J Bagh College Dentistry

Vol. 23(3), 2011

Prevalence, sex distribution

Prevalence, sex distribution of oral lesions in patients attending an oral diagnosis clinic in Sulaimani University
Shanaz M. Gaphor B .D.S., M.Sc, Ph.D (1) Mustafa J. Abdullah B.D.S., M.Sc. (1)

ABSTRACT
Background: Oral lesions prevalence studies are important to know the state of health and the needs of treatment. The age, gender, educational, socioeconomic, and cultural levels, smoking, medications used, and systemic diseases are factors that could predispose the presence of oral lesions. The present study was designed to determine the prevalence of oral lesions in patients who visit the Oral Diagnosis Clinic of the College of Dentistry, University of Sulaimani. Patients and methods: This prospective study was performed on 3144 patients from July 2009-July 2010. In this study a total of 3144 patients were examined. Of these 1507 (47.93%) were males and 1637 (52.06%) females. The patients' age ranged between 10 to 79 years. An interview was conducted to collect information using a structured questionnaire which was completed by each patient. The lesions that could not be diagnosed by clinical examination alone were analyzed histopathologically. Results: Among the 3144 patients, only 799 patients (25.41%) had one or more oral lesions. The number of oral lesions was 905. Females constituted 49.81% (n=398) and males 50.18% (n=401). Oral lesions were classified according to the following seven categories: tongue lesions (9.70%), anatomic changes (8.71%), white lesions (4.8%), ulcerated lesions (3.1%), candidiasis (1.3%), benign lesions (1.05%) and malignant lesions (0.03%). Tongue lesions were highly significantly more common among males (12.07%) than in females (7.51%). Denture stomatitis, Denture induced fibrous hyperplasia, and Torus palatinus were significantly more common among females than in males (P<0.05), while hairy tongue, Ankyloglossia, Fordyce granule were highly significantly more common among males than in females. Linea alba was highly significantly more common among females (5.86%) than in males (3.64%). Conclusion: Routine examinations of oral cavities are valuable in identifying several oral lesions and this will help to establish early diagnosis and treatment and better prognosis particularly early precancerous and other oral lesions. Keywords: Abnormalities, oral mucosal lesions, prevalence. (J Bagh Coll Dentistry 2011;23(3): 67-73).

INTRODUCTION
Oral health is important to the quality of life of all individuals. Oral lesions can cause discomfort or pain that interferes with mastication, swallowing, and speech. Oral lesions can produce symptoms such as halitosis, xerostomia, or oral dysesthesia, which interfere with daily social activities (1). Oral disease is a health problem that is not only a matter of oral hygiene and local condition, but can also be a precursor to other dangerous and potentially life threatening illnesses (2). Diagnosis of wide variety of lesions that occur in the oral cavity is an essential part of dental practice. An important element in establishing a diagnosis is knowledge of the lesions relative frequency, or prevalence at one point in time (3). Among the broad spectrum of causes leading to changes in the oral mucosa are infections from bacteria, fungi, viruses, parasites, and other agents; physical and thermal influences, changes in the immune system, systemic diseases, neoplasia, trauma and other factors, some of which are issues of aging (4,5).

Traditionally, the mucosal membrane of the oral cavity has been looked upon as mirroring the general health (6). The tongue lesions fissured, geographic and hairy tongue, oral lesions Fordyce granules, and leukoedema are classically considered to be developmental oral lesions rather than having virtual disease characteristics (6). Dental factors (poor oral hygiene, sharp teeth, and improperly fitting dentures) have been thought to play a role in the occurrence of oral mucosal lesions (4,7). Denture wearers, besides suffering the characteristic lesions from the dentures, they present traumatic ulcerations with more frequency than nonusers, candidosis pathology occupying second place in frequency (8). The present study was designed to determine the prevalence and sex distribution of oral lesions in patients who visit the Oral Diagnosis Clinic of the College of Dentistry, University of Sulaimani.

