THE PREVALENCE OF ORAL MUCOSAL LESIONS in MORADABAD - UTTAR PRADESH BY - DR. ANAND PRATAP SINGH SPONSERED BY: - RURAL DENTAL SOCIETY FOR ORAL DISEASE PREVENTION AND CURE - LUCKNOW

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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
ci in the subject of lso ta n ORAL MEDICINE AND RADIOLOGY de al r ru Year -2010 w. ww
Master of Dental ety Surgery
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KOTHIWAL DENTAL COLLEGE AND RESEARCH CENTRE MORADABAD, U.P. , INDIA
The Prevalence Of Oral Mucosal Lesions In Patients Visiting A Dental College In Moradabad, India
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
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Dr. Anand Pratap Singh
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
DATE:
ety ci o lsSUMA DR. G. a N. nt e ld Professor ra Department of Oral Medicine and Radiology .ru ww w
CO- SUPERVISOR
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DR. RAVI PRAKASH S.M. Associate Professor Department of Oral Medicine and Radiology
DATE:
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.
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H.O.D.
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Seal and Signature of the Principal
DR. OMPRAKASH D. TOSHINIWAL DATE:
DR. SANJAY SINGH DATE:
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
y etinspiration. I consider it my privilege ci and expert evaluation has been a continuous source of lso to work under her supervision. Her incessant encouragement and constructive criticism a nt and originality has triggered and nourished helped me to finish this project. Her involvement e ld from, for a long time to come. my intellectual maturity that I will benefit ra .ru A teacher is a compass that activates the magnets of curiosity, knowledge, and ww wisdom in the pupils. It is my immense pleasure to have the opportunity to convey my w
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
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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, R., Senior lecturer, Dept of Pedodontics and Preventive Dentistry, Dr. Chaitra T. Dr. Monika and Dr.
Rajesh Bansal, Faculty of Dental Science, B.H.U., Varanasi for their encouragement and 5
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
m co Dr. Sumit, Dr. Vivek, Dr. Dr.Kaushik Dutta, Dr. Kuber, Dr. Sayan, Dr. Amit, . ty assistance, without their help, Amrendra, Dr. Sharib and Dr. Abhishek for theire ci Ivaluable all the success. this work would not have been accomplished in so l time. wish them a nt Mishra, Director, Dr. Sanjay Singh, Principal, I am sincerely grateful to Mr. K.eK. d Mr. Sanjay Sinha, Adminsrtative Officer and Mr. Jeet Singh, Warden for their benevolence al r in providing me a platform on which this study was made possible. ru w. the help of Mr. Gurinder Singh for his statistical jobs. I gratefully acknowledge ww
Dhillon and Dr. Sumit Goel, my batchmates- Dr. Sankalp, Dr. Navneet and my juniorsThere 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
CONTENTS
S.NO 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. CONTENTS Acknowledgement List of Figures List of Tables List of Graphs List of Abbreviations List of Appendices Abstract Introduction PAGE NO. v- vi viii-ix x xi xii
Aims and Objectives Review of Literature
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Materials and Method Results
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xiii xiv- xv 1-3 4 5-26 27-34 35-67 68-86 87 88-89 90-94 95-102
Discussion Conclusion Summary Bibliography Appendices
LIST OF FIGURES
S. No Fig. 1 Fig. 2 Fig. 3 Fig.4 Fig.5 Fig.6 Fig.7 Fig.8 Fig.9 Fig.10 Fig.11 Fig.12 Fig.13 Fig.14 Fig.15 Fig.16 Fig.17 Fig.18 Fig.19 Fig.20 Title of figures Armamentarium Used For Clinical Examination Armamentarium Used For Radiographical Examination Armamentarium Used For Biopsy Procedure Aphthous stomatitis Fordyce's condition Page No. 32 33 34 60
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ety Linea Alba Buccalisi c so l Fissured tongue ta en Candidisais d al rLeukoedema ru .

Traumatic Ulcer Herpes labialis Pyogenic granuloma Lichen planus Coated tongue Tongue pigmentation Betel chewers mucosa
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60 60 60 60 60 61 61 61 61 61 61 62 62 62 62 62
Primary Herpetic Gingivostomatitis
Median Rhomboid Glossitis Squamous papilloma Frictional Keratosis
Fig.21 Fig.22 Fig.23 Fig.24 Fig.25 Fig.26 Fig.27 Fig.28 Fig.29 Fig.30 Fig.31 Fig.32 Fig.33 Fig.34 Fig.35 Fig.36 Fig.37 Fig.38 Fig.39 Fig.40 Fig.41 Fig.42 Fig.43 Fig.44 Fig.45 Fig.46
Smoker's palate OSMF Atrophic glossitis Tobacco pouch keratosis Peripheral giant cell granuloma Mucocele Sublingual varices Thermal Burn Geographic Tongue Commissural Pit
62 63 63 63 63 63 63 64 64
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Chemical Burn Denture Stomatitis Eruption Cyst Leukoplakia Parulis Hairy Tongue Hematoma Herpes zoster Ranula
ety ci Lichenoid reaction lso a Vitiligo nt e ld cheilitis Angular ra .ru Myolipoma

