Cheek Flexibility Research Articles

Comparative Efficacy of Oxitard Capsules and Immusante Tablets in Early Stages of Oral Submucous Fibrosis - A Randomized Controlled Trial

Objective: Oral submucous fibrosis (OSMF) is manifested by symptoms such as palpable fibrotic bands, ulceration, presence of stiffness in the mouth and lip, xerostomia, pigmentation in the oral mucosal layer, and burning sensation and drying of the mouth. It poses a challenge for researchers as there is no viable therapy for this gradually debilitating disorder with a high malignancy potential. Ayurveda is a traditional medicinal practice of the past and present times which can be useful in providing a viable cure. Thus, the current study was designed to assess and compare the effect of Oxitard capsule and Immusante tablet on the clinical and subjective symptoms of OSMF. Material and Methods: The study included 36 patients with clinically diagnosed OSMF who were split evenly into two groups: Group A, the Oxitard group, and Group B, the Immusante group. For three months, Group A received two Oxitard capsules twice daily, while Group B received two Immusante tablets twice daily. At regular intervals, the clinical parameters were evaluated, and the data were analysed using repeated measures ANOVA and the Bonferroni post hoc test. P-value≤0.05 was regarded as statistically significant. Results: On assessment of mouth opening, tongue protrusion, cheek flexibility and subjective symptoms there was significant improvement reported in both groups. In group comparison, the Oxitard and Immusante groups showed a significant difference in cheek flexibility at 3 months. There were no significant differences in subjective symptoms in either of the groups pre- and post-treatment. Conclusion: Efficacy of both the drugs were equall was found to be similar when used as an adjunct to tobacco cessation counselling in the management of early stages of oral submucous fibrosis when used as an adjunct to behavioral management.

Drug treatment for oral submucous fibrosis: an update

ObjectiveThe aim of this review is to evaluate the different medicinal interventions available for the management of oral submucous fibrosis (OSF).Materials and methodsWe conducted a comprehensive electronic search on PubMed, Web of Science, and Cochrane Library databases for articles related to OSF patients treated with medications from December 2011 to September 2022. GRADE system was used to evaluate the evidence quality. The reporting of the systematic review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The main outcomes were the improvement of maximum mouth opening, burning sensation, cheek flexibility, and tongue protrusion.ResultsTwenty-nine randomized controlled trials (RCTs), five clinical trials (CCTs) were included, and the use of drugs for OSF treatment were evaluated. Drugs like steroids, hyaluronidase, pentoxifylline, lycopene, curcumin, dpirulina, aloe vera, omega3, oxitard, allicin, colchicine have been used. It was found that drugs with evidence high quality were salvia miltiorrhiza combined with triamcinolone acetonide, lycopene, pentoxifylline, curcumin, and aloe vera, and those with evidence moderate quality were allicin, colchicine, omega 3, and oxitard.ConclusionBased on the results of our comprehensive analysis, for long-term treatment, we found lycopene with low side effects, whereas for relieving the symptoms of severe burning sensation, aloe vera is the most effective. Although the recent review has made some progress, drug therapy for OSF remains unclear, and more high-quality RCTs are needed to identify better treatments for OSF.

Comparative evaluation of autologous platelet rich plasma and triamcinolone acetonide injection in the management of erosive lichen planus and oral submucous fibrosis: a clinical study

