Mucous Fibrosis Research Articles

Frequency of Oral Sub Mucous Fibrosis and Its Correlation with the Level of Education in Patients Coming to a Tertiary Care Hospital of Karachi from January 2018 to December 2018

Objective: To determine the frequency of oral submucous fibrosis in patients coming to dental OPD of a tertiary care hospital and to correlate the association of level of education among patients of oral submucous fibrosis.Methodology: A cross sectional study was conducted from January 2018 to December 2018 among patients coming to the dental OPD of a tertiary care hospital in Karachi. Convenience sampling was used to select patients of Oral Submucous Fibrosis and a structured questionnaire was used to collect data on level of education, age, gender and Habit. Result: A total of 4405 patients visited the OPD and 135 patients were diagnosed with OSMF based on clinical findings. Mean age of OSMF patients was 33.6 years with nearly half 47.7% having no formal education.43.2% were skilled workers followed by 34.8% housewives and 22% were professionals. Betel nut was the most common used habit 79.5% among OSMF patients. Significant association of betelnut (p-0.001) among females(94.5%) compared to males (68.8%) and significant association of gutka (p-0.004) among males(24.7%) than females (5.5%)was observed. No significant association of level of education with substance abuse was observed. Conclusion: The finding of high frequency of betel nut usage among housewives and gutka among skilled workers is alarm some. Our literacy level despite being very low is not the sole reason of increase of substance abuse rather even the educated ones are not at par with this habit.

Management of Oral Sub-Mucous Fibrosis: An update

Oral submucous fibrosis (OSMF) is a complex, debilitating, and precancerous condition. Formerly restricted to the Indian subcontinent, it is now frequently seen in the Asian communities of the United Kingdom, the United States, and other developed countries, and thus constitutes a severe global health problem. Areca-nut, the well-known causative agent of the disease, is now recognized as a group one carcinogen. Several grading systems and management protocols have been published in the literature to deal with this progressive disease.Despite the numerous medical methods used in oral sub mucous fibrosis management, sometimes surgical intervention becomes inevitable. Here, we extensively reviewed existing literature to discuss about incidence, presentation, aetio-pathogenesis, medical and surgical management with outcome of OSMF
 J Bangladesh Coll Phys Surg 2020; 38(3): 135-144

Ordinal logistic regression model describing factors associated with extent of nodal involvement in oral cancer patients and its prospective validation

BackgroundOral cancer is the most common cancer among Indian men, and has strong tendency of metastatic spread to neck lymph node which strongly influences prognosis especially 5 year survival-rate and also guides the related managements more effectively. Therefore, a reliable and accurate means of preoperative evaluation of extent of nodal involvement becomes crucial. However, earlier researchers have preferred to address mainly its dichotomous form (involved/not-involved) instead of ordinal form while dealing with epidemiology of nodal involvement. As a matter of fact, consideration of ordinal form appropriately may increase not only the efficiency of the developed model but also accuracy in the results and related implications. Hence, to develop a model describing factors associated with ordinal form of nodal involvement was major focus of this study.MethodsThe data for model building were taken from the Department of Surgical Oncology, Dr.BRA-IRCH, AIIMS, New Delhi, India. All the OSCC patients (duly operated including neck dissection) and confirmed histopathologically from 1995 to 2013 were included. Further, another data of 204 patients collected prospectively from 2014 to 2015 was considered for the validation of the developed model. To assess the factors associated with extent of nodal involvement, as a first attempt in the field of OSCC, stepwise multivariable regression procedure was used and results are presented as odds-ratio and corresponding 95% confidence interval (CI). For appropriate accounting of ordinal form, the ordinal models were assessed and compared. Also, performance of the developed model was validated on a prospectively collected another data.ResultsUnder multivariable proportional odds model, pain at the time of presentation, sub mucous fibrosis, palpable neck node, oral site and degree of differentiation were found to be significantly associated factors with extent of nodal involvement. In addition, tumor size also emerged to be significant under partial-proportional odds model.ConclusionsThe analytical results under the present study reveal that in case of ordinal form of the outcome, appropriate ordinal regression may be a preferred choice. Present data suggest that, pain, sub mucous fibrosis, palpable neck node, oral site, degree of differentiation and tumor size are the most probable associated factors with extent of nodal involvement.

