Prevalence and Factors Associated with Oral Pre-Malignant Lesions in Northeast Thailand

  • Juntanong, Narongrit (Dental Department, Roi-et Hospital, Roi-et Province, Khon Kaen University) ;
  • Siewchaisakul, Pallop (Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University) ;
  • Bradshaw, Peter (Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University) ;
  • Vatanasapt, Patravoot (Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University) ;
  • Chen, Sam Li-Sheng (College of Oral Medicine, School of Oral Hygiene, Taipei Medical University) ;
  • Yen, Amy Ming-Fang (College of Oral Medicine, School of Oral Hygiene, Taipei Medical University) ;
  • Chen, Tony Hsiu-Hsi (Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University) ;
  • Promthet, Supannee (Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University)
  • Published : 2016.08.01


Background: Oral cavity cancer (OCC) is one of the most common cancers worldwide. No studies have reported on the prevalence and epidemiologic risk factors of oral premalignant lesions (OPLs) in Thailand. The purpose of this study was to investigate the prevalence of OPLs and associated factors in Roi Et Province, Thailand. Materials and Methods: To investigate the prevalence of OPLs, a cross-sectional descriptive study was conducted in which 2,300 subjects over 40 years of age were recruited and screened for the prevalence of OPLs. To identify factors associated with OPLs, a matched case-control study was used in which the subjects were 102 cases with OPL and 102 matched controls without OPLs. The studies were conducted in Roi Et Province during the period 1 February, 2014, to 30 April, 2014, and the data were collected by the use of a structured interview questionnaire and by extraction of information from medical records. Data analyses involved the use of descriptive statistics, McNemar's test, and conditional logistic regression. Results: The overall prevalence of OPLs was 3.8%, and no-one was diagnosed with more than one type of OPL. The factors found to be associated with a statistically significant higher risk of an OPL were betel nut chewing, smoking, and alcohol consumption. The associations with these factors were strong, especially for betel nut chewing and smoking. Conclusions: The habits of betel nut chewing, smoking, and alcohol use are confirmed as factors associated with OPLs in a population of Roi Et Province, Thailand. Campaigns to reduce such risk healthy behaviour are needed, but whether any actual decrease will prevent the eventual transformation of an OPL into an OCC remains an open question.


