Management of Oral Mucosal Red Lesions with Pathogenesis Considerations: Two Case Reports

SARS-CoV-2 develops well in the oral mucosa because, it is the first contact area with the virus. The oral mucosa is highly expressed with angiotensin-converting enzyme 2 (ACE2) and makes the virus replicated in the epithelial cells and produce both oral lesions and oral symptoms. This review aimed to describe the oral mucosal symptoms and lesions related to SARS-CoV-2-infected patients that have been reported around the world. A literature search was performed on PubMed, ScienceDirect and Google Scholar, from February to October 5, 2020, focusing on COVID-19 (SARS-CoV-2) oral lesions and oral symptoms. Eighteen studies were identified with a total of 25 cases describing the oral symptoms and oral mucosal lesions of the SARS-CoV-2 infection. The oral symptoms related to the SARS-CoV-2 infection included dysgeusia, ageusia, a burning mouth sensation, a dry mouth and severe halitosis. The oral mucosal lesions varied from ulceration and depapilation to pseudomembranous, maculae, nodules and plaque. The mucosal lesions related to the skin lesions were in the form of crusty lips, multiple ulcerations and rashes, targeted lesions, blisters and vesiculobullous lesions. The manifestations of the SARS-CoV-2 infection in the oral cavity are non-specific. The oral mucosal lesions that occur mimic the Herpes zoster virus infection, the Herpes simplex virus infection, Varicella and hand, foot and mouth disease, and the oral mucosal lesions with the skin manifestations (e.g. erythema multiforme).

Introdution: One of the most important signs of general health is oral health. Many systemic diseases have oral manifestations that could be appeared in the oral cavity at first. Therefore, considering the importance of timely diagnosis and treatment of oral lesions. This study was conducted to determine the prevalence of oral lesions in the patients admitted to Yazd ShahidSadoughi Hospital. Methods: In this cross sectional study, 443 hospitalized patients were clinically evaluated for oral mucosal lesions. All of the abnormal variations in oral mucosa in these patients, demographic data, type & location of oral lesion, existence of denture & smoking were documented. Data were analyzed by SPSS Inc., Chicago, IL; Version 19 was analyzed using Chi-square and Fisher exact tests. Results: Oral lesions were observed in 37.7% of patients. The most common type of lesion was related to red and white lesions, which was seen in 19.1% of patients. Palate was the common location for red and white lesions. Most of vesiculobollous lesions were observed in the hard palate and tongue. The lesions rate increased with aging. Among the lesions, only pigmented lesions were significantly higher in males. Conclusion: Regarding the high prevalence of oral mucosal lesions in admitted patients, the importance of more attention to oral cavity for timely diagnosis and referral in the routine examination is emphasized.

Purpose:To study the prevalence of oral mucosal variants (OMVs), oral mucosal lesions (OMLs) and to determine their association with demographic parameters, body mass index (BMI), and ABO/Rh blood group among the elderly population of Aligarh.Materials and Methods:The study was conducted among elderly patients, of both genders, aged more than 60 years. Demographic data (including age, gender, marital status, and history of systemic illness) BMI, and ABO/Rh blood group were recorded. Oral examination was performed by a single oral physician, and the presence of OMVs and OMLs was recorded as Class I and Class II. Langlais and Miller’s atlas was used to confirm the diagnosis. The perceived stress scale (PSS) was used to evaluate stress. Biopsy was performed if required. Data obtained were tabulated and statistically analysed using SPSS version 20.0.Results:A total of 989 patients were selected in the study, out of which 666 (318 OMVs and 348 OMLs) cases had oral mucosal findings. Maximum oral findings were noted in Group I (60–69 years). Fordyce granules (32.07%) were the most common OMV, while red and white lesions (43.67%) were the most common OMLs. A strong association (P < 0.005) was found between stress and vesico-bullous OMLs. 45.8% of elderly were found to be underweight. OMLs patients showed a strong association with at least two associated systemic diseases. B+ve was the most common blood group among patients with OMLs.Conclusion:We observed that geriatric oral health is strongly affected by increasing age, BMI, marital status, deleterious tobacco/betel nut chewing habits, systemic diseases, stress, and blood group.

