Serum Homocysteine and Its Diagnostic Significance in Oral Submucous Fibrosis: A Cross-Sectional Study.

Aim & Objective: The aim of the study was to evaluate the levels of serum folate and homocysteine in clinical stages of Oral submucous fibrosis (OSF) patients. Methodology: The study sample comprised of 40 clinically and histopathologically diagnosed OSF patients those who are not undergoing treatment and 10 healthy controls. OSF was categorised by clinical staging. Serum foliate and homocysteine levels estimation was done by reverse phase high performance liquid chromatography analysis unit and chemiluminescence immuno assay, respectively. Results were statistically analysed using one-way ANOVA [Analysis of variance]. Results: Irrespective of age and gender, serum folate deficiency and high levels of homocysteine were noted in OSF patients when compared with healthy controls. Conclusion: Serum hyper homocysteinemia and folate deficiency were noted with the progression of the disease. Folate supplements can be given to decrease the levels of homocysteine, to arrest the progression of the disease. However, further longitudinal studies are needed to establish an association between serum homocysteine and serum folate.

The objective of the study was to find out the prevalence of oral squamous cell carcinoma (OSCC) with oral submucous fibrosis (OSF) in patients with OSF. Of 48,757 patients, we found 300 OSF subjects. Three hundred patients of OSF were checked for OSCC. Both OSF and OSCC with OSF (OSCCwOSF) were diagnosed histopathologically. The prevalence of OSCCwOSF was calculated. Descriptive analysis was done. Chi-square test and t-test were calculated for proportions and mean, respectively, to check any difference among OSF and OSCCwOSF groups. Age-specific relative risk was calculated in OSF and OSCCwOSF groups. Multiple logistic regression analysis was done among odd ratios of the different variable between OSF and OSCCwOSF groups. The prevalence of OSCCwOSF among OSF was 13.7% over a period of 1 year. The mean age of OSCCwOSF group was 43.95 ± 10.22 years in comparison to the OSF group that was 35.51 ± 11.26 years (P < 0.00). The mean habit duration was significantly less in the OSF group when compared to OSCCwOSFgroup for mishri (P = 0.002). Age-specific adjusted relative risk of OSCC in OSF patient increases from 0.33 (18-34 years) to 3.86 (≥65 years). It could be concluded that a 13.7% prevalence rate of OSCCwOSF in OSF patients should alert the clinician. Clinicians should, therefore, anticipate OSSC in OSF patients. This awareness could lead to the early diagnosis and management of such OSCC.

Hematinic deficiencies and anemia in gastric parietal cell antibody-positive and -negative oral submucous fibrosis patients

This study aimed to correlate the oxidative stress marker levels in saliva with the clinical stage based on mouth opening, fibrotic bands and histopathological grades of oral submucous fibrosis (OSF) patients. The study included patients clinically diagnosed with OSF (n=63) and equal number of age and gender matched controls. Patients with OSF were defined by mouth opening stage, fibrotic bands and histopathological grades. Unstimulated saliva from both control and OSF patients were analysed for oxidative markers like lipid peroxides (LPO), non-enzymic antioxidants [reduced glutathione (GSH), vitamin A, vitamin E, vitamin C] and enzymatic antioxidants [glutathione peroxidase (GPx), superoxide dismutase (SOD)] and correlated with different stages and grades. Total salivary protein and LPO were significantly increased in OSF group with no significant change in the levels of GSH compared to controls. In OSF patients, a significant decrease in the levels of vitamins A, C and E was observed. The activities of salivary SOD and GPx were significantly decreased in OSF patients compared to controls. These changes significantly correlated with the increasing and differing grades of OSF that reflects increased oxidative stress with the progress of OSF.

