Oral Submucous Fibrosis: Causes, Symptoms, and Treatment Approaches.

Oral submucous fibrosis (OSMF) is a chronic, progressive disease of the oral cavity that primarily affects the mucosal tissue. The mucosa becomes inflexible and therefore, mouth opening is limited and, because of this, speech and eating are difficult. OSMF is a precancerous disease, that is, it can evolve into oral cancer if it is not treated. However, this condition primarily afflicts people in South and Southeast Asia, because of cultural habits such as betel quid chewing, but it is becoming more and more recognized in other parts of the world due to the spread of such practices.

Causes of Oral Submucous Fibrosis

The exact cause of oral submucous fibrosis is multifactorial, but the primary risk factors are linked to certain habits and lifestyle choices. Here are the major causes associated with the development of OSMF:

1. Chewing Betel Quid and Areca Nut: The habitual chewing of betel quid, a combination that usually contains areca nut, slaked lime, tobacco, and other ingredients, is the most important risk factor for OSMF. Areca nut is one of the known stimulants and it is the one that causes the oral mucosa to become fibrosis, thus making it less elastic and stiffer with time. The alkaloids and tannins in areca nuts stimulate fibroblasts, leading to increased collagen production and reduced collagen degradation.
2. Tobacco Use: Tobacco can lead to fibrotic changes in the mouth very rapidly, but it mostly works when it is used together with areca nuts. The toxic substances in tobacco, whether it is smoked or chewed, cause stimulation and inflammation, which, in turn, aggravates the OSMF disease.
3. Genetic and Immunologic Factors: It has been revealed that the genetic disposition of some people may be the reason for the occurrence of OSMF, since certain genetic markers have a correlation with the disease. Meanwhile, it appears that dysfunction in the immune system might also be relevant to the advancement of the disease of fibrosis.
4. Nutritional Deficiencies: Deficiencies in essential nutrients such as vitamins A, B, C, and iron have been associated with the development of OSMF. Malnutrition can impair the body’s ability to repair damaged tissue, making the oral mucosa more vulnerable to fibrotic changes.
5. Chronic Irritation: Chronic irritation from spicy foods, excessive alcohol consumption, and certain chemicals can also contribute to the onset of OSMF. These irritants can damage the mucosal lining of the mouth, promoting the development of fibrosis.

Symptoms of Oral Submucous Fibrosis

OSMF often begins with nonspecific symptoms, which can delay its diagnosis. As the disease progresses, the symptoms become more pronounced, leading to significant impairment in daily functions. Some of the common symptoms include:

1. Burning Sensation: One of the earliest signs of OSMF is a burning sensation in the mouth, especially when consuming spicy or hot foods. This is due to the inflammation and fibrosis of the oral tissues.
2. Restricted Mouth Opening (Trismus): As fibrosis progresses, the mucosal tissue becomes stiffer, leading to a reduction in mouth opening. In severe cases, the patient may find it difficult to eat, speak, or maintain proper oral hygiene due to trismus.
3. Blanching of Oral Mucosa: The oral mucosa may appear pale, whitish, or leathery due to the accumulation of fibrous tissue beneath the surface. This change in color is often one of the more visible signs of OSMF.
4. Ulceration: Recurrent oral ulcers may develop in areas of trauma or irritation. These ulcers are typically slow to heal due to the compromised blood supply and the fibrotic nature of the tissue.
5. Decreased Mobility of the Tongue and Soft Palate: In some cases, the tongue and soft palate may lose their mobility due to the fibrosis extending to these areas. This can affect speech and swallowing.
6. Dry Mouth: Fibrosis may reduce salivary gland function, leading to dry mouth (xerostomia). This can increase the risk of oral infections and tooth decay.

Treatment Approaches for Oral Submucous Fibrosis

The purpose of the treatment of OSMF is to manage the symptoms, increase the oral function, and restrict the development of oral cancer. The main reason is still the origin of the disease, and the treatment strategies are mostly concentrated on the management of the condition and the improvement of the quality of the patient. Below are some of the main treatment strategies:

1. Cessation of Areca Nut and Tobacco Use: The first and most crucial step in managing OSMF is to stop the use of areca nut, tobacco, and other irritants. Without addressing the root cause, treatment outcomes are likely to be poor.
2. Nutritional Supplements: Vitamin and mineral supplements, especially vitamins A, B-complex, and C, are often prescribed to help improve mucosal health and reduce symptoms. Iron supplementation may also be indicated if there is evidence of anemia.
3. Corticosteroid Therapy: Corticosteroids, either in the form of topical gels or intralesional injections, are commonly used to reduce inflammation and slow down fibrosis. They help improve mouth opening and reduce the burning sensation in the oral cavity.
4. Hyaluronidase Injections: Hyaluronidase is an enzyme that breaks down hyaluronic acid, a component of the extracellular matrix that contributes to fibrosis. It is often injected into fibrotic bands to improve mouth opening and oral mobility.
5. Physiotherapy: Exercises that involve mouth opening and stretching can help improve jaw mobility. Physiotherapy is often recommended alongside medical treatments to enhance the patient’s ability to perform daily activities such as eating and speaking.
6. Surgical Intervention:In the most extreme cases of oral submucous fibrosis, that is, when the damage caused by fibrosis has made it impossible to open the mouth properly, the doctor may prescribe surgery. Surgical options include the excision of some fibrous bands and reconstruction with grafts. Thus, laser surgery is also becoming a less invasive option for treating OSMF.
7. Antioxidant Therapy: Antioxidants like lycopene, beta-carotene, and curcumin have been researched for their promising antioxidant enzymes and slotting and fibrinogen obliterating. These compounds, which in turn come from nature, could be another way of healing OSMF, which has been confirmed through various patients.

Conclusion

Oral submucous fibrosis (OSMF) is a serious disease that has some long-term consequences and also a risk of malignant propensities for the oral cancer. Learning about its reasons, being aware of its signs, and choosing proper treatment methods can result in improvement of life for the patients. The early diagnosis and intervention together with the stopping of the harmful habits such as areca nut and tobacco use are very important in dealing with OSMF and its prevention. By getting medical, surgical, and lifestyle interventions, patients can get a better quality of life and have fewer complications with this serious illness.