BackgroundChronic kidney disease is a risk factor for oral diseases, which may be associated with premature death. We evaluated the risk of all-cause and cardiovascular mortality associated with oral mucosal lesions in adults with kidney failure treated with long-term haemodialysis.MethodsOral mucosal lesions (herpes, ulceration, neoformation, white lesion, red lesion, oral candidiasis, geographical tongue, petechial lesions, and fissured tongue) were evaluated within the Oral Diseases in Haemodialysis (ORAL-D) study, a multinational cohort study of 4726 haemodialysis adults. We conducted cox regression analyses adjusted for demographic and clinical variables to evaluate the association with all-cause and cardiovascular mortality.ResultsOverall, 4205 adults (mean age 61.6 ± 15.6 years) underwent oral mucosal examination with 40% affected by at least one lesion. The prevalence of oral lesions was (in order of frequency): oral herpes 0.5%, mucosal ulceration 1.7%, neoformation 2.0%, white lesion 3.5%, red lesion 4.0%, oral candidiasis 4.6%, geographical tongue 4.9%, petechial lesions 7.9%, and fissured tongue 10.7%. During median follow-up of 3.5 years, 2114 patients died (1013 due to cardiovascular disease). No association was observed between any individual oral lesion and all-cause or cardiovascular mortality when adjusted for comorbidities, except for oral candidiasis, which was associated with all-cause mortality (adjusted hazard ratio 1.37, 95% CI 1.00 to 1.86) and cardiovascular mortality (adjusted hazard ratio 1.64, 95% CI 1.09 to 2.46).ConclusionOral mucosal lesions are prevalent in haemodialysis patients. Oral candidiasis appears to be a risk factor for death due to cardiovascular diseases.

Background: Oral white and red lesions are usually assumed as premalignant lesions. Epidemiological characteristics of these lesions seem to be important. The aim of this study was to determine the prevalence of the oral red and white lesions in patients referred to oral and maxillofacial pathology department in Isfahan School of Dentistry during last two decades. Methods: In this descriptive study, clinical profiles of oral pathology department from 1988 to 2008 were reviewed. Gender, age, location and type of lesions and referring time were recorded. Data was analyzed using Chi-square with SPSS 11.5 statistical software. Results: 6509 patients referred to oral pathology department, which 1047 (16.1%) cases recorded as red and white lesions. The most prevalence red and white lesions were Peripheral Giant Cell Granuloma (PGCG) and Lichen Planus respectively. The mean age of red lesions was 33.9 ± 17.9 year with a prevalence rate of 57.8% in women. The mean age of white lesions was 44.92 ± 13.09 with the most prevalence rate of 67% in women. The most prevalent red (18.5%) and white (31.8%) lesions were related to age ranges of 31-40 and 41-50 years old. Red lesion mainly located in Gingival (79%) and white lesion in buccal mucosa (57.4%). Conclusion: Prevalence of white and red lesions is increasing in the recent years. More studies are required to investigate the probability of white and red lesions malignancy.

ObjectivesThis analysis examined the clinical and histopathological characteristics of white and red oral mucosal lesions and patient lifestyle behaviors to understand how the lesions changed over 19–23 years, including among patients who developed oral and pharyngeal cancer.Materials and methodsSeventy‐five individuals with red and/or white oral mucosal lesions with clinical diagnoses of smokeless tobacco lesions, leukoplakia, erythroplakia, lichen planus, ulcer, and virus‐associated lesions were identified in six Veterans Affairs Medical Center Dental Clinics (VAMC) from 1996 to 2001. Biopsy results and patients' sociodemographic, medical, and tobacco/alcohol use characteristics were obtained. Study dentists used standardized forms to capture information about the lesions. Study participants were re‐examined at intervals through January 2002. In 2020, a retrospective review of VAMC and public records ascertained whether participants developed oral cancer or died.ResultsThe most common red or white oral mucosal lesions among the 75 study participants were leukoplakia (36.0%), smokeless tobacco lesions (26.7%), virus‐associated lesions (18.7%), and lichen planus (16.0%). Lesions in 11% of participants with leukoplakia and one‐third of participants with lichen planus persisted for 5 years or more. Dysplasia was present in four participants with leukoplakia. Seventeen percent of participants developed a new white or red oral mucosal lesion. Five patients (6.1%) developed oral or pharyngeal cancer, four among participants with leukoplakia (one with prior dysplasia) and one among participants with lichen planus. Four of the cancers developed 6–20 years after enrollment, and only one was at the original lesion site.ConclusionsThe occurrence of oral and pharyngeal cancers in some study participants with white and red oral mucosal lesions many years after enrollment reinforces the need for patients, dentists, and health care systems to have better methods to identify and assess the malignant potential of oral lesions, monitor patients over time, and intercept high‐risk oral lesions before they become cancerous.

