Analyzing the relationship between tissue color observed in VELscope examination and histopathological factors in OSCC patients.

OBJECTIVE: Early detection of OSCC is a crucial step towards improving OSCC prognosis. In recent years, novel diagnostic aids such as light-based detection systems have been introduced for early diagnosis. VELscope is one such light-based device which is used to examine tissue fluorescence. Based on different studies, VELscope has a sensitivity of 90% in the diagnosis of oral premalignant and malignant lesions. Tumor depth of invasion and invasive front have recently been proposed as influential factors in OSCC prognosis. Therefore, the aim of this study was to assess the relationship between tissue color seen through this device and tumor depth of invasion. METHODS & MATERIALS: 20 histopathologically approved OSCCs were included in this study. Conventional oral examination was carried out followed by an assessment of the lesion using VELscope. The H&E slides prepared following the final OSCC surgeries were then examined by an oral pathologist to assess tumor depth of invasion (interpreted as low-risk/high-risk), invasivefront (low-risk/high-risk) and perivascular and perineural invasions. Data was transferred to SPSS 16 software. The association between color changes and histopathological factors was analyzed using the fisher's exact and chi-square tests. RESULTS: The mean age of the patients was 51/5+/-16/74, 60% of which were men. Most lesions were exophytic and the most common color seen during VELscope examination was red. 55% and 50% of the OSCCs showed high-risk tumor depths and high-risk invasive fronts respectively. Perivascular and perineural invasion was seen in 55% and 35% of the samples respectively. Statistical analysis showed that 72/2% of the lesions with high tumor depths and 70% with high-risk invasive fronts were seen as red, although these associations were not significant (P>0/05). Tumor depth was significantly correlated with invasive front (P<0/05). CONCLUSION: There was no significant relationship between the type of color seen through VELscope and tumor depth of invasion, however most cases with high-risk depth of invasions were red.

Assessment of salivary opiorphin in oral lichen planus

Opiorphin is a pentapeptide, which could be isolated from human fluids and has a decreasing effect on pain. Aim: Since lichen planus is a chronic mucocutaneous disease, which causes pain or burning feeling in the oral mucosa, this study aimed to compare salivary opiorphin levels of oral lichen planus (OLP) patients with healthy subjects. Methods: This case-control study, was performed on 24 patients with OLP lesions and 21 healthy subjects. After collecting unstimulated saliva, opiorphin levels were compared between two groups through statistical analyses. Results: There was not any significant difference between OLP patients and healthy subjects according to salivary opiorphin concentration (p=0.378). Also, in the OLP group, opiorphin concentration was not significantly different between males and females (p=0.601). Analytical analysis could not show any remarkable difference between various severity of OLP lesions regarding to salivary opiorphin levels (p=0.653). Conclusion: In this study, salivary opiorphin levels was not significantly different between patients with OLP and healthy subjects; however, more studies are suggested for better assessment of salivary opiorphin levels in various types of OLP lesions and its correlation with pain severity

Evaluation of the salivary glutaredoxin-1 levels in oral lichen planus and oral squamous cell carcinoma.

BACKGROUND: Glutaredoxin-1, as a component of antioxidant system, plays a crucial role in pathogenesis of some cancers and pre-malignant lesions. The aim of this study is to assess salivary levels of glutaredoxin-1 in oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC) patients compared with healthy controls. METHODS & MATERIALS: This cross-sectional study was conducted on 28 OLP patients, 20 OSCC cases, and 40 healthy subjects. Their salivary glutaredoxin-1 was assessed by the enzyme-linked immunosorbent assay (ELISA). RESULTS: Regarding the glutaredoxin-1 level, there was no significant difference between the three studied groups (p=0.073); however, the salivary glutaredoxin-1levels were higher in the healthy subjects than the OLP and OSCC patients. Among OSCC patients, the salivary glutaredoxin-1 levels were significantly higher in the males (p=0.03). According to glutaredoxin-1 levels, the difference between keratotic and non-keratotic OLP lesions were not significant (p=0.98). Furthermore, there was no significant difference between various clinical manifestations and grades of OSCC, (p=0.08, p=0.56, respectively). CONCLUSION: Salivary glutaredoxin-1 levels were lower in OLP and OSCC patients compared to the normal volunteers; therefore the role of glutaredoxin-1 in the pathogenesis of these diseases could be proposed.

