the prevalence of oral mucosal lesions in moradabad- uttar pradesh by- dr. anand pratap singh...

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MAHATMA JYOTIBA PHULE ROHILKHAND UNIVERSITY,

BAREILLY

“THE PREVALENCE OF ORAL MUCOSAL LESIONS IN PATIENTS

VISITING A DENTAL COLLEGE IN MORADABAD, INDIA”

BY

DR. ANAND PRATAP SINGH

Thesis Submitted To Mahatma Jyotiba Phule Rohilkhand University, Bareilly

In Partial Fulfillment Of The Requirements For The Degree Of

Master of Dental Surgery

in the subject of

ORAL MEDICINE AND RADIOLOGY

Year -2010

KOTHIWAL DENTAL COLLEGE AND RESEARCH CENTRE

MORADABAD, U.P. , INDIA

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The Prevalence Of Oral Mucosal Lesions In Patients Visiting A Dental College In Moradabad, India”

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DECLARATION BY THE CANDIDATE

I hereby declare that this thesis entitled “THE PREVALENCE OF ORAL MUCOSAL

LESIONS IN PATIENTS VISITING A DENTAL COLLEGE IN MORADABAD,

INDIA” is a bonafide and genuine research work carried out by me under the guidance of

Prof. Dr. G.N. Suma, Department of Oral Medicine and Radiology, Kothiwal Dental

College and Research Centre, Moradabad.

Date:

Place: Moradabad Dr. Anand Pratap Singh

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CERTIFICATE BY THE SUPERVISORS

This is to certify that the thesis entitled “THE PREVALENCE OF ORAL MUCOSAL


INDIA.” is a bonafide research work done by DR. ANAND PRATAP SINGH in partial

fulfillment of the requirement for the degree of MASTER OF DENTAL SURGERY

(M.D.S.) in Oral Medicine and Radiology, Kothiwal Dental College and Research Centre,

Moradabad.

SUPERVISOR

DR. G. N. SUMA

Professor

Department of Oral Medicine and Radiology

DATE:

CO- SUPERVISOR

DR. RAVI PRAKASH S.M.

Associate Professor

Department of Oral Medicine and Radiology

DATE:

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ENDORSEMENT BY THE HOD, PRINICIPAL/HEAD OF THE

INSTITUTION

This is to certify that the thesis entitled “THE PREVALENCE OF ORAL MUCOSAL


INDIA.” is a bonafide research work done by DR. ANAND PRATAP SINGH in partial

fulfillment of the requirement for the degree of MASTER OF DENTAL SURGERY

(M.D.S.) in Oral Medicine and Radiology, Kothiwal Dental College and Research Centre,

Moradabad.

Seal and Signature of the Seal and Signature of the

H.O.D. Principal

DR. OMPRAKASH D. TOSHINIWAL DR. SANJAY SINGH

DATE: DATE:

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ACKNOWLEDGEMENT

To begin with, I bow my head in reverence before God Almighty who has always

blessed me with His bountiful grace throughout my life and for being my strength and shield.

"Ideal teachers are those who use themselves as bridges over which they invite their

students to cross, then having facilitated their crossing, joyfully collapse, encouraging

them to create bridges of their own." These words are most suitable to express my deep

gratitude to my Professor and Guide Dr. G.N.SUMA, Department of Oral Medicine and

Radiology. The task of the excellent teacher is to stimulate "apparently ordinary" pupil to

unusual effort. The tough problem is not in identifying winners: it is in making winners

out of ordinary pupil. A renowned academician, her illuminative guidance, brilliant foresight

and expert evaluation has been a continuous source of inspiration. I consider it my privilege

to work under her supervision. Her incessant encouragement and constructive criticism

helped me to finish this project. Her involvement and originality has triggered and nourished

my intellectual maturity that I will benefit from, for a long time to come.

“A teacher is a compass that activates the magnets of curiosity, knowledge, and

wisdom in the pupils.” It is my immense pleasure to have the opportunity to convey my

humble regards and gratitude to my co-supervisor of this work Dr. Ravi Prakash S.M.,

Associate Professor for his invaluable guidance, constant support and sympathetic attitude

that enabled me to successfully complete this study.

“Guidance in the proper direction is a necessity for any form of success in life.” I

am highly thankful to Dr. Omprakash D. Toshiniwal, Professor and Head, Dept of Oral

Medicine and Radiology, Dr. M. Srinivasa Raju, Professor, Dr. Naveen Shankar, Reader,

Dr. Sumalatha M.N., Senior lecturer, Dept of Oral Medicine and Radiology, Dr. Ravi

Shankar T.L., Reader, Dept of Community Dentistry, Dr. U.P. Singh, Reader, Dr. Lalit

Chandra Boruah, Senior lecturer, Dept of Conservative Dentistry, Dr. Chaitra T.

R., Senior lecturer, Dept of Pedodontics and Preventive Dentistry, Dr. Monika and Dr.

Rajesh Bansal, Faculty of Dental Science, B.H.U., Varanasi for their encouragement and

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guidance at each step. Their unlimited patience, and affectionate moral boosting &

encouragement have led me to accomplish this task.

I am beholden to my parents Mr. R. N. Singh, Mrs. S. Singh, my brothers Mr.

Ravindra Pratap Singh, Er. Abhay Pratap Singh, and sister Swati for their support,

bearing with me when I was lost in the project and their all time encouragement without

which this project would not have been possible.

I would also like to thank my friends Dr. S.P.Singh, Dr. Mudit Mittal, Dr. Vipul,

Dr. Ishu, Dr. Faisal Azhar, Dr. Ravi Kant, Dr. Abhishek Rai, Dr. Amit Manjhi, Dr.

Javed Ahmad, Dr. Ankita, Dr. Kanika, Dr. Rohan Uppal and Dr. Abhay Gupta for their

constant support and the help they rendered during my thesis work.

I am thankful to my seniors Dr. Shirin, Dr. Upendra, Dr. Nitin Nigam, Dr. Manu

Dhillon and Dr. Sumit Goel, my batchmates- Dr. Sankalp, Dr. Navneet and my juniors-

Dr.Kaushik Dutta, Dr. Kuber, Dr. Sayan, Dr. Amit, Dr. Sumit, Dr. Vivek, Dr.

Amrendra, Dr. Sharib and Dr. Abhishek for their valuable assistance, without their help,

this work would not have been accomplished in time. I wish them all the success.

I am sincerely grateful to Mr. K. K. Mishra, Director, Dr. Sanjay Singh, Principal,

Mr. Sanjay Sinha, Adminsrtative Officer and Mr. Jeet Singh, Warden for their benevolence

in providing me a platform on which this study was made possible.

I gratefully acknowledge the help of Mr. Gurinder Singh for his statistical jobs.

There are many others whose names could not be included in this column. That does not

mean I am ignoring them. It simply means that they deserve more than my expressions in

writing.

Dr. ANAND PRATAP SINGH

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CONTENTS

S.NO CONTENTS PAGE NO.

1. Acknowledgement v- vi

2. List of Figures viii-ix

3. List of Tables x

4. List of Graphs xi

5. List of Abbreviations xii

6. List of Appendices xiii

7. Abstract xiv- xv

8. Introduction 1-3

9. Aims and Objectives 4

10. Review of Literature 5-26

11. Materials and Method 27-34

12. Results 35-67

13. Discussion 68-86

14. Conclusion 87

15. Summary 88-89

16. Bibliography 90-94

17. Appendices 95-102

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LIST OF FIGURES

S. No Title of figures Page No.

Fig. 1 Armamentarium Used For Clinical Examination 32

Fig. 2 Armamentarium Used For Radiographical Examination 33

Fig. 3 Armamentarium Used For Biopsy Procedure 34

Fig.4 Aphthous stomatitis 60

Fig.5 Fordyce's condition 60

Fig.6 Traumatic Ulcer 60

Fig.7 Linea Alba Buccalis 60

Fig.8 Fissured tongue 60

Fig.9 Candidisais 60

Fig.10 Leukoedema 61

Fig.11 Herpes labialis 61

Fig.12 Primary Herpetic Gingivostomatitis 61

Fig.13 Pyogenic granuloma 61

Fig.14 Lichen planus 61

Fig.15 Coated tongue 61

Fig.16 Tongue pigmentation 62

Fig.17 Betel chewer’s mucosa 62

Fig.18 Median Rhomboid Glossitis 62

Fig.19 Squamous papilloma 62

Fig.20 Frictional Keratosis 62

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Fig.21 Smoker's palate 62

Fig.22 OSMF 63

Fig.23 Atrophic glossitis 63

Fig.24 Tobacco pouch keratosis 63

Fig.25 Peripheral giant cell granuloma 63

Fig.26 Mucocele 63

Fig.27 Sublingual varices 63

Fig.28 Thermal Burn 64

Fig.29 Geographic Tongue 64

Fig.30 Commissural Pit 64

Fig.31 Traumatic Fibroma 64

Fig.32 SCC 64

Fig.33 Lichenoid reaction 64

Fig.34 Vitiligo 65

Fig.35 Angular cheilitis 65

Fig.36 Myolipoma 65

Fig.37 Papillary Hyperplasia 65

Fig.38 Chemical Burn 65

Fig.39 Denture Stomatitis 65

Fig.40 Eruption Cyst 66

Fig.41 Leukoplakia 66

Fig.42 Parulis 66

Fig.43 Hairy Tongue 66

Fig.44 Hematoma 67

Fig.45 Herpes zoster 67

Fig.46 Ranula 67

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LIST OF TABLES

S. No. List Of Tables Page No.

Table I. Demographic Data And Dentate Status of 5203 Patients 40-41

Table II. Prevalence Of Habit In Different Demographic Locations

42

Table III. Prevalence Of Habit In Different Age Groups 43

Table IV. Prevalence Of Oral Mucosal Lesions With Gender 43

Table V. Prevalence Of Oral Mucosal Variants 44

Table VI. Prevalence Of Oral Mucosal Abnormalities 45-48

Table VII. Prevalence Of Lesions According To Age Groups 49

Table VIII. Prevalence Of Oral Mucosal Lesions In Different Demographic Locations

50

Table IX. Prevalence Of Oral Mucosal Lesions With Different Type Of Habits

51

Table X. Prevalence Of Tobacco Related Oral Lesions 52

Table XI. Prevalence Of Oral Mucosal Lesions According To Dentate Status

52

Table XII. Prevalence Of Oral Mucosal Lesions In Relation To The Prosthesis

53

Table XIII. Prevalence Of Oral Lesions According To Systemic Health Status

53

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LIST OF GRAPHS

S. NO. LIST OF GRAPHS PAGE NO.

Graph I. Prevalence Of Habit In Different Demographic Locations

54

Graph II. Prevalence Of Oral Mucosal Lesions With Gender 54

Graph III. Prevalence Of Oral Mucosal Lesions According To Age Groups

55

Graph IV. Prevalence Of Oral Mucosal Lesions In Different Demographic Locations

55

Graph V. Prevalence Of Oral Mucosal Lesions With Different Type Of Habits

56

Graph VI. Prevalence Of Tobacco Related Oral Lesions 57

Graph VII. Prevalence Of Oral Mucosal Lesions According To Dentate Status

58

Graph VIII. Prevalence Of Oral Mucosal Lesions According To Prosthesis

58

Graph IX. Prevalence Of Oral Mucosal Lesions According To Health Status

59

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LIST OF ABBREVIATIONS

SCC Squamous Cell Carcinoma

OSMF Oral Sub Mucous Fibrosis

M Male

F Female

ST Smoking Tobacco

SLT Smokeless Tobacco

Yrs Years

% Percentage

Fig. Figure

Pts Patients

± Plus or Minus

< Less than

> Greater than

i.e That is

RPD Removable Partial Denture

FPD Fixed Partial Denture

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LIST OF APPENDICES

S. NO. LIST OF APPENDICES PAGE NO.

1. CASE HISTORY PROPORMA 95-100

2. CONSENT FORM 101-102

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ABSTRACT

Background and Objectives:

The oral mucosa performs essential protective functions that significantly affect the general

health of the patient. Besides dental caries and periodontal diseases, oral mucosal lesions are

another significant problem of public health importance. This study aims to evaluate the

prevalence of oral mucosal lesions in patients attending outpatient department of Kothiwal

Dental College and Research Centre, Moradabad and correlation of the prevalence with the

tobacco habit among study population.

Materials and Method:

5203 patients, who visited the department of oral medicine for diagnosis of various

complaints over a period of three months, were examined for oral mucosal lesions. All the

patients were taken consent to participate in the study. Patients from 2-80 years were

included in the study and were divided in to four groups: group I (02-20 years), group II (21-

40 years), group III (41-60 years) and group IV (61-80 years). The examination consisted of

collecting the demographic data, general history and the clinical findings. All the subjects

were examined clinically and questioned regarding any habit like smoking, pan/gutkha

chewing and the frequency and duration of the habit. All the lesions were recorded by digital

camera and the identification of lesion was done according to guidelines as given in the text

books of Oral Medicine. The identification was also supported by the color atlas of oral

lesions (Bengel, Veltman, Loevy & Taschini. Differential Diagnosis of Diseases of the Oral

Mucosa.Quintessence Publishing Co., Chicago, George Laskaris. Color Atlus of Oral

Diseases. 3rd Edition. Thieme Stuttgart, Newyork, Bork, Hoede, Korting, Burgdorf &

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Young. Diseases of Oral Mucosa & Lip. 2nd Edition. W.B. Saunders Company.

Philadelphia) and the data were documented on the proforma. The gathered data was sorted,

tabulated and subjected to statistical analysis.

Results:

The overall prevalence of oral mucosal lesions was 17.16% (males = 11.34%, females =

5.82%). Males have higher prevalence (18.83%) compare to females (14.64%). The

difference between male and female was found to be statistically highly significant (p<

0.001). It has been found that patients habitual to smoking have higher oral lesions (43.00%)

than who used smokeless tobacco (24.89%) and who do not have any deleterious habits

(13.83%). The comparison of prevalence of oral mucosal lesions in smokers versus no habit,

smokeless tobacco users versus no habit and smoker versus smokeless tobacco users was

found to be statistically highly significant (p˂ 0.001).

Conclusion:

This study establishes the prevalence of Oral Mucosal Lesions (OML's) in patients attending

outpatient department of Kothiwal Dental College and demonstrates that smoking, tobacco

chewing and increasing age is associated with greater occurence of Oral Mucosal Lesions.

Key Words:

Oral mucosal lesions, Prevalence, Tobacco users, Abnormalities

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INTRODUCTION

There is no region in the body in which so many diseases manifest themselves as in the oral

cavity. Total Oral health care aims at dental as well as oral health, and is important to the

quality of life of all individuals. Oral lesions can cause discomfort or pain that interferes with

mastication, swallowing, and speech, and they can produce symptoms such as halitosis,

xerostomia, or oral dysesthesia, which interfere with daily social activities [1].

The oral mucosa performs essential protective functions that significantly affect the general

health of the patient. The oral mucosa separates and protects deeper tissues and organs from

the environment of the oral cavity like mechanical forces (biting, chewing etc), surface

abrasives and toxic effects of toxins released by the micro-organisms. The oral mucosa

performs essential protective functions that significantly affect the general health of the

patient2. Besides dental caries and periodontal diseases, oral mucosal lesions are another

significant problem of public health importance [2].

The oral mucosa is subjected to many changes that are due to its complex embryonic origin.

These changes can be modified in specific immunological situations as a consequence of

local factors, or as an expression of a superimposed dermatosis or a manifestation of a

systemic disease [3].

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Among the broad spectrum of causes leading to changes in the oral mucosa are infections

from bacteria, fungi, viruses, parasites, and other agents; physical and thermal influences,

changes in the immune system, systemic diseases, neoplasia, trauma and other factors, some

of which are issues of aging. These lesions could develop as a result of reduced immunologic

reactivity, impaired DNA repair capacity, impaired carcinogen metabolism and age specific

involution and atrophy of oral tissues, particularly of the oral epithelium and the salivary

glands [2, 4]. These lesions can be found in any site in the oral cavity.

