Efficacy and Safety of Intralesional Xantinol Nicotinate in the Treatment of Various Stages of Oral Submucous Fibrosis

Physiotherapy in improving the interincisal mouth opening in oral submucous fibrosis: Meta-analysis

Background

Oral submucous fibrosis (OSMF) is a chronic, irreversible collagen metabolic disorder resulting in progressive reduction of mouth opening due to submucosal fibrosis. Currently, the benefit of interincisal mouth opening (IMO) has been attributed to physical therapy. This meta-analysis aimed to find evidence about effectiveness of physiotherapy in increasing of IMO.

Method

Literature search was conducted in Scopus, Web of Science, and PubMed databases using "Oral submucous fibrosis", "OSMF", "OSF", "treatment", "treatment modalities", "physiotherapy devices", "mouth opening exercise device", "mouth opening", "mouth opening device", and "physiotherapy" search terms to find the relevant studies published till March 2024. Studies evaluating the effectiveness of physiotherapy alone or in combination in improvement of IMO pre-post intervention in OSMF patients were included. Random-effect analysis was carried out to obtain the pooled IMO. Heterogeneity and publication bias was assessed using the I 2 and funnel plot. The main outcome variable was increase in IMO which was measured on linear scale.

Results

20 studies included in meta-analysis. Physiotherapy alone was found to be effective in improving IMO (4 studies; MD 1.19 [0.18, 2.20]). Further, addition of physiotherapy along with ultrasound (US) (3 studies; MD 3.96 [1.50, 6.42]), medicinal therapy including herbal (13 studies; MD 8.35 [5.18, 11.51]) and surgery (8 studies; MD 21.84 [18.29, 25.38]) improves the IMO.

Conclusion

There is evidence of effectiveness of physiotherapy in improving the IMO. However, evidence need to be substantiated with stringent methodology which is lacking in most of studies.

Medicinal management of oral submucous fibrosis in the past decade- A systematic review

INTRODUCTION

Oral submucous fibrosis (OSMF) is a potentially malignant disorder with a high rate of malignant transformation. It is associated with chewing of areca nut and tobacco products with a high global prevalence, particularly in the southeast Asian countries. A wide range of treatment modalities are available, ranging from corticosteroids, antioxidants, nutritional supplements to herbal medicines but lacks a reliable treatment regimen.

AIM

This systematic review will comprehensively analyze the medicinal treatment for OSMF from 2011 to 2020, apprise the literature with new clinical studies, and initiate a discussion about other potential medicines.

MATERIAL AND METHODS

A comprehensive electronic search was conducted in Pubmed, Scopus, and other databases from January 2011 to June 2020 according to the PRISMA guidelines, to identify all the clinical studies for the medicinal management of OSMF with definite keywords and defined criteria.

RESULTS

Among the thirty-two included clinical studies 23 were randomized controlled studies and 9 were case-control studies. The treatment outcomes were diverse, and the majority of the studies showed improvement in the subjective signs and symptoms of OSMF. Only a few studies noticed the side effects.

CONCLUSION

No single treatment modality is effective in the management of OSMF. The concurrent use of triple therapy is efficacious. The naturally occurring herbal medicines have an immense potential in the management of OSMF. Therefore, high-quality, longitudinal, multi-center randomized controlled trials with larger samples need to be conducted to further assess the efficacy of various medicinal formulations in conjunction with physiotherapy in the management of OSMF.