January , 2019
General guideline for oral ulcer
12:57 pm

Romita Dey

Renaissance or the revival of European art and literature began in the era of 14th and 16th centuries.The renaissance in dentistry rather in the Maxillofacial surgery began during the Second World War.

The oral cavity is that part of the aero digestive tract which begins at the lips and ends at the anterior surface of the faucial arches or in front of the tonsils. The sites of occurrence of ulcer in oral cavity are the lips (upper/lower), tongue, floor of mouth, gingiva (gums), buccal mucosa, retromolar trigone, hard palate, soft palate, lower jaw and upper jaw. Ulcer (painful or painless) occurring at any such sites, there are a few questions that should come to mind.

First, how long is that persisting? If it persists more than 14 days after standard treatment the patient needs a specialist consultation, a biopsy for a confirmed diagnosis and a definitive treatment plan. Not necessarily all ulcers are malignant, but it should not be ruled out.

Ulcers can be due to numerous causes including infections, specific fungal disease, from an autoimmune disease, or deficiencies from systemic vital elements. Secondly, is there any association of habits such as tobacco in any form, which contains more than 40 types of carcinogens. Betel nut on the other hand is a co-carcinogen, i,e when mixed with slaked lime it catalyses its action.

Our habits predispose our normal oral mucosa to an altered oral mucosa and the alteration of mucosa takes place from the very start i,e from the lip to the entire aerodigestive tract. And once such alteration is established, it is then termed as “Condemned Mucosal Syndrome” which was established by Slaughter in the year 1953 in the journals of Cancer. From a normal squamous mucosa to a squamous hyperplastic mucosa, then to a dysplastic mucosa, then to a carcinoma in situ and finally to a invasive carcinoma. And that is the reason behind an early diagnosis and moving out of the stigma behind biopsy.

Association of habits may give rise to a number of precancerous lesions and precancerous conditions. Lesions that a biopsy report confirms are Leukoplakia with dysplastic changes, erythroplakia with dysplasia, palatal keratosis associated with severe smoking needs to be addressed immediately. and conditions that again biopsy reports confirms are Lichan Planus (which is an autoimmune disorder manifestation), Oral Submucous Fibrosis, Systemic Lupus Erythomatosis on the other hand needs symptomatic relief or a definitive treatment, medical or surgical and a periodic review.

When we talk about a diagnosed squamous cell carcinoma, the statistical analysis of the two axises, the stages of the tumour and the five years of survival rate are inversely proportional to each other. That is, the lesser the stage of the cancer the more are years of rate of survival. The statistic reveals stage I has 80-90% chance of 5 years survival rate, stage II has 60 - 70%, stage III has 50 - 60% and stage IV has 30 - 40%. Stages of the disease is not alone the size of the lesion but also the lymph node involvement through which the cancer cells are draining, Staging the disease also helps us  to decide on  the treatment modalities to take, i.e. single (surgery alone) or combination treatments (surgery + radiotherapy +/- chemotherapy)  along with the newer version such as the Tailored Treatment.

An early diagnosis and early intervention can make a difference, may it be a cancerous ulcer or non - cancerous. Before we set back our mind behind any stigma let us open it to the awareness of tobacco consumption and early intervention once diagnosed before cancer becomes sporadic.

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