Many oral lesions which are habit related or not are found to have potential to undergo

malignant changes. A series of diseases may be unique to the oral cavity and its components,

others may involve other parts of the body. However, they localize preferentially and

frequently in the mouth. Others having symptomatic significance when localized in the oral

cavity appear as a partial manifestation of an acute or chronic general disease and elicit such

characteristic oral changes that they are of great importance for diagnosis.

Diagnosis of the wide variety of lesions that occur in the oral cavity is also an essential part

of the dental practice. A dental school setting may differ from the situation found in the

general population, because it is not open or randomized. This may be a model indicative of

general and daily dental practice, particularly compared with other settings that deal with

rather selected populations such as those seen in specialty centres, nursing homes and

veterans facilities, or oral mucosal disease prevalence established in biopsy services [5].

In spite of the diagnostic importance of the lesions, the lack of data may lead to a risk of

overlooking diseases of the soft tissues in, and adjacent to, the oral cavity [6].

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The prevalence of oral mucosal lesions is an important parameter in evaluating the oral health

of any population and the prevalence data of all the oral mucosal lesions becomes a

requirement for planning oral health care services.

The prevalence of oral mucosal lesions is somewhat limited, particularly those studies

documenting the entire range of oral lesions in a population group. The majority of

investigations of this nature have been limited to the study of a single condition, or a few

selected conditions with similar clinical appearances or presumed etiology. Except for oral

cancer and potentially malignant oral conditions, the epidemiological literatures on oral

mucosal diseases are scarce.

Hence, the need arises for more such prevalence studies. This study is undertaken to evaluate

the prevalence of oral mucosal lesions in patients who visit the department of oral medicine

and radiology, Kothiwal Dental College, Moradabad, UP, India, to obtain a data useful for

further planning of oral health care in this region.

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AIMS AND OBJECTIVES

1. To obtain a data base of the prevalence of oral mucosal lesions in patients attending the

OPD, Kothiwal Dental College and Research Centre, Moradabad, UP, India, in a span of

3 consecutive months.

2. To correlate the prevalence of oral mucosal lesions with the habits among the study

population.

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REVIEW OF LITERATURE

Redman R.[7], in a study to determine the prevalence of geographic tongue, fissured

tongue, hairy tongue, and median rhomboid glossitis among students of public

schools from the Robbinsdale, Minnesota. He included total 3611 Subjects (1819

male & 1792 female) between the age of 5-13 years. Students were examined for the

presence of one or more of the tongue anomalies.

He found, 51geographic tongue, 39Fissured tongue, 5 Hairy tongue and 5 median

rhomboid glossitis. They also found that, Geographic tongue affected 1.41 per cent of

the children, Fissured tongue affected 1.08 percent of the children, Median rhomboid

glossitis and hairy tongue were rare, affecting 0.14 and 0.06 per cent of the children,

respectively.

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

according to age or sex, although the possibility that it may be significantly greater

among the very young (2 to 3 years of age) needs exploration. The occurrence of

median rhomboid glossitis in young children is compatible with its supposed

developmental aetiology. Conversely, the extreme rarity of hairy tongue in ostensibly

healthy children is compatible with the concept that it is frequently associated with

adverse oral conditions resulting from systemic or oral disease.

B. Roed-Petersen and J. J. Pindborg [8], an epidemiological survey on the

prevalence of oral leukoedema was undertaken in four districts of Uganda (Kigezi in

the South-West, Toro in the West, Acholi in the North and Bugisu in the East). A total

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of 1399 persons comprising Ugandans of both African and Asian descent were

examined. Among the 1399 persons, Leukoedema was found in 199 subjects (14.2

%).

They found that, decreasing order of importance, age, race and tribe, and sex were

significantly related to the prevalence of leukoedema, but there was no association

could be shown for the variable district.

Tony Axell [9], an epidemiologic study was done to assess the prevalence of oral soft

tissue lesions in Swedish population. A total 8,696 subjects, older than 14 years of

age in two communities, Habo aud Enkoping, were included in this study.

A pretyped questionnaire was used to get data about tobacco and alcohol habits and

other relevant parameters. The examination of the oral cavity and the lips were made

with the aid of a dental mirror and a wooden spatula using light from a dental

operating lamp. The oral hygiene status and the presence of various dental filling

materials and prosthetic appliances were recorded. Soft tissue lesions were

categorized according to a diagnosis criteria system designed for the investigation,

and the location of each lesion was recorded.

He found 33 types of lesions. The number of Herpes labialis was 279, History of

herpes labialis was 1096, Acute pseudo membranous Candidiasis was 4, Carcinoma 1,

Fibroma19, Papilloma 5, Lipoma 5, Hemangioma 2, Lymphangioma 2, Recurrent

aphthae 227, History of recurrent aphthae was 1636, Periadenitis mucosa necrotica

recurrenc 2, Angular cheilitis 247, Preleukoplakia 472, Leukoplakia 272,

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Leukoedema 3994, Leukokeratosis nicotina palate 38, Snuff dipper's lesion 537,

Focal epithelial hyperplasia 3, Flabby ridge 624, Denture hyperplasia 237,

Fibroepithelial polyp 161, Denture sore mouth 1127, Traumatic ulcer 155, Cheek and

lip biting 411, Excessive melanin pigmentation 837, Glossitis 11, Geographic tongue

624, Hairy tongue 30, Atrophy of tongue papillae 152, Lichen planus 142, Fordyce's

condition 6783, and Amalgam tattoo were found 713 in number.

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

was done to determine the occurrence of oral sebaceous glands. The subjects were

divided in to four groups, in group 1(n=6677), there was no habit and no lesion, in

group II (n=388), there was no habit but lesions were present, in group III (n=20568),

there were no lesion but habit was present, in group IV (n=16021), both the habit and

lesion were present. In this study they found that oral sebaceous glands were

prevalent in 10870 persons (24.9%) out of the study population of 43654 industrial

workers. They also found that the highest prevalence of 42.6% was absorbed among

those who abstained from such habits and who did not show any oral lesion.

Conversely, in those in whom the habit and lesions were present, the prevalence rate

was the lowest (12.5%). When the habits were present, with no lesions, the rate was

29.0%, whereas the prevalence rate was only 15.7% when the lesions were present in

the absence of any oral habits. Bilateral buccal mucosal involvement was the most

common finding.

They concluded that comparatively low prevalence rate is attributed to the high

frequency of oral habits which may cause an atrophy of these glandular structures.

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Irenef Rodriguez et al.[11], in a prevalence study on 749 randomly selected workers

from Havana City, Cuba, was done to determine the occurrence of oral leukoplakia

according to age and sex distribution in relation to extrinsic factors as smoking and

alcohol habits and intra oral mechanical trauma. The sample of this study was

composed of 749 persons (394 female and 355 male) between the age from 20-60

years.

They found that 50% of the total of the sample were smokers. The prevalence of

leukoplakia and preleukoplakia was 4.4% (leukoplakia 2.1%, preleukoplakia 2.3%).

Males were more affected than females. They also found that the prevalence was up

to 16 times higher in smokers.

They concluded that the high significant relation between smokers and lesion supports

the strong relation between smoking and oral leukoplakia.

Meir Gorsky et al.[12], a study on randomly selected Israeli Jews to determine

prevalence of commissural lip pits, and a relation of commissural lip pits to ethnic

background was done in different parts of Israel and from a wide spectrum of

occupations.

The sample was consisted of 2462 apparently healthy Israeli Jews (1042 men, 1420

women), ranging in age from 18-90 yr.

They found the presence of commissural lip pits in 17.4% of the entire

sample, 9.7% were unilateral and 7.7% were bilaterally located. 20.6% of the males

had commissural lip pits (10.4% unilateral and 10.2% bilateral), and 15.1% of the

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women (9.2% unilateral and 5.9% bilateral). They also found a significant sex

predilection for males with P value <0.001.

Esmonde F. et al.[13], in a survey of 537 noninstitutionalized, 65-74 years olds

Chinese in Hong Kong, to determine the prevalence of oral mucosal lesions in

denture wearers, tobacco smokers, and alcohol drinkers. They found no mucosal

lesions in 64% of elderly. In the 193 elderly subjects with lesions, 80% exhibited

only one lesion. There was no difference in prevalence between men and women.

The more common lesions, each being found in 5-7% of the elderly, were lingual

varicosities, frictional keratosis on buccal mucosa, denture stomatitis on the

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

buccal sulcus. Denture wearers had a higher prevalence or number of oral mucosal

lesions between those defined as users of tobacco and alcohol and those defined as

nonusers in the study. No confirmed oral malignancies were found.

G. Campisi & V. Margiotta [14], a randomly selected study on 118 male subjects

(age ≥40 years) was done to evaluate presence of oral mucosal lesions, with

particular emphasis on the early diagnosis of oral precancerous and cancerous lesions

in Mediterranean island of Pantelleria, Southwest of Sicily, Italy. The subjects were

interviewed for socioeconomic and behavioural information, and were clinically

examined by using WHO criteria.

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They found that alcohol drinking was the most common habit in the study population

(73%), followed by tobacco smoking (58.5%, of whom 96% were cigarette smokers).

Only 3% showed good oral hygiene and 25% were edentate. Oral lesions were

observed in 81.3% of the study group, mainly coated tongue (51.4%), Leukoplakia

(13.8%), traumatic oral lesions (traumatic ulcers and frictional white lesions) in 9.2%,

actinic cheilitis (4.6%), and squamous cell carcinoma in one case (0.9%). They also

found statistically significant associations between the prevalence of coated tongue

and tobacco smoking (P< 0.0001), and between the prevalence of actinic cheilitis and

tobacco smoking/alcohol drinking (P< 0.05).

They concluded that the main risk factors tobacco smoking and/or alcohol

drinking were not only for oral cancer, but also for many other oral diseases.

Peter A. Reichart [4], in a cross-sectional study of aging Germans to determine

prevalence of oral mucosal lesions in 5040 subjects, 223 samples were dropped out

for quality-natural reason. The net random sample was 3065, the group of adolescent

(1043) was not included for screening. Total 2022 individuals were divided in Group I

(35-44 yrs, n=655) & 1367 were in group II (65-74 yrs).

He found labial herpetic lesion (31.7%), Fordyce’s granules (22.6%), recurrent

aphthous stomatitis (18.3%), lip & cheek biting (10.1%) in group I, and in group II he

found Fordyce’s granules 23.7%, labial herpes 20.0%, plicated tongue 19%, denture

stomatitis 18.3%, leukoplakia was seen in 1.8% (west), & 0.9% (east) respectively,

men were more often affected than women and there was an association between the

prevalence of leukoplakia and a lower or higher educational level.

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He concluded that, the spectrum of oral mucosal lesions changes with age and

increases with general morbidity, routine examination of oral cavity of the aging are

mandatory particularly to detect early precancerous and other mucosal lesions.

N Avcu, A Kanli [15], a study was done to assess the prevalence of nine different

tongue lesions and relate to data obtained about oral hygiene or habits among dental

outpatients during the period July 1995–August 2001 in the Hacettepe University,

Dental Care District of Ankara city, located in the central part of Turkey.

A total of 5150 subjects (2837 women, 2313 men) aged 13–83 years, mean age 36.2

± 0.28) dental outpatients were included in this study.

They found hairy tongue (n= 581), coated tongue (n=1197), fissured tongue (n=1028),

papillary atrophy (n=147), geographic tongue (n=62), median rhomboid glossitis

(n=13), crenation tongue (n=63), macroglossia (n=64) and, ankyloglossia (n=4).

They also found out of the 5150 subjects, 2690 subjects were detected as having

tongue lesions with a prevalence of 52.2%, 44.2 and 62.0% for women and men,

respectively.

The difference was found to be statistically significant (P < 0.0001). There was a

strong correlation between tongue lesions and increasing age. There was also a strong

association between tongue lesions and smoking, black tea drinking, and fair or poor

oral hygiene. Hairy and coated tongue was significantly higher in males. Contrary to

this, papillary atrophy was more prominent in women.

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They concluded that a strong correlation was found between tongue lesions and age,

sex, oral hygiene and habits in Turkish dental outpatients. An efficient oral health

program such as the elimination of risk habits and attention to cultural practices may

improve tongue hygiene.

Christian Scheifele [16], a study was done to assess the prevalence of OL in a

representative sample of the US population, data from the oral mucosal tissue

assessment and some other covariates of 16,128 participants in the US National

Health and Nutrition Examination Survey (NHANES III) were included. The clinical

definition of OL was applied according to the WHO criteria.

They found that weighted prevalence of OL were 0.66±0.14% in males, 0.21±0.05%

in females and 0.42±0.08% in total. The age peaks were at 40-49 years in males and at

≥70 years in females.

They also found that the prevalence estimates were 0.37% for homogeneous OL and

0.06% for non-homogeneous OL. Gingiva (38.8%) and buccal mucosa (30.9%) were

the most frequent locations.

They concluded that there was a substantial decline in prevalence of Leukoplakia

compared to previous studies in the USA.

C.F.N. Bessa et al.[17], in a cross-sectional study on 1211 Brazilian children, was done

to determine the prevalence of oral mucosal alterations. Subjects were divided in to

two age groups: 0-4 years (n=746) & 5-12 years (n=465). They found that the

frequency of children presenting alterations was 27% & it was higher in older

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children. The most common lesions were geographic tongue, cheek biting and

melanotic macule. Candidiasis was associated with antibiotic therapy and use of

pacifiers. Fissured tongue was associated with congenital anomalies, allergy in age

group from 5-12 years.

They also found that, there was a lack of association of patient’s economic status and

prevalence of oral mucosal alterations. They concluded that, the frequency of mucosal

alterations in children is high and increases with age and some of them are associated

with habits and medical history of the patients.

C. K. Harris et al. [18], in a prevalence survey among alcohol misuse's in south

London was done on Six hundred and ninety-three subjects (388alcohol misuse's and

305 alcohol + substance abuse) attending several clinical care facilities in south

London between 1994 and 1999 were interviewed on their alcohol and drug habits. A

comprehensive oral mucosal examination was performed, and soft tissue lesions found

were classified by the clinical criteria of Axles.

They found that, the mean age of the sample was 40.5 years. The majority was white

(92.6%); of the whites, 29.9% were Celts (i.e. Irish, Scots resident in London). Many

subjects reported misusing more than one type of beverage. Two hundred and twenty-

seven Oils were found in 195 subjects (28.1%). The highest prevalence was found for

frictional kurtosis (8.8%), scar tissue of the lips (4.8%) and candidacies (3.8%).

Angular chelitis was present in 21 subjects (3.0%). The alcohol-related Oils detected

were three white patches compatible with a diagnosis of leukoplakia and one

treated oral carcinoma. No Erythroplakia were detected. The differences in

prevalence of mucosal lesions in the two groups were not significant (x2=2.18;

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P=0.14). The prevalence of tobacco smoking was high in both study groups. Oils were

found with all four types of beverages consumed, and there was little variation by the

units per week consumed. Concurrent use of substances and alcohol did not make a

significant difference to the prevalence of OMB. In the logistic regression analysis,

minority ethnic groups (Black or Asian), smokers, those with a body mass index

(BMX) under 20 and beer drinkers had an increased risk of an OMB in this group of

alcohol misusers.

They concluded that, In comparison with previous oral mucosal screening

programmes undertaken in several settings in the UK, the present study has yielded a

higher prevalence of oral mucosal diseases and conditions in this risk population.

There are several ways in which alcohol could contribute to these detected oral

lesions, either directly or indirectly.

G Mumcu et al.[19] , a cross-sectional study was done to evaluate the prevalence and

distribution of oral lesions (OLs) in Turkish population. They selected 765 subjects

(F/M: 375/390) of age between 5–95 years by the cluster sampling method and

examined according to WHO criteria.

They found that excessive melanin pigmentation (6.9%) was the most common lesion

in the study population. The tongue lesions observed in this study were

fissured tongue (5.2%), varices (4.1%), hairy tongue (3.8%), geographic tongue

(1.0%), atrophic tongue papillae (0.7%) and ankyloglossia (0.3%). The denture-

related lesions were denture stomatitis (4.3%), suction irritation (0.8%), denture

hyperplasia and torus palatinus as bony lesion (0.5%) and traumatic ulcers (0.3%).

