|Year : 2020 | Volume
| Issue : 2 | Page : 124-131
Reporting frequency of potentially malignant oral disorders and oral cancer: A 10-year retrospective data analysis in a teaching dental institution
Namburu J Ramya1, Poosarla C Shekar2, Baddam V. Ramana Reddy2
1 SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
2 Department of Oral Pathology and Microbiology, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
|Date of Submission||12-Jan-2020|
|Date of Decision||09-Mar-2020|
|Date of Acceptance||15-Jun-2020|
|Date of Web Publication||18-Jul-2020|
Dr. Poosarla C Shekar
Department of Oral Pathology and Microbiology, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Incidence of oral potentially malignant and malignant lesions is increasing, thereby escalating the burden of cancer on our nation. Oral cancer and preceding lesions are of utmost importance for the present scenario. Various risk factors predominantly, consumption of tobacco with other synergetic products affect the oral mucosa. Registry of these lesions at a hospital-level and national level shall bring awareness in the public sector. Categorization of cases would lead to pooling of the overall data for oral potentially malignant disorders (OPMDs) and oral cancer (OC). The present study aimed to report the frequency of patients affected with potentially malignant oral disorders and oral cancer and to articulate the data at a teaching dental institution.
Materials and Methods: A retrospective study was conducted in the department of Oral Pathology from the archives between 2009 and 2019. Data were manually retrieved year-wise concerning age, sex, site involved, and histopathological findings. Cases were evaluated to segregate OPMDs and OC.
Results: Overall, 3223 oral biopsies were reviewed and analyzed. Six-hundred eighty-three (21.16%) patients were segregated, out of which OPMDs were 205 (6.38%) and 478 (14.8%) were oral cancer. Oral leukoplakia 3.2% constituted the highest number of patients in OPMDs group, followed by oral lichen planus (1.6%) and oral submucous fibrosis (1.36%). The most frequent lesion in the oral cancer group was oral squamous cell carcinoma (12.9%) followed by verrucous carcinoma (1.86%). The average age range affects the most common lesions was fifth decade in case of oral leukoplakia and sixth decade in case oral squamous cell carcinoma. The most frequently involved site in the oral cavity was buccal mucosa.
Conclusion: Studies evaluating the prevalence rate of the OPMDs and oral carcinoma of the oral cavity are beneficial for general dental practitioners in making early diagnosis and treatment. Awareness programs on preventive and diagnostic measures at public and health sectors shall help in understanding the latest scenario. This is possible only after the registry of the lesions at various programmed levels.
Keywords: Diagnosis, leukoplakia, lichen planus, oral cancer, screening
|How to cite this article:|
Ramya NJ, Shekar PC, Reddy BV. Reporting frequency of potentially malignant oral disorders and oral cancer: A 10-year retrospective data analysis in a teaching dental institution. J NTR Univ Health Sci 2020;9:124-31
|How to cite this URL:|
Ramya NJ, Shekar PC, Reddy BV. Reporting frequency of potentially malignant oral disorders and oral cancer: A 10-year retrospective data analysis in a teaching dental institution. J NTR Univ Health Sci [serial online] 2020 [cited 2021 Jan 21];9:124-31. Available from: https://www.jdrntruhs.org/text.asp?2020/9/2/124/289894
| Introduction|| |
Oral cancer is one of the most fatal health problems faced by mankind today. According to GLOBOCAN 2018, oral cancer is one of the top five cancers that affect the Indian population. India has one-third of oral cancer cases in the world. It accounts for 30% of all cancers in India, posing a significant challenge to both preventive and diagnostic health services. Due to the cultural, ethnic, geographic factors and the popularity of addictive habits, a probable track toward oral cancer is high. To decrease the high mortality and morbidity associated with this cancer, one way forward is to improve early detection of oral cancer by organized screening programs. There are few precancerous lesions and conditions that precede cancer. According to WHO (2005), some of the oral potentially malignant disorders (OPMDs) are leukoplakia, erythroplakia, oral submucous fibrosis, lichen planus, lichenoid reaction, smokers palate, graft vs. host disease, epidermolysis bullosa, actinic cheilitis, discoid lupus erythematosus and some of the most common oral carcinomas are squamous cell carcinoma, verrucous carcinoma, and melanoma. More than 90% of all oral cancers are oral squamous cell carcinomas, which is often preceded by an OPMD. The malignant transformation rate of most of the potentially malignant disorders is high. Among the above mentioned OPMDs, leukoplakia, erythroplakia, oral submucous fibrosis, and lichen planus are commonly seen in India. Hence, there is a need for knowledge about the prevalence rate and early detection of these OPMDs to decrease the burden of cancer incidence. Aim: This study aims to estimate the frequency of oral potentially malignant disorders and oral carcinomas referred to teaching dental institution for a period of 10 years (2009–2019). Objectives: To determine the frequency of OPMDs and oral carcinomas among other oral lesions. To analyze most common lesion, age, gender predilection, and the most common site involved among the common OPMDs and oral carcinomas.
