Research Article - (2022) Volume 9, Issue 6
Received: Mar 08, 2022, Manuscript No. JEBMH-21-50873; Editor assigned: Mar 11, 2022, Pre QC No. JEBMH-21-50873(PQ); Reviewed: Mar 25, 2022, QC No. JEBMH-21-50873; Revised: Mar 30, 2022, Manuscript No. JEBMH-21-50873(R); Published: Apr 05, 2022, DOI: 10.18410/jebmh/2022/09.06.24
Citation: Narayan V, Swetha A. Reactive Hyperplastic Lesions of the Oral cavity J Evid Based Med Healthc 2022;9(06):24.
Oral cavity is constantly being exposed to many stimuli which can irritate the oral mucosa leading to a variety of hyperplastic reactions. Reactive hyperplastic lesions (also called RHLs) are tumorlike hyperplasia produced in response to chronic irritation or trauma. These hyperplastic lesions simulate non-neoplastic proliferations. The aim of the study is to determine the prevalence of reactive hyperplastic lesions in the oral cavity. This is a retrospective study. All the data were taken from the patient archives of the dental institute. Patients with a wide age range were included. A total of 700 patients were included in the study. All the necessary information was collected and entered in Microsoft Excel spreadsheet and subsequently transferred to SPSS version 23.0 for statistical analysis. Chi square tests were employed to find the association between different variables and p < 5 % was considered statistically significant. The study was done in an institutional setting. The prevalence of the reactive lesions were found to be 79.14 %. A male predilection was seen for the reactive lesions. The 26 - 45 year age group was more prone for reactive hyperplastic oral lesions. Patients in their 2nd to 4th decades of life tend to neglect / ignore certain persistent irritants present in the oral cavity which leads to reactive lesions. Hence more patient awareness about the reactive hyperplastic lesions must be spread by the dental professionals so as to curtail the rising number of these lesions.
Reactive lesions, Hyperplastic lesions, Fibroma, Pyogenic granuloma, Pulp polyp, Novel study
Oral cavity is constantly being exposed to many stimuli which can irritate the oral mucosa leading to a variety of hyperplastic reactions. Reactive hyperplastic lesions (also called RHLs) are summerlike hyperplasia produced in response to chronic irritation or trauma. These hyperplastic lesions simulate non-neoplastic proliferations.1 The goal for the treatment of these conditions is the elimination of the stimulating agents followed by proper dental therapy. Reactive lesions are typically gives response to chronic inflammation caused by various forms of low grade chronic irritations to the oral mucosa such as dental plaque and calculus, sharp edges of grossly carious teeth, faulty dental restorations, chronic biting habits, ill-fitting dental / oral appliances and food impactions.2,3 These lesions have a very similar appearance to benign neoplastic proliferations. Different types of localized reactive lesions of oral cavity are Focal Fibrous Hyperplasia (FFH), pyogenic granuloma (PG), irrigational fibroma, Peripheral Giant Cell Granuloma (PGCG), Peripheral Ossifying Fibroma (POF), fibroepithelial hyperplasia / polyp, inflammatory fibrous hyperplasia, and inflammatory gingival hyperplasia.4 Pyogenic granuloma is the second predominant lesion among the RLs. Various synonyms include pregnancy tumour, benign vascular tumour, and vascular epulis. Recently, it has been also called lobular capillary haemangioma owing to the presence of well-circumscribed and distinct lobular arrangement, with central large vessels and peripheral aggregates of well-formed capillaries. If PGs are left untreated over time, it undergoes fibrous maturation with ossification and develops into POF. The main etiological factors are the presence of plaque, calculus, and pregnancy.5,6 Traumatic fibroma can occur anywhere in the mouth, the most common location is the buckle mucosa along the bite line. It was found that gingiva is the most common site for fibroma with equal incidence in lower and upper jaws. The term “focal fibrous hyperplasia” implies localized progressive proliferation of oral mucosa in response to local irritation or local injury. FFH was the most common lesion occurring over a wide age range (9 – 70 years), with a peak incidence in the third to fourth decades.7,8Clinically, the lesion may be round to ovoid, asymptomatic, smooth - surfaced, firm, sessile or pedunculated mass, the diameter of which may vary from 1 to 2 cm. Hard in consistency and pale pink in colour, the surface may be hyperkeratosis or ulcerated owing to repeated trauma. Histopathologically, the sections showed hyperplastic stratified squamous epithelium which was partly hyperkeratosis and hyperorthokeratosis at some places. Thin, finger-like rete ridges extend into underlying connective tissue stromal which is fibro cellular. Solid