The prevalence of oral mucosal lesions in adults from the Turin area

Aim:  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.
Materials and methods:  A retrospective study, based on an invitational self-selected screening, was performed on 4098 subjects. It included clinical examination plus biopsies when necessary. Patient history included age, sex, denture wearing and risk habits. Internationally accepted criteria were adopted to classify the OMLs.
Results:  Males were observed to have more OMLs (557/2040; 27.3% vs 471/2058; 22.89%). 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.
Conclusions:  The prevalence of OMLs in Turin seems to be comparable to those in other European studies and emphasize that risk habits and denture wearing have some relationship with the presence of OMLs.     

The prevalence of oral mucosal lesions in a population in Ljubljana, Slovenia

The purpose of the present study was to evaluate the prevalence of oral mucosal lesions and conditions in a population in Ljubljana, capital of Slovenia. A total 1609 subjects represented the study population in the survey about the periodontal treatment needs in a population in Ljubljana, conducted from 1983 to 1987. Ten years later the same 1609 subjects were invited to the second examination. Altogether, 555 (34.5%) of the invited subjects in the age range 25-75 years came for an interview and clinical examination at the Department of Oral Medicine and Periodontology of the Dental Clinic in Ljubljana. Oral mucosal lesions and conditions were evaluated according to the WHO Guide to Epidemiology and Diagnosis of Oral Mucosal Diseases and Conditions. The results showed the presence of one or more mucosal lesions in 61.6% of the population. Fordyce's condition was observed the most frequently (49.7%) followed by: fissured tongue (21.1%), varices (16.2%), history of herpes labialis (16.0%), history of recurrent aphthae (9.7%), denture stomatitis (4.3%), leukoplakia (3.1%), cheek biting (2.7%), lichen planus (2.3%), frictional keratosis (2.2%), geographic tongue (2.2%), geographic and fissured tongue together (1.1%), mucocele (0.9%), smoker's palate (0.5%) and angular chelitis (0.4%). In the population examined, no oral malignancies were observed. Mucosal lesions like whitish lesions, denture related lesions, fissured tongue, varices and mucocele were more prevalent with increasing age. Tobacco-related lesions (leukoplakia and smoker's palate together) were significantly more prevalent among men than among women (P<0.05), while lichen planus, denture stomatitis and herpes labialis occurred more frequently in the female population.     

Prevalence of oral mucosal lesions in elderly people in Santiago, Chile

BACKGROUND: Oral prevalence studies are important to know the state of health and the needs of treatment. Our aim was to determine the prevalence of oral mucosal lesions and associated factors among aging Chileans. METHODS: A random sample by age, gender, and socioeconomic status was obtained, comprising 889 individuals older than 65 years. Individuals were interviewed and examined in Santiago, the capital of Chile, according to the World Health Organization guidelines. RESULTS: The prevalence of one or more oral mucosal lesions in the sample was 53%. Logistic regression model revealed that denture use increased the probability of one or more oral mucosal lesions by threefold, while age, gender, smoking, medication use, xerostomia, and social or cultural factors had no effect. The most common lesion was denture stomatitis (22.3%), followed by irritative hyperplasia (9.4%), oral mucosal varicosities (9%), solitary pigmented lesions (4%), traumatic ulcer (3.5%), angular cheilitis (2.9%), multiple pigmented lesions (2.8%), hemangioma (2.3%), lichen planus (2.1%), leukoplakia (1.7%), recurrent aphthous stomatitis (1.4%), nicotine stomatitis (1.3%), median rhomboid glossitis (0.9%), actinic cheilitis (0.9%), pyogenic granuloma (0.7%), oral squamous papiloma (0.6%), and mucocele (0.2%). One case of oral cancer was observed. Different factors increased the probability of specific oral mucosal pathologies. CONCLUSIONS: We can conclude that oral mucosal lesions are common in elderly people in Santiago, suggesting the necessity for improved standards of prevention, and diagnostic and opportune treatment of these lesions.     