SCC
Traumatic Fibroma
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64 64 64 64 65 65 65 65 65 65 66 66 66 66 67 67 67
LIST OF TABLES
S. No. Table I. Table II. Table III. Table IV. Table V. Table VI. Table VII. Table VIII. Table IX. Table X. Table XI. Table XII. Table XIII.
List Of Tables
Demographic Data And Dentate Status of 5203 Patients Prevalence Of Habit In Different Demographic Locations Prevalence Of Habit In Different Age Groups Prevalence Of Oral Mucosal Lesions With Gender
alOral Mucosal Variants Prevalencer Of ru Prevalence Of Oral Mucosal Abnormalities w. ww Of Lesions According To Age Groups Prevalence
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Page No. 40-41 42 43 43 44 45-48 49 50 51 52 52 53 53
Prevalence Of Oral Mucosal Lesions In Different Demographic Locations Prevalence Of Oral Mucosal Lesions With Different Type Of Habits Prevalence Of Tobacco Related Oral Lesions Prevalence Of Oral Mucosal Lesions According To Dentate Status Prevalence Of Oral Mucosal Lesions In Relation To The Prosthesis Prevalence Of Oral Lesions According To Systemic Health Status
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LIST OF GRAPHS
S. NO. Graph I. Graph II. Graph III. Graph IV. Graph V. Graph VI. Graph VII. Graph VIII. Graph IX.
LIST OF GRAPHS Prevalence Of Habit In Different Demographic Locations Prevalence Of Oral Mucosal Lesions With Gender Prevalence Of Oral Mucosal Lesions According To Age Groups Prevalence Of Oral Mucosal Lesions In Different Demographic Locations
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Prevalence Of Oral Mucosal Lesions With Different Type Of Habits
ety ci lsoOral Lesions Prevalence Of Tobacco Related a nt e ld Lesions According To Prevalence Of Oral Mucosal ra Dentate Status .ru Mucosal Lesions According To Prevalence Of Oral ww Prosthesis w
Prevalence Of Oral Mucosal Lesions According To Health Status
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LIST OF ABBREVIATIONS
SCC OSMF M F ST SLT Yrs % Fig. Pts < > i.e RPD FPD
Squamous Cell Carcinoma Oral Sub Mucous Fibrosis Male Female Smoking Tobacco Smokeless Tobacco Years Percentage Figure
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Patients Greater than That is
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Removable Partial Denture Fixed Partial Denture
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LIST OF APPENDICES
S. NO. 1. 2.
LIST OF APPENDICES CASE HISTORY PROPORMA CONSENT FORM
PAGE NO. 95-100 101-102
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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.
ety ci so 5203 patients, who visited the department lof oral medicine for diagnosis of various a nt examined for oral mucosal lesions. All the complaints over a period of three months, were e ld in the study. Patients from 2-80 years were patients were taken consent to participate ra ru .divided in to four groups: group I (02-20 years), group II (21included in the study and were w wyears) and group IV (61-80 years). The examination consisted of w 40 years), group III (41-60
Materials and Method:
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
ety ci lso found to be statistically highly significant (p 0.001). a nt e Conclusion: ld ra .ru of Oral Mucosal Lesions (OML's) in patients attending This study establishes the prevalence ww w
smokeless tobacco users versus no habit and smoker versus smokeless tobacco users was outpatient department of Kothiwal Dental College and demonstrates that smoking, tobacco chewing and increasing age is associated with greater occurence of Oral Mucosal Lesions.
(13.83%). The comparison of prevalence of oral mucosal lesions in smokers versus no habit,
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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
ety ci the environment of the oral cavity like mechanical forces (biting, chewing etc), surface lso a abrasives and toxic effects of toxins released by the micro-organisms. The oral mucosa nt e ld that significantly affect the general health of the performs essential protective functions ra patient . Besides dental caries rand periodontal diseases, oral mucosal lesions are another .u wwhealth importance . significant problem of public w
health of the patient. The oral mucosa separates and protects deeper tissues and organs from
2 [2]
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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,
m co when localized in the oral . frequently in the mouth. Others having symptomatic significance ty i corechronic general disease and elicit such cavity appear as a partial manifestation of an acute lso a characteristic oral changes that they are of great importance for diagnosis. nt e ld ra .ru Diagnosis of the wide variety of lesions that occur in the oral cavity is also an essential part ww w
others may involve other parts of the body. However, they localize preferentially and 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.
ety ci lso a Hence, the need arises for more such prevalence studies. This study is undertaken to evaluate nt e ldin patients who visit the department of oral medicine the prevalence of oral mucosal lesions ra and radiology, Kothiwal Dental College, Moradabad, UP, India, to obtain a data useful for .ru w wof oral health care in this region. further planning w
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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
.r3uyears of age) needs exploration. The occurrence of among the very young (2 to ww w
median rhomboid glossitis in young children is compatible with its supposed
according to age or sex, although the possibility that it may be significantly greater
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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.
m co older than 14 years of tissue lesions in Swedish population. A total 8,696 . tysubjects, ie age in two communities, Habo aud Enkoping,oc included in this study. were s al t A pretyped questionnaire was used ton data about tobacco and alcohol habits and get e ld other relevant parameters. The ra examination of the oral cavity and the lips were made ru with the aid of a dental . mirror and a wooden spatula using light from a dental ww hygiene status and the presence of various dental filling operating lamp. The oral w
Tony Axell
[9]
, an epidemiologic study was done to assess the prevalence of oral soft
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, 23 Leukoplakia 272,
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,
ety was no habit and no lesion, in divided in to four groups, in group 1(n=6677), i c there lso group II (n=388), there was no habit but lesions were present, in group III (n=20568), a nt in group IV (n=16021), both the habit and e there were no lesion but habit was present, ld a lesion were present. In this rstudy they found that oral sebaceous glands were u .r(24.9%) out of the study population of 43654 industrial prevalent in 10870 persons ww workers. They alsow found that the highest prevalence of 42.6% was absorbed among
was done to determine the occurrence of oral sebaceous glands. The subjects were 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. 24
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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.
ety ci lso They concluded that the high significant relation between smokers and lesion supports a ntoral leukoplakia. e the strong relation between smoking and ld ra .ru w,wa study on randomly selected Israeli Jews to determine Meir Gorsky et al. w
[12]
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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 25
women (9.2% unilateral and 5.9% bilateral). predilection for males with P value <0.001.
They also found a significant sex
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
ety ci buccal sulcus. Denture wearers had a highero ls prevalence or number of oral mucosal a lesions between those defined as users of tobacco and alcohol and those defined as nt e ld oral malignancies were found. nonusers in the study. No confirmed ra .ru ww w
palatal mucosa, and denture-induced hyperplasia in maxillary and mandibular
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G. Campisi & V. Margiotta
[14]
, a randomly selected study on 118 male subjects presence of oral mucosal lesions, with
(age 40 years) was done to evaluate
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).
m coother oral diseases. . drinking were not only for oral cancer, but also for many ty cie lso a nt study of aging Germans to determine e Peter A. Reichart , in a cross-sectional ld ra prevalence of oral mucosal lesions in 5040 subjects, 223 samples were dropped out ru .The net random sample was 3065, the group of adolescent for quality-natural reason. ww w (1043) was not included for screening. Total 2022 individuals were divided in Group I
They concluded that the main risk factors tobacco smoking and/or alcohol
[4]
(35-44 yrs, n=655) & 1367 were in group II (65-74 yrs). He found labial herpetic lesion (31.7%), Fordyces granules (22.6%), recurrent aphthous stomatitis (18.3%), lip & cheek biting (10.1%) in group I, and in group II he found Fordyces 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 1995August 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 1383 years, mean age 36.2
ety ci They found hairy tongue (n= 581), coated tongue (n=1197), fissured tongue (n=1028), lso (n=62), median rhomboid glossitis papillary atrophy (n=147), geographic ta n tongue e (n=13), crenation tongue (n=63), macroglossia (n=64) and, ankyloglossia (n=4). ld ra .ru They also found out of the 5150 subjects, 2690 subjects were detected as having w wprevalence of 52.2%, 44.2 and 62.0% for women and men, tongue lesions with a w
0.28) dental outpatients were included in this study. 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.
ety They found that weighted prevalence of OL were 0.660.14% in males, 0.210.05% ci lso in females and 0.420.08% in total. The age peaks were at 40-49 years in males and at a nt e 70 years in females. ld ra They also found that the prevalence estimates were 0.37% for homogeneous OL and .ru 0.06% for non-homogeneous OL. Gingiva (38.8%) and buccal mucosa (30.9%) were ww w
the most frequent locations. They concluded that there was a substantial decline in prevalence of Leukoplakia compared to previous studies in the USA.
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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 29
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 patients 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.
ety (388alcohol misuse's and London was done on Six hundred and ninety-three subjects ci so 305 alcohol + substance abuse) attending l several clinical care facilities in south a nt e London between 1994 and 1999 were interviewed on their alcohol and drug habits. A ld ra comprehensive oral mucosal examination was performed, and soft tissue lesions found .rucriteria of Axles. were classified by the clinical ww w
, in a prevalence survey among alcohol misuse's in south
[18]
m co .
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 twentyseven 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;
30
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 595 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 denturerelated 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%).
ww
.ru w
al r
en d
ety ci lso ta
m co .
31
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 Goncalves 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.
alwas no statistically significant difference between r 1.1% in the control group. There ru . the 2 groups (P = .63). w They concluded that there was no association between OLP ww
They found that the prevalence of OLP was 1.5% in patients with HCV infection and 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 32
en d
ety ci lso ta
m co .
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 (I89%), 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
ety ci so lsurvey of 993 children aged between 13a AH Parlak et al. , in a cross-sectional nt e 16 years from eight secondary d l schools in Duzce, Turkey, to determine the rafound that, Two hundred sixty adolescents (26.2%) prevalence of oral lesions. They .ru were diagnosed with at least one oral mucosal lesion at the time of the ww w
[22]
those for children and youths (0.97% and 2-05%, respectively).
m co .
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.
33
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% chewers mucositis, 0.55% oral sub
ety ci 0.15% lichen planus and 0.05% mucous fibrosis, 0.25% median rhomboid glossitis, lso a candidiasis. nt e ld ra They concluded that Smokers were more likely to develop smoker's melanosis u .rAmong those who consumed alcoholic beverages alone, compared to other lesions. ww w 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.
m co .
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
34
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
m co and surgery (19.4% . and vascular malformation was managed with sclerotherapy ty each). cie lso a They concluded that benign vascular lesions are unusual alterations on the oral nt e ld mucosa and jaws. ra .ru ww w
malformation, in the lips. Oral hemangioma was treated with sclerotherapy (54.5%), 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 1996 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.
35
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), Smokers palate 6 (0.15) They concluded that the overall OML prevalence was linked to risk habits and age.
m co aphthous stomatitis and lesions and papilloma. It was negatively related to y. t recurrent oral lichen planus. Alcohol was linked to leukoplakia, frictional lesions and median cie lso was linked to frictional lesions, rhomboid glossitis. The tobaccoalcohol a nt association e leukoplakia, melanin pigmentation and smokers palate. Denture wearers had an ld ra in particular candidiasis, traumatic and frictional overall higher prevalence of OMLs, .ru lesions. ww w
Tobacco was linked to leukoplakia, melanin pigmentation, smokers palate, frictional 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 noninstitutionalized 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
36
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
ety ci 2003 from the department of oral diagnosis and medicine, dental school, Leon, lso a nt they found that among 23785 patients Maxico, to report the oral mucosal e lesions, ld ra the general lesion rate was 356.60 per 1000 patients. Lesions were more common .ru and a three-fold greater risk of developing among males (male:female=1.4:1) ww w mucosal lesions was recorded among the males compared with the female
examined data of 23785 patients,15-79 years of age from January 1982 to December 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.
[5]
m co .
, in a cross-sectional study of
37
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
ety ci was a high proportion of heavy nonsmokers. Among the current smokers,so l there a smokers (21 or more cigarettes/day). The habit of tobacco chewing was present in 123 nt e ld chewing was more prevalent in males than in subjects. The frequency of tobacco ra u females (98 males and 25 .r females) and was more prevalent in the 21-40 age-groups. ww number. Ex-pan chewers were 21 in w
(9.7%) were presently smokers, 22 (1.9%) were ex-smokers, and 1053 (88.4%) were 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
edentulous (1.1%). Forty-five subjects were denture wearers. One hundred and fifteen
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38
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
ety stress in Rajasthan, India. Mines laborer and uncover its relation with occupational ci lso Workers were divided in to four age groups- 15-24, 25-34 , 35-44, 45-54 years. a nt e They found that overall elevatedld prevalence of all three oral-mucosal lesion was ra (36.7%), mainly leukoplakia affecting 171 mine workers (33.3%). The affected .ru w workers were having w body problems like headache, backache and stressed due to w
leukoplakia, oral sub mucous fibrosis and papilloma among 513 Green Marble 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. 39
m co .
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.
ety ci lso They concluded that most of the diabetic patients presented at least one type of oral a nt can be associated with the fact that these e mucosa lesion or alteration. Such alterations ld ra conditions are commonly found in senile patients and are also associated with .ru prolonged wear of dentures. ww w
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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40
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%), Traumtic 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%),
ety ci lso factor determining the quality of life a They concluded that oral health is an important nt de in aged individuals. The role lof the dentist and stomatologist includes the ra and pharmacological oral manifestations in order management of systemic, nutritional .ru to establish an early diagnosis and subsequently an accurate treatment. ww w
overgrowt hyperplasia 10 (50%). Azizah-Al-Mobeeriek A et al.
[31]
Papiloma 2 (1%),
Pseudomembranous Candidiasis 10 (50%),
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Ginigival
, 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.
41
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
ety citypes and prevalence of oral lesions They concluded that provide information on o ls the a among Saudi dental patients will provide baseline data for future studies about the nt e ld population. prevalence of oral lesions in the general ra .ru ww w
nicotinic stomatitis (0.5%; n=13). Ali-Rza-lker Cebeci et al.
[1]
m co .
, 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
42
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.
ety ci health studies. mucosal lesions will help in planning of future oral lso a nt e ld ra Jahanfar Jahanbani et al. ru, a study was done to determine the prevalence of oral w. to age, gender, occupation, education, smoking habits, mucosal lesions in relation ww
They concluded that provided information about the epidemiologic aspects of oral
[32]
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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
43
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.
m cothe prevalence of recurrent . Rima Ahmad Safadi , a study was done to access ty ie aphthous ulceration among out patients at c Jordan University of Science and o lsJordan. 684 participants were included in a Technology's Dental Teaching Centre, Irbid, nt e the study. About 45% of participants were males and 55% were females. ld ra .ru They found that about 78% of subjects experienced recurrent aphthous ulceration. w wulcers were less than one cm in diameter, 66% were circular in Approximately 85% of w
[33]
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. 44
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
ety (OHI), age, smoking, and variables for this study were OML, Oral Hygiene Index ci so alcohol misuse (type and units consumed al duration of misuse). and nt e They found that out of the 500 patients, 77% were in the 25-44 years old age group ld ra and 84% were married. Thermean age of initiation of alcohol misuse was 34 years. In .u w addition to alcohol, w 72% smoked tobacco and 96% used other psychoactive w
500 consecutive alcohol misusers were examined by qualified dental surgeons and the 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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45
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
ety ci Lesions were present in 27 men (92%) and most chewers (65%) were women. lso a (33.34%) of subjects with smoking tobacco habits and 8 (25%) of them with chewing nt e ld5.51 times more likely to have lesions than those habits. Subjects with smoking were ra .ru who did not smoke. Patients with chewing habits were 2.89 times more likely to have ww who did not chew tobacco which was statistically lesions than their counterparts w
(6%) of the subjects consumed chewing tobacco in any forms. Most smokers were 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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46
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,
ety ci 1272(42%) tobacco chewers, the habit of tobacco use, 635(21%) wereso l smokers, a 341(11%) smokers and chewers, while 1464(48%) neither smoked nor chewed. 256 nt e ld mucosal lesions. Of these, 216 cases agreed to patients were found to have significant ra .ru undergo scalpel biopsy confirmation. 88 had leukoplakia, 21 had oral sub mucous ww melanosis, 6 patients had lichen planus, 17 had dysplasia, fibrosis, 9 showed smokers w
associated with prosthetic use, trauma and tobacco consumption. With reference to 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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47
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:
ww
.ru w
al r
en d
ety ci lso ta
m co .
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. 48
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. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.
Dental chair with illumination light Kidney Trays Sterile Straight Probes and Mouth Mirrors
ety Tweezers ci lso Sterile Gauze Pieces a nt e ld Sterile gloves ra u Sterile r .Mouth Masks ww blade Tongue w
Cotton Holder with Cotton Dettol soap. Big steel tray. Chittel forceps. Korsolex Disinfectant
m co .
Sterile Stainless Steel divider and scale Digital camera (Sony cyber-shot W-120, 7.2 mega pixels).
49
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 3141mm) 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
ww
.ru w
al r
en d
ety ci lso ta
m co .
10. Tissue holding forceps 11. Syringe

