J Oral Pathol Med (2015) 44: 490–494 © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
doi: 10.1111/jop.12264
wileyonlinelibrary.com/journal/jop
Prevalence and distribution of oral mucosal lesions: a cross-sectional study in Shanghai, China Jinqiu Feng1,*, Zengtong Zhou2,*, Xuemin Shen2, Yufeng Wang2, Linjun Shi2, Yijun Wang3, Ye Hu4, Hongying Sun5, Wei Liu2 1
Department of Preventive Dentistry, Shanghai Stomatological Disease Center, Shanghai, China; 2Department of Oral Mucosal Diseases, Shanghai Key Laboratory of Stomatology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; 3 Shanghai Dental Diseases Prevention and Cure Center of YangPu District, Shanghai, China; 4Shanghai Dental Diseases Prevention and Cure Center of MinHang District, Shanghai, China; 5Department of Stomatology, Huashan Hospital, Fudan University, Shanghai, China
BACKGROUND: An epidemiological study on the oral mucosal lesions (OMLs) in general population from China was scarce. The objective of this study was to investigate the prevalence and distribution of OMLs in Shanghai, China and to evaluate their association with demographic factors and smoking/drinking habits based on a large scaled population on a wide spectrum. METHODS: In this population-based cross-sectional study, 11054 community-dwelling individuals (M/F: 5140/ 5914; age range, 1–96 years) were randomly selected and examined according to WHO criteria. RESULTS: The prevalence of OMLs was 10.8% in this study. A total of 1192 (M/F: 543/649; mean age, 56.9 years) individuals were presented with different types of OMLs. The most common type of OMLs was fissured tongue (prevalence of 3.15%), followed by recurrent aphthae (1.48%), traumatic ulcer (1.13%), and angular cheilitis (0.86%). The two most common potentially malignant disorders were oral lichen planus (0.81%) and leukoplakia (0.22%). Regression analysis revealed that the elderly age, smoking, and alcohol intake were statistically significant risk factors of OMLs with emphasis on leukokeratosis, leukoplakia, and lichen planus. CONCLUSION: The prevalence and distribution of OMLs were elucidated in an eastern area of China, and the importance of tobacco and alcohol in the pathogenesis of OMLs was evidenced. Our data have provided baseline information about epidemiologic aspects of OMLs that can be valuable in organized program targeting on oral health and hygiene. J Oral Pathol Med (2015) 44: 490–494 Correspondence: Hongying Sun, Department of Stomatology, Huashan Hospital, Fudan University, Shanghai 200040, China. Tel/Fax: +86-2152889999, E-mail: [email protected] or Wei Liu, Shanghai Key Laboratory of Stomatology, Shanghai, China. Tel: +86 21 23271699, Fax: +86 21 63087076, E-mail: [email protected] *These authors contributed equally to this work. Accepted for publication August 15, 2014
Keywords: Chinese population; epidemiology; oral mucosal lesions; prevalence; risk factors
Introduction Oral mucosal lesion (OML) is defined as any abnormal alteration in color, surface aspect, swelling or loss of integrity of the oral mucosa surface. Although a proportion of OMLs are benign and require no active treatment, some may present with significant pathology. Of particular importance are oral potentially malignant disorders which may progress into malignancy. Besides, OMLs can interfere with daily quality of life in involved patients through impacts on mastication, swallowing, and speech with symptoms of burning, irritation, and pain (1). Epidemiological studies can provide important information for understanding the prevalence, distribution, and risk factors of OMLs in the population. Despite the World Health Organisation (WHO) (1) recommendations to encourage more epidemiological surveys of OMLs, the volume of literature on general population in this area is still limited (2–13), and there were only a couple of large scaled population-based studies, which enrolled over ten thousand study individuals (Table 1). The prevalence of OMLs in general population globally varies significantly across different regions and countries, ranging from 4.9% to 64.7% (Table 1). To the best of our knowledge, there have been no broad population-based epidemiological studies of OMLs in Chinese general population that have not been selected for age, gender, or risk habits. Thus, the objective of this study was to investigate the prevalence and distribution of OMLs in Shanghai, China and to evaluate their association with demographic factors and smoking/drinking habits, which was a population-based cross-sectional study of 11054 individuals representing an eastern area of China.
Prevalence of OMLs in Shanghai Feng et al.