A national epidemiological survey of oral mucosal lesions in Malaysia

Abstract The prevalence of oral mucosal lesions in Malaysia was determined by examining a representative sample of 11 707 subjects aged 25 years and above throughout the 14 states over a period of 5 months during 1993/1994. A two-stage stratified random sampling was undertaken. A predetermined number of enumeration blocks, the smallest population unit in the census publication was selected from each state. With the selected enumeration block, a systematic sample of living quarters was chosen with a random start. The survey instrument included a questionnaire on sociodemographic characteristics and a clinical examination. The clinical examination was carried out by 16 specially trained dental public health officers and the diagnosis calibrated with a final concordance rate of 92%. The age in the sample ranged from 25 to 115 years with a mean of 44.5+14.0. The sample comprised 40.2% males and 59.8% females; 55.8%. were Malays, 29.4% Chinese,10.0% Indians and 1.2% other ethnic groups. Oral mucosal lesions were detected in 1131 (9.7%.) subjects. 5 (0.04%) had oral cancer, 165 (1.4%) had lesions or conditions that may be precancerous (leukoplakia. erythroplakia, submucous fibrosis and lichen planus) and 187 (1.6%) had betel chewer's mucosa. The prevalence of oral precancer was highest amongst Indians (4.0%) and other Bumiputras (the indigenous people of Sabah and Sarawak) (2.5%) while the lowest prevalence was amongst the Chinese (0.5%).     

Occurrence of oral mucosal lesions, the influence of tobacco habits and an estimate of treatment time in an adult Swedish population

A randomly selected sample of adult subjects living in a Swedish county was examined for the presence of oral mucosal lesions. Nine hundred twenty (920, 95%) of the selected sample of 967 subjects, comprising approximately 0.75% of the total adult population, were examined; lesions were registered in 596 of the 920. The registered prevalence levels were very similar to earlier reported data from Sweden. Further, the relationship between tobacco habits and mucosal lesions was analyzed and the time needed for treatment of the lesions was estimated. A positive correlation could be demonstrated between tobacco use and leukoplakia, frictional white lesion, coated tongue, hairy tongue and excessive melanin pigmentation, while a negative correlation was observed for geographic tongue and aphthous ulcers. Approximately 70% of the lesions were associated with local irritants (e.g. dentures, tobacco, cheek and lip biting etc.). The estimated mean time required for registration and management of oral mucosal lesions in the studied group of adults was 24 min per individual.     

Prevalence and risk indicators of oral mucosal lesions in an urban population from South Brazil

Oral Diseases (2011) 17 , 171–179 Objective: The objective of the study was to assess the prevalence of oral mucosal lesions (OML) and to perform a multivariable risk assessment of demographic, socioeconomic, behavioral, and oral risk indicators for its occurrence in an urban population in South Brazil. Methods: This cross‐sectional study selected 1586 subjects (719M/867F, age: 14–104 years) using a multistage probability sampling strategy (65.1% response rate). Prevalence, odds ratios (OR), and confidence intervals (95% CI) were calculated accounting for the survey design. Results: Leukoplakia and lichen planus were observed in 1.01% and 1.02% of subjects, respectively. In the multivariable analysis, these lesions were significantly associated with moderate/heavy smoking (OR = 9.0, 95% CI = 2.1–39.1) and heavy drinking (OR = 2.0, 95% CI = 1.1–3.7). Candidiasis and proliferative lesions were observed in 14.09% and 3.80% of the subjects, respectively. These lesions were significantly associated with female gender (OR = 2.2, 95% CI = 1.5–3.2 and OR = 1.7, 95% CI = 1.0–2.8), older age (OR = 22, 95% CI = 8.0–60.8 and OR = 8.9, 95% CI = 3.4–23.7), and low socioeconomic status (OR = 1.9, 95% CI = 1.0–3.5 and OR = 3.0, 95% CI = 1.2–7.2). Conclusions: This population is in need of OML prevention and treatment. Future studies should validate the findings that premalignant lesions are causally related to smoking and alcohol consumption, and that other OML are associated with socioeconomic‐demographic disparities in this and similar populations.     