| Materials and Methods|| |
The data was collected retrospectively year wise for a period of 10 years from 2009 to 2019 from the archives of the teaching dental institution. Ethical approval for this study (protocol no. 30/IEC/SIBAR/UG/2018) was obtained from the Institutional Ethical Committee of Sibar Institution of Dental Sciences, Guntur 12th NOV 2018. All the reported biopsies involving the oral cavity were utilized to analyze the precise sample. The subjects with a histopathological diagnosis of OPMDs and oral carcinomas were included in the study. Periapical lesions, odontogenic cysts, odontogenic tumors, tumors arising from the soft tissue, salivary gland, bone, and secondary tumors were excluded from the study. Descriptive statistics were utilized for plotting parameters of the study sample on chronological distribution, age, gender, and site involved.
| Results|| |
A total of 3223 oral biopsies were reported during the study period that is from 2009 to 2019. Six-hundred eighty-three (21.1%) cases were OPMDs (6.36%) and oral carcinomas (14.8%). Distribution of different OPMDs and oral cancers were as follows: 103 were reported as oral leukoplakia (3.2%), 51 as oral lichen planus (1.6%), 44 as oral submucous fibrosis (1.36%), 7 as lichenoid reaction (0.2%), 60 as verrucous carcinoma (1.86%), and 418 as oral squamous cell carcinoma (12.9%) [Table 1].
Age-wise distribution revealed that a majority of cases were reported in fifth decade for oral leukoplakia, fourth decade for oral lichen planus, third decade for oral submucous fibrosis, sixth decade for lichenoid reaction, verrucous carcinoma, and oral squamous cell carcinoma [Table 2]. Gender-wise distribution in cases of oral leukoplakia, oral submucous fibrosis, verrucous carcinoma, and oral squamous cell carcinoma, a higher male predilection was noticed. In the contrary, a higher female predilection was seen in cases of oral lichen planus and lichenoid reaction [Table 3]. The most common site involved with these cases was the buccal mucosa and buccal vestibule (57%), followed by the tongue (10%), maxilla and palate (9%), retromolar area (9%), labial mucosa and labial vestibule (7%), alveolar ridge and gingiva (6%), and floor of the mouth (2%) [Graph 1].
| Discussion|| |
Rates of oral cancer in India are high, that is, 20 per 100,000 population and accounts for over 30% of all cancers in the country. It has been well established by researchers that virtually all oral cancers are preceded by visible clinical changes in the oral mucosa in the form of white or red patches which may or may not be associated with additional features of significant discomfort. They have a higher risk of malignant transformation unless diagnosed early and treated. Information about the real prevalence of OPMDs among the general population worldwide is scarcely available. However, it is reported to be from 1% to 5%.
Different forms of tobacco usages (smokeless and smoking), UV radiations, and nontobacco oral squamous cell carcinoma are related with human papillomavirus, and genetic effects can be the common risk factors that cause OPMD or oral squamous cell carcinoma. Surgery and chemotherapy along with radiation are the few treatment modalities which show promising results in prolonging the survival rate for early diagnosed patients. Past decade statistics show a 5-year survival rate of 50% cases with advanced treatments.
The frequency of OPMDs was (6.36%) in the present study which is in accordance with Byakodi et al. (2.5%–8.4%), Hassona et al. (2.8%), Mello et al. (4.47%), and Kumar et al. (5.6%) but in contrary to studies done by Al Attas et al. (10.5%). The overall frequency of oral cancer in the present study was (14.8%) which is congruence to the studies conducted by Bhatnagar et al. (16.8%) and Kumar et al. (18.8%) but in the contrary to the studies conducted by Patil et al. (26.88%) and Rooban (25%). Previous studies pondered various parameters and demographic factors to indicate the prevalence of OPMDs and oral cancers while evaluating the sample population.
Oral leukoplakia being the most common OPMD was first defined by World Health Organization in 1978 as “A white patch or plaque which cannot otherwise be characterized clinically or pathologically as any other disease. It can be diagnosed as a flat to slightly elevated, gray/white translucent plaque which was either fissured/wrinkled.” “Malignant transformation rate of oral leukoplakia on an average is 1% in diverse populaces and topographical areas with the greater risk reported by 43%.”
