Contributors

Prof. A. Epivatianos (moderator)
Assoc. Prof. A.Markopoulos
Assist. Prof. A. Poulopoulos
Lecturer D. Andreadis

Country –institution

School of Dentistry, Aristotle University of Thessaloniki, Greece

Title

Life threatening oral mucosal lesions

Summary 

The purpose of this panel is to provide the dentist with a comprehensive discussion of the wide variety of diseases that may affect the oral and maxillofacial region and especially those that may be life threatening for the patient.

Malignant neoplasms may present as mouth ulcers and even if ulcerated , are often but not always painful. About 90% of oral malignant tumours are squamous carcinomas.  The clinical appearance of carcinomas is highly variable and not all appear as ulcers ; they may be in the form of a red or white area, a lump , fissuring or ulceration often with rolled edges. Pain is a late feature in malignancy and any suspicious lesion including any ulcer not healing within 2-3 weeks,  must be biopsied.

Malignant salivary gland tumours, malignant melanomas, leukaemias, lymphomas, Kaposi's sarcoma and other malignant neoplasms occasionally involve the oral cavity.

Significant differences in the percentage of salivary gland malignancies and the relative frequency of various tumours can be noted for different minor salivary gland sites. 42%-50% of the tumours of the palate and buccal mucosa sites are malignant.

In addition, leukaemia which is a malignant haematological disorder, may present orofacial features such as cervical lymph node enlargement, oral bleeding, petechiae and gingival swelling.

Most carcinomas appear to arise in apparently normal mucosa, but some cases are preceded by clinically obvious premalignant lesions , especially erythroplasia , leukoplakia. Erythroplasia in particular , but also leukoplakia, erosive lichen planus, syphilitic glossitis , submucous fibrosis , iron deficiency may predispose to oral carcinoma.

Clinical features which suggest a potentially malignant lesion is likely to transform , or has transformed , to carcinoma include: the presence of red lesions ; a verrucous , speckled or granular appearance or an ulcer with fissuring or raised exophytic margins.

Any chronic lesion should be regarded with suspicion , especially if there are appearances as mentioned above , induration , fixation to underlying tissues , any recent changes in appearance, associated lymphadenopathy , or no obvious explanation for the lesion.

Furthermore a range of skin diseases may be associated with oral lesions ; lichen planus is the most common- oral pemphigoid- erythema multiforme and pemphigus the most serious. Lichen planus has a small premalignant potential which is predominantly associated with the atrophic or erosive forms. Pemphigus is a potentially lethal autoimmune bullous disease which almost affects exclusively late middle-aged or elderly adults. Erythema multiforme may present within a spectrum of severity from mild limited disease to a severe widespread and life threatening illness.

In conclusion there should be a high index of suspicion, especially of a solitary lesion present for over 3 weeks ; biopsy is invariably indicated. A specialist opinion should be asked at an early stage.