The association of tobacco and other factors with recurrent aphthous stomatitis in an US adult population

OBJECTIVE: To determine point and annual prevalence of recurrent aphthous stomatitis (RAS). SETTING: Reported prevalence of RAS in textbooks and much of the literature varies according to study location, patient selection and whether point prevalence (presence of lesions at examination) or period prevalence (history of lesions during a specified period) is reported. Many studies are based on non-probability samples and this may contribute to significant variation in reported prevalence and factors presumed to be associated with RAS. METHODS: We analyzed data from the Third National Health and Nutrition Examination Survey, 1988-1994, a large United States probability sample, for RAS and covariates suggested in the literature using bivariate and multivariate logistic regression. RESULTS: Oral mucosal examinations were performed on 17 235 adults 17 years and older. Of these, 146 (0.89%) had at least one clinically apparent aphthous lesion. For annual (reported) prevalence, Whites (20.87%) and Mexican-Americans (12.88%) had several fold higher prevalence of RAS than Blacks (4.96%). Adults younger than 40 years of age had almost twice the prevalence (22.54%) of those older than 40 years (13.42%). CONCLUSION: Annual prevalence was significantly higher in whites and Mexican-Americans (compared with blacks), individuals 17-39 years of age, cigarette non-smokers, and those with recurrent herpes labialis history; while it was lower in males. Point prevalence was significantly higher in whites, Mexican-American, individuals 17-39 years of age, cigarette non-smokers, and males.     

Denture-related oral mucosal lesions in a Brazilian school of dentistry

The purpose of this study was to survey the frequency of denture-related lesions of the oral mucosa in patients treated at a Brazilian dental school and to determine if the oral lesions were related to age, sex, denture type, length of denture use and denture cleaning methods. The denture-related lesions observed in this study were chronic atrophic candidiasis, chronic hyperplastic candidiasis, denture-induced fibrous inflammatory hyperplasia (FIH), traumatic ulcer, angular cheilitis and flabby ridge. The most frequent lesion, chronic atrophic candidiasis, occurred more frequently in females, in complete maxillary denture wearers, with denture use for 16-20 years. The most common method of cleaning dentures was a toothbrush and toothpaste. These results suggest that dentures can cause a wide range of lesions of the oral mucosa, that could be prevented with follow-up to evaluate dentures and provide instructions on how to maintain oral tissues healthy.     

陕西省口腔黏膜病相关危险因素分析

目的 探讨陕西省常见口腔黏膜病发病的相关危险因素。方法 采用多阶段分层等容量随机抽样的方法,对35~44岁组792人、65~74岁组408人进行口腔黏膜病问卷调查,利用Epidata3.1软件录入数据,用SPSS13.0软件进行PearsonChi-Square分析和Logistic回归分析。结果 每天早晚二次刷牙者口腔溃疡和沟纹舌的患病率低于每天只刷牙一次者。饮食入口温度高者,口腔溃疡的患病率较高。吸烟多者口腔白斑的患病率高。结论 ①刷牙可减少口腔溃疡和沟纹舌的发生;②入口食物的温度与口腔溃疡的发生有密切的关系;③吸烟是口腔白斑的危险因素之一。     

Prevalence of oral lesions in 13- to 16-year-old students in Duzce, Turkey

OBJECTIVE: The aim of this study was to determine the prevalence of oral lesions in 13- to 16-year-old students. METHODS: A cross-sectional survey was carried out on students in Duzce, a province in the western Black Sea region of Turkey. A total of 993 children aged between 13 and 16 from eight secondary schools were examined. Oral lesions with recurrent behavior, if observed, were recorded at the time of examination. Venous blood samples were obtained for detecting hemoglobin levels. RESULTS: 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 cheilitis (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 cheilitis and anemia (P < 0.05). CONCLUSION: This study is the first epidemiologic study of oral mucosal lesions in adolescents in Turkey. Angular cheilitis was the only oral mucosal lesion that had a significant correlation with anemia.     

