Desordens orais potencialmente malignas: o que o cirurgião-dentista precisa saber? / Oral potentially malignant disorders: what do dentists need to know?

Introdução:as desordens orais potencialmente malignas (DOPMs) são condições que podem preceder o aparecimento do câncer em cavidade bucal. Objetivo: descrever os principais aspectos clínicos, histológicos e tratamento da leucoplasia, eritroplasia, queilite actínica e líquen plano oral. Metodologia: trata-se de uma revisão da literatura atual, em que foram consultados artigos nas bases do MEDLINE/PUBMED e Biblioteca Virtual em Saúde, publicados nos últimos 10 anos. Os descritores foram localizados usando o vocabulário controlado do MeSH, sendo eles: Leukoplakia; Erythroplakia, Actinic cheilitis, Oral lichen planus, Diagnosis, Therapeutics. Resultados: asapresentações clínicas das DOPMs são diversas. A leucoplasia é a mais comum e deve ser distinguida da leucoplasia verrucosa proliferativa que tem uma apresentação clínica generalizada e uma tendência à recorrência após a excisão; a eritroplasia, embora rara, tem maior chance de malignização. A queilite actínica acomete com frequência o lábio inferior, tem forte relação com exposição solar e pode progredir para o carcinoma escamocelular labial; o líquen plano oral tem uma variedade de apresentações clínicas, sendo a forma reticular a mais comum. O tipo erosivo, atrófico ou bolhoso é acompanhado de sintomatologia dolorosa variável. A biópsia é essencial para confirmar a suspeita clínica das DOPMs e o encaminhamento oportuno para um especialista é indicado. Conclusão: as DOPMs podem ser encontradas durante o exame bucal, possibilitando assim, o diagnóstico precoce, e o correto encaminhamento a um especialista e a intervenção adequada, podendo reduzir a taxa de progressão dessas condições para câncer.

Introduction: Oral Potentially Malignant Disorders (OPMDs) are conditions that may precede the onset of cancer in the oral cavity. Objective: To describe the main clinical features, histological aspects and treatment of leukoplakia, erythroplakia, actinic cheilitis and oral lichen planus. Methodology: this is a review of the current literature, in which articles in the databases of MEDLINE/PUBMED and the Virtual Health Library, published in the last 10 years, were consulted. The descriptors were located using the MeSH controlled vocabulary, namely: Leukoplakia; Erythroplakia, Actinic cheilitis, Oral lichen planus, Diagnosis, Therapeutics. Results:the clinical presentations of OPMDs are diverse. Leukoplakia is the most common and must be distinguished from proliferative verrucous leukoplakia which has a generalized clinical presentation and a tendency to reoccur after excision; erythroplakia, although rare, has a greater chance of becoming malignant. Actinic cheilitis frequently affects the lower lip, is strongly related to sun exposure and can progress to labial squamous cell carcinoma; oral lichen planus has a variety of clinical presentations, with the reticular form being the most common. The erosive, atrophic or bullous type is accompanied by different levels of pain. Biopsy is essential to confirm the clinical suspicion of OPMDs and timely referral to a specialist is indicated. Conclusion: OPMDs can be found during oral examination, thus enabling early diagnosis, correct referral to a specialist and appropriate intervention, which may reduce the rate of progression of these conditions to cancer.

A clinical study on precancerous lesions of oral cavity in patients attending dental hospital, Telangana

Background: Aim of the retrospective study is to determine the type and frequency of the precancerous lesions of the oral cavity and to assess their sex, age distribution among the patients.Methods: Study was conducted based on year-wise data collected during 2015 to 2018 of all the patients with precancerous lesions of oral cavity.Results: The total number of patients was 1247, out of which 803 (64.39%) were males and 444 (35.60%) were females. Most common precancerous lesion is oral submucous fibrosis (70.24%) followed by oral lichen planus (19.08%), leukoplakia (8.98%), erythroplakia (1.68%).Conclusions: We observed marked geographical variation in the incidences of various precancerous lesions. Mostly males are affected by precancerous lesions than females.