  1. Auluck A, Hislop G, Poh C, et al (2009). Areca nut and betel quid chewing among South Asian immigrants to Western countries and its implications for oral cancer screening. Rural Remote Health, 9, 1118.
  2. Carrard VC, Haas AN, Rados PV, et al (2011). Prevalence and risk indicators of oral mucosal lesions in an urban population from South Brazil. Oral Dis, 17, 171-179.
  3. Chung C-H, Yang Y-H, Wang T-Y, et al (2005). Oral precancerous disorders associated with areca quid chewing, smoking, and alcohol drinking in southern Taiwan. J Oral Pathol Med, 34, 460-6.
  4. Coelho CMP, Sousa YTCS, Dare AMZ (2004). Denture-related oral mucosal lesions in a Brazilian school of dentistry. J Oral Rehabil, 31, 135-9.
  5. Detecting Oral Cancer: A Guide for Health Care Professionals. (2013, July). Retrieved from
  6. D’Costa J, Saranath D, Dedhia P, et al (1998). Detection of HPV- 16 genome in human oral cancers and potentially malignant lesions from India. Oral Oncol, 34, 413-20.
  7. Ferlay J, Soerjomataram I, Dikshit R, et al (2015). Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012: Globocan 2012. Int J Cancer, 136, 359-86.
  8. Gambhir RS, Veeresha KL, Sohi R, et al (2011).The prevalence of oral mucosal lesions in the patients visiting a dental school in Northern India in relation to sex, site and distribution: A retrospective study. J Clin Exp Dent, 3, 10-7.
  9. Gaphor SM, Sabri ZA (2014). Prevalence of oral premalignant and malignant lesions among referred kurdish patients attending department of oral and maxilofasial in sulaimani teaching hospital. IOSR-JDMS, 13, 32-36.
  10. Garcia-Pola Vallejo MJ, Martinez Diaz-Canel AI, Garcia Martin JM, Gonzalez Garcia M (2002). Risk factors for oral soft tissue lesions in an adult Spanish population. Community Dent Oral Epidemiol, 30, 277-285.
  11. Grinde B, Olsen I (2010). The role of viruses in oral disease. J Oral Microbiol, 2.
  12. Hashibe M, Jacob BJ, Thomas G (2003). Socioeconomic status, lifestyle factors and oral premalignant lesions. Oral Oncol, 39, 664-671.
  13. Hecht SS (2003). Tobacco carcinogens, their biomarkers and tobacco-induced cancer. Nat Rev Cancer, 3, 733-44.
  14. Hindle I, Downer MC, Moles DR, Speight PM (2000). Is alcohol responsible for more intra-oral cancer? Oral Oncol, 36, 328-333.
  15. Ho P-S, Chen P-L, Warnakulasuriya S, et al (2009). Malignant transformation of oral potentially malignant disorders in males: a retrospective cohort study. BMC Cancer, 9, 260.
  16. Imsamran W (2015). Cancer in Thailand (Vol. VIII, 2010-2012). National Cancer Institute, Thailand.
  17. Kumar S, Debnath N, Ismail MB, et al (2015). Prevalence and risk factors for oral potentially malignant disorders in indian population, prevalence and risk factors for oral potentially malignant disorders in indian population. Adv Prev Med, 208519.
  18. Lim K, Moles DR, Downer MC, Speight PM (2003). Opportunistic screening for oral cancer and precancer in general dental practice: results of a demonstration study. Br Dent J, 194, 497-502.
  19. Lin CF, Wang JD, Chen PH, et al (2006). Predictors of betel quid chewing behavior and cessation patterns in Taiwan aborigines. BMC Public Health, 6, 271.
  20. Liu W, Wang YF, Zhou HW, et al (2010). Malignant transformation of oral leukoplakia: a retrospective cohort study of 218 Chinese patients. BMC Cancer, 10, 685.
  21. Lwanga SK, Lemeshow S (1991). Sample size estimation in health studies : a practical manual. Geneva: World Health Organization.
  22. Manoharan S, Nagaraja V, Eslick GD (2014). Ill-fitting dentures and oral cancer: A meta-analysis. Oral Oncol, 50,1058-61.
  23. Mikkonen M, Nyyssönen V, Paunio I, Rajala M (1984). Prevalence of oral mucosal lesions associated with wearing removable dentures in Finnish adults. Community Dent Oral Epidemiol, 12, 191-4.
  24. Moyer VA., U.S. Preventive Services Task Force (2014). Screening for oral cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med, 160, 55-60.
  25. Prabhu S, Wilson D (2013). Human papillomavirus and oral disease - emerging evidence: a review. Aust Dent J, 58, 2-10.
  26. Reichart P, Mohr U (1987). Correlation between chewing and smoking habits and precancerous lesions in hill tribes of northern Thailand. IARC Sci Publ, 84, 463-4.
  27. Schlesselman JJ (1982). Case-control studies: design, conduct, analysis. Oxford University Press.
  28. Scully C, Prime S, Maitland N (1985). Papillomaviruses: their possible role in oral disease. Oral Surg Oral Med Oral Pathol, 60, 166-74.
  29. Shah G, Chaturvedi P, Vaishampayan S (2012). Areca nut as an emerging etiology of oral cancers in India. Indian J Med Paediatr Oncol, 33, 71-79.
  30. Shiu MN, Chen TH, Chang SH, Hahn LJ (2000). Risk factors for leukoplakia and malignant transformation to oral carcinoma: a leukoplakia cohort in Taiwan. Br J Cancer, 82, 1871-4.
  31. Syrjanen S (1992). Viral infections in oral mucosa. Eur J Oral Sci, 100, 17-31.
  32. Thomas G, Hashibe M, Jacob BJ, et al (2003). Risk factors for multiple oral premalignant lesions. Int J Cancer, 107, 285-291.
  33. Thomas SJ, Harris R, Ness AR, et al (2008). Betel quid not containing tobacco and oral leukoplakia: a report on a crosssectional study in Papua New Guinea and a meta-analysis of current evidence. Int J Cancer, 123, 1871-6.
  34. Tovosia S, Chen P-H, Ko AM-J, et al (2007). Prevalence and associated factors of betel quid use in the Solomon Islands: a hyperendemic area for oral and pharyngeal cancer. Am J Trop Med Hyg, 77, 86-590.
  35. Trivedy CR, Craig G, Warnakulasuriya S (2002). The oral health consequences of chewing areca nut. Addict Biol, 7, 115-25.
  36. Vlkova B, Stanko P, Minarik G et al (2012). Salivary markers of oxidative stress in patients with oral premalignant lesions. Arch Oral Biol, 57, 1651-6.
  37. Warnakulasuriya S, Johnson NW, van der Waal I (2007). Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med, 36, 575-80.
  38. Yardimci G, Kutlubay Z, Engin B, Tuzun Y (2014). Precancerous lesions of oral mucosa. World J Clin Cases, 2, 866.
  39. Yen AM-F, Chen SC, Chen TH-H (2007). Dose-response relationships of oral habits associated with the risk of oral pre-malignant lesions among men who chew betel quid. Oral Oncol, 43, 634-8.