Background: It is need of an hour to establish an effective and efficient treatment modality for OLP and OSMF with lesser or no adverse effects. Platelet rich plasma can be used in mucosal lesions as it has a high concentration of various growth factors and anti-inflammatory properties. It could be a better novel substitute to the corticosteroid without any side effects. The present study is an effort to evaluate the therapeutic effects of intralesional injection of PRP in oral erosive lichen planus and OSMF compared to intralesional corticosteroids in the same patient. Methods: It was a randomized controlled clinical study consisting of 40 patients between the age groups of 18-60 years visiting dental OPD diagnosed clinically with either erosive lichen planus or OSMF. Triamcinolone 40 mg(1mg/ml) mixed with 2% (1:80,000) lignocaine hydrochloride was injected into the lesion on one side in case of erosive lichen planus and into the submucosal plane and fibrous bands in case of OSMF patients. Autologous PRP was prepared and injected on the other side in same patients. At every visit, all the patients were evaluated for pain and burning sensations, size, and severity of the lesion, and interincisal mouth opening (mm). The parameters were measured and recorded during the patient’s every visit. All the results were obtained and statically analyzed. Results: Intralesional injections of triamcinolone acetonide and PRP are effective in reducing pain and burning sensation in OSMF, but PRP is less effective in improving cheek flexibility as compared to triamcinolone acetonide. In OLP, both triamcinolone acetonide and PRP are almost equally effective in reducing the size of the lesion. However, PRP shows slightly better results in reducing the severity of the lesion and in pain and burning sensation in the patients of OLP as compared to intralesional triamcinolone acetonide. Conclusions: Thus, PRP is an effective modality in treating both OSMF and oral erosive lichen planus with no adverse effects.

Comparative effectiveness of medicinal interventions for oral submucous fibrosis: A network meta-analysis

ObjectivesThis network meta-analysis presents an exhaustive description and comparison of the available medical interventions for the management of oral submucous fibrosis (OSMF). Materials and methodsA systematic review and network meta-analysis was conducted after registration with PROSPERO. (PROSPERO ID CRD42022303441). Databases (PubMed, Cochrane, EMBASE, Web of Science, and others) were searched for randomized clinical trials (RCT) trials from inception till September 2022 for the medical interventions in OSMF. The primary outcome was the improvement in mouth opening. The secondary outcomes were improvement in burning sensation, tongue protrusion, and cheek flexibility. The interventions were ranked according to their efficacy based on the surface under the cumulative ranking. Results47 studies including 2393 patients were assessed for quantitative analysis. For mouth opening, the combined treatment with steroid, hyaluronidase, and antioxidant was most effective [MD, 7.05 (95%CI 1.76,12.34)], followed by the combination of oral antioxidants with injectable steroids, [MD, 3.80 (95%CI -0.44,8.03)]. Additionally, the combined treatment with steroid, hyaluronidase, and antioxidant was most effective in reducing the burning sensation [MD, -8.62(-10.95,-6.30)], followed by aloe vera [MD, -8.45(-10.40,-6.49)] and pentoxifylline [MD -7.57(-9.46,-5.68)]. For tongue protrusion, curcumin was most effective followed by antioxidants. Most of the drugs used were reported to cause negligible or mild adverse effects. ConclusionThis network meta-analysis reported the efficacy of medicinal interventions in OSMF patients compared to the placebo in the improvement of mouth opening and burning sensation, and cheek flexibility. The methodological quality of included RCTs was low. Well-designed studies are recommended to obtain strong evidence.

Efficacy of Curcumin in Combination with Intralesional Dexamethasone with Hyaluronidase in the Treatment of Oral Submucous Fibrosis: A Randomized Controlled Trial.

The objective of this study was to determine the efficacy of curcumin in combination with intralesional dexamethasone with hyaluronidase in the treatment of oral submucous fibrosis (OSF). This randomized, double blind, parallel design, clinical trial was conducted at B.P. Koirala Institute of Health Sciences, Nepal. Thirty-four patients with clinically diagnosed OSF were randomized into two groups (17 participants in each) with baseline treatment of intralesional dexamethasone with hyaluronidase for 6 weeks for the both. Curcumin (2gm/day) was provided to Group A (Test) and Group B (Control) received placebo. Interincisal mouth opening, tongue protrusion, cheek flexibility and visual analogue scale (VAS) scoring of burning sensation of oral mucosa was recorded at baseline, 6, 8 and 12 weeks follow-up and independent t-test was used to compare the improvements in two groups. On comparing the 6 weeks and baseline values, in Group A and B the mean difference in mouth opening was 8.82±1.33 mm and 5.53±1.17 mm respectively (p<0.001), in cheek flexibility was 2.94±1.02 mm and 1.94±1.24 mm respectively (p=0.02) and in tongue protrusion was 6.23±1.48 and 3.65±1.37 mm respectively (p<0.001). The findings were consistent in the 8 weeks follow-up. In 12 weeks follow-up, on comparing with the baseline values, in Group A and B, the mean difference in mouth opening was 8.71±1.16 mm and 5.35±1.22 mm respectively (<0.001), ), in cheek flexibility was 2.81±1.01 mm and 1.76±1.35 mm respectively (p=0.02) and in tongue protrusion was 6.06±1.48 and 3.35±1.50 mm respectively (p<0.001). Both the arms showed 100% improvement in burning sensation in 6, 8 and 12 weeks follow-up. Curcumin in combination with intralesional dexamethasone with hyaluronidase is efficacious in the treatment of OSF.