No age predilection for a disease like OSMF. A case report of 5-year-old child

BackgroundOral Sub Mucous Fibrosis (OSMF) is a clinical entity, well known since the time of Sushruta as ‘Vidari’. OSMF is a chronic subtle disease that is associated with significant functional morbidity and an increased risk for malignancy. Generally, OSMF is considered as an adult disease, but recently Indian suburb area has reported incidence of 0.2–1.2 percent in pediatric age group as well. The pathogenesis of the disease is not well established, but is believed to be multifactorial. Areca nut chewing is considered as the major etiology amongst all. Children indulge in habit of chewing areca nuts due to its easy availability of different forms of multicolored attractive areca nut pouches in markets. Other factors involved in the consumption of Areca nut are levels of awareness, household environment, peer pressure, low cost, etc. Case presentationA 5-year-old boy reported with the complaint of restricted mouth opening since 3–4 months. He had habit of chewing betel nut, a minimum of 2–3 sachets daily since one and a half years. He also complained of intolerance to spicy food. The oral mucosa was pale, opaque, blanched with a reduced mouth opening of interincisal width being 06 mm.Palate was fibrotic with shrunken uvula. ConclusionThis Case of OSMF in a 5-year-old boy is reported to be the first incidence of OSMF in a child with least interincisal opening of 06 mm.

Surgical management of oral submucous fibrosis with “Seagull-nasolabial flap” combined with short-term oral pentoxifylline for preventing relapse

The aim of the study was to evaluate the effectiveness of seagull-shaped nasolabial flap (NLF) along with adjunctive short-term oral pentoxifylline in the surgical reconstruction of oral sub mucous fibrosis (OSMF) following fibrotomy. We retrospectively evaluated 18 patients with grade IV oral sub mucous fibrosis treated by NLF. There were 3 females and 15 males. All patients were classified as stage IV OSMF with a mean preoperative mouth opening of 8.11±3.38mm. Postoperatively, patients were administered 400mg of pentoxifylline (PTX) thrice daily for 3 months. Patients were followed up at one month, six months and one year. Mouth opening, presence or absence of malignant transformation, relapse and complications were recorded at each follow-up. We found statistically significant increase in mouth opening from 8.11±3.3 to 37.67±3.74 in the postoperative period. The complications associated with NLF were very minimal. The PTX was well tolerated by all the patients. There was no incidence of relapse or rebound fibrosis seen in our series. To the best of our knowledge, this is the first time that oral pentoxifylline has been administered along with surgical treatment of oral submucous fibrosis to prevent relapse. The use of oral PTX as an adjunct along with surgical reconstruction in OSMF improves mouth opening, reduces burning sensation and relapse.

Expression profile of salivary micro RNA-21 and 31 in oral potentially malignant disorders.

Oral potentially malignant disorders (OPMD) possess significant chances of malignancy conversion. In order to develop an early diagnostic tool, the present study evaluated the expression of miRNA-21 and 31 as salivary markers. The case-control study was carried out in 36 healthy participants as controls and in 36 patients who were newly diagnosed as OPMD having four different lesions including leucoplakia, oral sub mucous fibrosis (OSMF)궱, oral lichen planus, and (OSMF)궱 with leucoplakia. The samples were also classified as non-dysplastic, or with mild, moderate, and severe dysplasia according to their histopathological reports. The salivary miRNA-21 and 31 expressions were studied using real-time PCR. The statistical analysis was carried out using SPSS version 22. Salivary miRNA-21 (p-value = 0.02) and 31 (p-value = 0.01) were significantly upregulated in severe dysplasia compared with control. Among the different lesions, leucoplakia had significant upregulation of miRNA-21 and 31. miRNA-21 can be used as a diagnostic marker with specificity of 66% and sensitivity of 69%. The area under the ROC curve was 0.820 for miRNA-21 and 0.5 for miRNA-31, which proved that miRNA-21 is a better diagnostic marker than miRNA-31 for OPMD.