Assessment of salivary thioredoxin levels in oral lichen planus and oral squamous cell carcinoma.

OBJECTIVE: Oral lichen planus (OLP) is a chronic mucocutaneous inflammatory disease, which is considered as a potentially malignant condition and could transformed into oral squamous cell carcinoma (OSCC). Squamous cell carcinmoma is the most common oral cancer. This study aimed to compare salivary thioredoxin levels as an antioxidant protein among patients with OSSC, OLP and healthy subjects. MATERIALS AND METHODS: Twenty-eight patients with OLP, 20 patients with OSCC and 40 healthy people enrolled in this observational study. Saliva samples were collected from all subjects and salivary thioredoxin levels were evaluated by Elisa test. The data were recorded in the check lists and analyzed using SPSS (ver.17). RESULTS: Thioredoxin levels of healthy controls were insignificantly higher than OLP and SCC patients (p = 0.135). There was a statistically remarkable indirect relationship between thioredoxin levels and severity of the lesions determined by Thongprasom criteria among OLP patients. The thioredoxin concentration was significantly higher in the keratotic OLP. Among the OSCC patients, the highest levels of thioredoxin were found among patients aged more than 65 years. Salivary thioredoxin levels based on other variables were not significantly different between the studied groups. CONCLUSION: In this study, there was not any significant difference between salivary thioredoxin levels in the OLP and OSCC patients, though it was unremarkable higher in the healthy group compared to the patients; therefore, the role of thioredoxin in the cellular oxidation-reduction status could be suggested; however, further studies are recommended.

The diagnostic value of the native fluorescence visualization device for early detection of premalignant/malignant lesions of the oral cavity.

PURPOSE: The present study aimed to determine the diagnostic value of a native fluorescence visualization device in the identification of oral malignant/dysplastic lesions. METHODS: This study involved 45 patients who had oral lesions that were suspected to be malignant, potentially malignant, or benign. The patients visited the Oral Medicine Department of the Mashhad Dental School. The sensitivity, specificity, positive and negative predictive values, and likelihood ratio of this device were determined. RESULTS: The histopathological assessment of samples showed 9 cases of oral squamous cell carcinoma and 12 lesions with dysplasia. Ten samples of dysplastic lesions and all malignant lesions appeared dark or red/orange when examined with the native fluorescence visualization device. In 90% of the dysplastic/malignant lesions, the label-free fluorescence results were positive. The sensitivity, specificity, and positive and negative predictive values of this device were 90%, 15%, 40%, and 71%, respectively. CONCLUSIONS: The native fluorescence visualization device can be used in specialized centers as an adjunctive device to increase the sensitivity of a clinical examination, but is not capable of distinguishing benign lesions from malignant and dysplastic ones due to its low specificity.

A Randomized Placebo- Controlled Double Blind Clinical Trial of Quercetin in the Prevention and Treatment of Chemotherapy-Induced Oral Mucositis.

INTRODUCTION: Oral Mucositis (OM) is a serious complication of chemotherapy that results in painful debilitating inflammation that sometimes ends in interruption of treatment. AIM: The study evaluated the effect of quercetin (a natural flavonoid) on preventing and treating chemotherapy induced OM in patients with blood malignancies. Materials and Methods: This double-blind, placebo controlled randomized trial was carried out on 20 adult patients who underwent high dose chemotherapy for blood malignancies. Patients were divided into two groups (10 patients in the intervention group and 10 patients in the control group). Patients in the intervention group were administered 250 mg quercetin capsules twice daily for four weeks. RESULTS: Nine out of 20 patients developed OM (three in the intervention group and six in the control group). The incidence of OM was lower in the intervention group although it was not statistically significant (p=0.189). The mean severity of OM was higher in the intervention group (2.6 vs 2). Healing time, age, gender, type of malignancy, drug type and duration of OM were not different in two groups. CONCLUSION: The incidence of mucositis was lower in the quercetin group, but mucositis was more severe in the intervention group, which may be due to lower oral health status in the intervention group.

Evaluation of the Efficacy of Curcumin in the Treatment of Oral Lichen Planus: A Randomized Controlled Trial.

