Coming to America: Betel Nut and Oral Submucous Fibrosis

BackgroundOral submucous fibrosis (OSF) is an insidious precancerous disease affecting the oral cavity, pharynx and upper digestive tract. Its etiology is linked directly to betel nut use, which is common to the Indian subcontinent. With the increase in immigration of people from the Indian subcontinent to the United States, many American dental professionals will encounter this disease in the near future. The author provides a general overview of OSF.MethodsThe author provides a literature review of OSF, including its epidemiology, etiology, clinical presentation, histopathology and treatment modalities.ResultsOSF is a precancerous oral disease linked definitively to the use of betel nut. It is endemic to people in the Indian subcontinent. Patients' primary complaint is progressive trismus. Treatment is based on disease severity.Clinical ImplicationsOSF is a debilitating but preventable oral disease. Its incidence in the United States will increase as the South Asian immigrant population expands. Consequently, American dental professionals may encounter patients with this disease, and it is important that they are aware of it. In addition, for dental care professionals practicing in a South Asian American community, public health education is important to inform the population about the deleterious oral health effects of betel nut consumption.     

Dentoalveolar Surgery in Oral Submucous Fibrosis: Need for Caution

Performing exodontia in patients with the precancerous condition of oral submucous fibrosis is difficult but frequently necessary. There is mucositis and trismus, faulty wound healing and predisposition to infection. Exodontia and dentoalveolar surgery in these patients may result in distressing sequelae and diagnosis of any subsequent complications like space infection is difficult. Hence, these patients must be treated as a special care group and measures adopted to ease distress. Literature has been reviewed with an eye to understand the underlying nature of the disease and factors that contribute to these problems.     

Extended Nasolabial Flaps in the Management of Oral Submucous Fibrosis

Purpose  

We evaluated the use of extended nasolabial flaps in the management of oral submucous fibrosis.     

Evaluation of Elongated Styloid Process in Patients with Oral Submucous Fibrosis Using Panoramic Radiographs

Introduction

Oral submucous fibrosis (OSF) is an insidious disease affecting the oral cavity, pharynx, and upper digestive tract. It is characterized by a juxtaepithelial inflammatory reaction followed by fibroelastic change in the lamina propria and associated epithelial atrophy. Higher levels of TGF-β present in patients with OSF could be responsible for impetus to remnants of Reichert’s cartilage present in styloid complex leading to partial or complete ossification of associated ligaments. So, a study was conducted to evaluate the elongation of the styloid process in patients with OSF by using panoramic radiographs.

Materials and Methods

Panoramic radiographs of patients with OSF were studied from 2007–2011. The apparent lengths of styloid process were measured with the help of divider and steel metric ruler. The length of the styloid process and/or ossification of stylomandibular ligaments which were longer than 30 mm were considered.

Results

Out of 47 patients, 35 patients (34 males & 1 female) met the inclusion criteria. Eleven patients (31.4%) were found to have elongated styloid processes which included 10 male patients and 1 female patient.

Conclusion

It had been estimated that between 2 % and 4% of the general population presents radiographic evidence of an ossified portion of the styloid complex. The high incidence of elongation of styloid process (31.4 %) in patients with oral submucous fibrosis highlights that progressive OSF might have some influence on elongation of styloid process.     

The Efficacy of ErCr:YSGG Laser Fibrotomy in Management of Moderate Oral Submucous Fibrosis: A Preliminary Study

Introduction

Oral submucous fibrosis (OSMF) is a chronic insidious disease mainly associated with fibroelastic change of the oral mucous membrane, leading to progressive trismus and oral burning sensation. The management of OSMF is empirical, depends on staging of the condition and is combination of conservative/medical/surgical interventions. Management of moderate OSMF is more challenging as conservative and medical treatments are not effective while surgical techniques involving fibrotomy and reconstruction of resultant defect are excessive. Lasers can provide an alternative and better means for surgical fibrotomy in moderate OSMF as they are minimally invasive and have the advantage of short operating time, less hemorrhage, faster healing, less morbidity, less surgical-site scarring and relapse. Laser fibrotomy in moderate OSMF have been done under general anesthesia.

