Chronic inflammation as a diagnostic modifier in oral potentially malignant disorders: a clinical perspective

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Abstract
This study examines how local chronic inflammatory conditions, particularly oral dysbiosis, Candida-associated inflammation, and chronic mechanical irritation, may modify the clinical and histopathological presentation of oral potentially malignant disorders (OPMDs) and complicate their assessment in routine practice. This expert clinical perspective, supported by selected literature and representative clinical scenarios, addresses clinicopathological gray zones arising when OPMDs coexist with inflammatory and microbial disturbances. These conditions may accentuate erythema, ulceration, hyperkeratosis, epithelial hyperplasia, and reactive cytological atypia, potentially complicating the distinction between inflammation-associated changes and true oral epithelial dysplasia (OED). Oral dysbiosis and Candida-associated inflammation may further modify the local inflammatory microenvironment and lesion phenotype. Recognition of these modifiers may inform biopsy timing and site selection, histopathological interpretation, and communication between clinicians and pathologists. Local inflammatory and microbial modifiers should be considered when evaluating OPMDs, particularly when clinical and histopathological findings are equivocal or discordant. Careful clinicopathological correlation and further prospective studies are needed to clarify the interactions among oral dysbiosis, chronic inflammation, and epithelial alterations in OPMDs.

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