1. Introduction

Leukoplakia of the oral mucosa is a common disease in medicine, occurring mainly in patients over 30 years of age. This disease is accompanied by the development of pathological hyperkeratosis in the oral mucosa and, if not diagnosed in time or treated inadequately, has a high risk of malignant transformation [1,2,3,4,5,6,7,8]. According to epidemiological studies, the incidence of leukoplakia in the general population is about 1-3%, but among risk groups (smokers, alcohol drinkers) this figure has been found to increase to 6-7%. The variety of clinical forms of the disease (flat, verrucous, erosive-ulcerative), as well as in more severe cases, complicates the treatment tactics [9,10,11,12].

Leukoplakia diagnosis is based on clinical examination, laboratory and instrumental examinations. In addition to traditional approaches (vitamin A preparations, treatment with medicinal oils), modern methods are widely used in treatment - ozone therapy, photodynamic therapy, physiotherapeutic procedures. Therefore, the purpose of this study is to compare the clinical and laboratory effectiveness of various treatment approaches in leucoplakia [13,14,15].

2. Materials and Methods

The study was conducted in 2021–2024 with the participation of 120 patients. All patients were aged 30 to 60 years, and they were divided into groups according to gender, age, smoking and duration of alcohol consumption. Individuals with general somatic diseases and allergic reactions were excluded from the study.

Patients were divided into 3 main groups and 6 subgroups:

1. The first group consisted of 30 patients with flat leukoplakia. 15 of them received ozone therapy (general and local), and the remaining 15 were treated with healing oil and vitamin A.

2. The second group consisted of 30 patients with varicose veins. 15 of them received general and local ozone therapy after the treatment process, and 15 were treated only with traditional means.

3. The third group consisted of 30 patients with severe forms (varicose and erosive-ulcerative). 15 of them received photodynamic therapy, and the remaining 15 received only traditional treatments.

Thirty healthy individuals were recruited as controls. During the study, clinical examination, oral hygiene indices, Schiller-Pisarev test, perhydrol test, as well as microscopic and immunological parameters were studied.

3. Research Results

The program of work with patients was designed in stages: first, oral hygiene and the general condition of the mucous membrane were examined, then the Schiller–Pisarev and perhydrol tests were used to assess the degree of inflammation, and then the treatment (traditional or modern) appropriate to the clinical form was selected. Intergroup comparisons were performed while maintaining the proportion of age, gender and harmful habits (smoking, alcohol). During the observation period, all patients were given hygienic education, as well as recommendations to reduce factors that increase inflammation. The results are presented in detail below.

Table 1. Distribution of patients according to clinical forms

Every one clinical in the form main and control small groups proportional This design allowed for the assessment of clinical form-specific differences independent of treatment type.

Table 2. Oral Hygiene Index (OHI) by groups

OHI indicators in patients to the healthy 3–4 times more than that it has deteriorated Verrocq himself showed and especially erosion ulcer in forms index high values mucus on the floor broken patch keratinization in the background soft tissues easy injury and cleaning difficulty with The flat figure shows that although the OHI balance is relatively low, it still indicates that hygiene is not sufficient.

Table 3. Results of the Schiller–Pisarev test (staining in iodine solution)

Test high painting indicators to glycogen rich epithelium sectors many and chronic inflammation existence In the flat form, the highest staining intensity corresponds to diffuse hyperkeratosis and slow regeneration processes on the epithelial surface; in the erosive-ulcerative form, the staining is relatively reduced due to disruption of the epithelial layer, but this decrease does not indicate a decrease in inflammation, but an epithelial deficiency.

Table 4. Pergidrol (3% hydrogen peroxide) test results

Peroxide with of the leak high share microerosions and inflamed on surfaces catalytic activity increased The clinical significance is that patients are at increased risk of bleeding and discomfort during mechanical cleaning; hygiene training and the use of soft brushes are important.

