Oral Submucous Fibrosis: A Disease That Won’t Let You Open Your Mouth
A Disease that won’t let you open your mouth-Yes!
What is Oral Submucous Fibrosis (OSMF)?
OSMF affects oral cavity, Credits: pixabay
Oral submucous fibrosis (OSMF) is a chronic, precancerous condition characterized by inflammation, abnormal collagen deposition, and fibrosis of the submucosal tissues.
OSMF affects any part of the oral cavity and sometimes pharynx.
This condition leads to difficulty in opening the mouth.
It affects all age groups but is commonly seen in adults between the age group of 25 and 35 years.
The condition is reported in Southeast Asia and India. The prevalence in India is 0.2 to 0.5%.
It is estimated that India has the highest number of OSMF cases worldwide.
The high number of incidents are due to areca nuts, tobacco products like gutkha, pan masala and flavored supari.
The percentage of precancerous conditions turning into malignancy was reported to be 7.6%.
Symptoms of OSMF
OSMF causes restricted mouth opening, Credits: pexels
The symptoms of OSMF are as follows:
Submucous fibrosis
Ulceration
Xerostomia
A burning sensation when chewing spicy food
Restricted mouth opening.
Dry mouth and pain
Taste disorders
Restricted tongue mobility
Trismus
Dysphagia
Altered tone.
Causes of OSMF
This disease is multifactorial and the following factors may play a role in the etiopathogenesis of the disease.
Betel nut chewing
Nutritional deficiencies
Genetic and immunological factors
Infection
Betel Nut Chewing
Tobacco and betel nut chewing causes OSMF, Credits: pexels
Betel nut chewing is reported to be the main cause of OSMF. Betal nut contains tannins and alkaloids like arecoline. Arecoline causes fibroblast stimulation and proliferation, resulting in collagen synthesis. The other causative factors include tobacco and crude lime wrapped in betel leaf.
Nutritional Deficiencies
A deficiency of iron, vitamin B complex, minerals, and malnutrition can lead to inflammation in oral mucosa, resulting in scarring and fibrosis.
Genetic and Immunological Factors
Genetic and Immunological factors causes OSMF, Credits: pixabay
A genetic link has also been identified since this disease was identified in patients who had no history of betel nut chewing or chili ingestion.
In patients with OSMF, an increased frequency of certain HLA alleles like HLA-A10, HLA-B7, and HLA-DR3 have been reported.
There is also an increase in the number of CD4 cells which shows activation of the cellular immune response which causes altered tissue morphology and deranged immune regulation.
The increased levels of pro-inflammatory cytokines and interferon-gamma also contribute to the pathogenesis of the disease.
Infection
HPV causes OSMF, Credits: pixabay
Human Papilloma viral (HPV) infection can also cause OSMF.
Treatment of OSMF
The treatment depends on the progression of the disease and the clinical features. Some of the treatment options are listed below:
Nutritional supplements
Avoid betel nut chewing
Steroid therapy
Interferon-gamma treatment
Immune milk
Turmeric
Physiotherapy
Nutritional Supplements
Nutrient rich foods to treat OSMF, Credits: pixabay
A diet rich in vitamin, iron, and minerals is advised to the patients with OSMF. Vitamin B supplements are thought to prevent inflammation of tongue and cheilosis. An anti-oxidant rich diet (Lycopene) is recommended as it inhibits hepatic fibrosis.
Avoid Betel Nut Chewing
Quit smoking, Credits: pixabay
Avoid betel nut chewing, spicy and hot food, alcohol, and smoking. Patients are advised about the malignant transformation of the disease.
Steroid therapy
Steroid therapy to OSMF, Credits: pixabay
Steroid therapy is carried out to reduce the proliferation of fibroblasts and reduce the inflammatory response.
Interferon-gamma treatment
This cytokine has an antifibrotic effect and intralesional injection of interferon-gamma helps in reducing the symptoms of the disease.
5. Immune Milk
Immune milk contains an anti-inflammatory component that suppresses the inflammatory process and stimulates cytokine production. Micronutrients in the immune milk powder help provide symptomatic relief.
6. Turmeric
Turmeric reduces free radicals, Credits: pexels
Turmeric powder acts as scavenger against free radicals. Turmeric oil and turmeric resin have combined effects in protecting against DNA damage.
7. Physiotherapy
Since patients with OSMF have difficulties in opening the mouth, physiotherapy helps in preventing further reduction in mouth opening. Certain muscle stretching exercises are helpful for them.
In extreme cases of the disease, surgical interventions are required.
Take-Home Message
Oral Submucous Fibrosis is a precancerous condition and can transform into a malignant one. Betel nut chewing is an important cause of the disease.