Estimation of Levels of Glutathione Peroxidase (Gpx), Malondialdehyde (Mda), Tumor Necrosis Factor Alpha (Tnf Alpha) and Alpha Feto Protein (Afp) In Saliva of Potentially Malignant Disorders and Oral Squamous Cell Carcinoma.

The aim of the study was to estimate the levels of Glutathione peroxidase (GPx), malondialdehyde (MDA), Tumor necrosis factor alpha (TNF alpha) and Alpha feto protein (AFP) in saliva of potentially malignant disorders and oral squamous cell carcinoma, use them as an effective biomarkers in screening and diagnosis of oral squamous cell carcinoma as it is less invasive and more economical. 30 newly diagnosed patients with oral sub mucous fibrosis, oral leukoplakia, oral squamous cell carcinoma, who were not previously treated for the disease was selected for the study. 5ml of unstimulated saliva was collected from the patient for one minute in a sterile URICOL container and stored in sub-zero temperature before processing of the samples. Glutathione, malondialdehyde, alpha feto protein and TNF alpha was biochemically estimated and tabulated. There was increase mean concentration of glutathione, malondialdehyde, alpha feto protein and TNF alpha in carcinoma group and PMD group when compared to control group (p<0.05). Glutathione, Malondialdehyde, TNF alpha and alpha Feto protein are found to increase gradually from potentially malignant disorder to malignant condition. These factors can be used as potential biomarkers to indicate the prognosis of the disease and can be used as diagnostic tool for screening and early detection.

CLINICAL ASSESSMENT OF OCCURRENCE OF ORAL SUBMUCOUS FIBROSIS IN PATIENTS FROM PATNA DENTAL COLLEGE & HOSPITAL

Oral submucous fibrosis is a chronic progressive scarring disease of oral cavity and oropharynx characterized by epithelial atrophy and juxta epithelial inflammatory reaction with progressive fibrosis of the lamina propria and deeper connective tissue. The resulting stiffness of the oral mucosa then causes a progressive decrease in mouth opening. Hence based on above findings the present study was planned for Clinical Assessment of Occurrence of Oral Submucous Fibrosis in Patients from Patna Medical College & Hospital.
 The present study was planned in Department of Oral Pathology, Patna Dental College & Hospital, Patna. Total 50 cases of the patient diagnosed with the Oral Sub mucous Fibrosis (OSMF) were evaluated in the present study. History, examination and investigation of patients were done in detail as per predesigned proforma. Histopathological examination of biopsy tissue from oral mucosa was done in patients who had taken pre-therapy and post-therapy (if and when required). X-ray of temporomandibular joint was requested (whenever needed).
 OSMF is a commonly occurring and widely spread premalignant condition increasingly affecting the youth. The occurrence of OSMF in gutkha chewers is far faster and more severe as compared in other forms of areca nut products chewers. The easy availability and promotions of these areca nut products especially gutkha and pan masala outside the schools colleges and social places has impacted younger population in India which has led to the increased occurrence of OSMF.
 Keywords: Oral Submucous Fibrosis, OSFM, gutkha, pan masala, etc.

Management of Xerostomia in edentulous patient associated with multiple local conditions a case report

Saliva is an important factor in determining the quality of retention in prosthetic management of edentulous conditions. Edentulism associated with multiple local conditions such as hypopigmentation, diabetes, Asthma, oral sub mucous fibrosis, multiple carious lesions etc results in decreased overall flow of salivary rate resulting in xerostomic condition. Due to this, lubricating capability of the saliva gets compromised resulting in loss of comfort and retention of removable dentures.To counteract this problem, numerous techniques have been proposed for incorporating reservoirs that contain salivary substitutes into dentures. This article describes the simplified prosthetic approach in constructing a properly functioning salivary reservoir denture to provide good lubrication to the tissues. Keywords: Reservoir denture, Retention, Xerostomia, Artificial salivary substitute.

