2023 National Love Teeth Day Core Message (VII) Pay attention to changes in oral mucosa of the elderly and prevent oral cancer

Author: Jin Jianqiu , Beijing Hospital ; Liu Hongwei, Peking University School of Stomatology

What is oral mucosa?

First of all, "lips" are part of the oral mucosa. In addition, the moist, smooth, pink parts of the mouth are all oral mucosa, including the surface of the tongue. We need to use the oral mucosa every day to eat, drink, talk and even breathe, so it needs to withstand friction, stay moist, and not develop lesions in order to better serve us.

Diseases of various forms and types that occur in the oral mucosa and other soft tissues are collectively referred to as oral mucosal diseases. There are many causes of the disease, most of which recur and last for a long time.

Oral mucosal diseases may occur alone in the oral cavity, or they may occur together with skin diseases. Sometimes systemic diseases may also have unique oral manifestations. Therefore, we should pay attention to changes in the oral mucosa. If we find any abnormalities, we should first take a clear photo with our mobile phone and show it to the dentist during the consultation.

Elderly people are more likely to have oral mucosal diseases due to the aging of their organs and tooth loss, so they should pay more attention to its changes. For example, if you find that the oral mucosa is rough and thickened, or some areas have white spots (Figure 1), red spots (Figure 2), purple spots or even black spots, you should seek medical attention in time.

Figure 1 White spots on the left cheek

Figure 2 Left tongue flank erythema

So what diseases are most likely to occur in the oral mucosa?

The most common type is recurrent oral ulcers (Figure 3). Some ulcers can heal in a few days, while others recur, lasting 7 to 10 days each time, almost every month. Oral ulcers usually occur one or several times each time, with regular shapes, round or oval, sunken in the mucosal surface, with clear boundaries with the surrounding area, obvious pain, inconvenience in eating and talking, and serious impact on quality of life.

Figure 3 Recurrent oral ulcers

Most oral ulcers have a good prognosis and can be cured by using external medications such as mouthwash and ulcer powder. They can also be treated with long-term external or oral Chinese medicine, and the effect is very significant. However, when ulcers in the mouth do not heal for more than 3 months, or even hyperplasia and nodules, you must be alert and go to the hospital for examination as soon as possible, because it may be a precursor to oral cancer. There are also diseases such as oral lichen planus (Figure 4), oral candidal infection, leukoplakia, and erythema that also increase in incidence in the elderly, and some of these diseases are oral precancerous lesions.

Figure 4 Oral lichen planus

Although the incidence of oral cancer is not high, it has an insidious onset and progresses rapidly, so it needs to be taken seriously. There are many causes for oral cancer, and the main risk factors include smoking, alcoholism, betel nut chewing, infection with human papillomavirus or Candida albicans, poor oral hygiene habits, poor oral restorations, insufficient intake of fruits and vegetables, and ultraviolet radiation.

Oral cancer mainly occurs in middle-aged and elderly people, and is more common in men than in women. It is mostly squamous cell carcinoma (Figure 5). Depending on the location of the disease in the oral mucosa, it can be divided into lip cancer, tongue cancer, and cheek cancer. If oral cancer is not discovered in time, it is easy to metastasize to multiple organs in the body, such as the cervical lymph nodes or lungs.

Figure 5 Oral squamous cell carcinoma of the upper palate

Oral cancer is usually treated with surgical resection, which results in large areas of tissue loss. If the surgery is not thorough, it is easy to relapse. Therefore, it is necessary to detect changes in the oral mucosa as early as possible, otherwise it will seriously affect health.

In order to protect our fragile oral mucosa, we also need to protect it from adverse stimulation, such as quitting smoking and drinking, chewing less hard objects or eating less hot food, not chewing betel nuts, etc. Early prevention, early detection, and early treatment will make the oral mucosa work better for us!