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Chen JK, Kao WH, Huang PH, Tsao CK, Nee TE. Longitudinal outcomes of trismus release with free-flap reconstruction in primary and secondary oral submucous fibrosis-related trismus. J Plast Reconstr Aesthet Surg 2024; 92:26-32. [PMID: 38489984 DOI: 10.1016/j.bjps.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/08/2023] [Accepted: 02/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Oral submucous fibrosis is a global health concern associated with betel quid use and results in trismus, which can be either primary or secondary in origin. Severe cases often require trismus release with free-flap reconstruction. This study examined longitudinal outcome trends following trismus release and compared the outcomes of patients with primary and secondary oral submucous fibrosis-related trismus. METHODS We conducted a retrospective cohort study by including patients who underwent trismus release between 2013 and 2022. All procedures were performed by a single surgical team to ensure technique standardisation. We measured the maximum mouth opening, the interincisal distance, perioperatively and 1, 2, 3, 4, 6 and 12 months post-operatively. Data were analysed using generalised estimating equations. RESULTS A total of 35 patients were included in the study, 17 with primary and 18 with secondary oral submucous fibrosis-related trismus. Initially, patients with primary oral submucous fibrosis-related trismus had greater interincisal distance gains than those with secondary oral submucous fibrosis-related trismus (p = 0.015 and p = 0.025 at 3 and 4 months post-operatively, respectively). However, after 12 months, this initial advantage faded, with comparable interincisal distance improvements in patients with primary and secondary disease, despite the more complex surgical procedures required in secondary cases. CONCLUSION Surgeons should carefully consider the benefits of trismus release procedures for patients with secondary oral submucous fibrosis-related trismus by recognising the changes in post-operative outcomes.
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Affiliation(s)
- Jyh-Kwei Chen
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Chang Gung Memorial Hospital Taipei Branch, Taipei, Taiwan
| | - Wen-Hsiang Kao
- Department of Electronic Engineering, Chang Gung University, Taoyuan, Taiwan; JC Science Corporation, New Taipei, Taiwan
| | - Pin-Hsuan Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Tzer-En Nee
- Department of Electronic Engineering, Chang Gung University, Taoyuan, Taiwan.
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Chen X, Chen T, Xie H, Guo J. Salivary and serum levels of lactate dehydrogenase in oral submucous fibrosis: A meta-analysis. Medicine (Baltimore) 2024; 103:e37788. [PMID: 38608075 PMCID: PMC11018194 DOI: 10.1097/md.0000000000037788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/13/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The occurrence of oral submucous fibrosis (OSF) is often accompanied by an increase in lactate dehydrogenase (LDH) levels. In this meta-analysis, we compared the salivary and serum levels of LDH levels between OSF patients and controls. MATERIAL AND METHODS A comprehensive search was conducted in PubMed, Embase, Web of Science, and Cochrane Library from the establishment of the database to June 2023, and the quality of the studies was checked by the Newcastle-Ottawa Quality Assessment scale. The mean difference (MD) and 95% confidence interval (CI) were calculated using RevMan 5.4 software. RESULTS A total of 28 studies were retrieved from the database, and we included 5 studies in this meta-analysis. The salivary LDH level of OSF patients was higher than healthy controls (MD: 423.10 pg/L 95%CI: 276.42-569.77 pg/mL, P < .00001), the serum LDH level of OSF patients was also higher than that of healthy controls (MD: 226.20 pg/mL, 95%CI: 147.71-304.69 pg/mL, P < .00001). CONCLUSIONS This meta-analysis showed that salivary and serum LDH levels were higher in OSF patients than in healthy controls, suggesting that LDH may be a potential biomarker for OSF.
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Affiliation(s)
- Xueru Chen
- Department of Pharmacy, Changsha Stomatological Hospital, Changsha, China
| | - Tongqiang Chen
- Hunan Provincial Institute of Product and Goods Quality Inspection, Changsha, China
| | - Hui Xie
- Department of Pharmacy, Changsha Stomatological Hospital, Changsha, China
| | - Jincai Guo
- Department of Pharmacy, Changsha Stomatological Hospital, Changsha, China
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3
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Jones A, Veale B, Li T, Aggarwal VR, Twigg J. Interventions for managing oral submucous fibrosis. Cochrane Database Syst Rev 2024; 2:CD007156. [PMID: 38415846 PMCID: PMC10900301 DOI: 10.1002/14651858.cd007156.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
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.
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Affiliation(s)
- Adam Jones
- Oral Surgery, School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Benjamin Veale
- Oral and Maxillofacial Surgery, Airedale General Hospital, Keighley, UK
| | - Tiffany Li
- Oral and Maxillofacial Surgery, Leeds Teaching Hospitals, Leeds, UK
| | - Vishal R Aggarwal
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Joshua Twigg
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- Department of Restorative Dentistry, Leeds Dental Institute, Leeds, UK
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Shil M, Goswami P, Gaikwad TV, Jadaun G, Sridhar T, Bandyopadhyay B, Surana P. Efficacy of Oral Colchicine and Intralesional Hyaluronidase with and without Ultrasound Therapy in the Management of Oral Submucous Fibrosis-A Comparative Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S586-S588. [PMID: 38595551 PMCID: PMC11001099 DOI: 10.4103/jpbs.jpbs_879_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 04/11/2024] Open
Abstract
Aim To determine the therapeutic effect and efficacy of oral colchicine tablet and intralesional injection of hyaluronidase with and without ultrasound therapy in the clinical course of oral submucous fibrosis. Materials and Methods This comparative study involving 45 human participants was divided into three equal groups. The participants in group 1 received oral colchicine and intralesional hyaluronidase. The participants in group 2 received oral colchicine, intralesional hyaluronidase, and ultrasound therapy. The group 3 participants were treated with intralesional dexamethasone and hyaluronidase. Intergroup assessments were done using repeated measures of ANOVA test, where P value of <0.05 was considered as statistically significant difference. Results Group 2 patients had maximum improvement with respect to all the parameters. Conclusion Therapeutic ultrasound can be given effectively as an adjunct therapy along with conventional therapy in OSMF patients.
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Affiliation(s)
- Malabika Shil
- Oral and Maxillofacial Radiologist, Nidaan Diagnostic Centre, Pune, Maharashtra, India
| | - Poulami Goswami
- Department of Oral Medicine and Radiology, Mithila Minority Dental College and Hospital, Darbhanga, Bihar, India
| | - Trupti Vijay Gaikwad
- Department of Oral Medicine and Radiology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - Gargi Jadaun
- Department of Oral and Maxillofacial Surgery, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
| | - T Sridhar
- Department of Oral Medicine and Radiology, Priyadarshini Dental College and Hospital, Pandur, Thiruvallur, Tamil Nadu, India
| | - Basudhara Bandyopadhyay
- Department of Pedodontics and Preventive Dentistry, Intern, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Patia, Bhubaneswar, Odisha, India
| | - Pratik Surana
- Department of Pedodontics and Preventive Dentistry, Maitri College of Dentistry and Research Centre, Durg, Chhattisgarh, India
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Samanta I, Patil DJ, More CB. Assessment of vitamin D levels in patients with oral potentially malignant disorders and oral squamous cell carcinoma-A cross-sectional study. J Oral Biol Craniofac Res 2024; 14:27-32. [PMID: 38130424 PMCID: PMC10733696 DOI: 10.1016/j.jobcr.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/24/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives The aim of this study was to assess and compare the serum and salivary levels of Vitamin D in patients with oral potentially malignant disorders (OPMD) and Oral squamous cell carcinoma (OSCC) with healthy controls. Method This cross-sectional study was carried out among 60 patients reporting to the department of Oral Medicine and Radiology, and included patients with OPMDs, OSCC and healthy controls. The Vitamin D levels were estimated using the chemiluminescence immunoassay. One-way ANOVA was used to compare mean and statistical difference between the groups. Tukey's post HOC test calculated for inter group difference. Serum and salivary Vitamin D levels were corelated with Pearson's coefficient. The values of p < 0.005 was considered as significant. Results The levels of Vitamin D were decreased in study group as compared to controls both in serum and saliva. (p < 0.001). Between serum and salivary Vitamin D levels, a strong association was discovered using the Pearson's coefficient value of 0.737 (p < 0.001). Conclusion In this study, patients with both OPMDs and OSCC had Vitamin D insufficiency & deficiency. Vitamin D level assessment should be included as a standard component of routine investigations for these individuals.
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Affiliation(s)
- Ishita Samanta
- Department of Oral Medicine and Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India
| | - Deepa Jatti Patil
- Department of Oral Medicine and Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India
| | - Chandramani B. More
- Department of Oral Medicine and Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India
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Sumithrarachchi S, Athukorala I, Rumy F, Jayasinghe R. Prevalence of tobacco and areca-nut use among patients attending dental teaching hospital in the central province of Sri Lanka and its association with oral mucosal lesions; a cross sectional study. J Oral Biol Craniofac Res 2024; 14:39-43. [PMID: 38179108 PMCID: PMC10764264 DOI: 10.1016/j.jobcr.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/23/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Tobacco and areca-nut are risk factors for oral cancer and potentially malignant disorders. Oral cancer is ranked as the commonest among males in Sri Lanka (18.4 %). This research aims to determine the prevalence of tobacco and areca-nut use and its association with oral lesions. Method It is a cross-sectional study using 368 patients attending the Dental Diagnostic Clinic. Details of tobacco and areca-nut use were collected and participants were examined for mucosal lesions. Results It revealed that 23.9 % had tobacco use. Out of these, 41.1 %, 22.2 % and 36.7 % had smokeless-tobacco use, smoking and both, respectively. Similarly, 25.3 % had areca-nut/betel-quid use and majority (72.8 %) added tobacco to it. Tobacco (93.2 %) and areca-nut (79.6 %) use was higher among males (p < 0.05). Significant associations of areca-nut use with age (p = 0.001) and education level (p = 0.025) were noted. Oral lesions like de-pigmentation, white patches, ulcers, growths and oral sub-mucous fibrosis (OSF) had prevalences of 2.4 % each. Prevalence of pigmentation, lobulated tongue and erosive lesions was 10.6 %, 4.6 % and 1.4 %, respectively. 32.6 % had abnormalities like linea-alba, periodontal problems, pericoronitis and hairy tongue. The study revealed that >90 % of those who used tobacco and areca-nut had oral lesions (p < 0.05). Conclusion The prevalence of tobacco and areca-nut use is high among patients attending the Dental Teaching Hospital, and its association with mucosal lesions is significant. Hence regular awareness programs on the adverse effects of tobacco and areca-nut use should be carried out at the Diagnostic clinic as a preventive measure.
