• Shruti GOCHHWAL

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

OSMF affects oral cavity, Credits: pixabay


  1. Oral submucous fibrosis (OSMF) is a chronic, precancerous condition characterized by inflammation, abnormal collagen deposition, and fibrosis of the submucosal tissues.

  2. OSMF affects any part of the oral cavity and sometimes pharynx.

  3. This condition leads to difficulty in opening the mouth.

  4. It affects all age groups but is commonly seen in adults between the age group of 25 and 35 years.

  5. The condition is reported in Southeast Asia and India. The prevalence in India is 0.2 to 0.5%.

  6. It is estimated that India has the highest number of OSMF cases worldwide.

  7. The high number of incidents are due to areca nuts, tobacco products like gutkha, pan masala and flavored supari.

  8. The percentage of precancerous conditions turning into malignancy was reported to be 7.6%.

Symptoms of OSMF

Symptoms of OSMF

OSMF causes restricted mouth opening, Credits: pexels


The symptoms of OSMF are as follows:

  1. Submucous fibrosis

  2. Ulceration

  3. Xerostomia

  4. A burning sensation when chewing spicy food

  5. Restricted mouth opening.

  6. Dry mouth and pain

  7. Taste disorders

  8. Restricted tongue mobility

  9. Trismus

  10. Dysphagia

  11. Altered tone.

Causes of OSMF

This disease is multifactorial and the following factors may play a role in the etiopathogenesis of the disease.

  1. Betel nut chewing

  2. Nutritional deficiencies

  3. Genetic and immunological factors

  4. Infection

Betel Nut Chewing

Causes of OSMF

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

Causes of OSMF

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

Causes of OSMF

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:

  1. Nutritional supplements

  2. Avoid betel nut chewing

  3. Steroid therapy

  4. Interferon-gamma treatment

  5. Immune milk

  6. Turmeric

  7. Physiotherapy

Nutritional Supplements

Treatment of OSMF

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

Treatment of OSMF

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

Treatment of OSMF

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

Treatment of OSMF

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.

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