Oral submucous fibrosis: study of 1000 cases from central India

Interventions for managing oral submucous fibrosis

BACKGROUND

Oral submucous fibrosis (OSF) is a chronic disease of the oral cavity that causes progressive constriction of the cheeks and mouth accompanied by severe pain and reduced mouth opening. OSF has a significant impact on eating and swallowing, affecting quality of life. There is an increased risk of oral malignancy in people with OSF. The main risk factor for OSF is areca nut chewing, and the mainstay of treatment has been behavioural interventions to support habit cessation. This review is an update of a version last published in 2008.

OBJECTIVES

To evaluate the benefits and harms of interventions for the management of oral submucous fibrosis.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search date was 5 September 2022.

SELECTION CRITERIA

We considered randomised controlled trials (RCTs) of adults with a biopsy-confirmed diagnosis of OSF treated with systemic, locally delivered or topical drugs at any dosage, duration or delivery method compared against placebo or each other. We considered surgical procedures compared against other treatments or no active intervention. We also considered other interventions such as physiotherapy, ultrasound or alternative therapies.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were 1. participant-reported resumption of normal eating, chewing and speech; 2. change or improvement in maximal mouth opening (interincisal distance); 3. improvement in range of jaw movement; 4. change in severity of oral/mucosal burning pain/sensation; 5.

ADVERSE EFFECTS

Our secondary outcomes were 6. quality of life; 7. postoperative discomfort or pain as a result of the intervention; 8. participant satisfaction; 9. hospital admission; 10. direct costs of medication, hospital bed days and any associated inpatient costs for the surgical interventions. We used GRADE to assess certainty of evidence for each outcome.

MAIN RESULTS

We included 30 RCTs (2176 participants) in this updated review. We assessed one study at low risk of bias, five studies at unclear risk of bias and 24 studies at high risk of bias. We found diverse interventions, which we categorised according to putative mechanism of action. We present below our main findings for the comparison 'any intervention compared with placebo or no active treatment' (though most trials included habit cessation for all participants). Results for head-to-head comparisons of active interventions are presented in full in the main review. Any intervention versus placebo or no active treatment Participant-reported resumption of normal eating, chewing and speech No studies reported this outcome. Interincisal distance Antioxidants may increase mouth opening (indicated by interincisal distance (mm)) when measured at less than three months (mean difference (MD) 3.11 mm, 95% confidence interval (CI) 0.46 to 5.77; 2 studies, 520 participants; low-certainty evidence), and probably increase mouth opening slightly at three to six months (MD 8.83 mm, 95% CI 8.22 to 9.45; 3 studies, 620 participants; moderate-certainty evidence). Antioxidants may make no difference to interincisal distance at six-month follow-up or greater (MD -1.41 mm, 95% CI -5.74 to 2.92; 1 study, 90 participants; low-certainty evidence). Pentoxifylline may increase mouth opening slightly (MD 1.80 mm, 95% CI 1.02 to 2.58; 1 study, 106 participants; low-certainty evidence). However, it should be noted that these results are all less than 10 mm, which could be considered the minimal change that is meaningful to someone with oral submucous fibrosis. The evidence was very uncertain for all other interventions compared to placebo or no active treatment (intralesional dexamethasone injections, pentoxifylline, hydrocortisone plus hyaluronidase, physiotherapy). Burning sensation Antioxidants probably reduce burning sensation visual analogue scale (VAS) scores at less than three months (MD -30.92 mm, 95% CI -31.57 to -30.27; 1 study, 400 participants; moderate-certainty evidence), at three to six months (MD -70.82 mm, 95% CI -94.39 to -47.25; 2 studies, 500 participants; moderate-certainty evidence) and at more than six months (MD -27.60 mm, 95% CI -36.21 to -18.99; 1 study, 90 participants; moderate-certainty evidence). The evidence was very uncertain for the other interventions that were compared to placebo and measured burning sensation (intralesional dexamethasone, vasodilators). Adverse effects Fifteen studies reported adverse effects as an outcome. Six of these studies found no adverse effects. One study evaluating abdominal dermal fat graft reported serious adverse effects resulting in prolonged hospital stay for 3/30 participants. There were mild and transient general adverse effects to systemic drugs, such as dyspepsia, abdominal pain and bloating, gastritis and nausea, in studies evaluating vasodilators and antioxidants in particular.

AUTHORS' CONCLUSIONS

We found moderate-certainty evidence that antioxidants administered systemically probably improve mouth opening slightly at three to six months and improve burning sensation VAS scores up to and beyond six months. We found only low/very low-certainty evidence for all other comparisons and outcomes. There was insufficient evidence to make an informed judgement about potential adverse effects associated with any of these treatments. There was insufficient evidence to support or refute the effectiveness of the other interventions tested. High-quality, adequately powered intervention trials with a low risk of bias that compare biologically plausible treatments for OSF are needed. It is important that relevant participant-reported outcomes are evaluated.

Comparative Analysis of Tissue Copper Levels in Oral Submucous Fibrosis (OSMF) Patients

Background

Oral submucous fibrosis (OSMF) is a recognized potentially malignant oral condition linked to the consumption of areca nut. Chewing areca nut has been shown to elevate soluble copper levels in mouth fluids.

Materials and Methods

Participants: The study included a panel of 30 patients with OSMF from Rama Dental College, Kanpur, India, and 30 nonareca chewing individuals serving as controls. Tissue Sample Collection and Analysis: Buccal mucosal biopsies were obtained from both OSMF patients and controls. The tissue copper concentrations were quantified using mass absorption spectrometry (MAS). Additionally, energy-dispersive X-ray microanalysis (EDX) was employed to identify the presence and distribution of copper in the tissue.

Statistical Analysis

Statistical comparisons were performed using appropriate methods, with a P-value of less than 0.05 considered statistically significant.

Results

MAS analysis revealed that the mean tissue copper level was 6.2 ± 3.1 micrograms per gram (μg/g) in OSMF specimens (n = 30), slightly higher than the 4.5 ± 2.0 μg/g in the nonareca chewing controls (n = 30) (P = 0.1). EDX analysis showed distinct copper peaks in both the epithelium (22/23) and connective tissue (18/23) of OSMF specimens compared to control biopsies. These findings were corroborated by secondary ion mass spectrometry (SIMS) in a subset of samples.

Conclusion

The study revealed higher copper concentrations in buccal mucosal tissue of OSMF patients from Rama Dental College, Kanpur, suggesting a potential connection between copper and the initiation of OSMF.

Up regulation of serum L fucose glycoprotein as a diagnostic biomarker for dysplasia in oral sub mucous fibrosis patients

Glycoproteins, essential for cellular functions, contain monosaccharides like Levo-fucose, crucial for cell communication. Recent research highlights serum L-fucose as a potential biomarker for early detection of malignancies. Typically, serum L-fucose levels are low but rise with malignancy. This study evaluates serum L-fucose as an early biomarker in oral submucous fibrosis (OSMF) patients.

Aim

Assess serum L-fucose's diagnostic potential for dysplasia in OSMF patients.

Objectives

Determine the Association between Serum L Fucose Glycoprotein Levels and Dysplasia in OSF Patients.Evaluate the Diagnostic Accuracy of Serum L Fucose Glycoprotein as a Biomarker for OSF-Related Dysplasia.

Methodology

Over a span of two years, this study encompassed 80 subjects, aged between 18 and 60 years, who were clinically and histopathologically identified as OSMF patients, with or without dysplastic alterations. From each participant, 5 ml of blood was collected. Following centrifugation to separate the serum, the samples were analyzed to determine the levels of Levo-fucose.

Statistical analysis

Using SPSS (version 17.0), serum L-Fucose levels of the case group were compared to the control group using ANOVA. Frequencies were analyzed with the chi-square test, and Tukey's Test was used for multiple comparisons. Significance was set at p < 0.01.

Results

The analysis revealed a statistically significant disparity in the mean serum L-Fucose levels between the two groups (p < 0.01). Notably, Group II patients (those with OSMF and dysplasia) exhibited markedly elevated mean serum L-fucose levels.

Conclusion

Elevated serum L-Fucose levels were observed in OSMF patients with dysplasia. Harmful habits, especially gutkha chewing, were linked to Oral Squamous Cell Carcinoma onset. Serum L-fucose can be a reliable marker for evaluating precancerous conditions.