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Affiliation(s)
- Sumali Sumithrarachchi
- Centre for Research in Oral Cancer, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
| | - Isuru Athukorala
- Centre for Research in Oral Cancer, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
| | - Fazly Rumy
- Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
| | - Ruwan Jayasinghe
- Centre for Research in Oral Cancer and Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
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Chandrakapure D, Sachdeva K, Agarwal K, Shukla A. Comparative Study of Injection Triamcinolone and Hyaluronidase Combination with Injection Platelet Rich Plasma (PRP) in Management of Oral Submucous Fibrosis (OSMF). Indian J Otolaryngol Head Neck Surg 2023; 75:3725-3732. [PMID: 37974729 PMCID: PMC10645765 DOI: 10.1007/s12070-023-03912-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/26/2023] [Indexed: 11/19/2023] Open
Abstract
This study aimed to compare the results of injection triamcinolone and hyaluronidase combination with injection Platelet Rich Plasma (PRP) in management of Oral Submucous Fibrosis (OSMF). Present study was carried out in randomly divided two groups of 30 patients each of OSMF who all are presented with chief complain of reduced mouth opening. Group A patients were given 1 ml of injection triamcinolone and hyaluronidase combination. Group B patients received 1 ml of injection Platelet Rich Plasma. Both injections were given intralesionally once a week for 6 weeks. Results of ANOVA shows significant better results in improving mouth opening in group B patients receiving injection Platelet Rich Plasma as a treatment. In Group A, patients shows improvement in Maximum interincisal distance (MIID) of mean 6.51 ± 1.02 mm as compared to the patients in group B shows improvement in MIID of mean 9.53 ± 1.06 mm (p value < 0.05). Treatment of OSMF with injection Platelet Rich Plasma is a novel method and found to be more efficient than treatment with injection triamcinolone and hyaluronidase combination.
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Affiliation(s)
- Deepankar Chandrakapure
- Netaji Subhash Chandra Bose Medical College, Jabalpur, MP, Plot No 97, Ayyappa Nagar, Kohka, Bhilai, Durg, CG 490023 India
| | - Kavita Sachdeva
- Department of ENT, Netaji Subhash Chandra Bose Medical College, Jabalpur, India
| | - Kajal Agarwal
- Netaji Subhash Chandra Bose Medical College, Jabalpur, MP, Plot No 97, Ayyappa Nagar, Kohka, Bhilai, Durg, CG 490023 India
| | - Amrita Shukla
- Netaji Subhash Chandra Bose Medical College, Jabalpur, MP, Plot No 97, Ayyappa Nagar, Kohka, Bhilai, Durg, CG 490023 India
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Mahapatra M, Panda A, Kumar H, Barman D, Talukdar R, Dakshinakabat P. Lactate Dehydrogenase as a Biomarker in Oral Submucous Fibrosis: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e51008. [PMID: 38264399 PMCID: PMC10803290 DOI: 10.7759/cureus.51008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 01/25/2024] Open
Abstract
This systematic review and meta-analysis was planned with the objective of evaluating the level of Lactate Dehydrogenase (LDH) in oral submucous fibrosis patients and in controls and comparing them. For this meta-analysis, we searched Google Scholar, PubMed, Scopus, and Directory of Open Access Journals (DOAJ) databases using a search methodology that included combinations of MeSH terms and keywords and included cross-sectional studies to evaluate the levels of LDH in patients with Oral Submucous Fibrosis (OSMF), Oral Squamous Cell Carcinoma (OSCC) and compared it with the controls. The total number of records identified through database searching was 4161 (n). Analysis of the quality of the studies was done using the National Heart, Lungs and Blood Institute (NHLBI) tool for case-control studies. Twelve case-control studies which matched the inclusion criteria were included after the literature search. The meta-analysis was carried out using R Studio (version 4.1.3, 2022; The R Foundation for Statistical Computing, Vienna, Austria). The pooled estimate that has been calculated from the salivary LDH course for OSMF was 15.35% and from the serum LDH course for OSMF was 6.82%. There was a visual observation of the funnel's plot asymmetry suggesting publication bias. After adjusting the publication bias, the t2 values for salivary and serum LDH were 41% and 14.71%, respectively, which was less than 50%, indicating that the meta-analysis was statistically significant. The evaluation of salivary and serum LDH can be a useful method for early diagnosis of OSMF as well as OSCC. To infer that individuals may have OPMD or OSCC, specific values for salivary and serum LDH must be found in further investigations.
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Affiliation(s)
- Monalisha Mahapatra
- Oral and Maxillofacial Pathology, Kalinga Institute of Dental Sciences, Bhubaneswar, IND
| | - Abikshyeet Panda
- Oral Pathology, Kalinga Institute of Dental Sciences, Bhubaneswar, IND
| | - Harish Kumar
- Oral and Maxillofacial Pathology, Kalinga Institute of Dental Sciences, Bhubaneswar, IND
| | - Diplina Barman
- Department of Public Health Dentistry, Indian Council of Medical Research (ICMR) National Institute of Cholera and Enteric Diseases (NICED), Kolkata, IND
| | - Rounik Talukdar
- Department of Community Medicine, Indian Council of Medical Research (ICMR) National Institute of Cholera and Enteric Diseases (NICED), Kolkata, IND
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Choden K, Gyeltshen T. Iatrogenic cushing's syndrome post intralesional triamcinolone acetonide in oral submucous fibrosis: 2 case reports. BMC Oral Health 2023; 23:813. [PMID: 37898806 PMCID: PMC10612248 DOI: 10.1186/s12903-023-03505-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/08/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Oral Submucous Fibrosis (OFMF) is an oral potentially malignant disorder (OPMDs), strongly linked to betel quid chewing. It exhibits a significantly higher rate of malignant transformation compared to other OPMDs. The use of Intralesional Triamcinolone Acetonide Injection has emerged as a highly effective treatment option and has become the cornerstone of managing this condition. CASE PRESENTATION A 44-year-old female and a 40-year-old male presented with burning sensation and limited mouth opening, leading to diagnosis of OSMF. Both patients were treated with Triamcinolone Acetonide (TAC) Intralesional injections. Following a few months of treatment, a significant improvement in mouth opening was observed. However, both patients began experiencing symptoms such as facial rounding (mooning of the face), a buffalo hump, uneven hair growth, and swelling in the lower extremities. Upon recognizing these symptoms as indicative of Cushing's Syndrome, the administration of TAC injection was discontinued. Both patients were referred to a higher-level medical facility for confirmatory tests, which revealed elevated cortisol levels in both morning (Cortisol A.M) and evening (Cortisol P.M). CONCLUSION TAC injection has been established as an effective treatment for OSMF. However, it is crucial to closely monitor patients for any adverse effects resulting from the treatment, which may arise from high dosage or increased frequency.
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Affiliation(s)
- Kuenga Choden
- Department of Dentistry, Tsirang Hospital, Tsirang, Bhutan.
| | - Tshewang Gyeltshen
- Department of Dentistry, Tsirang Hospital, Tsirang, Bhutan
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
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10
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Chang CH, Lin CP, Chen YK, Hsiao YF, Wang YH. Simvastatin Attenuates Areca Nut Extract-Induced Subdermal Fibrosis in Mice by Targeting TGF-β Signaling Pathways. Curr Issues Mol Biol 2023; 45:8622-8632. [PMID: 37998719 PMCID: PMC10670689 DOI: 10.3390/cimb45110542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
Oral submucous fibrosis (OSMF) is a chronic inflammatory disease and a potentially malignant oral disorder, characterized by fibrosis of the oral mucosa. TGF-β signaling pathways have been implicated in the development of OSMF, with areca nut extract (ANE) contributing to the disease progression. Simvastatin, a statin drug, has demonstrated anti-fibrotic properties in various fibrotic conditions. However, its therapeutic potential in treating OSMF remains unclear. In this study, 8-week-old male BALB/c mice were randomly divided into three groups based on different time points. Each mouse was then treated with four different drug formulations. Post-treatment, specimens were collected for histopathological examination and staining to assess skin thickness, fibrosis, and collagen deposition. ANE treatment alone significantly increased skin thickness and collagen deposition compared to the control group after the 4-week time point. The combined administration of ANE and simvastatin, resulted in a notable reduction in skin thickness and collagen deposition. Western blot analysis revealed that simvastatin effectively suppressed the expression of fibrosis-related proteins, including CTGF, and α-SMA, in ANE-induced subdermal fibrosis. These results suggest that simvastatin has potential therapeutic effects on ANE-induced subdermal fibrosis, providing a foundation for future studies and possible clinical applications.
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Affiliation(s)
- Chi-Hua Chang
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
| | - Ching-Ping Lin
- Division of Periodontology, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
| | - Yuk-Kwan Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Division of Oral Pathology and Maxillofacial Radiology, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Oral & Maxillofacial Imaging Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yu-Fang Hsiao
- College of Medicine, Orthopaedic Research Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Yan-Hsiung Wang
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- College of Medicine, Orthopaedic Research Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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Chhabra AK, Sune R, Reche A. Oral Submucous Fibrosis: A Review of the Current Concepts in Management. Cureus 2023; 15:e47259. [PMID: 38022118 PMCID: PMC10655494 DOI: 10.7759/cureus.47259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
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.
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Affiliation(s)
- Avneet K Chhabra
- Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ravikant Sune
- Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amit Reche
- Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Ullah H, Maqsood A, Faheem S, Khan ZA, Ganji KK, Bashir O, Ahmed N, Heboyan A. Nasolabial Flap in the Management of Oral Sub Mucous Fibrosis: A Series of Cases. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231191030. [PMID: 37547486 PMCID: PMC10402279 DOI: 10.1177/11795476231191030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023]
Abstract
The objective of this study was to evaluate the outcomes of the nasolabial flap in the management of oral submucous fibrosis (OSMF). The descriptive case series included 75 patients diagnosed with OSMF who underwent surgical intervention under general anesthesia. Preoperative mouth opening measurements were compared with postoperative measurements taken after 2 months. Regarding mouth opening, out of the 75 patients, 4 (5.3%) had unsatisfactory results after treatment, while 22 (29.3%) experienced satisfactory outcomes. The majority of patients, 49 (65.3%), achieved normal mouth opening (more than 30 mm) following the Nasolabial flap procedure. This indicates that the Nasolabial flap yielded favorable results in terms of restoring normal mouth opening and benefiting the patients. Based on the findings of this study, the Nasolabial flap was determined to be a viable surgical option for managing oral submucous fibrosis due to its ease of operation, reliable flap vascularity, and low post-operative complication rate. The only drawback identified was the presence of a surgical scar, which can be addressed through secondary correction procedures.