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They concluded that pigmentation, fissured tongue and denture stomatitis were

observed to be the most common lesions in Turkish population and elderly population

was a significant risk factor for occurrence of some OLs.

Karin Soares Gonc¸alves Cunha et al. [20], in a hospital based study to assess the

prevalence of oral lichen planus (OLP) in Brazilian patients infected with hepatitis C

virus (HCV) from the Hepatology Service of Clementino Fraga Filho University

Hospital of Universidade Federal do Rio de Janeiro. The study group was consisted of

134 patients with HCV infection and the control group was consisted of 95

individuals. All patients were physically examined for evidence of OLP. The

diagnosis of OLP was established on the basis of usual clinical features and

histological findings.

They found that the prevalence of OLP was 1.5% in patients with HCV infection and

1.1% in the control group. There was no statistically significant difference between

the 2 groups (P = .63). They concluded that there was no association between OLP

and HCV infection in Brazilian patients from the state of Rio de Janeiro.

J. D. Shulman [21], in his paper describes the results of the "Third National Health

and Nutrition Examination Survey, 1988-1994 (NHANES III), and compares

them to those of the National Survey of Oral Health in US Schoolchildren,

1986-1987. The THANES III was a large US study based on a multistage

probability sample. Dentist examiners were trained to recognize, classify and

record, in a standard manner, the clinical characteristics of each of the 48

conditions of interest using procedures based on the World Health

Organization's Guide to Epidemiology and Diagnosis of Oral Mucosal

http://record.in/

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Diseases. Examinations were performed on 10 030 individuals (10.26%) aged

between 2 and 17 years, 914 of whom had a total of 976 lesions. The lip was

the most frequent site of lesions (30.7%), followed by the dorsum of the tongue

(14-7%) and the buccal mucous (13.6%). Lesions were more prevalent in males

(11.76%) than females (8-67%). The most prevalent lesions were lip/check bite

(I•89%), followed by aphthous stomatitis (1.64%), recurrent herpes labialis

(1.42%) and geographic tongue (1.05%). The prevalence of recurrent aphthous

stomatitis in the THANES Ill child and youth survey was substantially higher than

that for adults, while the THANES III adult estimates for geographic tongue

(1.85%; 95%) and check/lip bite (3.05%; 95%) were substantially greater than

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

AH Parlak et al. [22], in a cross-sectional survey of 993 children aged between 13-

16 years from eight secondary schools in Duzce, Turkey, to determine the

prevalence of oral lesions. They found that, Two hundred sixty adolescents (26.2%)

were diagnosed with at least one oral mucosal lesion at the time of the

examination. Thirteen different mucosal alterations were diagnosed, and the

most common lesions were angular chelitis (9%), linea alba (5.3%), and aphthous

ulceration (3.6%). The correlation between occurrence of mucosal lesions and sex

was not statistically significant (P > 0.05). Statistical evaluation of the data revealed a

significant relationship only between the presence of angular chelitis and anemia (P

< 0.05). They concluded this study as the first epidemiological study of oral

mucosal lesions in adolescents in Turkey and angular chelitis as the only oral mucosal

lesion that had a significant correlation with anemia.

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Saraswathi TR et al. [23], a hospital based cross-sectional study was carried out using

already existing data collected during a period of three months at Ragas Dental

College, Uthandi, Chennai, India. 63.75% males and 36.25% females made the study

population. 17.15% of the study participants were in the age group of 13 to 20 years,

38.13% were in the age group of 21 to 30years, 21.47% were in the age group of 31 to

40 years and the remaining 23.25% were in the age group of 41 to 84 years.

They found that the overall prevalence of smoking, drinking alcoholic beverages and

chewing were 15.02%, 8.78% and 6.99% respectively. The prevalence of smoking

was higher among men (23.25%) when compared to women (0.55%).

They also found 1.14% smoker's melanosis, 0.59% Leukoplakia, 0.89% Stomatitis

nicotina palatine, 0.25% leukedema, 0.25% chewer’s mucositis, 0.55% oral sub

mucous fibrosis, 0.25% median rhomboid glossitis, 0.15% lichen planus and 0.05%

candidiasis.

They concluded that Smokers were more likely to develop smoker's melanosis

compared to other lesions. Among those who consumed alcoholic beverages alone,

the prevalence of leukoplakia was higher compared to other lesions. OSF was the

most prevalent lesion among those who chewed pan masala or gutkha or betel quid

with or without tobacco. Programs to improve oral health should be conducted

regularly to promote oral health care in the population.

Priscila Henriques Correa et al. [24], a study was done to estimate the prevalence of

and to obtain clinical data on oral hemangioma, vascular malformation and varix in a

Brazilian population. Clinical data on those lesions were retrieved from the clinical

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forms from the files of the Oral Diagnosis Service, School of Dentistry, Federal

University of Minas Gerais, Brazil, from 1992 to 2002 and descriptive analysis was

performed.

A total of 2,419 clinical forms in the 10-year period were evaluated, of which 154

(6.4%) cases were categorized as oral hemangioma, oral vascular malformation or

oral varix. Oral varix was the most frequent lesion (65.6%). Females had more oral

hemangioma and oral varix than males. Oral vascular malformation and oral varix

were more prevalent in the 7th and 6th decades, respectively. Oral hemangioma and

oral varix were more prevalent in the ventral surface of the tongue and oral vascular

malformation, in the lips. Oral hemangioma was treated with sclerotherapy (54.5%),

and vascular malformation was managed with sclerotherapy and surgery (19.4%

each).

They concluded that benign vascular lesions are unusual alterations on the oral

mucosa and jaws.

M Pentenero et al. [25], a retrospective study was carried out to assess the prevalence

of oral mucosal lesions (OML) and evaluate its association with tobacco and alcohol

consumption and the wearing of removable dentures in an adult population from the

Turin area, Italy.

The study was performed on 4098 subjects, with average age 50.5 ± 13.7, and range

19–96 years. There were 2040 males (49.7%) with average age 51.3 ± 13.5, and 2058

(50.2%) females with average age 49.6 ± 13.8.

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They found that males have more OMLs (557/2040; 27.3% vs 471/2058; 22.89%).

They also found traumatic ulcers 122 (2.98), Cheek/lip biting 92 (2.24), Denture

stomatitis 78 (1.90), Fibrous hyperplasia 73 (1.78), Vascular lesion 72 (1.76),

Frictional lesion 71 (1.73), Recurrent aphthous stomatitis 71(1.73), Oral lichen planus

60 (1.46), Candidiasis 58 (1.42), Leukoplakia 47 (1.15), Melanin pigmentation 44

(1.07), Papilloma 26 (0.63), Median rhomboid glossitis 26 (0.63), Amalgam tattoo 23

(0.56), Mucocele 20 (0.49), Herpes 16 (0.39), Oral lichenoid lesions 12 (0.29),

Smoker’s palate 6 (0.15)

They concluded that the overall OML prevalence was linked to risk habits and age.

Tobacco was linked to leukoplakia, melanin pigmentation, smoker’s palate, frictional

lesions and papilloma. It was negatively related to recurrent aphthous stomatitis and

oral lichen planus. Alcohol was linked to leukoplakia, frictional lesions and median

rhomboid glossitis. The tobacco–alcohol association was linked to frictional lesions,

leukoplakia, melanin pigmentation and smoker’s palate. Denture wearers had an

overall higher prevalence of OMLs, in particular candidiasis, traumatic and frictional

lesions.

J.B. Freitas et al. [26], in a study of 344 individuals to evaluate the prevalence of

oral mucosal lesions associated with the use of full dentures (FD) among non-

institutionalized individuals of 60 or more years of age in a rural Brazilian population.

They found that, 146 were FD users and 198 FD, non-users. Angular cheilitis,

denture Stomatitis and inflammatory fibrous hyperplasia were statistically associated

with prosthesis use. Hygiene and integrity of the prosthesis were related to the

presence of oral lesions. While inflammatory fibrous hyperplasia was positively

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related to FD integrity, denture stomatitis was associated with time of use, hygiene

status and integrity of FD. The results indicate the need for oral health care

programmes for the elderly and show a relationship between time of use, quality

and hygiene of oral prostheses with the presence of mucosal lesions.They

concluded that, denture stomatitis, inflammatory fibrous hyperplasia and

angular chelitis are the pathological alterations most commonly found among elderly

FD users. Furthermore, the data show that both the integrity, time of use

and deficient hygiene of the prosthesis are related to the appearance of

oral mucosal lesions.

Jose L. Castellanos and Laura Diaz-Guzman [5], in a cross-sectional study of

examined data of 23785 patients,15-79 years of age from January 1982 to December

2003 from the department of oral diagnosis and medicine, dental school, Leon,

Maxico, to report the oral mucosal lesions, they found that among 23785 patients

the general lesion rate was 356.60 per 1000 patients. Lesions were more common

among males (male:female=1.4:1) and a three-fold greater risk of developing

mucosal lesions was recorded among the males compared with the female

population (6% in male vs. approximately 2% in females). Sixty-eight different

lesions were identified.

They concluded that, majority of identified lesions and their causes are largely

avoidable and can be controlled through education and measures targeted to both the

general population and to dental professionals.

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Anuna Laila Mathew et al. [27], a study was done to evaluate the prevalence of oral

mucosal lesions in Manipal College of Dental Sciences, Manipal, India, from 1 st

March 2005 to 1 st June 2005.

A total of 1190 patients (747 men and 443 women) in the age range 2-80 years were

included in the study population and the patients were divided into four groups based

on age: 2-20 years, 21-40 years, 41-60 years, and 61-80 years old. All the subjects

were examined clinically and questioned regarding any habits like smoking, pan

chewing, and alcohol intake, and the frequency and duration of the habit.

They found that out of 1190 subjects, 1167 were dentulous and 13 were totally

edentulous (1.1%). Forty-five subjects were denture wearers. One hundred and fifteen

(9.7%) were presently smokers, 22 (1.9%) were ex-smokers, and 1053 (88.4%) were

nonsmokers. Among the current smokers, there was a high proportion of heavy

smokers (21 or more cigarettes/day). The habit of tobacco chewing was present in 123

subjects. The frequency of tobacco chewing was more prevalent in males than in

females (98 males and 25 females) and was more prevalent in the 21-40 age-groups.

Ex-pan chewers were 21 in number.

They also found that the presence of one or more mucosal lesions was in

41.2% of the population and no mucosal abnormalities were detected in 58.8% of

subjects. Fordyce's condition was observed most frequently (6.55%) followed by

frictional keratosis (5.79%), fissured tongue (5.71%), leukoedema (3.78%), smoker's

palate (2.77%), recurrent aphthae, oral submucous fibrosis (2.01%), oral malignancies

(1.76%), leukoplakia (1.59%), median rhomboid glossitis (1.50%), candidiasis

(1.3%), lichen planus (1.20%), varices (1.17%), traumatic ulcer and oral hairy

leukoplakia (1.008%), denture stomatitis, geographic tongue, betel chewer's mucosa

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and irritational fibroma (0.84%), herpes labialis, angular cheilitis (0.58%), and

mucocele (0.16%).

They concluded that tobacco-associated lesions were observed more in males than in

females. Although some recent curbs have been put on the manufacture and sale of

gutkha, pan masala, and other established oral cancer-causing tobacco products,

further education is necessary to reduce or eliminate the use of these preparations

when stating the goals for oral health.

Rushabh J Dagli et al. [28], a study was done to determine the prevalence of

leukoplakia, oral sub mucous fibrosis and papilloma among 513 “Green Marble

Mines” laborer and uncover its relation with occupational stress in Rajasthan, India.

Workers were divided in to four age groups- 15-24, 25-34 , 35-44, 45-54 years.

They found that overall elevated prevalence of all three oral-mucosal lesion was

(36.7%), mainly leukoplakia affecting 171 mine workers (33.3%). The affected

workers were having body problems like headache, backache and stressed due to

under-payment. Individuals having papilloma have faced problem at work like noise,

dust or fumes and poor maintenance of equipment.

They also found that oral-mucosal lesion have a highly significant relation (p<0.01)

with increased stress, age, alcohol habits and malnutrition.

They concluded that, the prevalence of oral mucosal lesion is higher, among marble

mine laborers, and occupational stress can intensify the disease condition. Curative

services along with prevention and stress reduction program, requires primary

anticipation.

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Vasconcelos BC et al. [29], a cross-sectional study was done to evaluate the

prevalence of superficial lesions in the oral cavity mucosa in diabetic patients. The

sample was made of 30 patients. Of the 30 patients, 9 (30%) were males and 21 (70%)

females. Of the studied patients, 40% were below 60 years of age, and 60% were

older than 60 years.

They found thirteen different types of mucosal alterations. Tongue varicose veins

(36.6%) and Candidiasis (27.02%) were the most prevalent. Xerostomia was found1

in number, 2 cheilitis, 2 traumatic ulcer, 1 fissure tongue, 2 gingival hyperplasia, 1

atrophy of papilla, 10 erythematous Candidiasis, 1 mucocele, 1 racial pigmentation, 1

patechae and hyperkeratosis was 1 in number.

They concluded that most of the diabetic patients presented at least one type of oral

mucosa lesion or alteration. Such alterations can be associated with the fact that these

conditions are commonly found in senile patients and are also associated with

prolonged wear of dentures.

Valentina Mujica et al. [30], a study was done to determine the prevalence of the oral

soft tissue lesions in patients referred to the geriatric unit “Dr. Joaquin Quintero”,

National Institute of Gerontology, Venezuelan. 340 patients were included in the

study, of these 266 were institutionalized and 74 were seen at the outpatient clinic,

age ranging 60 to 104 years. 212 were females and 128 males. They found that Fifty

seven percent of the studied population presented one or more oral lesions, associated

to prosthetic use, trauma and tobacco consumption. Females were more affected than

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males. The lesions were more frequently observed between 60 to 74 years of the

institutionalized group of patients of these, 34% exhibited only one oral lesion. Few

cases presented up to 4 oral lesions. The most common alterations observed were:

Denture stomatitis54 (18%), Angular Cheilitis18 ( 5%), Eritematous Candidiasis12

(4%), Papillary Hiperplasia 4 (1%), Traumátic fibroma 23 (7%), Inflamatory fibrous

hyperplasia 22 (7%), Traumatic Ulcer 9 (3%), Piogenic granuloma 4 (1%),

Leucoplakia 42 (13%), Lichen planus 9 (3%), Nicotine stomatitis 7 (2%), Actinic

Cheilitis 6 (2%), Squamus cell carcinoma 6 (2%), Hemangioma 32 (11%) ,

Melanotic macule 25 (8%), Amalgam Tatoo 8 (3%), Nevus 5 (2%), Sialoadenitis 5

(2%), Median rhomboid glositis 5 (2%), Afthous Ulcers 3 (1%), Recurrent Herpes 3

(1%), Papiloma 2 (1%), Pseudomembranous Candidiasis 10 (50%), Ginigival

overgrowt hyperplasia 10 (50%).

They concluded that oral health is an important factor determining the quality of life

in aged individuals. The role of the dentist and stomatologist includes the

management of systemic, nutritional and pharmacological oral manifestations in order

to establish an early diagnosis and subsequently an accurate treatment.

Azizah-Al-Mobeeriek A et al. [31], a dental school based prevalence study was done

to evaluate the type and extent of oral lesions among dental patients at The College of

Dentistry, King Saud University, Riyadh, Saudi Arabia. The study sample included

adult subjects who were older than 15 years of age (15-73 yrs). A total of 2552

patients were interviewed and clinically investigated for the presence of oral lesions

from June 2002- to December 2005.

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They found that among the 2552 patients, only 383 patients (15.0%) had oral lesions.

Females constituted 57.7% (n=221) and males 42.3% (n=162). Twenty-four patients

(0.9%) admitted smoking habits and 196 patients (7.7%) had a systemic disease.

