Oral Submucous Fibrosis Patients Research Articles

Assessment of Maximum Bite Force in Oral Submucous Fibrosis Patients: A Preliminary Study

Objective: To determine the maximum bite force (MBF) in oral submucous fibrosis (OSMF) patients and to compare them with that of healthy subjects. Material and Methods: Twenty patients who were clinically confirmed, as OSMF and 20 healthy controls matched for age, gender, and number of intact functional teeth were included in this study. For each subject, age, gender, weight, height and body mass index (BMI) were recorded. The MBF registration was carried out by the two evaluators, who were previously calibrated. Bite force was measured in the first molar region using a force transducer occlusal force meter for each subject seated at the upright position, with Frankfort's plane nearly parallel to the floor, and no head support. The Student’s independent t-test was used to determine the statistical significance in relation to mean height, weight, BMI and the presence of number of intact teeth and MBF between the healthy subjects and OSMF individuals. A comparison of grades of OSMF with all variables was carried out by one-way ANOVA test. Results: No significant difference was found in mean age, mean height, weight, BMI and the presence of the number of intact teeth between healthy individuals and OSMF patients. The mean MBF in healthy subjects was 628.23 ± 24.39 N and 635.47 ± 31.22 N in OSMF patients. Even though the healthy subjects reported a higher MBF than OSMF patients did, the difference was statistically non-significant. With regards to sides, no significant difference was observed in mean MBF in healthy subjects and OSMF patients on the right (p=0.7818) and left side (p=0.6154). Conclusion: The healthy subjects reported higher MBF values than OSMF patients did and the difference was statistically non-significant.

Evaluation of Hematological profile in Oral Submucous Fibrosis: A Cross-sectional Study.

Aims:The purpose of this study was to estimate hemoglobin (Hb) level, red cell indices (RCIs), serum iron level and Vitamin B12 level in patients with oral submucous fibrosis (OSMF) and to analyze the association of these parameters in different stages of OSMF.Setting and Design:This case–control study comprised of 65 individuals, with 40 OSMF patients and 25 controls. The OSMF patients were graded clinically according to the classification by Arakeri et al. Fasting blood samples were collected from both groups for hematological evaluation.Statistical Analysis Used:The mean values and standard deviations were calculated by Chi-square test. Normality of various parameters was evaluated by Kolmogorov–Smirnov test. The independent t-test was used to compare more than two means simultaneously. Correlation analysis was done by Karl Pearson's correlation coefficient method.Results:The OSMF patients were in the age range of 21–67 years, with a mean age of 39.85 ± 10.42 years. The mean value of Hb of the control group was 14.24 ± 1.03 g/dL, whereas that of OSMF group was 11.18 ± 2.06 g/dL (P < 0.001). The mean value of the serum iron level of the control group was 119.67 ± 42.42 μg/dL, whereas that of the OSMF group was 45.04 ± 10.41 μg/dL (P < 0.001). The mean value of serum Vitamin B12 levels of the control group was 422.98 ± 112.57 μg/dL, whereas that of the OSMF group was 211.78 ± 45.17 μg/dL (P < 0.001). The RCIs including packed cell volume, mean corpuscular volume, mean corpuscular Hb (MCH) and MCH concentration were significantly reduced in OSMF cases. Iron deficiency was present in 38 patients among the study group and Vitamin B12 deficiency was present in 22 patients of the study group.Conclusion:OSMF causes depletion of minerals and trace elements, and its replenishment is required for the healing of tissues and performing daily routine activities.

Digital cephalometric analysis of pharyngeal airway space changes in oral submucous fibrosis patients: A cross sectional observational study

Background: Oral submucous fibrosis (OSMF) causes changes over the pharynx that may cause changes in airway dimensions. Cephalometry could be a reliable diagnostic tool for evaluation of the changes happening in the pharyngeal structures, so that preventive measures such as areca nut habit cessation could be initiated at an earlier stage. Aim: To test pharyngeal changes and airway dimensions in OSMF patients using digital lateral cephalograms. Setting and Design: This was a crossectional observational study done in the Department of Oral Medicine and Radiology. Material and Method: Twenty-two subjects with clinically diagnosed OSMF formed the study group A, and 30 healthy subjects formed the control group B. OSMF subjects were further divided into stage I, II, III according to Nagesh And Bailoor (1993) criteria. We tested all study subjects for velopharyngeal and upper airway dimensions as measured on Digital Lateral Cephalographs using Sirona Sidexis software. The findings were compiled to arrive at data in the study population. Result: Statistically significant difference was observed for mouth opening tongue between different stages of OSMF (p = 0.000) and significant difference was also observed for hyoid position to vertical, AH-FH (p = 0.023), tongue length (VT) (p = 0.002), mid airway width (p = 0.031), soft palate width (p = 0.012) between the groups. Conclusion: There was a significant change in the pharyngeal airway with the advancing stage of OSMF. Lateral cephalometric radiographs are a useful, non-invasive diagnostic tool to analyze pharyngeal airway changes in OSMF patient's to prevent the development of complications associated with advanced stages.

