ORAL SUBMUCOSA FIBROSIS:

OSMF

By: MacKenzie Locke & Brooke DeRouen

LIT Dental Hygiene
 • Oral submucosa fibrosis is a malignant and
irreversible disease affecting the oral cavity
• It affects the submucosal tissues, such as the
lamina propria and deeper connective tissues
• Commonly found in
WHAT IT IS: I. India
II. southeast Asia
III. Africa.
IV. Increasing in North America and Europe
 HISTORY:

• Discovered in 5 Indian women from Kenya

• Dr. Lewis J. Schwartz- atrophic idiopathica mucosa
oris in 1952
• Dr SG Joshi- oral sub mucosa fibrosis in 1953
 HISTORY
CONT’D:

• Most commonly caused by the

areca nut or betel nut.
• Classified as a carcinogen and
gives off soothing and euphoric
effects.
• The components of the areca nut
interfere with collagen production
and degradation.
• It leads to frictional tissue
alterations, chronic inflammation,
release of fibrogenic cytokines , and
transforming growth factor-ß.
• Other factors: chili and peppers.
deficiencies in zinc and iron, also
genetic, immunologic, viral and
autoimmune possibilities, tobacco
 WHAT IT EFFECTS:

• ORAL/OROPHARYNGEAL REGION
• ESOPHAGEAL REGION(SOMETIMES)
• JAW

Dental staining and irregular cobble-stone

pattern of oral mucosa. Blanching of buccal mucosa in oral Redness and irregular cobble-stone
submucous fibrosis. appearance in oral submucous fibrosis.
 Blanching
Decrease
present on
d mouth
soft palate of
opening in
patient with
patient with
oral
advanced-
submucous
stage oral
fibrosis.
submucous
fibrosis.

Oral squamous cell carcinoma in a patient with Leukoplakia of the tongue; a biopsy is
oral submucous fibrosis. indispensable to exclude cancer of the tongue.
 • burning sensations of the oral mucosa
• blisters/ulcerations
• pain
• increased salivation
• xerostomia
• sunken cheeks
SYMPTOMS: • nasal voice
• impaired speech/hearing
• restriction of mouth movements
• shrunken uvula
• thinning/stiffening of the lips
• small tongue
• eating/drinking problems.
THREE STAGES OF OSMF: Stage I: Stomatitis
ESTABLISHED BY Stage II: Fibrosis
PINDBORG JJ IN 1989 Stage III: Sequalae
 • Erythematous mucosa
• Vesicles
STAGE I: STOMATITIS • Ulcerations
• Melanotic mucosal
pigmentation
• petechiae
 STAGE II: FIBROSIS

• Vesicles and ulcers become fibrotic

• Blanching, circular/vertical palpable bands and mottled marble like appearance
• Soft palate because rubbery with decreased mobility
• Tonsils are atrophic
• Stiffness and inability to open the mouth occurs
 STAGE III: SEQUALAE

• Presences of leukoplakia in more than 25% of people

• Speech and hearing are compromised because of the eustachian tube
damage
GROUPS CLASSIFIED BY KHANNA AND
ANDRADE IN 1995:

Groups I-IV
• Characterized by the ability to open the mouth
• Group 1-distance of 35mm, which is considered normal
• Group II- 25-35 mm
• Group III: 15-25mm
• Group IV A- less than 15 mm
• Group IV – less than 15 mm with the presence of leukoplakia/
squamous cell carcinoma
 • NO CURE- but manageable to relief symptoms
• Treatment depends of the severity
• Physiotherapy and daily mouth exercises are
recommended
• Prevention:
• Patient education is the best way to prevent OSMF:
• No betel nut chewing
• avoiding spicy foods
• limit chili
PREVENTION AND
TREATMENT: • maintain proper oral hygiene
• iron, vitamins, and minerals rich diet
• Treatment options:
• Steroids
• Injections
• Surgery (most effective)
• Laser treatment
• Stem cell therapy
SURGICAL TREATMENT OPTIONS:

• simple excision of the fibrous bands,

• split-thickness skin grafting followed
by bilateral temporalis
myotomy/coronoidectomy,
• nasolabial flaps.
 • Nektarios. (2019, February 01). Oral Submucous Fibrosis.
Retrieved from
https://emedicine.medscape.com/article/1077241-
overview
• Wollina, U.,Verma, S. B., Ali, F. M., & Patil, K. (2015, April 13).
REFERENCES: Oral submucous fibrosis: An update. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC440
1336/
• Russo, J. (n.d.). The Effects of Chewing Betel Nut.
Retrieved from
https://www.livestrong.com/article/129158-effects-
betel-nut-chewing/