Effectiveness of Omega-3 Fatty Acids and Spirulina as an Adjuvant Antioxidant to Corticosteroid in the Treatment of Oral Submucous Fibrosis – A Comparative Study

Introduction: Oral submucous fibrosis (OSMF) is a chronic insidious and a well-recognized potentially malignant disorder of the oral cavity. Due to its high morbidity and malignant transformation rate, relentless efforts have been made to improve effective management, despite not much improvement in the prognosis. Omega 3 polyunsaturated fatty acids have been reported to have anti-inflammatory properties. With its antioxidant, anti-inflammatory, and immunomodulating properties, Spirulina has shown promising results in the management of OSMF. This present study was conducted to compare the effectiveness of Omega-3 fatty acids and Spirulina in the management of OSMF. Aims and Objectives: To find out and compare the effectiveness of Omega-3 fatty acids and spirulina in the management of OSMF. Methods and Material: 40 OSMF patients with clinically diagnosed OSMF were selected and divided into two groups. Group A was given biweekly intralesional injections of 1.5 ml Dexamethasone in 4 mg/1 ml and Hyaluronidase 1500 IU mixed with Lignocaine 0.5 ml for six weeks and with omega-3 fatty acid capsules 1 gm three times daily for three months. Group B received similar intralesional injections but with spirulina 500 mg twice daily for three months. All the patients were followed up every month for 3 months and then after six months. Results: Both groups improved mouth opening, cheek flexibility, and VAS burning sensation except tongue protrusion (p &lt; 0.05). When the efficacy was compared between two drugs, statistically insignificant results were found for mouth opening, tongue protrusion, cheek flexibility, and burning sensation. Conclusion: Omega 3 and Spirulina can be effective adjunctive treatment options in patients with OSMF to reduce subjective symptoms. Statistically, significant improvement was seen in both groups.

Clinical Assessment of Efficacy of Omega 3 in Oral Submucous Fibrosis Patients - A Randomized Controlled Trial.

Background:Oral submucous fibrosis (OSMF) is a chronic, potentially malignant condition affecting the oral cavity. Omega 3 has shown innumerable health benefits in yesteryears. So, the aim of the study was to evaluate the efficacy of Omega 3 in the medical management of this disease. Methods:A randomized controlled trial was designed and 48 clinically confirmed patients of OSMF (24 in each group) completed the study. Patients of both the groups were given biweekly intralesional injections of dexamethasone 1.5ml, hyaluronidase 1500 IU mixed with lignocaine for 6 weeks. Additionally, group A received a placebo (lactose capsule) for 3 months while group B received 1gm of omega 3 (flaxseed oil) three times daily continuously for 3 months. Patients were followed every month for 3 months and then, after 6 months and one year. Results:During the first two months, improvement was observed in both the groups independently but intergroup comparison showed no significant difference. However, after 3 months statistically significant (p<0.05) improvement among all three clinical parameters i.e. inter-incisal distance (mean improvement in group A = 3.79±1.07mm and group B = 6.58±1.24mm, p=0.019), tongue protrusion (mean improvement in group A = 1.87±1.54mm and group B = 4.62±1.78mm, p=0.044) and cheek flexibility (mean improvement in group A = 2.08±1.38mm and group B = 3.50±1.84mm, p=0.035) was observed in group B when compared to group A. In contrast, statistically significant improvement in burning sensation was observed after one month itself in group B when compared to group A (mean drop in group A = 2.5±0.78 points and group B = 6.0±1.144 points, p<0.05). Conclusion:Omega 3 in conjunction with intralesional injections is an effective therapy when compared to intralesional injections alone in treatment of patients with OSMF (grade II and III) with no side effects.

