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FEATURES OF THE TREATMENT OF FACULTATIVE PRECANCEROUS
DISEASES OF THE ORAL MUCOSA
Kamilov Khaydar Pozilovich, Kadirbaeva Alia Aristanovna,
Amirova Shaxnoza Sherzod kizi
Tashkent State Dental Institute, Tashkent, Uzbekistan
Abstract:
This article explores current approaches to the diagnosis and treatment of
facultative precancerous diseases of the oral mucosa, including leukoplakia, oral lichen
planus, and chronic hyperplastic candidiasis. Particular attention is paid to the pathogenetic
mechanisms of these conditions and the role of comprehensive therapy involving
elimination of etiological factors, local, and systemic treatment. The analysis of domestic
and international studies highlights the need for an individualized approach based on the
risk of malignant transformation. The work is aimed at increasing the effectiveness of
prevention and treatment to reduce the likelihood of malignancy.
Keywords:
facultative precancerous diseases, oral mucosa, leukoplakia, oral lichen
planus, chronic candidiasis, treatment, prevention, malignant transformation.
ОСОБЕННОСТИ ЛЕЧЕНИЯ ФАКУЛЬТАТИВНЫХ ПРЕДРАКОВЫХ
ЗАБОЛЕВАНИЙ СЛИЗИСТОЙ ОБОЛОЧКИ ПОЛОСТИ РТА
Аннотация:
В статье рассмотрены современные подходы к диагностике и лечению
факультативных предраковых заболеваний слизистой оболочки полости рта, включая
лейкоплакию, красный плоский лишай и хронический гиперпластический кандидоз.
Особое внимание уделено патогенетическим механизмам развития данных состояний,
а также значению комплексной терапии, включающей устранение этиологических
факторов, местное и системное лечение. Приведён анализ данных отечественных и
зарубежных исследований, подчеркивающий необходимость индивидуального
подхода к каждому пациенту с учетом степени риска малигнизации. Работа
направлена на повышение эффективности профилактики и терапии предраковых
заболеваний с целью предупреждения их перехода в злокачественные
новообразования.
Ключевые слова:
факультативные предраковые заболевания, слизистая оболочка
полости рта, лейкоплакия, красный плоский лишай, хронический кандидоз, лечение,
профилактика, малигнизация.
OG'IZ BO'SHLIĠ'I SHILLIQ QAVATINING FAKULTATIV XAVFLI O'SMA
OLDI KASALLIKLARINI DAVOLASH XUSUSIYATLARI
Annotatsiya:
Ushbu maqolada ogʻiz boʻshligʻi shilliq qavatining fakultativ xavfli o‘sma
oldi kasalliklari — leykoplakiya, qizil yassi temiratki va surunkali gipertrofik kandidozni
tashxislash va davolashning zamonaviy yondashuvlari koʻrib chiqilgan. Kasalliklarning
patogenetik mexanizmlari va kompleks terapiya — etiologik omillarni yoʻqotish, mahalliy
va tizimli davolashga e’tibor qaratilgan. Mahalliy va xorijiy tadqiqotlar asosida har bir
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bemorga individual yondashuv zarurligi ta’kidlangan. Maqola xavfli o‘sma rivojlanishining
oldini olishga yo‘naltirilgan profilaktika va davolash usullarining samaradorligini oshirishga
qaratilgan.
Kalit so‘zlar:
fakultativ xavfli o‘sma oldi kasalliklar, ogʻiz shilliq qavati, leykoplakiya,
surunkali kandidoz, davolash, profilaktika, malignizatsiya.
Introduction
Malignant neoplasms of the oral cavity represent a significant medical and social issue
due to their high incidence, late diagnosis, and unfavorable outcomes. Oral cancer most
commonly develops against the background of long-standing facultative precancerous
conditions of the oral mucosa (OM), such as leukoplakia, oral lichen planus, chronic trauma,
and inflammation. According to various sources, malignant transformation of facultative
precancerous lesions occurs in 4–20% of cases, with risk factors including tobacco use,
alcohol
consumption,
viral
infections,
and
mechanical
trauma.
The aim of this paper is to present current insights into the pathogenesis, clinical and
morphological characteristics, and treatment approaches for facultative precancerous
conditions of the oral mucosa.
Objective
To determine optimal treatment strategies for facultative precancerous conditions of the
oral mucosa based on the analysis of current clinical and scientific data, with consideration
of their malignant transformation risk.
Research Objectives
. To analyze domestic and international literature regarding the
etiology, pathogenesis, and classification of facultative oral precancerous conditions,
examine the clinical features of the most common forms of facultative precancerous lesions,
such as leukoplakia, oral lichen planus, and chronic hyperplastic candidiasis, evaluate the
efficacy of current treatment methods, including pharmacological, topical, and combined
therapies, determine the role of prevention, elimination of triggering factors, and
individualized
approaches
in
preventing
malignant
transformation,
develop
recommendations for improving therapeutic strategies for these conditions.