Prevalence Of Potentially Malignant Disorders Of Oral Cavity In Adult Population In The Rural And Urban Areas Of Aligarh

Introduction: Oral cancer is a serious problem worldwide. It is sometimes preceded by clinically visible lesions which are called precancerous lesions, and usually culminate in development of oral cancers. Oral malignancies lay a huge burden on the patients, socially as well as economically. Community intervention programs along with involvement if dental health professionals could play a huge role in limitation of the oral malignancies. Aims and objectives: To find out the prevalence of oral potentially malignant disorders in Aligarh, and its association with age and gender. Methods: Community based Cross sectional descriptive study was performed using a pretested questionnaire in a sample of 1078 participant .Systematic Random Sampling was used and the data analysis was done using SPSS24. Results: 25.3% of the participants were found to have clinical features of Oral Potentially Malignant Disorders (OPMD), overall prevalence of OPMD was 19.1% in study participants, more prevalent in age group 46-55 years (28.9%), and in males (33.5%) as compared to females (7.8%). Conclusion and Recommendations: Community intervention programs, and Government aided programs should be put in place to curb this very important public health problem. The role of dental health professionals in motivating the population to limit the consumption of tobacco and tobacco containing products also cannot be undermined.

Desordens orais potencialmente malignas: um estudo de prevalência / Potentially malignant oral disorders: a prevalence study

Este estudo realizou a prevalência das desordens orais com potencial de transformação maligna diagnosticadas nos pacientes atendidos pela Clínica-Escola de Odontologia da Universídade Federal de Campina Grande. A pesquisa foi realizada nos prontuários arquivados dos pacientes atendidos na clínica-escola. Os pacientes diagnosticados com lesão foram convidadas a comparecerem novamente à clínica-escola para a realização do controle clínico. De um total de 2.706 prontuários, foram encontrados 131 pacientes com desordens orais, revelando uma prevalência de 4,84%. A queilite actínica foi a mais frequente com 68 (50,4%) casos, seguida da leucoplasia com 61 (45,2%). Homens corresponderam a 85 (64,9%) casos; o tipo de pele mais comum foi o feoderma com 64 (48,8%), e a média de idade dos pacientes foi de 45,11 anos. Também foi observado que 89 (68%) pacientes não realizaram o tratamento preconizado para a lesão e que o resultado histopatológico mais comum foi a hiperceratose com 11 (18%) casos, seguida da displasia epitelial leve com 5 (8,2%) ocorrências. Com relação ao controle clínico, apenas 33 (25,2%) pacientes retornaram, sendo 22 livres da doença. Diante do exposto, conclui-se que a prevalência das desordens encontradas foi semelhante à prevalência mundial e que existe uma grande evasão por parte dos pacientes no tratamento e no controle clínico... (AU)

This study evaluated the prevalence of oral disorders with potential malignant transformation diagnosed in the patients attended by the Clinical School of Dentistry of the Federal University of Campina Grande. The research was carried out from medical files of patients attended at the school-clinic. Patients diagnosed with an injury were called to attend the school clinic again for clinical control. From a total of 2,706 medical records, 131 patients with oral disorders were found, showing a prevalence of 4.84%. Actinic cheilitis was the most frequent with 68 (50.4%) cases, followed by leukoplakia with 61 (45.2%). Men corresponded to 85 (64.9%) cases, the most common skin type was feoderma with 64 (48.8%), and the mean age of the patients was 45.11 years. It was also observed that 89 (68%) patients did not perform the recommended treatment for the lesion, and that the most common histopathological result was hyperkeratosis with 11 (18%) cases, followed by mild epithelial dysplasia with 5 (8.2%) occurrences. Regarding the clinical control, only 33 (25.2%) patients returned, being 22 free of the disease. In view of the above, it is concluded that the prevalence of the disorders found was similar to the worldwide prevalence and that there is a great deal of evasion by the patients to the treatment and in the clinical control... (AU)

Oxidative Stress and Antioxidant Defenses: With Special Reference to Oral Lesions

Background: Oxidative stress is involved in the pathogenesis of various lifestyle-related diseases, including malignancies. The body naturally produces antioxidants as a means of defending itself against these free radicals which neutralize them, thereby rendering them harmless to other cells. There is a close relation between oxidative stress and all aspects of cancer, from carcinogenesis to the tumor-bearing state, from treatment to its prevention. Aim: The present study was aimed to estimate the plasma levels of antioxidant enzymes and molecules in cases of oral lesion patients. Study Design and Methodology: A case control study was designed in Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow campus. A total of fifty histopathologically proven oral lesion cases (leukoplakia, erythroplakia, lichen planus and oral submucous fibrosis patients) were taken for the study. Their blood samples were collected and plasma was subjected to evaluation of oxidative stress markers. Control group consisted of equal number of healthy subjects. The data is expressed as mean±SD. Student -t test was applied for significance of the biochemical parameters. Results: The results have demonstrated that levels of catalase, myeloperoxidase, reduced glutathione glutathione reductase and glutathione peroxidase are decreased whereas those of malondialdehyde and nitric oxide have increased in the oral lesions patient group as compared to controls. Conclusion: Oxidative stress has been shown to be an important indicator in case of oral cancer. Similar findings in pre-malignant oral lesions can be correlated in establishing the role of oxidative stress in initiation and conversion of premalignant lesions into malignant ones.