Assessment of lactate dehydrogenase enzyme levels in saliva and serum of oral submucous fibrosis and leukoplakia patients.

Background:Pathology involving the oral epithelium may alter the level of salivary concentration of LDH. Thus its estimation can be used as a non invasive screening tool for the early detection of OPMDs and also to predict its malignant transformation especially in high risk population.Aims and Objectives:To evaluate the salivary and serum levels of lactate dehydrogenase (LDH) in patients having of oral submucous fibrosis (OSMF) and leukoplakia and compare it with healthy individuals.Materials and Methods:A total of 120 subjects were selected and divided into three groups comprising clinically diagnosed cases of OSMF and leukoplakia and healthy subjects as controls. Unstimulated whole saliva and blood samples were collected under aseptic conditions for biochemical estimation of LDH by Semiautomatic Analyzer using LDH kit utilizing enzymatic UV-Kinetic method. The values obtained were statistically analyzed using the SPSS software version 20.0. P-value < 0.05 was considered significant.Results:The mean salivary LDH level in Group I (OSMF) was 631.67 + 7.67, Group II (Leukoplakia) was 492.28 + 16.17 and Group III (Healthy Control) was 140.62 + 8.87. There was a statistically significant difference between the Serum and salivary LDH levels among the various groups of study population. A positive correlation between salivary LDH and serum LDH level was seen and the regression equation for OSMF and leukoplakia was computed.Conclusion:A significant difference was found between mean salivary LDH Levels and serum LDH levels in patients with leukoplakia, OSMF and health controls. A positive correlation was also established between salivary and serum LDH levels in patients with OSMF and leukoplakia patients making saliva a potent non invasive tool for early prediction and detection of PMOD and its malignant transformation.

Pulmonary function test in OSMF patients

Betel nut quid chewing is a common psychoactive substance or masticatory euphoriant used by 600 million people in the world and is a main etiological factor for Oral Submucous Fibrosis (OSMF). The areca nut metabolite arecoline causes aggravation of disease in asthmatics by increasing bronchoconstriction in a dose-dependent manner; however, the effect of betel (Areca catechu) nut chewing on the function of the normal human lungs is yet to be fully established. Aim: The aim of the study was to measure and to compare pulmonary function tests such as forced vital capacity (FVC), forced expiratory volume (FEV), FEV/FVC%, peak expiratory flow rate, and maximum voluntary capacity maximum voluntary capacity (MVV) between study groups (control and OSMF). Materials and Methods: The study population included 100 participants comprising 50 normal and 50 clinically diagnosed OSMF cases. Pulmonary function tests were assessed using spirometer. Data were statistically analyzed. Results: Pulmonary function tests were found to be decreased in OSMF patients when compared to controls. Conclusion: There were no statistically significant differences (P > 0.05) in the spirometry parameters between both the groups; however, a decrease in pulmonary function compared to normal can be a warning sign for obstructive and restrictive type of pulmonary disease.

Immunohistochemical detection of 8-hydroxydeoxyguanosine: A biomarker of oxidative DNA damage in oral submucous fibrosis.

