ON THE ISSUE OF CLINICAL CLASSIFICATION OF PRECANCEROUS CHANGES IN THE ORAL MUCOSA AND THE LIPS
Authors: Skrypnikova T.P. , Khmil T.A. , Pysarenko O.A. , Bieliaieva O.M. 
Published: September 2022

Diseases of the oral mucosa are an important and complex problem of dentistry. Due to the fact that diseases and pathological conditions of the oral cavity mucosa are diverse in etiology, pathogenesis, clinical manifestations, possible atypical course, have similarity of morphological elements, overall they characterized diseases of various organs and different body systems. In this regard, different methodological approaches are used for creating an optimal classification. P.T. Maksimenko (2012) indicated that each subsequent classification is statistical and intends to take into account diseases and pathological conditions.
The existing classifications of the oral mucosa diseases have different principles of design. Diseases and lesions of the oral mucosa according to pathogenesis are divided into primary (own), secondary (symptomatic) and syndromes. In all classifications, one of the subset is precancerous changes.
Nowadays in the world science literature sources there is a term "potentially malignant disorders of the oral cavity" (OPMDs). By this definition, it is recommended to replace the usual terms of precancer, epithelial precursor lesions, premalignant, precancerous, intraepithelial lesions. The definition of potentially malignant oral disorders is included in the WHO classification of Head and Neck Tumors (2017). In March 2020, this classification was supplemented at the WHO International Seminar on the Nomenclature and classification for Oral Cancer and included oral lichenoid lesions, chronic hyperplastic candidiasis and exophytic verrucous oral hyperplasia.
In 2008, Maksimenko P.T. and co-authors created a working nomenclature and clinical classification of diseases, changes of the oral mucosa, lips and tongue. Symptoms and complexes symptom of the oral mucosa and lips, which are determined by visualization, in a separate section is mentioned the precancerous changes.
Analysis of the 10-year work of the center for the diagnosis and treatment of diseases of the oral mucosa and the lips, organized at the Department of Dentists Postgraduate Education, made it possible to create some additions to this classification, taking into account atypically occurring precancerous changes and their malignancy. At the same time, regardless of changes in obligate and optional changes in clinical supervision, clinical signs of malignancy should be taken into account:

static course of disease,
progression of the lesion,
increasing in the area of the lesion,
increasing keratinization processes,
disappearance of boundaries clarity,
density of the lesion’s base,
the occurrence of pain.

As well as cytological and histological examination is crucial.
Conclusion. According to the methodological principles of classifications, data’s of scientific research, information about previously unknown diseases and their manifestation in the oral cavity, it is possible to make additions to existing classifications, as well as to use international ones.
Future perspectives. Clinical classification of precancerous changes in the oral mucosa and lips, and additions made to it made are very useful for clinicists in making a diagnosis, management of cancer, treatment of patients.