Evaluation of fluoride levels in areca nut, tobacco, and commercial smokeless tobacco products: a pilot study

Oral submucous fibrosis (OSMF) is a premalignant condition associated with chewing areca nut and tobacco products. We observed increased fluoride levels in some OSMF-endemic regions,and the observation suggested that fluoride exposure may contribute to its pathogenesis. This study aimed to assess the fluoride content of various smokeless tobacco items as a potential influencing source. Fluoride concentration was analysed in commercial areca nut products, including gutkha, pan masala, and raw areca nut, along with tobacco, slaked lime, and catechu samples from Karnataka, India. Fluoride was measured using alkali fusion and the ion selective electrode method. All products showed high fluoride, with catechu having the highest mean concentration at 51.20 mg/kg, followed by tobacco, gutkha, pan masala, processed areca nut, and raw areca nut. Fluoride was also elevated in soil, but not in water. The findings demonstrate substantial fluoride levels in popular types of smokeless tobacco, and highlight an overlooked source of exposure among consumers of gutkha, pan masala and similar oral tobacco-products. The fluoride content warrants an investigation of potential links with the occurrence and severity of OSMF.

Sociodemographic and Clinical Profile of Oral Submucous Fibrosis

Background: Oral Submucous Fibrosis is a pre-cancerous, progressive condition caused by gutkha, areca nut consumption which is characterized by limited mouth opening, burning pain inoral cavity, stiffness and blanching of oral mucosa. Aim: To study sociodemographic characters and clinical profile of Oral Submucous Fibrosis and to assess the association of duration of adverse habits with clinical staging of Oral Submucous Fibrosis. Methodology: This cross-sectional study of 70 clinically diagnosed cases of oral submucous fibrosis was carried out at the Tertiary Health Care Centre in Central India. Over the course of two years, demographic and clinical information, including specifics on addiction and its duration, was gathered. On the basis of symptoms, the presence of palpable fibrous bands, and measuring mouth opening, clinical staging was carried out. Results: The average age of the patients in the study was 33.2 ± 12.66 years with Male female ratio of 3:1. Significantly higher proportion of patients belonged to low socioeconomic status. The maximum number of patients were seen in stage III (62.86%) followed by Stage II (21.43%) and subjects who had the adverse habits for a period of 5 to 10 years had more severe OSMF. Conclusion: In the present study, frequency of OSMF was more in young age group and in males. There was higher frequency of disease in lower socioeconomic status. Longer duration addiction was highly associated with severity of clinical stage of OSMF.

Physiotherapeutic Approach in Oral Submucous Fibrosis: A Systematic Review

One of the most poorly recognized and inadequately managed diseases, oral submucous fibrosis progresses over time. Betel nut eating is the foremost cause of oral submucous fibrosis. One such condition is oral submucous fibrosis, which is characterized by severe trismus, disability, and a higher risk of cancer. The mouth opening gradually decreases, which is related to difficulty eating, altered gustatory sensation, and mouth dryness, leading to decreased oral intake. The main and beginning signs include decreased mouth opening, pain, difficulty eating, dry mouth, and blanching of the buccal mucosa. This is treated first with medication, then with exercises for the mouth that a physiotherapist has recommended. However, the function of a physical therapist is not clearly defined. Physiotherapy may be used with other therapies to treat oral submucous fibrosis. Mouth-opening exercises, ultrasound, and other therapeutic interventions are available. This article tries to describe the kind of physical therapy that can be recommended for treating oral submucous fibrosis. It is crucial to understand pain management, physiotherapy management for grade III and IV oral submucous fibrosis various additional exercises, modalities and their ideal dose, and strategy for the long-term effect of the treatments to conduct further research.

Oral Submucous Fibrosis: A Review of the Current Concepts in Management

Oral submucous fibrosis (OSMF) is a precancerous disorder of the submucosa that causes inflammation and progressive fibrosis, leading to pronounced stiffness and trismus. Chewing betel nuts is a significant risk factor for OSMF in India. Arecoline from betel nuts and copper, which causes fibroblast dysfunction and the development of fibrotic bands, are the main components of betel quid. OSMF is distinguished by fibrosis in the submucosal region, which affects the majority of the oral cavity and results in advanced lockjaw due to rigidity in the lips, pharynx, cheeks, and upper third of the oesophageal canal, which progresses to dysphagia. The prevalence of OSMF is rising, particularly among younger generations, as more commercially available areca nut products like gutka (chewing tobacco) and others are being introduced. The severity of OSMF develops as the practice continues and is permanent. It also persists even after chewing has been stopped. The hallmark of oral submucous fibrosis (OSF) is abnormal collagen deposition. It is a precancerous condition and progresses to malignant tumours. Symptoms include ulcers, xerostomia, submucous fibrosis, burning sensation, and a reduction in mouth opening. Each of these drastically reduces the patient's quality of life. In the past, many treatment modalities have been tried but none of them has resulted in a cure for the disease. The primary focus of the treatment is to reduce the signs and symptoms so that the patient can have a better quality of life. Along with principles, conservative, medical, and surgical management issues have also been covered.

A Novel Herbal Paste Formulation of Turmeric, Tulsi, and Honey for the Treatment of Oral Submucous Fibrosis

Background and objectives Oral submucous fibrosis (OSMF) is a condition that affects the oral cavity and is characterized by the development of fibrous bands in the submucosal layers, leading to progressive difficulty in mouth opening and other symptoms. Inflammation and advancing fibrosis of the submucosal tissues are the hallmarks of this chronic, disabling illness of the oral cavity. The disorder is well known for having a propensity for cancer and is particularly linked to the habit of chewing tobacco and areca nuts. The study mentioned aims to compare the effectiveness of a novel herbal paste formulation containing turmeric, tulsi (holy basil), and honey in managing OSMF. The use of herbal remedies is common in traditional medicine, and turmeric and tulsi are known for their potential anti-inflammatory and antioxidant properties. Honey, too, is believed to have some therapeutic benefits. Methodology A study was conducted at MNR Dental College and Hospital, Sangareddy, Telangana, India, in the Department of Oral Medicine and Radiology (OMR) on 80 oral submucous fibrosis patients to evaluate the efficacy of a novel herbal paste formulation of turmeric, tulsi, and honey, comprising 77 males and three females. Patients were given a novel herbal paste formulation consisting of 10 g of turmeric powder and 10 g of tulsi powder, mixed in 10 ml of honey, to study subjects, and a placebo consisting of anti-oxidants was administered to control subjects for three months. The subjective and objective symptoms were recorded and statistically analyzed. Results The majority of the subjects were in the age group of 18-22 years, with an average age of 28.09+/-8.38 years with the most predominant habit of gutka chewing. A statistically significant change in the mouth opening, tongue protrusion, burning sensation, blanching of the mucous membrane, and reduction in palpable fibrous bands was found in the study subjects when compared to control subjects. Conclusion The present study evaluated the efficacy of a novel herbal paste formulation of turmeric, tulsi, and honey in the management of OSMF.

Oral Submucous Fibrosis and Scleroderma: A Review of the Etiopathogenesis, Clinicopathological Correlation, and Management Aspects

Oral submucous fibrosis (OSMF) is a chronic, progressive, insidious premalignant disease with multifactorial etiology affecting any part of the oral cavity and sometimes the pharynx by triggering a rapid onset of trismus and dysphagia due to stiffness at the lips, cheek, pharynx, and upper oesophageal region. Submucous fibrosis resembles many auto-immune, dermatological, mucocutaneous, and fibrotic lesions that include scleroderma, amyloidosis, iron deficiency anemia, and systemic or generalized fibromatosis clinically and histologically. Several authors established an association between oral submucous fibrosis and scleroderma with predominant oral manifestations on the basis of similarity in clinical and histological characteristics despite different pathogenesis and prognostic aspects. Scleroderma or systemic sclerosis is an autoimmune connective tissue disorder clinically manifested as fibrosis of the skin, blood vessels, and visceral organs with or without the involvement of the oral cavity. Thus, understanding the disease mechanism, appropriate early diagnosis, and clinical management of these two entities play an important role in disease prognosis and treatment outcomes. The present review was carried out to briefly present a concise overview of the etiopathogenesis, clinical, histological, diagnosis, and management aspects of OSMF and scleroderma based on the available literature, with special emphasis on similarities and differences between these two entities subsequently aiding in appropriate treatment planning.

Challenges in the classification of oral submucous fibrosis and proposing a new classification based on systematic review of literature

Aims and Objectives

Oral submucous fibrosis is one of the common oral potentially malignant disorders that can result in severe morbidity. Due to its widespread involvement in the oral cavity and high risk of malignant transformation, the diagnosis and treatment of this disease at an early stage is essential to prevent further complications. This research was carried out to review various classification systems of oral submucous fibrosis documented in the literature to date, including their benefits and drawbacks, thus focusing on a need to discover some reliable classification systems.