Association between cigarette smoking and prevalence of oral mucosal lesions among Malaysian army personnel

The association between cigarette smoking and the prevalence of oral mucosal lesions was examined in 495 Malaysian army personnel. No associations between cigarette smoking and recurrent aphthous ulcerations, pre-leukoplakia and frictional keratosis could be obtained in this study. Positive associations were found between cigarette smoking and leukoedema as well as denture stomatitis. There was a negative association between cigarette smoking and the presence of coated tongue.     

Risk of severe periodontal disease in a Swedish adult population

Abstract. In this study, potential risk factors for severe periodontal disease were identified in a cross-sectional sample from the county of Jönköping, Sweden, 547 adults 20–70 years of age were categorised clinically and radiographically by level of periodontal disease experience. These levels were used to divide the sample into groups – individuals without any reduction in periodontal bone level (60%) and those with severe periodontal bone loss (13%) – which were then used in univeriate and multivariate logistic regression analyses as dependent variable. Demographic, socio-economic, general health, smoking habits, clinical, and dental care variables were used in the different regression analyses. In the univariate model, age (20–70 years) was found to be correlated with more severe periodontal disease experience (odds ratio: 1.13; 95% CI; 1.10–1.17). The association with periodontal disease was more pronounced for the older age groups (50, 60, and 70 years), A negative financial situation was also related to severe periodontal bone loss when regressed univariately (odds ratio 2.20 [95%: 1.04–4.68]). Moderate-heavy smoking (3=10 cigarettes/day) appeared to be associated with severe periodontal destruction with an odds ratio of 9.78 (95% CI: 3.62–36.42), Of the clinical variables in the univariate model, higher mean levels of supragingival dental plaque and the presence of subgingival calculus were related to more severe periodontal disease with odds ratios of 1.02 (95%: 1.01–1.03) and 2.96 (95% 1.50–5.88), respectively When the same variables were regressed multivariately, age (continuous) (odds ratio 1.17 [95% CI: 1.12–1.22]). moderate-heavy smoking (odds ratio 11.84 [95% CI: 4.19–33.50]), and higher mean levels of plaque (odds ratio 1.02 [95% CI: 1.00–1.03]) remained significant. Light smoking (1–9 cigarettes/day) was not significantly associated with severe periodontal disease in the 2 regression models. The present study demonstrated that smoking, greater age, and higher mean levels of plaque are potential risk factors for severe periodontal disease in this specific population.     

Prevalence of oral soft and hard tissue lesions related to mechanical toothcleansing procedures

The prevalence of oral soft and hard tissue lesions related to mechanical oral hygiene procedures was recorded and correlated to toothbrushing habits and oral hygiene status in two selected samples. Fifty-one percent of 533 persons examined exhibited gingival retractions and 45% had wedge-shaped defects in the cervical area of one or several teeth. Both types of lesions were often seen in the same area, indicating a common etiologic factor. The subjects with a good oral hygiene status, as well as those who brushed more than twice daily, showed a high frequency of lesions. The various toothbrushing techniques did not, however, seem to influence the development of such lesions in the present material. Subjective symptoms were reported in a few cases only.     

