Association of periodontitis with the risk of oral leukoplakia

Oral leukoplakia is an oral lesion suspected to be of premalignant character. Besides smoking and alcohol, the risk factors for the development of this oral lesion are still less identified. The purpose of this study was the search for a possible influence of periodontitis on the risk of leukoplakia.

We used data from 4233 subjects (2116 women and 2117 men) who were recruited for the population-based Study of Health in Pomerania (SHIP) and finished a standard medical and dental examination. One hundred two-three cases with oral leukoplakia were 1:2 age and sex-matched with 246 healthy control subjects. Measures of bleeding on probing and clinical attachment loss were related to oral leukoplakia.

We found increased periodontal measures in subjects with leukoplakia. Adjusting for risk factors and possible confounders revealed a periodontitis-related dose-dependent increase in the probability of having oral leukoplakia. Odds ratios adjusted for socioeconomic factors and smoking computed for the second, third and fourth quartiles of clinical attachment loss were OR=1.7 (0.6-5.0), 3.3 (0.8-13.1) and 5.3 (1.2-22.7), respectively. For bleeding on probing the respective odds ratios were OR=2.0 (0.8-4.90), 2.9 (1.1-7.8) and 3.8 (1.5-9.8), respectively. Measures of systemic inflammation and of lipid metabolism were important cofactors attenuating these figures. While smoking is a risk factor of leukoplakia, oral hygiene is protective. In a follow-up survey, the leukoplakia subjects had lost more teeth than their counterparts (p=0.043).

Periodontitis increases the risk of oral leukoplakia and, therefore, the risk of mucosal lesions predisposing to oral cancers.