oral submucous fibrosis

ORAL SUBMUCOUS FIBROSIS(atrophica idiopathic mucosae oris)

O

CONTENTSDefinitionEtiologyPathogenesisClinical findingsDiagnosismanagement

Definition:An insidious chronic disease affecting any

part of the oral cavity and sometimes pharynx although ocassionally preceded by or associated with vesicle formation,it is always associated with juxtaepithelial inflammatory reaction followed by fibroelastic changes in the lamina propria,with epithelial atrophy leading to stiffness of oral mucosa and causing trismus and inability to eat.

Etiology

1)habitual chewing of areca nut.2)genetic predisposition.3)vit b12 deficiency or nutritional deficiency4)collagen disorder.5)chilly consumption.6)tabacco chewing

Clinical findings:Age & sex distribution:Between 20 to 40 yrs of age

affect both sexes.

Site distribution:buccal mucosa,lip,palate,palatal fauces,uvula,tongue,labial mucosa,floor of the mouth.

Prodromal Symptoms:first sign is erythematous lesion sometimes in conjugation with petechiae,pigmentation & vesicles.

Burning sensation of the oral mucosa & it is aggravated by spicy food.

Hypersalivation or dryness of mouth may be seen.Late symptoms:trismus,difficulty in tongue

protrusion,difficulty in swallowing,interference with speech.tongue mobility,decrease ability to open mouth.

Reffered pain.Blanching of mucosa due to impairment of local vascularity.

CLINICAL GRADING OF OSMF ACCO.TO SEVERITYFEATURES

GRADE I INCIPIENT(very early stage)

GRADE II (mild)

GRADE III (moderate)

GRADE IV (advanced stage)

GRADE V (advanced premalignant&malignant changes)

Symtoms Burning sensation,dryness of mouth,vesicle or ulceration

Burning sensation,dryness of mouth

Burning sensation,dryness of mouth

Burning sensation,dryness of mouth

All classical sing of OSMF&associated with leukoplakia and lichen planus

Spicy food

Irritation with spicy food

Irritation with spicy food

Irretation with spicy food

Irretation with spicy food

FEATURES

GRADE I INCIPIENT(very early stage)

GRADE II (mild)

GRADE III (moderate)

GRADE IV (advanced stage)

GRADE V (advanced premalignant&malignant changes)

Mucosal color

No change in mucosal color

Mucosa is blanched&Loses its sensation

Blanched opaque leather like mucosa

Blanched opaque leather like mucosa

Fribrosis No fibrosis,bands palpable

No clear-cut fibrotic bands

Vertical fibrotic bands on buccal mucosa making it stiff

Thick fibrosed bands occuring on both the buccal mucosa in retromolar area&Pterygomandibular raphe

Mouth opening

normal44mm

Slight restriction26-35mm

Considerable restriction15-25mm

Very little mouth opening2-15mm

FEATURES

GRADE 1INCIPIENT(very early stage)

GRADE(mild)

GRADE(moderate)

GRADE(advanced stage)

GRADE(advanced premalignant&malignant changes)

Tongue Tongue protrusion normal

Tongue protrusion normal

Not much affected

Restricted tongue protrusion

Eating&speaking

_ _ Difficulty in eating &speaking

Eating &speaking very much impaired

Oral hygine

_ _ Poor oral hygiene

Very poor oral hygiene

DIAGNOSIS:

Based on clinical characteristicBased on patient report of a habit of betel quid

chewing.Blood chemistry & hematological variation.An international consensus has been reached

where atleast one of the following characteristics should be present:

-palpable fibrous band-mucosal texture feel tough and leathery-blanching of mucosa together with

histopathological features consistent with osmf.

MANAGEMENT.Restriction of habit and behavioural therapy.Nutritional support.Immuno modulatory drugs: systemic application

of steroids.Physiotherapy.Local drug delivery:local injection of

corticosteroids & placental extract in addition to hyaluronidase,collagenase & substance that decreases collagen formation.

Combined therapy.Surgical managementBy laser,cryotherap,diathermy.

REACTION TO MECHANICAL TRAUMAMorsicatioFrictional hyperkeratosis

MORSICATIOMorsicatio is instigated by habitual chewingThis parafuntional behavior is done

unconsciously & is therefore difficult to bring to an end.

Most frequently seen in the buccal & lip mucosa.

The prevalence has been reported to be in the range of 1.2 to0.5%.

ETIOLOGY:neurological,psychological,dental.

CLINICAL FEATURESAge&sex:occurs at any age,lesion is three

more common among women.site:on buccal mucosa at the level of

occlusion,lip, lateral border of tongue.appearence:there is lacerated&reddened

area.Signs-rough on palpation

DIAGNOSISTypical clinical appearance with typical location.D/D-hairy leukoplakia,candidiasis.

MANAGEMENTPsycotherapy.Acrylic guard.

FRICTIONAL HYPERKERATOSISIt is a white lesion observed in area of oral

mucosa subjected to increased friction caused by for eg. Food intake.

ETIOLOGY

It is observed in area subjected to increased abrasion

Due to minor traumaSmoking&alcohol consumption

CLINICAL FINDINGSMostly seen in edentulous areas of alveolar

ridge that are exposed to increased friction.Lesion is nonsymptomatic.

DIAGNOSISIt is based on clinical featuresIf doubtful biopsy is mandatory

MANAGEMENTOn the bases of etiologyNo surgical intervention is indicated