Pandemonium of oral flora in tobacco chewers and patients with associated oral cancer in a tertiary care hospital, Valsad, South Gujarat

Introduction: Tobacco chewing is a serious oral health problem in India responsible for halitosis, periodontitis, sub mucus fibrosis, leukoplakia and oral cancer. There is a need to understand the oral microbiological changes in tobacco chewers. Aim and Objective: To find out the changes in oral microbiota in tobacco chewing patients and patients with associated oral cancer. Materials and Methods: A case control study on 102 patients was conducted over a period of 2 months. Case group included subjects with tobacco chewing habits and presence of leukoplakia and oral cancer while control group included subjects with no tobacco chewing habits. Oral swabs collected were microscopically examined and grown on routine culture media- Blood Agar, Nutrient Agar and McConkey’s Agar. After obtaining the complete data of different bacteria isolated, a statistical analysis was made comparing the isolates from case and control group. Results: Streptococci spp. and Coagulase Negative Staphylococcispp (CONS) forms a part of normal oral flora, which was found in 79% of the control isolates but only in 49% of the case isolates. This result of normal flora being reduced in case group was statistically significant (p group, other species- Enterococci, Pseudomonas and Klebsiella were found in only 21% of control isolates while 51% of cases showed such result but Acinetobacter spp, Proteus spp and Citrobacter freundii were also isolated. Conclusion: Tobacco chewing is associated with a disruption of normal oral flora and a consequent increase in other organisms making the oral cavity more prone to ailments. Keywords: Oral flora, Tobacco chewers.

Copper containing fungicide – the actual culprit in the pathogenesis of OSMF?

Introduction: To estimate possible role of copper in etiology of oral sub mucus fibrosis. Aims and Objectives: To analyse and compare metal constituents of arecanuts sprayed with copper containing fungicide and that not sprayed with fungicide. To evaluate the effects of arecanuts sprayed with copper containing fungicide on the buccal mucosa of rats. Materials and Methods: Aquous solutions of arecanuts sprayed and not sprayed with fungicide, were prepared and sent to NITK for metal analyses. Buccal mucosa of 6 adult Wistar albino rats, were treated twice daily, for 6 days a week, with topical application of aqueous areca nut extracts, for one year. A control group (n = 6) was treated with distilled water. Biopsy was conducted at the end of six, nine and twelve months. The influence of areca nut on the oral epithelium and connective tissue of the rats were recorded semi quantitatively by light microscopy. Results: Metal analysis showed that the difference of copper content of arecanut treated with fungicide when compared to that of those not treated with fungicide was very meagre. The histopathological report of the tissue treated with arecanut solution showed development of fibrosis even at the 6th month. Though not uniformly progressive, fibrosis was noticed in all the tissues at 6, 9 and 12 months. Conclusion: The copper content of arecanut treated with fungicide and that not treated with fungicide was not very significant. The arecanut treated with copper containing fungicide can induce OSMF like changes in rat mucosa. Keywords: Arecanut, Copper containing fungicide, OSMF, Rat mucosa.

UTILIZATION OF BUCCAL FAT PAD IN ORAL SUB MUCOUS FIBROSIS - A CASE REPORT.

05May 2019 UTILIZATION OF BUCCAL FAT PAD IN ORAL SUB MUCOUS FIBROSIS - A CASE REPORT. Abin Varghese , Kamaraj Loganathan , Senthil Kumar G , Nimal Ram Gandhi and Tina Varghese. Department of Oral and Maxillofacial Surgery, Penang International Dental College, Malaysia. Department of Periodontolgy, MBDC, Kerala, India.

