What Is Oral Submucous Fibrosis?
Oral submucous fibrosis is a precancerous condition. It is due to tobacco chewing. It also occurs due to pan masala and other forms of tobacco including gutka and areca nut chewing. It is commonly seen in Asian countries, Southeast Asian countries, and India. It is a premalignant lesion that occurs in the oral cavity. Mostly the oral submucous fibrosis occurs internally and spreads externally in time.
Oral submucous fibrosis causes fibrosis in the submucous layers in the oral cavity more than the normal skin. It appears as a white area that is hard and has degradation in the submucous epithelium. The treatment and prognosis vary depending on the stage of the condition. It looks more similar to a condition called scleroderma, where the normal skin is affected more than the oral cavity. The submucosal layer in the oral cavity has a fibrous band under the mucosa which undergoes contraction. This contraction causes difficulty in mouth opening.
What Is the Possible Etiology of Oral Submucous Fibrosis?
Oral submucous fibrosis is caused by the following,
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Tobacco chewing.
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Chewing pan masala.
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Using gutka.
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Smoking tobacco.
What Are the Clinical Features of Oral Submucous Fibrosis?
Submucous fibrosis is seen in the soft palate, cheek and labial mucosa of lips, lingual mucosa of lips. It also affects the pharynx and retromolar areas. It mostly affects older people. Males are more commonly affected than females. The fibrosis condition is seen as a white area, which is hard and firm in consistency. The most commonly affected location is buccal mucosa. The fibrosis occurs on both sides and is symmetrical.
Initially, the fibrosis is seen as mottled or marble-like lesions. Then it develops into a hard fibrous band, as a line lesion in the buccal mucosa and in the form of a circular lesion in labial mucosa. It is palpable. Later it may also involve the tongue. The pathological changes include the excessive amount of collagen deposition of the connective tissue underneath the submucosal epithelium or skin, chronic inflammation, and local inflammation in deep connective tissues.
What Are the Possible Signs and Symptoms of Oral Submucous Fibrosis?
The symptoms of oral submucous fibrosis are as follows,
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Difficulty in opening the mouth.
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Dry mouth (xerostomia).
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Tongue protrusion.
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Stiffness of cheeks.
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Melanotic mucosal pigmentation.
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Burning sensation.
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Taste loss at the tip of the tongue.
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Stiffness of lips.
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Lips get thinner.
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Small swelling in that region.
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Oral ulcers develop.
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Chances of getting leukoplakia.
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Soft palate movements get affected.
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Pain may occur and also may radiate.
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Petechiae is seen.
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There will be a decrease in salivary flow.
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Extrinsic stains develop in oral mucosal tissues.
How Is the Morbidity in Oral Submucous Fibrosis?
Oral submucous fibrosis causes difficulties in opening the mouth. This kind of trismus causes difficulties during consuming food. So it gradually affects health and has a high morbidity rate. It can develop into cancer. Early diagnosis and treatment are necessary for a complete cure of oral submucous fibrosis.
What Is the Relationship Between Oral Submucous Fibrosis and Cancer?
The oral submucous fibrosis condition can develop into cancer soon. The treatment mainly involves the elimination of causative factors such as tobacco chewing, pan masala, gutka, and other forms of tobacco usage, once the oral submucous fibrosis condition is confirmed. The delay in treatment will have a high probability of developing into cancer. Hence, consultation with an oncologist is necessary for a confirmed diagnosis.
What Is the Diagnostic Method to Confirm Oral Submucous Fibrosis?
The diagnosis of oral submucous fibrosis can be done based on the signs and symptoms observed. The classic symptoms that help in confirming the oral submucous fibrosis condition are as follows,
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Difficulty in opening and closing the mouth or restricted mouth opening called trismus.
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Burning sensation in the tongue and lips.
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Oral ulcers.
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Pain.
A combination of all these symptoms helps in confirming the condition of submucous fibrosis.
What Treatment Methods Help Treat Oral Submucous Fibrosis?
- The oral submucous fibrosis treatment will be based on the severity and stage of infection spread. The initial stage of treatment involves the removal of the cause, that is, cessation of chewing tobacco and cessation of using other forms of tobacco.
- The spread of submucous fibrosis after crossing the initial stages of infection can be treated by topical medication and systemic medication.
- If submucous fibrosis persists even after medication, then the surgical removal of submucous fibrosis is done. The surgical removal involves splitting the skin and removing the white blanches and pigmentation, and mucosal grafting.
- The non-surgical method of laser is also used to remove the blanch. Oral submucous fibrosis usually will be diagnosed when it develops into an advanced stage. So the lesions would have spread more in the oral cavity. The surgical procedures were not processed at that time.
- The systemic intralesional corticosteroid injections are given. Collagenase and Hyaluronidase are also given as intralesional injections. The oral tissues are stretched using interdental screws. A TheraBite can also be used for stretching the oral tissues. The oral tissues can also be treated basically with mouth opening and closing exercises.
- A TheraBite is a device that helps in jaw movements. The TheraBite has a mouth pad of varying sizes and it helps in increasing the interdental gap between upper and lower teeth. Thereby the restriction in mouth opening can be corrected.
- Topical medications like COX-2 (cyclooxygenase) inhibitors are also prescribed. But the prognosis for topical medications is not good. Systemic medications such as tablet Lycopene and tablet Pentoxifylline are also prescribed.
What Is the Prognosis for Oral Submucous Fibrosis?
The prognosis for oral submucous fibrosis is mostly poor.
What Are the Preventive Measures for Oral Submucous Fibrosis?
Oral submucous fibrosis can be prevented by avoiding the cause. Avoid the use of tobacco and any other forms of tobacco like chewing tobacco, smoking tobacco, pan masala, and many more. Avoid being stressed. Take a nutritious diet including vitamins B and C. Drink plenty of water. Iron deficiency also adds a risk of developing cancer. So take iron-rich foods and iron supplements.
Conclusion:
Oral submucous fibrosis is a precancerous condition that is caused by tobacco chewing. It causes trismus and can be treated with intralesional corticosteroid injections and removing the cause.