Infection Control All autoclaved instruments were used and adequate number of each instrument was taken.
50
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
ety ci as chewers. chewing tobacco in any form were considered lso a History was obtained from parents or relatives for patients who were not able nt de lto age or disease. to communicate either due ra All the lesions werer recorded by digital camera (SONY, cyber-shot W-120, .u wwand the identification of lesion was done according to 7.2 mega pixels) w
year were considered as smokers. Patients consuming more than 5 pouches of 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.
m co .
51
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:
ww
.ru w
2
al r
en d
ety ci lso ta
m co .
(O E ) 2 E
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
52
ARMAMENTARIUM
ww
.ru w
al r
en d
ety ci lso ta
m co .
FIG I: ARMAMENTARIUM USED FOR CLINICAL EXAMINATION
53
ww
.ru w
al r
en d
ety ci lso ta
m co .
FIG II: ARMAMENTARIUM USED FOR RADIOGRAPHICAL EXAMINATION
54
ww
.ru w
al r
en d
ety ci lso ta
m co .
FIG III: ARMAMENTARIUM USED FOR BIOPSY PROCEDURE
55
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
m coand 1233 subjects [23.70%], . of subjects in each were as follows: group I [2-20 years] ty ie age group II [21-40 years] and 2625 subjects c [50.45%], age group III [41-60 years] lso years] and 246 subjects [4.73%]. 1099 subjects [21.12%], age group IVa[61-80 nt e Majority of the patients were fromd l rural area [44.23%] followed by urban [32.98%] ra and periurban [22.79%]. ru w. Among the patients visiting the outpatient department 3451 (66.33%) of them were ww
the study population ranges from 2-80 years. The different age groups and the number 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 56
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
ety ci group 1 (00.73%). This table also group 2 (13.98%), age group 4 (02.03%) and age lso a shows that 0.23% population in age group 2 and 0.73% population in age group 3 nt e ld and smokeless). uses tobacco in both forms (smoking ra .ruLesions with Gender [Table IV and Graph II] Prevalence of Oral Mucosal ww Shows that overallw 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 Fordyces granules 1.48% (77),
m co .
57
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%), smokers 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%),
ety ci denture stomatitis 7 (0.13%), mucosa 8 (0.15%), papillary hyperplasia 7so l (0.13%), a pyogenic granuloma 7 (0.13%), Candidiasis 6 (0.12%), gum boil 6 (0.12%), black nt e ld stomatitis 4 (0.08%), lichenoid reaction 2 hairy tongue 4 (0.08%), acute a r herpetic u . sq. (0.04%), vitiligo 2 (0.04%),r cell carcinoma 2 (0.04%), mucocele 2 (0.04%), ranula ww(0.04%), chemical burn 2 (0.04%), eruption cyst 2 (0.04%), 2 (0.04%), thermal burn 2 w
tongue pigmentation 11 (0.21%), median rhomboid glossitis 8 (0.15%), betel chewer 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%).
m co .
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).
58
Prevalence of Oral Mucosal Lesions in Different Demographic Locations [Table VIII and Graph IV] Shows the prevalence of oral mucosal abnormalities according to different sociodemographic 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
edoynot have any deleterious habits who uses smokeless tobacco (24.89%) and who it c so lesions among the groups of smoking l (13.83%). The comparison of the prevalence of ta n versus no habit, smokeless tobacco e versus no habit and smoking versus smokeless d al highly significant (p 0.001). r tobacco was found to be statistically ru w. Oral Lesions [Table X and Graph VI] Prevalence of Tobacco Related ww
been shown that patients habitual of smoking have higher oral lesions (43.00%) than Shows the prevalence of tobacco related oral lesions and its relation to tobacco habits. Smokers 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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59
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]
ety (100%) followed by denture prosthesis users have higher prevalence of lesions ci lso wearers (31.75%), RPD wearers (10.27%), and FPD wearer (5.43%). Patients using a nt lesions and type of prosthesis wise e no prosthesis have 17.35% oral mucosal ld ra prevalence was also statistically significant (p < 0.001). .ru Prevalence of Oral Lesions According To Systemic Health Status [Table XIII ww and Graph IX] w
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).
Shows the prevalence of oral mucosal lesions in relation to the prosthesis used. Faulty
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60
TABLES Table I. DEMOGRAPHIC DATA & DENTATE STATUS OF 5203 PATIENTS

AGE GROUP (YEARS) No. M 751
SEX
1 (2-20)
2 (21-40)
3 (41-50)
4 (61-80)
TOTAL
GRAND TOTAL
No. 1649 976 372 320 734 245 543 411 1337 710 310 266
No. 630 469 113 107 36 12 481 350 105
No. 103 143 16 47 10 45
No. 3133 2070 963 753 833 353
% 60.22 39.78 56.12 43.88 70.24
No.
482
5203
100
M 462
URBAN
F
PERIURBAN
279
1716
32.98
M 53 F
RURAL
51
M 236 F
DANTATE PATIENTS
152
M 750 F 480
M 01
PARTIALLY EDENTULOUS
02
M 00
COMPLETE EDENTULOUS
w 02
00 00 00 00 00
ww
d al 513 ur .r 399
63 12 07 00 00 00 00 618 462 530 414
om29.76 c 77 1337 y. 58.11 iet c 964 41.89 51 so 2196 63.63 l 04a t en 02 1255 36.37
40 54 59 87 00 00 00 00 44 56 91 100 864 721 73 94 43 01 224 183 2793 1792 2974 1925 54.51 45.49 43.71 56.29 97.73 2.27 55.04 44.96 60.92 39.08 60.71 39.29
1186
22.79
2301
44.23
3451
66.33
1585
30.46
00
167
3.21
M 43
DECIDIOUS DENTITION MIXED DENTITION
01
44
0.85
M 224 F 183
407
7.82
M 484
PERMANENT DENTITION NO PROSTHESIS USER
1665 976 1602 929
298
4585
88.12
M 751 F 482
4899
94.16
61
M 00
DENTURE WEARER
01 00 01 45 44 02 01 00
04 05 48 50 46 00 02 00
10 43 02 00 00 00 00 00
15 48 51 95 90 02 03 00
23.81 76.19 34.93 65.07 97.83 2.17 100 00 03 0.06 92 1.77 146 2.80 63 1.21
00
M 00
RPD WEARER
00
M 00
FPD WEARER
00
FAULTY PROSTHESIS
M 00 F 00
M= Male, F= Female
ww
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al r
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ety ci lso ta
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62
Table II. PREVALENCE OF HABIT IN DIFFERENT DEMOGRAPHIC LOCATIONS