Table 5. Home clinical complaints meeting frequency (semi-quantitative price)

“+” – low, “++” – medium, “+++” – high frequency of occurrence. In the flat form, subjective tightness predominates, while in the erosive-ulcerative form, pain and burning are more pronounced; in the varicose form, a rough change in the relief is the leading sign. This pattern helps to quickly differentiate the form during clinical examination and guides the selection of analgesia and covering gels/ointments.

• healthy controls, all functional tests were almost negative, indicating that these methods provide a high “signal-to-noise” ratio for differential diagnosis in clinical practice.

• Intergroup comparisons showed that the higher the hygiene index, the higher the positive signal in the Schiller–Pisarev and perhydrol tests; this indicates the need to introduce hygiene interventions as a first step in practice.

4. Discussion

In this study, the functional state of the mucous membrane and inflammatory markers in the forms of oral leukoplakia (flat, verrucous, erosive-ulcerative) were analyzed in a comprehensive manner. The results showed a sharp deterioration in hygiene indicators in all forms and a high positive response to tests (Schiller–Pisarev, perhydrol). This is explained, on the one hand, by the intensification of hyperkeratosis and parakeratosis, and, on the other hand, by the accumulation of microtraumas at the epithelial- connective tissue interface. If the high staining in the flat form indicates that the epithelial layer is preserved, but has undergone metaplasia, then in the erosive-ulcerative form the test percentage decreases due to the disruption of the epithelium - this indicates not a decrease in inflammation, but the loss of the protective layer.

The parallel upward trend observed between the hygienic index and functional tests dictates the sequence of interventions: first, professional cleaning and home hygiene retraining, then inflammation control (antiseptic rinses, barrier gels/ointments), and then form-specific treatments (relief smoothing and stimulation of re-epithelialization in varicose veins, epithelialization and pain control in erosive ulcers) are appropriate.

Modern approaches – ozone therapy and photodynamic therapy – seem promising in clinical practice. Ozone therapy can reduce symptoms more quickly by normalizing local redox balance, disrupting biofilms, and improving microcirculation; photodynamic therapy helps control pathological foci through selective photoinduced cytotoxicity. As a practical recommendation, these methods are expected to provide broader clinical benefits compared to small protocols limited to traditional oils and vitamins, especially in varicose and erosive ulcerative forms.

However, several limitations of the study design should be acknowledged: (i) the fact that histological dynamic follow-up was not performed to the same depth in all cases limits long-term conclusions regarding the risk of malignant transformation; (ii) the use of a semiquantitative scale of clinical complaints is less sensitive than a precise percentage assessment; (iii) the final results cannot be guaranteed to be completely independent of lifestyle factors (smoking intensity, alcohol consumption frequency). Future studies with a multicenter, larger sample size, and enriched with complete histomorphological monitoring will further clarify the results.

The lessons for clinical practice are summarized as follows: in the initial evaluation of a patient presenting with leukoplakia, measuring the hygiene index and performing two function tests provides sufficient information as a “quick filter” for diagnosis; the differential diagnosis of the form is consistent with the complaint pattern; and treatment should begin with hygiene and inflammation management, followed by form-specific modalities.

5. Conclusions

This study showed that in the forms of oral leukoplakia, hygiene disorders and inflammatory markers increased sharply, and the high positivity of the Schiller-Pisarev and perhydrol tests paralleled the clinical severity; in the flat form, the high staining intensity reflected the background of metaplastic epithelium, and in the erosive lesions, a relative decrease due to the disruption of the protective layer; at the same time, in the verrucous form, a rough change in the relief had a dominant effect on the clinical picture. In practice, initially re-education of patients in professional and home hygiene, the introduction of complex anti-inflammatory measures, and then the use of modern treatments (ozone therapy, photodynamic therapy) appropriate to the form can accelerate the regression of symptoms and restore the stability of the mucosa. In the future, it is desirable to further refine treatment algorithms through multicenter and long-term follow-up, histological monitoring, and strict control of lifestyle factors.