They also found that the most common lesion was Fordyce granules (3.8%; n=98),

followed by leukoedema (3.4%; n=86) and traumatic lesions (ulcer, erosion) in 1.9%

(n=48). Tongue abnormalities were present in 4.0% (n=101) of all oral conditions

observed, ranging from 1.4% (n=36) for fissured tongue to 0.1% (n=2) for bifid

tongue. Other findings detected were torous platinus (1.3%; n=34), mandibular tori

(0.1%; n=2) aphthous ulcer (0.4%; n=10), herpes simplex (0.3%; n=7), frictional

hyperkeratosis (0.9%; n=23), melanosis (0.6%; n=14), lichen planus (0.3%; n=9) and

nicotinic stomatitis (0.5%; n=13).

They concluded that provide information on the types and prevalence of oral lesions

among Saudi dental patients will provide baseline data for future studies about the

prevalence of oral lesions in the general population.

Ali-Rıza-İlker Cebeci et al. [1], a hospital based study was done to assess the

prevalence and distribution of oral mucosal lesions in a Turkish adult population. This

study was consisted of 5000 patients (2925, 58.5% women and 2075, 41.5% men; age

range, 17-85 years), referred to the Ankara University Faculty of Dentistry between

June 2004-September 2005.

They found that the overall incidence of oral mucosal changes or lesions was 15.5%.

The lesions were classified as anatomic changes, ulcerated lesions, tongue lesions,

white lesions, benign lesions, color alterations, and malignant lesions. Anatomic

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changes (7%), ulcerated lesions (6.6%), and tongue lesions (4.6%) were the most

common lesions. White lesions were observed in 2.2% of all patients. Among the

white lesions, leukoplakia was identified in men 4 times more frequently than it was

in women. Benign lesions and color alterations were identified in 1.6% and 1.2% of

all patients, respectively. 3 patients (0.06%) were diagnosed as having squamous cell

carcinoma, and 1 patient (0.02%) was diagnosed as having adenocarcinoma.

They also found a statistically significant relation between smoking and the

occurrence of mucosal lesions whereas no relation was found between alcohol

consumption and mucosal lesion and between systemic diseases and oral mucosal

lesion occurrence.

They concluded that provided information about the epidemiologic aspects of oral

mucosal lesions will help in planning of future oral health studies.

Jahanfar Jahanbani et al. [32], a study was done to determine the prevalence of oral

mucosal lesions in relation to age, gender, occupation, education, smoking habits,

general health, addictions and or drug therapies at Islamic Azad University, School of

Dentistry, Tehran, Iran during 12 successive months (Sept 2001-Sept 2002). 598

patients were included in this study. 62.4% were male and 37.6% were female. The

age ranges from 19-60 years.

They found that oral mucosa lesions were seen in 295 patients (49.3%). Oral

developmental lesions were seen in 295 patients (49.3%). Only Fordyce granules (27,

9%), fissured tongue (12, 9%), leukedema (12, 5%) and hairy tongue (8, 9%) had

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enough cases for statistical analysis. Three of these lesions increased with age but not

fissured tongue. All were more common in men.

They also found that fordyce granules were seen in oral mucosa of smoking men.

Leukoedema and hairy tongue were significantly associated with smoking,

leukoedema with diabetes mellitus.

They concluded that there was a highly significant association between these oral

lesions and age, gender and smoking. Few significant associations were found

between oral lesions and general diseases.

Rima Ahmad Safadi [33], a study was done to access the prevalence of recurrent

aphthous ulceration among out patients at Jordan University of Science and

Technology's Dental Teaching Centre, Irbid, Jordan. 684 participants were included in

the study. About 45% of participants were males and 55% were females.

They found that about 78% of subjects experienced recurrent aphthous ulceration.

Approximately 85% of ulcers were less than one cm in diameter, 66% were circular in

shape, 92% were painful, 82% interfered with eating, and 55% located in lips and

buccal mucosa. Only 50%of participants related ulcers to stress. Sixty eight percent

reported no association with tiredness and 85% no association with types of food

ingested. Of the 39% who had blood tests carried out, 7% had vitamin B12 and 4%

hemoglobin deficiency.

They concluded that understanding the prevalence and distribution of recurrent

aphthous ulceration among Jordanian population will give an indication about the

proportion of people who suffer the condition and who need dental management.

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Knowledge about the increased proportion of Jordanian people with recurrent

aphthous ulceration might help dental practitioner in reaching the proper diagnosis of

the ulcers affecting oral cavities and in providing information to patient to enhance

their awareness about the condition.

T Rooban et al. [34], a hospital based study was conducted to assess the prevalence of

oral mucosal lesions (OML) among alcohol misusers attending a rehabilitation centre

at Ragas Dental College and Hospital and TTK Hospital, Chennai, India. In this study

500 consecutive alcohol misusers were examined by qualified dental surgeons and the

variables for this study were OML, Oral Hygiene Index (OHI), age, smoking, and

alcohol misuse (type and units consumed and duration of misuse).

They found that out of the 500 patients, 77% were in the 25-44 years old age group

and 84% were married. The mean age of initiation of alcohol misuse was 34 years. In

addition to alcohol, 72% smoked tobacco and 96% used other psychoactive

substances. The mean alcohol use duration was 12.6 years.

They also found that a total of 25% of the study group had at least one OML. The

common oral lesions were smoker's melanosis (10.2%), oral sub mucous fibrosis

(8%), and leukoplakia (7.4%). Those who misused spirits had a higher incidence of

OML than those who misused beer or both. Patients with fair oral hygiene had an

odds ratio (OR) of 2.96 for OML compared with an OR of 2.08 for those who had

OML with good oral hygiene.

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They concluded that that subjects who misuse alcohol have poor oral hygiene and are

at risk for the development of periodontal disease and OML. Oral examination and

treatment should be a part of the standard care for alcohol misusers at rehabilitation

centres.

Shivakumar et al. [2], a study was done to establish the prevalence and site

distribution of oral mucosal lesions in patients attending outpatient clinics of Oxford

Dental College in Bangalore, India. The study population was consisted of 512

consecutive outpatients 292 (57%) were males and 220 (43%) were females. Patients

lesser than 10 years to greater than 60 years were included in the study.

They found that out of the study population, 89 (17%) of them were smokers and 32

(6%) of the subjects consumed chewing tobacco in any forms. Most smokers were

men (92%) and most chewers (65%) were women. Lesions were present in 27

(33.34%) of subjects with smoking tobacco habits and 8 (25%) of them with chewing

habits. Subjects with smoking were 5.51 times more likely to have lesions than those

who did not smoke. Patients with chewing habits were 2.89 times more likely to have

lesions than their counterparts who did not chew tobacco which was statistically

significant at p< 0.05.

They also found that the overall prevalence of oral mucosal lesions was 11.33%.

Relevant alterations of the oral mucosa were found in 58 subjects. Leukoplakia was

the most prevalent alteration with 18 (3.52%) of the subjects followed by, herpes

ulcer in 15 (2.93%), recurrent apthae in 9 (1.76%), smokers melanosis in 4(0.78%),

Nicotina palatine in 3 (0.59%), Submucous fibrosis in 3 (0.59%) and angular chelitis,

fissured tongue, irritational fibrosis, lichenoid like reactions, traumatic ulcer in 1

person each (0.19%).

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They concluded that the importance of frequent and regular inspection of the oral

cavity must be emphasized for all these lesions can be detected at an earlier stage and

promptly treated. Dental professionals should be advising and reinforcing patients to

quit the habit of tobacco. It is important to counsel patients who consume tobacco in

any form that there is no safe form of tobacco use and caution them against simply

switching from one nicotine source to another.

Ravi Mehrotra et al. [35], a hospital based study was done to determine the

prevalence of oral soft tissue lesions in 3030 patients (2150, 71% males and 880, 29%

females), belonging to a semi-urban district of Vidisha in Central India.

They found that 8.4 percent of the population studied had one or more oral lesions,

associated with prosthetic use, trauma and tobacco consumption. With reference to

the habit of tobacco use, 635(21%) were smokers, 1272(42%) tobacco chewers,

341(11%) smokers and chewers, while 1464(48%) neither smoked nor chewed. 256

patients were found to have significant mucosal lesions. Of these, 216 cases agreed to

undergo scalpel biopsy confirmation. 88 had leukoplakia, 21 had oral sub mucous

fibrosis, 9 showed smoker’s melanosis, 6 patients had lichen planus, 17 had dysplasia,

2 patients had squamous cell carcinoma while there was 1 patient each with lichenoid

reaction, angina bullosa hemorrhagica, allergic stomatitis and nutritional stomatitis.

They concluded that the findings in this population reveal a high prevalence of oral

soft tissue lesions and a rampant misuse of variety of addictive substances in the

community. Close follow up and systematic evaluation is required in this population.

There is an urgent need for awareness programs involving the community health

workers, dentists and allied medical professionals.

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METHODOLOGY

BACKGROUND OF STUDY:

The present epidemiological study was conducted to assess the prevalence of oral mucosal

lesions among the patients attending the department of oral medicine, Kothiwal Dental

College and Research Centre, Moradabad, Uttar Pradesh, India.

STUDY SAMPLE:

Study subjects constituted all the out patients attending the Department of Oral Medicine and

Radiology, during the period of three months from 16th April to 15th July, 2009. Patients were

divided in to four age groups: group I (02-20 years), group II (21-40 years), group III (41-60

years) and group IV (61-80 years).

The patients were selected based on the following criteria:

INCLUSION CRITERIA:

1. All the patients reported to the OPD of Oral Medicine Department during the

period of three months from 16th April to 15th July 2009.

2. Patients from 02-80 years of age attending the OPD.

3. Patients who were physically healthy and well oriented with time, space and

as a person.

EXCLUSION CRITERIA:

1. Patients in whom the intraoral examination was not possible due to inadequate

mouth opening.

2. The emergency cases like trauma.

3. Patients with findings of any physical or mental abnormality, which would

interfere with or be affected by the study procedure.

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Based on the inclusion and exclusion criteria 5203 subjects were included in the study. All the

patients were explained the need and design of the study, the need for undergoing a thorough

clinical examination, radiographical, blood and biopsy investigations at the start of the study

and a prior consent was obtained.

EQUIPMENTS AND MATERIALS USED (ARMAMENTARIUM):

Instruments and materials used for clinical examination:

1. Dental chair with illumination light

2. Kidney Trays

3. Sterile Straight Probes and Mouth Mirrors

4. Cotton Holder with Cotton

5. Tweezers

6. Sterile Gauze Pieces

7. Sterile gloves

8. Sterile Mouth Masks

9. Tongue blade

10. Dettol soap.

11. Big steel tray.

12. Chittel forceps.

13. Korsolex Disinfectant

14. Sterile Stainless Steel divider and scale

15. Digital camera (Sony cyber-shot W-120, 7.2 mega pixels).

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Instruments and materials used for radiographical examination:

1. The X-Ray machine (Chesa Dental Care Services Ltd, Bangalore)

2. Intraoral periapical films (no.2,size 31×41mm)

3. Developer Solution (Yellow Chem, India)

4. Fixing Solution (Yellow Chem, India)

5. X-ray viewer

Instruments and materials used for biopsy procedures:

1. Local anesthesia

2. Betadiene

3. BP knife

4. BP blade No. 11, 12, 15

5. Suture material

6. Suture needle

7. Needle holder

8. Scissors

9. Suction device

10. Tissue holding forceps

11. Syringe

Infection Control

All autoclaved instruments were used and adequate number of each instrument was taken.

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Method of Collection of Data:

Patients were made to sit comfortably on a dental chair. Clinical examination

was done by the two trained and calibrated examiners under the artificial light

on the dental chair, using mouth mirror, probe, gauze, cotton etc.

The examination was consisted of collecting the demographic data, general

history and the clinical findings.

All the subjects were examined clinically and questioned regarding any habit

like smoking, pan/gutkha chewing and alcohol intake, and the frequency and

duration of the habit.

Patients who used to smoke more than three cigarettes per day for more than a

year were considered as smokers. Patients consuming more than 5 pouches of

chewing tobacco in any form were considered as chewers.

History was obtained from parents or relatives for patients who were not able

to communicate either due to age or disease.

All the lesions were recorded by digital camera (SONY, cyber-shot W-120,

7.2 mega pixels) and the identification of lesion was done according to

guidelines as given in the text books of Oral Medicine. The identification was

also supported by the color atlas of oral lesions (Bengel, Veltman, Loevy &

Taschini. Differential Diagnosis of Diseases of the Oral Mucosa.Quintessence

Publishing Co., Chicago, George Laskaris. Color Atlus of Oral Diseases. 3rd

Edition. Thieme Stuttgart, Newyork, Bork, Hoede, Korting, Burgdorf &

Young. Diseases of Oral Mucosa & Lip. 2nd Edition. W.B. Saunders

Company. Philadelphia) to exclude bias.

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The diagnosis was made on the basis of history, clinical features and

investigations.

Investigations include radiographical, hematological and histopathological.

Biopsies were advised for suspicious lesions only.

All the collected datas were entered in a proforma, specially designed for this

particular study.

The gathered data was sorted, tabulated and subjected to appropriate statistical

analysis.

CONSENT

An ethical committee clearance prior to the study and a written informed

consent from the patient before the examination were obtained and in case of

minor patients, consent was taken from the guardian/parents.

STATISTICAL FORMULA USED IN THE DISSERTATION

Chi square test:

E

EO 22 )( −Σ=χ

Where O = Observed frequency

E = Expected frequency

Level of significance: "p" is level of significance

p > 0.05 Not significant

p <0.05 Significant at 5% significance level

p <0.01 Significant at 1% significance level

p <0.001 Highly significant

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ARMAMENTARIUM

FIG I: ARMAMENTARIUM USED FOR CLINICAL EXAMINATION

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FIG II: ARMAMENTARIUM USED FOR RADIOGRAPHICAL EXAMINATION

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FIG III: ARMAMENTARIUM USED FOR BIOPSY PROCEDURE

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RESULTS:

This study was conducted in the Kothiwal dental College & Research Centre,

Moradabad to assess the prevalence of oral mucosal lesions among patients attending

the outpatient clinic of Department of Oral Medicine and Radiology.

A total of 5203 patients were examined from 16th April to 15th July 2009.

Demographic Data & Dentate Status of 5203 Patients [Table I]

Demonstrates the demographic data and dentate status of the study population. The

study population includes 3133 [60.22%] males and 2070 [39.78%] females. Age of

the study population ranges from 2-80 years. The different age groups and the number

of subjects in each were as follows: group I [2-20 years] and 1233 subjects [23.70%],

age group II [21-40 years] and 2625 subjects [50.45%], age group III [41-60 years]

1099 subjects [21.12%], age group IV [61-80 years] and 246 subjects [4.73%].

Majority of the patients were from rural area [44.23%] followed by urban [32.98%]

and periurban [22.79%].

Among the patients visiting the outpatient department 3451 (66.33%) of them were

dentate, 1585 (30.46%) were partially edentulous and 167 (3.21%) were completely

edentulous. The greater number of females was reported with complete

edentulousness (94, 56.29%) compared to males (73, 43.71%). Out of 5203 patients

only 304 (5.84%) of the patients were using one type of prosthesis.

Prevalence of Habit in Different Demographic Locations [Table II and Graph I]

Shows the prevalence of habit among the study population. 83.64% (4352) of the

population did not have any habit. Smokeless tobacco is used by 08.80% (458),

smoking is used by 7.28% (379) and 0.28% (14) study population uses tobacco in

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both (smoking & smokeless) form. It is seen from the result that patients from

periurban background (22.43%) indulge more in adverse habits like smoking, tobacco

chewing compare to rural (16.73%) and urban (11.66%) population. These findings

were found to be statically significant (p< 0.001).

