Oral Submucous Fibrosis (OSMF)

Oral Submucous Fibrosis (OSMF) is a chronic, progressive, and potentially malignant disorder of the oral cavity. It leads to fibrosis (thickening and stiffening) of the oral mucosa, causing reduced mouth opening and an increased risk of developing oral cancer.

Causes & Risk Factors

The exact cause is unknown, but the primary risk factor is areca nut (betel nut) chewing. Other contributing factors include:

Tobacco use (smoked or smokeless)
Nutritional deficiencies (iron, vitamin B complex)
Genetic predisposition
Chronic irritation (from spicy food, alcohol, and chemical exposure)
Autoimmune factors

Symptoms

Early stage:
- Burning sensation in the mouth (especially with spicy food)
- Ulceration and pigmentation changes
- Dryness of the mouth
- Vesicles or blisters in the oral mucosa
Advanced stage:
- Progressive stiffness of oral mucosa
- Difficulty in opening the mouth (trismus)
- Restricted tongue movement
- Decreased salivation
- White fibrous bands in the cheeks, lips, soft palate, and floor of the mouth
- Speech and swallowing difficulties

Diagnosis

Clinical examination:
- Presence of blanching and fibrous bands
- Reduced mouth opening
Biopsy:
- Confirms fibrosis and epithelial changes
Other tests:
- Nutritional deficiency assessment
- Cancer screening in severe cases

Treatment & Management

Since there is no complete cure, treatment focuses on symptom relief and preventing progression.

Lifestyle Modification:
- Immediate cessation of areca nut, betel quid, and tobacco
- Avoid spicy and acidic foods
- Maintain good oral hygiene
Medical Management:
- Anti-inflammatory agents: Corticosteroids (topical or intralesional injections)
- Hyaluronidase injections: Helps in breaking fibrosis
- Collagenase therapy: To reduce tissue stiffness
- Nutritional supplements: Iron, zinc, and vitamin B-complex
Physiotherapy & Exercises:
- Jaw-stretching exercises
- Mouth-opening devices (e.g., Heister’s jaw stretcher)
Surgical Management (Severe Cases):
- Fibrotomy (release of fibrous bands)
- Skin grafting or flap reconstruction (if needed)
- Coronoidectomy (removal of the coronoid process of the mandible in extreme trismus cases)

Complications

Severe trismus (locked jaw)
Nutritional deficiencies due to difficulty in eating
High risk of malignant transformation (OSMF has a 7-30% chance of turning into oral cancer)

Prevention

Public awareness about the dangers of betel nut and tobacco use
Early diagnosis and intervention
Nutritional supplementation in high-risk individuals