Estimation Of Salivary Superoxide Dismutase Level In Oral Submucous Fibrosis: A Clinical And Biochemical Study

Objective: The objective of the study was to compare the salivary Superoxide dismutase (mU/L) level among stage one patients of Oral sub mucous fibrosis and healthy controls. Study Design and Setting: It was a comparative cross sectional study design conducted at Outpatient clinic of Dental Department at Ziauddin University Hospital from January 2012 till December 2013. Methodology: Eighty histo-pathologically confirmed patients of clinical stage one Oral Sub mucosal fibrosis (OSMF) and eighty healthy controls were matched for age and gender to recruit in the study. Socio demographic information (i.e. age, gender, ethnicity, education and occupation), oral health status, measurement of mouth opening (mm) and Superoxide dismutase (mU/L) were recorded. The study was conducted after the approval granted from the ethical review committee of Ziauddin University Hospital. Data was entered and analyzed using SPSS version 21 (IBM). Result: The standard mean (+/-SD) of Superoxide dismutase (mU/L) in both groups was 4.99 (+/-2.18). The mean of Superoxide dismutase (mU/L) in confirmed cases of oral sub mucosal fibrosis was 3.02 (+/-0.44) which was significantly lower as compared to the control group which was 6.96(+/-1.24) and the calculated p value was 0.001.The strong positive correlation was identified in mouth opening (mm) and superoxide dismutase (0.842). Conclusion: It was concluded that the levels of salivary superoxide dismutase was significantly lower in the sample of OSMF and lower levels of superoxide dismutase (mU/L) was the indication of decrease in mouth opening among the cases of OSMF. Therefore, salivary superoxide dismutase can be used as a biomarker for the early detection as well as successful treatment of OSMF

Analysis and Assessment of YouTube Uploads as a Source of Information for Oral Sub Mucous Fibrosis

Analysis and Assessment of YouTube Uploads as a Source of Information for Oral Sub Mucous Fibrosis

A study of clinical features and factors associated with oral sub mucous fibrosis at tertiary health care centre

A study of clinical features and factors associated with oral sub mucous fibrosis at tertiary health care centre

Serum fucose level in oral cancer, leukoplakia, and oral sub mucous fibrosis: A biochemical study.

Aims:To estimate the serum fucose levels in clinically and histopathologically diagnosed oral cancer, oral leukoplakia, and oral submucous fibrosis cases. To compare and correlate the severity of dysplasia or histopathological grading of the premalignant and malignant lesions with serum fucose levels.Objective:To determine the role of serum fucose as a reliable biomarker for early detection of malignant transformation of potentially malignant lesions and conditions and prediction of biologic behavior of the malignant lesions.Material and Method:The intended study shall include 100 participants divided into 4 groups. Groups I, II, and III will include 25 clinically and histological diagnosed cases of oral leukoplakia, oral submucous fibrosis, and oral cancer, and 25 normal control group. Fucose was measured according to the method of Dische and Shettles as adopted by Winzler.Statistical Analysis:Statistical analysis will be done using SPSS statistical software (Version 10), and the levels of significance will be analyzed using the paired and unpaired t-tests.Result:In subjects of 4 groups were age- and gender-matched and comparable thus these may also not influence the study outcome measure (fucose levels). ANOVA revealed significantly different fucose levels among the groups (F = 17.00, P < 0.001). Mean fucose level did not differ (P > 0.05) between oral leukoplakia, oral submucous fibrosis, and oral cancer (84.5%) groups. The increase in mean fucose levels with severity was the highest in the oral cancer group followed by oral submucous fibrosis and oral leukoplakia group. The mean fucose levels did not differ between mild and moderate grades (P > 0.05) in all the 3 groups.Conclusion:The evaluation of serum l-fucose would be of good help in assessing early malignant change in increasing the accuracy of clinical diagnosis and also in assessing the spread and invasiveness of oral cancer, oral submucous fibrosis, and leukoplakia.

