PERFIL EPIDEMIOLÓGICO DOS PACIENTES DIAGNOSTICADOS COM LIQUEN PLANO ORAL ATENDIDOS NO CENTRO DE ESPECIALIDADES ODONTOLOGICAS
REGISTRO DOI: 10.5281/zenodo.8350086
Luana Ferreira Oliveira1
Mateus Diego Pavelski2
Geovanna Maria Ramos Porto de Souza3
Martina Andreia Lage Nunes4
Maicon Douglas Pavelski5
Eduardo Francisco de Souza Facco6
Osvaldo Magro filho7
Luciana Estevam Simonato8
ABSTRACT
Objective: To identify the epidemiological profile of patients with oral lichen planus treated at the Centro de Especialidades Odontológicas (CEO). Method: The research was carried out by collecting data from the medical records of patients from 2016 to 2019. From the medical records, epidemiological data of the individuals and clinical data regarding the injuries were collected. Results: From a total of 38 (n=38) medical records analyzed, it was found that white women over the fourth decade of life, with a professional occupation exposed to solar radiation, had erosive lichen planus, assuming the epidemiological group, needing preventive measures in this predisposed public. Taking into account the methodology adopted and the sample studied, the number of patients with cancerous lesions of the oral mucosa is relevant, and it is extremely important for the dental surgeon to identify and prevent such diseases. Conclusion: The data collected will favor the planning and execution of oral health actions to improve the health conditions of this group of patients. In addition to establishing specific goals associated with the prevention of oral cancer, aiming at a significant improvement in the quality of care, identifying needs and proposing solutions to problems.
Keywords: Oral Neoplasms, Oral Lichen Planus, Epidemiology, Dentistry.
RESUMO
Objetivo: Identificar o perfil epidemiológico dos pacientes com líquen plano oral atendidos no Centro de Especialidades Odontológicas (CEO). Método: A pesquisa foi realizada por meio de levantamento de dados dos prontuários dos pacientes de 2016 a 2019. Do prontuário foram coletados dados epidemiológicos dos indivíduos, além dos dados clínicos referentes às lesões. Resultados: De um total de 38 (n=38) prontuários analisados, verificou-se que mulheres acima da quarta década de vida, brancas, com ocupação profissional exposta à radiação solar, eram portadoras de líquen plano erosivo, assumindo o grupo epidemiológico, necessitando preventivas nesse público predisposto. Levando em consideração a metodologia adotada e a amostra estudada, o número de pacientes com lesões cancerígenas da mucosa bucal é relevante, sendo de extrema importância para o cirurgião dentista identificar e prevenir tais doenças. Conclusão: Os dados coletados favorecerão o planejamento e execução de ações em saúde bucal para melhorar as condições de saúde desse grupo de pacientes. Além de estabelecer metas específicas associadas à prevenção do câncer bucal, visando uma melhora significativa na qualidade da assistência, identificando necessidades e propondo soluções para os problemas.
Palavras-chave: Neoplasias Bucais, Líquen Plano Bucal, Epidemiologia, Odontologia.
1. INTRODUCTION
Lichen planus is an immune-mediated chronic mucocutaneous inflammation that can affect the skin and mucosa simultaneously (WERNECK, MIRANDA, JUNIOR, 2016).
In the oral cavity, lichen planus is classified as a potentially malignable disease. Oral lesions can present in a reticular, erosive and papular form, with atrophic, erythematous, bullous or ulcerated areas and may progress to squamous cell carcinoma (Yang et al., 2015; Regezi; Sciubba, 2017). The atrophic, ulcerated and erosive forms represent the highest incidence of malignant transformation. The presence of dysplasia represents an increased risk of progression from lichen planus to squamous cell carcinoma (Canto et al., 2010).
The treatment of oral lichen planus is through corticosteroids, retinoids, cyclosporine, antihistamines and mouthwashes with lidocaine. Because it is a chronic disease, patients should be followed up every six months. (Regezi; Sciubba, 2017).
