POTENTIALLY MALIGNANT DISEASES OF THE ORAL MUCOSA

POTENTIALLY MALIGNANT DISEASES OF THE ORAL MUCOSA

I / INTRODUCTION: The latest work of the World Health Organization (WHO) expert group has recommended abandoning the distinction between lesions and precancerous conditions. The term to be used is “potentially malignant conditions .” This corresponds to morphologically altered tissue where the risk of cancer developing is higher than in healthy counterpart tissue. Among all these conditions, leukoplakia is the most common and erythroplakia is rather rare. They are always defined by excluding white or erythematous lesions of known origin.

II/ETIOLOGIES:

use of tobacco and alcohol

idiopathic areca nut .

III/ CLASSIFICATION

• LEUKOPLASIA
• ERYTHROPLASIA
• ACTINIC CHEILITIS
• BUCCAL LICHEN PLAINS

IV/ CLINIC AND THERAPEUTIC MANAGEMENT A/ LEUKOPLASI:

• DEFINITION :

White lesions with questionable risk of cancer after excluding all lesions or conditions that do not have an increased risk of cancer. Leukoplakia is a purely clinical term and has no histological specificity. Histologically, it can correspond to atrophy, hyperplasia (acanthosis), and possibly dysplasia.

  Atrophy: Reduction in the volume of an organ or tissue, due to lack of nutrition, lack of use, etc.

Hyperplasia: excessive increase in the volume of organic tissue due to multiplication of its cells which nevertheless retain a normal shape and function.

Dysplasia: An abnormality in the development of tissues and organs, resulting in malformations

• CLINICAL FORMS:

Leukoplakia can be homogeneous and inhomogeneous: The distinction between homogeneous and inhomogeneous leukoplakia is purely clinical. It is based on color and thickness; it provides an evolutionary or prognostic orientation.

 Homogeneous leukoplakia: has the appearance of a clearly circumscribed, flat or slightly raised, smooth or uniformly rough, slightly granular and wavy white plaque, sometimes crossed by fine cracks or fissures without erythema or with a discrete and uniform erythema without erosions. This is the most common form. It rarely presents dysplasia or only mild reversible dysplasia. It rarely undergoes malignant transformation.

 Inhomogeneous leukoplakia: may have an erythematous, erosive, verrucous or nodular appearance over their entire surface or in places. The surface is also irregular in thickness. The appearance may be an erythematous area speckled with keratosis (speckled leukoplakia in Anglo-Saxons). This leukoplakia

inhomogeneous is also called erythroleukoplakia. The risk of transformation is high.

• EVOLUTION :

The evolution of oral leukoplakia can be marked by:

• a regression,
• a lesion extension
• a change in appearance from homogeneous to inhomogeneous
• a malignant degeneration.

NB: This makes clinical and histological monitoring essential over a long period.

• TREATMENT :

The treatment of leukoplakia is mainly based on:

• on the elimination of risk factors
• on surgical excision. This allows for histological control of the entire surgical specimen and its edges. It confirms and, if necessary, completes or corrects the diagnosis made on the biopsy.
• Destruction by CO2 laser _which must be preceded by biopsy samples.
• Retinoids, but they are of low effectiveness.
• Sometimes, simple monitoring of leukoplakia is established.

NB: Recurrences are frequent and malignant transformation is always possible.

B / ERYTHROPLASIA

• DEFINITION AND CLINICAL FORM:

It is a velvety, bright red area, most often uniform without any trace of keratinization, often very extensive but with a clear limit. Erythroplakia of the oral mucosa is still considered the lesion with the highest potential for malignant transformation. Some authors no longer consider it a potentially malignant lesion since cancer is already present in the vast majority of cases. Its definition by the WHO has not been modified since 1978.

