Introduction 

Oral submucous fibrosis (OSMF) is a chronic, pre-malignant condition of the oral cavity characterized by fibrosis of the submucosa, leading to tissue scarring and restriction of mouth opening. It is strongly associated with the habit of chewing areca nut betel nut (Guthka).

What is Oral Submucous Fibrosis (OSMF) ?

OSMF is a chronic disease due to habit of chewing areca nut betel nut (Guthka), where the tissues lining the mouth become fibrotic, meaning they become stiff and thickened due to the deposition of collagen. This fibrosis can affect any part of the oral cavity, including the buccal mucosa, palate, and pharynx.

What Causes Oral Submucous Fibrosis ?

The primary cause of OSMF is the chewing of betel nut, often combined with tobacco and other substances. This habit is particularly prevalent in South and Southeast Asia. In india It is most commen in UP, Bihar and Andhra prradesh . Other factors like genetic predisposition, nutritional deficiencies, and the use of smokeless tobacco may also contribute.

What are the Symptoms of Oral Submucous Fibrosis ?

Early symptoms of OSMF can include burning sensation in the mouth, blanching of the oral mucosa, and dryness. As the disease progresses, there's a gradual loss of mobility and the inability to open the mouth fully (trismus). Other symptoms may include difficulty swallowing (dysphagia), changes in taste, and ulceration.

What are the Risks of Oral Submucous Fibrosis ?

OSMF is considered a premalignant condition, meaning it increases the risk of developing oral squamous cell carcinoma (OSCC).

How is Oral Submucous Fibrosis Diagnosed?

Dr. Abhishek Kumar diagnosis is primarily based on clinical signs and symptoms, such as progressive restriction in mouth opening, blanching of the mucosa, and loss of pigmentation.

What is the Prognosis of Oral Submucous Fibrosis ?

The prognosis of OSMF depends on the stage and severity of the disease. Early stages may respond well to treatment, while more advanced stages may have a poorer outlook. The risk of malignant transformation and the overall impact on quality of life are significant concerns.

Key points about OSMF:

It is a chronic, progressive condition that can significantly impact a person's quality of life.

It is strongly linked to the habit of areca nut chewing.

It is a precancerous condition, meaning it increases the risk of developing oral cancer.

Treatment options are limited, and early intervention is crucial. 

How is Oral Submucous Fibrosis treated at Magadh Oro Dental Clinic ?

Treatment of oral submucous fibrosis (OSMF) involves both medical and surgical approaches, depending on the stage of the disease and its severity. Medical management includes medications, injections, and physiotherapy, while surgery may be necessary to address advanced fibrosis.

Medical Management:

Medications:

Steroids, hyaluronidase, pentoxifylline, antioxidants, omega 3, colicine, and allicin can alleviate the symptoms of OSF, for long-term treatment, lycopene is effective and has few side effects. Aloe vera is the most effective for relieving the symptoms of severe burning.

Anti-inflammatory drugs:

Steroids, such as triamcinolone, may be injected into the fibrotic areas to reduce inflammation and improve mouth opening.

Enzymes:

Hyaluronidase, an enzyme that breaks down hyaluronic acid, may be combined with steroids in injections to enhance the effect of the steroid.

Collagenase:

Collagenase, which digests collagen, has been explored for use in OSMF, similar to its use in Dupuytren's contracture.

Antioxidants:

Lycopene, curcumin, and other antioxidants are often recommended to support overall health and potentially combat the effects of fibrosis.

Multivitamins and supplements:

Iron, vitamins A, B complex, C, and other supplements may be recommended to address nutritional deficiencies and support healing.

Injections:

Local injections of steroids, hyaluronidase, human placental extracts, and other substances are frequently used to reduce inflammation, break down fibrous tissue, and improve mouth opening.

Physiotherapy:

Exercise and physical therapy play a crucial role in maintaining and improving mouth opening.

Mouth opening exercises: 

Patients are encouraged to perform exercises that help to stretch and strengthen the muscles involved in mouth opening.

Tongue exercises:

Tongue blade exercises, tongue-in-cheek push, and other exercises help to improve tongue flexibility and movement.

Other therapies: 

Ultrasound therapy and thumb kneading physiotherapy may be used to improve flexibility and reduce pain.

Surgical Management:

Excision of fibrous bands:

In severe cases, surgery may be necessary to remove the fibrous bands that restrict mouth opening.

Coronoidectomy:

Removing the coronoid process of the mandible, along with or without the attached temporalis muscle, may be performed to release the pull of the temporalis muscle and improve mouth opening.

Interpositional grafts:

In some cases, interpositional grafts may be used to replace the removed tissue and maintain mouth opening.

Mucocele formation:

Some studies explore the possibility of mucocele formation in the mucosa to facilitate the expansion of the mouth opening.

Buccal fat pad transplantation:

Buccal fat pad transplantation has been explored as a newer method for increasing mouth opening.

Other Important Considerations:

Cessation of habits:

Patients should be encouraged to stop chewing betel quid, areca nut, and tobacco, as these are major risk factors for OSMF.

Dietary modifications:

Patients may be advised to avoid spicy foods and drinks, as well as alcohol and smoking, as these can irritate the oral mucosa.

Oral hygiene:

Maintaining good oral hygiene is crucial to prevent further complications and improve healing.

Early detection and intervention:

Early diagnosis and treatment are essential to prevent the disease from progressing to more severe stages.

Psychological support:

Patients may require psychological support and counseling, as OSMF can significantly impact their quality of life. 

Diode Laser in treatment of OSMF at Magadh Oro Dental Clinic, Patna

Laser therapy, particularly diode lasers, is used in the treatment of oral submucous fibrosis (OSMF) to improve mouth opening and reduce fibrosis. It can be used in conjunction with other therapies, like steroid injections or intralesional injections, and may be considered a minimally invasive alternative to surgery in some cases.

Improving mouth opening:

A primary goal of OSMF treatment is to increase mouth opening, and laser therapy can be effective in achieving this.

Watch : submucous fibrosis treatment | top dentist in patna | dr. abhishek kumar | ओरल सबम्यूकस फाइब्रोसिस

Fibrotomy:

Lasers can be used for fibrotomy, the surgical removal of fibrous bands, to improve mouth opening.

Watch : Submucous Fibrosis Treatment by Laser | Top Dentist in Patna | Dr Abhishek Kumar | Magadh Oro Dental

Synergy with other therapies:

Laser therapy is often used alongside other treatments like intralesional steroid injections or platelet-rich plasma (PRP) injections to maximize treatment outcomes.

Non-invasive alternative to surgery:

In some cases, laser therapy can be a less invasive alternative to surgical procedures for relieving fibrous tissue.

Potential side effects:

While generally considered safe, laser therapy can have some side effects, such as mild discomfort, tooth sensitivity, or gum discoloration, according to Gentle Dental of New England.

Low-Level Laser Therapy (LLLT) at Magadh Oro Dental Clinic, Patna:

LLLT is also explored as a potential treatment option for OSMF, with some studies suggesting its efficacy in biostimulation and reducing symptoms, according to Lippincott.

Summary

laser therapy, particularly diode lasers, is a promising technique for managing OSMF, offering a minimally invasive approach to improve mouth opening and reduce fibrosis, often in conjunction with other therapies