Prevalence of Habit in Different Age Groups [Table III]

Shows the prevalence of habits in difference age groups. The habits were more

prevalent in age group 3 (41-60 yrs, 26.84%) followed by age group 2 (21-40yrs,

18.17%), age group 4 (61-80yrs, 10.16%) & age group 1 (02-20yrs, 04.38%). The

smoking was more prevalent in age group 3 (19.11%) followed by age group 4

(08.13%), age group 2 (03.96%) and age group 1 (03.65%). Table also shows that

smokeless tobacco is more frequently used by age group 3 (36.67%) followed by age

group 2 (13.98%), age group 4 (02.03%) and age group 1 (00.73%). This table also

shows that 0.23% population in age group 2 and 0.73% population in age group 3

uses tobacco in both forms (smoking and smokeless).

Prevalence of Oral Mucosal Lesions with Gender [Table IV and Graph II] Shows that overall prevalence of mucosal lesions was 17.16% (males = 11.34%,

female = 5.82%). Males have higher prevalence (590, 18.83%) compare to females

(303, 14.64%). The difference between male and female was found to be statistically

highly significant (p< 0.001). This table also shows that more number of lesions are

seen in males (769, 69.85%) compared to female (332, 30.15%).

Prevalence of Oral Mucosal Variants [Table V]

Shows the prevalence of mucosal variants according to age and gender. Fissured

tongue seen in 1.69% (88) of population, followed by Fordyce’s granules 1.48% (77),

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commissural pit 0.71% (37), leukoedema 0.69% (36) and lingual varices in 0.35%

(18) of population.

Prevalence of Oral Mucosal Abnormalities [Table VI]

Showed the prevalence of oral mucosal abnormalities according to age and gender.

The most prevalent abnormality was lines alba buccalis 114 (02.19%) followed by

leukoplakia 100 (1.92%) coated tongue 95 (1.83%), frictional keratosis 73 (1.40%),

smoker’s palate 52 (1.00%), oral lichen planus 54 (1.04%), depapillation of tongue 44

(0.85%), recurrent apthous stomatitis 37 (0.71%), osmf 35 (0.67%), traumatic ulcer

34 (0.65%), herpes labialis 30 (0.58%), traumatic fibroma 28 (0.54%), geographic

tongue 24 (0.46%), angular chelitis 20 (0.38%), tobacco pouch keratosis 14 (0.27%),

tongue pigmentation 11 (0.21%), median rhomboid glossitis 8 (0.15%), betel chewer

mucosa 8 (0.15%), papillary hyperplasia 7 (0.13%), denture stomatitis 7 (0.13%),

pyogenic granuloma 7 (0.13%), Candidiasis 6 (0.12%), gum boil 6 (0.12%), black

hairy tongue 4 (0.08%), acute herpetic stomatitis 4 (0.08%), lichenoid reaction 2

(0.04%), vitiligo 2 (0.04%), sq. cell carcinoma 2 (0.04%), mucocele 2 (0.04%), ranula

2 (0.04%), thermal burn 2 (0.04%), chemical burn 2 (0.04%), eruption cyst 2 (0.04%),

peripheral giant cell granuloma 2 (0.04%), herpes zoster 1 (0.02%), squamous

papilloma 1 (0.02%), Petechae 1 (0.02%), myolipoma 1 (0.02%).

Prevalence of Lesions According To Age Groups [Table VII and Graph III]

Shows that total 124 (10.06%) lesions were seen in age group of I, 523 (19.92%) in

age group II, 359 (32.67%) in age group III and 95 (38.62%) were seen in age group

IV and the difference was statically significant (p<0.001).

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Prevalence of Oral Mucosal Lesions in Different Demographic Locations [Table

VIII and Graph IV]

Shows the prevalence of oral mucosal abnormalities according to different socio-

demographic locations. Population living in urban areas have shown higher oral

lesions (19.70%) than the rural (17.51%) and the periurban areas (12.82%) and the

difference was found to be statistically significant (p˂ 0.001).

Prevalence of Oral Mucosal Lesions with Different Type of Habits [Table IX and Graph V] Shows the prevalence of oral mucosal lesions in relation to deleterious habits. It has

been shown that patients habitual of smoking have higher oral lesions (43.00%) than

who uses smokeless tobacco (24.89%) and who do not have any deleterious habits

(13.83%). The comparison of the prevalence of lesions among the groups of smoking

versus no habit, smokeless tobacco versus no habit and smoking versus smokeless

tobacco was found to be statistically highly significant (p˂ 0.001).

Prevalence of Tobacco Related Oral Lesions [Table X and Graph VI]

Shows the prevalence of tobacco related oral lesions and its relation to tobacco habits.

Smoker’s palate (94.23%), Leukoplakia (78%), leukoedema (75%), candidiasis

(66.66%), and angular chelitis (60%) are strongly associated with smoking while betel

chewer mucosa (100%), tobacco pouch keratosis (85.71%), OSMF (85.71%),

lichenoid reaction (50%) and SCC (50%) are strongly associated with smokeless

tobacco. These lesions are also common in those patients who use tobacco in both

forms (smoking and smokeless).

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Prevalence of Oral Mucosal Lesions According To Dentate Status [Table XI and

Graph VII]

Shows the prevalence of oral mucosal lesions according to different dentate status. It

is seen that subjects with complete edentulousness have shown to have higher

prevalence of lesions (22.75%) followed by partially edentulous subjects (21.20%)

and dentate subjects (15.04%). The different among them was statistically significant

(p˂ 0.001).

Prevalence of Oral Mucosal Lesions In Relation To the Prosthesis [Table XII and

Graph VIII]

Shows the prevalence of oral mucosal lesions in relation to the prosthesis used. Faulty

prosthesis users have higher prevalence of lesions (100%) followed by denture

wearers (31.75%), RPD wearers (10.27%), and FPD wearer (5.43%). Patients using

no prosthesis have 17.35% oral mucosal lesions and type of prosthesis wise

prevalence was also statistically significant (p < 0.001).

Prevalence of Oral Lesions According To Systemic Health Status [Table XIII and Graph IX]

Shows the prevalence of oral lesions according to systemic health status. Subjects

with systemic diseases have shown to have less number of lesions (13.39%) compared

to subjects without any systemic disease (17.52%) and the difference being

statistically non significance at 1% (p= 0.0268).

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TABLES

Table I. DEMOGRAPHIC DATA & DENTATE STATUS OF 5203 PATIENTS

AGE GROUP

(YEARS)

1 (2-20)

2 (21-40)

3 (41-50)

4 (61-80)

TOTAL GRAND TOTAL

SEX

No. No. No. No. No. % No. %

M 751 1649 630 103 3133 60.22

5203

100 F 482 976 469 143 2070 39.78

URBAN

M 462 372 113 16 963 56.12

1716

32.98 F 279 320 107 47 753 43.88

PERIURBAN

M 53 734 36 10 833 70.24

1186

22.79 F 51 245 12 45 353 29.76

RURAL

M 236 543 481 77 1337 58.11

2301

44.23 F 152 411 350 51 964 41.89

DANTATE PATIENTS

M 750 1337 105 04 2196 63.63

3451

66.33 F 480 710 63 02 1255 36.37

PARTIALLY EDENTULOUS

M 01 310 513 40 864 54.51

1585

30.46 F 02 266 399 54 721 45.49

COMPLETE

EDENTULOUS

M 00 02 12 59 73 43.71

167

3.21 F 00 00 07 87 94 56.29

DECIDIOUS DENTITION

M 43 00 00 00 43 97.73

44

0.85 F 01 00 00 00 01 2.27

MIXED DENTITION

M 224 00 00 00 224 55.04

407

7.82 F 183 00 00 00 183 44.96

PERMANENT DENTITION

M 484 1665 618 44 2793 60.92

4585

88.12 F 298 976 462 56 1792 39.08

NO PROSTHESIS

USER

M 751 1602 530 91 2974 60.71

4899

94.16 F 482 929 414 100 1925 39.29

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DENTURE WEARER

M 00 01 04 10 15 23.81

63

1.21 F 00 00 05 43 48 76.19

RPD

WEARER

M 00 01 48 02 51 34.93

146

2.80 F 00 45 50 00 95 65.07

FPD

WEARER

M 00 44 46 00 90 97.83

92

1.77 F 00 02 00 00 02 2.17

FAULTY PROSTHESIS

M 00 01 02 00 03 100

03

0.06 F 00 00 00 00 00 00

M= Male, F= Female

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Table II. PREVALENCE OF HABIT IN DIFFERENT DEMOGRAPHIC LOCATIONS

TYPE OF HABIT SEX

URBAN (n=1716)

PERIURBAN (n=1186)

RURAL (n=2301)

NO HABIT

4352

(83.64%)

No. % No. % No. %

M

814 47.43 574 48.40 1007 45.76

F 702 40.91 346 29.17 909 39.51

TOTAL M+F 1516 88.34 920 77.57 1916 83.27

SMOKE-

LESS TOBACCO

458

(8.80 %)

M

46 2.68 187 15.76 114 4.95

F

50 2.91 06 0.51 55 2.39

TOTAL M + F 96 5.59 193 16.27 169 7.34

SMOKING

379

(7.28%)

M

97 5.65 68 5.74 212 9.22

F

01 0.06 01 0.08 00 00

TOTAL

M+F 98 5.71 69 5.82 212 9.22

SMOKING + SMOKELESS TOBACCO

14

(0.28%)

M

06 0.36 04 0.34 04 0.17

F

00 00 00 00 00 00

TOTAL

M + F 06 0.36 04 0.34 04 0.17

M= Male, F= Female

x2 = 133.098; df = 6; p < 0.001; Highly significant; Showing that incidence of habits differ significantly among urban, periurban and rural cases.

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Table III. PREVALENCE OF HABIT IN DIFFERENT AGE GROUPS

AGE

GROUP

(YEARS)

ST

%

SLT

%

SL +

SLT

%

TOTAL HABIT

%

NO

HABIT

%

1 (02-20)

(n=1233)

045

03.65

009

00.73 00 0.00 054 04.38 1179 95.62

2 (21-40)

(n=2625)

104

03.96 367

13.98 06 0.23 477 18.17 2148 81.83

3 (41-60)

(n=1099)

210 19.11 077 36.67 08 0.73 295 26.84 0804 73.16

4 (61-80) (n=246)

020 08.13 005 02.03 00 0.00 25 10.16 0221 89.84

TOTAL (5203)

379 07.28 458 08.80 14 0.27 851 16.36 4352 83.64

ST= Smoking, SLT= Smokeless

Table IV. PREVALENCE OF ORAL MUCOSAL LESIONS WITH GENDER

GENDER Total No. OF PATIENTS

No. OF LESIONS

NO OF PATIENTS

WITH LESION

OVERALL PREVALENCE

MALE

3133

(60.22%)

769

(69.85%)

590

(18.83%)

11.34%

FEMALE

2070

(39.78%)

332

(30.15%)

303

(14.64%)

5.82%

TOTAL

5203

(100%)

1101

(100 %)

893

(17.16%)

17.16%

Male vs Female : x2 = 15.422; df = 1; p < 0.001; Highly significant

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Table V. PREVALENCE OF ORAL MUCOSAL VARIANTS

MUCOSAL

FINDINGS

SEX AGE GROUP 1 (2-20 Yrs)

AGE GROUP 2

(21-40Yrs)

AGE GROUP 3

(41-60 Yrs)

AGE GROUP 4

(61-80Yrs)

TOTAL GRAND TOTAL

No. % No. % No. % No. % No. % No % Fissured Tongue

M 03 0.40 10 0.61 26 4.13 10 9.71 49 1.56 88

1.69 F 01 0.21 16 1.64 21 4.48 01 0.70 39 1.88

Fordyce’s Granule

M 04 0.53 46 2.79 20 3.17 02 1.94 72 2.30 77

1.48 F 01 0.21 03 0.31 01 0.21 00 0.00 05 0.24

Commissural

Pit

M 06 0.08 10 0.61 09 1.43 00 0.00 25 0.80 37

0.71 F 07 1.45 05 0.51 00 0.00 00 0.00 12 0.58

Leukoedema

M 01 0.13 17 1.03 11 1.75 04 3.88 33 1.05 36

0.69 F 00 0.00 02 0.20 01 0.21 00 0.00 03 0.14

Lingual Varices

M 00 0.00 00 0.00 04 0.63 07 6.80 11 0.35 18

0.35 F 00 0.00 00 0.00 05 1.07 02 1.40 07 0.34

M= Male, F= Female, Yrs= Years

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Table VI. PREVALENCE OF ORAL MUCOSAL ABNORMALITIES

MUCOSAL FINDINGS

SEX AGE GROUP 1

(2-20)

AGE GROUP 2

(21-40)

AGE GROUP 3

(41-60)

AGE GROUP 4

(61-80)

TOTAL GRAND TOTAL

No % No % No % No. % No. % No. % Papillary

Hyperplasia

M 00 0.00 00 0.00 03 0.48 02 1.94 05 0.16

07

0.13 F 00 0.00 00 0.00 02 0.43 00 0.00 02 0.10

Frictional Keratosis

M 07 0.93 28 1.70 16 2.54 05 4.85 56 1.79

73

1.40 F 02 0.41 09 0.92 06 1.28 00 0.00 17 0.82

Traumatic Ulcer

M 03 0.40 12 0.73 04 0.63 00 0.00 19 0.61

34

0.65 F 06 1.24 07 0.72 01 0.21 01 0.70 15 0.72

Traumatic Fibroma

M 01 0.13 04 0.24 05 0.79 02 1.94 12 0.38

28

0.54 F 02 0.41 06 0.61 07 1.49 01 0.70 16 0.77

Denture Stomatitis

M 00 0.00 00 0.00 02 0.32 00 0.00 02 0.06

07

0.13 F 00 0.00 03 0.31 02 0.43 00 0.00 05 0.24

Betel

Chewer Mucosa

M 01 0.26 04 0.24 02 0.32 00 0.00 07 0.22

08

0.15 F 00 0.00 01 0.10 00 0.00 00 0.00 01 0.05

Tobacco Pouch

Keratosis

M 01 0.13 12 0.73 01 0.16 00 0.00 14 0.45

14

0.27 F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00

Smoker’s

Palate

M 00 0.00 25 1.52 22 3.49 05 4.85 52 1.66

52

1.00 F 00 0.00 00 0.00 00 0.00 00 0.00 00 00

Leukoplakia

M 02 0.27 38 2.30 53 8.41 07 6.80 100 3.19 100 1.92

F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00

OSMF

M 03 0.40 22 1.33 06 0.95 00 0.00 31 0.99

35

0.67 F 01 0.21 02 0.20 01 0.21 00 0.00 04 0.19

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MUCOSAL

FINDINGS

SEX AGE GROUP 1

(2-20)

AGE GROUP 2

(21-40)

AGE GROUP 3

(41-60)

AGE GROUP 4

(61-80)

TOTAL GRAND TOTAL

No % No. % No. % No % No. % No %

Lichen Planus

M 03 0.40 16 0.97 12 1.90 01 .97 32 1.02 54

1.04 F 02 0.41 12 0.01 06 1.28 02 1.40 22 1.06

Lichenoid Reaction

M 00 0.00 00 0.00 01 0.16 01 0.97 02 0.06 02

0.04 F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00

Median Rhomboid Glossitis

M 00 0.00 03 0.18 02 0.32 00 0.00 05 0.16 08

0.15 F 00 0.00 01 0.10 02 0.43 00 0.00 03 0.14

Depapillation of Tongue

M 01 0.13 06 0.36 03 0.48 02 1.94 12 0.38 44

0.85 F 04 0.83 16 1.64 09 1.92 03 2.10 32 1.55

Coated Tongue

M 03 0.40 27 1.64 23 3.65 14 13.59 67 2.14 95

1.83 F 05 1.03 12 1.23 09 1.92 02 1.40 28 1.35

Pigmented Tongue

M 03 0.40 01 0.06 01 0.16 00 0.00 05 0.16 11

0.21 F 02 0.41 02 0.20 02 0.43 00 0.00 06 0.29

Geographic Tongue

M 02 0.27 05 0.30 03 0.48 01 0.97 11 0.35 24

0.46 F 01 0.21 11 1.13 01 0.21 00 0.00 13 0.63

Black Hairy Tongue

M 00 0.00 01 0.06 01 0.16 01 0.97 03 0.10 04

0.08 F 00 0.00 01 0.10 00 0.00 00 0.00 01 0.05

Recurrent Aphthous Stomatitis

M 03 0.40 15 0.10 07 1.11 01 0.97 26 0.83 37

0.71 F 05 1.04 05 0.51 01 0.21 00 0.00 11 0.53

Herpes Labialis

M 04 0.53 06 0.36 01 0.16 03 2.91 14 0.45 30

0.58 F 03 0.62 11 1.13 01 0.21 01 0.70 16 0.77

Acute Herpetic

Stomatitis

M 01 0.13 00 0.00 00 0.00 00 0.00 01 0.03 04

0.08 F 00 0.00 02 0.20 00 0.00 01 0.70 03 0.14

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MUCOSAL

FINDINGS

SEX AGE GROUP 1

(2-20)

AGE GROUP 2

(21-40)

AGE GROUP 3

(41-60)

AGE GROUP 4

(61-80)

TOTAL GRAND TOTAL

No. % No. % No. % No. % No. % No % Candidiasis

M 01 0.13 00 0.00 02 0.32 03 2.91 06 0.19 06

0.12 F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00

Angular Chelitis

M 01 0.13 07 0.42 08 1.27 04 3.88 20 0.64 20

0.38 F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00

Herpes Zoster

M 00 0.00 00 0.0 00 0.00 01 0.97 01 0.03 01

0.02 F 00 0.00 00 0.0 00 0.00 00 0.00 00 0.0

Squmous Papilloma

M 00 0.00 01 0.06 00 0.00 00 0.00 01 0.03 01

0.02 F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00

Vitiligo

M 00 0.00 00 0.00 00 0.00 01 0.97 01 0.03 02 0.04

F 00 0.00 00 0.00 01 0.21 00 0.00 01 0.05

S.C.C.

