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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 151-155

The range of pathological diagnoses of oral diseases in Jordan: An 11-year-retrospective study


Department of Oral and Maxillofacial Surgery, Oral Medicine, and Periodontics, School of Dentistry, The University of Jordan, Amman, Jordan

Date of Submission19-Mar-2020
Date of Decision21-May-2020
Date of Acceptance25-May-2020
Date of Web Publication04-Nov-2020

Correspondence Address:
Dr. Yazan Hassona
School of Dentistry, The University of Jordan, Queen Rania Street, P.O Box 11942, Amman
Jordan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjos.SJOralSci_17_20

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  Abstract 


Objectives: The objective of this study is to describe the pattern of oral and maxillofacial diseases in Jordan and to compare it with global trends.
Materials and Methods: A retrospective analysis of pathology records in a major university hospital in Jordan was conducted. Age, gender, anatomical site, and pathological diagnosis were assessed.
Results: A total of 1062 records were included. There were 525 (49.4%) females and 537 males (50.6%). The mean age of the study sample was 39 ± 18.7 years (range = 2–88 years). Nearly half of the lesions originated from the jaw bones (48.8%, n = 518), followed by oral mucosa (38.3%, n = 407), and gingivae (7.1%, n = 75). Cystic lesions were the most common type of pathologies (35.8%, n = 380), followed by reactive lesions (25.8, n = 274), and tumors (13.9%, n = 148). The most common individual pathologies were radicular cyst (19.8%, n = 210), followed by dentigerous cyst (11.3%, n = 120), and fibroepithelial polyp (8.8%, n = 93).
Conclusion: Reactive and cystic lesions are the most common type of diseases encountered in the present study. The pattern of oral and maxillofacial diseases reported here is consistent with global trends.

Keywords: Maxillofacial, oral diseases, pathology, prevalence


How to cite this article:
Hassona Y, Al Boosh D, Al Saed A, Al Mousa M, Barghout N, Al Kayed A, Sawair F. The range of pathological diagnoses of oral diseases in Jordan: An 11-year-retrospective study. Saudi J Oral Sci 2020;7:151-5

How to cite this URL:
Hassona Y, Al Boosh D, Al Saed A, Al Mousa M, Barghout N, Al Kayed A, Sawair F. The range of pathological diagnoses of oral diseases in Jordan: An 11-year-retrospective study. Saudi J Oral Sci [serial online] 2020 [cited 2020 Nov 30];7:151-5. Available from: https://www.saudijos.org/text.asp?2020/7/3/151/299963




  Introduction Top


The mouth and perioral tissues can be affected by several diseases, including developmental, neoplastic, infectious, inflammatory, and reactive pathologies.[1] The diagnosis of oral and maxillofacial pathologies can be challenging because of the diverse nature and the none specific features of diseases in this region. Knowledge about the relative frequency of oral pathologies is important to understand the pattern of oral diseases within a population, and to make proper use of pathology services for clinical, educational, and research purposes.[2]

The majority of previous studies about the pattern and frequency of oral and maxillofacial pathology were focused on either particular age groups or specific categories of diseases.[3],[4],[5],[6],[7],[8],[9] Descriptive studies about oral and maxillofacial pathologies in a general population are scarce. A study from USA, for example, analyzed the range of pathological diagnoses of 51,781 oral biopsies over a period of 13 years and reported reactive and infectious conditions to be the most common.[10] Similarly, a study from the UK retrospectively analyzed the range of oral and maxillofacial pathologies of a 44,000 specimens over a period of 30 years and reported benign mucosal diseases and odontogenic cysts to be the most common pathologies.[11] Similar results were reported from the studies in Australia, Singapore, and New Zealand.[2],[12],[13]

Studies about the relative frequency of oral and maxillofacial diseases from developing countries, particularly those in the Arab world are sparse.[14],[15],[16] A recent study from Iraq analyzed oral and maxillofacial pathologies during a 6-year period ad reported a high prevalence of neoplastic lesions.[16] Extrapolation of pathology data across the populations might be challenging because of the differences in disease classification and diagnostic criteria, and accessibility and utilization of pathology services in the different populations.[2] Currently, there are no studies about the prevalence and relative frequency of oral diseases in the Jordanian population.

