Suspicious Lesions Of The Oral Cavity
Weekend Special

Suspicious Lesions Of The Oral Cavity

Oral cavity (mouth) has been traditionally regarded as the mirror to one’s general body health. A healthy oral cavity usually reflects the general good health of the individual. Many symptoms which appear in the mouth – ulcers, swellings, blisters etc. – may actually be indicators of some underlying or accompanying system diseases. It is therefore important for every individual to have a basic knowledge about maintenance of one’s oral health. Self-examination of the oral cavity is an easy technique which can be done by each one of us at our homes. On a fixed routine basis, a couple of extra minutes spent in front of the mirror, preferably after tooth brushing can give a fairly good idea of any unusual change on the inside of the mouth. Any suspicious lesion if noticed within the mouth needs to be brought to the attention of a qualified Dental Practitioner immediately.

There are many lesions which appear in the mouth and which manifest with pain, swelling or any such symptom which alerts the individual regarding the presence of such a lesion in the mouth. But there are also a few lesions which may occur within the oral cavity without causing any pain or swelling in the initial stages (which in some cases may extend for a long time without any other symptom). Such lesions in the later stages may be aggressive in their biologic behaviour and may be difficult to be treated in the later stages. One such innocuous lesion is called “Leukoplakia” which literally means a ‘white patch’. This is one of the most common form of white patch encountered in the oral cavity and is associated with the continuous habitual use of smoking form of tobacco such as cigarettes, bidis, hookahs etc. It can occur on the gums (gingiva), cheek (buccal mucosa), lateral borders of tongue and palate. It is usually son-scrappable i.e., it cannot be removed by rubbing the surface of the patch. Other common example of a white patch in the mouth includes Candidiasis (infection with the fungus of genus Candida), which is usually scrappable and is resolved upon treatment with anti-fungal medication.

However it is extremely important to recognize oral leukoplakia at an early stage since it is considered under a group of diseases called “Potentially Malignant Disorders” (PMD). Such disorders or lesions have an increased tendency to turn into malignancy. Thus leukoplakia occurring in the oral cavity carries with it an increased risk of converting into oral cancer. This makes it extremely important for us to detect and identify leukoplakia occurring in the oral cavity at an early stage and treat it adequately, in order to prevent its development or conversion into oral cancer at an early stage.

Oral leukoplakia occurs invariably as a white patch on the inner surface of the oral cavity at any of the areas mentioned above. To a large extent, the appearance of this white patch is synchronous with the smoking habit – in people who smoke cigarettes or bidis in the usual manner can develop leukoplakic patch on the gingiva, palate or the surface of the tongue; people who practice hookah smoking are more likely to develop leukoplakia on the palate; and in certain parts of coastal India where reverse smoking is practiced (where the cigarette/bidi) is smoked with the burning end inside the mouth, the leukoplakia can develop on the palate. Thus those areas of the mouth which get maximum exposure to the harmful chemicals released by burning of tobacco (an essential ingredient of cigars, bidis, hookahs etc..) are more likely to develop the leukoplakic patch. The smokeless forms of tobacco are equally prevalent and of late such habits are on the rise amongst the younger generation. These incluse the chewing of pan masalas, tobacco or arecanut flakes etc, and the traditional betel chewing. In these cases, the chemicals from the tobacco and the arecanut leach out and directly affect the part of the oral cavity surface where they come in maximum contact. These lesions appear similar to leukoplakia as white or red patches on the oral mucosal surface and carry an increased risk of transforming into oral cancer. Thus youngsters who start chewing tobacco at an early age are likely to develop oral cancer within a few years after starting the habit.

There are a few white non scrappable patches which can occur in the mouth in persons without any tobacco related habit. These white patches can occur as a result of long standing or continuous injury to a particular area of the oral cavity. To quote an example, edge of a sharp tooth, impinging on the lateral border of the tongue for many months or years can lead to the gradual development of a white patch or an ulcer at the spot, which again over a further period of time, if left without treatment, can turn into oral cancer. Continuous trauma from sharp edges or borders of the dentures, orthodontic or other appliances etc. Are other common causes for such lesions, which, if left unattended can turn into oral cancer.

Very often, the presence or development of such white or red patches in the mouth cannot be felt by the person due to obvious lack of accompanying pain or swelling. This underlines the need for self examination of the mouth on a regular basis so that the development or presence of any such suspicious looking areas in the mouth can be noticed and immediate help from a dentist can be sought for further management.

As and when the individual feels or detects the presence any suspicious looking lesion – white or red – in the mouth, a qualified Dental Practitioner may be consulted. The Dentist usually evaluates the lesion and depending on the diagnosis made, advises for a biopsy – a piece of tissue taken from the suspicious lesion for microscopic examination – to confirm the true nature of that lesion. Any such suspicious lesion which cannot be diagnosed clinically by the Dental practitioner is indicated for biopsy, after which an Oral Pathologist gives the final diagnosis. This is extremely important as the presence or absence of oral cancer in the suspicious lesion can be understood only from the microscopic examination of the biopsy specimen taken from that lesion.

Thus, a few important self-help points need to be remembered with regards to the oral cavity or the mouth:

  1. The self examination of the oral cavity in a mirror can be made part of the routine, and can be carried out on a regular basis at monthly intervals, as the need may be. Care may be taken to have adequate lighting in the area for the parts of the mouth to be clearly visible in the mirror.
  2. In case any white or red patch or an ulcerated area is seen, consultation with a qualified Dental Practitioner may be done without delay. This is extremely important because some of these lesions may resolve if immediate treatment is given, or if their cause is removed. If they are true leukoplakia, the Dentist usually advises for a biopsy to be performed from the lesion.
  3. Tobacco in any form needs to be avoided. It contains nicotine, which is now considered by the W.H.O as the substance responsible for maximum addictions in the world, far surpassing the likes of ganja and other addictive substances. People with the active tobacco habit need to seek help from Medical or Dental professionals as well as Medical Social Workers to stop the habit as well as to successfully overcome the mental trauma or depression which can accompany the initial stages of the post habit stoppage phase.

Dr. Rakesh. S

Professor & Head, Dept of Oral Pathology & Microbiology and Vice Principal, Amrita School of Dentistry

AIMS Hospital Campus, Kochi - 682041