Background:Oral submucous fibrosis (OSMF) is one of the common potentially malignant disorders prevailing in India. The primary etiological factors include tobacco and arecanut, which contain numerous reactive oxygen species (ROS). ROS attack guanine bases in DNA and form 8-hydroxydeoxyguanosine (8-OHdG), which can be detected in patients who have diseases associated with oxidative stress. The oxidative DNA damage produced by oxidative stress may induce malignant transformation.Aim:The aim of the present study is to detect the expression of 8-OHdG in OSMF patients and compare the expression within different grades of OSMF and also normal buccal mucosa.Materials and Methods:A total of 30 samples were examined for the immunohistochemical expression of 8-OHdG. The control group included 10 formalin-fixed paraffin-embedded tissue blocks of the normal buccal mucosa. The study group includes 20 cases of formalin-fixed paraffin-embedded tissue blocks of OSMF (5 cases in each grade of very early, early, moderately advanced and advanced cases of OSMF). Three-micron thick tissue sections were made from each sample and stained with 8-OHdG antibody. The results were statistically analyzed using Kruskal–Wallis and Mann–Whitney U testResults:Statistically significant difference exists in the intensity of 8-OHdG expression between the study groups. The P-value obtained was <0.001, which was highly statistically significant.Conclusion:The present study is the first attempt to evaluate the expression of 8-OHdG in tissue samples of OSMF that revealed the role of free radicals and oxidative DNA damage in these patients. Further research with larger sample size, clinicopathologic correlation and long-term follow-up will shed more light on the pathogenesis of OSMF. It will also be useful for the development of new therapeutic strategies targeting treatment modalities for OSMF.

Evaluation of the nutritional status of oral submucous fibrosis patients using body mass index and mid-upper arm circumference (anthropometric assessment): A cross-sectional, observational study

Background: For a rapid nutritional status of oral submucous fibrosis (OSMF), body mass index (BMI) and mid-upper arm circumference (MUAC) are used in the study.Materials and Methods: The cross-sectional, observational study was conducted among 150 OSMF patients and categorized into four groups according to the functional stages of OSMF. The measurements of BMI and MUAC among all groups were noted, compared, and statistically analyzed.Results: Among 150 patients, BMI and MUAC scores showed a statistically significant difference and highly correlated in all stages of OSMF.Conclusion: In OSMF patients, BMI and MUAC scores were decreased with an increase in severity and stages of OSMF.

Malignant potentiality assessment of oral submucous fibrosis through semi-quantitative approach.

Background:In the context of early diagnosis and prevention of oral cancer, precise assessment of malignant potentiality of the oral potentially malignant disorders, particularly oral submucous fibrosis (OSF) is crucial. Till date, the assessment of malignant potentiality suffers from predictive ambiguity due to the lack of precision in the gold standard techniques. This can be addressed by integrating heuristic domain knowledge with quantitative analysis.Aim:The aim of this study is to propose an index for enhancing accuracy in malignant potentiality evaluation.Materials and Methods:The present study analyzes important histomorphometric attributes (epithelial thickness, basal cell nuclear size, nuclear-to-cytoplasmic area ratio of basal cells, chromaticity of basal cell nucleus, thickness of basement membrane, ratio of vasculature in juxta-epithelial connective tissue [i.e., area covered by blood vessels/total area], collagen density in the lamina propria) of oral mucosa in dysplastic and nondysplastic OSF in association with relevant oncopathological appreciations (weightage of different features as suggested by oral pathologists) toward proposing a “Malignant Potentiality Index” (MPI).Results:Analysis of variance and notch box plot analysis depict statistically significant differences (P < 0.0001) in the histopathological features among different study groups (normal oral mucosa, OSF without dysplasia, OSF with dysplasia). Histopathological observation of one OSF patient with calculated MPI is shown.Conclusion:This newly proposed diagnostic cum prognostic decision-making parameter, the “MPI” may bring a value addition to the conventional diagnostic gold standard.

The study of placentrex and hydrocortisone as an adjunct treatment in oral submucous fibrosis.

Background:Submucous fibrosis with a high incidence rate in the Indian subcontinent is a devastating disease affecting the oral cavity and oropharynx.Aims and Objective:To evaluate the efficacy of injection placentrex and injection hydrocortisone in oral submucous fibrosis patients in increasing mouth opening, burning sensation, and improve the mucosal lining.Materials and Methods:We recruited 60 patients with Stage II and Stage III of the ailment, who were randomly divided into Group A and Group B. They were administered submucosal injections of hydrocortisone and placentrex along with physiotherapy and oral iron, nutrients, and B-carotene supplements over a period of 2 months.Interpretations and Results:The pinnacle rate of the incidence was found in the age group of 30 to 40 years among both the genders. Statistically significant difference (P = 0.0001), that is, 5.19 ± 1.33 in Group A and 11.69 ± 1.26 mm in Group B was noted in the mean mouth opening values. Statistically significant difference in burning sensation was noted to be better in Group A than in Group B.Discussion and Conclusion:Overall hydrocortisone seems to be a better regimen for improving the mucosal health and increasing the mouth opening as compared to placentrix regimen. Although Placentrex is better than hydrocortisone in reducing burning sensation.