TYPE OF HABIT SEX URBAN (n=1716) No. % 814 47.43 PERIURBAN (n=1186) No. % 574 48.40 RURAL (n=2301) No. % 1007 45.76
M NO HABIT 4352 (83.64%) F
702
40.91
346
29.17
909
39.51
TOTAL
M+F
1516 46
88.34 2.68 2.91 5.59 5.65 0.06
920 187 06 193 68
77.57 15.76 0.51 16.27
1916 114 55 169 212 00 212 04 00 04
83.27 4.95 2.39 7.34 9.22 00 9.22 0.17 00 0.17
SMOKELESS TOBACCO
458 (8.80 %)
M 50 F M+F 96 97 5.74 m co . 0.08 5.82 0.34 00 0.34
TOTAL
SMOKING
379 (7.28%)
M 01 F M+F 98 06
TOTAL
SMOKING + SMOKELESS TOBACCO
14 (0.28%)
TOTAL
wwM + F w
F
.ru
al00 r
06
en d
e01y it c so 69 l 5.71 ta
0.36 00 0.36 04 00 04
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.
63
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) 2 (21-40) (n=2625) 3 (41-60) (n=1099) 4 (61-80) (n=246)
045
03.65
009
00.73
00
0.00
054
04.38
1179
95.62
104
03.96
367
13.98
06
0.23
477
18.17
2148
81.83
210
19.11
077
36.67
08
0.73
295
26.84
0804
73.16
020
08.13
005
02.03
00
0.00
ty e0.27 851 16.36 4352 83.64 458 14 i TOTAL 379 07.28 08.80 c (5203) so l ta ST= Smoking, SLT= Smokeless en d al r ru w. OF ORAL MUCOSAL LESIONS WITH GENDER Table IV. PREVALENCE ww
GENDER
Total No. OF PATIENTS
25 m .co
10.16
0221
89.84
No. OF LESIONS
769 (69.85%) 332 (30.15%) 1101 (100 %)
NO OF PATIENTS WITH LESION 590 (18.83%) 303 (14.64%) 893 (17.16%)
OVERALL PREVALENCE
MALE
3133 (60.22%) 2070 (39.78%) 5203 (100%)
11.34%
FEMALE
5.82%
TOTAL
17.16%
Male vs Female : x2 = 15.422; df = 1; p < 0.001; Highly significant
64
Table V. PREVALENCE OF ORAL MUCOSAL VARIANTS

MUCOSAL FINDINGS Fissured Tongue M
SEX
AGE GROUP 1 (2-20 Yrs) No. %
AGE GROUP 2 (21-40Yrs) No. %
AGE GROUP 3 (41-60 Yrs) No. %
AGE GROUP 4 (61-80Yrs) No. %
TOTAL
GRAND TOTAL No 88 %
No.
03 01 04 01 06 07 01
0.40 0.21 0.53 0.21 0.08 1.45 0.13
10 16 46 03 10 05 17
0.61 1.64 2.79 0.31 0.61 0.51 1.03
26 21 20 01 09 00 11
4.13 4.48 3.17 0.21 1.43 0.00
10 01 02 00
9.71 0.70 1.94 0.00 0.00 0.00 3.88 0.00 6.80 1.40
49 39 72 05 25 12 33 03 11 07
1.56 1.88 2.30 0.24 0.80 0.58 1.05 0.14 0.35 0.34
1.69
F Fordyces Granule M F M Commissural Pit F Leukoedema M F Lingual Varices M F
77
1.48
37
ety ci1.75 so 00 0.00 02 0.20 l01 0.21 a nt 04 0.63 00 0.00 00 e ld 0.00 a 00 0.00 r 00 0.00 05 1.07 .ru ww w
m co00 .
04 00 07 02
00
0.71
36
0.69
18
0.35
M= Male, F= Female, Yrs= Years
65
Table VI. PREVALENCE OF ORAL MUCOSAL ABNORMALITIES

MUCOSAL FINDINGS SEX AGE GROUP 1 (2-20) No % AGE GROUP 2 (21-40) No % AGE GROUP 3 (41-60) No % AGE GROUP 4 (61-80) No. % TOTAL GRAND TOTAL No. %
No.
Papillary Hyperplasia
M F
00 00 07 02 03 06 01 02 00 00 01 00 01 00 00 00 02 00 03 01
0.00 0.00 0.93 0.41 0.40 1.24 0.13 0.41 0.00 0.00 0.26 0.00
00 00 28 09 12 07 04 06 00 03 04
0.00 0.00 1.70 0.92 0.73 0.72 0.24 0.61 0.00 0.31
03 02 16 06 04 01 05 07 02
0.48 0.43 2.54 1.28 0.63 0.21 0.79 1.49
02 00 05 00 00 01 02
1.94 0.00 4.85 0.00 0.00 0.70
05 02 56 17 19 15 12 16 02 05 07 01 14 00 52 00 100 00 31 04
% 0.16 0.10 1.79 0.82
07
0.13
Frictional Keratosis
M F
73
1.40
Traumatic Ulcer
M F
0.61 0.72
34 0.65
Traumatic Fibroma
M F
Denture Stomatitis
M F M
Betel Chewer Mucosa Tobacco Pouch Keratosis Smokers Palate
F M F M F M
w w0.13 w
0.00 0.00 0.00 0.27 0.00 0.40 0.21
.ru01
12 00 25 00 38 00 22 02
d al0.24 r
0.10 0.73 0.00 1.52 0.00 2.30 0.00 1.33 0.20
en
c 0.32 so al t02 0.43

02 00 01 00 22 00 53 00 06 01 0.32 0.00 0.16 0.00 3.49 0.00 8.41 0.00 0.95 0.21
ety i 01
00 00 00 00 00 00 05 00 07 00 00 00
m co 1.94 .
0.70 0.00 0.00 0.00 0.00 0.00 0.00 4.85 0.00 6.80 0.00 0.00 0.00
0.38 0.77 0.06 0.24

0.22 0.05
08 0.15 07 0.13 28 0.54
0.45 0.00 1.66

00 3.19 0.00 52 1.00 14 0.27
100
1.92
Leukoplakia
F M
0.99
OSMF
F
0.19
35
0.67
66
MUCOSAL FINDINGS
SEX
AGE GROUP 1 (2-20) No %
AGE GROUP 2 (21-40) No. %
AGE GROUP 4 (61-80) No %
TOTAL
No. %
GRAND TOTAL No 54 %
M Lichen Planus F
03 02
0.40 0.41
16 12
0.97 0.01
12 06
1.90 1.28
01 02
.97 1.40
32 22
1.02 1.06
1.04
Lichenoid Reaction
M F
00 00 00 00 01 04 03 05
0.00 0.00 0.00 0.00 0.13 0.83 0.40 1.03
00 00 03 01 06 16 27 12
0.00 0.00 0.18 0.10 0.36 1.64 1.64 1.23
01 00 02 02 03 09 23 09
0.16 0.00 0.32 0.43 0.48 1.92 3.65
01 00 00 00 02 03
0.97 0.00 0.00 0.00 1.94 2.10
02 00 05 03 12 32 67 28 05 06 11 13 03 01 26 11 14 16 01 03
0.06 0.00 0.16 0.14 0.38 1.55 2.14 1.35 0.16 0.29 0.35 0.63 0.10 0.05 0.83 0.53 0.45 0.77 0.03 0.14
02
0.04
08
Median Rhomboid Glossitis Depapillation of Tongue
M F M F
0.15
44
Coated Tongue
M F
Pigmented Tongue
M F
Geographic Tongue
M F
Black Hairy Tongue
M F
ety i1.92 c 03 0.40 01 0.06 01 so 0.16 l ta 02 0.43 02 0.41 02 0.20 en 02 0.27 05 ld 0.30 03 0.48 a r 1.13 01 0.21 01 0.21 u 11 r . 00 w 0.00 01 0.06 01 0.16 w w 0.00 01 0.10 00 0.00 00
03 05 04 03 01 00 0.40 1.04 0.53 0.62 0.13 0.00 15 05 06 11 00 02 0.10 0.51 0.36 1.13 0.00 0.20 07 01 01 01 00 00 1.11 0.21 0.16 0.21 0.00 0.00
om c14 13.59 .
02 00 00 01 00 01 00 01 00 03 01 00 01 1.40 0.00 0.00 0.97 0.00 0.97 0.00 0.97 0.00 2.91 0.70 0.00 0.70
0.85
95
1.83
11
0.21
24
0.46
04
0.08
37
Recurrent Aphthous Stomatitis Herpes Labialis
M F M F
0.71
30
0.58
04
Acute Herpetic Stomatitis
M F
0.08
67
MUCOSAL FINDINGS Candidiasis
SEX
M F
AGE GROUP 1 (2-20) No. % 01 0.13 00 01 00 00 00 00 00 00 00 00 00 02 00 00 00 0.00 0.13 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.26 0.00 0.00
AGE GROUP 2 (21-40) No. % 00 0.00 00 07 00 00 00 01 00 00 00 00 00 01 0.00 0.42 0.00 0.0 0.0 0.06 0.00 0.00 0.00 0.00 0.00
AGE GROUP 3 (41-60) No. % 02 0.32 00 08 00 00 00 00 00 00 01 01 00 02 00 00 00 00 00 01 01 00 0.00 1.27 0.00 0.00 0.00 0.00 0.00 0.00 0.21 0.16 0.00 0.32 0.00 0.00 0.00 0.00 0.00 0.16 0.21 0.00
AGE GROUP 4 (61-80) No. % 03 2.91 00 04 00 01 00 00 00 01 00 01 00 00 00 01 00 00 00 00 00 00 0.00 3.88 0.00 0.97 0.00 0.00 0.00 0.97 0.00 0.97 0.00 0.00 0.00 0.97 0.00 0.00 0.00 0.00 0.00 0.00
TOTAL
GRAND TOTAL No 06 %
No. 06 00 20 00 01 00 01 00 01 01 02 00 05 02 02 00 00 02 03 03 01
% 0.19 0.00 0.64 0.00 0.03 0.0 0.03 0.00 0.03 0.05 0.06 0.00 0.16 0.10 0.06 0.00 0.00 0.10 0.10 0.14 0.03
0.12 20 0.38 01 0.02 01 0.02 02 0.04
Angular Chelitis
M F
Herpes Zoster
M F
Squmous Papilloma
M F
Vitiligo
M F
S.C.C.
M F
Pyogenic Granuloma
M F
Mucoceal
M F
Ranula
M F
w
00 02 02 01 00
ww
0.00 0.00 0.41 0.27 0.21 0.00
.ru
d al r
02 01 00 00 00 00 01 01
en
0.06 0.20 0.06 0.00 0.0 0.00 0.00 0.10 0.06
ety ci lso ta
m co .
02 0.04 07 0.13
02 0.04 02 0.04 06 0.12 02 0.04
Gum Boil
M F
Thermal Burn
M F
00
0.00
00
0.00
01
0.21
00
0.00
01
0.05
68
MUCOSAL FINDINGS Chemical Burn
SEX
AGE GROUP 4 (61-80)

