Gingival neoplasms: a multicenter collaborative study of 888 patients in Brazil.

BACKGROUND: To evaluate the prevalence and clinicopathological features of a large series of gingival neoplasms in Brazil. MATERIAL AND METHODS:  All gingival benign and malignant neoplasms were retrieved from the records of six Oral Pathology Services in Brazil, during a 41-year period. Clinical and demographic data, clinical diagnosis, and histopathological data were collected from the patients' clinical charts. For statistical analysis, the chi-square, median test of independent samples and the U Mann-Whitney tests were used, considering a significance of 5%. RESULTS:  From 100,026 oral lesions, 888 (0.9%) were gingival neoplasms. There were 496 (55.9%) males, with a mean age of 54.2 years. Most cases (70.3%) were malignant neoplasms. Nodules (46.2%) and ulcers (38.9%) were the most common clinical appearance for benign and malignant neoplasms, respectively. Squamous cell carcinoma (55.6%) was the most common gingival neoplasm, followed by squamous cell papilloma (19.6%). In 69 (11.1%) malignant neoplasms, the lesions were clinically considered to be inflammatory or of infectious origin. Malignant neoplasms were more common in older men, appeared with larger size, and with a time of complaint shorter than benign neoplasms (p<0.001). CONCLUSIONS:  Benign and malignant tumors may appear as nodules in gingival tissue. In addition, malignant neoplasms, especially squamous cell carcinoma, should be considered in the differential diagnosis of persistent single gingival ulcers.

The role of the dentist in the diagnosis and management of patients with oral mucosal diseases.

Based on a few case reports of oral mucosal diseases a number of questions is raised about the role of dentists-general practitioners in the diagnostic procedure and management of patients with such diseases. For instance, are dentists prepared to prescribe topical corticosteroids and should dentists be taught how and when to take a biopsy? And how about palpation of the neck? A strong recommendation is made to take clinical pictures for proper documentation and, if needed, for telediagnostic procedures. Another issue relates to the communication between dentists and dental specialists when dealing with patients with oral diseases. In case of a patient suffering from burning mouth syndrome or any other type of chronic orofacial pain, the question is raised whether dentists-general practitioners are prepared to manage such patients. Furthermore, there is a call for structuring the collaboration between dentists-general practitioners and dental specialists, including oral and maxillofacial surgeons.

A clinical diagnosis of oral leukoplakia; A guide for dentists.

BACKGROUND: In view of the many white or predominantly white lesions of the oral mucosa it is a challenge for dentists to clinically identify a leukoplakia, being a potentially (pre)malignant lesion. MATERIAL AND METHODS: Based on the available literature and experience of the authors the parameters of a clinical diagnosis of oral leukoplakia have been studied. RESULTS: A guide has been presented that should help dentists to establish a clinical diagnosis of leukoplakia as accurate as possible. CONCLUSIONS: Probably in most parts of the world dentists will need the help of a specialist for confirmation or exclusion of the clinical diagnosis of oral leukoplakia and for further management of the patient, including patient information.

Prevalence and risk indicators of oral mucosal lesions in an urban population from South Brazil.

OBJECTIVE: The objective of the study was to assess the prevalence of oral mucosal lesions (OML) and to perform a multivariable risk assessment of demographic, socioeconomic, behavioral, and oral risk indicators for its occurrence in an urban population in South Brazil. METHODS: This cross-sectional study selected 1586 subjects (719M/867F, age: 14-104 years) using a multistage probability sampling strategy (65.1% response rate). Prevalence, odds ratios (OR), and confidence intervals (95% CI) were calculated accounting for the survey design. RESULTS: Leukoplakia and lichen planus were observed in 1.01% and 1.02% of subjects, respectively. In the multivariable analysis, these lesions were significantly associated with moderate/heavy smoking (OR = 9.0, 95% CI = 2.1-39.1) and heavy drinking (OR = 2.0, 95% CI = 1.1-3.7). Candidiasis and proliferative lesions were observed in 14.09% and 3.80% of the subjects, respectively. These lesions were significantly associated with female gender (OR = 2.2, 95% CI = 1.5-3.2 and OR = 1.7, 95% CI = 1.0-2.8), older age (OR=22, 95% CI = 8.0-60.8 and OR = 8.9, 95% CI = 3.4-23.7), and low socioeconomic status (OR = 1.9, 95% CI = 1.0-3.5 and OR = 3.0, 95% CI = 1.2-7.2). CONCLUSIONS: This population is in need of OML prevention and treatment. Future studies should validate the findings that premalignant lesions are causally related to smoking and alcohol consumption, and that other OML are associated with socioeconomic-demographic disparities in this and similar populations.