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Oral_Submucous_Fibrosis

VIEWS: 11 PAGES: 10

									                              Oral Submucous Fibrosis 1




  Oral Submucous Fibrosis

   Britney A. Fernandez

Riverside Community College
                                                                        Oral Submucous Fibrosis 2


                                              Abstract

Oral submucous fibrosis (OSF) is a potentially cancerous and highly debilitating condition that

causes a stiffening of the oral mucosa due to a fibrotic change in the mucosa and its connective

tissue which then restricts the mouth opening of a person who suffers from it (Kiran, Saraswathi,

Ranganathan, Uma, Joshua, 2007). OSF is thought to be caused by the chewing of areca nut but

research has shown patents presenting with OSF who do not report having an areca nut habit,

this further adds to the mystery surrounding OSF and its etiology (Rajendran, Rani, Shaikh,

2006). This paper’s purpose is to discuss current literature on OSF and help the reader to be

better acquainted with the possible etiology, clinical manifestations, differential diagnosis, and

current treatment modalities of OSF.
                                                                        Oral Submucous Fibrosis 3


                                       Oral Submucous Fibrosis

       Oral submucous fibrosis (OSF) is known as a chronic disease of the oral mucosa that is

seemingly innocent but in the long run becomes an unfortunately disabling disease (Ahmad, Ali,

Ali, Chaubey, 2006). OSF can affect any part of the mouth and in some cases can involve the

pharynx, larynx, or the esophagus (Ariyawardana et al., 2007). The disease is believed to have

many etiological factors and is most often seen in South East Asian countries like India, Taiwan,

Pakistan, Bangladesh, Mayan mar, and Sri Lanka among people who are in lower socioeconomic

classes (Ariyawardana et al., 2007). The purpose of this paper is to present a review of current

literature on OSF regarding the etiology, clinical manifestations, differential diagnosis, and

treatment modalities of the disease.

Etiology

       OSF has an etiology that is not fully understood but through research and studies there

are some patterns that are emerging that are helping the medical and dental community figure out

what the cause of this debilitating disease might be. As far as the main etiologic factor regarding

OSF, the use of areca nut quid seems to be a main factor in the development of the disease

(Hazarey, Erlewad, Mundhe, Ughade, 2007). But because of the fact that there have been a few

cases of OSF in people who do not have a habit of using any areca nut products many other

factors have been suggested to help solve the issue of etiology of OSF (Rajendran et al., 2006).

Some of the things that have been suggested as factors that contribute to OSF are: consumption

of chilies, nutritional deficiency, the chewing of the areca nut, the alteration of components in

saliva, genetic factors, autoimmune disorders, and collagen disorders (Ahmad et al., 2006).


       Due to the fact that most of the OSF cases are seen in people who are of low

socioeconomic status it is believed that malnourishment might be a contributing factor in the
                                                                          Oral Submucous Fibrosis 4


development of OSF (Ahmad et al., 2006). It is thought that poor food quality, vitamin

deficiency (especially iron), and the use of many spices and chilies to make bland food taste

good, along with an overall lack of good nutritional education are some of the reasons why lower

socioeconomic classes are predisposed to getting OSF along with the use of areca nut products

(Ahmad et al., 2006). Chilies are thought to irritate the oral mucosa and cause an inflammatory

reaction and along with continued use of chilies and other spices, continued irritation of the

mucosa causes chronic inflammation which leads to fibrosis formation (Ahmad et al., 2006).

Another factor that might also point to OSF being caused by a nutritional issue is the evidence

that a high intake of fruits and vegetables can act as a shield against OSF (Ahmad et al., 2006).

Clinical Manifestations

       As far as clinical manifestations of OSF are concerned, OSF is characterized by a

changing of the oral mucosa from its normal elastic state to a stiff and fibrotic state (Ho et al.,

2007). Because of this changing of the oral mucosa the OSF patient over time, loses the ability to

open their mouth properly which leads to speech problems, eating problems, and an overall

lowered quality of life (Ahmad et al., 2006). Depending on if the OSF patient chews the areca

nut or swallows it after chewing, the fibrotic change in the mucosa can also occur in the pharynx

or esophagus (Kiran et al., 2007). The patient’s tissue that is fibrotic may also be painful and the

effected mucosa will also be firm when palpated due to the fibrotic change in the tissue

(Newland, Meiller, Wynn, Crossley, 2005).

Differential Diagnosis


       Some differential diagnoses for OSF could be leukoplakia due to smoking, tobacco

keratosis (from smokeless tobacco), plaque-type lichen planus, or chronic hyperplastic

candidiasis (Newland et al., 2005). The difference between smoking-related leukoplakia,
                                                                        Oral Submucous Fibrosis 5


hyperplastic candidiasis, and tobacco keratosis compared to OSF is that the leukoplakia,

keratosis, and candidiasis will be painless (OSF can be painful); they will also have a different

histological appearance when biopsied (Newland et al., 2005). Smokeless tobacco keratosis will

also appear more wrinkled than OSF which will have a smoother appearance. (Newland et al.,

2005). The main way that lichen planus and OSF can be distinguished between one another is

that lichen planus will have a lace like appearance while OSF is a more uniform whitish pink

color; lichen planus will also have a different histological appearance from OSF when biopsied

(Newland et al., 2005).