Correlation of Clinical Features in Oral Submucous Fibrosis: A 9-Year Retrospective Study.

Oral Submucous Fibrosis is a chronic debilitating disease and potentially malignant disorder of the oral cavity known in medical literature for a long time. The study aims to correlate the clinical staging of Oral Submucous Fibrosis with various clinical findings of the oral mucosa like hyperpigmentation, erosions, ulcerations, VAS score, tongue protrusion, and cheek flexibility. A retrospective observational study was undertaken and records of 1267 clinically diagnosed cases of OSMF were included in the study. Clinical grading was done as per criteria by Lai DR et al. The observations were tabulated and subjected to statistical analysis using SPSS software. In our study, the incidence of hyperpigmentation, erosions, and ulcerations was higher in Group C OSMF. Visual analog scores in the range of 5-6 was noted in 40.9% of the total subjects, out of which 36.2% belonged to Group C OSMF. Tongue protrusion of less than 25 mm was seen in 10.65% of the subjects. Cheek flexibility of less than 0.6 cm was seen in 19.62% of the subjects, most of which belonged to Group D. In our study, we found an increase in the occurrence and severity of symptoms with an increase in grades of OSMF, but this increase was not observed to be consistent. Hence classification based on a single clinical entity cannot be sufficient and correlations to other clinical findings should be studied over a large population and a multi-tier classification could be proposed in the future.

Black Turmeric and Aloe Vera in the Management of Oral Submucous Fibrosis: A Prospective Clinical Study.

Aim:To determine the therapeutic efficacy of Kali haldi in the management of Oral submucous Fibrosis (OSMF) v/s steroid therapy. Materials and Methods:A clinical prospective study was conducted on 42 patients of oral submucous fibrosis were equally divided into 2 groups. Group A patients were treated with a mixture of powdered Kali Haldi and aloe vera gel in equal ratio 3 times a day for 3 months. Group B patients were treated with intralesional injection of hydrocortisone and hyaluronidase for 6 weeks with oral antioxidant supplements for 3 months. Burning sensation, cheek flexibility, mouth opening, and tongue protrusion were evaluated before, during, and after treatment at an interval of 15 days, 1 month, 2, month and 3 months. Results:Statistically significant results were obtained at the end of 3 months duration for both the groups (P < 0.001). The Symptomatic correction was more evident in the case of Group A patients than Group B. Response of the ayurvedic regimen was potentially better as compared to the regular steroid therapy. Conclusion:The study concludes that Combination therapy works wonders in the case of OSMF in stages I, II, III and can be a good option, comparatively safe and with negligible side effects, but potent and equally effective management of oral submucous fibrosis. Henceforth, it will be better to do such kinds of studies on a vast scale including larger samples and longer duration to check the efficacy and durability of this ancient ayurvedic regimen.

Efficacy of collagen-silicone bilayer membrane in the management of oral submucous fibrosis: a prospective case series.

Oral submucous fibrosis is a scourge of Southeastern Asia since a long time resulting in significant health and social problems. Mainstay of the treatment is concentrated on attempts to improve mouth opening and relieve the symptoms by medicinal or surgical means. In moderate to severe cases, release of fibrous bands is advocated followed by placement of graft. The present study was conducted to evaluate the use of collagen-silicone bilayer membrane as a mucosal substitute in its management. Study consisted of 12 clinically and histologically proven cases of OSMF. After the incision and release of fibrous bands, a collagen membrane was placed and secured over the raw area by placement of a silicone sheet of adequate thickness. Parameters were assessed pre-operatively, intra-operatively, and post-operatively at 1week, 1month, and 3months. The data was recorded and statistical analysis was done. Pre-operatively, the mean values of inter-incisal opening, cheek flexibility, and width of oral commissure were 16.92, 24.58, and 53.17mm respectively whereas at 3months post-operatively, it was 27.67, 26.58, and 55.00mm, which was statistically significant. No incidence of infection was noted. The study concludes that the use of collagen membrane along with silicone sheet can be an alternative to other graft materials in context of reduced donor site morbidity as well as significant increase in inter-incisal opening. However, study with more sample size is needed to assess the long-term efficiency and surgical outcome of this material.

