Clinical, forensic aspects of oral lesions during tobacco use

Tobacco use provokes the development of numerous pathological changes in the oral mucosa, from inflammatory processes to precancerous conditions and malignant neoplasms, which requires a comprehensive forensic medical assessment to establish cause-and-effect relationships in the investigation of cases of occupational pathology and compensation for harm to health. The study was aimed at summarising existing scientific data on the clinical and forensic features of oral lesions caused by tobacco use and determining the role of dentists in conducting forensic examinations of such cases. A systematic analysis of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 methodology, with a search in international databases. The results of the analysis revealed three categories of lesions with maximum forensic value: erythroplakia (severe dysplasia/carcinoma in situ), leukoplakia with epithelial dysplasia, and submucosal fibrosis with stromal hyalinisation due to the high risk of malignancy. An aetiological relationship was established between tobacco use and the pathogenesis of lesions through biochemical (decrease in glutathione and albumin), immunohistochemical (expression of SERPINA6, SERPINF1, p16), and molecular (microRNA-21) markers. Epidemiological data showed mucosal lesions in 60.1% of tobacco users, with submucous fibrosis (110 cases, 27.5%) and leukoplakia (102 cases, 25.5%) dominating the 400 surveyed. A gradation system for assessing the severity from mild (5-15% disability) to severe (40-100%, persistent dysfunction) was developed, which provides a legal qualification of lesions. Comparative analysis showed a functional differentiation of the competencies of forensic medical experts and dentists, which justified the need for interdisciplinary integration in the examination of tobacco-related lesions. Morphological characteristics of lesions of forensic significance were systematised, and criteria for assessing the severity of tobacco-associated mucosal changes were determined. The necessity of integrating dental knowledge into forensic medical practice and involving dentists in conducting an expert examination in cases of oral pathology associated with tobacco use was substantiated