E.O. Oyetola1, I.K. Mogaji1, T.O. Agho1 and O.A. Ayilara2
- Department of Preventive and Community Dentistry, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun State, Nigeria.
- Department of Oral and Maxillofacial Surgery and Oral Pathology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria.
Aim: This study aimed at describing the epidemiology and pattern of presentation of oral ulcerations among patients seen in Oral Medicine clinic of Obafemi Awolowo University Complex, Ile-Ife.
Methodology: This study was a retrospective cohort study of all cases that presented with oral ulcers in the oral medicine clinic between May 2015 and May 2017. The clinical diagnosis of oral ulcers was based on the WHO guidelines for oral mucosa diagnosis. All the case notes in the unit were retrieved and reviewed. Information extracted from the case notes included age, sex, medical history, clinical findings and treatment received. The data was analyzed using STATA 13 statistical software.
Results: Out of 250 patients seen in the Oral Medicine Clinic during the study period, oral ulcerations were seen in 50 patients comprising 34(68%) males and 16(32%) females, giving a prevalence of 20%. The mean age was 35.4 +14.7years and patients were most frequently seen in the third decade of life 16 (32%). The commonest site was lower lip (20; 40%) and ulcers were rare on the gingiva (1, 2%). More than half of the ulcers were solitary (26; 52%) and painful at presentation. Recurrent aphthous ulceration accounted for 47 cases (94%), others were traumatic ulcer (2; 4%) and Chemical burns (1; 2%). Physical stress was the most frequent implicated predisposing factor observed in 38 (76%) patients.
Conclusion: Recurrent apthous ulcer was the most frequent form of oral ulceration and was commoner in males. Physical stress was the most frequently implicated predisposing factor.
Keywords: Oral ulcerations, Stress, Oral medicine
Dr. E.O. Oyetola
Dept. of Preventive and Comm. Dent.,
Obafemi Awolowo University Teaching
Ile-Ife, Osun State, Nigeria
Oral ulceration is one of the common reasons for Oral Medicine consultations. It is generally defined as damage of both epithelium and lamina propria of the oral mucosa leading to discontinuity of the oral mucosa.1 Unlike mucosa erosions which involves the loss of only the superficial layers of the oral epithelium, oral ulcerations is associated with loss of the entire epithelia layers and lamina propria. Patients usually present with oral painful wounds that may affect any oral mucosa especially the lips, tongue, floor of the mouth, palate and buccal mucosa.2 The usual presentation is that of painful ‘‘aphthae,’’ a term of ancient origin referring to ulceration of oral mucosal surface.3 The aetiology of oral ulcer has been well documented in the literature.1,3,4 Traumatic ulcer results from the presence of mechanical (sharp edges of tooth, appliances in the mouth, and so on), radiation, chemical (excessive topical medications such as salicylate, aspirin burns and so on) and radiation injury to oral mucosa during radiotherapy.3.5 Removal or the control of the respective source of trauma is critical to the management. Others are pain control and prevention of secondary infection which are quite essential steps in the management of such oral ulcerations.6 Infectious ulcers result from the presence of pathogenic organism such as bacterial (syphilitic ulcer, tuberculous ulcer, acute ulcerative gingivitis and so on), virus (herpetic gingivostomititis, shringles p) and fungi (such as in histoplasmosis).3,7 Other implicated aetiology are immune dysfunction (aphthous ulceration, erythema multiformis e.t.c), stress induced ulcer and drugs. Syndromic forms of oral ulceration had also been reported. Such include Behcet’s syndrome and Reiter’s syndromes in these cases, oral ulcerations are seen in conjunction with genital and cornea ulcerations. Stress and psychological factors have also been considered as notable etiological factors in some form of oral ulcerations probably due to the role played by stress in immune dysfunction.8
Pain and discomfort associated with oral ulcer has been reported to be associated with reduced quality of life.9 It is also associated with difficulty in feeding and taste disturbances. Although oral ulcerations are encountered frequently in daily dental practice, information on the local experience and pattern of presentation of this condition in Nigerian population is scanty. This study was aimed at describing the epidemiology and pattern of presentation of oral ulcerations among patients seen in Oral Medicine clinic of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife.
This study was designed as a retrospective cohort study of all cases presented with oral ulcers in our hospital from May 2012 to May 2017
This study was done at the Oral Medicine Clinic of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife. This hospital provides tertiary health care for the Nigerian population in the south Western Nigeria.
The subjects for this study were all patients diagnosed with oral ulcer for a period of five (5) years from May 2012 to May 2017.
Records of all patients that presented and were treated for oral ulcer within the study were retrieved and reviewed. Information retrieved from the case notes includes the biodata such as age, sex and marital status. Relevant history that revealed predisposing factors and systemic conditions of the patients were also recorded. Other information recorded are the results of the examinations such as the location, number and shape of ulcers as well as other lesions seen. The clinical diagnosis of oral ulcers in our clinic is usually routinely made based on the WHO guidelines for oral mucosa diagnosis as reported by Kramer et al in 1980.10 Information obtained was recorded on a Subject Information Sheet.
Data analysis was done using Stata 13 statistical software (Statacorp, College Station, Texas). Descriptive statistics was used to characterize sociodemographic variables such as sex, marital status and occupation. For descriptive continuous variables, the mean, median, minimum value, maximum value and appropriate measures of variability were determined depending on if they are normally distributed or not. For descriptive variables that are categorical, simple frequency and percentages was determined. Bivariate analysis such as t-test and Fisher’s exact or their nonparametric equivalents was used as appropriate to compare between two variables. Statistical significance was inferred at p<0.05 and confidence interval was set at 95% for all the analysis.