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Mucosal lesions in older adults
Sol Silverman Jr., DDS, MA


he specialty of oral medicine provides important services for oral health problems in older adults. These oral health conditions and diseases associated with aging often are complex and can affect the quality of life adversely. Three of the most common causes for referrals include suspected premalignant and cancerous lesions,oral inflammatory vesiculoerosive changes and candidiasis. The use of medications increases significantly in elderly people; therefore, the clinician must consider a patient’s potential drug reactions in the differential diagnosis of signs and symptoms. Additionally, when a patient has severe aphthae and herpetic reactivation, the clinician may have difficulty in both recognition and management ofthe conditions. The practitioner’s challenge is to establish a diagnosis so that he or she can institute appropriate treatment.

Background and A D A Overview. Many oral J diseases/conditions asso✷ ✷ ® ciated with aging are complex and can have a signifiN cant effect on the quality of C U U A ING ED 4 life for ambulatory older RT ICLE adults. Among these are oral cancers and premalignantlesions, vesiculoerosive diseases, candidiasis, aphthous ulcers and herpes virus reactivation. The practitioner should establish the diagnosis so that appropriate management can be instituted. Conclusions. The challenge to the practitioner is to formulate a differential diagnosis from oral mucosal signs and symptoms, arrange tests and referrals as needed, and establish a definitive diagnosis sothat appropriate management can be instituted. Clinical Implications. Recognition of benign and malignant muosal lesions will accelerate proper treatment that will help control a variety of oral diseases and conditions. It also will improve the quality of life for many elderly patients who experience associated pain and altered oral functions. Key Words. Mucosal lesions; older patients; oralmedicine. JADA 2007;138(9 supplement):41S-46S.





Epidemiology and control. Oral and pharyngeal cancer are estimated to exceed 34,000 new cases in the United States in 2007.1 Controlling these types of cancer depends on identifying and modifying etiologic factors, such as tobacco and alcohol use, diets low in fruits and vegetables, the potential role of thehuman papillomavirus (HPV), the influence of immunosuppression, genetic mutations and precancerous conditions (primarily leukoplakia).2 Ninety-five percent of oral and pharyngeal cancers occur after the age of 40 years.3 Treatment and survival. In spite of advancements in surgery, radiation and chemotherapy, the overall fiveyear survival rate for oral and pharyngeal cancer is approximately 59percent.3 It is conclusively apparent that early diagnosis combined with adequate treatment of oral cancers is the most effective way of reducing morbidity and mortality. Treatment is preceded with accurate staging, use of clinical findings and imaging with magnetic resonance imaging techniques. Positron-

Dr. Silverman is a professor, Oral Medicine, Department of Orofacial Sciences, School ofDentistry, University of California San Francisco, S-519B, Box 0422, 521 Parnassus Ave., San Francisco, Calif. 94143, e-mail “”. Address reprint requests to Dr. Silverman.

JADA, Vol. 138 Copyright ©2007 American Dental Association. All rights reserved.

September 2007


emission computerized tomography can be helpful. Delay in diagnosis.Early diagnosis requires both patient (public) and professional education. People must seek professional help when signs or symptoms in the mouth persist for more than three weeks so that clinicians can assess the seriousness as well as treatment of their problems. Clinicians must perform an appropriate oral screening examination to detect the cause of the complaints and findings. An oral cancer...
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