Materials and Methods

An electronic search of the published English literature was performed without publication year limitation in PubMed/Medline, Science Direct, Web of Science, Google Scholar, and Scopus databases using keywords like ('Oral submucous fibrosis' OR 'Oral submucous fibroses'), AND ('Classification' OR 'Grade' OR 'Stage'), AND ('Clinical', OR/ AND 'Histological', OR/AND 'Functional') following PRISMA guidelines. A manual search of all related Dental and Medical journals was also performed. We also checked the reference lists of the relevant articles for any other possible information on the subject.

Results

The search strategy revealed 31 relevant articles and it could be appreciated that oral submucous fibrosis has been classified in seven different ways. Each system is enclosed with its own limitations and benefits.

Conclusion

From this research, it can be concluded that despite the existence of several classification systems for oral submucous fibrosis, at present, no classification scheme is considered to be reliable that could help in the accurate assessment of the progression of the disease and classifying oral submucous fibrosis still remains a challenging task for clinicians, surgeons, and pathologists. We have postulated a proposed new classification system based on our literature research, but still robust research is needed in this aspect.

Oral Submucous Fibrosis: Association of Clinical and Histological Severity with Hearing Loss and Middle Ear Function

OSMF is a precancerous condition of the oral cavity. Cons umption of Areca nut in quid has been proved to be the most consistent factor. To assess middle ear function in OSMF patients by audiometry and tympanometry. Two Hundred patients of < 40 years of age with OSMF were examined and followed by PTA and impedance audiometry. Impaired mobility was seen in 20(10%) ears, and retraction of tympanic membrane was found in 36(18%) ears. Clinical staging was done in four stages. Majority of the patients were males (58%) in the age group of 21-30 years belonging to stage III (38%) and IV (26%) respectively. PTA showed varying degrees of hearing loss in 73 (36.5%) ears. In Grade I, mild hearing loss was seen in 10 (35.71%) ears and moderately severe hearing loss was in 5 (11.36%) ears whereas in Grade II mild hearing loss in 11(25%) ears. Grade III and IV showed mild hearing loss in 11(14.47%) and 12 (23.07%) respectively. Tympanometry revealed type A curve in 126 (63%) ears followed by C curve in 50 (25%) and B curve in 24 (12%) ears. In patients of OSMF, there is involvement of palatal/paratubal muscles in the fibrosis process, which causes eustachian tube malfunction leading to disturbed middle ear functions and negative middle ear pressure. Most patients of oral submucous fibrosis showed direct association with grade of hearing impairment and eustachian tube dysfunction. Higher clinical grades, both clinically and histologically showed similar findings thereby we concluded that if the disease is treated early, preventing patients from having higher grades of disease, involvement of ear can be avoided, and patients can be saved from hearing impairment.

Prevalence of precancerous lesions and conditions in India: A systematic review and meta-analysis

BACKGROUND

Smoking and chewing tobacco are associated with numerous oral mucosal lesions and conditions, often leading to cancer progression.

AIM

To investigate the prevalence of precancerous lesions and conditions among the Indian population.

METHODS

Systematic search was conducted for population or community-based observational epidemiological studies in PubMed, EMBASE, Web of Science, IndMED, Google Scholar, reports of the WHO South-East Asia Region, MOHFW India reports, Science Citation Index, WHO Index Medicus of the South-East Asian Region, Reference Citation Analysis (https://www.referencecitationanalysis.com/) and Open Grey from the earliest available up to 31^st January 2022. The effect size was calculated for the prevalence of precancerous lesions and conditions.

RESULTS

One hundred sixty-two estimates from 130 studies yielded 52 high, 71 moderate, and seven low-quality studies from 823845. Point estimate based on cross-sectional studies for leukoplakia was 4.3% (95%CI: 4.0-4.6), oral submucous fibrosis was 2.7% (95%CI: 2.5-3.0), palatal lesions in reverse smokers and nicotine palatine were 5.8% (95%CI: 4.4-7.2), and Erythroplakia was 1.2% (95%CI: 0.7-1.7), and lichen planus was 1.1% (95%CI: 0.9-1.2). Amongst hospital-based studies, the pooled prevalence for Leukoplakia was 6.7% (95%CI: 6.0-7.3), oral submucous fibrosis was 4.5% (95%CI: 4.2-4.9), lichen planus was 7.5% (95%CI: 5.3-9.6), and erythroplakia was 2.5% (95%CI: 0.4-4.5), and palatal lesions in reverse smokers and nicotine palatini were 11.5% (95%CI: 8.0-15.0).

CONCLUSION

Precancerous lesions and conditions are prevailing problems among the Indian population. It is mainly due to tobacco use, the smokeless form of tobacco. The meta-analysis indicates that hospital-based studies have a higher effect size of 6.7% than community-based studies. Patients who have already developed this condition may be advised to reduce their exposure to the risk factor to prevent the condition from progressing further.

Malignant Transformation Rate of Oral Submucous Fibrosis: A Systematic Review and Meta-Analysis

Oral submucous fibrosis (OSF) is a chronic progressive condition affecting the oral cavity, oropharynx and upper third of the oesophagus. It is a potentially malignant disorder. The authors collated and analysed the existing literature to establish the overall malignant transformation rate (MTR). A retrospective analysis of medical and dental scientific literature using online indexed databases was conducted for the period 1956 to 2021. The quality of the enrolled studies was assessed by the Newcastle-Ottawa Scale (NOS). A meta-analysis using a random effects model of a single proportion was performed along with statistical tests for heterogeneity. The overall proportion of malignancy across all studies was 0.06 (95% CI, 0.02–0.10), indicating an overall 6% risk of malignant transformation across all studies and cohorts. Sub-group analyses revealed strong differences in proportion of malignancy according to ethnicity/cohort; Chinese = 0.02 (95% CI 0.01–0.02), Taiwanese = 0.06 (95% CI, 0.03–0.10), Indian = 0.08 (95% CI, 0.03–0.14) and Pakistani = 0.27 (95% CI 0.25–0.29). Overall, the MTR was 6%; however, wide heterogeneity of the included studies was noted. Geographic variations in MTR were noted but were not statistically significant. Further studies are required to analyse the difference between cohort groups.

Quality of Life in Oral Submucous Fibrosis: A Systematic Review

Backgrounds

Oral submucous fibrosis (OSMF) is a chronic, insidious disease and is said to have a multifactorial origin with varied clinical manifestation of repeated oral ulcers, intolerance to spicy food, mucosal blanching resulting in stiffness of the oral mucosa and formation of taut bands leading to reduced mouth opening. We designed this study to systematically review the literature on QOL in OSMF and hope to make recommendations for future course of QOL assessment in OSMF.

Methods

An electronic bibliographic search of studies was done from year 1900-2019 using specified keywords. The following databases were searched: PubMed, Ovid, Google Scholar and manual search were done from references of relevant articles. Of the screened 156 articles, finally 10 studies were included after screening for inclusion/exclusion criteria. Quality assessment of studies was completed using the Effective Public Health Practice Project (EPHPP) criteria for quantitative studies.

Results

Most instruments used in the studies were not disease specific for OSMF except one study. Six types of questionnaires were used. The heterogeneity in study population, study designs, QOL instruments and outcome measures made it difficult for a comparison. Therefore, a quantification analysis was not possible. Also pure OSMF data without the involvement of other lesions were less in number.

Conclusions

OSMF not only physically debilitates a patient, it has its repercussions on the social, physical, psychological domains as well. Another aspect is that apart from trismus, which is the most common and evident symptom associated with OSMF, a substantial part of the suffering that ensues is also because of the ulcerations, burning sensation and worsening of dental health. Another focus was the association of worse QOL with a higher grade of disease, longer and higher tobacco abuse contact duration. This review is unable to give a confident answer to the evidence on QOL in OSMF but definitely showers light on the evident lack of robust data on the same. Robust Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation methodological and adequately powered studies on assessing QOL in OSMF using only a reliable disease specific questionnaire is the need of the hour.

Clinical Trial Registration

PROSPERO Registration: CRD42018102874.

In-vitro analysis on the potential use of dental pulp mesenchymal stem cells on arecoline-induced oral epithelial cells

To assess the protective role of the secretome of dental pulp mesenchymal stem cells on arecoline-induced epithelial-mesenchymal transition and senescence on epithelial cells of the oral mucosa. Effect of varying concentrations of arecoline extract and dental pulp mesenchymal stem cell condition media (DPSC-CM) were noted on oral mucosal epithelial cells. MTT assay, Annexin V-FITC/PI assay, and the quantitative gene expressions of BCL2, PUMA, BAD, BAX, CASP3, CASP9, CASP12, TGFB1, CST3, COL1A2, COL3A1, TIMP1, TIMP2, CDH1, and CDH2 were assessed. Oral mucosal epithelial cells exposed only to the arecoline were the control. 50% and 100% DPSC-CM decreased apoptosis-related gene expression in the cells exposed with 25 μM arecoline compared to the control. 50% DPSC-CM attenuated the expression of all fibrotic genes and EMT-related genes. 20% and 100% DPSC-CM showed differential effects on fibrotic and EMT-related genes. DPSC-CM inhibited apoptosis, and attenuated expression of fibrotic and EMT-related genes on arecoline treated human oral epithelial cells.

