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By Dr. Rita Colaci , Prof. Gian Luca Sfasciotti
Corresponding Author Dr. Rita Colaci
Department of Oral and Maxillo-Facial Science, "Sapienza" University of Rome, - Italy
Submitting Author Dr. Rita Colaci
Other Authors Prof. Gian Luca Sfasciotti
Department of Oral and Maxillo-Facial Science, "Sapienza" University of Rome, - Italy

DENTISTRY

Epidemiology, childhood oral mucosal lesions, paediatric population, Recurrent Aphthous Stomatitis, Tongue diseases, Herpes labialis, Oral Candidiasis

Colaci R, Sfasciotti G. Most common oral mucosal lesions in children: Prevalence and differential diagnosis. WebmedCentral DENTISTRY 2013;4(12):WMC004483
doi: 10.9754/journal.wmc.2013.004483

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
No
Submitted on: 30 Dec 2013 07:47:44 PM GMT
Published on: 31 Dec 2013 05:03:48 AM GMT

Abstract


Childhood oral mucosal lesions (COML) are one of the rare topics that pediatricians, dentists, and dermatologists are interested in. Considering the high number of lesions which can be found in children oral mouth, it becomes really important to make a correct diagnosis in order to plan the right research and treatment. So far studies for the incidence and classification of COML have been rare and, above all, they didn't have a certain standard, with regard to age grouping and methods. As a consequence, these studies have shown a wide variability in the prevalence of oral mucosal lesions in different regions of the world and have led researchers to draw disparate conclusions. This paper, reviewing the different epidemiological studies found in literature, wants to contribute data on the most common  oral mucosal diseases in children in terms of prevalence and differential diagnosis.

Introduction


In the maintenance of children oral health, specialists have to consider more than one purpose: ensuring a complete permanent dentition, a correct periodontal condition and finally a good health of the others oral structures. Childhood oral mucosal lesions (COML) are one of the rare topics that pediatricians, dentists, and dermatologists are interested in. Considering the high number of lesions which can be found  in children oral mouth, it becomes really important to make a correct diagnosis in order to plan the right research and treatment. An inadequate conduct during child oral examination and an inability to do a differential diagnosis between COML, can bring to overlook important diseases or to adopt unnecessary treatment plans. So far studies for the incidence and classification of COML have been rare and, above all, they didn’t have a certain standard, with regard to age grouping and methods. The aim of this article is to make a comparison between the different epidemiological studies in literature to find relevant data concerning the prevalence of oral mucosal lesions in the paediatric population.

Methods


Reviewing the literature, we found 12 epidemiological studies published from 1988 to 2013, each one considering the prevalence of children oral mucosal lesions among different regions throughout the world. As regards countries of origin of each study, 3 of them came from Brazil, 2 from Mexico, 2 from USA and 1 from Italy, Turkey, Spain, South Africa, and Argentina, respectively.

The selected studies showed a considerable variation in the prevalence of oral mucous lesions in examined children; in fact, the percentage of lesions ranges from 4.1 to 69,5 %. Moreover a comparison between the surveys faces considerable methodological problems because of the absence of standard protocols and the wide variation in the methods used; in particular the number of examined children of each research varies from 299 to 39206. In table 1, main features of each article (publication year, country of origin, number of examined children, total prevalence of oral lesions) are shown.

As regards the prevalence found for each lesion, they varies widely among research groups. In table 2, the frequencies of the most common children oral mucosal lesions found in each epidemiological study are presented.

Discussion


Even if the reported prevalence for each lesion is quite different, the various authors agree almost completely on the most frequently observed oral mucosal lesions in children; in particular, they are aphthous stomatitis, labial herpes, geographic, coated and scrotal tongue, candidiasis and traumatic oral lesions.

Recurrent Aphthous Stomatitis (RAS):The prevalence of RAS in the examined studies ranges from 0,67 to 10,87%. While Bessa et al.[3] found no significant association between the prevalence of RAS and socioeconomic level, Crivelli et al.[5] in a previous research,  observed an important difference between the prevalence of RAS in high level school students and low level school ones (19 % and 12%, respectively). In addition, Majorana et al.[10] in their study noticed that RAS was more common in children affected by systemic disease (immunodeficiency, nutrional deficiencies, malabsorption, celiac disease) than in healty children.

Recurrent Herpes labialis (RHL): The prevalence of RHL in the examined studies ranges from 0,2 to 5,20 %. Interestingly, Crivelli et al.[5] found that RHL lesions appeared in 10 % of a low socioeconomic level group and in 1% of a high socioeconomic level group, the inverse of the findings for EAR. Majorana et al.[10] expressed limitations of their study in evaluating the prevalence of recurrent alterations such as RAS or RHL because the oral mucosal lesions were diagnosed after only a single examinations of each patients.

Tongue Diseases (Geographic, Coated and Scrotal Tongue) Epidemiological studies have shown a high frequency of tongue diseases among mucosal lesions of the oral cavity, although the prevalence varies in different parts of the world. Kleiman [9]have stated that the study of tongue alteration in children is often overlooked. As regards geographic tongue, it is by far the most common tongue diseases reported in almost all studies; its onset starts in childhood, sometimes at a very early age [4] and occasionally in puberty with a predominant presence in female. Majorana et al.[10] found a high prevalence of this lesion in children with chronic disease, suggesting that underlying pathophysiologic abnormalities or the drugs these children take may account for this disorder. Regarding coated tongue, many authors have not considered it as a disease. On the other hand, the study of Garcìa-Pola [7]as well as the research of Viera-Andrade[15] which both included coated tongue as an oral mucosal lesion, found that it was the most frequently observed diseases . Finally, the prevalence of scrotal tongue in the examined studies ranges from 0,6% to 27,7%, being the second most frequently observed tongue diseases in various studies. Interestingly, Sedano et al. [13]underlined that the prevalence of scrotal tongue is higher in individuals with geographic tongue and vice-versa. This association can point out the importance of genetic factors in the pathogenesis of both these tongue diseases.

