Occurrence of oral leukoplakia and lichen planus in diabetes mellitus
Mitna Albrecht\ Joidn Bandczy\ EIek Dinya^ and Gyula Tamds Jr^ Department ot 'Conservative Dentistry. 'First DepartmenI ot Internal Medicine. 'Computer Center. Semmelweis University ot Medicine, Budapest, Hungary
Albrecht M. Banoczy J. Dinya E. Tamas Gy Jr; Occurrence of oral leukoplakia and lichen planus in diabetes mellitus. J Oral Pathol Med 1992; 21: 364-6. The occurrence of oral leukoplakia and lichen planus in 1600 patients with diabetes mellitus (815 type 1: insulin-dependent. 761 type 2: non-insulin-dependent) - under care at the International Medicine Department - was studied. Precancerous lesions and conditions were diagnosed and grouped according to internationally accepted criteria. The prevalence of oral leukoplakia in diabetic patients was 6.2'!^!. as compared to 2.2% in the healthy controls, that of oral lichen was 1.0"/. in the test-, and 0.0% in the control group. Leukoplakia and lichen both showed the highest occurrence in the second year of established diabetes, and their prevalence was higher among insulin-treated diabetics. Smokers were more often affected, by both kind of lesions, oral lichen showed a more frequent association with candidiasis. The prevalence of oral leukoplakia and lichen in diabetes mellitus patients was higher, than average ratios in population samples from the same country.
It is generally known from the literature, that accompanying symptoms of diabetes mellitus: poor oral hygiene, hyposalivation and xerostomia might be predisposing factors for an increased susceptibility of infections (1). and for the development of oral mucosal disea.ses (2). The atrophic oral mucosa might promote the development of leukoplakia, and other precancerous lesions, resp. conditions (3). However, numerous reports assume an association between diabetes mellitus and oral lichen planus. ba.sed on immunologic changes, observed in both diseases (4-6). Some authors reported a decreased glucose tolerance in oral lichen patients (7 9). however, this observation was not confirmed by other investigators (10. 11). The prevalence of manifest diabetes mellitus among oral lichen patients varies between 1.6%, and 37.7%, according to different investigators (Table I). Only a few studies deal with the occurrence of oral lichen in diabetics (17). Thus, data on the association between diabetes and oral lichen are conflicting both in relation to the prevalence of diabetes in oral lichen patients, and the prevalence of oral lichen in diabetics. The aim of the present study was: 1) to establish the prevalence of oral leukoplakia and oral lichen planus among diabetics, as compared to the healthy population: and 2) to examine.
Key words: diabetes mellitus: leukoplakia, oral: lichen planus, oral. Mdria Albrecht, Department of Conservative Dentistry. 5. MikszSth KSimSn t6r, H-1088 Budapest, Hungary Accepted lor publication February 27, 1992.
whether the occurrence of oral mucosal diseases showed any connection with the type, duration and therapy of diabetes.
Material and methods The material consisted of 1600 people with diabetes tncllitus, treated at the Di-
Table I. Prevalence of diabete!) in oral lichen patients Oral lichen patient Total Year
Author G R I N S P A N et al. (12) H ( ) W I : L I . & R I C K {\?I)
1973 1973 1977 1980 1983 1985
KovKsi & B A N 6 ( / . Y (14) ClIRISTHNShN Ci a I. ( I I ) H ( ) R N s n : i N (•/ al. ( 1 5 ) LtJNtXStRiiM ( 9 ) S t r v i : R M A N et al. ( 1 6 )
With diabetes
n
n
%
61 316 326 123
23 41 17 2 17 II 33
37.7 12.9
92 40 570
5.2 1.6
8.4 28.0 5.8
Table 2. Distribution of patients material according to sex and age Control
Diabetic Age groups
Men //
Women n
Total /;
Men /;
Women /(
Total n
162 82 43 19 40
198 117 64 30 53
41
55
58 9
84 16
454
617
45
18
63
36
117 143 114 75
46
45 52
163 188 166
35 21 II
72
147
51
60
55 +
164 271
149 178
III 313 449
13 14 26 7
Total
980
620
1600
163
15 20 25 30 .35 40 45
19 24 29 34 39 44 54
Oral letikoplakia and lichen in diabetes 365 Table 3. Prevalence of leukoplakia and lichen according to the duration of diabetes Group
Control Diabetic
Lesion
Duration of diabetes in yr 0-1
1-2
2-5
n = 141
;:1 = 211
= 621
5-10
n = 256
10 +
n = 518
Total
n = 473
Leukoplakia
n
"A\
n
"A
n
%
n
%
n
homogeneous non-homogeneous verrucous erosive
1
3.3
6
4.2
12
4.7
14
2.7
38
0 0
0.0 0.0
4 4
2.8 2.8
4 1
1.6 0.4
2 1
0.4 0.2
Total leukoplakia Lichen
7 1
3.3 0.5
14 4
9.9 2.8
17 3
6.6 1.2
17 2
3.3 0.4
0 =
1600 0/
%
n
%
n
8
11
4.8
14
2.2
4
0.8 0.4
14 8
0.9 0.5
0 0
0.0
44 7
9.3 1.5
99 17
6.2 1.0
14 0
2.2 0.0
Leukoplakia prevalence/duration of diabetes: NS.