Treatment Modalities

       Due to the fact that OSF is a disease that changes the normal structure of the oral mucosa

there are no treatments that have been proven to completely reverse the effects of OSF. Because

OSF is known to cause malignancy in up to 7.6% of people who have the condition (Ho et al.,

2007) there are surgical procedures that can be done to remove or partially remove the lesion

(Newland et al., 2005). In a study published in 2006 in the Indian Journal of Dental Research on

the effects of the drug pentoxifylline, it was suggested that due to results from the study

pentoxifylline may; with further studies and tests; prove to be a cure or partial cure for OSF

(Rajendran et al., 2006).

Conclusion

       Oral submucous fibrosis is a debilitating condition that causes an overall reduction in

quality of life due to its ability to cause speech problems, problems with swallowing, problems

with opening of the mouth, as well as the chances of developing into a malignant lesion

(Rajendran et al., 2006). Although little is known about OSF such as its true etiology and how it

can be treated, more research about the condition is helping the medical and dental community
                                                                      Oral Submucous Fibrosis 6


come a little closer to fully understanding OSF. Hopefully some day soon the mystery of the

disease can be solved so that those who suffer from OSF will be able to live normal lives once

again.
                                                                       Oral Submucous Fibrosis 7


                                           References

Ahmad, M.S., Ali, S. A., Ali, A.S., Chaubey, K. K. (2006). Epidemiological and etiological

       study of oral submucous fibrosis among gutkha chewers of patna, bihar, india. Journal of

       Indian Society of Pedodontics and Preventive Dentistry, 25(2), 84-89. Retrieved April 7,

       2008 from http://www.jisppd.com/text.asp?2006/24/2/84/26022

Ariyawardana, A., Panagoda, G. J., Fernando, H.N., Ellepola, A. N. B., Tilakaratne, W. M.,

       Samaranayake, L. P. (2007). Oral submucous fibrosis and oral yeast carriage-a case

       control study in sri lankan patients [Electronic version]. Mycoses, 50(2), 116-120.

Hazarey, V. K., Erlewad, D. M., Mundhe, K. A., Ughade, S. N. (2007) Oral submucous fibrosis:

       Study of 1000 cases from central india [Electronic version]. Journal of Oral Pathology

       and Medicine, 36(1), 12-17.

Ho, P., Yang, Y., Shieh, T., Huang, I., Chen, Y., Lin, K., et al. (2007). Consumption of areca

       quid, cigarettes, and alcohol related to the comorbidity of oral submucous fibrosis and

       oral cancer [Electronic version]. Oral Surgery, Oral Medicine, Oral Pathology, Oral

       Radiology, and Endodontology, 104(5), 647-652.

Kiran, K., Saraswathi, T. R., Ranganathan, K., Uma, D. M., Joshua, E. (2007). Oral submucous

       fibrosis: A clinico-histopathological study in chennai [Electronic version]. Indian Journal

       of Dental Research, 18(3), 106-111.

Newland, J. R., Meiller, T. F., Wynn, R. L., Crossley, H. L. (2005). Oral soft tissue diseases: A

       reference manual for diagnosis and management (3rd ed., pp. 24,28,30-32). Hudson, OH:

       Lexi-Comp.

Rajendran, R., Rani, V., Shaikh, S. (2006). Pentoxifylline therapy : A new adjunct in the
                                                             Oral Submucous Fibrosis 8


treatment of oral submucous fibrosis. Indian Journal of Dental Research, 17(4), 190-198.

Retrieved April 7, 2008 from http://www.ijdr.in/text.asp?2006/17/4/190/29865
                                                                     Oral Submucous Fibrosis 9


                                             Appendix A

                                                                 Figure 1. Buccal mucosa of a

                                                                 man with oral submucous

                                                                 fibrosis before (left) and after 7

                                                                 months of pentoxifylline

                                                                 therapy (right).

______________________________________________________________________________

From “Pentoxifylline therapy : A new adjunct in the treatment of oral submucous fibrosis,” by

Rajendran, R., Rani, V., and Shaikh, S., 2006, Indian Journal of Dental Research, 17(4), 190-

198. Retrieved April 7, 2008 from http://www.ijdr.in/text.asp?2006/17/4/190/29865




                                                                Figure 2. Right buccal mucosa

                                                                of a patient with oral

                                                                submucous fibrosis before

                                                                (left) and after 6 months of

                                                                pentoxifylline therapy (right).

______________________________________________________________________________

From “Pentoxifylline therapy : A new adjunct in the treatment of oral submucous fibrosis,” by

Rajendran, R., Rani, V., and Shaikh, S., 2006, Indian Journal of Dental Research, 17(4), 190-

198. Retrieved April 7, 2008 from http://www.ijdr.in/text.asp?2006/17/4/190/29865
                                                                    Oral Submucous Fibrosis 10


                                          Appendix B



                                                                Figure 3. Labial and gingival

                                                                  mucosa of a patient with oral

                                                                 submucous fibrosis before(left)

                                                                 and after a pentoxifylline trial

                                                                 (right).

_____________________________________________________________________________

From “Pentoxifylline therapy : A new adjunct in the treatment of oral submucous fibrosis,” by

Rajendran, R., Rani, V., and Shaikh, S., 2006, Indian Journal of Dental Research, 17(4), 190-

198. Retrieved April 7, 2008 from http://www.ijdr.in/text.asp?2006/17/4/190/29865

								
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