Correlation of Periodontal Disease Severity with Clinical and Histopathological Features of Oral Potentially Malignant Disorders

Abstract

Background: Periodontitis is a chronic inflammatory condition that may contribute to alterations in the local oral inflammatory environment. Oral potentially malignant disorders (OPMDs) represent a heterogeneous group of mucosal lesions with variable potential for malignant transformation. The relationship between periodontal disease severity and the histopathological severity of epithelial dysplasia remains incompletely understood.
Aim: To evaluate the association between periodontal disease severity and histopathological dysplasia in patients presenting with OPMDs and to identify clinical and periodontal factors independently associated with epithelial dysplasia.
Materials and Methods: A total of 100 patients diagnosed with OPMDs were evaluated. Demographic characteristics, tobacco-chewing and smoking habits, type of OPMD, and periodontal parameters were recorded. Participants were categorized according to periodontal disease severity into mild/no periodontitis (n=34), moderate periodontitis (n=36), and severe periodontitis (n=30). Plaque Index (PI), Gingival Index (GI), probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing (BOP) were assessed. Histopathological examination classified lesions as showing no, mild, moderate, or severe epithelial dysplasia. Group differences were evaluated using one-way Analysis of Variance (ANOVA) with Tukey’s post-hoc test, while associations were assessed using the Chi-square test and Spearman’s correlation. Multivariable logistic regression was performed to identify independent predictors of epithelial dysplasia.
Results: Periodontal parameters deteriorated progressively with increasing disease severity, with significant differences among the three groups for all evaluated variables (p<0.001). Histopathological examination identified epithelial dysplasia in 58% of lesions, comprising mild dysplasia in 31%, moderate dysplasia in 18%, and severe dysplasia in 9%. A significant association was observed between periodontal disease severity and dysplasia grade (χ²=18.52, p<0.001). CAL demonstrated the strongest correlation with dysplasia severity (r=0.52, p<0.001), followed by PPD (r=0.48, p<0.001). In multivariable analysis, severe periodontitis was independently associated with epithelial dysplasia (adjusted odds ratio (OR) =3.84, 95% confidence interval (CI): 1.42–10.38; probability (p) =0.008). Tobacco chewing (adjusted OR=2.46; p=0.029) and non-homogeneous lesion appearance (adjusted OR=2.71; p=0.034) were also significant predictors.
Conclusion: Greater periodontal disease severity was significantly associated with increasing histopathological severity of epithelial dysplasia among patients with OPMDs. Severe periodontitis, tobacco chewing, and non-homogeneous lesion morphology emerged as independent predictors of epithelial dysplasia. These findings suggest that comprehensive periodontal assessment may be relevant when evaluating patients with OPMDs, although prospective studies are required to establish temporal and causal relationships.