sis was diagnosed clinically on the basis of generally accepted criteria (21). Of the diabetics. 815 were type 1: insulin-dependent, and 761 type 2: noninsulin-depetident. treated by tablets or diet alone. The dtiration of diabetes is shown in Table 2. In the diabetic group 581 (36.3%). in the control group 140 persons (22.5%) were regular smokers. Data processing were performed by the help of the BMDP program package 1983. using Chi square tests, and analysis of variance. Significance tests were done at the 5 per cent level.
abetes Outpaticnls Clinic of the Department of Internal Medicine. The control group was made up of 621 textile workers, without known systemic disease (Table 2). The patients were examined sitting in a dental chair, in artificial light, using two mouth mirrors. Before the examination the chairside assistant filled a precodcd questionnaire, with anamnestic data on diabetes and other systemic disea.ses. questions on tobacco habits and subjective complaints. The oral examinations wete performed by the same dentist (MA). Clinical criteria for the diagnosis of precancerous lesions and conditions were used on the basis of previous classifications (2. 19). tnodified and grouped in accordance with recently accepted criteria (20). Candidia-
Results The prevalence of oral leukoplakia in diabetic patients was 6.2%. as compared
Table 4. Prevalence of leukoplakia and lichen in diabetics according to type o( therapy Therapy Diet n
Lesion
Leukoplakia homogeneous non-homogeneous
Insulin
Tablets
"/,
n
"A,
6.6
10 12.9
Control
Total
Diabetics
n
"A,
62 80.5
n
n
%
%
14 100.0
77 77.8
2 1
14.4 12.5
4 0
28.5 0
8 7
57.1 87.5
14 8
14.1 9.1
0 0
0 0
Total leukoplakia
8
9.1
14
14.1
77
77.8
99 100.0
14
100.0
Lichen
3
17.7
4
23.5
10
58.8
17 100.0
0
0
verrucous erosive
Table 5. Prevalence of leukoplakia and lichen according to smoking habits
^ 581
Leukoplakia
Lichen
n
y«
n
67
11.5
8
1
Prevalence in sniokers/non smokers: P
Mitna Albrecht\ Joidn Bandczy\ EIek Dinya^ and Gyula Tamds Jr^ Department ot 'Conservative Dentistry. 'First DepartmenI ot Internal Medicine. 'Computer Center. Semmelweis University ot Medicine, Budapest, Hungary
Albrecht M. Banoczy J. Dinya E. Tamas Gy Jr; Occurrence of oral leukoplakia and lichen planus in diabetes mellitus. J Oral Pathol Med 1992; 21: 364-6. The occurrence of oral leukoplakia and lichen planus in 1600 patients with diabetes mellitus (815 type 1: insulin-dependent. 761 type 2: non-insulin-dependent) - under care at the International Medicine Department - was studied. Precancerous lesions and conditions were diagnosed and grouped according to internationally accepted criteria. The prevalence of oral leukoplakia in diabetic patients was 6.2'!^!. as compared to 2.2% in the healthy controls, that of oral lichen was 1.0"/. in the test-, and 0.0% in the control group. Leukoplakia and lichen both showed the highest occurrence in the second year of established diabetes, and their prevalence was higher among insulin-treated diabetics. Smokers were more often affected, by both kind of lesions, oral lichen showed a more frequent association with candidiasis. The prevalence of oral leukoplakia and lichen in diabetes mellitus patients was higher, than average ratios in population samples from the same country.
It is generally known from the literature, that accompanying symptoms of diabetes mellitus: poor oral hygiene, hyposalivation and xerostomia might be predisposing factors for an increased susceptibility of infections (1). and for the development of oral mucosal disea.ses (2). The atrophic oral mucosa might promote the development of leukoplakia, and other precancerous lesions, resp. conditions (3). However, numerous reports assume an association between diabetes mellitus and oral lichen planus. ba.sed on immunologic changes, observed in both diseases (4-6). Some authors reported a decreased glucose tolerance in oral lichen patients (7 9). however, this observation was not confirmed by other investigators (10. 11). The prevalence of manifest diabetes mellitus among oral lichen patients varies between 1.6%, and 37.7%, according to different investigators (Table I). Only a few studies deal with the occurrence of oral lichen in diabetics (17). Thus, data on the association between diabetes and oral lichen are conflicting both in relation to the prevalence of diabetes in oral lichen patients, and the prevalence of oral lichen in diabetics. The aim of the present study was: 1) to establish the prevalence of oral leukoplakia and oral lichen planus among diabetics, as compared to the healthy population: and 2) to examine.