Expresiones clínicas de los desórdenes potencialmente malignos en cavidad oral. Revisión integrativa de la literatura / Clinical expressions of potentially malignant disorders in oral cavity. integrative review of literature

Antecedentes: Los desórdenes potencialmente malignos (DPM) son aquellas situaciones clínicas en la cavidad bucal que presentan un riesgo aumentado de malignización neoplásica, debido a la exposición a factores de riesgo o alteraciones genéticas. Es necesario realizar revisiones de la evidencia de este tipo de desórdenes para desarrollar o actualizar guías de práctica clínica idóneas. Objetivo: Identificar, a través de una revisión integrativa de la literatura, la evidencia reciente sobre DPM de la cavidad bucal y su transformación maligna, con el fin de proporcionar recomendaciones de manejo diagnóstico y terapéutico. Métodos: Se realizó una búsqueda de literatura en las bases de datos PubMed, Elsevier, SciELO y EMBASE, utilizando la combinación de seis descriptores. Resultados: La búsqueda inicial arrojó 1743 títulos y la muestra consistió en 67 artículos después de aplicar los criterios de inclusión y exclusión. Las DPM identificadas fueron liquen plano oral, palatitis nicotínica, hábito de fumar invertido, queilitis actínica, eritroplasia y leucoplasia oral y úlcera traumática crónica. Conclusión: Cada tipo de lesión tiene distinto potencial de malignización, entre los cuales la eritroplasia, el liquen plano oral variante erosivo y la queilitis actínica poseen el mayor riesgo.

Background: Potentially malignant disorders (PMD) are clinical oral cavity conditions that pose an increased risk of neoplastic malignization due to exposure to risk factors or genetic alterations. It is necessary to conduct evidence-based reviews of this type of disorders to develop or update adequate clinical practice guidelines. Purpose: Identify, through an integrative review of literature, recent evidence on PMDs in the oral cavity and their malignant transformation, in order to provide diagnostic and treatment recommendations. Methods: A literature search was carried out in the PubMed, Elsevier, SciELO, and EMBASE, using a combination of six descriptors. Results: The initial search showed 1743 titles and the sample, after applying the inclusion and exclusion criteria, consisted of 67 articles. The PMDs identified were oral lichen planus, nicotinic palatitis, inverted smoking habit, actinic cheilitis, oral erythroplakia and leukoplakia, and chronic traumatic ulcer.

Avaliação clínica e histopatológica e hábitos associados ao surgimento de leucoplasias e eritroplasias orais / Clinical and histopathological evaluation and habits associated with the onset of oral leukoplakia and erythroplakia

Objective: This research aims to establish the prevalence, factors associated with the onset, and clinical and histopathological features of oral leukoplakia and erythroplakia, so that these data can contribute to the prevention of these lesions and, consequently, of oral cancer. Material and method: A retrospective study was conducted at a reference service of Universidade Federal do Rio Grande do Norte (UFRN) from 2000 to 2012. To verify the association of variables, Pearson's chi-squared test and Fisher's exact test (p ≤ 0.05) were used. Results: Among 6,560 investigated records, 54 cases were selected, of which 44.4% were male and 55.6% female, with mean age of 56.93 years. Regarding habits, 72.2% were smokers and 25% were alcohol users; 17.9% showed association of both habits. Oral leukoplakia lesions were the most prevalent (0.65%) and oral erythroplakia showed greater association with malignancy in the histopathological presentation (p = 0.001). Most lesions showed no symptoms (p = 0.004). The most frequent was oral leukoplakia in smoking women, with mean age of 57 years. Conclusion: Knowledge of associated factors and clinical characteristics of oral leukoplakia and erythroplakia is essential for establishing the correct diagnosis and treatment...