Background:To assess and compare the salivary flow rate (SFR) and salivary pH among areca nut chewers, oral submucous fibrosis (OSMF) patients and apparently healthy individuals.Methods:A comparative study was conducted to assess and compare the SFR and pH among 135 outpatients (45 areca nut chewers + 45 OSMF + 45 control) at The Oxford Dental College and Research Hospital, Bangalore, India. Subjects were interviewed using structural proforma and Modified Schirmer strips and pH paper were implemented for assessing SFR and pH respectively. Statistical analysis was done using IBM SPSS ver. 21.0 software.Results:A statistically significant increase in SFR (35.7 mm at 3rd minutes) among areca nut group and a decrease in SFR among OSMF group (23.4 mm at 3rd minutes) when compared to apparently healthy subjects (30.7 mm at 3rd minutes). The mean pH among areca nut, OSMF and control groups was 6.76, 6.82, and 6.74 respectively with no statistical significance.Conclusions:The observation and findings of the study clearly showed hypersalivation among areca nut group and hyposalivation among OSMF group, with no significant change in salivary pH when compared to healthy subjects.

Background: Oral submucous fibrosis (OSF), a potentially malignant disorder, is a chronic, inflammatory, progressive debilitating disease of the oral cavity with a multifactorial etiology. As an inflammatory response, more fibrinogen and its degradation products are produced by the body in OSF patients. Detection of these plasma fibrinogen degradation products (FDP) in OSF patients has contributed a new direction to enlighten the etiopathogenesis of OSF. Objectives: To ascertain the role of FDP of OSF patients in betel nut chewers and in control subjects and also to estimate serum levels of proteins in the patients. Materials & Methods: The study included 25 clinically diagnosed oral submucous fibrosis patients with betel nut chewing habit & 25 healthy controls without any deleterious habits. All the patients were evaluated for fibrinogen degradation productions and total serum protein concentration (TSP) by agglutination and Biuret method respectively. The results were analysed using unpared ttest and Pearson chi square test. Results: The study revealed an increased FDP level in all the betel nut chewers with OSF when compared with the healthy individuals. There was a marginal increase in Total serum Protein concentration levels in OSF patients, thus inferring to a positive correlation between FDP and TSP in all OSF cases. Conclusion: This study validates the relationship of plasma FDPs in the etiology of OSF and can be used to measure the prognosis of the disease. Plasma FDP may also be useful as a nonsurgical diagnostic tool in suspected OSF cases without necessitating a histopathological confirmation. However, further studies with a larger sample size may be required to elucidate the precise role of plasma FDP levels and detailed fractional analysis of protein in OSF, thus facilitating to obtain more conclusive results. It can be suggested that biochemical assessment of patients with areca nut chewing habit may help in the earlier diagnosis of OSMF and thus may lead to a better prognosis of these lesions.

Estimation and correlation of plasma fibrinogen degradation product (FDP) and salivary fibrin precipitating factor (FPF) in oral sub mucous fibrosis (OSMF) patients, betel quid chewers without OSMF and healthy individuals. The study aims to evaluate whether FDP and FPF can be used as a marker for development and progression of OSMF and whether there is any correlation between the two. The study included 163 subjects grouped into three categories, Group 1, which included 54 control patients, Group 2, which included 55 betel quid chewers, and Group 3, which included 54 clinically confirmed OSMF patients. All of them were subjected to the estimation of plasma FDP and salivary FPF. FDP was present in 52 (96.3%) patients in Group 3, 2 (3.6%) patients in Group 2, and 1 patient in Group 1 (1.9%). FPF was positive in eight patients. The correlation of FDP and FPF was done by Fisher's exact test and was found to be statistically nonsignificant. In the present study, FDP was positive in 52 (96.3%) OSMF patients; hence, FDP may be used as an early indicator of OSMF. FDP was found to be positive in two patients with a habit of chewing betel quid without OSMF. It may be hypothesized that these patients are more likely to develop OSMF. Hence, the estimation of FDP may be used as a diagnostic test to predict an impending OSMF before it could manifest itself clinically. FPF was negative in some OSMF patients, may be because it is below the detectable range.

