Prevalence and the relationship of oral mucosal lesions in tobacco users and denture wearers in the North Indian population
Identifieur interne : 003132 ( Pmc/Corpus ); précédent : 003131; suivant : 003133Prevalence and the relationship of oral mucosal lesions in tobacco users and denture wearers in the North Indian population
Auteurs : Santosh Patil ; Nidhi Yadav ; Prashant Patil ; Sumita KaswanSource :
- Journal of Family & Community Medicine [ 1319-1683 ] ; 2013.
Abstract
The aim of the present study was to determine the prevalence and the relationship of oral mucosal lesions in tobacco users and denture wearers in a North Indian population.
The study comprised 3,749 patients attending the Department of Oral Medicine and Radiology, Jodhpur Dental College General Hospital between September 2008 and December 2012, for the treatment of dental problems other than oral mucosal lesions. The ages ranged from 28 years to 83 years, with a mean age of 49.7 years. The results were evaluated using the Pearson Chi-square test, with Yate’s correction and ANOVA tests.
A total of 2,318 patients were diagnosed with lesions associated with the use tobacco and the wearing of dentures. The most frequently seen lesion was melanin pigmentation (29.9%) followed by linea alba (22.2%) and frictional keratosis (19.9%). Ulcers (6.1%) were the most common oral lesion seen in patients who wore dentures, followed by hyperplasia (4.8%). A statistically significant relation (
The results of the present study indicate that the association of frictional keratosis with tobacco users and wearers of dentures can help in determining the diagnosis and treatment plan for oral cancer. Wearers of dentures should also be recalled for periodic checks at regular intervals and optimum preventive measures implemented.
Url:
DOI: 10.4103/2230-8229.122009
PubMed: 24672277
PubMed Central: 3957173
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PMC:3957173Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Prevalence and the relationship of oral mucosal lesions in tobacco users and denture wearers in the North Indian population</title><author><name sortKey="Patil, Santosh" sort="Patil, Santosh" uniqKey="Patil S" first="Santosh" last="Patil">Santosh Patil</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Yadav, Nidhi" sort="Yadav, Nidhi" uniqKey="Yadav N" first="Nidhi" last="Yadav">Nidhi Yadav</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Patil, Prashant" sort="Patil, Prashant" uniqKey="Patil P" first="Prashant" last="Patil">Prashant Patil</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Kaswan, Sumita" sort="Kaswan, Sumita" uniqKey="Kaswan S" first="Sumita" last="Kaswan">Sumita Kaswan</name><affiliation><nlm:aff id="aff2"><italic>Department of Conservative Dentistry and Endodontics, Jodhpur Dental College, Jodhpur National University, Jodhpur, Rajasthan, India</italic></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24672277</idno><idno type="pmc">3957173</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3957173</idno><idno type="RBID">PMC:3957173</idno><idno type="doi">10.4103/2230-8229.122009</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">003132</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003132</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Prevalence and the relationship of oral mucosal lesions in tobacco users and denture wearers in the North Indian population</title><author><name sortKey="Patil, Santosh" sort="Patil, Santosh" uniqKey="Patil S" first="Santosh" last="Patil">Santosh Patil</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Yadav, Nidhi" sort="Yadav, Nidhi" uniqKey="Yadav N" first="Nidhi" last="Yadav">Nidhi Yadav</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Patil, Prashant" sort="Patil, Prashant" uniqKey="Patil P" first="Prashant" last="Patil">Prashant Patil</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Kaswan, Sumita" sort="Kaswan, Sumita" uniqKey="Kaswan S" first="Sumita" last="Kaswan">Sumita Kaswan</name><affiliation><nlm:aff id="aff2"><italic>Department of Conservative Dentistry and Endodontics, Jodhpur Dental College, Jodhpur National University, Jodhpur, Rajasthan, India</italic></nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Family & Community Medicine</title><idno type="ISSN">1319-1683</idno><idno type="eISSN">2229-340X</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Aim:</title><p>The aim of the present study was to determine the prevalence and the relationship of oral mucosal lesions in tobacco users and denture wearers in a North Indian population.