Oral health is an important factor of individual’s quality of life. Disrupted oral health negatively affects speech, chewing and swallowing and deteriorates social contacts.1 Prevalence of oral mucosal diseases varies from 10.8%–81.3% in the general population as reported in the literature2,3,4,5, with malignant tumors, as the most widely studied entity, representing only a minority among these lesions. These reports point out that there is a need for additional epidemiological data as percentages of various oral mucosal conditions within studies differ greatly. Also, some studies report prevalence of only few diagnoses, which does not accurately show the variability and prevalence of all lesions in the oral cavity. Prevalence of oral mucosal diseases is even greater (95–100%) in the residents within nursing homes and patients referred to the oral medicine specialists.6,7 These differences in prevalence might be due to the geographic peculiarities, age, gender, habits, intake of medication, denture presence
Every participant signed informed consent according to the Helsinki II. Oral mucosal alterations were recorded according to the WHO protocol-Guide to the Epidemiology and Diagnosis of Oral Mucosal Diseases and Conditions.8 The statistical analysis was done using the SPSS software, where p < 0.05 was considered to be significant. Chi-square test was used to analyze the data.
This study included 2395 patients (904 men and 1491 women) who attended general dental practice in Ljubljana, Slovenia.
Mean age for men was 57.94 years, median 61 years, age range 25–92 years. Mean age for women was 57.62 years, median 60 years, age range 22–92 years. Out of 2395 patients, 1755 patients were without oral mucosal changes, while 645 patients (27%) had oral mucosal lesions (Table 1). Oral lesions were equally present in both gender (males 241/904, 26.66%; females 404/1 491, 27.09%). Majority of patients in all groups (smokers, non-smokers, ex-smokers) had only one oral lesion present, as seen in Table 2. In all patients with more than one lesion in the mouth, the median number of lesions was two. Statistically significant association was found only between oral cancer and tobacco smoking (p < 0.05, chi-square = 40.23), while statistical analysis of our results did not reveal significant differences in the prevalence of other oral lesions between smokers and non-smokers (chi square test). The most frequent oral lesions in smokers were cheek biting and linea alba, while the most frequent oral lesion in non-smokers were Fordyce spots and fibroma. Oral squamous cell carcinoma was found in only 0.37% of the patients, representing as low as 1.39% of all the examined patients with oral lesions (Table 3).
Frequency of lesion occurrence, diagnosis and percentage of the lesion within the whole sample and within the sample with oral lesionsFrequency of occurrence Oral lesion Number and % within the whole sample and within the patients with oral lesions 1. fibroma 56 (2.33%–8.7 %) 2. gingivitis 51 (2.12%–7.90%) 3. Fordyce spots 46 (1.92%–7.13%) 4. white coated tongue 40 (1.67%–6.20%) 5. cheek biting 39 (1.62%–6.04%) 6. linea alba 38 ( 1.58%–5.89%) 7. denture stomatitis 36 (1.50%–5.58%) 8. geographic tongue 32 (1.33%–4.96%) 9. recurrent aphthous ulceration 31 (1.29%–4.80%) 10. fissured tongue 27 (1.12%–4.18%) 11. traumatic ulcer 27 (1.12%–4.18%) 12. lichen 26 (1.08%–4.03%) 13. mucosal pigmentation 25 (1.04%–3.87%) 14. amalgam tattoo 21 (0.87%–3.25%) 15. vascular lesions 21 (0.87%–3.25%) 16. hyperkeratosis 21 (0.87%–3.25%) 17. mucocele 20 (0.83%–3.10%) 18. haemangioma 19 (0.79%–2.94%) 19. papilloma 18 (0.75%–2.79%) 20. reccurrent herpes 15 (0.62%–2.32%) 21. decubital ulcer 15 (0.62%–2.32%) 22. leukoplakia 12 (0.50%–1.86%) 23. papillitis lingue 10 (0.41%–1.55%) 24. oral squamous cell carcinoma 9 (0.37%–1.39%) 25. mucosal petechiae 7 (0.29%–1.08%) 26. candidal infection 7 (0.29%–1.08%) 27. leukoedema 5 (0.20%–0.77%) 28. frictional hyperkeratosis 5 (0.20%–0.77%) 29. teeth impressions on the mucosa 4 (0.16%–0.62%) 30. haematoma after bite 3 (0.12%–0.46%) 31. black hairy tongue 3 (0.12%–0.46%) 32. angular cheilitis 2 (0.08%–0.31%) 33. median rhomboid glossitis 2 (0.08%–0.31%) 34. lingua accreta 2 (0.08%–0,31%) 35. hyperplastic candidiasis 1 (0.04%–0.15%) 36. nicotine stomatitis 1 (0.04%–0.15%)