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Affiliation(s)
- Hidayat Ullah
- District Specialist Dentistry, DHQ Hospital Lower dir Timergrah, Mansehra, Pakistan
| | - Afsheen Maqsood
- Department of Oral Pathology, Bahria University Dental College, Karachi, Pakistan
| | - Samra Faheem
- Department of Oral Pathology, Bahria University Dental College, Karachi, Pakistan
| | - Zafar Ali Khan
- Department of Oral Maxillofacial Radiology & Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka, Al-Jouf, Kingdom of Saudi Arabia
| | - Kiran Kumar Ganji
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Al-Jouf, Kingdom of Saudi Arabia
| | - Omer Bashir
- Department of Oral and Maxillofacial Surgery, Rehman College of Dentistry, Peshawar, Pakistan
| | - Naseer Ahmed
- Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
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Kaur A, Kulkarni GR, Chaudhry K. Re: Re: Transdermal fentanyl patch versus standard analgesia in postoperative oral submucous fibrosis patients: A triple blinded, randomised control trial. Br J Oral Maxillofac Surg 2023; 61:191-192. [PMID: 36690501 DOI: 10.1016/j.bjoms.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Amanjot Kaur
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India.
| | - Gayatri R Kulkarni
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India.
| | - Kirti Chaudhry
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India.
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Gupta S, Subbappa A, Singh S, Sharma P, Singh A, Kumar A, Sandhu H, Nadar K. Challenges in the classification of oral submucous fibrosis and proposing a new classification based on systematic review of literature. J Int Soc Prev Community Dent 2023; 13:17-31. [PMID: 37153926 PMCID: PMC10155876 DOI: 10.4103/jispcd.jispcd_207_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/06/2023] [Accepted: 01/25/2023] [Indexed: 03/11/2023] Open
Abstract
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.
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Abbasi AI, Shetty SS, de Arruda JAA. Autotransplantation of teeth: An alternative for patients with malignant transformation of oral submucous fibrosis. Oral Oncol 2021; 124:105644. [PMID: 34861564 DOI: 10.1016/j.oraloncology.2021.105644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Aiman Itrat Abbasi
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Constituent of MAHE, Manipal, India.
| | - Sameep S Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Constituent of MAHE, Manipal, India.
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Memon AB, Rahman AAU, Channar KA, Zafar MS, Kumar N. Assessing the Quality of Life of Oral Submucous Fibrosis Patients: A Cross-Sectional Study Using the WHOQOL-BREF Tool. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189498. [PMID: 34574424 PMCID: PMC8464822 DOI: 10.3390/ijerph18189498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
- Abdul Bari Memon
- Medical Research Centre, Liaquat University of Medical and Health Sciences, Jamshoro 76090, Pakistan; (A.B.M.); (A.A.U.R.)
| | - Aneela Atta Ur Rahman
- Medical Research Centre, Liaquat University of Medical and Health Sciences, Jamshoro 76090, Pakistan; (A.B.M.); (A.A.U.R.)
- Faculty of Community Medicine and Public Health Sciences, Shaheed Mohtarama Benazir Bhutto Medical University, Larkana 77150, Pakistan
| | - Kashif Ali Channar
- Department of Oral and Maxillofacial Surgery, Institute of Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro 76090, Pakistan;
| | - Muhammad Sohail Zafar
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah, Al Munawwarah 41311, Saudi Arabia;
- Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad 44000, Pakistan
| | - Naresh Kumar
- Medical Research Centre, Liaquat University of Medical and Health Sciences, Jamshoro 76090, Pakistan; (A.B.M.); (A.A.U.R.)
- Ishrat Ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi 74200, Pakistan
- Correspondence: ; Tel.: +92-333-2818500
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Ramadoss R, Krishnan R, Vasanthi V, Bose D, Vijayalakshmi R, Padmanabhan R, Subramanian B. New Insights for Consummate Diagnosis and Management of Oral Submucous Fibrosis Using Reactive and Reparative Fibrotic Parameter Derived Algorithm. J Pharm Bioallied Sci 2021; 13:S323-S332. [PMID: 34447103 PMCID: PMC8375801 DOI: 10.4103/jpbs.jpbs_822_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 11/04/2022] Open
Abstract
Objective Reproducibility of qualitative changes in histopathological diagnosis involving narrow variation is often challenging. This study aims to characterize the histological fibrotic events in detail so as to derive an in-depth multiparametric algorithm with individually quantified histological parameters for effective monitoring of the. disease process in oral submucous fibrosis and for potential therapeutic targets for early intervention. Methods Formalin fixed paraffin embedded (FFPE) blocks of oral submucous fibrosis (OSMF), were taken and sections were stained with Hematoxylin & Eosin stain and Masson Trichrome stain. Photomicrographs were assessed for various morphometric parameters with Image J software version 1.8. Linear Regression was used to model the relationship using Inflammatory Cell Count, Extent of Inflammation collagen stained area, Epithelial thickness integrated density of collagen, MVPA, Area, Perimeter, were taken as variables. Result Inflammatory cell count and the extent of inflammation also decreased with increasing grades of OSMF. Collagen proportionate area, integrated collagen density and epithelial thickness were compared among different grades of OSMF. Grade IV OSMF had greatest mean collagen proportionate area , highest integrated collagen density and lowest epithelial thickness when compared to other grades of OSMF. Linear regression model revealed smaller variation between Grade I to Grade II. Whereas Grade II to Grade IV exhibited larger variation suggestive of increased growth rate and all the coefficients were found to lie within 95% confidence limits. Conclusion Diagnostic algorithm with multiparametric regression model were derived and combinatorial therapeutic approaches have been suggested for more effective management of oral submucous fibrosis.
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Affiliation(s)
- Ramya Ramadoss
- Department of Oral Pathology and Microbiology, SRM Dental College, SRMIST, Chennai, Tamil Nadu, India
| | - Rajkumar Krishnan
- Department of Oral Pathology and Microbiology, SRM Dental College, SRMIST, Chennai, Tamil Nadu, India
| | - V Vasanthi
- Department of Oral Pathology and Microbiology, SRM Dental College, SRMIST, Chennai, Tamil Nadu, India
| | - Divya Bose
- Department of Oral Pathology and Microbiology, SRM Dental College, SRMIST, Chennai, Tamil Nadu, India
| | - R Vijayalakshmi
- Department of Mathematics, SRM Institute of Science and Technology, Ramapuram, Chennai, Tamil Nadu, India
| | - Rajashree Padmanabhan
- CAS Crystallography and BioPhysics, University of Madras, Chennai, Tamil Nadu, India
| | - Balakumar Subramanian
- National Centre for Nanoscience and Nanotechnology, University of Madras, Guindy Campus, Chennai, Tamil Nadu, India
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Wang L, Tang Z. Immunopathogenesis of oral submucous fibrosis by chewing the areca nut. J Leukoc Biol 2021; 111:469-476. [PMID: 34124802 DOI: 10.1002/jlb.3mr0521-763rr] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Oral submucous fibrosis (OSF) is a chronic, progressive, scarring, and premalignant disease of the oral mucosa. Its pathogenic factors are complex and include chewing areca nuts or other spicy food items, nutrition, and genetic and immune factors. Recently, immune factors have become the focus of medical research, with increased attention being paid to the role of immune regulation in diseases, particularly tumors. OSF is accompanied by obvious changes in the immune microenvironment. The aim of this review is to discuss the potential relationship of OSF and areca nuts genetic with the immune system, including lymphocytes, macrophage, Langerhans cell, mast cell, and substances released by activated immune cells, to determine the pathogenesis and treatment of OSF from an immunologic viewpoint.
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Affiliation(s)
- Liping Wang
- Xiangya Stomatological Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Zhangui Tang
- Xiangya Stomatological Hospital, Central South University, Changsha, Hunan, P.R. China
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Efficacy of collagen-silicone bilayer membrane in the management of oral submucous fibrosis: a prospective case series. Oral Maxillofac Surg 2021; 26:73-79. [PMID: 33866454 DOI: 10.1007/s10006-021-00962-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Oral submucous fibrosis is a scourge of Southeastern Asia since a long time resulting in significant health and social problems. Mainstay of the treatment is concentrated on attempts to improve mouth opening and relieve the symptoms by medicinal or surgical means. In moderate to severe cases, release of fibrous bands is advocated followed by placement of graft. The present study was conducted to evaluate the use of collagen-silicone bilayer membrane as a mucosal substitute in its management. METHODOLOGY Study consisted of 12 clinically and histologically proven cases of OSMF. After the incision and release of fibrous bands, a collagen membrane was placed and secured over the raw area by placement of a silicone sheet of adequate thickness. Parameters were assessed pre-operatively, intra-operatively, and post-operatively at 1 week, 1 month, and 3 months. The data was recorded and statistical analysis was done. RESULTS Pre-operatively, the mean values of inter-incisal opening, cheek flexibility, and width of oral commissure were 16.92, 24.58, and 53.17 mm respectively whereas at 3 months post-operatively, it was 27.67, 26.58, and 55.00 mm, which was statistically significant. No incidence of infection was noted. CONCLUSION The study concludes that the use of collagen membrane along with silicone sheet can be an alternative to other graft materials in context of reduced donor site morbidity as well as significant increase in inter-incisal opening. However, study with more sample size is needed to assess the long-term efficiency and surgical outcome of this material.
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Research Achievements of Oral Submucous Fibrosis: Progress and Prospect. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6631856. [PMID: 33791368 PMCID: PMC7997751 DOI: 10.1155/2021/6631856] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022]
Abstract
Oral submucous fibrosis (OSMF) is a kind of chronic, insidious disease, and it is categorized into potentially malignant disorders (PMD), which poses a global and regional problem to public health. It is considered to be a multifactorial disease, such as due to areca nut chewing, trace element disorders, and genetic susceptibility. However, there is still no unanimous conclusion on its pathogenesis, diagnosis, and treatment strategies. Hence, this article provides a comprehensive review and prospect of OSMF research, providing scholars and clinicians with a better perspective and new ideas for the research and treatment of OSMF.