According to our study, the most common OPMD was leukoplakia (3.2%) with a similar data in studies conducted by Axell (3.4%), Kovac-Kavcic and Skaleric (3.6%), Saraswathi et al. (0.2%–5.2%), Petti (1.7%–2.7%), Al Attas et al. (2.8%), and Mello et al. (4.11%) but in contrary to the study conducted by Warnakulasuriya (15.1%). Cross-sectional studies state that the prevalence of oral leukoplakia in Indian subcontinent has been on a constant raise. Various etiological factors like smoking and chewing tobacco would lead to a hyperkeratotic lesion on the oral mucosa.
Oral Lichen planus (OLP) being the second most common OPMD in this study was first described in 1869 by Erasmus Wilson as “leichen planus,” “An eruption of pimples remarkable for their color, their figure, their structure, their habits of isolated and aggregated development, their habitat, their local and chronic character and for the melasmic stains which they leave behind them when they disappear.” “The etiology and pathogenesis of OLP are not clearly understood. Some potential external and internal etiologic events such as genetic background, autoimmunity, hepatitis C virus, and psychological stress have been suggested to trigger OLP.” Present study indicates the frequency of lichen planus (1.6%) which is in accordance with studies done by Pindborg et al. (0.1%–1.5%), Mathew et al. (1.20%), Patil et al. (0.9%), Hassona et al. (1.8%), and Ghom (0.1%–2.2%) but in contrary to study conducted by Saraswathi et al. (0.15%).
Oral submucous fibrous (Pindborg in 1966) defined as “an insidious chronic disease affecting any part of the oral cavity and sometimes pharynx. Although occasionally preceded by and/or associated with vesicle formation, it is always associated with juxta-epithelial inflammatory reaction followed by fibroblastic changes in the lamina propria, with epithelial atrophy leading to stiffness of the oral mucosa causing trismus and difficulty in eating.” “OSMF is regarded as a condition as it affects different regions of the oral cavity as well as pharynx. Genomic instability and altered keratinocyte phenotype have been reported to play an important role in malignant transformation.” Prevalence of OSMF is 2.01% and malignant transformation rate of 2.3%–7.6% has been reported in the literature.
Prevalence of OSMF in the present study (1.36%) which is in analogous to studies done by Mehta et al. (0.03% and 3.2%), Mathew et al. (2.01%), Chatterjee et al. (2.7%), and Sachdev et al. (0.03%–6.4%). This is in contrary to the studies done by Al Attas (0.50%) and Saraswathi et al. (0.55%)
Oral lichenoid reactions are “disease conditions with definite identifiable etiology. It can occur either due to intake of drug, i.e., lichenoid drug eruptions, or due to contact with some potential irritants which majority of times are dental materials.” Various terminologies have been used to describe this condition, as oral lichenoid lesions, oral lichenoid reaction, oral lichenoid tissue reaction, lichenoid contact stomatitis, or lichen-planus-like lesions, due to the similar clinical and histological aspects of OLL and oral lichen planus.
The present study plotted a prevalence of 0.2% in the study sample which does not match the with the study done by Robledo-Sierra et al. (2.4%). The frequency of lichenoid reactions plotted in the study sample is sufficient lesser than the global prevalence rate as its diagnosis resembles oral lichen planus. A thorough clinical history can help in segregation of patients in this category.
Oral verrucous carcinoma is a rare tumor first described by Ackerman. It is a special form of well-differentiated squamous cell carcinoma with specific clinical and histological features. Various names are used in the literature to describe this entity, including Ackerman's tumor, Buschke-Loewenstein tumor, florid oral papillomatosis, epithelioma cuniculatum, and carcinoma cuniculatum. The tumor grows slowly and locally, invasive in nature and unlikely to metastasize. The present study showed a frequency of verrucous carcinoma (1.86%), which is likewise to the study conducted by Franklyn et al. (2%), Chaisuparat et al. (2%), and Bouquot (3%).
Oral Squamous cell carcinoma is defined as “a malignant neoplasm exhibiting squamous differentiation as characterized by the formation of keratin and/or the presence of intercellular bridges.” It is the most common oral malignancy, representing up to 80%–90% of all malignant neoplasms of the oral cavity. Although oral cancer incidence is highly variable worldwide, it is accepted that oral cavity ranges from the sixth to the ninth most common anatomical location for cancer, depending mostly on the country (and even specific region in some countries) and gender of the patients. Despite this mean incidence, it can represent the most common location for cancer in some specific regions, especially in southeastern Asia.
