04 Benign Oral Cavity conditions that may turn into cancer !!

04 Benign Oral Cavity conditions that may turn into cancer !!

oral cavity
oral cavity

Some common diseases may happen in our oral cavity. some of them are just temporary. Even some may need no treatment at all. But today I will discuss 04 oral cavity diseases that may look very simple. But if not treated timely those may turn into CANCER!!

1. Aphthous ulcer/ Aphthous stomatitis:

Aphthae are recurrent oral immunological ulcers that are multifactorial in origin and arises as a result of T-call mediated damage to the mucosal epithelial basal layer.

They are not potentially malignant lesions that can occur at anywhere in the Gl tract.

Common site of origin:

1. Buccal mucosa

2. Tongue

3. Inner surface of the lip

4. Soft palate

Does not occur in fixed mucosa like hard palate.

Aetiology:

1. Unknown

2. Genetic predisposition

3. Iron deficiency

4. Folic acid deficiency

5. Vit-B12 deficiency

6. Immunological triggers like sodium lauryl sulfate-containing toothpaste

7. Dietary triggers like Benzoate, chocolate, cinnamon

8. Stress and hormonal changes

9. Other diseases associated with Celiac disease, Crohn’s disease, HIV.

Types:

Minor aphthous ulceration

  • Most common
  • Less than 10 mm in diameter, and fewer than 10 at a timne
  • Heal without scarring

Major aphthous ulceration:

  • Larger than 10 mm in diameter, usually single but 1-3 ulcers can occur
  • Can heal with or without scarring

Herpetiform ulceration:

  • Less than 5 mm in diameter, large in numbers- up to 100, coalesce to form large ulcer.
  • Heal without scarring
  • Similar in appearance to primary herpetic gingivostomatitis
  • Least common

Clinical Features:

  • Small vesicle is earliest features
  • Ulceration occurs soon as a pinhead to 2-3 cm in size has a sloughing base and ring of hyperemia at the periphery.
  • Recurrence of ulcers in the fresh site is characteristic.
  • Extreme pain on ulcer site

Treatment:

  • Maintenance of oral hygiene, avoiding trauma
  • Avoidance of triggering food (chocolate, cinnamon) or toothpaste containing Sodium lauryl sulphate-SLS
  • Avoidance of stressful conditions
  • Supplementation of
  • Folic
  • Vit-B12
  • Iron

Specific treatment:

A. Symptomatic:

  • Benzydamine solution- Spray on ulcer one minute before meals to reduce
  • ulcer sensitivity
  • Lignocaine gel–to relieve discomfort.
  • Topical steroid
  • Paracetamol or NSAID

B. Topical episodic:

  • Betamethasone mouthwash- twice daily until the ulcer heals
  • Beclomethasone Inhaler- thrice daily until the ulcer heals

C. Topical preventative:

  • Betamethasone mouthwash- once daily
  • Doxycycline mouthwash- twice daily

D. Systemic preventative

  • Colchicine
  • Azathioprine
  • Mycophenolate mofetil

2. Leukoplakia:

It is a premalignant condition. WHO defines leukoplakia as a clinical white patch which cannot be characterized by clinically or pathologically as any other disease.

Incidence:

  • Age-4th decade
  • Gender-Male preponderance with 2-3:1
  • Malignant potential-1-17% (average 5%)

Aetiology:

  • Smoking
  • Tobacco chewing
  • Alcohol abuse
  • Chronic trauma
  • 1l fitted denture
  • Cheek bite

Associated with:

  • Subcutaneous fibrosis
  • Plummer Vinson Syndrome
  • Hyperplastic candidiasis

Common site:

  • Buccal mucosa
  • Tongue
  • Oral commissure
  • Floor of the mouth
  • Gingivobuccal sulcus

Clinical type:

  • Homogenous-Smooth/wrinkled white patch
  • Nodular-white patches/ nodules on erythematous base.
  • Erosive: Erythroplakia + Leukoplakia

Investigation:

Histopathology-25% shows dysplasia (mild to moderate)

Treatment:

  • Assurance
  • Removal/ avoidance of causative agent
  • Higher potential of malignancy-biopsy and histopathology.
  • Suspicious small lesion
  • Surgical excision
  • LASER
  • Cryotherapy
  • Ablation

Other white lesions:

  • Lichen planus
  • Candidiasis
  • White spongy nevus
  • Discoid lupus erythromatosis

3. Erythroplakia:

Red patches/plaque on the mucosal surface which cannot be characterized by clinically or pathologically as any other disease. The red color is due to decreased keratinization, and as a result, the red vascular connective tissue of the submucosa is more visualized.

Incidence:

Male: Female-1:1

Aetiology of Erythroplakia:

  • Smoking
  • Tobacco chewing
  • Alcohol abuse
  • Chronic trauma
  • Ill fitted denture
  • Cheek bite

Common site:

  • Lower alveolar mucosa
  • Floor of the mouth
  • Gingivobuccal sulcus

Types:

Three types

  • Homogenouss
  • Granular
  • Erosive- Erythroplakia + Leukoplakia

Histopathology:

may reveal

Malignant potential– Is 17 times more malignant potential than leukoplakia

Treatment: Surgical excision and follow-up.

4. Oral submucosal fibrosis:

Oral submucosal fibrosis is a chronic, complex and a premalignant condition (3-7.6%) of the oral cavity characterized by juxtaepithelial deposition of fibrous tissue.

Aetiology:

Multifactorial condition, common aetiologies are

  • Tobacco chewing
  • Alcohol consumption
  • Areca nuts consumption
  • Lack of vit-A, Zinc, antioxidants due to decrease intake of fruits and vegetables,
  • Poor socioeconomic condition

Pathophysiology:

  • Activated T-lymphocytes mediated immune reaction causes fibrotic changes of subepithelial connective tissue.
  • Atrophy of the epithelial layer.

Clinical features:

  • Constant burning sensation, worsening during meal specially while taking spicy foods
  • Intolerance to spicy food
  • Mostly found in the buccal mucosa, soft palate, and faucial pillars
  • Initially red patches with the formation of vesicle then ulceration by the vesicular eruption and after that, blanching and loss of suppleness of mucosal epithelium.
  • Repeated vesicular eruption
  • Difficulty in mouth opening (advance stage).
  • Difficulty in protrusion of tongue (advance stage).
  • Poor oral hygiene

Treatment:

Medical treatment–

  • Avoidance of irritant
  • Supplementation of vit-A, Zinc, antioxidants and more intake of fruits and vegetables.
  • Steroid injection of triamcinolone or dexamethasone combined with hyaline
  • Mouth opening exercise.

Surgical treatment:

1. Excision and skin grafting or flap reconstruction.

2. Coronoidectomy and temporalis muscle myotomy.

In conclusion, it can be said that all these conditions are linked with food habit, bad oral hygiene, and abuse of substances. We should avoid these habits. Otherwise, these conditions may lead us to malignancy, which is far more difficult to treat.

Read More: https://tuneoflife.com/blog-2

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