Key words: diabetes mellitus: leukoplakia, oral: lichen planus, oral. Mdria Albrecht, Department of Conservative Dentistry. 5. MikszSth KSimSn t6r, H-1088 Budapest, Hungary Accepted lor publication February 27, 1992.
whether the occurrence of oral mucosal diseases showed any connection with the type, duration and therapy of diabetes.
Material and methods The material consisted of 1600 people with diabetes tncllitus, treated at the Di-
Table I. Prevalence of diabete!) in oral lichen patients Oral lichen patient Total Year
Author G R I N S P A N et al. (12) H ( ) W I : L I . & R I C K {\?I)
1973 1973 1977 1980 1983 1985
KovKsi & B A N 6 ( / . Y (14) ClIRISTHNShN Ci a I. ( I I ) H ( ) R N s n : i N (•/ al. ( 1 5 ) LtJNtXStRiiM ( 9 ) S t r v i : R M A N et al. ( 1 6 )
With diabetes
n
n
%
61 316 326 123
23 41 17 2 17 II 33
37.7 12.9
92 40 570
5.2 1.6
8.4 28.0 5.8
Table 2. Distribution of patients material according to sex and age Control
Diabetic Age groups
Men //
Women n
Total /;
Men /;
Women /(
Total n
162 82 43 19 40
198 117 64 30 53
41
55
58 9
84 16
454
617
45
18
63
36
117 143 114 75
46
45 52
163 188 166
35 21 II
72
147
51
60
55 +
164 271
149 178
III 313 449
13 14 26 7
Total
980
620
1600
163
15 20 25 30 .35 40 45
19 24 29 34 39 44 54
Oral letikoplakia and lichen in diabetes 365 Table 3. Prevalence of leukoplakia and lichen according to the duration of diabetes Group
Control Diabetic
Lesion
Duration of diabetes in yr 0-1
1-2
2-5
n = 141
;:1 = 211
= 621
5-10
n = 256
10 +
n = 518
Total
n = 473
Leukoplakia
n
"A\
n
"A
n
%
n
%
n
homogeneous non-homogeneous verrucous erosive
1
3.3
6
4.2
12
4.7
14
2.7
38
0 0
0.0 0.0
4 4
2.8 2.8
4 1
1.6 0.4
2 1
0.4 0.2
Total leukoplakia Lichen
7 1
3.3 0.5
14 4
9.9 2.8
17 3
6.6 1.2
17 2
3.3 0.4
0 =
1600 0/
%
n
%
n
8
11
4.8
14
2.2
4
0.8 0.4
14 8
0.9 0.5
0 0
0.0
44 7
9.3 1.5
99 17
6.2 1.0
14 0
2.2 0.0
Leukoplakia prevalence/duration of diabetes: NS.
sis was diagnosed clinically on the basis of generally accepted criteria (21). Of the diabetics. 815 were type 1: insulin-dependent, and 761 type 2: noninsulin-depetident. treated by tablets or diet alone. The dtiration of diabetes is shown in Table 2. In the diabetic group 581 (36.3%). in the control group 140 persons (22.5%) were regular smokers. Data processing were performed by the help of the BMDP program package 1983. using Chi square tests, and analysis of variance. Significance tests were done at the 5 per cent level.
abetes Outpaticnls Clinic of the Department of Internal Medicine. The control group was made up of 621 textile workers, without known systemic disease (Table 2). The patients were examined sitting in a dental chair, in artificial light, using two mouth mirrors. Before the examination the chairside assistant filled a precodcd questionnaire, with anamnestic data on diabetes and other systemic disea.ses. questions on tobacco habits and subjective complaints. The oral examinations wete performed by the same dentist (MA). Clinical criteria for the diagnosis of precancerous lesions and conditions were used on the basis of previous classifications (2. 19). tnodified and grouped in accordance with recently accepted criteria (20). Candidia-
Results The prevalence of oral leukoplakia in diabetic patients was 6.2%. as compared
Table 4. Prevalence of leukoplakia and lichen in diabetics according to type o( therapy Therapy Diet n
Lesion
Leukoplakia homogeneous non-homogeneous
Insulin
Tablets
"/,
n
"A,
6.6
10 12.9
Control
Total
Diabetics
n
"A,
62 80.5
n
n
%
%
14 100.0
77 77.8
2 1
14.4 12.5
4 0
28.5 0
8 7
57.1 87.5
14 8
14.1 9.1
0 0
0 0
Total leukoplakia
8
9.1
14
14.1
77
77.8
99 100.0
14
100.0
Lichen
3
17.7
4
23.5
10
58.8
17 100.0
0
0
verrucous erosive
Table 5. Prevalence of leukoplakia and lichen according to smoking habits
^ 581
Leukoplakia
Lichen
n
y«
n
67
11.5
8
1
Prevalence in sniokers/non smokers: P