Objetivo: Esta pesquisa objetiva estabelecer a prevalência, os fatores associados ao surgimento e as características clínicas e histopatológicas das leucoplasias e eritroplasias orais, a fim de que estes dados possam contribuir na estratégia de prevenção ao desenvolvimento dessas lesões e, consequentemente, do câncer oral. Material e método: Foi realizado estudo retrospectivo em um serviço de referência da Universidade Federal do Rio Grande do Norte (UFRN) no período de 2000 a 2012. Para verificar a associação das variáveis foi utilizado o teste qui-quadrado e o exato de Fisher (p ≤ 0,05). Resultados: Foram investigados 6.560 prontuários, tendo sido selecionados 54 casos, dos quais 44,4% do sexo masculino e 55,6% do feminino, com idade média de 56,93 anos. Com relação aos hábitos, 72,2% eram fumantes e 25% usuários de álcool, sendo que 17,9% exibiam associação dos dois hábitos. As leucoplasias orais foram as lesões mais prevalentes (0,65%), e as eritroplasias orais apresentaram maior associação com apresentação maligna no diagnóstico histopatológico (p = 0,001). A maioria das lesões não apresentou sintomatologia (p = 0,004). A leucoplasia oral foi mais frequente em mulheres fumantes com média de idade de 57 anos. Conclusão: O conhecimento dos fatores associados e das características clínicas das eritroplasias e leucoplasias orais é essencial para o estabelecimento do correto diagnóstico e tratamento...

An update on precancerous lesions of oral cavity.

Oral cancer is the most common head and neck cancer, found in 270,000 patients annually worldwide. Some cancers develop from precancerous lesions; however, there is no definitive clinico pathological factor or biomarker that reliably enables malignant transformation to be predicted in an individual patient. Early detection and early treatment of oral cancer are important for improving the survival rate of patients; prevention of oral cancer will clearly contribute most to decreasing its death rate. So correct diagnosis and timely treatment of premalignant lesions with high risk of malignant transformation may help to prevent malignant transformation.

Lesões orais com potencial de malignização: análise clínica e morfológica de 205 casos / Potentially malignant oral lesions: clinical and morphological analysis of 205 cases

OBJETIVOS: O objetivo desta pesquisa foi realizar uma análise clínica e morfológica em lesões orais com potencial de malignização. MATERIAL E MÉTODO: Os dados clínicos e morfológicos referentes a tais lesões foram obtidos a partir das fichas clínicas e dos laudos histopatológicos, respectivamente. RESULTADOS: Dos 205 casos analisados, a lesão mais prevalente foi a leucoplasia (70,7 por cento), seguida da queilite actínica (16,1 por cento), eritroplasia (9,8 por cento) e eritroleucoplasia (3,4 por cento). Verificou-se uma associação significativa entre o sexo e as lesões (p < 0,001), sendo o sexo feminino mais prevalente nas leucoplasias e eritroplasias. A raça branca foi mais acometida em todas as lesões. Quanto à localização anatômica, o rebordo alveolar prevaleceu na leucoplasia (21 por cento), na eritroplasia e eritroleucoplasia, o palato foi mais acometido com 47,4 por cento e 57,1 por cento, respectivamente. Com relação à idade, não houve diferença significativa entre as lesões (p > 0,05), sendo mais frequentes nas quinta, sexta e sétima décadas de vida. Observou-se que, na maioria dos casos de eritroplasias e eritroleucoplasias, os diagnósticos clínicos foram incompatíveis com o morfológico. Verificou-se associação significativa entre transformação maligna e lesões (p < 0,001), pois a eritroplasia apresentou uma taxa de malignização de 20 por cento, enquanto na leucoplasia o índice foi de 2,1 por cento. CONCLUSÃO: A prevalência das lesões orais com potencial de malignização foi semelhante ao encontrado na literatura, mas com algumas diferenças em relação ao perfil epidemiológico das mesmas, ressaltando-se que estas entidades merecem uma atenção especial por parte do clínico, especialmente as eritroplasias, que apresentaram um elevado percentual de malignização e o maior índice de equívocos no diagnóstico clínico.