INTRODUCTION: Oral Lichen Planus (OLP) is a chronic immunological, mucocutaneous disease with a wide range of clinical appearances. The treatment of oral lichen planus is often difficult and disappointing. AIM: We have studied the efficacy of curcumin, a low molecular weight flavonoid with anti-inflammatory and anti-oxidant activities, in the treatment of OLP. MATERIALS AND METHODS: In this study, a randomized, double-blind, placebo-controlled trial was conducted with a total of 20 OLP patients. The patients were randomly divided into two groups, each treated with curcumin tablets at a dose of 2000 mg/day or placebo for a period of four weeks. Furthermore, the patients of both groups received routine treatment for OLP (i.e. Mouthwash Dexamethasone 0.5 mg and suspension Nystatin 100,000 Units). The baseline data were recorded for each patient. Patients were evaluated on day 14 and after completing the course of treatment. Pain and burning sensation were measured based on the Visual Analogue Scale, and the Thongprasom Index was used for clinical improvement and healing. Mann-Whitney and independent t-test were used to compare the responses between the two groups, p-value < 0.05 was considered statistically significant. RESULTS: Our analyses demonstrated no significant difference between the curcumin and placebo treated groups. CONCLUSION: In conclusion, curcumin had no detectable effect in the treatment of OLP. However, a higher dose of curcumin administration and other forms of curcumin with improved bioavailability may be considered in future studies.

Evaluation of Plasma Isoprostane in Patients with Oral Lichen Planus.

STATEMENT OF THE PROBLEMS: Lichen planus is a chronic inflammatory disease. Free radicals and reactive oxygen species play important roles in pathogenesis of oral lichen planus (OLP). Isoprostanes show oxidative stress and are formed by free-radical mediated lipid peroxidation of arachidonic acid and cell membrane phospholipids. PURPOSE: This study was conducted to evaluate the plasma level of 8-isoprostane in patients suffering from erosive and non-erosive forms of OLP. MATERIALS AND METHOD: In this case-control study, 31 patients with OLP and 30 control subjects were enrolled. Plasma samples were obtained and the level of 8-isoprostane was measured with Sandwich enzyme-linked immunosorbent assay (ELISA) in both groups. The data were analyzed by using two-sample t-test, chi-square and ANOVA tests. RESULTS: The results showed significant increase in the plasma level of 8-isoprostane in OLP group compared with the control group. The results of independent t-test revealed no significant correlation between the plasma level of isoprostane and sex, smoking, or previous treatment. CONCLUSION: Based on the findings of this study, oxidative stress was increased in patients with OLP, reflected by higher concentrations of 8-isoprostane in plasma.

Oxidative stress factors and C-reactive protein in patients with oral lichen planus before and 2 weeks after treatment.

OBJECTIVES: Oral lichen planus (OLP) is an inflammatory disease with an unknown origin. Oxidative stress is suspected to play a role in its pathogenesis. The aim of this study was to evaluate serum levels of oxidative stress factors and C-reactive protein in patients with OLP. MATERIALS & METHODS: In this case-control study, 25 patients with OLP and 23 control subjects were enrolled. Serum levels of C-reactive protein (CRP), malondialdehyde (MDA), and total antioxidant capacity (TAC) were investigated in both groups. In case group, all these factors were re-evaluated after 14 days of treatment. The characteristics of the lesions were also recorded at each visit. RESULTS: Serum levels of MDA were significantly higher (P = 0.009), and TAC was significantly lower (P < 0.001) in patients with OLP. There were no significant differences between serum levels of TAC, CRP, and MDA in patients with OLP before and after treatment (P = 0.174, P = 0.556, P = 0.194, respectively). However, the difference in serum levels of TAC between erosive and atrophic patients with keratotic OLP was significant (P = 0.024). CONCLUSION: We concluded patients with OLP have increased of serum MDA and the decrease of serum TAC compared with the healthy subjects, and 14-day treatment of OLP did not have any effect on serum levels of oxidative stress factors.

Oral Health Related Quality of Life in a Group of Geriatrics.

