping, were included in this study.
A pretyped questionnaire was used to get data about tobacco and alcohol habits and
other relevant parameters. The examination of the oral cavity and the lips were made
with the aid of a dental mirror and a wooden spatula using light from a dental
operating lamp. The oral hygiene status and the presence of various dental filling
materials and prosthetic appliances were recorded. Soft tissue lesions were
categorized according to a diagnosis criteria system designed for the investigation,
and the location of each lesion was recorded.
He found 33 types of lesions. The number of Herpes labialis was 279, History of
herpes labialis was 1096, Acute pseudo membranous Candidiasis was 4, Carcinoma 1,
Fibroma19, Papilloma 5, Lipoma 5, Hemangioma 2, Lymphangioma 2, Recurrent
aphthae 227, History of recurrent aphthae was 1636, Periadenitis mucosa necrotica
recurrenc 2, Angular cheilitis 247, Preleukoplakia 472, Leukoplakia 272,
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Leukoedema 3994, Leukokeratosis nicotina palate 38, Snuff dipper's lesion 537,
Focal epithelial hyperplasia 3, Flabby ridge 624, Denture hyperplasia 237,
Fibroepithelial polyp 161, Denture sore mouth 1127, Traumatic ulcer 155, Cheek and
lip biting 411, Excessive melanin pigmentation 837, Glossitis 11, Geographic tongue
624, Hairy tongue 30, Atrophy of tongue papillae 152, Lichen planus 142, Fordyce's
condition 6783, and Amalgam tattoo were found 713 in number.
N.J.Mani et al.[10] , in a prevalence study on 43654 industrial workers of Gujarat,
was done to determine the occurrence of oral sebaceous glands. The subjects were
divided in to four groups, in group 1(n=6677), there was no habit and no lesion, in
group II (n=388), there was no habit but lesions were present, in group III (n=20568),
there were no lesion but habit was present, in group IV (n=16021), both the habit and
lesion were present. In this study they found that oral sebaceous glands were
prevalent in 10870 persons (24.9%) out of the study population of 43654 industrial
workers. They also found that the highest prevalence of 42.6% was absorbed among
those who abstained from such habits and who did not show any oral lesion.
Conversely, in those in whom the habit and lesions were present, the prevalence rate
was the lowest (12.5%). When the habits were present, with no lesions, the rate was
29.0%, whereas the prevalence rate was only 15.7% when the lesions were present in
the absence of any oral habits. Bilateral buccal mucosal involvement was the most
common finding.
They concluded that comparatively low prevalence rate is attributed to the high
frequency of oral habits which may cause an atrophy of these glandular structures.
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Irenef Rodriguez et al.[11], in a prevalence study on 749 randomly selected workers
from Havana City, Cuba, was done to determine the occurrence of oral leukoplakia
according to age and sex distribution in relation to extrinsic factors as smoking and
alcohol habits and intra oral mechanical trauma. The sample of this study was
composed of 749 persons (394 female and 355 male) between the age from 20-60
years.
They found that 50% of the total of the sample were smokers. The prevalence of
leukoplakia and preleukoplakia was 4.4% (leukoplakia 2.1%, preleukoplakia 2.3%).
Males were more affected than females. They also found that the prevalence was up
to 16 times higher in smokers.
They concluded that the high significant relation between smokers and lesion supports
the strong relation between smoking and oral leukoplakia.
Meir Gorsky et al.[12], a study on randomly selected Israeli Jews to determine
prevalence of commissural lip pits, and a relation of commissural lip pits to ethnic
background was done in different parts of Israel and from a wide spectrum of
occupations.
The sample was consisted of 2462 apparently healthy Israeli Jews (1042 men, 1420
women), ranging in age from 18-90 yr.
They found the presence of commissural lip pits in 17.4% of the entire
sample, 9.7% were unilateral and 7.7% were bilaterally located. 20.6% of the males
had commissural lip pits (10.4% unilateral and 10.2% bilateral), and 15.1% of the
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women (9.2% unilateral and 5.9% bilateral). They also found a significant sex
predilection for males with P value <0.001.
Esmonde F. et al.[13], in a survey of 537 noninstitutionalized, 65-74 years olds
Chinese in Hong Kong, to determine the prevalence of oral mucosal lesions in
denture wearers, tobacco smokers, and alcohol drinkers. They found no mucosal
lesions in 64% of elderly. In the 193 elderly subjects with lesions, 80% exhibited
only one lesion. There was no difference in prevalence between men and women.
The more common lesions, each being found in 5-7% of the elderly, were lingual
varicosities, frictional keratosis on buccal mucosa, denture stomatitis on the
palatal mucosa, and denture-induced hyperplasia in maxillary and mandibular
buccal sulcus. Denture wearers had a higher prevalence or number of oral mucosal
lesions between those defined as users of tobacco and alcohol and those defined as
nonusers in the study. No confirmed oral malignancies were found.
G. Campisi & V. Margiotta [14], a randomly selected study on 118 male subjects
(age ≥40 years) was done to evaluate presence of oral mucosal lesions, with
particular emphasis on the early diagnosis of oral precancerous and cancerous lesions
in Mediterranean island of Pantelleria, Southwest of Sicily, Italy. The subjects were
interviewed for socioeconomic and behavioural information, and were clinically
examined by using WHO criteria.
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They found that alcohol drinking was the most common habit in the study population
(73%), followed by tobacco smoking (58.5%, of whom 96% were cigarette smokers).
Only 3% showed good oral hygiene and 25% were edentate. Oral lesions were
observed in 81.3% of the study group, mainly coated tongue (51.4%), Leukoplakia
(13.8%), traumatic oral lesions (traumatic ulcers and frictional white lesions) in 9.2%,
actinic cheilitis (4.6%), and squamous cell carcinoma in one case (0.9%). They also
found statistically significant associations between the prevalence of coated tongue
and tobacco smoking (P< 0.0001), and between the prevalence of actinic cheilitis and
tobacco smoking/alcohol drinking (P< 0.05).
They concluded that the main risk factors tobacco smoking and/or alcohol
drinking were not only for oral cancer, but also for many other oral diseases.
Peter A. Reichart [4], in a cross-sectional study of aging Germans to determine
prevalence of oral mucosal lesions in 5040 subjects, 223 samples were dropped out
for quality-natural reason. The net random sample was 3065, the group of adolescent
(1043) was not included for screening. Total 2022 individuals were divided in Group I
(35-44 yrs, n=655) & 1367 were in group II (65-74 yrs).
He found labial herpetic lesion (31.7%), Fordyce’s granules (22.6%), recurrent
aphthous stomatitis (18.3%), lip & cheek biting (10.1%) in group I, and in group II he
found Fordyce’s granules 23.7%, labial herpes 20.0%, plicated tongue 19%, denture
stomatitis 18.3%, leukoplakia was seen in 1.8% (west), & 0.9% (east) respectively,
men were more often affected than women and there was an association between the
prevalence of leukoplakia and a lower or higher educational level.
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He concluded that, the spectrum of oral mucosal lesions changes with age and
increases with general morbidity, routine examination of oral cavity of the aging are
mandatory particularly to detect early precancerous and other mucosal lesions.
N Avcu, A Kanli [15], a study was done to assess the prevalence of nine different
tongue lesions and relate to data obtained about oral hygiene or habits among dental
outpatients during the period July 1995–August 2001 in the Hacettepe University,
Dental Care District of Ankara city, located in the central part of Turkey.
A total of 5150 subjects (2837 women, 2313 men) aged 13–83 years, mean age 36.2
± 0.28) dental outpatients were included in this study.
They found hairy tongue (n= 581), coated tongue (n=1197), fissured tongue (n=1028),
papillary atrophy (n=147), geographic tongue (n=62), median rhomboid glossitis
(n=13), crenation tongue (n=63), macroglossia (n=64) and, ankyloglossia (n=4).
They also found out of the 5150 subjects, 2690 subjects were detected as having
tongue lesions with a prevalence of 52.2%, 44.2 and 62.0% for women and men,
respectively.
The difference was found to be statistically significant (P < 0.0001). There was a
strong correlation between tongue lesions and increasing age. There was also a strong
association between tongue lesions and smoking, black tea drinking, and fair or poor
oral hygiene. Hairy and coated tongue was significantly higher in males. Contrary to
this, papillary atrophy was more prominent in women.
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They concluded that a strong correlation was found between tongue lesions and age,
sex, oral hygiene and habits in Turkish dental outpatients. An efficient oral health
program such as the elimination of risk habits and attention to cultural practices may
improve tongue hygiene.
Christian Scheifele [16], a study was done to assess the prevalence of OL in a
representative sample of the US population, data from the oral mucosal tissue
assessment and some other covariates of 16,128 participants in the US National
Health and Nutrition Examination Survey (NHANES III) were included. The clinical
definition of OL was applied according to the WHO criteria.
They found that weighted prevalence of OL were 0.66±0.14% in males, 0.21±0.05%
in females and 0.42±0.08% in total. The age peaks were at 40-49 years in males and at
≥70 years in females.
They also found that the prevalence estimates were 0.37% for homogeneous OL and
0.06% for non-homogeneous OL. Gingiva (38.8%) and buccal mucosa (30.9%) were
the most frequent locations.
They concluded that there was a substantial decline in prevalence of Leukoplakia
compared to previous studies in the USA.
C.F.N. Bessa et al.[17], in a cross-sectional study on 1211 Brazilian children, was done
to determine the prevalence of oral mucosal alterations. Subjects were divided in to
two age groups: 0-4 years (n=746) & 5-12 years (n=465). They found that the
frequency of children presenting alterations was 27% & it was higher in older
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children. The most common lesions were geographic tongue, cheek biting and
melanotic macule. Candidiasis was associated with antibiotic therapy and use of
pacifiers. Fissured tongue was associated with congenital anomalies, allergy in age
group from 5-12 years.
They also found that, there was a lack of association of patient’s economic status and
prevalence of oral mucosal alterations. They concluded that, the frequency of mucosal
alterations in children is high and increases with age and some of them are associated
with habits and medical history of the patients.
C. K. Harris et al. [18], in a prevalence survey among alcohol misuse's in south
London was done on Six hundred and ninety-three subjects (388alcohol misuse's and
305 alcohol + substance abuse) attending several clinical care facilities in south
London between 1994 and 1999 were interviewed on their alcohol and drug habits. A
comprehensive oral mucosal examination was performed, and soft tissue lesions found
were classified by the clinical criteria of Axles.
They found that, the mean age of the sample was 40.5 years. The majority was white
(92.6%); of the whites, 29.9% were Celts (i.e. Irish, Scots resident in London). Many
subjects reported misusing more than one type of beverage. Two hundred and twenty-
seven Oils were found in 195 subjects (28.1%). The highest prevalence was found for
frictional kurtosis (8.8%), scar tissue of the lips (4.8%) and candidacies (3.8%).
Angular chelitis was present in 21 subjects (3.0%). The alcohol-related Oils detected
were three white patches compatible with a diagnosis of leukoplakia and one
treated oral carcinoma. No Erythroplakia were detected. The differences in
prevalence of mucosal lesions in the two groups were not significant (x2=2.18;
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P=0.14). The prevalence of tobacco smoking was high in both study groups. Oils were
found with all four types of beverages consumed, and there was little variation by the
units per week consumed. Concurrent use of substances and alcohol did not make a
significant difference to the prevalence of OMB. In the logistic regression analysis,
minority ethnic groups (Black or Asian), smokers, those with a body mass index
(BMX) under 20 and beer drinkers had an increased risk of an OMB in this group of
alcohol misusers.
They concluded that, In comparison with previous oral mucosal screening
programmes undertaken in several settings in the UK, the present study has yielded a
higher prevalence of oral mucosal diseases and conditions in this risk population.
There are several ways in which alcohol could contribute to these detected oral
lesions, either directly or indirectly.
G Mumcu et al.[19] , a cross-sectional study was done to evaluate the prevalence and
distribution of oral lesions (OLs) in Turkish population. They selected 765 subjects
(F/M: 375/390) of age between 5–95 years by the cluster sampling method and
examined according to WHO criteria.
They found that excessive melanin pigmentation (6.9%) was the most common lesion
in the study population. The tongue lesions observed in this study were
fissured tongue (5.2%), varices (4.1%), hairy tongue (3.8%), geographic tongue
(1.0%), atrophic tongue papillae (0.7%) and ankyloglossia (0.3%). The denture-
related lesions were denture stomatitis (4.3%), suction irritation (0.8%), denture
hyperplasia and torus palatinus as bony lesion (0.5%) and traumatic ulcers (0.3%).
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They concluded that pigmentation, fissured tongue and denture stomatitis were
observed to be the most common lesions in Turkish population and elderly population
was a significant risk factor for occurrence of some OLs.
Karin Soares Gonc¸alves Cunha et al. [20], in a hospital based study to assess the
prevalence of oral lichen planus (OLP) in Brazilian patients infected with hepatitis C
virus (HCV) from the Hepatology Service of Clementino Fraga Filho University
Hospital of Universidade Federal do Rio de Janeiro. The study group was consisted of
134 patients with HCV infection and the control group was consisted of 95
individuals. All patients were physically examined for evidence of OLP. The
diagnosis of OLP was established on the basis of usual clinical features and
histological findings.
They found that the prevalence of OLP was 1.5% in patients with HCV infection and
1.1% in the control group. There was no statistically significant difference between
the 2 groups (P = .63). They concluded that there was no association between OLP
and HCV infection in Brazilian patients from the state of Rio de Janeiro.