Aim:To investigate the presence of lysyl oxidase (LOX) G473A polymorphism in group 1 {Oral submucous fibrosis (OSMF) patients}, group 2 (betel quid chewers without OSMF) and group 3 (healthy individuals).Materials and Methods:A total of 60 patients were taken for the study, which included 20 OSMF patients (group 1), 20 betel quid chewers without OSMF (group 2) and 20 healthy individuals without OSMF and betel quid chewing habit (group 3). DNA was isolated using Qiagen kit. The isolated DNA was quantified using spectroscopic methods. Polymerase chain reaction (PCR) was carried out at annealing temperature of 67o C. PCR amplification was checked on 2% agarose gel. Further, the amplified PCR products were subjected to automated DNA sequencer, to assess LOX G473A polymorphism.Results:The gene sequence data generated from the automated DNA sequencer was received as colored electropherograms. These gene-sequencing results did not show LOX G473A polymorphism in any of the 3 groups.Conclusion:In our study, gene-sequencing results did not show LOX G473A polymorphism in OSMF patients. Since only one study in the literature has shown the association of LOX gene polymorphism and OSMF patients, we conclude that further studies are required to unveil the role of LOX gene polymorphism in OSMF.

Background:Serum homocysteine (Hcy), a nonessential amino acid, is considered as a helpful indicator of vitamin status for its strong correlation with Vitamin B12. Although Hcy levels in oral submucous fibrosis (OSMF) have been studied, the relationship between Hcy and Vitamin B12 has not been studied yet. This study is the first one to compare and correlate the levels of serum Hcy and Vitamin B12 in OSMF patients.Materials and Methods:The study group comprised 60 patients. Serum Hcy and Vitamin B12 estimation were done by chemiluminescence immunoassay. These levels in OSMF patients were compared and correlated with corresponding levels in healthy controls.Results:Hcy levels were elevated in OSMF and were found to be statistically significant (P = 0.014) as compared to healthy controls. On the contrary, although Vitamin B12 levels were found to be higher in healthy controls, the difference was statistically nonsignificant (P = 0.657). A significant correlation was found (P = 0.01) between Hcy and Vitamin B12 in both groups, i.e., decreased Vitamin B12 levels led to elevated Hcy levels but vice versa was not found. No correlation was found between levels of Hcy and the severity of OSMF (P = 0.806).Conclusion:Chronic inflammation in OSMF leads to hyperhomocysteinemia, which may also be seen in cases of Vitamin B12 deficiency and certain systemic disorders. Thus, while serum Hcy could be used as biomarker for OSMF, Vitamin B12 deficiency and certain systemic disorders should be ruled out.

Objectives: The increased muscle activity and diminished blood supply following connective tissue changes in Oral Submucous Fibrosis (OSF) patients lead to muscle degeneration and fibrosis. The histopathological examination of OSF patients confirms fibrosis, but it also causes scarring and worsens OSF. Ultrasonography (USG) has been utilized in recent research to assess the echogenic patterns of the head and neck muscles in OSF patients. The study aimed to compare the echogenic pattern of the masseter muscle in OSF patients to that of normal mucosa using USG. Methods: The study population was split into cases and controls. The cases were 63 subjects who were clinically diagnosed with OSF. In comparison, the controls were 63 subjects who were randomly selected from the outpatient clinic of Oral Medicine and Radiology, Government Dental College, Thiruvananthapuram. According to Khanna and Andrade’s criteria, OSF subjects were divided into four groups based on their clinical findings. A high-resolution real-time LOGIQUE C5 ultrasonic scanner with 7-12MHz transducers was used to image the masseteric muscle. Results: In the present study, type II internal echogenic pattern (64.4 %) was predominant, followed by type III and type I in OSF subjects. So, type I internal echogenic patterns might be associated with normal muscles, and types II and III internal echogenic patterns might be associated with pathologic changes. A good interobserver agreement was observed. Conclusion: In OSF patients, the appearance of the masseter muscle’s internal echogenic pattern showed a varied pattern from that of normal types.