Resurgence of syphilis: a diagnosis based on unusual oral mucosa lesions

Geriatric dentistry or gerodontics is the delivery of dental care to older adults involving the diagnosis, prevention and treatment of problems associated with normal aging and age-related diseases as part of an interdisciplinary team with other health care professionals. To evaluate the oral mucosal status in the elderly population of different age group and fnd out the association of age, gender and denture with oral mucosal disorders. The study sample consisted of 570 geriatric persons concentrating mainly on the oral mucosal changes or lesions occurring in the geriatric population. Individuals those are aged above 60 years were selected, and all the examined geriatric persons were categorized into 3 age groups to fnd out the association of oral mucosal lesions in each group. Group I-60 to 65 years, Group II-66 to 70 years, Group III-71 and above years. The sample of 570 elderly patients included 279 (48.95%) men and 291 (51.05%) women in three age groups: 61 to 65 years (40.35%), 66 to 70 years (31.05%), and 71 years and older (28.60%). The sample included 254 (44.56%) dentate patients, 205 (35.96%) denture wearers (partial and complete denture wearers) and 111 (19.47%) edentulous persons who lacked dentures in both the jaws. Almost half of the patients examined (48%) had one or more oral mucosal lesions. The 48% of the patients who presented with oral mucosal lesions, twenty fve different oral mucosal conditions were identifed and the three most common fndings were lingual varices (13.68%), denture induced infammatory fbrous hyperplasia (4.21%), squamous cell carcinoma (4.21%). There was some differences in the distribution of oral mucosal condition among the sexes. Leukoplakia and dysplasia were signifcantly associated with men (p < 0.001) whereas the association of fbroma and lichen planus with women were signifcant (p < 0.001). In our study it was found that patients in groups II and III had more prevalence of oral mucosal disorders. Lingual varices, oral squamous cell carcinoma, fbroma and denture induced infammatory fbrous hyperplasia were more commonly associated with the geriatric patients. The oral lesions (fbroma and lichen planus) were strongly associated with women while leukoplakia was strongly associated with men. Ageing is an important factor that can infuence the occurrence of mucosal lesions and with age the oral mucosa becomes more permeable to noxious substances and more vulnerable to external carcinogens.

Syphilis is a worldwide sexually transmitted infection caused by Treponema pallidum. In most cases, the oral manifestations of syphilis infection are associated with cutaneous involvement. However, the present case report is noteworthy since the oral lesions are the sole clinical sign in an HIV-positive transgender patient. We reported an uncommon case of secondary syphilis in a 37-year-old seropositive transgender male, whose diagnostic suspect was based only on oral mucosal lesions. The patient was referred to the Oral Medicine Unit for the presence of multiple undiagnosed painful oral lesions. The intraoral examination revealed the presence of white and red plaques on the right and the left buccal mucosa and several painful lesions localized on the upper and lower labial mucosa. No cutaneous lesions were observed. Considering the sexual history of the patient and clinical findings, secondary syphilis infection was suspected. The serologic analysis was conducted, and the diagnosis of syphilis was confirmed. Moreover, to exclude the presence of oral epithelial dysplasia or malignant disease, an incisional biopsy was performed. Compared to the literature data, oral lesions as lone signs of secondary syphilis infection are uncommon, especially in HIV-positive patients. Syphilis and HIV coinfection create a concerning situation as they interact synergistically, leading to an increased risk of transmission and faster disease progression. This case report emphasizes the importance of considering syphilis as a diagnostic possibility, even when oral lesions are the only clinical manifestations, especially in HIV-positive patients. Comprehensive evaluation, including a detailed sexual history and careful oral examination, is essential for accurate diagnosis and appropriate management in such cases.

One challenging aspect of oral medicine is that many lesions of different conditions look alike. White lesions of oral mucosa are white as a consequence of several possible structural occurrences: increased thickness of the corneal layer, and formation of abnormal keratin. Oral mucosal lesions also present with different tissue surface consistency, and white lesions may appear as reticular, plaque-like, papular, or pseudomembranous, which affect the clinical appearance of the lesions. Red lesions may display a change of surface texture, which may become granular, velvety, and rough. Leukoplakia is idiopathic, having excluded white patches of known etiology. The development of oral leukoplakia and erythroplakia as potentially malignant lesions involves different genetic events. Erythroplakia is usually asymptomatic, although some patients may experience a burning sensation in conjunction with food intake. Oral lichen planus is bilateral and can appear both white and red, depending on disease activity.

Oral mucosal lesions occur frequently in older people and are important as they may reduce quality of life, represent pre-malignant change or indicate systemic disease. The commonest mucosal lesions in adults are denture-related lesions such as stomatitis, angular cheilitis, ulcers and hyperplasia, and occur in 8.4% of the adult population. In the hospital setting, oral mucosal lesions may lead to malnutrition, slow rehabilitation and recovery from illness, and adversely affect quality of life. The two major risk factors associated with oral lesions are denture use and smoking, and frequently older people have been exposed to both of these. Commonly used drugs such as antihypertensives, antidepressants and antibiotics may have oral mucosal side-effects, and polypharmacy may worsen these. Decreased awareness of changes in the oral mucosa, or inability to raise concerns due to dementia, delirium, social isolation, or difficulty accessing dental care may further compound the problem. Hospital admission could represent an opportunity to intervene, but oral mucosal lesions, and indeed oral hygiene, are areas which can be overlooked by doctors. This article is intended to highlight common or important oral mucosal diseases and increase awareness of these conditions for the practising hospital or community geriatrician.