In this way, the dentist must know its main clinical characteristics in order to favor the correct diagnosis and adequate treatment of the patient affected by the disease (Neville et al., 2016). Early diagnosis and adequate therapy minimize its clinical manifestations, promoting a better prognosis and increasing the patient’s quality of life (CARVALHO et al., 2011).
The epidemiological survey of patients affected by oral lichen planus allows us to assess which factors the sick individuals share and which may or may not be related to the disease, so that care for this population can be instituted as standard (AMATO-CUARTAS et al., 2019). In a study, Vilanova et al. (2012) observed the relationship between oral lichen planus and stress and anxiety, which are common conditions in the general population.
In view of the importance of the subject, the focus of this study was to describe the clinical-epidemiological characteristics of a series of cases of oral lichen planus diagnosed at the CEO (Centro de Especialidade Odontológicas) in the city of Fernandópolis/SP in order to improve the care provided to this patient.
2. METHODS
This study was approved by the Research Ethics Committee of Universidade Brasil, Brazil under CAAE nº 47052821.8.0000.5494.
The present study is a non-experimental, cross-sectional, quantitative and descriptive study. The research was carried out through a survey of data from the medical records belonging to patients with oral lichen planus treated at the Centro de Especialidades Odontológicas (CEO), between the years 2016 to 2019.
After making a checklist to be used to obtain data from the patients’ charts, in order to eliminate unnecessary information for the research, 27 charts with a diagnosis of oral lichen planus were separated and tabulated according to epidemiological data such as gender; ethnicity; age; occupation and clinical data such as classification in reticular, erosive, plaque or could not be identified; lesion location.
3. RESULTS
Patients were assessed for age, gender, ethnicity and professional occupation (Chart 1). The respective lesions were evaluated in terms of clinical classification and anatomical location (Chart 2).
Table 1 – Epidemiological variables and respective categories analyzed in the present study.
| Epidemiologic variables | Categories |
| Sex | Feminine Male |
| Breed | White Black Brown Yellow Indigenous |
| Age | < 45 years 45-60 years > 60 years |
| Occupation | With sun exposure No sun exposure |
Table 2 – Clinical variables and respective categories analyzed in the present study.
| Clinical variables | Categories |
| Classification | Lichen Planus Reticularis Erosive Lichen Planus Plaque-like oral lichen |
| Anatomical location | Lips Judical mucosa Palate Tongue Gum |
A total of 38 medical records of patients with oral lichen planus were included in the study. The following figures show the distribution of the patients studied in terms of clinical and epidemiological characteristics. Regarding the age of the patients, the most affected age group is from the 4th decade of life onwards (Figure 1). With regard to gender, 10 patients were male and 28 were female. Regarding the ethnicity of the patients cataloged in the present study, 26 of the cases (%) occurred in Caucasians, 06 were brown patients, 02 were in yellow patients and 02 (%) were in black people.
Figure 1- Distribution of patients analyzed according to age group (n=38).
Figures 2 and 3 refer to the race and occupation of the cataloged patients.
Figure 2 – Distribution of patients analyzed according to ethnicity.
Figure 3 – Distribution of patients analyzed in terms of occupation.
As for the clinical classification of oral lichen planus, in 26 cases (%), in reticular lichen planus, followed by erosive lichen planus, 08 cases, and finally plaque-type oral lichen planus with 04 cases (Figure 4) .
Figure 4 – Distribution of patients analyzed regarding the clinical classification of oral lichen planus.
As for the anatomical location, in 15 cases, it is highlighted in the jugal mucosa, in 10 cases in the tongue, followed by lesions on the lip, in 07 cases (%), gingiva in 03 cases and finally on the palate in 3 cases (%). (Figure 5).
Figure 5 – Distribution of patients analyzed regarding the anatomical location of oral lichen planus (n=38).