PATIENTS AND METHODS

Evaluation basis: This prospective study was performed on 3144 patients, of these 1507 (47.93%) were males and 1637 (52.06%) were females. The patients' ages were between 10 to 79 years. All patients included in this study were referred to the Department of Oral Medicine, College of Dentistry, University of Sulaimani
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(1) College of dentistry, university of Sulaimania.

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from July 2009-July 2010. The bases for attending to the clinic were to seek dental treatment. Patients An interview was conducted to collect information using a structured questionnaire which was completed by each patient and the examiner. Both dental and general medical histories of the patients were obtained. Methods The patients were examined clinically by two trained examiner using artificial light, mouth mirror, gauze. At the time of clinical examination, we established a preliminary diagnosis. Some of the mucosal changes where diagnosed solely by clinical examination (e.g. linea alba, fissured tongue, etc.). Some times a cotton swab was used to remove evident debris; a swab was always used to test whether a white lesion could be wiped off. In some cases where the observed lesion could be of traumatic origin, this was eliminated and the patients were requested to return for evaluation 15 days later for a new exploration. During the clinical examination, the following elements including features of the lesion, anatomical location, extension, etiological factors or related factors, dental status were analyzed. The diagnosis was made based on history, clinical features, and investigations according to the WHO (1997) criteria (9). When clinical features were not diagnostic and where no clinical improvement was observed, a biopsy was undertaken.

RESULTS
Among the 3144 patients, only 799 patients (25.41%) had oral lesions. Females constituted 49.81% (n=398) and males 50.18% (n=401). The age range of the patients was between 10-79 years. Nine hundred five oral lesions were detected. Oral lesions were slightly more prevalent among males (26.60%) than females (24.31%), but the difference was not statistically significant. Oral lesions were classified according to the following 7 categories: tongue lesions (9.70%), anatomic changes (8.71%), white lesions (4.8%), ulcerated lesions (3.1%), candidiasis (1.3%), benign lesions (1.05%) and malignant lesions (0.03%). Prevalence and sex distribution of tongue lesions: Table 1 shows the distribution of tongue lesions prevalence according to patient's sex. Tongue abnormalities were present in 9.70% (n=305) of the total sample. Tongue lesions were highly significantly more common among males (12.07%) than in females (7.51%). The most common tongue condition was fissured tongue, constituting about 5.24 % of all tongue conditions. Other tongue lesions include Black hairy tongue
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(1.87%), ankyloglossia (1.08%), lingual varicosities (0.82), geographic tongue (0.57) and scalloped tongue (0.09) consequently as shown in table 1. Prevalence and sex distribution of anatomic changes: Table 2 shows the distribution of anatomic changes prevalence according to patient's sex. Anatomic changes were observed in 8.71% of the patients. The most common anatomic changes were Linea alba (White line). Linea alba (White line) was seen in 4.80%. Other anatomic changes include Fordyce's granules (3.56%), torus mandibularis (0.19%) and torus palatinus (0.15%) consequently as shown in table 2. Prevalence and sex distribution of white lesions: Table 3 shows the distribution of white lesions prevalence according to patient's sex. White lesions were observed in 4.8% of all patients. The most common white lesion was Cheek biting. Cheek biting was seen in 3.49% of all patients. Other white lesions include Frictional (traumatic keratosis) (0.82%), oral lichen planus (0.25%), leukoplakia (0.09%), nicotine stomatitis (0.06%), actinic keratosis (cheilitis) (0.03%) and lichenoid reaction (0.03) consequently as shown in table 3. Prevalence and sex distribution of ulcerative, vesicular and bullous lesions: Table (4) shows the distribution of ulcerative, vesicular and bullous lesions prevalence according to patient's sex. Ulcerative, vesicular and bullous lesions were diagnosed in 3.1% of the studied populations. The most common ulcerative lesion was recurrent aphthous stomatitis. Recurrent aphthous stomatitis was seen in 1.68% of all patients. Other ulcerative, vesicular and bullous lesions include recurrent herpes simplex virus infection (0.69%), traumatic ulcer (0.69%), Behets Syndrome (0.03%) and erythema multiformi (0.03%) consequently as shown in table 4. Prevalence and sex distribution of candidiasis: Table 5 shows the distribution of candidiasis prevalence according to patient's sex. Candidiasis was observed in 1.3% of all patients. The most common candidal infection was denture stomatitis. Denture stomatitis was seen in 0.73% of all patients. Other candidiasis includes angular cheilitis (0.28%), median rhomboid glossitis (0.25%) and acute pseudomembranous candidiasis (thrush) (0.03%) consequently as shown in table (5). Prevalence and sex distribution of benign lesions: Table 6 shows the distribution of benign lesions prevalence according to patient's sex. Benign lesions were diagnosed in 1.05% of the studied population. The most common benign