Morphological and Clinical Characteristics of Oral Precancerous Conditions
The oral mucosa performs protective, sensory, and immune functions and consists of
keratinized and non-keratinized epithelium, a basement membrane, and connective tissue.
Prolonged exposure to pathogenic factors (mechanical, chemical, or viral) leads to
morphological changes such as hyperkeratosis, acanthosis, basal cell hyperplasia, and
dysplasia,
all
of
which
are
indicators
of
increased
malignancy
risk.
Special attention is given to molecular markers (miRNA-21, miRNA-184) and salivary
biomarkers (FGF2, endothelin-1), which reflect the extent of pathological changes and aid
in
early
diagnosis.
Facultative precancerous conditions of the oral mucosa include leukoplakia, oral lichen
planus (especially the erosive form), chronic traumatic lesions, and actinic cheilitis.
Leukoplakia is the most common form, characterized by areas of hyperkeratosis and
dysplasia of varying severity. Morphologically, these lesions exhibit cell polarity disruption,
atypia, and inflammatory infiltration. Clinically, they may present as plaques, erosions, or
ulcers.
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Current strategies for managing facultative oral precancerous conditions are based on:
personalized approaches considering disease form, dysplasia severity, patient age, and
comorbidities; active integration of conservative and surgical methods; application of
advanced technologies, including lasers, photodynamic therapy, and molecular modulation
systems and mandatory histological monitoring. Conservative therapy is primarily used in
the absence of severe dysplasia and includes: Keratolytics and retinoids (e.g., isotretinoin,
acitretin) to normalize epithelial differentiation; Topical corticosteroids (e.g., prednisolone,
triamcinolone) for oral lichen planus; Antiseptics and antifungals for secondary infections;
Immunomodulators (e.g., thymus-derived agents, interferons); NSAIDs and antioxidants
(vitamins A, E, C, coenzyme Q10).
Recent studies highlight the potential role of vitamin D as a modulator of inflammation
and epithelial growth in the oral mucosa. Vitamin D has been shown to reduce NF-κB
activity and related pro-inflammatory cascades. Surgical treatment is indicated in cases of
moderate to severe dysplasia or absence of lesion regression and includes: Scalpel excision
with histological margin control, often used for verrucous leukoplakia; Laser therapy using
CO₂, erbium, or diode lasers for bloodless removal and minimally invasive ablation of
affected tissue; Cryodestruction for leukoplakia and chronic ulcerative-necrotic lesions,
which promotes tissue necrosis, reduces antigen load, and stimulates regeneration via
cryoimmunostimulation.
Photodynamic therapy (PDT) is a selective method that involves administering a
photosensitizer followed by irradiation with a specific wavelength. It is effective in treating
leukoplakia and oral lichen planus, particularly in low to moderate dysplasia (grades I–II),
and preserves tissue morphology and function. A novel direction in therapy involves
targeting molecular pathways of malignant transformation. Research has shown that
compounds like fraxin inhibit the FGF2/NF-κB pathway via OCT3 modulation, reducing
inflammation
and
cancer
risk
in
oral
lichen
planus.
Furthermore: miRNA-21 and miRNA-184, detectable in saliva, may serve as early markers
of malignant transformation; Salivary metabolites and proteins (e.g., endothelin-1, bFGF)
can be used to monitor treatment efficacy; Targeted modulation of specific molecular
cascades holds promise for future therapies.
Regardless of treatment method, patients require: Regular follow-ups every 3–6 months;
Photographic documentation of lesions; Biopsy-based dysplasia assessment; Malignancy
risk evaluation using systems like WHO 2021 or the Binary Grading System. Emerging
trends include: The integration of artificial intelligence and mobile diagnostic systems; The
use of biotechnology, such as local delivery of antitumor agents; Combining laser and
photodynamic therapies with topical retinoids and cytostatics. Malignant transformation risk
factors include tobacco use, alcohol abuse, chronic trauma to the mucosa, and infection with
high-risk human papillomavirus (HPV). Combined exposure to these factors significantly
increases the likelihood of cancer development—up to 4–5 times higher in patients with
both smoking and HPV infection.
Conclusion
Facultative precancerous conditions of the oral mucosa pose a significant oncological risk.
Contemporary diagnostic and therapeutic methods enable effective management and
prevention of malignant transformation. A comprehensive approach that includes risk factor
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elimination, early diagnosis, molecular monitoring, and personalized therapy is essential.
Interdisciplinary collaboration among dentists, oncologists, dermatologists, and pathologists
is crucial for optimal outcomes.
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