BACKGROUND: A good quality of life in elderly population is related to different aspects of health including oral health. The aim of this study was to determine oral health-related quality of life (OHR-QoL) in elderly patients referred for dental or oro-maxillo-facial complaints to Mashhad dental school (MDS) and compare them with a group of normal population. MATERIALS AND METHODS: A total of 99 patients from MDS (as case group) and 114 elderly people as control were enrolled in this cross-sectional study. Control group were chosen among the pilgrims who had come to the holy shrine of Imam Reza (Haram). Persian version of OIDP (Oral Impact of Daily Performance) index was used. Data were entered to SPSS 11.5 and Statistical analysis was performed. RESULTS: A total of 213 (case =99, control=114) cases were enrolled. Mean Performance score (MPS) was 6.27±10.47 (7.96±11.95 in case group, and 4.80±8.77 in control group) and the difference was significant (p=0.015). Age was conversely correlated with MPS (r=0.0125, p=0.24) although this correlation was not significant. We found, in oro-maxillofacial functions, ill-fit dentures, oral ulcers, pain and tooth mobility were major determinants of OHR-QoL. Number of impaired functions was directly and significantly correlated with MPS (r=0.92, p<0.001). CONCLUSION: Some daily functions like speaking, emotional status, cleaning teeth, physical activity were impaired in case group. Oral and maxillofacial diseases were more prevalent in case group and can be an important impairing issue in OHR-QoL.

Human T-Lymphotropic Virus-1 Associated with Adult T-Cell Lymphoma/ Leukemia and Generalized Expansion of Palatal and Jaw Bones: A Rare Case Report.

Human T-lymphotropic virus-1 (HTLV-1) can cause adult T-cell leukemia/ lymphoma (ATL/L), which is a rare and aggressive type of blood cancer. Herein, we report a case of ATL/L in a middle-aged man with unusual jaw presentations. The patient presented with mandibular, maxillary and palatal bony hard expansion, accompanied by generalized tooth mobility six months prior to admission to the Department of Oral Medicine. The panoramic radiograph showed generalized rarefaction of jaw bones. After laboratory examinations and bone marrow aspiration, ATL/L was diagnosed in association with HTLV-1. The patient underwent chemotherapy. Although the majority of infections associated with HTLV-1 are asymptomatic, some patients may develop blood diseases such as ATL/L and neurological disorders, mainly HTLV-1 associated myelopathy and tropical spastic paraparesis. ATL/L is a rare hematological malignancy in oral cavity that should be included in the differential diagnosis of cases with jaw swelling or generalized demineralization. Serum levels of anti-HTLV-1 antibodies should be examined in suspicious patients, particularly in endemic regions.

A Randomized Placebo-controlled Double Blind Clinical Trial of Quercetin for Treatment of Oral Lichen Planus.

Background and aims. Standard treatment of oral lichen planus (OLP) includes topical or systemic corticosteroids that have many adverse effects. A trend toward alternative natural or herbal drugs has attended recently. This study was conducted to evaluate the effect of quercetin in treatment of erosive-atrophic OLP. Materials and methods. Thirty patients participated in this randomized clinical trial from April 2010 to June 2010 (TRIAL REGISTRATION NUMBER: NCT01375101). Patients were randomly allocated in two groups. Both groups received the standard treatment (dexamethasone mouthwash and nystatin suspension). Experimental group received oral 250 mg quercetin hydrate capsules (bid) and the control group received placebo capsules. The pain and severity of the lesions were recorded at the initial visit and the follow-ups. All recorded data were analyzed with chi-square, Mann-Whitney, t-test, Wilcoxon and Friedman tests using SPSS 11.5. Results. There were no significant differences between the two groups in severity of the lesions and pain in the follow-ups.According to the Friedman test, there was a significant reduction in pain (P = 0.01) and severity indices (P = 0.00) in the case group. These differences were not observed in the control group(P = 0.26,SI; and P = 0.86, PI). No adverse effect of quercetin was reported. Conclusion. According to the results, no significant therapeutic effect can be considered for quercetin in treatment of OLP.

Secondary Involvement of the Mandible due to Basal Cell Carcinoma: A Case Report.

Basal cell carcinoma (BCC) is the most common cutaneous malignancy among Caucasians. Rare examples of aggressive and neglected BCC have been reported. Here we report a unique case of a neglected BCC with significant jaw involvement. A 50-year-old female, referred by an otorhinologist, presented with a large ulcer on her chin, which was extended to her mandibular vestibule. The ulcer was 9×5.5 cm in size, and tissue destruction, necrosis was observed in the central portion, and the mandibular bone was exposed. On intraoral examination, tooth mobility and severe bone loss were evident. Due to the primary cutaneous origin of the lesion, BCC was considered as preliminary diagnosis. Biopsy was performed and diagnosis of BCC was confirmed. The diseased mandibular bone was resected and reconstructed with a surgical plate. The soft tissue defect was reconstructed with deltopectoral flap. The patient refused secondary stage plastic surgery. Although BCC is not a lethal malignancy, if left untreated and neglected, it can result in severe destruction, disfigurement, and even mortality.

