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Diagnosis and management of oral mucosal lesions in older people: a review

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  01 May 2008

Victoria Ewan  and
Konrad Staines
Victoria Ewan*
Affiliation:
Sunderland Royal Hospital, Sunderland, UK
Konrad Staines
Affiliation:
Dental School, Newcastle-upon-Tyne, UK
*
Address for correspondence: Victoria Ewan, Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP, UK.
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Extract

Oral mucosal lesions occur frequently in older people and are important as they may reduce quality of life, represent pre-malignant change or indicate systemic disease. The commonest mucosal lesions in adults are denture-related lesions such as stomatitis, angular cheilitis, ulcers and hyperplasia, and occur in 8.4% of the adult population. In the hospital setting, oral mucosal lesions may lead to malnutrition, slow rehabilitation and recovery from illness, and adversely affect quality of life. The two major risk factors associated with oral lesions are denture use and smoking, and frequently older people have been exposed to both of these. Commonly used drugs such as antihypertensives, antidepressants and antibiotics may have oral mucosal side-effects, and polypharmacy may worsen these. Decreased awareness of changes in the oral mucosa, or inability to raise concerns due to dementia, delirium, social isolation, or difficulty accessing dental care may further compound the problem. Hospital admission could represent an opportunity to intervene, but oral mucosal lesions, and indeed oral hygiene, are areas which can be overlooked by doctors. This article is intended to highlight common or important oral mucosal diseases and increase awareness of these conditions for the practising hospital or community geriatrician.

Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 18 , Issue 2 , May 2008 , pp. 115 - 128
Copyright
Copyright © Cambridge University Press 2009

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References

1Lin, HC, Corbet, EF, Lo, EC. Oral mucosal lesions in adult Chinese. J Dent Res 2001; 80: 1486–90.CrossRefGoogle ScholarPubMed
2Splieth, CH, Sumnig, W, Bessel, F, John, U, Kocher, T. Prevalence of oral mucosal lesions in a representative population. Quintessence Int 2007; 38: 23–29.Google ScholarPubMed
3Mumcu, G, Cimilli, H, Sur, H, Hayran, O, Atalay, T. Prevalence and distribution of oral lesions: a cross-sectional study in Turkey. Oral Dis 2005; 11: 81–87.CrossRefGoogle ScholarPubMed
4Espinoza, I, Rojas, R, Aranda, W, Gamonal, J. Prevalence of oral mucosal lesions in elderly people in Santiago, Chile. J Oral Pathol Med 2003; 32: 571–15.CrossRefGoogle ScholarPubMed
5Shulman, JD, Beach, MM, Rivera-Hidalgo, F. The prevalence of oral mucosal lesions in US adults: data from the Third National Health and Nutrition Examination Survey, 1988–1994 [see comment]. J Am Dental Assoc 2004; 135: 1279–86.CrossRefGoogle ScholarPubMed
6Shulman, JD, Rivera-Hidalgo, F, Beach, MM. Risk factors associated with denture stomatitis in the United States [see comment]. J Oral Pathol Med 2005; 34: 340–46.CrossRefGoogle ScholarPubMed
7MacEntee, MI, Glick, N, Stolar, E. Age, gender, dentures and oral mucosal disorders. Oral Dis 1998; 4: 32–36.CrossRefGoogle ScholarPubMed
8McCann, PJ, Sweeney, MP, Gibson, J, Bagg, J. Training in oral disease, diagnosis and treatment for medical students and doctors in the United Kingdom. Br J Oral Maxillofac Surg 2005; 43: 61–64.CrossRefGoogle ScholarPubMed