M 00 0.00 00 0.00 01 0.16 01 0.97 02 0.06 02

0.04 F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00

Pyogenic Granuloma

M 02 0.26 01 0.06 02 0.32 00 0.00 05 0.16 07

0.13 F 00 0.00 02 0.20 00 0.00 00 0.00 02 0.10

Mucoceal

M 00 0.00 01 0.06 00 0.00 01 0.97 02 0.06 02

0.04 F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00

Ranula

M 00 0.00 00 0.0 00 0.00 00 0.00 00 0.00 02

0.04 F 02 0.41 00 0.00 00 0.00 00 0.00 02 0.10

Gum Boil

M 02 0.27 00 0.00 01 0.16 00 0.00 03 0.10 06

0.12 F 01 0.21 01 0.10 01 0.21 00 0.00 03 0.14

Thermal Burn

M 00 0.00 01 0.06 00 0.00 00 0.00 01 0.03 02

0.04 F 00 0.00 00 0.00 01 0.21 00 0.00 01 0.05

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*M= Male, F= Female, OSMF= Oral Sub Mucous Fibrosis, SCC= Squamous Cell Carcinoma

MUCOSAL

FINDINGS

SEX AGE GROUP 1

(2-20)

AGE GROUP 2

(21-40)

AGE GROUP 3

(41-60)

AGE GROUP 4

(61-80)

TOTAL GRAND TOTAL

No. % No. % No. % No. % No. % No. % Chemical

Burn

M 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00 02

0.04 F 00 0.00 02 0.20 00 0.00 00 0.00 02 0.10

Petichae

M 00 0.00 00 0.00 01 0.16 00 0.00 01 0.03

01

0.02 F 00 0.00 00 0.00 00 0.00 00 0.00 00 0.00

Myolipoma M 00 0.00 00 0.0 00 0.00 00 0.00 00 0.00

01

0.02 F 01 0.21 00 0.0 00 0.00 00 0.00 01 0.05

Eruption Cyst

M 01 0.13 00 0.0 00 0.00 00 0.00 01 0.03

02

0.04 F 01 0.21 00 0.0 00 0.00 00 0.00 01 0.05

Sub Mucous Hematoma

M 00 0.00 00 0.0 01 0.16 00 0.00 01 0.03

01

0.02 F 00 0.00 00 0.0 00 0.00 00 0.00 00 0.00

Peripheral Giant Cell Granuloma

M 00 0.00 00 0.0 01 0.16 00 0.00 01 0.03 02

0.04 F 01 0.21 00 0.0 00 0.00 00 0.00 01 0.05

Linea Alba

Buccalis

M 10

1.33 31

1.88

15

2.38

01

0.97

57

1.82

114

2.19

F 07 1.45 41 4.20 08 1.71 01 0.70 57 2.75

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Table.VII.PREVALENCE OF LESIONS ACCORDING TO AGE GROUPS

AGE GROUP WITH LESIONS TOTAL WITH

LESIONS

% WITHOUT LESIONS

TOTAL WITHOUT

LESION

%

M F M F

1-(02-20 yrs) (n=1233)

69 55 124 10.06 682 427 1109 89.94

2-(21-40 yrs) (n=2625)

347 176 523 19.92 1302

800 2102 80.08

3-(41-60 yrs) (n=1099)

297 62 359 32.67 333 407 740 67.33

4-(61-80 yrs) (n=246)

80 15 95 38.62 023 128 151 61.38

*M= Male, F= Female, Yrs= Years

x2 = 225.672; df = 3; p < 0.001; Highly significant Shows that incidence of lesion is significantly different among various age groups.

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Table VIII. PREVALENCE OF ORAL MUCOSAL LESIONS IN DIFFERENT DEMOGRAPHIC LOCATIONS

x2 = 23.711; df = 2; p < 0.001; Highly Significant

Comparison of prevalence of lesions in different locations (viz. urban, periurban and rural) showed that the prevalence is statistically significantly different (p < 0.001) among

different locations.

*M= Male, F= Female

LOCATION

SEX

No. OF PATIENTS WITH LESION

No. OF PATIENTS WITHOUT LESION

URBAN

(n=1716)

No. % No. %

MALE 231 68.34 732 53.12

FEMALE 107 31.66 646 46.88

TOTAL M + F 338 19.70 1378 80.30

PERIURBAN

(n=1186)

MALE 101 66.45 732 70.79

FEMALE 051 33.55 302 29.21

TOTAL M + F 152 12.82 1034 87.18

RURAL

(n=2301)

MALE 258 64.02 1079 56.85

FEMALE 145 35.98 819 43.15

TOTAL M + F 403 17.51 1898 82.49

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Table IX. PREVALENCE OF ORAL MUCOSAL LESIONS WITH

DIFFERENT TYPE OF HABITS

TYPE OF HABIT SEX

No. OF Pts WITH LESION

No. OF Pts WITHOUT LESION

NO HABIT (n=4352)

No. % No. %

MALE 326 54.15 2069 55.17

FEMALE 276 45.85 1681 44.83

TOTAL M + F 602 13.83 3750 86.17

SMOKELESS TOBACCO (n=458)

MALE 89 78.07 258 75.00

FEMALE 25 21.93 86 25.00

TOTAL M + F 114 24.89 344 75.11

SMOKING (n=379)

MALE 161 98.77 216 100

FEMALE 02 1.23 00 00

TOTAL M + F 163 43.00 216 57.00

SMOKING+SMOKELESS TOBACCO (n=14)

MALE 14 100 00 00

FEMALE 00 00 00 00

TOTAL M + F 14 100 00 00

*Pts= Patients, M= Male, F= Female Incidence of Lesion among habits

No Habit vs. Smokeless tobacco : x2 = 39.995; df = 1; p < 0.001; Highly significant No Habit vs. Smoking : x2 = 218.925; df = 1; p < 0.001; Highly significant No Habit vs. Smoking +smokeless tobacco : x2 = 85.01; df = 1; p < 0.001; Highly significant Smokeless tobacco vs smoking : x2 = 30.742; df = 1; p < 0.001; Highly significant Smokeless tobacco alone vs both: x2 = 38.775; df = 1; p < 0.001; Highly significant Smoking alone vs both: x2 = 17.716; df = 1; p < 0.001; Highly significant

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Table X. PREVALENCE OF TOBACCO RELATED ORAL LESIONS

Name of the lesion

Total number

Smoker Smokeless Tobacco

Smoking + Smokeless

No Habit

No % No % No % No %

Leukoedema 36 27 75.00 01 02.78 03 08.33 05 13.89

Papillary Hyperplasia

07 02 28.57 00 00.00 00 00.00 05 71.43

Betel Chewer Mucosa

08 00 00.00 08 100.0 00 00.00 00 00.00

Tobacco pouch Keratosis

14 00 00.00 12 85.71 02 14.29 00 00.00

Smoker’s Palate

52 49 94.23 00 00.00 03 05.77 00 00.00

Leukoplakia 100 78 78.00 16 16.00 06 06.00 00 00.00

OSMF 35 00 00.00 30 85.71 04 11.43 01 02.86

Lichenoid Reaction

02 01 50.00 00 00.00 01 50.00 00 00.00

Candidiasis 06 04 66.66 01 16.67 01 16.67 00 00.00

Angular Chelitis

20 12 60.00 02 10.00 00 00.00 06 30.00

SCC 02 00 00.00 01 50.00 01 50.00 00 00.00

*OSMF= ORAL SUBMUCOUS FIBROSIS, SCC= SQUAMOUS CELL CARCINOMA

Table XI. PREVALENCE OF ORAL MUCOSAL LESIONS ACCORDING TO DENTATE STATUS

TYPE OF

DENTITION TOTAL NO. OF

PATINTS NO. OF PTs WITH LESION No. OF

LESIONS

DENTATE 3451 519 (15.04%) 610

PARTIALLY EDENTULOUS

1585 336 (21.20%) 441

COMPLETE EDENTULOUS

167 038 (22.75%) 053

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Table XII. PREVALENCE OF ORAL MUCOSAL LESIONS IN RELATION TO THE PROSTHESIS

TYPE OF PROSTHESIS

TOTAL NO. OF PATINTS

NO. OF PTs WITH LESION

No. OF LESIONS

DENTURE WEARER

63 20 (31.75%) 27

RPD 146 15 (10.27%) 20

FPD 92 05 (5.43%) 05

FAULTY PROSTHESIS

03 03 (100%) 04

NO PROSTHESIS 4899 850 (17.35%) 1049


Table XIII. PREVALENCE OF ORAL LESIONS ACCORDING TO SYSTEMIC HEALTH STATUS

TOTAL NO. OF PATIENTS

NO. OF PATIENTS WITH LESION (%)

No. OF LESIONS

PATIENTS WITH SYSTEMIC DISEASE

448 60 (13.39%) 77

PATIENTS WITH OUT SYSTEMIC DISEASE

4755 833 (17.52%) 1028

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x2 = 4.901; df = 1; p =0.0268; Significant at 5% significance level GRAPHS

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77

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78

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79

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80

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CLINICAL PICTURE OF LESIONS

Fig. 4: Aphthous stomatitis Fig. 5: Fordyce's condition

Fig. 6: Traumatic Ulcer Fig. 7: Linea Alba Buccalis

Fig. 8: Fissured tongue Fig. 9: Candidisais

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Fig. 10: Leukoedema Fig. 11: Herpes labialis

Fig. 12: Primary Herpetic Gingivostomatitis Fig. 13: Pyogenic granuloma

Fig.14: Lichen planus Fig.15: Coated tongue

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Fig.16: Tongue pigmentation Fig.17: Betel chewer’s mucosa

Fig.18: Median Rhomboid Glossitis Fig.19: Squamous papillo

Fig.20: Frictional Keratosis Fig.21: Smoker's palate

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Fig.22: OSMF Fig.23: Atrophic glossitis

Fig.24: Tobacco pouch keratosis Fig.25: Peripheral giant cell granuloma

Fig.26: Mucocele Fig.27: Sublingual varices

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Fig.28: Thermal Burn Fig.29: Geographic Tongue

Fig.30: Commissural Pit Fig.31: Traumatic Fibroma

Fig.32: SCC Fig.33: Lichenoid reaction

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Fig.34: Vitiligo Fig.35: Angular cheilitis

Fig.36: Myolipoma Fig.37: Papillary Hyperplas

Fig.38: Chemical Burn Fig.39: Denture Stomatitis

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Fig.40: Eruption Cyst Fig.41: Leukoplakia

Fig.42: Parulis Fig.43: Hairy Tongue

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Fig.44: Hematoma Fig.45: Herpes zoster

Fig.46: Ranula

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DISCUSSION

Traditionally, the mucosal membrane of the oral cavity has been looked upon as

mirroring the general health. Oral Mucosal lesions may be present at birth or become

evident later in life due to mechanical forces, infections, changes in immune system,

aging, physical, thermal influences and deleterious habits. Some systemic diseases

also presents with local symptoms and/or lesions in the oral mucosa. These lesions

may be discovered during routine dental examinations. Diagnosis of the wide variety

of lesions that occur in the oral cavity is an essential part of the dental practice. The

prevalence of oral mucosal lesions is an important parameter in evaluating the oral

health of any population and the prevalence data of all the oral mucosal lesions

becomes a requirement for planning oral health care services.

When planning for improving oral health, lack of data may lead to a risk of

overlooking diseases of the soft tissues in and adjacent to the oral cavity. Prevalence

data of oral mucosal lesions are available only from few parts of India [Saraswati et

al., Chennai in 2004, Mathew et al., Manipal in 2005, Mehrotra et al., Vidisha in

2008, Dagli et al., Rajasthan in 2008 & Shivakumar et al., Bangalore in 2010], the

information is usually restricted to a small study sample and very few lesions in each

study. On the other hand, no such study has been conducted in the population of

Moradabad region on oral mucosal lesions. So, the need arises for such prevalence

study in this region to obtain a data useful for planning of oral health care in this

region.

Hence this study was conducted with a larger sample size to obtain a data base on the

prevalence of oral mucosal lesions and to correlate this prevalence with the

deleterious habits among the study population.

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In the present study, conducted during the period of three months from 16th April to

15th July, 2009, 5203 subjects (3133 males & 2070 females) were included on the

basis of inclusion and exclusion criteria. Out of 5203 study population 1716 subjects

(963 male & 753 female) were from urban areas, 1186 (833 male & 353 female) from

periurban areas and 2301 subjects (1337 males & 964 female) were from rural region.

3451subjects (2196 male & 1255 female) were dentate, 1585 subjects (864 male &

721 female) were partially edentulous while 167 subjects (73 male & 94 female) were

complete edentulous. 63 subjects (48 male & 51 female) were denture wearer, 146 (51

male & 95 female) were RPD and 92 subjects (90 male & 02 female) were FPD

wearer. Out of the study population 379 subjects (377 male & 2 female) were smoker,

458 subjects (347 male & 111 female) were smokeless tobacco users while 14 male

subjects were using tobacco in both forms.

In previous studies, conducted on dental outpatients, comparatively small group of

patients were included. A total of 2000 outpatients [927 men & 1073 women] were

selected by Delilbas et al.[36] in 2003, 2017 outpatients [1287 males & 730 females]

were included by Saraswati et al.[23] in 2004, 1190 outpatients [747 males & 443

females] were included by Mathew et al.[27] in 2005, 2552 outpatients by Mobeeriek

et al.[31] in 2005, and 512 outpatients [292 males & 220 females] were included by

Shivakumar et al. [2] in 2010.

All the Subjects were divided into four groups: group I (02-20 years), group II (21-40

years), group III (41-60 years) and group IV (61-80 years). In group I, there were

1233 subjects (751 male & 482 female), in group II, there were 2625 subjects (1649

male & 976 female), in group III, there were 1099 subjects (630 male & 469 female)

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and in group IV, there were 246 subjects (103 male & 143 female), this is in

accordance with Mathew et al. [27].