J. D. Shulman [21], in his paper describes the results of the "Third National Health
and Nutrition Examination Survey, 1988-1994 (NHANES III), and compares
them to those of the National Survey of Oral Health in US Schoolchildren,
1986-1987. The THANES III was a large US study based on a multistage
probability sample. Dentist examiners were trained to recognize, classify and
record, in a standard manner, the clinical characteristics of each of the 48
conditions of interest using procedures based on the World Health
Organization's Guide to Epidemiology and Diagnosis of Oral Mucosal
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Diseases. Examinations were performed on 10 030 individuals (10.26%) aged
between 2 and 17 years, 914 of whom had a total of 976 lesions. The lip was
the most frequent site of lesions (30.7%), followed by the dorsum of the tongue
(14-7%) and the buccal mucous (13.6%). Lesions were more prevalent in males
(11.76%) than females (8-67%). The most prevalent lesions were lip/check bite
(I•89%), followed by aphthous stomatitis (1.64%), recurrent herpes labialis
(1.42%) and geographic tongue (1.05%). The prevalence of recurrent aphthous
stomatitis in the THANES Ill child and youth survey was substantially higher than
that for adults, while the THANES III adult estimates for geographic tongue
(1.85%; 95%) and check/lip bite (3.05%; 95%) were substantially greater than
those for children and youths (0.97% and 2-05%, respectively).
AH Parlak et al. [22], in a cross-sectional survey of 993 children aged between 13-
16 years from eight secondary schools in Duzce, Turkey, to determine the
prevalence of oral lesions. They found that, Two hundred sixty adolescents (26.2%)
were diagnosed with at least one oral mucosal lesion at the time of the
examination. Thirteen different mucosal alterations were diagnosed, and the
most common lesions were angular chelitis (9%), linea alba (5.3%), and aphthous
ulceration (3.6%). The correlation between occurrence of mucosal lesions and sex
was not statistically significant (P > 0.05). Statistical evaluation of the data revealed a
significant relationship only between the presence of angular chelitis and anemia (P
< 0.05). They concluded this study as the first epidemiological study of oral
mucosal lesions in adolescents in Turkey and angular chelitis as the only oral mucosal
lesion that had a significant correlation with anemia.
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Saraswathi TR et al. [23], a hospital based cross-sectional study was carried out using
already existing data collected during a period of three months at Ragas Dental
College, Uthandi, Chennai, India. 63.75% males and 36.25% females made the study
population. 17.15% of the study participants were in the age group of 13 to 20 years,
38.13% were in the age group of 21 to 30years, 21.47% were in the age group of 31 to
40 years and the remaining 23.25% were in the age group of 41 to 84 years.
They found that the overall prevalence of smoking, drinking alcoholic beverages and
chewing were 15.02%, 8.78% and 6.99% respectively. The prevalence of smoking
was higher among men (23.25%) when compared to women (0.55%).
They also found 1.14% smoker's melanosis, 0.59% Leukoplakia, 0.89% Stomatitis
nicotina palatine, 0.25% leukedema, 0.25% chewer’s mucositis, 0.55% oral sub
mucous fibrosis, 0.25% median rhomboid glossitis, 0.15% lichen planus and 0.05%
candidiasis.
They concluded that Smokers were more likely to develop smoker's melanosis
compared to other lesions. Among those who consumed alcoholic beverages alone,
the prevalence of leukoplakia was higher compared to other lesions. OSF was the
most prevalent lesion among those who chewed pan masala or gutkha or betel quid
with or without tobacco. Programs to improve oral health should be conducted
regularly to promote oral health care in the population.
Priscila Henriques Correa et al. [24], a study was done to estimate the prevalence of
and to obtain clinical data on oral hemangioma, vascular malformation and varix in a
Brazilian population. Clinical data on those lesions were retrieved from the clinical
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forms from the files of the Oral Diagnosis Service, School of Dentistry, Federal
University of Minas Gerais, Brazil, from 1992 to 2002 and descriptive analysis was
performed.
A total of 2,419 clinical forms in the 10-year period were evaluated, of which 154
(6.4%) cases were categorized as oral hemangioma, oral vascular malformation or
oral varix. Oral varix was the most frequent lesion (65.6%). Females had more oral
hemangioma and oral varix than males. Oral vascular malformation and oral varix
were more prevalent in the 7th and 6th decades, respectively. Oral hemangioma and
oral varix were more prevalent in the ventral surface of the tongue and oral vascular
malformation, in the lips. Oral hemangioma was treated with sclerotherapy (54.5%),
and vascular malformation was managed with sclerotherapy and surgery (19.4%
each).
They concluded that benign vascular lesions are unusual alterations on the oral
mucosa and jaws.
M Pentenero et al. [25], a retrospective study was carried out to assess the prevalence
of oral mucosal lesions (OML) and evaluate its association with tobacco and alcohol
consumption and the wearing of removable dentures in an adult population from the
Turin area, Italy.
The study was performed on 4098 subjects, with average age 50.5 ± 13.7, and range
19–96 years. There were 2040 males (49.7%) with average age 51.3 ± 13.5, and 2058
(50.2%) females with average age 49.6 ± 13.8.
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They found that males have more OMLs (557/2040; 27.3% vs 471/2058; 22.89%).
They also found traumatic ulcers 122 (2.98), Cheek/lip biting 92 (2.24), Denture
stomatitis 78 (1.90), Fibrous hyperplasia 73 (1.78), Vascular lesion 72 (1.76),
Frictional lesion 71 (1.73), Recurrent aphthous stomatitis 71(1.73), Oral lichen planus
60 (1.46), Candidiasis 58 (1.42), Leukoplakia 47 (1.15), Melanin pigmentation 44
(1.07), Papilloma 26 (0.63), Median rhomboid glossitis 26 (0.63), Amalgam tattoo 23
(0.56), Mucocele 20 (0.49), Herpes 16 (0.39), Oral lichenoid lesions 12 (0.29),
Smoker’s palate 6 (0.15)
They concluded that the overall OML prevalence was linked to risk habits and age.
Tobacco was linked to leukoplakia, melanin pigmentation, smoker’s palate, frictional
lesions and papilloma. It was negatively related to recurrent aphthous stomatitis and
oral lichen planus. Alcohol was linked to leukoplakia, frictional lesions and median
rhomboid glossitis. The tobacco–alcohol association was linked to frictional lesions,
leukoplakia, melanin pigmentation and smoker’s palate. Denture wearers had an
overall higher prevalence of OMLs, in particular candidiasis, traumatic and frictional
lesions.
J.B. Freitas et al. [26], in a study of 344 individuals to evaluate the prevalence of
oral mucosal lesions associated with the use of full dentures (FD) among non-
institutionalized individuals of 60 or more years of age in a rural Brazilian population.
They found that, 146 were FD users and 198 FD, non-users. Angular cheilitis,
denture Stomatitis and inflammatory fibrous hyperplasia were statistically associated
with prosthesis use. Hygiene and integrity of the prosthesis were related to the
presence of oral lesions. While inflammatory fibrous hyperplasia was positively
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related to FD integrity, denture stomatitis was associated with time of use, hygiene
status and integrity of FD. The results indicate the need for oral health care
programmes for the elderly and show a relationship between time of use, quality
and hygiene of oral prostheses with the presence of mucosal lesions.They
concluded that, denture stomatitis, inflammatory fibrous hyperplasia and
angular chelitis are the pathological alterations most commonly found among elderly
FD users. Furthermore, the data show that both the integrity, time of use
and deficient hygiene of the prosthesis are related to the appearance of
oral mucosal lesions.
Jose L. Castellanos and Laura Diaz-Guzman [5], in a cross-sectional study of
examined data of 23785 patients,15-79 years of age from January 1982 to December
2003 from the department of oral diagnosis and medicine, dental school, Leon,
Maxico, to report the oral mucosal lesions, they found that among 23785 patients
the general lesion rate was 356.60 per 1000 patients. Lesions were more common
among males (male:female=1.4:1) and a three-fold greater risk of developing
mucosal lesions was recorded among the males compared with the female
population (6% in male vs. approximately 2% in females). Sixty-eight different
lesions were identified.
They concluded that, majority of identified lesions and their causes are largely
avoidable and can be controlled through education and measures targeted to both the
general population and to dental professionals.
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Anuna Laila Mathew et al. [27], a study was done to evaluate the prevalence of oral
mucosal lesions in Manipal College of Dental Sciences, Manipal, India, from 1 st
March 2005 to 1 st June 2005.
A total of 1190 patients (747 men and 443 women) in the age range 2-80 years were
included in the study population and the patients were divided into four groups based
on age: 2-20 years, 21-40 years, 41-60 years, and 61-80 years old. All the subjects
were examined clinically and questioned regarding any habits like smoking, pan
chewing, and alcohol intake, and the frequency and duration of the habit.
They found that out of 1190 subjects, 1167 were dentulous and 13 were totally
edentulous (1.1%). Forty-five subjects were denture wearers. One hundred and fifteen
(9.7%) were presently smokers, 22 (1.9%) were ex-smokers, and 1053 (88.4%) were
nonsmokers. Among the current smokers, there was a high proportion of heavy
smokers (21 or more cigarettes/day). The habit of tobacco chewing was present in 123
subjects. The frequency of tobacco chewing was more prevalent in males than in
females (98 males and 25 females) and was more prevalent in the 21-40 age-groups.
Ex-pan chewers were 21 in number.
They also found that the presence of one or more mucosal lesions was in
41.2% of the population and no mucosal abnormalities were detected in 58.8% of
subjects. Fordyce's condition was observed most frequently (6.55%) followed by
frictional keratosis (5.79%), fissured tongue (5.71%), leukoedema (3.78%), smoker's
palate (2.77%), recurrent aphthae, oral submucous fibrosis (2.01%), oral malignancies
(1.76%), leukoplakia (1.59%), median rhomboid glossitis (1.50%), candidiasis
(1.3%), lichen planus (1.20%), varices (1.17%), traumatic ulcer and oral hairy
leukoplakia (1.008%), denture stomatitis, geographic tongue, betel chewer's mucosa
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and irritational fibroma (0.84%), herpes labialis, angular cheilitis (0.58%), and
mucocele (0.16%).
They concluded that tobacco-associated lesions were observed more in males than in
females. Although some recent curbs have been put on the manufacture and sale of
gutkha, pan masala, and other established oral cancer-causing tobacco products,
further education is necessary to reduce or eliminate the use of these preparations
when stating the goals for oral health.
Rushabh J Dagli et al. [28], a study was done to determine the prevalence of
leukoplakia, oral sub mucous fibrosis and papilloma among 513 “Green Marble
Mines” laborer and uncover its relation with occupational stress in Rajasthan, India.
Workers were divided in to four age groups- 15-24, 25-34 , 35-44, 45-54 years.
They found that overall elevated prevalence of all three oral-mucosal lesion was
(36.7%), mainly leukoplakia affecting 171 mine workers (33.3%). The affected
workers were having body problems like headache, backache and stressed due to
under-payment. Individuals having papilloma have faced problem at work like noise,
dust or fumes and poor maintenance of equipment.
They also found that oral-mucosal lesion have a highly significant relation (p<0.01)
with increased stress, age, alcohol habits and malnutrition.
They concluded that, the prevalence of oral mucosal lesion is higher, among marble
mine laborers, and occupational stress can intensify the disease condition. Curative
services along with prevention and stress reduction program, requires primary
anticipation.
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Vasconcelos BC et al. [29], a cross-sectional study was done to evaluate the
prevalence of superficial lesions in the oral cavity mucosa in diabetic patients. The
sample was made of 30 patients. Of the 30 patients, 9 (30%) were males and 21 (70%)
females. Of the studied patients, 40% were below 60 years of age, and 60% were
older than 60 years.
They found thirteen different types of mucosal alterations. Tongue varicose veins
(36.6%) and Candidiasis (27.02%) were the most prevalent. Xerostomia was found1
in number, 2 cheilitis, 2 traumatic ulcer, 1 fissure tongue, 2 gingival hyperplasia, 1
atrophy of papilla, 10 erythematous Candidiasis, 1 mucocele, 1 racial pigmentation, 1
patechae and hyperkeratosis was 1 in number.
They concluded that most of the diabetic patients presented at least one type of oral
mucosa lesion or alteration. Such alterations can be associated with the fact that these
conditions are commonly found in senile patients and are also associated with
prolonged wear of dentures.
Valentina Mujica et al. [30], a study was done to determine the prevalence of the oral
soft tissue lesions in patients referred to the geriatric unit “Dr. Joaquin Quintero”,
National Institute of Gerontology, Venezuelan. 340 patients were included in the
study, of these 266 were institutionalized and 74 were seen at the outpatient clinic,
age ranging 60 to 104 years. 212 were females and 128 males. They found that Fifty
seven percent of the studied population presented one or more oral lesions, associated
to prosthetic use, trauma and tobacco consumption. Females were more affected than
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males. The lesions were more frequently observed between 60 to 74 years of the
institutionalized group of patients of these, 34% exhibited only one oral lesion. Few
cases presented up to 4 oral lesions. The most common alterations observed were:
Denture stomatitis54 (18%), Angular Cheilitis18 ( 5%), Eritematous Candidiasis12
(4%), Papillary Hiperplasia 4 (1%), Traumátic fibroma 23 (7%), Inflamatory fibrous
hyperplasia 22 (7%), Traumatic Ulcer 9 (3%), Piogenic granuloma 4 (1%),
Leucoplakia 42 (13%), Lichen planus 9 (3%), Nicotine stomatitis 7 (2%), Actinic
Cheilitis 6 (2%), Squamus cell carcinoma 6 (2%), Hemangioma 32 (11%) ,
Melanotic macule 25 (8%), Amalgam Tatoo 8 (3%), Nevus 5 (2%), Sialoadenitis 5
(2%), Median rhomboid glositis 5 (2%), Afthous Ulcers 3 (1%), Recurrent Herpes 3
(1%), Papiloma 2 (1%), Pseudomembranous Candidiasis 10 (50%), Ginigival
overgrowt hyperplasia 10 (50%).