Can Artificial Intelligence (AI) assist in the diagnosis of oral mucosal lesions and/or oral cancer?

Introduction: India ranks second in the total incidence of oral cancer. The purpose of the present study is to identify the predictive risk factors for potentially premalignant oral mucosal lesions among a vulnerable Indigenous community in Bhopal. Materials and Methods: A cross-sectional study design with a prevalidated questionnaire including the demographic characteristics, tobacco usage, and other predictive risk factors was used to survey subjects aged between 15 and 75 years, both males and females of the Gond community in the Bhopal division. Type III Oral examination was conducted to determine oral mucosal changes. Statistical Analysis: Descriptive statistics were done to estimate the prevalence of oral premalignant mucosal lesions (OPMLs) and the demographic characteristics of participants. Chi-square statistics was employed to analyze the association between predictive risk factors and with the prevalence of oral premalignant lesions. Linear logistic regression was done to correlate the significance of predictive risk factors of OPMLs. P ≤ 0.05 was considered statistically significant. Results: A statistically significant association for OPMLs was observed with tobacco use, alcohol, and tobacco with alcohol usage and gender (P = 0.00). OPMLs do not show any significant association with trauma, oral ulcers, or dentures (P ≥ 0.05). The most common lesion identified was leukoplakia (39.1%), followed by Oral sub mucous fibrosis (33.33%) and both (16.66%). Lesions were most commonly seen on the buccal mucosa (60.3%), followed by the tongue (21.8%) and alveolar ridge/gingiva (9.6%). Logistic regression of predictive risk factors showed a significant correlation of OPMLs with smokeless, smoking, alcohol, and tobacco with alcohol usage. Conclusion: There is a higher burden of OPMLs and increased tobacco consumption observed in the Gond community residing in the rural areas of Bhopal. The increased burden of tobacco usage and oral mucosal lesions needs to be addressed, and interventions, including tobacco cessation counseling and awareness of oral hygiene practices, should be made feasible for the problem.

BackgroundSo far there have been no studies focusing on the prevalence of a wide spectrum of oral mucosal lesions (OML) in patients with dermatologic diseases. This is noteworthy as skin lesions are strongly associated with oral lesions and could easily be neglected by dentists. This study aimed to estimate the frequency and socio-behavioural correlates of OML in skin diseased patients attending outpatient's facility of Khartoum Teaching Hospital - Dermatology Clinic, Sudan.MethodsA cross-sectional hospital-based study was conducted in Khartoum from October 2008 to January 2009. A total of 588 patients (mean age 37.2 ± 16 years, 50.3% females) completed an oral examination and a personal interview of which 544 patients (mean age 37.1 ± 15.9 years, 50% females) with confirmed skin disease diagnosis were included for further analyses. OML were recorded using the World Health Organization criteria (WHO). Biopsy and smear were used as adjuvant techniques for confirmation. Data were analysed using the Statistical Package for Social Science (Version 15.0.1). Cross tabulation and Chi-square with Fisher's exact test were used.ResultsA total of 438 OML were registered in 315 (57.9%, males: 54.6% versus females: 45.6%, p < 0.05) skin diseased patients. Thus, a certain number of patients had more than one type of OML. Tongue lesions were the most frequently diagnosed OML (23.3%), followed in descending order by white lesions (19.1%), red and blue lesions (11%) and vesiculobullous diseases (6%). OML in various skin diseases were; vesiculobullous reaction pattern (72.2%), lichenoid reaction pattern (60.5%), infectious lesions (56.5%), psoriasiform reaction pattern (56.7%), and spongiotic reaction pattern (46.8%). Presence of OML in skin diseased patients was most frequent in older age groups (62.4% older versus 52.7% younger, p < 0.05), in males (63.2% males versus 52.6% females, p < 0.05), patients with a systemic disease (65.2% with systemic versus 51.9% without systemic disease, p < 0.05) and among current users of smokeless tobacco (toombak) (77% current use versus 54.8% no use, p < 0.00).ConclusionsOML were frequently diagnosed in skin diseased patients and varied systematically with age, gender, systemic condition and use of toombak. The high prevalence of OML emphasizes the importance of routine examination of oral mucosa in a dermatology clinic.

Prevalence and clinical features of herpes simplex virus infection in oral lesions of pemphigus vulgaris: A prospective, cross-sectional study