Is chronic irritation in oral cavity is a risk factor for oral cancer…….

Hiiii… warm greetings to you all….. today we will look through  the most neglected causes of oral cancer.

Oral mucosa could host many lesions originated by Chronic Mechanical Irritation (CMI) either from teeth or dentures. The most common of CMI lesions are as follows

      tongue/cheek biting,
      frictional keratosis,
       sharp/broken teeth
      indentations,
      chronic traumatic ulcer,
      papillary hyperplasia,
      denture-induced fibrous hyperplasia and
      focal fibrous hyperplasia.

CMI is produced through low-intensity, sustained, and repeated action of an oral deleterious agent. The mechanic damage can be caused by teeth, dentures, and functional alterations, either through separate or combined action.

There are three types of CMI factors: 

v  DENTAL FACTORS which include malpositions, sharp/broken teeth, and/or rough or defective restorations.
    In adults traumatic ulcers results from fractured, carious, malformed teeth/sharp/broken teeth and ill-fitting dentures.Surface ulcerations usually heal within 10-14 days but it can persist for a longer time due to systemic disorders.Sites of traumatic ulcerations can vary according to etiology. Usually presentation is well defined erythematous area with raised margins surrounded by erythematous halo and floor covered with yellowish or greyish pseudomembranous slough.

v  PROSTHETIC FACTORS which include ill-fitting dentures, rough/sharp/overextended flanges, and lack of retention/stability and 

v  FUNCTIONAL FACTORS which include swallowing, occlusal, and other dysfunctional disorders.

Is chronic mechanical irritation is a risk factor for oral cancer…….

The notion is that chemically induced carcinogenesis with CMI that showed an increase in cancer occurrence, higher malignancy grade, and a shorter latency period. CMI per se may not be able to produce genetic mutations but may prompt epigenetic changes that ultimately inhibits DNA reparation and apoptosis. This suggests that CMI could at least play a role as promoter and progressor in oral carcinogenesis. Thus, if a cancer has eventually started from another cause, CMI will probably hasten the process.

Clinical findings……

Chronic Traumatic Ulcer (CTU) is a relevant clinical finding because it represents the effect of a low-intensity and persistent CMI. The cause (mechanical agent) and effect (lesion) relationship is usually clear. It often appears in regions that are easily injured by teeth or dentures, such as lip, tongue and buccal mucosa.

In denture wearers it may also be found on floor of the mouth and on the mucobuccal fold. CTU usually exhibit a yellow base, whitish elevated margins, and a roughly oval shape that resembles the causative agent. Induration, often associated with CTU borders, is due to scar formation and chronic inflammatory cell infiltration.

CTU may clinically resemble a squamous cell carcinoma, so it would be proper to analyze it apart from other oral CMI lesions. Previous studies have shown a clear link between persistent inflammation and cancer, through the overexpression of genes regulating proliferation, angiogenesis, and immune evasion. So, CMI could also play a role promoting a continuous inflammatory state.

The following links may also helpful for you..... please go through

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5397630/
http://www.sbdmj.com/172/172-03.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398106/

We, the team of Hyderabad Smiles Dental Hospital...... are always open for any sort of doubts and we explained above the common causes, clinical features of chronic traumatic ulcer which can cause oral squamous cell carcinoma and the factors which can aggravate the oral cancer. For any other quires please contact the below address.

Regards,

Dr.Dilip Kumar BDS, MDS (Oral and Maxillofacial Surgeon)

Certified Implantologist (Noble Bio-care Germany)

Certified Smile Care Dentist (New York University)

Hyderabad Smiles Dental Hospital

Phone Number: 9247864642, 8801627272.