ETIOLOGY HISTOPATHOLOGY

LOCAL FACTORS :
ORAL SUBMUCOUS FIBROSIS EPITHELIAL CHANGES:
•Increased keratinization,intracellular edema, appearance
1.Areca nut- Excessive chewing of this increases the chance of
OSF since it releases arecoline causing submucosal fibrosis with
& IT’S MANAGEMENT of’signet cells’& dysplasia.
•More collagen in underlying lamina propria causes
upward pressure resulting in atrophy & flattening of rete
rigidity of oral mucosa.
pegs.
2.Red chilies- It contains an ingredient ,’capsaicin ’ DEFINITION ACCORDING TO WHO - It is a chronic progressive scaring CONNECTIVE TISSUE CHANGES:
that produces hypersensitivity reactions in oral mucosa,causing disease of oral mucosa ,characterized by juxtraepithelial inflammatory •Initial Stage: Juxtra epithelial inflammation &
increased collagen synthesis. proliferation of fibroblasts.
reaction followed by a fibroelastic transformation of lamina propria leading
SYSTEMIC FACTORS: •Early Stage:Thickenig of collagen bundles is seen with
1.Nutritional Deficiency: Deficiency of vitamin A,B complex,C &
to mucosal atrophy, rigidity & trismus. early hyalinizatipon
iron deficiency. - It is more common in South -Asian countries like India,Srilanka,Pakistan & •Advanced stage :Collagen is completely hyalinized.& seen
2.Genetic Factors: Some people are more susceptible to this. Bangladesh, due to extreme climate conditions &spicy food habits. as smooth sheet instead of separate bundles.
3.Immunological factors: OSF exhibits increased number of MANAGEMENT
meosinophils. STEPS IN ETIOPATHOGENESIS OF OSMF Conservative & medical managagement of OSMF
include:
1.Restriction of habits:Reduction &elimination of
ARECA NUT areca nut chewing is preventive measure.
CLINICAL FEATURES 2.Drug Therapy:
•-Corticosteroids- Suppresses inflammatory
EARLY ORAL SUBMUCOUS FIBROSIS: response by anti-inflammatory action. Intralesional
• The onset is either insidious or develop gradually over 2-5 ALKALOIDS (Arecoline) POLYPHENOLS TRACE ELEMENTS injection or in form of mouth wash
years. (Flavonoids) (Copper) •-Hyaluronidase-Breakdown of hyaluronic acid
• Patient complains of burning sensation during intake of hot lower the viscosity of intercellular substance &
and spicy food. ROS GROWTH TIMP decreases collagen formation. DOSE- Intralesional
FACTOR/CYTOKINES MMP injection of 1500IU
• There can be increased or decreased salivation(xerostomia). COPPER
CYTOTOXICITY •-Lycopene- 8mg twice a day for 2 months
• Palpation of the mucosa shows a ‘wet leathery’ feeling & DEPENDENT
there is a feeling of pain where fibrotic bands appear. ENZYME •-Pentoxyfilline-400mg 3 times a day for 7 months
-TGF
• There are numerous petechial spots over :mucosal surface. LYSYL OXIDASE •-Steroids- Submucosal injection twice a week in
SENESCENCE -IGF
ADVANCED ORAL SUBMUCOUS FIBROSIS DDBs -BMP7 multiple sites for 3 months
• Blanching of oral mucosa(white-marble like appearance) are FIBROBLASTS EPITHELIAL •-Placental Extracts-Combination of
seen on buccal mucosa & palate. CELLS dexamethasone,hyaluronidase&placental extract
• Fibrous bands appear in buccal mucosa & mouth orifice. ENDOTHELIAL CELLS proved to be highly efficient.
MYOFIBROBLASTS ATROPHY 3.Physiotherapy:Forceful mouth opening
• Gradual stiffening of oral mucosa is seen with fibrosis in
VASCULARITY COLLAGEN COLLAGEN ABNORMAL
pterygomandibular region which leads to reduced mouth SURGICAL TREATMENT
PRODUCTION DEGRADATION CROSS LINKING
opening. CLASSIFICATION OF OSF •Excision of fibrous bands remains the
According To Clinical Features: DIFFERENTIAL DIAGNOSIS
• Uvula will shrink & take a bud or ‘hockey-stick’ like
appearance. Desa JV: mainstay of surgical management of OSF.
•SCLERODERMA
Stage I:Stomatitis & vesiculation. •SIDEROPHENIC DYSPHAGIA •Split thickness skin grafting following bilateral
Stage II: Fibrosis •ORAL LICHEN PLANUS temporalis myotomy or coronoidectomy.
Stage III : As its sequelae
Pindborg JJ:
•SYPHILIS •Nasolabial flaps & lingual pedicle flaps.
Stage I: Stomatitis including erythematous mucosa. LAB INVESTIGATIONS •Cryosurgery-Liquid nitrogen or argon gas
Stage II:Fibrosis occurs in healing vesicles& ulcers •RAISED ESR used preferably as sprays,frozen tissues thaws
Stage III:Sequelae of OSMF- leukoplakia is found in 25% of •ANEMIA & is naturally absorbed by body.
individuals with OSMF •EOSINOPHILIA
According To Histopathological Features:
•Extractiing 3rd molar improve mouth opening
•VITAMIN A LEVELS
Pindborg JJ & Sirsat SM: •HYPERGAMMGLOBULINMIA REETODIP DAS FINAL PROFF, BDS
Very Early Stage: Finely fibrillar collagen dispersed •ZINC&IRON RATIIO IN BLOOD
Moderately Advanced Stage: Collagen moderate hyalinized. •INCREASED SERUM ALKALINE REGISTRATION NO.- 201704913
Advanced Stage: Collagen is completely hyalinized. PHOSPHATASE LEVELS ROLL NO. - 20143010082