Qualitative expression of hypoxia-inducible factor-1α in malignant transformation of oral submucous fibrosis: An immunohistochemical study.

Background:Oral submucous fibrosis (OSF) is a precancerous condition predominantly seen in people of Asian descent. About 7%–12% of OSF patients develop oral squamous cell carcinoma. Morphological features of OSF, especially fibrosis, suggest a possibility of hypoxic environment in diseased tissues. Neovascularization and increased glycolysis, represent adaptations to a hypoxic microenvironment that are correlated with tumor invasion and metastasis. The adaptation of cells to hypoxia appears to be mediated through hypoxia-inducible factor-1α (HIF-1α). HIF-1α is said to be associated with malignant transformation of epithelium in other sites.Aim:The aim of this study was to investigate the relationship between the expression of HIF-1α in OSMF and its role in malignant transformation.Materials and Methods:A retrospective study which included 20 histopathologically diagnosed cases of OSF was conducted. A qualitative evaluation of HIF-1α was performed. Statistical analysis was carried out using the IBM Statistical Package for Social Sciences 20.0 version (IBM Corporation, Armonk, NY, USA).Results:Results showed an increased expression of HIF-1α in OSF.Conclusion:HIF-1α appears to play a role in malignant transformation of OSF.

Therapeutic Potential of Allicin-Rich Garlic Preparations: Emphasis on Clinical Evidence toward Upcoming Drugs Formulation

Garlic has been used for a long time in human history. Allicin, the main active compound present in freshly injured garlic, is enzymatically formed from alliin. Allicin has shown doubtless beneficial effects and even be conceived as medicine. The present review highlights allicin-associated studies. Indeed, clinical studies on healthy subjects have evidenced that standardized garlic treatment (900 mg/day) significantly reduces total cholesterol (TC) and low-density lipoprotein cholesterol (c-LDL). Besides, allicin also led to a marked improvement in mouth opening, burning sensation, and oral health-related quality of life on stage II oral submucous fibrosis patients. Interestingly, in children, allicin also has been proposed for thrush prevention and as an alternative antibiotic therapy. Nonetheless, there is particular attention to allicin bioavailability, given its high instability. Although clinical evidence has promoted allicin release from garlic powder tablets under simulated gastrointestinal conditions, garlic tablets are those that have provided less alliinase protection due to its fast disintegration, releasing low allicin amounts.

Inverse correlation of Serum Lactate Dehydrogenase and Haemoglobin Levels in patients with Oral Submucous Fibrosis

Serum lactate dehydrogenase (LDH) is a marker of cellular necrosis and is elevated in oral potentially malignant disorders, Oral Submucous Fibrosis (OSMF). Serum LDH levels have been used as a valuable biochemical marker in diagnosis of OSMF. To evaluate and compare the levels of serum LDH and haemoglobin in OSMF with normal healthy individuals. Two mL of venous blood was collected by under aseptic conditions and serum was separated from the normal healthy control subjects (Group 1, n= 22) and the OSMF (clinically and histopathologically confirmed cases) patients (Group 2, n= 22). Quantitative estimation of serum LDH and haemoglobin was performed. Significant rise was observed in the serum LDH levels (518.14 ± 48.62 IU/L) while the mean Hb levels (11.3 ± 1.14) were decreased in patients with OSMF in comparison with normal healthy individuals (LDH: 189.77 ± 28.30 IU/L, Hb: 12.94± 0.98 gm%) (P value &lt; 0.0001, &lt; 0.0001). Serum LDH and Hb estimation would serve as a valuable biochemical marker in the diagnosis of OSMF

Association of Increased Red Cell Distribution Width with Malignant Transformation of Oral Submucous Fibrosis