Currently considered a public health problem, oral cancer needs detection in the early stages of the disease and especially of cancerous lesions in order to avoid possible dysplasias of these lesions prone to squamous cell carcinoma, increasing the expectation and quality of life of these patients. (Guerra et al., 2005)
Potentially malignant oral disorders include a variety of epithelial lesions and conditions, including dysplasia that reflects histological changes such as loss of uniformity or epithelial cell architecture (Torras et al., 2015).
Thus, the epidemiological study has great relevance, since it is the science that supports health planning based on collected population information, being essential in the production of knowledge and decision-making. Therefore, epidemiology plays a fundamental role in the reorganization of the health sector, by determining the prevalence of lesions found in a given geographic region, establishing preventive methods and promoting oral health (Gonçalves et al., 2017).
In the present study, in a universe of 38 patients, it is emphasized that most of the patients belong to the female gender. This result is similar to the research by Florêncio et al. (2011) in which the highest percentage were women, which, according to these authors, may be related to the greater contact with carcinogenic agents by the female population of that study.
With regard to the ethnicity of the patients analyzed in the present study, 26 cases (%) occurred in white people and 02 cases (%) in black people. The result obtained is in agreement with the study by Moro et al. (2018), in Santa Maria/RS, in which, of the 155 patients studied, most were white, corresponding to 95% of cases in relation to non-whites.
Regarding the classification of the most frequent lesions, reticular lichen planus with 26 cases, followed by erosive, with 08 cases (%). by language (10 cases-%).
The dentist has a key role in the early diagnosis of oral cancer and cancerous lesions, such as erythroplakia, nicotinic stomatitis, leukoplakia, erosive lichen planus and actinic cheilitis (Pérez et al., 2014).
4. DISCUSSION
Therefore, the number of patients with oral lichen planus is relevant, and it is extremely important for the dentist to identify and prevent such diseases.
Due to the number of patients with cancerous lesions of the oral mucosa of the oral lichen planus type, it demonstrates the need for affirmative policies, especially in the aforementioned epidemiological profile, being of paramount importance for the dentist to identify and prevent such diseases. As for the epidemiological characteristics of patients treated at the CEO (Centro de Especialidades Odontológicas) in the city of Fernandópolis/SP, the most prevalent were females, from the fourth decade of life, Caucasian and inhabitants of the northwest region of São Paulo. And as for the clinical characteristics were the reticular and erosive type, being the professional occupation with sun exposure. Early diagnosis and adequate therapy minimize its clinical manifestations, promoting a better prognosis and increasing the patient’s quality of life.
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1Master’s student in Dentistry with Concentration Area in Oral and Maxillofacial Surgery and Traumatology – São Paulo State University Júlio de Mesquita Filho – Brazil
2Oral and maxillofacial surgeon, Doctoral student in Dentistry with Concentration Area in Oral and Maxillofacial Surgery and Traumatology – São Paulo State University Júlio de Mesquita Filho – Brazil
3Dental Surgeon from Universidade Brasil, Fernandópolis/SP – Brazil
4Master’s student in Dentistry with Concentration Area in Oral and Maxillofacial Surgery and Traumatology – São Paulo State University Júlio de Mesquita Filho – Brazil
5Oral and maxillofacial surgeon, Doctoral student in Dentistry with Concentration Area in Oral and Maxillofacial Surgery and Traumatology – São Paulo State University Júlio de Mesquita Filho – Brazil
6PhD in Dentistry with Concentration in Implant Dentistry, Doctoral student in Dentistry with Concentration Area in Oral and Maxillofacial Surgery and Traumatology – São Paulo State University Júlio de Mesquita Filho – Brazil
7Oral and Maxillofacial Surgeon, Professor of the Department of Surgery and Diagnosis São Paulo State University Júlio de Mesquita Filho – Brazil
8PhD in Stomatology, Specialist in Stomatology – Brazil