Oral submucous fibrosis

Oral submucous fibrosis
Classification and external resources
Specialty gastroenterology
ICD-10 K13.5
DiseasesDB 33590

Oral submucous fibrosis (OSMF or OSF) is a chronic, complex, premalignant (1% transformation risk) lesion of the oral cavity, characterized by juxta-epithelial inflammatory reaction and progressive fibrosis of the submucosal tissues (the lamina propria and deeper connective tissues). As the disease progresses, the jaws become rigid to the point that the person is unable to open the mouth.[1][2] The condition is remotely linked to oral cancers and is associated with areca nut or betel quid chewing, a habit similar to tobacco chewing, is practiced predominantly in Southeast Asia and India, dating back thousands of years.

Symptoms

In the initial phase of the disease, the mucosa feels leathery with palpable fibrotic bands. In the advanced stage 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:

Causes

Dried products such as paan masala and gutkha have higher concentrations of areca nut and appear to cause the disease. Other causes include:

Pathogenesis

"Exposure to arecanut (Arecacatechu) containing products with or without tobacco (ANCP/T) is currently believed to lead to OSF in individuals with genetic immunologic or nutritional predisposition to the disease. "[3]

This hypersensitivity reaction results in a juxta-epithelial inflammation that leads to increased fibroblastic activity and decreased breakdown of fibers. The fibroblasts are phenotypically modified, and the fibers they form are more stable, produce thicker bundles that progressively become less elastic. once the original loosely arranged fibrous tissue is replaced by the ongoing fibrosis, the movability of the oral tissues is reduced, there is loss of flexibility and reduced opening of the mouth.

These collagen fibers are non degradable and the phagocytic activity is minimized.

According to a recent cross sectional study the time taken for return of salivary pH to baseline levels after chewing arecanut containing mixtures is significantly longer in habitual users with OSF when compared to unaffected users.[3]

Diagnosis

Classification

Oral submucous fibrosis is clinically divided into three stages:[4]

Khanna and Andrade in 1995 developed a group classification system for the surgical management of trismus:[5]

Treatment

Biopsy screening although necessary is not mandatory most dentist can visually examine the area and proceed with the proper course of treatment.

Treatment includes:

Treatment also includes following:

The treatment of patients with oral submucous fibrosis depends on the degree of clinical involvement. If the disease is detected at a very early stage, cessation of the habit is sufficient. Most patients with oral submucous fibrosis present with moderate-to-severe disease. Severe oral submucous fibrosis is irreversible. Moderate oral submucous fibrosis is reversible with cessation of habit and mouth opening exercise. Current modern day medical treatments can make the mouth opening to normal minimum levels of 30 mm mouth opening with proper treatment.

Epidemiology

The incidence of the disease is higher in people from certain parts of the world including South-East Asia, South Africa and the Middle East.[11]

Stem cell therapy for oral submucosal fibrosis

Recently scientists have proven that intralesional injection of autologous bone marrow stem cells is a safe and effective treatment modality in oral sub mucosal fibrosis. It has been shown autologous bone marrow stem cell injections induces angiogenesis in the area of lesion which in turn decreases the extent of fibrosis thereby leading to significant increase in mouth opening.[12][13]

History

In 1952, T.Sheikh coined the term distrophica idiopathica mucosa oris to describe an oral fibrosing disease he discovered in five Indian women from Kenya.[14] S.G. Joshi subsequently coined the termed oral submucous fibrosis (OSF) for the condition in 1953.[15]

See also

References

  1. Cox, S. C.; Walker, D. M. (1996). "Oral submucous fibrosis. A review". Australian Dental Journal. 41 (5): 294–9. PMID 8961601. doi:10.1111/j.1834-7819.1996.tb03136.x.
  2. Aziz, SR (1997). "Oral submucous fibrosis: an unusual disease". Journal of the New Jersey Dental Association. 68 (2): 17–9. PMID 9540735.
  3. 1 2 "Habit-associated salivary pH changes in oral submucous fibrosis-A controlled cross-sectional study Donoghue M, Basandi PS, Adarsh H, Madhushankari G S, Selvamani M, Nayak P - J Oral Maxillofac Pathol". www.jomfp.in. Retrieved 2015-09-23.
  4. Pindborg, JJ (1989). "Oral submucous fibrosis: a review". Annals of the Academy of Medicine, Singapore. 18 (5): 603–7. PMID 2694917.
  5. Khanna, J.N.; Andrade, N.N. (1995). "Oral submucous fibrosis: a new concept in surgical management". International Journal of Oral and Maxillofacial Surgery. 24 (6): 433–9. PMID 8636640. doi:10.1016/S0901-5027(05)80473-4.
  6. Kakar, P. K.; Puri, R. K.; Venkatachalam, V. P. (1985). "Oral Submucous Fibrosis—treatment with hyalase". The Journal of Laryngology & Otology. 99 (1): 57–9. PMID 3968475. doi:10.1017/S0022215100096286.
  7. Rajendran, R; Rani, V; Shaikh, S (2006). "Pentoxifylline therapy: a new adjunct in the treatment of oral submucous fibrosis". Indian Journal of Dental Research. 17 (4): 190–8. PMID 17217216.
  8. Haque, M. F.; Meghji, S.; Nazir, R.; Harris, M. (2001). "Interferon gamma (IFN-gamma) may reverse oral submucous fibrosis". Journal of Oral Pathology and Medicine. 30 (1): 12–21. PMID 11140895. doi:10.1034/j.1600-0714.2001.300103.x.
  9. Krishnamoorthy, Bhuvana; Khan, Mubeen (2013). "Management of oral submucous fibrosis by two different drug regimens: A comparative study". Dental Research Journal. 10 (4): 527–32. PMC 3793419Freely accessible. PMID 24130591.
  10. Kumar, Abhinav; Bagewadi, Anjana; Keluskar, Vaishali; Singh, Mohitpal (2007). "Efficacy of lycopene in the management of oral submucous fibrosis". Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 103 (2): 207–13. PMID 17234537. doi:10.1016/j.tripleo.2006.07.011.
  11. Oral Submucous Fibrosis at eMedicine
  12. Sankaranarayanan S, Padmanaban J, Ramachandran CR, Manjunath S, Baskar S, Senthil Kumar R, Senthil Nagarajan R, Murugan P, Srinivasan V, Abraham S (June 2008). Autologous Bone Marrow stem cells for treatment of Oral Sub-Mucous Fibrosis - a case report. Sixth Annual Meeting of International Society for Stem Cell Research (ISSCR). Philadelphia.
  13. Abraham S, Sankaranarayanan S, Padmanaban J, Manimaran K, Srinivasan V, Senthil Nagarajan R, Murugan P, Manjunath S, Senthil Kumar R, Baskar S (June 2008). Autologous Bone Marrow Stem Cells in Oral Submucous Fibrosis – Our experience in three cases with six months follow-up. 8th Annual Meeting of Japanese Society of Regenerative Medicine. 68. Tokyo, Japan. pp. 233–55.
  14. Hetland, G.; Johnson, E.; Lyberg, T.; Bernardshaw, S.; Tryggestad, A. M. A.; Grinde, B. (2008). "Effects of the Medicinal MushroomAgaricus blazeiMurill on Immunity, Infection and Cancer". Scandinavian Journal of Immunology. 68 (4): 363–70. PMID 18782264. doi:10.1111/j.1365-3083.2008.02156.x.
  15. Joshi, SG (1952). "Fibrosis of the palate and pillars". Indian Journal of Otolaryngology. 4 (1): 1–4.
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