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Oral Submucous Fibrosis - Causes, Symptoms, Diagnosis, and Treatment

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Oral Submucous Fibrosis - Causes, Symptoms, Diagnosis, and Treatment

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The oral mucosa is impacted by a precancerous disorder called oral submucous fibrosis (OSMF) and it is a chronic malignant disease.

Medically reviewed by

Dr. Sneha Kannan

Published At February 3, 2020
Reviewed AtDecember 15, 2023

Introduction

Schwartz coined the term atrophia idiopathica mucosae oris in 1952 to explain a fibrotic oral condition. In 1953, oral submucous fibrosis was coined by Joshi. Scientifically, it can be defined as a chronic fibrotic disease of the oral cavity due to inflammation of submucosal tissues. It leads to a rigid oral mucosa. The most commonly involved site is the buccal mucosa, but it has to be kept in mind that any part of the oral cavity can be affected. It is a premalignant condition, indicating that if not managed early, it can lead to cancer of the oral cavity. Oral submucous fibrosis treatments have been developed in recent years.

Where Is It Very Common?

The incidence is reported to be higher in people from certain parts of the world, like South and Southeast Asia, South Africa, and the Middle Eastern countries.

What Causes It?

It can be caused by various factors, as explained below:

1. Excessive consumption of red chilies.

2. Too much chewing of areca nuts.

3. Deficiency of certain nutrients, like vitamin A.

4. Immunological factors: poor immune response of the body.

5. Genetically transmitted.

6. Extensive tobacco usage.

7. Patients with a deficiency of certain micronutrients.

What Are the Basic Clinical Signs and Symptoms?

The clinical features are varied according to various factors, like gender, but some of the symptoms and signs are common and are as follows:

1. It is usually seen as occurring between 20 and 40.

2. Females are more affected than males.

3. The fibrotic changes are usually visible in the cheek mucosa, tongue, etc. In severe cases, fibrotic bands can be felt.

4. Early on in the condition, the patient typically reports burns in the mouth, especially after consuming hot or spicy meals.

5. Furthermore, excessive salivation or decreased salivation and gustatory sensation can be seen.

6. There is a wet, leathery feeling in the mucosa in the initial stages.

7. The advanced stage makes the mucosa more rigid and blanched; hence, difficulty in mouth opening is present, or there will be reduced mouth opening.

8. More commonly, palpable bands in the cheek are vertical bands.

It is usually classified into various stages depending on its severity

of disease.

1. Stage 1 - involves inflammation of the mucosa.

2. Stage 2 - involves fibrosis, which can be further divided into:

  • Blanching is observed in the oral mucosa (initial stages).

  • Vertical or circular palpable bands can be felt in the oral mucosa (older lesions).

3. Stage 3 - is the sequelae of the condition, which can be either leukoplakia or speech and hearing deficits.

Which Types of Nutritional Factors Are Used in OSMF?

Oral submucous fibrosis (OSMF) is a progressive condition affecting the oral cavity. While the exact cause isn't fully understood, it's believed to be linked to various factors, including chewing betel quid (a mixture that often contains areca nut, betel leaf, and slaked lime), nutritional deficiencies, and sometimes genetic predisposition.

Nutritional Factors That May Play a Role in the Development or Progression of Include:

  • IOSMF may arise as a result of inadequate consumption of specific vitamins and minerals, including zinc, vitamin B12, and folate. These deficiencies might weaken the oral mucosa and affect its ability to heal.

  • A diet lacking in fruits, vegetables, and various nutrients might contribute to the progression of OSMF.

  • Antioxidants from fruits and vegetables are important for maintaining oral health. Iron deficiency has been linked to OSMF.

  • The preservation of healthy oral tissues depends on sufficient iron levels.

  • Specifically, deficiencies in vitamins like B12 and folate (B9) may impact oral health and play a role in the development of OSMF.

  • Imbalances in the intake of various nutrients, particularly in populations with poor dietary diversity or imbalanced diets, may contribute to the susceptibility to OSMF.

  • For optimal dental health, a diet rich in whole grains, lean proteins, a range of fruits and vegetables, and enough water should be consumed.

How Can It Be Diagnosed?

When you have an unusual burning sensation in the mouth or reduced mouth opening, it is better to consult a dentist for further evaluation. The doctor initially takes a personal and medical history, including the habits. Then an oral examination consists of measurements of the mouth opening and palpation of the mucosa, along with visualizing various signs and symptoms. Even a histopathological examination can be done to confirm the diagnosis of the lesion.

Who Is at Risk of Getting It?

Mainly, tobacco chewers are prone to getting it. But other factors, like smoking, malnutrition, etc., may add to the risk of getting it. Chewing betel nut, betel quid, or paan, a common habit in some Asian countries, greatly increases the risk of developing OSMF. These substances are combined with tobacco, which further escalates the risk. Smoking or using smokeless tobacco in various forms increases the risk of developing OSMF.

Smokeless tobacco, including gutkha, snuff, or other tobacco-containing products, has been strongly linked to OSMF. Regular exposure to irritants like spicy foods, alcohol, and certain chemicals might contribute to the development of OSMF. Genetic predisposition might be a genetic predisposition in some individuals, making them more susceptible to OSMF. The genetic factors contributing to this predisposition have yet to be fully understood.

Nutritional deficiencies, particularly deficiencies in vitamins like B12, iron, and folate, might increase vulnerability to OSMF. OSMF is more prevalent in certain geographic regions, especially in areas where the habit of betel nut and tobacco chewing is widespread. While OSMF can affect individuals of any age, it's often observed in adults. There might be variations in prevalence based on gender, with some studies suggesting a higher prevalence in males.