Turmeric in the management of oral submucous fibrosis: A systematic review and meta-analysis.

Turmeric exhibits a big promise as a therapeutic agent in the management of oral submucous fibrosis (OSMF). The primary aim of our study is to synthesize the evidence of the use of turmeric/curcumin in the management of OSMF. The secondary goal of this study is to assess the limitations of previous studies to identify gaps in evidence for future research and give an evidence-based recommendation regarding the usage of turmeric/curcumin for OSMF patients and outline the direction of research. A comprehensive search of PubMed, Web of Science, Scopus, Cochrane Library database, Google Scholar, clinical trial registries, and hand searching was conducted from inception until December 2018. This systematic review was conducted according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (guidelines). In this review, 11 articles were selected for qualitative analysis and 3 out of 11 were selected for meta-analysis. Of these 11 studies, involving 428 patients, 7 were randomized control trials (RCTs), 1 was a nonrandomized trial, and 3 were observational studies. Turmeric was found to be effective in reducing signs and symptoms of OSMF in all 11 studies. All the studies included in this review have reported improvement in mouth opening after treatment with turmeric formulations. This could also be concluded from the meta-analysis of three RCTs. Similar improvement in tongue protrusion, burning sensation, and cheek flexibility has been reported. The lack of reliable evidence for the effectiveness of turmeric for the management of OSMF is illustrated by the paucity and poor methodological quality of studies retrieved for this review. We recommend that RCTs are needed using larger sample size with longer duration follow-up with special attention to the recurrence of signs and symptoms.

COMPARISON OF SYSTEMIC CURCUMIN AND INTRALESIONAL STEROID INJECTIONS IN THE MANAGEMENT OF ORAL SUBMUCOUS FIBROSIS: A CLINICAL STUDY

Objective: To compare the efficacy of curcumin to intralesional steroid injections in the treatment of oral submucous fibrosis (OSMF).&#x0D; Study design: Forty patients with clinically and histologically proven OSMF were divided into 2 groups. Group I patients were given oral administration of 2 capsules of curcumin 300mg once daily for 3 months. Group II patients were given weekly intralesional injections of a combination of dexamethasone and hyaluronidase for six weeks and antioxidant capsules (Cap. SM Fibro - Alpha lipoic acid 50mg, Beta-carotene 10mg, Elemental copper 1mg, Elemental selenium 75mcg, Lycopene 5mg, Vitamin E 10 IU, Zinc sulphate 27.45mg) once daily for 3 months. Patients were assessed for burning sensation, inter incisal distance, cheek flexibility and tongue protrusion at an interval of every 15 days for 3 months. Physiotherapy for mouth opening was advised twice daily for 6 weeks in both the groups and assessed in each visit.&#x0D; Results: Both curcumin group and intralesional injection group showed reduction in burning sensation with p&lt;0.05 which was statistically significant at 75 days. Statistically significant improvement was noted in inter incisal distance, cheek flexibility and tongue protrusion at 30 days and 75 days of the study period in the both the groups.&#x0D; Conclusion: Curcumin capsule is effective, safe and alternative treatment modality in OSMF.

An overview of effect of lycopene and curcumin in oral leukoplakia and oral submucous fibrosis.

