What Is Erythroplakia?
Erythroplakia of the oral cavity is a specific disease entity that should be differentiated from normal inflammatory lesions occurring within the oral cavity. However, only biopsy and exfoliative cytology can detect oral cancers and assess potential risk from premalignant lesions like oral erythroplakia, leukoplakia, and leuko erythroplakia. Though the pathogenesis is not precisely elucidated in literature, tobacco chewing, and chronic alcohol usage are the risk factors that mainly predispose an individual to erythroplakia lesions. Research states these two detrimental habits are the main possible etiologic factors for developing erythroplakia over some time.
Clinical research and surveys indicate the predisposition of this condition in people who chew tobacco and are in chronic or long-term alcohol drinking. The risk of precancerous lesions turning malignant is always high in these elaborated populations, that is, addicts or victims of smoking, tobacco consumption, chronic alcoholism, lifestyle diseases, stress, systemic diseases, and immunocompromised patients. The general hypothesis is that oral cancer may arise from premalignant or potentially premalignant disorders. This demonstrates that oral erythroplakia, primarily identified as the lesions with the highest malignant transformation rates, needs timely diagnosis and management.
How Prevalent Is Erythroplakia?
Less frequently than leukoplakia, erythroplakia affects approximately one in 2,500 adults in the United States.
How Dangerous Is Erythroplakia?
According to medical professionals, erythroplakia is a precancerous disorder. The majority of lesions are benign; however, some are malignant and may develop into a malignancy. Make an appointment with a doctor or dentist as soon as possible if there are any unusual lesions in the mouth. A biopsy will be carried out to determine if the lesion is malignant.
What Are the Clinical Features of Erythroplakia?
Erythroplakia is mainly characterized by fiery red patches in the oral mucous membranes of the oral cavity that cannot be clinically or pathologically identifiable as any other definable disease entity. The clinical appearance in affected individuals is characterized by flat or depressed lesions that undergo an erythematous mucosa change. When red and white changes are detectable in the oral mucosa around the same lesion, they are called erythroleukoplakia. According to traditional evidence and documentation, the prevalence of erythroplakia ranges between 0.02 percent and 0.83 percent. However, lesions occur or impact the middle-aged and elderly
population more frequently. The peak incidence of the disease occurs in tobacco users who have been in this habit for several decades or victims of chronic alcoholism. The locations more commonly involved in developing these lesions are:
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The mandibular alveolar mucosa.
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The mandibular gingiva.
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The mandibular sulcus region.
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The floor of the mouth region.
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The retromolar pad area.
Clinically, the typical lesions present in oral erythroplakia may be less than 0.59 inches. Still, they may range anywhere from 0.39 inches to greater than 1.57 inches, depending on the extent of the condition. In addition, the male gender is comparatively more frequently affected than the females. Therefore, the dentist considers the occurrence of solitary red or red-and-white combination lesions that occur over the surface of any part of the oral cavity as a lesion worth investigating for erythroplakia.
What Is the Risk of Malignant Transformation of Erythroplakia?
According to research studies, identifying the p53 mutations in the gene is associated with high prevalence rates in developing premalignant oral erythroplakia. Upon histopathological observation of this condition, most of the cells have not turned malignant yet or are undergoing any dysplastic features that signify the serious nature of the disease. In severe cases of erythroplakia, case reports of approximately 91 % of the specimens have been associated with either invasive forms of carcinoma, in situ carcinoma, or severe forms of epithelial dysplasia. Though the occurrence of erythroplakia lesions is low, they have a higher chance of malignant transformation.
How to Diagnose Erythroplakia?
Though, in recent decades, dentistry, as well as oral pathology, has witnessed significant advances in treatment as well as timely detection of oral cancer by biopsy and exfoliative cytology methods, the survival rates are still low for oral cancers that are of the aggressive origin or because of the leading unawareness in rural areas or people who ignore their oral health. Hence, histopathologic examination plays a crucial role in diagnosis, apart from the surgeon's in-clinic evaluation of oral lesions. The dental surgeon assesses the patient by taking detailed medical and dental history and evaluating premalignant oral lesions. The features most important to be noted are the time span since the lesion presented or existed, the changes in texture, shape, or lesion size, the presence or absence of pain, history of dental trauma, bleeding, dysphagia, odynophagia, trismus, weight loss, as well as habit history of smoking or alcohol exposure. In addition, focusing on the medical history and drug history of patients suffering from autoimmune disorders and organ transplants is vital. It can help the dental surgeon identify high-risk cases of developing oral cancer.
How Long Does Recovery From Erythroplakia Take?
Several variables, such as the kind of operation carried out, the dimension of the lesion, and the body's ability to heal, affect how quickly patients recover from erythroplakia therapy. After undergoing laser therapy or cryotherapy, the majority of patients usually recover completely in three to four weeks. A complete recovery from cancer therapies may take several weeks or months.
What Is the Differential Diagnosis of Erythroplakia?
As the risk of malignant transformation rate is high (from 14 to 50 percent approximately), the dental surgeon should establish the differential diagnosis correctly. The differential diagnosis should be elicited to identify actual lesions of erythroplakia and should not be confused with the following conditions by histopathologic examination and history:
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Oral candidiasis.
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Histoplasmosis.
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Tuberculosis of the oral cavity.
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Lupus erythematosus.
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Lingual varices.
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Initial stages of squamous cell carcinoma.
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Drug-associated mucositis.
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Median rhomboid glossitis.
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Oral purpuras.
How to Manage Erythroplakia?
People with a history of detrimental habits, such as tobacco users or alcoholics, should carefully observe if the lesions are aggravating or not subsiding over time. As it is not a self-limiting condition, the dentist may perform a biopsy and cytology and confirm the exact diagnosis after the histopathologic examination. These lesions require prompt treatment even if they have no risk of malignant transformation, yet by surgical management with surgical excision of lesions by cold knife, cryosurgery, or laser therapy. Frequent dental follow-ups and proper oral hygiene, alongside motivation to quit smoking and alcohol, would help improve the long-term prognosis of these individuals.
Can Erythroplakia Be Prevented?
Erythroplakia can occasionally occur for unknown reasons. There are steps people can take to lower the likelihood of developing erythroplakia, such as:
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Steer clear of all tobacco products.
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Minimize or give up drinking alcohol.
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Maintain proper dental hygiene.
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See the dentist regularly.
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Get the dentures examined every two to three years if one wears them.
Conclusion
An early or prompt diagnosis of erythroplakia can indeed be beneficial in preventing the significant risks that are associated with the malignant potential of this condition. In addition, patient education and awareness about the ill effects of tobacco usage, smoking, alcoholism, and motivation towards maintaining proper oral hygiene, going for regular dental follow-ups, and timely management of the erythematous lesions by surgery would help prevent life-threatening or severe forms of oral cancer.
