Month: February 2020

Precancerous lesions of oral mucosa, known as potentially malignant disorders in recent years, are consists of a group of diseases, which should be diagnosed in the early stage. Oral leukoplakia, oral submucous fibrosis, and oral erythroplakia are the most common oral mucosal diseases that have a very high malignant transformation rate.
The etiology of precancerous lesions of oral mucosa is not well-known. Some risk factors such as tobacco chewing, tobacco smoking, and alcohol play an important role in development of potentially malignant oral conditions.

Leukoplaki is defined as “A white plaque of questionable risk having excluded (other) known diseases or disorders that carry no increased risk for cancer”.  Although leukoplakia can occur at any age, it often occurs in individuals under the age of 40. Leukoplakia is seen six times more among smokers than among non-smokers. Oral leukoplakia should be confirmed by mucosal biopsy.The most commonly preferred treatment options are surgical excision or CO2 laser therapy.

Erythroplakia is defined as “A fiery red patch that cannot be characterized clinically or pathologically as any other definable disease”. Clinical appearance is characterized by flat or even depressed erythematous change of the mucosa without a patch lesion.  It mainly occurs in the middle aged and the elderly. Male gender is most frequently affected. Chewing tobacco and alcohol use are the possible etiologic factors for the development erythroplakia. Clinically, typical lesion of oral erythroplakia is less than 1.5 cm in diameter, but it also be less than 1 cm and larger than 4 cm. Owing to the high malignant transformation rate, early effective treatment is mandatory. Surgery, either by cold knife or by laser, is the recommended therapy.

Lichen Planus , is a chronic, autoimmune, inflammatory disease which may affect skin, oral mucosa, genital mucosa, scalp, and nails. It mainly occurs among female gender and the age of onset is usually between third and sixth decade. Several factors have been proposed for the etiology including genetic background, dental materials (amalgam, metals, gold) drugs (especially anti malarials, cardiovascular agents, gold salts, non-steroidal anti-inflammatory drugs, hypoglycemic), infectious agents (herpes simplex virus, Epstein-Barr virus, cytomegalovirus, herpes virus-6, hepatitis-C virus, and human papilloma virus), autoimmunity, immunodeficiency, food allergies, stress, habits, trauma, diabetes and hypertension, malignant neoplasms, and bowel disease. Even though OLP may affect any part of the oral mucosa, most commonly affected areas are dorsum of the tongue, buccal mucosa, and gingiva.

Oral submucous fibrosis (OSF) is a premalignant condition mainly associated with the practice of chewing betel quid containing areca nut, a habit common among south Asian people. It is characterized by inflammation, increased deposition of submucosal collagen, and formation of fibrotic bands in the oral and paraoral tissues, which increasingly limit mouth opening. The most common initial symptoms and signs are a burning sensation, dry mouth, blanching oral mucosa, and ulceration. The burning sensation usually occurs while chewing spicy food. These features can be observed at all stages of OSF. In the more advanced stage of the disease, the essential feature is a fibrous band restricting mouth opening and causing difficulty in mastication, speech, swallowing, and maintaining oral hygiene.] Development of fibrous bands in the lip makes the lip thick, rubbery, and difficult to retract or evert; a band around the lips gives the mouth opening an elliptical shape. Fibrosis makes cheeks thick and rigid. When a patient blows a whistle or tries to inflate a balloon, the usual puffed-out appearance of the cheeks is missing. In the tongue, depapillation of the mucosa around the tip and lateral margins may occur with blanching or fibrosis of the ventral mucosa. Fibrosis of the tongue and the floor of the mouth interfere with tongue movement. Hard palate involvement includes extensively blanched mucosa. No known treatment for OSF is effective, although some conservative and surgical interventions may result in improvement. Most important aspect of medical treatment is the cessation of habit of eating betel quid, areca nut, other local irritants, spicy and hot food, alcohol, and smoking. The most common mode of medical treatment had been the use of steroids in its various forms.