exudates and Lichen-Planus--Oral

A variety of betel/areca nut/tobacco habits have been reviewed and categorized because of their possible causal association with oral cancer and various oral precancerous lesions and conditions, and on account of their widespread occurrence in different parts of the world. At a recent workshop in Kuala Lumpur it was recommended that "quid" be defined as "a substance, or mixture of substances, placed in the mouth or chewed and remaining in contact with the mucosa, usually containing one or both of the two basic ingredients, tobacco and/or areca nut, in raw or any manufactured or processed form." Clear delineations on contents of the quid (areca nut quid, tobacco quid, and tobacco and areca nut quid) are recommended as absolute criteria with finer subdivisions to be added if necessary. The betel quid refers to any quid wrapped in betel leaf and is therefore a specific variety of quid. The workshop proposed that quid-related lesions should be categorized conceptually into two categories: first, those that are diffusely outlined and second, those localized at the site where a quid is regularly placed. Additional or expanded criteria and guidelines were proposed to define, describe or identify lesions such as chewer's mucosa, areca nut chewer's lesion, oral submucous fibrosis and other quid-related lesions. A new clinical entity, betel-quid lichenoid lesion, was also proposed to describe an oral lichen planus-like lesion associated with the betel quid habit.

Topics: Areca; Humans; Lichen Planus, Oral; Lichenoid Eruptions; Malaysia; Mouth Diseases; Mouth Mucosa; Mouth Neoplasms; Oral Submucous Fibrosis; Plants, Medicinal; Plants, Toxic; Precancerous Conditions; Terminology as Topic; Tobacco, Smokeless

Topics: Adult; Female; Humans; Lichen Planus, Oral; Malaysia; Mouth

Oral lichen planus (OLP) is a chronic mucocutaneous condition that affects the oral mucous membrane as well as skin. It is a chronic cell-mediated autoimmune condition where the T-cell-mediated immune response plays an important part in the pathogenesis by causing damage to basal keratinocytes in oral mucosa. Cytokine gene polymorphisms have an unquestionable role in the orchestration of the immune response, leading to different functional scenarios, which in turn influence the outcome of the disease establishment and evolution. The purpose of this study was to understand the role of these cytokine gene polymorphisms in the tumor necrosis factor-alpha (TNF-α), interleukin-1β (IL-1β), and IL-6 genes with OLP in 101 individuals of Malayalam-speaking ethnicity from South India (Kerala). We further investigated the role of these polymorphisms in patients suffering from OLP with other comorbid factors. Genotyping was carried out by polymerase chain reaction-restriction fragment length polymorphism. The results demonstrate that the A allele in the TNF-α -308 polymorphism could play an important role in the susceptibility to OLP. IL-1β +3954 in OLP was associated with other comorbid factors in both allelic and genotypic combinations. However, when patients suffering from OLP were stratified to understand the involvement of other comorbid factors, we observed that the T and C alleles were independent risk factors for chronic periodontitits and diabetes mellitus. On the other hand, IL-6 -597 did not show any disease association with OLP in the study population. This study indicates that proinflammatory cytokines are an important factor in understanding the disease burden of OLP and their comorbid factors.

Topics: Adult; Alleles; Case-Control Studies; Female; Gene Frequency; Genetic Predisposition to Disease; Genotype; Humans; India; Interleukin-1beta; Interleukin-6; Lichen Planus, Oral; Malaysia; Male; Middle Aged; Odds Ratio; Polymorphism, Single Nucleotide; Tumor Necrosis Factor-alpha

Early detection of oral potentially malignant epithelial lesions (PMELs) is aimed at improving survival rates as carcinogenesis is a multistep process and prevention is possible if these lesions are detected at an early and reversible stage of the disease. A prospective clinical study aimed at determining the prevalence of bilateral 'mirror-image' oral PMELs was carried out. Sample consisted of 32 (53.3%) Indians, 23 (38.3%) Chinese, 4 (6.7%) Malays and one (1.7%) Nepalese. All had histopathological confirmation of their primary existing PMEL as inclusion criteria. A total of 70 primary lesions were detected. The most common PMEL found was oral lichen planus. Of these, 28 (46.7%) patients exhibited bilateral 'mirror-image' lesions (n = 42) either synchronously (n = 32/42) or metachronously (n = 10/42). The remaining 32 (53.3%) patients had normal-looking contralateral mucosa. Present findings suggest that patients presenting with oral PMELs are at greater risk of developing a second lesion, most probably in the contralateral 'mirror-image' site.

