Specialty Dentistry DiseasesDB 33590 | ICD-10 K13.5 | |
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. 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.
Contents
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. S.G. Joshi subsequently coined the termed oral submucous fibrosis (OSF) for the condition in 1953.
Classification
Oral submucous fibrosis is clinically divided into three stages:
Khanna and Andrade in 1995 developed a group classification system for the surgical management of trismus:
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. "
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.
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:
Common sufferers
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.
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.
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.