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lesions were Fibroepithelial hyperplasia. Fibroepithelial hyperplasia was seen in 0.38% of all patients. Other benign lesions include denture induced fibrous hyperplasia (0.34%) , peripheral giant cell granuloma (0.06%), gingival hyperplasia (0.09%), mucoceles (0.09%), radicular cyst (0.06%) and port wine stain (0.03%) consequently as shown in table 6. Prevalence and sex distribution of malignant lesions: Squamous cell carcinoma was seen in 0.03% of the studied population.

DISCUSSION
Epidemiological studies performed over the past few years have shown considerable variation in the prevalence of oral mucous lesions among different regions throughout the world (10). There are considerable methodological problems because of the absence of standard protocols and the wide variation in the methods used. Consequently, the prevalences found for each lesion vary widely among research groups (10). Among 3144 patients, 799 patients (25.41%) had one or more oral lesions, a result comparable with that in a study by Rooban et al. (11) in Chennai, south India (25%), but lower than that in other studies done by Garcia-pola Vallejo et al. (12) among an adult Spanish population (51.1%), and more than that found by Saraswathi et al. (13) in a cross-sectional study in south India (4.1%). These variations could be explained due to: Geographical factors, Different methodologies used, Sex distribution of the sample, Age distribution of the sample, Specific cultural habits like smoking and use of alcohol, Variation in the clinical interpretation of parameters, Real differences in the prevalence of oral lesions, Racial factor, Educational level of the patients, Socioeconomic factors, Cultural levels, Medication used, Systemic diseases, use of dentures, Food type and the number and type of the lesion included in the study, because recording all oral mucosal lesions detected during a physical examination clearly results in a high prevalence of oral mucosal disease. Oral lesions were slightly more prevalent among males (26.60%) than in females (24.31%). This is in agreement with the finding of Pentenero et al. (14) in Turin area but disagrees with the finding of Al-mobeeriek and Aldosari (15) among Saudi dental patients in which oral lesions where more prevalent in females than in males. Prevalence, sex distribution of tongue lesions: Tongue abnormalities were present in 9.70% (n=305) of the total sample. Tongue lesions were highly significantly more common among males (12.07%) than in females (7.51%). This is in
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agreement with the finding of Avcu and Kanli (16) among Turkish dental outpatients. Our result disagrees with the finding of Al-mobeeriek and Aldosari (15) where tongue lesions were higher among females than males and it was not statistically significant. The most common tongue condition was fissured tongue, constituting about 54.09% of all tongue conditions. This is in agreement with the finding of Al-mobeeriek and Aldosari (15) and disagrees with the finding of Mojarrad and Vaziri (17) in Hamadan, Iran. Fissured tongue was observed in 5.24% of all patients. This is comparable to the finding by Mathew et al. (18) in southern India (5.7%), and it is more than that found by Al-mobeeriek and Aldosari (15) in Saudi Arabia (1.41%). Fissured tongue was more prevalent among males (5.90%) than in females (4.64%) however, sex differences were not statistically significant which are in agreement with the finding of Mojarrad and Vaziri (17). Black hairy tongue was seen in 1.87%. This prevalence is comparable to the finding Almobeeriek and Aldosari (15) (0.55%), and inferior to that observed in a cross-sectional study in Jahanbani et al.(6) (8.9%) in Iran. Ankyloglossia was diagnosed in 1.08%. This prevalence is comparable to the finding by Mojarrad and Vaziri (17) (0.8%), and Al-mobeeriek and Aldosari (15). Ankyloglossia was highly significantly more common among males (1.59%) than in females (0.61%). This is in agreement with the finding of Ricke et al. (19). Lingual varicosities were seen in 0.82% of the studied population. This prevalence is comparable to the finding by Mathew et al. (18) in southern India, Al-mobeeriek and Aldosari (15) (0.39%).Geographic tongue was seen in 0.57% of all patients. This prevalence is comparable to the finding by Mathew et al. (18) (0.84%), Almobeeriek and Aldosari (15) (0.51%).Geographic tongue was more prevalent in females (0.67%) than in males (0.46%), however sex difference was not statistically significant. Among the patients with geographic tongue 61.11% also had fissured tongue, while 6.66% of the patients with fissured tongue had geographic tongue. Similarly, Voros-Balog et al. (20) found that among the children with geographic tongue 44.82% also had fissured tongue, while 8.75% of the children with fissured tongue had geographic tongue. Prevalence, sex distribution analysis of anatomic changes: Anatomic changes were observed in 8.71% of the patients. Linea alba (white line) was seen in 4.80%. It was highly significantly more common among females (5.86%) than in males (3.64%). This prevalence is comparable to the finding by Cebeci et al. (21) in Turkey (4.2%), but it is lower than that found by