Background: According to the WHO, stroke is the second most important cause of death in elderly people with age &gt;60 years and fifth leading cause in the age group of 15 to 59 years. Hyperhomocysteinemia has been linked to increased incidence of ischemic strokes. Thus, the aim of the present study was to assess serum homocysteine levels as an individual risk factor of stroke in young patients.Methods: This was a prospective, cross-sectional, single center study performed in 50 patients admitted in the Department of Medicine, Thanjavur Medical College and Hospital, Thanjavur, over a period of 7 months (i.e., from December 2013 to June 2014). Young patients, aged 1545 years, and diagnosed with stroke were included in the study. Serum homocysteine was measured by fluorescein polarization immunoassay (FPIA). Significant difference between the patients with normal and elevated mean serum homocysteine levels was identified by using unpaired t-test. P value ≤0.05 was considered as statistically significant.Results: Majority of the stroke patients were male (78%). Similarly, male patients dominated the total number of patients with elevated serum homocysteine levels (75%). Thirty-two (64%) patients had an elevated serum homocysteine level. There was a significant difference between the patients with increased homocysteine levels as compared to patients with normal homocysteine levels (p value &lt;0.05). Out of 32 patients with hyperhomocysteinemia, 27 (84.38%) patients had ischemic stroke, 4 (12.50%) had cortical vein thrombosis and 1 (3.12%) had hemorrhagic stroke.Conclusions: Findings of the present study confirm that hyperhomocysteinemia is associated with an increased incidence of stroke in young patients. As healthcare providers, we must stress on prevention of stroke, especially by identifying treatable risk factors.

Introduction Oral submucous fibrosis (OSMF) is a persistent, collagen metabolic disorder distinguished by the presence of fibrosis of the connective tissue stroma in the oral mucosa with a higher malignant potential rate for oral cancer. This study aimed to analyze the utility of electromyography (EMG) as the prognostic assessment tool in the management of OSMF with conventional intralesional corticosteroid therapy. Materials and methods This study included 20 OSMF cases of age range 20 to 80 years without systemic comorbidities to assess pre-treatment and post-treatment changes with intralesional corticosteroid therapy as an intervention and to determine if it could be assessed using electromyographic study. Clinical and histopathological grading of OSMF was done. The five clinical parameters were evaluated for measuring treatment prognosis. Among them, mouth opening, tongue protrusion, and burning sensation assessments were quantitative parameters, and palpable fibrotic bands and mucosa colour were qualitative parameters. As OSMF involves changes in muscle plane in moderately advanced and advanced cases, EMG was used as an assessment tool for measuring muscle activity. Among the muscles of mastication, the masseterand temporalis were selected for evaluation. Twenty age and gender-matched healthy controls were required for this study as there are no standardized normal values for amplitude and onset of activity in muscle analysis. The EMG activity of the right and left temporalis and masseter muscles were recorded using surface electrodes and were correlated with five clinical assessment parameters. Results In the right masseter, the rest amplitude of 1.6010 µV of the OSMFwas statistically significant (p-value: 0.050) when compared with 4.1275 µV of the control. The clench amplitude of 133.370 µV of the OSMFwas statistically significant (p-value: 0.062) when compared with 94.310 µV of the control. In the left masseter, the rest amplitude of 1.6695 µV of the OSMFwas statistically significant (p-value 0.066) when compared with 2.5735 µV of the control. In the left masseter, the onset of muscle action of 62.670 ms of the OSMFwas statistically significant (p-value: 0.017) when compared with 131.835 ms of the control. The clench amplitude differences in the right masseter of 133.370 µV pre-treatment, and 102.775 µV post-treatment were statistically significant (p-value: 0.007). The clench amplitude in the left masseter of 102.535 µV pre-treatment, and 92.090 µV post-treatment were statistically significant (p-value: 0.036). The correlation was seen between tongue protrusion and rest amplitude in the right masseter in OSMF (r = 0.376, p-value: 0.023). Conclusion There was a correlation between tongue protrusion and rest amplitude in the right masseter muscle in OSMF patients before treatment. In the right and left masseter, during rest, the amplitude of the OSMF group was lesser than that of the control group. During clench, in the right masseter, the amplitude of the OSMF group was higher than that of the control group. During clench in the left masseter, the onset of muscle action was lesser in the OSMF group than in the control group. After treatment, there was a reduction in clench amplitude in OSMF patients from their pretreatment values signifying muscle relaxation and a better onset of muscle action.