Effect of cedar honey in the treatment of oral lichen planus.

INTRODUCTION: Oral Lichen Planus (OLP) is a chronic mucocutaneous disease with an immunological etiology. This study was conducted to evaluate the effect of cedar honey in the treatment of erosive- atrophic OLP. MATERIALS AND METHODS: Thirty patients with a confirmed clinical and histopathologic diagnosis of OLP participated in this randomized clinical trial in Mashhad Dental School. Patients were randomly allocated into one of two groups. Both groups received standard OLP treatment (dexamethasone mouthwash 0.5 mg three times daily and fluconazole capsule 100 mg daily). The intervention group received cedar honey (20 ml three times daily, via a swish and swallow technique) in addition to standard treatment. The patients were followed for 4 weeks. The pain and severity of the lesions were recorded at the initial visit and follow ups. All recorded data were analyzed using the chi-square test, T-test, and analysis of variance (ANOVA) using SPSS version 11.5. A p-value less than 0.05 was considered significant. RESULTS: Both groups had a marked reduction in pain, size of erosive area, and atrophic lesions, particularly in the first follow-up period, but there was no significant difference between the two groups (P>0.05). Honey was effective in the healing of ulcerative lesions (average recovery in the experimental group was 69% while the average relief of ulcerative lesion in the control group was 50%), but the difference was not significant (P=0.896). CONCLUSION: No significant difference was found in the treatment of atrophic and erosive lesions of OLP through use of honey as an alternative treatment. However, this approach may be effective in managing ulcerative lesions of OLP; although more research with a larger sample size is necessary.

Immunohistochemical expression of p16 protein in oral squamous cell carcinoma and lichen planus.

Epithelial carcinogenesis is a multistep process. Specific genetic events lead to malignant transformation of oral epithelium. Oral squamous cell carcinoma (OSCC) may be preceded by potentially malignant lesions such as oral lichen planus (OLP). The p16 protein functions as a negative regulator of the cell cycle progression. Altered pattern of p16 serves as a biomarker for oral mucosal dysplasia and malignant growth. The purpose of this study was to evaluate p16 expression in OSCC and OLP to determine whether it can be a useful marker for early detection of carcinogenesis. We examined p16 expression in 45 OSCCs (15 grade I, 15 grade II, and 15 grade III), 15 OLPs without dysplasia, and 8 normal mucosal specimens with immunohistochemistry. p16 was interpreted as positive if more than 70% of tumor cells showed brown nuclear and cytoplasmic staining. All of the OSCC and control group samples showed negative immunoreactivity, whereas 26.7% of OLP samples were positive for p16. Our findings suggest that p16 expression could not be used as a helpful marker for detection of development toward malignancy in OLP samples.

Comparison of COX2 expression between oral squamous cell carcinoma, leukoplakia and normal mucosa.

AIM: To compare cyclooxygenase 2 expression (COX2-E) between normal, oral leukoplakia lesions and different grades of oral squamous cell carcinoma (SCC). MATERIALS AND METHODS: Around 90 paraffin embedded blocks consisting of 45 SCC, 15 leukoplakia and 17 controls were selected for immunohistochemistry (IHC) for detection of COX2- E. COX2-E was divided in four grades, as A (0-10%), B (11- 40%), C (41-70%) and D (< 70%) cellularity. RESULTS: Mean age of the patients was 55.17 ± 18.41 (M:57.92 ± 16.87, F:52.19 ± 19.74). A significant difference was found in COX2 expression between SCC total and, basal and spinous layers of leukoplakia (p > 0.05). COX2-E in spinous layer of normal tissue was significantly lower than SCC (p = 0.000). COX2-E was significantly different in SCC grade 3 and leukoplakia (p = 0.001) and normal tissue (p = 0.000). COX2-E was significantly higher in SCC grade 3 compared to leukoplakia (basal layer) (p = 0.000). CONCLUSION: We showed a significant higher COX2-E in SCC lesions compared to leukoplakias and normal controls. In our study COX2-E was not significantly different in SCC grades 1, 2 and 3 (p < 0.05).

Prevalence of oral mucosal lesions in institutionalized elderly people in Mashhad, Northeast Iran.