Assessing the Quality of Life of Oral Submucous Fibrosis Patients: A Cross-Sectional Study Using the WHOQOL-BREF Tool

The aim of the present study was to evaluate the quality of life (QoL) of oral submucous fibrosis (OSMF) patients using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire. This cross-sectional study was conducted at the Department of Oral and Maxillofacial Surgery, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro. We used the consecutive sampling technique to recruit patients who were clinically diagnosed with OSMF (n = 112). Data were collected using the WHOQOL-BREF questionnaire, which contains a total of 26 questions. The first two questions, related to overall QoL and overall health status, were evaluated separately. The remaining questions (3-26), which represented four domains-physical, psychological, social, and environmental health-were evaluated separately. Patients were asked questions in their native language (Urdu). The relationship between these four domains of life was evaluated with gender, age categories, functional staging, and habit duration using the independent t-test to determine statistical significance. Cronbach's Alpha was used to assess the reliability of the WHOQOL-BREF domains. The overall QoL of the OSMF patients was considerably poor, and the majority of the patients were unsatisfied with their oral health status. The age variable significantly affected the scores of all domains except for social relationships, whereas habit duration and functional staging of OSMF did not significantly affect the scores of all domains. The domains of the WHOQOL-BREF questionnaire (translated into the Urdu language) showed good reliability, except for social relationships.

Non-specific Chief Complaints Among Oral Submucous Fibrosis Patients at Outpatient Department and Pan Shop at Rural Region in India

Aim:

The first communication with a healthcare professional is critical for determining the correct diagnosis, particularly when it comes to patients’ description of symptoms. This study aimed at exploring the primary symptoms observed in oral submucous fibrosis patients with non-specific complaints visiting outpatient department and pan shop at Kanpur, India.

Materials and Methods:

It was a cross-sectional study involving a two-stage sampling to select clinically diagnosed oral submucous fibrosis (OSF) patients from the outpatient department and pan shop customers (PSCs) at rural healthcare centers. A total of 321 participants were selected based on convenience sampling. Patient demographics, history of relevant habits with a period, and socioeconomic status were all documented. The extent of mouth opening was used to grade OSF cases. Data were analyzed using MedCalc Version 19.7.2 with χ², Wilcoxon signed-rank, and t-tests used, as appropriate, to calculate P-values.

Results:

Out of the 184 OSF-OPD patients, only 59 (32.06%) described relevant disease symptoms of OSF: in stage III, 28.5% or stage IV, 38.7%. One hundred and twenty-five patients (67.93%) reported chief complaints (CCs) unrelated to OSF, and all of these cases were diagnosed with an early stage of OSF (stage I: 72.41% and stage II: 61.53%). Out of the total 137 PSCs, 74 PSCs have had prior dental consultations, but only 44 (32.11%) people had sought medical help because of OSF-related CCs.

Conclusion:

A limited number of studies were conducted in this area, particularly in the rural population of central India. Our study found that considerable amount of main complaints from OSF patients was unrelated to their symptoms. There is insufficient knowledge of OSF symptoms among rural population, which further restricts early detection of the disease.

Potential Application of an Aqueous Extract of Tinospora Cordifolia (Thunb.) Miers (Giloy) in Oral Submucous Fibrosis-An In Vitro Study

The in vitro antifibrotic activity of Tinospora cordifolia (Thunb.) Miers (giloy) was assessed to explore its potential for the management of oral submucous fibrosis. Epithelial cells dissociated from the tissue obtained from histopathologically normal oral mucosa during surgical extraction of third molars were cultured and fibrosis was induced by TGF-β1 in the oral keratinocytes. Cell viability was assessed by MTT and comparative gene expression analysis was carried out in the fibrosis-induced oral keratinocytes treated with various concentrations of Tinospora cordifolia extract (TcE) for matricellular protein-related gene expression. Concentrations of 0.5 µg/mL and 1 µg/mL TcE demonstrated a significant reduction in the expression of CTGF, SERPINE1, COL1A1, FN1, MMP1, MMP2, MMP3, and TIMP2 and an increase in the expression of PLAU, COL3A1, TIMP1, and TIMP3. Although TcE was found to reduce the expression of several fibrotic genes and increase the expression of antifibrotic genes, a varied effect was found, causing increased expression of COL3A1 and decreased expression of TIMP2 on TGF-β1-induced human buccal epithelial cells. However, further studies are warranted to assess the exact mechanism of antifibrotic activity and its clinical applications.

Serum aflatoxin B1 antibody titer, percent hemolysis and transaminases in oral submucous fibrosis

Introduction

Areca nut is deeply rooted sociocultural habit in India. Areca nut reported to be infested by fungi during the field and storage conditions. Areca nut alkaloids, nitrosamines, tobacco and aflatoxin are cytotoxic, immunotoxic to red blood cell and epithelial cell. Hence, the present study was conducted to assess the serum aflatoxin B₁ (AFB₁) antibody titer, percent hemolysis and transaminases in oral submucous fibrosis (OSMF) patients.

Materials and Methods

In this study, 128 participants of which 88 were suffering from OSMF. Twenty participants were areca nut habitual without OSMF (habitual control) and 20 participants without any habit (healthy control). For the detection of AFB₁ antibody titer, AFB₁ antigen (Sigma) A6636 from Aspergillus flavus was used. Percent hemolysis was estimated as per the procedure described by Mathuria and Verma. Serum Glutamic oxalo acetic transaminase (SGOT) and Serum Glutamic pyruvic transaminase (SGPT) were estimated by the optimized ultraviolet method using the enzyme-linked immunosorbent assay kit.

Results

Mean SGOT, SGPT, percent hemolysis and AFB₁ antibody titer were significantly higher in participants with OSMF than the habitual and healthy controls. AFB₁ antibody titer and % hemolysis in both OSMF and habitual without OSMF were showed significant correlation, i.e., increased AFB₁ antibody titer with increased % hemolysis.

Conclusions

A study result demonstrates that aflatoxin causes increase in serum transaminases which is indicative of liver damage in OSMF. The combined toxic effects of areca nut alkaloids, tobacco and AFB₁ on red blood cell (RBC) cell wall might be responsible for increased percent hemolysis in OSMF and habitual control.

Oral submucous fibrosis: An overview of a challenging entity

The oral cavity is considered to be a mirror of the body's health, as it reflects the manifestations of various systemic disorders. Most of the oral mucosa is derived embryologically from an invagination of ectoderm and thus, like other similar orifices, it may become involved in the disorders that are primarily associated with the skin. Oral submucous fibrosis is one of the commonest precancerous conditions of the oral mucosa involving any part of the oral cavity resulting in tissue scarring, dysphagia and trismus. It is a collagen-related disorder characterized by excessive fibrosis in the oral submucosa, hyalinization and degenerative changes in the muscles. This disease has become a challenging entity for dermatologists due to resemblance of its features to various mucocutaneous conditions. An improper diagnosis can lead to wrong treatment and additional complications. Dermatologists need to be aware of the characteristic features of this disease which can distinguish it from other similar conditions. This review aims to focus on the detailed aspects of oral submucous fibrosis including its historical background, etiological factors, pathogenesis, clinical features, differential diagnosis, investigations, management and future perspectives.

Small Molecule "Silmitasertib" Repurposed as Inhibitor of Transforming Growth Factor Beta 1 for the Development of Therapeutics for Oral Submucous Fibrosis

Oral submucous fibrosis (OSMF) is considered a premalignant condition characterized by aggressive fibrosis of the submucosal tissues of the oral cavity reflecting its malignant transformation potential. Activation of transforming growth factor beta (TGF-β) signaling has been reported to lead increased collagen production and fibrosis. Recently, significant upregulation of TGF-β1 has been reported in OSMF as compared to normal tissues. Therefore, inhibition of the TGF-β1 may pave for the development of therapeutics of OSMF. Based on the structure-assisted drug designing, we found "silmitasertib" as potent inhibitor of TGF-β1. We suggest that this molecule can be validated and implemented for the treatment of OSMF.

Genome-wide DNA methylation changes in oral submucous fibrosis

OBJECTIVE

Oral submucous fibrosis (OSF) is a debilitating potentially malignant condition of the buccal cavity characterized by extensive extracellular matrix deposition resulting in stiffness and trismus. As OSF is a progressive disease, we hypothesized that there would be extensive epigenetic changes in OSF tissues.

