Oral submucous fibrosis is a chronic, complex, premalignant condition of the oral cavity, characterized by juxta-epithelial inflammatory reaction and progressive fibrosis of the submucosal tissues.

The disease is characterised by blainching and stiffness of the oral mucosa, trismus, burning sensation in the mouth, hypomobility of the soft palate and tongue, loss of gustatory sensation, and occasionally, mild hearing loss due to blockage of Eustachian tube.

Oral submucous fibrosis (OSMF) is an oral precancerous condition characterized by inflammation and progressive fibrosis of the submucosal tissues resulting in marked rigidity and trismus. OSMF still remains a dilemma to the clinicians due to elusive pathogenesis and less well-defined classification systems.

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:

• Xerostomia
• Recurrent ulceration
• Pain in the ear or deafness
• Nasal intonation of voice
• Restriction of the movement of the soft palate
• Thinning and stiffening of the lips

Causes

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

• Immunological diseases
• Extreme climatic conditions
• Prolonged deficiency to iron and vitamins in the diet

Diagnosis

Oral submucous fibrosis is clinically divided into three stages:

• Stage 1: Stomatitis
• Stage 2: Fibrosis
  • a- Early lesions, blanching of the oral mucosa
  • b- Older lesions, vertical and circular palpable fibrous bands in and around the mouth or lips, resulting in a mottled, marble-like appearance of the buccal mucosa
• Stage 3: Sequelae of oral submucous fibrosis
  • a- Leukoplakia
  • b- Speech and hearing deficits

 

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:

• Abstention from chewing areca nut (also known as betel nut) and tobacco
• Minimizing consumption of spicy foods, including chiles
• Maintaining proper oral hygiene
• Supplementing the diet with foods rich in vitamins A, B complex, and C and iron
• Forgoing hot fluids like tea, coffee
• Forgoing alcohol
• Employing a dental surgeon to round off sharp teeth and extract third molars
• Interprofessional treatment approach