In the present study, we aimed to investigate the pattern of oral and maxillofacial pathological diagnoses in a university hospital in Jordan to establish a baseline data about oral and maxillofacial pathology that can be used by educators, clinicians, researchers, and health-care policy planners.


  Materials and Methods Top


Our study was retrospective in nature and was conducted at the pathology service in the University of Jordan Hospital. The service is the largest diagnostic oral histopathology service in Jordan, and the only service in the capital city to be staffed by oral pathologists. The study was reviewed and approved by the Institutional Review Board and was conducted in accordance with the World Medical Declaration of Helsinki. The study conformed to the STROBE statement for observational studies.

Details of all maxillofacial pathology reports (excluding smears and swabs) during the period from January 2008 to December 2018 were retrieved and computerized using the SPSS for windows release. Initial screening of the reports was conducted by two authors (AA and DA) to exclude the duplicate reports, repeated specimens, and reports of normal tissues. Furthermore, reports of lesions other than those from the tongue, lips, oral mucosa, palate and uvula, retro-molar area and pillar of the fauces, minor salivary glands, gingivae, mandible, and maxillae were excluded. Reports with ambiguous diagnosis were identified by two authors (AA and DA), and specimens were reviewed by a trained oral pathologist (FS) for a definitive diagnosis before inclusion.

To facilitate comparison with other studies, reports were categorized by the site of specimen into three categories: jaw bone, oral mucosae, minor salivary glands, and gingivae. Furthermore, the diagnoses were sorted into the following categories to enable a more detailed analysis and comparisons: neoplasms, cysts, mucosal diseases (other than neoplasms), developmental conditions, infections, reactive conditions, salivary gland diseases (other than neoplasms), and miscellaneous.

Descriptive statistical analyses were performed using SPSS/16.0 (SPSS Inc., Chicago, IL, USA), and Student's t-test and Chi-square test were used to compare the differences between the groups.


  Results Top


A total of 1477 cases were initially identified, but 415 were excluded because they were either duplicate reports, repeated specimens, reports of normal tissue, or reports of lesions other than those from the tongue, lips, oral mucosa, palate and uvula, retro-molar area and pillar of the fauces, minor salivary glands, gingivae, mandible, and maxillae. Following exclusion, a total of 1062 patients (525 [49.4%] females and 537 males [50.6%]) were included; their mean age was 39 ± 18.7 years (range 2–88 years).

Nearly half of the lesions originated from the jaw bones (48.8%, n = 518), followed by oral mucosa (38.3%, n = 407), and gingivae (7.1%, n = 75) [Figure 1].
Figure 1: Distribution of oral and maxillofacial pathology by the site

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Cystic lesions were the most common type of pathologies (35.8%, n = 380), followed by reactive lesions (25.8, n = 274) and tumors (13.9%, n = 148) [Figure 2]. The most common individual pathologies were radicular cyst (19.8%, n = 210), followed by dentigerous cyst (11.3%, n = 120) and fibroepithelial polyp (8.8%, n = 93) [Table 1]. Overall, there were no statistically significant differences in the male/female ratios among various categories.
Figure 2: Relative frequency of oral and maxillofacial pathologies by disease category

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Table 1: The most common pathological diagnoses reported in this study

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Radicular cyst was the most common type of cystic lesions (19.8%, n = 210) followed by dentigerous cyst (11.3%, n = 120) and keratocyst (8.9%, n = 34). Other cystic lesions included inclusion cyst, paradental cyst, nasopalatine cyst, and solitary bone cyst [Figure 3]. The most common sites were the posterior mandible (51.3%, n = 195) and the anterior maxilla (28.9%, n = 110). The most common reactive diseases were fibroepithelial polyp (33.9%, n = 93), pyogenic granuloma (12.4%, n = 34), peripheral giant cell granuloma (7.7%, n = 21), and mucocele (7.3%, n = 20) [Figure 4]. While the most common sites for reactive oral diseases were the buccal mucosa (39.7%, n = 109), gingivae (25.9%, n = 71), and lower labial mucosa (15.3%, n = 42).
Figure 3: Relative frequency of cystic lesions of the jaw

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Figure 4: Relative frequency of reactive oral lesions

