Oral Submucus Fibrosis

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Dr. Sanjay Kalra

Posted By : Dr. Sanjay Kalra - BDS, MDS, PCAD, FPFA, FICD, FICCDE (USA)

Posted On : Oct 18, 2007 (Views : 18704)

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Oral submucous fibrosis (OSMF) is a chronic disease of oral mucosa characterized by inflammation and progressive fibrosis  followed by stiffening of an other wise yielding mucosa resulting in difficulty in opening the mouth. It is generally accepted today that areca nut quid plays a major role in the etiology .The younger generation is very much addicted to these products especially gutkha and panmasala. The condition is well recognized for its malignant potential. 

The pathogenesis of the disease is not well established, but the cause of OSMF is believed to be multifactorial. Factors include areca nut chewing, ingestion of chilies, genetic and immunologic processes, nutritional deficiencies, and other factors.Iron deficiency anemia, vitamin B complex deficiency, and malnutrition are promoting factors that derange the repair of the inflamed oral mucosa, leading to defective healing and resultant scarring .

The rate varies from 0.2-2.3% in males and 1.2-4.57% in females in Indian communities. OSMF is widely prevalent in all age groups and across all socioeconomic strata in India. ; it is even prevalent among teenagers in India, 8.8% of teenagers with a mean age 16.3 years (? 1.5 y) were found to have OSMF . Generally, patient age ranges from 11-60 years  most patients are aged 45-54 years and chew betel nuts 5 times per day .

Mortality/Morbidity: OSMF has a high rate of morbidity because is causes a progressive inability to open the mouth, resulting in  in eating and consequent nutritional deficiencies. OSMF also has a significant mortality rate becausef it can transform into oral cancer, particularly squamous cell carcinoma, at a rate of 7.6% .

History: Symptoms of OSMF include the following :

  1. Progressive inability to open the mouth (trismus) due to oral fibrosis and scarring

  2. Oral pain and a burning sensation upon consumption of spicy foodstuffs

  3. Increased salivation

  4. Change of gustatory sensation

  5. Hearing loss due to stenosis of the eustachian tubes

  6. Dryness of the mouth

  7. Nasal tonality to the voice

  8. Dysphagia to solids (if the esophagus is involved)

  9. Impaired mouth movements (eg, eating, whistling, blowing, sucking)

Laboratory findings:

  1. Decreased hemoglobin levels

  2. Decreased iron levels

  3. Decreased protein levels

  4. Increased erythrocyte sedimentation rate

  5. Decreased vitamin B complex levels


Medical Care: The treatment of patients with OSMF depends on the degree of clinical involvement. If the disease is detected at a very early stage, cessation of the habit is sufficient. Most patients with OSF present with moderate-to-severe disease. Moderate-to-severe OSF is irreversible. Medical treatment is symptomatic and aimed at improving mouth movements.

Treatment includes the following 

Steroids: In patients with moderate OSMF, weekly submucosal intralesional injections or topical application of steroids may help prevent further damage.

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