MATERIALS AND METHODS

Using the Infinium HumanMethylation450 BeadChip Array, we analyzed gross DNA methylation changes in seven OSF tissues compared to five controls. Comparison with transcriptomic data and pathway analyses was conducted to find commonly regulated genes.

RESULTS

A total of 3,294 differentially methylated regions mapping to 857 genes were identified. Comparison with transcriptome data revealed 38 downregulated-hypermethylated genes and 55 hypomethylated-upregulated genes. Using methylation-specific and qRT-PCR, aberrant hypomethylation and increased expression of FGF13, RPS6KA3, and ACSL4 genes were confirmed. Pathways involved in insulin signaling, ubiquitin-mediated proteolysis, nicotine addiction, and RAS/MAPK pathways were dysregulated, among others. Intriguingly, numerous genes located on the X chromosome were dysregulated in OSF tissues as the transcript for XIST gene was downregulated due to hypermethylation of the XIST promoter.

CONCLUSIONS

This study highlights global epigenetic dysregulation of tissues of the oral cavity in OSF patients and hints at possible X chromosomal dysregulation, previously not implicated in the pathogenesis of OSF.

Quality of Life in Oral Submucous Fibrosis- A Case Report with a Literature Review

Introduction:

Oral Submucous Fibrosis (OSMF) is a potentially malignant disorder commonly found in the Southeast Asian region, classically characterized through restricted mouth opening and burning sensation in the mouth on consuming spicy food. The etiopathogenesis and treatment aspects of OSMF have been extensively researched and reviewed. However, the effect of this condition on the Quality of Life (QoL) of patients has not gained much consideration. The aim of our case report is to highlight the importance of evaluating the QoL in an OSMF patient by using discipline-specific questionnaire and also to present to the readers a review of the recently published research articles on the application of QoL questionnaires in OSMF patients.

Results:

It was observed that most of the researchers used generic and discipline-specific questionnaire for evaluating the quality of life in OSMF patients.

Conclusion:

Evaluation of QoL is recommended during the treatment of OSMF patients. There is a need to develop and employ more of disease-specific QoL instruments for OSMF patients.

A clinicobiochemical evaluation of curcumin as gel and as buccal mucoadhesive patches in the management of oral submucous fibrosis

OBJECTIVE

The objective of this study was to evaluate and compare the efficacy of topical curcumin gel and buccal mucoadhesive patches in the management of oral submucous fibrosis (OSMF).

STUDY DESIGN

Forty patients clinically diagnosed with OSMF were randomly divided into 2 groups. Group A received curcumin gel and group B received curcumin mucoadhesive patches, to be used twice daily for 8 weeks. Evaluation was done every 2 weeks. Serum lactate dehydrogenase (LDH) levels were measured before and after treatment and also in 20 healthy controls.

RESULTS

A 100% reduction in burning sensation was observed in all 40 patients at the end of 4 weeks. Mouth opening improved by 5.45 ± 1.64 mm in group A and 5.9 ± 2.00 mm in group B. Pretreatment LDH was 359.72 ± 77.02 IU/L in patients with OSMF, which was significantly higher than that in healthy volunteers (173.2 ± 46.20 IU/L). In group A, LDH values reduced from 341.85 ± 71 IU/L to 264.95 ± 65.09 IU/L and in group B, values reduced from 377.6 ± 79.76 IU/L to 286.15 ± 72.95 IU/L after treatment.

CONCLUSION

Curcumin gel and mucoadhesive patches were effective in improving mouth opening and reducing burning sensation in patients with OSMF. They can therefore be considered as safe, noninvasive modalities for treatment of OSMF.

Biochemical status of serum iron in histopathological grades of oral submucous fibrosis

Background

Oral submucous fibrosis is a multifactorial, chronic disease of oral mucosa characterized by mucosal atrophy and fibrosis leading to functional morbidity; amongst many iron deficiency is considered as one of the risk factor. Also the iron level is considered to be depleted due to increased utilization during collagen synthesis. This study was conducted to evaluate the level of iron in patients with fibrosis and correlate with different histopathological grades.

Methods

A total of 40 clinically diagnosed and histopathologically confirmed cases of submucous fibrosis were considered. Clinical data were recorded and status of iron was estimated through serum iron and total iron binding capacity by ferrozine method using a digital auto-analyzer. The level of iron was correlated with the histopathological grades and epithelial dysplasia.

Result

The mean age of patients was 37.07 ± 14.63 years with the male to female ratio of 6.5:1. Areca nut consumption was associated with all the cases among which 87.5% of cases were exposed to commercial forms. 37.5% of cases were in early grade whereas 60% in moderately advanced histopathological grade. The level of mean serum iron and total iron binding capacity was higher in moderately advanced than in early grade. However no statistically significant difference was observed within the histopathological grades.

Conclusion

Iron is influenced by many factors like dietary intake, food habits, metabolic reactions, chronic diseases, etc. Serum iron is reduced in patients with oral submucous fibrosis which should be supplemented to impede the carcinogenic potential and improve the treatment outcome.

Oral Submucous Fibrosis: A Review on Biomarkers, Pathogenic Mechanisms, and Treatments

Oral submucous fibrosis (OSF) is a collagen deposition disorder that affects a patient’s oral function and quality of life. It may also potentially transform into malignancy. This review summarizes the risk factors, pathogenic mechanisms, and treatments of OSF based on clinical and bio-molecular evidence. Betel nut chewing is a major risk factor that causes OSF in Asia. However, no direct evidence of arecoline-induced carcinogenesis has been found in animal models. Despite identification of numerous biomarkers of OSF lesions and conducting trials with different drug combinations, clinicians still adopt conservative treatments that primarily focus on relieving the symptoms of OSF. Treatments focus on reducing inflammation and improving mouth opening to improve a patient’s quality of life. In conclusion, high-quality clinical studies are needed to aid clinicians in developing and applying molecular biomarkers as well as standard treatment guidelines.

Long non-coding RNA expression profiles and related regulatory networks in areca nut chewing-induced tongue squamous cell carcinoma

Areca nut chewing is an important risk factor for developing tongue squamous cell carcinoma (TSCC), although the underlying molecular mechanism is unknown. To determine the potential molecular mechanisms of areca nut chewing-induced TSCC, the present study performed whole-genome detection with five pairs of TSCC and adjacent normal tissues, via mRNA- and long non-coding (lnc)RNA-gene chip analysis. A total of 3,860 differentially expressed genes were identified, including 2,193 lncRNAs and 1,667 mRNAs. Gene set-enrichment analysis revealed that the differentially expressed mRNAs were enriched in chromosome 22q13, 8p21 and 3p21 regions, and were regulated by nuclear factor kappa B (NF-κB) and interferon regulatory factors (IRFs). The results of ingenuity pathway analysis revealed that these mRNAs were significantly enriched for inflammatory immune-related signaling pathways. A co-expression network of mRNAs and lncRNAs was constructed by performing weighted gene co-expression network analysis. The present study focused on NF-κB-, IRF- and Th cell-signaling pathway-related lncRNAs and the corresponding mRNA-lncRNA regulatory networks. To the best of our knowledge, the present study was the first to investigate differential mRNA- and lncRNA-expression profiles in TSCCs induced by areca nut chewing. Inflammation-related mRNA-lncRNA regulatory networks driven by IRFs and NF-κB were identified, as well as the Th cell-related signaling pathways that play important carcinogenic roles in areca nut chewing-induced TSCC. These differentially expressed mRNAs and lncRNAs, and their regulatory networks provide insight for further analysis on the molecular mechanism of areca nut chewing-induced TSCC, candidate molecular markers and targets for further clinical intervention.

Oral submucous fibrosis and its impact on psychological stress: a case-control study

Our aim was to evaluate the impact of OSF on psychological stress. Ninety OSF cases and age and sex-matched controls, enrolled from relatives or accompanying person were included in the study. Psychological stress was evaluated by the Psychological General Well Being Index short version (PGWBI-S). Sets of the psychological component were generated by principal component analysis (PCA). Association between components was accommodated for confounder and interaction was evaluated by conditional stepwise logistic regression analysis. Psychological component generated was component 1 (depressed mood, lack of positive well being, low vitality, anxiety, low vitality, and low self-control). The odds ratio (OR) of low score of component 1 for OSF was 3.66. Depressed mood, lack of positive well being, low vitality, anxiety, low vitality, and low self-control were associated with OSF. Psychological intervention should, therefore, be included in the management of OSF.