The purpose of the current article was to evaluate the recently published researches on the use of lycopene and curcumin in oral leukoplakia (OL) and oral submucous fibrosis (OSF). A comprehensive review of the current researches enveloping PubMed, Ovid, and Cochrane was made using the keywords [(Lycopene) OR (Curcumin) AND (Leukoplakia OR OL OR OSF OR OSMF OR OSF OR Submucous Fibrosis)]. We included only randomized control trials and in the English language. The search covers the data from 1994 to August 2020. Six studies (2 of OL and 4 of OSF) finally qualified are included in the study for the qualitative analysis of the result. Out of these six studies, four were found having high risk, one with unclear risk and one with low risk. Only one study came out as finally suitable for the quantitative analysis of the result. A total of 90 participants were included in this review, with a mean age of 32 with a range of 17–60 years. Out of 90 participants, 70 were male and 20 were female. It is evident from the result of this study that the use of oral curcumin and lycopene has significant improvement in the mouth opening, burning sensation, and cheek flexibility in comparison to the placebo. The use of oral curcumin and lycopene appears to be effective and safe in the treatment of OL and OSF but to read the result of use of oral curcumin and lycopene in OL caution should be taken because of bias.

Effectiveness of Pentoxifylline in the treatment of oral submucous fibrosis patients: a case-control study

BackgroundOral submucous fibrosis (OSMF) is a potentially malignant disorder largely seen in the South-Asian countries where areca nut is found to be the main predisposing factor. Pentoxifylline, a methylxanthine derivative, has vasodilating properties and is believed to increase the vascularity of the mucosal layer. This study was designed to determine the effect of pentoxifylline (Trental) on the clinical progression of oral submucous fibrosis. Aim: The present study was aimed to evaluate the effectiveness of drug pentoxifylline in the management of OSMF and to correlate the clinical parameters evaluated before and after treatment.MethodsStudy Design: This investigation was conducted as a case-control study incorporating a Control Group in comparison to a Study Group where pentoxifylline 400 mg was administered 3 times daily, as coated, sustained-release tablets for prescribed for 3 months. The stipulated period for the study was 8 months and a total of 80 cases of oral submucous fibrosis (40 test subjects and 40 controls) were included in this study and 100% acquiescence was reported at the end of the test period.ResultsMild dizziness and gastric irritation were the only untoward symptoms reported in 2 of the volunteers in the study group during this trial. These were managed by diet protocols. A review of the patients and controls was done at an interval of every 4 weeks for 3 months. The subjective and objective measurements were recorded. The follow-up data at each visit concerning each other and to base-line values were calibrated using nonparametric tests of the Chi-Square test and Mann-Whitney. Significant comparisons with regard to improvement were recorded as objective criteria of mouth opening (u value =1.137, p = 0.260), tongue protrusion (u value = 0.262, p = 0.794 and cheek flexibility (u value =0.990, p = 0.326). Subjective symptoms of burning sensation of mouth (U value = 2.673, p = 0.008), pain on opening the mouth (U value = 4.320, p < 0.0001), difficulty in swallowing and difficulty in the speech were also recorded.ConclusionThis study showed the effectiveness of pentoxifylline as an additional therapy in the routine management of oral submucous fibrosis.

Immunoexpression of alpha smooth muscle actin correlates with serum transforming growth factor-β1 levels in oral submucous fibrosis.

The aim of the present study was to correlate the immunoexpression of alpha-smooth muscle actin (α-SMA) for myofibroblasts with the serum levels of transforming growth factor-β1 (TGF-β1) in oral submucous fibrosis (OSMF). A total of 100 cases of histopathologically confirmed OSMF were assessed for α-SMA expression. Clinical data, such as age, sex, mouth opening, and habit history, were obtained for each case. Serum TGF-β1 levels were recorded in 73 patients with the help of enzymelinked immunosorbent assay technique. The staining index of α-SMA increased concomitantly with higher myofibroblast count in the increasing histopathological grades of OSMF (P≤.05). Serum TGF-β1 levels were highest in the intermediate grades of OSMF. Clinical parameters, such as mouth opening, cheek flexibility, and tongue protrusion, showed a direct correlation with increasing clinical grades of OSMF. The progressive increase in myofibroblasts from early to advanced stages suggests their potential use as markers for evaluating the severity of OSMF. Additionally, as myofibroblasts are responsible for producing a variety of factors that are involved in the fibrotic processes; they could be the key link in the pathogenesis of OSMF. Interruption of their development, recruitment, or activation could provide a unique therapeutic target for future treatment options in patients with OSMF.

