Oral Sub Mucous Fibrosis: Tobacco Chewer

Service Description

Oral submucous fibrosis (OSMF) is a chronic, progressive, and irreversible collagen metabolic disorder localized in the mouth, primarily caused by chewing tobacco and/or areca nuts, often found in betel quid and its variants. While it resembles scleroderma, OSMF is specific to the oral cavity and carries an increased risk of developing squamous cell carcinoma. At-Risk Populations: OSMF is predominantly observed in individuals who chew betel quid or its variants, such as gutkha (mitha pan), kiwam, zarda, and pan masala. Sweetened forms of betel quid, marketed to children as sweet supari, gua, mawa, or mistee pan, also contribute to the prevalence of this condition. It most commonly affects adults aged 20 to 40 years. Notably, gutkha chewing typically begins at a younger age and leads to a quicker onset of the disease compared to traditional betel quid. Clinical Features of OSMF: The initial symptom of OSMF is often a burning sensation in the mouth, particularly when consuming spicy foods, sometimes accompanied by small blister formations. Other clinical features include: 1. Reduced Mouth Opening: As the condition progresses, patients may find it difficult to open their mouths wide, impacting eating, swallowing, speaking, and maintaining dental hygiene. 2. Fibrous Cheeks: The cheeks may feel thick and firm, losing the ability to puff out. 3. Rubbery Lips: The lips may thicken, taking on an elliptical shape. 4. Limited Tongue Mobility: The tongue becomes smooth, white, and may have restricted movement. Treatment Approaches: The treatment for OSMF varies based on the severity of the condition and typically involves: 1. Lifestyle Changes: Patients are advised to discontinue the use of pan masala, betel nut, tobacco, alcohol, and spicy foods. 2. Corticosteroid Injections: Weekly corticosteroid injections into the fibrotic bands are administered for 6-8 weeks. These may be combined with hyaluronidase, an enzyme that helps break down connective tissue. 3. Nutritional Support: Nutritional supplements are recommended, along with mouth opening exercises to improve mobility. 4. Surgical Options: In advanced cases, surgery may be necessary to enhance mouth opening. Jaw stretching appliances may also be provided to assist with mobility.