9Zaremba, ML, Daniluk, T, Rozkiewicz, D et al. Incidence rate of Candida species in the oral cavity of middle-aged and elderly subjects. Adv Med Sci 2006; 51 (suppl 1): 233–36.Google ScholarPubMed
10Kamagata-Kiyoura, Y, Abe, S, Yamaguchi, H, Nitta, T. Reduced activity of Candida detachment factors in the saliva of the elderly. J Infect Chemother 2004; 10: 59–61.CrossRefGoogle ScholarPubMed
11Sherman, RG, Prusinski, L, Ravenel, MC, Joralmon, RA. Oral candidosis. Quintessence Int 2002; 33: 521–32.Google ScholarPubMed
12Sakashita, S, Takayama, K, Nishioka, K, Katoh, T. Taste disorders in healthy ‘carriers’ and ‘non-carriers’ of Candida albicans and in patients with candidosis of the tongue. J Dermatol 2004; 31: 890–97.CrossRefGoogle ScholarPubMed
13Paillaud, E, Merlier, I, Dupeyron, C, Scherman, E, Poupon, J, Bories, P-N. Oral candidiasis and nutritional deficiencies in elderly hospitalised patients. Br J Nutr 2004; 92: 861–67.CrossRefGoogle ScholarPubMed
14Axell, T, Samaranayake, LP, Reichart, PA, Olsen, I. Aproposal for reclassification of oral candidosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endodont 1997; 84: 111–12.CrossRefGoogle ScholarPubMed
15Holmstrup, P, Axell, T. Classification and clinical manifestations of oral yeast infections. Acta Odontol Scand 1990; 48: 57–59.CrossRefGoogle ScholarPubMed
16Sitheeque, MAM, Samaranayake, LP. Chronic hyperplastic candidosis/candidiasis (candidal leukoplakia). Crit Rev Oral Biol Med 2003; 14: 253–67.CrossRefGoogle ScholarPubMed
17Lewis, MAO, Lamey, PJ. Clinical Oral Medicine. Oxford: Wright; 1993.Google Scholar
18Grimoud, AM, Lodter, JP, Marty, N et al. Improved oral hygiene and Candida species colonization level in geriatric patients. Oral Dis 2005; 11: 163–69.CrossRefGoogle ScholarPubMed
19Hatakka, K, Ahola, AJ, Yli-Knuuttila, H et al. Probiotics reduce the prevalence of oral candida in the elderly–a randomized controlled trial. J Dent Res 2007; 86: 125–30.CrossRefGoogle ScholarPubMed
20Southam, JV, Soames, AC. Oral Pathology, third edition. Oxford: Oxford University Press; 1998.Google Scholar
21Oude Lashof, AML, De Bock, R, Herbrecht, R et al. An open multicentre comparative study of the efficacy, safety and tolerance of fluconazole and itraconazole in the treatment of cancer patients with oropharyngeal candidiasis. Eur J Cancer 2004; 40: 1314–19.CrossRefGoogle ScholarPubMed
22Dorocka-Bobkowska, B, Konopka, K. Susceptibility of Candida isolates from denture-related stomatitis to antifungal agents in vitro. Int J Prosthodont 2007; 20: 504–06.Google ScholarPubMed
23Rodriguez-Tudela, JL, Almirante, B, Rodriguez-Pa, et al. Correlation of the MIC and dose/MIC ratio of fluconazole to the therapeutic response of patients with mucosal candidiasis and candidemia. Antimicrob Agents Chemother 2007; 51: 3599–604.CrossRefGoogle Scholar
24Zissis, A, Yannikakis, S, Harrison, A. Comparison of denture stomatitis prevalence in two population groups. Int J Prosthodont 2006; 19: 621–25.Google Scholar
25Figueiral, MH, Azul, A, Pinto, E, Fonseca, PA, Branco, FM, Scully, C. Denture-related stomatitis: identification of aetiological and predisposing factors – a large cohort. J Oral Rehabil 2007; 34: 448–55.CrossRefGoogle ScholarPubMed
26Arendorf, TM, Walker, DM. Denture stomatitis: a review. J Oral Rehabil 1987 May; 14: 217–27.CrossRefGoogle ScholarPubMed
27Budtz-Jorgensen, E.Etiology, pathogenesis, therapy, and prophylaxis of oral yeast infections. Acta Odontolog Scand 1990; 48: 61–9.CrossRefGoogle ScholarPubMed
28Marchini, L, Vieira, PC, Bossan, TP, Montenegro, FLB, Cunha, VPP. Self-reported oral hygiene habits among institutionalised elderly and their relationship to the condition of oral tissues in Taubate, Brazil. Gerodontology 2006; 23: 33–37.CrossRefGoogle Scholar