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M. Mounika S, Manne R, Kannan N, Beeraka S, Sarath P, Saikiran K. Colchicine as a therapeutic drug in the management of oral submucous fibrosis - A randomized clinical study. JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY 2021. [DOI: 10.4103/jiaomr.jiaomr_108_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pandey A, Sharma NK, Dhiman NK, Jaiswara C, Tiwari P, Singh AK, Verma V, Singh S. Comparative evaluation of buccal pad of fat with and without bovine collagen membrane in the management of oral submucous fibrosis: A prospective clinical study. Natl J Maxillofac Surg 2020; 11:57-63. [PMID: 33041578 PMCID: PMC7518498 DOI: 10.4103/njms.njms_70_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/23/2019] [Accepted: 02/26/2020] [Indexed: 11/04/2022] Open
Abstract
Background Oral submucous fibrosis (OSMF) is a chronic, debilitating disease characterized by juxtaepithelial fibrosis. The present study evaluates the efficacy of buccal fat pad (BFP) and bovine collagen membrane as reconstruction options. Materials and Methods The sample size includes 22 patients between 20 and 60 years, randomly distributed in two groups: Group I in which BFP was used and Group II where BFP with bovine collagen membrane was used after surgical resection of fibrotic bands. The clinical evaluation on postoperative 1st, 3rd, and 5th days and 1st, 2nd, 3rd, 4th, 12th, and 24th weeks subsequently. Results The mean age in Group I was 27.17 ± 3.157 years and Group II was 37.90 ± 6.657 years. The mean preoperative mouth opening was 9.75 ± 6.717 and 8.90 ± 3.784 mm in Groups I and II, respectively. The mean duration of presenting illness in Group I was 9.75 ± 2.598 years and in Group II was 8.80 ± 1.989 years. There was no significant difference observed between Groups I and II in relation to reduced mouth opening and duration of symptoms (P > 0.05) except for age. No significant difference was observed between both the groups in relation to preoperative pain, burning sensation, cheek stiffness, mucosal suppleness, postoperative infection, and postoperative pain at days 1 and 5 and 1st week. There was a significant difference observed in postoperative pain among both the groups on the 3rd day and 2nd week. Conclusion In the present study, both the groups have proved to give better results, as BFP in the form of interposition material showed rapid epithelization and minimum wound contracture.
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Affiliation(s)
- Arun Pandey
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Naresh Kumar Sharma
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Neeraj Kumar Dhiman
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Chandresh Jaiswara
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Preeti Tiwari
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Akhilesh Kumar Singh
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vishal Verma
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shankar Singh
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Saalim M, Sansare K, Ali IK, Sonawane H, Singla N, Vanga K, Kapoor R, Karjodkar FR. Efficacy of betamethasone, hyaluronidase and its combination on mouth opening, burning sensation and QOL in patients with OSF. J Oral Biol Craniofac Res 2020; 10:492-497. [DOI: 10.1016/j.jobcr.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/22/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022] Open
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Gupta SR, Sharma A, Gupta N, Mani K. Single nucleotide polymorphisms and serologic levels of hypoxia-inducible factor1 α and vascular endothelial growth factor are associated with increased risk of oral submucous fibrosis in gutka users among a North Indian population. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:557-564. [PMID: 32981864 DOI: 10.1016/j.oooo.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/04/2020] [Accepted: 08/02/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Tissue hypoxia in oral submucous fibrosis (OSMF) induces hypoxia-inducible factor (HIF)-1 α and vascular endothelial growth factor (VEGF), causing angiogenesis. Single nucleotide polymorphisms (SNPs) may predict susceptibility to environmental carcinogens and to development of OSMF, as well as its severity and malignant transformation. This study aimed to determine the serologic levels and frequencies of SNPs of HIF-1 α and VEGF in OSMF. STUDY DESIGN In this prospective pilot study, the frequencies of SNPs of HIF-1 α (C1772 T, G1790 A); VEGF-A 936 C/T; and VEGF-C (rs7664413, rs1485766) in patients with OSMF or oral squamous cell carcinoma (OSCC) and in healthy controls were determined by using polymerase chain reaction (PCR) (n = 100 each), and serologic levels were determined by using enzyme-linked immunosorbent assay (ELISA (n = 50 each), in a North Indian population. RESULTS Heterozygous forms of HIF-1 α C1772 T (CT: odds ratio [OR] 5.0; 95% confidence interval [CI] 2.24-11.16; P < .001); HIF-1 α G1790 A (GA: OR 2.8; 95% CI 1.62-5.16; P < .001); and VEGF-C rs1485766 (AC: OR 2.18; 95% CI 1.19-3.99; P < .05) were associated with OSMF. The mean serologic levels of HIF-1 α, VEGF-A, and VEGF-C were significantly raised in patients with OSMF compared with healthy controls (P < .001). CONCLUSIONS The SNPs of HIF-1 α, VEGF-A, and VEGF-C and their serologic levels can act as prognostic biomarkers and aid in the development of specialized anti-HIF-1 α or anti-VEGF drugs for the management and prevention of OSCC in patients with OSMF.
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Affiliation(s)
- Shalini R Gupta
- Associate Professor, Oral Medicine & Radiology, Centre for Dental Education Research, All India Institute of Medical Sciences, New Delhi, India.
| | - Alpana Sharma
- Professor, Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Nidhi Gupta
- Research Associate, Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Kalaivani Mani
- Scientist III, Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Kumar LB, Mathew P, Madhavan N, Siddique S, Kshetrimayum N, Iyer K. Evaluation of mast cells and burning sensation in various stages of Oral Submucous Fibrosis. J Oral Biol Craniofac Res 2020; 10:430-434. [PMID: 32793410 DOI: 10.1016/j.jobcr.2020.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/02/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022] Open
Abstract
Background Oral Submucous Fibrosis (OSMF) is a potentially malignant disorder and burning sensation is the initial complaint among these patients. Scientific literature has established that mast cells play a major role in various inflammatory disorders. However, OSMF being an inflammatory disorder, the role of mast cells is yet to be established. Hence the aim of this study was to evaluate mast cells and burning sensation in various stages of Oral Submucous Fibrosis. Methods The study population comprised of forty subjects, thirty were clinically confirmed cases of OSMF and ten healthy individuals served as control. A complete history and clinical examination followed by an incisional biopsy was performed. Samples obtained were subjected to routine histopathological examination and mast cells evaluation. Results Mean number of total mast cells in Stage I, II and III OSMF were 8.5 ± 0.7, 11.31 ± 8.8 and 24.7 ± 21.2 respectively. There was a significant difference in total mast cell count between cases and controls. Degranulated mast cells was a significant predictor (p = 0.028), indicating role in clinical staging of OSMF. Degranulated mast cells had a significant role and was a positive predictor (B = 0.763, OR 2.145[95%CI 1.055-4.630]) at moderate levels of burning sensation. A significant difference (p = 0.029) in burning sensation across histopathological grades was also observed in the study. Conclusion Degranulated mast cells were found to have a significant influence in mild to moderate levels of burning sensation among OSMF patients. Role of degranulated mast cells were also found to be significant in various clinical stages of OSMF.
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Affiliation(s)
- Laliytha Bijai Kumar
- Rajah Muthiah Dental College and Hospital, Annamalai Nagar, Chidambaram, 608002, India
| | - Philips Mathew
- Rajah Muthiah Dental College and Hospital, Annamalai Nagar, Chidambaram, 608002, India
| | - Nirmal Madhavan
- Rajah Muthiah Dental College and Hospital, Annamalai Nagar, Chidambaram, 608002, India
| | - Sabin Siddique
- Department of Public Health Dentistry, MES Dental College and Hospital, Malappuram, Perinthalamanna, Kerala, 679321, India
| | - Nandita Kshetrimayum
- Department of Public Health Dentistry, Regional Institute of Medical Sciences, Lamphelpat, Imphal West, Manipur, 795004, India
| | - Kiran Iyer
- Department of Public Health Dentistry, Ragas Dental College and Hospital, 2/102 SH49, Uthandi, Chennai, 600119, India
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Shetty RK, Pradhan S, Kannan R, Doctor A, Surnare K, Jondhale M, Patil D, Shetty N. Clinical Profile and Quality of Life Assessment of Oral Cancer Patients Following Nasolabial Flap Reconstruction Surgery. Indian J Otolaryngol Head Neck Surg 2020; 72:200-207. [PMID: 32551278 DOI: 10.1007/s12070-019-01760-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/02/2019] [Indexed: 11/27/2022] Open
Abstract
To evaluate the quality of life (QOL) of oral cancer patients who had undergone surgical reconstruction with nasolabial flap. A cross-sectional study was conducted over a period of 1 year at a tertiary care hospital and 128 subjects were included. The subjective assessment of quality of life using The University of Washington QOL Questionnaire including physical, socio-emotional, composite and overall QOL, Objective assessment of functional mouth opening and Nasolabial crease scar assessment using Vancouver scar scale was done. Majority of the subjects, 98.4% were male. Maximum cases were involving the lower gingivobuccal complex and retromolar trigone followed by buccal mucosa. Majority of the tumors were T2, 53.1% followed by T1, 18.8%. Statistically significant (p < 0.05) difference was found in relation to age, tumor size (T1, T2, T3), absence of adjuvant radiation therapy, presence or absence of neck dissection, tumor site; buccal mucosa and lower gingivobuccal complex plus retromolar trigone and intact bone status in physical functional, social-emotional subscores, composite score and overall QOL assessment. Improved mouth opening postoperatively was statistically significant (p < 0.05) in T1 and T2 lesions of buccal mucosa and lower gingivobuccal complex plus retromolar trigone who did not receive radiation and with intact bone status. Majority of the cases, 36.7% had a nasolabial crease scar score 2. Nasolabial flap is a viable option in the reconstruction of small and medium sized oral defects with good quality of life (QOL) outcome and objective outcome as depicted by significantly improved mouth opening. The aesthetic outcome of nasolabial crease scar is good in our study.