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Martinez and Garcia pola (8) (10.1%). Fordyce granule was seen in 3.56% of all patients. This is comparable to the finding by Al mobeeriek and Aldosari (15) (3.84%), and Cebeci et al. (21) in Turkey (2.8%). Fordyce granules was highly significantly more common among males (5.44%) than in females (1.83%) which is in agreement with the finding of Jahanbani et al. (6) in Iran, but conflicts with the finding of Al-mobeeriek and Aldosari (15) in which Fordyce granules were significantly more common in females. Fordyce granules may be a target of the androgenic hormones (22). Torus mandibularis (TM) was observed in 0.19%. This is comparable to the finding by Al-mobeeriek and Aldosari (15) (0.08%) and less than that found by Nair et al. (23) in Vietnamese population (3%). Torus mandibularis (TM) was more prevalent in females (0.30%) than in males (0.06%) however, sex differences was not statistically significant which is in agreement with the finding of Al-mobeeriek and Aldosari (15) and disagrees with the finding of Ihunwo and Phukubye (24) in Black South African population. Torus platinus (TP) was diagnosed in 0.15% of all patients. This prevalence is lower than that found by Al-mobeeriek and Aldosari (15) (1.33%). The reason for the variation in the prevalence of torus palatinus (TP) was thought to be environmental, genetic and functional factors which are important for this prevalence. Torus platinus (TP) was significantly more common among females (0.30%) which are in agreement with the finding of Sisman et al. (25) in Turkey. Prevalence, sex distribution of white lesions: White lesions were observed in 4.8% of all patients. Cheek biting was seen in 3.49% of all patients. This is comparable to the finding by Shulman et al. (3) in US adults (3.05%). Frictional (traumatic) keratosis was seen in 0.82% of all patients. This is comparable to the finding of Almobeeriek and Aldosari (15) (0.90%), but lowers than that found by Garcia-pola Vallejo et al. (12) in an adult Spanish population (7.5%). Frictional keratosis was more prevalent in males (0.92%) than in females (0.73). The higher prevalence of frictional keratosis among males is in agreement with the finding of Mathew et al. (18) in southern India and Al-mobeeriek and Aldosari (15). Oral lichen planus was seen in 0.25% of all patients. This is comparable to the finding by Saraswathi et al. (13) (0.15%), and Al-mobeeriek and Aldosari (15) (0.35%). The high prevalence of oral lichen planus among females is in agreement with the finding of Martinez and Garcia pola (8) and Mathew et al. (18). Leukoplakia was seen in 0.09%. This is comparable to the finding by Cebeci et al. (21) in Turkey (0.4%), but it is lower
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than that of several other studies done by Rooban et al. (11) in Chennai, south India (7.4%). Leukoplakia was found only in males (0.19%) however, sex difference was not statistically significant which is in agreement with the finding of Lapthanasupkul et al. (26) in a Thai population. Prevalence, sex distribution of ulcerative, vesicular, and bullous lesions: Ulcerative, vesicular, and bullous lesions were diagnosed in 3.1% of the studied populations. Recurrent aphthous stomatitis was seen in 1.68%. This is comparable to the finding by Shulman (27) in the USA (1.64%), Mathew et al. (18) (2.1%). Recurrent aphthous stomatitis was more prevalent in females (1.77%) than in males (1.59%). Similar finding has been reported by Lin et al. (28) in adult Chinese, and disagrees with the finding of Mathew et al. (18) in which RAS was more frequent in males (2.27%) than in females (1.8%). Recurrent herpes labialis (RHL), the common cold sore or fever blister was observed in 0.69%. This is comparable to the finding by Mathew et al. (18) in India (0.58%) and Al-mobeeriek and Aldosari (15) (0.27%) The higher prevalence of recurrent herpes simplex virus infection among females in which (0.73% among females and 0.66% among males) is in agreement with the finding of Mathew et al. (18), Al-mobeeriek and Aldosari (15). The most common cause of single ulcers on the oral mucosa is trauma. Trauma may be caused by teeth, food, dental appliances, dental treatment, heat, chemicals, or electricity (29). Traumatic ulcer was seen in 0.69%. This prevalence is comparable to the finding by Mathew et al. (18) (1.008%), Cebeci et al. (21) in Turkey (0.9%). Traumatic ulcer was more prevalent in females (0.85%) than in males (0.53%). Prevalence, sex distribution of Candidiasis: Candidiasis was observed in 1.3% of all patients. Denture stomatitis was seen in 0.73%. This prevalence is comparable to the finding by Mathew et al. (18) (0.84%). Denture stomatitis was significantly more common among females than in males (1.09% and 0.33% respectively). This is in agreement with the finding of Dos Santos et al. (30) among south Brazilian older adults. Angular cheilitis was seen in 0.28% of all patients. This prevalence is in accordance with the study done by Al Jubori (31) among Iraqi patients (0.4%), but it is lower than that of several other studies done by Espinoza et al. (32) in an elderly people in Santiago, Chile (2.9%). Angular cheilitis was more prevalent in males (0.33%) than in females (0.24%). Median rhomboid glossitis was seen in 0.25%. This study is comparable to the finding by Mojarrad and Vaziri (17) in Hamadan, Iran (0.2%),