Abstract Introduction Oral submucous fibrosis (OSMF) is associated with nutritional deficiencies—primarily of iron and vitamins and usually seem to be associated with anemia. Red cell distribution width (RDW) is one of the routinely assessed parameters in complete blood picture analysis of any patient. It measures range of variation in erythrocyte size. A high RDW value has been associated to adverse outcomes in several diseases and risk of death. However, the relationship of RDW and OSMF is yet to be established. Aim To analyze the association of RDW levels and other erythrocytic indices with clinical staging and prognosis of OSMF patients. Materials and Methods Analysis of clinical stage and hematologic status of 86 patients comprising the study group (OSMF cases and OSMF with malignant changes) and control group was performed. It was done using Kruskal–Wallis analysis of variance test. Results The values of mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration were below normal from the onset of oral submucous fibrosis and they continued to decrease as the disease progressed. On other hand, RDW values were found to be in normal range in initial stages of disease and they became high in stage IV OSMF and increased further in OSMF patients with malignant changes. Conclusion We observed that higher values of RDW are strongly and independently associated with OSMF and OSCC, suggesting that RDW may contribute as most economic novel biochemical marker for progression and malignant transformation of OSMF.

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.

Cytokines secreted by arecoline activate fibroblasts that affect the balance of TH17 and Treg.

Oral submucous fibrosis (OSF) is a chronic progressive oral disease with cancerous tendency. Arecoline plays an important role in the pathogenesis of OSF. Fibroblasts (FBs) are the primary cells involved in the pathogenesis of OSF. There is a change in CD4+ IL-17+ helper T cells (Th17) and CD4+ CD25+ Foxp3+ regulatory T cells (Treg) in OSF patients, but the molecular mechanisms of are not clearly understood. In this work, we studied the molecular mechanisms. Enzyme digestion was used to extract primary FBs, and immunofluorescence was used to identify FBs. Cytotoxic experiment was then performed to determine the effect of arecoline on FB activity. Enzyme-linked immunosorbent assay (ELISA) was used to detect changes in the amount of cytokines. In addition, we treated human peripheral blood mononuclear cells (PBMC) with the above cytokines and detected their changes. Flow cytometry was used to detect the changes of Th17 and Treg, and quantitative-polymerase chain reaction (Q-PCR) was used to detect the changes of RORγt and Foxp3. We have found that the stimulation of arecoline on FBs increased interleukin-2, interleukin-6, and interleukin-21 (IL-2, IL-6, and IL-21) while decreased transforming growth cytokine-β (TGF-β). After the cytokine-containing supernatant was co-cultured with PBMC, the cytometry results showed that Th17 was increased, while Treg was significantly decreased and Q-PCR results showed that RORγt expression was increased and Foxp3 expression was decreased. The arecoline can affect inflammatory cytokines produced by FBs, which then act on immune cells Th17 and Treg, and make them change.

Evaluation of Ki-67 Expression in Oral Submucous Fibrosis and Its Correlation with Clinical and Histopathological Features.

Objectives:Oral submucous fibrosis (OSMF) is a potentially malignant disorder. Although it shows atrophic epithelium, it has a high proliferative capacity. Therefore, this study correlates the Ki-67. (The name “ki” is derived from the city of origin [Kiel, Germany] expression with functional grading and epithelial thickness in OSMF).Methods:The study group comprised of thirty patients of OSMF, divided randomly into Group A, Group B, Group C, and Group D as per mouth opening (functional staging). Five participants without OSMF formed the negative control group. The positive control group comprised of five patients of diagnosed cases of squamous cell carcinoma. All the sections of biopsy were subjected for hematoxylin and eosin and immunohistochemistry staining and observed for expression of Ki-67. Epithelial thickness was evaluated using image analysis software of Leica research microscope. Images were analyzed by three independent observers who were blindfolded. All the findings were tabulated and statistically analyzed.Results:In the present study, as the functional staging increased, the Ki-67 expression also increased. Ki-67 expression was highest in severe functional staging/severely decreased mouth opening (100.78) and is least in mild functional staging/mild decreased mouth opening (10.39). However, there was no significant correlation between epithelial thickness and functional staging/mouth opening (P > 0.05).Conclusion:A decrease in functional staging (mouth opening) showed a greater expression of Ki-67, and there was no significant correlation between functional staging and epithelial thickness.