No. %
TOTAL
GRAND TOTAL No. 02 %
No.
M F
00 00 00 00
0.00 0.00 0.00 0.00 0.00 0.21 0.13 0.21 0.00 0.00
00 02 00 00
0.00 0.20 0.00 0.00
00 00 01 00
0.00 0.00 0.16 0.00
00 00 00 00
0.00 0.00 0.00 0.00
00 02 01 00
0.00 0.10 0.03
0.04
Petichae
01 F
0.02
0.00
Myolipoma
M F
00 01 01 01 00 00
00 00 00 00 00 00
0.0 0.0 0.0 0.0 0.0 0.0
00 00 00 00 01 00
0.00 0.00 0.00 0.00
00 00 00 00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.97 0.70
00 01 01 01 01 00 01 01
57 57
0.00 0.05 0.03 0.05 0.03 0.00 0.03 0.05

1.82
114 01 02 01
0.02
Eruption Cyst
M F
Sub Mucous Hematoma
M F
Peripheral Giant Cell Granuloma
M F
M Linea Alba Buccalis F
ci 0.00 so 00 0.00 00 0.0 l 01 0.16 a nt 00 0.00 01 0.21 00 e0.0 d al 1.88 15 2.38 10 1.33 r 31 .ru 41 4.20 08 1.71 07 w 1.45 w w
ety
0.16
m co00 .
00 00 00
01 01
0.04
0.02
02
0.04
2.19
2.75
*M= Male, F= Female, OSMF= Oral Sub Mucous Fibrosis, SCC= Squamous Cell Carcinoma
69
Table.VII.PREVALENCE OF LESIONS ACCORDING TO AGE GROUPS
AGE GROUP
WITH LESIONS
TOTAL WITH LESIONS
WITHOUT LESIONS M F
TOTAL WITHOUT LESION
1-(02-20 yrs) (n=1233) 2-(21-40 yrs) (n=2625) 3-(41-60 yrs) (n=1099) 4-(61-80 yrs) (n=246)
69 347 297 80
55 176 62 15
124 523 359 95
10.06 19.92 32.67 38.62
682 130 2 333 023
427 800 407 128
1109 2102 740 151
89.94 80.08 67.33 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.
ww
.ru w
al r
en d
ety ci lso ta
m co .
70
Table VIII. PREVALENCE OF ORAL MUCOSAL LESIONS IN DIFFERENT DEMOGRAPHIC LOCATIONS
LOCATION SEX
No. OF PATIENTS WITH LESION No. %
No. OF PATIENTS WITHOUT LESION No. %
URBAN (n=1716) TOTAL
MALE FEMALE M+F MALE
231 107 338 101 051
68.34 31.66 19.70 66.45 33.55
732 646 1378 732 302
53.12 46.88 80.30 70.79 29.21
PERIURBAN FEMALE (n=1186) TOTAL M+F MALE RURAL FEMALE (n=2301) TOTAL M+F
ww
.ru w
m co 152 12.82. ety 258 ci64.02 lso a 145 nt 35.98 e ld ra

403 17.51
1034 1079 819
87.18 56.85 43.15
1898
82.49
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
71
Table IX. PREVALENCE OF ORAL MUCOSAL LESIONS WITH DIFFERENT TYPE OF HABITS
TYPE OF HABIT SEX No. OF Pts WITH LESION No. % No. OF Pts WITHOUT LESION No. %
NO HABIT (n=4352) TOTAL
MALE FEMALE M+F MALE
326 276 602 89 25 114 161
54.15 45.85 13.83 78.07 21.93 24.89 98.77
2069 1681 3750 258 86
55.17 44.83 86.17 75.00 25.00 75.11 100 00 57.00 00 00 00
SMOKELESS TOBACCO (n=458) FEMALE
TOTAL
M+F MALE
SMOKING (n=379) TOTAL FEMALE
ru .MALE SMOKING+SMOKELESS TOBACCO wwFEMALE w (n=14)

TOTAL M+F
M+F
d al r
ety ci so 1.23 02 l a nt e
163 14 00 14 100 00 100
m co 344 .
216 00 216 00 00 00
43.00
*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
72
Table X. PREVALENCE OF TOBACCO RELATED ORAL LESIONS

Name of the lesion Total number Smoker Smokeless Tobacco No 01 00 08 12 % 02.78 00.00 100.0 85.71 Smoking + Smokeless No 03 00 00 02 % 08.33 00.00 00.00 14.29 No 05 05 00 00 No Habit
No Leukoedema Papillary Hyperplasia Betel Chewer Mucosa Tobacco pouch Keratosis Smokers Palate Leukoplakia OSMF Lichenoid Reaction Candidiasis Angular Chelitis SCC 36 07 08 14 27 02 00 00
% 75.00 28.57 00.00 00.00
% 13.89 71.43 00.00 00.00
52 100 35 02 06 20 02
49 78 00 01 04 12 00
94.23 78.00 00.00 50.00 66.66
00 16 30 00 01
00.00 16.00 85.71 00.00 16.67
03 06 04
05.77 06.00
00 00 01 00 00 06 00
00.00 00.00 02.86 00.00 00.00 30.00 00.00
*OSMF= ORAL SUBMUCOUS FIBROSIS, SCC= SQUAMOUS CELL CARCINOMA
ww
.ru w
c so10.00 60.00 02 l a nt01 50.00 00.00 e ld ra
ety 01 i
00 01
11.43 om 50.00 c .01 16.67 00.00 50.00
Table XI. PREVALENCE OF ORAL MUCOSAL LESIONS ACCORDING TO DENTATE STATUS

TYPE OF DENTITION
DENTATE PARTIALLY EDENTULOUS COMPLETE EDENTULOUS
TOTAL NO. OF PATINTS
NO. OF PTs WITH LESION
No. OF LESIONS
3451 1585 167
519 336 038
(15.04%) (21.20%) (22.75%)
610 441 053
73
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 DENTURE WEARER RPD TOTAL NO. OF PATINTS 63 NO. OF PTs WITH LESION No. OF LESIONS
20
(31.75%)
27
146
15
(10.27%)
20
FPD
92
05
(5.43%)
05
FAULTY PROSTHESIS NO PROSTHESIS
03
03
(100%)
4899
Table XIII. PREVALENCE OF ORAL LESIONS ACCORDING TO SYSTEMIC HEALTH STATUS

TOTAL NO. OF PATIENTS NO. OF PATIENTS WITH LESION (%) No. OF LESIONS
e ld p < 0.001; Highly Significant x = 37.798; df = 4; ra .ru ww w