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Neoplasms were the third-most common diagnostic category (13.9%, n = 148). The most common neoplasms were squamous cell carcinoma (31.1%, n = 46), ameloblastoma (10.1%, n = 15), and pleomorphic adenoma (6.8%, n = 10) [Figure 5]. The most common sites for squamous cell carcinoma were the tongue and floor of the mouth (54.3%, n = 25), alveolar mucosa (15.2%, n = 7), buccal mucosae (13.04%, n = 6), lips (8.7%, n = 4), and palate (8.7%, n = 4). Squamous cell carcinoma was more common in female patients (67.4%, n = 31) in their 5th decades (mean age = 47.2 ± 11).
Figure 5: Relative frequency of oral and maxillofacial tumors (excluding major salivary glands tumors)

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Chronic sialadenitis (n = 35) and mucocele (n = 20) were the most common nonneoplastic salivary gland disease, and lichen planus was the most common nonneoplastic oral mucosal disease (n = 57).


  Discussion Top


The present study is the first to present the full range of oral and maxillofacial pathology among the Jordanian population in contrast to previous studies which were either focused on a particular disease category or a particular age group.[17],[18] The present study was conducted at the histopathology department at the University of Jordan which is one of the largest departments in the country and the only to provide specialized oral and maxillofacial pathology service in Amman.

Previous studies, from different population, reported variable results regarding the relative frequency and the pattern of oral and maxillofacial pathology.[10],[11],[12],[13],[14],[15],[16] These differences could be attributed to the variations in disease categorization, age of studied population, source of biopsies, and the type of collection center involved.[19] One inherent limitation of this type of studies is that they do not give the true prevalence rates of oral diseases because many diseases, particularly common and benign ones, are routinely diagnosed based on the clinical and radiographic findings without a need for histopathological examination.[2] Furthermore, the results might vary according to the type of referring practices and the experience of pathology service providers.

The results about gender distribution of oral and maxillofacial pathologies in previous studies were inconsistent; our data showed nearly equal prevalence in both genders. Similarly, the age range observed in this study was consistent with several previous studies from the different parts of the world.[13],[14],[15],[16]

Similar to global reports, our study showed a high prevalence of benign lesions, in particular cystic lesions of the jaw and reactive oral mucosal diseases.[2],[10],[11],[12],[13],[14],[15],[16] Cystic lesions of the jaw were the most common disease representing nearly 35% of all submitted specimens. The proportion of cysts to all biopsies in our study is significantly higher than figures from most other studies which reported values of 11.7%–16.7%.[16] The high rate of cystic lesions in this study can be explained by the fact that oral surgeons are the main source of referral to our diagnostic pathology service.

Cysts of dental origin (i.e., odontogenic cysts) were the most common cystic lesions in our study. Radicular cyst (55.3%), dentigerous cyst (31.6%), and keratocyst (9%) represented more than 95% of all the submitted cystic lesions. Compared to other studies which found a higher prevalence of radicular cyst,[8] the true prevalence rate of radicular cyst in this study could be higher as some of these cysts, particularly small ones, are frequently diagnosed based on the clinical and radiographic features without being submitted to histopathological examination. Similar to other studies, the posterior mandibular region was the most frequently involved anatomical site for cystic lesions.[20]

Reactive lesions (25.8%) were the second-most common diagnostic category in the present study. Fibroepithelial polyp, a benign fibrous hyperplasia, was the most common lesions and represented 8.8% of all submitted specimens. This result is comparable to other studies in the literature.[2],[21] As expected, the buccal mucosa, followed by gingivae, were the most common site of reactive pathologies due to frequent chronic mild irritations to these sites in the mouth.

The findings of our study indicated that <5% of cases were malignant. This rate of malignancy is significantly lower than that reported in some regional studies in Iraq, Saudi Arabia, and Yemen.[16],[21],[22] Squamous cell carcinoma was the most frequently diagnosed malignant neoplasm and represented around 4% of all submitted specimens, a finding similar to that reported by regional studies.[16],[21] This may be related to the increasing prevalence of tobacco smoking, and alcohol use is becoming more popular in conservative communities including those of the Middle East. Interestingly, squamous cell carcinoma in the present study was found to be more common in females, it is possible that females with oral cancer present to the dental services earlier than males and therefore diagnosed and treated at our hospital while males present late and get referred to the nearby King Hussein Cancer Center.