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Affiliation(s)
- Rohan Kishor Shetty
- Fellow Head and Neck Oncology, Department of Surgical Oncology, Prince Aly Khan Hospital, Mazgaon, Mumbai India
| | - Sultan Pradhan
- Department of Surgical Oncology, Prince Aly Khan Hospital, Mazgaon, Mumbai India
| | - Rajan Kannan
- Department of Surgical Oncology, Prince Aly Khan Hospital, Mazgaon, Mumbai India
| | - Azmat Doctor
- Department of Surgical Oncology, Prince Aly Khan Hospital, Mazgaon, Mumbai India
| | - Kailash Surnare
- Department of Surgical Oncology, Prince Aly Khan Hospital, Mazgaon, Mumbai India
| | - Manoj Jondhale
- Fellow Head and Neck Oncology, Department of Surgical Oncology, Prince Aly Khan Hospital, Mazgaon, Mumbai India
| | - Devashri Patil
- Fellow Head and Neck Oncology, Department of Surgical Oncology, Prince Aly Khan Hospital, Mazgaon, Mumbai India
| | - Neeraj Shetty
- Fellow Head and Neck Oncology, Department of Surgical Oncology, Prince Aly Khan Hospital, Mazgaon, Mumbai India
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27
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Kariya P, Khobragade V, Sura S, Singh S. No age predilection for a disease like OSMF. A case report of 5-year-old child. J Oral Biol Craniofac Res 2020; 10:153-157. [PMID: 32346505 DOI: 10.1016/j.jobcr.2020.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/18/2020] [Accepted: 03/31/2020] [Indexed: 12/25/2022] Open
Abstract
Background Oral Sub Mucous Fibrosis (OSMF) is a clinical entity, well known since the time of Sushruta as 'Vidari'. OSMF is a chronic subtle disease that is associated with significant functional morbidity and an increased risk for malignancy. Generally, OSMF is considered as an adult disease, but recently Indian suburb area has reported incidence of 0.2-1.2 percent in pediatric age group as well. The pathogenesis of the disease is not well established, but is believed to be multifactorial. Areca nut chewing is considered as the major etiology amongst all. Children indulge in habit of chewing areca nuts due to its easy availability of different forms of multicolored attractive areca nut pouches in markets. Other factors involved in the consumption of Areca nut are levels of awareness, household environment, peer pressure, low cost, etc. Case presentation A 5-year-old boy reported with the complaint of restricted mouth opening since 3-4 months. He had habit of chewing betel nut, a minimum of 2-3 sachets daily since one and a half years. He also complained of intolerance to spicy food. The oral mucosa was pale, opaque, blanched with a reduced mouth opening of interincisal width being 06 mm.Palate was fibrotic with shrunken uvula. Conclusion This Case of OSMF in a 5-year-old boy is reported to be the first incidence of OSMF in a child with least interincisal opening of 06 mm.
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Affiliation(s)
- Pratik Kariya
- Dept of Pediatric and Preventive Dentistry, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | | | - Shraddha Sura
- Dept of Pediatric and Preventive Dentistry, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Sweta Singh
- Dept of Public Health Dentistry, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
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More CB, Rao NR, Hegde R, Brahmbhatt RM, Shrestha A, Kumar G. Oral submucous fibrosis in children and adolescents: Analysis of 36 cases. J Indian Soc Pedod Prev Dent 2020; 38:190-199. [PMID: 32611867 DOI: 10.4103/jisppd.jisppd_173_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Oral submucous fibrosis (OSMF) is a chronic debilitating irreversible oral potentially malignant disorder affecting any part of the oral cavity. It is usually seen in adults but rarely noticed in children and adolescents. Since the paucity of the cases, there exists a gap of knowledge in the causative habits, root reasons of habit initiation, age of habit initiation, and the common clinical representation of this disorder. The current article aims to bridge this gap by presenting unusual 36 cases of children and adolescents reported at the tertiary care hospital of Vadodara, Gujarat, India, with specific areca nut chewing habit and distinct features of OSMF. Furthermore, the present case series is the first of its kind in the scientific literature with a high number of OSMF cases in children and adolescents.
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Affiliation(s)
- Chandramani Bhagwan More
- Department of Oral Medicine and Maxillofacial Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed University, Vadodara, Gujarat, India
| | - Naman R Rao
- Harvard Medical school, Harvard University; Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rahul Hegde
- Director, Ajinkya D Y Patil University, Pune, Maharashtra, India
| | - Rahi M Brahmbhatt
- Department of Neuroscience, University of Illinois at Chicago, Illinois, USA
| | - Ashish Shrestha
- Department of Oral Pathology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Gyanendra Kumar
- Department of Pedodontics and Preventive Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India
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29
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Rao NR, Villa A, More CB, Jayasinghe RD, Kerr AR, Johnson NW. Oral submucous fibrosis: a contemporary narrative review with a proposed inter-professional approach for an early diagnosis and clinical management. J Otolaryngol Head Neck Surg 2020; 49:3. [PMID: 31915073 PMCID: PMC6951010 DOI: 10.1186/s40463-020-0399-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/01/2020] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- Naman R Rao
- Harvard Medical School, Harvard University, Boston, MA, USA.
| | - Alessandro Villa
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
| | - Chandramani B More
- Department of Oral Medicine and Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India
| | - Ruwan D Jayasinghe
- Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Alexander Ross Kerr
- Department of Oral and Maxillofacial Pathology, Radiology and Medicine, NYU College of Dentistry, New York, NY, USA
| | - Newell W Johnson
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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30
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More CB, Rao NR, More S, Johnson NW. Reasons for Initiation of Areca Nut and Related Products in Patients with Oral Submucous Fibrosis within an Endemic Area in Gujarat, India. Subst Use Misuse 2020; 55:1413-1421. [PMID: 32569538 DOI: 10.1080/10826084.2019.1660678] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: While the patterns of consumption of areca nut and its by-products (ANBP) vary across South Asia and the rest of the world, all users share the probable severe outcome of oral submucous fibrosis (OSMF), and this is well reported. The role of psychosocial drivers of habit initiation and addiction is reported less. Objective: To reveal the burden of ANBP abuse, exploring the psychosocial relationship between sex, age at first exposure (AFE), the reason for initiation (RFI) with the type of habit (TOH). Methodology: Data came from the prospective hospital-based study conducted at K.M. Shah Dental College and Hospital covering years 2017 and 2018. Patients with oral lesions were assessed with complete history recording demographics, TOH, AFE, RFI, duration of habit, and clinical diagnosis of any oral and systemic diseases. Patients with a history of scleroderma, facial burns, and oral malignancy were excluded. Results: Of the 13,874 patients, 9.89% reported ANBP. We included 1000 OSMF patients. The mean age of the study cohort was 38.97 ± 14.29 years, with a range of 17-75 years. Males constituted the majority (80.1%). The most common TOH reported was regular use of gutkha (60.1%) followed by mawa (31.4%) with tension and stress (30.3%) being the most common RFI among the cohort. TOH was notably different in relation to AFE. Interestingly, mawa chewing (38.69%) was observed more in females. Importance: This study reveals the burden of ANBP abuse and reports the complex psychosocial relationships between sex, AFE, and RFI with TOH in OSMF patients in this high incidence population.
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Affiliation(s)
- Chandramani B More
- Department of Oral Medicine and Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth University, Piparia, Vadodara, Gujarat, India
| | - Naman Rajeshkumar Rao
- Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sucheta More
- Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Newell W Johnson
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia.,Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
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Mukul SK, Kumar S, Pandey S, Mokhtar EA, Kumar A. Ultrasound elastography as a potential diagnostic aid in oral submucous fibrosis. Natl J Maxillofac Surg 2019; 10:129-133. [PMID: 31798245 PMCID: PMC6883875 DOI: 10.4103/njms.njms_20_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/19/2019] [Accepted: 06/11/2019] [Indexed: 11/04/2022] Open
Abstract
Background Oral submucous fibrosis (OSMF) is a well-recognized "potentially malignant" disorder. It mostly affects the productive population of young adults and adolescents. The diagnosis of oral submucous fibrosis is primarily clinical and subjective. The only objective diagnostic method for OSMF is tissue biopsy. This study was conducted to find the potential use of ultrasound elastography to objectively quantify the clinical presentation in accordance with severity of the clinical condition in OSMF. Materials and Methods The study sample consisted of 27 clinically diagnosed and staged participants with OSMF. Transcutaneous ultrasonography was done by a single operator on GE Logiq E9 machine with a 6-15 MHz linear matrix probe. Color-coded scheme was used to qualitatively grade the eight different zones of oral mucosa with the use of stress-strain elastography. The grades ranged from 0 to 5, where 0 represented artifacts and color range from red to blue corresponded to varying degree of increasing tissue stiffness. Clinical stage 1, 2, and 3 corresponded to mouth opening of >30 mm, 20-30 mm, and <20 mm, respectively. The summative elastography score range as follows: 8-10, 11-14, and ≥15 represented the respective degree of tissue stiffness from soft, mild stiff to severe stiff. Results The results obtained by Pearson's correlation between the elastographic grading and clinical grading came out to be 0.007, and it was highly significant. The sensitivity and specificity of the diagnostic method were 90.9% and 20%, respectively. Conclusion The advantages of ultrasound elastography as a diagnostic tool over the subjective clinical method of diagnosis and staging of OSMF looks promising. Further studies should be conducted with a suitable specific transducer probe and with quantitative diagnostic elastography method.