Materials and Methods

A case series of 16 cases of moderate OSMF treated with Erbium Chromium Yttrium Scandium Gallium Garnet (ErCr:YSGG) laser fibrotomy under local anesthesia in combination with cessation of habits, topical steroids, lycopene and oral physiotherapy is presented.

Results

The mean increase in mouth opening achieved at 1 year was 17.5 mm. The mean difference in the preoperative and 1 year mouth opening was found to be statistically significant. The mean difference in the preoperative and six-month Visual Analogue Scale scores for oral burning sensation and Oral Health Impact Profile-14 scores for assessment of oral health-related quality of life was statistically significant implying improvement.

Conclusions

ErCr:YSGG laser fibrotomy under local anesthesia is a minimally invasive, cost effective, chair-side procedure and an useful adjunct in management of moderate OSMF.     

Efficacy of Lycopene in the Treatment of Oral Submucous Fibrosis: A Meta-analysis of Randomized Controlled Trials

ObjectivesThe aim of this meta-analysis was to systematically evaluate the efficacy of lycopene in improving maximum mouth opening and other clinical symptoms in patients with oral submucous fibrosis (OSF).MethodsWe searched 5 databases: PubMed, Web of Science, Embase, The Cochrane Library, and EBSCO. Randomized controlled trials were collected to evaluate the efficacy of lycopene in the treatment of OSF. Each database was searched from inception to April 30, 2019. The RevMan 5.3 software was used for this meta-analysis.ResultsThe included studies were 7 randomized controlled trials involving 758 patients with OSF. The results of this meta-analysis showed that lycopene was significantly more effective in improving maximum mouth opening in OSF patients than placebo treatment (mean difference [MD]: 3.15; 95% confidence interval [CI]: 2.19-4.10, P < .0001, I² = 0%). Compared with control groups, lycopene could significantly increase the maximum mouth opening in patients with OSF after 1 month of treatment (MD, 2.40; 95% CI, 2.22-2.58; P = .91; I² = 0%), 2 months of treatment (MD, 3.19; 95% CI, 2.87-3.51; P = .93; I² = 0%), and 3 months of treatment (MD, 4.89; 95% CI, 4.51-5.28; P = .86; I² = 0%). However, no significant difference was found in alleviation of burning sensation after 1 month (risk ratio [RR], 1.04; 95% CI, 0.89-1.23; P = .73; I² = 0%), 2 months (RR, 0.98; 95% CI, 0.73-1.31; P = .69; I² = 0%), and 3 months of treatment (RR, 0.84; 95% CI, 0.47-1.52; P = .81; I² = 0%); tongue protrusion (MD, −1.59; 95% CI, −4.15 to 0.97; P = .12; I² = 58%); and pain associated with the lesion after 1 month (RR, 1.05; 95% CI, 0.92-1.21; P = .77; I² = 0%), 2 months (RR, 0.95; 95% CI, 0.75-1.19; P = .35; I² = 0%), and 3 months (RR, 0.95; 95% CI, 0.68-1.33; P = .14; I² = 51%) in patients with OSF between lycopene and control groups.ConclusionsThe results of this meta-analysis showed that lycopene is more effective for improving symptoms of maximum mouth opening than placebo groups and control groups, but there were no significant differences in burning sensation, pain associated with lesion, and tongue protrusion in patients with OSF compared with control groups.     

Role of Collagen Impregnated with Dexamethasone and Placentrix in Patients with Oral Submucous Fibrosis

Purpose

To evaluate the versatility of the collagen membrane as both drug carrier and biologic dressing material to cover the raw wounds created after the surgical excision of fibrotic bands in oral submucous fibrosis.