The present study showed that oral squamous cell carcinoma 12.9% is the most frequent tumor of the oral cavity, which is in accordance with the study conducted by Bhatnagar et al. (16.8%) and Kumar et al. (18.8%) but in contrary to the studies conducted by Patil et al. (26.88%) and Rooban (25%), and Tandon et al. (39.4%).
Various lesions in OPMDs and OC revealed the highest frequency in the age groups they prevailed. Oral leukoplakia in the present study reveals the highest frequency of oral leukoplakia in the fifth decade of life which is in accordance with Liu et al., warankulasuriya et al., and Gopinath et al. Oral lichen planus showed a peak age in fourth to fifth decade of life, which is in consistent with Mathew et al., Fernández-González et al., and Lauritano et al. Oral submucous fibrosis revealed a peak age of occurrence in third decade of life which is similarly stated by Ali et al., Sabarinath et al., Rajendran, and Kumar et al. Cases of lichenoid reaction showed the peak age in sixth decade of life which is analogous to the Bernardes et al. Oral verrucous carcinoma showed a peak age in sixth decade of life which is in accordance with Alkan et al., Rodrigues et al., and Sonalika et al. Oral squamous cell carcinoma cases showed a peak age frequency around sixth decade of life which is similar to studies done by Tandon et al.,Lin et al., Gaitán-Cepeda et al., Tandon et al., Sharma et al., Johnson et al., Misra et al., and Kumar et al.
The present study plotted a higher male predilection in cases with oral leukoplakia. This is in accordance with the study conducted by Lapthanasupkul et al., Gopinath et al., Liu et al., Parlatescu et al., and Sivakumar et al. Higher female predilection was plotted for cases of oral lichen planus which is in accordance with Parashar, Chatterjee et al., Omal et al., Ingafou et al., and Xue et al. Higher male predominance was seen in oral submucous fibrosis which is comparable to studies reported by Rajendran, Vinay et al., Rooban et al., Ali et al., Sarode et al., and Mathew et al. Cases of oral lichenoid reaction also showed higher female predilection which is similar to studiesofBernardes et al., Cortés-Ramírez et al., and Ramalingam et al. Oral verrucous carcinoma showed a higher male predilection which is similar to the studies of Alkan et al., Franklyn et al., Garcia et al., and Sonalika and Anand. The study sample showed a higher male predilection in cases with oral squamous cell carcinoma which is analogous to the studies conducted by Tandon et al., Tandon et al., Kumar et al., Singh et al., Jayasooriya et al., and Shah et al.
The present study showed that the most common site involved in the oral cavity was buccal mucosa in cases of oral leukoplakia which is in accordance with Lapthanasupkul et al., Gopinath et al., Liu et al., Parlatescu et al., Sivakumar et al. and Starzyńska et al. Study sample showed that the cases of oral lichen planus affected most commonly buccal mucosa. This is in accordance with the study conducted by Mohan et al., Gupta et al., Fernández-González et al., Rajendran et al., and Varghese et al. Oral submucous fibrosis cases showed site predilection of buccal mucosa which is consistent to studies reported by Chatterjee et al., Sachdev et al., Mathew et al., Al Attas, and Saraswathi et al. Buccal mucosa was the commonest site for cases of lichenoid reactions which is similarly stated by Cortés-Ramírez et al., Ramalingam et al., and Mallo Pérez and Díaz Donado. The most frequent site for oral verrucous carcinoma is buccal mucosa, which is similar to the studies of Franklyn et al.,Yeh, and Waskowska et al. Similar site predilection was noticed in cases with oral squamous cell carcinoma, in which the chiefly affected site is nonkeratinized mucosa, i.e., buccal mucosa, as described by numerous authors. Our study also goes in congruence with Tandon et al., Pathak et al., Tandon et al., Shah et al., More and D'Cruz, Mehrotra et al., Shenoi et al., Addala et al., Gowhar et al., and Naga et al.
Evaluation of OPMDs and oral carcinomas frequency would add a minimal data of a region, which shall contribute to the national registry on cancer and precancer.
| Conclusion|| |
Studies evaluating the prevalence and incidence rates of these lesions help us conducting awareness programs at community centers. These are also beneficial for oral pathologists and general dental practitioners in making early and better diagnosis and treatment. Based on the knowledge, early detection of these lesions minimizes the potential complications and enhances the life expectancy of the patient.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Byakodi R, Shipurkar A, Byakodi S, Marathe K. Prevalence of oral soft tissue lesions in Sangli, India. J Community Health 2011;36:756-9.
