Increased severity of oral submucous fibrosis in young Pakistani men

Optimizing the Synergistic Role of Diode Laser and Drug Therapies in the Management of Oral Submucous Fibrosis: A Case Report

Oral submucous fibrosis (OSMF) is one of the most common precancerous conditions of the oral mucosa involving any part of the oral cavity resulting in tissue scarring, dysphagia, and trismus. Habits of chewing areca nut, tobacco, and pan masala and smoking have revealed a strong association with the occurrence of OSMF. Due to its high morbidity and high malignant transformation rate (MTR), continuous efforts have been made to develop effective treatment options. Based on the stage of the disease, various treatment modalities such as medical and surgical therapies are available, each with its own set of advantages and disadvantages. Photobiomodulation (PBM) is an emerging minimally invasive therapy that can be utilized to treat OSMF through its anti-inflammatory and analgesic effects. With the advent of dual-wavelength diode lasers, the current case report focuses on a novel treatment strategy for managing OSMF in combination with pharmacological and oral physiotherapy to achieve optimal results.

Serum and salivary Cu/Zn ratio as a diagnostic biomarker for oral submucosal fibrosis: an analysis of trace metals and LOX gene variants

This study aimed to analyze the serum and salivary levels of copper (Cu), zinc (Zn), iron (Fe), chromium (Cr), manganese (Mn) and the Cu/Zn ratio and investigate the association between LOX gene variants (rs18800449 and rs2288393) and oral submucosal fibrosis (OSMF). A total of 250 subjects were included in the study: OSMF patients (n = 50), areca nut chewers without OSMF (n = 100) and controls (n = 100). Trace metals were measured using an atomic absorption spectrophotometer, while LOX gene variants were genotyped using the tetra primer amplification refractory mutation system (tetra ARMS) polymerase chain reaction (PCR) method. The results showed significant variations in serum and salivary Cu, Zn, Fe and Cr levels and serum Mn concentrations among the three groups (p < 0.0001). Serum Cu levels were significantly higher in OSMF patients, while serum Zn levels were significantly lower. Both serum and salivary Cu/Zn ratios demonstrated a statistically significant difference (p < 0.0001) and diagnostic potential to differentiate OSMF from chewers and controls. However, LOX gene variants did not show an association between OSMF and chewers, except for rs1800449 genotypes, which showed a significant and increased risk with the AA genotype in OSMF patients compared to controls (OR = 7.58; 95%CI 2.30-24.97). The study suggests that trace elements and genetic variants may impact the etiology of OSMF. The findings may aid in early diagnosis, suitable treatment, and as a prognostic indicator for disease progression.

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

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

Label-free quantitation of the changes in salivary proteome associated with the chronic consumption of the betel nut (Areca catechu)

Areca nut or betel nut chewing is most frequently used in Pakistan and is associated with a high risk for oral cancer. Until now, however, there has not been any research conducted on the long-term effect(s) of betel nut chewing on the saliva proteome. In the present study, initially, the changes in the saliva proteome associated with betel nut chewing were investigated. Secondly, the analysis was focused on the changes in salivary proteome with respect to prolonged usage of betel nuts. After extraction, the saliva proteins were digested into peptides and these were subsequently analyzed using mass spectrometry. Data are available via ProteomeXchange with identifier PXD029768. Label-free quantitation of saliva samples revealed a total of 12 proteins that were differentially expressed between betel nut addicts (BNAs), and the control group. The study groups were further divided into three subgroups, the BNA-1, BNA-2, and BNA-3 groups, with respect to the extent of consumption of betel nuts in terms of years. The data analysis revealed a more detailed profiling of proteins expressed after five, ten, and more than ten years of betel nut consumption. A total of 30, 17, and 22 proteins were found to be differentially expressed when divided into the BNA-1, BNA-2, and BNA-3 groups. The present study shows that the chronic usage of betel nuts leads to the expression of proteins, such as SPARC1, profilin, and SBSN, which are known to be involved in head and neck cancers.

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

Introduction:

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

Results:

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

Conclusion:

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

Evaluation of role of trace elements in oral submucous fibrosis patients: A study on Gujarati population

INTRODUCTION

Oral submucous fibrosis (OSMF), a precancerous condition, is highly prevalent in the Indian subcontinent. Among many trace elements, copper and iron are required for the functioning of numerous enzymes. The biochemical alterations of these trace elements in the serum of patients with premalignant conditions can help in determining the staging of the disease, its appropriate treatment and as an indicator for prognosis.

AIMS AND OBJECTIVES

The objective of the study was to evaluate the role of iron and copper as well as to identify the better predictor of the two in the diagnosis and progression of OSMF.

MATERIALS AND METHODS

The study sample consisted of 150 patients, out of which the cases group consisting of 100 OSMF patients and control group consisting of 50 individuals. All the cases were confirmed of having OSMF by histopathological examination. The blood sample was obtained from all 150 patients and evaluated by digital autoanalyzer photometer for serum level of copper and iron by the colorimetric method. The results obtained for cases and controls were compared by statistical analysis.