Topics: Cell Transformation, Neoplastic; Diagnosis, Differential; Early Diagnosis; Ethnicity; Female; Humans; Lichen Planus, Oral; Malaysia; Male; Mass Screening; Mouth Mucosa; Mouth Neoplasms; Precancerous Conditions; Prevalence; Prospective Studies

Conventional methods for writing case notes detailing the progress of oral lichen planus (OLP), a precancerous condition that requires long-term surveillance, is both time-consuming and tedious for the busy clinician.. To design and perform a simple surveillance on OLP patients based on colour-coded topography mouth maps (TMM).. Three colour-coded TMM were employed: red for OLP in high risk oral mucosal sites, yellow for cases showing improvement and green for asymptomatic lesions at each recall visit. In this preliminary study, these were applied on 30 histologically confirmed OLP individuals attending the Oral Medicine Clinic at the Department of Oral Pathology, Oral Medicine and Periodontology, Faculty of Dentistry, University of Malaya. The sites and extent of OLP lesions were charted on either red, yellow or green TMM based on defined criteria. This surveillance evaluated OLP in relation to patientandapos;s age, race, gender, underlying systemic conditions, oral habits, initial onset of OLP, oral manifestations and presence/absence of clinically suspicious areas.. Study sample comprised 4 (13.3%) Malays, 9 (30.0%) Chinese and 17 (56.7%) Indians. Most OLP patients belong to the green TMM (n= 14, 46.6%) group followed by red (n= 11, 36.7%) and yellow (n= 5, 16.7%) groups. Of the 11 cases with red TMM, rebiopsy was performed on 4 cases but no dysplasia was detected. Any local confounding factors namely periodontal disease or faulty dental restorations were managed accordingly.. TMM is simple to use and aided the clinicians in terms of time saving and patient management. Hence, follow-up of OLP patients can be carried out more efficiently and appropriately. TMM can be used for surveillance of other oral precancerous lesions and conditions.

Topics: Biopsy; Cell Transformation, Neoplastic; China; Color; Disease Progression; Female; Humans; India; Lichen Planus, Oral; Malaysia; Male; Neoplasm Staging; Population Surveillance; Precancerous Conditions; Prognosis; Risk Factors; Surveys and Questionnaires

The objective of this study was to determine the socio-demography (age, race and gender) of a group of Malaysian patients who were diagnosed as suffering from oral lichen planus (OLP). The occurrence of malignancy was also investigated. A total of 77 clinical and biopsy records of patients with OLP were studied. Females were affected more than males, with the female to male ratio being 2:1. Middle-aged Indian and Chinese females tend to be affected by OLP when compared with the rest of the population. Only 19 patients returned for further follow-up. One adult Indian female with a six-year history of lichenoid reaction showed the presence of malignancy.

Topics: Adolescent; Adult; Age Distribution; Aged; Carcinoma, Squamous Cell; Cell Transformation, Neoplastic; China; Female; Humans; India; Lichen Planus, Oral; Malaysia; Male; Middle Aged; Oral Hygiene; Retrospective Studies; Sex Ratio; Tongue Neoplasms

The prevalence of oral mucosal lesions in Malaysia was determined by examining a representative sample of 11,707 subjects aged 25 years and above throughout the 14 states over a period of 5 months during 1993/1994. A two-stage stratified random sampling was undertaken. A predetermined number of enumeration blocks, the smallest population unit in the census publication, was selected from each state. With the selected enumeration block, a systematic sample of living quarters was chosen with a random start. The survey instrument included a questionnaire on sociodemographic characteristics and a clinical examination. The clinical examination was carried out by 16 specially trained dental public health officers and the diagnosis calibrated with a final concordance rate of 92%. The age in the sample ranged from 25 to 115 years with a mean of 44.5+/-14.0. The sample comprised 40.2% males and 59.8% females; 55.8% were Malays, 29.4% Chinese, 10.0% Indians and 1.2% other ethnic groups. Oral mucosal lesions were detected in 1131 (9.7%) subjects, 5 (0.04%) had oral cancer, 165 (1.4%) had lesions or conditions that may be precancerous (leukoplakia, erythroplakia, submucous fibrosis and lichen planus) and 187 (1.6%) had betel chewer's mucosa. The prevalence of oral precancer was highest amongst Indians (4.0%) and other Bumiputras (the indigenous people of Sabah and Sarawak) (2.5%) while the lowest prevalence was amongst the Chinese (0.5%).

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Areca; China; Demography; Erythroplasia; Ethnicity; Female; Humans; India; Lichen Planus, Oral; Malaysia; Male; Middle Aged; Mouth Diseases; Mouth Mucosa; Mouth Neoplasms; Oral Submucous Fibrosis; Plants, Medicinal; Precancerous Conditions; Prevalence; Sex Factors; Socioeconomic Factors; Surveys and Questionnaires