nodular mass of dense hyalinised fibrous connective tissue arranged in haphazard fascicles was seen in one of the lesions. A mild-to-moderate chronic inflammatory cell infiltrate was seen at a few sites. Frictional keratosis represents increased keratin production in response to chronic mechanical irritation. The retro molar pad and edentulous alveolar ridge are the most common sites of involvement due to trauma from food being crushed against the mucosa during mastication.1 A fractured tooth or rough restoration may lead to the development of frictional keratosis on the adjacent lateral tongue or buckle mucosa.9,10Frictional keratosis appears as a discrete white plaque with a rough or corrugated surface and frequently has blending margins with the adjacent unaffected mucosa. These lesions do not undergo malignant change and should resolve after the source of irritation is eliminate.11 Because frictional keratosis is a specific entity, it should not be described or categorized as a leukoplakia. Including frictional10 keratosis in studies of leukoplakia dilutes the prevalence of dysplasia and squamous cell carcinoma seen in true leukoplakia, a potentially malignant disorder. Epulis fissuratum or dentureinduced hyperplasia is a reactive lesion of the oral cavity caused by low grade chronic trauma from denture.12,13 About 70 % of patients wear ill-fit dentures continuously all day long for more than 10 years. The lesion appears as an asymptomatic single fold or multiple folds of hyperplastic tissues in the alveolar vestibule along denture flanges with a smooth surface, soft to firm consistency, and a normal coloration. Pulp polyp or chronic hyperplastic pulpitis or pulpitis apart is an uncommon reactive lesion, which occurs when caries have destroyed the tooth crown.1It appears as a smooth, soft to firm, red to pink, pedunculated, or sessile mass occupying the entire carious cavity in the affected tooth resembling an enlarged gingival tissue. The size of the lesion varies from less than 1 cm in diameter to large masses.14,15 It is most frequently found in the deciduous and permanent first molars of children and young adults and is a rare phenomenon in middle-aged adults. It is usually asymptomatic, but discomfort can occur during mastication. Response to electrical and thermal stimuli may be normal. Our team has extensive knowledge and research experience that has translate into high quality publications.16-35 The aim of the study is to determine the prevalence of reactive hyperplastic lesions of the oral cavity.
Study Design
This is a retrospective study conducted in a private dental institution. The patient case records were reviewed for the necessary information by a trained examiner. The advantage of conducting the study in an institutional set up provides a population with similar ethnicity. Among patients who have visited the dental clinic of the institution, the case records of 700 patients were reviewed. A wide age range is selected for the study. The institutional ethical committee provided approval for the study.
Inclusion criteria
1. Patients who have been diagnosed with reactive lesions
2. Patients from 20 years to 70 years of age
Exclusion criteria
1. Incomplete patient data
2. Duplicate patient data
3. Patients having reactive lesions coexisting with other non-reactive / hyperplastic mucosal lesions
Sampling
A total of 700 case records of patients were reviewed to find out the prevalence of reactive / hyperplastic lesions. Convenient sampling method was used to select the patients for the study. The data obtained from the case records were cross verified with photographs.
Data Collection
All the data after thorough checking for duplicates, incomplete entries and cross verification with photographs were entered in Microsoft excel spread sheet in order to organise the data. The variables obtained from the data included age, gender, different types of reactive lesions and the presence of reactive lesions.
Statistics
The statistical analysis of the obtained data was performed by the SPSS software version 23.0. The data from the excel spread sheet was transferred to SPSS software for analysis. Chi square tests were employed in order to find the association between different variables. The final results are presented in the form of graphs for further interpretation and discussion.
Among the 700 patients, 554 patients had the presence of oral reactive hyperplastic lesions. The prevalence of oral reactive hyperplastic lesions is 79.14 %. This appears to be a significant value and could be due to the sample size. A higher sample size may have yielded a different value. According to Reddy. V et al.3 the prevalence of reactive lesions were found to be 12.8 % which is less when compared with the present study result. This difference in the result can be attributed to sample size and ethnicity.