RESULTS

The mean serum copper level increases while the mean serum iron level decreases with the advancement in the severity of clinical and histological stages of OSMF.

CONCLUSION

Biopsy is the gold standard to diagnose OSMF, but it is an invasive and time-consuming technique. However, nowadays, many recent advances are used to diagnose OSMF at an early stage and reduce its progression into late and reversible stages. The trace elements serve as potential prognostic and diagnostic markers for OSMF patients.

Psychiatric and anesthetic implications of substance abuse: Present scenario

Substance abuse has crossed all social, economic, and geographic borders and is spreading its fangs in each and every sphere of society irrespective of age, gender, caste, creed, and religion. These days, we encounter several patients of substance dependence who visit different hospitals for elective surgical procedures or in emergency (e.g., roadside accidents and with various complications associated with substance abuse). These patients at that time may be either addicted to them or are intoxicated by them or on de addiction treatment. Acute or chronic use of these drugs affect the respiratory, cardiovascular, central nervous, renal, hematological, and hepatic system variably in individuals thus due to diverse clinical presentations a complete understanding of the path physiology and anesthetic implications of drug abuse is essential to tailor a safe anesthetic plan for these high-risk group of patients.

Various terminologies associated with areca nut and tobacco chewing: A review

Globally, arecanut and tobacco are among the most common addictions. Tobacco and arecanut alone or in combination are practiced in different regions in various forms. Subsequently, oral mucosal lesions also show marked variations in their clinical as well as histopathological appearance. However, it has been found that there is no uniformity and awareness while reporting these habits. Various terminologies used by investigators like ‘betel chewing’,‘betel quid chewing’,‘betel nut chewing’,‘betel nut habit’,‘tobacco chewing’and ‘paan chewing’ clearly indicate that there is lack of knowledge and lots of confusion about the exact terminology and content of the habit. If the health promotion initiatives are to be considered, a thorough knowledge of composition and way of practicing the habit is essential. In this article we reviewed composition and various terminologies associated with areca nut and tobacco habits in an effort to clearly delineate various habits.

Oral submucous fibrosis: an overview of the aetiology, pathogenesis, classification, and principles of management

Oral submucous fibrosis (OSMF) is a complex, debilitating, and precancerous condition. Formerly confined to the Indian subcontinent, it is now often seen in the Asian populations of the United Kingdom, USA, and other developed countries, and is therefore a serious problem for global health. The well-known causative agent of the disease, areca-nut is now recognised as a group one carcinogen. We review and discuss all components of OSMF, including the terminology, presentation, aetiology, and pathogenesis, and provide a brief overview of its management.

Areca nut in pathogenesis of oral submucous fibrosis: revisited

BACKGROUND

Oral submucous fibrosis is a disease due to a chronic, insidious change in fibro-elasticity, characterized by burning sensation in the oral cavity, blanching, and stiffening of the oral mucosa and oropharynx leading to trismus and inability to open the mouth. The symptoms and signs depend on the progression of the lesions and number of affected sites. It is predominantly seen in Indians and other Asians. Once the disease has developed, there is neither regression nor any effective treatment. It is considered as a pre-malignant stage of oral cancer, and the reported risk of malignant transformation varies from 2.3-7.6%.

CONCLUSIONS

The common etiological factor considered for this unremitting disease is use of areca nut; however, the precise mechanism still remains elusive and controversial. A wide range of treatment consisting of drugs, surgical therapy, and physiotherapy have been attempted till date, with varying degrees of benefit, but none of them have proved to be a cure for this disease. This field remains open for clinical trials and research. This paper aims to give an overview on the role of areca nut in the pathogenesis and malignant potential of oral submucous fibrosis.

Management of oral submucous fibrosis: an overview

Oral submucous fibrosis is a disease due to a chronic, insidious change in fibroelasticity, characterized by burning sensation in the oral cavity, blanching, and stiffening of the oral mucosa and oro-pharynx leading to trismus and inability to open the mouth. The symptoms and signs depend on the progression of the lesions and number of affected sites. It is predominantly seen in Indians and other Asians. Once, the disease has developed, there is neither regression nor any effective treatment. It is considered as a pre-malignant stage of oral cancer and reported risk of malignant transformation varies from 2.3-7.6%.The common etiological factor considered for this unremitting disease is use of areca nut; however, the precise pathogenesis still remains elusive and controversial. A wide range of treatment consisting of drug management, surgical therapy, and physiotherapy have been attempted till date; with varying degrees of benefit, but none of them have proved to be a cure for this disease. This field remains open for clinical trials and research. This paper aims to provide an overview on various management modalities available for oral submucous fibrosis.

[Oral submucous fibrosis in a 31-year-old Indian women: first case report from Germany]

BACKGROUND

Oral submucous fibrosis (OSF) is a chronic disease characterized by subepithelial collagen deposition with formation of bands involving the oral cavity and adjacent structures. Oral submucous fibrosis is a precancerous condition. It is caused by chewing of betel quid (Areca catechu L., Piper betle, lime and tobacco) and ready-made products like pan masala and gutka which also contain areca nut. These products are available all over South Asia. The hallmark of OSF is extremely restricted mouth opening.

