Dr.G.Gomathi M.D.S .,

PROFESSOR - Maxillofacial Prosthodontist

Stanley medical college, chennai

Shakthi Dental Care & Impress Dentals - Villivakkam

Dr.Ruth Jasmina Jacob B.D.S.,FAGE

Chief Dental Surgeon, Consultant Implantologist

Dr. Gladys Jacob M.B,B,S., D,G,O., Obstetrician & Gynaecologist

Arun Clinic - villivakkam

INELASTIC MOUTH / ORAL SUBMUCOUS FIBROSIS A POTENTIAL THREAT TO THE SOCIETY

Introduction

     In the past two decades, both in government and private practice, it’s not an uncommon scenario to get a patient with the typical complaints of burning sensation in the mouth, and difficulty in opening the mouth. The dentist with a thorough detailed history taking and clinical examination of the patient can and will nail the diagnosis as OSMF- Oral Submucous Fibrosis efficiently/effectively.

Etiology/Causative Factors

The causative agent of OSMF is not limited to a particular single factor, but a variety of causes like
     ➛  Areca/betel nut related chewing habits (pan, maava, gutkha)
     ➛  Tobacco usage
     ➛  Chillies, and spicy foods
     ➛  Mine
     ➛  Nutritional deficiencies- vitamins and minerals
     ➛  Immunologic disorders
     ➛  Collagen disorders
     ➛  Collagen disorders

Age/Sex:

     OSMF can occur at any age, but the commonly affected age group ranges from 16 to 35 years.

Clinical features:

Male to Female ratio varies in different studies, but strongly associated with the chewing of etiological factors.

Epidemiology /occurrence:

     OSMF is seen predominantly in Asian countries India, Bangladesh, Pakistan, and Srilanka being more common in India. In the last ten years, the occurrence rate is more marked, owing to the marketing popularity of areca/betel related products. This habit is more common among drivers, to be in alert stage..

     ➛   Progressive inability to open the mouth
     ➛   Pain & burning sensation on taking food
     ➛   Hardening/Hypo mobility of the soft palate & tongue
     ➛   Blanching of oral mucosa, ulceration stiffness.
     ➛      In advanced stage, Appearance / development of fibrous band in the oral cavity. Lips, Cheeks. Hearing loss may also occur due to blockage of Eustachian tube.

Diagnosis:

     The presence of palpable fibrous band is a definite indication or diagnostic criterion for submucosa fibrosis. In addition to that a positive and correlate history of pan related chewing and the association of trismus inability or difficulty in opening the mouth will establish a positive diagnosis of OSMF.

OSMF & Premalignant nature:

     OSMF is strongly associated with a risk of oral cancer and the rate of transformation of malignancy varies from 3% to 19%.

Management:

     Habit :

          Reduction restriction & a complete elimination of areca nut related chewing.

     DIET :

          Minimizing foods that have chilies & spices. Maximizing foods rich in iron & vitamins.

     Nutritional Enhancement :

          Vitamins A, C, E, B Complex

     Medicinal :

          Lycopene & Pentoxyfilline

      Intralesional :

          Enzymes like hyaluronidase, Chymotrypsin with dexamethasone Placenta extracts.

Conclusion:

     A steep increase in the usage of pan, gutkha, masala combined with diet alteration enhance the incidence of OSMF in the recent decades. Very often we encounter such patients in clinic itself shows the incident rate. Though the government has taken measures in the recent years to create awareness of these products, the usage of these products has decreased in drastic manner. Thus areca nut related pan, maava, gutkha, betel, tobacco chewing possess a great potential danger to the society. Hope this article helps in creating awareness among public and motivates them to get an early intervention and treatments.

Referrences:

    ➜ Ajit Auluck, Miriam P.Rosin, Lewei Zhang, Sumanth KN : Oral Submucous Fibrosis, a Clinically Benign but Potentially Malignant Disease : Report of 3 cases and Review of the Literature. Journal of Canadian Dental Association 08;(8) 735-740

    ➜ M.K.Gupta,ShubhangiMhaske, Raju Ragavendra, Imtiaz : Oral submucous fibrosis – Current Concepts in Etiopathogenesis. People’s Journal of Scientific Research Vol 1 –July 08;39-44.

    ➜ F M Ali, S Taluka. Global Journal of Medicine and Public Health Jan –Feb 2012, Vol 1 (1)12-13

    ➜ C B More, S Gupta, J Joshi, S N Varma. Classification System for Oral Submucous Fibrosis. Journal of Indian Academy of Oral Medicine and Radiology. Jan –Mar 2012;24(1):24-29