Chronic Inflammation as a Diagnostic Modifier in Oral Potentially Malignant Disorders: A Clinical Perspective

Gerardo Gilligan; Federico Garola; María Fernanda Galindez-Costa; Jerónimo Lazos; Eduardo David Piemonte; René Luis Panico

doi:10.5327/2525-5711.499

Authors

Gerardo Gilligan Oral Medicine Department, Facultad de Odontología Universidad Nacional de Córdoba https://orcid.org/0000-0002-5201-1444
Federico Garola Oral Medicine Department, Facultad de Odontología Universidad Nacional de Córdoba https://orcid.org/0000-0001-8639-2057
María Fernanda Galindez-Costa Oral Medicine Department, Facultad de Odontología Universidad Nacional de Córdoba https://orcid.org/0009-0007-5768-9557
Jerónimo Lazos Oral Medicine Department, Facultad de Odontología Universidad Nacional de Córdoba https://orcid.org/0000-0002-0881-9614
Eduardo David Piemonte Oral Medicine Department, Facultad de Odontología Universidad Nacional de Córdoba https://orcid.org/0000-0001-5955-1139
René Luis Panico Oral Medicine Department, Facultad de Odontología Universidad Nacional de Córdoba https://orcid.org/0000-0002-5833-5546

DOI:

https://doi.org/10.5327/2525-5711.499

Keywords:

Oral potentially malignant disorders, chronic inflammation, oral epithelial dysplasia, chronic mechanical irritation, Candida

Abstract

Objective. To discuss how chronic inflammatory conditions may complicate the clinical and histopathological interpretation of oral potentially malignant disorders (OPMDs) in daily oral medicine and oral surgery practice.

Clinical Perspective. This article presents an expert clinical perspective supported by selected literature and representative clinical scenarios illustrating diagnostic challenges encountered when OPMDs coexist with chronic mechanical irritation, oral dysbiosis, and Candida-associated inflammation. This perspective aims to highlight unresolved clinicopathological gray zones that may influence biopsy interpretation and clinical decision-making.

Discussion. Chronic inflammatory stimuli may alter lesion phenotype by accentuating erythema, ulceration, hyperkeratosis, and reactive epithelial changes, potentially complicating the distinction between reactive atypia and true oral epithelial dysplasia (OED). In selected cases, these inflammatory modifiers may contribute to diagnostic uncertainty, particularly in clinically ambiguous or low-grade lesions. In addition, local inflammatory conditions may influence communication between clinicians and pathologists regarding biopsy timing, site selection, and clinicopathological correlation. Representative clinical examples are discussed to illustrate how inflammatory factors may confound interpretation of OPMDs in routine practice.

Conclusions. Awareness of local inflammatory modifiers may help contextualize the interpretation of selected OPMDs during clinical and surgical assessment. This clinical perspective underscores the importance of careful clinicopathological correlation and encourages further prospective research exploring the interaction between chronic inflammation and epithelial alterations in OPMDs.

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