Risk of severe periodontal disease in a Swedish adult population

Abstract. The aim of this study was to identify risk factors for severe periodontal disease progression in a Swedish adult population between the years 1973 and 1988–91. In 1973, a random sample of 474 dentate adults living in Jönko ping County was examined clinically and radiographically. A questionnaire on demographic and socio-economic status, general health, and dental care habits was also used. During the years 1988–1991, 361 of the individuals examined in 1973 were re-examined. A total of 506 (6%) teeth or in average 1.4 teeth per subject were lost between the 2 examinations. 4 subjects had become completely edentulous. The mean loss of teeth in the different age groups 20–60 years was 0.2, 0.9, 1.4, 2.3, and 2.6, respectively. The periodontal bone level decreased by age both in 1973 and in 1988–91. The mean annual progression rate was 0.06 mm for all 357 individuals and varied between 0.04 and 0.07 mm per subject in the different age groups. The presence of periodontal disease progression was defined as bone loss of >20% at a proximal site between the 2 examinations. The most prevalent tooth types with bone loss of >20% at proximal sites were the maxillary and mandibular 2nd molars and the 1st maxillary molar, representing a % of 18.0, 12.8, and 13.5, respectively. The degree of association between severe periodontal disease progression and explanatory variables was investigated using logistic regression models. The dependent variable was no progression of periodontal disease or severe periodontal disease progression, i.e., subjects with periodontal bone loss >20% at ≥6 sites. Age was found to be correlated with severe periodontal disease progression by an odds ratio of 1.05 (CI: 1.02–1.07). The frequency of females in the group with severe bone loss was 58% and higher than in the non-progressing group, 50%. Only 9% in the group with no bone loss smoked as compared to 38% in the group of individuals with severe periodontal bone loss. % supragingival plaque, gingival inflammation, and deepened periodontal pockets (≥4 mm) at baseline were related to severe periodontal disease progression by odds ratios of 1.03 (CI: 1.02–1.05), 1.01 (1.00–1.03), and 1.03 (1.00–1.05), respectively. In the multivariate logistic regression model, age (odds ratio 1.13 (CI: 1.06–1.19)), smoking (odds ratio 20.25 (5.07–80.83)), and % pockets ≥4 mm (odds ratio 1.15 (1.04–1.27)) remained significantly associated with severe disease progression. Furthermore, female gender and differences in income level appeared in the multivariate analysis to be related with severe bone loss, with odds ratios of 3.19 (CI: 1.02–9.97) and 8.46 (CI: 1.97–36.37), respectively.     

Risk factors for developing apical periodontitis in a general population

AIM: To identify and describe individual and tooth-specific factors associated with the incidence or the persistence of apical periodontitis (AP) in a general population. METHODOLOGY: In 1997, 616 randomly selected individuals had a full-mouth radiographic survey. In 2003, 77% of the participants returned for a new full-mouth radiographic examination. All teeth were assessed individually and data recorded for caries, marginal bone level, and tooth restorations. Multiple logistic regression analyses were performed to identify predictors of AP in the individual. Conditional logistic regression analyses were used to identify risk factors for development of AP in a tooth. Independent variables included a number of individual and tooth-specific variables. RESULTS: Root fillings, coronal restorations, primary carious lesions, and reduced marginal bone level were associated with the incidence of AP in the individual. In teeth, the quality and presence of a coronal restoration was associated with the incidence of AP, and presence of a root filling also increased the risk of developing AP. Furthermore, an increased risk of developing AP was seen in relation to primary carious lesions, reduced marginal bone level, and molar teeth. The quality of the root filling was not associated with the incidence of AP, but the results suggest an association between the quality of the root filling and the healing of AP. CONCLUSIONS: Results from the present study demonstrate that it is important to provide high quality dental restorations to minimize the risk of pulpal infection. The clinical focus, in relation to the incidence of AP, should be on improving the quality of the coronal restoration. The quality of a root filling was not associated with the incidence of AP, but may be of importance in relation to healing of AP.     