They concluded that oral health is an important factor determining the quality of life
in aged individuals. The role of the dentist and stomatologist includes the
management of systemic, nutritional and pharmacological oral manifestations in order
to establish an early diagnosis and subsequently an accurate treatment.
Azizah-Al-Mobeeriek A et al. [31], a dental school based prevalence study was done
to evaluate the type and extent of oral lesions among dental patients at The College of
Dentistry, King Saud University, Riyadh, Saudi Arabia. The study sample included
adult subjects who were older than 15 years of age (15-73 yrs). A total of 2552
patients were interviewed and clinically investigated for the presence of oral lesions
from June 2002- to December 2005.
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They found that among the 2552 patients, only 383 patients (15.0%) had oral lesions.
Females constituted 57.7% (n=221) and males 42.3% (n=162). Twenty-four patients
(0.9%) admitted smoking habits and 196 patients (7.7%) had a systemic disease.
They also found that the most common lesion was Fordyce granules (3.8%; n=98),
followed by leukoedema (3.4%; n=86) and traumatic lesions (ulcer, erosion) in 1.9%
(n=48). Tongue abnormalities were present in 4.0% (n=101) of all oral conditions
observed, ranging from 1.4% (n=36) for fissured tongue to 0.1% (n=2) for bifid
tongue. Other findings detected were torous platinus (1.3%; n=34), mandibular tori
(0.1%; n=2) aphthous ulcer (0.4%; n=10), herpes simplex (0.3%; n=7), frictional
hyperkeratosis (0.9%; n=23), melanosis (0.6%; n=14), lichen planus (0.3%; n=9) and
nicotinic stomatitis (0.5%; n=13).
They concluded that provide information on the types and prevalence of oral lesions
among Saudi dental patients will provide baseline data for future studies about the
prevalence of oral lesions in the general population.
Ali-Rıza-İlker Cebeci et al. [1], a hospital based study was done to assess the
prevalence and distribution of oral mucosal lesions in a Turkish adult population. This
study was consisted of 5000 patients (2925, 58.5% women and 2075, 41.5% men; age
range, 17-85 years), referred to the Ankara University Faculty of Dentistry between
June 2004-September 2005.
They found that the overall incidence of oral mucosal changes or lesions was 15.5%.
The lesions were classified as anatomic changes, ulcerated lesions, tongue lesions,
white lesions, benign lesions, color alterations, and malignant lesions. Anatomic
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changes (7%), ulcerated lesions (6.6%), and tongue lesions (4.6%) were the most
common lesions. White lesions were observed in 2.2% of all patients. Among the
white lesions, leukoplakia was identified in men 4 times more frequently than it was
in women. Benign lesions and color alterations were identified in 1.6% and 1.2% of
all patients, respectively. 3 patients (0.06%) were diagnosed as having squamous cell
carcinoma, and 1 patient (0.02%) was diagnosed as having adenocarcinoma.
They also found a statistically significant relation between smoking and the
occurrence of mucosal lesions whereas no relation was found between alcohol
consumption and mucosal lesion and between systemic diseases and oral mucosal
lesion occurrence.
They concluded that provided information about the epidemiologic aspects of oral
mucosal lesions will help in planning of future oral health studies.
Jahanfar Jahanbani et al. [32], a study was done to determine the prevalence of oral
mucosal lesions in relation to age, gender, occupation, education, smoking habits,
general health, addictions and or drug therapies at Islamic Azad University, School of
Dentistry, Tehran, Iran during 12 successive months (Sept 2001-Sept 2002). 598
patients were included in this study. 62.4% were male and 37.6% were female. The
age ranges from 19-60 years.
They found that oral mucosa lesions were seen in 295 patients (49.3%). Oral
developmental lesions were seen in 295 patients (49.3%). Only Fordyce granules (27,
9%), fissured tongue (12, 9%), leukedema (12, 5%) and hairy tongue (8, 9%) had
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enough cases for statistical analysis. Three of these lesions increased with age but not
fissured tongue. All were more common in men.
They also found that fordyce granules were seen in oral mucosa of smoking men.
Leukoedema and hairy tongue were significantly associated with smoking,
leukoedema with diabetes mellitus.
They concluded that there was a highly significant association between these oral
lesions and age, gender and smoking. Few significant associations were found
between oral lesions and general diseases.
Rima Ahmad Safadi [33], a study was done to access the prevalence of recurrent
aphthous ulceration among out patients at Jordan University of Science and
Technology's Dental Teaching Centre, Irbid, Jordan. 684 participants were included in
the study. About 45% of participants were males and 55% were females.
They found that about 78% of subjects experienced recurrent aphthous ulceration.
Approximately 85% of ulcers were less than one cm in diameter, 66% were circular in
shape, 92% were painful, 82% interfered with eating, and 55% located in lips and
buccal mucosa. Only 50%of participants related ulcers to stress. Sixty eight percent
reported no association with tiredness and 85% no association with types of food
ingested. Of the 39% who had blood tests carried out, 7% had vitamin B12 and 4%
hemoglobin deficiency.
They concluded that understanding the prevalence and distribution of recurrent
aphthous ulceration among Jordanian population will give an indication about the
proportion of people who suffer the condition and who need dental management.
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Knowledge about the increased proportion of Jordanian people with recurrent
aphthous ulceration might help dental practitioner in reaching the proper diagnosis of
the ulcers affecting oral cavities and in providing information to patient to enhance
their awareness about the condition.
T Rooban et al. [34], a hospital based study was conducted to assess the prevalence of
oral mucosal lesions (OML) among alcohol misusers attending a rehabilitation centre
at Ragas Dental College and Hospital and TTK Hospital, Chennai, India. In this study
500 consecutive alcohol misusers were examined by qualified dental surgeons and the
variables for this study were OML, Oral Hygiene Index (OHI), age, smoking, and
alcohol misuse (type and units consumed and duration of misuse).
They found that out of the 500 patients, 77% were in the 25-44 years old age group
and 84% were married. The mean age of initiation of alcohol misuse was 34 years. In
addition to alcohol, 72% smoked tobacco and 96% used other psychoactive
substances. The mean alcohol use duration was 12.6 years.
They also found that a total of 25% of the study group had at least one OML. The
common oral lesions were smoker's melanosis (10.2%), oral sub mucous fibrosis
(8%), and leukoplakia (7.4%). Those who misused spirits had a higher incidence of
OML than those who misused beer or both. Patients with fair oral hygiene had an
odds ratio (OR) of 2.96 for OML compared with an OR of 2.08 for those who had
OML with good oral hygiene.
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They concluded that that subjects who misuse alcohol have poor oral hygiene and are
at risk for the development of periodontal disease and OML. Oral examination and
treatment should be a part of the standard care for alcohol misusers at rehabilitation
centres.
Shivakumar et al. [2], a study was done to establish the prevalence and site
distribution of oral mucosal lesions in patients attending outpatient clinics of Oxford
Dental College in Bangalore, India. The study population was consisted of 512
consecutive outpatients 292 (57%) were males and 220 (43%) were females. Patients
lesser than 10 years to greater than 60 years were included in the study.
They found that out of the study population, 89 (17%) of them were smokers and 32
(6%) of the subjects consumed chewing tobacco in any forms. Most smokers were
men (92%) and most chewers (65%) were women. Lesions were present in 27
(33.34%) of subjects with smoking tobacco habits and 8 (25%) of them with chewing
habits. Subjects with smoking were 5.51 times more likely to have lesions than those
who did not smoke. Patients with chewing habits were 2.89 times more likely to have
lesions than their counterparts who did not chew tobacco which was statistically
significant at p< 0.05.
They also found that the overall prevalence of oral mucosal lesions was 11.33%.
Relevant alterations of the oral mucosa were found in 58 subjects. Leukoplakia was
the most prevalent alteration with 18 (3.52%) of the subjects followed by, herpes
ulcer in 15 (2.93%), recurrent apthae in 9 (1.76%), smokers melanosis in 4(0.78%),
Nicotina palatine in 3 (0.59%), Submucous fibrosis in 3 (0.59%) and angular chelitis,
fissured tongue, irritational fibrosis, lichenoid like reactions, traumatic ulcer in 1
person each (0.19%).
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They concluded that the importance of frequent and regular inspection of the oral
cavity must be emphasized for all these lesions can be detected at an earlier stage and
promptly treated. Dental professionals should be advising and reinforcing patients to
quit the habit of tobacco. It is important to counsel patients who consume tobacco in
any form that there is no safe form of tobacco use and caution them against simply
switching from one nicotine source to another.
Ravi Mehrotra et al. [35], a hospital based study was done to determine the
prevalence of oral soft tissue lesions in 3030 patients (2150, 71% males and 880, 29%
females), belonging to a semi-urban district of Vidisha in Central India.
They found that 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 sub mucous
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.
They concluded that 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.
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METHODOLOGY
BACKGROUND OF STUDY:
The present epidemiological study was conducted to assess the prevalence of oral mucosal
lesions among the patients attending the department of oral medicine, Kothiwal Dental
College and Research Centre, Moradabad, Uttar Pradesh, India.
STUDY SAMPLE:
Study subjects constituted all the out patients attending the Department of Oral Medicine and
Radiology, during the period of three months from 16th April to 15th July, 2009. Patients were
divided in to four age groups: group I (02-20 years), group II (21-40 years), group III (41-60
years) and group IV (61-80 years).
The patients were selected based on the following criteria:
INCLUSION CRITERIA:
1. All the patients reported to the OPD of Oral Medicine Department during the
period of three months from 16th April to 15th July 2009.
2. Patients from 02-80 years of age attending the OPD.
3. Patients who were physically healthy and well oriented with time, space and
as a person.
EXCLUSION CRITERIA:
1. Patients in whom the intraoral examination was not possible due to inadequate
mouth opening.
2. The emergency cases like trauma.
3. Patients with findings of any physical or mental abnormality, which would
interfere with or be affected by the study procedure.
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Based on the inclusion and exclusion criteria 5203 subjects were included in the study. All the
patients were explained the need and design of the study, the need for undergoing a thorough
clinical examination, radiographical, blood and biopsy investigations at the start of the study
and a prior consent was obtained.
EQUIPMENTS AND MATERIALS USED (ARMAMENTARIUM):
Instruments and materials used for clinical examination:
1. Dental chair with illumination light
2. Kidney Trays
3. Sterile Straight Probes and Mouth Mirrors
4. Cotton Holder with Cotton
5. Tweezers
6. Sterile Gauze Pieces
7. Sterile gloves
8. Sterile Mouth Masks
9. Tongue blade
10. Dettol soap.
11. Big steel tray.
12. Chittel forceps.
13. Korsolex Disinfectant
14. Sterile Stainless Steel divider and scale
15. Digital camera (Sony cyber-shot W-120, 7.2 mega pixels).
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Instruments and materials used for radiographical examination:
1. The X-Ray machine (Chesa Dental Care Services Ltd, Bangalore)
2. Intraoral periapical films (no.2,size 31×41mm)
3. Developer Solution (Yellow Chem, India)
4. Fixing Solution (Yellow Chem, India)
5. X-ray viewer
Instruments and materials used for biopsy procedures:
1. Local anesthesia
2. Betadiene
3. BP knife
4. BP blade No. 11, 12, 15
5. Suture material
6. Suture needle
7. Needle holder
8. Scissors
9. Suction device
10. Tissue holding forceps
11. Syringe
Infection Control
All autoclaved instruments were used and adequate number of each instrument was taken.
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Method of Collection of Data:
Patients were made to sit comfortably on a dental chair. Clinical examination
was done by the two trained and calibrated examiners under the artificial light
on the dental chair, using mouth mirror, probe, gauze, cotton etc.
The examination was consisted of collecting the demographic data, general
history and the clinical findings.
All the subjects were examined clinically and questioned regarding any habit
like smoking, pan/gutkha chewing and alcohol intake, and the frequency and
duration of the habit.
Patients who used to smoke more than three cigarettes per day for more than a
year were considered as smokers. Patients consuming more than 5 pouches of
chewing tobacco in any form were considered as chewers.
History was obtained from parents or relatives for patients who were not able
to communicate either due to age or disease.
All the lesions were recorded by digital camera (SONY, cyber-shot W-120,
7.2 mega pixels) and the identification of lesion was done according to
guidelines as given in the text books of Oral Medicine. The identification was
also supported by the color atlas of oral lesions (Bengel, Veltman, Loevy &
Taschini. Differential Diagnosis of Diseases of the Oral Mucosa.Quintessence
Publishing Co., Chicago, George Laskaris. Color Atlus of Oral Diseases. 3rd
Edition. Thieme Stuttgart, Newyork, Bork, Hoede, Korting, Burgdorf &
Young. Diseases of Oral Mucosa & Lip. 2nd Edition. W.B. Saunders
Company. Philadelphia) to exclude bias.
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The diagnosis was made on the basis of history, clinical features and
investigations.
Investigations include radiographical, hematological and histopathological.
Biopsies were advised for suspicious lesions only.
All the collected datas were entered in a proforma, specially designed for this
particular study.
The gathered data was sorted, tabulated and subjected to appropriate statistical
analysis.