Assessment of intraoperative risk factors for surgical difficulty in surgical extraction of impacted mandibular third molar – A prospective study.

The extraction of impacted third molars is among the most common surgical procedures carried out in the field of Oral and Maxillofacial Surgery. For proper planning of surgical extraction, especially for impacted mandibular third molars the estimated level of surgical difficulty of the case is important. This study was conducted to evaluate the intraoperative risk factors contributing to surgical difficulty in extraction of impacted mandibular third molars and consequently the post-operative outcome. Here, we have undertaken a study in which the intraoperative variables were considered, to evaluate their contribution for surgical difficulty and postoperative complications in surgical removal of 100 impacted mandibular third molars. Three variables were found significant associated with total surgical time intervention, i.e., surgeon’s experience (p=0.006), Inter-incisal opening (p=0.032), and cheek flexibility (p=0.004). Total surgical time intervention for ‘right side’ was higher with 49.20 ± 17.94 minutes (p=0.691). Total surgical time intervention for ‘gagging reflex present’ was 50.21 ± 17.812 (p=0.674). Multiple linear regression shows that surgeon’s experience was the only predictor (p&lt;0.001). The surgical difficulty of impacted mandibular third molar are likely to depend on the intraoperative factors like Surgeon’s time, surgeon’s experience, check flexibility, and inter incisal mouth opening.

Comparative efficacy of intralesional placental extract and intralesional triamcinolone acetonide in the management of OSMF

Context: Oral submucous fibrosis (OSMF) is characterized by excessive collagen production in the submucosa leading to progressive fibrosis of the oral mucosa and atrophic changes of the epithelium. Aim: To clinically evaluate the efficacy of intralesional injections of placental extract (2ml) in comparison to intralesional injections of triamcinolone acetonide (40mg/ml; 1ml) in the management of OSMF patients. Methodology: This randomized, parallel-group, single-blinded outcome-based study, consisted of 40 diagnosed cases of OSMF. The patients were divided into two groups of 20 each in placental extract group and triamcinolone acetonide group. Patients were administered test medications weekly in respective groups by intralesional mode for a period of 10 weeks. Parameters taken into consideration and compared weekly were burning sensation, pain, mouth opening, tongue protrusion, and cheek flexibility. Result: The data so obtained was tabulated and subjected to statistical analysis using Chi-square test, Mann–Whitney test, Wilcoxon ranked test, and t-test by means of SPSS version 20 software to reach conclusive results. There was significant improvement in burning sensation, pain, mouth opening, tongue protrusion, and cheek flexibility in both groups. Better and faster improvement in tongue protrusion and cheek flexibility was achieved in triamcinolone group as against placental extract group. Conclusion: The intralesional triamcinolone acetonide was found to be a superior intralesional drug in comparison to placental extract.

Efficacy of Spirulina along with Different Physiotherapeutic Modalities in the Management of Oral Submucous Fibrosis.

