Medical and Surgical Treatment options for Oral Submucous Fibrosis

Oral submucous fibrosis is a pre malignant condition caused mainly due to chewing of Beetle Quid or Areca nuts. The hyalinisation of the buccal mucosa forming bands and decrease in mouth opening is the first symptom.

Followed by White bands seen in labial mucosa, palate, and even spreads to uvula. Burning sensation while taking food and also difficulty in swallowing.

There are many treatment options for Oral Sub mucous Fibrous which are mainly decided by the Dentist depending on the stage of osmf.

The main and first step in getting Osmf successfully treated is asking the patient to stop Areca nuts chewing in the form of Pan/Ghutka/Jarda etc and make it clear that only after stopping the habit treatment will be useful.

Disclaimer: The treatment forms and medications are just for informative purpose and should not be used by the patient without consulting a Dental/Medical practitioner.

• Detailed description of Oral Submucous Fibrosis

The various treatment modalities are divided based on stage of the disease:

1. Medication and Regular Physiotherapy
2. Surgical therapy
3. Laser therapy and Physiotherapy

Note: Before any of this treatments is started make sure the patient has stopped chewing Areca nuts completely and tell him/her the importnace of getting the full treatment and the concequences of half therapy or restarting the habit of chewing Areca nuts.

Medication:

1. Steroid injections: Steroid injections are given directly on the affected region to primarily decrease the inflammatory process going on in the lesion. Dexamethasone and Betamethasone are some steroids used commonly by Dentists.
2. Placental Extracts: These are human placental extracts which have similar effect as steroids of giving anti inflammatory effect and causing cessation and stopping progress of the lesion. Placental extracts along with steroids and local anesthesia is injected directly into the lesion/bands submucosally to give better effect.
3. Hyaluronidase: This is an enzyme which degrades/breakdowns Hyaluronic acid which in OSMF helps in decreasing the hyaline bands and inturn helping in increaing elasticity of mucosa and when given along with Steroids intralesionally along with physiotherapy leads to better results and increases mouth opening quickly.
4. Lycopene: It is an Antioxidant which is mostly useful in improving healing and when given as a oral suppliment in osmf patients along with steroid therapy has found increased rate of healing and better results compared to patients only on steroid therapy. Lycopene oral capsules in combination with Beta carotene, Selenium etc are given on daily basis to aid in treatment of osmf.

Various other medications are in trail stage and even these medications mentioned above have not been approved by US food and drug administration as the primary treatment for OSMF.

Surgical treatment of OSMF:

Surgical treatmet is done in OSMF cases which are seen with severe restriction of mouth opening and heavy bands are seen in buccal mucosa, labial mucosa of lower lip, soft palate, uvula. Mostly surgical treatment is done on Bands seen in Buccal mucosa which are the main reason for Trismus or Decreased mouth opening in patients.

Surgical techniques used in treatment of OSMF:

1. Surgical Excision of Fibrous bands along with split thickness skin graft
2. Surgical Excision of Fibrous bands along with fresh ammonia graft
3. Surgical Excision of Fibrous along with pedicled buccal fat pad graft

Surgical excision of these bands are done along with the above mentioned grafts in sever OSMF patients.

Surgical Treatment of OSMF with Lasers:

Latest treatmet modality of OSMF is Lasers, the hyaline bands are excised with the help of lasers which is a very good alternative to traditional surgical therapy but a bit costly and most of the OSMF patients who have come to me were not in a position to afford Laset therapy.

Physiotherapy:

Physiotherapy for OSMF is a very important part of the treatment procedure as it helps in increasing mouth opening and should be strictly followed as the Dentist has ordered. It is mainly important in post surgical cases as the hyaline bands are excised and with physiotherapy the contraction of bands can be prevented.