CONSENT
An ethical committee clearance prior to the study and a written informed
consent from the patient before the examination were obtained and in case of
minor patients, consent was taken from the guardian/parents.
STATISTICAL FORMULA USED IN THE DISSERTATION
Chi square test:
E
EO 22 )( −Σ=χ
Where O = Observed frequency
E = Expected frequency
Level of significance: "p" is level of significance
p > 0.05 Not significant
p <0.05 Significant at 5% significance level
p <0.01 Significant at 1% significance level
p <0.001 Highly significant
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ARMAMENTARIUM
FIG I: ARMAMENTARIUM USED FOR CLINICAL EXAMINATION
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FIG II: ARMAMENTARIUM USED FOR RADIOGRAPHICAL EXAMINATION
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FIG III: ARMAMENTARIUM USED FOR BIOPSY PROCEDURE
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RESULTS:
This study was conducted in the Kothiwal dental College & Research Centre,
Moradabad to assess the prevalence of oral mucosal lesions among patients attending
the outpatient clinic of Department of Oral Medicine and Radiology.
A total of 5203 patients were examined from 16th April to 15th July 2009.
Demographic Data & Dentate Status of 5203 Patients [Table I]
Demonstrates the demographic data and dentate status of the study population. The
study population includes 3133 [60.22%] males and 2070 [39.78%] females. Age of
the study population ranges from 2-80 years. The different age groups and the number
of subjects in each were as follows: group I [2-20 years] and 1233 subjects [23.70%],
age group II [21-40 years] and 2625 subjects [50.45%], age group III [41-60 years]
1099 subjects [21.12%], age group IV [61-80 years] and 246 subjects [4.73%].
Majority of the patients were from rural area [44.23%] followed by urban [32.98%]
and periurban [22.79%].
Among the patients visiting the outpatient department 3451 (66.33%) of them were
dentate, 1585 (30.46%) were partially edentulous and 167 (3.21%) were completely
edentulous. The greater number of females was reported with complete
edentulousness (94, 56.29%) compared to males (73, 43.71%). Out of 5203 patients
only 304 (5.84%) of the patients were using one type of prosthesis.
Prevalence of Habit in Different Demographic Locations [Table II and Graph I]
Shows the prevalence of habit among the study population. 83.64% (4352) of the
population did not have any habit. Smokeless tobacco is used by 08.80% (458),
smoking is used by 7.28% (379) and 0.28% (14) study population uses tobacco in
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both (smoking & smokeless) form. It is seen from the result that patients from
periurban background (22.43%) indulge more in adverse habits like smoking, tobacco
chewing compare to rural (16.73%) and urban (11.66%) population. These findings
were found to be statically significant (p< 0.001).
Prevalence of Habit in Different Age Groups [Table III]
Shows the prevalence of habits in difference age groups. The habits were more
prevalent in age group 3 (41-60 yrs, 26.84%) followed by age group 2 (21-40yrs,
18.17%), age group 4 (61-80yrs, 10.16%) & age group 1 (02-20yrs, 04.38%). The
smoking was more prevalent in age group 3 (19.11%) followed by age group 4
(08.13%), age group 2 (03.96%) and age group 1 (03.65%). Table also shows that
smokeless tobacco is more frequently used by age group 3 (36.67%) followed by age
group 2 (13.98%), age group 4 (02.03%) and age group 1 (00.73%). This table also
shows that 0.23% population in age group 2 and 0.73% population in age group 3
uses tobacco in both forms (smoking and smokeless).
Prevalence of Oral Mucosal Lesions with Gender [Table IV and Graph II] Shows that overall prevalence of mucosal lesions was 17.16% (males = 11.34%,
female = 5.82%). Males have higher prevalence (590, 18.83%) compare to females
(303, 14.64%). The difference between male and female was found to be statistically
highly significant (p< 0.001). This table also shows that more number of lesions are
seen in males (769, 69.85%) compared to female (332, 30.15%).
Prevalence of Oral Mucosal Variants [Table V]
Shows the prevalence of mucosal variants according to age and gender. Fissured
tongue seen in 1.69% (88) of population, followed by Fordyce’s granules 1.48% (77),
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commissural pit 0.71% (37), leukoedema 0.69% (36) and lingual varices in 0.35%
(18) of population.
Prevalence of Oral Mucosal Abnormalities [Table VI]
Showed the prevalence of oral mucosal abnormalities according to age and gender.
The most prevalent abnormality was lines alba buccalis 114 (02.19%) followed by
leukoplakia 100 (1.92%) coated tongue 95 (1.83%), frictional keratosis 73 (1.40%),
smoker’s palate 52 (1.00%), oral lichen planus 54 (1.04%), depapillation of tongue 44
(0.85%), recurrent apthous stomatitis 37 (0.71%), osmf 35 (0.67%), traumatic ulcer
34 (0.65%), herpes labialis 30 (0.58%), traumatic fibroma 28 (0.54%), geographic
tongue 24 (0.46%), angular chelitis 20 (0.38%), tobacco pouch keratosis 14 (0.27%),
tongue pigmentation 11 (0.21%), median rhomboid glossitis 8 (0.15%), betel chewer
mucosa 8 (0.15%), papillary hyperplasia 7 (0.13%), denture stomatitis 7 (0.13%),
pyogenic granuloma 7 (0.13%), Candidiasis 6 (0.12%), gum boil 6 (0.12%), black
hairy tongue 4 (0.08%), acute herpetic stomatitis 4 (0.08%), lichenoid reaction 2
(0.04%), vitiligo 2 (0.04%), sq. cell carcinoma 2 (0.04%), mucocele 2 (0.04%), ranula
2 (0.04%), thermal burn 2 (0.04%), chemical burn 2 (0.04%), eruption cyst 2 (0.04%),
peripheral giant cell granuloma 2 (0.04%), herpes zoster 1 (0.02%), squamous
papilloma 1 (0.02%), Petechae 1 (0.02%), myolipoma 1 (0.02%).
Prevalence of Lesions According To Age Groups [Table VII and Graph III]
Shows that total 124 (10.06%) lesions were seen in age group of I, 523 (19.92%) in
age group II, 359 (32.67%) in age group III and 95 (38.62%) were seen in age group
IV and the difference was statically significant (p<0.001).
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Prevalence of Oral Mucosal Lesions in Different Demographic Locations [Table
VIII and Graph IV]
Shows the prevalence of oral mucosal abnormalities according to different socio-
demographic locations. Population living in urban areas have shown higher oral
lesions (19.70%) than the rural (17.51%) and the periurban areas (12.82%) and the
difference was found to be statistically significant (p˂ 0.001).
Prevalence of Oral Mucosal Lesions with Different Type of Habits [Table IX and Graph V] Shows the prevalence of oral mucosal lesions in relation to deleterious habits. It has
been shown that patients habitual of smoking have higher oral lesions (43.00%) than
who uses smokeless tobacco (24.89%) and who do not have any deleterious habits
(13.83%). The comparison of the prevalence of lesions among the groups of smoking
versus no habit, smokeless tobacco versus no habit and smoking versus smokeless
tobacco was found to be statistically highly significant (p˂ 0.001).
Prevalence of Tobacco Related Oral Lesions [Table X and Graph VI]
Shows the prevalence of tobacco related oral lesions and its relation to tobacco habits.
Smoker’s palate (94.23%), Leukoplakia (78%), leukoedema (75%), candidiasis
(66.66%), and angular chelitis (60%) are strongly associated with smoking while betel
chewer mucosa (100%), tobacco pouch keratosis (85.71%), OSMF (85.71%),
lichenoid reaction (50%) and SCC (50%) are strongly associated with smokeless
tobacco. These lesions are also common in those patients who use tobacco in both
forms (smoking and smokeless).
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Prevalence of Oral Mucosal Lesions According To Dentate Status [Table XI and
Graph VII]
Shows the prevalence of oral mucosal lesions according to different dentate status. It
is seen that subjects with complete edentulousness have shown to have higher
prevalence of lesions (22.75%) followed by partially edentulous subjects (21.20%)
and dentate subjects (15.04%). The different among them was statistically significant
(p˂ 0.001).
Prevalence of Oral Mucosal Lesions In Relation To the Prosthesis [Table XII and
Graph VIII]
Shows the prevalence of oral mucosal lesions in relation to the prosthesis used. Faulty
prosthesis users have higher prevalence of lesions (100%) followed by denture
wearers (31.75%), RPD wearers (10.27%), and FPD wearer (5.43%). Patients using
no prosthesis have 17.35% oral mucosal lesions and type of prosthesis wise
prevalence was also statistically significant (p < 0.001).
Prevalence of Oral Lesions According To Systemic Health Status [Table XIII and Graph IX]
Shows the prevalence of oral lesions according to systemic health status. Subjects
with systemic diseases have shown to have less number of lesions (13.39%) compared
to subjects without any systemic disease (17.52%) and the difference being
statistically non significance at 1% (p= 0.0268).
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TABLES
Table I. DEMOGRAPHIC DATA & DENTATE STATUS OF 5203 PATIENTS
AGE GROUP
(YEARS)
1 (2-20)
2 (21-40)
3 (41-50)
4 (61-80)
TOTAL GRAND TOTAL
SEX
No. No. No. No. No. % No. %
M 751 1649 630 103 3133 60.22
5203
100 F 482 976 469 143 2070 39.78
URBAN
M 462 372 113 16 963 56.12
1716
32.98 F 279 320 107 47 753 43.88
PERIURBAN
M 53 734 36 10 833 70.24
1186
22.79 F 51 245 12 45 353 29.76
RURAL
M 236 543 481 77 1337 58.11
2301
44.23 F 152 411 350 51 964 41.89
DANTATE PATIENTS
M 750 1337 105 04 2196 63.63
3451
66.33 F 480 710 63 02 1255 36.37
PARTIALLY EDENTULOUS
M 01 310 513 40 864 54.51
1585
30.46 F 02 266 399 54 721 45.49
COMPLETE
EDENTULOUS
M 00 02 12 59 73 43.71
167
3.21 F 00 00 07 87 94 56.29
DECIDIOUS DENTITION
M 43 00 00 00 43 97.73
44
0.85 F 01 00 00 00 01 2.27
MIXED DENTITION
M 224 00 00 00 224 55.04
407
7.82 F 183 00 00 00 183 44.96
PERMANENT DENTITION
M 484 1665 618 44 2793 60.92
4585
88.12 F 298 976 462 56 1792 39.08
NO PROSTHESIS
USER
M 751 1602 530 91 2974 60.71
4899
94.16 F 482 929 414 100 1925 39.29
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DENTURE WEARER
M 00 01 04 10 15 23.81
63
1.21 F 00 00 05 43 48 76.19
RPD
WEARER
M 00 01 48 02 51 34.93
146
2.80 F 00 45 50 00 95 65.07
FPD
WEARER
M 00 44 46 00 90 97.83
92
1.77 F 00 02 00 00 02 2.17
FAULTY PROSTHESIS
M 00 01 02 00 03 100
03
0.06 F 00 00 00 00 00 00
M= Male, F= Female
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Table II. PREVALENCE OF HABIT IN DIFFERENT DEMOGRAPHIC LOCATIONS
TYPE OF HABIT SEX
URBAN (n=1716)
PERIURBAN (n=1186)
RURAL (n=2301)
NO HABIT
4352
(83.64%)
No. % No. % No. %
M
814 47.43 574 48.40 1007 45.76
F 702 40.91 346 29.17 909 39.51
TOTAL M+F 1516 88.34 920 77.57 1916 83.27
SMOKE-
LESS TOBACCO
458
(8.80 %)
M
46 2.68 187 15.76 114 4.95
F
50 2.91 06 0.51 55 2.39
TOTAL M + F 96 5.59 193 16.27 169 7.34
SMOKING
379
(7.28%)
M
97 5.65 68 5.74 212 9.22
F
01 0.06 01 0.08 00 00
TOTAL
M+F 98 5.71 69 5.82 212 9.22
SMOKING + SMOKELESS TOBACCO
14
(0.28%)
M
06 0.36 04 0.34 04 0.17
F
00 00 00 00 00 00
TOTAL
M + F 06 0.36 04 0.34 04 0.17
M= Male, F= Female
x2 = 133.098; df = 6; p < 0.001; Highly significant; Showing that incidence of habits differ significantly among urban, periurban and rural cases.
