Oral Ulcer & Oral Cancer
As per reports published in 2013, India has 26 per cent chewing tobacco users as against 14 per cent smokers. Preventing tobacco use can be the single biggest program for to reduction of non-communicable diseases. Obviously, prevention of cancer has to be major concern, prevention of other oral afflictions is as important, e.g. Aphthous Ulcer.
Oral Ulcers: Occurrence Rate
The word Aphthous Ulcer is derived from the Latin word aphtha (plural: aphthae: a small ulcer occurring in groups in the mouth or on the tongue). It is reported to occur to varying extent in different populations ranging from 25% to over 60%. Although the exact etiology of aphthous ulcer is unknown, stress, trauma, food sensitivity, and genetic predisposition may be some of the precipitating factors. Maintaining oral hygiene assumes importance if one has to maintain ulcer-free periods. (A Study on Aphthous Ulcer and its Association with Stress among Medical Students of an Indian Medical Institution, Shiny George, Biju Baby Joseph, Volume 3 | Issue 6 | June 2016 | ICV: 50.43 | ISSN (Online): 2393-915X; (Print): 2454-7379,
Poor oral hygiene may also cause oral cancer. In one study, more than 85% of oral cancer patients had poor oral hygiene. Poor oral hygiene related attributable risk is around 32% for men and 64% for women in India. (Prevalence of Oral Cancer in India, Varshitha. A/J. Pharm. Sci. & Res. Vol. 7(10), 2015, 845-848,
While Oral Ulcer prevalence is low in the US, UK has an occurrence rate of about 20% against 25 % global occurrence rate.
Oral Ulcers: Characteristics
Oral ulcers are characterized by a loss of the mucosal layer within the mouth, which can acute or chronic, localized or diffuse. This is distinctly different from Oral Cancer, which denotes chronic condition developed over a period of time. According to British Study, Women, age under 40, being Non-smokers and People of higher socio-economic status are more likely to have aphthous ulcers.
Also read: Mumbai’s Young Samaritan
Oral Ulcers: Local Causes
Mechanical trauma is possibly the most common cause of oral mucosal ulceration.
1. Injury caused by dentures, braces or sharp/broken teeth.
2. Tongue or cheek biting, scratching with fingernails, or eating rough foods.
3. Oral ulcers may be caused by trauma caused by using of improperly rinsed dentures. Ulcers associated with dentures usually occur in a line along the gums.
Drugs like Aspirin, Biphosphanates, if allowed to come in contact directly with oral mucosa can cause chemical trauma. These are usually more painful than mechanical ulcers.
These arise from mucosal contact with hot food or liquids.
Although the palate is most commonly affected, these injuries can also occur on the lip, tongue or in the oropharyngeal region.
Recurrent aphthous ulceration
1. Known as ‘canker sores’,the condition is characterized by clearly defined, painful, shallow round or ovoid ulcers not associated with systemic disease (systemic is e.g. in blood against local). Aphthous Ulcer is not infective.
2. Beginning in childhood, its frequency & severity may decrease with age.
3. Around 40% of cases have a family history.
4. Other causes for Recurrent Apthous Ulcers could be: Local trauma, Stress, Food sensitivity (e.g. chocolate, coffee, peanuts, almonds, strawberries, cheese and tomatoes), Hormonal change (which may subside during pregnancy) and Cessation of smoking.
Apart from the above reasons, Oral Ulcers could be caused by a central cause such as a viral infection such as Herpes Simplex Virus Type 1 (HSV-1) and Type 2 (HSV-2), HSV 8, Candida albicans or those on Long Term treatment such as antibiotic therapy or steroid treatment.
Oral Ulcers could be formed during Radiation Therapy treatment, either as acute reaction as a result of direct damage to epithelial cells or more long-term, secondary to epithelial atrophy (shrinking) and damage to underlying blood vessels.
These ulcers are different from those found in otherwise normal population.
Oral Ulcer: Response
1. Any ulcer usually should start to heal within 10 days following removal of the presumed cause. If it does not, then an urgent further investigation is indicated.
2. Proper treatment based on diagnosis would provide quicker and better results.
3. It is important to remember that occurrence of an acute ulcer should not be mistaken for oral cancer as self diagnosis as mouth ulcers because of noncancerous growth are fairly common.
4. However, recurrent or non-healing ulcers deserve a quick medical opinion for early diagnosis and disease directed therapy.
A 2005 study reported 20 Oral Cancer patients per 100,000 of population, 30% of all cancers found in India. (R. Sankaranarayanan, K. Ramadas, G. Thomas et al., “Effect of screening on oral cancer mortality in Kerala, India: a cluster-randomised controlled trial,” The Lancet, vol. 365, no. 9475, pp. 1927–193 3, 2005).
Prevalence of Oral Cancer in India, Varshitha. A/J. Pharm. Sci. & Res. Vol. 7(10), 2015, 845-848
In India, 20 per 100000 population are affected by oral cancer which accounts for about 30% of all types of cancer (R. Sankaranarayanan, K. Ramadas, G. Thomas et al., “Effect of screening on oral cancer mortality in Kerala, India: a cluster-randomised controlled trial,” The Lancet, vol. 365, no. 9475, pp. 1927–193 3, 2005. )
Poor oral hygiene also causes oral cancer. In one study, more than 85% of oral cancer patients had poor oral hygiene. Poor oral hygiene related risk is around 32% for men and 64% for women in India. Patients wearing denture for more than 15 years and not visiting a dentist regularly was highly associated with Oral cancer (Guneri P, Cankaya H, Yavuzer A, et al (2005). Primary oral cancer in a Turkish population sample: Association with sociodemographic features, smoking, alcohol, diet, dentition. Oral Oncol, 41, 1005-12.
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