CASE REPORT

A 31-year-old Indian woman who has lived in Germany since 1997 presented herself because of limitation of mouth opening. She reported that she has chewed pan masala and gutka since she was 17 years of age. History, clinical and histological findings clearly pointed to the diagnosis of OSF.

DISCUSSION

Conservative as well as surgical interventions for OSF have not resulted in adequate long-term results. Since OSF may occur in children and young adults, the primary aim should be to avoid progression of the disease, initially by physiotherapy. Surgical interventions should not be applied at an early stage of the disease because recurrences and further surgical interventions are often necessary. Due to the increasing numbers of migrants from South Asia more cases of OSF will probably also be observed in Germany, where areca nut-containing products are also available.

Oral submucous fibrosis: study of 1000 cases from central India

BACKGROUND

Very few reports have been published on the gender specificity of oral submucous fibrosis (OSF) in relation to habit patterns and the severity of disease in the world literature. The purpose of the study was to ascertain the gender specificity for different habits and severity of OSF.

METHODS

A hospital-based cross-sectional study on various habit patterns associated with OSF was performed in Nagpur over a 5-year period. A total of 1000 OSF cases from 266,418 out patients comprised the study sample.

RESULTS

The male-to-female ratio of OSF was 4.9:1. Occurrence of OSF was at a significant younger age group (<30 years) among men when compared with women (OR = 4.62, 3.22-6.63, P = 0.0001). Reduced mouth opening, altered salivation and altered taste sensation were found to be significantly more prevalent in women when compared with men. Exclusive areca nut chewing habit was significantly more prevalent in women (OR = 44.5, 25.4-79.8, P = 0.0001). Whereas significant increase for Gutkha (Areca quid with tobacco) (OR = 2.33, 1.56-3.54, P = 0.0001) and kharra/Mawa (crude combination of areca nut and tobacco) (OR = 6.8, 4.36-11.06, P = 0.0001) chewing was found in men when compared with women.

CONCLUSIONS

There is a marked difference in literacy, socioeconomic status, areca nut chewing habits, symptoms and disease severity in women when compared with men in the central Indian population.

Oral submucous fibrosis: Review on aetiology and pathogenesis

Data from recent epidemiological studies provide overwhelming evidence that areca nut is the main aetiological factor for OSF. A clear dose-dependent relationship was observed for both frequency and duration of chewing areca nut (without tobacco) in the development of OSF. Commercially freeze dried products such as pan masala, Guthka and mawa (areca and lime) have high concentrates of areca nut per chew and appear to cause OSF more rapidly than by self prepared conventional betel quid that contain smaller amounts of areca nut. It is logical to hypothesise that the increased collagen synthesis or reduced collagen degradation as possible mechanisms in the development of the disease. There are numerous biological pathways involved in the above processes and, it is likely that the normal regulatory mechanisms are either down regulated or up regulated at different stages of the disease. Among the chemical constituents, alkaloids from areca nut are the most important biologically whilst tannin may have a synergistic role. These chemicals appear to interfere with the molecular processes of deposition and/or degradation of extracellular matrix molecules such as collagen. In vitro studies on human fibroblasts using areca extracts or chemically purified arecoline support the theory of fibroblastic proliferation and increased collagen formation that is also demonstrable histologically in human OSF tissues. The copper content of areca nut is high and the possible role of copper as a mediator of fibrosis is supported by the demonstration of up regulation of lysyl oxidase in OSF biopsies. It has been postulated that areca nut may also induce the development of the disease by increased levels of cytokines in the lamina propria. Increased and continuous deposition of extracellular matrix may take place as a result of disruption of the equilibrium between matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMP). Current evidence implicates collagen-related genes in the susceptibility and pathogenesis of OSF. The individual mechanisms operating at various stages of the disease-initial, intermediate and advanced-need further study in order to propose appropriate therapeutic interventions.

The Chewing of Betel Quid and Oral Submucous Fibrosis and Anesthesia

Oral submucous fibrosis (OSMF) is a premalignant lesion of the buccal mucosa caused by chewing betel quid. It results in progressive inability to open the mouth. OSMF causes difficulty in laryngoscopy and intubation of the trachea. Patients with OSMF require anesthesia for trismus correction, resection, and reconstructive (oncoplastic) surgery for coexisting oral malignancies or other unrelated surgeries. Our review of the anesthetics of 44 patients with oral malignancies suggested that 8 had OSMF. The preoperative airway assessment, including the Mallampati score and the clinical Tumor Node Metastasis stage, were useful in predicting the need for fiberoptic intubation. Patients with oral malignancies and OSMF had increased requirement for fiberoptic endotracheal intubations (62.5%) compared with those without OSMF (44.4%). Three different techniques of airway management (tracheal intubation after direct laryngoscopy, fiberoptic tracheal intubation, and tracheostomy) in four patients with OSMF are described. OSMF contributes to the development of the malignancy, delays the diagnoses, and complicates the anesthetic management.