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Mehrotra et al. BMC Research Notes 2010, 3:23
http://www.biomedcentral.com/1756-0500/3/23




 SHORT REPORT                                                                                                                                Open Access

Prevalence of oral soft tissue lesions in Vidisha
Ravi Mehrotra1*, Shaji Thomas2, Preeti Nair3, Shruti Pandya1, Mamta Singh1, Niraj S Nigam4, Pankaj Shukla5


  Abstract
  Background: The purpose of this study was to determine the prevalence of oral soft tissue lesions in patients and
  to assess their clinicopathological attributes. 3030 subjects belonging to a semi-urban district of Vidisha in Central
  India were screened. Patients were examined with an overhead examination light and those who were identified
  with a questionable lesion underwent further investigations. Statistical analysis was done using the SPSS software.
  Findings: 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 submucous 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.
  Conclusions: 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.


Background                                                                         from various regions which may give an understanding
Oral malignancies are the sixth most common cancer                                 of the national scenario.
around the globe [1]. Oral mucosal lesions could be due                              In an earlier study, the authors reported that poten-
to infection (bacterial, viral, fungal), local trauma and or                       tially malignant and malignant oral lesions were wide-
irritation (traumatic keratosis, irritational fibroma,                             spread in the patients visiting a tertiary level referral
burns), systemic disease (metabolic or immunological),                             hospital at Allahabad in North India [2]. This study was
or related to lifestyle factors such as the usage of                               undertaken at a semi-urban community at Vidisha in
tobacco, areca nut, betel quid, or alcohol.                                        Central India (Fig. 1) to assess magnitude of various oral
  For planning of national or regional oral health pro-                            lesions associated with usage of tobacco, betel nut, betel
motion programs as well as to prevent and treat oral                               leaf etc in various forms. As per the 2001 [update]
health problems, baseline data about magnitude of the                              Indian census, Vidisha has a population of 1, 25,457.
problem is required. India has a vast geographic area,                             Males constituted 53% of the population and females
divided into states, which differ with regard to their                             47%. The average literacy rate was 70% which was
socioeconomic, educational, cultural and behavioural                               higher than the national average of 59.5%. Male literacy
traditions. These factors may affect the oral health sta-                          was 77%, and female literacy was 62%. In Vidisha, 15%
tus. Hence to obtain nationwide representative data, a                             of the population was under 6 years of age [3]. The vast
nationwide study is required. A more practical alterna-                            majority of the people at Vidisha belonged to the lower
tive is to develop regional databases and review data                              socio-economic status with poor access to dental care.
                                                                                   To the best of our knowledge, there is no data on the
                                                                                   oral health status of this community. This study
                                                                                   explores the prevalence of oral lesions in this commu-
* Correspondence: rm8509@gmail.com                                                 nity and attempts to correlate the various risk factors
1
 Department of Pathology, Moti Lal Nehru Medical College, Lowther Road,            with the lesions found.
Allahabad, 211001, India

                                      © 2010 Mehrotra et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
                                      Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
                                      reproduction in any medium, provided the original work is properly cited.
Mehrotra et al. BMC Research Notes 2010, 3:23                                                                 Page 2 of 6
http://www.biomedcentral.com/1756-0500/3/23




Methods                                                        trauma, use of prosthesis and if these were well adapted.
Data collection                                                In addition, in those cases requiring further examina-
Individuals presenting to the out-patient department           tion, biopsies were performed to establish a definitive
(OPD) of the Government-run District Hospital at               diagnosis.
Vidisha district in the state of Madhya Pradesh in Cen-        Statistical analysis
tral India were screened at an Oral health camp held           The variables were analyzed on all patients, using the
during the months of May- June 2008, over a period of          SPSS software (11.0).
10 days by a team of dental and medical specialists.
Information about this screening was also disseminated         Results
by public announcements, distribution of handbills,            The population under study consisted mainly of indivi-
media coverage and door-to-door publicity in the               duals living in isolated settlements away from the gen-
remote areas.                                                  eral population. A total of 3030 subjects were screened.
Ethical permission                                             Of these 2150 (71%) were males and 880 (29%) were
Permission was obtained from the Institutional ethical         females. (Fig. 1) Analyzing the clinical symptoms, 417
committee at Vidisha and written consent was obtained          (14%) reported moderate pain/discomfort, 412 (14%)
from the participating patients.                               suffered from difficulty in opening the mouth; 244 (8%)
Questionnaire                                                  patients reported slight burning sensation, 140(5%)
The WHO Oral Health Assessment Form was used as a              reported moderate and 37 (1%) reported severe burning
basis of a questionnaire and clinical assessment form          sensation in the oral cavity; 97(3%) patients had altered
[4]. General information related to the subjects’ oral         taste sensation. 19(1%) reported increased while 108(4%)
hygiene practices and habits were collected through            reported decreased salivation. (Fig. 2)
interview by paramedical workers. The questionnaire               Regarding the habit of tobacco use, 635(21%) were
was constructed and administered in English. After a           smokers, 1272(42%) tobacco chewers, 341(11%) smokers
pilot study, the questionnaire was translated into the         and chewers, while 1464(48%) neither smoked nor
local language (Hindi) using appropriate and simple            chewed. (Fig. 3) 256 patients were found to have signifi-
words. For validation, the questionnaire was translated        cant mucosal lesions which were maculopapular, ero-
back into English. During the survey the questions were        sions, ulcerations or growths. Of these, maximum
read to most of the subjects, as the majority were             number of patients i.e. 32(14%) had lesions measuring
illiterate.                                                    1-3 mm. lesion, 8% had lesions of 11-20 mm, while, 27
Patient Population                                             (12%) had lesions more than 20 mm of size.
Patients who were at least 18 years of age were included          In 121(53%) patients, both the right and left buccal
in the study. Those who gave a history of usage of             mucosae were involved. This was followed by involve-
tobacco, betel nut and betel leaf in various forms were        ment of the retromolar trigone. The other areas of the
considered to be at high risk for oral lesions. Prior to       oral cavity like tongue, gingivae, floor of mouth, hard
the examination, patients rinsed their mouth thoroughly        palate, soft palate and alveolar mucosa were less com-
with water and were examined under an incandescent             monly involved.
light source. Patients with oral mucosal lesions were             Of these 256 patients who were identified with
identified and lesions that, in the opinion of the investi-    abnormalities on clinical examination, 40 patients
gator warranted histopathological examination, under-          refused to undergo scalpel biopsy and 216 cases agreed
went scalpel biopsies.                                         for scalpel biopsy confirmation.
Clinical examination                                              On histopathological examination, maximum number
Each patient was evaluated using a pre-designed chart.         i.e. 88 (40%) patients had leukoplakia. 17 (11%) patients
The clinical diagnosis was established and classified          were found to have dysplasia - of which 13 had dyspla-
according to the Epidemiology guide for the diagnosis of       sia grade 1, 3 had dysplasia grade II and 1 had dysplasia
oral mucosal diseases (WHO) [5]. Correlation, if any,          grade III, while 2 patients were confirmed to have squa-
with etiological factors was assessed. The questionnaire       mous cell carcinoma. Other lesions are detailed in Fig.
included information on general status of the patient,         4.
systemic diseases, medications used, age, gender, alcohol         On statistical analysis, the patients with leukoplakia
and tobacco consumption, habits (trauma) and prosthe-          had an Odds ratio of 4.5 while chewers had an Odds
tic or other appliances use. During the clinical examina-      ratio of 5.6 as compared to non-users. More males had
tion the following elements were analyzed: features of         dysplasia than females i.e. 17/18 (p < 0.02) and, at the
the lesion, anatomical location, extension, etiological        same time, more males used addictive substances vis-à-
factors or related factors, dental status, alcohol, tobacco,   vis females (p < 0.02).
Mehrotra et al. BMC Research Notes 2010, 3:23                                                                            Page 3 of 6
http://www.biomedcentral.com/1756-0500/3/23




 Figure 1 Distribution of patients according to their complaints.


  The patients with a diagnosis of premalignant condi-                   available, however few isolated studies of prevalent
tions like speckled leukoplakia and oral submucous                       lesions have been reported [6-11]. The prevalence of
fibrosis were advised abstinence from tobacco and a                      oral lesions in population has been documented in other
visit to their dentist, while the patients with dysplasia                parts of the world like Colombia [12], Mexico [13], Bra-
were advised follow-up at a tertiary level teaching hospi-               zil [14], Chile [15], Spain [16], Argentina [17], USA[18],
tal in Bhopal and those with squamous cell carcinoma                     Israel [19] and Cambodia [20], mainly based on clinical
were advised surgery at the Jawaharlal Cancer Hospital,                  evaluation of the lesions. In contrast, Correa et al [21]
Bhopal.                                                                  and Dehler et al [22] conducted prevalence studies
                                                                         based on the clinicopathological correlation, evaluating
Discussion                                                               the biopsies of the observed lesions.
Only limited information on oral mucosal abnormalities                     While emerging lifestyle and food habits have been
in the rural or semi-urban population of India is                        contributing factors, the problem of bad oral health is




 Figure 2 Distribution of patients according to their personal habits.
Mehrotra et al. BMC Research Notes 2010, 3:23                                                                 Page 4 of 6
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 Figure 3 Histopathological diagnosis of lesions.


compounded by a low dentist to population ratio. The           prevalence of 23.2% in the elderly. Sanchez reporting in
World Health Organisation (WHO) recommends a 1:                Spain, documented 39% of aged patients had oral
7500 dentist to population ratio whereas the dentist to        mucosa alterations [16].
population ratio in India is as low as 1:22500 [23]. In           Of the clinically significant lesions which were biop-
2004, India had one dentist for 10,000 persons in urban        sied, the percentage of patients suffering from leuko-
areas and about 2.5 lakh persons in rural areas. Almost        plakia was 40.7%, oral submucous fibrosis 9.7% and
three-fourths of the total number of dentists were clus-       lichen planus 2.7% which was higher to those found by
tered in urban areas, which house only one-fourth of           Saraswathi et al (0.59%, 0.55% and 0.15% respectively)
the country’s population [24]. This limits the curative        Prevalence of smoker’s melanosis was 2.3% in this
approach to tackle dental problems in rural areas while        study while it was lesser in Chennai (1.14%) [6]. Dys-
it is widely acknowledged that oral cancer can best be         plasia was found in 17 patients out of which 6% was
prevented through early detection and primary preven-          found with grade I, 1.4% with grade II and 0.5% with
tion. Unfortunately, the awareness levels of lesions asso-     grade III while squamous cell carcinoma was found in
ciated with usage of addictive agents continue to remain       0.93% in this study. These findings reveal higher per-
abysmally low.                                                 centages than similar studies from India, [6-11] and
   This study was a community survey, in which the pre-        this difference may probably be explained by the fact
valence of clinically significant oral lesions was 8.4% -      that, unlike most other clinical studies, in this report,
which was higher in comparison to a previous study             histopathological confirmation was obtained in most of
from Chennai (4.1%). This could probably be due to             the cases.
higher prevalence of smoking and/or tobacco chewing               Subjects who smoked or chewed tobacco in any form
(52%) in this study in comparison to 31% reported by           had a far higher incidence of oral lesions vis-à-vis non-
Saraswathi et al [6]. Vellappally et al found that in a sur-   users. On assessing the correlation of habits with inci-
vey of 805 subjects for dental caries, the highest preva-      dence of leukoplakia, smokers were found to have an
lence of oral mucosal lesions were present in tobacco          Odds ratio of 4.5 while chewers had 5.6 as compared to
chewers (22.7%) followed by regular smokers (12.9%),           non-users. This was less than findings of Saraswathi et
occasional smokers (8.6%), ex-smokers (5.1%) and non           al who reported figures of 5.08 and 6.82, respectively.
tobacco users (2.8%) [11]. The prevalence figure of oral       Subjects who chewed areca nut with or without tobacco
lesions was 8.4% covering all age groups. On the other         had a higher prevalence of oral submucous fibrosis,
hand, Gonzalez et al [13] in Mexico, demonstrated a            similar to earlier findings[6].
Mehrotra et al. BMC Research Notes 2010, 3:23   Page 5 of 6
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 Figure 4 Spectrum of clinical lesions.
Mehrotra et al. BMC Research Notes 2010, 3:23                                                                                                          Page 6 of 6
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  Since the information on habits was garnered by the                           8.      Mehta FS, Gupta PC, Daftary DK, Pindborg JJ, Choksi SK: An epidemiologic
                                                                                        study of oral cancer and precancerous conditions among 101,761
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                                                                                        Allahabad. Indian J Med Sci 2003, 57:400-4.
that due to the rather small sample size, inherent in a                         10.     Mathew Iype E, Pandey M, Mathew A, Thomas G, Sebastian P, Krishnan
population survey vis-à-vis a hospital survey, there is a                               Nair M: Squamous cell carcinoma of the tongue among young Indian
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of addictive substances as well as the high prevalence of                               2000 y cual es la percepción que tienen estos pacientes sobre su propio
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                                                                                        encolombia.com.
for awareness programs utilizing the community health                           13.     González B, González L, Bobadilla A: Prevalencia de patología bucal y de
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Bmc Res Notes Vidisha

  • 1. Mehrotra et al. BMC Research Notes 2010, 3:23 http://www.biomedcentral.com/1756-0500/3/23 SHORT REPORT Open Access Prevalence of oral soft tissue lesions in Vidisha Ravi Mehrotra1*, Shaji Thomas2, Preeti Nair3, Shruti Pandya1, Mamta Singh1, Niraj S Nigam4, Pankaj Shukla5 Abstract Background: The purpose of this study was to determine the prevalence of oral soft tissue lesions in patients and to assess their clinicopathological attributes. 3030 subjects belonging to a semi-urban district of Vidisha in Central India were screened. Patients were examined with an overhead examination light and those who were identified with a questionable lesion underwent further investigations. Statistical analysis was done using the SPSS software. Findings: 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 submucous 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. Conclusions: 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. Background from various regions which may give an understanding Oral malignancies are the sixth most common cancer of the national scenario. around the globe [1]. Oral mucosal lesions could be due In an earlier study, the authors reported that poten- to infection (bacterial, viral, fungal), local trauma and or tially malignant and malignant oral lesions were wide- irritation (traumatic keratosis, irritational fibroma, spread in the patients visiting a tertiary level referral burns), systemic disease (metabolic or immunological), hospital at Allahabad in North India [2]. This study was or related to lifestyle factors such as the usage of undertaken at a semi-urban community at Vidisha in tobacco, areca nut, betel quid, or alcohol. Central India (Fig. 1) to assess magnitude of various oral For planning of national or regional oral health pro- lesions associated with usage of tobacco, betel nut, betel motion programs as well as to prevent and treat oral leaf etc in various forms. As per the 2001 [update] health problems, baseline data about magnitude of the Indian census, Vidisha has a population of 1, 25,457. problem is required. India has a vast geographic area, Males constituted 53% of the population and females divided into states, which differ with regard to their 47%. The average literacy rate was 70% which was socioeconomic, educational, cultural and behavioural higher than the national average of 59.5%. Male literacy traditions. These factors may affect the oral health sta- was 77%, and female literacy was 62%. In Vidisha, 15% tus. Hence to obtain nationwide representative data, a of the population was under 6 years of age [3]. The vast nationwide study is required. A more practical alterna- majority of the people at Vidisha belonged to the lower tive is to develop regional databases and review data socio-economic status with poor access to dental care. To the best of our knowledge, there is no data on the oral health status of this community. This study explores the prevalence of oral lesions in this commu- * Correspondence: rm8509@gmail.com nity and attempts to correlate the various risk factors 1 Department of Pathology, Moti Lal Nehru Medical College, Lowther Road, with the lesions found. Allahabad, 211001, India © 2010 Mehrotra et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
  • 2. Mehrotra et al. BMC Research Notes 2010, 3:23 Page 2 of 6 http://www.biomedcentral.com/1756-0500/3/23 Methods trauma, use of prosthesis and if these were well adapted. Data collection In addition, in those cases requiring further examina- Individuals presenting to the out-patient department tion, biopsies were performed to establish a definitive (OPD) of the Government-run District Hospital at diagnosis. Vidisha district in the state of Madhya Pradesh in Cen- Statistical analysis tral India were screened at an Oral health camp held The variables were analyzed on all patients, using the during the months of May- June 2008, over a period of SPSS software (11.0). 10 days by a team of dental and medical specialists. Information about this screening was also disseminated Results by public announcements, distribution of handbills, The population under study consisted mainly of indivi- media coverage and door-to-door publicity in the duals living in isolated settlements away from the gen- remote areas. eral population. A total of 3030 subjects were screened. Ethical permission Of these 2150 (71%) were males and 880 (29%) were Permission was obtained from the Institutional ethical females. (Fig. 1) Analyzing the clinical symptoms, 417 committee at Vidisha and written consent was obtained (14%) reported moderate pain/discomfort, 412 (14%) from the participating patients. suffered from difficulty in opening the mouth; 244 (8%) Questionnaire patients reported slight burning sensation, 140(5%) The WHO Oral Health Assessment Form was used as a reported moderate and 37 (1%) reported severe burning basis of a questionnaire and clinical assessment form sensation in the oral cavity; 97(3%) patients had altered [4]. General information related to the subjects’ oral taste sensation. 19(1%) reported increased while 108(4%) hygiene practices and habits were collected through reported decreased salivation. (Fig. 2) interview by paramedical workers. The questionnaire Regarding the habit of tobacco use, 635(21%) were was constructed and administered in English. After a smokers, 1272(42%) tobacco chewers, 341(11%) smokers pilot study, the questionnaire was translated into the and chewers, while 1464(48%) neither smoked nor local language (Hindi) using appropriate and simple chewed. (Fig. 3) 256 patients were found to have signifi- words. For validation, the questionnaire was translated cant mucosal lesions which were maculopapular, ero- back into English. During the survey the questions were sions, ulcerations or growths. Of these, maximum read to most of the subjects, as the majority were number of patients i.e. 32(14%) had lesions measuring illiterate. 1-3 mm. lesion, 8% had lesions of 11-20 mm, while, 27 Patient Population (12%) had lesions more than 20 mm of size. Patients who were at least 18 years of age were included In 121(53%) patients, both the right and left buccal in the study. Those who gave a history of usage of mucosae were involved. This was followed by involve- tobacco, betel nut and betel leaf in various forms were ment of the retromolar trigone. The other areas of the considered to be at high risk for oral lesions. Prior to oral cavity like tongue, gingivae, floor of mouth, hard the examination, patients rinsed their mouth thoroughly palate, soft palate and alveolar mucosa were less com- with water and were examined under an incandescent monly involved. light source. Patients with oral mucosal lesions were Of these 256 patients who were identified with identified and lesions that, in the opinion of the investi- abnormalities on clinical examination, 40 patients gator warranted histopathological examination, under- refused to undergo scalpel biopsy and 216 cases agreed went scalpel biopsies. for scalpel biopsy confirmation. Clinical examination On histopathological examination, maximum number Each patient was evaluated using a pre-designed chart. i.e. 88 (40%) patients had leukoplakia. 17 (11%) patients The clinical diagnosis was established and classified were found to have dysplasia - of which 13 had dyspla- according to the Epidemiology guide for the diagnosis of sia grade 1, 3 had dysplasia grade II and 1 had dysplasia oral mucosal diseases (WHO) [5]. Correlation, if any, grade III, while 2 patients were confirmed to have squa- with etiological factors was assessed. The questionnaire mous cell carcinoma. Other lesions are detailed in Fig. included information on general status of the patient, 4. systemic diseases, medications used, age, gender, alcohol On statistical analysis, the patients with leukoplakia and tobacco consumption, habits (trauma) and prosthe- had an Odds ratio of 4.5 while chewers had an Odds tic or other appliances use. During the clinical examina- ratio of 5.6 as compared to non-users. More males had tion the following elements were analyzed: features of dysplasia than females i.e. 17/18 (p < 0.02) and, at the the lesion, anatomical location, extension, etiological same time, more males used addictive substances vis-à- factors or related factors, dental status, alcohol, tobacco, vis females (p < 0.02).
  • 3. Mehrotra et al. BMC Research Notes 2010, 3:23 Page 3 of 6 http://www.biomedcentral.com/1756-0500/3/23 Figure 1 Distribution of patients according to their complaints. The patients with a diagnosis of premalignant condi- available, however few isolated studies of prevalent tions like speckled leukoplakia and oral submucous lesions have been reported [6-11]. The prevalence of fibrosis were advised abstinence from tobacco and a oral lesions in population has been documented in other visit to their dentist, while the patients with dysplasia parts of the world like Colombia [12], Mexico [13], Bra- were advised follow-up at a tertiary level teaching hospi- zil [14], Chile [15], Spain [16], Argentina [17], USA[18], tal in Bhopal and those with squamous cell carcinoma Israel [19] and Cambodia [20], mainly based on clinical were advised surgery at the Jawaharlal Cancer Hospital, evaluation of the lesions. In contrast, Correa et al [21] Bhopal. and Dehler et al [22] conducted prevalence studies based on the clinicopathological correlation, evaluating Discussion the biopsies of the observed lesions. Only limited information on oral mucosal abnormalities While emerging lifestyle and food habits have been in the rural or semi-urban population of India is contributing factors, the problem of bad oral health is Figure 2 Distribution of patients according to their personal habits.
  • 4. Mehrotra et al. BMC Research Notes 2010, 3:23 Page 4 of 6 http://www.biomedcentral.com/1756-0500/3/23 Figure 3 Histopathological diagnosis of lesions. compounded by a low dentist to population ratio. The prevalence of 23.2% in the elderly. Sanchez reporting in World Health Organisation (WHO) recommends a 1: Spain, documented 39% of aged patients had oral 7500 dentist to population ratio whereas the dentist to mucosa alterations [16]. population ratio in India is as low as 1:22500 [23]. In Of the clinically significant lesions which were biop- 2004, India had one dentist for 10,000 persons in urban sied, the percentage of patients suffering from leuko- areas and about 2.5 lakh persons in rural areas. Almost plakia was 40.7%, oral submucous fibrosis 9.7% and three-fourths of the total number of dentists were clus- lichen planus 2.7% which was higher to those found by tered in urban areas, which house only one-fourth of Saraswathi et al (0.59%, 0.55% and 0.15% respectively) the country’s population [24]. This limits the curative Prevalence of smoker’s melanosis was 2.3% in this approach to tackle dental problems in rural areas while study while it was lesser in Chennai (1.14%) [6]. Dys- it is widely acknowledged that oral cancer can best be plasia was found in 17 patients out of which 6% was prevented through early detection and primary preven- found with grade I, 1.4% with grade II and 0.5% with tion. Unfortunately, the awareness levels of lesions asso- grade III while squamous cell carcinoma was found in ciated with usage of addictive agents continue to remain 0.93% in this study. These findings reveal higher per- abysmally low. centages than similar studies from India, [6-11] and This study was a community survey, in which the pre- this difference may probably be explained by the fact valence of clinically significant oral lesions was 8.4% - that, unlike most other clinical studies, in this report, which was higher in comparison to a previous study histopathological confirmation was obtained in most of from Chennai (4.1%). This could probably be due to the cases. higher prevalence of smoking and/or tobacco chewing Subjects who smoked or chewed tobacco in any form (52%) in this study in comparison to 31% reported by had a far higher incidence of oral lesions vis-à-vis non- Saraswathi et al [6]. Vellappally et al found that in a sur- users. On assessing the correlation of habits with inci- vey of 805 subjects for dental caries, the highest preva- dence of leukoplakia, smokers were found to have an lence of oral mucosal lesions were present in tobacco Odds ratio of 4.5 while chewers had 5.6 as compared to chewers (22.7%) followed by regular smokers (12.9%), non-users. This was less than findings of Saraswathi et occasional smokers (8.6%), ex-smokers (5.1%) and non al who reported figures of 5.08 and 6.82, respectively. tobacco users (2.8%) [11]. The prevalence figure of oral Subjects who chewed areca nut with or without tobacco lesions was 8.4% covering all age groups. On the other had a higher prevalence of oral submucous fibrosis, hand, Gonzalez et al [13] in Mexico, demonstrated a similar to earlier findings[6].
  • 5. Mehrotra et al. BMC Research Notes 2010, 3:23 Page 5 of 6 http://www.biomedcentral.com/1756-0500/3/23 Figure 4 Spectrum of clinical lesions.
  • 6. Mehrotra et al. BMC Research Notes 2010, 3:23 Page 6 of 6 http://www.biomedcentral.com/1756-0500/3/23 Since the information on habits was garnered by the 8. Mehta FS, Gupta PC, Daftary DK, Pindborg JJ, Choksi SK: An epidemiologic study of oral cancer and precancerous conditions among 101,761 patients or attendants by a questionnaire, the possibility villagers in Maharashtra, India. Int J Cancer 1972, 10:134-41. of an information bias should be considered while inter- 9. Mehrotra R, Singh M, Kumar D, Pandey AN, Gupta RK, Sinha US: Age preting the results. Another limitation of the study was specific incidence rate and pathological spectrum or oral cancer in Allahabad. Indian J Med Sci 2003, 57:400-4. that due to the rather small sample size, inherent in a 10. Mathew Iype E, Pandey M, Mathew A, Thomas G, Sebastian P, Krishnan population survey vis-à-vis a hospital survey, there is a Nair M: Squamous cell carcinoma of the tongue among young Indian lack of generalizability and limited statistical adults. Neoplasia 2001, 3:273-7. 11. Vellappally S, Jacob V, Smejkalová J, Shriharsha P, Kumar V, Fiala Z: Tobacco significance. habits and oral health status in selected Indian population. Cent Eur J Public Health 2008, 16(2):77-84. Conclusion 12. Munevar AM, Rojas J, Marín D: Perfil epidemiológico bucal de los pacientes de 55 años y más que asisten a las clínicas del geronte a la This survey high-lighted the rampant misuse of variety facultad de odontología de la u.n. durante el primer semestre del año of addictive substances as well as the high prevalence of 2000 y cual es la percepción que tienen estos pacientes sobre su propio oral lesions in the community. There is an urgent need estado de salud bucal. Revista de la Fed Od Col 2001, 61http://www. encolombia.com. for awareness programs utilizing the community health 13. González B, González L, Bobadilla A: Prevalencia de patología bucal y de workers, dentists and allied medical professionals. It is estructuras relacionadas en paciente geriátrico de la región I del estado hoped that these results will form the basis of a state de México. Revista ADM 1995, 3:129-37. 14. Jorge Júnior J, De Almeida OP, Bozzo L, Scully C, Graner E: Oral mucosal level, followed by a national level survey of oral lesions. health and disease in institutionalized elderly in Brazil. Community Dent Oral Epidemiol 1991, 19(3):173-5. 15. Espinoza I, Rojas R, Aranda W, Gamonal J: Prevalence of oral mucosal Acknowledgements lesions in elderly people in Santiago, Chile. J Oral Pathol Med 2003, The authors are grateful to the Suhsilaben Ramniklal Jhaveri Trust for 32:571-5. logistical support for this study. 16. Sánchez J, Vera J, Hernández R: Prevención de la patología bucodental en la población mayor de 65 años. Publicación oficial de la Sociedad Author details Andaluza de Geriatría y Gerontólogia 2004, 2(2):6-9. 1 Department of Pathology, Moti Lal Nehru Medical College, Lowther Road, 17. Crivelli MR, Domínguez FV, Adler IL, Keszler A: Frequency and distribution Allahabad, 211001, India. 2Departments of Oral and Maxillofacial Surgery, of oral lesions in elderly patients. Rev Asoc Odontol Argent 1990, People’s College of Dental Sciences & Research Centre, Bhopal, India. 3Oral 78(1):55-8. Medicine and Radiology, People’s College of Dental Sciences & Research 18. Shulman JD, Beach MM, Rivera-Hidalgo F: The prevalence of oral mucosal Centre, Bhopal, India. 4Consultant Dental Surgeon, Vidisha, India. 5District lesions in U.S. adults: data from the Third National Health and Nutrition Hospital, Vidisha, India. Examination Survey, 1988-1994. J Am Dent Assoc 2004, 135(9):1279-86. 19. Fleishman R, Peles DB, Pisanti S: Oral mucosal lesions among elderly in Authors’ contributions Israel. J Dent Res 1985, 64(5):831-6. RM, SJ and PJ carried out survey, analysis and drafted the manuscript. SP, 20. Ikeda N, Handa Y, Khim SP, Durward C, Axéll T, Mizuno T, et al: Prevalence MS, NSN and PS conceived of the study, participated in its design and study of oral mucosal lesions in a selected Cambodian population. coordination as well as helped to draft the manuscript. Community Dent Oral Epidemiol 1995, 23(1):49-54. 21. Corrêa L, Frigerio ML, Sousa SC, Novelli MD: Oral lesions in elderly Competing interests population: a biopsy survey using 2250 histopathological records. The authors declare that they have no competing interests. Gerodontology 2006, 23(1):48-54. 22. Dehler K, Brannon R, Muzyka B: Biopsied oral lesions in a geriatric Received: 12 November 2009 population. Oral Surg Oral Med Oral Pat 2003, 95(4):417. Accepted: 25 January 2010 Published: 25 January 2010 23. 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