Coelho KR. Challenges of the oral cancer burden in India. J Cancer Epidemiol 2012;2012:701932.
Sankaranarayanan R, Ramadas K, Thomas G, Muwonge R, Thara S, Mathew B, et al
. Effect of screening on oral cancer mortality in Kerala, India: A cluster-randomised controlled trial. Lancet 2005;365:1927-33.
Vinay BH, Baghirath PV, Kumar JV, Arvind. Prevalence of precancerous lesions and conditions in Telangana region, Andhra Pradesh, India. J Indian Assoc Public Health Dent 2014;12:23-7. [Full text]
Sarode SC, Sarode GS, Tupkari JV. Oral potentially malignant disorders: Precising the definition. Oral Oncol 2012;48:759-60.
Manthapuri S, Sanjeevareddygari S. Prevalence of potentially malignant disorders: An institutional study. Int J Appl Dent Sci 2018;4:101-3.
Hassona Y, Scully C, Almangush A, Baqain Z, Sawair F. Oral potentially malignant disorders among dental patients: A pilot study in Jordan. Asian Pac J Cancer Prev 2015;15:10427-31.
Mello FW, Miguel AFP, Dutra KL, Porporatti AL, Warnakulasuriya S, Guerra ENS, et al
. Prevalence of oral potentially malignant disorders: A systematic review and meta-analysis. J Oral Pathol Med 2018;47:633-40.
Kumar S, Narayanan VS, Ananda SR, Kavitha AP, Krupashankar R. Prevalence and risk indicators of oral mucosal lesions in adult population visiting primary health centers and community health centers in Kodagu district. J Family Med Prim Care 2019;8:2337-42.
] [Full text]
Al Attas SA, Ibrahim SS, Amer HA, Darwish ZE, Hassan MH. Prevalence of potentially malignant oral mucosal lesions among tobacco users in Jeddah, Saudi Arabia. Asian Pac J Cancer Prev 2014;15:757-62.
Bhatnagar P, Rai S, Bhatnagar G, Kaur M, Goel S, Prabhat M. Prevalence study of oral mucosal lesions, mucosal variants, and treatment required for patients reporting to a dental school in North India: In accordance with WHO guidelines. J Family Community Med 2013;20:41-8.
Patil PB, Bathi R, Chaudhari S. Prevalence of oral mucosal lesions in dental patients with tobacco smoking, chewing, and mixed habits: A cross-sectional study in South India. J Family Community Med 2013;20:130-5.
Rooban T, Rao A, Joshua E, Ranganathan K. The prevalence of oral mucosal lesions in alcohol misusers in Chennai, south India. Indian J Dent Res 2009;20:41-6.
] [Full text]
Kramer IR, Lucas RB, Pindborg JJ, Sobin LH. Definition of leukoplakia and related lesions: An aid to studies on oral precancer. Oral Surg Oral Med Oral Pathol 1978;46:518-39.
Van der Waal I. Potentially malignant disorders of the oral and oropharyngeal mucosa; terminology, classification and present concepts of management. Oral Oncol 2009;45:317-23.
Axell T. Occurrence of leukoplakia and some other oral white lesions among 20,333 adult Swedish people. Community Dent Oral Epidemiol 1987;15:46-51.
Kovac-Kavcic M, Skaleric U. The prevalence of oral mucosal lesions in a population in Ljubljana, Slovenia. J Oral Pathol Med 2000;29:331-5.
Saraswathi TR, Ranganathan K, Shanmugam S, Sowmya R, Narasimhan PD, Gunaseelan R. Prevalence of oral lesions in relation to habits: Cross-sectional study in South India. Indian J Dent Res 2006;17:121-5.
] [Full text]
Petti S. Pooled estimate of world leukoplakia prevalence: A systematic review. Oral Oncol 2003;39:770-80.
Warnakulasuriya S, Kovacevic T, Madden P, Coupland VH, Sperandio M, Odell E, et al
. Factors predicting malignant transformation in oral potentially malignant disorders among patients accrued over a 10-year period in South East England. J Oral Pathol Med 2011;40:677-83.
McCarthy PL, Gerald S, editors. Diseases of the Oral Mucosa. 2nd
ed. Philadelphia: Lea & Fegiber; 1980. p. 203-24.
Huang SM, Huang JY, Yu HC, Su NY, Chang YC. Trends, demographics, and conditions of emergency dental visits in Taiwan 1997-2013: A nationwide population-based retrospective study. J Formos Med Assoc 2019;118:582-7.