491
Table 1 The prevalence of oral mucosal lesion (OML) in general population in the past three decades Country
Year (ref) a
Australia Iran Turin, Italy Pomerania, Germany Istanbul, Turkey Brazilb USA Oviedo, Spain Malaysia Cambodia Sweden USA
2014 2013 2008 2007 2005 2004 2004 2002 1997 1995 1990 1986
No. of subjects
Age range (years)
OML identified (%)
3551 1581 4098 6267 765 587 17 235 308 11 707 1319 920 23 616
15+ 30+ 19+ 20+ 5+ 12+ 17+ 30+ 25+ 15+ 20+ /
20.5 19.4 25.1 11.8 41.7 61.7 27.9 51.1 9.7 4.9 64.7 10.0
(2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)
a
The study did not discriminated between subtypes of OMLs. The subjects were a special central Amazonian Indian community.
b
Material and methods Study population In this cross-sectional survey, the target population was community-dwelling inhabitants form the whole 12 main districts of Shanghai city between June 2012 and March 2013. Multistage stratified method was applied for sampling from general population. First, all the streets of each district were numbered, a couple of streets of each district were randomly selected by a computer-generated randomization numbers; secondly, a couple of communities of each street were randomly selected similarly; thirdly, households were selected by systematic sampling. All households were required for clinical oral examinations. Consequently, a total of 11054 inhabitants (M/F: 5140/5914), non-institutionalized people whom not selected for age (range 1– 96 years) from 4631 households were enrolled in this population-based study. Oral mucosal assessment This study was approved by the local institutional review board and assisted from the local government and health authority and the Shanghai Stomatological Association. The written informed consent was obtained from each subject, and the juveniles’ consent was obtained from their guardians. All subjects were underwent a comprehensive clinical examination of the oral mucosa performed by the physicians from the Department of Oral Mucosal Diseases, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine using a portable light, mouth mirrors, explorer, and cotton swaps, while no biopsies and laboratory tests were performed in this study. The portable halogen light with fiber optics was used to obtain sufficient illumination during the examinations. The diagnostic criteria for the description of OMLs were based on WHO guide to epidemiology and diagnosis of oral mucosal diseases (2, 14, 15). Information regarding age, gender, cigarette smoking, alcohol intake, and lesion type at the time of examination was documented in detail. The use of smokeless tobacco and betel chewing was not required for interview as it is almost non-existent in Shanghai area. Recurrent aphthae and recurrent herpes were recorded if observed at the time of
examination. The subjects were divided into 3 age groups:
doi: 10.1111/jop.12264
wileyonlinelibrary.com/journal/jop
Prevalence and distribution of oral mucosal lesions: a cross-sectional study in Shanghai, China Jinqiu Feng1,*, Zengtong Zhou2,*, Xuemin Shen2, Yufeng Wang2, Linjun Shi2, Yijun Wang3, Ye Hu4, Hongying Sun5, Wei Liu2 1
Department of Preventive Dentistry, Shanghai Stomatological Disease Center, Shanghai, China; 2Department of Oral Mucosal Diseases, Shanghai Key Laboratory of Stomatology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; 3 Shanghai Dental Diseases Prevention and Cure Center of YangPu District, Shanghai, China; 4Shanghai Dental Diseases Prevention and Cure Center of MinHang District, Shanghai, China; 5Department of Stomatology, Huashan Hospital, Fudan University, Shanghai, China
BACKGROUND: An epidemiological study on the oral mucosal lesions (OMLs) in general population from China was scarce. The objective of this study was to investigate the prevalence and distribution of OMLs in Shanghai, China and to evaluate their association with demographic factors and smoking/drinking habits based on a large scaled population on a wide spectrum. METHODS: In this population-based cross-sectional study, 11054 community-dwelling individuals (M/F: 5140/ 5914; age range, 1–96 years) were randomly selected and examined according to WHO criteria. RESULTS: The prevalence of OMLs was 10.8% in this study. A total of 1192 (M/F: 543/649; mean age, 56.9 years) individuals were presented with different types of OMLs. The most common type of OMLs was fissured tongue (prevalence of 3.15%), followed by recurrent aphthae (1.48%), traumatic ulcer (1.13%), and angular cheilitis (0.86%). The two most common potentially malignant disorders were oral lichen planus (0.81%) and leukoplakia (0.22%). Regression analysis revealed that the elderly age, smoking, and alcohol intake were statistically significant risk factors of OMLs with emphasis on leukokeratosis, leukoplakia, and lichen planus. CONCLUSION: The prevalence and distribution of OMLs were elucidated in an eastern area of China, and the importance of tobacco and alcohol in the pathogenesis of OMLs was evidenced. Our data have provided baseline information about epidemiologic aspects of OMLs that can be valuable in organized program targeting on oral health and hygiene. J Oral Pathol Med (2015) 44: 490–494 Correspondence: Hongying Sun, Department of Stomatology, Huashan Hospital, Fudan University, Shanghai 200040, China. Tel/Fax: +86-2152889999, E-mail: [email protected] or Wei Liu, Shanghai Key Laboratory of Stomatology, Shanghai, China. Tel: +86 21 23271699, Fax: +86 21 63087076, E-mail: [email protected] *These authors contributed equally to this work. Accepted for publication August 15, 2014