OBJECTIVE: The aim of this study was to determine the prevalence of oral mucosal lesions in institutionalized elderly people in Mashhad, northeast of Iran. BACKGROUND: This study was conducted to assess the prevalence of oral lesions in the institutionalized elderly. METHODS: In this survey, we studied all of the nursing homes in Mashhad; a total of five encompassing 237 residents. The subjects were examined and lesions recorded in a designed checklist. T-test, chi-square and Fisher's exact tests were used for the analysis. RESULTS: The mean age of the patients was 79.59 ± 8.88. Ninety-eight per cent of cases had at least one oral mucosal lesion. The most common lesions were fissured tongue (66.5%), atrophic glossitis (48.8%), sublingual varicosity (42%) and xerostomia (38%). There was no significant difference in the prevalence of denture-related lesions (DRLs) between men and women (p > 0.05). Xerostomia was more prevalent in 70-79-year-old than in 60-69-year-old subjects. No case of oral malignant lesion was detected. DISCUSSION: These findings revealed a higher prevalence of oral mucosal lesions in Mashhad city compared with other studies conducted in other major cities in Iran and abroad. The results emphasise the necessity of national programmes towards oral health promotion.

Survey of reactive hyperplastic lesions of the oral cavity in mashhad, northeast iran.

BACKGROUND AND AIMS: Reactive hyperplasias (RHs) are common oral mucosal lesions caused by irritation of the mu-cosa. The aim of this study was to evaluate the frequencies of various types of oral RHs in a university clinic. MATERIALS AND METHODS: Oral RH cases, undergone biopsy in a four-year period, were studied retrospectively. Data including age and gender as well as the location and clinical characteristics of the lesion were collected and analyzed. RESULTS: A total of 123 cases (age range 7-79 years old; mean: 38.8 ± 18.50 years; male: female ratio, 1.9:1) were evalu-ated. Over a half of the lesions including pyogenic granuloma, giant cell granuloma, and peripheral ossifying fibroma were found in gingiva (52%). Fibroma involved mostly the buccal mucosa. Most lesions had smooth surface and sessile base. CONCLUSION: The clinical features of oral inflammatory hyperplasia in the studied sample were similar to those previously reported.

Multifocal epithelial hyperplasia, a rare oral infection in Asia: Report of twelve cases in Iran

Objectives: Multifocal epithelial hyperplasia (MEH) is benign, asymptomatic oral disease with viral etiology. The frequency of this disease varies widely from one geographic region to another, and can vary, from 0.002 to 35% depending on the population studied.Study design: Here we report the clinicopathological features of twelve cases of MEH referred to Oral Medicine Department of Mashhad Dental School for the first time in Iran. Records of patients with the diagnosis of MEH in our department during 7 years were analyzed and data were extracted. Results: Most of the patients were younger than 20-year-old (66%), and females were predominantly affected(7:12). The mean age of onset was 12.72±10.14 years and the mean duration was 52.54 ± 78.51 months. Patients had multiple, well circumscribed, soft, non tender, flattened papules, with a color similar to the adjacent mucosa,in different areas of the oral cavity but the most affected site was buccal mucosa. Familial history of such lesions was negative in all patients. Only three cases showed spontaneous regression.Conclusion: In spite of rare nature of this disease in Asia, it seems that it is not the case in Khorasan Province,southeast Iran (AU)

Multifocal epithelial hyperplasia, a rare oral infection in Asia: report of twelve cases in Iran.

OBJECTIVES: Multifocal epithelial hyperplasia (MEH) is benign, asymptomatic oral disease with viral etiology. The frequency of this disease varies widely from one geographic region to another, and can vary, from 0.002 to 35% depending on the population studied. STUDY DESIGN: Here we report the clinicopathological features of twelve cases of MEH referred to Oral Medicine Department of Mashhad Dental School for the first time in Iran. Records of patients with the diagnosis of MEH in our department during 7 years were analyzed and data were extracted. RESULTS: Most of the patients were younger than 20-year-old (66%), and females were predominantly affected (7:12). The mean age of onset was 12.72+/-10.14 years and the mean duration was 52.54 +/- 78.51 months. Patients had multiple, well circumscribed, soft, non tender, flattened papules, with a color similar to the adjacent mucosa, in different areas of the oral cavity but the most affected site was buccal mucosa. Familial history of such lesions was negative in all patients. Only three cases showed spontaneous regression. CONCLUSION: In spite of rare nature of this disease in Asia, it seems that it is not the case in Khorasan Province, southeast Iran.