Pindborg JJ, Mehta FS, Daftary DK, Gupta PC, Bhonsle RB. Prevalence of oral lichen planus among 7639 Indian Villagers in Kerala, South India, Acta Derm Venereol 1972;52:216-20.
Mathew AL, Pai KM, Sholapurkar AA, Vengal M. The prevalence of oral mucosal lesions in patients visiting a dental school in Southern India. Indian J Dent Res 2008;19:99-103.
] [Full text]
Ghom AG. Oral Premalignant lesions and conditions. In: Ghom AG, editor. Text of Oral Medicine. 2nd
ed. Delhi: Jaypee Brothers; 2010. p. 208.
Ali FM, Patil A, Patil K, Prasant MC. Oral submucous fibrosis and its dermatological relation. Indian Dermatol Online J 2014;5:260-5.
] [Full text]
Mehta FS, Gupta PC, Daftary DK, Pindborg JJ, Choksi SK. An epidemiological study of oral cancer and precancerous conditions among 101, 761 villagers in Maharashtra, India. Intermit J Cancer 1972;10:134-41.
Chatterjee R, Gupta B, Bose S. Oral screening for pre-cancerous lesions among areca-nut chewing population from rural India. Oral Health Prev Dent 2015;13:509-14.
Sachdev PK, Jeanne Freeland-Graves J, Beretvas S, Sanjeevi N. Zinc, copper, and iron in oral submucous fibrosis: A meta-analysis. Int J Dent 2018;2018:3472087.
Sarode SC, Sarode GS, Kalele K. Oral lichenoid reaction: A review. Int J Oral Maxillofac Pathol 2012;3:17-26.
Grossmann SMC, Oliveira CNA, Souto GR, Góes C, Mesquita RA. Oral lichenoid lesion: A review of the literature. World J Stomatol 2015;4:103-7.
Robledo-Sierra J, Mattsson U, Svedensten T, Jontell M. The morbidity of oral mucosal lesions in an adult Swedish population. Med Oral Patol Oral Cir Bucal 2013;18:e766-72.
ACKERMAN LV. Verrucous carcinoma of the oral cavity. Surgery 1948;23:670-8.
Alkan A, Bulut E, Gunhan O, Ozden B. Oral verrucous carcinoma: A study of 12 cases. Eur J Dent 2010;4:202-7.
Franklyn J, Janakiraman R, Tirkey AJ, Thankachan C, Muthusami J. Oral verrucous carcinoma: Ten year experience from a tertiary care hospital in India. Indian J Med Paediatr Oncol 2017;38:452-5.
] [Full text]
Chaisuparat R, Limpiwatana S, Kongpanitkul S, Yodsanga S, Jham BC. The Akt/mTOR pathway is activated in verrucous carcinoma of the oral cavity. J Oral Pathol Med 2016;45:581-5.
Bouquot JE. Oral verrucous carcinoma. Incidence in two US populations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:318-24.
Gupta PC, Mehta FS, Daftary DK, Pindborg JJ, Bhonsle RB, Jalnawalla PN, et al
. Incidence rates of oral cancer and natural history of oral precancerous lesions in a 10-year follow-up study of Indian villagers. Community Dent Oral Epidemiol 1980;8:283-333.
Johnson NW, Jayasekara P, Amarasinghe AA. Squamous cell carcinoma and precursor lesions of the oral cavity: Epidemiology and etiology. Periodontol 2000 2011;57:19-37.
Tandon P, Dadhich A, Saluja H, Bawane S, Sachdeva S. The prevalence of squamous cell carcinoma in different sites of oral cavity at our Rural Health Care Centre in Loni, Maharashtra-A retrospective 10-year study. Contemp Oncol (Pozn) 2017;21:178-83.
Liu W, Wang YF, Zhou HW, Shi P, Zhou ZT, Tang GY. Malignant transformation of oral leukoplakia: A retrospective cohort study of 218 Chinese patients. BMC Cancer 2010;16:685.
Gopinath D, Thannikunnath BV, Neermunda SF. Prevalence of carcinomatous foci in oral leukoplakia: A clinicopathologic study of 546 Indian samples. J Clin Diagn Res 2016;10:ZC78-83.
Fernández-González F, Vázquez-Alvarez R, Reboiras-López D, Gándara-Vila P, García-García A, Gándara-Rey JM. Histopathological findings in oral lichen planus and their correlation with the clinical manifestations. Med Oral Patol Oral Cir Bucal 2011;16:e641-6.
Lauritano D, Arrica M, Lucchese A, Valente M, Pannone G, Lajolo C, et al
. Oral lichen planus clinical characteristics in Italian patients: A retrospective analysis. Head Face Med 2016;12:18.
