Jaber, Mohamed Abdullah; (1999) Clinical studies of oral epithelial dysplasia. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This study has investigated a number of aspects of the clinical presentation, aetiology and management of oral epithelial dysplasia (OED) in a large number of affected patients. The results reveal that the peak frequency for occurrence of OED is the 6th decade, a predilection for males was confirmed. The tongue, buccal mucosa and floor of mouth are the most common sites of involvement. Most OED is mild; carcinoma-in-situ is rare, the sites likely to have areas of severe dysplasia are the floor of mouth and lateral border of tongue. There is a positive association between heavy tobacco smoking, especially non-filter cigarettes and risk of OED, although the risk may decline following cessation of smoking. In non-smokers, consumption of alcohol is not a significant predictor of OED but there is interaction between alcohol and some aspects of tobacco smoking. The relative risk associated with tobacco smoking appeared to be highest for OED of the labial mucosa and floor of mouth in males and tongue and floor of mouth in females. While alcohol drinking is not a significant predictor of specific OED subsites in both males and females. OED may occur in nonusers of tobacco and alcohol, these patients tend to be older women presenting with erythroleukoplakic type lesions. There is a significant association between reduced serum folate, red blood cell folate and risk of OED. Infectious agents such as Candida albicans may have a slight significance in the aetiology of OED but infection with hepatitis C virus or Helicobacter pylori are not significantly associated with OED. Follow-up of these patients with OED suggest that 5.5% of patients develop oral squamous cell carcinoma while 10.3% develop a second dysplastic lesion and 17.5% develop recurrence. It is evident that dental practitioners have some knowledge and experience of oral malignancy and premalignancy but they may fail to recognise appropriate signs and symptoms of such disease, do not always provide appropriate preventive advice and may delay referral of patients to appropriate centres.

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