Prevalence and Risk Factors of Potentially Malignant Oral Lesion in Prison Population: A Systematic Review

Background: Potentially malignant oral disorders (OPMDs) and oral carcinomas repre- sent a significant oncological concern in incarcerated populations, where multiple modi- fiable risk factors such as tobacco use, illicit drug consumption, oncogenic human papil- lomavirus infections, and poor oral hygiene coexist with limited access to preventive and routine dental care. This combination may increase the risk of delayed diagnosis and ma- lignant transformation. Objective: This PRISMA-compliant systematic review aimed to evaluate the prevalence of OPMDs and associated risk factors in prison populations, with a particular focus on identifying gaps in the current evidence. Methods. A systematic lit- erature search was conducted in PubMed, Scopus and Cochrane Library using predefined search strategies. The final search yielded 24 records, which were screened according to PRISMA 2020 guidelines. After title and abstract screening, 10 full-text articles were as- sessed for eligibility, and 5 cross-sectional studies were included in the qualitative syn- thesis following independent review. Results: The included studies revealed a substantial burden of oral mucosal lesions in incarcerated populations. Premalignant lesions were reported in a significant proportion of inmates, with oral submucous fibrosis particularly prevalent in some cohorts. Additionally, a high prevalence of oral high-risk HPV infection and widespread oral manifestations were observed. Tobacco use, often combined with betel quid, alcohol, or illicit drugs, emerged as the primary and consistently associated risk factor for oral lesions. Conclusions: Prison populations appear to represent a high- risk group for OPMDs due to the combined effect of behavioral and structural risk factors. However, the limited number of available studies, their cross-sectional design, and meth- odological heterogeneity prevent definitive conclusions. Further longitudinal and meth- odologically robust studies are needed to better define prevalence patterns and support targeted screening and prevention strategies in correctional settings.