  Conclusion Top


In this study, the most commonly encountered oral and maxillofacial pathologies were odontogenic cysts, followed by reactive mucosal lesions. This is the first comprehensive study to report on the prevalence of oral and maxillofacial pathology in the Jordanian population. Further studies with more consistent diagnostic criteria are needed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in children over a 30-year period. Int J Paediatr Dent 2006;16:19-30.  Back to cited text no. 3
    
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Ataíde AP, Fonseca FP, Santos Silva AR, Jorge Júnior J, Lopes MA, Vargas PA. Distribution of oral and maxillofacial lesions in pediatric patients from a Brazilian Southeastern population. Int J Pediatr Otorhinolaryngol 2016;90:241-4.  Back to cited text no. 4
    
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Açikgöz A, Uzun-Bulut E, Özden B, Gündüz K. Prevalence and distribution of odontogenic and nonodontogenic cysts in a Turkish population. Med Oral Patol Oral Cir Bucal 2012;17:e108-15.  Back to cited text no. 8
    
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Johnson NR, Savage NW, Kazoullis S, Batstone MD. A prospective epidemiological study for odontogenic and non-odontogenic lesions of the maxilla and mandible in Queensland. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:515-22.  Back to cited text no. 9
    
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Dovigi EA, Kwok EY, Eversole LR, Dovigi AJ. A retrospective study of 51,781 adult oral and maxillofacial biopsies. J Am Dent Assoc 2016;147:170-6.  Back to cited text no. 10
    
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Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults over a 30-year period. J Oral Pathol Med 2006;35:392-401.  Back to cited text no. 11
    
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Tay AB. A 5-year survey of oral biopsies in an oral surgical unit in Singapore: 1993-1997. Ann Acad Med Singapore 1999;28:665-71.  Back to cited text no. 12
    
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Rich AM, Firth NA, Kardos TB. Review of oral pathology service, Medlab Dental, University of Otago, 2002-2005. N Z Dent J 2007;103:34-6.  Back to cited text no. 13
    
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Dimba EA, Gichana J, Limo AK, Wakoli KA, Chindia ML, Awange DO. An audit of oral diseases at a Nairobi centre, 2000-2004. Int Dent J 2007;57:439-44.  Back to cited text no. 14
    
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Monteiro LS, Albuquerque R, Paiva A, de la Peña-Moral J, Amaral JB, Lopes CA. A comparative analysis of oral and maxillofacial pathology over a 16-year period, in the North of Portugal. Int Dent J 2017;67:38-45.  Back to cited text no. 15
    
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Yakin M, Jalal JA, Al-Khurri LE, Rich AM. Oral and maxillofacial pathology submitted to Rizgary Teaching Hospital: A 6-year retrospective study. Int Dent J 2016;66:78-85.  Back to cited text no. 16
    
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Al-Khateeb T, Al-Hadi Hamasha A, Almasri NM. Oral and maxillofacial tumours in north Jordanian children and adolescents: A retrospective analysis over 10 years. Int J Oral Maxillofac Surg 2003;32:78-83.  Back to cited text no. 17
    
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Al-Khateeb TH, Ababneh KT. Salivary tumors in North Jordanians: A descriptive study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:e53-9.  Back to cited text no. 18
    
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Huang G, Moore L, Logan RM, Gue S. Retrospective analysis of South Australian pediatric oral and maxillofacial pathology over a 16-year period. J Investig Clin Dent 2019;10:e12410.  Back to cited text no. 19
    
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Akinyamoju AO, Adeyemi BF, Adisa AO, Okoli CN. Audit of oral histopathology service at a Nigerian tertiary institution over a 24-year period. Ethiop J Health Sci 2017;27:383-92.  Back to cited text no. 20
    
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Saleh SM, Idris AM, Vani NV, Tubaigy FM, Alharbi FA, Sharwani AA, et al. Retrospective analysis of biopsied oral and maxillofacial lesions in South-Western Saudi Arabia. Saudi Med J 2017;38:405-12.  Back to cited text no. 21
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
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