Risk factors for dental caries in the five-year-old South Australian population

BACKGROUND: This study tested the hypothesis that risk behaviours in disadvantaged groups would explain socio-economic inequality in dental caries prevalence among preschool children. METHODS: Using a case-control study, children with caries experience (one or more decayed, missing or filled primary tooth surfaces) and with no caries experience were sampled with known probabilities from among five year olds attending the South Australian Dental Service (SADS). Dental caries experience of primary teeth was recorded by SADS clinicians. Social and behavioural information was collected using a questionnaire mailed to parents. Prevalence rates, prevalence ratios (PR) and 95 per cent confidence intervals (95% CI) were computed, taking into account sampling probabilities. RESULTS: Questionnaires were obtained for 64.6 per cent of sampled children (n = 1398) and 40.2 per cent (95% CI = 37.8-42.6) of them had caries experience. Five statistically significant risk factors were identified relating to previous feeding, current oral hygiene and parent's own oral health perceptions. The prevalence of four risk factors was greater in low-income households compared with high-income households (P < or = 0.01). In multivariate analysis, after adjusting for age of tooth cleaning onset, age at which toothpaste was introduced was not significantly associated with caries prevalence. Behavioural risk factors did not explain income-related gradients in caries prevalence but modified the level of risk associated with delayed onset of tooth cleaning. Children who delayed tooth cleaning until the age of 24 months or more and who were from low-income households had a 2.7-fold increase in caries prevalence (95% CI = 2.1-3.4). CONCLUSIONS: Caries prevention efforts need to target behaviours in infancy and non-behavioural risk factors among preschoolers in low-income households.     

Prevalence of oral mucosal lesions in alcohol misusers in south London

BACKGROUND: Information on alcohol-associated oral mucosal lesions (OMLs) and conditions is meagre. A prevalence survey among alcohol misusers in south London was therefore undertaken. METHODS: Six hundred and ninety-three subjects (388 alcohol misusers 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 Axéll. RESULTS: 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 OMLs were found in 195 subjects (28.1%). The highest prevalences were found for frictional keratosis (8.8%), scar tissue of the lips (4.8%) and candidiasis (3.8%). Angular cheilitis was present in 21 subjects (3.0%). The alcohol-related OMLs detected were three white patches compatible with a diagnosis of leukoplakia and one treated oral carcinoma. No erythroplakias were detected. The differences in prevalence of mucosal lesions in the two groups were not significant (chi(2) = 2.18; P = 0.14). The prevalence of tobacco smoking was high in both study groups. OMLs 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 OML. In the logistic regression analysis, minority ethnic groups (Black or Asian), smokers, those with a body mass index (BMI) under 20 and beer drinkers had an increased risk of an OML in this group of alcohol misusers. CONCLUSIONS: 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.     

Risk factors for oral hairy leukoplakia in HIV-infected adults of Brazil

BACKGROUND: Oral hairy leukoplakia (OHL) may be an indicator of the progression of Human Immunodeficiency Virus (HIV)-induced immuno-depression, and the evaluation of risk factors leading to OHL is important in the management of these HIV-infected patients. However, there are few studies that analyze risk factors leading to OHL in the Brazilian population. The aim of this case-control study is to present data about prevalence rates and risk factors leading to OHL in a sample of HIV-infected adults in Brazil. METHODS: This case-control study included 111 HIV-infected patients treated at a clinic for sexually transmitted diseases and HIV. In the initial examinations with dentists, variables were collected from all patients. Diagnosis of OHL was performed in accordance with the International Classification System and cytological features. The Fisher and the chi-squared tests were used for statistical analysis. The proportional prevalence and odds ratio were estimated. RESULTS: Outcome presented a positive, statistically significant association among the presence of OHL and viral load of 3000 copies/mul or greater (P = 0.0001; odds ratio (OR) = 5.8), presence of oral candidiasis (P = 0.0000; OR = 11.1), previous use of fluconazole (P = 0.0000; OR = 24.6), and use of systemic acyclovir (P = 0.032; OR = 4.3). Antiretroviral medication presented a negative, statistically significant association with the presence of OHL (P = 0.002; OR = 8.4). CONCLUSIONS: Prevalence of OHL was 28.8%. Viral load, oral candidiasis, previous use of fluconazole, and systemic acyclovir were determined to be risk factors for OHL. Antiretroviral medication proved to be protective against the development of OHL.