Oral potentially malignant disorders: leukoplakia, erythroplakia, oral submucosal fibrosis. Systematic review of associated risk factors
Authors: Motelica Cristinela , Motelica Gabriela , Ciochina Irina , Argittu Claudio , Beliniuc Sergiu , Chele Nicolae , Marcu Diana 
Published: December 2024

Introduction. Oral potentially malignant disorders (OPMD) represent a heterogeneous group of oral mucosal disorders associated with an increased risk of malignant transformation. The specialty literature indicates that tobacco consumption in various forms, such as smoking products containing tobacco, reverse smoking, chewing tobacco, alcohol consumption, consumption of areca (betel) nuts, are the factors most often involved in the development of OPMD. The aim of the study. Systematic review of scientific researches and clinical trials on risk factors involved in the development of leukoplakia, erythroplakia and oral submucosal fibrosis. Material and methods. To carry out the systematic review, scientific researches and clinical studies from the last 5 years available on the platforms PubMed, Embase, Scopus and Cochrane Library were analyzed. The identification of the studies was based on the presence in them of the terms specific to the topic of the systematic review and the data analysis was carried out by 2 doctors - dento-alveolar surgeons independently. Results. 16 articles that met the inclusion criteria were analyzed, with a total of 3874 patients, 5 articles - risk factors of leukoplasia, 2 articles - risk factors of erythroplasia, 4 articles risk factors of oral submucosal fibrosis and 5 articles included studies of risk factors for two or all three forms of OPMD examined. Conclusion. The mucosa of the oral cavity is constantly subjected to external aggressions in the case of patients with harmful habits such as the consumption of tobacco, alcohol or other products with a carcinogenic effect that prove to be high risk factors in the development of oral lesions with malignant potential.Oral potentially malignant disorders (OPMD) represent a heterogeneous group of oral mucosal lesions associated with an increased risk of malignant transformation into invasive forms of oral cavity cancer. A systematic review of the prevalence of oral potentially malignant disorders by Mello FW et al. in 2018 [14], reports that approximately 4.5% of the world’s population presents OPMD, the study being based on the presence at the given stage of scientific researches from different geographical regions. Leukoplakia, erythroplakia and oral submucosal fibrosis represent 3 of the most common types of oral potentially malignant disorders [20]. At the current stage, the specialty literature assert the fact that OPMD are polyetiological, rarely being involved only on a single risk factor in their development [6]. Tobacco consumption in various forms, such as smoking products containing tobacco, reverse smoking, chewing tobacco, alcohol consumption, consumption of areca (betel) nuts, are the factors most often incriminated in the development of oral potentially malignant disorders Chewing tobacco is a major risk factor for all three previously mentioned entities, while smoking tobacco products increases the risk of predominantly developing leukoplakia, chewing areca nuts is associated with the development of oral submucosal fibrosis and the combination of alcohol consumption and smoking creates premises for the development of erythroplakia [5]. Among other risk factors associated with the occurrence of OPDM, we distinguish, sexual transmission of the human papillomavirus (HPV, with a predilection for type 16), chronic inflammation of the mucosa and trauma of the oral mucosa caused by teeth or prosthetics, the presence of various types of metals in the oral cavity with the formation of galvanic currents, poor oral hygiene, vitamin and iron deficiencies, oral candidiasis and syphilis, congenital immunodeficiencies as well as those acquired posttransplant, HIV infection, ultraviolet radiation and last but not least, genetic predisposition [12]. It is important to note that a clinical patient diagnosed with one of the entities of oral potentlly malignant disorders has an increased risk of developing oral cancer and the screening of patients and the early detection of these lesions, as well as the exclusion of risk factors, remain the most effective methods to prevent malignant transformations. The aim of this study was to make a systematic review the current scientific researches and clinical studies on the risk factors implicated in the development of leukoplakia, erythroplakia and oral submucosal fibrosis.