Oral submucous fibrosis

Objective To evaluate the habit patterns and clinical features of oral submucous fibrosis. Materials and Methods A hospital-based cross-sectional study was conducted in a sample of 75 subjects with clinically diagnosed oral submucous fibrosis. Prior to the treatment, a detailed habit history was elicited. Clinical symptoms and signs were recorded. Mouth opening, cheek flexibility and tongue protrusion were also recorded. Results 93.33% had the habit of using processed areca nut products like Gutkha (54.66%), Mawa (20%). The burning sensation was the most common symptom seen in 82% of cases, followed by restricted mouth opening. Blanching and palpable fibrous bands were present in all cases. The mean mouth opening of the sample was 32.73 (±9.10) mm, cheek flexibility was 6.48 (±3.06) mm, and tongue protrusion was 43.92 (±10.24) mm. Conclusion It is important to be familiar with the habit patterns and clinical features of oral submucous fibrosis to facilitate early diagnosis and prompt management to reduce oral cancer-related morbidity and mortality.

Background: Oral submucous fibrosis (OSMF) is regarded as a potentially malignant condition. It is characterized by a mucosal rigidity of variable intensity because of the fibroelastic changes of the juxta epithelial layer, resulting in a progressive inability to open the mouth. Oral submucous fibrosis can cause fibrosis and degeneration of tubal and paratubal muscles extending to nasopharynx causing alteration in eustachian tube function. So, this study was carried out with an aim to determine the effect of OSMF on the function of the eustachian tube.

In this study the efficacy of Lycopene capsules was evaluated in 30 OSMF patients. Lycopene capsules due to its special antioxidant properties were found to be effective in the improvement of signs and symptoms of Oral Submucous Fibrosis. It is effective in reducing the objectives signs of OSMF thereby improving the mouth opening (percentage of which was 8.05%) and decreasing the burning sensation (percentage of which was 31.54%). Thus, it can be concluded that Oxitard capsules appears to be a very promising drug in the improvement of the symptoms and management of Oral Submucous Fibrosis.

Background: Genetics plays an important role in the detection of an Oral potentially malignant lesion. A major contributor to genetic study is Dermatoglyphics or the study of fingerprints and lines of palmer and plantar surfaces. Many researchers have used dermatoglyphics to connect genetics with oral lesions and malignancies. Thus, the current study has been conducted to find out an association between dermatoglyphic patterns and oral leukoplakia, oral submucous fibrosis and healthy subjects.

Oral Submucous Fibrosis is defined as an insidious, chronic disease which affects any part of the oral cavity and sometimes the pharynx 1 and is occasionally preceded by and/or associated with vesicle formation 2 and is always associated with a juxta-epithelial inflammatory reaction which is followed by progressive hyalinization of the lamina propria 3 leading to stiffness of the oral mucosa and deeper tissues with progressive limitation in opening of the mouth and protrusion of the tongue leading to difficulty in eating, swallowing and phonation. 4 It is a precancerous condition seen most commonly in the Indian sub-continent and has a reported incidence of between 0.2–1.2% of the urban population who attend the dental clinic and the condition shows a

Background: Oral submucous fibrosis is a potentially pre-malignant disease, that results in progressive juxta- epithelial fibrosis of oral soft tissues, resulting in increased loss of tissue mobility, marked rigidity and inability to open the mouth. Actual treatment includes iron, multi vitamins, lycopene, pentoxifyline, steroid injections and human placental extracts. Currently available treatment with intradermal injection of Kenacort with hyaluronidase is effective to some extent.

Yeh (1996) described the application of pedicled buccal fat pad after incision of fibrous bands and suggested that this was a very logical, convenient, and reliable technique for treatment of oral submucous fibrosis, easy, less time-consuming since the donor site is in close proximity to the posterior third of the buccal defect. Improvement in the suppleness and elasticity of the buccal mucosa on clinical examination were noted. The graft begins to show signs of epithelization from 2nd week with mean value of 14.73 days, so does not necessitate coverage with a skin graft (Amin, 2005). Buccal fat pad serves as a good substitute; because it provides excellent function without deteriorating the esthetics and the results obtained were sustained long term.

