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Premalignant Lesions of the Oral Mucosa

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Premalignant lesions in the mouth can take different shapes and frequently coexist with other medical conditions. Read below to know more.

Medically reviewed by

Dr. Shweta Sharma

Published At December 29, 2023
Reviewed AtJanuary 29, 2024

Introduction

Premalignant oral illnesses are a range of conditions that can affect oral health. For the best outcomes, it is critical to recognize them early and treat them right away. But a lot of doctors do not know enough about these illnesses. According to a recent study, less than half of medical professionals were aware of the common risk factors for these illnesses. A more in-depth awareness of these situations is needed. These conditions are frequently caused by issues with the oral mucosa. Premalignant oral conditions such as lichen planus, submucous fibrosis, erythroplakia, and leukoplakia are common. This article covers the causes and symptoms of these oral cancer precursors and the available treatments.

What Is the Etiology of Premalignant Oral Problems?

Premalignant oral problems are primarily brought on by alcohol, tobacco, and smoking. These issues can also arise from chewing betel nuts. Furthermore, a risk factor known as the HPV (human papillomavirus) has been found. Research revealed that HPV, of which HPV16 is the most prevalent kind and is also associated with throat cancer, was present in 22.5 percent of patients with premalignant oral diseases.

What Is the Prevalence of Oral Premalignant Lesions?

Oral premalignant lesions are mouth ailments that affect men more than women and affect 1.5 percent to 4.5 percent of persons globally. Due to disparities in alcohol and tobacco usage, populations in Asia, South America, and the Caribbean are more likely to experience it. Oral cancer is a result of these lesions in 17 percent to 35 percent of new cases. A small portion of these lesions (between 0.7 percent and 2.9 percent) develop into cancer each year.

What Is the Pathophysiology of Premalignant Lesions?

Stratified squamous epithelium is the delicate layer that covers the interior of our mouths. This layer can be harmed by some substances, such as alcohol, tobacco, betel nut, or human papillomavirus, which can result in abnormal growths like lichen planus, erythroplakia, or oral leukoplakia. It is crucial to examine these growths under a microscope since they have the potential to develop into cancer. Although the possibility of oral lichen planus turning malignant is debatable, oral lichenoid lesions have a higher probability of doing so.

Another problem brought on by betel nut use is known as oral submucous fibrosis. It causes oral scarring, which makes it difficult to swallow, open the mouth, or eat comfortably. This disorder can occasionally coexist with erythroplakia or leukoplakia.

What Is the Histopathology of Premalignant Lesions?

Doctors frequently discover thicker or atypical skin layers in the mouth with varying degrees of inflammation when examining tissue samples from oral leukoplakia. Excessive cell proliferation and occasionally early indications of cancer may be present. Comparable in appearance to leukoplakia, erythroplakia is a mouth ailment that is more likely to develop malignant alterations. Another oral condition termed lichen planus can have thicker skin, immune cell presence, and particular formations known as Civatte bodies. Particular tissue alterations, such as aberrant collagen and a buildup of fibrous material in the inner layers of the mouth, are evident in oral submucous fibrosis.

How to Physically Examine Oral Health Problems?

A thorough examination and close attention to detail are essential when looking for any oral health problems. The patient's history of dental problems or weight loss, the length of time the problem has existed, whether it has altered, and whether there is discomfort or bleeding should all be reported to the doctor. Risk factors include alcohol consumption, smoking, and certain diseases like Hepatitis C or HIV (human immunodeficiency viruses).

The doctor examines the lesion's size, shape, color, and location during the physical examination. Leukoplakia presents as an intractable white patch, erythroplakia as a firm red patch, and oral submucous fibrosis as a pale, mottled patch that can make opening the mouth difficult. On the tongue or inner cheeks, oral lichen planus may manifest as a painful ulcer with a characteristic pattern.

How Does a Doctor Evaluate Premalignant Oral Lesions?

Doctors do a physical examination and occasionally a biopsy to look for premalignant oral lesions. They use the right lighting to carefully inspect the mouth. To check for cancer, a tiny tissue sample is extracted if there is a suspect spot. When a lesion is extensive or affects several areas, samples are collected from various locations. In order to rule out cancer, the physician may remove the impacted tissue if the biopsy reveals significant abnormalities.

A contrasted computed tomography (CT) is a special type of X-ray that doctors may recommend if cancer is suspected or if there are enlarged glands in the neck. This makes it easier for them to interpret the lesion and assess whether the cancer has spread.

What Is the Management of Premalignant Oral Lesions?

Preventing oral cancer is the main goal of managing premalignant oral lesions. Giving up risky habits like drinking and smoking and getting regular checkups may be sufficient for low-risk lesions. However, surgical excision is the best option in high-risk cases, particularly when the lesion exhibits dramatic alterations or is in sensitive locations. There are techniques like formal surgery or laser therapy.

One disadvantage of laser treatment is its inability to give an exhaustive assessment of the lesion. According to recent studies, surgical excision of the lesion is preferable since it may precisely determine the degree of tissue irregularity and identify tumors that may be hidden.

In a research study, participants with a particular kind of oral lesion underwent surgery in addition to intensive observation and cessation of smoking. There was no discernible difference in the two methods' effects on the development of cancer. This implies that keeping a tight eye on low-risk people could be a possibility.

There are non-surgical options as well, such as certain medications, but there is not much high-level evidence to support their efficacy. Topical corticosteroids can be used for conditions such as lichen planus, though the outcomes may differ.

Conclusion

In summary, premalignant lesions of the oral mucosa provide early indicators of oral cancer that should be taken seriously. It is critical to recognize and treat these lesions in order to avert cancer. Depending on the lesion's features and danger level, several treatment options are used. In low-risk cases, quitting unhealthy habits and getting regular checkups could be enough. Surgical removal is often necessary in high-risk cases. There are non-surgical treatments available; however, there is insufficient evidence to support their efficacy. Working with medical experts is essential to figuring out the best course of action given each person's unique situation. Oral cancer can be prevented in large part by timely intervention and routine monitoring.

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Dr. Ashwini Kumar

Dentistry

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