In the present study the overall prevalence of oral mucosal lesions was 17.16% [table

IV]. This is in accordance with studies conducted by Splieth et al.[37] (11.83%,

Germany) Shivakumar et al.[2] (11.33%, Bangalore), Mobeeriek et al.[31] (15.0%,

Saudi Arabia), Cebeci et al.[1] (15.5%, Turkey) and Shulman et al.[21] (10.26%, USA)

but some studies have shown a higher prevalence of oral mucosal lesions like study

done in southern China (Lin et al.[38], 66.2%), in Ljubljana Slovenia (Marija KK, U

Skarelic[39], 61.6%), in Brazil (J J junior et al[40]., 58.9%), in Venezuela (Valentina et

al.[30], 57%) in Santiago, Chile (Espinoza et al.[41], 53%) and in Manipal (Mathew et

al.[27], 41.2%). On the other hand, some studies have shown the lower prevalence of

oral mucosal lesions like study done in Chennai (Saraswati et al.[23], 4.1%), in

Cambodia (Ikeda et al.[42], 4.9%), in Vidisha, Madhya Pradesh (Mehrotra et al.[35],

8.4%) and in Malaysia (Zain RB et al.[43], 9.7%).

These variations in the prevalence could be because of the reason that prevalence

studies in dentistry are mostly based on either the examination of total population

samples or dental outpatients and a dental school setting may differ from the situation

found in the general population (because it is not open or randomized) this may be a

model indicative of general and daily dental practice, particularly compared with

other settings that deal with rather selected populations such as those seen in

specialty centers, nursing homes and veterans facilities, or oral mucosal disease

prevalence established in biopsy services. Patients spontaneously presenting for

dental consultation exhibit an attitude that may differ from that found in an

epidemiological survey of an open population [5].

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The methods of recording the incidence and prevalence of oral mucosal disease vary.

Most population-based surveys correlate oral mucosal disease with oral cancer and

precancerous conditions, but few authors have recorded overall oral mucosal lesions

or mucosal changes. For example, Axell[9] reported 60 different oral mucosal lesions

in his survey of a Swedish population, Field et al.[44] also reported all premalignant

and benign lesions found on screening, and nearly 50% of their reported lesions were

diagnosed as frictional keratosis. While other authors have reported on a few types of

lesions.

It should be stressed that the findings are influenced by the conditions under which

the data were collected. If the operative and circumstantial particularities associated

with the geographic, social, and cultural setting are taken into consideration, the

result obtained can be compared with those of similar studies.

In this study males have shown the higher numbers of lesions (11.34%) compared to

female (05.82%) [table IV] and this is in accordance with the studies done by Avcu

& Kanli[15] [Turkey], Salonen et al.[45] [Sweden], Castellanos & Laura DG[5]

[Mexico], and Mehrotra et al.[35] [Vidisha, Madhya Pradesh], while study done in

Saudi Arabia [Mobeeriek et al.[31]] showed the higher prevalence of oral lesions in

females and study from Hong Kong [Corbet et al.[13]] showed no difference in

prevalence between men and women.

The high prevalence of lesions in male could be attributed to the higher number

examined and the more frequent tobacco consumption in males, while women, who

are always expected to maintain a lady like image, are more reluctant to develop the

adverse habits[5].

Another possibility is that males are more exposed to risk factors, or alternatively,

females may be genetically less susceptible to the development of oral lesions. It

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could also be a possible explanation that males may be comparatively less sensitive

to health matters, and their concept of well being places little emphasis on oral or

dental aspects. In contrast, women may be more health conscious and might extend

such consciousness to younger family members, thus causing the lesions not to

appear or advance as a result of earlier identification and treatment. An additional

question is whether male adaptation to the environment leads to more manias, self

aggressive behavior, and neglect of oral health. It could also be that social, economic

and family roles prevent males from receiving care as often timely as women,

because the existing time availability may be different. Furthermore, although

medical insurance and public health are available for covering the costs of health

care, women may be more frequently benefitted in that they combine opportunity

with a positive attitude towards health and dental care[5].

Despite the less number of adverse habits [11.66%], being more educated, well

nourished and more familiar to oral preventive measure, the urban population shows a

higher prevalence [19.70%] of oral mucosal lesions [table II & VIII]. This might be

due to adverse habits and stressful urban life style. Risk associated with various stress

can also be modified by other exposures such as diet and nutrition, tobacco, alcohol

consumption, and genetics. Occupational or environmental exposures affect a large

number of urban populations, causing chronic irritative process. It increases the

vulnerability to infections that favors the progression of oral lesions [28].

Lesser levels of knowledge and neglect regarding oral health, oral preventive

measures, nutritional deficiencies and adverse habits cause significant increase on

prevalence of oral lesions in rural [17.51%] and periurban [12.82%] population.

Another possibility is that in rural and periurban areas the most prevalent type of

tobacco used by the population is Beedi smoking. Beedi smoking carries a higher risk

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for oral lesions compared with cigarette smoking [46]. When compared to cigarettes,

bidis produce only a smaller volume of smoke. But the smoke which is generated is

rich in higher concentrations of several toxic agents such as hydrogen cyanide, carbon

monoxide, ammonia and carcinogenic hydro carbons. Bidi smoking is also considered

to cause about 2-3 times greater nicotine and tar inhalation than conventional

cigarettes [47]. The presence of habits in increased form in the population also reflects

on the oral mucosal health.

The World Health Organization recommends a 1:7500 dentists to population ratio

where as the dentist to population ration in India is as low as 1:22500. In India there is

one dentist for 10000 persons in urban areas and about 2.5 lac persons in rural areas.

This might be a possible explanation why the lesions are more prevalent in rural and

periurban areas [35].

In this study the oral lesions were found in higher prevalence associated with adverse

habits like smoking, smokeless tobacco [table X] and this finding is similar to the

other studies like Shivakumar et al.[2] [Bangalore], Mathew et al.[27] [Manipal],

Ariyawardana et al.[46] [Sri Lanka], Mehrotra et al.[35] [Vidisha, Madhya Pradesh],

Zain RB & Razak IA [43] [Malaysia], G. Campisi & V. Margiotta[14] [Italy], Cebeci et

al.[1] [Turkey] and Sraswathi et al.[23] [Chennai].

The total number of tobacco-related lesions was 282 [5.42%]. Smoker’s palate

(94.23%), Leukoplakia (78%), leukoedema (75%), candidiasis (66.66%), and angular

chelitis (60%) were strongly associated with smoking while betel chewer mucosa

(100%), tobacco pouch keratosis (85.71%), OSMF (85.71%), lichenoid reaction

(50%) and SCC (50%) were strongly associated with smokeless tobacco. These

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lesions are also common in that patient who uses tobacco in both forms (smoking and

smokeless). [Table 10]

But on the other hand population habitual to smoking have shown the higher

prevalence of oral lesions [43%] compared to smokeless tobacco users [24.89%]

[table IX], and these findings are supported by studies done in Sudan [A.M. Idris et al.

[47]] and Turkey [Delilbasi et al.[36]], this might be due to the reason that smoking is

more dangerous to cause oral lesions than the smokeless tobacco[36]. Smokeless

tobacco products contain a large array of carcinogens, but the actual number found is

fewer than in cigarette smoke [48]. In the present study all the persons using tobacco in

both forms [smoking and smokeless form] were affected by tobacco related lesions

[100%]. This finding is nearly similar to study done in Tiwan [Chung et al.[49]] and

suggests that tobacco consumption in its both forms is more injurious than its single

form.

In this study, the higher prevalence (38.62%) of significant oral mucosal lesions

were found in the age group ranging from 61-80 years. This finding is almost similar

to study from Cambodia (Ikeda et al.[42]), and Venezuela (Valentina et al.[30]). But on

other hand, this finding is less than the study from Hong Kong (Corbet et al.[13]) with

52% and higher than study from Guangdong province, South China (Lin et al[38])

with 18% prevalence of oral mucosal lesions.

The possible explanation for these differences may be related to the proportions of

subjects and denture wearers, tobacco habits and normal mucosal variants findings

such as sublingual varices, melanotic pigmentation and fissured tongue.

In this age group (61-80 years) the maximum population were completely edentulous

(67.89%) and with higher number of lesions (22.75%) compared to dentate (15.04%)

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and partially edentulous (21.20%) population with lesions. Among the denture users

maximum number of lesions (31.75%) were observed compared to no prosthesis

users (17.35%), removable partial denture (10.27%) and fixed partial denture

(5.43%) users. This age group (61-80 years) is third most adverse habits users group

(10.16%) with 8.13% smoking and 2.30% smokeless tobacco users in this study.

The lesions characteristic of older age ranges, such as those predominantly

manifesting in patients more than 50 years of age, are associated with the wearing of

partial or complete dentures, the latter in turn being related to tooth loss resulting

from caries and periodontitis accumulating over time. Defects in the manufacture of

partial or complete dentures and the adaptive and progressive atrophic changes of the

bone and mucosa of the maxillary processes explain the presence of inflammatory

papillary hyperplasia, and candidiasis. Smoking also shows cumulative effects,

resulting in melanosis in some cases proportional to the duration of habit.

Leukoplakia, another lesion associated with smoking and other chronic irritants, also

develops in proportion to the duration of exposure. Thus, the higher prevalence of

oral mucosal lesions can be expected to be more common among older patients.

It is well known that aging causes changes to oral mucosal epithelium, such as

thinning and reduction of collagen synthesis, decreasing the ability to epithelial

regeneration and subsequently, the resistance of the organism to any disease of

microbial or traumatic in nature [50]. So it is not surprising that the majority of the

elderly subjects of the present study experienced oral health problems.

Second most prevalent oral mucosal lesions were seen in the age group ranging from

41-60 years. In this study, it is also found that tobacco related oral lesions such as

Leukoplakia, Candidiasis and angular chelitis were highly associated with smoking

while betel chewer mucosa, tobacco pouch keratosis and oral sub mucous fibrosis

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were highly associated with smokeless tobacco users [table X].

Thus, the significant finding of oral mucosal lesions in this group might be due to the

ageing effects on the overall health and oral epithelium and highest prevalence of

adverse habits (26.84%) with 19.11% smoking, 36.67% smokeless tobacco and

0.73% users of both forms of tobacco.

Patients with systemic disease showed a lower prevalence of oral lesions (13.39%) in

comparison to without systemic disease (17.52%) subjects, and this finding was

statically non significant [table XIII].

This might be due to less number of study subjects with systemic disease and more

number of tobacco users in other group.

Fordyce's condition

Fordyce's condition was observed in 1.48% of study population and was more

frequently observed on the buccal and labial mucosa. It was more prevalent in men

(2.30%) than in women (0.24%). Corbet et al. [13] (0.6%) and Mathew et al.[27] (6.5%)

had reported a prevalence of Fordyce’s condition, which is very different from our

finding.

Fissured tongue

Fissured tongue was seen in 1.69% (1.56% male, 1.88% female) of study population.

This included all subjects with fissures of at least 2-mm depth on the dorsal aspect of

the tongue. This prevalence is lower than that found by Mathew et al. [27] (5.7%),

Darwazeh and Pillai in Jordan [51] (11.4%) and also by Marija in Slovenia (21.1%).

This finding is similar to that found by Mobeeriek et al. [31] in Saudi Arabia (1.41%)

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and by Cebeci et al. [1] in Turkey (1.0%).

Leukoedema

In this study population, the prevalence of leukoedema was 0.69%. Males (1.05%)

were more affected than females (0.14%). The prevalence was more among smokers

than nonsmokers and correlation between leukoedema and smoking, tobacco

chewing, could be demonstrated in our study and this in accordance with Mathew et

al.[27].

Sublingual varices

The prevalence of sublingual varices was 0.35% (0.35% male, 0.34% female) in our

population. It occurred more frequently in the 61-80 years age-group. It is

considerably lower than the prevalence of 7.1% found by Mathew et al.[27], in

Manipal, India and similar to Mobeeriek et al.[31] in Saudi Arabia (0.39%).

Frictional keratosis

The occurrence of frictional keratosis was in 1.40% (1.79% male, 0.82% female) of

all subjects. The highest prevalence of this lesion in men was in the 21-60 years age-

group and in women in the 21-40 years age-group. This result is comparable to that of

Castellanos et al.[5] (1.46%) and Mobeeriek et al.[31] (1.33%). This finding is lower

than the prevalence reported by Mathew et al.[27] (5.79%).

Smoker's palate

In this study population, smoker's palate was observed only in men. The prevalence of

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1.00% was found more than that observed in Ljubljana, Slovenia, by Marija[39]

(0.5%), in Bangalore, India, by Shivakumar et al.[2] (0.59%) and lower than in

Swedish men by Axell[9] (2.1%) and by Mathew et al.[27] (4.4%), this could be due to

number of study population. Tobacco-related white lesions (leukoplakia and smoker's

palate) in our study population were more prevalent in men than in women. This

difference was attributable to the high tobacco consumption in men.

Aphthous stomatitis

The presence of recurrent aphthae was 0.71%. It was most prevalent in the 21-40

years age-group and more frequent in women than in men. This finding is similar to

studies conducted in Mexico by Castellanos JL[5] (0.08%) and in Saudi Arabia by

Mobeeriek et al.[31] (0.39%), and is lower than the finding by Mathew et al.[27] (2.1%).

This difference may be attributable to number of study population, level of stress and

hormonal changes.

Oral submucous fibrosis

The prevalence of oral submucous fibrosis in this population was (0.67%); it was

more among men (0.99%) than women (0.19%) and more often seen in the 21-60

years age-group. This is comparable to the prevalence found in a Cambodian

population[42] (0.2%) and similar to prevalence found Bangalore[2], India (0.59%).

This prevalence is less than the finding of Mathew et al.[27] (2.01%). This difference

may be attributable to number of study population and tobacco chewers.

Oral malignancies

The prevalence of oral malignancies in this study was 0.04%. It was observed in the

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age-group of 41-60 and 61-80 years. It was more prevalent in patients who were

chronic smokers and tobacco chewers. This prevalence is less than that found by

Ikeda [42] (0.1%) in a Cambodian population and Mathew et al.[27] (1.7%) in Manipal.

Leukoplakia

The prevalence of leukoplakia in study population was 1.92%. All the subjects with

leukoplakia in our population were smokers and tobacco chewers. It was prevalent

only in men. This prevalence is similar with the results obtained in Manipal by

Mathew et al.[27] (1.59%), Chile by Espinoza et al.[41] (1.70%), and in Hungary by

Banoczy[52] (1.3%) but low in prevalence when compared with the studies by Ikeda[42]

in Japan (25%), and Axell[9] in Sweden (3.6%). The highest prevalence of leukoplakia

in male population was in the 41-60 years age-group. The most frequent site of

involvement was the buccal mucosa, including the commissures. This difference may

be attributable to number of study population and tobacco habits.

Median rhomboid glossitis

The prevalence of median rhomboid glossitis was 0.15% and was observed more in

males (0.16%) compared to females (0.14%). This finding is less than the study

conducted in Manipal by Mathew et al.[27] (1.5%), and this might be due to the

variation in study population.

Oral candidiasis

The prevalence of oral candidiasis in study population was 0.12%. Oral Candidiasis

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was only seen in males of the older age-groups (41-80 years). This is lower than the

finding by Mathew et al. [27] (3.07%) and similar to that found by Axell[53] in Kuala

Lumpur (0.4%), and by Cebeci et al.[1] (0.2%) in Turkey. This difference might be

due to variation in number of subjects and smokers.

Lichen planus

Lichen planus was found in 1.04% of study population, which is comparable to study

conducted in Manipal[27], India (1.26%). In our population, lichen planus was most

prevalent in the 21-40 year age-group. It was more frequently observed among men

than women (1.02 and 1.06%, respectively). This is in accordance with the results

obtained by Mobeeriek et al. [31] in Saudi Arabia, and Saraswati et al. [23], in Chennai.

The most prevalent type was the reticular type. It was located most frequently on the

buccal mucosa followed by the tongue and the alveolar ridge.

Denture stomatitis

Denture stomatitis was observed in seven subjects (out of 63 denture wearers). The

prevalence in this study was 0.13%. The majority of denture stomatitis was observed

in the 41-60 years age-group. The frequency was observed to be more in females

(0.24%) than in males (0.06%). The higher prevalence of denture stomatitis among

women is in accordance with the findings of Mathew et al.[27] This is lower than that

observed by Corbet et al.[13] in a Chinese population in Hong Kong (10%) and by

Marija[39] in Slovenia (14.7%).