Oral submucous fibrosis (OSMF) is a condition that was first described in the 1950s. It is caused as a result of addiction to harmful areca nut products with or without tobacco. The rationale of using exfoliative cytology in our study lies in the epithelial physiology where continuous exfoliation of epithelial cells is a part of physiological turnover. Deeper cells, which are strongly adhered in normal conditions, become loose in the case of malignancy and exfoliate along with superficial cells.

different tobacco products and areca nut products available in different multicolored attractive pouches. OSMF is a well- recognized potentially malignant condition in the oral cavity, and the transformation rate as high as 7.6% over a period of ten year have been reported from India (Fareedi, 2014). Currently areca nut use is most important etiological factor in pathogenesis OSMF. The formulation in which areca is consumed varies according to geographical location and often associated with cultural and religious practices. Many oral sub mucous fibrosis have been proposed to alleviate the signs and symptoms of the disorder. Patient is advised to completely quit the habit of betel nut chewing. The treatment of oral submucous fibrosis includes iron, multivitamins including lycopene, pentoxifylline, local submucosal injections of steroids, hyaluronidase and chylomicrons, aqueous extract of healthy human placenta, and surgical excision of the fibrous bands (Anjana, 2017). The aim of the present review is to understand the etiology and pathogenesis, clinical features and various treatment

ABSTRACT: Introduction and Objectives: Oral submucous fibrosis (OSMF) is a chronic, progressive, and irreversible disease of the oral mucosa. Though numerous modalities have been tried but all are palliative and have no curative value. Pentoxifylline possessing vasorelaxive and antifibrotic properties believed to potentiate the anti-inflammatory, anti-oxidant and immune modulating properties of garlic. So, the present preliminary clinical trial was undertaken to evaluate the efficacy of Garlic in conjunction with pentoxifylline in the management of OSMF. Methods: The study consisted of 15 OSMF patients. Pentoxifylline (400 mg) was administered thrice daily along with garlic pearls, 2 pearls; thrice daily. Drugs were administered systemically after food for a duration of 3 months. Patients were evaluated every 15 days for the assessment of clinical parameters, i.e. burning sensation, reduction in mouth opening, tongue protrusion and cheek flexibility. Pre and post treatment SOD level were measured and compared. The improvement was assessed at the end of the study. Results: All the patients were males with the mean age of 26.04 years. Patients exhibited a mean reduction of 95.68% in burning sensation and an increment of 5.37 mm in mouth opening. The cheek flexibility and tongue protrusion also showed significant improvements in the study groups. All the patients showed significant (p > 0.001) improvement in SOD levels following treatment. Conclusion: Overall assessment of the all clinico-biochemical parameters showed a significant improvement. Thus, choice of such therapy is beneficial, affordable, easily available and most importantly a non-invasive treatment modality for OSMF .

Oral Submucous Fibrosis is defined as an insidious, chronic disease which affects any part of the oral cavity and sometimes the pharynx 1 and is occasionally preceded by and/or associated with vesicle formation 2 and is always associated with a juxta-epithelial inflammatory reaction which is followed by progressive hyalinization of the lamina propria 3 leading to stiffness of the oral mucosa and deeper tissues with progressive limitation in opening of the mouth and protrusion of the tongue leading to difficulty in eating, swallowing and phonation. 3,4 It is a precancerous condition seen most commonly in the Indian sub-continent and has a reported incidence of between 0.2–1.2% of the urban population who attend the dental clinic and the condition shows a

Oral cancer is the eleventh most common malignancy in the world. 1 Oral squamous cell carcinoma (OSCC), the most common type of oral cancer, is often preceded by potentially malignant disorders such as leukoplakia, erythroplakia, oral submucous fibrosis (OSF) and lichen planus. 1, 2 OSFis a chronic, progressive, insidious disorder affecting the oral mucosa associated with areca nut chewing. It was first described by Schwartz. In 1966,Pindborg and Sirsat defined OSF as “an insidious chronic disease affecting any part of the oral cavity and sometimes the pharynx. Although occasionally preceded by and/ or associated with vesicle formation, it is always associated with juxtaepithelial inflammatory reaction followed by fibroelastic change of lamina propria with epithelial atrophy leading to stiffness of mucosa and causing trismus and inability to eat.” 3, 4

A link between scleroderma and oral submucous fibrosis has also been suspected on the basis of similarity of histological characteristics (Tsai et al, 1999; Tilakratne et al, 2005). Transforming growth factor beta (TGF-beta) plays a major role in wound repair and fibrosis. It causes deposition of extracellular matrix by increasing the synthesis of matrix proteins like collagen and decreasing its degradation by stimulating various inhibitory mechanisms. The molecular events in the causation of OSMF takes place through collagen production pathway and collagen degradation pathway. In the initial events of disease arecanut acts as a major initiative agent. Luquman M, Dinesh V, Prabhu, Vidya M (10) (2004) evaluated serum copper and iron level in normal individuals and OSMF patients. Increased serum copper could cause an upregulation of the enzyme lysyl oxidase leading to cross-linking of collagen and elastin. Whereas serum iron level was found to be decreased, that might be due to lack of consumption of normal diet.