Materials and Methods

The study comprises of ten patients. The patients of age group 20 to 50 years were selected. The collagen is reconstituted by injecting with dexamethasone and placentrix solution leaving a small overlap on to the remaining mucous membrane and the graft is sutured. Preoperative and post operative assessment was done regarding the improvement in mouth opening, decrease in burning sensation, change in colour of oral mucosa and clinically grading the extent of lesion.

Results

The results were found appreciable in seven patients while in the remaining three patients it showed relapse because of inadequate physiotherapy. All the ten patients were comfortable with intra oral collagen grafting. The collagen remained moist and supple intraorally, and remained in close contact with the underlying tissues, providing a strong mechanical barrier. The material was effective in attaining haemostasis, relieving pain and preventing extensive contracture.

Conclusion

In this study of short duration, the nature of collagen membrane was observed as both biological dressing material and drug carrier. It was found as a very suitable alternative to the other graft material mentioned for the repair of defects in the mucous membrane created by surgical excision of fibrous bands in oral submucous fibrosis.     

Surgical Interventions in Oral Submucous Fibrosis: A Systematic Analysis of the Literature

Background

Oral submucous fibrosis (OSMF) is a potentially malignant disorder of the oral cavity. The surgical management of this condition involves excision of the fibrotic bands and interpositional grafts to retain the increased oral opening. Various procedures and graft material have been utilised with differing success rates.

Objectives

The present review aims to collate and analyze from world literature the different modalities utilized in the surgical management of OSMF. The reasons for the choice of a particular surgical procedure, the study protocol, the average follow-up period and the results were scrutinized.

Materials and Methods

The PRISMA protocol was followed for the systematic review. Search engines and medical databases like Ovid, Medline, Pubgate, Researchgate, PubMed, Google etc. were tapped for information related to the subject. The search words “OSMF”, “surgical interventions in OSMF”, “flaps and grafts in treatment of OSMF” were employed for retrieval of data. An analysis of the treatment modalities, the reason for the selection of a particular modality, the organization of the sample selection and the follow-up periods including the proclaimed success rates was done.

Results

The review resulted in a total of 56 articles on the subject from the sources mentioned above. A total of 995 surgically treated cases were included in the analysis. Interestingly the review revealed very few controlled clinical trials, most being random trials on surgical procedures in small groups of patients with very short follow up periods. The choice of procedure seems to be determined entirely by the preference of the operator/s.

Conclusions

There exist no definite protocols for the adoption of a particular treatment mode in OSMF. Adequate documentation and follow up need to be established to statistically analyse the results and proclaimed successes of various treatment modalities.     

高压氧治疗促进局部丹参和确炎舒松注射治疗口腔粘膜下纤维性变的研究

目的:探讨高压氧治疗能否促进丹参和确炎舒松局部注射治疗口腔粘膜下纤维性变的治疗效果及其安全性。方法:设计随机临床试验,对随机分成3组的46名口腔粘膜下纤维性变患者进行单纯高压氧治疗、单纯注射丹参和确炎舒松治疗及联合两种治疗共8周。在治疗结束和治疗结束后12周进行最大开口度及口腔粘膜感觉的检查。结果:经过8周治疗,3组患者表现出不同的治疗效果,无明显不良反应。A组在治疗结束时和随访12周后最大开口度分别为(2.94±1.01 ) mm和(1.98±0.78) mm,B组分别为(3.89±0.67) mm 和(3.18±0.66) mm,C组分别为(6.14±1.46 ) mm 和(5.42±1.53) mm。 A组在治疗结束时和随访12周后口腔粘膜感觉改善分别为(2.00±0.72)和(1.15±0.31),B组为(3.08±0.73)和(2.08±0.60), C组为(3.38±0.94)和(2.80±0.78)。结论:高压氧治疗能够促进丹参和确炎舒松局部注射治疗口腔粘膜下纤维性变的治疗效果且具有安全性。