Sabarinath B, Sriram G, Saraswathi TR, Sivapathasundharam B. immunohistochemical evaluation of mast cells and vascular endothelial proliferation in oral submucous fibrosis. Indian J Dent Res 2011;22:116-21.
] [Full text]
Rajendran R. Oral submucous fibrosis: Etiology, pathogenesis and future research. WHO Bull OMS 1994;72:986-96.
Kumar A, Bagewadi A, Keluskar V, Singh M. Efficacy of lycopene in the management of oral submucous fibrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Oral Endod 2007;103:207-13.
Bernardes VF, Garcia BG, Souto GR, Novaes-Junior JB, Aguiar MCF, Mesquita RA. Lesão liquenóide oral relacionada ao amálgama. An Bras Dermatol 2007;82:549-52.
Rodrigues J, Vaz OP, Salelkar RS, Ramani A, Falari S, Veeresh HM, et al
. A rare case of verrucous carcinoma on the dorsum of the tongue. Int J Adv Case Rep 2015;2:530-1.
Sonalika WG, Anand T. Oral verrucous carcinoma: A retrospective analysis for clinicopathologic features. J Cancer Res Ther 2016;12:142-5.
Lin CS, Jen YM, Cheng MF, Lin YS, Su WF, Hwang JM, et al
. Squamous cell carcinoma of the buccal mucosa: An aggressive cancer requiring multimodality treatment. Head Neck 2006;28:150-7.
Gaitán-Cepeda LA, Peniche-Becerra AG, Quezada-Rivera D. Trends in frequency and prevalence of oral cancer and oral squamous cell carcinoma in Mexicans. A 20 years retrospective study. Med Oral Patol Oral Cir Bucal 2011;16:e1-5.
Tandon A, Bordoloi B, Jaiswal R, Srivastava A, Singh RB, Shafique U. Demographic and clinicopathological profile of oral squamous cell carcinoma patients of North India: A retrospective institutional study. SRM J Res Dent Sci 2018;9:114-8. [Full text]
Sharma P, Saxena S, Aggarwal P. Trends in the epidemiology of oral squamous cell carcinoma in western UP: An institutional study. Indian J Dent Res 2010;21:316-9.
] [Full text]
Misra V, Singh PA, Lal N, Agarwal P, Singh M. Changing pattern of oral cavity lesions and personal habits over a decade: Hospital based record analysis from Allahabad. Indian J Community Med 2009;34:321-5.
] [Full text]
Kumar GK, Abidullah M, Elbadawi L, Dakhil S, Mawardi H. Epidemiological profile and clinical characteristics of oral potentially malignant disorders and oral squamous cell carcinoma: A pilot study in Bidar and Gulbarga Districts, Karnataka, India. J Oral Maxillofac Pathol 2019;23:90-6.
] [Full text]
Lapthanasupkul P, Poomsawat S, Punyasingh J. A clinicopathologic study of oral leukoplakia and erythroplakia in a Thai population. Quint Int 2007;38:e448-55.
Parlatescu I, Gheorghe C, Coculescu E, Tovaru S. Oral leukoplakia-An update. Maedica (Buchar) 2014;9:88-93.
Sivakumar TT, Sam N, Joseph AP. Prevalence of oral potentially malignant disorders and oral malignant lesions: A population-based study in a municipal town of southern Kerala. J Oral Maxillofac Pathol 2018;22:413-4.
] [Full text]
Parashar P. Oral lichen planus. Otolaryngol Clin North Am 2011;44:89-107, vi.
Chatterjee K, Bhattacharya S, Mukherjee CG, Mazumdar A. A retrospective study of oral lichen planus in paediatric population. J Oral Maxillofac Pathol 2012;16:363-7.
] [Full text]
Omal P, Jacob V, Prathap A, Thomas NG. Prevalence of oral, skin, and oral and skin lesions of lichen planus in patients visiting a dental school in southern India. Indian J Dermatol 2012;57:107-9.
] [Full text]
Ingafou M, Leao JC, Porter SR, Scully C. Oral lichen planus: A retrospective study of 690 British patients. Oral Dis 2006;12:463-8.
Xue JL, Fan MW, Wang SZ, Chen XM, Li Y, Wang L. A clinical study of 674 patients with oral lichen planus in China. J Oral Pathol Med 2005;34:467-72.
Cortés-Ramírez D-A, Gainza-Cirauqui M-L, Echebarria-Goikouria MA, Aguirre-Urizar JM. Oral lichenoid disease as a premalignant condition: The controversies and the unknown. Med Oral Patol Oral Cir Bucal 2009;14:E118-22.