E3 ligase carboxyl-terminus of Hsp70-interacting protein (CHIP) suppresses fibrotic properties in oral mucosa

Oral submucous fibrosis (OSF) represents a precancerous lesion of oral mucosa that may progress into oral cancer and its major etiological factor is areca nut chewing. Carboxyl-terminus of Hsp70-interacting protein (CHIP) functions as an ubiquitin E3 ligase and is associated with fibrosis diseases. In the current study, we sought to investigate whether CHIP participated in the areca nut-mediated OSF development. The mRNA expression of CHIP in arecoline-stimulated buccal mucosal fibroblasts (BMFs) and OSF tissues was determined by qRT-PCR. Collagen gel contraction, migration and invasion assays were carried out to evaluate the myofibroblast activation. The protein expression levels of α-SMA and transglutaminase 2 (TGM2) were assessed by Western blot. The expression level of CHIP was reduced in BMFs following arecoline treatment in a dose-dependent manner, which was consistent with the observation of lower CHIP expression in OSF specimen compared to the normal counterparts. Ectopic expression of CHIP mitigated the myofibroblast activities, including elevated collagen gel contractility and cell motility. In addition, we showed that overexpression of CHIP downregulated the α-SMA and TGM-2 expression, which may lead to less fibrosis alteration. CHIP may not only function as a key regulator of protein quality control but also a critical deciding factor to oral fibrogenesis. Our findings suggested that CHIP possesses the anti-fibrotic effect, which may be mediated by TGM2 regulation. Restoration of CHIP could be a therapeutic direction to help OSF patients.

Morphometric Evaluation of Soft Palate in OSMF Patients Using Cephalometrics.

Oral submucous fibrosis (OSF) is a chronic disease and a well-recognized potentially malignant condition of the oral cavity characterized by inflammation and a progressive fibrosis of the lamina propria and deeper connective tissues. To study the morphology of soft palate in different stages of OSF on digital lateral cephalogram. To compare the changes in morphology of soft palate in OSF patients with control. The study was conducted from 2017 to 2018 on 217 patients with their age ranging from 17 to 60years. All patients detailed clinical examination and history was taken and cephalometric evaluation was done. Type I (51.14%) was found to be the most common in OSF group followed by type II (21.86%) and type VI (13.64%). The present study highlighted the variable radiographic appearances of the soft palate on lateral cephalograms with type I as most common morphology. Cephalometric analysis is one of the most commonly accepted techniques for evaluating the soft palate in both normal individuals and in those with cleft lip and palate.

A comparative clinical study on physiotherapy outcomes with wooden tongue depressors versus Heister jaw opener in oral submucous fibrosis patients

ObjectiveThe aim of this study was to compare mouth opening exercise outcomes with wooden tongue depressors (WTDs) versus Heister jaw opener (HJO) in improving mouth opening after reconstruction of the surgical defect with buccal fat pad (BFP) in oral submucous fibrosis (OSF) patients. Materials and methodsFifty consecutive patients were divided randomly into two groups (25 patients in each group) corresponding to postoperative physiotherapy with WTDs (group 1) and HJO (group 2) respectively. Groups 1 and 2 were evaluated for maximum interincisal distance at 3, 6 and 12 months of follow up. In groups 1 and 2, mouth opening differed substantially at all periods of follow up from preoperative values. ResultsThe increase in mouth opening was greater in group 2 at 3 (P = 0.003) and 6 (P = 0.010) month follow up visit respectively. No relevant difference was observed in mouth opening between groups 1 and 2 at 12 months (P = 0.066). The mean increase in mouth opening at 12 months compared with the preoperative value was 22.2 mm in group 1 and 25 mm in group 2. ConclusionWe conclude both WTDs and HJO are effective in improving postoperative mouth opening in OSF surgical patients.

Oral submucous fibrosis: A global challenge. Rising incidence, risk factors, management, and research priorities.

Oral submucous fibrosis is a potentially malignant disorder of the oral cavity, with a high rate of malignant transformation. It is very common among habitual areca nut chewers. The pathogenesis of oral submucous fibrosis is not well established, but it is believed to be a disease of multifactorial origin, including areca nut chewing, ingestion of chilies, genetic factors, immunologic processes and nutritional deficiencies. Genetically susceptible individuals when exposed to areca nut chewing develop this disease over a variable period of time. Oral submucous fibrosis is considered to be a disease of collagen metabolism. Several genetic factors are reported but there is no consensus about the exact mechanism of disease initiation. Variations in histopathological presentation are noted among oral submucous fibrosis patients with habitual areca nut chewing in different forms and other additive agents, eg betel quid, pan masala and gutkha, together with a variety of tobacco habits. The role of epigenetic modifications, such as miRNA regulation, and DNA methylation is also being reported as part of the pathogenesis of oral submucous fibrosis. A combined approach, including analysis of genetic and epigenetic regulations with different habits, might be helpful to better understand the contributory factors and pathogenesis of this serious disorder.