Impact of Oral Submucous Fibrosis on Quality of Life: A Multifactorial Assessment

Background

Oral submucous fibrosis (OSMF) has been extensively researched for its etiopathogenesis, malignant potential, and various available treatment modalities, but its effect on different domains of patient's life has not been thoroughly investigated. The present study aimed to clearly construe the effects of OSMF like severity and demographic variables on different domains of quality of life in OSMF patients.

Methods

A cross-sectional study was conducted in the Department of Dentistry, AIIMS Jodhpur, India. A total of 200 patients (after informed consent) were selected and detailed proforma filled including patient's demographics, habits, clinical features, and quality of life using a World Health Organization Quality of life-BREF tool (WHOQOL-BREF questionnaire). Thereafter, interpretation and statistics were done by a separate trained examiner minimizing the risk of assessment bias.

Result

Quality of life (QOL) scores differed significantly according to age, site affected, habit duration, and severity of OSMF. It, however, did not differ according to gender.

Conclusion

In this study, there has been a statistically significant deterioration of quality of life in OSMF patients in all the domains. Realization of this would increase our chance to bring the focus of the society and its policy makers to confront the growing menace of OSMF.

Prevalence of oral premalignant lesions and conditions among the population of Kanpur City, India: A cross-sectional study

Background

The habit of smoking and chewing tobacco is associated with various types of oral mucosal lesions and conditions, many of which pose a potential threat to cancer growth. The present study aims to evaluate the prevalence of potentially malignant lesions (PML) and oral cancer in North India and to identify the associated risk factors.

Materials and Methods

A cross-sectional study was carried out in the Department of Oral Medicine and Radiology Rama Dental College Hospital and research center Kanpur over a period of 5 years with1,10,625 patients. Participants were divided into study group with a positive history of the chewing habit as well as oral lesions and control group who had a positive history of habits with no oral lesions. Detailed case history and clinical examination were carried out under visible light by trained professionals to assess any oral mucosal changes.

Results

The study group consisted of 76.31% males and 23.69% females. In total, 84.34% participants in the study group were literate. However, 57.56% subjects were having oral submucous fibrosis, 23.7% were having leukoplakia, 13.12% were having Lichen planus, and 5.62% were having oral cancer.

Conclusion

Results from the present study indicate that tobacco smoking, chewing of betel quid with and/or without tobacco chewing are the major risk factors for PML and oral cancer.

Expression of transforming growth factor beta in oral submucous fibrosis

Background

Oral submucous fibrosis (OSMF) is a premalignant condition mainly caused by areca nut chewing and is characterized by progressive fibrosis of submucosal tissues and epithelial atrophy. Activation of transforming growth factor beta (TGF-β) signaling is considered main causative event for increased collagen production and fibrosis. In this study, molecular pathogenesis of OSMF was investigated based on the expression of the TGF-β genes in OSMF tissues compared to normal controls.

Methods

A total of 33 OSMF and 10 normal tissues were collected from patients and their clinic-epidemiological data was recorded. The expression of TGF-β isoform genes- TGF β1, TGF β2, TGF β3 and its receptor TGF βR1, TGF βR2 was studied by real time polymerase chain reaction (PCR). Comparison of the expression of these genes among normal controls and OSMF patients was done. The PCR results were confirmed by histopathological and immunohistochemical staining.

Results

The histological changes included atrophic epithelium, loss of rete ridges, presence of inflammatory cells and dense collagen bundles in connective tissue. PCR showed statistically significant upregulation of TGF-β isoforms in OSMF as compared to normal tissues. Of the three isoforms, maximum fold change was observed in TGF-β1. Similarly, both TGF-βR1 and TGF-βR2 were found to be elevated in OSMF tissues compared to normal. The semi-quantitative analysis by immunohistochemical staining revealed statistically significant difference between normal and OSMF tissues.

Conclusion

TGF-β signaling plays a major role in the molecular pathogenesis of OSMF as shown by increased mRNA expression of all the three TGF-β isotypes and their receptors.

Expression of Salivary S100A7 Levels in Stage I Oral Submucous Fibrosis: A Clinical and Laboratory Study

Background:

Oral submucous fibrosis (OSF) is a chronic debilitating condition characterized by juxta-epithelial fibrosis. The main etiological agent associated with the high-risk precancerous condition is areca nut use. S100A7 is a member of the largest calcium-binding proteins exclusively found in vertebrates and are associated with the regulation of numerous intracellular and extracellular functions. The aim of this study was to investigate the expression of protein S100A7 in salivary samples of individuals with stage I OSF and healthy controls.

Methods:

This study included 63 participants, 30 of whom had OSF stage I and 33 healthy controls. Nonprobability quota sampling technique was utilized for recruitment of the study participants. A structured baseline questionnaire was used to collect demographic data. Saliva samples were collected by passive droll technique in a sterile container. Salivary levels of S100A7 were quantified by enzyme-linked immunosorbent assay. For the normality of the data Shapiro Wilk test was performed. Student t-test was commuted to evaluate the expression of S100A7 protein expression between both the study groups.

Results:

The mean salivary S100A7 value for stage I OSF group was 0.334 ng/ml, compared to 0.172 ng/ml for healthy controls. Student t-test reported a statistically significant difference, indicating higher levels of S100A7 in stage I OSF group than in healthy controls (p < 0.001). In the individual group analysis, a significant negative correlation was found between salivary S100A7 and duration of areca nut use (r = –0.45, p = 0.009) and gutka chewing (r = –0.20, p = 0.03), while a significant positive correlation was found between salivary S100A7 and mouth opening (r = 0.03, p = 0.04).

Conclusions:

Higher levels of S100A7 protein level was seen in stage I OSF group in comparison to the healthy individuals. Results of our study suggest that S100A7 could be used as a surrogate assessment to identify patients at risk of OSF development.

Oral submucous fibrosis: a contemporary narrative review with a proposed inter-professional approach for an early diagnosis and clinical management

Oral Submucous fibrosis (OSMF) has traditionally been described as “a chronic, insidious, scarring disease of the oral cavity, often with involvement of the pharynx and the upper esophagus”. Millions of individuals are affected, especially in South and South East Asian countries. The main risk factor is areca nut chewing. Due to its high morbidity and high malignant transformation rate, constant efforts have been made to develop effective management. Despite this, there have been no significant improvements in prognosis for decades. This expert opinion paper updates the literature and provides a critique of diagnostic and therapeutic pitfalls common in developing countries and of deficiencies in management. An inter-professional model is proposed to avoid these pitfalls and to reduce these deficiencies.

Potentially malignant disorders of the oral cavity and oral dysplasia: A systematic review and meta-analysis of malignant transformation rate by subtype

IMPORTANCE

Potentially malignant disorders of the oral cavity (OPMD) are a heterogeneous group of lesions associated with a variable risk of malignant transformation (MT) to invasive cancer. Leukoplakia (LE), lichen planus (LP), oral lichenoid lesions (OLL), oral erythroplakia (OE), oral submucous fibrosis (OSF), and proliferative verrucous leukoplakia (PVL) are among the most common of these lesions. Oral dysplasia is a mucosal area characterized by cellular and architectural derangement, which may be associated with OPMDs or not.

OBJECTIVE

To define the MT rate of OPMDs and the risk of development into cancer of mild vs moderate/severe oral dysplasia. This in order to implement adequate follow-up strategies and treatment decisions.

STUDY DESIGN

We performed a systematic review and meta-analysis on studies reporting the MT rates of OPMDs and oral dysplasia. Ninety-two studies were included for the analysis. Cumulative rates were reported for OPMDs overall and as a subgroup, a comparison was made of mild vs moderate/severe dysplasia. Meta-regression on OPMD and year of publication was also performed.

MAIN OUTCOME AND MEASURES

Overall MT rates of OPMDs and odds ratio of MT of mild vs moderate/severe dysplasia.

RESULTS

Overall MT rate across all OPMD groups was 7.9% (99% confidence interval [CI] 4.9%-11.5%). MT rates of the specific OPMD subgroups were as follows: LP 1.4% (99% CI 0.9%-1.9%), LE 9.5 (5.9%-14.00%), OLL 3.8% (99% CI 1.6%-7.00%), OSF 5.2% (99% CI 2.9%-8.00%), OE 33.1% (99% CI 13.6%-56.1%), and PVL 49.5% (99% CI 26.7%-72.4%). Regarding the dysplasia grades comparison, the meta-analysis showed that moderate/severe dysplasia is meaningfully associated to a much greater risk of MT compared to mild dysplasia with an odds ratio of 2.4 (95% CI 1.5-3.8) [Correction added on 27 December 2019, after first online publication: CI updated from 99% to 95%.]. Heterogeneity was not significant. Annual MT rates were approximated based on the average follow-up as reported in the various subgroups. Lichen planus had an annual MT of 0.28%, OLL of 0.57%, leukoplakia of 1.56%, PVL of 9.3%, and OSF of 0.98%. Mild dysplasia had an annual MT of 1.7%, while severe dysplasia of 3.57%. Meta-regression showed a significant negative correlation of PVL MT rate and year of the study (P value <.001).