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Table III. PREVALENCE OF HABIT IN DIFFERENT AGE GROUPS
AGE
GROUP
(YEARS)
ST
%
SLT
%
SL +
SLT
%
TOTAL HABIT
%
NO
HABIT
%
1 (02-20)
(n=1233)
045
03.65
009
00.73 00 0.00 054 04.38 1179 95.62
2 (21-40)
(n=2625)
104
03.96 367
13.98 06 0.23 477 18.17 2148 81.83
3 (41-60)
(n=1099)
210 19.11 077 36.67 08 0.73 295 26.84 0804 73.16
4 (61-80) (n=246)
020 08.13 005 02.03 00 0.00 25 10.16 0221 89.84
TOTAL (5203)
379 07.28 458 08.80 14 0.27 851 16.36 4352 83.64
ST= Smoking, SLT= Smokeless
Table IV. PREVALENCE OF ORAL MUCOSAL LESIONS WITH GENDER
GENDER Total No. OF PATIENTS
No. OF LESIONS
NO OF PATIENTS
WITH LESION
OVERALL PREVALENCE
MALE
3133
(60.22%)
769
(69.85%)
590
(18.83%)
11.34%
FEMALE
2070
(39.78%)
332
(30.15%)
303
(14.64%)
5.82%
TOTAL
5203
(100%)
1101
(100 %)
893
(17.16%)
17.16%
Male vs Female : x2 = 15.422; df = 1; p < 0.001; Highly significant
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Table V. PREVALENCE OF ORAL MUCOSAL VARIANTS
MUCOSAL
FINDINGS
SEX AGE GROUP 1 (2-20 Yrs)
AGE GROUP 2
(21-40Yrs)
AGE GROUP 3
(41-60 Yrs)
AGE GROUP 4
(61-80Yrs)
TOTAL GRAND TOTAL
No. % No. % No. % No. % No. % No % Fissured Tongue
M 03 0.40 10 0.61 26 4.13 10 9.71 49 1.56 88
1.69 F 01 0.21 16 1.64 21 4.48 01 0.70 39 1.88
Fordyce’s Granule
M 04 0.53 46 2.79 20 3.17 02 1.94 72 2.30 77
1.48 F 01 0.21 03 0.31 01 0.21 00 0.00 05 0.24
Commissural
Pit
M 06 0.08 10 0.61 09 1.43 00 0.00 25 0.80 37
0.71 F 07 1.45 05 0.51 00 0.00 00 0.00 12 0.58
Leukoedema
M 01 0.13 17 1.03 11 1.75 04 3.88 33 1.05 36
0.69 F 00 0.00 02 0.20 01 0.21 00 0.00 03 0.14
Lingual Varices
M 00 0.00 00 0.00 04 0.63 07 6.80 11 0.35 18
0.35 F 00 0.00 00 0.00 05 1.07 02 1.40 07 0.34
M= Male, F= Female, Yrs= Years
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Table VI. PREVALENCE OF ORAL MUCOSAL ABNORMALITIES
MUCOSAL FINDINGS
SEX AGE GROUP 1
(2-20)
AGE GROUP 2
(21-40)
AGE GROUP 3
(41-60)
AGE GROUP 4
(61-80)
TOTAL GRAND TOTAL
No % No % No % No. % No. % No. % Papillary
Hyperplasia
M 00 0.00 00 0.00 03 0.48 02 1.94 05 0.16
07
0.13 F 00 0.00 00 0.00 02 0.43 00 0.00 02 0.10
Frictional Keratosis
M 07 0.93 28 1.70 16 2.54 05 4.85 56 1.79
73
1.40 F 02 0.41 09 0.92 06 1.28 00 0.00 17 0.82
Traumatic Ulcer
M 03 0.40 12 0.73 04 0.63 00 0.00 19 0.61
34
0.65 F 06 1.24 07 0.72 01 0.21 01 0.70 15 0.72
Traumatic Fibroma
M 01 0.13 04 0.24 05 0.79 02 1.94 12 0.38
28
0.54 F 02 0.41 06 0.61 07 1.49 01 0.70 16 0.77
Denture Stomatitis
M 00 0.00 00 0.00 02 0.32 00 0.00 02 0.06
07
0.13 F 00 0.00 03 0.31 02 0.43 00 0.00 05 0.24
Betel
Chewer Mucosa
M 01 0.26 04 0.24 02 0.32 00 0.00 07 0.22
08
0.15 F 00 0.00 01 0.10 00 0.00 00 0.00 01 0.05
Tobacco Pouch
Keratosis
M 01 0.13 12 0.73 01 0.16 00 0.00 14 0.45
14
0.27 F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00
Smoker’s
Palate
M 00 0.00 25 1.52 22 3.49 05 4.85 52 1.66
52
1.00 F 00 0.00 00 0.00 00 0.00 00 0.00 00 00
Leukoplakia
M 02 0.27 38 2.30 53 8.41 07 6.80 100 3.19 100 1.92
F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00
OSMF
M 03 0.40 22 1.33 06 0.95 00 0.00 31 0.99
35
0.67 F 01 0.21 02 0.20 01 0.21 00 0.00 04 0.19
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MUCOSAL
FINDINGS
SEX AGE GROUP 1
(2-20)
AGE GROUP 2
(21-40)
AGE GROUP 3
(41-60)
AGE GROUP 4
(61-80)
TOTAL GRAND TOTAL
No % No. % No. % No % No. % No %
Lichen Planus
M 03 0.40 16 0.97 12 1.90 01 .97 32 1.02 54
1.04 F 02 0.41 12 0.01 06 1.28 02 1.40 22 1.06
Lichenoid Reaction
M 00 0.00 00 0.00 01 0.16 01 0.97 02 0.06 02
0.04 F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00
Median Rhomboid Glossitis
M 00 0.00 03 0.18 02 0.32 00 0.00 05 0.16 08
0.15 F 00 0.00 01 0.10 02 0.43 00 0.00 03 0.14
Depapillation of Tongue
M 01 0.13 06 0.36 03 0.48 02 1.94 12 0.38 44
0.85 F 04 0.83 16 1.64 09 1.92 03 2.10 32 1.55
Coated Tongue
M 03 0.40 27 1.64 23 3.65 14 13.59 67 2.14 95
1.83 F 05 1.03 12 1.23 09 1.92 02 1.40 28 1.35
Pigmented Tongue
M 03 0.40 01 0.06 01 0.16 00 0.00 05 0.16 11
0.21 F 02 0.41 02 0.20 02 0.43 00 0.00 06 0.29
Geographic Tongue
M 02 0.27 05 0.30 03 0.48 01 0.97 11 0.35 24
0.46 F 01 0.21 11 1.13 01 0.21 00 0.00 13 0.63
Black Hairy Tongue
M 00 0.00 01 0.06 01 0.16 01 0.97 03 0.10 04
0.08 F 00 0.00 01 0.10 00 0.00 00 0.00 01 0.05
Recurrent Aphthous Stomatitis
M 03 0.40 15 0.10 07 1.11 01 0.97 26 0.83 37
0.71 F 05 1.04 05 0.51 01 0.21 00 0.00 11 0.53
Herpes Labialis
M 04 0.53 06 0.36 01 0.16 03 2.91 14 0.45 30
0.58 F 03 0.62 11 1.13 01 0.21 01 0.70 16 0.77
Acute Herpetic
Stomatitis
M 01 0.13 00 0.00 00 0.00 00 0.00 01 0.03 04
0.08 F 00 0.00 02 0.20 00 0.00 01 0.70 03 0.14
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MUCOSAL
FINDINGS
SEX AGE GROUP 1
(2-20)
AGE GROUP 2
(21-40)
AGE GROUP 3
(41-60)
AGE GROUP 4
(61-80)
TOTAL GRAND TOTAL
No. % No. % No. % No. % No. % No % Candidiasis
M 01 0.13 00 0.00 02 0.32 03 2.91 06 0.19 06
0.12 F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00
Angular Chelitis
M 01 0.13 07 0.42 08 1.27 04 3.88 20 0.64 20
0.38 F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00
Herpes Zoster
M 00 0.00 00 0.0 00 0.00 01 0.97 01 0.03 01
0.02 F 00 0.00 00 0.0 00 0.00 00 0.00 00 0.0
Squmous Papilloma
M 00 0.00 01 0.06 00 0.00 00 0.00 01 0.03 01
0.02 F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00
Vitiligo
M 00 0.00 00 0.00 00 0.00 01 0.97 01 0.03 02 0.04
F 00 0.00 00 0.00 01 0.21 00 0.00 01 0.05
S.C.C.
M 00 0.00 00 0.00 01 0.16 01 0.97 02 0.06 02
0.04 F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00
Pyogenic Granuloma
M 02 0.26 01 0.06 02 0.32 00 0.00 05 0.16 07
0.13 F 00 0.00 02 0.20 00 0.00 00 0.00 02 0.10
Mucoceal
M 00 0.00 01 0.06 00 0.00 01 0.97 02 0.06 02
0.04 F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00
Ranula
M 00 0.00 00 0.0 00 0.00 00 0.00 00 0.00 02
0.04 F 02 0.41 00 0.00 00 0.00 00 0.00 02 0.10
Gum Boil
M 02 0.27 00 0.00 01 0.16 00 0.00 03 0.10 06
0.12 F 01 0.21 01 0.10 01 0.21 00 0.00 03 0.14
Thermal Burn
M 00 0.00 01 0.06 00 0.00 00 0.00 01 0.03 02
0.04 F 00 0.00 00 0.00 01 0.21 00 0.00 01 0.05
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*M= Male, F= Female, OSMF= Oral Sub Mucous Fibrosis, SCC= Squamous Cell Carcinoma
MUCOSAL
FINDINGS
SEX AGE GROUP 1
(2-20)
AGE GROUP 2
(21-40)
AGE GROUP 3
(41-60)
AGE GROUP 4
(61-80)
TOTAL GRAND TOTAL
No. % No. % No. % No. % No. % No. % Chemical
Burn
M 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00 02
0.04 F 00 0.00 02 0.20 00 0.00 00 0.00 02 0.10
Petichae
M 00 0.00 00 0.00 01 0.16 00 0.00 01 0.03
01
0.02 F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00
Myolipoma M 00 0.00 00 0.0 00 0.00 00 0.00 00 0.00
01
0.02 F 01 0.21 00 0.0 00 0.00 00 0.00 01 0.05
Eruption Cyst
M 01 0.13 00 0.0 00 0.00 00 0.00 01 0.03
02
0.04 F 01 0.21 00 0.0 00 0.00 00 0.00 01 0.05
Sub Mucous Hematoma
M 00 0.00 00 0.0 01 0.16 00 0.00 01 0.03
01
0.02 F 00 0.00 00 0.0 00 0.00 00 0.00 00 0.00
Peripheral Giant Cell Granuloma
M 00 0.00 00 0.0 01 0.16 00 0.00 01 0.03 02
0.04 F 01 0.21 00 0.0 00 0.00 00 0.00 01 0.05
Linea Alba
Buccalis
M 10
1.33 31
1.88
15
2.38
01
0.97
57
1.82
114
2.19
F 07 1.45 41 4.20 08 1.71 01 0.70 57 2.75
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Table.VII.PREVALENCE OF LESIONS ACCORDING TO AGE GROUPS
AGE GROUP WITH LESIONS TOTAL WITH
LESIONS
% WITHOUT LESIONS
TOTAL WITHOUT
LESION
%
M F M F
1-(02-20 yrs) (n=1233)
69 55 124 10.06 682 427 1109 89.94
2-(21-40 yrs) (n=2625)
347 176 523 19.92 1302
800 2102 80.08
3-(41-60 yrs) (n=1099)
297 62 359 32.67 333 407 740 67.33
4-(61-80 yrs) (n=246)
80 15 95 38.62 023 128 151 61.38
*M= Male, F= Female, Yrs= Years
x2 = 225.672; df = 3; p < 0.001; Highly significant Shows that incidence of lesion is significantly different among various age groups.
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Table VIII. PREVALENCE OF ORAL MUCOSAL LESIONS IN DIFFERENT DEMOGRAPHIC LOCATIONS
x2 = 23.711; df = 2; p < 0.001; Highly Significant
Comparison of prevalence of lesions in different locations (viz. urban, periurban and rural) showed that the prevalence is statistically significantly different (p < 0.001) among
different locations.
