Causes and risk factors
Oral submucous fibrosis is considered to be a collagen disorder. It is formed by deposition of hyaline and fibrous tissue in the submucosa. There is muscle fibrosis. It consists of progressive fibrosis of mucosal tissues. The predisposing factors include irritants like chewing ‘pan,’ betel nuts, tobacco, ‘gutkha,’ ‘pan masala,’ ‘mawa’ and ‘misri’ common in Indian subcontinent. Chillies and spicy food may cause the condition. Trauma such as repeated mechanical or thermal trauma can cause the disease. Poor nutrition may be one of the causes of submucous fibrosis. It can also be caused due to vitamin deficiency. Poor dental hygiene can lead to this condition. Achlorhydria, hyperacidity may cause oral submucous fibrosis.
Clinical presentation
The disease occurs in the retromolar area behind the last molars and in front of ramus of the mandible. Thus patient presents with varying degrees of trismus [difficulty in opening the mouth]. Burning sensation in the mouth is present. Blowing, whistling, and sucking becomes difficult due to involvement of cheeks. White patches are seen in the oral cavity on cheeks, retromolar area, hard palate, and soft palate. The patches are diffuse and dense. Vertical fibrous bands are seen in labial and buccal tissues. Oropharynx is also affected. Uvula may become small and contracted. Dental hygiene becomes poor. Swelling of regional lymph nodes may occur due to dental infection. Vesicle formation leads to painful ulcers in early stages. Recurrent ulcers may affect the oral cavity. Untreated submucous fibrosis may lead to malignancy.
Investigation
Medical history by the patient and clinical examination by the doctor helps in diagnosis. Routine hemogram is recommended. Gastric analysis is advised. Biopsy is required if malignant change is suspected.
Treatment
Treatment involves corticosteroid injections. Antacids are useful in patients with hyperacidity. Surgical intervention for removal of fibrous bands in the retromolar area and thus opening the mouth is needed in case of severe trismus. Laser surgery, condylectomy may be required in severe cases. Irritants like tobacco, betel nuts should be avoided. Nutrition should be improved with balanced diet and exercise. Dental hygiene should be maintained. Physiotherapy treatment is required after surgery to prevent recurrent trismus.
Other Modes of treatment
The other modes of treatment can also be effective in treating oral submucous fibrosis. Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly, the Ayurvedic system of medicine which uses herbal medicines and synthetic derivates is also found to be effective in treating oral submucous fibrosis.
Facts and figures
Oral submucous fibrosis is predominantly seen in South East Asia and Indian subcontinent. The prevalence rate in India is 0.2 to 0.5 %.