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Affiliation(s)
| | - Subhash Kumar
- Department of Radiodiagnosis, AIIMS, Patna, Bihar, India
| | | | | | - Amit Kumar
- Department of Dentistry, AIIMS, Patna, Bihar, India
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32
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Iqbal A, Tamgadge S, Tamgadge A, Pereira T, Kumar S, Acharya S, Jadhav A. Evaluation of Ki-67 Expression in Oral Submucous Fibrosis and Its Correlation with Clinical and Histopathological Features. J Microsc Ultrastruct 2019; 8:20-24. [PMID: 32166060 PMCID: PMC7045623 DOI: 10.4103/jmau.jmau_28_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 09/10/2019] [Indexed: 11/10/2022] Open
Abstract
Objectives: Oral submucous fibrosis (OSMF) is a potentially malignant disorder. Although it shows atrophic epithelium, it has a high proliferative capacity. Therefore, this study correlates the Ki-67. (The name “ki” is derived from the city of origin [Kiel, Germany] expression with functional grading and epithelial thickness in OSMF). Methods: The study group comprised of thirty patients of OSMF, divided randomly into Group A, Group B, Group C, and Group D as per mouth opening (functional staging). Five participants without OSMF formed the negative control group. The positive control group comprised of five patients of diagnosed cases of squamous cell carcinoma. All the sections of biopsy were subjected for hematoxylin and eosin and immunohistochemistry staining and observed for expression of Ki-67. Epithelial thickness was evaluated using image analysis software of Leica research microscope. Images were analyzed by three independent observers who were blindfolded. All the findings were tabulated and statistically analyzed. Results: In the present study, as the functional staging increased, the Ki-67 expression also increased. Ki-67 expression was highest in severe functional staging/severely decreased mouth opening (100.78) and is least in mild functional staging/mild decreased mouth opening (10.39). However, there was no significant correlation between epithelial thickness and functional staging/mouth opening (P > 0.05). Conclusion: A decrease in functional staging (mouth opening) showed a greater expression of Ki-67, and there was no significant correlation between functional staging and epithelial thickness.
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Affiliation(s)
- Asif Iqbal
- Department of Oral and Maxillofacial Pathology and Microbiology, D. Y. Patil Deemed to be University School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Sandhya Tamgadge
- Department of Oral and Maxillofacial Pathology and Microbiology, D. Y. Patil Deemed to be University School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Avinash Tamgadge
- Department of Oral and Maxillofacial Pathology and Microbiology, D. Y. Patil Deemed to be University School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Treville Pereira
- Department of Oral and Maxillofacial Pathology and Microbiology, D. Y. Patil Deemed to be University School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Sourab Kumar
- Department of Oral and Maxillofacial Pathology and Microbiology, D. Y. Patil Deemed to be University School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Siddarth Acharya
- Department of Public Health Dentistry, D. Y. Patil University School of Dentistry, Nerul, Navi Mumbai, Maharashtra, India
| | - Abhishek Jadhav
- Department of Oral and Maxillofacial Pathology and Microbiology, D. Y. Patil Deemed to be University School of Dentistry, Navi Mumbai, Maharashtra, India
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33
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More CB, Rao NR. Proposed clinical definition for oral submucous fibrosis. J Oral Biol Craniofac Res 2019; 9:311-314. [PMID: 31334003 DOI: 10.1016/j.jobcr.2019.06.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022] Open
Abstract
Oral Submucous Fibrosis (OSMF) is an insidious, chronic, complex, crippling, debilitating, irreversible, progressive, scarring, potentially malignant and collagen metabolic disorder, induced by a known carcinogen areca nut; wherein the oral mucosa, and occasionally the pharynx and esophagus is subjected to various pathological changes with significant clinical manifestations at different stages of progression, leading to functional morbidity; and with a risk of malignant transformation in the overlying epithelium. Although the condition is mainly diagnosed based on classic clinical manifestations, the commonly used existing definition for oral submucous fibrosis is primarily based on histological features. The authors have conducted extensive clinical research studies on OSMF and intends to propose a new clinical definition as 'a debilitating, progressive, irreversible collagen metabolic disorder induced by chronic chewing of areca nut and its commercial preparations; affecting the oral mucosa and occasionally the pharynx and esophagus; leading to mucosal stiffness and functional morbidity; and has a potential risk of malignant transformation.' Thus, a new clinical definition is put forward so as to assist the academicians, researchers and clinicians in terming and grouping this disease according to its clinical and biological behaviour for its subsequent management.
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Affiliation(s)
- Chandramani B More
- Department of Oral Medicine and Maxillofacial Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth University, Piparia, Vadodara, Gujarat State, India
| | - Naman R Rao
- Harvard Medical School, Boston, MA, USA.,Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA
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Use of Aloe Vera and Turmeric Paste as a Supplementary Medicine in Oral Submucosal Fibrosis: A Pilot Study. Indian J Otolaryngol Head Neck Surg 2019; 71:883-886. [PMID: 31742088 DOI: 10.1007/s12070-019-01599-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/17/2019] [Indexed: 11/27/2022] Open
Abstract
Oral submucosal fibrosis is the major health issue affecting 2.5 million Indian population under the age of 40 years. All the available treatments give only symptomatic relief which is short lived.The incidence of Oral submucosal fibrosis still rising alarmingly and there is a dire need to search for an effective and safe remedy because of lack of present therapies to either provide a complete cure or treating the patients at the cost of adverse effects. A total of 140 clinically diagnosed patients with Oral submucosal fibrosis (diagnosed on the basis of reduction in interincisal distance on maximum mouth opening and palpable fibrous bands involving oral mucosa) within the age range of 18-50 years with decreased interincisal opening were selected (time period 1.5 year). These patients were given Inj. Triamcinolone (40 mg) and Inj Hyaluronidase every 21 days. Pt was divided in 2 groups (each containing both males and females) those receiving Triamcinolone ointment alone BD (control) and those receiving Triamcinolone ointment BD along with turmeric & aloe vera paste combination (test). A statistically significant improvement was seen in both burning sensation and mouth opening in both males and females. The result of the study shows that the synergistic action of these herbs results in higher efficacy and highly potent Oral submucosal fibrosis treatment.
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35
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Arakeri G, Aljabab A, Maddur N, Hunasgi S, Patil S, Hale B, Merkx MAW, Gomes CC, Gomez RS, Brennan PA. A potential new oral mapping (OM) method in the clinical evaluation and documentation of oral submucous fibrosis-A prospective clinical crossover study. J Oral Pathol Med 2019; 48:315-320. [PMID: 30604897 DOI: 10.1111/jop.12821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite much research, there is a lack of a definite protocol or method for documenting oral submucous fibrosis (OSMF) site presentation. In this study, we propose a new potential oral mapping (OM) method and evaluated its use in recording OSMF-affected mucosal sites. METHODS Fifty OSMF patients were evaluated by 15 primary care dental practitioners using both, a conventional subjective recording method and a new OM method, to document the degree of involvement of affected oral mucosa with a crossover study design. Mann-Whitney test (non-parametric test) was used to make comparison between groups to determine any significant differences between the two identification methods. Wilcoxon tests were used to evaluate any significant differences in the difficulty in identification of two methods. RESULTS There was a low agreement between the two methods used to detect OSMF in affected mucosal surfaces (P-value < 0.0001). More lesions were identified using the proposed OM method, and less discrepancy was found among dental practitioners. A difference in difficulty of OSMF documentation was found (Wilcoxon z = 3.615, P-value < 0.001), with the proposed OM method found to be easier. CONCLUSION The proposed OM method appears to be useful for documentation, can easily be adapted in clinical practice, and effectively administered in clinical research. Additionally, it could be a useful tool to helping to maintain an OSMF database.
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Affiliation(s)
- Gururaj Arakeri
- Department of Oral and Maxillofacial Surgery, King Fahad Medical City, Riyadh, Saudi Arabia.,Department of Oral and Maxillofacial Surgery, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - Abdulsalam Aljabab
- Department of Oral and Maxillofacial Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nagaraj Maddur
- Department of Oral and Maxillofacial Surgery, ESIC Dental College and Hospital, Kalaburgi, Karnataka, India
| | - Santosh Hunasgi
- Department of Oral and Maxillofacial Pathology, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - Shekar Patil
- Department of Medical Oncology, HCG Cancer Hospital, Bangalore, Karnataka, India
| | - Beverley Hale
- Institute of Sport, University of Chichester, Chichester, UK
| | - Matthias A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Carolina C Gomes
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo S Gomez
- Department of Oral Surgery and Pathology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Peter A Brennan
- Department of Oral & Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
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36
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Johny J, Bhagvandas SC, Mohan SP, Punathil S, Moyin S, Bhaskaran MK. Comparison of Efficacy of Lycopene and Lycopene-Hyaluronidase Combination in the Treatment of Oral Submucous Fibrosis. J Pharm Bioallied Sci 2019; 11:S260-S264. [PMID: 31198349 PMCID: PMC6555355 DOI: 10.4103/jpbs.jpbs_6_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Oral submucous fibrosis (OSMF) is a chronic progressively scarring disease of the oral cavity. Lycopene is a powerful antioxidant obtained from tomatoes and has the highest singlet oxygen quenching capacity and a high capacity of quenching other free radicals in vitro among dietary carotenoids. Hyaluronidase is a substance prepared from the testes and semen of mammals that modifies the permeability of connective tissue through the hydrolysis of hyaluronic acid. Objective: To evaluate the efficacy of lycopene and lycopene−hyaluronidase combination, and to compare the efficacy of lycopene and lycopene−hyaluronidase combination in the treatment of OSMF. Study Design: The study consisted of 45 patients with OSMF divided into three equal groups. Patients in Group A were given Lycored 16 mg daily in two equally divided doses for 3 months. Patients in Group B were given LycoRed along with hyaluronidase intralesional injection of 1500 IU twice weekly for 3 months. Patients in Group C were given placebo capsules. Patients were evaluated after 3 months. The following parameters were recorded: mouth opening, visual inspection, palpatory findings, and burning sensation. Results: There was statistically significant change in mouth opening and burning sensation for lycopene and lycopene–hyaluronidase combination than in the placebo group in the treatment of OSMF, but the lycopene–hyaluronidase combination did not show any statistically significant change when compared with lycopene alone. Conclusion: Lycopene appears to be a very promising antioxidant in the management of oral submucous fibrosis, both in clinical and symptomatic improvement.