OBJECTIVE: The objective of this study was to perform a clinical and morphological analysis of potentially malignant oral lesions. MATERIAL AND METHOD: The clinical and morphological data related to these lesions were obtained from clinical and histopathological records, respectively. RESULTS: Out of 205 cases, the most prevalent lesion was oral leukoplakia (70.7 percent), followed by actinic cheilitis (16.1 percent), erythroplakia (9.8 percent) and erythroleukoplakia (3.4 percent). There was a significant association between the lesions and gender (p < 0.001). The female gender was the most affected in leukoplakias and erythroplakias. Caucasians were mostly affected in all conditions. As far as anatomical location is concerned, the alveolar ridge was the most prevalent site in oral leukoplakias (21 percent); the palate was the most affected in erythroplakia (47.4 percent) and erythroleukoplakia (57.1 percent). There was no significant difference among the lesions as to age (p > 0.05), although they were more frequent in the 5th, 6th and 7th decades of life. In most cases of erythroplakias and erythroleukoplakias, it was observed that clinical and morphological diagnoses were incompatible. There was a significant association between malignant transformation and lesions (p < 0.001) as the erythroplakia presented a malignization rate of 20 percent, whereas in leukoplakias the rate was 2.1 percent. CONCLUSION: The prevalence of potentially malignant oral lesions was similar to other findings in the medical literature, but with some differences in their epidemiological profile. It is important to highlight that these entities require further medical investigation, mainly erythroplakias, which showed high risk of malignization and the highest rate of clinical misdiagnosis.

Correlación clínico - patológica de la eritroplasia bucal con diagnóstico histopatológico de displasia epitelial en una muestra de la población venezolana / Pathological and clinical correlation with histopathologic diagnosis eritoplasia oral epithelial dysplasia in a sample of the Venezuelan population

El objetivo de este estudio fue establecer la correlación clínico-patológica entre la Eritroplasia Bucal (EB) y la Displasia Epitelial (DE). Se realizó un estudio de carácter retrospectivo, transversal y descriptivo. Para tal fin se revisaron un total de 11.250 historias, que representan todos los casos diagnosticados desde octubre de 1968 hasta diciembre de 1998 en el Laboratorio Central de Histopatología Bucal, pudiéndose determinar que 8 de éstas correspondían a la patología a estudiar. Estos datos fueron analizados de acuerdo a su aspecto clínico, localización anatómica, sexo, edad, y grado de Displasia Epitelial, 8 casos representaron Eritroplasias de la mucosa bucal con diferentes grados de Displasia Epitelial, de las cuales 3(37,5 por ciento) eran DE leves, 4(50 por ciento) DE moderadas y 1(12,5 por ciento) DE severas. La localización anatómica más frecuentemente afectada fue el paladar duro con 3 casos (37,5 por ciento), seguido por paladar blando con 2 casos (25 por ciento), labio, lengua  y encía con 1 caso cada uno (12,5 por ciento). No hubo prevalencia en edad mostrando igual proporción para el grupo de 20- 29 años, 30-39 años y 60 y más años(n=2; 25 por ciento) y para el grupo de 10 a 19 y 50 a 59 años 1 caso cada uno (12,5 por ciento) El sexo femenino fue el de mayor predilección 5 casos (62,5 por ciento). Se reportó un 100 por ciento de pacientes con hábitos tabáquicos. Al correlacionar clínico-patológicamente los casos de este estudio se pudo evidenciar que la EB esta más frecuentemente relacionada con el diagnóstico histopatológico de Displasia Epitelial Moderada

The objective of this study was to establish the clinical-pathological correlation between the Buccal Erythroplakia and the Epithelial Dysplasia (ED).  A study of retrospective, cross-sectional and descriptive character was made (Prevalence).  For such aim a total of 11,250 histories was reviewed, that represent all the cases diagnosed from October of 1968 to December of 1998 in the Central Laboratory of Oral Histopatología, being able to determine that 8 of these corresponded to the pathology to study.  These data were analyzed according to their anatomical location, sex, age, ethnic group and degree of Epithelial Dysplasias, 8 cases represented Erythroplakias of the buccal mucosa with different degrees from Epithelial Dysplasia, of which 3(37,5 percent) they were ED slight, 4(50 percent) ED moderate and 1(12,5 percent) ED severe.  More the frequently affected anatomical location was to palate hard with 3 cases (37,5 percent), followed by palate soft with 2 cases (25 percent), lip, tongue and gingiva with 1 case each one (12,5 percent). There was prevalence in age showing no equal proportion for the 20- 29 group  years, 30-39 years and 60 and more years(n=2;  25 percent)  Female sex was the one of greater predilection 5 cases (62,5 percent).  A 100 percent of patients with tabáquicos habits were reported.  When clinical-pathological correlating the cases of this study could be demonstrated that the Erythroplakias of the buccal mucosa this more frequently related to the histopatológico diagnosis of Moderate Epithelial Dysplasia