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Globally Oral Cancer is the sixth most common cause of death with India. Oral habits like tobacco chewing in the form of betel quid areca nut, smoking and alcohol consumption are most prevalent in Indian population. India accounts for 86% of the world’s oral cancer cases.
Chronic tobacco quid consumption (betel quid chewing or areca nuts) results in a progressive premalignant condition called Oral Submucous Fibrosis (OSMF). The hyalinaisation of the buccal mucosa forming white bands on the inner surface of cheeks and decrease in mouth opening is the first symptom followed by burning sensation while taking food and also difficulty in swallowing. Free radicals released during the metabolism of tobacco and areca nut may involve in the initiation and propagation of mucosal fibrosis. The disease predominantly affects people of South-East Asian origin.
Oral Submucous Fibrosis (OSMF) is an extremely discomforting oral condition that is marked by the development of painful lesions inside the mouth that refuse to go away on their own.
This is a highly potent, insidious and chronic pre-cancerous condition that affects various portions of the oral cavity as well as the pharynx. It is a collagen related disorder associated with betel quid chewing and characterized by progressive hyalinization of the submucosa. It causes progressive fibrosis of submucosal tissues and juxta-epithelial inflammatory reactions.
This disabling disease also leads to fibro-elastic changes in the lamina propria along with epithelial atrophy, which results in stiffness of the oral mucosa. It may become impossible to open to the mouth due to the extreme stiffness of the jaw. It manifests as blanching and stiffness of the oral mucosa, progressive trismus due to rigid lips, cheeks and pharynx, burning sensation in the mouth, reduced mobility of the soft palate and tongue, loss of gustatory sensation, intolerance to eating hot and spicy foods and occasionally, mild hearing loss due to blockage of Eustachian tube.
The condition is found in as many as 5 million young Indians who are suffering from this precancerous condition as a result of the increased popularity of the habit of chewing pan masala. Pan masala is a mixture of spices including, betel nuts, catechu, menthol, cardamom, lime and others. It has a mild stimulating effect and is often eaten at the end of the meal to help digest food and as a breath mint.
Causes of OSMF
The factors that have been discussed as possible causative factors are-
Osmf is as serious disease. Early diagnosis and timely treatment can cure it completely, allowing patients to have normal oral movements. However, if left untreated, it can lead to serious health conditions such as oral cancer. Thus in dental clinics in Delhi, the dentists make sure they point it out as soon as they diagnose it. Dentist in Delhi, counsel patients on this condition and this motivated the patients to discontinue their habits.
OSMF is preceded by symptoms such as burning sensation of the oral mucosa, ulceration and pain. The initial stage of osmf is characterized by loss of pigmentation of oral mucosa, leathery texture and blanching of oral mucosa, depapillation and reduced movement of tongue, progressive reduction of mouth opening and sunken cheeks. The changes of OSMF are similar to those of systemic sclerosis (scleroderma) but are limited to oral tissue.
In the more advanced stage of the disease, the mucosa loses its elasticity and becomes stiff and blanched. The essential feature is a fibrous band restricting mouth opening and causing difficulty in mastication, speech, swallowing and maintaining oral hygiene.
This condition is thought to arise in the back of the mouth and gradually spread towards the outer parts. Some of its clinical features include the following-
There are many treatment options for oral submucous fibrosis which are mainly decided by the dentist depending on the stage of osmf.
The main and first step which is being stressed in dental clinics in India in getting osmf successfully treated is asking the patient to stop areca nuts chewing in the form of pan/gutka/jarda/beetle nut /smoking/tobacco chewing/ alcohol and eating less spicy food, maintaining oral hygiene and following a diet that contains plenty of iron, vitamin A,B complex as well as C rich foods.
And most important only after stopping the habit, dentists in India advise the following treatments to resolve the condition.
With the use of proper treatment, the prognosis or outcome of the disorder is positive in most patients. Osmf can be cured completely when treated at an early stage. This is what dentist in Delhi have been trying to advise patients on. There has been a marked improvement in the prognosis of this condition in dental clinics in Delhi as well as dental clinics in India.
Osmf is a completely preventable disorder. As the osmf is a progressive disease, an important step to avoid progression of osmf is to stop the habit completely. Avoiding chewing betel nuts as well as mouth freshners containing this eatable significantly reduces the chances of developing osmf. One should also limit the amount of chillies consumed. Having plenty of chillies may damage the oral mucosa and lead to this disorder. Counselling by the dentists in India to these patients helps a lot.
Posted By – Dr. Suprriya B. Bhatia