How Can Oral Submucous Fibrosis Be Treated?

Management usually focuses on the causing factor, followed by the management of symptoms.

The following are the treatment options that can be used to manage OSMF:

  • Eradication of all causative factors or habits. The definitive treatment is injected within the lesion when the bands have formed.

  • The injection consists of Collagenase, Corticosteroids, Fibrinolysin, etc. Nutrient supplementation for deficient nutrients. Also, vitamin A can be beneficial as it is an antioxidant.

  • Systemic administration of steroids can also be done. Laser therapy and other advanced treatments have been explored as adjuncts to conventional treatments to improve mouth opening and reduce fibrosis. These approaches aim to break down fibrous bands and improve tissue elasticity.

  • Currently, research has proven that autologous bone marrow stem cell injection within the lesion can be a safe and effective treatment for oral submucous fibrosis.

  • Ongoing research and trials are exploring the effectiveness of different drugs, including antioxidants, immunomodulators, and other medications, to alleviate symptoms and slow down fibrosis progression.

  • Some studies investigated the potential benefits of certain enzymes or drugs that could target the underlying fibrotic process.

Conclusion

One premalignant disease that can have a widespread effect on the human being is oral submucous fibrosis. If not treated in earlier stages, it can lead to the formation of oral cancer and, hence, be fatal. If you develop any unusual symptoms in the oral cavity, it is important to consult a dentist for further evaluation. With the help of online consultation platforms, it has become easy to consult a specialist anytime, anywhere.

Frequently Asked Questions

1.

What Are the Features of Early Stage OSMF?

In the early stage of oral submucous fibrosis, mouth opening is normal (above 35 mm) and not affected. However, recurrent ulcerations and bands of fibrosed tissues begin to form in the oral tissues like the soft palate, inner cheek or buccal mucosa, etc. Burning sensation, marble-like and pale oral tissues are present.

2.

Does OSMF Cause Pain?

Oral submucous fibrosis leads to painful swallow, pain in the throat, burning sensation of the mouth, and difficult or restricted mouth opening.

3.

How to Identify Oral Submucous Fibrosis?

Oral submucous fibrosis causes,
- Blanching of the tissues of the inner cheek with a whitish marble-like appearance that is persistent.
- Palpable whitish fibrous bands in the inner cheek region.
- Oral tissues with a thick or tough leathery texture.
- Trismus or limited mouth opening will be present.
- Ulceration of the oral tissues.
- Dry mouth.
- Burning sensation.
- Reduced tongue movements.

4.

What Causes OSMF?

- Betel-quid and areca nut chewing.
- Chewing smokeless tobacco products.
- Vitamin B and C deficiency.
- Iron deficiency.
- Autoimmune disorder.
- Consuming spicy foods.
- Genetic mutations.
- Human papillomavirus infection.

5.

What Does Oral Submucous Fibrosis Do to the Mouth?

Oral submucous fibrosis leads to the formation of thick, palpable fibrosed bands in the oral tissues, especially the inner cheek region. This causes restricted mouth opening and tongue movements accompanied by painful swallow, dry mouth, and burning sensation of the mouth.

6.

Is Oral Submucous Fibrosis Deadly?

Oral submucous fibrosis is a premalignant and irreversible condition meaning it has a high risk of transforming into cancer. It is a dangerous condition as it may lead to oral cancer, and the decreased mouth opening causes difficulty eating food, further deteriorating the health condition.

7.

Is OSMF Associated With Cigarette Smoking?

Smoking cigarettes along with chewing betel-quid, areca nut, and smokeless tobacco products increases or induces the risk of oral submucous fibrosis.

8.

Is OSMF Associated With Alcoholism?

Alcoholism in association with smokeless tobacco and areca nut chewing increases the risk of incidence of oral submucous fibrosis.

9.

Does Oral Submucous Fibrosis Have the Risk of Transforming Into Cancer?

Oral submucous fibrosis has high rates of malignant transformation with 1.5 to 15% of all cases.

10.

Is Oral Submucous Fibrosis a Type of Cancer?

Oral submucous fibrosis is not a type of cancer but is a precursor of oral cancer. It has an increased risk of transforming into cancer over time, leading to mortality.

11.

Can Oral Submucous Fibrosis Be Reversed?

Oral submucous fibrosis is not reversible. Upon discontinuation of tobacco or betel nut chewing, smoking, and alcoholism with supportive treatment to relieve the symptoms, the disease progression can be arrested at the present stage.

12.

How Curable Is Oral Submucous Fibrosis?

Oral submucous fibrosis cannot be cured, but its progression can be stopped with effective treatment measures. Treatment aims to relieve the symptoms.

13.

How Can Oral Submucous Fibrosis Be Managed?

Oral submucous fibrosis can be managed effectively with physical and drug therapy. Treatments predominantly aim to reduce the inflammatory action, hydrolyze collagen activity, and supplement necessary nutrients and antioxidants. Abstinence from betel nut chewing with or without tobacco, smoking, and alcoholism is essential. Spicy foods should not be consumed.

14.

What Treatment Effectively Treats OSMF?

- Discontinuing betel nut chewing, smoking, and alcoholism.
- Intralesional corticosteroids injection.
- Chewable Hydrocortisone.
- Hyaluronidase and Chymotrypsin intralesional injections and topicals.
- Pentoxifylline tablets.
- Oral Colchicine.
- Lycopene tablets.
- Lignocaine intralesional injections.
- Hyperbaric oxygen treatment.
- Vitamin A, B, C, and iron supplements.
- Laser release.
- Surgical excision of the bands with flap repair.
Source Article IclonSourcesSource Article Arrow
Dr. Divya Banu M
Dr. Divya Banu M

Dentistry

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