|Year : 2014 | Volume
| Issue : 2 | Page : 81-85
Prevalence of oral mucosal lesions in dermatologically diseased patients: A cross-sectional study in Meerut
Tanushree Keswani1, Sreenivasan Venkatraman1, B. S. Rathore2, K. Nagaraju1, Sumit Goel1, Swati Gupta1
1 Department of Oral Medicine and Radiology, Subharti Dental College, Meerut, Uttar Pradesh, India
2 Department of Oral Dermatology, Subharti Dental College, Meerut, Uttar Pradesh, India
|Date of Web Publication||5-Jun-2014|
Department of Oral Medicine and Radiology, Subharti Dental College, Meerut, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: It is a noted fact that dermatologic diseases have varied oral manifestations. By far, there have been inordinately few studies focusing on the prevalence of a wide spectrum of oral mucosal lesions (OML) in patients with dermatologic diseases. This is significant as oral lesions may be the only or the primary feature of the skin disease, which could be neglected by dentists. This study aimed to estimate the frequency and sociobehavioral correlates of OML in skin disease patients attending outpatient's facility of Subharti Hospital, Dermatology Clinic, Meerut, India. Materials and Methods: This was a cross-sectional hospital-based study conducted in Meerut during the period from August 2013 to October 2013. A total of 500 patients (mean age 37.2 ± 14.11 years, 41.4% females) completed an oral examination and a personal interview. OML were recorded using the World Health Organization criteria. Data were analyzed using the Statistical Package for Social Science (version 15.0.1). Cross tabulation and Chi-square with Fisher's exact test were used. Results: At least one kind of OML was registered in 11.8%, males (58.6%): 60.0% versus females (40.0%): 45.6%, P < 0.01) skin disease patients. Thus, a certain number of patients had more than one type of OML. Aphthae were the most frequently diagnosed OML (3.4%), followed in descending order by oral lichen planus (1.8%) and geographic tongue (1.6%). Conclusion: OML were frequently diagnosed in skin disease patients (11.80%) and varied systematically with the dermatologic disease, age, and gender. The substantial prevalence rates of OML emphasize the importance of routine examination of the oral mucosa in a dermatology clinic.
Keywords: Dermatologic diseases, oral mucosal lesions, prevalence
|How to cite this article:|
Keswani T, Venkatraman S, Rathore BS, Nagaraju K, Goel S, Gupta S. Prevalence of oral mucosal lesions in dermatologically diseased patients: A cross-sectional study in Meerut. J Dent Res Rev 2014;1:81-5
|How to cite this URL:|
Keswani T, Venkatraman S, Rathore BS, Nagaraju K, Goel S, Gupta S. Prevalence of oral mucosal lesions in dermatologically diseased patients: A cross-sectional study in Meerut. J Dent Res Rev [serial online] 2014 [cited 2019 Mar 19];1:81-5. Available from: http://www.jdrr.org/text.asp?2014/1/2/81/133944
| Introduction|| |
There is a dearth of studies focusing on the prevalence of a wide spectrum of different types of oral mucosal lesions (OML) in patients with dermatologic diseases. This is noteworthy, as a certain amount of skin lesions are strongly associated with oral lesions and could be neglected by dentists due to lack of information and/or improper diagnosis. 
Oral mucosal lesions in skin disease patients may be the initial or the only manifestation, and a dentist is usually the first to be consulted for such complaints.
This again brings to light the importance of a dentist or an oral physician in the management of patients with dermatologic diseases.
Currently, dermatoses constitute an area of great scientific and odontological interest, considering that oral lesions can precede cutaneous marks for long periods of time, being, sometimes, the only signs of the disease.  This brings about a great physical, social, and psychological bearing on the patients affected, which is detrimental to them. Thus, it is the need of the hour to pay special attention to these patients as, along with the above-mentioned; some of these diseases may be life-threatening. If diagnosed early, we might cut the root cause of suffering and pain borne by these very patients.
The purpose of this study was to estimate the frequency, diversity, and sociobehavioral correlates of different types of OML in adult patients with dermatological diseases attending outpatient's facility of Subharti Hospital, Meerut, Uttar Pradesh.
| Materials and Methods|| |
A cross-sectional hospital-based study was carried out focusing on patients with skin lesions, attending an outpatient dermatologic clinic at Subharti Hospital from August 2013 to October 2013. A minimum sample size of 500 patients was calculated based on an assumed prevalence of OML in skin disease patients of 5%, a confidence interval of 95%, and absolute precision of 0.02. The patients were informed in detail about the study procedure and informed consent was taken from each patient. The participants were informed about their oral conditions, and health education was provided.
Interview and examination
A face-to-face interview was conducted by a trained oral physician. The interview schedule was framed containing questions regarding sociodemographics, general health and oral health related characteristics, and lifestyle (smoking, use of smoke and smokeless tobacco or alcohol or other addictive substances). Counseling was offered to these patients to quit the deleterious habits.
An expert dermatologist evaluated the patient's dermatological disease in the outpatient department of the dermatology clinic. Elements evaluated during skin examination were chief complaints, and duration and history of chief complaints. Past history and family history were also recorded.
Comprehensive extraoral and intraoral clinical examinations based on visual inspection and palpation, following the World Health Organization criteria , for field surveys were carried out by an oral physician.