2
ety i 850 c(17.35%) lso a nt
m co .
04
1049
PATIENTS WITH SYSTEMIC DISEASE PATIENTS WITH OUT SYSTEMIC DISEASE
448
60
(13.39%)
77
4755
833
(17.52%)
1028
74
x2 = 4.901; df = 1; p =0.0268; Significant at 5% significance level
GRAPHS
ww
.ru w
al r
en d
ety ci lso ta
m co .
75
ww
.ru w
al r
en d
ety ci lso ta
m co .
76
ww
.ru w
al r
en d
ety ci lso ta
m co .
77
ww
.ru w
al r
en d
ety ci lso ta
m co .
78
ww
.ru w
al r
en d
ety ci lso ta
m co .
79
ww
.ru w
al r
en d
ety ci lso ta
m co .
80
ww
.ru w
al r
en d
ety ci lso ta
m co .
81
CLINICAL PICTURE OF LESIONS
Fig. 4: Aphthous stomatitis
Fig. 5: Fordyce's condition
Fig. 6: Traumatic Ulcer
ww
.ru w
al r
en d
ety ci lso ta
m co .
Fig. 7: Linea Alba Buccalis
Fig. 8: Fissured tongue
Fig. 9: Candidisais
82
Fig. 10: Leukoedema
Fig. 11: Herpes labialis
Fig. 12: Primary Herpetic Gingivostomatitis
ww w
.ru
al r
en d
ety ci lso ta
m co .
Fig. 13: Pyogenic granuloma
Fig.14: Lichen planus
Fig.15: Coated tongue
83
Fig.16: Tongue pigmentation
Fig.17: Betel chewers mucosa
Fig.18: Median Rhomboid Glossitis
ww
.ru w
al r
en d
ety ci lso ta
m co .
Fig.19: Squamous papillo
Fig.20: Frictional Keratosis
Fig.21: Smoker's palate
84
Fig.22: OSMF
Fig.23: Atrophic glossitis
Fig.24: Tobacco pouch keratosis
ww
.ru w
al r
en d
ety ci lso ta
m co .
Fig.25: Peripheral giant cell granuloma
Fig.26: Mucocele
Fig.27: Sublingual varices
85
Fig.28: Thermal Burn
Fig.29: Geographic Tongue
Fig.30: Commissural Pit
ww
.ru w
al r
en d
ety ci lso ta
m co .
Fig.31: Traumatic Fibroma
Fig.32:
SCC
Fig.33:
Lichenoid reaction
86
Fig.34: Vitiligo
Fig.35: Angular cheilitis
Fig.36: Myolipoma
ww
.ru w
al r
en d
ety ci lso ta
m co .
Fig.37: Papillary Hyperplas
Fig.38: Chemical Burn
Fig.39: Denture Stomatitis
87
Fig.40: Eruption Cyst
Fig.41: Leukoplakia
ww
Fig.42: Parulis
.ru w
al r
en d
ety ci lso ta
m co .
Fig.43: Hairy Tongue
88
Fig.44: Hematoma
Fig.45: Herpes zoster
ww
.ru w
al r
en d
ety ci lso ta
m co .
Fig.46: Ranula
89
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
ety becomes a requirement for planning oral healthci services. care lso When planning for improving oral health, lack of data may lead to a risk of a nt and adjacent to the oral cavity. Prevalence e overlooking diseases of the soft tissues in ld a data of oral mucosal lesions ur available only from few parts of India [Saraswati et are .r al., Chennai in 2004, Mathew et al., Manipal in 2005, Mehrotra et al., Vidisha in ww w 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
health of any population and the prevalence data of all the oral mucosal lesions
m co .
prevalence of oral mucosal lesions and to correlate this prevalence with the deleterious habits among the study population. 90
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
females] were included by Mathew et al.[27] in 2005, 2552 outpatients by Mobeeriek
ety ci lso a In previous studies, conducted on dental outpatients, comparatively small group of nt e patients were included. A total ofld 2000 outpatients [927 men & 1073 women] were ra 2017 outpatients [1287 males & 730 females] selected by Delilbas et al. ru 2003, . in were included by Saraswati et al. in 2004, 1190 outpatients [747 males & 443 ww w
subjects were using tobacco in both forms.
[36] [23]
m co .
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)
91
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
m co the lower prevalence of al. , 41.2%). On the other hand, some studies have . ty shown oral mucosal lesions like study done in Chennai (Saraswati et al. , 4.1%), in cie lso Madhya Pradesh (Mehrotra et al. , a Cambodia (Ikeda et al. , 4.9%), in Vidisha, nt e 8.4%) and in Malaysia (Zain RB et d , 9.7%). l al. ra These variations in the prevalence could be because of the reason that prevalence .ru ww studies in dentistry are mostly based on either the examination of total population w
al.[30], 57%) in Santiago, Chile (Espinoza et al.[41], 53%) and in Manipal (Mathew et
[27] [23] [42] [35] [43]
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].
92
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
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 93
etystudies. result obtained can be compared with those of similar ci lso of lesions (11.34%) compared to In this study males have shown the higher numbers a nt e female (05.82%) [table IV] and this is in accordance with the studies done by Avcu ld raet al. [Sweden], Castellanos & Laura DG & Kanli [Turkey], Salonen .ru [Mexico], and Mehrotraw al. w et [Vidisha, Madhya Pradesh], while study done in w
with the geographic, social, and cultural setting are taken into consideration, the
[15] [45] [35]
m co .
[5]
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].
ety ci Despite the less number of adverse habits [11.66%], being more educated, well lso a nt measure, the urban population shows a nourished and more familiar to oral preventive e ld a higher prevalence [19.70%] ofroral mucosal lesions [table II & VIII]. This might be .ru urban life style. Risk associated with various stress due to adverse habits and stressful ww w 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 94
m co .
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
m co more prevalent in rural and This might be a possible explanation why the lesions.are ety periurban areas . ci lso a In this study the oral lesions were found in higher prevalence associated with adverse nt e ld [table X] and this finding is similar to the habits like smoking, smokeless a r tobacco .ru other studies like Shivakumar et al. [Bangalore], Mathew et al. [Manipal], w Ariyawardana et al. ww[Sri Lanka], Mehrotra et al. [Vidisha, Madhya Pradesh],
one dentist for 10000 persons in urban areas and about 2.5 lac persons in rural areas.
[35] [2] [27] [46] [35]
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%]. Smokers 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
95
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
m coTiwan [Chung et al. ] and [100%]. This finding is nearly similar to study done .in etyis more injurious than its single suggests that tobacco consumption in its both ci forms so l form. ta en d In this study, the higher prevalence (38.62%) of significant oral mucosal lesions al ur rranging from 61-80 years. This finding is almost similar were found in the age group w. to study from Cambodia (Ikeda et al. ), and Venezuela (Valentina et al. ). But on ww
both forms [smoking and smokeless form] were affected by tobacco related lesions
[49] [42] [30]
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%)
96
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
ety shows cumulative effects, papillary hyperplasia, and candidiasis. Smoking also ci so resulting in melanosis in some casesal proportional to the duration of habit. t nwith smoking and other chronic irritants, also e Leukoplakia, another lesion associated ld ra develops in proportion to the duration of exposure. Thus, the higher prevalence of .ru oral mucosal lesions canw expected to be more common among older patients. w be w
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
bone and mucosa of the maxillary processes explain the presence of inflammatory
m co .
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 97
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
.ru Corbet et al. (0.6%) and Mathew et al. (6.5%) (2.30%) than in women (0.24%). ww of Fordyces condition, which is very different from our had reported a prevalence w
frequently observed on the buccal and labial mucosa. It was more prevalent in men
[13] [27]
al r
en d
ety ci lso ta
m co .
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%)
98
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
ety ci considerably lower than the prevalence lso7.1% found by Mathew et al. of a nt Manipal, India and similar to Mobeeriek et al. in Saudi Arabia (0.39%). e ld ra .ru ww Frictional keratosis w
[31]
m co .
population. It occurred more frequently in the 61-80 years age-group. It is