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Affiliation(s)
- Joseph Johny
- Department of Oral Medicine and Radiology, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
| | - Sudeep C Bhagvandas
- Department of Public Health Dentistry, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
| | - Sunil Paramel Mohan
- Department of Stem Cell and Regenerative Medicine, Oral and Maxillofacial Pathology, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
| | - Sameer Punathil
- Department of Pediatric and Preventive Dentistry, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
| | - Shabna Moyin
- Department of Conservative Dentistry and Endodontics, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
| | - Manoj K Bhaskaran
- Department of Oral and Maxillofacial Surgery, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
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Tom A, Baghirath V, Krishna B, Ganepalli A, Kumar JV, Mohan SP. Ultrastructural Changes of Collagen in Different Histopathological Grades of Oral Submucous Fibrosis. J Pharm Bioallied Sci 2019; 11:S309-S313. [PMID: 31198360 PMCID: PMC6555333 DOI: 10.4103/jpbs.jpbs_20_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- Arun Tom
- Department of Oral Pathology and Microbiology, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
| | - Venkat Baghirath
- Department of Oral Pathology and Microbiology, Panineeya Mahavidyalaya Institute of Dental Sciences, Hyderabad, Telangana, India
| | - Bhargavi Krishna
- Department of Oral Pathology and Microbiology, Panineeya Mahavidyalaya Institute of Dental Sciences, Hyderabad, Telangana, India
| | - Ashalata Ganepalli
- Department of Oral Pathology and Microbiology, Panineeya Mahavidyalaya Institute of Dental Sciences, Hyderabad, Telangana, India
| | - Jogishetty Vijay Kumar
- Department of Oral Pathology and Microbiology, Panineeya Mahavidyalaya Institute of Dental Sciences, Hyderabad, Telangana, India
| | - Sunil Paramel Mohan
- Department of Oral Pathology and Microbiology, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India.,Department of Stem Cells and Regenerative Medicine, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India, India
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Farah CS, Pollaers K, Frydrych A. Management of Premalignant Disease of the Oral Mucosa. HEAD AND NECK CANCER CLINICS 2019. [DOI: 10.1007/978-981-13-2931-9_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Mishra S, Kritika C, Bajoria AA, Choudhury P, Sahoo SK, Sangamesh NC. Estimation of Salivary and Serum Lactate Dehydrogenase in Oral Submucous Fibrosis. J Int Soc Prev Community Dent 2018; 8:289-295. [PMID: 30123759 PMCID: PMC6071348 DOI: 10.4103/jispcd.jispcd_214_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/28/2018] [Indexed: 12/03/2022] Open
Abstract
AIM AND OBJECTIVES The objective of the present study was to estimate the serum and salivary lactate dehydrogenase (LDH) levels in patients with oral submucous fibrosis (OSMF) and to study the association between serum and salivary LDH levels and mouth opening, frequency of habit, and duration of habit in patients with OSMF. MATERIALS AND METHODS Participants were divided into two groups: Group I - case group diagnosed with OSMF and Group II - the control group. Unstimulated whole saliva was collected from all the participants. The International Federation of Clinical Chemistry method was carried out with the help of LDH (P-L) kit (Crest Biosystems, Goa). Collection of blood sample was done under aseptic precautions and processed for LDH. The data were analyzed using SPSS software 2010 (version 19, IBM, Armonk, NY, USA). Descriptive statistics including mean, range, standard deviation, and percentage were used along with unpaired t-test and Pearson's correlation test. RESULTS All the participants were male and were in the age range of 18-60 years, with a mean age of 28.63 ± 10.39 years. The mean salivary LDH levels in patients with OSMF were 1057.30 ± 640.12 μg/dl and in the control group were 668.25 ± 498.45 μg/dl. The mean serum LDH level in patients with OSMF was 408.35 ± 158.35 μg/dl as compared to the control group was 313.05 ± 82.69 μg/dl. The Pearson's correlation coefficient between serum LDH and frequency of habit, duration of habit, and mouth opening was found to be 0.55, 0.53, and 0.69, respectively. The Pearson's correlation coefficient between salivary LDH and frequency of habit, duration of habit, and mouth opening was found to be 0.33, 0.04, and 0.13, respectively. The Pearson's correlation coefficient between salivary LDH and serum LDH was found to be -0.18. CONCLUSIONS There was a significant increase in the serum and salivary LDH in OSMF patients as compared to controls; the salivary LDH did not seem to correlate with frequency of the habit, duration of the habit, or mouth opening of OSMF patients. However, serum LDH was found to correlate directly with frequency of the habit and mouth opening in OSMF patients. Hence, based on the results of the present study, it can be hypothesized that serum LDH is a better biological marker than salivary LDH in the evaluation of OSMF.
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Affiliation(s)
- Silpiranjan Mishra
- Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - C. Kritika
- Department of Oral Medicine, Diagnosis and Radiology, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Atul Anand Bajoria
- Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Priyadarshini Choudhury
- Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Sanjay Kumar Sahoo
- Department of Periodontics and Implantology, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - N. C. Sangamesh
- Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
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Arakeri G, Thomas D, Aljabab AS, Hunasgi S, Rai KK, Hale B, Fonseca FP, Gomez RS, Rahimi S, Merkx MAW, Brennan PA. TFM classification and staging of oral submucous fibrosis: A new proposal. J Oral Pathol Med 2018; 47:403-409. [DOI: 10.1111/jop.12689] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Gururaj Arakeri
- Department of Oral and Maxillofacial Surgery; King Fahad Medical City; Riyadh Saudi Arabia
- Department of Oral and Maxillofacial Surgery; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Deepak Thomas
- Department of Oral & Maxillofacial Surgery; Queen Alexandra Hospital; Portsmouth UK
| | - Abdulsalam S. Aljabab
- Department of Oral and Maxillofacial Surgery; King Fahad Medical City; Riyadh Saudi Arabia
- Faculty of Dentistry; Department of Dentistry; King Saud University; Riyadh Saudi Arabia
| | - Santosh Hunasgi
- Department of Oral and Maxillofacial Surgery; Navodaya Dental College and Hospital; Raichur Karnataka India
| | - Kirthi Kumar Rai
- Department of Oral and Maxillofacial Surgery; Bapuji Dental College and Hospital; Davangere Karnataka India
| | - Beverley Hale
- Institute of Sport; University of Chichester; Chichester UK
| | - Felipe Paiva Fonseca
- Department of Oral Surgery and Pathology; School of Dentistry; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology; School of Dentistry; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | - Siavash Rahimi
- Pathology Centre-Histopathology; Queen Alexandra Hospital; Portsmouth UK
- School of Pharmacy and Biomedical Science; University of Portsmouth; Portsmouth UK
| | - Matthias A. W. Merkx
- Department of Oral and Maxillofacial Surgery; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Peter A. Brennan
- Department of Oral & Maxillofacial Surgery; Queen Alexandra Hospital; Portsmouth UK
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More CB, Gavli N, Chen Y, Rao NR. A novel clinical protocol for therapeutic intervention in oral submucous fibrosis: An evidence based approach. J Oral Maxillofac Pathol 2018; 22:382-391. [PMID: 30651684 PMCID: PMC6306594 DOI: 10.4103/jomfp.jomfp_223_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Oral submucous fibrosis (OSMF) is a chronic, progressive, debilitating, scarring and crippling disorder of the oral cavity. It is a potentially malignant oral disease which predominantly affects people of South and Southeast Asia, especially Indian subcontinent, where chewing of areca nut and its commercial preparation is rampant. However, due to increase in immigration of people from the Indian subcontinent, the health professionals in many developed countries do come across this disease very often. Since decades, many treatment modalities are suggested and studied using medicines, surgery and physiotherapy, with varying degrees of benefit, but none have been able to cure this disease completely, and hence, it has become a challenging condition. The present article emphasizes on various therapeutic interventions used till date to curb the menace of this disease and the principal author with his vast academic research and clinical experience in treating this disease has proposed the stage-wise treatment regimen for OSMF. The current article is an attempt to compile the available treatment, its current status and future perspectives, so as to assist early intervention of the disease with evidence-based approach. This article will ignite the research minds of dental clinician, oral medicine specialist, otolaryngologist and general physician in treating OSMF.
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Affiliation(s)
- Chandramani Bhagwan More
- Department of Oral Medicine and Maxillofacial Radiology, K.M. Shah Dental College and Hospital, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India
| | - Nishma Gavli
- Department of Oral Medicine and Maxillofacial Radiology, K.M. Shah Dental College and Hospital, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India
| | - Youbai Chen
- Department of Plastic and Reconstructive Surgery, Chinese PLA General Hospital, Beijing, China.,Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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Liu J, Chen F, Wei Z, Qiu M, Li Z, Dan H, Chen Q, Jiang L. Evaluating the efficacy of pentoxifylline in the treatment of oral submucous fibrosis: A meta-analysis. Oral Dis 2017; 24:706-716. [PMID: 28737007 DOI: 10.1111/odi.12715] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 06/30/2017] [Accepted: 07/13/2017] [Indexed: 02/05/2023]
Affiliation(s)
- J Liu
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - F Chen
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - Z Wei
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - M Qiu
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - Z Li
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - H Dan
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - Q Chen
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - L Jiang
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
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Passi D, Bhanot P, Kacker D, Chahal D, Atri M, Panwar Y. Oral submucous fibrosis: Newer proposed classification with critical updates in pathogenesis and management strategies. Natl J Maxillofac Surg 2017; 8:89-94. [PMID: 29386809 PMCID: PMC5773997 DOI: 10.4103/njms.njms_32_17] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Oral submucous fibrosis (OSMF) is an oral precancerous condition characterized by inflammation and progressive fibrosis of the submucosal tissues resulting in marked rigidity and trismus. OSMF still remains a dilemma to the clinicians due to elusive pathogenesis and less well-defined classification systems. Over the years, many classification systems have been documented in medical literature based on clinical, histopathological, or functional aspects. However, none of these classifications have achieved universal acceptance. Each classification has its own merits and demerits. An attempt is made to provide and update the knowledge of classification system of OSMF so that it can assist the clinicians, beneficial in researches and academics in categorizing this potentially malignant disease for early detection, prompt management, and reducing the mortality. Along with this, pathogenesis and management have also been discussed.
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Affiliation(s)
- Deepak Passi
- Department of Oral and Maxillofacial Surgery, Inderprastha Dental College and Hospital, Sahibabad, Ghaziabad, India
| | - Prateek Bhanot
- Department of Anaesthesiology, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Dhruv Kacker
- Department of Prosthodontics, ESIC Dental College and Hospital, Rohini, India
| | - Deepak Chahal
- Department of Oral and Maxillofacial Surgery, ESIC Dental College and Hospital, Rohini, India
| | - Mansi Atri
- Department of Public Health Dentistry, ESIC Dental College and Hospital, Rohini, India
| | - Yoshi Panwar
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Paediatric oral submucous fibrosis - The neglected pre-malignancy of childhood. Int J Pediatr Otorhinolaryngol 2017; 97:55-60. [PMID: 28483252 DOI: 10.1016/j.ijporl.2017.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 03/23/2017] [Accepted: 03/26/2017] [Indexed: 11/27/2022]
Abstract
Oral submucous fibrosis in children is one of the devastating consequences of arecanut addiction in children. Arecanut is the fourth commonest psychoactive agents used worldwide. However, regrettably, unlike other addictions like tobacco and alcohol, its use in children has become socially acceptable atleast in a few countries. Consequently, children as young as two years have been noticed to be addicted to arecanuts. It has been a menace in most Asian countries and with increasing population migration, this has picked up even in the west. In order to understand the social factors leading to arecanut addiction in children and prognostic outcomes of paediatric oral submucous fibrosis, this review has been undertaken.