Collagen is most abundant protein in human body and plays important role in structural element of connective tissue. . TGF-beta play an important role in inducing fibrotic tissue formation and connective tissue growth factor is important in maintaining fibrosis. The TGF-beta activates procollagen genes col1a2, col3a1, col6a1, col6a3, col7a1 causing an increased expression and thus an increased collagen level in oral submucous fibrosis. Arecoline stimulates connective tissue growth factor production in fibroblasts of buccal mucosa. 13

In the field of removable prosthodontics, rehabilitation of patient with microstomia presents a challenge at all stages . The management of such patient requires different approach, compared to conventional denture fabrication.This clinical report describes the fabrication of sectional single complete denture for patient with microstomia due to oral submucous fibrosis. The sectional prosthesis was fabricated into two pieces which were held together by magnets, enabling the patient to insert and remove the denture with ease.

All normal and oral submucous fibrosis (OSF) biopsy samples are collected from Department of Oral and Maxillofacial Pathology, Guru Nanak Institute of Dental Sciences and Research, Kolkata, India. Those biopsy samples were processed for histopathological examination and paraffin embedded tissue sections of 5µm thickness were prepared and then stained by Haematoxylin and Eosin (H & E). 50 images of normal oral mucosa, 30 images of OSF without dysplasia and 20 images of OSF with dysplasia have been considered in this study. The images are captured using a light microscope mounted with an Axio Vision camera attached to a Zeiss Observer.Z1 Microscope (CarlZeiss, Germany) system. Low- power magnification of 40x (numerical aperture 0.6) was used for grabbing the images. All the images are sampled and digitized to 24 bits of color information and stored as 1388 1040  pixel with resolution of 0.16 µm.

authors earlier reported that oral submucous fibrosis con- stituted the highest number of patients in premalignant group in a tertiary level hospital based study at Allahabad [3]. Tilakaratne et al. reported that areca nut is the main etiological factor for OSMF [4]. Pandya et al., again from Allahabad, confirmed that dohra/paan masala containing areca nut is a major risk factor of OSMF, especially in the younger age group. They also reported an increase in his-

Oral potentially malignant disorders(OPMD) are the ones that are described as “Not all lesions and conditions may transform to cancer rather than a morphological alteration amongst which some may have an increased potential for malignant transformation ". It conveys tha t not all precancerous lesions and conditions may transform to cancer, rather some may have increased chance for malignant transformation 1 . Precancerous lesions like leukoplakia, erythroplakia and palatal lesions in reverse s moking and Precancerous conditions like oral submucous fibrosis (OSMF), actini c keratosis, lichen planus and d iscoid lupus erythematosus that were previously recognized as precancer by WHO in 1978 are now categorised as potentially malignant disorders 2 . In Indian subcontinent, leukoplakia and oral submucous fibrosis are the most common potentially malignant disorders caused largely by tobacco smoking and areca nut consumption. Areca nut has been declared as a known human carcinogen by International agency f or research on cancer (IARC) expert group in 2003 3 .

Utsunomiya H, Tilakaratne WM, Oshiro K, Maruyama S, Suzuki M, Ida-Yonemochi H, et al. 2005. Extracellular matrix remodeling in oral submucous fibrosis: its stage- specific modes revealed by immunohistochemistry and in situ hybridization. J Oral Pathol Med Off Publ Int Assoc Oral Pathol Am Acad Oral Pathol., Sep;34(8):498–507. Wahi, P. N., V. L. Kapur, U. K. Luthra, and M. C. Srivastava

Occasionally presence of oral mucosal lesions such as oral submucous fibrosis (OSMF) as reported here, alters the presentation of the space infection. Oral submucous fibrosis is a chronic, progressive, potentially malignant oral disorder which results in rigidity and stiffness of the oral mucosa with loss of tissue mobility and eventual inability to open the mouth. 1 Various treatment modalities are being used