• EVOLUTION :

The evolution of oral erythroplasia can be marked by:

• a regression,
• a lesion extension with ulceration
• a malignant degeneration.
• TREATMENT :

• Surgical excision: IF erythroplakia is severe or at the carcinoma stage.
• Regular monitoring IF moderate dysplasia

C/ ACTINIC CHEILITIS:

• DEFINITION AND CLINICAL FORM:

It is the chronic alteration of the semi-mucous membrane of the lower lip caused by ultraviolet rays. The lip is dry, keratotic and cracked.

• – Poor oral hygiene and especially associated tobacco poisoning typically worsen the course.
• EVOLUTION :

• Evolution towards regression is very rare.
• a lesion extension with ulceration
• malignant degeneration
• TREATMENT :

PROPHYLACTIC:

• Avoid prolonged and repeated exposure.
• Sun protection

CURATIVE:

• Initially, local applications of 5-fluorouracil (Efudix 5%®)
• CO2 laser.
• In a 2-stage surgical excision (vermillectomy).

D/ BUCCAL LICHEN PLAIN: (LPB)

• DEFINITION :

It is a chronic, benign inflammatory skin and mucosal disease of unknown origin, characterized by a keratinization disorder with polymorphic clinical aspects. Several factors are implicated in its occurrence:

• Chronic liver disease + cirrhosis + viral hepatitis
• Graft versus host disease
• Certain medications: NSAIDs, antihypertensives, diuretics, etc.
• Dental products: amalgam, nickel, cobalt, etc.
• Neurological and psychosomatic factors
• Tobacco, alcohol.
• CLINICAL FORMS AND EVOLUTION:

 Erythematous LPB: characterized by less obvious white streaks, sometimes reduced to vague marbling. This form can evolve into the erosive form

 Erosive LPB : this is the painful form. It presents as a bright red, glazed appearance, with an edematous base, of variable size and slightly protruding. The Koebner phenomenon is observed at the mucosal level. This form can develop into carcinoma.

NB: The Köbner phenomenon is the appearance, along the path of a scratch, of new elements of a dermatosis which the subject already has.

Network LBP : These are white, streak-like lesions (Wickham’s striae), symmetrical, bilateral and asymptomatic. They are located mainly on the inner side of the cheek. This form can evolve into the erosive form.

 Pigmented lichen planus (or nigricans): The pigmentation is gray and/or blackish. The lymphocytes attack the basal layer of the epithelium and cause migration of the melanin pigment into the chorion. This form can evolve into the erosive form.

• TREATMENT :

• Quitting alcohol and tobacco
• Oral cavity restoration
• IF THE LICHEN PLAIN IS EROSIVE:

• Local corticosteroid therapy
• Retinoid which is a derivative of vitamin A
• IF THE LICHEN IS EROSIVE, SEVERE OR NOT RESPONDING TO LOCAL THERAPIES :

• General corticosteroid therapy
• Cyclosporine (immunosuppressants): halidomide (anti-inflammatory substance + immunomodulator + antitumor)
• Otherwise: localized surgical excision.

When lichen becomes complicated by cancer, treatment is surgical combined with chemotherapy. Radiotherapy is not recommended .

V/Conclusion : Undiagnosed and therefore untreated precancerous oral lesions can develop into squamous cell carcinoma, which is life-threatening and can lead to significant functional and/or aesthetic deficits . To overcome this, it is essential that the dentist, often the patient’s first point of contact, systematically performs a complete clinical examination of the oral cavity, including visual inspection and palpation of the oral mucosa. If a lesion deemed “suspicious” is detected, the practitioner should, if necessary, perform a biopsy, as no other method has been universally accepted and validated with sufficient diagnostic certainty.

POTENTIALLY MALIGNANT DISEASES OF THE ORAL MUCOSA

  Wisdom teeth can cause pain if they erupt crooked.
Ceramic crowns offer a natural appearance and great strength.
Bleeding gums when brushing may indicate gingivitis.
Short orthodontic treatments quickly correct minor misalignments.
Composite dental fillings are discreet and long-lasting.
Interdental brushes are essential for cleaning narrow spaces.
A vitamin-rich diet strengthens teeth and gums.

POTENTIALLY MALIGNANT DISEASES OF THE ORAL MUCOSA