Frequency of oral lesions in non-smokers, smokers and ex-smokersWithout oral lesions Oral lesions present One oral lesion Two or more oral lesions The most frequent oral lesion Male (N = 904) Non-smokers (N = 719) 531 (73.85%) 188 (26.14%) 154/188 (81.91%) 34/188 (18.08%) Fordyce spots Smokers (N = 166) 117 (70.48%) 49 (29.51%) 35/49 (71.5%) 14/49 (28.5%) cheek biting Ex-smokers (N = 19) 15 (78.94 %) 4 (21.05%) 4/4 - - Female (N = 1491) Non-smokers (N = 1249) 914 (73.17%) 335 (26.82%) 288/335 (85.97%) 47/335 (14.02%) fibroma Smokers (N = 226) 163 (72.12%) 63 (27.87%) 53/63 (84.12%) 10/63 (15.85%) linea alba Ex-smokers (N = 16) 10 (62.5%) 6 (37.5%) 6/6 - traumatic ulcer
Prevalence of tobacco smoking and most frequent oral lesions, precancerous lesions (oral lichen planus and leukoplakia) and oral cancer. Exsmokers who have stopped smoking more than 10 years ago are considered as non-smokers. Statistically significant association was found only between oral cancer and tobacco smoking (p < 0.05, chi-square = 40.23)Study group(N = 2395; %) Cheek biting (N = 39) Linea alba (N = 38) Fibroma (N = 56) Fordyce spots (N = 46) Oral cancer (N = 9) Oral lichen planus (N = 26) Oral leukoplakia (N = 12) Smokers 392; 16.37% 20; 51.28% 15; 39.47% 10; 17.86% 11; 23.91% 9∗∗; 100% 6; 23.1% 4; 3.33% Non-smokers 2003; 83.63% 19; 48.72% 23; 46; 35; 76.08% 0; 0% 20; 76.9% 8; 6.66% 60.53% 82.14%
Literature data about the prevalence of oral mucosal lesions are very variable and depend on the observed diagnoses and studied population. Most of published literature observes only the prevalence of precancerous and cancerous lesions. The results of our study show that malignant (OSCC) and potentially malignant lesions of leukoplakia were more frequently diagnosed in males (OSCC - all male patients; leukoplakia - 33.3% females, 66.6% males), which is consistent with the findings from the published literature.3 It is interesting to note that potentially malignant lesion,
Regarding the prevalence of different oral mucosal lesions in population, several authors have reported higher prevalence than in our study.3,5,10 According to Kovač-Kavčič
Feng
It is interesting to note that the results from this study are different from the study we performed three years ago on the Slovenian population when cheek biting was the most common lesions followed by fibroma, geographic tongue, amalgam tattoo and Fordyce spots.12 On the other hand, among five most common oral lesions in our previous13 and current study, three are consistent (Fordyce spots, cheek biting and fibroma). Furthermore, when our data are compared to an earlier study on Slovene population3, it can be observed that the prevalence of smokers among the examined patients is much lower than 20 years ago (35% compared to 13.7%), while the prevalence of the oral mucosal lesions is higher (27% compared to 16.8%).
Our results have shown that oral lesions were equally present in both gender (males 241/904, 26.66%; females 404/1 491, 27.09%), unlike Pentenero
Additionally, higher percentage of patients with oral malignancies was found within this sample (9 patients with OSCC; 0.37%) when compared to our previous12 and also when compared to the other authors such as Triantos
Our study provided information that one fourth (1/4) of the population attending general dental practice had oral mucosal alterations. Irritational, inflammatory and anatomic changes were the most common types of oral mucosal lesions. The frequency of newly diagnosed oral malignancies increased when compared with the previous results. These data provide valuable information for planning future oral health studies and strategy.
It is important to encourage people, to attend preventive medical examination by doctors and dentists. In the same time it is important to educate medical doctors and dentists, to be able to recognize suspicious oral mucosal lesions, because early treatment of oral cancer significantly improves prognosis, treatment outcomes and diminishes post treatment morbidity.