Thu. Nov 25th, 2021

    oral submucous fibrosis causes and treatment

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    Oral submucous fibrosis is a chronic, complex, premalignant (1% transformation risk) condition of the oral cavity, characterized by juxta-epithelial inflammatory reaction and progressive fibrosis of the submucosal tissues (the lamina propria and deeper connective tissues). As the disease progresses, the oral mucosa becomes fibrotic to the point that the person is unable to open the mouth.[1][2] The condition is remotely linked to oral cancers and is associated with areca nut and / or its by-products chewing, majorly practiced in South and South-East Asian countries.[3] The incidence of OSMF has also increased in the western countries due to the changing habits and constant migrating population.


    Dried products such as paan masala and gutkha have higher concentrations of areca nut and appear to cause the disease. Other causes include:

    • Immunological diseases
    • Extreme climatic conditions
    • Prolonged deficiency to iron and vitamins in the diet


    Biopsy screening although necessary is not mandatory most dentist can visually examine the area and proceed with the proper course of treatment.

    Treatment includes:

    • Abstention from chewing areca nut (also known as betel nut) and tobacco
    • Minimizing consumption of spicy foods, including chiles
    • Maintaining proper oral hygiene
    • Supplementing the diet with foods rich in vitamins AB complex, and C and iron
    • Forgoing hot fluids like tea, coffee
    • Forgoing alcohol
    • Employing a dental surgeon to round off sharp teeth and extract third molars
    • Interprofessional treatment approach [15]

    Treatment also includes following:

    • The prescription of chewable pellets of hydrocortisone (Efcorlin); one pellet to be chewed every three to four hours for three to four weeks
    • 0.5 ml intralesional injection Hyaluronidase 1500 IU mixed in 1 ml of Lignocaine into each buccal mucosa once a week for 4 weeks or more as per condition
    • 0.5 ml intralesional injection of Hyaluronidase 1500 IU and 0.5 ml of injection Hydrocortisone acetate 25 mg/ml in each buccal mucosa once a week alternatively for 4 weeks or more as per condition[16]
    • Submucosal injections of hydrocortisone 100 mg once or twice daily depending upon the severity of the disease for two to three weeks
    • Submucosal injections of human chorionic gonadotrophins (Placentrax) 2-3 ml per sitting twice or thrice in a week for three to four weeks
    • Surgical treatment is recommended in cases of progressive fibrosis when interincisor distance becomes less than 2 centimetres (0.79 in). (Multiple release incisions deep to mucosa, submucosa and fibrotic tissue and suturing the gap or dehiscence so created by mucosal graft obtained from tongue and Z-plasty. In this procedure multiple deep z-shaped incisions are made into fibrotic tissue and then sutured in a straighter fashion.)
    • Pentoxifylline (Trental), a methylxanthine derivative that has vasodilating properties and increases mucosal vascularity, is also recommended as an adjunct therapy in the routine management of oral submucous fibrosis.[17]
    • IFN-gamma is antifibrotic cytokine which alters collagen synthesis and helps in OSF.[18]
    • Colchicine tablets 0.5 mg twice a day[19]
    • Lycopene, 16 mg a day helps in improvement of OSF[20]

    The treatment of patients with oral submucous fibrosis depends on the degree of clinical involvement. [21] If the disease is detected at a very early stage, cessation of the habit is sufficient. Most patients with oral submucous fibrosis present with moderate-to-severe disease. Severe oral submucous fibrosis is irreversible. Moderate oral submucous fibrosis is reversible with cessation of habit and mouth opening exercise. Current modern day medical treatments can make the mouth opening to normal minimum levels of 30 mm mouth opening with proper treatment.

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