Diagnostic criteria for oral mucosal lesions
An OML was defined as any abnormal change or any swelling on the oral mucosal surface. Diagnostic criteria for OML were based on Axell criteria and those defined in previous studies and reviews. ,,,
Data were analyzed using the Statistical Packages for Social Sciences ( SPSS, version 15.0, Delhi, India). Cross tabulation and Chi-square with Fisher's exact test were used to test the statistical significance of the relationships between skin disease groups and types OML on one hand side and sociobehavioral variables on the other.
| Results|| |
A total of 500 patients with a skin disease diagnosis participated in this study. [Figure 1] depicts the sociodemographic profile, tobacco use and prevalence rate of oral mucosal lesion in dermatologically diseased patients. [Figure 2] depicts the number of males and females in the total sample size, number of employed and unemployed patients, patients with a positive medical history and drug history. [Table 1] depicts the mean age i.e. 37.2 ± 14.11 years (range 5-80), 41.4% were females. Males were more frequently employed than females (65.6% vs. 34.4%), whereas use of tobacco, or alcohol was more reported in males than females.
|Figure 1: Bar graph depicting the sociodemographic profile (area of residence), tobacco use and prevalence rate of oral mucosal lesion in dermatologically diseased patients|
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|Figure 2: Bar graph depicting the number of males and females in the total sample size, number of employed and unemployed patients, patients with a positive medical history and drug history|
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|Table 1: Depicting the distribution of total number of patients with mean age and age ranges |
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Oral mucosal lesion occurred most commonly in the group of infective dermatoses (33.3%), followed by papilla-squamous skin lesions (25.9%).
The most common group of dermatologic diseases and oral mucosal lesions were the "Infective group" and aphthous respectively [Table 2] and [Table 3]. Of the 41 patients affected with systemic illnesses, 8% had OML [Table 4]. [Table 5] shows the distribution of patients with more than 2 OML. [Table 6] and [Table 7] show the Correlation of skin lesions and oral lesions of the same dermatologic disease.
|Table 4: Depicts prevalence of OML in patients with a positive medical history |
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|Table 6: Correlation of skin lesions and oral lesions of the same dermatologic disease |
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|Table 7: Distribution of geographic tongue in different dermatologic disease categories |
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| Discussion|| |
Until date, very few studies have assessed the prevalence of OML in skin disease patients. In our study, the most frequently occurring groups of dermatological diseases were acne, infectious diseases (fungal), and vesiculobullous diseases. This is in accordance with the results of a recent survey by the International Foundation of Dermatology, showing that infectious diseases, dermatitis and HIV-related skin disease are the main skin lesions at the community level worldwide.  According to the present results, about 11.80% of the subjects investigated, suffered from at least one type of OML. Aphthous was the most common OML (3.4%), followed by oral lichen planus (1.8%), and geographic tongue (1.6%).
Being a hospital-based study; it is not possible to generalize from the study group to any larger population of skin diseased individuals inside or outside Meerut. This is because only patients who sought the opinion from the hospital, were examined. Community-based studies with larger sample sizes would yield and present the true scenario of the same.
Our study did not have a control group to assess the occurrence of these oral lesions in the healthy population. Self-selection bias was considered to influence the result of the study as patients were more likely to respond when they had OML (the characteristic of interest). The prevalence of OML with prevalence rates of >1%, must be interpreted with a pinch of salt, since the precision of estimates tend to decrease with decreasing prevalence.
A major limitation of self-reported data is recall biases in terms of underreporting of socially undesired events and a tendency to recall events as having occurred more recently than they actually did. 
Comparison of present findings with those of previous studies
Compared with the frequency of patients with OML observed in this study (11.08%), previous ones have shown prevalence of 57.4%.  Ramirez et al.  have reported prevalence of 35% OML in subjects affected with mucocutaneous candidiasis, and recurrent aphthae were the most frequently diagnosed conditions. Lower prevalence of OML in our study can be attributed to nontabulation of OML due to known etiologic factors or factors not due to the dermatologic disease per se. Any OML with known etiologic factors or a normal variation of the anatomy was not included for statistical analysis. This points out at the precise prevalence rates, as per the aim of the study.
Males constituted the majority of our sample patients, seen in reported bystudies. 
The most common dermatologic diagnosis was a fungal infection (19.6%) and acne (19.2%), versus spongiotic reaction pattern (23.3%), as seen in referred studies.
In our study, the most common OML were aphthae (3.4%) versus coated tongue (11.2%).
Since our study is a cross-sectional one, any causal relationship of the OMLs could not be established.
The most common OML in our study were aphthae (3.4%), which is higher than 2.9%,  which is higher than 2% and 0.8% reported by Axell  and National Health and Nutrition Examination Survey III, respectively. Not all the OMLs identified in the study can attributed to be due to the dermatologic disease per se.
In a study by Costa et al.,  59% of patients were seen to have tongue lesions, which was the most common OML. Some authors believe that the presence of geographic tongue and fissured tongue in patients with Psoriasis, is a mere coincidence.  Gonzaga et al.  believe the same to be an associated pathogenicity.
Tobacco and alcohol use was reported in 16% of the study population. OML secondary to these habits were seen in 77.9% users.
| Conclusion|| |
This study provides information regarding the frequency, diversity, and sociobehavioral correlates of OML of an important subgroup of the population of Meerut. It is an important suggestion that dentists must be included as a team member with dermatologists to identify a disease at the initial stage and manage these patients, readily, and adequately. Although no expeditious alterations can be brought about, the current frame of functioning can be enriched steadily and enduringly.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]