Oral health is important to individuals of all age groups. Oral mucosal lesions and its normal anatomical variations are very common in all age group. The oral mucosa performs essential protective functions that plays an important role in the general health status of an individual. Any decline in the protective functions of the oral mucosa could expose the aging individual to a variety of pathogens and chemicals. During aging, oral epithelium becomes thinner and collagen synthesis also decreases, which leads to decreased tissue regeneration and disease resistance. The oral mucosa becomes permeable to toxic substances and more vulnerable to external carcinogens.
Objectives: To study the clinical pattern and the types of oral mucosal lesions in geriatric population. To study the distribution and possible etiological factors of oral mucosal lesions in geriatric population.
Material and methods: The study was carried out from September 2016 to September 2019. All patients above 60 years of age, reporting to Dermatology OPD at GITAM institute of Medical sciences & Research, Visakhapatnam, Andhra Pradesh were examined and evaluated for oral mucosal lesions. A detailed medical history including demographic data, chief complaints related to skin, presence of oral mucosal lesions, medical disorders, medications used, and habits (smoking, alcohol consumption, chewing of betel nut, other forms of tobacco use, prosthetic or other appliances use) taken and detailed general physical examination was made to see any associated lesions elsewhere in the body. The clinical diagnosis was established and classified. Correlation, if any, with etiological factor was assessed. In relevant cases, necessary investigations were done with a written consent from the patient, to establish the definitive diagnosis. The final definitive diagnosis was based on histopathological examination given by pathologists and its clinical correlation. The data collected was documented in the prescribed proforma and further validated by the consultants.
Results: A total of 130 cases fulfilling above 60 years with oral mucosal lesions who presented to Dermatology OPD were enrolled in this clinical study. In the present study, majority of the patients, were in the age group of 60-69 years (71%), followed by the age group of 70-79 years (24%), least were the age group of 60-69 year (5%) and there was no cases above 90 years. Males (56.2%) were affected marginally more than females (43.8%). Buccal mucosa was the most frequently involved site in 58% of the study population. In the present study, common risk factors associated with oral mucosal lesions observed were smoking (40%), alcohol (17.7%), other forms of tobacco use (46.2%), betel nut chewing (52.3%), dentures (12.3%) and stress (13.8%). A total 130 conditions, classified into 8 various etiological categories. Malignancy (25.4%) was the most common etiology, followed by dermatological etiology (19.2%) and then premalignant and infective etiologies (16.9%). Other miscellaneous conditions (13.8%), inflammatory (4.6%), developmental (2.3%) and systemic etiologies (0.8%) were the uncommon observed etiologies. Amongst malignancy, squamous cell carcinoma was the common clinical type. The second most frequently observed condition was oral candidiasis (12.4%). Amongst dermatological conditions, most common was oral lichen planus 8%, followed by vitiligo 6%, pemphigus 3% and psoriasis (2%). The least conditions were Steven Johnson syndrome, systemic lupus erythematosus and discoid lupus erythematosus. Leukoplakia (8.5%) was the most common premalignant conditions, followed by oral submucous fibrosis (7.7%).
Conclusion: The present study brings to light various oral mucosal lesions in geriatric population, which also highlights the importance of early diagnosis of oral precancerous lesions before it develops into malignancy.