Oral Candidiasis:In the study of Yilmaz et al.[16], candidiasis was the most common lesion found (10, 70%); moreover they underlined  that  the prevalence was higher in infants who were breastfeeding compared to bottle usage. Majorana et al.[10] observed that oral candidiasis was more likely to occur in children with systemic diseases, owing to local and systemic predisposing factors. In addition, Espinosa-Zapata et al.[6]have reported that the erythematous type was the most common found as well as the hard palate the most frequent localization.  

Traumatic Oral Lesions: Examined studies found a prevalence of traumatic injuries which ranges from 0,09 to 12,17%. In the study by Garcìa–Pola [7], they were the second most common oral disease in children after the coated tongue. Moreover, Majorana et al.[10] have not observed significant differences between healthy and systemically affected children regarding the prevalence of traumatic lesion; this can be explain considering that soft tissue lesions caused by incorrect habits such as cheek biting, morsicatio buccarum, tongue or lip sucking, object biting or by local injuries were common in both groups.

Conclusions


A complete oral examination is an essential part of any dermatological and pediatric examination. Unfortunately, the oral cavity is frequently examined in a fleetting manner, particularly in the context of an uncooperative child.

The frequency of children with oral mucosal lesions and the prevalence of each lesion show a wide range of literature and this may be a result of the difference of geographic areas, sociodermographic characteristics of the population studied, and the clinical diagnostic criteria. Although examined studies have provided helpful information in this field, the lack of uniformity in the criteria adopted by the researchers makes it difficult to draw coherent conclusions. Therefore, an appropriate protocol should be create in order to exactly evaluate the prevalence of the most common oral mucosal lesions in children and their association with a particular condition (age, gender, systemic disease, socioeconomic level).

References


1. Arendorf TM, Van der Ross R. Oral lesions in a black pre-school South African population. Community Dent Oral Epidemiol 1996;24:296-97.
2. Benevides dos Santos PJ, Ferreira C, Ferreira de Aguilar MC, Vieria do Carmo MA. Cross-sectional study of oral mucosal conditions among a central Amazonian Indian comunity, Brazil. J Oral Pathol Med 2004;33:7-12.
3. Bessa CFN, Santos PBJ, Aguilar MCF, Do Carmo MAV. Prevalence of oral mucosal alterations in children from 0 to 12 years old. J Oral Pathol Med 2004;33:17-32.
4. Bezerra S, Costa Isabel. Oral conditions in childrens from birth to 5 years: the findings of a children’s dental program. J Clin Pediatr Dent 2000;25:79-81.
5. Crivelli MR, Aguas S, Quarrancino C, Bazerque P. Influence of the socioeconomic estatus on oral mucosa lesion prevalence in schoolchildren. Community Dent Oral Epidemiol 1988;16: 58-60.
6. Espinosa-Zapata M, Loza-Hernández G, Mondragón-Ballesteros R. Prevalencia de lesiones de la mucosa bucal en pacientes pediátricos. Informe preliminar. Cir Ciruj 2006;74:153-157.
7. García-Pola MJ, García JM, González M. Estudio epidemológico de lapatología de la mucosa oral en la población infantil de 6 años de Oviedo(España).Medicina Oral 2002;7:184- 91.
8. Kleiman DV, Swango PA, Niessen LC. Epidemiologic studies of oral mucosal conditions-methodologic issues. Community Dent Oral Epidemiol 1991;19:129-40.
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10. Majorana A, Bardellini E, Flocchini P, Amadori F, Conti G, Campus G. Oral mucosal lesions in children from 0 to 12 years old: ten years’ experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:e13-e18.
11. Rioboo R. Estudio epidemiológico de las enfermedades y alteraciones bucodentales: patrones cambiantes y tendencias. Epidemiología de las lesiones de los tejidos blandos. En: Rioboo R. Odontología preventiva y odontología comunitaria.Madrid: Ed Avances; 2002. p. 1127-54.
12. Rioboo-Crespo MR, Planells-del Pozo P, Rioboo-García R. Epidemiology of the most common oral mucosal diseases in children. Med Oral Patol Oral Cir Bucal 2005;10:376-87.
13. Sedano HO y col. Clinical orodental abnormalities in Mexican children. Oral Surg Oral Med Oral Pathol 1989;68: 300-11.
14. Shulman JD. Prevalence of oral mucosal lesions in children and youths in the USA. Int J Paed Dent 2005;15(2):89-97.
15. Vieira-Andrade RG, Martins-Jùn PA, Correa-Faria P, Stella PEM, Marinho SA, Marques LS, Ramos-Jorge ML. Oral mucosal conditions in preschool children of low socioeconomic status: prevalence and determinant factors. Eur Jour Ped 2013; 172(5): 675-681.
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Source(s) of Funding


No source of funding.

Competing Interests


No competing interests.

Reviews
2 reviews posted so far

Childhood Oral Mucosal Lesions
Posted by Prof. Alessandro L Cavalcanti on 08 Feb 2014 02:36:14 PM GMT Reviewed by WMC Editors

Oral Mucosal Lesions in Children
Posted by Dr. William J Maloney on 31 Jan 2014 02:28:26 PM GMT Reviewed by Interested Peers

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