Chronic Inflammatory Mediators Induced Malignant Changes in Inflammatory Microenvironment of Oral Potentialy Malignant Conditions - An Emerging Concept

Potentially malignant conditions of the oral cavity are potential threat to mankind because of its malignant changes later. Oral potentially malignant conditions are chronic inflammatory mucocutaneous disorder affecting oral mucosa. Inflammatory mediators induced by chronic inflammatory microenvironment of premalignant conditions are cytokines, chemokines, growth factors, proteolytic enzymes, released by inflammatory cells such as macrophages, lymphocytes, neutrophils, mast cells, activate transcriptional factors such as NF-kB, STAT-3 and HIF-1, promotes cell proliferation, angiogenesis, tumor promotion, resistant to apoptosis, epithelial to mesenchymal transition, induced invasion and metastasis. Carcinoma associated fibroblasts in tumor microenvironment originated by activated fibroblasts secretes cytokines and growth factors promotes tumor progression by cell proliferation, angiogenesis, cell survival, genomic instability, invasion and metastasis. Myeloid derived suppressor cells are specialized heterogeneous immature myeloid progenitor cells that are dendritic cells, macrophages, granulocytes produced upon chronic inflammatory mediators. These cells responsible for immune evasion, immunosuppression and tumor progression by various mechanisms and interaction with other immune cells, activating transcriptional factors such as NF-kB and STAT-3. This article describe about roles of chronic inflammatory cells and their mediators in inflammatory microenvironment of premalignant conditions bring about malignant changes in oral sub mucous fibrosis and oral lichen planus.

Extended nasolabial flap in oral submucous fibrosis - our modification

Nasolabial Flaps are the most popular and commonly used flap in reconstructing mucosal defect left by fibrous band excision in developing countries like India where free flap expertise is not easily available and affordable by poor patients. Extended nasolabial flaps have been used in oral sub mucous fibrosis to cover mucosal defect. Normally these flaps are not wide enough to cover the mucosal defect left by fibrous band excision. Our modification utilises the extended nasolabilal flap to cover the wide mucosal defect in young patients by modified insetting of these flaps. I hope this technical modification will be useful to surgeons managing oral sub mucous fibrosis in developing countries or when free flap is not possible.

Evaluation of aberrant metabolism related proteins in oral submucous fibrosis: A pilot study

ObjectivesThe mortality rate within five years of diagnosis is very high (>60%) for patients with oral cancer (OC), primarily due to late stage detection. Oral submucous fibrosis (OSF) is a heterogeneous oral lesion that has a high probability of developing into OC. One of the hallmark characteristics of malignant cells is alteration of metabolic pathways as the disease progresses towards carcinogenesis. This study aims to examine the altered metabolism-related proteins using immunohistochemistry (IHC). MethodsThe expression levels of glucose transporter 1 (GLUT1), hexokinase 2 (HK2), and fatty acid synthase (FASN) were analyzed in normal oral mucosa (NOM) (n = 30) and oral sub mucous fibrosis (OSF) (n = 30) using IHC. The degree of intensity and distribution of immunostaining was semi-quantitatively assessed. ResultsThe expression levels of GLUT-1, HK 2, and FASN were higher in the OSF group (p < 0.001) than in NOM control group. ConclusionsThese results indicate evidence of increased levels and alteration in the expression of metabolism-related proteins. Overexpression of these proteins may play an oncogenic role in the proliferative processes and disease progression of OSF. These results serve as a fundamental base for employing these proteins in future clinical applications.

Alteration of Serum Lipid in Oral Sub Mucous Fibrosis in Central India.

Oral sub mucous fibrosis is the most common precancerous lesion in India. Lipids are the major cell membrane components essential for various biological function including cell growth and division for the maintenance of cell integrity of normal and malignant tissue. Low levels of lipids serves as a marker and prognostic indicator in the early detection of oral precancerous and cancerous states. In spite of high prevalence and its potential to undergo malignant transformation, this condition has not widely been investigated with respect to serum lipid levels. In present study an attempt is made to analyze the complete serum profile, total cholesterol, triglycerides, high density lipoprotein. Low density lipoprotein, and very low density lipoprotein in oral precancerous lesion and control. Study was conducted in 30 clinically and histopathologically diagnosed cases of premalignant lesion and 30 age and sex match controls. The complete lipid profile including TC, TG, HDL, LDL, and VLDL was analyzed. Serum lipid levels were significantly lower in patients with oral lesion than in controls. From the finding it appears that the decreases in the lipid levels may be considered as useful marker in the early diagnosis of oral premalignant lesion.