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More CB, Shah PH, Venkatesh R. Estimation of Serum Protein in Oral Potentially Malignant Disorders and Oral Malignancy - A Cross-Sectional Study. J Clin Diagn Res 2017; 11:ZC17-ZC19. [PMID: 28384973 DOI: 10.7860/jcdr/2017/20815.9254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 11/12/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In carcinogenesis, increased oxidative stress and weakened antioxidant defense produces damage to the macromolecules like proteins. Thus, protein can act as potential biomarker in oral premalignant and malignant lesions. AIM To determine and compare the levels of serum proteins in Oral Submucuous Fibrosis (OSMF), Oral Leukoplakia (OL), Nicotina Stomatitis (NS), Oral Malignancy (OM) and Healthy Controls (HC). MATERIALS AND METHODS A total of 250 participants, were equally divided in five groups i.e., OSMF, OL, NS, OM and HC. Five ml of blood was collected from antecubital vein from each participant. The serum was analyzed for total protein, albumin and globulin levels using EBRA EM 200 semi-quantitive analyzer with the help of diagnostic kits. RESULTS There were total 193 males and 57 females, who were between 18 to 82 years of age, with a mean of 46.32±13.89 years. The serum protein and globulin levels were significantly decreased in OSMF, OL and NS and increased in OM as compared to HC (p<0.001). No statistically significant difference was found in serum albumin levels between the study groups (p>0.05). CONCLUSION Serum proteins can be used as diagnostic and prognostic marker for oral premalignant and malignant lesions.
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Affiliation(s)
- Chandramani B More
- Professor and Head, Department of Oral Medicine and Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth University , Piparia, Vadodara, Gujarat, India
| | - Palak H Shah
- Postgraduate Student, Department of Oral Medicine and Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth University , Piparia, Vadodara, Gujarat, India
| | - Rashmi Venkatesh
- Reader, Department of Oral Medicine and Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth University , Piparia, Vadodara, Gujarat, India
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Effectiveness of Long Term Supervised and Assisted Physiotherapy in Postsurgery Oral Submucous Fibrosis Patients. Case Rep Dent 2016; 2016:6081905. [PMID: 27885345 PMCID: PMC5112303 DOI: 10.1155/2016/6081905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/14/2016] [Indexed: 11/17/2022] Open
Abstract
Oral submucous fibrosis is one of the leading potentially malignant disorders prevailing in India. A number of conservative and surgical treatment options have been suggested for this potentially malignant disorder (Arakeri and Brennan, 2013). While the role of physiotherapy has been highlighted in the conservative management, its importance in postsurgical cases to avoid scar contracture and subsequent relapse has not been given due importance in the literature. The following is a case report of a male patient surgically treated for OSMF (oral submucous fibrosis) and meticulously followed up for recalls and physiotherapy. The constant supervision and motivation for physiotherapy along with the constant assistance helped achieve satisfying results.
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Shah PH, Venkatesh R, More CB, Vassandacoumara V. Comparison of Therapeutic Efficacy of Placental Extract with Dexamethasone and Hyaluronic Acid with Dexamethasone for Oral Submucous Fibrosis - A Retrospective Analysis. J Clin Diagn Res 2016; 10:ZC63-ZC66. [PMID: 27891461 DOI: 10.7860/jcdr/2016/20369.8652] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/17/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Oral Submucous Fibrosis (OSMF) is a potentially malignant disease of the oral cavity associated with betel nut chewing. The management of OSMF has been a subject of controversy and no definitive and widely accepted treatment is currently available for this condition. AIM To retrospectively evaluate the therapeutic efficacy of two treatment regimens (placental extract with dexamethasone and hyaluronic acid with dexamethasone) for the treatment of OSMF. MATERIALS AND METHODS The records of the patients diagnosed with OSMF were obtained from the departmental archives. A total of 25 records were selected and divided into two study groups based on the treatment regimens, as Group A (placental extract + dexamethasone) and Group B (hyaluronidase + dexamethasone). The records were studied for improvement in mouth opening and reduction in burning sensation. Descriptive statistics, paired t test and student's t test were used for statistical analysis. RESULTS In Group A and Group B, the average increase in mouth opening from baseline record to 8th week of treatment was 3.53±1.26mm and 3.65±1.42mm respectively and average decrease in burning sensation, noted by VAS scale, was 5.13±1.13 and 4.90 ±1.29 respectively. The pre- and post-treatment differences were found to be statistically significant for both the groups (p<0.001) and for both the treatment outcomes. When the average difference of the treatment outcomes was compared between the two study groups, no statistically significant difference was noted (p>0.05). CONCLUSION The results of the present study indicate that both the treatment regimens studied are equally effective in the treatment of oral submucous fibrosis.
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Affiliation(s)
- Palak Hasmukhbhai Shah
- Postgraduate Student, Department of Oral Medicine and Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth , Vadodara, Gujarat, India
| | - Rashmi Venkatesh
- Reader, Department of Oral Medicine and Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth , Vadodara, Gujarat, India
| | - Chandramani Bhagawan More
- Professor and Head, Department of Oral Medicine and Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth , Vadodara, Gujarat, India
| | - Vaishnavee Vassandacoumara
- Reader, Department of Oral Medicine and Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth , Vadodara, Gujarat, India
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Tilakaratne WM, Ekanayaka RP, Herath M, Jayasinghe RD, Sitheeque M, Amarasinghe H. Intralesional corticosteroids as a treatment for restricted mouth opening in oral submucous fibrosis. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:224-31. [PMID: 27422421 DOI: 10.1016/j.oooo.2015.11.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 11/13/2015] [Accepted: 11/26/2015] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Oral submucous fibrosis (OSF) is a chronic debilitating disease of the oral mucosa, associated with an increased risk of malignancy. The primary objective of this study was to evaluate the effectiveness of intralesional corticosteroid injection as a treatment modality for OSF. We also studied the correlation between the treatment outcome and a number of individual variables. STUDY DESIGN A total of 230 histologically confirmed patients with OSF were included in the study, of which 116 patients with a 30 mm or less interincisal mouth opening were subjected to intralesional injections of 40 mg methylprednisolone at monthly intervals for 6 consecutive months. The effect of the treatment was assessed by evaluating the degree of improvement in mouth opening. RESULTS All patients included in the study had a history of chewing areca nut. In paired comparison, statistically significant difference (t = -8.78; df = 115; P < .001) was observed in mouth opening over a period of 12 months in the patients who had corticosteroid injections. CONCLUSIONS Intralesional corticosteroid injection is one of the most widely implemented interventions for OSF at present, particularly for those patients with palpable fibrous bands. The present study provides justification for the use of corticosteroids in improving mouth opening.
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Affiliation(s)
- Wanninayake M Tilakaratne
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka.
| | - Rasika P Ekanayaka
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Manjula Herath
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ruwan D Jayasinghe
- Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Mohaideen Sitheeque
- Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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"Oral Submucous Fibrosis Scoring Index" to Predict the Treatment Algorithm in Oral Submucous Fibrosis. J Maxillofac Oral Surg 2015; 15:18-24. [PMID: 26929548 DOI: 10.1007/s12663-015-0796-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 04/13/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE The main aim of the study is to propose a treatment protocol based on scoring system. MATERIALS AND METHODS One hundred patients were selected randomly having oral submucous fibrosis. They were classified into five groups based on clinical signs and symptoms, radiological and histopathological grading and severity of fibrosis. Patients of particular group were subjected to specific treatment for each group and followed for 2 years regularly. RESULTS We found that almost all patients got symptomatic relief and they are able to take regular diet. Patient's interincisal mouth opening increased significantly. CONCLUSION Based on this scoring and grouping we can give definite and prompt treatment to the patients with satisfactory results. This proposed scoring and staging can play major role in controlling and treating this widespread global disease. Thus, OSMF scoring index is very effective to decide the severity of disease and progress.
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Synergistic effects of betel quid chewing, tobacco use (in the form of cigarette smoking), and alcohol consumption on the risk of malignant transformation of oral submucous fibrosis (OSF): a case-control study in Hunan Province, China. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:337-45. [PMID: 26130067 DOI: 10.1016/j.oooo.2015.04.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 04/12/2015] [Accepted: 04/18/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Oral submucous fibrosis (OSF) is a potentially malignant disorder, wherein 7% to 13% of patients with OSF develop oral squamous cell carcinoma (OSCC) at clinically coincident sites established to have OSF. We aimed at investigating the lifestyle-related risk factors for malignant transformation of OSF. STUDY DESIGN A case-control study was conducted among 80 cases with OSF-associated OSCC and 80 controls with OSF but without clinically or histopathologically evident OSCC, recruited from January 2012 to October 2014 in the Xiangya Hospital, Hunan Province, Mainland China. RESULTS The odds ratios (OR) for OSCC were 13.3 (95% confidence interval [95% CI]: 3.1-56.4) and 45.1 (95% CI: 9.6-212.9) at the highest exposure of betel quid (BQ) chewing, by duration and frequency, respectively. Higher risks were also found to be associated with the consumption of cigarette (OR = 5.0, 95% CI: 1.7-14.8) and alcohol (OR = 3.1, 95% CI: 1.1-8.6). Adjusted ORs increased substantially among patients who consumed BQ and cigarette or alcohol simultaneously, which were 26.1 (95% CI: 4.0-172.6) and 55.-(95% CI: 1.8-1742.8) at the longest duration, and 160.3 (95% CI: 18.7-11371.2) and 58.1 (95% CI: 2.4-1434.9) at the highest dose, respectively. CONCLUSIONS The use of BQ, cigarette, and alcohol were identified as risk factors for malignant transformation of OSF in the Hunan province, Mainland China. Synergistic effects between BQ chewing and cigarette or alcohol consumption were revealed.
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