</p></sec><sec id="st2"><title>Materials and Methods:</title><p>The study comprised 3,749 patients attending the Department of Oral Medicine and Radiology, Jodhpur Dental College General Hospital between September 2008 and December 2012, for the treatment of dental problems other than oral mucosal lesions. The ages ranged from 28 years to 83 years, with a mean age of 49.7 years. The results were evaluated using the Pearson Chi-square test, with Yate’s correction and ANOVA tests.</p></sec><sec id="st3"><title>Results:</title><p>A total of 2,318 patients were diagnosed with lesions associated with the use tobacco and the wearing of dentures. The most frequently seen lesion was melanin pigmentation (29.9%) followed by linea alba (22.2%) and frictional keratosis (19.9%). Ulcers (6.1%) were the most common oral lesion seen in patients who wore dentures, followed by hyperplasia (4.8%). A statistically significant relation (<italic>P</italic> < 0.05) was established between tobacco and melanin pigmentation, frictional keratosis, traumatic ulcerations and leukoplakia. In those who wore dentures a statistically significant relation (<italic>P</italic> < 0.05) was found between candidiasis, traumatic ulceration and frictional keratosis.</p></sec><sec id="st4"><title>Conclusion:</title><p>The results of the present study indicate that the association of frictional keratosis with tobacco users and wearers of dentures can help in determining the diagnosis and treatment plan for oral cancer. Wearers of dentures should also be recalled for periodic checks at regular intervals and optimum preventive measures implemented.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Bouquot, Je" uniqKey="Bouquot J">JE Bouquot</name></author><author><name sortKey="Gorlin, Rj" uniqKey="Gorlin R">RJ Gorlin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sedano, Ho" uniqKey="Sedano H">HO Sedano</name></author><author><name sortKey="Carreon Freyre, I" uniqKey="Carreon Freyre I">I Carreon Freyre</name></author><author><name sortKey="Garza De La Garza, Ml" uniqKey="Garza De La Garza M">ML Garza de la Garza</name></author><author><name sortKey="Gomar Franco, Cm" uniqKey="Gomar Franco C">CM Gomar Franco</name></author><author><name sortKey="Grimaldo Hernandez, C" uniqKey="Grimaldo Hernandez C">C Grimaldo Hernandez</name></author><author><name sortKey="Hernandez Montoya, Me" uniqKey="Hernandez Montoya 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Family Community Med</journal-id><journal-id journal-id-type="iso-abbrev">J Family Community Med</journal-id><journal-id journal-id-type="publisher-id">JFCM</journal-id><journal-title-group><journal-title>Journal of Family & Community Medicine</journal-title></journal-title-group><issn pub-type="ppub">1319-1683</issn><issn pub-type="epub">2229-340X</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24672277</article-id><article-id pub-id-type="pmc">3957173</article-id><article-id pub-id-type="publisher-id">JFCM-20-187</article-id><article-id pub-id-type="doi">10.4103/2230-8229.122009</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Prevalence and the relationship of oral mucosal lesions in tobacco users and denture wearers in the North Indian population</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Patil</surname><given-names>Santosh</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Yadav</surname><given-names>Nidhi</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Patil</surname><given-names>Prashant</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Kaswan</surname><given-names>Sumita</given-names></name><xref ref-type="aff" rid="aff2">1</xref></contrib></contrib-group><aff id="aff1"><italic>Department of Oral Medicine and Radiology, Jodhpur Dental College, Jodhpur National University, Jodhpur, Rajasthan, India</italic></aff><aff id="aff2"><label>1</label><italic>Department of Conservative Dentistry and Endodontics, Jodhpur Dental College, Jodhpur National University, Jodhpur, Rajasthan, India</italic></aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold> Dr. Santosh Patil, Department of Oral Medicine and Radiology, Jodhpur Dental College, Jodhpur National University, Jodhpur - 342 001, Rajasthan, India. E-mail: <email xlink:href="drpsantosh@yahoo.com">drpsantosh@yahoo.com</email></corresp></author-notes><pub-date pub-type="ppub"><season>Sep-Dec</season><year>2013</year></pub-date><volume>20</volume><issue>3</issue><fpage>187</fpage><lpage>191</lpage><permissions><copyright-statement>Copyright: © Journal of Family and Community Medicine</copyright-statement><copyright-year>2013</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec id="st1"><title>Aim:</title><p>The aim of the present study was to determine the prevalence and the relationship of oral mucosal lesions in tobacco users and denture wearers in a North Indian population.