22nd April 2024

Oral mucosal disorders

Oral Lichen Planus

This is a chronic inflammatory disorder illustrated by white, reticular, or erosive lesions forming a lace-like pattern (Wickham’s striae) that primarily affect the oral mucosa. The exact aetiology remains unknown, although it is believed to involve autoimmune mechanisms triggered by various factors such as stress, genetics, and viral infections. The lesions are occasionally bilateral and symmetrical and can be accompanied by symptoms of pain, burning sensation, and altered taste. Biopsy of the lesion may reveal characteristic features such as sawtooth-shaped rete ridges, lymphocytic infiltration and basal cell degeneration. Treatment involves the use of topical corticosteroids, immunomodulatory agents, and meticulous oral hygiene practices to control symptoms and prevent disease progression.

Image Source: Frontiers (2022). fmed-09-997190-g001, Licensed under a creative commons licence. Available for free at: https://www.frontiersin.org/files/Articles/997190/fmed-09-997190-HTML/image_m/fmed-09-997190-g001.jpg (Accessed: 23 January 2024)

Erythroplakia

Erythroplakia is a possible malignant disorder distinguished by red, velvety patches or plaques that cannot be attributed to any specific pathological condition. It is considered a high-risk lesion due to its strong association with oral squamous cell carcinoma. The exact aetiology of erythroplakia is not fully understood, but risk factors include tobacco use, alcohol consumption, chronic irritation, and HPV infection. The critical aspect of managing erythroplakia is its prompt identification and referral for biopsy. Excisional biopsy or incisional biopsy is performed to establish a definitive diagnosis and exclude malignancy. Treatment involves complete removal of the lesion, and patients should be closely monitored for recurrence or malignant transformation.

Image Source: NIH (2014). 25242838, Licensed under a creative commons licence. Available for free at: https://pubmed.ncbi.nlm.nih.gov/25242838/#&gid=article-figures&pid=figure-2-uid-1 (Accessed: 23 January 2024).

Leukoplakia

Leukoplakia refers to a white patch or plaque that cannot be branded as any other disease. Like erythroplakia, it is considered a potentially malignant disorder, with a significant proportion of cases progressing to oral squamous cell carcinoma. The primary etiological factors associated with leukoplakia include tobacco use, alcohol consumption, chronic irritation, and viral infections. Clinical diagnosis of leukoplakia is based on the identification of a white patch that cannot be scraped off and persists for more than two weeks. A biopsy is essential to establish a definitive diagnosis and exclude malignancy. Management involves eliminating or managing the underlying causative factors, such as smoking cessation, alcohol abstinence, and meticulous oral hygiene. Surgical excision or laser treatment may be necessary for dysplastic or high-risk lesions.

Image Source: Research Gate (2022). Homogenous leukoplakia involving the left dorsal/lateral tongue, Licensed under a creative commons licence. Available for free at: https://www.researchgate.net/figure/Homogenous-leukoplakia-involving-the-left-dorsal-lateral-tongue-image-provided-by-Guys_fig1_363796414 (Accessed: 23 January 2024).

Oral cancer

Oral cancer comprises a group of malignancies affecting the lips, tongue, cheeks, floor of the mouth, and other oral structures. The majority of oral cancers are squamous cell carcinomas. The most significant risk factors include tobacco use, heavy alcohol consumption, HPV infection (particularly high-risk strains such as HPV-16 and HPV-18), sun exposure (lip cancer), older age, male gender, a history of precancerous oral lesions, a weakened immune system, and a family history of oral cancer. Common symptoms of oral cancer include persistent mouth sores, red or white patches in the mouth, a lump or thickening of the oral tissues, difficulty swallowing or chewing, persistent sore throat, hoarseness, unexplained bleeding, numbness or pain in the mouth or lips, loose teeth, and changes in speech. Early detection through regular oral examinations is crucial for improving survival rates. Treatment modalities encompass surgery, radiation therapy, and chemotherapy, often used in combination.

Aphthous ulcers

Aphthous ulcers, also known as canker sores, are common painful, round, or oval-shaped oral lesions that develop on the mucous membranes of the mouth. The exact cause of aphthous ulcers remains unknown, but multiple factors are believed including genetic predisposition, immunological factors, trauma, and dietary factors. Although aphthous ulcers cannot be completely cured, several management strategies aim to alleviate symptoms, promote healing, and prevent recurrence such as pain relief, topical treatments, good oral hygiene, avoiding irritants and stress management. Recurrent aphthous-like ulcers are the hallmark of Behçet’s disease, a complex systemic vasculitis. They tend to be larger, deeper, and more persistent compared to typical aphthous ulcers. Healing of these ulcers often leads to scarring and may result in limited mouth opening or deformities.

References

• Warnakulasuriya S, Johnson NW, van der Waal I. Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med. 2007;36(10):575-580.
• McCartan BE, Healy CM. The reported prevalence of oral lichen planus: a review and critique. J Oral Pathol Med. 2008;37(8):447-453.
• Fox, R. I. Sjögren’s syndrome. The Lancet, (2005). 366(9482), 321-331.
• Chavan M, Jain H, Diwan N, Khedkar S, Shete A, Durkar S. Recurrent aphthous stomatitis: A review. J Oral Pathol Med. 2012;41(8):577-583.