*M= Male, F= Female
LOCATION
SEX
No. OF PATIENTS WITH LESION
No. OF PATIENTS WITHOUT LESION
URBAN
(n=1716)
No. % No. %
MALE 231 68.34 732 53.12
FEMALE 107 31.66 646 46.88
TOTAL M + F 338 19.70 1378 80.30
PERIURBAN
(n=1186)
MALE 101 66.45 732 70.79
FEMALE 051 33.55 302 29.21
TOTAL M + F 152 12.82 1034 87.18
RURAL
(n=2301)
MALE 258 64.02 1079 56.85
FEMALE 145 35.98 819 43.15
TOTAL M + F 403 17.51 1898 82.49
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Table IX. PREVALENCE OF ORAL MUCOSAL LESIONS WITH
DIFFERENT TYPE OF HABITS
TYPE OF HABIT SEX
No. OF Pts WITH LESION
No. OF Pts WITHOUT LESION
NO HABIT (n=4352)
No. % No. %
MALE 326 54.15 2069 55.17
FEMALE 276 45.85 1681 44.83
TOTAL M + F 602 13.83 3750 86.17
SMOKELESS TOBACCO (n=458)
MALE 89 78.07 258 75.00
FEMALE 25 21.93 86 25.00
TOTAL M + F 114 24.89 344 75.11
SMOKING (n=379)
MALE 161 98.77 216 100
FEMALE 02 1.23 00 00
TOTAL M + F 163 43.00 216 57.00
SMOKING+SMOKELESS TOBACCO (n=14)
MALE 14 100 00 00
FEMALE 00 00 00 00
TOTAL M + F 14 100 00 00
*Pts= Patients, M= Male, F= Female Incidence of Lesion among habits
No Habit vs. Smokeless tobacco : x2 = 39.995; df = 1; p < 0.001; Highly significant No Habit vs. Smoking : x2 = 218.925; df = 1; p < 0.001; Highly significant No Habit vs. Smoking +smokeless tobacco : x2 = 85.01; df = 1; p < 0.001; Highly significant Smokeless tobacco vs smoking : x2 = 30.742; df = 1; p < 0.001; Highly significant Smokeless tobacco alone vs both: x2 = 38.775; df = 1; p < 0.001; Highly significant Smoking alone vs both: x2 = 17.716; df = 1; p < 0.001; Highly significant
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Table X. PREVALENCE OF TOBACCO RELATED ORAL LESIONS
Name of the lesion
Total number
Smoker Smokeless Tobacco
Smoking + Smokeless
No Habit
No % No % No % No %
Leukoedema 36 27 75.00 01 02.78 03 08.33 05 13.89
Papillary Hyperplasia
07 02 28.57 00 00.00 00 00.00 05 71.43
Betel Chewer Mucosa
08 00 00.00 08 100.0 00 00.00 00 00.00
Tobacco pouch Keratosis
14 00 00.00 12 85.71 02 14.29 00 00.00
Smoker’s Palate
52 49 94.23 00 00.00 03 05.77 00 00.00
Leukoplakia 100 78 78.00 16 16.00 06 06.00 00 00.00
OSMF 35 00 00.00 30 85.71 04 11.43 01 02.86
Lichenoid Reaction
02 01 50.00 00 00.00 01 50.00 00 00.00
Candidiasis 06 04 66.66 01 16.67 01 16.67 00 00.00
Angular Chelitis
20 12 60.00 02 10.00 00 00.00 06 30.00
SCC 02 00 00.00 01 50.00 01 50.00 00 00.00
*OSMF= ORAL SUBMUCOUS FIBROSIS, SCC= SQUAMOUS CELL CARCINOMA
Table XI. PREVALENCE OF ORAL MUCOSAL LESIONS ACCORDING TO DENTATE STATUS
TYPE OF
DENTITION TOTAL NO. OF
PATINTS NO. OF PTs WITH LESION No. OF
LESIONS
DENTATE 3451 519 (15.04%) 610
PARTIALLY EDENTULOUS
1585 336 (21.20%) 441
COMPLETE EDENTULOUS
167 038 (22.75%) 053
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x2 = 32.779; df = 2; p < 0.001; Highly Significant
Table XII. PREVALENCE OF ORAL MUCOSAL LESIONS IN RELATION TO THE PROSTHESIS
TYPE OF PROSTHESIS
TOTAL NO. OF PATINTS
NO. OF PTs WITH LESION
No. OF LESIONS
DENTURE WEARER
63 20 (31.75%) 27
RPD 146 15 (10.27%) 20
FPD 92 05 (5.43%) 05
FAULTY PROSTHESIS
03 03 (100%) 04
NO PROSTHESIS 4899 850 (17.35%) 1049
x2 = 37.798; df = 4; p < 0.001; Highly Significant
Table XIII. PREVALENCE OF ORAL LESIONS ACCORDING TO SYSTEMIC HEALTH STATUS
TOTAL NO. OF PATIENTS
NO. OF PATIENTS WITH LESION (%)
No. OF LESIONS
PATIENTS WITH SYSTEMIC DISEASE
448 60 (13.39%) 77
PATIENTS WITH OUT SYSTEMIC DISEASE
4755 833 (17.52%) 1028
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x2 = 4.901; df = 1; p =0.0268; Significant at 5% significance level GRAPHS
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CLINICAL PICTURE OF LESIONS
Fig. 4: Aphthous stomatitis Fig. 5: Fordyce's condition
Fig. 6: Traumatic Ulcer Fig. 7: Linea Alba Buccalis
Fig. 8: Fissured tongue Fig. 9: Candidisais
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Fig. 10: Leukoedema Fig. 11: Herpes labialis
Fig. 12: Primary Herpetic Gingivostomatitis Fig. 13: Pyogenic granuloma
Fig.14: Lichen planus Fig.15: Coated tongue
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Fig.16: Tongue pigmentation Fig.17: Betel chewer’s mucosa
Fig.18: Median Rhomboid Glossitis Fig.19: Squamous papillo
Fig.20: Frictional Keratosis Fig.21: Smoker's palate
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Fig.22: OSMF Fig.23: Atrophic glossitis
Fig.24: Tobacco pouch keratosis Fig.25: Peripheral giant cell granuloma
Fig.26: Mucocele Fig.27: Sublingual varices
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Fig.28: Thermal Burn Fig.29: Geographic Tongue
Fig.30: Commissural Pit Fig.31: Traumatic Fibroma
Fig.32: SCC Fig.33: Lichenoid reaction
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Fig.34: Vitiligo Fig.35: Angular cheilitis
Fig.36: Myolipoma Fig.37: Papillary Hyperplas
Fig.38: Chemical Burn Fig.39: Denture Stomatitis
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Fig.40: Eruption Cyst Fig.41: Leukoplakia
Fig.42: Parulis Fig.43: Hairy Tongue
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Fig.44: Hematoma Fig.45: Herpes zoster
Fig.46: Ranula
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DISCUSSION
Traditionally, the mucosal membrane of the oral cavity has been looked upon as
mirroring the general health. Oral Mucosal lesions may be present at birth or become
evident later in life due to mechanical forces, infections, changes in immune system,
aging, physical, thermal influences and deleterious habits. Some systemic diseases
also presents with local symptoms and/or lesions in the oral mucosa. These lesions
may be discovered during routine dental examinations. Diagnosis of the wide variety
of lesions that occur in the oral cavity is an essential part of the dental practice. The
prevalence of oral mucosal lesions is an important parameter in evaluating the oral
health of any population and the prevalence data of all the oral mucosal lesions
becomes a requirement for planning oral health care services.
When planning for improving oral health, lack of data may lead to a risk of
overlooking diseases of the soft tissues in and adjacent to the oral cavity. Prevalence
data of oral mucosal lesions are available only from few parts of India [Saraswati et
al., Chennai in 2004, Mathew et al., Manipal in 2005, Mehrotra et al., Vidisha in
2008, Dagli et al., Rajasthan in 2008 & Shivakumar et al., Bangalore in 2010], the
information is usually restricted to a small study sample and very few lesions in each
study. On the other hand, no such study has been conducted in the population of
Moradabad region on oral mucosal lesions. So, the need arises for such prevalence
study in this region to obtain a data useful for planning of oral health care in this
region.
Hence this study was conducted with a larger sample size to obtain a data base on the
prevalence of oral mucosal lesions and to correlate this prevalence with the
deleterious habits among the study population.
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In the present study, conducted during the period of three months from 16th April to
15th July, 2009, 5203 subjects (3133 males & 2070 females) were included on the
basis of inclusion and exclusion criteria. Out of 5203 study population 1716 subjects
(963 male & 753 female) were from urban areas, 1186 (833 male & 353 female) from
periurban areas and 2301 subjects (1337 males & 964 female) were from rural region.
3451subjects (2196 male & 1255 female) were dentate, 1585 subjects (864 male &
721 female) were partially edentulous while 167 subjects (73 male & 94 female) were
complete edentulous. 63 subjects (48 male & 51 female) were denture wearer, 146 (51
male & 95 female) were RPD and 92 subjects (90 male & 02 female) were FPD
wearer. Out of the study population 379 subjects (377 male & 2 female) were smoker,
458 subjects (347 male & 111 female) were smokeless tobacco users while 14 male
subjects were using tobacco in both forms.
In previous studies, conducted on dental outpatients, comparatively small group of
patients were included. A total of 2000 outpatients [927 men & 1073 women] were
selected by Delilbas et al.[36] in 2003, 2017 outpatients [1287 males & 730 females]
were included by Saraswati et al.[23] in 2004, 1190 outpatients [747 males & 443
females] were included by Mathew et al.[27] in 2005, 2552 outpatients by Mobeeriek
et al.[31] in 2005, and 512 outpatients [292 males & 220 females] were included by
Shivakumar et al. [2] in 2010.
All the Subjects were divided into four groups: group I (02-20 years), group II (21-40
years), group III (41-60 years) and group IV (61-80 years). In group I, there were
1233 subjects (751 male & 482 female), in group II, there were 2625 subjects (1649
male & 976 female), in group III, there were 1099 subjects (630 male & 469 female)
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and in group IV, there were 246 subjects (103 male & 143 female), this is in
accordance with Mathew et al. [27].
In the present study the overall prevalence of oral mucosal lesions was 17.16% [table
IV]. This is in accordance with studies conducted by Splieth et al.[37] (11.83%,
Germany) Shivakumar et al.[2] (11.33%, Bangalore), Mobeeriek et al.[31] (15.0%,
Saudi Arabia), Cebeci et al.[1] (15.5%, Turkey) and Shulman et al.[21] (10.26%, USA)
but some studies have shown a higher prevalence of oral mucosal lesions like study
done in southern China (Lin et al.[38], 66.2%), in Ljubljana Slovenia (Marija KK, U
Skarelic[39], 61.6%), in Brazil (J J junior et al[40]., 58.9%), in Venezuela (Valentina et
al.[30], 57%) in Santiago, Chile (Espinoza et al.[41], 53%) and in Manipal (Mathew et
al.[27], 41.2%). On the other hand, some studies have shown the lower prevalence of
oral mucosal lesions like study done in Chennai (Saraswati et al.[23], 4.1%), in
Cambodia (Ikeda et al.[42], 4.9%), in Vidisha, Madhya Pradesh (Mehrotra et al.[35],
8.4%) and in Malaysia (Zain RB et al.[43], 9.7%).
These variations in the prevalence could be because of the reason that prevalence
studies in dentistry are mostly based on either the examination of total population
samples or dental outpatients and a dental school setting may differ from the situation
found in the general population (because it is not open or randomized) this may be a
model indicative of general and daily dental practice, particularly compared with
other settings that deal with rather selected populations such as those seen in
specialty centers, nursing homes and veterans facilities, or oral mucosal disease
prevalence established in biopsy services. Patients spontaneously presenting for
dental consultation exhibit an attitude that may differ from that found in an
epidemiological survey of an open population [5].
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The methods of recording the incidence and prevalence of oral mucosal disease vary.
Most population-based surveys correlate oral mucosal disease with oral cancer and
precancerous conditions, but few authors have recorded overall oral mucosal lesions
or mucosal changes. For example, Axell[9] reported 60 different oral mucosal lesions
in his survey of a Swedish population, Field et al.[44] also reported all premalignant
and benign lesions found on screening, and nearly 50% of their reported lesions were
diagnosed as frictional keratosis. While other authors have reported on a few types of
lesions.
It should be stressed that the findings are influenced by the conditions under which
the data were collected. If the operative and circumstantial particularities associated
with the geographic, social, and cultural setting are taken into consideration, the
result obtained can be compared with those of similar studies.
In this study males have shown the higher numbers of lesions (11.34%) compared to
female (05.82%) [table IV] and this is in accordance with the studies done by Avcu
& Kanli[15] [Turkey], Salonen et al.[45] [Sweden], Castellanos & Laura DG[5]
[Mexico], and Mehrotra et al.[35] [Vidisha, Madhya Pradesh], while study done in
Saudi Arabia [Mobeeriek et al.[31]] showed the higher prevalence of oral lesions in
females and study from Hong Kong [Corbet et al.[13]] showed no difference in
prevalence between men and women.
The high prevalence of lesions in male could be attributed to the higher number
examined and the more frequent tobacco consumption in males, while women, who
are always expected to maintain a lady like image, are more reluctant to develop the
adverse habits[5].
Another possibility is that males are more exposed to risk factors, or alternatively,
females may be genetically less susceptible to the development of oral lesions. It
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could also be a possible explanation that males may be comparatively less sensitive
to health matters, and their concept of well being places little emphasis on oral or
dental aspects. In contrast, women may be more health conscious and might extend
such consciousness to younger family members, thus causing the lesions not to
appear or advance as a result of earlier identification and treatment. An additional
question is whether male adaptation to the environment leads to more manias, self
aggressive behavior, and neglect of oral health. It could also be that social, economic
and family roles prevent males from receiving care as often timely as women,
because the existing time availability may be different. Furthermore, although
medical insurance and public health are available for covering the costs of health
care, women may be more frequently benefitted in that they combine opportunity
with a positive attitude towards health and dental care[5].
Despite the less number of adverse habits [11.66%], being more educated, well
nourished and more familiar to oral preventive measure, the urban population shows a
higher prevalence [19.70%] of oral mucosal lesions [table II & VIII]. This might be
due to adverse habits and stressful urban life style. Risk associated with various stress
can also be modified by other exposures such as diet and nutrition, tobacco, alcohol
consumption, and genetics. Occupational or environmental exposures affect a large
number of urban populations, causing chronic irritative process. It increases the
vulnerability to infections that favors the progression of oral lesions [28].
Lesser levels of knowledge and neglect regarding oral health, oral preventive
measures, nutritional deficiencies and adverse habits cause significant increase on
prevalence of oral lesions in rural [17.51%] and periurban [12.82%] population.
Another possibility is that in rural and periurban areas the most prevalent type of
tobacco used by the population is Beedi smoking. Beedi smoking carries a higher risk
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for oral lesions compared with cigarette smoking [46]. When compared to cigarettes,
bidis produce only a smaller volume of smoke. But the smoke which is generated is
rich in higher concentrations of several toxic agents such as hydrogen cyanide, carbon
monoxide, ammonia and carcinogenic hydro carbons. Bidi smoking is also considered
to cause about 2-3 times greater nicotine and tar inhalation than conventional
cigarettes [47]. The presence of habits in increased form in the population also reflects
on the oral mucosal health.
The World Health Organization recommends a 1:7500 dentists to population ratio
where as the dentist to population ration in India is as low as 1:22500. In India there is
one dentist for 10000 persons in urban areas and about 2.5 lac persons in rural areas.
This might be a possible explanation why the lesions are more prevalent in rural and
periurban areas [35].
In this study the oral lesions were found in higher prevalence associated with adverse
habits like smoking, smokeless tobacco [table X] and this finding is similar to the
other studies like Shivakumar et al.[2] [Bangalore], Mathew et al.[27] [Manipal],
Ariyawardana et al.[46] [Sri Lanka], Mehrotra et al.[35] [Vidisha, Madhya Pradesh],
Zain RB & Razak IA [43] [Malaysia], G. Campisi & V. Margiotta[14] [Italy], Cebeci et
al.[1] [Turkey] and Sraswathi et al.[23] [Chennai].