Keywords: Chinese population; epidemiology; oral mucosal lesions; prevalence; risk factors
Introduction Oral mucosal lesion (OML) is defined as any abnormal alteration in color, surface aspect, swelling or loss of integrity of the oral mucosa surface. Although a proportion of OMLs are benign and require no active treatment, some may present with significant pathology. Of particular importance are oral potentially malignant disorders which may progress into malignancy. Besides, OMLs can interfere with daily quality of life in involved patients through impacts on mastication, swallowing, and speech with symptoms of burning, irritation, and pain (1). Epidemiological studies can provide important information for understanding the prevalence, distribution, and risk factors of OMLs in the population. Despite the World Health Organisation (WHO) (1) recommendations to encourage more epidemiological surveys of OMLs, the volume of literature on general population in this area is still limited (2–13), and there were only a couple of large scaled population-based studies, which enrolled over ten thousand study individuals (Table 1). The prevalence of OMLs in general population globally varies significantly across different regions and countries, ranging from 4.9% to 64.7% (Table 1). To the best of our knowledge, there have been no broad population-based epidemiological studies of OMLs in Chinese general population that have not been selected for age, gender, or risk habits. Thus, the objective of this study was to investigate the prevalence and distribution of OMLs in Shanghai, China and to evaluate their association with demographic factors and smoking/drinking habits, which was a population-based cross-sectional study of 11054 individuals representing an eastern area of China.
Prevalence of OMLs in Shanghai Feng et al.
491
Table 1 The prevalence of oral mucosal lesion (OML) in general population in the past three decades Country
Year (ref) a
Australia Iran Turin, Italy Pomerania, Germany Istanbul, Turkey Brazilb USA Oviedo, Spain Malaysia Cambodia Sweden USA
2014 2013 2008 2007 2005 2004 2004 2002 1997 1995 1990 1986
No. of subjects
Age range (years)
OML identified (%)
3551 1581 4098 6267 765 587 17 235 308 11 707 1319 920 23 616
15+ 30+ 19+ 20+ 5+ 12+ 17+ 30+ 25+ 15+ 20+ /
20.5 19.4 25.1 11.8 41.7 61.7 27.9 51.1 9.7 4.9 64.7 10.0
(2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)
a
The study did not discriminated between subtypes of OMLs. The subjects were a special central Amazonian Indian community.
b
Material and methods Study population In this cross-sectional survey, the target population was community-dwelling inhabitants form the whole 12 main districts of Shanghai city between June 2012 and March 2013. Multistage stratified method was applied for sampling from general population. First, all the streets of each district were numbered, a couple of streets of each district were randomly selected by a computer-generated randomization numbers; secondly, a couple of communities of each street were randomly selected similarly; thirdly, households were selected by systematic sampling. All households were required for clinical oral examinations. Consequently, a total of 11054 inhabitants (M/F: 5140/5914), non-institutionalized people whom not selected for age (range 1– 96 years) from 4631 households were enrolled in this population-based study. Oral mucosal assessment This study was approved by the local institutional review board and assisted from the local government and health authority and the Shanghai Stomatological Association. The written informed consent was obtained from each subject, and the juveniles’ consent was obtained from their guardians. All subjects were underwent a comprehensive clinical examination of the oral mucosa performed by the physicians from the Department of Oral Mucosal Diseases, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine using a portable light, mouth mirrors, explorer, and cotton swaps, while no biopsies and laboratory tests were performed in this study. The portable halogen light with fiber optics was used to obtain sufficient illumination during the examinations. The diagnostic criteria for the description of OMLs were based on WHO guide to epidemiology and diagnosis of oral mucosal diseases (2, 14, 15). Information regarding age, gender, cigarette smoking, alcohol intake, and lesion type at the time of examination was documented in detail. The use of smokeless tobacco and betel chewing was not required for interview as it is almost non-existent in Shanghai area. Recurrent aphthae and recurrent herpes were recorded if observed at the time of
examination. The subjects were divided into 3 age groups:
