ORAL HEALTH IN PULMONARY TUBERCULOSIS PATIENTS – THE MOST UNMET NEED

Objectives: Oral lesions in pulmonary tuberculosis cause significant morbidities. Relevant data is quite inadequate in the literature besides no such study has ever been reported from Pakistan. This study was therefore carried out to determine the clinico-pathological changes in oral mucosa of the patients with pulmonary tuberculosis.
Methods: Detailed history, clinical and oral examination findings were recorded from n=100 patients already diagnosed with pulmonary tuberculosis. Gingival biopsies were taken and complete blood count (CBC) with erythrocyte sedimentation rate (ESR) was performed.
Results: Mean age of the patients was 32.31± 13.27 years with a male to female ratio being 1:2. The patients presented with complaints of fever (99%), cough (97%), sputum (86%), weight loss (72%) and hemoptysis (9%). The most prevalent oral lesion was mucositis (95%) followed by periodontitis (22%) and oral ulcerations (8%). Mean hemoglobin (hb) concentration was 10.8 ±1.937 (mg/dl). Mild, moderate and severe degree of anemia was observed in 26%, 67% and 7% patients respectively. Mean ESR levels were 56+ 21.1 mm/hr.
Histologically, gingival epithelium revealed acanthosis (100%), basal atypia (62%) and superficial neutrophilic abscesses (4%). The stroma showed hyalinized collagen (100%), neovascularization (69%), chronic nonspecific inflammation (54%), amyloid deposition (35%), fibrinoid necrosis (12%) and calcification (2%). Frequency of oral lesions increased with an increase in anemia and ESR although the association was insignificant (p>0.05). Mucositis, neovascularization and amyloidosis were significantly higher (p<0.05) in females while oral ulcers were significantly higher (p=0.03) in males. No patient was attending dental clinic for management of these oral lesions.
Conclusions: Oral lesions associated with pulmonary tuberculosis unveil the difficulties faced by these patients during deglutition and eating which further leads to nutritional deficiencies and noncompliance to drug intake. Appropriate preventive strategies must be called for to improve the oral health which subsequently may enhance the quality of life in these patients.