The total number of tobacco-related lesions was 282 [5.42%]. Smoker’s palate
(94.23%), Leukoplakia (78%), leukoedema (75%), candidiasis (66.66%), and angular
chelitis (60%) were strongly associated with smoking while betel chewer mucosa
(100%), tobacco pouch keratosis (85.71%), OSMF (85.71%), lichenoid reaction
(50%) and SCC (50%) were strongly associated with smokeless tobacco. These
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lesions are also common in that patient who uses tobacco in both forms (smoking and
smokeless). [Table 10]
But on the other hand population habitual to smoking have shown the higher
prevalence of oral lesions [43%] compared to smokeless tobacco users [24.89%]
[table IX], and these findings are supported by studies done in Sudan [A.M. Idris et al.
[47]] and Turkey [Delilbasi et al.[36]], this might be due to the reason that smoking is
more dangerous to cause oral lesions than the smokeless tobacco[36]. Smokeless
tobacco products contain a large array of carcinogens, but the actual number found is
fewer than in cigarette smoke [48]. In the present study all the persons using tobacco in
both forms [smoking and smokeless form] were affected by tobacco related lesions
[100%]. This finding is nearly similar to study done in Tiwan [Chung et al.[49]] and
suggests that tobacco consumption in its both forms is more injurious than its single
form.
In this study, the higher prevalence (38.62%) of significant oral mucosal lesions
were found in the age group ranging from 61-80 years. This finding is almost similar
to study from Cambodia (Ikeda et al.[42]), and Venezuela (Valentina et al.[30]). But on
other hand, this finding is less than the study from Hong Kong (Corbet et al.[13]) with
52% and higher than study from Guangdong province, South China (Lin et al[38])
with 18% prevalence of oral mucosal lesions.
The possible explanation for these differences may be related to the proportions of
subjects and denture wearers, tobacco habits and normal mucosal variants findings
such as sublingual varices, melanotic pigmentation and fissured tongue.
In this age group (61-80 years) the maximum population were completely edentulous
(67.89%) and with higher number of lesions (22.75%) compared to dentate (15.04%)
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and partially edentulous (21.20%) population with lesions. Among the denture users
maximum number of lesions (31.75%) were observed compared to no prosthesis
users (17.35%), removable partial denture (10.27%) and fixed partial denture
(5.43%) users. This age group (61-80 years) is third most adverse habits users group
(10.16%) with 8.13% smoking and 2.30% smokeless tobacco users in this study.
The lesions characteristic of older age ranges, such as those predominantly
manifesting in patients more than 50 years of age, are associated with the wearing of
partial or complete dentures, the latter in turn being related to tooth loss resulting
from caries and periodontitis accumulating over time. Defects in the manufacture of
partial or complete dentures and the adaptive and progressive atrophic changes of the
bone and mucosa of the maxillary processes explain the presence of inflammatory
papillary hyperplasia, and candidiasis. Smoking also shows cumulative effects,
resulting in melanosis in some cases proportional to the duration of habit.
Leukoplakia, another lesion associated with smoking and other chronic irritants, also
develops in proportion to the duration of exposure. Thus, the higher prevalence of
oral mucosal lesions can be expected to be more common among older patients.
It is well known that aging causes changes to oral mucosal epithelium, such as
thinning and reduction of collagen synthesis, decreasing the ability to epithelial
regeneration and subsequently, the resistance of the organism to any disease of
microbial or traumatic in nature [50]. So it is not surprising that the majority of the
elderly subjects of the present study experienced oral health problems.
Second most prevalent oral mucosal lesions were seen in the age group ranging from
41-60 years. In this study, it is also found that tobacco related oral lesions such as
Leukoplakia, Candidiasis and angular chelitis were highly associated with smoking
while betel chewer mucosa, tobacco pouch keratosis and oral sub mucous fibrosis
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were highly associated with smokeless tobacco users [table X].
Thus, the significant finding of oral mucosal lesions in this group might be due to the
ageing effects on the overall health and oral epithelium and highest prevalence of
adverse habits (26.84%) with 19.11% smoking, 36.67% smokeless tobacco and
0.73% users of both forms of tobacco.
Patients with systemic disease showed a lower prevalence of oral lesions (13.39%) in
comparison to without systemic disease (17.52%) subjects, and this finding was
statically non significant [table XIII].
This might be due to less number of study subjects with systemic disease and more
number of tobacco users in other group.
Fordyce's condition
Fordyce's condition was observed in 1.48% of study population and was more
frequently observed on the buccal and labial mucosa. It was more prevalent in men
(2.30%) than in women (0.24%). Corbet et al. [13] (0.6%) and Mathew et al.[27] (6.5%)
had reported a prevalence of Fordyce’s condition, which is very different from our
finding.
Fissured tongue
Fissured tongue was seen in 1.69% (1.56% male, 1.88% female) of study population.
This included all subjects with fissures of at least 2-mm depth on the dorsal aspect of
the tongue. This prevalence is lower than that found by Mathew et al. [27] (5.7%),
Darwazeh and Pillai in Jordan [51] (11.4%) and also by Marija in Slovenia (21.1%).
This finding is similar to that found by Mobeeriek et al. [31] in Saudi Arabia (1.41%)
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and by Cebeci et al. [1] in Turkey (1.0%).
Leukoedema
In this study population, the prevalence of leukoedema was 0.69%. Males (1.05%)
were more affected than females (0.14%). The prevalence was more among smokers
than nonsmokers and correlation between leukoedema and smoking, tobacco
chewing, could be demonstrated in our study and this in accordance with Mathew et
al.[27].
Sublingual varices
The prevalence of sublingual varices was 0.35% (0.35% male, 0.34% female) in our
population. It occurred more frequently in the 61-80 years age-group. It is
considerably lower than the prevalence of 7.1% found by Mathew et al.[27], in
Manipal, India and similar to Mobeeriek et al.[31] in Saudi Arabia (0.39%).
Frictional keratosis
The occurrence of frictional keratosis was in 1.40% (1.79% male, 0.82% female) of
all subjects. The highest prevalence of this lesion in men was in the 21-60 years age-
group and in women in the 21-40 years age-group. This result is comparable to that of
Castellanos et al.[5] (1.46%) and Mobeeriek et al.[31] (1.33%). This finding is lower
than the prevalence reported by Mathew et al.[27] (5.79%).
Smoker's palate
In this study population, smoker's palate was observed only in men. The prevalence of
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1.00% was found more than that observed in Ljubljana, Slovenia, by Marija[39]
(0.5%), in Bangalore, India, by Shivakumar et al.[2] (0.59%) and lower than in
Swedish men by Axell[9] (2.1%) and by Mathew et al.[27] (4.4%), this could be due to
number of study population. Tobacco-related white lesions (leukoplakia and smoker's
palate) in our study population were more prevalent in men than in women. This
difference was attributable to the high tobacco consumption in men.
Aphthous stomatitis
The presence of recurrent aphthae was 0.71%. It was most prevalent in the 21-40
years age-group and more frequent in women than in men. This finding is similar to
studies conducted in Mexico by Castellanos JL[5] (0.08%) and in Saudi Arabia by
Mobeeriek et al.[31] (0.39%), and is lower than the finding by Mathew et al.[27] (2.1%).
This difference may be attributable to number of study population, level of stress and
hormonal changes.
Oral submucous fibrosis
The prevalence of oral submucous fibrosis in this population was (0.67%); it was
more among men (0.99%) than women (0.19%) and more often seen in the 21-60
years age-group. This is comparable to the prevalence found in a Cambodian
population[42] (0.2%) and similar to prevalence found Bangalore[2], India (0.59%).
This prevalence is less than the finding of Mathew et al.[27] (2.01%). This difference
may be attributable to number of study population and tobacco chewers.
Oral malignancies
The prevalence of oral malignancies in this study was 0.04%. It was observed in the
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age-group of 41-60 and 61-80 years. It was more prevalent in patients who were
chronic smokers and tobacco chewers. This prevalence is less than that found by
Ikeda [42] (0.1%) in a Cambodian population and Mathew et al.[27] (1.7%) in Manipal.
Leukoplakia
The prevalence of leukoplakia in study population was 1.92%. All the subjects with
leukoplakia in our population were smokers and tobacco chewers. It was prevalent
only in men. This prevalence is similar with the results obtained in Manipal by
Mathew et al.[27] (1.59%), Chile by Espinoza et al.[41] (1.70%), and in Hungary by
Banoczy[52] (1.3%) but low in prevalence when compared with the studies by Ikeda[42]
in Japan (25%), and Axell[9] in Sweden (3.6%). The highest prevalence of leukoplakia
in male population was in the 41-60 years age-group. The most frequent site of
involvement was the buccal mucosa, including the commissures. This difference may
be attributable to number of study population and tobacco habits.
Median rhomboid glossitis
The prevalence of median rhomboid glossitis was 0.15% and was observed more in
males (0.16%) compared to females (0.14%). This finding is less than the study
conducted in Manipal by Mathew et al.[27] (1.5%), and this might be due to the
variation in study population.
Oral candidiasis
The prevalence of oral candidiasis in study population was 0.12%. Oral Candidiasis
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was only seen in males of the older age-groups (41-80 years). This is lower than the
finding by Mathew et al. [27] (3.07%) and similar to that found by Axell[53] in Kuala
Lumpur (0.4%), and by Cebeci et al.[1] (0.2%) in Turkey. This difference might be
due to variation in number of subjects and smokers.
Lichen planus
Lichen planus was found in 1.04% of study population, which is comparable to study
conducted in Manipal[27], India (1.26%). In our population, lichen planus was most
prevalent in the 21-40 year age-group. It was more frequently observed among men
than women (1.02 and 1.06%, respectively). This is in accordance with the results
obtained by Mobeeriek et al. [31] in Saudi Arabia, and Saraswati et al. [23], in Chennai.
The most prevalent type was the reticular type. It was located most frequently on the
buccal mucosa followed by the tongue and the alveolar ridge.
Denture stomatitis
Denture stomatitis was observed in seven subjects (out of 63 denture wearers). The
prevalence in this study was 0.13%. The majority of denture stomatitis was observed
in the 41-60 years age-group. The frequency was observed to be more in females
(0.24%) than in males (0.06%). The higher prevalence of denture stomatitis among
women is in accordance with the findings of Mathew et al.[27] This is lower than that
observed by Corbet et al.[13] in a Chinese population in Hong Kong (10%) and by
Marija[39] in Slovenia (14.7%).
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Geographic tongue
Geographic tongue was present in 0.46% of study population, which is similar to
finding of Vigild M[54] (0.40%) in Denmark and Mobeeriek et al.[31] (0.51%) in Saudi
population and lower than the finding of Mathew et al.[27] (0.84%). It was more
prevalent in females (0.63%) than males (0.35%) and in age group of 21-40 year. The
higher female prevalence is accordance with Mobeeriek et al.
Betel chewer's mucosa
The prevalence of betel chewer's mucosa in this study was 0.15% with a high
prevalence in males (0.22%) than females (0.05%). It was more prevalent in 21-40
age groups. This finding is less than the prevalence found by Mathew et al. [27]
(0.84%).
Irritational fibroma
The prevalence of irritational fibroma in this study was 0.54%. It was more prevalent
in females (0.77%) than in males (0.38%) and in 21-40, 41-60 years age groups. This
is in accordance with the study done by Mathew et al.[27], where the prevalence was
found to be 0.84%.
Angular cheilitis
Angular cheilitis was found in 0.38% of study population, which is similar to the
finding recorded by Castellanos et al.[5] (0.36%) and comparable to the finding
recorded by Mathew et al.[27] (0.84%) and by Shivakumar et al.[2] (0.19%). It was only
found in the 41-60 years males.
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Herpes labialis
The prevalence of recurrent herpes labialis was 0.58%. In this study it was more
prevalent in the 21-40 year age-group and was more common in females than in males
(0.77% and 0.45%, respectively). This is similar to study done by Mathew et al.[27]
(0.58%) and Mobeeriek et al.[31] (0.39%). This is comparable to the finding by Chiang
Mai[53] in Thailand (0.9%).
Mucocele
The prevalence of mucocele in this population was 0.04%, and it was found only in
males. This prevalence is less than the study done by Mathew et al.[27] (0.16%).
Traumatic ulceration
The prevalence of traumatic ulceration in this study was 0.65%. It was more prevalent
in females (0.72%) than in males (0.61%) and in 21-40 years age groups. This is in
accordance with the study done by Mathew et al.[27] (1%), and by Shivakumar et al.[2]
(0.19%). This finding is less than the prevalence found by Castellanos et al.[5] (4%)
and by Dimitris Triantos[50] in Greek (3.7%).
Lichenoid like Reaction
The prevalence of lichenoid reaction in this study was 0.04%. It was only found in
males (0.06%). This prevalence is comparable with finding by Shivakumar et al.[2]
where the prevalence was 0.19%.
Papilloma
The prevalence of papilloma in this study was 0.02%. It was only found in a male of
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age group 21-40 years. This prevalence is similar to J.D. Sulman[21] (USA, 0.02%)
and comparable with findings by Ikeda et al.[42] (Cambodia), Cobert et al.[13] (Hong
Kong), and Castellanos et al.[5] (Mexico), where the prevalence were 0.1%, 0.2% and
0.29% respectively.