Context:Oral submucous fibrosis (OSMF) is an insidious, chronic, disabling disease that mainly affects the oral mucosa. Spirulina is a freshwater microalga which is considered as superfood by the WHO. Due to its antioxidant, anti-inflammatory, and immunomodulating properties, spirulina has shown promising results in the management of OSMF. A wide range of treatment modalities have been tried ranging from medical, physical, or surgical interventions, but combinations of these have shown better results.Aims:The study aimed to evaluate the efficacy of spirulina along with different physiotherapeutic modalities in the management of OSMF.Setting and Design:The present comparative study was conducted in the Department of Oral medicine and radiology, College of Dental Sciences, Davangere, Karnataka, India. The block randomization technique was used in the present study to enroll patients into three different groups.Methods:The study consisted of 45 OSMF patients who were divided randomly into three groups. All patients were given spirulina 500 mg twice a day for 3 months. Group A patients were instructed to perform isometric mouth exercises for 20 min, twice daily. Group B patients and Group C patients perform exercises using threaded tapered screw and mouth stretching device (MSD), respectively, ten times bilaterally twice a day. Clinical parameters such as burning sensation, mouth opening, tongue protrusion, and cheek flexibility were assessed every 15 days.Statistical Analysis Used:Descriptive data that included mean, numbers, and percentages were calculated for each group and were used for analysis. For intra- and inter-group comparison, paired t- and unpaired t-test was used, respectively. For all the tests, P = 0.05 or less was considered for statistical significance.Results and Conclusion:All the groups have shown statistically significant improvement in burning sensation, mouth opening, tongue protrusion, and cheek flexibility (P < 0.05). Group C patients have shown better results followed by Group B and Group A patients. In the present study, spirulina along with different physiotherapeutic modalities was well tolerated by the patients, and significant improvement was seen in the MSD group.

Comparison of therapeutic response of lycopene and curcumin in oral submucous fibrosis: A randomized controlled trial.

To evaluate and compare the therapeutic response of lycopene and curcumin with placebo in patients suffering from oral submucous fibrosis (OSMF) and to correlate the habit variables of smoked and smokeless tobacco products in OSMF. A randomized placebo-controlled parallel clinical study was conducted on ninety OSMF patients, who were divided into three treatment groups using computer-generated randomization. Group A patients (n=30) were given curcumin tablet (300mg) twice daily, Group B patients (n=30) received lycopene capsules (8mg) twice daily, and for Group C (n=30), placebo capsules were given once daily for a period of six months. Both the participant and outcome assessor were blinded. Pre- and post-treatment comparison of mouth opening, burning sensation, tongue protrusion, and cheek flexibility was analyzed at periodic follow-up of 9months. The overall improvement in mouth opening, burning sensation, tongue protrusion, and cheek flexibility was 3.9±4.9mm, 4.8±2.6, 5.0±7.2mm, & 0.36±0.71mm, respectively, for curcumin and 4.1±4.2mm, 5.0±2.3, 2.4±3.5mm, & 0.66±0.80mm, respectively, for lycopene with the p value <0.05. Statistically significant improvement in clinical findings was observed in both curcumin and lycopene treatment groups in comparison with placebo. However, the therapeutic efficacy of curcumin and lycopene was found to be almost equal in OSMF patients.

Physiotherapy in Treatment of Oral Submucous Fibrosis Related Restricted Mouth Opening

BACKGROUND: Multiple treatment approaches including surgical and non surgical therapies have been tried to improve restricted mouth opening in Oral Submucous Fibrosis (OSMF).AIM: To evaluate the effectiveness of physiotherapy in improving mouth opening, tongue protrusion and cheek flexibility in patients with OSMF.MATERIALS AND METHODS: Forty eight OSMF patients were assigned into three groups by drawing chits. Group 1: patients receiving intralesional injections of dexamethasone and hyaluronidase; Group 2: patients receiving physiotherapy; Group 3: patients receiving both intralesional injections and physiotherapy. Mouth opening, tongue protrusion and cheek flexibility was assessed in all the patients before intervention and at different time intervals of 2 weeks, 4 weeks and 6 weeks after treatment.RESULTS: Intragroup: In Group 2, the mean values of mouth opening, tongue protrusion and cheek flexibility were increased in time but were statistically insignificant. The mean values of mouth opening, tongue protrusion and cheek flexibility were markedly increased over a period of time in Group 3 and cheek flexibility was found to be statistically significant (p = 0.05).Intergroup: The mean differences of mouth opening, cheek flexibility and tongue protrusion was found to be maximum in group 3 and it was statistically significant (p=0.03) for tongue protrusion.CONCLUSION: Concurrent treatment with physiotherapy and intralesional injections was found to improve the mean mouth opening, tongue protrusion and cheek flexibility. Hence, physiotherapy can be used as an adjuvant treatment for OSMF as it is non invasive, more patient compliant and doesn’t require any financial resources.