Current updates on dental perspectives of leprosy – Revisited

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Abstract

The present review summarizes the current updates on dental perspectives on leprosy and the affording factors that are responsible for the prevalence of caries and periodontal diseases in leprosy. It also highlights immunopathological phenomena and reactional episodes of leprosy that occur due to daedal interactions between the perio-odontopathic bacteria and M. leprae. In addition, a brief introduction, historiography, classification and clinicopathological aspects are also been covered.

Introduction

Leprosy, a chronic granulomatous infectious disease caused by Mycobacterium Leprae, has been known to foist humans from ancient times.1 According to the forged figures from 159 countries of six WHO regions (African region, region of the Americans, South East Asia, European, East Mediterranean and Western Pacific region), the estimates of the world prevalence of leprosy registered globally is about 211,009 new cases.2 The second highest prevalent country in the world, Brazil documented about 37,610 new cases in 2009.3,4 The National leprosy survey registry conducted in December 2010 registered 6032 cases in China.5 India also accounted for about 70% of new cases annually. The ANCDR (Annual new case detection rate) has recently shown a plateau from 9.71/100,000 in 2016 to 10.12/100,000 in 2017.1 All these statistical data indicate that despite the advent of multidrug therapy, leprosy still remains as appurtenant public health concern that needs immediate attention. Also, the leprotic patients, who suffer from social repudiation or banishment and stigma remain isolated from their families and community due to the negative attitudes of general public, thus having low quality of life and neglecting both general and dental health care.5

Historically, leprosy has afflicted humans since 1500 BC. The origin and worldwide distribution of leprosy, when traced, babbled from East Africa and migrated with humans involved in goods trading and slavery.2 The word leprosy was derived from the Latin word “leprosus” which means “defilement’, denoted that the leper (person suffering from leprosy) were inflicted by God for the sins they committed and hence called as a ‘defiled human’, a ritually unclean person who should be condemned.6, 7, 8, 9 A brief historiography of leprosy is summarized in Table 1.10 The causative organism, Mycobacterium Leprae was first described by dr Gerhard Henrik Armaeur Hansen in 1873 and hence, also known as Hansen's disease or “death before death”.11, 12, 13, 14 This organism is an obligate, intracellular, gram positive, acid fast bacilli measuring about 0.3–0.5 µm in diameter and can be best demonstrated by acid fast staining.13,15,16 This pathogen has tropism for cooler regions of body, thus affecting the skin, peripheral nerves, upper respiratory tract, eyes and oral mucosa. It is transmitted through secretions like semen, tears, sweat and saliva of individuals infected with this disease.17 Left untreated, it causes severe deformity and orofacial manifestations18 that further aggravate type 1 and type 2 leprosy reaction, together called as “Reactional episodes in leprosy”. These episodes result due to daedal interactions of the pathogen with the individual's immune system, provoking a dynamic immunopathological phenomena in the body.19

Section snippets

Classification

According to Ridley–Jopling classification,20 leprosy is classified into Indeterminate type, Tuberculoid type (T lep), Lepromatous type (L lep), Borderline tuberculoid type (BT), Mid borderline (MB), borderline lepromatous types (BL) based on clinical, immunological and histological criteria. It displays a broad range of clinical manifestations, thus reflecting the enigmatic cellular immune response of the host with the pathogen M leprae. The tuberculoid type (T lep) demonstrates high level of

Clinical features and oral manifestations

Leprosy, the disease of great antiquity, is clinically diagnosed on presence of cardinal signs such as hypopigmented or erythematous anesthetic patches on skin, thickened tender peripheral nerves and presence of bacilli in skin smears. The nerve involvement of superficial nerves of auricle, ulna, posterior tibia etc. causes thickening of these nerves resulting in loss of sensation to temperature, touch and pain. The fall in motor nerve conduction velocities and electrophysiological assessment

Dental perspectives of oral leprosy

In the view of dental manifestations, it is documented that about 67.7% of leprosy have periodontal complaints, 54.8% show attrition, 54.8% gingivitis and 74.2% show dental caries and pulpitis.12,35 Periodontal diseases in leprosy are characterized by recurrent gingival bleeding at light touch, loss of tooth, papillary hypertrophy of gums and areas of hypoesthesia at the border of alveolar mucosa. Nunez Marti et al36 in Spanish survey in 2004 investigated the periodontal status of the anterior

Conclusion

This review highlights the current updates on dental perspectives of leprosy patients and thus alters the dentists in developing countries to pay immediate attention regarding the oral hygiene care amongst such cases. Future research is warranted to better define the long term outcome of such cases and improve their quality of life by creating awareness among the health care workers working in leprosy centers.

Declaration of Competing Interest

None.

Disclaimer

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Funding

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