Oral Sub Mucous Fibrosis
Oral sub mucous fibrosis (Osmf) is a chronic, complex, pre-malignant condition of the oral cavity, characterized by juxta-epithelial inflammatory reaction and progressive fibrosis of the submucosal tissues i.e. the lamina propria and deeper connective tissues.
Definition
Pathological Definition
An insidious chronic disease affecting any part of the oral cavity and sometimes the pharynx. Although occasionally preceded by and associated with vesicle formation, it is always associated with a juxta-epithelial inflammatory reaction followed by a fibro-elastic change of the lamina propria, with epithelial atrophy leading to stiffness.
Clinical Definition
A debilitating, progressive, irreversible collagen metabolic disorder induced by chronic chewing of Areca nut and its commercial preparations; affecting the oral mucosa and occasionally the pharynx and esophagus; leading to mucosal stiffness and functional morbidity; and has a potential risk of malignant transformation.
Epidemiology
The incidence of the disease occurrence is higher in people from certain parts of the world including South and South East Asian, South Africa and the Middle Eastern countries.
Causes
Dried products such as paan masala and gutkha have higher concentrations of areca nut and appear to cause the disease.
Other causes include the following
- Various immunological diseases
- Extreme climatic conditions
- Prolonged deficiency to iron and vitamins in the diet can be a cause
Symptoms
In the initial phase of oral sub mucous fibrosis, the mucosa feels leathery with palpable fibrotic bands and in the advanced stages the oral mucosa loses its resiliency and becomes blanched and stiff. The disease is believed to begin in the posterior part of the oral cavity and gradually spread outward.
Other features of the disease include the following
- Xerostomia or dry mouth
- Recurrent ulcers in mouth
- Pain in the ear
- Nasal intonation of voice
- Restriction of the movement of the soft palate
- A bud-like shrunken uvula
- Thinning and stiffening of the lips or tissues around the mouth
- Pigmentation of the oral mucosa
- Dryness of the mouth and burning sensation (stomatopyrosis)
- Restricted mouth opening
Classification
Oral submucous fibrosis is clinically divided into three stages which are stated as follows
Stage 1 - Stomatitis
Stage 2 - Fibrosis
a - Early lesions, blanching of the oral mucosa
b - Older lesions, vertical and circular palpable fibrous bands in and around the mouth or lips, resulting in a mottled, marble-like appearance of the buccal mucosa
Stage 3 - Sequelae of oral submucous fibrosis
a - Leukoplakia
b - Speech and hearing deficits
Treatment
Biopsy screening although necessary is not mandatory all the times, most dentist can visually examine the area and proceed with the proper course of treatment.
Treatment includes the following
Abstention or quitting from chewing areca nut (also known as betel nut) and tobacco
Minimizing the consumption of spicy foods, including chillies or other spices
Maintaining proper oral hygiene daily
Supplementing the diet with foods rich in vitamins A, B complex, and C, iron, and other necessary supplements
Forgoing hot fluids like tea, coffee
Reducing alcohol consumption
Employing a dental surgeon to round off or smoothen the sharp teeth and extract third molars if needed or causing any trouble
Interprofessional treatment approach may be needed
The prescription of chewable pellets of hydrocortisone 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
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 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).
Pentoxifylline, 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.
Colchicine tablets 0.5 mg twice a day
Lycopene, 16 mg a day helps in improvement of oral sub mucous fibrosis