Papillary Hyperplasia
The prevalence of papillary hyperplasia in this study was 0.13%. It was found 0.16%
in males and 0.10% in females. This prevalence is similar to finding by Parlak et al.[22]
(0.1%) and by Castellanos et al.[5] where the prevalence was 0.24%. The difference in
the findings might be due to the number of denture users in the study.
Atrophy of Tongue Papillae
The prevalence of glossitis in this study was 0.85%. It was found 0.38% in males and
1.55% in females. It was found more in age group 21-40 years. This prevalence is
similar to finding by Corbet et al.[13] (1%) and by Axell et al.[9] where the prevalence
was 1% and is less than the findings by Jackes et al.[40] (4.4%) and higher than the
finding Mobeeriek et al.[31] by (0.12%).
Pyogenic Granuloma
The prevalence of pyogenic granuloma in this study was 0.13%. It was found 0.16%
in males and 0.10% in females. This prevalence is similar to finding by Axell et al.[9]
(0.1%, Sweden) and by Castellanos et al.[5] where the prevalence was 0.08%. This is
comparable with findings by Espinoza et al.[41] (Chile, 0.7%), and by Dimitris
Triantos[50] (Greece, 1%).
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Primary Herpetic Gingivostomatitis
The prevalence of primary herpetic gingivostomatitis in this study was 0.08%. It was
found 0.03% in males and 0.14% in females. It was found more in age group 21-40
years. This prevalence is comparable with Bess et al.[17] (0.33%).
Eruption Cyst
The prevalence of eruption cyst in this study was 0.04%. It was found 0.03% in males
and 0.05% in females. It was found only in age group 02-20 years. This prevalence is
comparable with Bess et al[17] (0.17%).
Snuff Dipper’s Lesion
The prevalence of Snuff Dipper’s Lesion in this study was 0.27%. It was found only
in 0.45% males in age group 21-40 years and was associated with smokeless tobacco
uses. This prevalence is less than the finding recorded by Axell[9] (1.3%) and Salonen
et al.[45] (13.75%).
Hairy Tongue
The prevalence of Hairy Tongue in this study was 0.08%. It was found 0.10% in
males and 0.05% in females. This prevalence is comparable with Salonen et al[45]
(0.4%) and is less than the finding recorded by Reichart[4] (26.6% & 1.8%) in two
groups respectively and by Avcu & Kanli[15] (11.3%).
Coated Tongue
The prevalence of Coated Tongue in this study was 1.83%. It was found in 2.14%
males and 1.35% in females of age group 21-40 years. This prevalence is similar with
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finding recorded by Axell et al.[9] (1.2%) in Sweden and less than finding recorded by
Avcu & Kanli[15] (23.2%).
Commissural Pit
The prevalence of Commissural pits in this study was 0.71% [0.80% male & 0.58%
female]. It was more prevalent in males of age group II and was absent in subjects of
age group IV.
Chemical And Thermal Burn
In this study 0.04% chemical and 0.04% thermal burns were observed. Chemical
burns were found only in age group II women, who were undergoing root canal
treatment. While thermal burns were found in one male and one female, which were
due to taking hot drinks.
Linea Alba Buccalis
The prevalence of linea alba buccalis in this study was 2.19%. It was found 1.82% in
males and 2.75% in females. It was highly prevalent in females of age group II.
Other Lesions
One case (0.02%) of petichae in age group III female, one case (0.02%) of myolipoma
in age group I female, single case (0.02%) of hematoma, herpes zoster, and vitiligo
were found in age group III males.
Two cases of ranula in age group 1 females, 2 cases of peripheral giant cell
granuloma, one in male and one in female were observed in this study.
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CONCLUSION:
This study establishes a prevalence rate [17.16%] of Oral Mucosal Lesions in patients
attending outpatient department of Kothiwal Dental College and Research Centre and
demonstrates that smoking, tobacco chewing and increasing age is associated with
greater odds of oral mucosal lesions, emphasizing the importance of frequent and
regular inspection of the oral cavity for early detection and prompt treatment.
In this study male [11.34%] showed a higher significant prevalence of oral mucosal
lesions than female [5.82%]. The higher significant prevalence was found in urban
population [19.70%] followed by rural [17.51%] and periurban population [12.82%].
The lesions were more prevalent in age group IV [38.62%] and III [32.67%]. 16.36%
study population were tobacco users, out of which 8.80% were smokers, 7.28% were
smokeless tobacco users and 0.27% were using tobacco in both forms. 5.43% were
tobacco-related lesions and 3.63% were precancers.
No lesions were found in 82.84% of the population; 33.87% of them were females
and 44.97% were males. The maximum number of lesion-free patients was in the 21-
40 years old male population.
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Most prevalent normal mucosal variant was fissured tongue [1.69%] followed by
fordyce’s granules [1.48%], commissural pit [0.71%], leukoedema [0.69%] and
lingual varices [0.35%].
From all these results we can arise at a conclusion that tobacco use among people are
existing and increasing at a higher pace. Tobacco related oral lesions are also high,
which brings an alarming signal towards development of cancer.
There is an urgent need for awareness programs utilizing the community health
workers, dentists and allied medical professionals. It is hoped that these results will
form the basis of a state level, followed by a national level survey of oral lesions.
SUMMARY:
The oral mucosa performs essential protective functions that significantly affect the
general health of the patient. Besides dental caries and periodontal diseases, oral
mucosal lesions are another significant problem of public health importance. This
study was conducted to evaluate the prevalence of oral mucosal lesions in patients
attending outpatient department of Kothiwal Dental College and Research Centre,
Moradabad and correlation of the prevalence with the uses of tobacco among study
population.
The prevalence of oral mucosal lesions was determined by the clinical examination in
a sample of 5203 patients during the period of three months from 16th April to 15th
July, 2009. Patients from 2-80 years were included in the study.
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The present study established an overall prevalence of oral mucosal lesions of 17.16%
(males = 11.34%, females = 5.82%). Males have higher prevalence (18.83%)
compared to females (14.64%). The difference between male and female was found to
be statistically highly significant. It has been found that patients habitual to smoke
have higher oral lesions (43.00%) than who uses smokeless tobacco (24.89%) and
who do not have any deleterious habits (13.83%).
The prevalence of oral mucosal lesion in smokers and smokeless tobacco users was
more than in non tobacco users. The uses of smoking and tobacco together showed
higher prevalence of oral mucosal lesions in general and this was statistically highly
significant. Prevalence of tobacco related premalignant diseases were more than the
nontobacco related precancers.
This prevalence study in a dental institute showing a strange correlation between
tobacco use and oral mucosal lesions calls for the importance of the role of dentist in
educating the patients of the ill-effects of tobacco on their health and in helping them
in tobacco cessation.
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BIBLIOGRAPHY:
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2. Shivakumar GC, Sahana S, Saha S. Prevalence and site distributon of Oral Mucosal Lesions in patients attending outpatient clinics of Oxford Dental College, Bangalore. Journal of the Indian Association of Public Health Dentistry 2010; 15:69-73.
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of tobacco habits and an estimate of treatment time in an adult Swedish population. J Oral Pathol Med 1990; 19:170-176.
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APPENDIX-1
CASE HISTORY PROFORMA FOR THESIS
Title of the thesis
“The Prevalence Of Oral Mucosa Lesions In Patients Visiting A Dental College In Moradabad, India”
By : Under the Guidance of :
Dr. Anand Pratap Singh Prof. Dr. G.N. Suma
PG Student (Supervisor)
Dr. Ravi Prakash S.M
(Co- Supervisor)
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S.No: REGISTRATION No: DATE:
I. NAME:
II. SEX : 1 MALE 2. FEMALE
III. AGE:-
IV. AGE GROUP: 1. 2 -20 YRS
2. 21-40 YRS
3. 41-60 YRS
4. 61-80 YRS
V. ETHNIC GROUP 1. H 2. M 3. OTHERS
VI. GEOGRAPHIC LOCATION
1. URBAN
2. PERIURBAN
3. RURAL
VII.OCCUPATION……………………………………………………………………
VIII. MEDICAL HISTORY
0. NO HISTORY
1. DM 2. HT
3. TB 4. CARDIAC
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5. EPILEPSY 6. ALLERGY
7. BLOOD TRANSFUSION 8. HOSPITALIZATION
9. ENT 10. BLEEDING DISORDER
11. OTHERS……………………………
COMMENTS…………………………………………………………………………………………………………………………………………………………………..
IX. MEDICATION
0. NO MEDICATION 2. SOME TIMES TAKES MEDICATION
1. UNDER TREATMENT 3. TAKEN MEDICATION
X. DURATION…………………………………………………………………………….
XI. FAMILY HISTORY
0. NO H/O SIMILAR LESION
1. SIMILAR LESION IN FAMILY
XII. PERSONAL HISTORY
a. DIET
1. VEG
2. NON-VEG
3. MIXED
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b. SLEEP
0. UNDISTRUBED
1 DISTRUBED
c. APPETITE
0. NORMAL
1. REDUCED
d. MENSTURATION
0. REGULAR
1. IRREGULAR
2. MENOPAUSE
e. PREGNANCY TRIMESTER
0. NO
1. Ist TM
2. 2nd TM
3. 3rd TM
f. LACTATION
0. NO
1. YES
g. ORAL HYGINE METHODS
0. NO
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1. TOOTH BRUSH
2. FINGER
3. OTHER……………………………………………………..
h. PARAFUNCTION
0. NOT PRESENT
1. PRESENT
COMMENT:………………………………………………………………………..
i. HABIT
0. NO HABIT
1. SMOKELES TOBACCO
2. SMOKING
3. ALCOHOL
4. DRUGS
5. OTHERS……………………………………………………
DURATION…………………………… FREQUENCY……………………...
j. HABIT INDEX…………………………………………………………………….
XIII. DENTITION
1. DANTATE
2. PARTIALLY EDENTULOUS
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3. COMPLEAT EDENTULOUS
1. DECIDUOUS
2. MIXED
3. PERMANENT
XIV. PROSTHESIS
0. NO PROSTHESIS
1. DENTURE WEARER
2. RPD
3. FPD
4. FAULTY PROSTHESIS
XV. H/O LESION:
0. NO H/O SIMILAR LESIONS IN PAST
1. +ve H/O SIMILAR LESIONS IN PAST
FREQUENCY AND COMMENTS:……………………………………………………
XVI. EXTRA ORAL EXAMINATION
a. LOCATION
OTHERS………………………………………………………
…………………………………………………………………
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COMMENTS……………………………………………………
b. LESION :-
OTHERS………………………………………………………………………………
COMMENTS…………………………………………………………………………
XVII. ORAL MUCOSAL EXAMINATION
a. LOCATION:-
OTHERS………………………………………………………………………………
COMMENT……………………………………………………………………………
b. LESION:-
OTHERS………………………………………………………………………………
COMMENTS…………………………………………………………………………
XVIII. ASSOCIATED SYMPTOMS
0. NO ASSOCIATED SYMPTOMS
1. FEVER
2. LYMPHADENOPATHY
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3. DISCHARGE
4. DIFFICULTY IN SWALLOWING
5. BURNING SENSATION
6. PAIN
7. OTHERS……………………………………………………
COMMENTS………………………………………………………………………
XIX. SIMILAR LESIONS IN OTHER PART OF BODY
0. NO
1. YES
LOCATION…………………………………………………………………………
XX. INVESTIGATIONS
0. NO NEED
1. HISTOPATHOLOGICAL
2. RADIOGRAPHIC
3. HAEMATOLOGICAL
4. OTHERS……………………………………………….
INVESTIGATIONAL REPORT & COMMENTS:-
XXI. FINALDIAGNOSIS…………………………………………………………
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APPENDIX- II
CONSENT FOR PARTICIPATION IN RESEARCH
“THE PREVALENCE OF ORAL MUCOSAL LESIONS IN PATIENTS VISITING A DENTAL COLLEGE IN MORADABAD, INDIA”
Dr. Anand Pratap Singh, Post Graduate student in department of Oral Medicine and Radiology, Kothiwal Dental College, Moradabad, is doing thesis work on “THE PREVALENCE OF ORAL MUCOSAL LESIONS IN PATIENTS VISITING A DENTAL COLLEGE IN MORADABAD, INDIA” You are being asked to be a subject in this research work.
Your participation in this research is voluntary. Your decision whether or not to participate will not affect your current or future relationship with Kothiwal Dental College. If you decide to participate, you are free to withdraw at any time without affecting that relationship.
PROCEDURE INVOLVED:
After oral examination, biopsy will be done, if required.
RISK AND BENEFITS:
There will be no significant physical or psychological risks to the participants.
During the course of study, you will be informed of any significant findings (either good or bad) such as changes in the risks or benefits resulting from participation in research.
PRIVACY AND CONFIDENTIALITY:
The only people who will know that you are a research subjects are members of the research team. No information about you, or provided by you during the research will be disclosed to others without your written permission except
1. If necessary to protect your rights and welfare.
2. If required by the law
When the results are published or discussed in conferences, no information will be disclosed that would reveal your identity. Any information that is obtained in connection with this study and that can be identified with you will remain confidential and will be disclosed only with your permission or if required by the law.
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You will not be paid /offered any gifts for participating in research. There will not be any remuneration for participation in the research.
Your participation is voluntary and you have the right to withdraw from the study at any time.
“I hereby have no objection to give my voluntary consent on behalf of myself to be included in the study”
SIGNATURE/THUMB IMPRESSION……………………..
NAME DATE:
NAME & SIGNATURE OF RESEARCHER: DATE:
NAME & SIGNATURE OF WITNESS: DATE: