Year : 2008 | Volume
: 19 | Issue : 2 | Page : 99--103
The prevalence of oral mucosal lesions in patients visiting a dental school in Southern India
Anuna Laila Mathew, Keerthilatha M Pai, Amar A Sholapurkar, Manoj Vengal
Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Karnataka - 576 104, India
Amar A Sholapurkar
Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Karnataka - 576 104
The purpose of the present study was to evaluate the prevalence of oral mucosal lesions in Manipal, Karnataka State, India. A total of 1190 subjects who visited the department of oral medicine and radiology for diagnosis of various oral complaints over a period of 3 months were interviewed and clinically examined for oral mucosal lesions. The result showed the presence of one or more mucosal lesions in (41.2%) of the population. Fordyce«SQ»s condition was observed most frequently (6.55%) followed by frictional keratosis (5.79%), fissured tongue (5.71%), leukoedema (3.78%), smoker«SQ»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«SQ»s mucosa and irritational fibroma (0.84%), herpes labialis, angular cheilitis (0.58%), and mucocele (0.16%). Mucosal lesions like tobacco-related lesions (leukoplakia, smoker«SQ»s palate, oral submucous fibrosis, and oral malignancies) were more prevalent among men than among women. Denture stomatitis, herpes labialis, and angular cheilitis occurred more frequently in the female population.
|How to cite this article:|
Mathew AL, Pai KM, Sholapurkar AA, Vengal M. The prevalence of oral mucosal lesions in patients visiting a dental school in Southern India.Indian J Dent Res 2008;19:99-103
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Mathew AL, Pai KM, Sholapurkar AA, Vengal M. The prevalence of oral mucosal lesions in patients visiting a dental school in Southern India. Indian J Dent Res [serial online] 2008 [cited 2020 Jan 28 ];19:99-103
Available from: http://www.ijdr.in/text.asp?2008/19/2/99/40461
Although the terms dental health and oral health are used almost synonymously when stating the goals for oral health, such statements are usually valid only for dental health. This may lead to severe underestimation of the need for total oral health care.  When planning measures for improving oral health, the 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 from many countries, but the information is usually restricted to very few lesions in each survey. Only two studies, , with sufficiently large number of individuals, have presented data on a broad spectrum of oral mucosal lesions in a general population.
Hence, the aim of the present study was to evaluate the prevalence of oral mucosal lesions in patients who visited the Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, India.
Materials and Methods
A total of 1190 outpatients seeking dental treatment at the Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, India, from 1 st March 2005 to 1 st June 2005 were included in the study. 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. Patients in whom an intraoral examination was not possible due to inadequate mouth opening were excluded from the study. History was obtained from parents or relatives for patients who were not able to communicate either due to age or disease. The patients were examined clinically by two trained examiners using artificial light, mouth mirror, gauze, etc.; the diagnosis was made based on history, clinical features, and investigations, according to the WHO guidelines and color atlas. Biopsies were advised for suspicious lesions.
Results and Discussion
A total of 1190 patients (747 men and 443 women) in the age range 2-80 years represented the population in this 3-month study conducted in our department. The different age-groups and the number of subjects in each was as follows: 2-20 years old (n = 243, 21-40 years old (n = 527), 41-60 years old (n = 325), 61-80 years old (n = 95). Reference to the color atlas while making the clinical examination and diagnosis resulted in a high proportion of both intra-examiner and inter-examiner agreement for the presence of lesions and their categorization. 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-group. Ex-pan chewers were 21 in number.
[Table 1] shows the demographic data. [Table 2],[Table 3] shows the prevalence of oral mucosal variants and abnormalities according to age and gender. No mucosal abnormalities were detected in 58.8% of subjects. The most prevalent normal variant was Fordyce's granules (6.55%), followed by fissured tongue (5.71%), Leukoedema (3.78%), and varices (1.17%).The most prevalent lesion was frictional keratosis (5.79%), followed by smoker's palate (2.77%), aphthous stomatitis (2.1%), oral submucous fibrosis (2.01%), oral malignancies (1.76%), leukoplakia (1.59%), median rhomboid glossitis (1.5%), oral candidiasis (1.3%), lichen planus (1.26%), traumatic ulcer (1.01%), denture stomatitis (0.84%), geographic tongue (0.84%), betel chewers mucosa (0.84%), irritational fibroma (0.84%), angular cheilitis (0.58%), herpes labialis (0.58%), and mucocele (0.16%).
Fordyce's condition was observed in 6.5% of our population and was more frequently observed on the buccal and lip mucosa. It was more prevalent in men (8.9%) than in women (2.48%). Corbet,  however, had reported a prevalence of 0.6%, which was very different from our finding.
Fissured tongue was seen in 5.7% of our 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 Darwazeh and Pillai (11.4%)  and also by Marija in Slovenia  (21.1%). In our population, the presence of fissured tongue increased with age and was more prevalent among men than in women which is in accordance with the findings of Aboyons and Ghaemma Ghami in Iran  and Darwazeh and Pillai in Jordan. 
In our study population, the prevalence of leukoedema was 3.7%. Males were more affected than females. It was especially prevalent in the 41-60 years age-group (5.35% and 1.1%, respectively, in males and females). The prevalence was more among smokers than nonsmokers, with an increase in age. A correlation between leukoedema and smoking, tobacco chewing, and alcoholism could be demonstrated in our study as was seen in some groups of people in the study by Karen in Thailand. 
The prevalence of sublingual varices was 1.17% in our population. It occurred more frequently in the 61-80 years age-group; however, the prevalence of 14.2% that we found in this age-group is considerably lower than the prevalence of 68.2% found by Ettinger and Mandersan in Edinbourgh.  Our observation was 7.1% more than that found Corbet. 
White lesions near rough dental restorations, a sharp tooth, or due to biting because of unsuitable prosthesis were registered as frictional keratosis.  The occurrence of frictional keratosis was in 5.79% of all subjects. The highest prevalence of this lesion in men was in the 21-60 years age-group (8.03%) and in women in the 21-40 years age-group (2.03%). This result is comparable to that of Corbet et al . (6%). 
In our population, smoker's palate was observed only in men. The prevalence of 4.4% that we found was more than that observed in Ljubljana, Slovenia, by Marija (0.5%) and in Swedish men by Axell (2.1%).  Tobacco-related white lesions (leukoplakia and smoker's palate) in our study population were more prevalent in men than in women (3.3% and 0.22%, respectively). This difference was attributable to the high tobacco consumption in men.
The presence of recurrent aphthae was 2.1%. It was most prevalent (2.6%) in the 21-40 years age-group and more frequent in men (2.27%) than in women (1.8%). However, the prevalence in a Swedish population as reported by Axell and Henricsson  and in Slovenia by Marija  was 17.7% and 9.7%, respectively. Irwin  conducted a study in Pennsylvania and concluded that the prevalence of recurrent aphthous stomatitis was higher in students.
Oral submucous fibrosis
The prevalence of oral submucous fibrosis in our population was (2.01%); it was more among men (3.07%) than women (0.22%) and more often seen in the 41-60 years age-group. This is comparable to the prevalence found in a Cambodian population  (0.2%). There was generalized blanching, fibrotic bands on the buccal mucosa and hard and soft palate, limited mouth opening, and complaints of a burning sensation.
The prevalence of oral malignancies in our study was 1.7%. Males (2.14%) had a higher predilection for this lesion than females (1.12%); it was observed more often in the age-group of 41-60 years. In clinically suspicious lesions, biopsy was done; some cases had already been histopathologically proven to be malignancies. The main site of involvement was the buccal mucosa and the lateral border of the tongue. It was more prevalent in patients who were chronic smokers and tobacco chewers, with or without alcohol consumption. This prevalence is more than that found by Ikeda (0.1%) in a Cambodian population  and by Axell ( 
The prevalence of leukoplakia in our population was 1.59%. All the subjects with leukoplakia in our population were smokers and tobacco chewers. It was more prevalent in men than in women (2.27% and 0.45%, respectively). This prevalence is in agreement with the results obtained in Thailand by Reichart et al .  (1.1%) and in Hungary by Banoczy (1.3%)  but low when compared with the studies by Ikeda in Japan (25%),  Bouquot in USA (2.96%), and Axell in Sweden (3.6%).  Axell found more tobacco-associated leukoplakia as compared to our study. The highest prevalence of leukoplakia in our male population was in the 41-60 years age-group (4.76%). The most frequent site of involvement was the buccal mucosa, including the commissures, followed by the alveolar ridge and the retromolar region. No leukoplakia was seen in the floor of the mouth. All the leukoplakias were of the homogenous type. Toluidine blue staining was done and biopsy advised if there was stain uptake.
Median rhomboid glossitis
The prevalence of median rhomboid glossitis was 1.5% and was observed more in males (1.7%) compared to females (1.12%). This prevalence is comparable to that in the studies conducted in Thailand, Kuala Lumpur, and Sweden (1.3%, 1.3%, and 1.4%, respectively).
The prevalence of oral candidiasis in our population was 3.07%. Pseudomembranous candidiasis was present in 1.3% and was more frequently observed in males (1.7%) than in females (.67%) and in the older age-group (61-80 years). This is comparable to the finding by Ikeda  (1.4%) and more than that found by Axell in Kuala Lumpur (0.4%). 
Lichen planus was found in 1.26% of our population, which is comparable to that in Swedish  and Japanese populations  (1.9% and 1.8%, respectively). In our population, lichen planus was most prevalent in the 41-60 year age-group (2.4%). It was more frequently observed among women than men (1.3 and 1.2%, respectively). This is in accordance with the results obtained by Axell and Rundquist,  Ikeda et al .,  and Marija Kovac Kavcic (in Slovenia).  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 was observed in ten subjects (out of 45 denture wearers). The prevalence in our study was 0.84%. The majority of denture stomatitis was observed in the 41-60 years age-group. The frequency was observed to be more in females (1.35%) than in men (.53%). The higher prevalence of denture stomatitis among women is in accordance with the findings of Axell.  This is lower than that observed by Corbet et al . in a Chinese population in Hong Kong  (10%) and by Marija in Slovenia  (14.7%).
Geographic tongue was present in 0.84% of our population, which is less than the prevalence found by Axell in a Swedish population (8.5%) and by Marija in Slovenia (2.2%)  and more than that found by Bouquot (0.3%) and by Ikeda in 18-63 years old Japanese subjects (Betel chewer's mucosa
The prevalence of betel chewer's mucosa in our study was 0.84%. It was only observed in men, probably because of the chronic and high usage of tobacco in men. Our study findings were in agreement with the study by Chiag Mai in Thailand (1%). Older subjects had higher prevalence (2.85%) than the younger ones.
The prevalence of irritational fibroma in our study was 0.84%. It was more prevalent in males than in females and in older subjects (2.85%). This is in accordance with the study done by Corbet et al ., where the prevalence was found to be 1%.
Angular cheilitis was found in 0.58% of our population, which is comparable to the finding recorded by Corbet et al . (1%)  and Marija in Slovenia  (1%). It was more frequently found in the 41-60 years age-group and had more predilection for females.
The prevalence of a positive history of recurrent herpes labialis was 0.58%. In our study population it decreased with age and was more prevalent in the 21-40 year age-group and was more common in females than in males (0.9% and 0.4%, respectively). This is comparable to the finding by Chiang Mai in Thailand (0.9%).  According to Bouquot  and Axell  it was 2.5% and 14.3%, respectively, in males and females.
The prevalence of mucocele in our population was 0.16%, and it was found only in males. This prevalence is comparable with that in the study by Axell  (0.1%) and by Bouquot  (0.2%) and less than in the population studied in Slovenia (0.9%). 
No lesions were found in 58.8% of the population; 67.9% of them were females and 53.4% were males. The maximum number of lesion-free patients were in the 0-20 years old female population.
The result of the present study provides some information on the prevalence of oral mucosal findings in Manipal, India. The results showed that tobacco-associated lesions were observed more in males than in females. Habituated patients were advised to give up smoking and other harmful habits. All patients underwent scaling and were advised about individual oral and dental needs. 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.
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