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Geographic tongue

Geographic tongue was present in 0.46% of study population, which is similar to

finding of Vigild M[54] (0.40%) in Denmark and Mobeeriek et al.[31] (0.51%) in Saudi

population and lower than the finding of Mathew et al.[27] (0.84%). It was more

prevalent in females (0.63%) than males (0.35%) and in age group of 21-40 year. The

higher female prevalence is accordance with Mobeeriek et al.

Betel chewer's mucosa

The prevalence of betel chewer's mucosa in this study was 0.15% with a high

prevalence in males (0.22%) than females (0.05%). It was more prevalent in 21-40

age groups. This finding is less than the prevalence found by Mathew et al. [27]

(0.84%).

Irritational fibroma

The prevalence of irritational fibroma in this study was 0.54%. It was more prevalent

in females (0.77%) than in males (0.38%) and in 21-40, 41-60 years age groups. This

is in accordance with the study done by Mathew et al.[27], where the prevalence was

found to be 0.84%.

Angular cheilitis

Angular cheilitis was found in 0.38% of study population, which is similar to the

finding recorded by Castellanos et al.[5] (0.36%) and comparable to the finding

recorded by Mathew et al.[27] (0.84%) and by Shivakumar et al.[2] (0.19%). It was only

found in the 41-60 years males.

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Herpes labialis

The prevalence of recurrent herpes labialis was 0.58%. In this study it was more

prevalent in the 21-40 year age-group and was more common in females than in males

(0.77% and 0.45%, respectively). This is similar to study done by Mathew et al.[27]

(0.58%) and Mobeeriek et al.[31] (0.39%). This is comparable to the finding by Chiang

Mai[53] in Thailand (0.9%).

Mucocele

The prevalence of mucocele in this population was 0.04%, and it was found only in

males. This prevalence is less than the study done by Mathew et al.[27] (0.16%).

Traumatic ulceration

The prevalence of traumatic ulceration in this study was 0.65%. It was more prevalent

in females (0.72%) than in males (0.61%) and in 21-40 years age groups. This is in

accordance with the study done by Mathew et al.[27] (1%), and by Shivakumar et al.[2]

(0.19%). This finding is less than the prevalence found by Castellanos et al.[5] (4%)

and by Dimitris Triantos[50] in Greek (3.7%).

Lichenoid like Reaction

The prevalence of lichenoid reaction in this study was 0.04%. It was only found in

males (0.06%). This prevalence is comparable with finding by Shivakumar et al.[2]

where the prevalence was 0.19%.

Papilloma

The prevalence of papilloma in this study was 0.02%. It was only found in a male of

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age group 21-40 years. This prevalence is similar to J.D. Sulman[21] (USA, 0.02%)

and comparable with findings by Ikeda et al.[42] (Cambodia), Cobert et al.[13] (Hong

Kong), and Castellanos et al.[5] (Mexico), where the prevalence were 0.1%, 0.2% and

0.29% respectively.

Papillary Hyperplasia

The prevalence of papillary hyperplasia in this study was 0.13%. It was found 0.16%

in males and 0.10% in females. This prevalence is similar to finding by Parlak et al.[22]

(0.1%) and by Castellanos et al.[5] where the prevalence was 0.24%. The difference in

the findings might be due to the number of denture users in the study.

Atrophy of Tongue Papillae

The prevalence of glossitis in this study was 0.85%. It was found 0.38% in males and

1.55% in females. It was found more in age group 21-40 years. This prevalence is

similar to finding by Corbet et al.[13] (1%) and by Axell et al.[9] where the prevalence

was 1% and is less than the findings by Jackes et al.[40] (4.4%) and higher than the

finding Mobeeriek et al.[31] by (0.12%).

Pyogenic Granuloma

The prevalence of pyogenic granuloma in this study was 0.13%. It was found 0.16%

in males and 0.10% in females. This prevalence is similar to finding by Axell et al.[9]

(0.1%, Sweden) and by Castellanos et al.[5] where the prevalence was 0.08%. This is

comparable with findings by Espinoza et al.[41] (Chile, 0.7%), and by Dimitris

Triantos[50] (Greece, 1%).

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Primary Herpetic Gingivostomatitis

The prevalence of primary herpetic gingivostomatitis in this study was 0.08%. It was

found 0.03% in males and 0.14% in females. It was found more in age group 21-40

years. This prevalence is comparable with Bess et al.[17] (0.33%).

Eruption Cyst

The prevalence of eruption cyst in this study was 0.04%. It was found 0.03% in males

and 0.05% in females. It was found only in age group 02-20 years. This prevalence is

comparable with Bess et al[17] (0.17%).

Snuff Dipper’s Lesion

The prevalence of Snuff Dipper’s Lesion in this study was 0.27%. It was found only

in 0.45% males in age group 21-40 years and was associated with smokeless tobacco

uses. This prevalence is less than the finding recorded by Axell[9] (1.3%) and Salonen

et al.[45] (13.75%).

Hairy Tongue

The prevalence of Hairy Tongue in this study was 0.08%. It was found 0.10% in

males and 0.05% in females. This prevalence is comparable with Salonen et al[45]

(0.4%) and is less than the finding recorded by Reichart[4] (26.6% & 1.8%) in two

groups respectively and by Avcu & Kanli[15] (11.3%).

Coated Tongue

The prevalence of Coated Tongue in this study was 1.83%. It was found in 2.14%

males and 1.35% in females of age group 21-40 years. This prevalence is similar with

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finding recorded by Axell et al.[9] (1.2%) in Sweden and less than finding recorded by

Avcu & Kanli[15] (23.2%).

Commissural Pit

The prevalence of Commissural pits in this study was 0.71% [0.80% male & 0.58%

female]. It was more prevalent in males of age group II and was absent in subjects of

age group IV.

Chemical And Thermal Burn

In this study 0.04% chemical and 0.04% thermal burns were observed. Chemical

burns were found only in age group II women, who were undergoing root canal

treatment. While thermal burns were found in one male and one female, which were

due to taking hot drinks.

Linea Alba Buccalis

The prevalence of linea alba buccalis in this study was 2.19%. It was found 1.82% in

males and 2.75% in females. It was highly prevalent in females of age group II.

Other Lesions

One case (0.02%) of petichae in age group III female, one case (0.02%) of myolipoma

in age group I female, single case (0.02%) of hematoma, herpes zoster, and vitiligo

were found in age group III males.

Two cases of ranula in age group 1 females, 2 cases of peripheral giant cell

granuloma, one in male and one in female were observed in this study.

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CONCLUSION:

This study establishes a prevalence rate [17.16%] of Oral Mucosal Lesions in patients

attending outpatient department of Kothiwal Dental College and Research Centre and

demonstrates that smoking, tobacco chewing and increasing age is associated with

greater odds of oral mucosal lesions, emphasizing the importance of frequent and

regular inspection of the oral cavity for early detection and prompt treatment.

In this study male [11.34%] showed a higher significant prevalence of oral mucosal

lesions than female [5.82%]. The higher significant prevalence was found in urban

population [19.70%] followed by rural [17.51%] and periurban population [12.82%].

The lesions were more prevalent in age group IV [38.62%] and III [32.67%]. 16.36%

study population were tobacco users, out of which 8.80% were smokers, 7.28% were

smokeless tobacco users and 0.27% were using tobacco in both forms. 5.43% were

tobacco-related lesions and 3.63% were precancers.

No lesions were found in 82.84% of the population; 33.87% of them were females

and 44.97% were males. The maximum number of lesion-free patients was in the 21-

40 years old male population.

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Most prevalent normal mucosal variant was fissured tongue [1.69%] followed by

fordyce’s granules [1.48%], commissural pit [0.71%], leukoedema [0.69%] and

lingual varices [0.35%].

From all these results we can arise at a conclusion that tobacco use among people are

existing and increasing at a higher pace. Tobacco related oral lesions are also high,

which brings an alarming signal towards development of cancer.

There is an urgent need for awareness programs utilizing the community health

workers, dentists and allied medical professionals. It is hoped that these results will

form the basis of a state level, followed by a national level survey of oral lesions.

SUMMARY:

The oral mucosa performs essential protective functions that significantly affect the

general health of the patient. Besides dental caries and periodontal diseases, oral

mucosal lesions are another significant problem of public health importance. This

study was conducted to evaluate the prevalence of oral mucosal lesions in patients

attending outpatient department of Kothiwal Dental College and Research Centre,

Moradabad and correlation of the prevalence with the uses of tobacco among study

population.

The prevalence of oral mucosal lesions was determined by the clinical examination in

a sample of 5203 patients during the period of three months from 16th April to 15th

July, 2009. Patients from 2-80 years were included in the study.

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The present study established an overall prevalence of oral mucosal lesions of 17.16%

(males = 11.34%, females = 5.82%). Males have higher prevalence (18.83%)

compared to females (14.64%). The difference between male and female was found to

be statistically highly significant. It has been found that patients habitual to smoke

have higher oral lesions (43.00%) than who uses smokeless tobacco (24.89%) and

who do not have any deleterious habits (13.83%).

The prevalence of oral mucosal lesion in smokers and smokeless tobacco users was

more than in non tobacco users. The uses of smoking and tobacco together showed

higher prevalence of oral mucosal lesions in general and this was statistically highly

significant. Prevalence of tobacco related premalignant diseases were more than the

nontobacco related precancers.

This prevalence study in a dental institute showing a strange correlation between

tobacco use and oral mucosal lesions calls for the importance of the role of dentist in

educating the patients of the ill-effects of tobacco on their health and in helping them

in tobacco cessation.

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APPENDIX-1

CASE HISTORY PROFORMA FOR THESIS

Title of the thesis

“The Prevalence Of Oral Mucosa Lesions In Patients Visiting A Dental College In Moradabad, India”

By : Under the Guidance of :

Dr. Anand Pratap Singh Prof. Dr. G.N. Suma

PG Student (Supervisor)

Dr. Ravi Prakash S.M

(Co- Supervisor)

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S.No: REGISTRATION No: DATE:

I. NAME:

II. SEX : 1 MALE 2. FEMALE

III. AGE:-

IV. AGE GROUP: 1. 2 -20 YRS

2. 21-40 YRS

3. 41-60 YRS

4. 61-80 YRS

V. ETHNIC GROUP 1. H 2. M 3. OTHERS

VI. GEOGRAPHIC LOCATION

1. URBAN

2. PERIURBAN

3. RURAL

VII.OCCUPATION……………………………………………………………………

VIII. MEDICAL HISTORY

0. NO HISTORY

1. DM 2. HT

3. TB 4. CARDIAC

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5. EPILEPSY 6. ALLERGY

7. BLOOD TRANSFUSION 8. HOSPITALIZATION

9. ENT 10. BLEEDING DISORDER

11. OTHERS……………………………

COMMENTS…………………………………………………………………………………………………………………………………………………………………..

IX. MEDICATION

0. NO MEDICATION 2. SOME TIMES TAKES MEDICATION

1. UNDER TREATMENT 3. TAKEN MEDICATION

X. DURATION…………………………………………………………………………….

XI. FAMILY HISTORY

0. NO H/O SIMILAR LESION

1. SIMILAR LESION IN FAMILY

XII. PERSONAL HISTORY

a. DIET

1. VEG

2. NON-VEG

3. MIXED

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b. SLEEP

0. UNDISTRUBED

1 DISTRUBED

c. APPETITE

0. NORMAL

1. REDUCED

d. MENSTURATION

0. REGULAR

1. IRREGULAR

2. MENOPAUSE

e. PREGNANCY TRIMESTER

0. NO

1. Ist TM

2. 2nd TM

3. 3rd TM

f. LACTATION

0. NO

1. YES

g. ORAL HYGINE METHODS

0. NO

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1. TOOTH BRUSH

2. FINGER

3. OTHER……………………………………………………..

h. PARAFUNCTION

0. NOT PRESENT

1. PRESENT

COMMENT:………………………………………………………………………..

i. HABIT

0. NO HABIT

1. SMOKELES TOBACCO

2. SMOKING

3. ALCOHOL

4. DRUGS

5. OTHERS……………………………………………………

DURATION…………………………… FREQUENCY……………………...

j. HABIT INDEX…………………………………………………………………….

XIII. DENTITION

1. DANTATE

2. PARTIALLY EDENTULOUS

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3. COMPLEAT EDENTULOUS

1. DECIDUOUS

2. MIXED

3. PERMANENT

XIV. PROSTHESIS

0. NO PROSTHESIS

1. DENTURE WEARER

2. RPD

3. FPD

4. FAULTY PROSTHESIS

XV. H/O LESION:

0. NO H/O SIMILAR LESIONS IN PAST

1. +ve H/O SIMILAR LESIONS IN PAST

FREQUENCY AND COMMENTS:……………………………………………………

XVI. EXTRA ORAL EXAMINATION

a. LOCATION

OTHERS………………………………………………………

…………………………………………………………………

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COMMENTS……………………………………………………

b. LESION :-

OTHERS………………………………………………………………………………

COMMENTS…………………………………………………………………………

XVII. ORAL MUCOSAL EXAMINATION

a. LOCATION:-

OTHERS………………………………………………………………………………

COMMENT……………………………………………………………………………

b. LESION:-

OTHERS………………………………………………………………………………

COMMENTS…………………………………………………………………………

XVIII. ASSOCIATED SYMPTOMS

0. NO ASSOCIATED SYMPTOMS

1. FEVER

2. LYMPHADENOPATHY

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3. DISCHARGE

4. DIFFICULTY IN SWALLOWING

5. BURNING SENSATION

6. PAIN

7. OTHERS……………………………………………………

COMMENTS………………………………………………………………………

XIX. SIMILAR LESIONS IN OTHER PART OF BODY

0. NO

1. YES

LOCATION…………………………………………………………………………

XX. INVESTIGATIONS

0. NO NEED

1. HISTOPATHOLOGICAL

2. RADIOGRAPHIC

3. HAEMATOLOGICAL

4. OTHERS……………………………………………….

INVESTIGATIONAL REPORT & COMMENTS:-

XXI. FINALDIAGNOSIS…………………………………………………………

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APPENDIX- II

CONSENT FOR PARTICIPATION IN RESEARCH

“THE PREVALENCE OF ORAL MUCOSAL LESIONS IN PATIENTS VISITING A DENTAL COLLEGE IN MORADABAD, INDIA”

Dr. Anand Pratap Singh, Post Graduate student in department of Oral Medicine and Radiology, Kothiwal Dental College, Moradabad, is doing thesis work on “THE PREVALENCE OF ORAL MUCOSAL LESIONS IN PATIENTS VISITING A DENTAL COLLEGE IN MORADABAD, INDIA” You are being asked to be a subject in this research work.

Your participation in this research is voluntary. Your decision whether or not to participate will not affect your current or future relationship with Kothiwal Dental College. If you decide to participate, you are free to withdraw at any time without affecting that relationship.

PROCEDURE INVOLVED:

After oral examination, biopsy will be done, if required.

RISK AND BENEFITS:

There will be no significant physical or psychological risks to the participants.

During the course of study, you will be informed of any significant findings (either good or bad) such as changes in the risks or benefits resulting from participation in research.

PRIVACY AND CONFIDENTIALITY:

The only people who will know that you are a research subjects are members of the research team. No information about you, or provided by you during the research will be disclosed to others without your written permission except

1. If necessary to protect your rights and welfare.

2. If required by the law

When the results are published or discussed in conferences, no information will be disclosed that would reveal your identity. Any information that is obtained in connection with this study and that can be identified with you will remain confidential and will be disclosed only with your permission or if required by the law.

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You will not be paid /offered any gifts for participating in research. There will not be any remuneration for participation in the research.

Your participation is voluntary and you have the right to withdraw from the study at any time.

“I hereby have no objection to give my voluntary consent on behalf of myself to be included in the study”

SIGNATURE/THUMB IMPRESSION……………………..

NAME DATE:

NAME & SIGNATURE OF RESEARCHER: DATE:

NAME & SIGNATURE OF WITNESS: DATE:

the prevalence of oral mucosal lesions in moradabad- uttar pradesh by- dr. anand pratap singh...

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