CONCLUSIONS AND RELEVANCE

OPMDs and oral dysplasia are relatively common conditions that general practitioners, head and neck, and oral medicine specialists, face in their everyday practice. Our analysis confirms the significant risk of MT of these lesions, although variable among the subgroups. Moderate/severe dysplasia bears a much higher risk of cancer evolution than mild dysplasia. It is important to raise public health awareness on the MT rates of these conditions, at the same time efficacious communication with the patient is of utmost importance. This, coupled with strict follow-up measures and optimal treatment strategies, would help in reducing the transformation of these oral conditions into invasive cancer.

Comparative evaluation of curcumin and antioxidants in the management of oral submucous fibrosis

AIM

The present study aims to evaluate the efficacy and safety of curcumin in both topical and systemic forms for management of oral submucous fibrosis in comparison with the antioxidants.

METHODS

In this randomized parallel-group single-center trial, 119 patients were enrolled. Group I received antioxidants, group II received curcumin in systemic form and group III received curcumin in both systemic and topical forms. The primary outcomes assessed were interincisal mouth opening and burning sensation using a visual analog scale. The secondary outcomes were tongue protrusion and adverse reactions. The response to treatment was analyzed using ANOVA and Fisher's exact test.

RESULTS

Significant improvement in mouth opening, burning sensation and tongue protrusion was observed in all groups at 12 weeks. Mean improvement in burning sensation did not show statistical difference across the groups. A significant difference between groups II and III for improvement in mouth opening and groups I and III for improvement in tongue protrusion was noted.

CONCLUSION

When administrated in both systemic and topical forms together, curcumin showed better results in the management of oral submucous fibrosis as compared with the systemic form alone or antioxidants. Curcumin has the potential to emerge as an effective alternative to conventionally prescribed medications.

Prevalence of oral submucous fibrosis in patients visiting dental OPD of a dental college in Kanpur: A demographic study

Background:

Oral submucous fibrosis (OSMF) is now globally accepted as an Indian disease. It has one of the highest rates of malignant transformation among potentially malignant oral lesions and conditions, therefore, a cause of concern for oral healthcare professionals. The present study aims to evaluate the prevalence of OSMF among betel nut chewers in different age groups in patients visiting Dental College and Hospital Kanpur city, India.

Materials and Methods:

A total of 860 patients of OSMF visiting the dental outpatient clinic of the Department of Oral Medicine and Radiology Rama Dental College Hospital and research center, Kanpur over a period of 24 months (1 January 2016 to 31 December 2018) were selected for the study. A detailed case history and clinical examination was carried out under visible light. The diagnosis of OSMF was based on difficulty in opening the mouth and associated blanched oral mucosa, with palpable fibrous bands. Other diagnostic features included burning sensation, salivation, tongue protrusion, habits, and associated malignant changes. Study was done on the basis of age group, habit duration, frequency of habit, and type of habit. Simple correlation analysis was performed.

Results:

Of the 860 cases of OSF studied, 390 (46.42%) cases were stage II, 290 (34.52%) were stage III, 90 (10.73%) stage I, and 70 (8.33%) stage IV. Based upon age group, group III (30--40 years) showed more prevalence than the others. Areca nut (gutkha) was a significant etiological factor (55.8%) as compared with other etiological factors.

Conclusion:

The high prevalence of OSMF requires significant awareness and management of these lesions among general population. Primary healthcare professionals and dentists should be knowledgeable and familiar with the etiopathogenesis, clinical presentation, diagnosis, and management of these lesions.

Smokeless tobacco use and oral neoplasia among urban Indian women

OBJECTIVES

Oral cavity cancers are fourth most common cancers among Indian women. The objectives were to create cancer awareness (CA) and screen tobacco-using women for oral cavity cancers.

MATERIALS AND METHODS

A community-based CA and screening programme was conducted among women in Mumbai, India. The tobacco-using women participated in CA and oral cavity screening by oral visual inspection (OVI). All screen-positive women were referred to nodal hospital and assisted for diagnostic confirmation and treatment completion.

RESULTS

Twelve slum clusters comprising of 138,383 population and 13,492 tobacco-using women have been covered. Among them, 11,895 (88.2%) participated in CA and 11,768 (87.2%) in OVI. A total of 377 (3.2%) women were screened positive, 275 (72.9%) complied with referral and 207 oral precancers [173 leukoplakia, 9 erythroplakia, 3 erythroleukoplakia and 41 sub-mucus fibrosis (SMF) including 35 women with multiple precancers] and 7 oral cancers were diagnosed. The detection rate of oral precancerous lesions and oral cancers was 17.6 and 0.6 per 1,000 screened women. Thirty-five women had multiple oral precancerous lesions. The results of multivariate analysis indicate dose-response relationship between tobacco use and risk of oral precancers.

CONCLUSION

Good participation rates (>85%) for cancer awareness and OVI were seen among urban slum women in India. Many oral precancer and cancer cases were detected and were managed at the nodal hospital.

Efficacy of Spirulina along with Different Physiotherapeutic Modalities in the Management of Oral Submucous Fibrosis

Context:

Oral submucous fibrosis (OSMF) is an insidious, chronic, disabling disease that mainly affects the oral mucosa. Spirulina is a freshwater microalga which is considered as superfood by the WHO. Due to its antioxidant, anti-inflammatory, and immunomodulating properties, spirulina has shown promising results in the management of OSMF. A wide range of treatment modalities have been tried ranging from medical, physical, or surgical interventions, but combinations of these have shown better results.

Aims:

The study aimed to evaluate the efficacy of spirulina along with different physiotherapeutic modalities in the management of OSMF.

Setting and Design:

The present comparative study was conducted in the Department of Oral medicine and radiology, College of Dental Sciences, Davangere, Karnataka, India. The block randomization technique was used in the present study to enroll patients into three different groups.

Methods:

The study consisted of 45 OSMF patients who were divided randomly into three groups. All patients were given spirulina 500 mg twice a day for 3 months. Group A patients were instructed to perform isometric mouth exercises for 20 min, twice daily. Group B patients and Group C patients perform exercises using threaded tapered screw and mouth stretching device (MSD), respectively, ten times bilaterally twice a day. Clinical parameters such as burning sensation, mouth opening, tongue protrusion, and cheek flexibility were assessed every 15 days.

Statistical Analysis Used:

Descriptive data that included mean, numbers, and percentages were calculated for each group and were used for analysis. For intra- and inter-group comparison, paired t- and unpaired t-test was used, respectively. For all the tests, P = 0.05 or less was considered for statistical significance.

Results and Conclusion:

All the groups have shown statistically significant improvement in burning sensation, mouth opening, tongue protrusion, and cheek flexibility (P < 0.05). Group C patients have shown better results followed by Group B and Group A patients. In the present study, spirulina along with different physiotherapeutic modalities was well tolerated by the patients, and significant improvement was seen in the MSD group.

Patients with oral submucous fibrosis who visit dental hospitals have nonspecific chief complaints

Background:

The first consultation with a health-care professional is crucial to make the correct diagnosis particularly with respect to narrating the symptoms encountered by the patient. Yet, currently, no information is available concerning the primary symptoms documented by patients with oral submucous fibrosis (OSF).

Materials and Methods:

A total of 158 OSF patients visiting outdoor patient departments (OSF-OPDs) and 104 pan shop customers (PSCs) were investigated. OSF-OPD cases and relevant PSCs cases were investigated to discover the chief complaints (CCs) leading to dental visits. Detailed demographic data, patient histories concerning relevant habits (with duration), and socioeconomic status were recorded. OSF cases were graded based on the degree of mouth opening.

Results:

Out of 158 OSF-OPD patients, only 43 (26.58%) reported relevant disease symptoms of OSF: in stage III, 28.57%, or stage IV, 38.09%. One hundred and sixteen patients (73.41%) reported CCs unrelated to OSF, and all of these cases were diagnosed with an early stage of OSF (stage I: 47.05% and stage II: 22.5%). Out of the total 104 PSCs, 66 PSCs have had prior dental consultations, but only five (4.80%) individuals had visited a health-care professional due to OSF-related CCs.

Conclusion:

A significant number of CCs made by OSF patients were unrelated to their disease signs and symptoms. There is a lack of awareness of OSF symptoms by pan chewers, thus hindering early detection.