29Webb, BC, Thomas, CJ, Whittle, T. A 2-year study of Candida-associated denture stomatitis treatment in aged-care subjects. Gerodontology 2005; 22: 168–76.CrossRefGoogle ScholarPubMed
30Maver-Biscanin, M, Mravak-Stipetic, M, Jerolimov, V. Effect of low-level laser therapy on Candida albicans growth in patients with denture stomatitis. Photomed Laser Surg 2005; 23: 328–32.CrossRefGoogle ScholarPubMed
31Pesci-Bardon, C, Fosse, T, Serre, D, Madinier, I. In vitro antiseptic properties of an ammonium compound combined with denture base acrylic resin. Gerodontology 2006; 23: 111–16.CrossRefGoogle ScholarPubMed
32Sciubba, JJ. Herpes simplex and aphthous ulcerations: presentation, diagnosis and management–an update. Gen Dent 2003; 51: 510–16.Google ScholarPubMed
33Espy, MJ, Uhl, JR, Sloan, LM et al. Real-time PCR in clinical microbiology: applications for routine laboratory testing.[Erratum appears in Clin Microbiol Rev 2006;19:595]. Clin Microbiol Rev 2006; 19: 165–256.CrossRefGoogle ScholarPubMed
34Wood, MJ, Kay, R, Dworkin, RH, Soong, SJ, Whitley, RJ. Oral acyclovir therapy accelerates pain resolution in patients with herpes zoster: a meta-analysis of placebo-controlled trials. Clin Infect Dis 1996; 22: 341–47.CrossRefGoogle ScholarPubMed
35Jackson, JL, Gibbons, R, Meyer, G, Inouye, L. The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia. A meta-analysis. Arch Intern Med 1997; 157: 909–12.CrossRefGoogle ScholarPubMed
36Holland, NJ, Weiner, GM. Recent developments in Bell's palsy. [see comment]. BMJ 2004; 329 (7465): 553–57.CrossRefGoogle ScholarPubMed
37Wareham, D. Postherpetic neuralgia. Journal [serial on the Internet]. Date: Available from: http://www.clinicalevidence.bmj.com/ceweb/conditions/ind/0905/0905.Google Scholar
38Pindborg, JJ. Pathology of oral leukoplakia. Am J Dermatopathol 1980; 2: 277–78.Google ScholarPubMed
39Petti, S. Pooled estimate of world leukoplakia prevalence: a systematic review [see comment]. Oral Oncol 2003; 39: 770–80.CrossRefGoogle ScholarPubMed
40Napier, SS, Speight, PM. Natural history of potentially malignant oral lesions and conditions: an overview of the literature. J Oral Pathol Med 2008; 37: 1–10.CrossRefGoogle ScholarPubMed
41Reibel, J.Prognosis of oral pre-malignant lesions: significance of clinical, histopathological, and molecular biological characteristics. Crit Rev Oral Biol Med 2003; 14: 47–62.CrossRefGoogle ScholarPubMed
42Petti, S, Scully, C. Association between different alcoholic beverages and leukoplakia among non- to moderate-drinking adults: a matched case-control study. Eur J Cancer 2006; 42: 521–27.CrossRefGoogle ScholarPubMed
43Holmstrup, P, Vedtofte, P, Reibel, J, Stoltze, K. Long-term treatment outcome of oral premalignant lesions. Oral Oncol 2006; 42: 461–74.CrossRefGoogle ScholarPubMed
44Thomson, PJ, Hamadah, O. Cancerisation within the oral cavity: the use of ‘field mapping biopsies’ in clinical management. Oral Oncol 2007; 43: 20–26.CrossRefGoogle ScholarPubMed
45Lodi, G, Sardella, A, Bez, C, Demarosi, F, Carrassi, A. Interventions for treating oral leukoplakia.[update of Cochrane Database Syst Rev. 2004;:CD001829; PMID: 15266454]. Cochrane Database Syst Rev 2006: CD001829.CrossRefGoogle Scholar
46Reichart, PA, Philipsen, HP. Oral erythroplakia–a review. Oral Oncol 2005; 41: 551–61.CrossRefGoogle ScholarPubMed
47Scully, C, Felix, DH. Oral medicine–update for the dental practitioner: red and pigmented lesions[see comment]. Br Dent J 2005; 199: 639–45.CrossRefGoogle ScholarPubMed
48Peterson, P. World Oral Health Report; 2003. Report No.: WHO/NMH/NPH/ORH/03.2 Contract No.: Document Number|.Google Scholar
49Abdollahi. A review of drug-induced oral reactions. J Contemp Dent Pract 2003; 4: 010–31.CrossRefGoogle Scholar
50Ismail, SB, Kumar, SKS, Zain, RB. Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation. J Oral Sci 2007; 49: 89–106.CrossRefGoogle ScholarPubMed
51Gonzalez-Moles, MA, Scully, C, Gil-Montoya, JA. Oral lichen planus: controversies surrounding malignant transformation. Oral Dis 2008; 14: 229–43.CrossRefGoogle ScholarPubMed
52Al-Hashimi, I, Schifter, M, Lockhart, PB et al. Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations. Oral Surg Oral Med Oral Pathol Oral Radiol Endodont 2007; 103 (suppl): S25 el.–12.CrossRefGoogle ScholarPubMed
53Chan, ES, Thornhill, M, Zakrzewska, J. Interventions for treating oral lichen planus. Cochrane Database Syst Rev 2000:CD001168.CrossRefGoogle Scholar
54Heizmann, M, Itin, P, Wernli, M, Borradori, L, Bargetzi, MJ. Successful treatment of paraneoplastic pemphigus in follicular NHL with rituximab: report of a case and review of treatment for paraneoplastic pemphigus in NHL and CLL. Am J Hematol 2001; 66: 142–4.3.0.CO;2-0>CrossRefGoogle ScholarPubMed
55Oyama, N, Setterfield, JF, Powell, AM et al. Bullous pemphigoid antigen II (BP180) and its soluble extracellular domains are major autoantigens in mucous membrane pemphigoid: the pathogenic relevance to HLA class II alleles and disease severity. Br J Dermatol 2006; 154: 90–98.CrossRefGoogle ScholarPubMed
56Challacombe, SJ, Setterfield, J, Shirlaw, P, Harman, K, Scully, C, Black, MM. Immunodiagnosis of pemphigus and mucous membrane pemphigoid. Acta Odontol Scand. 2001; 59: 226–34.CrossRefGoogle ScholarPubMed
57Robinson, JC, Lozada-Nur, F, Frieden, I. Oral pemphigus vulgaris: a review of the literature and a report on the management of 12 cases. Oral Surg Oral Med Oral Oral Radiol Endodont Pathol 1997; 84: 349–55.CrossRefGoogle Scholar
58Scully, C, Challacombe, SJ. Pemphigus vulgaris: update on etiopathogenesis, oral manifestations, and management. Crit Rev Oral Biol Med 2002; 13: 397–408.CrossRefGoogle Scholar
59Allen, KJ, Wolverton, SE. The efficacy and safety of rituximab in refractory pemphigus: a review of case reports. J Drugs Dermatol 2007; 6: 883–89.Google ScholarPubMed
60Eming, R, Hertl, M. Immunoadsorption in pemphigus[see comment]. Autoimmunity 2006; 39: 609–16.CrossRefGoogle ScholarPubMed
61Scully, C, Bagan, J. Oral mucosal diseases: erythema multiforme. Br J Oral Maxillofac Surg 2008; 46: 90–95.CrossRefGoogle ScholarPubMed
62Scully, C, Porter, S. Oral mucosal disease: recurrent aphthous stomatitis. Br J Oral Maxillofac Surg 2008; 46: 198–206.CrossRefGoogle ScholarPubMed
63Tsakos, G, Steele, JG, Marcenes, W, Walls, AWG, Sheiham, A. Clinical correlates of oral health-related quality of life: evidence from a national sample of British older people. Eur J Oral Sci 2006; 114: 391–95.CrossRefGoogle ScholarPubMed
64Hassel, AJ, Koke, U, Schmitter, M, Rammelsberg, P. Factors associated with oral health-related quality of life in institutionalized elderly. Acta Odontol Scand 2006; 64: 9–15.CrossRefGoogle ScholarPubMed
65Scully, C, Felix, DH. Oral medicine – update for the dental practitioner: dry mouth and disorders of salivation. Br Dent J 2005; 199: 423–27.CrossRefGoogle ScholarPubMed
66Sweeney, MP, Bagg, J. The mouth and palliative care. Am J Hospice Pall Care 2000; 17: 118–24.CrossRefGoogle ScholarPubMed
67Bagg, J, Sweeney, MP, Lewis, MAO et al. High prevalence of non-albicans yeasts and detection of anti-fungal resistance in the oral flora of patients with advanced cancer. Palliat Med 2003; 17: 477–81.CrossRefGoogle ScholarPubMed