</p></sec><sec id="st2"><title>Materials and Methods:</title><p>The study comprised 3,749 patients attending the Department of Oral Medicine and Radiology, Jodhpur Dental College General Hospital between September 2008 and December 2012, for the treatment of dental problems other than oral mucosal lesions. The ages ranged from 28 years to 83 years, with a mean age of 49.7 years. The results were evaluated using the Pearson Chi-square test, with Yate’s correction and ANOVA tests.</p></sec><sec id="st3"><title>Results:</title><p>A total of 2,318 patients were diagnosed with lesions associated with the use tobacco and the wearing of dentures. The most frequently seen lesion was melanin pigmentation (29.9%) followed by linea alba (22.2%) and frictional keratosis (19.9%). Ulcers (6.1%) were the most common oral lesion seen in patients who wore dentures, followed by hyperplasia (4.8%). A statistically significant relation (<italic>P</italic> < 0.05) was established between tobacco and melanin pigmentation, frictional keratosis, traumatic ulcerations and leukoplakia. In those who wore dentures a statistically significant relation (<italic>P</italic> < 0.05) was found between candidiasis, traumatic ulceration and frictional keratosis.</p></sec><sec id="st4"><title>Conclusion:</title><p>The results of the present study indicate that the association of frictional keratosis with tobacco users and wearers of dentures can help in determining the diagnosis and treatment plan for oral cancer. Wearers of dentures should also be recalled for periodic checks at regular intervals and optimum preventive measures implemented.</p></sec></abstract><kwd-group><kwd>Denture wearers</kwd><kwd>oral mucosal pathology</kwd><kwd>smokers</kwd></kwd-group></article-meta></front><body><sec id="sec1-1"><title>INTRODUCTION</title><p>Most studies on the prevalence of oral mucosal lesions have been conducted in the developed world such the American,[<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref2" ref-type="bibr">2</xref>] European[<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref>] and Asian[<xref rid="ref5" ref-type="bibr">5</xref><xref rid="ref6" ref-type="bibr">6</xref>] continents. Since there are vast cultural, ethnic and geographical differences between the Indian subcontinent and the countries on these continents, it would not be realistic to apply the results of those studies to the Indian population. As stated previously, tobacco and its related products are notable risk factors for the development of pre-cancerous lesions and conditions, which may eventually lead to oral cancer.[<xref rid="ref7" ref-type="bibr">7</xref><xref rid="ref8" ref-type="bibr">8</xref>] The prevalence of melanin pigmentation, various oral lesions and white lesions is higher among smokers.[<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref9" ref-type="bibr">9</xref>] However, some studies do not identify smoking as a risk factor for oral lesions.[<xref rid="ref10" ref-type="bibr">10</xref>] The use of dentures in the elderly has also been known to act as a potential risk factor for oral lesions and the development of oral cancer as well as other characteristic lesions such as denture stomatitis and hyperplasia.[<xref rid="ref11" ref-type="bibr">11</xref><xref rid="ref12" ref-type="bibr">12</xref>] Traumatic ulcers are the most frequently seen oral lesion in users of dentures.[<xref rid="ref13" ref-type="bibr">13</xref>]</p><p>The present study was carried out to verify the association between the use of tobacco and dentures and the development of oral mucosal lesions and to find the prevalence of oral lesions in a North Indian population.</p></sec><sec sec-type="materials|methods" id="sec1-2"><title>MATERIALS AND METHODS</title><p>For the study, 3,749 patients attending the Department of Oral Medicine and Radiology, Jodhpur Dental College General Hospital, between September 2008 and December 2012 for the treatment of dental problems other than oral mucosal lesions, were selected. Ethical clearance was obtained from the Institutional Ethical Committee, Jodhpur Dental College General Hospital and Jodhpur National University. Informed consent was obtained from all patients prior to the examination. The study was designed as per the World Health Organization (WHO) guidelines for the conduct of oral health epidemiological studies and all diseases were diagnosed and recorded according to the WHO classification.[<xref rid="ref14" ref-type="bibr">14</xref><xref rid="ref15" ref-type="bibr">15</xref><xref rid="ref16" ref-type="bibr">16</xref>] Patients with any lesions resulting from trauma were excluded from the study. The oral examination was conducted with appropriate instruments under suitable lighting. A patient who has smoked >8 cigarettes/bidis a day for the past 10 years was identified as a smoker. A patient who uses either partially removable or complete dentures was included as a wearer of dentures for the study. A provisional diagnosis was established at the time of examination. If there was no improvement in the lesion after 15 days, a biopsy of the lesion for histopathological examination was advised. The observations were analyzed using the computer program, SPSS 12 (SPSS Inc. Chicago, USA). The results were evaluated using the Pearson Chi-square test, with Yate’s correction and ANOVA tests. <italic>P</italic> < 0.05 were considered statistically significant.