The distribution of the presence of oral reactive lesions was studied among males and females (Figure 1). A slight male predilection is seen (41.86 %) when compared to females (33 %). There was a statistically significant association between the gender and the presence of oral reactive lesions (p < 0.05). In the study by Reddy V et al.3, it was found that there was a female predilection (125 females and 85 males) which is also in contrast with the present study. This also could be due to the sample size and ethnicity.
Figure 1.Bar graph depicts the association between the gender and the presence (blue) and absence (green) of reactive oral lesions. X axis represents the gender and Y axis represents the total number of patients. Chi square analysis reveals that the association between the variables is statistically significant (p < 0.05). A slight male predilection was seen for the presence of reactive lesions compared to females.
The presence of reactive oral lesions was studied in different age groups (Figure 2). The age group 26 - 45 years had the maximum occurrence of oral reactive lesions (40.43 %) this was followed by the 46 - 65 age group (20.86 %), 10 - 25 age group (10.57 %) and finally by the 66 - 80 age group (3 %). There was a statistically significant association between the different age groups and presence of oral reactive lesions (p < 0.05). According to Hameideh Kadeh et al, lesions were more common in the 21 – 40 year age group.36 This is in accordance with the current study as the lesions were more common in the 26 - 45 age groups.
Figure 2.Bar graph depicts association between the age with presence (blue) and absence (green) of reactive hyperplastic lesions. X axis represents the age and Y axis represents the total number of patients. From the present graph it can be inferred that the association between the variables is statistically significant (p < 0.05) and reactive lesions was seen maximum in the 26 - 45 age group followed by 46 - 65 and 10 - 25 age groups.
The distribution of different types of oral reactive lesions was studied among males and females (Figure 3). It was found that the males had a high number of frictional keratosis (26.91 %) followed by fibroma (15.27 %) and pulp polyp (5.53 %). In females fibroma was found to be the highest (21.18 %) followed by pulp polyp (8.59 %) and frictional keratosis (7.44 %). Other lesions such as epulis fissuratum, gingival polyp, pyogenic granuloma and fibroepithelial polyp were found in small numbers in each gender. According to Hameideh Kadeh et al.36 Peripheral reactive lesions are a common group of lesions that may be encountered during routine dental examinations. The most common lesions were pyogenic granuloma and irritation fibroma, respectively. These lesions were more frequent in women (60 %) than men (40 %).
Figure 3.Bar graph depicts the association between the gender and the types of reactive oral lesions. X axis represents the gender and Y axis represents the total number of patients. Chi square analysis reveals that the association between the variables is statistically significant (p < 0.05). Among males frictional keratosis was the highest and in females it was fibroma which occurred the highest. The least occurring lesion in males is the fibroepithelial polyp and in females it is fibroepithelial and pyogenic granuloma.
The distribution of different types of oral reactive lesions among different age groups were studied (Figure 4). Fibroma was found to be the most common lesion (20.8 %) followed by frictional keratosis (16.41 %), followed by pulp polyp (8.02 %) and gingival polyp (8.02 %). These lesions are seen very commonly in the 26 - 45 years age group. The next most common age group to have oral reactive lesions is the 46 - 65 age groups. The association between the types of oral reactive lesions and the age groups was found to be statistically significant (p < 0.05). According to Sangle V et al.37 reactive lesions were more commonly found in the 3rd and 4th decades of life which is similar to the present study where lesions are found in the 26 - 45 age group. This similarity in the result could be attributed to the similarities in the characteristics of the sample.
Figure 4.Bar graph depicts the association between the age and the types of reactive oral lesions. X axis represents the age and the Y axis represents the total number of patients. Chi square analysis reveals that the association between the variables is statistically significant (p < 0.05). The highest occurring lesion is fibroma and is found maximum in the 26 - 45 age group. This is followed by frictional keratosis and pulp polyp.
In the present study a slight male predilection was found and the middle aged people were commonly affected by the lesions and fibroma and frictional keratosis were found to be the commonest oral reactive hyperplastic lesions. It can be concluded that most patients neglect such oral lesions which are commonly due to persistent chronic irritation given from the teeth. More awareness about these lesions is needed in order to curtail the rising number of oral reactive hyperplastic lesions.
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