Conflict of interest
The author would like to thank the College of Dentistry Research Centre and Deanship of Scientific Research at King Saud University, Saudi Arabia for supporting this research project.
Life expectancy increased steadily worldwide, from 46.9years in the 1950s to 68.7years by 2010 (United Nations, 2012). The increase in life expectancy for Saudi Arabia was even greater for the same period (41.9years in the 1950s to 74.3years by 2010) (United Nations, 2012). Moreover, the percentage of the Saudi population aged 60years and older is projected to reach 25.3% by 2050, compared to just 5.6% in 1950 (United Nations, 2012). Clearly the oral health care needs of elderly Saudi Arabians will increase in the coming years, and epidemiological surveys to identify these needs are needed. Surveys based on only clinical data need to be supplemented by those based on biopsy records, as both are necessary to adequately define oral health care needs. Additionally, records based on histological diagnosis are generally considered more accurate than those based on clinical diagnosis.
Geriatric mucosa is marked by decreased epithelial thickness, decreased synthesis of collagen by connective tissue cells, and increased vascular sclerosis, all of which are likely to result in decreased tissue regeneration, loss of elasticity, and decreased disease resistance (Breustedt, 1983; Vigild, 1987). A number of epidemiologic studies (often pikfyve inhibitor in design and presentation of results) on the oral mucosal disease of the elderly (van Wyk et al., 1977; Fleishman et al., 1985; Ekelund, 1988; Hoad-Reddick, 1989; Kaplan and Moskona, 1990; Corbet et al., 1994; Nevalainen et al., 1997; Reichart, 2000; Lin et al., 2001; Garcia-Pola Vallejo et al., 2002; Jainkittivong et al., 2002; Espinoza et al., 2003) have been published in the last 3 decades. Most of these studies were based on clinical examination of institutionalized or home-based elderly people, or were done in the context of denture-related oral pathologies. There have also been a number of studies that analyzed the prevalence of oral lesions in the elderly based on oral tissue biopsies submitted for pathology (Kononen et al., 1987; Skinner and Weir, 1987; Scott and Cheah, 1989; Correa et al., 2006; Franklin and Jones, 2006; Muzyka et al., 2009; Carvalho Mde et al., 2011). Owing to the paucity of data from either clinical examinations or oral biopsies from Saudi Arabia, phylum study was aimed at surveying soft-tissue biopsies in patients over age 60 who were diagnosed in the biopsy service of a teaching hospital over a 30year period, comparing these data with similar studies done in other parts of the world. Soft-tissue pathologies were chosen because these are usually the most common and the most clinically significant category of oral lesions in the elderly (Correa et al., 2006; Muzyka et al., 2009).
Materials and methods
The biopsies included in this study were those diagnosed between 1984 and 2013 in the College of Dentistry, King Saud University; the premier dental school in Saudi Arabia. Ethical approval for the study was obtained from the Institutional Review Board of the institution (College of Dentistry Research Center, FR 0181). All cases with incomplete data on age, sex, and location of the lesion were excluded (n=54 cases). We included 231 (of 285) soft-tissue biopsies of patients aged 60years and above with complete demographic data, in addition to their histological slides from the archives, in the analysis. The pathology reports of all cases, including the accompanying hematoxylin-eosin-stained slides, those with special stains and/or immunohistochemical stains were re-evaluated by the two authors (who are practicing oral pathologists) to ensure that the previous diagnoses were correct. When found to be inaccurate, particularly based on current knowledge, new diagnoses were assigned. Descriptive and qualitative analyses of the data were then made using the IBM SPSS version 20 software. Data are presented as frequencies and percentages. Associations between important variables (mainly age and sex in relation to lesions) were tested by Pearson’s Chi-square test or Fisher’s exact test where necessary. A P value <0.05 was considered statistically significant.