Assessment of oral health-related quality of life instruments for oral submucous fibrosis: A systematic review using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist

Quality of life (QoL) instruments are becoming increasingly important in research and often used in clinical practice. Various QoL instruments have been developed/ validated for assessment of oral health-related QoL (OHRQoL) in patients with oral submucous fibrosis (OSF). Selection of an adequate instrument is challenging in routine practice due to lack of information on psychometric quality of measurement instruments. This systematic review gives an extensive overview of quality of all the currently available measurement instruments for use in OSF patients. PubMed, Scopus, Web of Science and CINAHL were searched for relevant literature until December 2018 and the information was extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of the identified studies was assessed per measurement property according to the COnsensus-based Standards for the selection of health Measurements Instruments (COSMIN) checklist. Four studies that met the inclusion criteria were included. Three generic and one disease-specific QoL instruments were identified. Information regarding important measurement properties was often incomplete. The evidence for the quality of measurement instruments was found to be variable, none of the instruments performed sufficient on all measurement properties. Based on the available information, OHRQoL-OSF appeared to have adequate COSMIN measurement properties. As recently published, newer QoL instruments have not yet been evaluated in an adequate manner for use in OSF. We suggest future studies should implement OSF-specific OHRQoL-OSF to better understand OSF patients' perspectives and help inform clinicians to propose treatment strategies as per patients' needs.

Effect of gutkha chewing on periodontal health and oral hygiene of peoples in Delhi NCR region of North India: A cross-sectional multicentered study

Background

In India, gutkha is popular among all socioeconomic groups, since it is available easily and is of less cost. Various investigations have demonstrated the relationship of gutkha biting with periodontal status and oral hygiene.

Aim

The aim of this study is to assess the effect of gutkha chewing on periodontal health and oral hygiene of patients attending the dental department in India.

Materials and Methods

A cross-sectional investigation was directed among 200 patients going to dental camps. Among them, 100 were gutkha chewers and 100 were smokers. The oral hygiene status of selected patients was determined by using the Simplified Oral Hygiene Index. Various periodontal parameters like a gingival recession, clinical attachment loss, mobility, and furcation were used to evaluate the periodontal status. Data were collected and analyzed with the help of SPSS software version 20.

Result

Among the 200 subjects, 102 were males and 78 were females. In 100 gutkha chewers, 67% were male and 33% were females. About 68% gutkha chewers showed poor oral hygiene as compared to nonchewers (41%). The values of all the periodontal parameters were significantly higher in gutkha smokers compared to nonchewers.

Conclusion

Gutkha chewing has a strong effect on oral hygiene. The findings can contribute to the evidence of smokeless tobacco (gutkha) as a risk factor for periodontal disease.

Study of oral potentially malignant disorders related to various risk factors amongst the patients attending hospitals in Bhopal, India

Background and aims

Oral potentially malignant disorders constitute one of the major oral health problems in India. Few studies have been undertaken on potentially malignant disorders in central India, specifically in Bhopal. Hence the present study was conducted to assess the oral potentially malignant disorders in the patients attending hospitals of Bhopal, India.

Methods

Four hundred subjects diagnosed with oral potentially malignant disorders were included in this study. Detailed information was gathered in a proforma and emphasis was given to the various addictions and clinical findings.

Results

Among the 400 oral potentially malignant disorders diagnosed during the study period, males constituted 78% (n=312) and females 22% (n=88). The mean age of the patients was 33.50 ± 13.24 years for males and 42.60 ± 14.18 years for females. The most commonly affected age group was 21-30 years (37.5%), followed by 31-40 years (25%) and 41-50 years (13%). 87.75% patients were addicted to chewing of betel nut and/or tobacco and/or betel quid, 15.25% were addicted to smoking bidi and/or cigarette, 15.25% were addicted to chewing and smoking, 1% was addicted to chewing and alcohol, and 0.25% was addicted to alcohol and smoking.

Conclusion

In this study, an increase in clinical grading of oral potentially malignant disorders was found with severity and duration of addiction habit. In order to decrease the prevalence of these disorders, it is imperative to continue educational campaigns at national and international level to impart education to the public about the risk factors and early signs and symptoms of the oral potentially malignant disorders.

Oral Submucous Fibrosis in Pediatric Patients: A Systematic Review and Protocol for Management

Aim

To conduct a systematic review evaluating the cases of oral submucous fibrosis in pediatric patients.

Material and Method

Systematic review was conducted using PRISMA guidelines. The article focused on oral submucous fibrosis in pediatric patients were included. A total of five manuscripts were included in our systematic review. The prevalence of OSMF in pediatric patients, gender distribution, causes, and clinical presentation were reviewed.

Results

On systematically reviewing, a total of 10 cases of OSMF in pediatric patients were found. The youngest patient reported to be diagnosed with OSMF was of 2.5 years of age. Female preponderance was noticed. All the patients had the habit of areca nut chewing which subsequently led to fibrosis.

Conclusion

Such a rapid increase in the rate of OSMF among pediatric population is a potential danger to the society. The habit of areca nut chewing is the major cause for this dreadful condition. Lack of health consciousness and low level of education are the major factors for initiation of this habit among children. Therefore it is imperative for the parents and school as well as government authorities to take serious actions.

Oral submucous fibrosis: A clinicopathological study of 674 cases in China

Background

Oral submucous fibrosis (OSF) has been reported frequently in India and other countries in South Asia. There are few reports on the clinicopathological features of OSF in China, where OSF is an epidemic. This study analyses the clinicopathological features of OSF in Hunan Province, China.

Methods

A total of 674 cases of OSF were collected from July 2013 to August 2018 in Xiangya Stomatological Hospital, Central South University, and gender, age, site, pathological stage, habits, symptoms and associated lesions were recorded.

Results

The male to female ratio was 32.7:1. The average age was 35.23 ± 10.08. The buccal mucosa was the most common site. A total of 99.85% of OSF cases chewed areca nut. Pale mucosa, restricted mouth opening, burning and fibrous bands were common clinical manifestations. Oral leukoplakia (OLK) was the most common associated lesion. The extended duration of chewing areca nut increased the risk of associated lesions (P < 0.05). The risk of OSF associated with OLK decreased with increasing OSF stage (P < 0.05).

Conclusion

The prevalence of OSF in males was higher than that in females, the buccal mucosa was most affected, and chewing areca nut is the most common habit of OSF patients.

Impact of socioeconomic inequalities on quality of life in oral submucous fibrosis patients

AIM

The purpose of this study was to analyze the impact of socioeconomic characteristics on oral health-related quality of life (OHRQoL) in patients with oral submucous fibrosis (OSF).

METHODS

 A total of 300 OSF patients' quality of life (QoL) data were obtained using OHRQoL-OSF and global self ratings of oral health and overall wellbeing. The socioeconomic status (SES) of participants was analyzed by using modified Kuppuswamy scale.

RESULTS

OSF patients with lower SES had worse OHRQoL as compared with those with middle and upper SES (p < 0.001). The household income of the family was found to be strongly associated with poor OHRQoL.

CONCLUSION

Socioeconomic characteristics should be considered in the holistic management of OSF as it has been strongly associated with the OHRQoL of these patients.

Ultrastructural Changes of Collagen in Different Histopathological Grades of Oral Submucous Fibrosis

Background and Objectives:

Oral submucous fibrosis (OSMF) is a potentially malignant disorder and a crippling condition of oral mucosa. It is usually seen in adults with areca nut chewing habit, which is characterized by changes in the connective tissue fibers leading to stiffness of the mucosa and restricted mouth opening. Patients with severe cases have distinct difficulties in chewing, swallowing, and speaking. It predominantly occurs in Indians and other population of the Indian subcontinent with a prevalence of 0.2%–0.5%. The potentiality of malignant transformation associated with OSMF is much higher with a range of 4.5%–7.6%. This article is about the ultrastructural changes pertaining to collagen and with respect to the histopathological grades of OSMF.

Materials and Methods:

A total of 20 biopsy samples from clinically diagnosed OSMF subjects and 5 healthy controls were collected. After obtaining the biopsy, the specimens were divided into two halves, of which one was studied under light microscope and the other half was observed under transmission electron microscope.

Results:

Of the 20 subjects in the study group, most of the subjects were in the 20–29 years age group with an overall male predilection (19 subjects). Four subjects were in grade 1, nine were in grade 2, and seven were in grade 3. Collagen showed sparse to dense fibrosis and normal to thick collagen bundles, and some subjects showed encroachment of collagen into the blood vessels.

Conclusion:

This study showed definitive changes with respect to collagen in the OSMF samples compared to the controls. The changes were found to be increasing with the progression of the disease to the higher grades. The changes were pertaining to the collagen and were drawing toward an increased fibrosis of the connective tissue, which compresses the blood vessels. Hence, the state of hypoperfusion and subsequent epithelial atrophy can be considered in the progression of disease to the higher grades.