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but lowers than that found by Mathew et al. (18) (1.5%). The higher prevalence of median rhomboid glossitis among males in which (0.39% male and 0.12% female) is in agreement with the finding of Mathew et al. (18). Prevalence, sex distribution of benign lesions: Benign lesions were diagnosed in 1.05% of the studied population. Fibroepithelial hyperplasia was seen in 0.38%. This is comparable to the finding by Mathew et al. (18) (0.84%), and Cebeci et al. (21) (0.6%) and lower than that found by Espinoza et al. (32) in Santiago, Chile (9.4%). Fibroepithelial hyperplasia was more prevalent in females (0.42%) than in males (0.33%). Denture induced fibrous hyperplasia was seen in 0.34% of all patients which is comparable with the finding of Cebeci et al. (21) in an adult Turkish population (0.2%) and it is lower than that found by Martinez and Garcia-pola (8) (5%). Denture induced fibrous hyperplasia was significantly more common among females (0.61%) than in males (0.06%). This is in agreement with the finding of Zarei et al. (33) in Kerman province, Iran. Peripheral giant cell granuloma (PGCG) was diagnosed in 0.06%. In a study by Chen et al. (34) among a population from southern Taiwan PGCG form 0.1% of trauma-associated soft tissue lesions. Mucoceles was observed in 0.09% of the studied population. This is comparable to the finding by Espinoza et al. (32) in Santiago, Chile (0.2%). Prevalence, sex distribution of malignant lesions: Squamous cell carcinoma was seen in 0.03% of the studied population. This is comparable with the finding of Cebeci et al. (21) in an adult Turkish population (0.06%). Campisi and Margiotta (7) found that of 180 patients, only 1 had Squamous cell carcinoma (0.9%). The lower prevalence of squamous cell carcinoma in our study is probably because many patients with oral cancer go to the Department of Oral and Maxillofacial Surgery in the Teaching Hospital and only few cases of oral cancer are diagnosed at the university.

