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

Published on Feb 03, 2020 and last reviewed on Nov 29, 2022   -  3 min read


Oral submucous fibrosis (OSMF) is a precancerous condition that affects the oral mucosa. Learn about its history, causes, signs and symptoms, diagnosis, and treatment.

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

Sometimes, it becomes difficult to open the mouth or there can be constant burning sensation inside the mouth and tongue. Mostly they are due to common non-serious pathological conditions. But sometimes, it may indicate a serious condition of oral tissues called oral submucous fibrosis.


Schwartz in 1952 coined the term atrophica idiopathica mucosa oris to explain an oral condition that was fibrotic in nature. 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 rigid oral mucosa. The most commonly involved site is 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.

Where Is It Very Common?

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

What Causes It?

It can be caused due to 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 to occur during the ages of 20 to 40 years.

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. The patient in initial stages usually complains of burning sensation in the mouth, specifically during the intake of any hot or spicy foods.

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

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

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

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

It is usually classified into various stages depending on the severity

of disease.

  1. Stage 1 - involves inflammation of the mucosa.

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

    1. Blanching observed in the oral mucosa (initial stages).

    2. 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.

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 personal and medical history including the habits. Then an oral examination is done comprising of measurement of 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 Are at Risk of Getting It?

Mainly tobacco chewers are prone to get it. But other factors like smoking, malnutrition, etc., may add to the risk of getting it.

How Can It Be Treated?

The management usually lies in focusing on the causing factor followed by the management of symptoms. Following are the treatment options that can be used to manage OSMF:

1. Eradication of all causative factors or habits.

2.When the bands have formed, the definitive treatment is giving injection within the lesion. The injection consists of Collagenase, Corticosteroids, Fibrinolysin, etc.

3.Nutrient supplementation for deficient nutrients. Also, Vitamin A can prove to be beneficial as it is an antioxidant in nature.

4.Systemic administration of steroids can also be done.

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

Oral submucous fibrosis is a premalignant condition that can affect the body in a generalized way. If not treated in earlier stages, it can lead to formation of oral cancer and hence, can be fatal. If you develop any unusual symptom 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


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.


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.


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.


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.


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.


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.


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.


Is OSMF Associated With Alcoholism?

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


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.


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.


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.


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.


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.


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.

Article Resources

Last reviewed at:
29 Nov 2022  -  3 min read




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