[27]
, in
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 agegroup 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
99
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
ety ci This difference may be attributable to number of study population, level of stress and lso a nt hormonal changes. e ld ra Oral submucous fibrosis ru w. w The prevalence of w submucous fibrosis in this population was (0.67%); it was oral
Mobeeriek et al.[31] (0.39%), and is lower than the finding by Mathew et al.[27] (2.1%). 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
m co .
100
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
m co with the studies by Ikeda . Banoczy (1.3%) but low in prevalence when compared ty ie in Japan (25%), and Axell in Sweden (3.6%).c The highest prevalence of leukoplakia lsoage-group. The most frequent site of in male population was in the 41-60 ta nyears e involvement was the buccal mucosa, including the commissures. This difference may ld ra population and tobacco habits. be attributable to number ofru . study ww Median rhomboid w glossitis
[52] [42] [9]
Mathew et al.[27] (1.59%), Chile by Espinoza et al.[41] (1.70%), and in Hungary by
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
101
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
m coaccordance with the results than women (1.02 and 1.06%, respectively). This y. in t is cie obtained by Mobeeriek et al. in Saudi Arabia, and Saraswati et al. , in Chennai. lso It was located most frequently on the a The most prevalent type was the reticular type. nt e buccal mucosa followed by the tongue and the alveolar ridge. ld ra .ru Denture stomatitis ww w Denture stomatitis was observed in seven subjects (out of 63 denture wearers). The
prevalent in the 21-40 year age-group. It was more frequently observed among men
[31] [23]
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%).
102
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
m co by Mathew et al. . age groups. This finding is less than the prevalence found ty cie (0.84%). lso a nt Irritational fibroma e ld ra in this study was 0.54%. It was more prevalent The prevalence of irritationalu fibroma .r in females (0.77%) than w males (0.38%) and in 21-40, 41-60 years age groups. This w in w
[27]
prevalence in males (0.22%) than females (0.05%). It was more prevalent in 21-40
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.
103
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%).
ety ci lso was 0.65%. It was more prevalent The prevalence of traumatic ulceration in a study this nt e in females (0.72%) than in males (0.61%) and in 21-40 years age groups. This is in ld a rby Mathew et al. (1%), and by Shivakumar et al. accordance with the study done .ru (0.19%). This finding isw than the prevalence found by Castellanos et al. (4%) w less w and by Dimitris Triantos in Greek (3.7%).
Traumatic ulceration
[27] [2] [5] [50]
m co .
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
104
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.
ety ci The prevalence of glossitis in this study wass0.85%. It was found 0.38% in males and lo ta nin age group 21-40 years. This prevalence is 1.55% in females. It was found more e ld (1%) and by Axell et al. where the prevalence similar to finding by Corbet et ra al. u .r was 1% and is less than the findings by Jackes et al. (4.4%) and higher than the ww by (0.12%). finding Mobeeriek et al. w
Atrophy of Tongue Papillae
[13] [9] [40] [31]
m co .
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%).
105
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 Dippers Lesion
ety was 0.27%. It was found only The prevalence of Snuff Dippers Lesion in thisistudy c sowas associated with smokeless tobacco l in 0.45% males in age group 21-40 yearsa t and en recorded by Axell (1.3%) and Salonen uses. This prevalence is less than the finding d al r et al. (13.75%). ru w. Hairy Tongue ww
[9] [45]
m co .
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
106
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.
ww
.ru w
al r
en d
ety ci lso ta
m co .
107
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 2140 years old male population.
CONCLUSION:
m coMucosal Lesions in patients . This study establishes a prevalence rate [17.16%] of Oral ty attending outpatient department of Kothiwal Dental College and Research Centre and cie lso and increasing age is associated with a demonstrates that smoking, tobacco chewing nt e greater odds of oral mucosal lesions, emphasizing the importance of frequent and ld ra for early detection and prompt treatment. regular inspection of the oral u .r cavity ww showed a higher significant prevalence of oral mucosal In this study male [11.34%] w
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.
108
Most prevalent normal mucosal variant was fissured tongue [1.69%] followed by fordyces 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
al dental caries and periodontal diseases, oral general health of the patient. r Besides ru mucosal lesions are another significant problem of public health importance. This w. ww 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.
en d
ety ci lso ta
m co .
109
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.
al calls for the importance of the role of dentist in r tobacco use and oral mucosal lesions ru . educating the patients ofw ill-effects of tobacco on their health and in helping them the ww
This prevalence study in a dental institute showing a strange correlation between in tobacco cessation.
en d
ety ci lso ta
m co .
110
BIBLIOGRAPHY:
1. Cebeci ARI, Glah A, Kamburolu K, Orhan BK, zta B. Prevalence and distribution of oral mucosal lesions in an adult turkish population. Med Oral Patol Oral Cir Bucal. 2009; 14(6):272-277. 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. 3. Bengel, Veltman, Loevy, Taschini. Differential Diagnosis of Diseases of the Oral Mucosa. Quintessence Publishing Co., Chicago. 15-17. 4. Reichart PA. Oral mucosal lesions in representative cross study of ageing Germans. Community Oral Dental Epidemiol 2000; 28:390-398. 5. Castellanos JL, Guzman LD. Lesions of the oral mucosa: an epidemiological study of 23785 Mexican Patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105:79-85. 6. Majorana A, Bardellini E, Flocchini P, Amadori F, Conti G, Campus G. Oral mucosal lesions in children from 0 to 12 years old: ten years experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 110:e13-e18. 7.
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ety ci lso Redman RX. Prevalence of geographic tongue, fissured tongue, median rhomboid a glossitis, and hairy tongue among 3,611 Minnesota schoolchildren. Oral nt Surg1970; 30(3):390-395. e ld Petersen BR, Pindborg JJ.a r Prevalence of Oral Leukoedema in Uganda. Arch Oral Biol. 1973; 18:1191-1196. ru w. Report on Prevalence of Oral Mucosal Lesions in a Axell T. A Preliminary Swedish Population. Community Dent Oral Epidemiol. 1975; 3:143-145. ww
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10. Mani NJ, Bhargava K, Malaowalla AK. Occurrence of oral sebaceous glands in 43,654 industrial workers of Gujarat, India. Community Dent Oral Epidemiol. 1976; 4:165-168. 11. Rodriguez I, Santana JC, Sanabria J, Banoczy J. Prevalence of Oral Leukoplakia in Havana City, Cuba. Community Dent Oral Epidemiol 1983; 11: 379-383. 12. Gorsky M, Buchner A, Cohen C. Commissural lip pits in israeii Jews of different ethnic origin. Community Dent Oral Epidemiol 1985; 13;195-196. 13. Corbet EF, Holmgren CJ, Philipsen HP. Oral mucosal lesions in 65-74-year-old Hong Kong Chinese. Community Dent Oral Epidemiol 1994; 22:392-395. 14. Campisi G, Margiotta V. Oral mucosal lesions and risk habits among men in an Italian study population. J Oral Pathol Med 2001; 30:2228. 15. Avcu N, Kanli A. The prevalence of tongue lesions in 5150 Turkish dental outpatients. Oral Diseases 2003; 9:188195.
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16. Scheifele C, Reichart PA, Dietrich T. Low prevalence of oral leukoplakia in a representative sample of the US population. Oral Oncology 2003; 39:619625. 17. Bessa CFN, Santos PJB, Aguiar MCF, Carmo MAVD. Prevalance of oral mucosal alterations in children from 0 t 12 years old. Oral Pathol Med 2004: 1722. 18. Harris CK, Warnakulasuriya KAAS, Cooper DJ, Peters TJ, Gelbier S. Prevalence of oral mucosal lesions in alcohol misusers in south London. J Oral Pathol Med 2004; 33:253-259. 19. Mumcu G, Cimilli H, Sur H, Hayran O, Atalay T. Prevalence and distribution of oral lesions: a cross-sectional study in Turkey, Oral Diseases 2005; 11:8187 20. Cunha KSGA, Manso AC, Cardoso AS, Paixao JBA, Coelho HSM, Torres SR, Rio de Janeiro. Prevalence of oral lichen planus in Brazilian patients with HCV infection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100:330333. 21. Shulman JD. Prevalence of oral mucosal lesions in children and youths in the USA. International Journal of Paediatric Dentistry 2005; 15:8997.
m co H, Aydogan I, Cetinkaya R, . 22. Parlak AH, Koybasi S, Yavuz T, Yesildal N, y Anul t to 16-year-old students in Duzce, Kavak A. Prevalence of oral lesions in 13cie Turkey. Oral Diseases 2006; 12:553558. lso S, Ramesh S, Narasimhan PD, a 23. Saraswathi TR, Ranganathan K, tShanmugam n in relation to habits: Cross-sectional study Gunaseelan. Prevelance of oralelesions d in South India. Ind J Dent Res 2006; 17(3):121-125. al r 24. Corra PH, Nunes LCC, Johann ACBR, Aguiar MCFD, Gomez RS, Mesquita RA. ru Prevalence of oral hemangioma, vascular malformation and varix in a Brazilian w. Res 2007; 21(1):40-45. population. Braz Oral ww
25. Pentenero M, Broccoletti R, Carbone M, Conrotto D, Gandolfo S. The prevalence of oral mucosal lesions in adults from the Turin area. Oral Diseases 2008; 14:356366. 26. Freitas JB, Gomez RS, Abreu MHNGD, Ferreira E. Relationship between the use of full dentures and mucosal alterations among elderly Brazilians. Journal of Oral Rehabilitation 2008; 35;370374. 27. Mathew AL, Pai KM, Sholapurkar AA, Vengal M. The prevalence of oral mucosal lesions in patients visiting a dental school in Southern India. Indian J Dent Res 2008; 19(2);99-103. 28. Dagli RJ, Kumar S, Mathur A, Balasubrimanyam G, Duraiswamy P, Kulkarni S. Prevalence of leukoplakia, oral submucous fibrosis, papilloma and its relation with stress among green marbles mine laborers, India. Med Oral Patol Oral Cir Bucal. 2008; 13(11):E687-E692.
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29. Vasconcelos BC, Novaes M, Sandrini FA, Maranho Filho AW, Coimbra LS. Prevalence of oral mucosa lesions in diabetic patients: a preliminary study. Braz J Otorhinolaryngol. 2008; 74(3):423-428. 30. Mujica V, Rivera H, Carrero M. Prevalence of oral soft tissue lesions in an elderly venezuelan population. Med Oral Patol Oral Cir Bucal. 2008; 13(5): E270-E274. 31. Mobeeriek A, AlDosari AM. Prevalence of oral lesions among Saudi dental patients. Ann Saudi Med 2009; 29(5):365-368. 32. Jahanbani J, Sandvik L, Lyberg T, Ahlfors E. Evaluation of Oral Mucosal Lesions in 598 Referred Iranian Patients. The Open Dentistry Journal 2009; 3:42-47. 33. Safadi RA. Prevalence of recurrent aphthous ulceration in Jordanian dental Patients. BMC Oral Health 2009; 31(9):1-5. 34. Rooban T, Rao A, Joshua E, Ranganathan K. The prevalence of oral mucosal lesions in alcohol misusers in Chennai, South India. Indian J Dent Res 2009; 20:41-46. 35. Mehrotra R, Thomas S, Nair P, Pandya S, Singh M, Nigam NS, Shukla P. Prevalence of oral soft tissue lesions in Vidisha. BMC Research Notes 2010; 3:23.
ety ci lsoU, Kocher T. Prevalence of oral mucosal 37. Splieth CH, Sumnig W, Bessel F, ta n John lesions in a representative population. Quintessence International 2007; 38:23-29. e ld Oral mucosal lesions in adult Chinese. J Dent Res 38. Lin HC, Corbet EF, Lo ECM. ra 2001; 80(5):1486-1490. .ru 39. Kovac KM, Skaleric U. The prevalence oral mucosal lesions in a population in wwJ Oral Pathol Med 2000; 29:331-335. Ljubljana,Slovenia. w
36. Delilbasi C, Akman H, Redzep E, Akal UK. Prevalence of Oral Precancerous lesions in a selected Tukish Population. Turk J Med Sci 2003; 33:39-42. 40. Jorge J Jr., Almeida OPD, Bozzo L, Scully C, Graner E. Oral mucosal health and diseases in institutionalized elderly in Brazil. Community Dent Oral Epidemiol 1991; 19:173-175. 41. Espinoza I, Rojas R, Aranda W, Gamonal J. Prevalence of oral mucosal lesions in elderly people in Santiago,Chile. J Oral Pathol Med 2003; 32:571-575. 42. Ikeda N, Handa Y, Khim SP et al. Prevalence study of Oral Mucosal lesions in a selected Cambodian population. Community Dentistry Oral Epidemiology 1995; 23: 49-54. 43. Zain RB, Razak IA. Association between cigarette smoking and prevalence of oral mucosal lesions among Malaysian army personnel. Community Dent Oral Epidemiol 1989; 17:148-149. 44. Field EA, Morrison t, Darling AE, Parr TA, Zakrzewska JM. Oral mucosal screening as an integral part of routine dental care. Br Dent J 1995; 179:262-266.
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45. Salonen L, Axell T, Hellden L. Occurrence of oral mucosal lesions, the influence of tobacco habits and an estimate of treatment time in an adult Swedish population. J Oral Pathol Med 1990; 19:170-176. 46. Ariyawardana A, Sitheeque MAM, Ranasinghe AW, Perera I, Tilakaratne WM, Amaratunga EAPD, Yang YH, Warnakulasuriya S. Prevalence of oral cancer and pre-cancer and associated risk factors among tea estate workers in the central Sri Lanka. J Oral Pathol Med 2007; 36:581-587. 47. Idris M, Warnakulasuriya KAAS,Ibrahim YE, Nielsen R, Cooper D, Johnson NW. Toombak-associated oral mucosal lesions in Sudanese show a low prevalence of epithelial dysplasia. J Oral Pathol Med 1996; 25:239-244. 48. Warnakulasuriya KAAS, Ralhan R. Clinical, pathological, cellular and molecular lesions caused by oral smokeless tobacco a review. J Oral Pathol Med 2007; 36:6377. 49. Chung CH, Yang YH, Wang TY, Shieh TY, Warnakulasuriya S. Oral precancerous disorders associated with areca quid chewing, smoking, and alcohol drinking in southern Taiwan. J Oral Pathol Med 2005; 34:460-466.
m co health conditions among . 50. Triantos D. Intra-oral findings and general ty in Greece. J Oral Pathol Med institutionalized and non-institutionalized ie c elderly 2005; 34:577-582. so 51. Darwazeh AM, Pillai K. Prvalence ofltongue lesions in 1013: Jordanian dental out a patients. Community Dent Oral Epidemiol 1993; 21:323-324. nt e 52. Banoczy J, Rigo O. Prevalence study of oral precancerous lesions with a complex ldCommunity Dent Oral Epidemiol 1991; 19:265-267. screening system in Hungary. ra .ru 53. Axell T, Zain RB, Siwamogstham P, Tantiniran D, Thampipit J. Prevalence of w oral soft tissue w lesions in out-patients at two Malaysian and Thai dental schools. Community Dent Oral Epidemiol 1990; 18:95-99. w
54. Vigild M. Oral mucosal lesions among institutionalized elderly in Denmark. Community Dent Oral Epidemiol 1987; 15:309-313.
114
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 : Dr. Anand Pratap Singh PG Student
ww
.ru w
al r
en d
ety Under the Guidance of : ci lso Prof. Dr. G.N. Suma ta

