Areca nuts role in OSF : Putting the pieces together

Presented by : Swetha Padaala Intern Ragas Dental College & Hospital

Endosperm of the Areca catechu Linn Cured: sun drying, boiling or combination

Roasted/ Powdered
Often taken with betel leaves/ lime/tobacco/spices- catechu, saffron, flavoring agents

Pan masala, gutkha, Mawa- Commercially available forms Freeze dried products have high concentrates of areca nut per chew. Areca nut chewing habit is widely practiced in India, Pakistan, Sri Lanka, Indonesia and Micronesia.

The practice dates back to ancient times It is of much importance in various cultures Has a stimulant effect Sense of well-being

Arecoline

Arecaidine
Guvacine

Guvacoline

Frequent usage of areca nut

ORAL SUBMUCOUS FIBROSIS

(Prolonged time)

ORAL CANCER
Stomatopyrosis-aggravated by spicy food Restriction of mouth opening, Cheek flexibility, tongue protrusion hockey stick uvula Blanching of oral mucosa Palpable fibrous bands Vesiculations Ulceration Recurrent stomatitis

Leathery in consistency
Salivary alteration Pigmentation

Taste alteration

OSCC in the tongue of a young adult chewing pan masala

Stimulation - fibroblast proliferation & collagen synthesis

Clonal selection of fibroblasts with a high amount of collagen production

Stabilization of collagen structure by catechin and tannins from arecanut

Decreased secretion of collagenase

Production of stable collagen (type I trimer) by OSF fibroblasts

Increase in collagen cross linking by upregulation of lysyl oxidase

Deficiency in collagen phagocytosis

Effect of fibrogenic cytokines secreted by activated macrophages and T lymphocytes on fibroblasts

There is no effective treatment for OSF and the condition is irreversible once formed. It can be:
1. Medical 2. Physiotherapy 3. Surgical

Medical treatment is symptomatic Nutritional support Immunomodulatory drugs ( IFN- ) Locally acting drugs Hyaluronidase, dexamethasone Antioxidants (vitamin E) Alternative medicine

Turmeric oil & paste Vinegar 4%

Forceful mouth opening Heat/ warm rinse Selective deep heating Short wave diathermy Microwave diathermy

Cutting fibrous bands Submucosal resection Mucosal / partial thickness/ full thickness grafts Buccal pad of fat insertion Temporalis myotomy