Aims: The present clinico-radiological study was done to evaluate the morphological variants of soft palate in oral submucous fibrosis (OSMF) patients using digital lateral cephalometry. Different variations in the morphology of soft palate were compared with stages of OSMF. Further, soft palate morphology in OSMF patients was compared radiographically with that of normal population. Materials and Methods: A total number of 100 patients who were a part of this study were divided in two equal Groups. Group 1 comprised of 50 patients clinically diagnosed with OSMF and Group 2 included 50 routine patients. Results: Six different morphological variants of soft palate were found. Among the study Groups, type 1soft palate was most commonly seen (56%) whereas type 5 was the least common variant. Majority of patients belonged to stage II OSMF and type 1soft palate was commonly seen in this stage of disease whereas butt shaped soft palate (type 3) was more common in stage III OSMF. Conclusion: In OSMF, type 1 and 2 are commonly seen but as the diseases advances, these are replaced by type 3 and 6 variants. In OSMF patients, there in reduction in the anterio-posterior dimension of soft palate.

Oral submucous fibrosis (OSF) could have a significant impact on daily life activities of affected individuals. The objective of this study was to investigate the impacts of OSF on oral health-related quality of life (OHRQoL). A total of 206 clinically diagnosed OSF patients were recruited and subjected to the condition-specific OHRQoL-OSF instrument and global self-ratings of oral health and overall well-being. "Discomfort and functional impairment" dimension was highly prevalent among patients with all stages (p<0.001). OSF also has impacts on other domains, namely "psychological wellness" (82.35%) and "social wellness" (61.16%). Stage IV OSF (25.94±4.05) patients reported higher OHRQoL-OSF scores as compared to stage III (16.20±2.58) and stage II OSF (7.26±1.70) patients. However, stage I OSF patients reported significantly better OHRQoL (p<0.001). A significant trend demonstrating overall OHRQoL-OSF scores increasing with advancing stages of OSF was observed. The majority of the participants rated their overall oral health status "fair" (34.95%) to "very poor" (26.21%), whereas overall well-being was rated as moderate (33.00%) to good (31.55%). OSF has a significant impact on OHRQoL. Increasing severity of OSF is associated with the worsening QoL.

Background: With serious oral and systemic implications, oral submucous fibrosis (OSMF) is a crippling disorder that is common in some areas, especially among areca nut chewers. A thorough investigation of the relationship between OSMF and hearing impairment is necessary due to the growing evidence that, despite its well-established effects on dental health, there may be a connection. Aim: To investigate the association between OSMF and hearing impairment, particularly the mechanisms behind Eustachian tube dysfunction (ETD) and auditory dysfunction in OSMF patients. Methodology: This systematic review aimed to assess the association between hearing impairment and OSMF using the PICOS framework. A comprehensive search of 1137 articles published between 2015 and 2024 across various databases was conducted, resulting in 18 studies meeting the inclusion criteria. Data on population demographics, audiological assessments, and outcomes were extracted independently by 3 reviewers. The quality of the included studies was evaluated using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. Risk of bias assessments was conducted to categorize studies as low, moderate, or high risk. Results: The review identified 18 studies examining the link between OSMF and hearing impairment, revealing a significant correlation between OSMF severity and hearing loss. Patient-reported hearing issues ranged from 27.69% to 76.7%. Conductive hearing loss was prevalent, particularly in advanced OSMF stages. Most studies employed pure tone audiometry and tympanometry, highlighting ETD as a common contributor. Quality assessments indicated that most studies had good methodological rigor, with several rated as very good, underscoring the need for comprehensive evaluations in understanding the audiological implications of OSMF. Conclusion: There is a substantial association between OSMF and hearing loss, particularly through ETD. Multidisciplinary management and early audiological screening are essential for improving outcomes in OSMF patients.