Abstract
Objectives Oral cancer (OC) may be preceded by clinically evident oral potentially malignant disorders (OPMDs). Oral carcinogenesis is a multistep process that begins as epithelial hyperplasia and progresses to oral epithelial dysplasia and finally to fully malignant phenotypes. The aim of our study was to estimate the prevalence of OPMDs in a large population of dental patients.Methods Patients were seen in the Oral Diagnosis and Oral Medicine clinics at Boston University Henry M. Goldman School of Dental Medicine between July 2013 and February 2014 and received a comprehensive oral examination to identify any possible mucosal lesions. Patients with a suspected OPMD (submucous fibrosis, oral lichen planus, leukoplakia and erythroplakia) that did not resolve in 2–3 weeks received a biopsy for definitive diagnosis. Logistic regression models were used to explore the relationship between OPMDs and associated risk factors.Results A total of 3,142 patients received a comprehensive oral examination [median age: 43 (range: 18–97); 54.3% females]. Among these, 4.5% had an oral mucosal lesion with 0.9% being an OPMD (one submucous fibrosis, three epithelial dysplasias, fourteen with hyperkeratosis/epithelial hyperplasia and nine with oral lichen planus). Males and current smokers were associated with higher odds of having OPMD (OR 1.7, 95% CI 0.8–3.8; OR 1.9, 95%CI 0.8–4.1). Increasing age was associated with having OPMDs (p<0.01).Conclusion Optimal oral visual screening for OC remains a simple and essential tool to identify any suspicious lesions and potentially increase survival. Although OPMDs were rare, our results confirm the importance of a thorough chairside screening by dentists and dental students to detect any mucosal changes.
Highlights
Almost 263,020 oral cavity cancers, and 127,654 oral cancer deaths occur worldwide each year9
Male patients were associated with higher odds of having oral potentially malignant disorders (OPMDs)
Individuals who were current tobacco smokers were twice as likely to have an OPMD compared to never
Summary
Almost 263,020 oral cavity cancers, and 127,654 oral cancer deaths occur worldwide each year. On January 1, 2010, in the US there were around 275,193 women and men alive who had a history of oral and oro-pharyngeal cancer (181,084 men and 94,109 women). Recent studies have implicated HPV infection as an independent risk factor for oro-pharyngeal cancers. Oral squamous cell carcinoma initiates in a multistep process in which normal cells are transformed into preneoplastic cells and to cancer. Oral squamous cell carcinoma initiates in a multistep process in which normal cells are transformed into preneoplastic cells and to cancer20 During this process, a sequential accumulation of genetic and molecular changes occur. The majority of oral cancers are preceded by visible changes of the oral mucosa. Oral potentially malignant disorders (OPMD) transform to oral cancers through various
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