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5- Jainkittivong A, Aneksuk V, Langlais RP. Oral mucosal conditions in elderly dental patients. Oral Dis 2002; Jul: 8(4):218-23 6- Jahanbani J, Sandvik L, Lyberg T, Ahlfors E. Evaluation of Oral Mucosal Lesions in 598 Referred Iranian Patients. The Open Dent J 2009; 3: 42-7. 7- Campisi G, Margiotta V. Oral mucosal lesions and risk habits among men in an Italian study population. J Oral Pathol Med 2001; Jan: 30(1):22-8. 8- Martnez AI, Garca-Pola MJ. Epidemiological study of oral mucosal pathology in patients of the Oviedo School of Stomatology. Med Oral 2002; 7(1): 4-16. 9- WHO. Oral health surveys, basic methods, Criteria for the examination of the oral mucosa and soft tissues. 4th edition 1997. England, 1-66. 10- Rioboo-Crespo MR, Planells-del Pozo P, RiobooGarca R. Epidemiology of the most common oral mucosal diseases in children. Med Oral Patol Oral Cir Bucal 2005; 10:376-87. 11- Rooban T, Rao A, Joshua E, Ranganathan K. The prevalence of oral mucosal lesions in alcohol misusers in Chennai, south India. Indian J Dent Res 2009; JanMar: 20(1): 41-6. 12- Garca-Pola Vallejo MJ, Martnez Daz-Canel AI, Garca Martn JM, Gonzlez Garca M. Risk factors for oral soft tissue lesions in an adult Spanish population. Community Dent Oral Epidemiol 2002; Aug: 30(4): 277-85. 13- Saraswathi TR, Ranganathan K, Shanmugam S, Sowmya R, Narasimhan PD, Gunaseelan R. Prevalence of oral lesions in relation to habits: Crosssectional study in South India. Indian J Dent Res 2006; Jul-Sep: 17(3): 121-5. 14- Pentenero M, Broccoletti R, Carbone M, Conrotto D, Gandolfo S. The prevalence of oral mucosal lesions in adults from the Turin area. Oral Dis 2008; May: 14(4): 356-66. 15- Al-Mobeeriek A, Aldosari AM. Prevalence of oral lesions among Saudi dental patients. Ann Saudi Med 2009; 29(5): 365-8. 16- Avcu N, Kanli A. The prevalence of tongue lesions in 5150 Turkish dental outpatients. Oral Dis 2003; Jul: 9(4):188-95. 17- Mojarrad F, Vaziri P Bakianian. Prevalence of Tongue Anomalies in Hamadan, Iran. Iranian J Publ Health 2008; 37(2): 101-5. 18- Mathew AL, Pai KM, Sholapurkar AA, Vengal M. The prevalence of oral mucosal lesions in patients visiting a dental school in Southern India. Indian J Dent Res 2008; 19(2): 99-103. 19- Ricke LA, Baker NJ, Madlon-Kay DJ, DeFor TA. Newborn Tongue-tie: Prevalence and Effect on BreastFeeding. J Am Board Fam Pract 2005; 18:1-7. 20- Vrs-Balog T, Vincze N, Bnczy J. Prevalence of tongue lesions in Hungarian children. Oral Dis 2003; Mar: 9(2):84-7. 21- Cebeci AR , Glah A, Kamburolu K, Orhan BK, zta B. Prevalence and distribution of oral mucosal lesions in an adult Turkish population. Med Oral Patol Oral Cir Bucal 2009; Jun: 14 (6): E272-7. 22- Whitaker SB, Vigneswaran N, Singh BB. Androgen receptor statusof the oral sebaceous glands. Am J Dermatopathol 1997; 19: 415-8. 23- Nair RG, Samaranayake LP, Philipsen HP, Graham RG, Itthagarun A. Prevalence of oral lesions in a selected Vietnamese population. Int Dent J 1996; Feb: 46(1):48-51.

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24- Ihunwo AO, Phukubye P. The frequency and anatomical features of torus mandibularis in a Black South African population. Homo 2006; 57(4):253-62. 25- Sisman Y, Ertas ET, Gokce C, Akgunlu F. Prevalence of Torus Palatinus in Cappadocia Region Population of Turkey. Eur J Dent 2008; Oct: 2: 26975. 26- Lapthanasupkul P, Poomsawat S, Punyasingh J. A clinicopathologic study of oral leukoplakia and erythroplakia in a Thai population. Quintessence Int 2007; Sep: 38(8): e448-55. 27- Shulman JD. Prevalence of oral mucosal lesions in children and youths in the USA. Int J Paediatr Dent2005; Mar: 15(2): 89-97. 28- Lin HC, Corbet EF, Lo EC. Oral mucosal lesions in adult Chinese. J Dent Res 2001; 80:1486-90. 29- Greenberg MS. Ulcerative, Vesicular, and Bullous lesions. In: Greenberg Martin S, Glick Michael, editors. Burkets Oral Medicine Diagnosis & Treatment. 10th Ed Spain: BC Decker Inc.2003; 50-84.

30- Dos Santos CM, Hilgert JB, Padilha DM, Hugo FN. Denture stomatitis and its risk indicators in south Brazilian older adults. Gerodontology 2010; Jun: 27(2):134-40. 31- Al Jubori RH. Prevalence of oral mucosal lesions in Iraqi patients. Iraqi Dent J 1997; 21:187-200. 32- Espinoza I, Rojas R, Aranda W, Gamonal J. Prevalence of oral mucosal lesions in elderly people in Santiago, Chile. J Oral Pathol Med 2003; Nov: 32(10):571-5. 33- Zarei MR, Chamani G, Amanpoor S. Reactive hyperplasia of the oral cavity in Kerman province, Iran: a review of 172 cases. Br J Oral Maxillofac Surg 2007; Jun: 45(4):288-92. 34- Chen JY, Wang WC, Chen YK, Lin LM. A retrospective study of trauma-associated oral and maxillofacial lesions in a population from southern Taiwan. J Appl Oral Sci 2010; 18(1).

Table 1: Distribution of tongue diseases prevalence according to patient's sex

Sex Presence/ absence Male (1507) Female (1637) Total (3144) X2 of lesion No % No % No % 89 5.9 76 4.64 165 5.24 Yes Fissured 1418 94.09 1561 95.35 2979 94.75 N.S No Tongue Total 1507 47.93 1637 52.06 3144 100 46 3.05 13 0.79 59 1.87 X2=21.732 Yes Black hairy 1461 96.94 1624 99.2 3085 98.12 d.f=1, P<0.001 No Tongue Total 1507 47.93 1637 52.06 3144 100 24 1.59 10 0.61 34 1.08 X2=7.069 Yes Ankylo1483 98.4 1627 99.38 3110 98.91 d.f=1, P<0.01 No Glossia Total 1507 47.93 1637 52.06 3144 100 Tongue Diseases

Table 2: Distribution of normal structural variants prevalence according to patient's sex

Sex Presence/ Normal absence Male (1507) Female (1637) Total (3144) X2 structural variants of lesion No % No % No % 55 3.64 96 5.86 151 4.8 X2=8.418 Yes Linea alba 1452 96.35 1541 94.13 2993 95.19 d.f=1, P<0.01 No (White line) Total 1507 47.93 1637 52.06 3144 100 82 5.44 30 1.83 112 3.56 X2=29.743 Yes Fordyces 1425 94.55 1607 98.16 3032 96.43 d.f=1, P<0.001 No Granules Total 1507 47.93 1637 52.06 3144 100

Table 3: Distribution of white lesions prevalence according to patient's sex

Sex Presence/ White lesions absence Male (1507) Female (1637) Total (3144) X2 of lesion No % No % No % 44 2.91 66 4.03 110 3.49 Yes N.S Cheek 1463 97.08 1571 95.96 3034 96.5 No biting Total 1507 47.93 1637 52.06 3144 100 Frictional 14 0.92 12 0.73 26 0.82 Yes (Traumatic) N.S 1493 99.07 1625 99.26 3118 99.17 Keratosis No Total 1507 47.93 1637 52.06 3144 100 Oral lichen 3 0.19 5 0.3 8 0.25 N.S Yes planus

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Table 4: Distribution of ulcerative lesions prevalence according to patient's sex

Sex Presence/ Ulcerative, vesicular Male (1507) Female (1637) Total (3144) and Bullous lesions absence of lesion No % No % No % X2 24 1.59 29 1.77 53 1.68 Yes N.S Recurrent aphthous 1483 98.4 1608 98.22 3091 98.31 No stomatitis 1507 47.93 1637 52.06 3144 100 Total 10 0.66 12 0.73 22 0.69 Yes N.S Recurrent herpes 1497 99.33 1625 99.26 3122 99.3 No simplex virus infection 1507 47.93 1637 52.06 3144 100 Total Traumatic ulcer Yes 8 0.53 14 0.85 22 0.69 N.S

Table 5: Distribution of candidiasis prevalence according to patient's sex

Presence/ Sex Candidiasis absence Male (1507) Female (1637) Total (3144) X2 of lesion No % No % No % 5 0.33 18 1.09 23 0.73 X2=6.369 Denture Yes 1502 99.66 1619 98.9 3121 99.26 d.f=1, P<0.05 stomatitis No Total 1507 47.93 1637 52.06 3144 100 5 0.33 4 0.24 9 0.28 Angular Yes N.S 1502 99.66 1633 99.75 3135 99.71 cheilitis No Total 1507 47.93 1637 52.06 3144 100

Table 6: Distribution of benign lesions prevalence according to patients sex

Inflammatory (reactive) hyperplasia Fibro epithelial hyperplasia Denture induced fibrous hyperplasia Peripheral giant cell granuloma Presence/ absence of lesion Yes No Total Yes No Total Yes No Total Sex Male Female Total (1507) (1637) (3144) No % No % No % 5 0.33 7 0.42 12 0.38 1502 99.66 1630 99.57 3132 99.61 1507 47.93 1637 52.06 3144 100 1 0.06 10 0.61 11 0.34 1506 99.93 1627 99.38 3133 99.65 1507 2 1505 1507 47.93 1637 52.06 3144 100 0.13 0 0 2 0.06 99.86 1637 100 3142 99.93 47.93 1637 52.06 3144 100 X2

N.S X2=6.673 d.f=1, P<0.05 N.S

Oral Diagnosis

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