Dr. Ravi Prakash S.M
m co .
(Supervisor)
(Co- Supervisor)
115
S.No:
REGISTRATION No:
DATE:
I. II. III. IV. 2. 3. 4.
NAME: SEX : AGE:AGE GROUP: 21-40 YRS 41-60 YRS 61-80 YRS 1. 2 -20 YRS 1 MALE 2. FEMALE
V.
ETHNIC GROUP
1. H
VI. 1. 2. 3.
.ru GEOGRAPHIC LOCATION ww w

URBAN PERIURBAN RURAL
al r
n e2. M d
ety ci lso ta
m co .
3. OTHERS
VII.OCCUPATION
VIII. 0. 1. 3.
MEDICAL HISTORY NO HISTORY DM TB 2. 4. 116 HT CARDIAC
5. 7. 9. 11.
EPILEPSY BLOOD TRANSFUSION ENT OTHERS
6.
ALLERGY 8. HOSPITALIZATION
10.
BLEEDING DISORDER
COMMENTS ..
IX. 0. 1.
MEDICATION NO MEDICATION UNDER TREATMENT 2. SOME TIMES TAKES MEDICATION 3. TAKEN MEDICATION
en d DURATION al . r ru w. XI. FAMILY HISTORY ww

X. 0. 1. NO H/O SIMILAR LESION SIMILAR LESION IN FAMILY
ety ci lso ta
m co .
XII. a.
PERSONAL HISTORY DIET 1. 2. 3. VEG NON-VEG MIXED
117
b. 0. 1
SLEEP UNDISTRUBED DISTRUBED
c. 0. 1.
APPETITE NORMAL REDUCED
d. 0. 1. 2.
MENSTURATION REGULAR IRREGULAR MENOPAUSE
e. 0. 1. 2. 3.
al r PREGNANCY TRIMESTER ru NO w. ww Ist TM

2nd TM 3rd TM
en d
ety ci lso ta
m co .
f. 0. 1.
LACTATION NO YES
g. 0.
ORAL HYGINE METHODS NO 118
1. 2. 3.
TOOTH BRUSH FINGER OTHER..
h. 0. 1.
PARAFUNCTION NOT PRESENT PRESENT
COMMENT:..
i. 0. 1. 2. 3. 4. 5.
HABIT NO HABIT SMOKELES TOBACCO SMOKING ALCOHOL DRUGS
.ru OTHERS ww w
al r
en d
ety ci lso ta
m co .
DURATION FREQUENCY...
j. HABIT INDEX.
XIII. 1. 2.
DENTITION DANTATE PARTIALLY EDENTULOUS
119
3.
COMPLEAT EDENTULOUS
1. 2. 3.
DECIDUOUS MIXED PERMANENT
XIV. PROSTHESIS 0. 1. 2. 3. 4. NO PROSTHESIS DENTURE WEARER RPD FPD FAULTY PROSTHESIS
XV.
H/O LESION:
0. 1.
l aSIMILAR LESIONS IN PAST r NO H/O ru +ve H/O SIMILAR LESIONS IN PAST w. ww
en d
ety ci lso ta
m co .
FREQUENCY AND COMMENTS:
XVI. EXTRA ORAL EXAMINATION a. LOCATION
OTHERS
120
COMMENTS
b.
LESION :-
OTHERS
COMMENTS
XVII. ORAL MUCOSAL EXAMINATION
ety ci lso OTHERS a nt e ld ra COMMENT .ru ww b. LESION:- w

a. LOCATION:OTHERS
m co .
COMMENTS
XVIII. ASSOCIATED SYMPTOMS 0. 1. 2. NO ASSOCIATED SYMPTOMS FEVER LYMPHADENOPATHY 121
3. 4. 5. 6. 7.
DISCHARGE DIFFICULTY IN SWALLOWING BURNING SENSATION PAIN OTHERS
COMMENTS
XIX. SIMILAR LESIONS IN OTHER PART OF BODY 0. 1. NO YES
ety LOCATION ci lso a nt e XX. INVESTIGATIONS ld ra 0. NO NEED .ru 1. HISTOPATHOLOGICAL ww w

2. 3. 4. RADIOGRAPHIC HAEMATOLOGICAL OTHERS.
m co .
INVESTIGATIONAL REPORT & COMMENTS:-
XXI. FINALDIAGNOSIS
122
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.
ety After oral examination, biopsy will be done, if required. ci lso RISK AND BENEFITS: ta npsychological risks to the participants. e There will be no significant physical or ld a During the course of study, yourwill be informed of any significant findings (either good or bad) such as changes in the risks or benefits resulting from participation in .ru research. ww w
PROCEDURE INVOLVED: 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. 2. If necessary to protect your rights and welfare. If required by the law
m co .
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.
123
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:
ety ci o NAME & SIGNATURE OF WITNESS: ls a nt e ld ra .ru ww w
mDATE: .co
DATE:
124

THE PREVALENCE OF ORAL MUCOSAL LESIONS in MORADABAD - UTTAR PRADESH BY - DR. ANAND PRATAP SINGH SPONSERED BY: - RURAL DENTAL SOCIETY FOR ORAL DISEASE PREVENTION AND CURE - LUCKNOW

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THE PREVALENCE OF ORAL MUCOSAL LESIONS in MORADABAD - UTTAR PRADESH BY - DR. ANAND PRATAP SINGH SPONSERED BY: - RURAL DENTAL SOCIETY FOR ORAL DISEASE PREVENTION AND CURE - LUCKNOW

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MAHATMA JYOTIBA PHULE ROHILKHAND UNIVERSITY, BAREILLY

BY DR. ANAND PRATAP SINGH

ci in the subject of lso ta n ORAL MEDICINE AND RADIOLOGY de al r ru Year -2010 w. ww

Master of Dental ety Surgery

KOTHIWAL DENTAL COLLEGE AND RESEARCH CENTRE MORADABAD, U.P. , INDIA

DECLARATION BY THE CANDIDATE

Date: Place: Moradabad

CERTIFICATE BY THE SUPERVISORS

ENDORSEMENT BY THE HOD, PRINICIPAL/HEAD OF THE INSTITUTION

.ru Seal and Signature of the ww w

Seal and Signature of the Principal

DR. OMPRAKASH D. TOSHINIWAL DATE:

DR. SANJAY SINGH DATE:

Dr. ANAND PRATAP SINGH

Aims and Objectives Review of Literature

Materials and Method Results

Discussion Conclusion Summary Bibliography Appendices

ety Linea Alba Buccalisi c so l Fissured tongue ta en Candidisais d al rLeukoedema ru .

Primary Herpetic Gingivostomatitis

Median Rhomboid Glossitis Squamous papilloma Frictional Keratosis

ety ci Lichenoid reaction lso a Vitiligo nt e ld cheilitis Angular ra .ru Myolipoma

Page No. 40-41 42 43 43 44 45-48 49 50 51 52 52 53 53

Prevalence Of Oral Mucosal Lesions With Different Type Of Habits

ety ci lo Plussor Minus a nt Less than e

Removable Partial Denture Fixed Partial Denture

LIST OF APPENDICES CASE HISTORY PROPORMA CONSENT FORM

PAGE NO. 95-100 101-102

ABSTRACT Background and Objectives:

AIMS AND OBJECTIVES

He concluded that the prevalence of these conditions differs in no important respect

B. Roed-Petersen and J. J. Pindborg

, an epidemiological survey on the

, an epidemiologic study was done to assess the prevalence of oral soft

N.J.Mani et al.[10] , in a prevalence study on 43654 industrial workers of Gujarat,

They also found a significant sex

palatal mucosa, and denture-induced hyperplasia in maxillary and mandibular

G. Campisi & V. Margiotta

(age 40 years) was done to evaluate

, a study was done to assess the prevalence of nine different

, a study was done to assess the prevalence of OL in a

Karin Soares Goncalves Cunha et al.

, in a hospital based study to assess the

those for children and youths (0.97% and 2-05%, respectively).

examination. Thirteen different mucosal alterations were diagnosed, and the

, a retrospective study was carried out to assess the prevalence

, in a study of 344 individuals to evaluate the prevalence of

Jose L. Castellanos and Laura Diaz-Guzman

Anuna Laila Mathew et al.

, a study was done to evaluate the prevalence of oral

Rushabh J Dagli et al.

, a study was done to determine the prevalence of

, a cross-sectional study was done to evaluate the

Pseudomembranous Candidiasis 10 (50%),

, a dental school based prevalence study was done

, a hospital based study was done to assess the

, a study was done

to establish the prevalence and site

, a hospital based study was done to determine the

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

Instruments and materials used for radiographical examination:

10. Tissue holding forceps 11. Syringe

Method of Collection of Data: