AIPMED

ANNALS OF IBADAN POSTGRADUATE MEDICINE

PATTERN OF PRESENTATION OF ORAL ULCERATIONS IN PATIENTS ATTENDING AN ORAL MEDICINE CLINIC IN NIGERIA

E.O. Oyetola1, I.K. Mogaji1, T.O. Agho1 and O.A. Ayilara2

  1. Department of Preventive and Community Dentistry, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun State, Nigeria.
  2. Department of Oral and Maxillofacial Surgery and Oral Pathology, Obafemi Awolowo University
  3. Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria.

ABSTRACT

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 +14.7 years 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

Correspondence

Dr. E.O. Oyetola

Dept. of Preventive and Comm. Dent.,

Obafemi Awolowo University Teaching

Hospital Complex,

Ile-Ife, Osun State, Nigeria

Email: phemyhoye12@yahoo.com


INTRODUCTION

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.