Ramalingam S, Malathi N, Thamizhchelvan H, Sangeetha N, Rajan ST. Role of mast cells in oral lichen planus and oral lichenoid reactions. Autoimmune Dis 2018;2018:7936564.
Garcia NG, Oliveira DT, Hanemann JA, Pereira AA. Oral verrucous carcinoma mimicking a chronic candidiasis: A case report. Case Rep Oncol Med 2012;2012:190272.
Singh MP, Kumar V, Agarwal A, Kumar R, Bhatt ML, Misra S, et al
. Clinico-epidemiological study of oral squamous cell carcinoma: A tertiary care centre study in North India. J Oral Biol Craniofac Res 2016;6:31-4.
Jayasooriya PR, Pitakotuwage TN, Mendis BR, Lombardi T. Descriptive study of 896 oral squamous cell carcinomas from the only university based oral pathology diagnostic service in Sri Lanka. BMC Oral Health 2016;16:1.
Shah S, Parikh N, Ayre D, Patel H, Sutariya R, Rakesh PS. Prevalence of oral squamous cell carcinoma in South Gujarat population. Int J Prev Clin Dent Res 2019;6:42-5. [Full text]
Starzyńska A, Pawłowska A, Renkielska D, Michajłowski I, Sobjanek M, Błażewicz I. Oral premalignant lesions: Epidemiological and clinical analysis in the northern Polish population. Postepy Dermatol Alergol 2014;31:341-50.
Mohan RP, Gupta A, Kamarthi N, Malik S, Goel S, Gupta S. Incidence of oral lichen planus in perimenopausal women: A cross-sectional study in Western Uttar Pradesh population. J Midlife Health 2017;8:70-4.
Gupta S, Jawanda MK. Oral lichen planus: An update on etiology, pathogenesis, clinical presentation, diagnosis and management. Indian J Dermatol 2015;60:222-9.
] [Full text]
Rajendran R. Diseases of the skin. In: Rajendran R, Sivapathasundharam, editors. Shafer's Text book of Oral Pathology. 6th
ed. Amsterdam: Elsevier; 2009. p. 799-803.
Varghese SS, George GB, Sarojini SB, Vinod S, Mathew P, Mathew DG, et al
. Epidemiology of oral lichen planus in a cohort of south indian population: A retrospective study. J Cancer Prev 2016;21:55-9.
Mallo Pérez L, Díaz Donado C. Intraoral contact allergy to materials used in dental practice. A critical review. Med Oral 2003;8:334-47.
Yeh CJ. Treatment of verrucous hyperplasia and verrucous carcinoma by shave excision and simple cryosurgery. Int J Oral Maxillofac Surg 2003;32:280-3.
Waskowska J, Koszowski R, Raczkowska-Siostrzonek A, Stemplewska K. Verrucous carcinoma of the tongue-a rare case study. Cent Eur J Med 2012;7:145-8.
Pathak KA, Gupta S, Talole S, Khanna V, Chaturvedi P, Deshpande MS, et al
. Advanced squamous cell carcinoma of lower gingiva-buccal complex: Patterns of spread and failure. Head Neck 2005;27:597-602.
More Y, D'Cruz AK. Oral cancer: Review of current management strategies. Natl Med J India 2013;26:152-8.
Mehrotra R, Singh M, Gupta RK, Singh M, Kapoor AK. Trends of prevalence and pathological spectrum of head and neck cancers in North India. Indian J Cancer 2005;42:89-93.
] [Full text]
Shenoi R, Devrukhkar V, Chaudhuri, Sharma BK, Sapre SB, Chikhale A, et al
. Demographic and clinical profile of oral squamous cell carcinoma patients: A retrospective study. Indian J Cancer 2012;49:21-6.
] [Full text]
Addala L, Pentapati CK, Reddy Thavanati PK, Anjaneyulu V, Sadhnani MD. Risk factor profiles of head and neck cancer patients of Andhra Pradesh, India. Indian J Cancer 2012;49:215-9.
] [Full text]
Gowhar O, Ain TS, Singh NN, Sultan S. Prevalence of oral premalignant and malignant lesions in Moradabad, India-A retrospective study. Int J Contemp Med Res 2016;3:2079-81.
Naga SD, Gundamaraju KK, Bujunuru SR, Navakoti P, Kantheti LC, Poosarla C. Prevalence of oral potentially malignant and malignant lesions at a tertiary level hospital in Hyderabad, India. J NTR Univ Health Sci 2014;3:S13-6
[Table 1], [Table 2], [Table 3]