</p></sec><sec sec-type="results" id="sec1-3"><title>RESULTS</title><p>The study sample comprised 2035 (54.3%) male and 1714 (45.7%) female patients. The ages of the patients ranged from 28 years to 83 years with a mean age of 49.7 years. The distribution of the sample by age and gender is shown in <xref ref-type="table" rid="T1">Table 1</xref>. Most of the patients (<italic>n</italic> = 1049; 58.34%) in the 28-37 years age group were smokers and the number of patients with either partial or complete dentures (<italic>n</italic> = 553) (non-denture wearers, n = 318) increased after the fourth decade [<xref ref-type="table" rid="T2">Table 2</xref>]. A total of 2,318 patients (61.8%) were diagnosed with lesions associated with tobacco use and the wearing of dentures. The most frequently seen lesion was melanin pigmentation (<italic>n</italic> = 1121; 29.9%) followed by linea alba (<italic>n</italic> = 835; 22.2%) and frictional keratosis (<italic>n</italic> = 746; 19.9%) [<xref ref-type="table" rid="T3">Table 3</xref>]. Melanin pigmentation was more commonly seen in males (<italic>n</italic> = 632; 40.8%) while females showed a higher prevalence of linea alba (<italic>n</italic> = 423; 24.6%) and frictional keratosis (<italic>n</italic> = 418; 24.4%). Ulcers (<italic>n</italic> = 232; 6.1%) were the most commonly seen oral lesion in patients who wore dentures, followed by hyperplasia (<italic>n</italic> = 181; 4.8%). All the denture-related lesions were more common in females. It was noticed that a large number of the lesions occurred on the buccal mucosa and the lips. Most of the patients examined were of middle and lower socio-economic status (>80%).</p><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Distribution of the sample according to age and gender</p></caption><graphic xlink:href="JFCM-20-187-g001"></graphic></table-wrap><table-wrap id="T2" position="float"><label>Table 2</label><caption><p>Distribution of the sample according to age and smoking habits and age and denture wearing status</p></caption><graphic xlink:href="JFCM-20-187-g002"></graphic></table-wrap><table-wrap id="T3" position="float"><label>Table 3</label><caption><p>Distribution of oral pathology lesion according to gender</p></caption><graphic xlink:href="JFCM-20-187-g003"></graphic></table-wrap><p>The distribution of the oral mucosal lesions according to the habit of smoking and the use of dentures is shown in <xref ref-type="table" rid="T4">Table 4</xref>. The statistical analysis showed a statistically significant relation (<italic>P</italic> < 0.05) between the tobacco habit and melanin pigmentation (<italic>P</italic> = 0.0001), frictional keratosis (<italic>P</italic> = 0.0016), traumatic ulcerations (<italic>P</italic> = 0.0342) and leukoplakia. Similarly, in wearers of dentures a statistically significant relation (<italic>P</italic> < 0.05) was found between Candidiasis (<italic>P</italic> = 0.0004), traumatic ulceration (0.0073), stomatitis (<italic>P</italic> = 0.0116) and frictional keratosis (<italic>P</italic> = 0.0000). No significant relation was established between gender and melanin pigmentation (<italic>P</italic> = 0.0012) and melanin pigmentation and the socio-economic status of patients (<italic>P</italic> > 0.05). However, a statistically significant relation was found between frictional keratosis and gender (<italic>P</italic> = 0.0024) as well as in patients of low socio-economic status (<italic>P</italic> < 0.05).</p><table-wrap id="T4" position="float"><label>Table 4</label><caption><p>Distribution of oral mucosal lesions according to smoking habit and denture wearing status</p></caption><graphic xlink:href="JFCM-20-187-g004"></graphic></table-wrap></sec><sec sec-type="discussion" id="sec1-4"><title>DISCUSSION</title><p>The prevalence of the various oral mucosal lesions in the present study (61.8%) was similar to other studies mentioned in the literature.[<xref rid="ref17" ref-type="bibr">17</xref><xref rid="ref18" ref-type="bibr">18</xref><xref rid="ref19" ref-type="bibr">19</xref>] However, these results are much higher than the global prevalence, which is reported to be <10%.[<xref rid="ref6" ref-type="bibr">6</xref>] The number of patients who have the habit of smoking is much higher (55.0%), than in similar studies with the reported number of smokers as approximately 34-37%.[<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref17" ref-type="bibr">17</xref>] Some studies had a higher percentage of patients who wore dentures,[<xref rid="ref18" ref-type="bibr">18</xref>] but the present study had 969 patients who wore dentures (25.8%).</p><p>In certain countries, the pigmentation of the oral mucosa ranges from 70.5% to 88.4%.[<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref18" ref-type="bibr">18</xref>] The current study showed melanin pigmentation in 29.9% of the patients, a much higher finding than those of Salonen <italic>et al.</italic>[<xref rid="ref3" ref-type="bibr">3</xref>] who reported prevalence of 9.9% in 1976 and 6.6% in the 1990 study. Similar to the findings of Axéll <italic>et al.</italic>[<xref rid="ref18" ref-type="bibr">18</xref>] and Hedin and Axéll[<xref rid="ref9" ref-type="bibr">9</xref>] melanin pigmentation was more common in males (40.8%). However, a few other studies have reported a higher prevalence in females taking contraceptives.[<xref rid="ref20" ref-type="bibr">20</xref>] Hedin and Axéll[<xref rid="ref9" ref-type="bibr">9</xref>] reported a statistically significant relationship between melanin pigmentation and the tobacco habit, but no statistically significant relation was established in the present study.</p><p>The prevalence of leukoplakia in the current study was 6.6%, similar to the findings of other studies.[<xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref21" ref-type="bibr">21</xref>] This was, however, much higher than the 0.5% prevalence reported by Martínez Díaz-Canel and García-Pola Vallejo.[<xref rid="ref17" ref-type="bibr">17</xref>] The relationship of leukoplakia with the tobacco habit is somewhat controversial. Some studies[<xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref22" ref-type="bibr">22</xref>] link tobacco habits to leukoplakia, as in the study, which showed 13.6% of smokers afflicted with leukoplakia.[<xref rid="ref3" ref-type="bibr">3</xref>] While others have shown no relation between leukoplakia and smoking.[<xref rid="ref23" ref-type="bibr">23</xref>] The present study established a statistically significant relation between the 2 entities.</p><p>Lichen planus represents approximately 20% of the diagnoses in routine practice and is the most frequent non-infectious disease of the oral mucosa.[<xref rid="ref24" ref-type="bibr">24</xref>] The present study reported prevalence of 1.5%, a figure which is much higher than that of the previous study done in an Indian population.[<xref rid="ref25" ref-type="bibr">25</xref>] Other similar studies done in Thailand and in Sweden showed a higher prevalence of 3.8% and 2.4% respectively.[<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref18" ref-type="bibr">18</xref>] Lichen planus was more commonly seen in males in the current study, similar to the findings of Bouquot and Gorlin[<xref rid="ref1" ref-type="bibr">1</xref>] and Salem.[<xref rid="ref26" ref-type="bibr">26</xref>] On the other hand, a few studies have shown it to be more common in females.[<xref rid="ref17" ref-type="bibr">17</xref>]</p><p>According to the symposium on white lesions held in Uppsala in 1994,[<xref rid="ref27" ref-type="bibr">27</xref>] the origin of a white lesion of the oral mucosa is unlikely to be trauma. The theory of cheek biting in anxiety and stress is shown by the difference in prevalence depending on where the study is conducted. In a study in Denmark,[<xref rid="ref28" ref-type="bibr">28</xref>] 0.5% of the patients presented with cheek or lip biting while in another study carried out in South Africa the prevalence was 4.6%.[<xref rid="ref29" ref-type="bibr">29</xref>] The prevalence in the present study was estimated as 16.9%, a much higher figure than the studies done in American and Spanish populations showed.[<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref17" ref-type="bibr">17</xref>] The prevalence of frictional keratosis observed in the current study was 19.9%, which was much higher than was reported by Salonen <italic>et al.</italic> (4,6%).[<xref rid="ref3" ref-type="bibr">3</xref>] The greater frequency of keratosis seen in patients younger than 50 years, was thought to have originated from caries and fractured teeth rather than from dentures. A statistically significant relationship between frictional keratosis and tobacco was established.</p><p>The prevalence of pathologies of the tongue in the present study (11.1%) was similar to that observed Axéll <italic>et al.</italic>(12,6%).[<xref rid="ref18" ref-type="bibr">18</xref>] Some studies have however, suggested the prevalence as high as 18%.[<xref rid="ref30" ref-type="bibr">30</xref>] The prevalence of geographical tongue or benign migratory tongue in patients of the present study was 3.3%, which is closer to what was seen in the Swedish population.[<xref rid="ref3" ref-type="bibr">3</xref>] However, a much lower prevalence was seen in the United States (0.3%)[<xref rid="ref31" ref-type="bibr">31</xref>] and in the Spanish population (0.8%).[<xref rid="ref17" ref-type="bibr">17</xref>] The prevalence of hairy tongue, was 7.8%, a much higher figure than has been reported in similar studies.[<xref rid="ref18" ref-type="bibr">18</xref><xref rid="ref30" ref-type="bibr">30</xref>] This phenomenon is more frequent in males, its prevalence increasing with age. No statistically significant relation was established between this lesion and the habit of smoking or the wearing of dentures as proposed by Beaven and Brooks.[<xref rid="ref32" ref-type="bibr">32</xref>]</p><p>Some studies have shown the highest prevalence of oral lesions to be traumatic ulcerations.[<xref rid="ref20" ref-type="bibr">20</xref>] However, this was not so in the present study. The prevalence of traumatic ulcerations found in the present study (11.5%) was higher than was estimated by Salonen <italic>et al.</italic>[<xref rid="ref3" ref-type="bibr">3</xref>] who reported it as 8%. The prevalence of recurrent aphthous stomatitis also shows great variations in different populations owing to the differences in the methodology used for the study, socio-economic status and the professional level.[<xref rid="ref17" ref-type="bibr">17</xref><xref rid="ref33" ref-type="bibr">33</xref>] The result of the present study (8.2%) is higher than the 2% found in the Swedish study.[<xref rid="ref3" ref-type="bibr">3</xref>] However, there was no indication in the present study that this entity is related to a determined socioeconomic-professional level. The prevalence is higher in females, which is in accord with other similar studies.[<xref rid="ref33" ref-type="bibr">33</xref><xref rid="ref34" ref-type="bibr">34</xref>] Ship[<xref rid="ref35" ref-type="bibr">35</xref>] stated that in edentulous patients, underlying denture aphthous lesions are uncommon. Indeed some similar studies have reported a relationship between non-denture wearers and non-smokers and the presence of aphthous. Some authors consider local trauma as one of the predisposing factors for recurrent aphthous.[<xref rid="ref17" ref-type="bibr">17</xref>]</p><p>Embil <italic>et al.</italic>[<xref rid="ref36" ref-type="bibr">36</xref>] indicated that there are geographical variations in the prevalence of herpes labialis. These variations may be seen as possibly due to social and ethnic differences, as seen in other Asian countries.[<xref rid="ref18" ref-type="bibr">18</xref>] The differences in the results of the present study and the study of Salonen <italic>et al.</italic>[<xref rid="ref3" ref-type="bibr">3</xref>] may be because in these studies, the lesion was verified when it was present and not from recurrence in the clinical history. It has been suggested, that recurrent herpes is more frequent in low social classes than in higher social classes.[<xref rid="ref37" ref-type="bibr">37</xref>] The values for the prevalence of candidiasis in previous studies (<0.5%)[<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref18" ref-type="bibr">18</xref>] were much lower than the present study (5.5%). These differences may be due to the high percentage of wearers of dentures in the present study sample. This was statistically significant, as in other similar studies.[<xref rid="ref17" ref-type="bibr">17</xref><xref rid="ref38" ref-type="bibr">38</xref>]</p><p>In the present study, the percentage of hyperplasia caused by the suction effect or negative pressure[<xref rid="ref39" ref-type="bibr">39</xref>] diagnosed in those who do not wear dentures is very similar to the findings of Salonen <italic>et al.</italic>[<xref rid="ref3" ref-type="bibr">3</xref>] and Axéll <italic>et al.</italic>[<xref rid="ref18" ref-type="bibr">18</xref>] As indicated in similar studies,[<xref rid="ref13" ref-type="bibr">13</xref>] our study shows that wearers of dentures more frequently suffer from traumatic ulceration. While a few other studies have shown that frictional keratosis, denture stomatitis and hyperplasia[<xref rid="ref10" ref-type="bibr">10</xref>] were more commonly seen in wearers of dentures. Due the presence of fibrous hyperplasia and candidiasis in a high number of denture wearers, it is essential to carry out periodic examination of the oral mucosa in these patients to establish a preventive protocol to eradicate the pathology caused by the use of dentures.</p></sec><sec sec-type="conclusions" id="sec1-5"><title>CONCLUSION</title><p>The results of the present study indicate a strong association of frictional keratosis with tobacco users and wearers of dentures with the etiology of oral cancer. This should be of interest to dental clinicians since it would help in quick diagnosis and planning the treatment of oral cancer. 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