Oral mucosal lesion findings from a national multistage probability oral health survey of United States schoolchildren in kindergarten through grade 12 are reported. In the 1986-87 school year 39,206 children aged 5-17 yr were examined by 14 dentists trained in standardized clinical diagnostic criteria for dental caries, periodontal conditions and oral mucosal lesions. In addition all children were asked whether or not they ever had "cold sores," "fever blisters," or "canker sores", and adolescents (grades 6-12) were questioned about their history of tobacco use. About 4% of the children had one or more oral mucosal lesions present at the time of the examination, while 33 and 37% reported a history of recurrent herpes labialis and recurrent aphthous ulcers, respectively. The most prevalent lesions clinically observed were recurrent aphthous ulcers (1.23%), recurrent herpes labialis (0.78), smokeless tobacco lesions (0.71), and geographic tongue (0.60). Differences in prevalence were analyzed by age, sex, race, metropolitan area, and geographic region. Almost 10% of 12-17-yr-olds reported current use of some type of tobacco product. In adolescents the current use of tobacco products had a marked effect on the prevalence of oral lesions.

Traumatic injuries to the teeth are among the most serious of dental conditions, yet little is known about the prevalence of tooth or dental trauma at the national level. The National Institute of Dental Research (NIDR) modified existing indices for specific use in national epidemiologic studies of tooth trauma among both children and adults. The NIDR index was developed not only to track the status of the tooth from sound (no evidence of trauma) through missing due to trauma, but also to reflect selected sequelae of trauma. The index is based on clinical, non-radiographic evidence of tooth inujury and treatment received in the eight permanent incisors, including a positive history of injury obtained from the subject. The trauma assessment index was applied immediately following the caries examination for dentate participants ages 6-50 years old (n=7,707) in Phase 1 of the NHANES III oral examination. This article reports the first national overall and age-specific population-based prevalence of dental trauma among gender, racial, and ethnic groups. There is a higher prevalence of incisal trauma, of both maxillary and mandibular incisors, in males than females, in both the younger and older age groups. The prevalence of incisal trauma of both maxillary and mandibular incisors in whites and blacks in both younger and older age categories is similar. The study found that half of the individuals with trauma had only one incisor tooth classified as having trauma. Males and older age groups showed larger numbers of traumatized teeth. Further study and examination of methodological issues are desirable for additional understanding of incisal trauma in the general population .

Demographic changes will greatly influence the epidemiology of oral and pharyngeal cancer in coming decades. For older Americans, these cancer types are likely to remain a serious and perhaps increasing problem. Understanding of these cancers can be furthered by continued analysis of existing databases and the creation of new data sources for the future.

The methods used in the international English-language literature of epidemiologic investigations of oral mucosal conditions were reviewed. Methods used to study leukoplakia, lichen planus, recurrent herpes labialis, recurrent aphthous ulcers, geographic tongue and candidiasis are highlighted. In addition, studies of the full range of pathologies documented in a population were reviewed. The methodologic issues raised by the epidemiologic literature as well as those to be considered for future studies of oral mucosal conditions are presented. Emphasis is placed on study population selection, diagnostic criteria development, type and training of examiners, risk factor assessment and issues related to data collection, analysis and reporting.